MEDICAL and SURGICAL MEMOIRS: 
CONTAINING 
INVESTIGATIONS ON THE GEOGRAPHICAL DISTRIBUTION, CAUSES, 
NATURE, RELATIONS AND TREATMENT 
OF 
VARIOUS DISEASES, 
1853-1886. 
By JOSEPH JONES, M. E., 
Professor of Chemistry and Clinical Medicine, Medical Department Tulane University of Louisiana; 
Visiting Physician of Charity Hospital; Honorary Felloio of the Medical Society of Virginia; 
. Formerly Surgeon in the Provisional Army of the Confederate States; President of the Board of 
Health} of the State of Louisiana, 1880,1881,1883,1883,188k; Associate Felloiv of the College of Physi- 
cians of Philadelphia; Member of the American Medical Association; Vice J resident of the 
Medical Society of Louisiana; Member of the Medico-Legal Society of New York; Member of the 
American Association for the advancement of Science ; Honorary Member of the American Anti- 
quarian Society ; Honorary Vice President of the Numismatic and Antiquarian Society of Phila- 
delphia ;' Honorary Member of Museum fur Volkerkunde in Leipzig ; Fellow of the Academy of 
Sciences of New Orleans, etc., etc. 
VOLUME II. 
CONTAINING RESEARCHES ON THE ORIGIN AND EFFECTS OF ENDEMIC, EPIDEMIC, 
INFECTIOUS AND CONTAGIOUS DISEASES. INVESTIGATIONS ON THE NATURE, 
CAUSES, RELATIONS AN I) TREATMENT OF MALARIAL (PAROXYSMAL) FEVER. 
INTERMITTENT, REMITTENT, PERNICIOUS AND HAEMORRHAGIC MALA- 
RIAL FEVERS. COMPARATIVE PATHOLOGICAL ANATOMY OF MALA- 
RIAL, TYPHOID AND YELLOW FEVERS. INDIGENOUS REMEDIES 
OF THE SOUTHERN STATES. ALBINISM IN THE NEGRO 
RACE. ORIENTAL LEPROSY. ELEPHANTIASIS GRzE- 
CORUM, ELEPHANT'S LEG (ELEPHANTIASIS 
ARABUM). 
■Vince M a In m Bono. 
NEW ORLEANS, LA. : 
Joseph Jones, M. D., 156 Washington Avenue, Cor. Camp St., 4th District. 
1S87. 
ALL RIGHTS RESERVED. Entered according to Act of Congress, in the year 1887, by 
JOSEPH JONES, Ml D., 
In the office of the Librarian of Congress at Washington, D. C. 
Printed for the author by A. W. Hyatt, Stationer, 73 Camp Street, H. O. TO THE MEMORY 
-OF- 
MY FRIEND AND. PRECEPTOR, 
Professor SAMUEL JRCKSDNj M. IL, 
4 
OF THE 
MEDICAL DEPARTMENT 
-OF- 
THE UNIVERSITY OF PENNSYLVANIA, 
PHILADELPHIA, 
THIS VOLUME 
JS 
GRATEFULLY DEDICATED. PREFACE. 
The first volume of this work was published in 1876, eleven years 
ago. No period in the history of medicine has been more fertile in research 
and discovery. The vast and important subject relating to the causation 
of certain diseases by well defined morbific ferments, micro-organisms, 
bacilli and bacteria, has received its greatest extension and development 
during the past decade. 
The epidemic yellow fever of 1878, which swept like a great tidal wave 
from the Gulf of Mexico far into the interior of the continent, carrying- 
death, terror and devastation throughout the borders of the Valley of the 
Mississippi, afforded an opportunity for careful clinical study and patho- 
logical research. Falling a victim to the pestilence near the close of the 
epidemic, the author dragged out a painful existence for over six months 
before he was able to resume the active discharge of his professional duties. 
In accordance with the request and appointment of His Excellency, 
the late Louis Alfred Wiltz, Governor of the State of Louisiana, the author 
served as President of the Board of Health of the State of Louisiana dur- 
ing the four years, extending from April, 1880, to April, 1881, and during 
this period was enabled to put to the crucial test the actual application of 
every principle relative to the nature and exclusion of foreign pestilence. 
During the period specified the measures instituted were effective in 
excluding Yellow Fever from the Mississippi Valley; and the principles of 
diagnosis based upon his Clinical and Pathological Kesearches, gave pre- 
cision and confidence to the official decisions of the Board of Health, and 
prevented panic, alarm and useless quarantine. 
The Board of Health of the State of Louisiana (1880-1881), successfully 
contended with the most powerful railroad and steamship corporations of the 
United States, which had been for years in open rebellion to the quaran- 
tine laws of Louisiana. Failing to maintain the rights of the State in the 
lower courts, the Board of Health added to its counsel the Honorable E. 
D. White, formerly Judge on the Supreme Bench of Louisiana. The final 
vindication of the Quarantine Laws of Louisiana, by the official decision 
of its Supreme Court, was largely due to the learned and practical exposi- 
tion of constitutional law, contained in the brief, but conclusive argument 
of Judge E. D. White. VI 
PREFACE. 
The victory achieved by the Board of Health of the State of Louisi- 
ana (April, 1880, April, 1884), was wide-spread in its results, as it affected 
the quarantine rights and laws of every sovereign State composing the 
American Union, and defined more clearly the views of the framers of the 
original Constitution, and placed in a clearer light the police powers of 
the people. 
The present volume relates chiefly to the great endemic fevers of tropi- 
cal and temperate climates such as: Intermittent, Remittent, Perni- 
cious and Hemorrhagic Malarial Fevers. 
Careful comparisons are instituted between the symptoms and Patho- 
logical Anatomy of Yellow Fever, and Typhoid Fever, and the various 
subjects are enriched by the observations and drawings of the author 
before, during and subsequent to the American Civil War (1861-1865), 
embracing a period of thirty years, 1856-1886. 
We have also included in this volume memoirs relating to Oriental 
Leprosy (Elephantiasis Graecorum) and Elephant's Leg (Elephantiasis 
Arabum). As is well known, these diseases are chiefly characteristic of 
tropical and subtropical climates, and as the researches of our day have 
traced them to the action of certain Bacilli and Entozoa, their consider- 
ation in connection with the various forms of Malarial Fever may be 
regarded as appropriate and instructive. 
Tn this work on Malarial Paroxysmal Fevers the author has endeav- 
ored to make each chapter a complete monograph in the division of the 
subject of which it treats, and this plan has necessitated the occasional 
repetition of cases and illustrations. The chapters relating to the char- 
acter and changes of blood in different diseases, will be found to embrace 
a considerable amount of research, and also to contain a summary of the 
labors of the most distinguished chemists, physiologists and pathologists in 
England, France and Germany, relating to the chemistry, comparative 
anatomy, physiology and pathology of blood in man, in the various 
conditions of health and disease. The chapter which relates to the 
prevention and treatment of Malarial Fevers will be found to contain full 
descriptions of the botanical, chemical and therapeutical properties of the 
Indigenous Remedies of the United States which possess febrifuge and 
antiperiodic properties, and which may be employed as Substitutes for 
Quinine (Peruvian Bark and its preparations). It is hoped that the prac- 
titioners of medicine in the malarious regions of our Southern, Western 
and Southwestern States will find much of practical value in Chapter VII. 
The researches relating to the Pathological Anatomy of the Brain, Heart, 
Liver, Spleen, Kidneys and Alimentary Canal in Malarial, Yellow and 
Typhoid Fevers have been the product of a large amount of severe and pro- 
tracted original investigation and research, and the author expresses the 
hope that the facts and illustrations grouped in Chapter VI of this Volume 
will prove a lasting addition to our knowledge of the pathology of the PREFACE. 
VII 
fevers of tropical and temperate regions and serve as the basis of future 
studies and investigations in this most difficult branch of medical knowledge. 
The author, who, from the absence of medical publishing houses in 
the South, has been compelled to act as his own publisher, assuming every 
responsibility, and meeting by cash payments every expense of original 
research and of printing and engraving, has spared no pains to secure 
accurate engravings. One hundred and forty engravings were executed 
for the author by the accomplished engraver, Mr. Alfred Maurice, of New 
Orleans, who has been engaged on this work during the past two and a 
half years. Upon inspection, it will be observed that many of the engrav- 
ings are of the most elaborate character. In addition to the plates con- 
tained in the present volume, Mr. Alfred Maurice has also completed about 
two hundred and fifty additional engravings, which will appear in the 
future volumes of these Memoirs relating to Yellow Fever, Typhoid Fever, 
Dysentery, Scurvy, Small-Pox, Vaccination, Spurious Vaccination, Syph- 
ilis, Hospital Gangrene and other diseases,< provided the author shall 
receive that generous and hearty support from the Medical Profes- 
sion which will enable him to conduct the work to a successful ter- 
mination. 
JOSEPH JONES, M. D.; 
156 Washington Avenue. 
New Orleans, January, 1887. CONTENTS. 
CHAPTER I. 
INVESTIGATIONS ON ENDEMIC, EPIDEMIC, INFECTIOUS AND CONTAGIOUS DISEASES, 
AND ON THE NATURE, CAUSES, RELATIONS AND TREATMENT OF MALARIAL 
PAROXYSMAL FEVERS ; MODE OF INVESTIGATING THE ORIGIN, NATURE AND 
EFFECTS OF M ALARIA; CLASSIFICATION OF THE VARIOUS FORMS OF MALARIAL 
FEVERS. 
Pages. 
Facts relating to the History of the Investigation. Mode of Investigating 
Malaria. Climate. Soil. Variations in the Composition of the Atmos- 
phere. Relations of the Soil, Waters, Atmosphere and Climate to the 
origin and spread of Malarial Fevers. Relations of Micro-organisms to 
disease. The action and relations of various Febrile Poisons. Method 
of determining the relations of various Febrile Poisons. Classifica- 
tion of the various forms of Malarial Fever. Complications of Malarial 
Fever by the lesions of various organs which arise during the progress 
of the disease. The division of the forms of Malarial Fever into Inter- 
mittent and Remittent imperfect. The complications of Malarial 
Fever, and its relations to other diseases illustrated by the experience 
of the author in the Charity Hospital of New Orleans,Louisiana, 1869- 
1886. Classification and brief description of the varieties of Pernicious, 
Malignant and Congestive Malarial Paroxysmal Fevers. Classifica- 
tions of Senac, Torti, Alibert and other writers. Divisions of the Mono- 
graph on Malarial Fever 5-64 
CHAPTER II. 
PHYSICAL AND CHEMICAL CHARACTERS AND CHANGES OF THE BLOOD IN 
MALARIAL FEVER AND OTHER DISEASES. 
The Blood.-Imperfect state of our knowledge of this fluid. Imperfec- 
tions in the methods of analysis. Importance and difficulty of estab- 
lishing a standard formula of the composition of the blood in health. 
The composition of the blood varies not only with the class, but with 
each species of animals, and corresponds with the development of the 
organs and apparatus; illustrated by the development of the blood and 
organs of invertebrate and vertebrate animals. Standard of Lehmann, 
and of Becquerel andRodier. Importance of determining the changes 
of the blood during thirst and starvation. Importance and difficulty 
of determining the amount of blood in the system. Changes of the 
Blood in Malarial Fever-Difficulties of the investigation. Color of the 
blood and serum in Malarial Fever. Specific gravity and coagulation 
of the blood in Malarial Fever and other diseases. Fibrin decreases in 
Malarial Fever. Formation of heart-clots in Congestive Fever during 
life. Occurrence of heart-clots in other diseases. Conditions most 
favorable to the deposition of fibrinous concretions. Symptoms and 
diagnosis of fibrinous concretions in the heart and blood-vessels. 
Perilous effects resulting from the detachment of fibrinous concretions' 
Imperfect state of knowledge, with reference to the formation of fibrin- 
ous concretions in the living body. Cause of the coagulation of the 
blood unknown. Principles of treatment best adapted to prevent the 
formation of fibrinous concretions in Malarial Fever. Physical and CONTENTS. 
IX 
Pages, 
chemical changes of the constituents of the blood in Malarial Fever. 
Illustrative cases. Relations of the cerebro-spinal and sympathetic 
nervous systems to the changes of the blood and organs in Malarial 
Fever. Gangrenous erosion of cheek following Malarial Fever. Com- 
parison of the changes of the blood in Malarial Fever, with the changes 
in Marsh Cachexia. Mechanical Dropsy. Acute Dropsy. Cachectic 
dropsies. Alterations of the colored blood-corpuscles in Malarial 
Fever. Principles of treatment suggested by the changes of the blood 
in Malarial Fever. Effects of bloodletting. Of excessive purgation. 
Of nutritious diet and stimulants. Of phosphates. Of pepsin. Deter- 
mination of the place of the destruction of the colored blood-corpuscles 
in Malarial Fever. Constitution of the blood in various diseases, in 
Typhoid, Typhus, and Ephemeral Fevers. In Small-pox, Scarlatina, 
Measles, Scurvy, Erysipelas, Cholera, Phthisis, Scrofula, Carcinoma, 
Bright's Disease, Chlorosis. Anaemia, Rheumatism, Puerperal Fever, 
Pneumonia, Peritonitis, Angina Tonsillaris, Bronchitis, Carditis, 
Pericarditis, Inflammation of Brain, Glanders, Lead-poisoning. The 
colored blood-corpuscles are more uniformly and rapidly destroyed in 
severe cases of Malarial Fever than in anyotheracutedisea.se. Dim- 
inution of fibrin in Malarial Fever corresponds to the severity of the 
disease. Discussion of the question. Do these changes of the blood 
precede, or succeed, or are they simultaneously with, the aberration of 
the physical, chemical, vital, and nervous phenomena, denominated 
fever? ' The constitution of the blood varies nbt only with the class, 
but with each species of animals, and corresponds with the develop- 
ment and perfection of the organs and apparatus. Blood of protozoa, 
polypi, acalephse, echinodermata, cephalopoda, amphioxus, garfish 
(lepisosteous osseus), reptiles, birds and mammalia. Chemical consti- 
tution of moist blood-corpuscles. Chemical constitution of liquor 
sanguinis. Importance of establishing the typical formula of the blood 
in starvation. Difficulties of establishing the amount of blood in health 
and disease. Estimates of the amount of blood in the human system 
by Blumenbach, Heller. Borelli, Young, Dumas, Fletcher, Ancell, 
Valentine and Lehmann, and by the author. Changes of the blood 
in Malarial Fever. Difficulties of investigations upon the blood in dis- 
ease. Color of the blood and serum in Malarial Fever. Specific gravity 
of the blood and serum in various diseases, as determined by Becque- 
rel, Rodier, Nasse, Zimmerman, Guenauchde Mussy and Joseph Jones. 
Coagulation of the blood. Table of blood corpuscles in 1000 parts of 
healthy and malarial blood. Fibrin in healthy and diseased blood, as 
determined by Andral, Gavarret, Becquerel, Rodier, Guenaud de 
Mussy, Popp, Wittstock, Simon, Glover, Heller, and Joseph Jones. 
Cases illustrating the physical changes of the fibrin, and the formation 
of heart-clots in Malarial Fever. Observations of Hewson, Baillie, 
Morgagni, Albinos, Burns, Stewart, Wardrop, Crowell, Graham, 
Stenzel, Meckel, Stoerk, Petit, O'Halloran, Martial, Baron, Virchow, 
Paget, Crampton, Louis, Bougen, Desaolt Duncan, Reid, Hodgson, 
Andral, Tiedemann, Otto, Lobstein, Cloquet, Carsewell. Langstaff. and 
Richardson, on the formation of fibrinous concretions during life. 
■Conditions most favorable to the deposition of fibrinous concretions. 
Observations of Gairdner, Richardson, Gaspard, Lee, Hewson, Thack- 
rah, Cooper, and Briicke, upon the coagulation of the blood. Symp- 
toms and diagnosis of fibrinous concretions in the heart and blood- 
vessels. Observations of Dr. Wm. Sen house Kirkes upon the effects 
■of detachment of fibrinous concretions during life. Discussion of the 
causes of the formation of fibrinous concretions in the heart and blood- 
vessels in Malarial Fever. Principles of treatment best adapted to 
prevent the formation of fibrinous concretions in the heart and blood- 
vessels. Method of analyzing the blood. Table illustrating the com- 
position of venous blood in Malarial Fever. History of the cases 
which furnished the blood for analyses. Comparison of their results 
with the typical formula of the blood in health and disease, Colored 
blood-corpuscles are diminished during Malarial Fevers, and the extent 
and rapidity of the diminution correspond to the severity and extent 
of the disease Researches of Andral and Gavarret upon the blood oi 
Intermittent Fever. Composition of the blood in Marsh Cachexia, X 
Pages* 
according to Becquerel and Rodier. Composition of the blood in 
Mechanical Dropsy. Composition of the blood in Acute Dropsy. Com- 
position of the blood in Cachectic Dropsies. The fixed saline con- 
stituents of the colored blood-corpuscles are diminished in Malarial 
Fever. The iron of the disintegrated blood-corpuscles appears in the 
urine. Physiological, pathological, and therapeutical bearing of the 
changes of the blood-corpuscles in Malarial Fevers. Researches of 
Schmidt upon the specific gravity of the colored blood-corpuscles in 
various diseases. Relations of the colored blood-corpuscles to the mus- 
cular and nervous system. Principles of treatment based upon the 
changes of the blood in Malarial Fever. Injurious effects of blood- 
letting in Malarial Fever. Active and excessive purgation should be 
avoided in Malarial Fever. Importance of nutritious diet, and of the 
phosphates and iron. Principles which should govern the administra- 
tion of pepsin in Malarial Fever. The excretion of the products result- 
ing from the dead disintegrated blood-corpuscles should be promoted 
by diuretics and depurants, and the liver and spleen should be roused 
to throw off their perverted secretions. Place of the destruction of the- 
colored corpuscles in Malarial Fever. Animal starch accumulates in 
the malarial liver; whilst grape sugar is absent. Alterations of the 
blood, and especially of the blood-corpuscles in the spleen during 
Malarial Fever. Comparison of the changes of the blood in Malarial 
Fever, with the changes of the blood in Typhoid Fever, Typhus Fever, 
Ephemeral Fever, Small-pox, Scarlatina. Measles, Acute Scurvy, 
Chronic Scurvy, Erysipelas, Cholera, Phthisis, Scrofula, Carcinoma, 
Bright's Disease, Chlorosis, Anemia, Simple Rheumatic Fever, Febrile 
Arthritic Rheumatism, Rheumatism, Puerperal Fever, Pneumonia, 
Pleuritis, Peritonitis, Angina, 'Tonsillaris, Acute Bronchitis, Carditis, 
Pericarditis, Inflammation of Brain, Glanders, and Lead-poisoning.. 
The colored blood-corpuscles are more uniform and rapidly destroyed 
in Malarial Fevei* than in any other acute disease. Comparison of the 
changes of the blood and organs in Malarial Fever, with the changes 
of the blood and organs in Typhoid and Typhus Fevers. The diminu- 
tion of fibrin in Malarial Fever corresponds with the severity of the- 
disease. Observations of Andral upon the diminution of fibrin in 
fevers. Discussion of the question: Do these changes of the blood 
precede or succeed, or are they simultaneous with, the aberration of 
the physical, chemical, vital, and nervous phenomena denominated 
fever? Bleeding should be employed with caution in malarious dis- 
tricts. Sulphate of quinia beneficial in Pneumonia and Pleurisy, and 
irritative fevers following amputations, occurring in malarious coun- 
tries. Observations of the author upon three attacks of Malarial Fever 
occurring in his own person. Observations of Drs. Stevens, Ball, 
Mitchell, Salvagnoli, Archer, Porter, and Potter, upon the changes of 
the blood preceding the phenomena of fever. Brain-Pathological 
alterations of in Malarial Fever. Physical and chemical changes of 
the blood in Malarial Fever: Imperfect state of our knowledge of this 
fluid. Imperfections in our methods of analysis. Importance, and 
difficulty of establishing a standard formula of the constitution of the 
blood in health. The composition of the blood varies, not only with 
the class, but with each species of animals, and corresponds with the 
development of the organs and apparatus, illustrated by development 
of the blood and organs of invertebrate and vertebrate animals. 
Standard of Lehmann, and of Becquerel and Rodier. Importance of 
establishing the changes of the blood during thirst and starvation. 
Importance and difficulty of determining the amount of blood in the 
system 65-275 
CONTENTS. 
CHAPTER III. 
COMPARISON OF THE CHANGES OF THE BEOOD IN MALARIAL FEVER AND OTHER 
DISEASES, PYREXIAL AND PHLEGMASIAL. MICROSCOPICAL CHARACTERS AND 
CHANGES OF THE BLOOD IN VARIOUS DISEASES. MICRO-ORGANISMS IN MALA' 
RIAL FEVER AND OTHER DISEASES. 
Comparison of the changes of the blood in various diseases. Analysis of 
the blood in Diabetes Mellitus and Malarial Fever. Reports of cases CONTENTS. 
XI 
Pages. 
illustrating the phenomena of Diabetes Mellitus and Malarial Fever, 
with original investigations and practical observations on the digestion 
of albumen and flesh and oleaginous matters, and the comparative 
anatomy and physiology of the Pancreas. Qualitative and Quantitative- 
determination of sugar in the urine, blood and organs of man and 
animals. Chemistry of the carbohydrates, chemical, physiological and 
pathological relations of glucose. Qualitative and quantitative tests- 
for sugar. Specific gravity. Balance urinometer. Liquor-potassa 
tests. Reduction tests for the qualitative determination of sugar. 
Fehling's solution of cupric oxide. Volumetric method of analysis 
of sugar in animal and vegetable fluids. Description of apparatus. 
Paby's cu pro-potassic test solution for sugar. Dr. Piffard's formula for 
Fehling's solution. Fermentation test. Quantitative estimation of 
sugar by fermentation. Polarimetry diabetometer of Robiquet. Rela- 
tions of Leucocythaemia tQ Malarial Fever. Outline of lecture by the 
author on Leucocythaemia. Relations of the changes of the blood in 
Malarial Fever to the phenomena, progress and treatment of Pneumo- 
nia. Microscopical characters of the blood in Malarial Fever and in 
various diseases. History of the investigation of the microscopical 
changes of the blood in endemic and epidemic diseases. Statistics 
illustrating the nature and mortality of the various forms of fever, 
Malarial, Yellow, Typhus and Typhoid, treated by the author in 
the Charity Hospital of New Orleans and in various portions of the 
Southern States. Investigation of the microscopical characters of the 
blood in the malarial fevers of Central America. Detail of cases illus- 
trating the changes of the pulse and temperature in the fevers of South 
America. Essential conditions for the establishment of the relations 
of micro-organisms and morbific ferments to the causation and phe- 
nomena of certain diseases. Importance of examining the blood 
microscopically and chemically, immediately after its removal from 
the blood-vessels of healthy and diseased human beings. Method of 
observation and research-entozooa hominis. Investigations of various 
microscopists and naturalists, as Leeuwenhoek. Ehrenberg, Dujardin,. 
Diesing, Robin, Joseph Leidy and others, with reference to the origin, 
comparative anatomy and physiology and pathology of vegetable 
animal parasites. Classifications of micro-organisms, micrococci, 
bacilli and bacteria, by Cohn, Davaine, Robin, Nagelli, Billroth, 
Klein and other microscopists and physiologists. Results of the 
microscopical examination of the blood in the various forms of Mala- 
rial Paroxysmal Fever. Outline of results of experiments and obser- 
vations on the microscopical appearances of the fluids and solids of 
Malarial Fever, under the action of water and certain re-agents. Medico- 
legal evidence concerning the chemical, microscopic and spectroscopic 
detection of human blood. Detection of blood on the clothing of a man 
accused of murder; said blood presented the appearance ot the blood 
of a human being suffering with Malarial Fever. Testimony of tie 
author in the case of Narcisse Arrieux, murdered near D naldsonviiie, 
Louisiana, December 27th, 1876. Comparison of human blood in 
health and disease. Relative size of the blood globules in man an 
animals. Influence of the malarial poison in human blood, i 
spectroscope and spectroscopic analysis. The employment o 
spectroscope in medico-legal investigations. Comparison of the m - 
organisms of Malarial Fever with well-known micrococci, acl ' 
bacteria, spirilla and Spirochaetas, which have been describee 
delineated by many observers, as associated with septic processe 
various diseases. Micrococci. Zymogenic Micrococci. Patnog 
Micrococci. Micrococcus Variolae. Micrococcus Erysipelatous. Micio- 
coccus Pneumoniae. Micrococcus Gonorrhoea. Schizomycetes. ' 
teria. Bacilli. Bacillus Anthracis, Bacterium. Microbacterium. 
Septic Bacteria. Zymogenic Bacteria. Pathogenic Bacteiia. Be -. 
Bacillus Subtilis. Bacillus Seplicus. Zymogenic Bacilli. - 
genic Bacilli. Bacilli of Septicaemia, of Typhoid Fever, of 
of Malignant (Edema, of Anthrax, of Tuberculosis, of Oriel ta 
Leprosy and other diseases, as Asiatic Cholera. »elt nhcorv-v 
Pathogenic Spirilla. Micro-organism of Relapsing Fever. . .. ' 
tions of Koch, Klein and others on micro-organisms, Investi^atioi s XII 
CONTENTS. 
Pages. 
of Prof. A. Kelsch, on the destruction of the colored blood-corpuscles 
by the malarial poison. Numerical determination of the colored 
blood-corpuscles in the various forms of Malarial Fever. Morbific fer- 
ments. Relations of bacteria to putrefaction. Theory of the author 
as to the origin and production of Malarial Fever. General conclu- 
sions drawn from the preceding observations on the constitution and 
changes of the blood in Malarial Fever 276-497 
CHAPTER IV. 
HEMORRHAGIC MALARIAL Fh'.VER. MALIGNANT FORMS OF MALARIAL PAROX- 
YSMAL FEVER. MALARIAL HEMATURIA. 
Malignant forms of Malarial Paroxysmal Fever. Extensive prevalence 
of Malignant Paroxysmal Fever, including Haemorrhagic Fevers in 
the alluvial regions, in tropical, semi-tropical and temperate countries 
in both hemispheres. Wide-spread and destructive effects of the Mala- 
ria of the swamps and rice fields of the Southern States. Area of the 
Mississippi Valley. Area of alluvium of the Mississippi Valley. Area 
of the delta. Extensive prevalence of the various forms of Malarial 
Fever in the Valley of the Mississippi during the summer and autumn 
of 1880. The wide spread and destructive effects of Malarial Fever in 
other Southern States, as the great State Georgia. Mortuary statistics 
of Midway Church, Liberty county, Georgia. Deaths amongst the 
whites in Savannah, Georgia, from 1804 to 1818. Medical statistics of 
Oglethorpe Barracks, Savannah, Georgia. Cases of Malarial Fever and 
of all diseases occurring during a period of fifteen months, October, 
1862, to January, 1864, in the Confederate troops serving in and around 
Fort Jackson on the Savannah river. The prophylactic properties of 
quinine. Experience of the author as to the power of sulphate of qui- 
nine, administered daily to ward off Malarial Paroxysmal Fever. Wide- 
spread and destructive effects of the Malarial Fevers of the alluvial 
regions of tropical and semi-tropical Africa. Testimony of various 
travellers, as Mungo Park, Ledyard, Captain Cook and others, as to 
the unhealthy nature of the coast of Africa. Destructive effects of the 
Malarial Fevers of Africa in the expedition to the Congo, commanded 
by Captain Tuckey. Destructive effects of the climate of Sierra Leone. 
Numerous examples of the deadly effects of the Malarial Fever of the 
coast of Africa, as recorded by the Deputy Inspectors of the English 
Navy. Prophylactic powers of quinine in warding off the Malarial 
Fever of the coastof Africa, as shown by the experience of the surgeons of 
the British Navy. Haemorrhagic Fevers dependent upon the peculiar 
constitution of the blood, as induced by salt meats, sameness of diet and 
the concurrent action of febrile poisons. Investigations of Andral and 
Magendie on the constitution and changes of the blood in low forms of 
Fever. Causes which destroy the coagulability of the blood in dis- 
eases. Investigations of the Italian physician, Bufalini, on thechanges 
of the blood in Fevers. Observations of Grant on the effects of the 
peculiar hygienic conditions of the people of Europe before the 
eighteenth century, on the composition of the blood and the nature of 
Pestilential and Haemorrhagic Fevers. Observations of John Huxham 
in 1757, on Putrid, Malignant and Petechial Fevers. Description of 
the epidemic of Naples in 1764, by Sarcone. Description of thechanges 
in the types of Fever in India, by Surgeon James Raynald Martin. 
History of Haemorrhagic Malarial Fever. Malignant', Intermittent 
and Remittent Fevers, accompanied with vomiting of black bile, with 
Petechiae and Haemorrhages, have from time immemorial been fre- 
quent and fatal in the various marshy countries bordering on the Med- 
iterranean and Black seas. Description of Haemorrhagic and Malignant 
Fevers by Hippocrates. Observations by Galen, Aretaeus, the Cappa- 
docian, Celsus, Paulus JEgineta, Rufus, Burserius, Lancisi, Ramazzini, 
Lautter, Alibert, Torti, Lind, Jean Senac. William Hillary, R. b' 
Todd, McLean, Dr. Charles Faget. of New Orleans, Berenger Feraud 
and others on Haemorrhagic Fevers. Haematuria (bloody urine) 
and Malarial Haematuria. Causes of Haematuria (bloody urine). Idio- 
pathic and Vicarious Haematuria. Illustrative cases, reported by Drs. CONTENTS. 
XIII 
Pages* 
Willis, Barsham, Chopart and others. Haematuria resulting from the 
action of febrile poisons, and irritating and poisonous substances intro- 
duced into the circulation. The Haematuria of certain febrile diseases, 
as Scarlet Fever, Small-pox, Typhus Fever, Pyaemia, Malarial and 
Yellow Fever, referred both to a general haemorrhagic condition, and 
to structural changes of the kidneys. Observations of Dr. John John- 
son on structural alterations of the kidneys. Investigations of Dr. 
Daniel Blair on the Haematuria of Yellow Fever. State in which the 
blood escapes from the kidneys in Haematuriaresulting from the action 
of febrile poisons and irritating substances; observations of Vogel, 
Thudichum and others; observations of the author. Haematuria caused 
by living organisms in the blood. Haematuria induced by the Bilhar- 
zia Haematobia; observations of Chapotain, Salesse, Griesinger, Bilharz, 
Cobbold and John Harley. Parasitical haemoptysis caused by the dis- 
toma ringeri; observations of Dr. Patrick Manson. Paroxysmal Haema- 
turia. History of a case of periodical discharge of blood from the 
urethra, by Charles Stewart, in 1794. Case of Haematuria associated 
with disease of the heart, reported by Dr. John Elliottson. Cases of 
Haematuria reported by various observers, as Beale, Bigbie, Dickinson, 
Druitt, Greenhow, Hassall, Harley, Murchison, Pavy, Southey, Stevens, 
Tyson and others. Importance of the microscopical examination of 
the urine in Haematuria. Paroxysmal Haematuria has some symptoms 
in common with the Haematuria caused by the malarial poison. Causes 
of bloody urine. History of Malarial Haematuria. Absence of critical 
and scientific observations upon the physical and chemical characters 
of the urine of Fevers, in the writings of American physicians, upto 
the middle of the nineteenth century. Malarial Haematuria was 
observed by Dr. C. G. Young, of Louisiana, in ,1,843. Observations of 
Dr. R. H. Day, of Baton Rouge, on Malarial Haematuria. Observa- 
tions of F. W. Baird, M. D., J. L. Deslattes, M. D., L. H. Anderson, 
M. D., F. M. Hall, M. D., J. C. Oxamendi, M. D., James Copeland, M. 
D., William Roberts, M. D., Fried Theod. Frerichs, M. D., Joseph 
Jones, M. D., Francis Barnes, M. D., S. F. Starley. M. D., H. C. 
Ghent, M. D., D. S. Joynes, M. D., Edward H. Sholl, M. D., T. C. 
Osborn, M. D., Benjamin H. Riggs, M. D., E. S. Sharpe, M. D., R. F. 
Michel, M. D., M. H. Taylor, M. D., U. S. A., and many other South- 
ern physicians, on the symptoms, pathology and treatment of Mala- 
rial Haematuria. Cases investigated by Joseph Jones, M. I)., illustrat- 
ing the symptoms, changes of temperature, pulse, respiration, compo- 
sition of the blood and urine and treatment. Jaundice, its phenomena 
and symptoms in Malarial Haematuria and in other forms of Malignant 
Fevers. Historical account of Jaundice. Physical and ehemical prop- 
erties of human bile in health and disease Physical and chemical 
properties of the bile in man and animals. Composition ot the bile in 
man and animals compared. Relations of the coloring matters or the 
bile to the colored blood-corpuscles. Constituents of the colored blood- 
corpuscles. Relations of the coloring matters of the bile to those ot the 
urine. Effects of ligature of bile ducts. Classification of the causes ot 
Jaundice. General conclusion relative to Malarial Haematuria 
CHAPTER V. 
CIRCULATION, RESPIRATION, TEMPERATURE, STATE OF THE 
CHANGES OF THE URINE IN INTERMITTENT, REMITTENT AND• C - ts 
FEVER. PRINCIPLES OF TREATMENT BASED UPON THESE OBSERN A 
Fever-Its phenomena. History of investigations in animal tempem- 
ture. Investigations of the author relative to animal temperatuie a 
the changes of the body heat in diseases. Determination ot the na - 
tions of the human temperature at stated intervals in health an - 
ease, and in the various stages of different diseases. Deterinma 
the variations of the pulse and respiration in health and a sease. 
Physical and chemical changes of the urine m the various si „ - 
disease. General results of the labors of the author published in the 
Southern Medical and Surgical Journal, in 1858, and m the < • ' 
tions of the American Medical Association, 1859. Important XIV 
CONTENTS. 
Pages. 
results in the investigation and differential diagnosis of Malarial and 
Continued Fevers, during the Civil War, 1861-1865, and in the differen- 
tial diagnosis of Yellow and Malarial Fevers, during the term of service 
of the author as President of the Board of Health of the State of Louisi- 
ana, 1880-1884. Circulation, respiration, temperature, state of the skin, 
tongue, and changes of the urine in Intermittent, Remittent and Con- 
gestive Fever. Principles of treatment based upon these observations. 
Reports of cases of Malarial Fever by the author, 1857-1886. Effects of 
the Civil War upon the labors of the author. Intermittent Fever.- 
During the cold stage (chill) there is a rapid, feeble pulse; full, rapid 
respiration, and a hot trunk and cold extremities. The chemical 
changes and elevation of temperature due to the action of the morbific 
ferment of Malarial Fever, precede the cold stage. Analysis of the 
phenomena of the various stages of Intermittent Fever. During the 
■cold stage the temperature of the extremities is reduced far below that 
•of the trunk, even below the standard of health, whilst that of the 
trunk may rise to 107° F. Cases illustrating the condition of the pulse 
and respiration, aud the changes of temperature in Intermittent Fever. 
The higher the temperature of the trunk in the cold and hot stages in 
Intermittent Fever the milder will be the subsequent attacks, and the 
•elimination of the malarial poison will be more rapid and complete. 
Illustrative cases. Comparison of the thermic phenomena of Yellow 
.and Malarial Fevers. Appearance of the tongue in Intermittent Fever. 
Characters of the urine in Intermittent Fever. Illustrative cases. 
Remittent Fever.-The phenomena of the cold stage of Remittent 
Fever are similar to those of Intermittent Fever. In Remittent as 
well as Intermittent Fever, the increase of the action of the pulse and 
respiration is attended by elevation of temperature, which corresponds 
with the increased actions of the circulatory and respiratory systems. 
The elevation of temperature is- more persistent in Remittent than 
Intermittent Fever. Condition of the tongue and secretions of the 
mouth in Remittent Fever. The coma, delirium and nervous di>turb- 
.ances in Remittent Fever not indicative of inflammation of the brain. 
The changes of the urine are the same in kind, but different in degree 
from those of Intermittent Fever. Cases illustrating the changes of 
pulse, respiration and temperature and of the urine in Remittent 
Fever. Cases illustrating the treatment of and pathological anatomy 
•of Remittent Fever. Congestive Fever-Pernicious Malarial Fever, 
Malignant Malarial Fever. Profound impressions of the malarial 
poison on the blood and upon the capillary and general circulations, 
on the ganglia of the heart, and on the ganglionic cells of the sympa- 
thetic and cerebro-spinal nervous systems in Congestive Fever. Condi- 
tions of the tongue, skin, pulse, respiration and bodily temperature in 
Pernicious Malarial Fever. Changes of the urine in Congestive Mala- 
rial Fever. Illustrative cases. Changes of the urine, pulse and res- 
piration in Malarial Haematuria. Comparison of the phenomena of 
Malarial Haematuria with those of Yellow Fever. Tabular view of the 
pulse, respiration, temperature and urine in Intermittent, Remittent, 
•Congestive and Haernaturial Malarial Fever 698-840 
CHAPTER VI. 
TATHOLOGICAL ANATOMY OF MALARIAL FEVER. CHANGES OF THE ORGANS AND 
TISSUES, AND APPARATUS OF THE BODIES OF THOSE WHO HAVE DIED WITH THE 
DIFFERENT TYPES OF MALARIAL FEVER, INTERMITTENT, REMITTENT, AND CON- 
GESTIVE. COMPARISON OF THESE CHANGES WITH THE PHENOMENA OF MALA- 
RIAL FEVER, AND WITH SIMILAR CHANGES IN OTHER DISEASES, AND WITH THE 
ORGANS, TISSUES, AND APPARATUS OF MEN AND ANIMALS IN THE NORMAL 
CONDITION. 
Exterior skin-Muscular system. Head-dura-mater, arachnoid mem- 
brane, pia-mater, cerebrum, cerebellum, medulla oblongata, ventricles 
of brain, etc. Nervous phenomena of fever, compared with post-mor- 
tem examinations. Chest-Lungs, heart. Alimentary and intestinal 
canal-Mouth, tongue, oesophagus,stomach, duodenum, jejunum,ileum, 
-colon, rectum, glands of Peyer solitary glands. Liver-Slate and CONTENTS. 
XV 
oronze color of liver; changes of blood of liver; malarial liver contains P 
animal starch, but no hepatic sugar; bile. Spleen-Slate color of spleen- 
pulp of spleen; alterations of structure. Kidnevs-Supra-renal canl 
stiles. Bladder. Pathological anatomy of the various forms of endemic 
paroxysmal, non-contagious Malarial Fever, and of specific contagious 
Yellow Fever. Importance of investigating the pathological anatomy 
of the endemic, epidemic and contagious fevers, of tropical and sub- 
tiopical countlies. Data upon which the author bases his conclusions 
Appearance of the exterior of the body in fatal cases of Malarial Fever 
and of Yellow lever. Pathological anatomy of the cerebro-spinal and 
sympathetic nervous systems in Malarial and Yellow Fever. Difficul- 
ties of the investigation. Value of microscopical and chemical obser- 
vations. Necessity of delineating accurately anatomical details by 
micro-photography. Appearance of the membranes of the brain after 
death from Malarial Fever. The opalescent pearl color of the arach- 
noid membrane in Malarial Fever, of little diagnostic value. Observa- 
tions on the pathological changes and lesions of the brain and spinal 
cord in acute sthenic cases of Malarial Fever. Theory of the action of 
the malarial poison, morbific ferment or micro-organism in the cerebro- 
spinal and sympathetic nervous system. Analysis of the phenomena 
of malarial chill. Cases illustrating the appearances presented by the 
brain and its membranes in fatal cases of Malarial Fever. General 
results of the changes of the nervous structures in Malarial Fever. 
Deposit of pigment in the brain in certain cases of chronic Malariai 
Fever. Historical account. Observations of Bailly, Ballard, Bright, 
Meckel, Frerichs and others, on the pigmentation of the brain in 
•chronic malarial disease. Engravings illustrating the deposit of pig- 
ment matter and pigment cells in the brain of. Malarial Fever. Com- 
parative changes of the cerebro-spinal and sympathetic nervous sys- 
tems in specific Yellow Fever. Pathological anatomy of the lungs'in 
Malarial and Yellow Fever. Pathological anatomy and microscopical 
and chemical changes of the heart in Malarial "and Yellow Fever. 
Fatty degeneration of the heart in Yellow Fever. Comparative patho- 
logical anatomy of the alimentary canal in Malarial and Yellow Fever. 
Lesions of the stomach and intestinal canal in Malarial Fever. Cases 
illustrating the condition and appearance of the stomach and intestines 
after death from Malarial Fever. Comparative view of the pathologi- 
cal changes of the stomach and intestines in Malarial Fever, Yellow 
Fever and Typhoid Fever. Engravings illustrating the lesions of the 
stomach in Yellow Fever. Engravings illustrating'the lesions of the 
intestines in Typhoid Fever and Acute Dysentery. Uniformity of the 
intestinal lesions of Typhoid Fever, as it prevailed in the Confederate 
army in different portions of the Southern States. Lesions of Acute 
and Chronic Dysentery amongst the Confederate troops, 1861-1865. 
Pathological anatomy of the liver in Malarial and Yellow Fever. Anat- 
omy and functions of the human liver. Relative weights of the liver 
in different animals. Weight of the human liver in health and in 
Malarial Fever. Glycogenic function of the liver. Effects of disease 
upon the glycogenic function of the liver. Effectsof previous diseases, 
as cirrhosis and fatty degeneration, in modifying the appearance of the 
liver after death from Malarial Fever. Color of the liver in Malariai 
Fever. Deposit'of pigment in the malarial liver. Acute and chronic 
parenchymatous hepatitis caused by Paroxysmal Paludal Fever. Re- 
searches of Professors A. Kelsch and Keiner, of Val-de-Grace, upon 
Acute Parenchymatous and Chronic Ncdular Parenchymatous Mala- 
rial Hepatitis. Engravings illustrating the pathological anatomy of 
the liver in Malarial and Yellow Fever. Cases illustrating the patho- 
logical changes of the liver in Malarial Fever. Sources of the changes 
of color in the liver. Characters of the bile in Malarial Fever. The 
liver of those cases which died in the active stages of Malarial Fever 
contained animal starch, whilst hepatic sugar was absent. Points of 
difference between the Malarial Fever liver and the Yellow Fever liver. 
Comparative pathological anatomy of the liver in Malarial Fever and 
in Yellow Fever. Pigment liver of Malarial Fever. Hepatitis and 
abscess of the liver due to the action of the malarial poison. Fatty 
degeneration of the liver in specific Yellow Fever. Pathological anat- 
omy of the spleen in Malarial Fever. Functions of the spleen. Weight XVI 
CONTENTS. 
Pages. 
of the spleen in different animals. Relative size of the spleen in health 
and disease. The enlarged spleen of Malarial Fever. Cases illustrating 
the pathological changes of the spleen in Malarial fever Comparative 
pathological anatomy of the spleen in Malarial and Yellow Fever. 
Deposit of pigment and pigment cells in the malarial spleen. Engra- 
vings illustrating the pathological changes of the spleen. Compara- 
tive pathological anatomy of the kidneys in Malarial and Yellow Fever. 
Effects of the repeated congestions of Malarial Fever on the structures of 
the kidneys. Relations of Malaria to the causation of Bright's disease 
of the kidneys. Interstitial parenchymatous inflammation of the renal 
structures caused by the action of Malaria. Researches of Professors 
Kelsch and Keiner, of Val-de-Grace, on the alterations of the renal 
structures in Malarial Fever. Pathological anatomy of rhe kidneys in 
Malarial Hsematuria. Presence of blood-corpuscles and blood casts of 
the tubuli uriniferi. Cases illustrating the effects of the malarial 
poison in inducing albuminuria. Pathological anatomy of the kidneys 
in Yellow Fever. Engravings and plates illustrating the comparative 
pathological anatomy of the kidneys in Malarial and Yellow Fever 841-990 
CHAPTER VII. 
TREATMENT OF MALARIAL EEVER. PREVENTION OF MALARIAL FEVER. INDIGE- 
NOUS REMEDIES OF THE SOUTHERN STATES OF THE UNITED STATES OF AMERICA; 
WHICH MAY BE EMPLOYED AS SUBSTITUTES FOR THE SULPHATE OF QUINIA IN 
THE TREATMENT OF THE VARIOUS FORMS OF MALARIAL FEVER. PREVENTION 
OF MALARIAL FEVER BY HYGIENIC, DIETETIC AND THERAPEUTIC MEASURES. 
PRINCIPLES OF THE TREATMENT OF THE VARIOUS FORMS AND EFFECTS OF 
MALARIAL FEVER. 
Indigenous remedies of the Southern States which may be employed in 
the treatment of Malarial Fever. Necessity for the use of indigenous 
remedies at the present time. Georgia Bark (Pinckneya pubens). Its 
affinities with Peruvian Bark. Geographical distribution. Active 
alkaloid principle. Medicinal properties. Use of by the inhabitants 
of Georgia in the treatment of Intermittent Fever. Testimony of Dr. 
John Stevens Law, of Sunbury, to its efficacy as an anti-periodic. 
Method of using it. Dogwood (Cornus Florida). Botanical descrip- 
tion. Geographical distribution. Chemical composition. Examina- 
tion of Dr. Walker, of Virginia, 1803. Dr. Walker's recipe for making 
ink from the bark. Examination of Mr. Carpenter, of Philadelphia. 
Cornine. Examination of Drs. Staples, S. Jackson, James Cockburn 
and D. C. O'Keeffe. Medicinal properties and uses. Testimony of 
Dr. Walker, of Virginia, to the medicinal properties of Dogwood; of 
Dr. Gregg, of Bristol; of Drs. Jacob Bigelow, S. G. Morton, R. Coates, 
D. C. O'Keeffe and others. Method of preparing the extract. Dose. 
Cornus Circinata (Round-leaved Dogwood). Testimony of Morson 
and Ives to its medicinal value. Buttonwood shrub (Cephalanthus 
occidentalis). Anti-periodic properties. Virtue as a febrifuge and tonic. 
Effective remedy in chronic pulmonary complaints. Poplar or Tulip 
Tree (Liriodendron Tulipifera). Botanical character. Examination 
by Dr. Rogers, 1802; by Dr. J. P. Emmet, 1832. Discovery of Lirioden- 
drine. Chemical and physical properties. Medical properties and 
uses of Poplar Bark. Testimony of Michaux, of Dr Benjamin Rush, 
of Dr. I. T. Young, of Governor Clayton, of Drs. Barton, Bigelow, and 
Eberlie. Great value as an antiperiodic. Small Magnolia or Sweet 
Bay (Magnoliaglauca). Botanical characters. Geographical distribu- 
tion. Chemical composition. Examination of Dr. Jacob Bigelow. 
Medical properties and uses known to the Indians. Testimony of Dr. 
Bigelow. A domestic remedy in chill and fever. Dose. Cucumber 
Tree (Magnolia acuminata). Big Laurel (Magnolia grandiflora). 
Umbrella Tree (Magnolia tripetala). Persimmon (Diospyros Virgini- 
ana). Catalpa (Bignonia Catalpa). Virginia Snakeroot (Aristolochia 
serpentaria). Botanical description. Geographical distribution. 
Chemical constitution. Analyses of Bucholz, Chevallier, Dr. Jacob 
Bigelow, Conwell. Medical propertiesand uses. Experiments of Jorg 
on Virginia Snakeroot. Used by the Indians and early settlers of 
America. Employed and extolled by numerous physicians. Testi- 
mony of Dr. Nathaniel Chapman, of Sydenham, of Dr. John Eberlie, CONTENTS. 
XVII 
Pages 
of Dr. Jacob Bigelow, of Dr. George B. Wood and others. Dose and 
mode of administration. Indian Quinine or Ague Weed (Gentiana 
quinquifolia). Thorough Wort (Eupatorium perfoliatum). Botani- 
cal description. Geographical distribution. Chemical composition. 
Examina'ion of Drs. Anderson and Bigelow. Discovery of a salifi- 
able base in, by Mr. J. Scattergood. Medical properties arid uses. The 
Indians acquainted with its uses. Use of by early settlers. Testimony 
of Drs. Chapman, Wood, Anderson, Hosack, Baird, Eberlie, Ives, 
Bigelow and others. Dose and mode of administration. Wild Cherry 
(Arasus Virginiana). Salicin. Chemical and therapeutical properties 
of Salicin. Salicylic Acid. Chemical and therapeutical properties of 
Salicylic Acid. Employment of Salicylic Acid in the treatment of 
Fevers and acute Rheumatism. Salicylate of Soda and Salicylates. 
Chemical and therapeutic properties of the Salicylates. Clinical facts 
illustrating the therapeutic value of the Salicylate of Soda. Effects of 
Salicylate of Soda in the treatment of Rheumatism. Investigations of 
Dr. Sydney, Ringer and others on the physiologic and therapeutic 
effects of Salicin, Salicylic and Salicylate of Soda and the Salicylates 
in the treatment of febrile diseases and Acute Rheumatism. Experi- 
ence of the author in the treatment of Acute and Chronic Rheumatism. 
Apocynum Cannabinum (Indian Herb). Corcellorhiza Adontorhiza 
(Coral Root). Hydrastes Canadensis (Blood Root). Cotton Plant 
(Gossypium). Cartanea Vesca and Pumilla (Chestnut). Ulma Sirulata 
(Alder). Polygnum Avicularic (Knob Grass). Prinos Verticillatus 
(Black Alder, Winter Berry). Verbascum Thapsus (Mullein). Sabbatia 
Angularis Pursh (American Centaury). Apocynum Cannabinum 
(Indian Hemp. Dog's Bane). Chionanthus Virginia (Old Man's 
Beard, Poison Ash). Ilex Opaca, or 'American Holly. Patanus Occi- 
dentalis (Sycamore, Button Wood). Ptelea Trefoliata (Water Ash, 
Wingseed). Capsicum (Cayenne Pepper). Oil of Turpentine (Oleum 
Terebinthinse). Wild Horehound (Eupatorium Rotundifolium). 
Botanical description. Geographical distribution. Medical operation 
and uses; extensively employed in domestic practice in the treatment 
of Intermittent Fever. Medical properties first brought prominently 
to the notice of the profession by George Jones, President of the Geor- 
gia Medical Society. Testimony of Dr. Jones, showing that it serves 
as an excellent substitute for Peruvian Bark. Testimony of Dr. 
Nathaniel Chapman, of Philadelphia, to its value in Intermittent 
Fever. Black Willow (Salix Nigra). Testimony of Michaux to its 
value in Intermittent Fever. White Willow of Europe (Salix Alba). 
Chemical composition. Analysis of M. M. Pelletier and Caventou. 
Discovery of the principle Salicin by Buchner, of Germany. Investi- 
gations of M. Fontana, Rigatalli, M. Leroux, upon the different species 
of willow. Properties of Salicin. Medical properties and uses of Wil- 
low Bark; use of, by the ancients, brought to the notice of the profess- 
ion in 1763, by Rev. Mr. Stone. Testimony of Mr. Stone to its value. 
Testimony of Messrs. James White and Wilkinson. Use of by Haller. 
Testimony of European physicians to the value of Salicin. Yellow 
Jessamine (Gelseminum Sempervirens). Accidental discovery of its 
value in Malarial Fever. Use of in Western States. Testimony of 
Drs. Cleveland, Nash, J. A. Mayes and others, to its medicinal proper- 
ties and uses. Dose and mode of administration. Milk Weed, or Root 
of Man (Asclepias Syriaca). Testimony of Dr. Richard S. Cauthorn, 
of Richmond, Va., to its value in Intermittent Fever. Common Salt 
(Chloride of Sodium). Dr. Seelie Montdezert the first to call the atten- 
tion of the profession to the value of Chloride of Sodium in the treat- 
ment of Intermittent Fever. Testimony of Dr. W. P. Lattimore to 
the success of M. Piory, with common salt in the treatment of Inter- 
mittent Fever. Testimony of Drs. Moroschkin and Hutchinson. Dose 
and mode of administration. Sal Ammoniac (Hydrochlorate of 
Ammonia). Testimony of Dr. Felix Jacquot, to its value in Intermit- 
tent Fever. Nitric Acid. Testimony of Drs. George Mendenhall, Bai- 
ley, J. C. Thompson, an,d Dr. William A. Hammond. Arsenic. Testi- 
mony, experiments and investigations of Dr. Felix Jacquot upon its 
relative value in the treatment of Malarial Fever. Testimony of M. 
Boudin. Ligature of the Extremities in Intermittent Fever, resti- 
mony of J. DeBrauw and others to the effects of ligature of the extremi- XVIII 
CONTENTS. 
Pages. 
ties in Intermittent Fever. Cold water in the treatment of Malarial 
Fever. Use of by Dr. Wright in 1786; practical rules for its use, by Dr. 
J. Currie, of England. Testimony of M. Fleury to the value of cold 
douches in the treatment of Intermittent Fever.' Prevalence of Mala- 
rial Fever. Importance of determining the Character of the Drinking 
Water. Analyses of the Waters of various Geological Regions of the 
Southern States. Experiments illustrating the poisonous properties of 
stagnant Swamp Water. The Prophylactic properties of the Sulphate 
of Quinine. Treatment of Intermittent, Remittent, Congestive and 
Pernicious Malarial Fevers. Principles which govern the adminis- 
tration of Purgatives and Antipyretics and Antiperiodics in the treat- 
ment of the various forms of Malarial Fever. Treatment of the Seque- 
be of Malarial Fever 991-1143 
CHAPTER VIII. 
CHANGES OF COLOB. IN THE HUMAN RACE-OBSERVATIONS AND RESEARCHES ON 
ALBINISM IN THE NEGRO RACE. 
Description of cases of Albinism in the negro race. Two white children 
born in succession to two black negroes, man and wife. On the 
mother's side, the great-grandfather, the grandmother, and the mother 
of the two Albino children spotted with white spots. The skin of the 
negro, originally black, may ata period subsequent to birth,.gradually 
change its color from black to white, until the complete Albino charac- 
ter is induced. Cases observed by the author, and by various observers, 
Will Byrd, James Bate, Samuel Stanhope Smith, Blumenbach and 
others. Albinos occur amongst all the races of men, as well as amongst 
many of the species of domestic and wild animals. The Albino is not 
necessarily feeble or sterile, but is capable of procreation, and when 
two Albinos are united there is a tendency to the establishment of a 
permanent variety. Views of various observers and writers. Seats 
and nature of the change of color in the Albino, eyes, hair and skin. 
Investigations of various naturalists. Between the epidermis of the 
Colored and white races there is an identity of structure and no specific 
differences. The hair of the head of the negro possesses all the charac- 
teristics of hair, and is not wool 1147-1175 
LEPROSY IN AMERICA. 
General observations 1179-1183 
CHAPTER IX. 
CHAPTER X. 
Yaws, Libbens, Sivvens, Pian, Epian, Frambcesia, Syphilis JEthiopica. 1184-1204 
CHAPTER XI. 
Leprosy, Elephantiasis Greecorum, 1205-1216 
CHAPTER XII. 
Notes on the History of Leprosy in the Southern States 1217-1234 
CHAPTER XIII. 
^Etiology: Causes and origin of Leprosy (Elephantiasis Graecorum) in 
North America, and more especially in the Valley of the Mississippi 
River 1235-1252 CONTENTS. 
XIX 
CHAPTER XIV. 
Pages. 
Morbid Anatomy of Leprosy 1253-1261 
Bacillus Leprse 1262-1270 
CHAPTER XV. 
CHAPTER XVI. 
Treatment of Oriental Leprosy (Elephantiasis Grsecorum). Views of 
the older writers 1271-1284 
CHAPTER XVII. 
Elephantiasis Arabum, Elephant's Leg, Barbadoes Leg..... 1287-1332 
List of Engravings illustrating Volume II, Medical apd Surgical Menjoirs, 
, 1 
mo. of 
;raving. Page. 
Eng 
Colored blood-corpuscles of men and animals 
1 
104 
Human colored and colorless corpuscles 
2 
107 
Structure of colored blood-corpuscles 
3 
112 
Micro-organism in intestinal canal in Fever 
4 
155 
Section of surface in Peyer's gland in Typhoid Fever 
5 
156 
Microscopic character of enlarged mesenteric gland in Typhoid Fever 
6 
157 
Liver cells of Typhoid Fever 
7 
157 
Casts, bacilli and micrococci in urine of Typhoid Fever 
8 
158 
Casts of tubuli uriniferi and micro-organisms in the urine of Typhoid 
9 
158 
Deposits and micro-organisms in urine of Typhoid Fever 
10 
159 
Deposits in urine of Malarial Fever 
11 
160 
Micro-organisms of Typhoid Fever 
12 
161 
Heart clots (fibrinous concretion).... 7. 
13 
164 
Microscopical objects in blood of Malarial Fever 
14 
195 
Micro-organisms in blood of Malarial Fever 
15 
196 
Micro-organisms in blood of Malarial Fever 
16 
196 
Micro-organisms in splenic mud of Malarial Fever 
17 
197 
Fungus developed in splenic mud of spleen of Malarial Fever 
18 
197 
Blood of Relapsing Fever (human) spirilla Obermeyeri 
19 
199 
Blood of Relapsing Fever (ape) 
20 
200 
Heart of dog containing filaria sanguinis 
21 
201 
22 
202 
23 
203 
24 
203 
25 
204 
Flephantiasis Arahum 
26 
204 
Flppha.ntia.sis Ara.hip.fl. 
27 
205 
Filaria. Sancninis Hominis 
28 
205 
Anatomy of mature Filaria Sanguinis Hominis 
29 
206 
30 
206 
Bilharzia. Hrnmflfohjsi .. 
31 
208 
Balance with specific gravity bottle 
32 
304 
FT ri nometer 
33 
305 
Speeifie gravity hnlh 
34 
305 
35 
307 
Pipette for dilution 
36 
307 
Graduated Burettes 38, 
37 
39 
307 
308 
Arrangement for estimating the amount of Sugar by the Cupro- 
Potassio. Solution 
40 
mu 
Fermentation Apparatus for the detection of Sugar 
41 
311 XX 
MnnriilpQ nf ^Tnrnlfi C^prPvisifP 
No. of 
Engraving. 
42 
Page. 
312 
The Diabetometer of Robiquet 43, 
44, 45 
314, 315 
Micro-Organism in blood of Malarial Fever . 46, 
47, 48 
357, 358 
Splenic Mud of case of Pernicious Malarial Fever 
49 
360 
Micro-Organisms of Splenic Mud from Spleen of Pernicious Mala- 
50 
361 
Human Blood-corpuscles, colored and colorless 
51 
372 
Comparative Size of red corpuscles 
52 
372 
Red Corpuscles of the Blood of various Vertebrate Animals 
53 
373 
378 
Map of Solar Spectrum 
379 
Sorby's Spectrum Eye Piece 
387 
Absorption Bands of Blood under Spectroscope 
57 
388 
Micrococci of putrid human sputum - 
58 
393 
Pathogenic Micrococci 
59 
397 
Schizomycetes: Bacteria, Bacilli 
60 
397 
Life History of Bacillus Anthracis 
61 
399 
Micro-Organisms in Typhoid Fever 62, 63, 64, 
65, 66 
406, 407 
Bacillus Tuberculosis 
.67, 68 
411 
Bacillus Leprse 
69 
412 
Comma Bacillus of Asiatic Cholera 
.70, 71 
414,415 
Spirillum of Relapsing Fever (man) 
72 
419 
Spirillum of Relapsing Fever (monkey) 
. ... 73 
420 
Bilharzia Hsematobia 
74 
542 
Distoma Ringeri Parasitical Haemoptysis 75, 
76, 77 
545, 547 
Urinary Deposits in Malarial Fever 
78 
713 
Urinary Deposits in Remittent and Continued Fever 
79 
789 
Symphographic Tracings of the Pulse 
80 
839 
Pigment Brain in Malarial Fever 
81 
864 
Deposit of Pigment in Cerebral Capillary in Malarial Fever 
82 
865 
Deposit of Pigment in Capillaries of Brain in Malarial Fever.... 
83 
866 
Section of Brain in Malarial Fever 
84 
866 
Capillary Vessel of Brain in Malarial Fever .. 
85 
867 
Small Intestine (Ileum) in Typhoid Fever 
86 
888 
Small Intestine in Typhoid Fever. Enlarged Glands of Peyer- 
Mesenteric Glands 
87 
889 
Fibrinous Bodies in Small Intestine in case of Typhoid Fever... 
88 
889 
Microscopic Appearance of the Mesenteric Glands of Typhoid Fever 89 
890 
Enlarged Peyer's Patches and Mesenteric Glands in Typhoid Fever 90 
890 
Ulceration of Peyer's Patches and of Intestinal Mucous Membrane 
and Enlarged Mesenteric Glands in Typhoid Fever 
91 
891 
Ulcerations of intestinal mucous membrane in Typhoid Fever. 
92 
892 
Ulceration and fibrinous exudation in Chronic Dysentery 
93 
893 
Perforation of the intestine in Typhoid Fever 
94 
894 
Pathological anatomy of the liver in Malarial Fever 95. 
, 96, 97 926, 927, 928 
Pigment liver of Malarial Fever 
98 
943 
Magnified section of liver of Pernicious Malarial Fever 
99 
943 
Pathological anatomy of liver and stomach in specific contagious 
Yellow Fever 
100 
946 
Liver cells of Typhoid Fever 
101 
949 
Changes of the blood, liver and spleen in Malarial Fever.... 
102 
958 
Malarial M elan semia . 
103 
971 
Pathological anatomy of human kidney in Malarial Nephritis 
104, 105, 106 978 
, 979, 980 
Pathological anatomy of the kidney in Bright's Disease and Yellow 
Fever 
107 
986 
Georgia bark (Pinckneya Pubens) 
108 
993 
Dogwood (Cornus Florida) 
......109 
1007 
Pond Dogwood (Cephalanthus Occidentalis) 
110 
1012 
Poplar or Tulip Tree (Lirodendron Tulipifera) 
Ill 
1013 
Small magnolia (Magnolia Glauca) 
112 
1016 
Large Magnolia (Magnolia Grandiflora) 
113 
1018 
Persimmon (Diospyros Virginiana) 
114 
1019 
Catalpa (Bignonia Catalpa) 
115 
1021 
Wild Cherry (Cerasus Virginiana) 
116 
1022 
Virginia Snakeroot (Aristolochia Serpentaria) 
117 
1025 
LIST OF ENGRAVINGS. No. of 
Black Willow (Salix Nigra) Engraving. Page 
Thorough wort (Eupatorium Perfoliatum) p. 
Yellow Jasmine kGelsemium Sempervirens) j20 1074 
Apparatus for bathing during febrile stages of Remittent "and 
Typhoid Fevers 120 n 
Margaret Aikens and her Albino son ' '191 
Albino cliild 122 1140 
Albino negro man 115J 
Spotted negress ]24 
T u bercu lar Lep rosy i ......... "125 120." 
Atrophy of the hand in Elephantiasis Graecorum.... 126 1^09 
Anaesthetic Leprosy of the hand of a leper ...........127 1210 
EXPLANATION OF PLATES. 
XXI 
Explanation of Plates illustrating Volume 11, l^edical and Surgical Memoirs 
plate no. 1.-Leprosy in Louisiana. 
plate no. 2.-Leprosy in Louisiana. 
plate no. 3.-Leprosy in Louisiana. 
plate no. 4.-Leprosy ip Louisiana. 
PLATE no., 5. 
Figure 16. First stage of Yellow Fever. 
plate no. 6. 
Figure 17. Last stage of Yellow Fever (black vomit). 
plate no. 7.-Yellow Fever. 
Figure 18. Portion of pericardium magnified two inch objective; death sixth day 
of disease, August 5th, 1871. 
Figure 19. Blood of Yellow Fever; Wm. Droger, September 14th, 1878 (420 diam- 
eters). 
Figure 20. Appearance of Heart of E. Griffin, died of Yellow Fever, November 
2d, 1876 (reduced one-fourth). 
Figure 21. Fibres of heart of E. Griffin, died of Yellow Fever, Charity Hospital, 
November 2d, 1876, (one-fifth inch objective Becks). Fibres of heart after treat- 
ment with sulphuric ether; Yellow Fever (one-sixth inch objective.) 
plate no. 8.- Fellow Fever. 
Figure 22. Mucous membrane of stomach in Yellow Fever; Charity Hospital, 
October, 1871. 
Figure 23. Mucous membrane of stomach in Yellow Fever; Charity Hospital, 1876. 
Figure 24. Black Vomit of Yellow Fever, 1876 (450 diameters). 
Figure 25. Fungus developed in Black Vomit, 1876 (450 diameters). 
Figure 26. Fungus developed on surface of Black Vomit, 1876 (one-fifth objec- 
tive). 
Figure27. Black VomitofWm. Droger, September 11th, 1878 (one-fifth objective). 
Figure 28. Black Vomit; James Kenney, Bark Excelsior, 10th July, 1880 (one- 
fifth inch objective). 
plate no. 9.-Yellow Fever. 
Figure 29. Appearance of liver in Yellow Fever; Charity Hospital, October, 1871. 
Figure 30. Liver of Yellow Fever succeeding Malarial Fever; Edward Griffin, 
November 2d, 1876. 
Figure 31. Section of 30 magnified. 
Figure 32. Liver of Yellow Fever following Malarial Fever. 
Figure 33. Appearance of hepatic cells in Yellow Fever (one-fifth inch), 1876. 
Figure 34. Splenic mud; Edward Griffin, 1876 (420 diameters). 
plate no. 10.-Yellow Fever. 
Figure 35. Cirrhosis and Fatty Degeneration of Liver; Savannah, Georgia, 1856. 
Figure 36. Kidney, Yellow Fever (reduced one-fourth). 
Figure 37. Section of Kidney, Yellow Fever (reduced one-fourth). 
Figure 38. Granular Casts in Urine of Yellow Fever, 1870 (one-fifth objective). 
Figure 39. Granular Casts in Urine of Yellow Fever; Edward Griffin, 1876. 
Figure 40. Granular Casts in Urine of Yellow Fever of James Kenney, Bark 
Excelsior, July 10th, 1880. XXII 
EXPLANATION OF PLATES. 
plate no. 11.-Malarial Fever. 
Figure 41. Liver Malarial Fever, acute stage. 
Figure 42. Liver Malarial Fever. 
Figure 43. Liver Malarial Fever, loaded with Pigment Granules. 
Figure 44. Section of Liver, Malarial Fever, showing Pigment deposit (one inch 
objective, 1871). 
Figure 45. Liver Cells and Pigment Particles; Liver of Malarial Fever (420 
diameters, 1871). 
Figure 46. Urate of Soda and Triple Phosphate in Urine of Malarial Fever. 
plate no. 12.-Malarial Fever. 
Figure 47. Section of Spleen in Pyaemia, C- S. A., 1864. 
Figure 48. Spleen in Malarial Fever (reduced one-fourth). 
Figure 49. Splenic Mud, Malarial Spleen, October, 1871. 
Figure 50. Splenic Mud, Pernicious Malarial Fever (420 diameters). 
plate no. 13.-Malarial Haematuria. 
Figure 51. Appearance of Drops of Blood on Bibulous Paper, Malarial Haema- 
turia (420 diameters). 
Figure 52. Blood of Malarial Haematuria (420 diameters). 
Figure 53. Casts in Urine of Malarial Haematuria (420 diameters). 
Figure 54. Casts in Urine of Malarial Haematuria. 
Figure 55. Section of Kidneys, Malarial Haematuria (reduced one-fourth). 
Figure 56. Extremity of Pyramid of Kidney, Malarial Haematuria (one inch 
objective). 
plate no. 14.-Microscopical Objects in Yellow Fever Blood. 
Figure 57. Appearance of Putrid Blood of D. W. Droger, September 28th, 1878 
(magnified 420 diameters). 
Figure 58. Putrid Yellow Fever Blood, 1882 (450 diameters). 
Figure 59. Yellow Fever Blood, 1878, mixed with water (420 diameters). 
Figure 60. Yellow Fever Blood mixed with sugar, 1868 (420 diameters). 
Figure 61. Yellow Fever Blood mixed with lime-water, 1878 (420 diameters). 
Figure 62. Putrid Blood of Yellow Fever, 1878 (420 diameters). 
Figure 63. Putrid Bile. Yellow Fever, 1878 (420 diameters). 
Figure 64. Putrid Liver, Yellow Fever, 1878 (450 diameters). 
Figure 65. Fungus developed in Black Vomit of Yellow Fever, 1873; similar fun- 
gus observed in Black Vomit, 1870, 1871, 1872, 1873, 1874, 1875, 1876, 1877, 1878, 
1879, 1880 and 1882 (450 diameters). 
plate no. 15.-Microscopical objects in Air during Yellow Fever Epidemic, New 
Orleans, 1878. 
Figure 66. Microscopical objects in Urine of Miss Claudia Harrison, 363 Magazine 
street, August 10th, 1878 (420 diameters). 
Figure 67. Microscopical objects in air passed through ice in room of Joseph Oli- 
ver, 363 Magazine street, August, 1878 (520 diameters). 
Figure 68. Crystalline bodies and Sporules from evaporated .water in room of 
Joseph Oliver, August, 1878 (520 diameters). 
Figure 69. Microscopical objects in air of room of Miss Rhodes, 363 Magazine 
street, August, 1878 (520 diameters). 
Figure 70. Microscopical objects from air of room of E. Vonderburg, 363 Magazine 
street (520 diameters). 
Figure 71. Crystalline bodies from evaporated water, from room of Miss Rhodes, 
363 Magazine street (520 diameters). 
plate no. 16.-Microscopical objects in the air during the Yellow Fever epi- 
demic, New Orleans, 1878. 
Figure 72. Microscopical objects in air of Yellow Fever room, 495 St. Charles 
street, 1878 (420 diameters, one-fifth inch Beck). 
Figure 73. Microscopical objects in air of Yellow Fever room, 44 S. Villere street 
1878 (one-fifth inch, Beck). 
Figure 74. Microscopical objects in air of Yellow Fever room, 44 S. Villere street 
New Orleans, 1878 (one-fifth inch, Beck). 
Figure 75. Microscopical objects in air of yard, 47 S. Villere street, 1878 (one-fifth 
inch, Beck). PLATE 1. 
LEPROSY IN LOUISIANA. 
' FI®-- 1. 
NUMA KERN. 
FIG- S. 
DONACIEN OURBLANC 
Fia. 2. 
NUMA KERN. 
ZFIG- 
donacien ourblanc. PLATE 2. 
LEPROSY IN LOUISIANA. 
Fia. 5. 
NUMA KERN. 
e. 
DONACIEN OURBLANC. 
FI&. 7. 
FATHER BOGLIOLL PLATE 3. 
LEPROSY IN LOUISIANA. 
ROSETTA FRANCISCO 
JF!©-. e. 
E'lQ-. 3. 
FEMALE AFFLICTED WITH LEPROSY IN NEW ORLEANS. 
no. io. 
FI&. 11. PLATE 4. 
LEPROSY IN LOUISIANA. 
FIG-. 12. 
^ZO-. 13. 
WILHELMENA BOYENS. 
FZG. i-i. 
FI®. 15- 
GLENDENA BO YENS. Figure 
Yellow Fever. 
PI<ATE 5 
f'^rst Stage SSt^nic Fm7/i  
J,(/st. Stage : TtaemarrTiage y. Bigj£ Voyat 
Yellow Fever. 
jt juxTkA jt-h <u> PLATE 7 
Yellow Jever. 
•Fig./#.- 
W^OivyerSepiJfrtW.i 
42O.7)urmeters. 
Fig. 7F: Rrum-duim 
magnrfied 2f7uft ofyeOur 
DcaFt ^■elayofiiisca.fe 
AuguftS& M7f. 
Fi/ -(/■. ippea/wuK aflSeart 
'f F6tyffiHyFrrtofYel/en'ftree 
Aer. 
Tcdiiead Pi 
Fibres cfJlear t 
after- treatment 
with st/1ah arte 
Ft her IrllawFci tr 
*S for* objectUf. 
Med i/Ycltowfeier 
Charly*indt objective Xecfa- 
~«tw omeniis uric? io uiiioh sr 
FromNature t»y JOSEPH JONES, M.D. PLATE a 
Yell oav Fever. 
Fig. 22 'Mucus utcuiiuvne 
fFFforiMc/i inFe/lcruFiver 
iFu/itf' gef/877 
Fig. 2FMucus mcmAnoi& 
ofSfvmach. mye/ionFeicr 
77itt/'i7>' Z2ispfi<'7 /876~. 
7S7& 75O (iTawetTr? 
Fig. 26'Fungus dcrciuped 
uu .w/fusc iFBfuck Tirwii 
7876- *5 ohjerfti'e. 
7 / 0 Z.j- j7 'Jiywj> dci-eteped 
fa fl fa efl Vomit M76 tso^mut'rt 
4s06jert>j'e 
Eli/. Z8Bftitk Vt/tnif. itw/vnni? -.Bark E.rrrlw 
-s i/i<7i tri/rF/rc 
Txt NEW ORLEANS LfTH.C® 10 UNION ST. 
FromXatore by JOSEPH JOBTES, M D. PJLATK S3 
Yellow Fevei*. 
FigE&Appeamnce of Fiver in fellow Fever 
CharityHospital October 7877. 
Ftg.3(7Fivercf^llowFever Succeecling.3ifafarialFever. 
Edwvrt ^rifFin Fov 2 "S/S76' 
Fig. SZFivnr of 1clion Fever 
f/Zowiltg MalAricclFc ver. 
fiff. 37■ ' Section of3o J/ar/mfied 
Fig. 33 Appearance of 'Hepatic cells 
infillowFever if tncF 7376' 
Fig.3f: Splenic-Mud HFwarcl Griffin 
78777 fio .Diameters. 
ORLEANS UTH-C° IO UNION ST 
TVamKature by JOSEPH JOKES, ftfj JELATK W 
bellow Fever. 
'Cirrkosts^-Jri^ty de&enrnifum. ofLimr 
Saw/mak Georgia. /£j6. 
Fl/.. 'Kulnev, Yellow/Iver 
reduced 4 
Fay 37 ■ Section afTiadney 
Yellow Fever, reduced 
yTvmtlar Caste i/t . 
KneoflYUoH lever' 
7%70- >s ai/oUrc Z3 
Fw -Fd ' I 
dranuloj" Casts in Urine ofYellowrever 
of James Knne) .Bark Excelsior,July 70 - '/Mo. 
3^7. SSt 'Fnmuistr Casts tn Frine of 
YellowFre/'FSdwaril Griffin 7376. 
I»NBW ORLEANS LITH.C? 10 UNION ST. 
From Nature by JOSEP H J ONES, M.B. FILAT® Al 
Afalarial Fever 
41 ■' LiterjUalarinl J^rer-Aculc Slope 
loadedpigment grannie? 
FigiZ: 
Lill'tAlda/vo/ Freer 
Fiy-'t'd . „ 
Section of/.n > ■/ Jfuiai mifri-e> • 
skoH irirf fhiintt'nl dr twit . 
/inck pbjectire /d7> 
fig 'm-Liver cells jwiicles 
Liver ofifalarial fever, diameters 747i 
Fig^-iTrnde ofSodn ^J-tpir pitnepkair 
m timie af Maiarm.i Few: 
iNEW ORLEANS UTH-C? 10 UNION ST. 
From Nature by JOSFJP.H JO^xhS. M .D 1'I.JkTE 1 2 
Xfalanal Fewr 
tfSpfeen tn piwntut FS^AdBSi^ 
ltq.-+X:Sf>fcrH tn Aidcrtal ftw -'-cr^ t 
Fuf. 49 - 
Sp/mc mud J&foniti Splem r^t.^7/ 
ftq- 30- 
Sp&n/r mud Ptrttteitms J^tcr 
Wi wr V^txr»r by JOdLPE JO^E^* 
"*• ** J*X**S URLC* I • U«t M ST .Malarial Haematuria. 
PLATE 1 3 
Fd/- dlcdppeanance of drops ofidood on 
bilndmts paperjfalarial Eaemaiurdl. 720 dictrtt cfpi'S' 
fig. a 2 ■' Stood of Malarial /farmohuie 
4ZO dux.7n.ctew 
S3 fads in I fins of Malarial 
irOjn/ltl/ltrULtrZOiliamcfers'. 
Fig..54: 
Casts in Urine of 
Malaria?flae/naturia 
' .Fig-55: 
Section, ofFuinej' 
Malarial Baetnabmo 
redijuxa 
ORLEANS LITKC? IO UNION ST. 
Sig. Sdfrjremity of pyramid of Sidney 
Malar tattiSdematuna-d indi objective 
From.Nature by JOSEPH JONES, M.D PLATE 8 % 
Microscopical objects in'YellowFever blood . 
Fig- S7-'d-ppearanre of putrid blood 
dlil/V-Hwyer, ,Scpt.2<S^ /X7S. 7UilffHfficd.42O<tiVmrferw. 
Fig.-58PubtdYlloyv Fever blood, 7882 
4-50 diameters 
Fig-39 bellow Fever blood 1878 
mixed With WettCtbZOrUaonxtenr. 
Fig. 67 ■' YellrwFever blood mixed 
With lime water7878Fio ammeters 
Fig- GO.YdloyvFever blood, mired with 
sugar, 7868. -72-0 diameters. 
fig-62:Putrid. blood afYel7owFever,7878 
U2O diameters. 
Fig. 63-'IidndFileYellowFever,7d7S tezodiameteTs. 
Fig. GizPuttid diverYeUaw Fey my Id/# 
^50 tifampters' 
Fig- GSFtmgUS',developed m blade vomit ofYllowFever. 
>873,stnnlarfiuigtts' observed i/t blade vomit 7670,77,2^,9, 
•7/63,30andA2. 930dltundbrs. 
>1"i* ORlUNS UTH.C5 IOUHIONST. 
From Nature by JOSEPH JOKES. M 1> PIRATE 1 o 
Microscopical objects inair dining theYellow Fever epidemic 
New Orleans, 1878. 
.Fig- 66'dFcms(jo^icaf ofyccts m Urine 
ofAfissClaudzaHftrrts'smi^tS3Maff<izmrSt. 
Aufl./ce M/S. 120 riiatiicteis. 
Fuf.F7Jdicroscopical object# tn air passed 
tkrouffb ice th mom. of Joseph tFu'erJ63 
hhigazine St. August IS73- 520 diameters. 
FigdidCrysfaibme bodies and spomter from 
evirpara&d water in mna. of Joseph Olii'cr,Jraf 
/S78. .7ZO 
Fid G(?-Jfirmsa>pical object# in. air of room of 
JltssJfhodcs FfHJdaffciztheSt. Jupust /S7S 
320 diameters 
JFia. 70'Jficrvscapicalobjects from. arc ofmm 
ofJf. .Vdnc&ricn?,3633/a(/azi7ieSt320c(oi7n€tfKS' 
Fur. 7r:<'n.rta7fmr Irv7irsfmw cittporo/rrl uv7cr 
from room (ifJ/f.sxl77o>r7rA\3633ft</ttzmr''7- 
SZOdtametens. 
*«HW ORLEANS LITH.C® IO UNION ST. 
From Nature by JOSEPH JONES, M.D. PLATE MS 
Microscopical objects in air during tlieTellow Fever epidemic 
New Orleans, 1878 . 
7'io 72 '77tcmsco7>tcat ofrects- in air of 
filo w Fever fooniSfff^^ St. 
7S 7S. 720 diameters. si inc/r- Bectss 
73 jfcmsawiazi objects- in air of 
ieUnwiever 77oo?n.4iSoutit VrfereStMO. 
7S7S. Si mc/t Bed:. 
ff-77:3jicrosan,tcai objects- in air of 
irfoiv Fever Koran.-M South VfUereStJWy. 
7S7S "s indiSech. 
Jfj 7f'J/tonKcopwa7 objects- in air of 
yard -77South TfZ7ereSt7S7S ft mrt&rk 
°W**SUTH.C»IOU«IONST. 
FromNatnre by JOSEPH JONES, M.D INVESTIGATIONS AND RESEARCHES 
ON THE 
ORIGIN, CAUSES, EFFECTS, TREATMENT, PREVENTION 
• AND ARREST 
OF 
ENDEMIC, EPIDEMIC, INFECTIOUS 
AND 
CONTAGIOUS DISEASES. RESEARCHES 
-ON- 
THE-ORIGIN AND EFFECTS OF ENDEMIC, EPIDEMIC, 
INFECTIOUS AND CONTAGIOUS DISEASES. 
INVESTIGATIONS 
- ON- 
The Nature, Causes, Relations and Treatment 
-OF- 
MALA RIAL 
(PAROXYSMAL) 
FEVER. CHAPTER I. 
INVESTIGATIONS ON ENDEMIC, EPIDEMIC, INFECTIOUS AND CONTAGIOUS UTS 
EASES. AND ON THE NATURE, CAUSES, RELATIONS AND TREATMENT OF 
MALARIAL PAROXYSMAL FEVERS: MODE OF INVESTIGATING THE ORIGIN 
ofvExVai^^ CLASSIFICATION OF THE VARIOUS FORMS 
ur oi-AijAi'iifii j riLv 
„ .Facts relating to the History of the Investigation. Mode of Investigating Malaria. Climate 
Soil. A apations in the Composition of the Atmosphere. Relations of the Soil, Waters Atmos- 
phere and Climate to the origin and spread of Malarial Fevers. Relations of Micro-organisms to 
Q1S63S6. 
The action and relations of various Febrile Poisons. Method of determining the relations 
of various Febrile Poisons. Classification of the various forms of Malarial Fever. Comuli- 
catmns of Malarial Fever by the lesions of various organs which arise during the progress of 
me disease. 
TbAhe division of the forms of Malarial Fever into Intermittent and Remittent imperfect 
The complications of Malarial Fever, and its relations to other diseases illustrated by the exne- 
"e??e .of,.author in the Charity Hospital of New Orleans, Louisiana, 1869-1886. Classification 
^dbpef description of the varieties of Pernicious, Malignant and Congestive Malarial Parox- 
gr^honlt"' Classifications of Senac, Torti, Alibert and other writers. Divisions of the Mono- 
FACTS RELATING TO THE HISTORY OF THE INVESTIGATIONS RELATIVE TO 
MALARIA AND MALARIAL FEVER, AND TO ENDEMIC, EPIDEMIC, INFEC- 
TIOUS AND CONTAGIOUS DISEASES. 
The investigations of the author on malarial and other fevers were 
commenced in Savannah, Georgia, in the year 1856, and have been con- 
ducted in various parts of the Southern States up to the present time 
when this work is being prepared for the printer, July 14th, 1886. 
The Marine Hospital of Savannah, Georgia, formed an interesting and 
important field of study during the years 1856 and 1857. The diseases of 
this city, as well as those of Athens, Georgia, and Augusta, Georgia, were 
carefully investigated, and an extended series of observations and chem- 
ical and microscopical researches instituted upon the climate, soil, waters 
and diseases of rice, sugar and cotton plantations from the beginning of 
the year 1856 to the time of the breaking out of the American Civil War 
m 1861. 
fihe essential facts relative to the efforts of the author to investigate 
the diseases of the Confederate troops, in the camp, in the field, on the 
battle field, in the fortress, in the prison and in the Field and General 
Hospitals, have been recorded in the first volume of these Medical and 
Surgical Memoirs, Preface, pp. vi, vii and viii. Some of the results of 
these labors, relating chiefly to diseases of the nervous system, circulatory, 
respiratory and osseous systems, have been recorded in the first volume of 
the Medical and Surgical Memoirs. 
After the civil war, during the years 1866, 1867 and 1868, investiga- 
tions were continued in Augusta, Georgia, and Nashville, Tennessee. In 
the latter place, the position of Health Officer afforded the author superior 6 
History of Investigations by Joseph Jones, M. D. 
advantages for the development and application of sanitary measures; 
and the field of observation and responsibility was vastly increased by his 
discharge of the duties of President of the Board of Health of the State 
of Louisiana during a period of four years-April, 1880, to April,'1884. 
The latter period embraced labors of the most arduous, responsible 
and onerous character. The four years of active service in the Confederate 
army appeared light and pleasant, in comparison to the four years spent in 
the service of Louisiana as the chief executive of her health department; 
and during the four years' struggle to maintain and defend the quarantine 
laws of Louisiana, and exclude foreign pestilence from the valley of the 
Mississippi on the one hand, and on the other, to protect the sacred rights 
of the State and the honor and standing of the medical profession against 
domestic and so-called national emissaries, it was necessary to meet, 
expose and overthrow a more numerous spawn of domestic spies and slan- 
derers than could have been evolved by a state of actual warfare. During 
this period-1880-1884-as well as the period of the American Civil War, 
the following subjects demanded careful investigation: 
QUESTIONS RELATING TO PUBLIC AND INTERNATIONAL HYGIENE 
I. Quarantine. 
(a.) History of quarantine. 
(b.) Conductof quarantine stations. 
(c.) Sanitation of ships. 
(d.) Sanitation of quarantine ports. 
(e.) Regulation and control, by sea and land, of such diseases as 
yellow fever, Asiatic cholera, Oriental plague, Oriental leprosy, 
typhus and typhoid fevers, small-pox, scarlatina and measles. 
(f.) The relations of the duration of quarantine, as determined by 
the natural history of various diseases, or more especially by 
the period of incubation of their specific poisons. 
(g.) Value of heat (dry heat and heated steam) and steam, in the 
disinfection and cleansing of infected vessels. 
(h.) Relative value of sulphurous acid and other agents, as carbolic 
acid, sulphate of iron and bichloride of mercury. 
(i.) Describe the apparatus for the application of disinfectants. 
(j.) Quarantine should embrace, not merely detention, but also 
thorough cleansing and disinfection; and when necessary, the 
cargo should be discharged, thoroughly aired and fumigated. 
(k.) Structure and conduct of quarantine hospitals. 
(1.) Land quarantine; its objects, value and mode of conduction. 
(m.) The proper structure, ventilation and conduct of railroads so 
as to prevent the dissemination of contagious and infectious 
diseases. 
(n.) Shall the General Governments of the civilized World assume 
control of all the quarantine systems, and by mutual consent 
reduce the entire subject of quarantine to order, and apply 
the most improved methods of sanitation and disinfection? 
(o.) Shall the Government of the United States assume charge of the 
entire subject of quarantine, within her borders, and relieve 
the individual States of all further responsibility of regula- 
ting not merely foreign, but also interstate quarantine ? Questions Relating to Public and International Hygiene. 
7 
QUESTIONS RELATIVE TO INTERNATIONAL QUARANTINE. 
The object in propounding Questions N and O, is for the purpose of 
bringing about a grand union of action on the part of all civilized nations, 
on the subject of quarantine, so as to advance the cause of medical science 
and humanity. As matters now stand, commerce is made to bear the 
brunt of quarantine. The unfortunate ship stricken by pestilence, suffers 
delay, and in some cases immense expense. The unfortunate crew and 
passengers, who have committed no crime, are treated like outcasts and 
outlaws-they appear to have no rights which humanity is supposed to 
respect. 
Commerce bears in its bosom the germs of civilization; commerce 
establishes and sustains the markets of the world; commerce is the agent 
for the dissemination of all that is grand and noble in the life and develop- 
ment of our common humanity: and the brave and hardy sons of commerce 
have, in all ages and in all times, rallied to the defense of their native 
lands. 
Is it just, is it right that the pestilence stricken ship should bear all 
her expenses, and suffer all that the safety of man may demand, and that 
avarice and cowardice may suggest? Has not civilization advanced to 
that stage, and are not the great civilized and Christian powers of the 
world (the United States of America, the British Empire. France, Ger- 
many, Austria, Russia, Denmark, Norway, Sweden, Italy, Spain and Por- 
tugal), sufficiently strong, wealthy and enlightened, to establish a uniform 
system of quarantine, which shall embrace : 
1st. A system of mutual confidence: a uniform system of registration 
of diseases and deaths. 
2d. A system of regular health reports, giving detailed statements at 
regular intervals, daily, weekly, monthly and annually, of all matters 
relating to the public health-to the sanitary welfare of nations. 
By the use of the telegraph all civilized nations could be kept informed 
of the appearance, spread and arrest of any contagious or infectious dis- 
ease, as small-pox, cholera and yellow fever. 
3d. A uniform system of quarantine adapted to the climate, latitude 
and endemic and epidemic diseases of each nation. By a uniform system, 
we mean uniformity in the construction of quarantines and their adminis- 
tration, and the uniform assumption by the great Powers of the world of 
all quarantine expenses of cleansing, discharge of cargo, disinfection and 
fumigation, and of the care and treatment of the sick. The only expense 
necessarily borne by the pestilence stricken ship, or suspected ship, detained 
in quarantine, would be the loss of time, and the necessary expense for 
food, etc., of the crew and passengers. 
As quarantine is now conducted, the owners of ships, as well as their 
passengers and crew, suffer often unequally and unjustly for the public 
good. 
The two questions are complementary, the one to the other; O Hows 
necessarily from N; to be of any practical value, the discussion of N must 
precede that of O; N cannot be construed as relating to any government 
but the United States of America and its individual States, and does not 
refer to foreign States, only so far as that the United States may become 
one of the contracting parties under proposition N. 
The high purpose of this discussion is clear-it is designed for the 
benefit of all civilized nations; it is designed to lead ultimately to the 
establishment of uniform National and International Quarantine Laws, Quar- 
antine Methods, and Quarantine Administration and Charges. 8 
Questions Relating to Public and International Hygiene. 
II. Military Hygiene. 
(a.-) Food of the soldier. 
(b.) Clothing of the soldier. 
(c.) Exercise and rest: effect of infantry, cavalry, artillery and bicy- 
cle exercise upon the soldier. 
(d.) Shelter, structure of tents. 
(e.) Water supply of armies: method of testing and improving. 
(f. ) Military prisoners and military prisons. 
(g.) The establishment of uniform rules, to be recognized by all civil- 
ized nations for the treatment, food and clothing of military 
prisoners, and for the regular and continuous exchange of all 
military prisoners. 
(h.) Hygienic arrangements of Field and General Hospitals. 
III. Naval Hygiene. 
IV. Structure, arrangement of Prisons And treatment of 
Prisoners. 
(a.) Treatment of prisoners: food, clothing and occupation. 
(b.) Has the State the right to work prisoners in swamps and marshes, 
and to cause the destruction of human life by the neglect ot 
all the laws of hygiene? 
(c.) Are not deaths occasioned amongst prisoners by cruelty, over 
work, scant clothing, poor food, directly chargeable against 
the officials composing the government, whether acting in 
behalf of a city, county, State or Government ? 
V. Structure, Hygienic arrangement and Ventilation of 
Buildings. 
(a.) Proper condition of the soil for the location of buildings. 
(b.) Relations of building materials to moisture and fire. 
(c.) Public buildings-legislative halls, depots, churches, etc. 
(d.) School houses and colleges. 
(e.) Factories. 
(f.) Dwellings. 
VI. Influence of Agriculture on Public Health. 
(a.) Influence of overflows on the public health. 
(b.) Importance of drainage: drainage of swamps, marshes, and land 
generally. 
(c.) Influence of the cultivation of rice on the public health. 
(d.) Influence of cotton, tobacco, sugar and indigo cultures on the 
public health. 
VII. Food and its Adulterations. 
(a.) Influence of different methods of preserving food on the public 
health. 
(b.) Influence of canned food upon the public health. 
(c.) The injurious effects of lead, copper, tin, zinc and antimony upon 
food; said metals being used for culinary vessels, dishes and 
receptacles. 
VIII. Relations of Water to the Public Health. 
(a.) Properties of wholesome, potable water. 
(b.) Water supply of cities. 
(c.) Proper supply of water to each inhabitant. 
(d.) Transmission of disease germs through the medium of water. Questions Relating to Public and International Hygiene. 
9 
IX. The Influence of Alcohol on the Public Health. 
(a.) Wine. 
(b.) Malt liquors. 
(c.) Distilled liquors. 
X. Influence of Narcotics upon the Public Health. 
(a.) Tobacco. 
(b.) Canahis India, etc. 
(c.) Opium and its preparations. 
(d.) Chloral Hydrate-Chloroform and ether. 
XI. Influence of the Electric Light and of the various forms 
of Coal Gas upon Public Health. 
XII. Influence of the Modern mode of Travel on the Public 
Health. 
(a.) Effects of railroad travel in inducing paralysis. 
(b.) Hygienic structure and conduct of railroad trains, so as to avoid 
the introduction and dissemination of infectious and conta- 
gious diseases. 
(c.) Structure and arrangement of sailing and steaming ships. 
(d.) Hygienic regulations of officers, crew and passengers. 
XIII. Relation of Filth to Public Health. 
(a.) Relative merit of the various plans of sewerage and of the dis- 
posal of garbage and foecal matter. 
(b.) Organization of the scavenger force. 
(c.) Best method of disposing of the dead. 
(d.) Effects of putrefaction in the dissemination of the disease germs 
of contagious and infectious diseases, such as cholera, yellow 
fever, small-pox, measles, scarlet fever, etc. 
(e.) Cremation. 
XIV. Relation of Disease geems to the origin and spread of 
Contagious and Infectious Diseases, and to Endemic and 
Epidemic Diseases. 
(a.) Relations of malaria to the public health. 
(b.) Nature of the malarial poison. 
(c.) Physical, chemical and microscopical characters of the poison 
or cause of the following diseases: 
Yellow fever. 
Typhoid fever. 
Typhus fever. 
Measles. 
Relapsing fever. 
Scarlatina. 
Syphilis. 
Phthisis. 
Oriental leprosy. 
Elephantiasis. 
Small-pox. 
(d.) Relations of phthisis to the public health. 
(e.) Relations of syphilis to the public health. 
(f.) Measures for the arrest of small-pox. 
(g.) Value of cow-pox vaccination. 10 
Public Health and Hygiene. 
(h.) Accidents attending vaccination; transmission of the syphilitic 
virus through the medium of the vaccine virus. 
(i.) Value of vaccination with yellow fever virus or microbes in 
modifying the disease. 
(j.) Value of vaccination against hydrophobia, charbon, Asiatic 
cholera and other diseases. 
XV. Effects of Trades and Manufactures on the Public 
Health . 
(a.) Relative effects of agriculture and of trades upon the longevity 
and health of the people. 
(b.) Detailed statement of the effects of various trades on the health. 
(c.) Effects of the introduction of machinery upon the longevity and 
health of the people. 
(d.) Effects of manufactures upon the atmosphere and waters of vil- 
lages, towns and cities. 
(e.) Effects of various manufactures upon the public health. 
PUBLIC HEALTH AND HYGIENE. 
The preceding questions demand careful consideration and investiga- 
tion at the hands of the physicians and hygienists of all nations, and the 
cause of humanity will be advanced by their solution, and by the adoption 
of uniform methods for the control and removal of all preventable sources 
of disease. 
Many of the results of theie inquiries will be recorded in this and sub- 
sequent volumes of the Medical and Surgical Memoirs. 
The sanitary and medical labors relating to quarantine and the exclu- 
sion of foreign pestilence and the prevention and arrest of contagious and 
infectious diseases, will be fully discussed in the third volume of these 
Medical and Surgical Memoirs, and we dismiss this subject for the present, 
with the statement that yellow fever was effectually excluded from the 
valley of the Mississippi during my term of service as President of the 
Board of Health of the State of Louisiana, 1880-1884, and the methods 
of quarantine, discharge of cargo, fumigation, disinfection and maritime 
sanitation practised during that period were in accordance with the most 
advanced teachings of science, and were fully adequate to the protection 
of New Orleans, Louisiana, and the Valley of the Mississippi from the 
introduction of yellow fever by the way of the mouths of the Mississippi 
river. 
The Charity Hospital of New Orleans has furnished a most valuable 
and extensive field for the study of disease, and especially for the investi- 
gation of the various forms of malarial fever. From the 1st of January, 
1869, to the 1st of April, 1886, I have treated within the walls of this 
institution 6311 cases of disease, of which 668 (10 5 per cent.) terminated 
fatally; and of this number the various forms of malarial fever caused 
2885 cases, of which 88 (3.05 per cent.) terminated fatally. In accordance 
with my health, time and strength, I have endeavored by clinical studies, 
by post-mortem examinations, and by microscopical, chemical and patho- 
logical investigations, to utilize this vast mass of material. Results of Hospital Practice of Joseph Jones, M. D. 
11 
PRACTICAL RESULTS OF HOSPITAL SERVICE, BY JOSEPH JONES, M. D., OF 
NEW ORLEANS, LA., 1869-1886. 
The following tables will present the general results of the treatment, 
by the author, of six thousand three hundred and eleven cases of disease in 
the Charity Hospital of New Orleans: 
TABULAR STATEMENT OF CASES AND DEATHS AND PERCENTAGE AND RATIO OF 
MORTALITY DURING THE VARIOUS PERIODS SPECIFIED IN THE MEDICAL SER- 
VICE OF JOSEPH JONES, M. D., IN THE CHAftITY HOSPITAL OF NEW ORLEANS, 
LOUISIANA. 
Periods of Time Embraced in Medical Service in the Charity 
Total 
Cases 
Treated. 
Total 
Deaths. | 
Per Cent, 
of 
Deaths. 
Ratio 
of 
Deaths 
in 
1000 
Cases. 
One 
Death 
in so 
many 
Cases. 
Hospital of New Orleans. 
Jan. 
1, 1869 to April 1, 1870, 15 months 
Oct. 
1,1870 " 1871, 6 " 
' 1871 " 1872, 6 " 
Total, 27 months 
1111 
106 
9.5 
95. 
10.48 
Oct. 
1, 1872 to April 1, 1873, 6 months 
213 
39. 
18.3 
183. 
5.46 
1 4 
1873 " 1874, 6 " 
51 
9.8 
98. 
10 13 
LI 
1874 " 1875,6 " 
44 
1875 " 1876,' 6 " 
Total, 12 months 
757 
65. 
8.5 
85. 
11.60 
Oct. 
1, 1876 to April 1, 1877, 6 months 
437 
43. 
9.8 
98. 
10.16 
4 4 
1877 " 1878, 6 " 
510 
58- 
11.3 
113. 
8.79 
4 4 
1878 " 1879' 6 " 
283 
32. 
11.3 
113. 
8.87 
44 
1879 " 1880,'6 " 
262 
29. 
11 08 
110. 
9.03 
4 4 
1880 " 1881' 6 " 
4 I 
1881 " 1882,' 6 " 
Total, 12 months 
516 
10.8 
108. 
9.21 
Oct. 
1, 1882 to April 1, 1883, 6 months 
43. 
11.5 
115. 
8.67 
4 4 
' 1883 " " ' 1884, 6 " 
462 
55. 
11.9 
119. 
7.96 
4 4 
1884 " 1885,' 6 " 
63. 
11.5 
115. 
8.36 
4 4 
18S5 " 1886^ 6 " ■ 
323 
28. 
8.6 
86. 
11.53 
Total 
6311 
668 
10.5 
105. 
9.44 
GENERAL SUMMARY. 
Cases. 
Deaths. 
General diseases 
... 4034 
276 
Diseases of the nervous system 
... 442 
59 
" " heart and blood-vessels 
... 91 
36 
" " absorbent system 
3 
1 
" " respiratory system 
... 493 
82 
" " alimentary canal 
... 709 
123 
" " liver 
.... 85 
38 
" " spleen 
4 
1 
" " kidneys 
... 88 
26 
" " bladder and male organs 
... 70 
1 
" " female organs of generation 
... 20 
organs of locomotion 
.... 
... 15 
cutaneous system 
... 15 
1 
" " eye, nose and ear 
... 25 
Injuries, ulcers and wounds 
... 96 
8 
Poisons 
... 21 
2 
Conditions not necessarily associated with local or 
general diseases.. 
.... 89 
14 
Parasites 
... 11 
Total 
... 6311 
668 
Per cent, of deaths from all causes, 10.5. 
Ratio of deaths per 1000 cases, 105. 
One death in 9.44 cases. 12 
Pernicious Malarial Fever. 
Practical conclusions of value may be obtained by a general review of 
the results of medical service extending over a series of years. The nature 
of such conclusions and their relations to the practice of medicine must 
evidently depend, not merely upon the number of the observations, but 
also upon the mode in which they were recorded. 
I have served in the Charity Hospital of New Orleans, Louisiana, from 
January 1, 1869, to April 1, 1870, and since that time, to April 1,1886, six 
months of each year, from the 1st of October to the 1st of April; and during 
this period, extending over eighteen years, I have kept a careful record of 
the names, ages, and nativity of patients-diagnosis, prognosis, and the 
final results of the cases treated by me in the wards of the hospital. Dur- 
ing this period the total number of cases under my immediate care was 
6311, of which 668, or 10.5 per cent, terminated fatally. 
The following consolidated records will, we hope, prove of permanent 
value for comparison, and for the illustration of the nature and mortality of 
the prevalent diseases of the delta of the Mississippi. 
GENERAL DISEASES. 
Cases. 
Deaths. 
Intermittent fevers, including quotidian, tertian and quartan 2327 
5 
Remittent malarial fever 247 
Pernicious congestive malarial fever, including the comatose, algid and 
other varieties (a large proportion of the cases were brought into 
7 
the hospital in a moribund condition) 87 
Chronic malarial poisoning (malarial toxaemia cachexia), with various 
complications, as enlarged liver and spleen, contracted liver and 
hardened spleen, anaemia anasarca 212 
56 
14 
Malarial haematuria 12 
6 
Total malarial, endemic, non-contagious fevers 2885 
Per cent, of deaths in various forms of malarial fever, 3.05. 
Ratio of deaths in 1000 cases of the various forms of malarial fever, 30.5. 
One death in 32.8 cases of the various forms of malarial fever. 
88 
Malarial. Paroxysmal, Endemic, Non-Contagious Fevers. 
PERNICIOUS MALARIAL FEVER. 
Cases of Pernicious {Congestive} Malarial Fever frequently brought into the 
Charity Hospital of New Orleans in a Moribund and Insensible Condition. 
During a period of 27 months of hospital service, extending at various 
intervals, as previously indicated, from January 1st, 1869, to April 1st, 
1872, fifteen cases of congestive or pernicious malarial fever were brought 
into the wards under the care of the author in an insensible condition : ten 
of these cases appeared to be in a state of hopeless insensibility. The most 
energetic measures, as purgatives, sinapisms, blisters, quinine and stimu- 
lants, failed to arouse them from profound and fatal coma, and they died in 
from 8 to 48 hours. In the 10 fatal cases counter irritants, quinine and 
stimulants appeared to prolong life, and thus 5 cases which recovered out 
of the 15 cases were preserved from death by these measures and remedies. 
During the same period, of 19 cases of chronic malarial poisoning (malarial 
cachexia), 2 terminated fatally, and post-mortem examination revealed the 
presence of cirrhosis of the liver induced by the action of the malarial poi- 
son in virtue of its power to produce repeated congestions of the liver, and 
to induce alterations in the amount and composition of the blood and bile. 
The 19 cases of chronic malarial poisoning entered the hospital in a 
most enfeebled condition, with pale anaemic countenances, feeble rapid 
action of the heart; nervous and muscular prostration; enlargement of Sun Stroke and Congestive Fever. 
13 
spleen and liver, chronic interstitial hepatitis : jaundice watery condition 
of the blood, and general anasarca. 
The treatment adopted in such cases, consisted in the regulation of the 
bowels and the functions of the liver by purgation ; the arrest of the par- 
oxysms by quinine and arsenic, and the improvement of the blood by the 
preparations of iron and nutritious diet. Of the 19 cases, 17 were discharged 
cured, or greatly relieved. 
Two cases of sun stroke occurred during this period, and were brought 
into the hospital with high temperature, marked capillary congestion, and 
nervous and muscular prostration. One of these cases terminated fatally 
within twenty four hours after entering the hospital; the other case 
recovered. 
In one case of "szm stroke" which occurred during the month of July, 
1878, in which the temperature was noted, it was found to be 112° F , in 
the axilla at the time of death. 
The phenomena characteristic of thermic fever {sun stroke') appear to 
be dependent, in a large measure, upon the complex and unstable composi- 
tion of the blood. Like all complex and highly elaborated organic fluids, 
which are continually supplied with oxygen, the blood can maintain a 
definite physical and chemical constitution, only within certain degrees of 
temperature. Unless a definite physical and chemical constitution of the 
blood be maintained, the necessary nutritive elements will not be supplied 
to the organs and tissues, and alterations in the secretions and aberrations 
of the muscular and nervous forces will result. When the temperature of 
the blood rises above a certain degree, not only is the amount of carbonic 
acid increased, and the cerebro spinal and sympathetic systems affected 
injuriously thereby, but it is also probable that a new series of chemical 
actions are developed, and compounds are generated, which act as poisons 
to the nervous system. The irritability of the heart is rapidly exhausted 
by high temperature. 
The rapid and extraordinary rise of temperature in the blood charac- 
teristic of thermic fever {heat stroke-sunstroke) should also be attended 
with disturbances in the normal electric currents in the nerves and 
muscles. 
The great increase of carbonic acid and the corresponding consump- 
tion qf oxygen and the rapid generation of urea, and of other excretory 
products, the alterations of the haemoglobin and fibrin ; and the dilatation 
of the capillaries, and the passive congestions of the internal organs, but 
more especially of the brain, spinal chord and liver, must also be regarded 
as important factors in the state known as " sun-stroked 
As far as the experience of the author extends, sun-stroke is less com- 
mon in New Orleans than in New York, Philadelphia, Cincinnati or St. 
Louis. This difference appears to be due to the more uniform tempera- 
ture, the large masses of water penetrating Louisiana in all directions, 
the prevalence of cool gulf breezes in the summer months, the wide streets, 
the construction of the habitations largely of wood, the one or two storied 
size of the dwellings, and the absence of crowding in most parts of this 
city. 
SUN STROKE. 
CONGESTIVE MALARIAL FEVER. 
During a period of six months, October 1, 1872, to April 1, 1873, 
thirteen cases of congestive or pernicious malarial fever were entered in 
wards 13, 14 and 15, of which number live cases were brought in a hope- 14 
Congestive Malarial Fever. 
less ^moribund) condition-comatose-small, rapid, almost imperceptible 
pulse ; congestion of superficial capillaries ; stimulants, counter irritants 
(sinapisms and blisters), and quinine had no appreciable effect in arous- 
ing the nervous system. 
Five cases of chronic malarial poisoning were complicated with jaun- 
dice, hepatitis, enlarged spleen, ascites and general anasarca. No deaths 
occurred amongst these cases, and after prolonged and tedious treatment 
they were cured or greatly relieved. 
Three cases of malarial fever were complicated with acute dysentery, 
attended with profuse haemorrhages from the bowels. Two of these cases 
terminated fatally. 
During the six months embraced between October 1, 1873, and April 
1, 1874, out of a total of 517 cases of disease treated, only one case of 
malarial congestive fever was recorded, and this case recovered. Twenty- 
six cases of malarial toxaemia, with four deaths, and eleven cases of general 
anasarca, caused by the prolonged action of malaria, with two deaths, were 
recorded. Intermittent fever, 211 cases, with no deaths. Remittent mala- 
rial fever, twenty cases and one death. During the same period, or rather 
during the months of October, November, December, 1873, yellow fever is 
credited with forty-five cases and nineteen deaths. 
COMPLICATIONS OF MALARIAL FEVER WITH OTHER DISEASES. 
The poison of malaria, like that of syphilis, produces a condition of 
the human system characterized by certain lesions of the blood or other 
organs upon which may be engrafted various acute affections, as pleuritis 
pneumonitis and acute articular rheumatism, diarrhoea and dysentery. 
Thus a careful analysis of the clinical record of 757 cases of diseases 
treated in the Charity Hospital, October 1st, 1874, to April 1st, 1875 ; 
October 1st, 1875, to April 1st, 1876, gives the following statistics with 
reference to uncomplicated and complicated cases of malarial fevers : 
Diseases. 
Cases. 
Deaths.- 
Intermittent fever 
286 
1 
Intermittent fever and pneumonia 
o 
Intermittent fever and dysentery 
2 
Intermittent fever and diarrhoea 
14 
2 
Intermittent fever and erysipelas 
1 
Intermittent fever and organic disease of the heart 
1 
Remittent fever 
37 
Remittent fever and diarrhoea 
1 
Remittent fever and malarial hsematuria 
1 
1 
Pernicious malarial fever 
*) 
9 
Intermittent fever and rheumatism 
Intermittent fever and epilepsy 
1 
Intermittent fever and coma 
1 
Intermittent fever and bronchitis 
Intermittent fever and anasarca..... 
1 
Intermittent fever and necrosis of humerus 
1 
Remittent fever and lead poisoning 
1 
Malarial fever 
3 
Malarial coma 
1 
1 
Congestive chill 
1 ■ 
1 
Malarial cachexia 
2 
Chronic malarial poisoning 
29 
2 
In the preceding 384 cases of malarial diseases with various complica- 
tions, 11 proved fatal; of this number uncomplicated intermittent and 
remittent fever, occasioned 323, with one death; the remaining 61 cases Complication of Malarial Fever with Other Diseases. 
15 
complicated with intercurring diseases occasioned ten deaths; the various 
complications therefore greatly increased the otherwise slight mortality of 
malarial fever. 
It is worthy of note that chronic interstitial hepatitis, terminating in 
cirrhosis of the liver, ascites and death, frequently results from the pro- 
longed action of the malarial poison, as may be illustrated by the follow- 
ing case : 
Case 807.-Cirrhosis of the Liver, caused by the prolonged action of the mala- 
rial poison:--Ascites: Abdomen tapped; two gallons and one quart of 
serous liquid drawn off; Supervention of Hospital Gangrene of walls of 
abdomen in neighborhood of the wound; Death. 
James Lewis, age 42, native of Louisiana, farmer, father of large family, tem- 
perate habits: entered ward 15, bed 197, Charity Hospital. December 8, 1882. 
Patient stated that he had resided and cultivated a farm in Pointe Coupee, Lou- 
isiana, and was attacked with severe malarial fever in the month of August, 1882, 
and has had frequent paroxysms, and has never had any relief from the fever and 
its effects, during the past few months. As the disease progressed, the patient 
discovered that bis abdomen began to swell, and he attributed this to the frequent 
doses of calomel and quinine which he had taken during the progress of his 
disease. 
Condition at the time of admission into the Charity Hospital: pale, sallow, 
pinched features; upper extremities emaciated; abdomen distended with liquid 
(rendered evident by palpation;; veins of abdomen enlarged and filled with dark 
venous blood, presenting an arborescent appearance; lower extremities oedema- 
tons; diaphragm pressed upwards by liquid accumulated in the abdomen; lungs 
compressed ; respiration difficult and greatly disturbed upon the slightest exertion. 
Heart pushed upwards, the apex beat being between the4th and 5th ribs; anaemic 
murmur heard with second sound of heart; spleen enlarged. Careful examination 
indicates that the liver is hardened and reduced in size. Urine contains some 
albumen. 
Diagnosis: Cirrhosis of liver, resulting from the action of malaria, and com- 
plicated with the results of malarial poisoning. 
Purgatives and diuretics with iron and quinine, produced some temporary 
relief, but after the full and faithful trial of these measures, for the relief of the 
ascites, it was deemed necessary to draw off the liquid by mechanical means. 
It is worthy of note that during the most favorable action of the purgatives 
and diuretics, the albumen disappeared from the urine, and its presence was 
clearly referable to the obstruction of the circulation and functions of the kidneys 
from the mechanical pressure of the liquid effused into the abdominal cavity. 
On the 25th of January, 18S3, I introduced the trochar and canula (tapped- 
paracentesis abdominalis) into the abdominal cavity, at a point midway between 
the umbilicus and the superior-spinous process of the ilium, and drew off eighteen 
pints (two gallons and one quart) of serous liquid. The patient expressed great 
relief from the evacuation of the fluid, but on the second day after the operation 
the lips of the wound became swollen, with a red erysipelatous blush in the 
adjoining abdominal surface. The inflammatory action spread rapidly ; the parts 
immediately around the area assumed a blue lurid look, the swelling increased, 
the blue line steadily advanced over the abdominal walls, leaving an ash-colored 
stinking slough in the centre. 
The pulse became rapid and feeble, and the patient died February 2, 1883. 
ELEVATED TEMPERATURE IN SOME CASES OF PERNICIOUS (CONGESTIVE) 
MALARIAL FEVER. 
It is worthy of note that many of the cases of congestive or pernicious 
malarial fever, and especially of the comatose variety, frequently mani- 
fested an elevated temperature. The following case will illustrate this 
proposition: 
Case 808.-Comatose Malarial Fever. 
Emanuel Carneno, native of Portugal, entered ward 30, bed 448, Charity Hos- 
pital, October 13, 1S74; had suffered with malarial fever for four months; pale 
anaemic sallow, dark hue ; general anasarca ; urine free from albumen. 16 
Elevated Temperature in Pernicious Malarial Fever. 
The patient appeared to be improving slowly under the action of quinine, iron 
and arsenic. On the 5th of November, 1874, the patient was seized with a severe 
chill and became comatose. There was a rapid rise of temperature, and one and a 
half hours before death, whilst the patient was in a profound coma, the tempera- 
ture of the axilla was 107.5° F. No albumen in the urine. 
Died during the night of the 5th, all measures having failed to arouse the 
patient from the comatose state. 
Post-mortem examination. Heart and lungs normal; blood deficient in blood 
corpuscles, and of low specific gravity and abounding in a thin serous fluid : gen- 
eral anasarca. 
Liver: Dark brown and slate color on the exterior, interior of a dark bronze 
hue; deposit of dark pigment and pigment cells within and around hepatic capil- 
laries. Bile thick, dark and grumous, about 1800 grains of dark bile in gall- 
bladder. 
Kidneys normal. Bladder contained high colored urine, rich in urea, but free 
from albumen casts and colored blood corpuscles. 
Cranium. Membranes of brain as well as the blood vessels of the brain sub- 
stance greatly congested with dark blood; cortical substance of the cerebrum and 
cerebellum of a dark gray and chocolate color. Deposits of dark pigment and of 
large pigment cells within and around cerebral capillaries. Blood vessels of brain 
and spinal cord congested with blood. 
Case 809.-Pernicious -Malarial Fever. 
In a similar case, which was brought into the Charity Hospital in a comatose 
condition, the patient, although anaemic and anasarcous, with enlarged spleen and 
liver, manifested during the last forty-eight hours of life, passed in a profound 
coma, a temperature in the axilla of from 104° to 106° F. 
Immediately before death the temperature was 106°. 
Case 810.-Pernicious Malarial Fever. 
M. Shea, age 27; entered ward 18, bed 206, Charity Hospital, November 3d, 
1884: comatose ; passes urine and faeces in bed : jaundiced ; hot, dry skin ; marked 
capillary congestion; foul breath; great epigastric tenderness; urine contains 
blood corpuscles (red), albumen and blood casts of the tubuli urinifiri; liver and 
spleen enlarged; heart and lungs healthy; pulse rapid and feeble, 192 beats per 
minute; respiration 42 per minute. Temperature of axilla 103.7° F. 
The patient continued in a comatose state and died within twelve hours after 
his entrance into the hospital. During this period the eyes were fixed in one 
position, and the pupils did not respond to light. It was ascertained that this 
patient had suffered with malarial fever before entering the hospital. Diagnosis: 
Pernicious hcemorrhagic malarial fever. 
Post-mortem examination. Heart and lungs normal; valves of heart normal; 
dependent portions of lungs congested ; pericardium contained about two fluid 
drachms of golden-yellow fluid. Liver enlarged, greatly congested, and pervaded 
by pigment granules Spleen enlarged about three times its normal size, and 
filled with dark purplish altered blood, or splenic mud, rich in haematin, pigment- 
corpuscles and. altered colored blood-corpuscles; kidneys enlarged and greatly 
congested; urinary bladder contained about five fluid ounces of red urine which 
contained some blood; brain congested ; gray matter of a dark chocolate color 
from deposits of pigment granules and cells. 
Case 811.-Pernicious Malarial Fever. Sudden Death. 
Peter Dooling, age 45, native of Ireland; cabman; entered ward 13, bed 163, 
January 3d, 1883. On the 1st of January, 1883, whilst working on the banks of 
the Mississippi river, was seized with a violent chill, which rendered him uncon- 
scious. Entered the Charity Hospital January 3d ; slight jaundice; great muscular 
prostration; rapid pulse, 120 per minute; temperature of axilla 103° F.; stomach 
very irritable; great tenderness of epigastrium; tongue very red at edges and 
coated with dark brown fur in centre. When the epigastric region is pressed, the 
patient complains of great tenderness and pain. Bowels constipated; complains 
of violent pain in the occipital region ; urine scanty, and contains a small quan- 
tity of albumen. Contagious and Infectious Fevers and Diseases. 
17 
On the morning of January 5th, whilst the patient was attempting to eat a 
little toast and milk, he was suddenly seized with a violent chill. The hospital 
student, upon being called to his bedside, found the patient in a comatose state: 
livid lips ; skin covered with a cold clammy sweat; pupils contracted. In a short 
time the patient died. 
Case 813.-Pernicious Hcemorrhagic Malarial Fever. 
John Galvin, age 21, native of Ireland, laborer; admitted to ward 14, bed 183, 
Charity Hospital, October 12th, 1882; complained of great pain in head and lum- 
bar region ; intellect dull; aroused with difficulty, and then complains of the pain 
in the head and back; bowels constipated. 12 m. Patient in full perspiration, 
dull and drowsy. 8 p. m. Patient stupid, great tenderness in epigastric region, 
pupils dilated, photophobia, temperature, 101° F.; pulse 120, respiration 22. Tongue 
red at tip and edges, heavily coated with brown fur. 
October 13, morning. Nurse stated that the patient had fallen out of bed dur- 
ing the night. Pulse very ~apid ; respiration 18 ; temperature of axilla, 104° F. ; intel- 
lect dull; great tenderness in epigastric region. Patient has passed small quanti- 
ties of urine during the night and morning. Evening, temperature 101° F. ; pulse 
96; respiration 18. Great tenderness and pain on pressing the epigastric region; 
patient very restless. At 9 p. m., the patient vomited black matter resembling 
coffee grounds. Pulse feeble and gaseous. Great capillary congestion. Patient 
died about 2 a. m., October 15th, 1882. 
Post-mortem examination.-Lungs normal. Heart soft and containing an 
abnormal amount of fat. Stomach : mucous membrane congested, and this viscus 
contained a small quantity of dark blood. Liver, spleen and kidneys greatly 
congested ; liver and spleen of dark slate color. The urinary bladder contained 
a small quantity of urine, which upon examination was found to be albuminous. 
We conclude from the preceding facts : 
1st. Pernicious paroxysms frequently occur in patients already suffer- 
ing from the prolonged action of the malarial poison which has already 
induced profound lesions of the blood, brain, liver and spleen. 
2d. Pernicious malarial fever is frequently characterized by high tem- 
perature, which may continue during the most profound coma, even up to 
the moment of death. 
3d. The phenomena of pernicious (congestive) malarial fever indi- 
cate the action of a powerful poison, or morbific ferment. 
Contagious and Infectious Fevers and Diseases. 
Dengue 
Cases. 
15 
Deaths'. 
Yellow fever 
76 
35 
Typhoid fever 
16 
3 
Measles 
10 
2 
Scarlatina 
4 
1 
Diphtheria 
2 
Cases. 
Deaths. 
Mumps 
3 
Small-pox 
18 
1 
Asiatic cholera 
2 
2 
- 
- 
Total 
146 
44 
Per cent, of deaths in contagious and infectious fevers and diseases, 30.1. 
Ratio of deaths in 1000 cases of contagious and infectious fevers and diseases, 
301. 
One death from contagious and infectious fevers and diseases in 3.31 cases. 
Cases. 
Deaths. 
Phthisis pulmonalis 
413 
122 
Per cent, of deaths 
in 
cases of phthisis 
pul- 
monalis 
29.5 
Elephantiasis Graecorum... 
(Oriental leprosy).. 
5 
3 
Elephantiasis Arabum. 
3 
Yaws, African 
Cases. Deaths. 
1 
Scrofula 
.... 14 3 
Scurvy 
.... 7 
Pu rpu ra heemorrhagica.. 
.... 8 
Total 
.... 38 6 Phthisis Pnlmonalis in New Orleans. 
18 
PHTHISIS PULMONALIS. 
Cases, 413. Deaths, 122. 
Per cent, of deaths in cases of phthisis pnlmonalis, 29 5. 
One death from phthisis pnlmonalis in 33.8 cases. 
On examination, the mortuary record of New Orleans will show that 
phthisis pnlmonalis does not confine its ravages to more Northern cities, 
but is the cause of an alarming mortality, even amongst the natives 
(" creoles of New Orleans; showing that one-tenth of all the deaths 
occurring in New Orleans are due tn phthisis pnlmonalis. Thus the total 
deaths in New Orleans during thirty-four years, 1844 to 1880, were242,426, 
and of this number, phthisis pnlmonalis occasioned 24.071. 
During the period just specified (1844-1880, thirty-four years) the 
principal diseases pccasioned the following number of deaths, as shown by 
the following table. 
DEATHS IN NEW ORLEANS, LOUISIANA, FROM SOME OF THE PRINCIPAL DIS- 
EASES, DURING A PERIOD OF THIRTY-FOUR YEARS, 1844-1880. 
Cholera (Asiatic) 11,847 
Cholera morbus 889 
Cholera infantum 2,408 
Total 15,144 
Enteritis 6,915 
Diarrhoea 8,289 
Dysentery 7,097 
Total 22,301 
Phthisis pnlmonalis : 24,071 
Small-pox, scarlet fever, measles 9,381 
Dengue, typhoid, typhus fever, eerebro-spinal fever and simple continued 
fever.. 5,932 
Yellow Fever 28,739 
Various forms of malarial fever 12,416 
Total 56,468 
Whilst fevers of all varieties destroyed, in the City of New Orleans, 
56,478 citizens, in thirtydbur years, yellow fever destroyed only one-half of 
that number, namely, 28,739, and notwithstanding the fact, that only about 
one-half of the mortality from fever in New Orleans during the period 
specified was due to yellow fever, the attention of the citizens of the entire 
Mississippi Valley is directed to this disease. 
Congestive fever alone occasioned in New Orleans, during 34 years, 
6337 deaths. Phthisis pnlmonalis destroyed nearly as many citizens as 
yellow fever, namely 24,071; enteritis, dysentery and diarrhoea, 22,301; 
and cholera, cholera morbus and cholera infantum, 15,144. 
Total deaths from phthisis pnlmonalis and bowel affections, 61,516. 
These diseases, which are common to the entire valley, caused 61,516 
deaths, exceeding those caused by fevers, which were 56,478. 
Fevers, bowel affections and Phthisis Pnlmonalis alone caused in New 
Orleans, 117,991 deaths in thirty-four years, out of a total of deaths from 
all causes of 242,426. 
The statistics afforded by the Charity Hospital of New Orleans are no 
less instructive. 
During a period of eighteen years preceding the American Civil War, 
1842-1860, there were treated in the wards of the Charity Hospital of 
New Orleans, 5690 cases of phthisis pnlmonalis, of which 3084 terminated 
fatally, giving 54.1 per cent, mortality. Causes of Phthisis in Valley of the Mississippi. 
19 
During the sixteen years following the Civil War, there were invalided 
in the Charity Hospital, 5251 cases of phthisis pulmonalis, of which 2525, 
or 40.8 per cent. died. During a period of 34 years, 1842-1880, 10,950 
cases of phthisis pulmonalis were treated in the wards of the Charity Hos- 
pital, 5669, or 51.2 per cent, of which terminated fatally. 
Whilst the statistics of the Charity Hospital refer chiefly to the labor- 
ing classes, and to those who have been reduced in their circumstances by 
misfortunes and diseases, at the same time we have shown that the statis- 
tics of the city at large illustrate, to an equal extent, the destructive effects 
of this insidious disease. 
During a per iod of years extending from 1845 to 1881, the deaths from 
phthisis pulmonalis have, with the exception of a single year, annually 
exceeded half a thousand, and in many years have been more than eight 
hundred. 
During ten years, 1845-1855 (records of those years which were imper- 
fect being, as in all other estimates, excluded), the deaths from phthisis 
pulmonalis in New Orleans, numbered 6367; during ten years, 1859-1869, 
7251; during eleven years, 1870-1881, 9016. We have thus daring a period 
of thirty-one years, 18*5-1880, a grand total of 22,598 deaths by phthisis 
pulmonalis. 
Surely, a disease which steadily claims its victims each year; which in 
any long series of years has been as destructive as the dreaded yellow 
fever, should secure the earnest consideration of those charged with the 
sanitary affairs of this city and other cities. 
The epidemic of 1878 threw the professional minds of a certain order 
into a state of morbid excitability on the subject of yellow fever, and the 
public have been served with numerous lucubrations on this subject and 
quarantine, and the National and State Legislatures have been repeatedly 
and freely plied with advice, and urged to provide money and places for 
the self-constituted guardians of Public Health and Foreign and Interstate 
Commerce. 
In comparison with phthisispulmonalis. which every year destroys its 
thousands and tens of thousands in every State in this Union, yellow fever 
should be regarded only as a casual and minor disease, visiting only certain 
limited portions of the tropical and temperate regions at long intervals. 
We hear much of the cost of epidemics, but nothing as to the fearful 
cost of such a disease as phthisis, which holds its doomed victims in its 
deadly embrace for months and even years, and inflicts, in addition to 
indescribable tortures, vast and ruinous pecuniary expenses. 
I have given stern facts, with the design of arousing the attention of 
the medical profession to some of the prominent causes of this disease, and 
have ventured to suggest some modes of prevention. 
The necessity of personaland domestic sanitation should appeal to all 
alike. 
The people may escape the yellow fever, by leaving the infected 
places, but they cannot escape those causes of disease which spring from 
their habits, modes of living and climate, and which are ever present with 
them, in their assemblies, counting-houses, dwellings-around their fire- 
sides. and in their beds devoted to quiet and rest. 
The chief causes of the prevalence of phthisis pulmonalis in New 
Orleans appear to be: 
1. Imperfect drainage. 
2. The saturation of the atmosphere with moisture. 
3. Imperfect construction of houses. 
4. Imperfect ventilation of houses. 20 
Causes of Phthisis in Valley of the Mississippi. 
5. Crowding. 
6. The neglect of regular exercise for diversion and recreation. 
7. Imperfect nourishment. 
8. Hereditary taint. 
9. Imperfect warming and drying of the houses by fire during the 
winter months. 
10. The wearing of insufficient clothing during the winter months. 
A volume might be written on the preceding divisions, or causes, but 
our intention is clearly to present practical observations, which may prove 
of benefit to those interested. 
Owing to the peculiar topographical and geographical situation of New 
Orleans, the soil is saturated with moisture, the atmosphere is habitually 
near the dew-point. The old city, Second District, bounded by Esplan- 
ade and Rampart streets, and large portions of the First, Third and Fourth 
Districts, are compactly built with brick, and the sudden changes of the 
Fall, Winter and Spring are frequently manifested by the precipitation 
of the moisture on the cold walls, in the form of streams of water. 
Dampness checks the cutaneous perspiration; it abstracts the normal 
heat and electricity from the body; it receives and holds the noxious 
exhalations from the human body and from all other sources, and it pro- 
motes the development and rapid multiplication of low or simple forms of 
vegetable and animal life, and more especially of Micrococci, Bacilli, Bac- 
teria and Fungi. 
In many instances no attention has been paid to the proper filling in 
with sand or gravel, of building lots, and stagnant water frequently stands 
under the houses, and is a potent source of disease. WJrole blocks can be 
pointed out in the heart of this great city, in which there is no proper 
ventilation, and in which the lowest floor rests directly upon the damp 
earth. 
Houses, churches, schoolhouses, stores and all buildings inhabited or 
occupied by human beings, should be thoroughly ventilated-laterally and 
perpendicularly. As far as practicable the expired air should be diluted, 
and as far as possible, robbed of its noxious properties. The air should 
circulate freely unde]- the lower floor of every house; and should be 
admitted by ventilation, in the front and rear of each room, and if possible 
on all sides ; and a system of ventilation should be so arranged, as to allow 
of the escape of the foul air of the sleeping apartment directly up through 
the roof into the open air. Each room should have a good draft of air 
from the outside. 
If people would send for the carpenter, and properly ventilate their houses, 
they would not so often need his services in the g\ aveyard. 
The effects of imperfect ventilation and close confinement and crowd- 
ing, with insufficient food, is fully illustrated by the frequent occurrence 
of phthisis pulmonalis, among females who are compelled to live by the 
needle or sewing machine, and who occupy small, ill-ventilated houses, 
resting upon the ground. 
Warm clothing, regular exercise in the open air, nutritious food, and such 
thorough ventilation as shall at all times secure pure air in the store, workshop, 
sitting-room and bed room, are the great means of pr venting the development of 
phthisis pulmonalis. 
War destroys its thousands, but phthisis claims its tens of thousands. 
The improvidence, ignorance and avarice of mankind, as manifested 
in the neglect of sanitary laws, in the construction and conduct of dwell- 
ing houses, stores, factories, school-houses and churches, are more destruc- 
tive to human life than yellow fever and all other pestilences. Treatment of Phthisis. 
21 
TREATMENT OF PHTHISIS. 
In hospital practice among charity patients, the results of treatment 
will depend upon the stage of the disease; the extent to which the lungs 
and other organs have been invaded by the tuberculous deposits; the con- 
stitution of the patient; the habits and condition of the patient before the 
onset of the d'sease; the cause of the disease; the absence or existence of 
heredity. 
The experience of the author is to the effect that good results may be 
achieved in almost all cases, and that the progress of the disease may 
be temporarily arrested. 
The remedies of greatest value appear to be cod-liver oil, phosphates 
and hypophosphites of lime, soda and irou, strychnia and the bitter 
tonics. 
Throughout the entire hospital service, cod-liver oil maintained its 
place at the head of the list of remedies adapted to the treatment of 
phthisis. 
The following combination was found useful as a tonic: 
K. Tincture of nux vomica, f^iv; syrup of hypophosphites, fgviii: 
Mix. Dose, teaspoonful three times a day. 
In allaying cough, the following formula was frequently used: 
11. Syrup of morphia (one grain of sulphate of morphia to the fluid 
ounce of simple syrup), f§ii; syrup of squills. f^i; syrup of ipecac, fgii; 
syrup of tolu, fgiiss: Mix. Dose, from one to three fluid drachms when 
necessary. 
K. Syrup of morphia, f^b; syrup of squills, f§i; syrup of wild 
cherry (pruni Virginian®) bark, f§iv: Mix. Dose, from one to three fluid 
drachms when necessary. 
Alcoholic stimulants, administered in a diluted state with cane sugar, 
was found beneficial in arresting the waste of tissue. When good whisky 
is diluted with four parts of sweetened water, in many cases it acts as a 
nutriment and anaesthetic, allaying the cough and inducing sleep. In the 
treatment of phthisis, whisky and brandy or rum appear to accomplish 
the best results when they are diluted with from four to six parts of 
water or fresh milk. The combination of sugar or honey with the alco- 
holic stimulants is well borne in many cases, and these hydro carbons 
appear to prevent the rapid waste of tissue. Genuine port, sherry or 
Madeira wines have proved beneficial in the treatment of this disease, 
used at regular intervals; but the extensive use of these costly wines is 
out of the question in Charity Hospitals, where the pecuniary means are 
necessarily limited. The use of water charged with carbonic acid, in 
combination with whisky flavored with lemon, pine apple or raspberry 
syrup, is often both grateful and beneficial to the phthisical patient con- 
sumed with thirst and fever. 
The hypophosphites of iron, lime, soda and potassia, as well as the 
triple phosphates of lime and iron, have been extensively employed by 
the author in the treatment of phthisis in the Charity Hospital, and the 
effect of this class of remedies appeared to be favorable in improving the 
digestion, causing an increase of the red corpuscles, and in arresting, to a 
certain extent, the progress of the disease. 
Nutritious diet, as beef steak, soft-boiled eggs, rich milk and cream, 
turtle soup and fish, appear to be essential to the successful treatment of 
these cases, and the absence of means of obtaining proper diet, stimulants 22 
Treatment of Phthisis. 
and medicines is one of the chief causes why the ravages of this disease 
are so often seen amongst the poor of our large cities. 
Strchynia, extract of nux vomica, the preparations of Peruvian bark, 
quassia and gentian, were frequently used, either singly or in combination 
with iron and pepsin. 
In the treatment of haemorrhage from the lungs, the remedies chiefly 
relied on were opium, acetate of lead and ergot. 
Chloral hydrate, either by itself or in combination with sulphate of 
morphia, was used to produce sleep and relieve pain; and the fit st remedy 
proved beneficial in some cases of obstinate hiccough. 
Counter irritants, such as blisters, croton oil and tincture of iodine, 
applied on the surface of the thorax, frequently mitigated distressing 
cough and pleuritic pains. 
The use of such agents as naphtha, iodine, carbolic acid, sulphurous 
acid; of the following R.: Extract of Pine needles, f^iv; tincture of 
iodine, f.^iij; glycerine, f^viij; water, f.^lxx; by inhalation and by the 
atomizer; as well as pneumatic differentiation, have received investigation, 
but the discussion of this mode of treatment must be deferred to a future 
occasion. 
THE ESTABLISHMENT OE A HOSPITAL FOR THE TREATMENT OF PHTHISIS IN 
THE PINE REGION OF SOUTHERN LOUISIANA- 
The Pine region of Louisiana lying north of Lake Pontchart] ain, in 
the neighborhood of Mandeville, Covington and the Abita Springs, appears, 
from the experience of the author, to present most favorable conditions of 
soil, water and climate for the treatment of phthisis pulmonalis. 
The dry, sandy nature of the soil, and its freedom from inorganic 
matter, of this portion of Louisiana has not only been determined by the 
author by chemical and microscopical analysis, but he has also established 
the great purity of the drinking water. 
The long-leaved pine requires a dry sandy soil for its growth, and the 
main root frequently penetrates to a distance downwards of fourteen feet. 
Its leaves exhale a balsamic odor, which appears to be beneficial to the 
lungs. It is also stated that ozone is created by the pine forests. 
Rain falling upon this sandy soil is quickly absorbed, and the absence 
of organic matters in its composition furnishes conditions favorable to the 
existence of a dry, pure atmosphere. Combined with these circumstances 
we have a mild, agreeable climate, similar to that of the localities of 
Florida, so noted as the resorts of those suffering with phthisis. 
The proximity of this pine region of Louisiana to the city of New 
Orleans, the metropolis of the Gulf coast, renders available all the fruits 
of the tropics, as well as every variety of fish, game, vegetable and fowl. 
Properly conducted retreats and hospitals would accomplish good, 
located in this healthy dry pine region, and arrangements might be made 
for the transference of the cases of phthisis, at stated intervals, from the 
Charity Hospital to a branch of this institution established in this locality, 
for the treatment of phthisis and chronic pulmonary disease. 
In this dry locality many of the cases of phthisis and of chronic 
bronchitis, or asthma, might spend a large portion of their time in the 
open air, and also assist in the cultivation of vegetables and fruits. Cancer of Testicle and Mesenteric Glands. 
23 
Cases. 
Deaths. 
Medullary cancer 
2 
Epithelial cancer 
1 
Osteoid cancer 
2 
2 
Schirrus cancer 
2 
Cancer of the uterus 
1 
Cancer of the stomach 
1 
1 
Cancer of the pylorus and pancreas , 
1 
1 
Cancer of the liver 
2 
2 
Cancer of the testicle and mesenteric glands 
1 
1 
Cancer of the rectum 
1 
Cancer of the tongue 
1 
1 
Cancer of the penis 
I 
Total 
16 
8 
The following cases of cancer present some points of interest: 
Case 813.-Cancer of the Testicle and of the Mesenteric Glands. 
William Roberts, age 37; admitted into ward 13, Charity Hospital, bed 216, 
November 10, 1881. Patient was born in Mississippi; during childhood went to 
Arkansas, and from thence came to Louisiana at the age of 19 years, and resided in 
Baton Rouge; laborer; accustomed to hard work; temperate habits; used neither 
tobacco nor whisky; regarded himself as in good health until June, 1881, when 
he was attacked with typhoid fever. During the period of convalescence, a tumor 
or swelling was observed in the abdomen, which continued to increase in size. 
Patient says that his father and mother were healthy. Roberts was sent by his 
attending physician to the care of the author, in the Charity Hospital, on the 10th 
of November, 1881. 
Upon examination I found the abdomen greatly distended by a large nodulated 
movable tumor; that is, some of the nodules were movable upon manipulation. 
Palpation and percussion revealed the fact that the abdominal cavity contained 
little or no free fluid. Aspiration resulted in the evacuation of only small quanti- 
ties of bloody fluid. 
The left testicle was enlarged, forming a nodulated and slightly fluctuating 
tumor about 3J inches in diameter. 
The patient stated that this tumor had existed for many months, and, perhaps, 
had commenced to form at least two years before the attack of typhoid fever, and 
the rapid growth of the abdominal tumor. 
Appetite good, and the stomach retains all the nourishment administered. 
The tumor continued to increase daily; the distress from the tension of the 
abdominal walls, and the forcing up of the diaphragm continued. 
Patient died November 22, 1881, twelve days after his entrance into the hos- 
pital. 
Post-mortem examination revealed the presence of a large nodulated encepha- 
loid cancer of the mesenteric glands, which filled and distended the abdominal 
cavity, and weighed about thirty pounds. The tumor (or rather series of tumors) 
was found attached to the posterior wall of the abdominal cavity. When cut a brain- 
like substance exuded. 
The testicle upon dissection was found to be a mass of encephaloid cancer, and 
contained the same brain-like substance. All the mesenteric glands along the 
track of the spermatic cord of the left testicle were enlarged with the same cancer- 
ous matter. The liver contained several small abscesses. The left kidney was 
atrophied from pressure of the tumor; the right kidney was hypertrophied, spleen 
enlarged, heart and lungs healthy. 
AU the mesenteric glands of the abdomen were enlarged and cancerous. 
The diagnosis, cancer of the left testicle, and of the mesenteric glands, made in 
the amphitheatre, to the Medical Class of 1881-2, at the time of the examination of 
this patient immediately after his entrance into the hospital, was confirmed in the 
Dead House. 
In this interesting case, it is reasonable to suppose, that the left tes- 
ticle was the starting point of the cancerous disease; and that the super- 
vention of typhoid fever promoted the rapid dissemination of the cancer 
cells. 24 
Cancer of Stomach and Liver. 
Case 8 If-Cancer of Stomach and Liver. 
A. W. King, native of Franklin, Tennessee, age 60; admitted to ward 14, 
Charity Hospital, November 13, 1881; has been in Louisiana about one month ; 
occupation printer and editor; can give no history of his father and mother, with 
reference to their health ; says that he has been a hard drinker all his life ; never- 
theless has enjoyed good health, until about six months before entering the 
hospital. 
Upon examination, the patient was found to be suffering with incessant vomit- 
ing and great prostration, which he stated had commenced about six weeks before, 
during which time he had been unable to retain anything on his stomach. A hard 
tumor occupies the epigastrium, right and left hyperchondrise, and portions of the 
umbilical and right and left lumbar regions The tumor was hard and nodulated 
upon the surface, flat on percussion and without fluctuation. I pronounced this 
tumor to be a scirrhous cancer of the liver. Patient stated that he had never 
vomited blood, but ejected everything that he ate, shortly after its entrance into 
the stomach, and exclaimed : " I am hungry all the time, and am dying of star- 
vation.'1'1 Complains of sharp lancinating pains in the tumor and stomach. The 
effort was made to sustain life by the injection of beef tea and milk into the 
rectum. Sulphate of morphia (J gr.) was injected subcutaneously, at regular inter- 
vals, to relieve the pain. From the fact that food is received into the stomach 
and then rejected, and from the fact that no food passes downward, the conclu- 
sion was reached that the pyloric extremity of the stomach, as well as the superior 
portions of the pylorus, were the seat of a scirrhous cancer, The diagnosis 
announced to the medical class at the clinical lecture, with the patient on the 
table in the amphitheatre, was cancer of the pyloric extremity of the stomach, 
of the superior portion of the pylorus and of the liver. 
The effort to sustain life by means of nutritive enema was only partially suc- 
cessful; the powers gradually declined, the emaciation was extreme, and the patient 
died, apparently from starvation, on the 21st of November, 1881, eight days after 
his entrance into the hospital. 
On post-mortem examination, the brain, heart and lungs, and in fact all the 
organs, with the exception of the stomach and liver, were normal. 
The pyloric extremity of the stomach and the superior portion of the pylorus 
were occupied by a scirrhous cancer, which completely excluded the pyloric orifice 
and precluded the passage of solids and liquids from the stomach into the intes- 
tinal canal. 
The enlarged nodulated cancerous liver formed the hard tumor, occupying the 
region above described. 
When sections of the liver were made, it was evident that cirrhosis and fatty 
degeneration of the organ co-existed with the extensive invasion of the organ by 
the cancerous cells, structures and deposits. The cirrhosis and fatty degeneration 
were due most probably to the excessive use of alcohol, and most probably ante- 
dated the supervention of the cancer of the stomach and liver. Tt was not possible 
to trace any relationship of cause and effect between the excessive use of alcohol 
and the development of cancer. 
Cases. 
Deaths 
Erysipelas 
19 
2 
Acute articular rheumatism 
152 
2 
Chronic articular rheumatism 
157 
Muscular rheumatism 
17 
Gonorrhoeal rheumatism 
6 
Syphilitic rheumatism 
Gout (chronic) 
30 
1 
Primary syphilis 
34 
Secondary (constitutional) syphilis 
120 
2 
Total 
8 
Grand total general diseases, including all the forms of malarial 
and other fevers, phthisis and other constitutional diseases 4034 276 
Per cent, of deaths in general diseases, 6.83. 
Ratio of deaths per 1000 cases of general diseases, 68.3. 
One death from general diseases in 14.6 cases. Treatment of Rheumatism. 
25 
It is evident from the preceding figures that, whilst the malarial (par- 
oxysmal fevers) numbered 2885 cases out of a total of 4073 cases of consti- 
tutional diseases, or about 71.2 per cent., on the other hand, the mortality 
occasioned by malarial fevers was only 88 out of 268 deaths from all gen- 
eral diseases. 
The mortality occasioned by the various forms of malarial fever was 
only about 31 per cent, of the mortality occasioned by all general diseases, 
including the former. 
Before proceeding to examine the numerical relations of the local dis- 
eases treated by the author in the Charity Hospital of New Orleans, during 
the periods already specified, we will make some practical observations 
upon the treatment of rheumatism and syphilis. 
TREATMENT OF ACUTE AND CHRONIC RHEUMATISM. 
It will be seen that we have classified the cases of rheumatism under 
the following heads: Acute Articular Rheumatism, Chronic Articular 
Rheumatism, Muscular Rheumatism, Gonorrhoeal Rheumatism, and Syph- 
ilitic Rheumatism. Of these forms of rheumatism, the clinical record 
reveals that 362 cases were treated, with 4 deaths; per cent, of deaths, 1.1. 
The mortality was small, being a little over one per cent, of the cases 
treated, or one death in 90.5 cases treated. The four deaths were distrib- 
uted equally between the cases of acute and chronic rheumatism. 
As far as the experience of the author extends, rheumatism is not 
a fatal form of disease, either in hospital or civil practice in New Orleans. 
I did not employ salicin, salicylic acid or salicylate of soda to any 
extent, either in hospital or civil practice, previous to the year 1878; and 
up to this date no deaths had occurred among the cases of rheumatism 
treated by the author in the wards of the Charity Hospital of New Orleans; 
the three deaths from acute and chronic rheumatism which occurred in 
1881 were not, however, in any manner referable to the action of the sali- 
cylates, but rather to cardiac malarial and other complications. 
Pieceding the use of the salicylates,' I employed the following general 
plan of treatment, in both private and hospital practice : 
1. The bowels were opened by a mercurial or saline purgative. In 
cases complicated with malarial influences, an efficient dose of calomel or 
blue mass, combined with sulphate of quinia, yielded the best results. 
The bowels were kept open, and the constipating effects of opiates, 
counteracted by the occasional use of saline purgatives, as effervescing pow- 
ders, sulphate of magnesia, sulphate of soda and citrate of magnesia. 
In uncomplicated cases of acute rheumatism, free from all syphilitic 
taint, mercurials are used as purgatives, and not to produce a decided con- 
stitutional effect, as manifested by ptyalism. 
2. The temperature was controlled, and at the same time certain indi- 
cations induced by the action of the malarial poison, met by the regular 
administration of the sulphate of quiniain doses of from five to ten grains. 
3. For the relief of pain, opium and its preparations were used at 
regular intervals, and in amounts adapted to each case, and sufficient to 
relieve acute suffering. 
In many cases we combined the Dover's powders (pulv. ipecac et opii, 
U. S. P.) with the quinine, thus securing at once the antipyretic? proper- 
ties of the quinine, the sedative effects of the opium, and the diaphoretic 
and diuretic properties of the ipecac and sulphate of potash. 
The following formulae will give a general id< a of the mode in which 
these remedies were combined and used : 26 
Treatment of Rheumatism. 
B. Sulphate of quinia grs. xxx. 
Pulv. ipecac et opii (Dover's nowder) grs. xx. 
Mix : Divide into 10 powders. 
Administer one powder every three, four or six hours. 
When the pulse was rapid and full, digitalis, in the form of tincture 
or powder, or the tincture of yellow jasmine, or the tinctures of aconite or 
veratrum viride, were used at regular intervals in conjunction with the 
quinine and Dover's powders. 
In some cases it was found advisable to administer a full dose of 
opium, from one to two grains at bed-time. The administration of the 
opium was guided by the nature and intensity of the pain. 
Chloral hydrate, combined with the sulphate of morphia, was used in 
some cases, in which the pain in the inflamed joint was of an intense spas- 
modic and jerking character. 
The following formulae were used according to circumstances to accom- 
plish the results just indicated: 
B. Quinise Sulph Qii. 
Pulv. digitalis ^ss. 
Pulv. ipecac et opii (Dover's powder) Qi. 
Pulv. potassii nitras Qii. 
Mix : Divide into 20 powders. One powder every four hours. 
B- Morphise sulph grs.ii. 
Tincture gelsemium (yellow jasmine) f3U- 
Chloral hydrate %ii. 
Aquae camphorse f3 vi. 
Mix : Tablespoonful every three, four or six hours, if necessary to relieve pain 
and induce sleep. 
4. The local treatment consisted of the application of the tincture of 
iodine, and of the combination of the tinctures of iodine, aconite and opium 
to the inflamed joints, and the use of these agents in combination with 
olive oil. 
The following formula were used: 
B. Tincture of iodine 
" opium 
" aconite aaf^iv. 
Mix: Apply directly by means of brush to the inflamed joints. 
B. Tincture of iodine 
" opium 
" aconite aiif^ss. 
Olive oil f5 iiss. 
Mix : Use as a liniment to the inflamed joints. 
B. Tincture of opium 
" camphor aaf^iv. 
Wqua ammonise f 3 i i i. 
Olive oil f^iv. 
Mix: Use as a liniment to the inflamed joints. 
B. Chloroform f 3 hi. 
Tincture of opium f^iv- 
Tincture of camphor f 3 ii. 
Olive oil f3iii. 
Mix : Use as a liniment to the inflamed joints. 
Without doubt, the tincture of iodine was the most efficient applica- 
tion to the inflamed joints, in either acute or chronic rheumatism. 
The inflamed limbs, after the local applications were applied, were 
carefully wrapped up in cotton, surrounded with red flannel, and over this 
oiled silk was wrapped. The cotton equalized the pressure and absoi bed 
the moisture and sweat, condensed by the oiled silk. In this manner the 
joints were subjected to a vapor bath, the oiled silk being confined by Treatment of Constitutional Syphilis. 
27 
bands above and below the joints. The temperature of the vapor bath 
was a little lower than that of the surface of the patient. 
5. Since the year 1878, I have employed salicylic acid and the sali- 
cylate of soda, in the treatment of rheumatism. These agents are used 
freely in both chronic and acute rheumatism for their antipyretic effects, 
and also for their marked power in relieving and mitigating pain. After 
careful observation I have been induced to consider the following as one 
of the best modes of administering salicylic acid and the salicylates: 
R. Salicylate of soda zii. 
Liquor ammoniac ascetatis t 3 vi. 
Mix: Tablespoon fill with three tablespoon fills of water eveiy 2, 4 or 6 hours 
I have been led to regard the acetate of ammonia in the preceding 
combination, as of marked value in the treatment of rheumatism. 
I have also derived benefit from the wine of colchicum, combined with 
iodide of potassium, in the treatment of chronic rheumatism and rheu- 
matic gout, as in the following formula: 
R. Vini colchici sem f^i. 
Potassi iodidi 5i. 
Aqua menthse pip f^vii. 
Mix : Teaspoonful in wineglassful of water every 4, 6 or 8 hours. 
R . Morphise sulphas grs. ii. 
Vini colchici sem f 3 ii. 
Potassii iodidi 5 vi. 
Aqua camphorae f^viii. 
Mix : Tablespoonful every 4, 6 or 8 hours. 
6. The diet should be simple, but nutritious. As a rule wines and 
malt liquors should be avoided, and when alcoholic stimulants are neces- 
sary, pure whisky or brandy, properly diluted with water, should be used 
in moderate quantities at regular intervals. 
TREATMENT OF SYPHILITIC RHEUMATISM AND CONSTITUTIONAL SYPHILIS. 
Of the 362 cases of rheumatism, thirty cases, or less than one-tenth, 
were referred to the action of the syphilitic virus. Primary syphilis 
caused 34 cases, and secondary or constitutional syphilis caused 120 cases. 
Total cases of disease referable to the action of the syphilitic poison, 184; 
total deaths, 2. The cases of syphilitic rheumatism might have been 
classed with those of secondary or constitutional syphilis; the former is 
credited with no death', whilst the latter (120 cases) occasioned 2 deaths. 
The treatment of syphilitic rheumatism did not differ essentially from 
that of constitutional syphilis, with the exception of the local treatment of 
the inflamed joints, and the measures for the relief of acute pain. 
It is not our intention at this time to enter into an elaborate statement 
of the treatment of constitutional syphilis; we shall confine ourselves to 
the notice of the most efficient remedies. 
The chief indications in the treatment of constitutional syphilis are: 
1. The elimination of the syphilitic virus from the human system. 
2. The removal of glandular enlargements and of syphilitic deposits 
and tumors. 
3. The cure of syphilitic ulcerations, caries and cutaneous eruptions. 
4. The restoration of the blood to its normal state. 
5. The relief of nervous symptoms and lesions. 
6. The removal of the effects of syphilitic inflammation from the 
joints. 28 
Treatment of Constitutional Syphilis. 
The first, second and third indications are best met by the use of the 
following remedies, which are placed in their relative positions of value 
and potency: 
1. Mercury. 
2. Iodide of potassium. 
3. Iodine. 
As far as the experience of the author extends, the best, most uniform 
and lasting results have been achieved by the employment of the preceding 
remedies, simultaneously, as in the following formula : 
R. Biniodide of mercury (red iodide of mercury) grs. iv. 
Iodide of potassium 5 iss. 
Tincture of iodine f$iii. 
Peppermint water f 3 viiss. 
Mix : One teaspoonful in four tablespoonfuls of water three times a day. 
In the preceding combination, the red iodide of mercury is held in 
solution by the iodide of potassium; and the iodine exists in the free state, 
and in virtue of its physiological properties, in this condition, excites a 
profound effect upon the glandular system. Such a combination as that 
just given, is not merely a powerful alterative, but is also an efficient anti- 
septic and germicide. 
I have seen a large number of patients in hospital and in private 
practice (the latter greatly outnumbering the former), restored to good 
health by the continued use of the above combination in the treatment of 
constitutional syphilis. 
The fourth indication may be met, and the natural tendency of the 
syphilitic poison to induce profound anaemia overcome by the following 
formula: 
R. Red iodide (biniodide) of mercury grs. iv. 
Iodide of potassium 5 i. 
Tincture of iodine 
Syrup of the iodide of iron ,...f§i. 
Peppermint water f5ii. 
Syrup of ginger f^v. 
Mix: Dissolve the iodide of potassium in the peppermint water, then add the 
red iodide of mercury and tincture of iodine, and finally, the syrup of the iodide of 
iron and ginger. 
Dose, teaspoonful in four tablespoonfuls of water three times a day. 
We have the same dose of the red iodide of mercury (1-16 of a grain), 
in each wineglassful of both formulae, but in the latter we have the iodide 
of iron. 
When the nervous system is seriously involved during the progress of 
syphilis, in addition to the preceding remedies, strychnine and electricity 
should be employed. The following lormula for the administration of 
strychnine has proved beneficial in haemaplegia, paraplegia, general par- 
alysis and muscular and nervous debility, induced by the prolonged action 
of the syphilitic poison: 
R. Strychnine sulph grs. ii. 
Acidi nitro-muriatici dil T^iij. 
Tinct. ferri sesqui chloridi f^vi. 
Quinime sulph 3 i. 
Aqua menthae pip f^vii. 
Mix: Dose, teaspoonful in four tablespoonfuls of water every S hours; suck 
through a glass tube. 
This combination may be used alternately (that is, preceding or follow- 
ing a continuous course) with either of the two preceding formulae. Syphilitic Tumor at Base of Brain. 
29 
The success of the physician in dealing with the nervous affections 
induced by the poisou of syphilis will evidently depend upon the extent and 
nature and position of the lesions. Thus the effect of the syphilitic deposits 
or tumors, depend largely upon their location along the cerebro-spinal sys- 
tem. The effects of syphilitic deposits or tumors of the brain, will depend 
upon the position they occupy, and rapidity of growth. The effects of 
syphilitic tumors of the brain and spinal cord will vary with the functions 
of those portions of the cerebrum, cerebellum, medulla oblongata and spinal 
cord, upon which they induce pressure. 
The sudden fatal effects of syphilitic tumors of the brain will be illus- 
trated by the following case : 
Case No. 815.-Constitutional Syphilis-, Persistent Pain inthe Head; Convulsions 
and Death; Syphilitic Tumor at Base of Brain. 
John Armigee. aged 32 years, native of Baltimore, boiler maker, well formed and 
muscular man, of average size; entered Ward 30, bed 449, Charity Hospital, March 
8,1878. The patient had been discharged upon two occasions from the hospital, 
the attending physicians holding that he presented no marks or signs of disease. 
Upon examination, I found the patient to be suffering with severe pains in the 
spinal column, and shooting pains inthe forehead and in the occipital region; 
staggering gait: wandering intellect; aphasia. He presented, however, to the 
casual observer, the general appearance of health. At times the patient com- 
plained of wandering pains in the chest and lower extremities; dull, sleepy 
expression of the eyes ; bowels constipated ; urine normal in appearance and free 
from albumen and casts. Upon careful inquiry I ascertained that the patient had 
contracted syphilis in 1870. 
The continuous and distressing headache was referred to the effects of the syph- 
ilitic poison, and the usual treatment for constitutional syphilis was instituted, viz: 
R. Red iodide of mercury grs. iv. 
Iodide of potassium 5 iss. 
Tincture of iodine 
Peppermint water f3vb. 
Mix: Teaspoonful in four tablespoonfuls of water three times a day. 
This treatment was supplemented also by full doses of bromide and iodide of 
potassium ; from one to two scruples of each drug administered at bed time, when- 
ever the pain in the head was specially severe. 
The patient expressed himself as greatly relieved by this plan of treatment. 
At9 o'clock, p. M., March 22. 1878, the patient was seized with a violent con- 
vulsion, and died in one hour. The spasm of the respiratory muscles was never 
relaxed, nor was consciousness restored during the hour preceding death. 
Post-mortem examination: Heart and lungs healthy, and nothing abnormal 
was observed in the abdominal viscera. When, however, the cranium was 
opened, a,small pyriform tumor about one inch in length and half an inch in 
diameter, was found at the base of ths brain, towards the left of the median line, 
attached to the pedunclesand pressing upon the optic thalamus of the left side. 
The supervention of cranial pains, unsteadiness of gait, the occurrence of con- 
vulsions, spasms of the respiratory muscles, coma and death, were clearly referable 
to the origin and slow but continuous growth and consequent cerebral compression 
of the syphilitic tumor. 
LOCAL DISEASES. 
.uidtwwd uj 
VIW _Lt v/ uU (to O^/ouO 
Cases. 
Deaths. 
Men i n otitis 
s 
2 
Cerebri tis 
2 
2 
Softening of the brain 
7 
3 
Abscess of brain 
2 
Syphilitic tumor at base of brain 
1 
1 
15 
11 
Cerebro-spinal sclerosis 
Spinal meningitis 
1 
1 
9 
2 
1 
1 
Diseases of the Nervous System. 30 
Local Diseases. 
Atrophy of spinal cord 
9 
1 
Sclerosis of spinal cord 
6 
Haemiplegia 
59 
12 
Paraplegia 
34 
4 
Paralysis caused by lead 
8 
1 
Paralysis (agitans) 
Epilepsy 
40 
2 
Loco-motor ataxia 
6 
Sciatica 
8 
Facial neuralgia 
27 
Chorea 
1 
Dementia 
13 
Dementia and general paralysis 
6 
2 
Insanity 
1 
Tetanus 
1 
Sunstroke (thermic disease) 
3 
1 
Alcoholism (delirium tremens) 
170 
9 
Total diseases of the nervous system 
442 
59 
Three of the eases of epilepsy were traced to the habit of self-abuse; 
and. four of the eases of dementia and general paralysis were traced to the 
same cause. Without doubt a considerable number of these ami other ner- 
vous disorders were induced originally by self-abuse and excessive indul- 
gence of the sexual appetite ; but the absolute reticence of many patients 
with regard to their personal history in such matters precludes the deter- 
mination of the cause beyond all doubt. 
Six of the cases of epilepsy were referable to blows inflicted upon the 
cranium, causing fractures and depressions of the bones. 
Many of the cases of cerebro-spinal diseases, dementia, general para- 
lysis, paraplegia and luemiplegia, appeared to have their origin in the 
abuse of alcoholic stimulants. 
In the first volume of the Medical and Surgical Memoirs, the author 
has recorded a large number of cases of disease of the cerebro spinal system; 
and will add at this time but the following case: 
Case No. 816.-Cerebral Haemorrhage; Sclerosis; Hcemiplegia; Aphasia; Death 
from Pneumonia. 
James Crow, native of Ireland ; cotton screwer. Brought to the Charity Hos- 
pital, June 6th, 1869, in a state of profound coma. Gradually recovered the use of 
his intellect and senses, but suffered with partial paralysis of right side and walked 
with difficulty. Came under my treatment in ward 28, bed 418, Charity Hospital, 
October 1st, 1877. Patient walked about with difficulty, the right leg and arm 
being partially paralyzed, with stiff and atrophied muscles. Mind feeble-aphasia. 
When asked his name, would say, " f do not know," and would point to his ticket 
at the head of his bed, and would appear to be highly pleased, when the name 
James Crow was called. When directed to count, he would run up to 20 and then 
stop, and commence over again; after doing this twice, if still urged to count, 
he would repeat the "Lord's Prayer," and the " Creed," and then stop. The 
mental powers appeared to be entirely exhausted by this effort, and time was 
required for them to gain sufficient strength to repeat these simple exercises. Was 
unable to call the names of many familiar objects. 
Had an attack of pneumonia on the 1st of December, 187-7, involving the left 
lung, from which James Crow recovered ; on the 2d of March, 1878, the right lung 
was attacked with pneumonia, which caused his death on the 23d of March. 
The post-mortem examination, held 12 hours after death, revealed the site and 
effects of the original lesion of the brain. Brain appeared small and somewhat 
atrophied ; dura-mater thickened ; right cerebral hemisphere appeared to be nor- 
mal in structure. The fissure of Sylvias on the left side of the brain was greatly 
enlarged, and had evidently been the seat of the original clot. Surface of Pia and Aphasia and Paralysis. Misplacement of the Heart. 
31 
arachnoid membranes covering those portions of the brain constituting and 
surrounding the left transverse fissure, were discolored, atrophied and coated with 
a thick, rough deposit of Phosphate of Lime. Coats of the arteries thickened and 
degenerated and dilated. Optic thalamus on left side, softened and degenerated. 
DISEASES OF THE CIRCULATORY SYSTEM. 
Cases. 
Deaths. 
Heart: valve disease ; mitral 
30 
11 
" " " tricuspid 
1 
Aortic, pulmonary and tricuspid valves 
8 
3 
Fibrinous concretion in heart 
1 
1 
Hypertrophy and dilatation of heart 
Hypertrophy, dilatation and valvular disease 
1 
20 
io 
Fatty degeneration 
4 
3 
Palpitation and irregular action 
2 
Pericarditis 
1 
Aneurism of ascending aorta 
10 
2 
Fatty and calcareous degeneration of heart and arteries 
1 
1 
Aneurism of arch of aorta 
5 
3 
Aneurism of carotid 
1 
Aneurism of descending aorta 
1 
Aneurism of abdominal aorta 
4 
1 
Valvular disease of heart and aneurism 
1 
1 
Total diseases of heart and blood-vessels - 
91 
36 
The following cases, relating to the Heart and Blood-vessels, are 
recorded, in addition to those presented by the author in 1876 : 
Case 817.-Congenital Misplacement of Heart; Heart on Right Side. 
Charles H. Crats, age 37, native of New York; has resided in Louisiana 20 
years; carpenter; married; has two children; parents strong and healthy. 
Admitted November 20th, 1884. Complained of bronchial irritation, accompa- 
nied with occasional attacks of asthma. 
Physical Examination : Sternum prominent-"chicken breasted." No per- 
ceptible difference in size between the right and left sides of the thorax ; muscles 
moderately well developed--no fullness of abdomen. Upon commencing ausculta- 
tion on the left side over the region of the heart, the sounds of this organ were 
entirely absent, notwithstanding that the pulse was full and regular in both the 
left and right radial arteries, the number of beats being 72 per minute. The left 
lung was resonant, and with the exception of some sibilant and sonorous rales, 
nothing abnormal was present; there was no solidification of the left lung, no 
accumulation of water, and no effusion of air into the pleural cavity. The heart had 
not been displaced either by hydro-thorax, or pneumo-thorax, or hydro-pneumo- 
thorax. Upon examination of the right side, the lung was in like manner with the 
left, resonant and free from any solidification, and the right plural cavity was free 
from any effusion of water, pus or air, or any combination of liquid and air. 
The heart was found to occupy a position on the right side corresponding to its 
usual place on the left side, namely : of a triangular figure, the base above the apex 
below, heart situated obliquely, downward, forward and towards the right costal 
cartilage. Its axis might be represented by a line passing from the cartilage of the 
second rib, obliquely, downward and forward, and towards the right costal cartilage, 
or the interval between the fifth and sixth, occupying a space corresponding to the 
left margin of the sternum, the whole width of that bone and the cartilages of the 
third, fourth and fifth ribs of the right side in front, and the borders of the fifth, 
sixth and seventh dorsal vertebrae posteriorly. The first and second sounds of the 
heart were clear and distinct, and differed in no manner from those of sound hearts, 
with the exception of their location on the right side. Percussion and ausculta- 
tion showed that the heart was normal in size and action; the base upwards, 
backwards, on the left; the apex forwards and to the right, and the impulse 
corresponding to the interspace between the fifth and sixth ribs, an inch to the 
right of the right nipple. 32 
Aneurism of Arch of Aorta. 
Case 818.-Aneurism of Ascending Aorta and Arch of the Aorta, and of the In- 
nominate and right Carotid Artery; Progressive Growth of the Aneurism, 
causing absorption of right superior portion of the Sternum, and the sternal 
portion of right Clavicle, also of Sternal Extremities of First and Second 
Ribs; Death caused by suffocation resulting from pressure of the Aneurismal 
Tumor on the trachea and bronchial tubes. 
William F. Prescott, white, aged 54, native of New Orleans, La., mechanical 
engineer by trade; admitted into Ward 18, Charity Hospital, November 25th, 1885, 
1 examined the patient for the first time upon the day of his admission, in the 
ampitheatre, in presence of the medical class, with the following results: Patient 
temperate in his habits; no hereditary tendencies; never had syphilis; active, 
industrious, mechanical engineer; always enjoyed good health until the year 1884. 
In the Kall of 1884, while working at theCotton Centennial and World's Indus- 
trial Exposition of New Orleans, and exerting all his strength in lifting heavy 
pieces of iron, suddenly felt something give way in the upper part of his chest, 
followed by severe pain. The pain was so intense, and the feeling of weakness 
and prostration so great, that he was compelled to leave work almost immediately. 
Was unable to use his right arm on account of pain in the right side of the chest, 
and on this account, as well as a feeling of weakness, was unable to resume work. 
Gradually he experienced difficulty of breathing, attended with a troublesome 
cough. In the month of September, 1885, applied to one of the attending physicians 
for treatment; says that upon auscultation and percussion, he was pronounced 
sound as to his heart, and the cough was referred to bronchial irritation. No 
relief was experienced from the treatment instituted, and he left the hospital. 
The difficulty of breathing, the cough, and the nervous and muscular debility 
increasing, he again returned to the Charity Hospital. 
On the 25th of November, 1885, critical examination revealed the following 
facts: Robust, hardy looking man; well developed muscles; clear, florid complexion; 
full head of dark hair; full beard; anxious, distressed countenance; loud and 
difficult breathing ; every effort, especially that of talking, increases the difficulty 
of respiration ; respiratory sounds croupy and stridulous; right pulse weaker than 
the left; auscultation and percussion revealed neither tubercular deposit nor bron- 
chial inflammation. The difficulty of breathing appears to be caused by a purely 
mechanical cause; aneurismal bruit distinctly heard in the super sternal and right 
interclavicular regions and right superior mammary region. The aneurismal 
bruit was heard loudest in the first and second costal and intercostal regions or 
spaces, at the sternal extremities, and on the right superior sternal region. The 
aneurismal thrill could be distinctly perceived when the hand was placed upon 
the thoracic walls. A distinct pulsation could be observed in the sternal notch. 
The dilated arch of the aortic wall, with its pulsations, could be distinctly felt 
by the hand in the notch of the sternum ; it was also evident that the innominate 
artery was dilated ; was compelled to bend his body, neck and. head frequently so 
as to get some relief from the distress in breathing and from the harassing cough. 
When he attempted to bend the neck back and throw his head upwards and back 
wards, the pain in the upper portion of the chest, and the difficulty in breathing 
was greatly increased. In this position, with his neck thrown back, the patient 
felt as if ''something heavy and painful was drawing against his efforts, inside of 
his chest, and as if he wMid strangle to death;" his respirations became loud, 
stridulous, and asthmatic and labored, and his voice tremulous, irregular and 
hoarse; experiences some difficulty in swallowing food; has no oedema of the 
extremities, or any derangement of bowels; appetite good. Great pain along 
course of nerves in right arm, which he cannot raise above the level of the clavicle; 
movements of the right arm cause pain, and a sense of constriction about the 
throat and upper portion of the chest. 
The diagnosis was at once announced to the class : Aneurism of the superior 
portion of the aorta, Uncludiny the arch and embracing also the innominate artery, 
The cough and difficulty of breathing were referred to the mechanical pressure of 
the aneurismal tumor. The patient was put upon tincture of digitalis, 10 drops, 
three times a day, to control the action of the heart. As an expectorant and seda- 
tive the following was administered : R. Syrupi morphias: syiupi sciila: syrupi 
tolutani aa, f 5 ii. Powdered extract of glycyrrhiza, ^iv. Mix: Teaspoonful 
every three or four hours. Ten grains each of the bromide and iodide of potassium 
ANEURISM OF ARCH OF AORTA. Aneurism of Arch of Aorta. 
33 
were also administered at intervals of eight hours. These measures gave temporary, 
but not permanent, relief. The tumor steadily increased, pressing forward it caused 
the gradual erosion and absorption of the right superior portion of the sternum 
the right sternal extremity of the clavicle, and the sternal extremities of the first 
and second right ribs. 
The sufferings of the patient were exceedingly great during these changes, and 
to ease the pain, one grain of opium was administered at regular intervals of from 
six to twelve hours. A solution of acetate of lead and tincture of opium was 
also applied over the region of the pulsating tumor. When the nervous excite- 
ment was extreme, chloral hydrate was used to promote sleep at night. When 
the aneurismal tumor had been measurably relieved from its confinement by 
the destruction of, the bony walls of the thorax, which temporarily barred its on- 
ward progress anteriorly, the patient experienced a great relief from pain. He could 
lift his right hand to his head and throw his neck back. Such was the relief experi- 
enced that he expressed hopes of soon going out to work. The removal to a partial 
degree of the pressure of the aneurismal tumor from the bronchi was followed by 
a great relief of the difficulty of breathing. This relief, however, was only tempo- 
rary, as the tumor continued to increase both internally and externally, attaining 
on the surface a diameter of about three and one-half inches, and an elevation 
in the centre of about three-fourths of an inch above the surface of the thorax. 
During the night of March 9th, 1886, the patient was seized with great difficulty 
in breathing; the face became congested and cyanosed. The House Surgeon directed 
the resident student to inject tincture of digitalis subcutaneously, and to administer 
sulphuric ether by inhalation. These measures produced no favorable results, and 
the patient died of asphyxia at 2 o'clock, A. M. 
The autopsy revealed the accuracy of the diagnosis. A large aneurismal 
tumor involving the ascending aorta, the arch, superior portion of the descending 
aorta and the innominate and lower portion of the right carotid artery had 
caused the erosion of the sternum clavicle and first and second ribs. The tumor 
was filled with dark, coagulated and fibrous concretions, and extended backwards 
to the spinal column and compressed the bronchial tubes. There had been no 
rupture of the tumor, and the patient died from asphyxia, produced by mechanical 
occlusion of the bronchial tubes. It is worthy of note that this case was under daily 
observation, from November 25th, 1885, to the date of death, March 9th, 1886, and 
the gradual erosion of the bones of the thorax constituting its anterior boundary, 
and the progressive increase of the tumor was carefully noted. The patient was 
under treatment for 104 days, and during this period the erosion of the sternum 
clavicle and ribs was accomplished. The cause of this aneurism appears clearly 
to have been mechanical-the result of violent muscular exertion. 
As far as my experience extends, the progress and growth of aneurismal tumors, 
especially those of the aorta, vary within wide limits; and I have preserved a large 
number of specimens taken from the patients treated, illustrating the various 
anatomical and pathological lesions resulting from the growth and pressure of the 
tumors. If the growth is chiefly forwards, the sternum and ribs give way ; if the 
growth and pressure are greatest in a posterior direction, the vertebral column 
may be eroded, and even the spinal cord be laid bare and incorporated with the 
aneurisn^al walls. 
Several cases, similar in most respects to the one just recorded, resulting in com- 
plete erosion of the bony walls of the thorax and the liberation of the surface of 
the tumor anteriorly, have within the past twelve years, occurred in my private 
practice. I have also observed cases in which the progress of the aneurism was 
very slow and almost imperceptible during comparatively long periods, as in the 
following case: 
Case 819.-Aneurism of Arch of Aorta, Innominate and Right and Left Sub- 
clavian Arteries; Slow Progress of the Aneurism ; Death of Patient by 
Obstruction of the Vena Cava Ascendens. 
Henry Eyjers, age 50 ; ward 18, bed 199; native of Germany. Admitted into 
ward 13, November 5th, 1877. Patient was brought from the railroad, with high 
fever and in a comatose condition. His disease had been contracted in the swamps, 
and presented the character of pernicious malarial fever. Calomel and sulphate 
of quinia, 10 grains of each, were administered internally; a blister, 4x8 inches, 
applied to the back of the neck, and the extremities covered with sinapisms. 
The calomel and quinia were repeated until the bowels were fully moved. The 
patient lay in a comatose condition for about 72 hours, passing his excrements 
and urine in the bed. 34 
Aneurism of Arch of Aorta. 
Upon the return of consciousness, it was found that the left arm and leg were 
paralyzed. A large bed sore had formed over the sacral region. The paralysis 
confined the patient to his bed. Under the use of strychnia, electricity and tonics, 
the patient recovered in a measure his strength, and was able to get out of bed. 
The left arm and leg, however, were stiff, and in walking, the left arm hung like 
a useless appendage, incapable of performing any useful office, and the left leg 
was stiff and was dragged along mechanically in walking ; the right leg perform- 
ing the entire labor. The temperature of the left arm and leg was considerably 
lower than that of the right arm and leg. When both hands were held at the 
same time, the left paralyzed hand felt cold and clammy. The case was used 
before the medical class on various occasions, to illustrate the relation of nerve force 
to the production of animal heat. The patient was restored to a full measure of 
health ; good appetite, good digestion, cheerful spirits and active habits, with the 
exception of the paralysis of the left side, arm and leg. The left arm and leg 
slowly but steadily decreased in size, whilst the muscles of the right arm and leg 
maintained their fullness and vigor. 
A careful and critical examination of this patient in October, 1878, about 
eleven months after his entrance into the hospital, revealed the existence of an 
aneurism of the arch of the aorta, and great dilatation of the innominate and 
right and left carotids. 
The patient was confined to the ward; ordered to avoid all excessive fatigue, 
and treated with the iodides and bromides of potassium. During the years 1879 
and 1880, a very slow increase of the aneurisms was observed; then they appeared 
to be stationary during the years 1881. 1882, 1883 and 1884. The patient was upon 
several occasions presented to the medical class, and was also used as an illustra- 
tion of the physical signs of aneurism in the daily bedside clinical lectures. The 
patient ate heartily, and went around the ward and in the halls and grounds 
of the hospital, and even acted as nurse. 
The patient continued in his usual health until October, about two months 
before his death, when he began to feel weak, and could not move about with his 
accustomed ease. His feet and hands became cedematous. The swelling gradually 
spread to his face, head and neck, and he was compelled to lie all the time in his 
bed. The urine was carefully examined, but it presented a normal appearance and 
composition, and no albumen and no casts were found. The face became so swollen 
by the serous effusion in the cellular tissue that the eyes were closed and he could 
not see. His intellect, however, continued clear, and his voice strong, and 
appetite good. The oedema of the entire body and extremities and face continued 
to increase to a remarkable extent, and a few days before his death the patient 
became unconscious. The swelling of the patient was attributed to the obstruc- 
tion of the venous circulation by the pressure of the aneurism upon the vena 
cava. 
Post-mortem: Body and extremities pale and cedematous; left leg more 
swollen than the right. Abdominal cavity: Small amount of serous fluid in 
abdominal cavity ; spleen of normal size; capsule thickened and adhering to the 
diaphraghm; liver and kidneys congested, but nothing abnormal observed when 
sections were made of these organs. The bladder contained about half a pint of 
clear, healthy urine. The urine was free from albumen and casts. Thoracic 
cavity: Pericardium filled with fluid. Heart enlarged, with dilated cavities. 
Valves atheromatous. The aorta and large arteries generally presented evidences of 
atheromatous degeneration with calcareous deposits. The ascending arch and supe- 
rior portion of descending aorta greatly dilated, constituting an aneurismal pouch 
or tumor, which pressed upon and interrupted the flow of venous blood through 
the vena cava. The innominate and carotid arteries dilated. Pulmonary cavities 
contained much fluid. Lungs normal. Head: Vessels of dura-mater atheroma- 
tous. Considerable amounts of fluid in arachnoidal cavity. Many of the vessels 
of the brain presented marks of atheromatous degeneration. Weight of brain 
39 ounces. The seat of former haemorrhages were indicated by two yellow spots 
on surface of brain. Extensive lesions were observed on right side of brain 
external to corpus striatum, extending back into occipital convolutions. Dark 
brown, firm and gritty tissue form the borders of the ventricle near right side of 
posterior horn. 
It will be noted that the left arm and leg were the seat of paralysis, and dis- 
turbed nutrition and calorification. In the preceding case a serious- aneurism 
existed for more than six years; and seven years after his first " stroke of paral- 
ysis" it was possible to detect profound lesions in the right side of his brain 
sufficient to account for the loss of muscular and nervous power in the left side. Diseases of Absorbent and Respiratory Systems and Alimentary Canal. 
35 
Case 820.-Aneurism of Superior Portion of Arch and Descending portion of 
the Aorta; Compression of Trachea and Oesophagus; Difficulty of Swallow- 
ing and Breathing; Death from Apnoea. 
Joseph Domingue, age 68, native of Palermo, Sicily; has been in Louisiana 
about 40 years; marketman.; entered ward 15, November 21st, 1881; habits intem- 
perate ; was in Texas about eight months ago, when he first noticed some trouble 
with the throat and.difficulty of breathing. 
Condition on entering the hospital: Great prostration of strength; difficulty 
of breathing; difficulty of swallowing even small quantities of fluid. Patient 
referred the difficulty of swallowing to sore throat; careful examination of the 
mouth, fauces and upper portion of the larynx, reveals no inflammation or irrita- 
tion of these parts. Auscultation reveals the existence of a murmur synchronus, 
with the contraction of the ventricles, also a loud aneurismal bruit at the base of 
the heart and along the course of the aorta. The pulsations of the dilated arch of 
the aorta can be distinctly seen and felt in the notch of the sternum. The innom- 
inate carotid, subclavian and brachial arteries, dilated ; radial artery, so much 
ossified that the pulse at the wrist is felt with great difficulty. Digitalis afforded 
only temporary relief; efforts to sustain life by nutritive enema were only par- 
tially successful, and seemed only to prolong life. The patient grew worse and 
worse; only a few drops of liquid could be occasionally swallowed; the voice 
was lost, breathing became labored and difficult, and the patient died on the 18th 
of December, from apnoea. Post-mortem revealed the dilatation and calcareous 
degeneration of ascending arch and upper portion of the descending aorta. There 
was calcareous degeneration also of the mitral and aortic semi-lunar valves. The 
trachea and oesophagus were pressed by the aortic tumor forming against the 
vertebral column, so as completely to prevent the entrance of air or nutritive 
fluids. 
DISEASES OF ABSORBENT SYSTEM. 
Non-syphilitic bubo, case 1; scrofulous disease of glands, case 1; 
disease of renal capsules (Addison's disease), case 1. Death, 1. . 
Total diseases of absorbent system-cases, 3; deaths, 1. 
Cases. 
Deaths. 
Bronchitis 
IGO 
4 
Vesicular emphysema ... 
1 
Asthma 
49 
3 
Grangrene of Lungs 
1 
1 
Pneumonia 
152 
32 
Pneumonia (double) 
41 
21 
Pleuro-pneumonia 
16 
6 
Pleuro-pneumonia (double) 
supervening on malarial 
fever 
4 
4 
DISEASES OF THE RESPIRATORY SYSTEM. 
Cases. 
Pleuro-pneumonia superven- 
Deaths. 
ing on phthisis 
2 
2 
Abscess of lungs 
2 
1 
Laryngitis (acute) 
.... 7 
2 
Pleuritis ■ 
.... 47 
3 
Hydrothorax 
.... 6 
1 
Pneu mo-thorax 
.... 2 
1 
Hydro-pneu mo-thorax 
.... 3 
1 
■ -» 
Total diseases of respiratory 
system..... 
.... 493 
82 
DISEASES OF ALIMENTARY CANAL. 
Cases. Deaths. 
Cases. 
Deaths. 
Inflammation of 
fauces and 
Dysentery (chronic) 
90 
42 
palate 
1 
Diarrhoea (acute) 
160 
7 
Ptyalism 
1 
Diarrhoea (chronic) 
125 
25 
Tonsillitis 
, 6 
Dysentery and diarrhoea 
Pharyngitis 
3 
(chronic) 
131 
30 
Trachitis 
4 
Constipation 
5 
Dyspepsia 
4 
Hernia 
6 
... 
Gastritis 
10 
Obstruction of the bowels 
2 
2 
Gastralgia 
1 
Haemorrhoids 
8 
Gastro-enteritisand jaundice 2 
Fistula in ano 
2 
Gastro-enteritis... 
5 
Prolapsus of anus 
1 
Cholera morbus... 
10 
Abscess of rectum 
1 
Enteritis 
7 
Cancer of rectum 
1 
Dysentery (acute) 
122 
17 
Peritonitis 
1 
Total diseases of the alimentary canal 
709 
123 36 
Acute Dysentery. Diseases of the Liver. 
It will be observed that in the class of diseases of the alimentary canal 
acute diarrhoea and acute dysentery occasioned 282 cases, with 24 deaths, 
and chronic diarrhoea and dysentery occasioned 346 cases and 97 deaths ; 
the mortality being relatively greater in the chronic than in the acute forms 
of these diseases. 
Many of these cases were brought in wretched condition from the 
swamps along the railroads, and from the rice fields above and below New 
Orleans, on the banks of the Mississippi and its tributaries, and were com- 
plicated by the action of the malarial poison. 
Many cases of dysentery were subjected to careful clinical study, and 
post-mortem examinations were frequently made in fatal cases. The more 
important lessons were : 
1. Inflammatory thickening and ulceration of the mucous membrane 
of the colon and rectum. 
2. The transudation of blood and gelatinous, fibrinous and bloody 
exudation from the ulcerated surfaces. 
3. The co-existence and pre-existence of abscesses of the liver. 
4. The co existence and pre-existence of hepatitis. 
5. The co-existence of the characteristic lesions of malarial fever, 
such as enlarged pigmented liver and spleen and watery blood. 
The persistence of many cases of dysentery, as well as the oft-recur- 
ring relapses in the chronic stage of the disease, must be referred mainly to 
the existence of ulcerations of the mucous membrane of the colon find rectum. 
As long as one or more ulcers remain unhealed, any imprudence of 
diet, as well as exposure to cold and wet, and excessive fatigue, may light 
up the disease and excite severe symptoms. This proposition might be 
illustrated by numerous cases, but we select the following from the clinical 
record : 
Case 821.-Acute Dysentery ; Death; Thickening and Ulceration of Large 
Intestine; Multiple Abscesses of Liver. 
Morgan Heard, native of Tennessee, age 42 years, barkeeper; entered ward 16, 
Charity Hospital. November 1, 1883, suffering with severe pain in abdomen and 
violent tormina and tenesmus, fever, great prostration, frequent offensive evacua- 
tions from the bowels, consisting of blood, thick bloody mucous and thick fibrin- 
ous and gelatinous matters. Patient states that he has suffered with dysentery 
and diarrhoea during the past month ; complains of severe paroxysmal pains in 
the right hypochondriac region, the paroxysms numbering from eight to ten 
during the day, each severe paroxysm of pain in this region, being followed by 
great prostration and colliquative sweats. Sulphate of morphia, combined with 
subnitrate of bismuth, gave temporary relief, but the patient gradually lost flesh 
and strength, and died November 7, 1886. 
Post-mortem: Brain and spinal cord, heart and lungs healthy. Abdominal 
cavity: Mucous membrane of colon and rectum greatly congested, thickened 
and ulcerated. Lower portion of ilium also greatly congested and thickened. 
No special changes observed in the solitary and peyers glands. The ulcerated 
and adjacent parts of the thickened intestinal raucous membrane were covered 
with a thick, tenacious, fibrous, semi-transparent, and in places bloody exudation. 
The right lobe of the liver was considerably enlarged, and contained several cir- 
cumscribed abscesses, containing from half a fluid ounce to one fluid ounce of pus. 
DISEASES OF THE LIVER. 
Cases. 
Deaths. 
Hepatitis 
24 
6 
Hepatitis and abscess of 
liver .< 
12 
7 
Cirrhosis of liver, with 
ascites and anasarca of 
lower extremities 
31 
21 
Adenoma and cirrhosis of 
liver 
1 
1 
Jaundice 
10 
Cases. 
Deaths. 
Fatty degeneration of liver 
3 
Amyloid degeneration of 
liver 
1 
Hydatids of liver 
1 
i 
Tuberculosis of liver 
1 
i 
Obstruction of common 
bile duct and jaundice... 
1 
i 
Total diseases of liver. 
85 
38 Diseases of the Spleen, Kidneys and Bladder. 
37 
DISEASES OF THE SPLEEN. 
Cases. Deaths. 
Splenitis 
2 
Hypertrophy of spleen... 
1 
Cases. 
Deaths. 
Leucocythsemia 
1 
1 
Total diseases of spleen. 
4 
1 
The following facts should be noted with reference to the preceding 
classification of the diseases of the liver and spleen. 
The cases recorded as jaundice did not express the number of cases 
presenting this symptom, for almost every case of yellow fever, and a large 
number of the various forms of malarial fever, as well as some cases of 
hepatitis, cirrhosis and pneumonia, were jaundiced. Every case of pro- 
longed malarial fever presented more or les^ hepatic derangement and 
enlargement of the spleen, but the secondary derangements were included 
under the head of original malarious diseases. 
Cases. 
Deaths. 
Bright's diseaseof the kid- 
neys 
80 
24 
Acute nephritis 
2 
1 
Diabetes mellitus 
3 
1 
Diabetes insipidus 
2 
DISEASES OF THE KIDNEYS. 
Renal calculus 
Cases. 
1 
Deaths. 
Total diseases 
of the 
kidneys 
88 
26 
DISEASES OF THE BLADDER AND MALE ORGANS OF GENERATION. 
Cases. Deaths, 
Cystitis 
6 
Enlarged prostate 
1 
Stricture 
; 9 
Urinary fistula 
i . ... 
Vesico-rectal fistula.. 
i 
Gonorrhoea 
25. 
Haemorrhage from 
ure- 
thra 
1 
Varicocele 
4 
Cancer of the penis.. 
1 
Cases. Deaths. 
Phymosis 
g 
Hydrocele 
6 
Orchitis 
10 
Syphilitic enlargement 
and induration of tes- 
ticle 
2 
Total diseases of the 
J 
bladder and male or- 
gans of generation.. 
70 
DISEASES OF FEMALE ORGANS OF GENERATION. 
Gonorrhoea 
Cases. Deaths. 
5 
Prolapsus uteri 
o 
Amenorrhoea 
1 
Metritis 
3 
Abortion 
3 
Vesico-vaginal fistula.... 
1 
Cases. 
Deaths. 
Recto-vaginal fistula 
2 
Fibrous tumor of uterus. , 
2 
i 
Cancer of uterus 
] 
Total diseases 
20 
i 
During the year 1869, I took charge of the female wards, during the 
absence of my friend and colleague, the late Professor Frank Hawthorne, 
and hence these cases of female diseases appear amongst my records. 
DISEASES OF THE ORGANS OF LOCOMOTION. 
Cases. Deaths. 
-Caries and necrosis of 
bones 
6. 
Synovitis 
4 
Caries of spine with cur- 
vatu re.... 
2 
Cases. 
Deaths. 
Psoas and lumbar abscess- 
es 3 
1 
- 
■ ■■ 
Total diseases of or- 
gans of locomotion.. 15 
1 38 
Diseases of the Cutaneous System. Poisons. 
DISEASES OF THE CUTANEOUS SYSTEM. # 
Cases. Deaths. 
Urticaria 
o 
Psoriasis 
5 
Pemphigus 
1 
Scabies 
..... o 
Cases. Deaths. 
Eczema 
2 
Total diseases of 
cu- 
taneous system.. 
15 
Cases. Deaths. 
Conjunctivitis 
1 
Purulent opthalmia 
1 
Gonorrhoea 
2 
Scrofulous opthalmia. .. 
1 
Opacity of cornea 
3 
Syphilitic iritis 
3 
Scrofulous iritis 
2 
DISEASES OF THE EYE, NOSE AND EAR. 
Cases. Deaths. 
Cataracts... 
4 
Blindness 
6 
Ozsena 
1 
Otorrhoea 
1 
Total diseases of the 
eye, nose and ear ... 
25 
Cases. 
Deaths. 
Burns and scalds 
6 
Ulcers 
Amputations of lower ex- 
28 
i 
tremities for ulcers 
Gangrene of both feet (re- 
3 
i 
suit of exposure to cold 
during nights in Louis- 
iana swamp), amputa- 
tion of both feet 
1 
Concussion of brain 
6 
3 
Contusion of head 
1 
Contusion of back 
5 
Contusion of abdomen 
4 
Fractures 
Fracture of femur in old 
5 
age 
1 
1 
INJURIES, ULCERS AND ABSCESSES. 
Cases. 
Deaths. 
Incised wounds 
6 
Dislocations 
2 
Gunshot wounds 
4 
... 
Abscesses of thigh, ear, 
throat and parotid gland 
21 
Abscesses of parotid gland 
and pyaemia 
1 
1 
Abscess of rectum and 
pyaemia 
1 
1 
Cancrum oris 
1 
Total injuries, ulcers 
and abscesses 
96 
8 
POISONS. 
Cases. 
Deaths. 
Lead poisoning 
11 
1 
Opium habit 
7 
Poisoning by carbonic acid 
and carbonic oxidegases 
1 
1 
Cases. Deaths. 
Opium poisoning 
1 
Poisoning by oxalic acid.. 
1 
Total poisons 
21 2 
During the period comprised in the present statistics the author has 
been called upon in private practice to treat a large number of cases of 
poisoning by various agents, and has also been actively engaged in the 
investigation of said cases and their prosecution before the courts of 
justice. He has also illustrated his lectures on Toxicology before the 
medical classes of the Medical Department of the University of Louis- 
iana (now Tulane), with numerous experiments with various poisons upon 
animals. It would be foreign to our present purpose to enter into a 
detailed statement of the results of such labors and demonstrations ; but 
we feel constrained to urge upon the attention of the medical profession 
the great value of fresh milk administered internally in large and frequently 
repeated doses in all cases of irritant poisoning. I have found fresh milk 
of especial value in the treatment of acute arsenical poisoning. 
We will cite three instances illustrating the value of fresh milk in 
large quantities, administered internally in Acute Arsenical Poisoning. 
39 
ACUTE ARSENICAL POISONING. 
1. An entire family, consisting of the father, mother, four children 
and a young man were poisoned by arsenious acid thrown into the boiling- 
pot of soup in the year 1874, in New Orleans. 
The excitation of vomiting and the use of large and repeated doses of 
fresh milk, followed by rest and milk and lime water, resulted in the 
recovery of the six individuals. The young man was the most strongly 
impressed, and suffered with suppression of the urinary excretion for 
about thirty-six hours. The scanty urine excreted at the end of this time 
yielded arsenic by the processes of Reinsch, and also was shown, by 
chemical and microscopical analysis, to contain albumen and granular casts. 
The entire surface of this young man's body was covered with a bright 
scarlet rash (resembling that of scarlatina) during the suppression of 
the action of the kidneys. 
2. About the time of the outbreak of the memorable yellow fever 
epidemic of 1878, I was summoned at night to visit a family residing near 
St. Charles street and Napoleon Avenue, who were said to be suffering 
from symptoms of poison. 
I found the head of the house, a large man about fifty years of age, 
lying dead on the floor of the family parlor. 
His wife, son and four servants were suffering with violent vomiting 
and cramps. Investigation showed that white arsenic, which had been 
purchased to destroy vermin and rats, had been used by accident in the 
place of white sugar, in the preparation of pastry. 
The free use of fresh milk and milk and lime water, resulted in the 
recovery of the remaining victims. 
3. On the 1st of June, 1885, I was summoned early in the morning 
to visit some members of the family of a neighbor, who had been taken 
violently ill after drinking black coffee. 
The patients presented all the characteristic symptoms of acute 
arsenical poisoning, and I found, on examination of the premises, that a 
large quantity of white arsenic (arsenious acid) had been placed in the 
coffee mill and ground up with the coffee. 
I immediately administered large quantities of fresh milk, followed 
by ipecac and warm water. 
Profuse and repeated vomitings were thus excited, and the stomachs 
were washed out with the warm milk and warm infusion of ipecac. As 
soon as the nausea and vomiting had ceased, the bowels were opened with 
castor oil. The patients were then confined to bed and nourished with milk, 
and lime water, three parts of fresh cow's milk to one part of lime water. 
Although these patients suffered extreme agony and were greatly pros- 
trated from the poisonous and irritant effects of the arsenic, they one and 
all recovered. 
The milk dilutes the poison, encloses it in its coagula, sheathes the 
inflamed surface of the mucous membrane, and when the stomach is 
capable of absorption and digestion, forms an element of the greatest value. 
CONDITIONS NOT NECESSARILY ASSOCIATED WITH LOCAL OR GENERAL 
DISEASES. 
Cases. Deaths. 
Parturition 
16 1 
Hypochondriasis ?... 
8 
Old age, senile debility (many of the fatal cases were 
attended with 
ossification and degeneration of blood-vessels and 
failure of the 
heart and brain and lungs) 
65 13 
Total diseases 
89 14 40 
Parasites. 
Cases. Deaths. 
Ttenia solium (tape worm) 
11 
Total parasites 
11 
PARASITES. 
The mode in which we have grouped the different diseases is not free 
from certain objections. Thus, we have classed alcoholism (delirium tre- 
mens and mania a potu) under the head of nervous diseases, whilst the 
effects of alcohol may, with almost equal propriety, be classed under the 
head of poisons. As the habitual use and abuse of alcoholic stimulants 
leads to fatty degeneration, hepatic derangements, cirrhosis of the liver 
and kidneys, exhausted nervous and intellectual actions, and other abnor- 
mal conditions, it is evident that alcoholism, delirium tremens and mania 
a potu might also, with equal propriety, be classed with general diseases. 
Nevertheless, as the most prominent symptoms caused by the exces- 
sive use of alcohol, in patients transferred from the streets and crowded 
habitations of the poor, to the crowded wards of the hospital, are referable 
to the nervous system, such as mild delirium, sleeplessness, muscular and 
nervous agitation, it is evident that for all practical purposes those suffer- 
ing from the effects of alcohol may be classed as in the preceding consoli- 
dated statements. 
The preceding facts are significant, showing that alcohol does not 
destroy its victims, in most cases, suddenly, as in the dead sleep of profound 
intoxication, or in the wild maniacal ravings of delirium tremens. By 
slow and measured steps, in most cases, by inducing cirrhosis of the liver, 
Bright's disease of the kidneys, anasarca, ascites, rheumatism, rheumatic 
gout, defective vision, fatty degeneration of heart, arteries and muscular 
system, which finally end in paralysis, imbecility and insanity; alcohol 
involves its victims in irremediable and everlasting ruin. 
Without doubt alcohol occasions a vast amount of disease over the 
face of this mighty Republic, and carries death, destruction, dishonor and 
shame into thousands of happy homes. Alcohol is at the bottom of a large 
proportion of the crimes committed in the United States. Alcohol 
dethrones reason and poisons the fountains of sentiment and morals, and 
is even more destructive upon the moral and intellectual nature than 
upon the physical organism of man. 
We must not suppose that the effects of alcohol are discernible only 
in the drivelling idiotic drunkard, and the physically and morally rotten 
and abandoned wretches who crowd our bar-rooms, jails and brothels; 
but they are seen on every hand, in the dropsical, paralyzed, demented 
inmates of our hospitals and almshouses, and in those suffering with 
various diseases of the kidney and liver, in high life as well as in low 
places. 
The constitutions of the wealthy and successful in any walk of life, 
whether professional or mercantile, maybe as slowly and effectually under- 
mined by the habitual use and abuse of alcoholic stimulants as that of the 
day-laborers working in the sewers of our streets or in the bogs of our 
swamps. 
The paralysis produced by the prolonged action of lead upon the 
nervous system might be classed with nervous diseases; whilst the acute 
form of colica pictonum would find a place under the head of poisons. 
If a comparison be instituted between the rate of mortality in these 
cases under the immediate care of the author, and the general statistics of 
the Charity Hospital, we obtain the following data which he has consoli- 
dated at the expense of much time and labor. Clinical Instruction. 
41 
During eighteen years preceding the civil war (1842-1861), the total 
admissions into the Charity Hospital of New Orleans were 207,356, total 
deaths, 29,614; per cent, of deaths, 14.2. 
During sixteen years following the civil war (1864-1881), total admis- 
sions, 96,857; total deaths, 14,104; per cent., 14.5. 
Total admissions during thirty-four years, 304,213; total deaths, 
43,718; per cent, of deaths in the Charity Hospital of New Orleans during 
the thirty-four year's specified, 14.3. 
The greater proportion of the cases of fever, and of all other diseases 
treated by the author in the Charity Hospital during the period specified 
(1869-1886), were natives of foreign countries and surrounding States. 
Many had resided in Louisiana only a short time, not exceeding one year 
in the United States, whilst many were brought directly to the wards of 
the hospital from the swamps and rice-fields of the delta of the Mississippi 
river, within a mouth after their arrival from Europe. Upon a careful 
examination and classification of the statistics of the Charity Hospital of 
New Orleans, during the period of forty years-1836-1876-we found that 
310,659 patients were admitted; and of this number, 248,011 were foreign- 
ers; 54,403 natives of the United States, outside of Louisiana, and only 
11,761 were natives of Louisiana. 
During the entire period of the Hospital Service of the author, similar 
relations with reference to nativity existed amongst the patients under his 
care and treatment. During a term of service extending from October 
1st. 1884, to April 1st, 1885, of a grand, total of 547 cases treated by the 
author in the Charily Hospital, only 42 were natives of Louisiana, and 
of these only 18 were natives-of New Orleans, the remaining 24 having 
been born in the various parishes of Louisiana. Of the 63 deaths occur- 
ring during this period, only two were natives of New Orleans, and the 
cause of death was the same in both-namely, phthisis pulmonalis. Among 
the 24 natives ot the other parishes of Louisiana, four deaths occurred by 
the following causes : chronic Bright's disease, chronic dysentery, perni- 
cious malarial fever, malarial toxaemia, or cachexia of Jong standing, with 
enlarged spleen, anaemia and general anasarca. The natives of Louisiana 
constituted only 7.6 per cent, of all cases treated, and the mortality 9.2 
per cent, of the deaths from all causes. During a term of Hospital Service 
extending from October 1st, 1885, to April 1st, 1886, of a grand total of 323 
cases of all diseases treated by the author, 11 were natives of New 
Orleans, and 60 of the parishes outside of the limits of the parish of 
Orleans. The foreigners and natives of other States of the Union num- 
bered 252. 
The labor and responsibility involved in the gratuitous medical service 
rendered to 6311 cases treated in the Charity Hospital during the period 
specified from January, 1869, to Anril 1st, 1886, was considerable, and was 
only equalled* if not excelled, by that of the practical instruction of the 
medical students, by the bedside of the patients, in the wards of the Charity 
Hospital, under the care of the author. 
The number of clinical bedside and ampitheatre lectures was about 100 
during each term of service ; amounting during the 18 years, 1869-1886, to 
1800 lectures. Post-mortem examinations were made on the most impor- 
tant cases and clinical records preserved; and chemical analyses and 
miscroscopic investigations conducted in the laboratory. 
In this manner the effort was made to make the medical service in the 
Charity Hospital of New Orleans, serve the triple purpose of relieving and 
CLINICAL INSTRUCTION. 42 
Private Practice. Relative Mortality in the White and Negro Races. 
healing the sick and destitute poor; of practical bedside, clinical, chemical, 
microscopical, and pathological instruction to medical students; and the 
advancement of medical science by original pathological, chemical, micro- 
scopical, and therapeutical investigations. 
The establishment in 1870 of a practical laboratory by the author for 
the study of chemistry, microscopy, toxicology and pharmacy, has resulted 
in a material advancement of the knowledge of these sciences amongst the 
students.of medicine and pharmacy in the medical ^department of the 
University of Louisiana (now Tulane). 
Previous to the establishment of the course of practical instruction, 
the entire number of graduates in pharmacy, in the medical department of 
the University of Louisiana (now Tulane), during a period of 34 years, 
1836-1870, did not exceed 24; whilst during a period of 16 years, 1870-1886, 
the graduates in pharmacy have exceeded 150. 
Each year we have been tendered assurances from the medical profes- 
sion of Louisiana, Texas, Alabama and Mississippi, as to the value of this 
practical instruction. 
PRIVATE PRACTICE. 
The preceding statistics are practical observations relating exclusively 
to the gratuitous service rendered the State of Louisiana by the author in 
his capacity of Visiting Physician of the Charity Hospital of New Orleans; 
the cases treated in private practice have been more numerous ; a large 
number of out door patients have also been attended by the author in his 
wards in the Charity Hospital. The private patients, as well as the charity 
out door patients, found no place upon the hospital records, the results of 
which have been tabulated and recorded. 
Whenever the cases treated in private practice were of sufficient 
interest, and when the necessary time could be commanded, careful inves- 
tigations into the changes of the temperature, blood, urine and organs 
were instituted, and records preserved. Thus, during the epidemic yellow 
fever of 1878, the author made careful records of about 256 cases of yellow 
fever, which will find an appropriate and full notice under those portions 
of this volume which relate to this disease. 
RELATIVE MORTALITY IN THE WHITE AND NEGRO RACES IN 
NEW ORLEANS. 
The statistics which the author has preserved, illustrating the general 
results of his medical practice in the Charity Hospital of New Orleans, 
relate almost exclusively to the white race; the occasional presence of 
Chinese, Japanese, Malays, Arabs, and Whites slightly tainted with Negro 
blood, in his wards, could not afford sufficient material for consideration, 
as far as the diseases and mortality of different races were concerned. 
Preceding the civil war, the number of colored people tfeated in the 
Charity Hospital was comparatively small ; but since the emacipation of 
the Negro slaves, the number of Negroes applying annually to be treated 
in this institution has increased. 
It is well known that the colored race form a larger proportion of the 
population of New Orleans than of any other American city ; and at the 
same time, it has been established that the death rate of the colored popu- 
lation exceeds that of the whites in American cities. 
I have prepared the following table, illustrating the mortality of New 
Orleans for a series of years, giving the death rate for white and colored. Mortality of New Orleans. Death Rate per 1000 Inhabitants. 
43 
MORTALITY OF NEW ORLEANS, LOUISIANA. DEATH RATE PER 1000 
INHABITANTS PER ANNUM. 
Year. 
Whites. 
Colored. 
Total. 
Year. 
Whites. 
Colored. 
Total. 
1845 
... 25.10 
22.50 
24.32 
1867 
... 56.79 
47.80 
54.69 
1847 
37.08 
62.03 
1868 
... 25.49 
38.97 
28.60 
1849 
... 81.92 
62.91 
77.44 
1869 
.... 27.29 
44.80 
31.75 
1850 
... 63.08 
52.10 
59.38 
1870 
- 33.74 
52.20 
38.61 
1852 
.... 67 91 
43.04 
62.90 
1871 
.... 27.26 
42.76 
31.32 
1853 
.... 124.68 
48.98 
110.09 
1872 
.... 27.29 
41.93 
31.17 
1856 
.... 32.98 
35.66 
33.89 
1873 
.... 32.79 
51.42 
37.73 
1857 
.... 34.86 
38.07 
35.49 
1874 
.... 29.53 
43.44 
33.75 
1858 
.... 69.64 
80.37 
72 70 
1875 
.... 26.28 
40.25 
30.00 
1859 
.... 33.58 
86.78 
41.53 
1876 
.... 25.S7 
4'2.50 
30.31 
1860 
.... 41.99 
52.79 
43.51 
1877. ... 
.... 25.96 
49.02 
32.11 
1861 
.... 31.58 
37.16 
31.87 
1878 
39.94 
48.81 
1863 
.... 37.30 
59.53 
41.35 
1879 
.... 20.85 
32.41 
23.95 
1864 
.... 42.14 
81.75 
49.86 
1880 
.... 22.96 
34.38 
26.01 
1865 
.... 33.32 
60.88 
38.99 
1881 
.... 25.79 
38.95 
29.31 
1866 
.... 36.77 
65.56 
42.52 
1882 
.... 21.89 
39.03 
26.45 
During the period of thirty-two years embraced in the above table, 
with the exception of the year 1879, the death rate amongst the whites 
was the lowest in 1882. The average death rate for the thirty-two years 
amongst the whites was about 39.6; and for the colored people about 47.1. 
We observe a marked diminution of the death rate amongst the whites 
during the past four years, which ranged from 20.85 to 25.79 per 1000 
inhabitants per annum. 
These figures (1879-1882) will compare favorably with those of other 
cities in which the vast proportion of inhabitants belong to the white race. 
Thus, during the same years, (namely, 1879, 1880, 1881 and 1882) 
the death rate in Boston ranged between 20 38 and 23.53; New York, 
25.82 to 31.08; Brooklyn, 21.09 to 24.84; Philadelphia, 17.17 to 22.62; 
Pittsburg, 19.49 to 27.23; St. Louis, 18.01 to 22.07; Chicago, 18.01 to 25.69. 
When it is considered that New Orleans receives a vast number of sick 
whites from all the States tributary to the Mississippi river, in her great 
and noble Charity Hospital, as I have shown by the statistics recorded in 
this paper, and also by the elaborate and extended statistics which the 
author published in his Annual Reports as President of the Board of 
Health of the State of Louisiana, 1880. 1881, 1882 and 1883; and when it is 
still further noticed that the deaths of these strangers and aliens are 
recorded to the credit of New Orleans, it is evident that the mortality rate 
amongst her white inhabitants will compare favorably with that of any 
American city. Of course, we exclude from this statement the ravages of 
foreign pestilence, and more especially of Asiatic cholera and yellow fever. 
The results of the rigid system of quarantine, and of domestic and 
maritime disinfection and sanitation established and conducted during the 
four years in which the author held the position of President of the Board 
of Health of the State of Louisiana (1880,1881, 1882 and 1883), lead us to 
hope that foreign pestilence may be forever excluded from the Valley of 
the Mississippi. 
MODE OF INVESTIGATING THE ORIGIN, NATURE AND EFFECTS OF MALARIA. 
The subject of malaria, that is, the discussion of its origin and nature, is 
difficult and intricate; and being stripped of all unnecessary hypotheses, its 
investigation should embrace the following essential subjects : 44 
Relation of Malaria to Climate, Soil and Waters. 
FIRST : RELATION OF MALARIA TO CLIMATE, SOIL AND WATERS. . 
By climate, should be embraced everything which relates to the physics, 
chemistry, flora and fauna of the atmosphere. 
By soil and water, should be embraced everything relating to the 
physical and chemical constitution, and climatic and topographical rela- 
tions of the soilsand waters generating malaria, and the organic and inor- 
ganic constituents and impurities, and the living flora and fauna, and more 
especially the micro-organisms of the soil and waters of malarial districts. 
Climate : 
(a.) Elevation above sea level. 
(b.) Geographical position on surface of globe. 
(c.) Physical and geological structure of surface soil-of relations of 
absorption, and relations of heat, and absorption and reten- 
tion of moisture. 
(d.) Relative distribution of land and water. 
(e.) Temperature. 
(f.) Electrical conditions. 
(g.) Moisture. 
(h.) Barometric pressure and changes. 
(i.) Rain fall. 
(j.) Force and direction of winds. 
(k.) Amount and effects of solar radiation. 
(1.) Amount anil effects of the actinic or chemical rays of the sun. 
(m.) Variations of the preceding forces and conditions, in different 
days, months, seasons and years, and the relations of such 
variations to diseases. 
(n.) Amount and nature of the living vegetable and animal organisms 
in the atmosphere. 
(o.) Relations of the origin and propagation of the living micro-organ- 
isms of the atmosphere to its chemical constitution, and to 
the physical forces, heat, light, and electricity. 
(p.) Relations of the micro organisms of the atmosphere to the soil and 
waters. 
(q.) Relations of the micro-organisms of the atmosphere to the origin 
and propagation of disease. 
(r.) Variations of the proportions of oxygen, ozone, nitrogen, car- 
bonic acid, sulphuretted hydrogen, phosphuretted hydrogen, 
carburet!ed hydrogen, carbonic oxide, ammonia, nitrous and 
nitric acids, albuminoid and nitrogenous matters. 
(s.) Relations of the variations in the chemical constituents and living 
micro-organsms of the atmosphere to the varying conditions 
of heat, moisture, electrical tension, barometric pressure, 
moisture and variations of season due to the revolution of the 
earth on its axis and around the sun. 
(t.) Effects of cosmic agents. 
(n.) Effects of telluric agencies, gaseous emanations from the earth, 
and volcanic disturbances and emanations. 
INVESTIGATION OF CAUSES AND CONDITIONS OF MALARIA. 
Soil: 
(a.) General topographical features, geographical position, distribu- 
tion and elevation. 
(b.) Relations to surrounding and interpenetrating waters. 
.(c.) Geological structure and age. Investigation of Causes and Conditions of Malaria. 
45 
(dj Chemical constitution. 
(e.) Physical structure, more especially with reference to the absorp- 
tion and radiation of heat, and the absorption and retention 
of moisture. 
(f.) Drainage. 
(g.) Agriculture. 
(h.) Nature of flora and fauna. 
(i.) Organic constituents, including all products of decomposing and 
decomposed animal and vegetable matter. 
(j.) Nature, relations and effects of gases, such as carbonic acid, car- 
bonic oxide, carburetted hydrogen phosphuretted hydrogen, 
sulphuretted hydrogen, etc., either absorbed from the atmos- 
phere or engendered by chemical and vital actions, occurring 
in the soil itself. 
(k.) Micro-organisms and ferments of the soil, their origin and nature. 
(1. ) Relations of the micro-organisms and ferments of the soil to the 
origin and propagation of malarial fevers and other diseases. 
(m.) Relations of the products of the putrefactive changes occurring 
in the soil, such as the animal alkaloids or ptomaines, to the 
origin and propagation of malarial fever and other diseases. 
(n.) Effects of the micro-organisms and morbific ferments of the soil, 
upon living animals, by inhalation, ingestion and inoculation. 
Waters: 
(a.) Topographical, geological and climatic relations of water. 
(b.) Temperature. 
(c.) Volume. 
(d.) General constitution, whether fresh, brackish or salt. 
(e.) Physical conditions, whether moving or stagnant. 
(f.) Sources, whether from the heavens by condensation, or from 
springs, swamps, creeks, rivers, lakes, bays, gulfs or oceans. 
Physical and chemical constitution, and relations of the strata 
furnishing the water supply. 
(g.) Chemical constituents. 
Inorganic chemical constituents. 
It is well known that certain inorganic compounds of the alkalis and 
alkaline earths and of the metals, may exist in minute quantities in water, 
without imparting to it injurious properties; an excess, however, of the 
sulphates of sodium, potassium and magnesium, and of the chlorides of 
sodium and calcium, and of the carbonates of calcium, sodium and iron, 
render water unsuited to the ordinary uses of life, and within certain 
degrees may constitute valuable medicinal agents. No distinct or specific 
febrile disease has been traced to the action of the inorganic constituents 
of water. 
(h.) Gaseous constituents. 
(i.) Micro-organisms of water. 
(j.) Organic constituents; albumen and ammonia; products of putre- 
faction; putrefying animal and vegetable remains; foecal 
matters. 
The potential disease germs of water are measured in their morbid 
activity rather by their pathogenic powers, than by their numbers. The 
products of putrefaction in water, appear to owe their morbific powers, not 
so much to their amounts, as to the micro-organisms with which they are 
accompanied. 
The noxious properties of filthy soil and impure waters, depend not so 
much upon their offensive gases and chemical constituents as upou the exist- The Nature and Relations of Various Febrile Poisons. 
46 
ence in them of morbific ferments, which are not only not gaseous, but have 
their essence in certain minute microscopic organisms, which in virtue of 
their vitality, are capable cf rapid self-multiplication, within their respec- 
tive spheres of operation, and which, unlike common poisons of definite 
chemical composition, can develope large ulterior effects from exceedingly 
minute microscopical germs. The birthplace of the morbific ferments, 
inducing the various forms of malarial fever, is extraneous to the human 
organism, and whilst the micro-organisms of malarial fever are capable of 
self-multiplication after gaining access to the human organism, unlike 
those of small pox, whose birthplace is the body of man, possess no power 
of multiplying their germs indefinitely from individual to individual, 
through an unending series. 
The micro-organisms of malarial fever, whether originating and pro- 
pagating in the air, water and soil, cannot be communicated from one 
human being to another; these morbific ferments, therefore, are not in the 
ordinary sense contagious, although it may .be possible to communicate 
malarial fever by injecting the micro-organisms in the blood of the malarial 
patient, into that of the healthy individual. Hence, in the treatment and 
sanitary management of this class of diseases, it does not appear unphilo- 
sophical to act by certain disinfectants, on the matters discharged by each, 
patient, whether contained in his liquid or solid excreta or suspended in 
the air, so as to prevent untoward spreading of his infection. 
The micro-organisms of malaria have clearly two states of existence: 
the first, in which they vegetate in the external medium; the second, in 
which they have their abode in living blood or tissue, and there exercise 
their hurtful function. 
In the investigation of the nature of malaria, the first place must be 
assigned to the microphytes of the soil, air and water. And as water 
appears to be the necessary medium for the prolonged existence and pro- 
gressive multiplication of microphytes, as well in the soil and atmos- 
phere as in swamps, marshes, rivers and streams, it is evident that the 
investigation should commence with the determination of the specific 
microphytes. 
We need for sanitary and nosological science, not merely analyses of 
the air, soil, and water, in which all these chemical components and the 
various forms of organic animal and vegetable matter are determined, but 
more especially the most rigid microscopical investigation. Each micro- 
organism should be subjdbted to culture experiments, and should also be 
examined in its physiological and pathological relations, by experiments 
in living animals. Their effects upon the temperature, blood, organs and 
tissues, after injection into living animals, should be carefully noted and 
studied. When this vast field has been thoroughly explored, we may hope 
to be able to attain to the natural history of each morbific ferment, and 
thus not only deal with it in its native environment, but also arrest its 
action in the living organism by the administration of such remedies as 
shall render the human organism insusceptible in its morbific action and 
effect. 
SECOND. THE NATURE AND RELATIONS OE VARIOUS FEBRILE POISONS. 
However important the preceding investigations, designed to connect 
the physics and chemistry of the atmosphere and soil and waters, with the 
origin and effects of malaria in the human constitution, and to demonstrate 
the beneficial effects of thorough drainage and enlightened systems of agri- 
culture and hygiene, in altering the character of and mitigating certain Methods of Determining the Nature of Febrile Poisons. 
47 
diseases produced by atmospheric and terrestrial conditions :-the present 
great questions demanding investigation appear to be : 
Are the various forms of malarial diseases, including yellow fever, caused 
by living germs or organisms, peculiar to the different forms of disease ? 
Do the various forms of fever arise from the action of physical causes upon 
the human system, inducing the generation of special poisons ? 
Is it possible for a disease originally caused by the action of external physi- 
cal agents and conditions upon human beings, to become, by crowding, infectious 
or contagious f 
In what manner, or by what particles of matter, are the so-called infectious 
and contagious diseases transmitted ? 
Is it possible to separate from the atmosphere, or from the soil or water or 
from the human being the material cause of malarious diseases % 
When the special poison of each malarious disease is isolated, then we 
may hope for the application of precise principles, to neutralize, and modify 
and destroy their effects, and even to destroy the poisons before they enter 
the human system. 
THIRD. THE METHODS OF DETERMINING THE NATURE OF FEBRILE 
POISONS. 
These questions can only be determined by the condensation of the 
organic constituents of large volumes of atmospheric air, and of exhala- 
tions from the soil, and from diseased bodies, in various seasons, under 
various conditions, and different periods of the day and night in different 
localities (marshes, swamps, forests, mountains, cities, hospitals, and cham- 
bers of the sick), and by the subjection of the products thus obtained to 
the most careful microscopical and chemical examination, and by experi- 
ments, such as cultivating the products in various soils, and injecting them 
into the tissues and blood of various animals. 
Such investigations, of course, demand the aid of standard instruments, 
the command of well-appointed laboratories, and the possession of the 
necessary learning and training. 
We have reasoning and hypotheses in abundance; medical science now 
demands the facts; these will not be obtained by legislative enactments, 
nor by the windy discussions of conventions and committees, where the 
superficial and brazen-faced egotists most generally succeed in establishing 
so-called conclusions. 
The work must be executed at all seasons, and under all circumstances, 
by quiet, honest, capable observers, actuated by a love of truth. 
If it be decided that in this country such men cannot be obtained, and 
that such work is impracticable, and that such knowledge as we seek is 
the growth of ages, springing alone from philosophic minds, who are born 
and not made to order, much yet remains which may be accomplished by 
those endowed with the necessary ability and bravery to encounter the 
difficulties necessarily involved by such labors in hot tropical and semi- 
tropical climates. 
We propose to limit this discussion chiefly to the alluvial regions of 
the United States, and more especially to the delta of the Mississippi 
river. Comparisons will be instituted also with certain definite topographi- 
cal, geographical and civil divisions of the North American Continent. 
With reference to disease, we propose to confine the inquiry chiefly 
to endemic and epidemic fevers, as the various forms of malarial fever, 
yellow fever, typhus and typhoid fevers; and to endemic and epidemic 
diseases of the alimentary, respiratory and cutaneous systems. Classification of Malarial Fevers. 
48 
CLASSIFICATION OF THE VARIOUS FORMS OF MALARIAL FEVER. 
Benjamin Rush, in North America, taught the unity of disease, and 
Torti, in Italy, held the doctrine of the unity of fevers. 
The efforts of Rush to refer all diseases, fevers included, to a general 
cause, dependent upon the structure and vital endowments of the human 
organism, was a bold and brilliant generalization aud directly antagonistic 
to the teachings of Cullen, the most learned and lenowned nosologist of 
his age. If the fame of Rush had rested upon his theory of disease, he 
would long since have passed into oblivion; the enduring monument 
which he erected to his own genius and learning rested on his practical 
observations of various diseases, and moie especially of yellow fever, thus 
emulating the great Thomas Sydenham, of the seventeenth century, 
whose works* Rush edited and caused to be published in America. 
The great truths enumerated by Sydenham, which Rush endeavored to 
overthrow in his teachings and writings, have been recognized more and 
more by the medical profession, from the death of the English Hippocrates 
in 1689, to the present moment. 
Sydenham advanced the cause of medical science by advocating and 
practising the inductive method of Hippocrates. 
Thus Sydenham taught: 
1st. The improvement of physic depends, first-upon collecting a 
genuine aud natur al description or history of all diseases; and second- 
laying down a fixed and complete method of cure. 
2d. All diseases ought to be reduced to certain and determinate kinds, 
with the same exactness as we see it done by botanical writers in their 
treatises of plants. 
There are diseases that come under the same genus, bear the same 
name and have the same symptoms in common, which notwithstanding, 
being of a different nature, require a different treatment. 
3d. In writing a history of a disease, every philosophical hypothesis 
which hath prepossessed the writer in its favor, ought to be totally laid 
aside, and the manifest and natural phenomena of diseases, however minute, 
must be noted with the utmost accuracy, imitating in this the great exact- 
ness of painters, who in their pictures, copy the smallest spots or motes in 
the originals. 
4th. In describing any disease, it is necessary to enumerate both the 
peculiar and constant phenomena or symptoms, and the accidental ones 
separately; of which latter kind are those which differ occasionally, by 
jeason of the age and constitution of the patient, and the different method 
of cure. For the appearance or aspect of the disorder often varies accord- 
ing to the different metuod of cure, some symptoms being rather occasioned 
by the physician than the disease itself; so that persons laboring under the 
same illness, being differently treated, have different symptoms. And 
hence, unless great caution be used in this point, our notions of the symp- 
toms of diseases must necessarily be very loose and uncertain. 
5th. The seasons of the year that principally promote any particular 
kind of diseases, are to be carefully remarked. Some diseases happen 
indiscriminately at any time, whilst many others by a secret power of 
nature, follow the seasons of the year wirh as much certainty as some birds 
and plants. A knowledge of the seasons in which diseases ordinarily arise, 
*The works of Thomas Sydenham, M. D., on Acute and Chronic Diseases, with their histories 
and modes of cure, with Notes intended to accommodate them to the present state of medicine, 
and to the climate and diseases of the United States, by Benjamin Rush, M. D., Professor of the 
Institute and Practice of Medicine and of Clinical Practice in the University of Pennsylvania. 
Philadelphia, 1809. Nosology of Dr. Cullen and of Dr. Alexander Philips Wilson. 
49 
is of great use to a physician towards discovering the species of the 
disease, as well as the method of curing it; and the consequence of neglect- 
ing this knowledge leads to ill success, both in the discovery and cure of 
diseases. 
These principles constituted the work of Thomas Sydenham, the 
Novum Organum of the medical sciences in the seventeenth century, as the 
great work of Lord Bacon, which Lad appeared in 1620, was the immortal 
Novum Organum of all the physical sciences. 
NOSOLOGY OF DR. CULLEN. 
Dr. Cullen, whose system of nosology was superior to that of Sauvages, 
Linmeus, Vogelius, Sagare and McBride, and of other systematic writers 
which had preceded it, divided all diseases into four classes: Pyrexia, 
neuroses, cachexia and locales. 
The first class, which he terms pyrexia, comprises all febrile diseases, 
which he sub-divides into five orders: febres, phlegmasise, exanthemata, 
luemorrhagi<T and profluvia. 
The class pyrexia, Dr. Cullen defines "posthorrorem pulsus frequens, 
calor major, plures functiones hesa?, viribus pnesertim artuumimminutis." 
The first order arranged under this class [the febres], he defines 
"praegressis languore, lassitudine et aliis debilitatis signis, pyrexia, sine 
morbo locali primario." 
The second order, the phlegmasia, is defined, " febris synocha; phlo- 
gosis; vel dolor topicus, simul Isesa partis interna? functione; sanguis 
missus, et jam concretus, superficiem coriaceam albam ostondens." 
The third order of the pyrexia (the exanthemata), Dr. Cullen defines, 
"Morbi contagiosi, semel tantumin decursu vitae aliquemu afficientes; cum 
febre incipientes; definite tempore apparent phlogoses, saepe plures, exi- 
gme per cutem sparsae." His definition of the fourth of the pyrexia 
(the Haemorrhagiae) is, " Pyrexia cum profusione sanguinis absque vi 
externa, sanguis missus nt ip phlegmasiis apparet." 
The last order of the pyrexia (the profluvia) is defined, " Pyrexia cum 
excretione aucta, naturaliter non sanguinea.'' 
Dr. Cullen gives the following definition of intermitting and remitting 
fevers : " Febres miasmate paladum ortae, paroxysmis pluribus, apyrexia, 
saltern remissione evidente, interposita; cum exacerbatione notabili, ple- 
rumque cum horrore, redeuntibus, constantes; paroxysmo quo vis die unico 
tantum." 
In this definition Dr. Cullen includes both intermitting and remitting 
fevers ; because, as he observes, these fevers arise from the same cause, are 
cured by the same means, and in the same person the fever often changes 
from the one form to the other. 
NOSOLOGY OF DE. ALEXANDER PHILIPS WILSON. 
Alexander Philips Wilson, M. D., F. R. S. Ed., in his treatise on 
Febrile Diseases, printed in 1799, after discussing with ability the Nosology 
of Dr. Cullen, presents the following arrangement of Febrile Diseases : 
CLASSIS 1. 
Febres Idiopathica. 
ORDO I. 
Febres Intermittentes et Remittentes. 50 
Theory of Fever by Benjamin Rush. 
ORDO II. 
Febres Continuse. 
Species 1- Synocha. 
Species Typhus. 
Species 3-Synochus. 
Varietas Ima.-Synochus Simplex. 
Varietas 2da.-Synochus Petechialis. 
Varietas 3ta.-Synochus Miliaris. 
Varietas 4ta.-Synochus Apthosus. 
Varietas 5ta.-Synochus Erysipelatous. 
Varietas 6ta.-Synochus Vesicularis. 
ORDO III. 
Exanthemata. 
Species 1-Variola. 
Species 2-Varicella. 
Species 3-Rubeola. 
Species 4-Scarlatina. 
Species 5-Pestis. 
Species 6'-Urticaria. 
CLASSIS II. 
Febres Symptomaticce. 
ORDO i. 
Phlegmasise. 
Species 1-Phlogosis. 
Species 2-Ophthalmia. 
Species 3-Phrenitis. 
Species 4-Cynanche. 
Species 5-Pneumonia. 
Species 6-Carditis. 
Species 7-Peritonitis. 
Species 8- Gastritis. 
Species P-Enteritis. 
Species 10-Hepatitis. 
Species 11-Splenitis. 
Species 12-Nephritis. 
Species 13-Cystitis. 
Species 14-Hysteritis. 
Species 15 -Rheumatismus. 
Species 16-Odontalgia. 
Species 17-Podagra. 
Species 18-Arthropuosis. 
OBDO II. 
Hsemorrhagise. 
Speeies 1 -Epistaxis. 
Species 2-Hemoptysis. 
Species 3-Hemorrhois. 
Species 4--Menorrhagia. 
Species 5-Haematemesis. 
Species 6-Hematuria. 
ORDO III. 
Proflu via. 
Species 1-Catarrh us. 
Species 2-Dysenteria.* 
THEORY OF FEVER BY BENJAMIN RUSH. 
Dr. Benjamin Rush, in the third volume of his Medical Inquiries and 
Observations [2d edition, published 1805, pages 1 to 66], propounds a 
theory of fever, the skeleton and main propositions of which we have classi- 
fied and consolidated, as follows: 
I. Fevers of all kinds are preceded by general debility. This debility 
is natural or accidental. The former is the effect of the sanguineous tem- 
perament, and exists at all times in many constitutions. The latter is 
induced, first-by such preternatural stimuli, as after first elevating the 
excitement of the system above its healthy grade, and thereby wasting a 
part of its strength, or what Dr. Brown calls excitability and Darwin semi- 
nal power, afterwards reduces it down to that state which Rush calls 
debility of action; second-this debility is induced by such an abstraction 
*Two American editions of this work were published (the author having changed his name), 
under the title of " A Treatise of Febrile Diseases, including the varieties of fever and all diseases 
attended with fever; by A. P. Wilson Philips, M. D., F. R. S. Ed., etc., with Notes and Additions 
by Nathan Smith, M. D,, Professor of Physic, Surgery and Obstetrics in Yale College." The second 
edition was printed in Hartford in 1816. In this work the editor, or. Nathan Smith, presents a 
nosological arrangement of diseases, in which we find many valuable observations on fevers. 
See Second Edition, Introduction, pp. 29-42. Dr. Alexander Philips Wilson, in his treatise on 
Febrile Diseases, treats of intermitting and remitting levers, under the head of Quotidians,(Tertians 
and Quartans, that is, fevers returning every day, every second day, and every third day. He 
gives descriptions of the three forms of malarial fevers, and points out their varieties and 
complications. Theory of Fever by Benjamin Bush. 
51 
of natural stimuli, as to reduce the system below its healthy grade of 
excitement, and thereby to induce what Dr. Brown calls direct debility, 
but what Bush calls debility from abstraction. The system in this state 
is. exactly similar to that which arises from a sudden reduction of its 
healthy excitement, by the abstraction of stimuli. 
That fevers are preceded by general debility, Rush infers from these 
causes, all of which act by reducing the excitement of the system, by the 
abstraction of stimuli, or by their excessive or unusual application. The 
causes which operate in the former way, are cold; the debilitating passions 
of fear, grief and despair; all excessive evacuations, whether by the 
bowels, blood-vessels, pores or urinary passages; famine or the abstraction 
of the usual quantity of nourishing food ; heat; intemperance in eating and 
drinking; unusual labor or exercise; violent emotions, and stimulating 
passions of the mind ; certain causes which act by over-stretching a part 
or the whole of the body, such as lifting heavy weights, external violence, 
acting mechanically in wounding, bruising or compressing particular parts, 
extraneous substances, acting by their bulk or growth, burning, and the 
like. 
II. Debility having thus formed in the system by the causes which 
have been enumerated, a sudden accumulation of excitability takes place, 
whereby a predisposition is created to fever. 
III. Depression of the whole system or what Dr. Brown calls debility. 
It manifests itself in weakness of the limbs, inability to stand or walk with- 
out pain, or a sense of fatigue, a dry, cool or cold skin, chilliness, a shrink- 
ing of the hands and face, and a weak or quick pulse. 
IV. Re-action-is induced, and by this re-action according to its 
greater or less force and extent, consists the different degrees of fever. It 
is of an irregular or convulsive nature. In common cases it is seated pri- 
marily in the blood-vessels, and particularly in the arteries. These pervade 
every part of the body. They terminate upon its whole surface, in which 
Rush includes the lungs and alimentary canal, as well as the skin. They 
are the outposts of the system, in consequence of which they are most 
exposed to cold, heat,'intemperance and all the other external and internal, 
remote and exciting causes of fever, and are first roused into resistance by 
them. 
The blood-vessels possess muscular fibres, and thus irritability or dis- 
position to motion depends upon them. 
The re-action or morbid excitement of the arteries, discovers itself in 
preternatural force or frequency in their pulsation. 
In ordinary fever it is equally diffused throughout the whole sanguinifer- 
ous system, for the heart and arteries are so intimately connected that, like 
the bells of the Jewish high priest, when one of them is touched they all 
vibrate in unison with each other. 
V. There is but one exciting cause of fever, and that is stimulus: 
heat alternating with cold, marsh and human miasmata, contagions and 
poisons of all kinds, intemperance, passions of the mind, bruises, burns 
and the like, all act by a stimulating power, only, in producing fever. 
VI. There is but one fever. However different the predisposing, 
remote or exciting causes of fever may be, whether debility from abstrac- 
tion, or action whether heat or cold succeeding to each other, whether 
marsh or human miasmata, whether intemperance, a fright or a fall, still 
Rush held that there can be but one fever. Rush founded this proposition 
upon all the supposed varieties of fever having but one proximate cause. 
Thus, fire is a unit, whether it be produced by friction, percussion, electri- 
city, fermentation, or by a piece of wood or coal in a state of inflammation. 52 
Forms of Pernicious Malarial Fever, by F. Torti. 
VII. All ordinary fever being seated in rhe blood-vessels, it follows, 
of course, that all those local afflictions we call pleurisy, angina, phrenitis, 
internal dropsy of the brain, pulmonary consumption, and inflammation 
of the liver, stomach, bowels and limbs, are symptoms only of an original 
and primary disease in the sanguiniferous system. 
Holding these peculiar views which he applied to disease in general, in 
his lectures on Pathology, Benjamin Rush rejected the nosologies of Cullen 
and of the schools generally; denied the existence of distinct genera and 
species of fever, and simply calls the essential and symptomatic fevers, 
different states of fever. 
Rush divided all the different states of fever into : 
1st. Such as affect the whole arterial system; but with uo, or very 
little, local disease. 
2d. Such as affect the whole arterial system, and are accompanied at 
the same time with evident local disease. 
3d. Such as appear to pass by the arterial system and to fix themselves 
upon other parts of the body. 
In the first class of the states of fever belong the malignant, the 
gangrenous, the synocha, the synochus, the synochula, the synochoid, the 
typhus, the nervous, the typhoid, the hectic, the intermitting and remitting, the 
inward or febricula, the sweating, the burning and the coMand chilly states 
of fever. 
In the second class, in which there are local affections combined with 
general fever, Rush referred the intestinal, the pulmonary, the eruptive, the 
anginose, the rheumatic, the arthritic or gouty, the cephalic, the nephritic, the 
hydropic, the haemorrhagic, the amenorrhagie states of fever. 
Under the third head of states of fever, which Rush also calls mis- 
placed states of fever, he included the chronic hepatic, the hoemorrhoidal, 
the opthalmic, the odontalgic, the otalgic, the aptheus, the scrofulous, the scor- 
butic, the convulsive or spasmodic, the hysterical and hypochondriacal, the 
cutaneous states of fever.* 
In the first volume of the celebrated work of F. Torti, " Therapeutice 
Specialis, ad Febres Periodicas Perniciosasfi there appears a remarkable 
chart in the form of a tree. Below the trunk and roots of the tree is 
inscribed: 
LIGNUM FEBRIUM. 
On die trunk of the tree : 
FEB RIS. 
The trunk is divided into two main branches, Putrida and Simplex. 
Simplex is divided into three branches, ephemera, synochus and heetica. 
Hectica is divided into two branches, primaria and secondaria. 
Putrida, divided into two main branches, continua and intermittens. 
Continua, two branches, continens and remittens. 
Continens, two branches, symptomatica and essentialis. 
Symptomatica, two branches, privata and officialis. 
Privata two branches, vaga and fixa. 
Vaga, three branches, venera, scorbutica and verminosa. 
Fixa, four branches, lenta, ulcerosa, pustulosa and infiammatoria. 
Lenta, two branches, cachectica and marasmodes. 
Ulcerosa, two branches, tabida and dysenterica. 
Pustulosa, two branches, scabiosa and herpetica. 
nflammatoria, three branches, arthritica, anginosa and pleuritica. 
Officialis, two branches, alba and lactea. 
Essentialis, two branches, comitata and solitaria. 
Comitata, two branches, coagulativa and colliquativa. 
*Nova editio Leodii, 1821. 
tOutlines of a Theory of Fever. Medical Inquiries and Observations; by Benjamin Rush, 
Vol. Ill, pp. 1-66. Classification of Fever, by Dr. George B. Wood. 
53 
Coagulativa, four branches, variolosa, morbilosa, catarrhalis and scarlatina. 
Colliquativa, three branches, diabetica, dejectoria, and diaphoretica. 
Solitaria, three branches, acmastica, paracmastica and epacmastica. 
Remittens joins with subintrans, a large branch springing from intermit- 
tens, and the two form proportionata. 
Proportionata, three branches; quartana, tertiana and quotidiana. 
Quartana, three branches, simplex, duplex and triplex. 
Tertiana, two branches, simplex and duplex. 
Simplex, two branches, syncopalis minuta andcauson. 
Duplex, two branches, assodes and helodes. 
Quotidiana, two branches, hepiala, and syncopalis humorosa. 
Intermittens, two main) branches, discreta and subintrans; subintrans, as we 
have stated, joins remittens to form one of the large branches of the febrile tree, 
proportionata. 
Discreta, two branches, erraticaand periodica. 
Periodica, three branches, tertiana, quotidiana and quartana. 
Tertiana, two branches, maligna and benigna. 
Maligna, two branches, solitaria and comitata. 
Solitaria continued into subcontinua. 
Comitata, two branches, coagulativa and colliquativa. 
Coagulativa, three branches, algida, lethargica and syncopalis. 
Colliquativa, four branches, cordiaca, subcruenta, diaphoretica and cholerica. 
Benigna, two branches, duplex and simplex. 
Duplex continued into subintrans, which divides into acuta and lenta, acuta 
sends a branch downwards to subcontinua, which springs from maligna. 
Quotidiana continued with subintrans, and this branch continues into lenta. 
Quartana,. three branches, triplex, duplex and simplex. 
Triplex, continued into subintrans, this in turn joins lenta; duplex and sim- 
plex have no branches. 
A branch from remittens and continuens unite and form complicata. 
CLASSIFICATION OF FEVER, BY DR. GEORGE B. WOOD. 
The late Professor George B. Wood, in the first volume of his work on 
the Practice of Medicine (6th edition, 1866, page 265), treats of the follow- 
ing fevers, as distinct diseases: . 
1. Irritative fever. 2. Miasmatic or bilious fever. 3. Yellow fever. 
4. Enteric or typhoid fever. 5. Typhoid fever. 6. Petechial or spotted 
fever. 7 Eelapsing fever. 8. Plague. 9. Small-pox or variola. 10. 
Vaccine disease, or vaccina. 11. Chicken pox or varicella. 12. Measles 
or rubeola. 13. Scarlet fever or scarlatina. 14. Erysipelas. 15. Diph- 
theria. 16. Glanders or equinia. 17. Dengue. 18. Milk sickness. 
Under the head of miasmatic fever, Wood includes all the fevers result- 
ing from the action of marsh miasmata, and enumerates: 
1. Intermittent fever (fever and ague). 
2. Remittent fever (bilious fever, bilious remittent fever). 
3. Pernicious fever (congestive fever, pernicious intermittent, perni- 
cious remittent). 
Intermittent fever is characterized by febrile paroxysms, recurring at 
stated times and by the absence of fever between the paroxysms. The 
intervening period from the end of one paroxysm to the commencement of 
the next, is called the intermission or apyrexia; the whole period occupied 
by one paroxysm and the succeeding intermission is called the interval. 
The type of the fever has reference to the length of the interval. 
There are three ordinary types; the quotidian, tertian and quartan. In 
the quotidian, the paroxysm recurs every day, with an interval of about 
twenty-four hours; in the tertian, every other day, with an interval of 
forty-eight hours; and in the quartan, every third day, with an interval 
of seventy-two hours. The invention of the two later names considered the 
two nearest paroxysmal days, with the intervening day or days, as consti- 54 
Remittent Fever. Miasmatic Remittent Fever. 
tuting one period, and thus counted every paroxysmal day twice in the 
succession. 
Other types are mentioned by authors; such as the quintan, sextan, sep- 
tan and octan, the last occurring at intervals of a week ; but these varieties 
are comparatively rare. 
The regular types above mentioned, are liable to numerous diversities. 
The quotidian is sometimes double, having two paroxysms every day. 
There is a double tertian, with a daily paroxysm, occurring at different 
periods, or with different characters, on successive days; the paroxysms of 
alternate days exactly corresponding with each other. Thus on the first 
and third days, the paroxysms may take place in the morning and corres- 
pond with each other in grade and character; while on the second and 
fourth days, they will occur in the afternoon, and in like manner corres- 
pond with each other, but differ from those of the two other days. 
Sometimes there are two paroxysms in one day, and none in the next. 
This variety is named duplicated or doubled tertian. The triple tertian has 
two paroxysms every other day, and one in the intervening day ; that is, 
three instead of one in forty-eight hours. The double quartan is the variety 
in which out of three days, two have each one paroxysm and the other 
none; the triple quartan, that in which there is a paroxysm every day, but 
the three successive paroxysms differ from each other, while they corres- 
pond respectively with the three which follow. 
Remittent Fever [bilious fever, bilious remittent fever] has received 
numerous names, all of which are liable to objections. It is undoubtedly 
remittent; but there are other fevers which are more or less remittent, and 
cases of this fever sometimes occur, in which it is difficult to detect any 
decidedremission. It is often bilious, but so also is yellow fever, in at least 
an equal degree ; and it often happens that the one which we are considering 
does not show any special disorder of the hepatic functions. It has fre- 
quently received names from the localities in which it prevails, as the 
African fever, the Mediterranean fever, the Bengal lever, the Walcheren 
fever, and the Chagres lever. 
AU these are one and the same disease, and therefore improperly 
named. If the exclusive miasmatic origin be admitted, the title of mias- 
matic remittent would, perhaps, be the least objectionable of any hitherto 
given to il. 
Miasmatic remittent fever is essentially the same disease as the inter- 
mittent. The two affections sometimes approach each other so closely in 
form that it may be impossible, in relation to a particular case, to decide to 
which of them it belongs. In intermittent there is often some degree of 
morbid action between the paroxysms, and in remittent often very little ; 
and it is not always possible to determine whether the morbid action that 
exists does or does not amount to fever. If it be pronounced not to be 
fever, the disease must be considered intermittent; if fever, remittent. In 
the latter affection there is every grade, from the doubtful form just alluded 
to, up to an almost uniform continuous fever. 
In many cases, the paroxysms of remittent occur at regular stated 
intervals, like those of intermittent, and like them consist of the cold, hot 
and sweating stages, though in general less distinct and decided. In other 
cases, with the same regularity in the occurrence of the paroxysms, there 
is no cold stage, after that of the accession of the disease, and the sweating- 
stage is either slight or wanting. In others, again, the fever merely fluctu- 
ates in its course, at one time rising into a moderate exacerbation, at 
another falling into a moderate remission, without forming well-defined 
paroxysms. Instances, however, do occur, though they are comparatively Classification of the Forms of Malarial Fever, by Joseph Jones, M. D. 
55 
rare, and always short, in which the fever pursues a uniform course with- 
out discernible relaxation, and sometimes with a regular increase, to the 
crisis. 
Remittent fever has the same types as the intermittent. The most 
frequent is the quotidian, with a paroxysm occurring at almost the same 
hour every day- The tertian, with the every other day paroxysm, is not 
uncommon. Next, perhaps,* to the quotidian is the double tertian, having 
a daily paroxysm, but that of one day differing from that of the next, and 
the alternate paroxysms resembling each other, both in character and time 
of occurrence. At the commencement there may be two or more regular- 
paroxysms, as in the intermittent, afterwards the paroxysms may recur 
regularly without the chill or the perspiration , and at length the fever 
may assume the continued form, and thus run into its termination. Or 
the disease may commence as continued fever, may after a time become 
paroxysmal or remittent, and may finally end in intermittent. 
As regards the violence of the disease, it may be of all conceivable 
grades, from a mildness which scarcely confines the patient, or requires 
the interposition of remedies, to a severity which demands the promptest 
treatment to preserve life; and against which all the resources of nature 
and art occasionally fail. 
Pernicious Fever {Congestive Fever ; Pernicious Intermittent; Perni- 
cious Remittent Fever}. It is not to all dangerous cases of intermittent or 
remittent fever that the epithet pernicious, as here employed, belongs. 
These affections may prove fatal by the supervention of various inflamma- 
tions, by haemorrhagic effusion from ordinary causes within the cranium, 
chest, etc., by a typhous degeneration of the blood, or by the gradual 
exhaustion of the vital powers, through the excessive disturbance of the 
functions. None of these cases are necessarily included under the present 
heading ; the name is restricted to an affection in which there is great and 
sudden prostration or depression of the nervous force, or, to use a custom- 
ary phrase, in which the innervation is extremely and most dangerously 
defective or deranged. 
This modification of miasmatic fever may be intermittent, remittent 
or continued. But it is only when of two or three days' duration that it 
can be said to be of the last mentioned form, for if the patient survives 
this period, and the disease persists, it will almost certainly become par- 
oxysmal. Most frequently it is either intermittent or exhibits a close 
approximation to that form; and happily, though often quotidian, its more 
common type is tertian. The disease exhibits different phenomena, 
according to the seat of the morbid innervation. Thus, in some cases, 
the organic functions are especially affected; in others, the animal. In 
the former the signs of disease are presented chiefly in the organs of 
digestion, respiration, circulation, calorification and secretion; in the 
latter, most prominently in the brain. 
CLASSIFICATION OF THE FORMS OF PERNICIOUS MALARIAL FEVER, BY 
JOSEPH JONES. M. D. 
Forms of Pernicious Malarial Fever. 
The general division of the malarial or paroxysmal fevers into three 
types, namely, intermittent, remittent and pernicious or congestive fever, 
admits of several subdivisions. 
Thus the forms of malignant intermittent are numerous, but all are 
attended with congestion of one or morn vital organs, which may endanger 
the life of the patient, and which may pass into actual inflammation 56 
Classification of Pernicious Malarial Feuer, by Joseph Jones, M. D. 
attended with effusion of plastic lymph, serum or blood. In many cases 
in which no structural alterations have ensued during the congestive 
stage, there comes on at the conclusion of the paroxysm a perfect inter- 
mission of all the violent symptoms. The sudden disappearance of the most 
alarming symptoms may lead to a false prognosis, and prevent the institu- 
tion of energetic measures. It is well known that in the malarious regions 
of the Southern and Western States, one oY these violent paroxysms, 
whenever occurring, either at the onset of the disease or during the pro- 
gress of an ordinary mild intermittent, is the harbinger of others still 
more violent. If unheeded, the disease may prove fatal at the third, 
fourth or fifth paroxysm. 
The nature and effect of the malignant paroxysm will depend upon 
various causes, as the state of the constitution of the patient, peculiar 
idiosyncracies, pre-existing diseases, the effects of diet and occupation, the 
composition of the blood, and the organ or organs chiefly involved. If 
the cerebro-spinal system is chiefly affected the paroxysm may be charac- 
terized by delirium, coma, convulsions and tetanic spasms; hence some 
writers have distinguished the comatose, the delirious, the convulsive and 
the tetanic varieties of the malignant intermittent. 
Effects of the Malarial Poison on the Cer ebro-Spinal Nervous System. 
In many cases, in which the whole force of the disease appears to fall 
upon the cerebro-spinal system, these symptoms, indicating serious disturb 
ances of the functions of animal life, as disorder of the mind, coma, apo- 
plexy and paralysis, catalepsy, and various involuntary spasmodic move- 
ments, may disappear entirely as the paroxysm abates, not even a trace of 
headache being left during the intermission; in some cases, however, effu- 
sion may take place into the ventricles, or within and around the cerebro- 
spinal system, and lead to the establishment of permanent coma, with 
dilatation of the pupils, general paralysis and death. In some cases the 
effusion consists chiefly bf serum, and in others of blood, with all the 
symptoms of haemaplegia, paraplegia, apoplexy and paralysis. A true 
inflammation of some portion of the cerebro-spinal substance may result 
from the congestion induced during the malignant paroxysm. Becovery is 
possible from such states, but convalescence is often tedious, and accompa- 
nied with paralysis of one or more sets of voluntary muscles. In many 
cases of malarial coma, I have observed the temperature to be elevated to 
a degree varying from 192° to 106° F., and such elevation may be attended 
either with a hot, dry skin, or with a surface bathed in a hot, profuse per- 
spiration. The action of the malarial poison is without doubt one of the 
causes of fatal and sudden apoplexy. It is probable that the result during 
the paroxysm is largely determined by preceding alterations of the arteries 
of the brain and spinal cord, such as fatty and calcareous degeneration. 
Congestion of the Lungs in Malarial Fever. 
If the lungs or the pleura be principally and chiefly involved, diffi- 
culty of breathing, syncope, capillary obstruction, and excruciating-pains 
in the pleura, lungs and diaphragm may characterize the paroxysm. In 
like manner these alarming and distressing symptoms may vanish, after 
the disappearance of the paroxysm, or structural alterations characterized 
chiefly by serous effusion into the air cells, bronchial tubes and pleural 
cavities may ensue, and either destroy the patient suddenly or lead to 
painful and protracted pneumonitis and pleuritis. In some cases the effu- 
sion into the air cells consists chiefly of blood, and such pulmonic haemorr- 
hage must be regarded as similar to the haemorrhages from the stomach, Pernicious Malarial Fever: Classification by Joseph Jones, M. D. 
57 
small intestines and large intestines, which characterize certain forms of 
malignant intermittent fever. 
Paralysis of the Heart resulting from the Action of Malaria. 
In a third form, the heart and lungs may be chiefly affected, either 
directly or through the cerebro-spinal and sympathetic system. This, the 
so-called cardialgic variety, is marked by excruciating pain at the epigas- 
trium, either continuous or intermittent, intense suffering, great anxiety 
of countenance, vomiting, and sometimes general spasm of the muscles. 
Congestion of the Stomach and Intestines in Malarial Fever. 
In a fourth form, the abdominal viscera, the peritoneum, the stomach, 
the small intestines, the large intestines, the liver and the kidneys, may one 
and all be involved, giving rise to the so-called peritonitic, gastric, choleraic, 
dysenteric, hepatic and nephritic forms of malignant intermittent. The 
tenderness of the peritoneum, the profuse vomitings of biliary matters, 
and the choleraic and dysenteric and bilious discharges, may one and all 
disappear during the intermission. 
Algid Form of Malarial Fever. 
In a fifth form, known as algid fever, the cold stage is unusually pro- 
tracted ; there is great oppression at the chest and abdomen, restlessness, 
and prostration of nervous and muscular power. The attempt at the 
formation of the hot stage proves abortive; the skin becomes cold, pale 
and shrunken on the extremities, and covered with a cold, clammy perspi- 
ration, while, on the contrary, the central portion of the body and the 
internal organs are hot. In some cases of algid fever, I have observed the 
temperature of the extremities to be 80°, whilst that of the trunk has 
reached 101°, and higher. The patient complains of intense thirst, and 
when water is drank it is frequently rejected by vomiting; the pulse is 
small, frequent, and almost imperceptible at the wrist; the heart beats in 
a tumultuous, irregular manner, giving a thumping sound to the ear, the 
number of beats sometimes reaching 180 ; the respiration is irregular, 
often panting, and numbering 40 and over to the minute; there is great 
restlessness, jactitation, impatience of bed covering, with continuous com- 
plaints of oppressive heat, not only at the chest and abdomen, but even on 
the cold extremities, so that the patient refuses to have them covered. 
The intellect is generally undisturbed and the expression of the coun- 
tenance may be quiet, even when the pulse cannot be felt, and when the 
disorder of the circulation and temperature becomes so extreme that the 
heat of the trunk is reduced, and even the tongue and mouth become cold. 
This irregularity continues through the whole period of the paroxysm, 
and it is only at the end of it, in favorable cases, that the temperature and 
circulation are partially restored. 
Phenomena of Algid Malarial Fever.. 
In algid fever we have congestion of the internal organs, prostration 
of the nervous and muscular forces, and marked disturbances of the circu- 
lation and calorification. As the circulation and calorification depend 
largely upon the cerebro-spinal and sympathetic nervous systems, as well 
as upon the physical and chemical changes of the blood and organs, the 
algid state must be referred, in part at least, to lesions of certain ganglionic 
cells or tracts of the cerebro-spinal and sympathetic nervous systems ; and 
whilst similar phenomena, but less in degree and duration, are manifested 
in every true malarial chill, it is not entirely correct to regard the algid 
state as simply a prolonged chill, for in the algid state the chill is followed 58 
Pernicious Malarial Fever: Classification by Joseph Jones, M. D. 
by imperfect reaction, and the elevated temperature of true chill is rarely 
reached in the central organs, whilst there may be an actual diminution of 
heat. 
Hcemorrhagic Malarial Fever-Malarial Hcematuria. 
When from any cause, as bad diet, excessive exposure to cold and 
wet, the continuous use of salt meat, or the prolonged action of the mala- 
rial poison, the constitution of the blood is altered, haemorrhages take 
place during the congestive stage of malignant intermittent fever, we may 
have a sixth variety, which has been indicated as haemorrhagic malarial 
fever. 
Without doubt, in this sixth form of intermittent, haemorrhages from 
various organs, as the stomach, lungs, kidneys and bowels, are directly due 
to the prolonged and potent action of the malarial poison upon the fibrin 
and colored corpuscles of the blood, as well as to the various alterations in 
the spleen and liver, characteristic of all the forms of malarial fever. 
The haemorrhagic form of malarial fever may be attended with many 
of the prominent symptoms of the preceding varieties, as obstinate vomit- 
ing of biliary (grass green) acrid matters, intense thirst, restlessness, feeble 
rapid pulse, oscillations of temperature, oppression of breathing, coma, 
•convulsions and apoplexy. 
In many cases of malarial haematuria, after the supervention of jaun- 
dice, the pulse becomes slow, falling even below the standard of health, 
even when the temperature of the trunk may be elevated to from 101° to 
104° F. In this respect, as well as in the great irritation of the gastric 
mucous membrane, accompanied with incessant vomiting, the haemorr- 
hagic form of malarial resembles yellow fever. The latter disease, how- 
ever, differs from the former in the character of the vomited matters. 
Whilst in the first stages of yellow fever the vomited matters may consist 
of mucus and bile, in the latter stages the black vomit is essentially 
altered blood. In malarial haematuria the dark, and in some cases black 
vomit, consists almost always of dark greenish black biliary matters, and 
rarely contains blood. The urine also differs essentially in the two dis- 
eases ; in grave cases of yellow fever, the urine contains albumen and 
yellow granular casts, and detached cells of the tubuli uriniferi. In well 
marked cases of yellow fever, albumen may appear as early as the first day 
of the disease, but most generally it appears upon the second, third or 
fourth day. Blood may be present in the urine of yellow fever, but it is 
rarely a constituent; and even when present the granular casts of the 
tubuli uriniferi present a yellow color. In malarial haematuria the urine 
contains albumen, but this constituent of the blood is invariably associated 
with blood corpuscles and haematin. The casts of the tubuli uriniferi in 
the urine of malarial haematuria present a red or reddish brown color. 
Suppression of urine in yellow fever appears to be due to the blocking 
up of the tubuli uriniferi with granular and oleaginous matter and detached 
cells; this symptom in malarial haematuria appear to be due not merely to 
congestion of the kidney, but to the filling of the urinary tubes with coagu- 
lated blood. 
The microscopical examination of the blood also reveals marked differ- 
ences in the two diseases; in yellow fever the colored blood corpuscles 
frequently assume a crenated appearance, and in uncomplicated cases 
there is no accumulation of pigment particles and pigment cells, and the 
dark cells of an algae, resembling large colorless corpuscles filled with 
spores of a dark brownish red color. 
In malarial haematuria, it is rarely the case that the colored corpuscles 
present any other than the normal form of biconcave discs; whilst pig- Senac on Malignant Intermittents. 
59 
ment particles, dark granular masses, and cells of a dark reddish brown 
hue, some of which are similar in all respects to certain palmelke, are 
often present in considerable numbers. 
In malarial haematuria, after death; the intestines give the reaction of 
bile throughout their entire extent; in yellow fever we thus obtain no evi- 
dence of the presence of bile. 
H.EMORRHAGIC MALARIAL FEVER. 
The haemorrhagic malarial fevers prevail only at certain periods of the 
year, in certain seasons and in certain well defined districts of the United 
States, Mexico, Central and South America, and the Antilles. The inves- 
tigation should, therefore, be conducted in the various localities anti under 
various conditions. 
The history of medicine, both in this country and in Europe, has 
shown that fever attended with haemorrhages from the mucous surfaces, 
and even black vomit, has prevailed at widely separated periods, and in 
different countries ard localities. Without doubt, certain causes wrought 
this change in the type of these diseases, and these causes may be arranged 
for purposes of investigation, under the following heads: 
(a.) Peculiarities of the climate, temperature, rainfall, and physical 
and chemical constitution of the atmosphere, (b.) Conditions of soil, as 
to drainage, cultivation, etc. (c.) Sanitary condition of the inhabitants, 
effects of food, clothing, occupation, agriculture and manners. 
The preceding divisions embrace the different varieties of malignant 
intermittents of the older writers, as Jean Senac,1 Torti,2 Alibert,3 Bailly,4 
Maillot,5 and others. 
In this connection, the description "of the malignant form of inter- 
mittents," by Jean Senac, published more than a century ago, is well 
worthy of consideration, as illustrating the fixed character of malarial 
diseases at all times and in all places, and also as revealing the mode in 
which the older writers classified these diseases. With reference to 
malignant intermittents, Senac observes: 
SENAC ON MALIGNANT INTERMITTENTS. 
" Oftentimes almost the whole force of these diseases falls on the brain ; the 
patients become comatose; the mind is disordered ; a lethargy is induced, and at 
times, even a true palsy and apoplexy follow. In some cases (though this is a rare 
phenomenon), a kind of catalepsy has been met with. We must not be surprised, 
then, at the occurrence of convulsive motions, subsultus tendinum, tremors, defects 
of vision, hearing and other senses, or finally, an entire prostration of the vital prin- 
ciple. All these symptoms, so very unexpected, are marked by variety in their 
origin, progress and decline. They sometimes proceed from a slight, and' at other 
times from a serious and dangerous beginning. In some cases, their violence is 
such from their commencement, that they appear to be idiopathic; that is, alto- 
gether foreign from the nature of an intermittent. But their-true nature becomes 
at length unmasked, for after a certain time they usually remit, and then proceed 
in the form of paroxysms. * * * 
" The febrile poison falls not only on the brain, but also on the organs of respi- 
ration ; it mostly excites spasms in them, which are at the same time communi- 
cated to other parts of the system. But from these spasms, or from the irritating 
and almost corrosive action of the poison, arise various pains. These sometimes 
1 De Recondita, Febrium Intermittentium, turn Remittentium Natura, et de carum cura- 
tioneEditio Secunda, Genevae, 1769. 
2 Therap. Spec, lib 4. 
3 Dissertation sur les Fi6vres' Pernicieuses ou st-ixiques, Intermittenies. Pr6sent6e et sou- 
tenue a TEcole de M6decine de Paris, le 28 Brumaire an viii, de la RSpublique lran?aise, Seconde 
Edition, Paris, 1801. 
4 Traits, Anatomico-Pothologique, des Fievres Intermittentes, Paris, 1825. 
5 Traitfi des Fievres ou Irritations C6r6bro-Spi Dales Intermittentes, Paris, 1836. 60 
Senac on Malignant Intermittents. 
attack the diaphragm and settle there, raging with the utmost severity. At other 
times they become fixed in the sidesand occasion such torture to the patients, as to 
render them unable to change their position. From these causes, respiration 
becomes confined and difficult, attended with cough, panting and shortness of 
breath. At times the disease assumes something of the form of suffocation, catarrh 
or asthma, from a congestion and oppression of the lungs by means of a thick 
mucus. It occasionally appears as a severe pleurisy or peripneumony. The patient 
is then affected by a spitting of blood, a fixed and lancinating pain in the thorax, 
and a depressed pulse. 
" The stomach also suffers acutely from the action of the febrile poison ; at times 
it becomes the seat of the most intolerable anguish ; at others, of a sharp and gnaw- 
ing pain ; so that it might be supposed to be affected by inflammation or even ero- 
sion. Hence arise nausea, and forcible, though fruitless efforts to vomit. In this 
state of the disease, the occurrence of deliquium animi, the face and whole counte- 
nance being bathed in sweat, a dimness of vision, a small, feeble pulse, and a cold- 
ness of the skin, seem to threaten approach of death. Nor indeed, is it possible for 
the patients to survive, if these symptoms continue long, increase in force, or recur 
in several successive paroxysms. 
" In the midst of these troublesome and dangerous symptoms, a distressing 
vomiting often occurs. 'The matter evacuated in this way is bilious, yellow, tena- 
cious, foetid, sometimes bloody and black, and is thrown up with great force. In 
some patients, similar evacuations occur by stool, although the epigastric region 
alone suffers pain and anguish. 
"The tongue is scurfty and the urine is secreted in small quantity, owing to the 
spasms that affect the kidneys. The same symptoms therefore occur in inter- 
mitting fevers that take place in cholera morbus. There exists, however, this 
difference, that in fever these symptoms end when the paroxysm ends ; whilst in 
cholera there is no such respite. 
" At times the febrile poison expends its force, not in the stomach, but in that 
portion of the alimentary tube which is situated beneath it. Hence arise excruci- 
ating pains, as if the intestines were acted on by a caustic. These evacuations by 
stool are profuse and various, being either serous, bilious or mixed. But in some 
patients the acrimony of the irritating cause is such that the stools are mucous or 
bloody, as in dysentery ; at times they are marked with pure blood, and at other 
times they resemble the lotura carnis, or water in which raw flesh has been 
washed. To these symptoms great prostration of strength succeeds. The patients 
are affected with singultus, become cold, and lie almost lifeless. A person inex- 
perienced in the disease, would scarcely believe it possible for them to rise again. 
But, strange to tell, at the termination of the paroxysm these terrible symptoms 
abate, and sometimes entirely disappear. In various diseases of the intestines the 
irritation remains even after the cause is removed, but when the febrile poison is 
dissipated or exhausted, it seems to carry all its effects along with it. 
" The force of the miasmata may fail on the external as well as on the internal 
parts of the system. Thus papulae or pimples of various kinds occur at times over 
the whole surface of the body, and yield to the use of febrifuge remedies. At 
another time the skin is suffused with a deep red, which is lighter, however, in 
some parts than in others. But more frequently a kind of Sudor Anglicanus 
breaks out. In many cases this flows abundantly from the forehead and breast; it 
is everywhere warm ; and the more plentiful it flows, the more intense is the fever. 
After a certain space of time, sometimes longer, sometimes shorter, the sweat 
becomes cold; the pulse is depressed and in some cases creeping. Under these 
circumstances, some patients experience a tightness and oppression about the pra?- 
cordia, others a sense of heat and burning in the stomach, while all are affected 
with restlessness, tossing and a suppression of urine. The appearance of the body 
itself bespeaks impending danger, for the flesh becomes of a livid or blueish color. 
In these profuse sweats of which we have just spoken, the sick sometimes experi- 
ence in their legsand thighs such sharp and excruciating pains, that the parts around 
seem as if pierced with a sword. In certain cases, a kind of rheumatic pain is 
diffused throughout the whole body; in others it settles in some particular part, and 
in others, again, wanders about from place to place. Though this pain appears to 
be the leading symptom, yet it is accompanied by various others. In some*patients 
it produces deliquium animi, in others spasmodic affections, and is not unfrequently 
attended with inflammatory affections, which shift from one part of the body to 
another. 
" But if the febrile poison may prove injurious to certain parts, and even become 
fixed in them, it may also attack the vital principle itself, and derange the whole Senac, Diversus, Valesius, Torti and Alibert on Malignant Fevers. 
61 
economy of rthe system. This is Uie case in those persons who labor under an 
alarming syncope du ring the paroxysms of the disease. Under these circumstances 
the countenance is cadaverous, the eyes are closed, the respiration is laborious, and 
everything seems to threaten immediate dissolution. 
'• But there are cases in which the principle of life and motion does not seem to 
be so immediately attacked as the source of heat. Sometimes when the paroxysm 
is ushered in by a cold lit, no hot fit succeeds. At other times, after the hot fit has 
commenced, it is gradually extinguished again. The external surface of the body 
has then a marked appearance, the countenance a leaden cast, the extremities are 
livid, and, to embrace everything in a few words, all these symptoms occur which 
are met with in the malignant causus. There are also at times accidental symp- 
toms. which do not uniformly prevail, such as intense thirst, a dullness and feeble- 
ness of intellect, a diminished flow of urine," etc. 
Salins Diversus, a more ancient writer than Senac, or the celebrated 
Morton, or the learned and accurate Torti, has given an accurate descrip- 
tion of the algid fever: 
" Tn the commencement of some intermittents," says he, " while the patient 
experiences a slight chilliness or shivering, such a great retrocession of heat 
occurs that the skin becomes quite cold, the countenance like that of a person in a 
dying state, and the pulse so small and feeble as to be scarcely perceptible. As 
the hot stage comes on, the pulse increases a little, but is still small, unequal, 
frequent and weak; the thirst is obstinate and distressing, with great anxiety, 
dejection and restlessness ; the sense of heat to the patient himself is intense and 
burning, while to the touch of another person it is either imperceptible or very 
slight; there is a great debility or alienation of mind, with cold sweat, palpitation 
of the heart and trembling." 
Vai esius and Louis Mercatus have in like manner described with accu- 
racy malignant intermittents, drawing their descriptions directly from 
nature, laying down with great clearness and precision their diagnosis and 
prognosis, and delineating their multiform nature and various appearances 
with such accuracy as to render it evident that there is no form of disease 
which they cannot assume. 
Torti, the celebrated practitioner of Modena, directed in his inquiry 
by the light of analysis, grouped or collected into separate points of view 
the leading symptoms w hich, under certain circumstances, bestow a sort of 
peculiar physiognomy on the disease, and he adverted with great sagacity 
to its metamorphosis or masked forms. 
Torti enumerates seven varieties of the malignant intermittent fever : 
the first form is characterized by bilious vomitings and a preternatural 
discharge from the bowels, resembling sometimes That of cholera morbus, 
and at others that of dysentery ; in the second form there is a hepatic 
flux, or one which is sometimes of a blackish color ; in the third, a cardi- 
algic affection or burning sensation in the stomach, accompanied with fruit- 
less efforts to discharge the contents of that viscus; in the fourth, a profuse 
sweat, which affords no relief to the patient; in the fifth, repeated fainting 
fits ; in the sixth, a continued coldness, which increases by degrees without 
being followed by any augmentation of heat; and lastly, in the seventh, a 
deep soporose or lethargic affection, differing but little from apoplexy. 
Dr. J. L. Alibert, who has been regarded superior to most writers on this 
subject and inferior to none, subsequently in his Inaugural Thesis on Malig- 
nant Intermittents, extended the varieties to nineteen. Alibert enumer- 
ates as varieties, the choleraic or dysenteric, the hepatic or atrabiliary, the 
cardialgic, the diaphoretic, the syncopal, the algid, the soporose, the deli- 
rious, the peripneumonic or pleuritic state, the rheumatic, the nephritic, 
the epileptic, the convulsive, the cephalic, the dyspnoeic, the hydrophobic, 
the catarrhal, the icteric state and the exanthematic state of the malignant 
intermittent. 62 
Investigation of the Phenomena and Treatment of Malarial Fever. 
It is evident, that these various divisions of Senac, Torti and Alibert 
may all be referred to the six varieties which wre have laid down, viz: the 
cerebro spinal, the pulmonic, the cardialgic, the abdominal, the algid, and 
the haemorrhagic. 
■ Whilst it is true that in each of these forms there is combined a local 
congestion and in some cases a true phlegmasia, with paroxysmal fever 
which may be of the quotidian, tertian, quartan or remittent types; at the 
same time in all the varieties there occur profound lesions of the blood, 
spleen and liver. Certain results, as defibrination and destruction of the 
colored corpuscles, the increased formation of blood pigment, splenic and 
hepatic enlargement and biliary derangement, are common to all the various 
forms, and underlie all the peculiar manifestations of the action of malaria. 
Even when energetic measures have arrested the paroxysm, the lesions of 
the blood and liver and spleen demand careful attention and protracted 
treatment. It follows from the preceding facts, that certain symptoms, as 
jaundice, portal obstruction, obstinate vomiting of biliary matters, and 
serous or bloody effusions, may characterize any one of the forms of the 
malignant intermittents. In each case the physician must not merely treat 
the paroxysm, but also its peculiar accident or lesion, by the appropriate 
remedies, for the local phlegmasise and structural alteration and impair- 
ment of function and hematic change may continue even after the arrest 
of the paroxysmal fever. 
Whilst, therefore,*the physician regards the intermittent fever as the 
main affection, and the recurrence of successive paroxysms as the true 
source of danger, inasmuch as they renew the local affection and push it 
to the degree of fatal.structural change and disorganization, in most cases 
he is compelled to regard the disease as consisting of two distinct elements. 
We propose to examine the sixth form of malignant intermittent fever, 
which we have designated as the haemorrhagic, under a distinct head, 
because of the more recent prevalence upon an extended scale, and the 
fearful fatality of that variety known as malarial hmmaturia. 
III. INVESTIGATION OF THE PHENOMENA AND TREATMENT OF MALARIAL 
FEVER. 
The complete investigation of the nature, causes and treatment of 
malignant intermittents should embrace, in addition to the above: 
(d.) Accurate records of the symptoms, at stated periods of the day 
and night, exhibiting the changes of temperature, pulse and respiration, 
and unfolding accurately the manifestations of the nervous, muscular, 
cutaneous, circulatory, alimentary and urinary systems. 
(e.) Micioscopical examinations of the blood, associated also with 
microscopical and chemical analysis of the surrounding air and waters. 
(f.) Chemical analysis of the blood. 
(g.) Chemical and microscopical analysis of the urine. 
(h.) Chemical analysis of the sweat. 
(i.) Chemical and microscopical analysis of saliva. 
(j.) Chemical and microscopical analysis of vomited matters. 
(k.) Chemical and microscopical analysis of excrements. 
The whole amounts of the urinary constituents should be quantitatively 
determined each day and throughout the progress of the disease- 
The post-mortem examinations should embrace accurate details as to 
the physical, chemical and microscopical characters of the solids and fluids. 
(1.) General description of appearances of the cadaver. 
(m.) Post-mortem changes of temperature. Investigation of the Phenomena and Treatment of Malarial Fever. 
63 
(n.) Physical, chemical and microscopical characters of the cerebro- 
spinal and sympathetic nervous systems. 
(o.) Physical, chemical, microscopical characters of the heart, and of 
the blood contained in the vessels. 
(p.) Physical, chemical and microscopical characters of the liver and 
bile; the analysis of the bile should receive especial attention. 
(q.) Physical, chemical and microscopical characters of the alimentary 
canal and its contents. 
(r.) Physical, chemical and microscopical characters of the spleen, 
kidneys and urine. 
(s.) Physical, chemical and microscopical characters of the spinal 
marrow and the bones. 
All these changes or deviations from the usual standard should be 
carefully delineated by colored drawings and micro photographs. 
The preceding investigations can only be conducted by the aid of the 
apparatus and reagents of a well appointed laboratory. But even under 
the most adverse circumstances, and in localities remote from large cities, 
reports might be drawn up of great value by "country practitioners," 
embracing medical topography. 
Reports of cases including careful daily records of variations of symp- 
toms, temperatures, pulse, respiration, etc. 
Mortality to cases and population, vital statistics, influence ofage, sex 
and race. 
Effects of diet, location, habits and modes of agriculture. 
Results of post-mortem examinations. 
In the presentation of the results of these investigations, which were 
commenced in 1855, we shall give in the present volume (Medical and Sur- 
gical Memoirs, vol. 2), those facts which relate chiefly to the phenomena 
and treatment of malarial fever. We shall endeavor to illustrate each 
inquiry by actual observations, analysis of the blood and urine, chemical 
and microscopical examinations of the fluids and solids, reports of cases 
and post-mortem examinations. The mass of facts thus accumulated will 
serve their purpose not merely for present analysis and comparison and 
instruction, but also for future study and use by original investigation. 
In an extended inquiry so original in its design and execution, it is 
difficult, if not absolutely impossible, to present all the details in an abso- 
lutely systematic manner according to the conventional methods of the 
systematic compilations and text books of the present day. 
Whilst, therefore, we shall not follow the exact order of investigation 
laid down in the preceding pages, we shall endeavor to group the various 
facts, observations andinquiries in such manner as shall be most convenient 
for practical purposes. 
Questions relating to the prevention and arrest of contagious diseases, 
as well as the important subject of quarantine, disinfection and the relations 
of endemic, epidemic and contagious diseases, to climate, soil and waters, 
will be discussed and illustrated in the third and fourth volumes of these 
Medical and Surgical Memoirs. 
In the present volume, we shall present the original observations relat- 
ing to malarial fever, under the following heads or divisions : 
I. Physical and Chemical Characters of the Blood in Malarial 
Fever. 
II. Microscopical Characters of the Blood in Malarial Fever. 
III. Hemorrhagic Malarial Fever. 64 
Investigation of the Phenomena and Treatment of Malarial Fever. 
IV. Pathological Anatomy of Malarial Fever. 
V. Phenomena of Fever in General. 
VI. Cases Illustrating the Symptoms, History, Pathology, and 
Treatment of the various forms of Malarial Fever. 
VII. Prevention of Malarial Fever. 
VIII. Indigenous Remedies of the United States of America, 
WHICH MAY BE EMPLOYED IN THE TREATMENT OF THE VARIOUS 
forms of Malarial Fever, as substitutes for the Sulphate 
of Quinia. 
IX. Practical Observations of the Author on the Treatment of 
THE VARIOUS FORMS OF MALARIAL FEVER, AND THE COMPLICA- 
TIONS ARISING FROM THE PATHOLOGICAL ALTERATIONS INDUCED 
by the Malarial poison, and from the supervention of 
OTHER DISEASES. CHAPTER II. 
PHYSICAL AND CHEMICAL CHARACTERS AND CHANGES OF THE BLOOD IN 
MALARIAL FEVER AND OTHER DISEASES. 
The Blood-Imperfect state of our knowledge of this fluid. Imperfections in the methods 
of analysis. Importance and difficulty of establishing a standard formula of the composition of 
the blood in health. The composition of the blood varies not only with the class, but with each 
species of animals, and corresponds with the development of the organs and apparatus; illus- 
trated by the development of the blood and organs of invertebrate and vertebrate animals. 
Standard of Lehmann, and of Becquerel and Rodier. Importance of determining the changes of 
the blood during thirst and starvation. Importance and difficulty of determining the amount 
of blood in the system. Changes of the Blood in Malarial Fever-Difficulties of the investigation. 
Color of the blood and serum in malarial fever. Specific gravity and coagulation of the blood 
in malarial fever and other diseases. Fibrin decreases in malarial fever. Formation of heart- 
clots in congestive fever during life. Occurrence of heart-clots in other diseases. Conditions 
most favorable to the deposition of fibrinous concretions. Symptoms and diagnosis of fibrinous 
concretions in the heart and blood-vessels. Perilous effects resulting from the detachment of 
fibrinous concretions. Imperfect state of knowledge, with reference to the formation of fibrin- 
ous concretions in the living body. Cause of the coagulation of the blood unknown. Principles 
of treatment best adapted to prevent the formation of fibrinous concretions in malarial fever. 
Physical and chemical changes of the constituents of the blood in malarial fever. Illustrative 
cases. Relations of the cerebro-spinal and sympathetic nervous systems to the changes of the 
blood and organs in malarial fever. Gangrenous erosion of cheek following malarial fever. 
Comparison of the changes of the blood in malarial fever, with the changes in marsh 
cachexia. Mechanical dropsy. Acute dropsy. Cachetic dropsies. Alterations of the colored 
blood-corpuscles in malarial fever. Principles of treatment suggested by the changes of 
the blood in malarial fever. Effects of bloodletting. Of excessive purgation. Of nutri- 
tious diet and stimulants. Of phosphates. Of pepsin. Determination of the place of 
the destruction of the colored blood-corpuscles in malarial fever. Constitution of the blood in 
various diseases, in typhoid, typhus, and ephemeral fevers. In small-pox, scarlatina, measles, 
scurvy, erysipelas, cholera, phthisis, scrofula, carcinoma, Bright's disease, chlorosis, anemia, 
rheumatism, puerperal fever, pneumonia, peritonits, angina, .tonsillaris, bronchitis, carditis, 
pericarditis, imflammation of brain, glanders, lead-poisoning. The colored blood-corpuscles are 
more uniformly and rapidly destroyed in severe cases of malarial fever than in any other acute 
disease. Diminution of fibrin in malarial fever corresponds to the severity of the disease. Dis- 
cussion of the question, Do these changes of the blood precede, or succeed, or are they simul- 
taneously with, the aberration of the physical, chemical, vital, and nervous phenomena, denomi- 
nated fever? The constitution of the blood varies not only with the class, but. with each species 
of animals, and corresponds with the development and perfection of the organs and apparatus. 
Blood of protozoa, polypi, acalephse, echinodermata, cephalopoda, amphioxus, garfish (lepisos- 
teous osseus), reptiles, birds and mammalia. Chemical constitution of moist blood-corpuscles. 
Chemical constitution of liquor sanguinis. Importance of establishing the typical formula of 
the blood in starvation. Difficulties of establishing the amount of blood in health and disease. 
Estimates ol the amount of blood in the human system by Blumenbach, Haller, Borelli, Young, 
Dumas, Fletcher. Ancell, Valentine and Lehmann, and by the author. Changes of the blood in 
malarial fever. Difficulties of investigations upon the blood in disease. Color.of the blood and 
serum in malarial fever. Specific gravity of the blood and serum in various diseases, as deter- 
mined by Becquerel, Rodier, Nasse, Zimmerman, Guenaud de Mussy, and Joseph Jones. Coagu- 
lation of the blood. Table of blood-corpuscles in 1000 parts of healthy and malarial blood. 
Fibrin in healthy and diseased blood, as determined by Andral, Gavarret, Becquerel, Rodier, 
Guenaud de Mussy, Popp, Wittstock, Simon, Glover, Heller, and Joseph Jones. Cases illustrating 
the physical changes of the fibrin, and tlie formation of heart-clots in malarial fever. Observa- 
tions of Hewson, Baillie, Morgagni. Albinus,Burns,Stewart, Wardrop,Oruwell, Graham, Stenzel, 
Meckel, Stoerk, Petit, O'Halloran, Martial, Baron, Virchow, Paget, Crampton, Louis, Bougeu, 
Desault, Duncan, Reid, Hodgson, Andral, Tiedemann, Otto, Lobstein, Cloquet, Carsewell, Lang- 
staff, and Richardson, on the formation of fibrinous concretions during lite. Conditions most 
favorable to the deposition of fibrinous concretions. Observations of Gairdner, Richardson, 
Gaspard, Lee, Hewson, Thackrah, Cooper, and Briicke, upon the coagulation of the blood. Symp- 
toms and diagnosis of fibrinous concretions in the heart and blood-vessels. Observations of Dr. 
Wm. Senhouse Kirkes upon the effects of detachment of fibrinous concretions during life. Dis- 
cussion of thecauses of the formation of fibrinous concretions in the heart and blood-vessels in 
malarial fever. Principles of treatment best adapted to prevent the formation of fibrinous con- 
cretions in the heart and blood-vessels. Method of analyzing! the blood. Table illustrating the 
composition of venous blood in malarial fever, History of the cases which furnished the blood 66 
Physical and Chemical Changes of the Blood in Malarial Fever. 
for analyses. Comparison of their results with the typical formula of the blood in health and 
disease. Colored blood-corpuscles are diminished during malarial fevers, and the extent and 
rapidity of the diminution correspond to the severity and exlent of the disease. Researches of 
Andral and Gavarret upon the blood of intermittent fever. Composition o' the blood in marsh 
cachexia, according to Becquerel & Rodier. Composition of the blood in mechanical dropsy. 
Composition of the blood in acute dropsy. Composition of the blood in cachectic dropsies- The 
fixed saline constituents of the colored blood-corpuscles are diminished in malarial fever. The 
iron of the disintegrated blood-corpuscles appears in the urine. Physiological, pathological, and 
therapeutical bearing of the changes of the blood-corpuscles in malarial fevers. Researches of 
Schmidt upon the specific gravity of the colored blood-corpuscles in various diseases. Relations 
of the colored blood-corpuscles to the muscular and nervous system. Principles of treatment, 
based upon the changes of the blood in malarial fever. Injurious effects of bloodletting in mala- 
rial fever. Active and excessive purgation should be avoided in malarial fever. Importance of 
nutritious diet, and of the phosphates and iron. Principles which should govern the adminis- 
tration of pepsin in malarial fever. The excretion of the products resulting from the dead disin- 
tegrated blood-corpuscles should be promoted by diuretics and depurants,and the liver and spleen 
should be roused to t hrow off their perverted secretions. Place of the destruction of the colored 
corpuscles in malarial fever. Animal starch accumulates in the malarial liver; whilst grape 
sugar is absent, .alterations of the blood, and especially of the blood-corpuscles in the spleen 
during malarial fever. Comparison of the changes of the blood in malarial fever, with the 
changes of the blood in typhoid fever, typhus fever, ephemeral fever, small-pox, scarlatina, 
measles, acute scurvy, chronic scurvy, erysipelas, cholera, phthisis, scrofula, carcinoma, Bright's 
disease, chlorosis, anemia, simple rheumatic fever, febrile arthritic rheumatism, rheumatism, 
puerperal fever, pneumonia, pleuritis, peritonitis, angina, tonsillaris, acute bronchitis, carditis, 
pericarditis, inflammation of brain, glanders, and lead-poisoning. The colored blood-corpuscles 
are more uniform and rapidly destroyed in malarial fever than in any other acute disease. 
Comparison of the changes of the blood and organs in malarial fever, with the changes of the 
blood and organs in typhoid and typhus fevers. The diminution of fibrin in malarial fever corre- 
sponds with the severity of the disease. Observations of Andral upon the diminution of fibrin 
in fevers. Discussion of the question, Do thesechanges of the blood precede or succeed, orarethey 
simultaneously with, the aberration of the physical, chemical, vital, and nervous phenomena 
denominated fever. Bleeding should be employed with caution in malarious districts. Sulphate 
of quinta beneficial in pneumonia and pleurisy, and irritative fevers following amputations, 
occurring in malarious countries. Observations of the author upon three attacks of malarial 
fever occurring in his own person. Observations of Drs. Stevens, Ball, Mitchell, Saivagnoli, 
Archer, Porter, and Potter, upon the changes of the blood preceding the phenomena of fever. 
Brain-Pathological alterations of in malarial fever. 
PHYSICAL AND CHEMICAL CHANGES OF THE BLOOD IN MALARIAL FEVER. 
Imperfect state of our knowledge of this fluid. Imperfections in our methods of analysis. 
Importance and difficulty of establishing a standard formula of the constitution of the blood in 
health. The composition of the blood varies, not only with the class, but with each speeies of 
animals, and corresponds with the development of the organs and apparatus, illustrated by de- 
velopment of the blood and organs of invertebrate and vertebrate aniffials. Standard of Leh- 
mann, and of Becquerel and Rodier. Importance of establishing the changes of the blood during 
thirst and starvation. Importance and difficulty of determining the amount of blood in the 
system. 
Iii the present state of physiological and pathological science, the 
investigation of the changes of the blood in health and in disease is attended 
by great labor and numerous difficulties; and from the complexity of the 
substances, the number'and delicacy and complexity of the chemical 
changes of these substances, and from the numerous obscure and complex 
relations of these substances of the blood with the surrounding organs and 
tissues, and from imperfections of the methods and instruments of investi- 
gation. absolute accuracy is impossible. 
Whilst the physiological chemist knows that the elements of the blood 
are ultimately derived from the inorganic world (one portion directly and 
the other secondarily through the vegetable kingdom); whilst the chemist is 
able to investigate the combinations and relations of these inorganic bodies, 
out of the living organism; whilst the physicist can demonstrate the 
mechanical equivalents of the forces generated during these chemical 
changes; whilst the physiologist can desciibe the general process of diges- 
tion, and the general changes of the inorganic and organic materials during 
their preparation for the blood and structures; whilst the physiological 
chemist can isolate many of the constituents of the blood, and of the secre- 
tions formed from the blood; whilst the physiological chemist can isolate 
many of t he substances resulting from the metamorphosis of the tissues and 
blood, and form plausible hypotheses with reference to the relations of 
these chemical changes to secretion, nutrition and the development of the 
forces; still the knowledge of the physiological chemist is incomplete, 
because numerous chemical changes have never been investigated, and his Complex Nature of Physiological Phenomena. 
67 
knowledge does not cover sufficient ground to allow the analysis,, compari- 
son and generalization of all the physical, chemical and physiological 
actions, or the determination of the origin, development and metamorpho- 
sis, and physical, chemical and physiological relations of each substance, 
or the determination of those fixed relations or laws by which it would be 
possible, not only to explain the correlation of the physical, chemical, 
vital and nervous forces, but also predict with absolute certainty the effects 
of disturbances in the chemical changes and in the development and mutual 
relations of the forces. 
The imperfection of physiological and pathological science is placed in 
a clear light when we consider- that the cause of the coagulation of the 
blood, the most striking and apparently simple phenomenon presented by 
this fluid, is still undetermined, notwithstanding the researches of Hewson, 
Hey, Prater, Hunter, Fordyce, Langish, Thackrah, Scudamore, Briicke 
and Richardson; when we consider that the mode of origin and offices of 
fibrin are still matters of dispute, Zimmerman, Simon and Inman consid- 
ering it as an excretory product, of no further use in the animal economy, 
destined to be still further metamorphosed, and finally cast off, whilst Paget, 
Carpenter and other physiologists regard it as the most perfect of the 
nutritious products destined to enter into the constitution of the organs 
and tissues; 'when we consider that the mode ami place of origin, and the 
offices, and the mode and place of death and disintegration and excretion 
of the colored blood-corpuscles are still subjects of dispute and investiga- 
tion with the best physiological chemists; when we consider that the mode 
of the formation of the secretions from the blood, and the connection of the 
nervous system with secretion, nutrition and excretion, are undetermined, 
and are now engaging the attention of the best minds of the profession; 
when we consider that the series of chemical changes which the elements 
undergo during the nutrition of the organs and tissues, and during the 
development of the forces, are very imperfectly understood, if not wholly 
unknown; when we consider that the physical and chemical relations of 
the elements of the living body to the vast majority of poisonous compounds 
are unknown; when we consider that physiological and pathological know- 
ledge extends merely to the time and place, and results of change, and not 
absolutely to the nature of the changes themselves; when we consider that 
no definite opinions prevail with reference to the relations of the physical, 
chemical and nervous forces and phenomena with the vital and intellectual 
and moral principles. Should these imperfections in physiological and 
pathological science cause indolence and indifference? Should the com- 
plexity of the phenomena, and the imperfections in the instruments and 
modes of analysis, lead the honest inquirer after truth to abandon the 
investigation in despair? 
The honest attempts to unravel complicated phenomena, by honest 
and truth loving minds, who are not afraid or ashamed to point out their 
failures, and the imperfections of their modes of investigation, and who 
ardently desire to incite others to investigation, and who would cheerfully 
destroy with their own hands every erroneous statement or hypothesis or 
theory which they have promulgated, have been and will often be char- 
acterized as failures, simply because they yield only negative results, or 
fail to elicit the whole truth. 
In judging of the value of original investigations, we should at all 
times bear in mind the fact, that the development of all sciences has been 
the slow result of the labors of many minds, and that the rapidity of the 
development of each branch of knowledge has been in exact proportion to 
the complexity of the phenomena. Thus mathematics and astronomy and 68 
Difficulty of Establishing a Standard Formula of Blood. 
mechanics, which deal with the most simple and general phenomena, were 
the first developed, and are now the most perfect of all sciences. As man 
stands upon a pyramid, the foundation of which is the inorganic world, 
and the materials composing this pyramid, consisting first of plants in 
various stages of development, the simpler extending downwards, the more 
complicated extending upwards, diminishing in numbers as they increase 
in complexity; and secondly, of animals in various stages of development, 
increasing in complexity and diminishing in numbers as they extend up- 
wards; and as the existence of man is absolutely dependent upon the rela- 
tions of the component members of the universe ; and as the forces of man 
are all the resultants of the action of the same forces of the sun which keep 
up a never ending circulation and change of the matter upon the surface of 
our globe; and as the development and action and life of man and of all 
organized beings depend upon the forces, not only of our sun but also of the 
fixed stars, it is evident that he is a type of the universe and comprehends 
within himself all phenomena, astronomical, physical, chemical, physio- 
logical and psychological, and that his phenomena are exceedingly com- 
plex, and require for their complete solution the most laborious investiga- 
tions and the most exalted exercise of the reasoning faculties. Notwith- 
standing that from the complexity of the phenomena and the difficulties 
of the investigations, the progress of physiology and pathology must be 
slow, the observer, so far from being discouraged, should be animated to 
vigorous and prolonged effort, remembering that every honest, physiologi- 
cal and pathological investigation must be productive of good, even if its 
results be only negative. Negative results are always valuable, because 
they assist in defining the bounds of knowledge, and in determining the 
extent of man's power over the phenomena of nature, which depends abso- 
lutely upon his knowledge of the. properties, forces, and relations and laws 
of matter. 
IMPORTANCE AND DIFFICULTY OF ESTABLISHING A STANDARD FORMULA OF 
THE CONSTITUTION OF THE BLOOD IN HEALTH. 
The blood is composed of so many and such different materials, and is 
liable to so many variations from causes entirely compatible with health, 
that the establishment of a reliable standard, to which the changes of the 
blood in disease may be referred, is difficult, if not impossible, and requires 
nice discrimination, laborious investigation, and wide generalization. 
The blood is composed not alone of the elements of nutrition and secre- 
tion and force, it receives also the products of the disintegration of the 
tissues and organs, and the products resulting from the chemical changes 
of the elements used in working the apparatus and in maintaining a defi- 
nite temperature. 
The elements of the blood may be furnished from the food and atmos- 
phere alone, through the stomach, lungs and skin ; but the blood, as blood, 
is the resultant of the elaboration of many organs, and of the chemical 
changes of all the organs and tissues. 
The blood is not only distributed by innumerable channels through 
every recess of the body; the blood is not only the source of all the elements 
of structure; the blood not only furnishes the materials for all the secre- 
tions and excretions, and for all the chemical changes but the blood is in 
turn affected by the physical and chemical changes of every vessel, of 
every nerve, of every organ and texture of the body. It is evident, 
then, that the constitution of the blood will depend upon the food ; upon 
the vigor and perfection of the organs of digestion, respiration, circulation, Difficulty of Establishing a Standard Formula of Blood. 
69 
and secretion and excretion : upon the vigor and perfection of the nervous 
system, and of all the organs and appaiatus; and upon the correlation of 
the physical, vital, and nervous forces. 
The character of the blood, then, will vary with the animal ; with the 
organ and tissue through which it is circulating; with the age, sex, tempera- 
ment, race, diet, previous habits, occupation and previous diseases; with 
the soil and climate; and with the relative states of activity of the forces. 
The constitution of the blood varies not only with the class, but with each 
species of animals, and corresponds with the development and perfection of the 
organs and apparatus. 
Thus, in the lowest forms of the protozoa, which resemble simple cells 
provided with vibratile cilise, we find no circulatory system; no fluid 
separated from the albuminous fluid which permeates the structures, to 
which the name blood may be applied; no special organs; and no nervous 
system. In the higher members of this group we discover the first rudi- 
ments of a circulatory system, and an attempt at the interchange of the fluids 
from different parts of the body. All the stomatoda have contractile pul- 
satory cavities situated in the denser and outer layers of the parenchyma of 
the body. Du ring their expansion these cavities become filled with a clear, 
transparent, colorless liquid, which disappears entirely during the contrac- 
tion. No blood-vessels communicate with these cavities, and no special 
walls have been discovered surrounding them; and the fluid which they 
contain, although analogous to blood, contains no corpuscles. By these 
simple means, corresponding to the structure of these animals, fhe fluids of 
the body are prevented from stagnation, and a free interchange of the 
nutritive elements promoted. 
In the polypi-inarticulate fleshy bodies, having asimple visceral cavity, 
with a single opening at the center above, without intestines, without 
glands separated from the wells of the visceral cavity, with no distinction 
of sex, and an imperfectly developed nervous system in the highest, and 
none whatever in the lowest-the'circulatory system is rudimentary, and 
the fluid which it distributes nothing but the digested matter s of the visceral 
cavity mixed with sea water. This circulatory fluid contains a few spheri- 
cal corpuscles, apparently albuminous, and a few oil globules. According 
to Dr. T. Williams,f a few of these corpuscles appear to be nucleated, others 
appear to contain secondary cells, and others again are charged with 
minute granules. The fluid is incapable of coagulation, and contains albu- 
men in very small amount. 
In the highest species of the acalephae, the nervous system is more 
developed than that of the polyps, and the blood and circulatory system 
show a corresponding degree of development. The transparent gelatinous 
bodies of these animals are traversed by canals, which receive water from 
the stomach or directly from without, and being lined with cilia1 effect a 
constant renewal of the water, and thus perform the office of a respiratory 
system. These aquiferous canals are surrounded by vessels which have 
exceedingly thin walls, and are without ciliated epithelium and longi 
tudinal and circular fibres, and which open directly by large tubes into the 
alimentary canal. In some species, according to Will, these sanguiferous 
vessels contain a greenish fluid, with spheroidal and slightly elongated red 
corpuscles with large nuclei; in others the corpuscles are brown, and iu 
others again they are of a greenish color. There is no regular circulation, 
the blood being shifted hither and thither by the regular contractions of 
the body. The blood of the acaleplue although like that of the polyps, the 
t Memoir on the Blood-proper and Chylaq:;cous Fluid of Invertebrate Animals, by Dr. T. 
Williams, Philos. Transact., 1852; Brit, and For. Med.-Chir. Review, vol. xii, p. 484. 70 
Blood of Invertebrate Animals. 
direct product of digestion mixed with sea-water, is of a higher typej 
because its corpuscles are larger, contain more granules and oil-globules, 
and their cell-membranes are more distinct. 
The higher members of the echiuodermata have a distinct circulatory 
system separated from the alimentary canal, composed of arterial and 
nervous trunks, between which, in some species, there is an organ 
analogous to a h^art. The echiuodermata is the only class amongst the 
radiata in which a proper circulation of the nutritive fluid takes place, and 
this is attended with a corresponding development of the nervous and 
muscular systems and organs of secretion. It is in this class that we first 
find the liver in its rudimentary state, however, consisting of simple caeca, 
opening into the digestive cavity. According to Dr. T. Williams, the 
corpuscles resemble spherules, composed of hard and very minute granules 
of coagulated albumen, without any detectable nucleus or cell wall, or oily 
particles, and are readily broken up into their individual molecules. 
In the spiunculida, the highest order of this class, the corpuscles are 
more highly developed, being flat and irregularly oblong, having small, 
bright, highly refractive nuclei. 
As the great object of these observations is to show that the constitu- 
tion of the blood depends upon the development and perfection of the 
organs, and apparatus, and nervous system, and place in a clear light the 
great difficulty and complexity of the problem to establish a definite stan- 
dard to which diseased blood may be referred, we will pass over the 
remaining classes of the invertebrata, and notice only the highest division 
of the mollusca, the cephalopoda. 
The nervous system of the cephalopoda is highly developed, having a 
central portion resembling the brain of the vertebrata, in the extraordinary 
increase of its ganglionic substance, and in being contained in a cartilagi- 
nous cranium. They have a well-developed muscular system, and the 
rudiments of an internal skeleton, and all the organs, except the spleen, 
which are found in the vertebrata. They have organs of seuse correspond- 
ing in perfection with the development of the nervous system; digestive- 
apparatus complicated in structure; salivary glands highly developed; a 
pancreas present in some species; the liver present in all, and consisting of 
a compact glandular mass, with distinct excretory ducts; kidneys also 
present. The circulatory and respiratory systems exhibit a development, 
and the blood shows au elaboration corresponding to the perfection of the 
organs and apparatuses of rhe cephalopoda. It coagulates spontaneously 
upon standing, and the number of corpuscles is greatly increased. They 
inclose numerous granules, thus resembling the colorless corpuscles of the 
vertebrata. The majority of the blood-corpuscles are colorless; some few,, 
scattered here and there, have a violet hue. 
Blood of Vertebrate Animals.-In the amphioxus or branchiostoma 
(Lancelot), the most simply constructed of vertebrate animals, the circula- 
tory system resembles closely that of some of the Annelida, as the Eunice,, 
in its division and the distribution of numerous pulsatile dilatations upon 
the different vascular trunks. The respiratory system is formed upon an 
equally degraded type. The branchial apparatus is placed in the same 
cavity in which are lodged the liver, kidneys, generative apparatus, and 
greater portion of the intestinal canal, thus resembling closely the inverte- 
brata. The nervous and organic systems are correspondingly simple in 
structure. The canal which incloses the spinal column presents anteriorly 
no cranial expansion, but the- spinal cord extends from one extremity to 
the other. The liver is reduced to its rudimentary condition, a greenish 
glandular layer lining a portion of the intestines, and the spleen is absent. Blood of Man and Animals. 
71 
Accompanying these simple undeveloped organs and feeble forces we 
find colorless blood, rich in water and poor in solid constituents. In 
the blood of this animal we find only colorless corpuscles. This is 
remarkable when we remember that the spleen also is absent. Colored cor- 
puscles and a well developed spleen mark the more highly organized fishes. 
We can assert that as far as our researches and experiments upon fishes 
have extended, the number of the colored blood-corpuscles, and the 
elaboration of the blood, and the rapidity of the development, and the 
energy of the forces, correspond to the development and perfection of the 
organs. Thus, in the Garfish (Lepisosteous osseus), which, in addition to 
branchial apparatus, has a capacious lung (opening by a short trachea and 
extending nearly the whole length of the abdominal cavity), we find a 
greater number of colored blood-corpuscles, and more active and vigorous 
forces. The Gar is a destructive and active pirate, and consequently needs 
great muscular power to outstrip and capture the swift inhabitants of the 
watery elements. Without the simultaneous development of the colored 
blood-corpuscles, and of the organs and apparatus, this would be impossible. 
We might demonstrate these propositions by numerous examples obtained 
by our own laborious investigations, but these will suffice to establish the 
truth of our propositions with reference to the class of fishes. 
In the class of reptiles we find a^imilar development of the blood, 
corresponding to the development of the organs and nervous system, and 
the activity of the forces and intelligence. Thus, the blood of the doubt- 
ful reptiles, as the Congo snake of our Southern swamps and ricefields 
(Amphiuma means) and the Hellbender (Menopoma Alleganiensis), is thin, 
deficient in blood-corpuscles, and far less highly developed than the blood 
of the Alligator, or Chelonians. 
In birds and mammalia we observe a great increase of colored cor- 
puscles, not only in quantity, but also in numbers. The size of the cor- 
puscles are greatly diminished. The character of the blood varies in the 
different species, and even with the same ; but the facts are as yet wanting 
which would enable us to introduce these elements with accuracy in the 
calculations destined to the establishment of a typical formula, to which 
the changes of the blood in disease may be referred. 
COMPARATIVE ANATOMY AND CHEMISTRY OF THE BLOOD IN MAN AND 
ANIMALS. 
During the years 1853, 1854 and 1855, I conducted at my father's resi- 
dence, Maybank, on Colonels Island, in Liberty county, Georgia, an elabo- 
rate series of investigations, the chief objects of which were to determine- 
1st. The chemical, physical, physiological and microscopical characters 
of the blood of various vertebrate animals in the normal state, and during 
thirst and starvation. 
2d. The structure and offices of the various organs in health and 
during thirst and starvation. 
3d. The relations of the constituents of the blood to the different 
species and genera of animals, and to the development and offices of the 
individual organs. 
4th. The effects of gases upon the blood, secretions and excretions. 
A large portion of these labors were published by the Smithsonian 
Institution in 1856, illustrated by twenty-seven drawings by the author 
from nature. (Investigations, chemical and physiological, relative to 
certain American vertebrate, by Joseph Jones, M. D. Smithsonian Con- 
tributions to Knowledge 1856, page 137.) 72 
Investigations of Joseph Jones, M. D., on Blood of Birds. 
As this work had only a limited circulation and never reached the 
medical profession, we have consolidated and reprinted those portions 
which relate to the 
COMPARATIVE ANATOMY AND CHEMISTRY OF THE BLOOD IN MAN AND 
ANIMALS, AND THE EFFECTS OF THIRST AND STARVATION UPON 
THE PHYSICAL AND CHEMICAL CONSTITUTION OF THE BLOOD. 
These investigations, as far as our knowledge extends, have never 
been repeated in this or in any foreign country, and they form a fitting 
introduction to the study of the changes and composition of the blood in 
various diseases, and also furnish facts of great value and importance 
bearing on medico legal investigations. 
The most accurate instruments (balances, microscopes, porcelain, pla- 
tinum and glass apparatus, and furnaces) and the approved methods of 
amalysis were employed. As the method of analysis was fully described 
in the Smithsonian contributions to knowledge for 1856, the chemistand 
physiologist is referred to this work. 
BLOOD OF BIRDS. 
Ardea Nycticorax, Linnaeus (female). Night Heron. June 12. 
This bird had its wing broken, and was also wounded in the neck, 
where some blood had been extravasated into the cellular tissue. The 
blood was drawn about two hours after its capture. 
Specific gravity of the blood 1028 
Solid constituents in 1000 parts of blood 127.11 s 
Solid constituents in 1000 parts of serum 50.00 
Solid constituents in serum of 1000 parts of blood 45.95 
Water in 1000 parts of blood ? 872.89 
Water in 1000 parts of serum 950.00 
1000 parts of blood contained- 
Water 872.89 
Blood-corpuscles (dried organic constituents) 74.91 
Albumen, fattv and extractive matter 43.41 
Fibrin " 2.20 
Fixed saline constituents 6.59 
1000 parts of blood contained- 
Moist blood-corpuscles 315.84 
Water 236.88 
Solid constituents 78.96 
Liquor sanguinis 684.16 
Water 636.01 
Solid constituents 48.15 
Syrnium nebulosum, Linnaeus. Barred Owl. May 14. 
This bird had been shot in the epe, wing, and other parts of the body, 
and kept without food for twenty-four hours. 
Solid constituents in 1000 parts of blood 160.34 
Solid constituents in 1000 parts of serum 54.94 
Solid constituents in serum of 1000 parts of blood 48.81 
Water in 1000 parts of blood 839.66 
Water in 1000 parts of serum 945.06 
1000 parts of blood contained- 
Water 839.66 
Blood-corpuscles (dried organic constituents) 101.08 
Albumen, fatty and extractive matter 46.51 
Fibrin 4.69 
Fixed saline constituents 8.06 Composition of Blood of Birds. 
73 
1000 parts of blood contained- 
Water 320.52 
Solid constituents 106.84 
Moist blood-corpuscles 427.36 
Liquor sanguinis 572.64 
Water 519.14 
Solid constituents 53.-50 
Cathartes atratus, Wils. Black Turkey-Buzzard. Sept. 8. 
The blood had a strong, disagreeable, musky odor, similar in all 
respects to that of the bird itself. When the serum was treated with 
sulphuric acid and gently heated, this smell was developed with great 
power. 
The odor of the turkey-buzzard is not only disagreeable in the extreme, 
but also lasts for a great length of time. It was difficult to remove it from 
the hands, and my laboratory was fumigated for a considerable length of 
time after this analysis. 
The serum, like that of several terrapins, was of a bright orange color. 
The fibrin was unusually soft and inconsistent, and much of it dis- 
solved during the process of washing. 
Solid constituents in 1000 parts of blood 200.83 
Solid constituents in 1000 parts of serum 51.85 
Solid constituents in serum of 1000 parts of blood 43.70 
Water in 1000 parts of blood h 799.17 
Water in 1000 parts of serum 948.15 
1000 parts of blood contained- 
Water -. 799.17 
Blood-corpuscles (dried organic constituents) 150 47 
Albumen, fatty and extractive matter 41.62 
Fibrin '. .41 
Fixed saline constituents 8.33 
1000 parts of blood contained- 
Moist blood-corpuscles 626.88 
Water 470.16 
Solid constituents 156.72 
Liquor sanguinis 373.12 
Water 329.01 
Solid constituents 44.11 
The number of the analyses of the blood of birds which have been 
published is very limited. The following analyses of the blood of the 
goose and' hen were made by Nasse :- 
Water. 
Blood- 
corpuscles. 
Albumen and ex- 
tractive matter. 
Fibrin. 
Fat. 
Soluble 
salts. 
Insolu- 
ble salts. 
Goose 
Hen 
814.88 
793.24 
121.45 
144.75 
50.78 
48.25 
3.46 
4.67 
2.56 
2.03 
6.87 
6.97 
1.09 
1.82 
The following analyses of the blood of domestic birds were made by 
Dumas and Prevost :- 
Water. 
Solid constituents. 
Blood-corpuscles. 
Residue of serum. 
Raven 
797.0 
203.0 
146.6 
56.4 
Heron 
808.2 
191.8 
132.6 
59.2 
Duck.. 
765.2 
234.8 
150,1 
84.7 
Hen 
779.9 
220.1 
157.1 
63.0 
Pigeon 
797.4 
202.6 
155.7 
46.9 74 
Composition of the Blood of Mammals. 
BLOOD OF MAMMALS. 
Common Cur-dog. June 28. 
Previously to this analysis, the dog had been poorly fed, principally 
upon vegetable food. 
The blood coagulated rapidly; the clot was large, and the relative 
amount of serum small. After standing for several hours, 400 grains of 
blood yielded not more than 40 grains of serum suitable for analysis. 
The serum was transparent, but of a bright red color. 
Specific gravity of the blood 1043.6 
Solid constituents in 1000 parts of blood 188.13 
Solid constituents in 1000 parts of serum 128.95 
Solid constituents in serum of 1000 parts of blood 120.18 
Water in 1000 parts of blood 811.87 
Water in 1000 parts of serum 871.05 
1000 parts of blood contained- 
Water .'. 811.87 
Blood-corpuscles (dried organic constituents) 62.72 
Albumen, fatty and extractive matter 116.33 
Fibrin 3.04 
Fixed saline constituents 6.04 
1000 parts of blood contained- 
Moist blood-corpuscles 263.64 
Water 197.73 
Solid constituents 65.91 
Liquor sanguinis 736.36 
Water 613.14 
. Solid constituents 123.22 
Common Cur-dog, used in the preceding analysis. August 7th. 
For a week previous to this analysis, the dog was supplied with more 
mutton than he could devour. Upon this diet of animal food, he became 
very fat and fleshy in a few days. 
The blood coagulated in a few moments after it left the body. 
Specific gravity of the blood 1045.5 
Specific gravity of the serum 1030.5 
Solid constituents in 1000 parts of blood 193.48 
Solid.constituents in 1000 parts of serum 119.67 
Solid constituents in serum of 1000 parts of blood T09.64 
Water in 1000 parts of blood 806.52 
Water in 1000parts of serum 880.33 
1000 parts of blood contained- 
Water 806.52 
Blood-corpuscles (dried organic constituents) 78.04 
Albumen, fatty and extractive matter 106.18 
Fibrin 3.15 
Fixed saline constituents 6.11 
1000 parts of blood contained- ' 
Moist blood-corpuscles 322.76 
Water 242.07 
„ Solid constituents 80.69 
Liquor sanguinis 677.24 
Water 561.45 
Solid constituents 112.79 
Andral, Gavarret and Delafond made no less than 222 analyses of the 
blood of 155 Mammals. The following results of their investigations may 
be compared with my analyses of the blood of cold-blooded animals. Composition of the Blood of Mammals. 
75 
Water. 
Blood 
Corpuscles. 
Residue of 
serum. 
Fibrin. 
Blood of 17 Horses 
Blood of 14 Cattle 
Blood of 19 Sheep (Rambou- 
illet breed) 
Blood of 11 Sheep (cross 
variety) 
Blood of 13 English Sheep.. 
Blood of 6 English Swine... 
Blood of 2 Goats 
Blood of 16 Dogs 
( Mean 
4 Maximum 
( Minimuni 
? Mean 
- Maximum 
( Minimum 
( Mean 
- Maximum 
( Minimum 
? Mean 
Maximum 
( Minimum 
( Mean 
4 Maximum 
( Minimum 
( Mean 
■] Maximum 
( Minimum 
( Mean 
Maximum 
( Minimum 
( Mean 
< Maximum 
( Minimum 
810.5 
833.3 
795.7 
810.3 
824.9 
799.0 
815.3 
830.3 
808.7 
810.8 
827.2 
789.8 
810.8 
822.1 
795.3 
809.6 
816.9 
793.9 
804.0 
809.2 
798.8 
774.1 
795.5 
744.6 
102.9 
112.1 
81.5 
99.7 
117.1 
85.1 
98.1 
109.6 
82 5 
106.1 
123.4 
94.6 
95.0 
110.4 
83.8 
105.7 
120.6 
92.1 
101.4 
105.7 
97.2 
148.3 
176.6 
127.3 
82.6 
91.0 
74.6 
86.3 
93.6 
82.9 
83.5 
96.6 
74.7 
80.3 
87.7 
74.7 
92.4 
97.0 
82.6 
80.1 
88.7 
73.6 
91.4 
92.0 
90.8 
75.5 
88.7 
60.9 
4.0 
5.0 
3.0 
3.7 
4.4. 
3.0 
3.1 
3.8 
2.6 
2.8 
3.4 
23 
2.6 
3.3 
2.0 
4.6 
5.0 
4.1 
3.2 
3.5 
2.6 
2.1 
3.5 
1.6 
The following are the analyses of the blood of different mammals made 
by Nasse. The extractive matter and insoluble salts of the blood are in- 
cluded with the albumen. 
Water, 
s 
Blood- 
corpuscles. 
Albumen. 
Fat. 
Fibrin. 
Soluble 
Salts. 
Horse 
117.13 
67.*85 
1.31 
2.41 
6.82 
Ox 
799.59 
121.86 
66.90 
2.04 
3.62 
5.98 
Calf 
826.71 
102.50 
56.41 
1.61 
5.76 
7.00 
Goat 
839.44 
86.00 
62.70 
0.91 
3.90 
7.04 
Sheep 
827.76 
92.42 
68.77 
1.16 
2.97 
6.91 
Rabbit 
817.30 
1.90 
3.80 
6.28 
Swine 
768.94 
145.35 
72.78 
1.95 
3.95 
6.74 
Cat 
810.02 
113.39 
64.46 
2.70 
2.42 
7.01 
Dog 
790.50 
123.85 
65.19 
2.25 
1.93 
6.28 
Dumas and Prevost analyzed the blood of.numerous animals. The 
method of analysis which they employed was similar, in some respects, to 
that of Andral, Gavarret and Delafond. The fibrin, however, was not 
determined. The following are the results which they obtained with the 
blood of the mammals: 
Water. 
Solid 
constituents. 
Blood- 
corpuscle.0. 
Solid 
matter of serum 
Ape ^Simia callitriche} 
776.0 
224.0 
146.1 
77.9- 
Dog 
810.7 
189.3 
123.8 
65.5 
Dat 
795.3 
204.7 
120.4 
84.3 
Horse 
818.3 
181.7 
92.0 
89.7' 
Calf 
826.0 
174.0 
91.2 
82.8 
Sheep 
829.3 
170.7 
93.5 
77.2 
Goat 
814.6 
185.4 
102.0 
83.4 
Babbit 
837.9 
162.1 
93.8 
68.3 
Guinea-pig 
784.8 
215.2 
128.0 
87.2 76 
Amount of Blood in Warm and Cold-Blooded Animals. 
Having examined in detail the blood of cold and w'arm-blooded ani- 
mals in a normal condition, we shall next compare the individual results 
and analyses together, and endeavor to point out the characteristic distinc- 
tions of the blood of these two great classes of animals. 
AMOUNT OF BLOOD EXISTING IN THE BODIES OF WARM AND COLD-BLOODED 
ANIMALS IN A NORMAL STATE. 
In determining the amount of blood, several methods have been 
employed by different chemists and physiologists. 
M. Valentin* adopted the following ingenious mode: 
Having weighed the animal, he abstracted a definite amount of blood, 
determined its solid constituents, and then injected a given quantity of 
distilled water into the blood-vessels. Time was allowed for Hie diffusion 
of this by the circulatory apparatus throughout the mass of the blood. A 
fresh portion of blood was then abstracted, and the amount of solid matters 
determined. The relation between the amount of solid matters in the 
blood first drawn and the blood diluted with a given quantity of distilled 
water, enabled him to calculate the quantity of the entire blood of the 
animal. 
Although this method is sufficiently accurate for general purposes, 
still the following objections have been urged against it with justice: 
The water injected is not diffused uniformly throughout the mass of 
blood. This is determined by the fact that the blood drawn from different 
veins yields different proportions of water and solid matters. When an 
excess of water is injected into the circulatory system, it has a tendency to 
lodge in certain organs, as the kidneys and spleen, and in a less degree in 
the lungs. Other circumstances affect the accuracy of the results; as the 
loss of blood in any of the steps of the operation, the elimination of the 
water by evaporation from the surface of the lungs and skin, and by the 
action of the kidneys, and exosmose into the surrounding tissues in the 
interval of time between the in jection of the water and the abstraction of 
the second portion of blood. 
If, however, the experiment be carefully performed, without allowing 
any loss of blood, or too great a length of time to elapse between the 
injection of the water and the abstraction of the second portion of blood, 
results approaching very nearly to the truth may be obtained. 
Another method has been suggested, dependent for its accuracy upon 
the fact that iron exists only in the blood-corpuscles and hair, and conse- 
quently, when the latter is shaved off, it will be found only in the former. 
A definite portion of the blood is abstracted, and the proportion of 
iron determined. The whole animal is then burned, the ashes collected, 
and the amount of iron ascertained. By a comparison of this with the 
amount existing in a definite quantity of blood, the whole amount of blood 
may be determined. This method, if practicable, promises accurate 
results. 
Another method, proposed by Lehmann,f is founded upon the fact 
that onh' a definite amount of grape sugar can exist in the blood at any 
one time, without its elimination by the kidneys. 
* Rept. der Physiol., Rd. s. 281-293. 
t Lehmann's Physiological Chemistry, translated by G. E. Day, Amer, edit., Philad., 1855, 
I, 639. 
Other methods of determining the amount of blood have been proposed, but not practised by 
the following physiologists: Vogel. Pathol. Anat, des menchl. Kbrpers, Leipz., 1845, s. 59 (or 
English translation, p. 84). Dumas, Chim. Physiol et Med., Paris, 1848, p. 326. Weisz, Zeitsch. 
d. k. k. Gesellsch. d. Aertze Dec. 1847, s. 203-229. Amount of Blood in Warm and Cold-Blooded Animals. 
77 
Having ascertained, how much grape sugar the blood may normally 
contain under favorable circumstances, the quantity of blood contained in 
an animal may be calculated by ascertaining the quantity of sugar which 
must be introduced into the circulatory fluid in order to make it pass into 
the urine. 
The methods of Valentin and Lehmann might be applicable to warm- 
blooded animals, whose circulation is rapid, and whose excretions and 
secretions are correspondingly abundant. They are, however, wholly 
inapplicable to cold-blooded animals. 
In the first place, the circulation in this class is sluggish, and the 
blood, owing to the peculiarities of the structure of the circulatory appa- 
ratus, is not diffused uniformly to all the organs and tissues, as in the 
higher animals. In the second place, the secretions and excretions are 
exceedingly slow, and small in amount. Many animals of this class do 
not void their urine more chan once in a month during starvation, and 
then in exceedingly small quantities. In many the bladder is absent, and 
where it does exist, even supposing that the urine was rapidly excreted, 
owing to the structure and position of the urinary apparatus, it is next to 
impossible to draw off the contents of the bladder. 
From these considerations, then, it would be utterly impossible to 
determine the amount of blood in cold-blocded animals, by injecting into 
the circulatory system either water or grape sugar. 
The method, also, of determining the quantity of blood from the rela- 
tive proportion of iron in a definite amount of blood and in the ash of the 
whole body, would also, in many animals of this class, be absolutely 
impossible. The Chelonians are provided with such an enormous external 
skeleton, that the errors in the calculation of the amount of iron in this 
would be numerous. 
The only practical method which I was able to devise was, to cut the 
jugular veins and arteries, and, stretching the neck out, hold the body 
perpendicular, with the head downwards. The contraction of the heart, 
blood-vessels and capillaries, aided by gravity, expelled very nearly all 
the blood ; a fact which was often proved by the thin, watery aspect of 
the last portions. 
This method is more accurate in cold than warm-blooded animals, 
because their nervous and muscular system, requiring but little nutriment 
from the blood, the heart continues to beat, and the muscles, blood-vessels, 
and capillaries to contract, for hours after almost all the blood has been 
abstracted. In warm-blooded animals, the heart ceases to beat, and the 
contractility of the muscular system is lost, when not more than one-third 
of the blood has been abstracted. 'Phis method, then, which I employed 
to determine the amount of blood in cold blooded animals, should not be 
condemned because it is not applicable to warm-blooded animals. 
Great discrepancies have prevailed amongst physiologists with regard 
to the amount of blood contained in the bodies of warm-blooded animals. 
Blumeubach estimated the quantity in an adult man at 8.5 to 11 
pounds, and Beil at 44 pounds. 
M. Valentin, by his method of injecting water, arrived at the follow- 
ing results. The numbers represent the relation existing between the 
quantity of blood and the weight of the body : 
Large Dogs (the mean of four experiments) as 1 : 4.5 
A lean, debilitated Sheep as 1 : 5.02 
Cats, female (the mean of two experiments) as 1 : 5.78 
A large female Rabbit as 1 : 6.20 78 
Odor of Animals. Specific Gravity of the Serum and Blood. 
From these data, he estimated tin; amount of human blood to be- 
Male sex as ] : 4.36 
Female sex as 1 : 4.93 
At the present day, the blood is generally estimated at 22 pounds, 
which is equal to about the eighth part of the weight of the body. 
Lehmann* determined the amount of blood in the bodies of two crimi- 
nals, who were decapitated, to be from 17.5 to nearly 19 pounds, or oue- 
<eighth the weight of their bodies. 
From numerous careful examinations of cold-blooded animals, by the 
method previously described, I have arrived at the following results, 
which must be considered only as an approximation to the truth: 
Amount of blood in Serpents to T'3 of the weight of body. 
Emys terrapin A t^ tt " 
" Emys serra ta A t° A " " 
" Testudo polyphemus... to A " " 
Our investigations have shown that the blood is far less abundant in cold 
than in warm-blooded animal*. 
This fact is important, because it will aid us in the investigation of 
many of the phenomena of cold blooded animals, and in the explanation 
of the differences which distinguish the two great classes of animals. 
The arterial blood of cold-blooded animals is never of that bright red 
color of the arterial blood of warm-blooded animals, on account of the 
mixture of the arterial and venous blood in the common ventricle of the 
heart. For the same reason, the venous blood is not of so dark a color as 
that of warm-blooded animals. 
The color of the serum in most reptiles-as ophidians, batrachians, 
fishes-and some chelonians-as the gopher festudo polyphemus)-is of a 
light yellow color. 
In many carnivorous terrapins-as the yellow-belly terrapin (emys 
serrata), chicken terrapin (emys reticulata}, and salt-water terrapin (emys 
terrapin)-the serum is of a golden color. 
In most birds and mammalia which I have examined, the serum is of 
a light yellow color. In the black turkey-buzzard (cathartes atratus), it is 
of a golden color. 
COLOR OF THE BLOOD AND SERUM. 
ODOR OF ANIMALS. 
The strong smell of both cold and warm-blooded animals appears to 
reside especially in the serum, and may be developed by treating the serum 
with a little sulphuric acid, and applying a gentle heat. I have demon- 
strated this fact in numerous instances, and often in the serum of disagree- 
able animals, with disgusting power. The odor of animals is also due, as 
in the alligator and rattlesnake, to peculiar glands. The secretion of the 
anal gland of the rattlesnake emits such a powerful and disagreeable odor 
that it may produce giddiness of the head and sickness of the stomach.f 
These results were accurately determined upon the balance used in all 
my analyses, which, as we have before stated, was capable of indicating 
1-lOOOth of a grai n. 
*Loc. cit., p. 638. 
fin dissecting a large male rattlesnake (crotalus durissus), I accidentally cut the anal gland, 
and the odor was so peculiar, heavy, and disgusting, and exerted such an effect upon the head, 
■that it was with the greatest difficulty that the dissection and drawing were completed. 
SPECIFIC GRAVITY OF THE SERUM AND BLOOD. Specific Gravities of the Blood and Serum of Animals. 
79 
TABLE OF THE SPECIFIC GRAVITIES OF THE BLOOD AND SERUM 
OF ANIMALS. 
Name of observer. 
Name of animal. 
Sp. gr. of 
blood. 
Sp. gr. of 
serum. 
Job. Jones 
Psammophis flagelliformis (Coachwhip Snake) 
1036.0 
u 
Alligator Mississippiensis (Alligator) 
1046.0 
4 4 
Chelonia caretta (Loggerhead Turtle; 
1032.5 
1014.8 
4 4 
Chelonura serpentina (Snapping Turtle) 
1025.5 
1013.6 
4 4 
Emys terrapin (Salt-water Terrapin) 
1035.3 
1012.7 
4 4 
Emys reticulata. (Chicken Tortoise) 
1034.0 
■ 4 4 
Emys serrata (Yellow-bellied Terrapin) ' 
1026.5 
1013.7 
4 4 
Emys serrata (Yellow-bellied Terrapin) 
1029.6 
1014.0 
4 4 
Testudo polyphemus (Gopher) 
1030.0 
1018.0 
4 4 
Testudo polyphemus (Gopher) ... 
1037.0 
1017.0 
4 4 
Common Cur-Dog 
1043.0 
Common Cur-Dog 
1045.5 
1030.5 
Becquerel 1 
and Rodier J 
f Mean 
Pregnant Women 4 Maximum 
1051.5 
1055.1 
1025.5 
1026.8 
( Minimum 
1046.2 
1023.6 
20 human beings, mean 
1055.0 
1026.1 
10 human beings, mean 
1056.0 
1028.0 
11 Men, mean 
1060.2 
8 Females, mean 
1057.5 
1027.4 
Lehmann 
Human 
1057.4 
1028.0 
From this table we learn that the blood becomes more concentrated as the 
argans, and apparatus, and intelligence of animals are developed. 
TABLE SHOWING THE AMOUNTS, IN 1000 PARTS, OF THE AVATER AND 
SOLID MATTERS OF THE BLOOD AND SERUM OF DIFFERENT ANIMALS. 
Cold-Blooded Animals. 
BLOOD OF INVERTEBRATE ANIMALS. 
Name of observer 
i w t 
। W ater 
' in 1000 
Name of animal. | parts of 
i blood. 
Solid 
matter 
in 1000 
parts of 
blood. 
Water 
in 1000 
parts of 
serum. 
Solid 
matter 
in 1000 
parts of 
serum. 
Solid 
matter 
in serum 
Of 1000 
parts of 
blood. 
C. Schmidt 
Harless & Bibra 
Anodonta cygnea (Pond Mussel)..j 999.146 
Helix pomatia (She! 1 Snail) | 985.482 
Loligo and Eledone (Cephalopods: 992.67 
0.854 
14.518 
7.33 
0.665 
8.398 
4.70 
BLOOD OF VERTEBRATE ANIMALS. 
Jos. Jones 
J. F. Simon 
.Dumas & Prevost 
Fishes. 
Tryyon sabina (Stingray) 
Zyyncenn. malleus (Hammerhead) 
Shark) 
884.20 
861.14 
886.70 
872.00 
900.00 
863.70 
886.20 
846.00 
115.80 
138.86 929.31 70,96 
113.30 i 945.55 59.45 
128.00 
100.00 
136.30 
113.80 
154.00 
65.50 
56.05 
83.85 
68.80 
72.50 
65.70 
94.00 
Lepisosteus osseus (Garfish) 
Carp 
Tench 
Trout 
Eelpout 
Eel. 80 
Water and Solid Matters of the Blood and Serum of Different Animals. 
Cold-Blooded Animals-Continued. 
BLOOD OF VERTEBRATE ANIMALS. 
Name of observer 
Name of animal. 
Water 
in 1000 
parts of 
blood. 
Solid 
matter 
in 1000 
parts of 
blood. 
Water 
in 1000 
parts of 
serum. 
Solid 
matter 
in 1000 
parts of 
serum. 
Solid 
matter 
in serum 
of 1000 
parts of 
blood. 
Jos. Jones 
Aquatic Reptiles. 
Rana Catesboeana (Bullfrog) 
832.51 
167.49 
938.07 
61.93 
54.96 
Pumas & Prevost 
Jos. Jones 
Frog 
Chelonia caretta (Loggerhead 
Turtle) 
884.60 
879.10 
115.40 
120.81 
950.56 
49.44 
46.40 
45.82 
Chelonura serpentina (Snapping 
Turtle) 
895.00 
105.00 
951.32 
48.68 
45.80 
ll 
Emys terrapin (Salt-water Terra- 
pin) 
845.28 
154.72 
956.17 
43.83 
38.75 
** 
Emys reticulata (Chicken Tor- 
toise) 
846.98 
153.02 
936.42 
63.58 
57.51 
Emys serrata (Yellow-bellied Ter- 
rapin) 
875.41 
124.59 
956.97 
43.03 
39.36 
Alligator Mississip pie nsis (Alliga- 
tor) 
823.86 
176.14 
909.20 
90.80 
82.05 
J. P. Simon 
Jos. Jones 
Land Reptiles. 
Bufo variabilis 
Heterodox platy rhinos (Hog-nose 
Viper) 
848.20 
833.24 
151.80 
166.76 
937.50 
62.50 
112.33 
55.55 
1I 
Heterodon niger (Black Viper).... 
860.57 
139.43 
925.11 
74.89 
69.67 
ll 
Psammophisflagelliformis (■ oach- 
whip Snake) 
818.30 
181.70 
934.22 
65.78 
57.62 
it 
Coluber constrictor (Black Snake) 
788.63 
211.37 
898.58 
101.42 
89.01 
ll 
Testudo polyphemus (Gopher) 
843.38 
156.62 
933.59 
66.41 
60.00 
Warm-Blooded Animals. 
BLOOD OF BIRDS. 
Name of observer 
Name of animal. 
Water 
in 1000 
parts of 
blood. 
Solid 
matters 
in 1000 
parts of 
blood. 
Water 
in 1000 
parts of 
serum. 
Solid 
matters 
in 1000 
parts Of 
serum. 
Solid 
matters 
in serum 
of 1000 
parts of 
blood. 
Nasse 
Goose 
814.88 
185.12 
55.78 
ll 
Hen 
793.24 
206.76 
Dumas & Prevost 
Hen 
779.90 
220.10 
63.00 
ll ll 
Pigeon 
797.40 
202.60 
46.90 
ll ll 
Duck 
765.20 
234.80 
84 70 
ll ll 
Raven 
797.00 
203.00 
56.40 
ll ll 
Heron 
808.20 
191.80 
59.20 
Jos. Jones 
Ardea nyetieorax (Heron) 
872.89 
127 11 
950.00 
50.00 
45.95 
1I 
Syrnium nebulosum (Hooting 
Owl) 
839.66 
160.34 
945.06 
51.94 
48.81 
ll 
Cathartes atratus (Black Tur- 
key-buzzard) 
799.17 
200.83 
948.15 
51.85 
43.70 
BLOOD OF MAMMALS. 
An dr al, Gavar-l 
(Mean 
810.50 
189 50 
82.60 
ret, and Dela- > 
17 Horses^ Maximum 
833.30 
204'30 
91.00 
fond ) 
(Minimum 
795.70 
166'70 
74.60 
Nasse 
Horse 
804.75 
195.25 
70.85 
Dumas & Prevost 
Horse 
818.30 
181.70 
89.70 
Andral, Gavar-1 
(Mean 
M0.30 
189.70 
86.30 
ret, and Dela- > 
14 Cattle < Maximum 
824.90 
201.00 
93.60 
fond ) 
(Minimum 
799.00 
175.10 
82.90 
Nasse 
Ox 
799.59 
200.41 
69.90 
Dumas & Prevost 
Andral, Gavar-l 
Calf 
826.00 
174.00 
82.80 
ret, and Dela- > 
30 Sheep, mean... 
813.50 
186.50 
82.40 
fond ) 
Nasse 
Swine 
768.91 
231.06 
75.78 
u 
Rabbit 
817.30 
182.70 
68.30 
Dumas & Prevost 
Rabbit 
837.90 
162.10 
ll ll 
Goat 
814.60 
185.40 
83.40 
Nasse 
Andral, Gavar-'i 
Goat 
839.44 
160.56 
65.70 
ret, and Dela- > 
fond J 
16 Dogs, mean 
774.10 
225.90 
75.50 
Nasse 
Dumas & Prevost 
Dog 
799.50 
209.50 
68.19 
Dog 
810.70 
189.30 
65.50 
Jos. Jones 
Common Cur-Dog 
811.87 
188.13 
871.05 
128.95 
120.18 
ll 
Common Cur-Dog 
806.52 
193.48 
880.33 
119.67 
109.64 
Dumas & Prevost 
Cat 
795.30 
201.70 
84.30 
Nasse 
Cat 
810.02 
189.98 
68.46 
( Max i mum 
853.135 
221.37 
78.27 
M. Lecanu 
Man . Minimum 
778.625 
146.86 
57.89 
( Mean 
815.880 
184.12 
. 68.08 Moist Blood-Corpuscles and Liquor Sanguinis. 
81 
A careful comparison of these results leads to the following conclusions: 
1. The proportion of water is greatest in the invertebrata. The blood 
of these animals has, according to Genth, a specific gravity not many 
degrees above that of common water. 
2. Amongst vertebrate animals, the amount of water existing in the 
blood is greatest in fishes and aquatic reptiles, and least in serpents, 
birds, and mammals. As a necessary consequence, the solid matters of 
the blood are least in the invertebrata, fish, and aquatic reptiles, and 
greatest in serpents, birds, and mammalia. 
3. It may be laid down as a general law, that as the organs and apparatus 
of the animal are developed, and the temperature and intellect correspondingly 
increased, the blood becomes richer in organic constituents. 
The blood of serpents appears, at first sight, to form an exception. 
The large amount of solid constituents, however, existing in their blood, 
is readily accounted for, when we consider their habits. These reptiles 
seldom or never drink water; consequently, the fluids of their bodies are 
derived from the animals which they consume. In all animals, the water 
of the blood and tissues is continually evaporating from the surface of the 
lungs and body. The amount of evaporation is in proportion to the struc- 
ture, habits, and temperature of the animal, and the temperature and 
moisture of the atmosphere. It is greatest in warm-blooded animals, and 
in hot and dry climates. Amongst cold-blooded animals, it is greatest in 
those having naked skins, and least in those covered by scales, bone, and 
horn. No matter how slow and small this evaporation, if it be not coun- 
teracted by a corresponding supply of water, the blood necessarily becomes 
concentrated, and yields a larger proportion of solid constituents upon 
analysis. 
4. Our knowledge is as yet too limited to develop any laws respect- 
ing the amount of water and solid materials which characterize the blood 
of each species and genus. By comparing the analysis of the blood of the 
mammalia, we see that the proportions of its constituents vary as much in 
individuals of the same species as in individuals of remotely separated 
genera. 
Table of Moist Blood-Corpuscles and Liquor Sanguinis in 1000 Parts of Blood. 82 
Moist Blood-Corpuscles in 1000 Parts of Blood. 
Moist Blood-Corpuscles and Liquor Sanguinis in 1000 Parts of Blood-Conlin'd. 
Observer. 
Name of animal. 
MOIST BLOOD-CORPUSCLES. 
LIQUOR SANGUINIS. 
Blood 
corpus- 
cles. 
Water. 
Solid 
matters. 
Liquor 
san- 
guinis. 
Water. 
Solid 
matters. 
Jos. Jones 
Nasse 
Dumas & Prevost 
ll ll 
Cl ll 
Ci ll 
ll ll 
Jos. Jones 
ll 
ll 
Andral, Gavar-) 
ret, and Dela- v 
fond ) 
Nasse 
Andral, Gavar-) 
ret, and Dela- > 
fond ) 
Nasse 
Andral, Gavar-) 
ret, and Dela- > 
fond ) 
ll ll 
Cl ll 
Jos. Jones 
ll 
Alligator 
(Alligat 
Goose 
Mississippiensis 
or) 
364.08 
485.80 
579.00 
028.40 
600.40 
622.80 
586.40 
530.40 
315.84 
427.36 
626.88 
411.60 
448.40 
326.00 
468.52 
401.40 
369.68 
398.80 
468.40 
340.40 
422.80' 
593.20 
706.40 
273.06 
364.35 
434.25 
461.30 
450.30 
467.10 
339.80 
367.80 
236.88 
320.52 
470.16 
308.70 
336.30 
244.50 
351.39 
303.30 
277.26 
299.10 
351.30 
255.30 
317.10 
444.90 
529.80 
387.90 
197.73 
242.07 
91.02 
121.45 
144.75 
157.10 
150.10 
155.70 
146.60 
132.60 
78.96 
106.84 
156.72 
102.90 
112.10 
81.50 
117.13 
101.10 
92.42 
99.70 
117.10 
85.10 
105.70 
148.30 
176.60 
121.30 
65.91 
80.69 
635.92 
684.16 
572.64 
373.12 
736.36 
550.80 
636.01 
519.14 
329.01 
613.14 
564.45 
85.12 
48.15 
53.50 
44.11 
125.22 
112.79 
Hen 
Hen 
Duck 
Pigeon 
Raven 
FTeron. 
Ardea no 
Surnium ? 
ing Owl 
Cathartes 
Buzzard 
17 Horses 
Horse 
itieorax (Heron).. 
lebulosum (Hoot- 
) 
atratus (Black 
) 
iMean 
Maximum 
( Minimum 
30 Sheep, 
Shpon 
Mean 
14 Cattl 
6 Swin 
mean 
16Dogs- 
Commo 
Oom mo 
Mean 
Maximum 
Minimum. 
English breed, 
U 
it 
5 
n 
n 
lean 
laximum 
Hnimum 
509.20 
363.64 
122.76 
Cur-Dog 
Cur-Dog 
The following general facts and conclusions have been derived from a 
careful comparison of the results contained in this table, and those derived 
from our previous investigations. 
In the invertebrata, the number of blood-corpuscles is very small in 
comparison with the number which exists in the blood of the vertebrata. In 
this class, we find only colorless corpuscles. 
In the branchiostoma or amphioxus, the connecting link between the 
highest orders, the mollusca and fishes, the blood, like that of the inver- 
rebrata, is described as containing only colorless corpuscles, and exceed- 
ingly rich in water, and correspondingly poor in solid constituents. 
As the organs and apparatus are developed, the blood is correspondingly 
improved. 
The increased development of the cerebrospinal system, and the organs of 
vertebrate animals, is attended, by a corresponding increase in the solitary gland- 
cells of the blood. 
In this class, the number of blood corpuscles is, as a general rule, least 
in cold-blooded animals, and greatest in birds and mammals. There are, 
however, exceptions to this rule. I have found the number of blood-corpus- 
cles in some cold-blooded animals, especially serpents, higher than that 
of some birds and mammals. 
The following table will illustrate this fact:- Moist Blood-Corpuscles in 1000 Parts of Blohd. 
83 
Name of observer. 
Name of Animal. 
Elood corpuscles in 
1000 parts of blood. 
Jos. Jones 
Rana catesbceana (Bullfrog) 
450.12 
44 
Emys terrapin (Salt-water Terrapin) 
447.28 
4 4 
Alligator Mississippiensis (Alligator) 
364.08 
4 4 
Heterodon platy rhinos (Hog-nose Viper)... 
444.84 
4 4 
Psammophis jtagelliformls (Coachwhip 
488.80 
Snake) 
44 
Coluber constrictor (Black Snake) 
469.20 
• 4 
Ardea nycticorax (Heron) 
315.84 
4 4 
Syrnium nebulosum (Hooting Owl) 
427.36 
Andral, Gavarret and 
Delafond 
Horse 
326.20 
Dumas and Prevost 
Horse 
368.00 
4 4 4 4 
Goat 
408.00 
Nasse 
Goat 
344.00 
Jos. Jones 
Cur-Dog 
363.64 
Dumas and Prevost 
Cur-Dog 
322.76 
Dog 
495.20 
Call 
364.80 
Notwithstanding the differences in the number of blood corpuscles, the 
differences of temperature were preserved, not only between the warm and 
cold-blooded animals, but also between the individual species of each class. 
The thermometer indicated a temperature of over 100° in the heron, 
having only 364.08 parts of blood-corpuscles, whilst in the frog, serpents 
and chelonians, having nearly double the number of blood-corpuscles in a 
given quantity of blood, the thermometer indicated a temperature several 
degrees below that of the surrounding medium. 
Several physiologists assert that the sole office of the blood-corpuscles 
is to carry oxygen in, and convey carbonic acid gas out of the animal 
economy, If this be true, the temperature of an animal would, at first 
sight, seem to be determined, in great measure, by the number of its blood- 
corpuscles ; but the temperature also depends upon the velocity of transfer 
of the oxygen, and consequently upon the rapidity of the circulation. Many 
facts, however, might be brought forward, to prove that the office of the 
blood-corpuscles is not solely the introduction of oxygen, and the carrying- 
out of carbonic acid. The following facts will show that the liquor-sangui- 
nis is also active in the performance of these important offices. 
In the capillaries and blood-vessels, the colored corpuscles rush along 
in the centre of the streams, whilst pure liquor sanguinis alone is in contact 
with the walls of the vessels In the capillaries of the lungs, the oxygen, 
from this arrangement, must necessarily be absorbed first by the liquor 
sanguinis. Again, in no case do we find the organic cells, the active agents 
in all secretions and excretions, in immediate contact with the blood-cor- 
puscles. They are separated from them by the coats of the capillaries, and a 
structureless basement membrane. The same is true of the anatomical ele- 
ments of the muscular tissue. From whence do they derive oxygen, a con- 
tinuous supply of which is absolutely necessary for the life and activity of 
every living molecule of organized beings'? The same argument will also 
prove that the blood-corpuscles are not the sole agents in the conveyance 
of carbonic acid gas out of the organs and tissues. 
These conclusions can be sustained by numerous examples. 
Do we find blood-corpuscles in plants'? Do we find blood-corpuscles 
in the lowest orders of invertebrate animals ? These bodies absorb oxygen, 
and give out carbonic acid gas, notwithstanding the absence of blood- 
corpuscles. Spallanzani* has long since demonstrated that all organized 
bodies, whether living or dead, possess the property of absorbing oxygen 
and giving out carbonic acid gas. 
«Memoirs on Respiration, by Lazarus Spallanzani, Edited by John Lenebier. London, 1805. 84 
Moist Blood-Corpuscles in 1000 Parts of Blood. 
We do not, for one moment, deny that one important office of the blood- 
corpuscles is the absorption of gases, for it has been often demonstrated 
that blood containing its corpuscles possesses far greater powers of absorb- 
ing oxygen, nitrogen and carbonic acid than pure serum. We wish to show 
that this is not the sole office of the blood-corpuscle, because it is performed 
by the liquor sanguinis, and all organic matters, whether living or dead; 
and respiration is carried on in plants and the lowest animals, which are 
without blood-corpuscles ; and an increase in the number of blood-corpus- 
cles is not necessarily followed by an increase in the temperature. 
What, then, are the principal offices of the blood-corpuscles, and what 
does an increase in their number denote1? 
These questions can only be answered by a consideration of their con- 
stitution, and their relations with the liquor sanguinis by which they are 
surrounded. 
Each corpuscle is a cell, resembling, in its nutrition, growth and 
general structure, the active agents in the formation, elaboration and 
separation of all secretions and excretions. Their cell walls possess the 
property of separating from the surrounding medium certain peculiar 
organic and mineral compounds. If a blood corpuscle be placed in water, 
it swells up, and finally bursts. If it is placed in a solution denser than its 
internal contents, they pass out more rapidly than the exterior solution 
passes in. and the cell wall shrivels up. The same physical Jaws of endos- 
mose are at work in the animal economy, A mutual action and reaction is 
incessantly carried on between the interior contents of the blood-corpuscles 
and the exterior liquor sanguinis. Whenever water, or liquids of low 
specific gravity, are introduced into the circulatory system, they dilute the 
serum, and immediately there is an endosmose of the less dense fluid into 
the denser contents of the corpuscles. Whenever water is withheld, the 
liquor sanguinis continually loses this element by evaporation from the 
surface of the lungs and skin, and by the action of the kidneys, becomes 
denser than the contents of the corpuscles, and exosmose takes place into 
the surrounding medium. The cell-wall modifies the physical and chemi- 
cal properties of every molecule of liquor sanguinis that passes through its 
structure. 
The researches of C. Schmidt have shown that the fluid contents of 
the blood-corpuscles contain, in addition to peculiar organic matters, a 
preponderance of the phosphates and potash salts; whilst the liquor san- 
guinis contains the chloride of sodium in large amount, with a little chlo- 
ride of potassium and phosphate of soda. 
In the blood-cells, the fatty acids and globulin are combined both 
with potash and soda; whilst in the plasma, the organic materials are com- 
bined only with soda. The researches of Liebig, confirmed by those of 
Schmidt, have shown that the fluid contained in the tubules of muscles is, 
like that of the blood-corpuscles, exceedingly rich in the phosphates and 
potasli salts. The phosphates also exist in large amount in the brain. 
These facts render it highly probable that the office of the blood-cor- 
puscles, taken collectively, is that of an immense gland, which separates 
and elaborates from the liquor sanguinis those organic and inorganic com- 
pounds which constitute the most important part of the structure of the 
muscles and brain. 
fn the mammalia, we have an increase, not only by weight, but also an 
immense increase in numbers of the blood-corpuscles, owing to their 
greatly diminished size, and the amount of secreting surface exposed to 
the intercellular fluid is correspondingly increased. This being the case, 
the blood of these animals must be more highly elaborated, and all their 
organs and apparatus correspondingly developed. Fibrin in 1000 Parts of the Blood of Animals. 
85 
TABLE OF THE FIBBIN IN 1000 PARTS OF THE BLOOD OF ANIMALS. 
Name of observer. 
Name of animal. 
Fibrin in 1000 
sarts of blood 
Jos. Jones 
44 
44 
J. F. Simon 
• 4 
Jos. Jones 
J. F. Simon 
Jos. Jones 
41 
44 
44 
4 4 
4 4 
4 4 
4 4 
4 4 
Masse 
Jos. Jones 
4 4 
4 4 
Andral, Gavarret, and 
Delafond 
Nasse 
Andral, Gavarret, and 
Delafond 
Nasse 
Andral, Gavarret, and 
Delafond 
Andral, Gavarret, and 
Delafond 
Nasse 
4 4 
Andral, Gavarret, and 
Delafond 
Nasse 
Jos. Jones 
4 4 
Nasse 
Trygon sabina (Stingray) 
Zygcena malleus (Hammerhead Shark) 
Lepisosteus osseus (Garfish) 
Carp 
Tench 
Rana catesbceana (Bullfrog) 
Rufo variabilis 
Heterodon niger (Black Viper) 
Psammophis flagelliformis (Coach whip Snake) 
Coluber constrictor (Black Snake) 
Chelonia caretta (Loggerhead Turtle) 
Chelonura serpentina (Snapping Turtle) 
Ernys terrapin (Salt-water Terrapin) 
Ernys reticulata (Chicken Terrapin) 
Ernys serrata (Yellow-bellied Terrapin) 
Testudopolyphemus (Gopher) 
Alligator Mississippiensis (Alligator) 
Goose 
Hen • 
Ardea nycticorax (Heron) 
Syrnium nebulosum (Barred Owl) 
Cathartes atratus (Black Turkey-Buzzard) 
< Mean 
17 Horses x Maximu<m 
( Minimum 
Horse 
( Mean 
14 Cattle • Maximum 
(. Minimum 
Ox : 
| Mean 
19 Sheep j Maximum 
( Minimum 
f Mean 
6 Swine • Maximum 
( Minimum 
Swine 
Goat 
( Mean 
16 Dogs • Maximum 
( Minimum.... 
Dog 
Common Cur-dog 
Common Cur-dog 
Cat 
unstable 
unstable 
unstable 
unstable 
unstable 
unstable 
unstable 
2.16 
1.88 
5.06 
2.61 
0.35 
4.15 
2.51 
1.04 
5.73 
3.07 
3.46 
4.67 
2.20 
4.69 
0.41 
4.0 
5.0 
3.0 
2.41 
3.7 
4.4 
3.0 
3.62 
3.1 - 
3,8 
2.6 
4.6 
5.0 
4.1 
3.95 
3.90 
2.1 
3.5 
1.6 
1.93 
3.04 
3.15 
| 2.42 
From this table we learn that the fibrin constitutes a remarkable index of the 
vital, organic, and intellectual endowments of animals. 
In the whole of the invertebrate kingdom it is absent, except in a few 
of the most highly organized, in which its presence is accompanied 
by a corresponding improvement of the cerebro-spinal system, and all 
the organs. 
In the lowest orders of the vertebrata, as fishes and batrachians, it is 
soft, unstable, and readily converted into albumen. 
In the ophidians and chelonians, although it is stable and does not 
dissolve, still its structure is soft and inconsistent, and resembles, in many 
respects, the fibrin which is formed when the vital forces of warm-blooded 
animals have been exhausted by copious and continued bleedings. 
Here we have a demonstration of the fact, that the animal kingdom is 
constructed upon one great plan. Pathological conditions of the most 86 
Fixed Saline Constituents in the Blood of Different Animals. 
highly organized animals are found to exist as the normal and permanent 
conditions of those placed below in the scale of creation. If the forces of 
a warm-blooded animal be reduced, it presents a condition in many respects 
similar to that of a cold-blooded animal. We will illustrate this by one 
other example. 
Warm-blooded animals, in health, are able to maintain their tempera- 
ture at a fixed standard, regardless of that of the surrounding medium. 
As the surrounding temperature descends, the efforts of nature to sustain 
a definite degree of heat increase. If, however, the forces of the animal 
economy be impaired, the efforts of nature are no longer sufficient to keep 
the body heated to the normal degree, and gradually the body assumes the 
temperature of the surrounding medium. The intellect and all the organic 
forces become torpid,, the chemical actions cease, or are performed in a 
feeble or perverted manner; and, finally, the once active and warm- 
blooded animal is reduced to the condition of a sluggish cold-blooded one. 
This table also apparently shows that the fibrin is one of the most 
variable of all the constituents of the blood. This, however, probably 
arises in some measure, from imperfections in our methods of analysis. 
We shall next consider the amount of fixed saline constituents in the 
blood of different animals. 
TABLE OF FIXED SALINE CONSTITUENTS IN BLOOD OF DIFFERENT ANIMALS. 
Name of observer. 
Name of animal. 
Fixed saline 
constituents 
in 1000 parts 
of blood. 
C. Schmidt 
Anodonta cygnea (Pond Mussel) 
0.256 
1 
Harless & Bibra 
Helixpomatia (Shell Snail) 
6.12 
1 Invertebrate 
Bibra 
Ascidians and Cephalopods 
2.63 
| animals. 
Genth 
Limulus Cyclops 
3.327 
J 
Jos. Jones 
Trygon sabina (Stingray) 
14.70 
4i 
Zygoma malleus (Hammerhead Shark).. 
8.36 
4 4 
Lepisosteus osseus (Garfish) 
10.27 
4 4 
Emys terrapin (Salt-water Terrapin) 
10.74 
4 C 
Alligator Mississippiensis (Alligator).... 
8.65 
ivejj tiles. 
4 4 
Chelonia caretta (Loggerhead Turtle)... 
3.58 
J 
4 4 
Rana catesbceana (Bullfrog) 
5.78 
] 
4 4 
Chelonura serpentina (Snapping Turtle) 
4.39 
1 Fresh-water 
4 4 
Emys serrata (Yellow-bellied Terrapin) 
5.22 
| Reptiles. 
4 4 
Emys reticulata (Chicken Terrapin) 
7.79 
J 
4 4 
Heterodon platy rhinos (Hog-nose Viper) 
13.47 
4 4 
Heterodon nig er (Black Viper) 
7.04 
! 
4 4 
Psammophis Jiagelliformis (Coach-whip 
I Land Rep- 
Snake) 
5.57 
} tiles. 
4 4 
Coluber constrictor (Black Snake) 
8.77 
44 
Testudo polyphemus (Gopher) 
5.83 
J 
» 4 
Cathartes atratm (Black Buzzard) 
8.33 
1 
4 4 
Ardea nycticorax (Heron) 
6.59 
4 4 
Syrnium nebulosum (Owl)..... 
8.06 
t Birds. 
'N'a.ssa 
Goose 
7.92 
44 
Hen 
8.79 
44 
Sheep 
7.76 
4 4 
Horse 
7.85 
4 4 
Ox 
6.95 
4 4 
(Jalf 
7.87 
44 
4 4 
Goat 
Rabbit 
7.84 
6.28 
}■ Mammalia. 
4 4 
Cat 
7.84 
4 4 
Dog 
7.33 
Jos Jones 
Common Cur-dog 
6.04 
4 4 
Common Cur-dog 
6.11 
J Effects of Thirst and Starvation on the Blood of Animals. 
87 
From this table we learn that the proportion of fixed saline constitu- 
ents in the blood is remarkably uniform throughout the whole animal 
kingdom. This fact demonstrates their importance. 
In the invertebrata they exist in larger amount relatively to that of 
the organic constituents of the blood than in vertebrate animals. Thus, 
in the blood of the esculent snail (Jielix pomatid) there were, according to 
Harless and Bibra, 6.12 parts of mineral, and only 8.39 parts of organic 
substances. In the blood of ascidians and cephalopods, Bibra found 4.7 
parts of organic and 2.63 parts of mineral substances. When we consider 
the constitution of the shells of these animals, it is not wonderful that 
the blood should contain so large a proportion of mineral substances. 
Schmidt found the albumen of the blood of the pond mussel {anodonta 
cygned) combined with lime. This fact shows that these mineral bodies 
are chemically combined with the organic constituents of their bodies. 
Amongst vertebrate animals, we find the largest amount of mineral 
constituents in the blood of fishes and reptiles inhabiting the salt water. 
The only exception to this rule was found in the blood of the loggerhead' 
turtle (chelonia caretta), which had been kept, for forty-eight hours pre- 
vious to this analysis, in a tub of fresh water. It is possible that an inter- 
change may have taken place between the exterior water and the salts held 
in solution in the blood. The blood of the hog-nose viper {heterodox 
platyrhinos) yielded a larger amount of ash than that of any other animal. 
This is accounted for by the fact that the reptile had been starved for a 
length of time, and the blood was in a concentrated condition. The alli- 
gator is classed amongst the salt-water reptiles, because it had resided in 
a small salt-water stream, in a salt marsh. This reptile inhabits, most 
generally, the brackish and fresh-water rivers, lakes, swamps, and rice- 
fields. 
That the fixed saline constituents are absolutely necessary, not only for 
the formation of the different structures, but also for the maintenance of 
life itself, was conclusively demonstrated by a series of experiments per- 
formed in France. It was found that when animals were fed upon grain, 
from which only one element (phosphate of lime) was abstracted, they 
rapidly lost their forces, and died in the course of a few weeks. 
Having completed the study of the blood in its normal condition, we 
are now prepared to investigate the effects of starvation and thirst. 88 
Effects of Starvation. Constituents of 1000 Parts of Blood. 
I. Tables showing the Changes in the Relative Amounts of the Organic and 
Inorganic Constituents of the Blood of Warm and Cold-blooded Animals, 
during different periods of Starvation and Thirst, The numbers repre- 
sent the amounts existing in 1000 parts of blood. The changes, therefore, 
are relative and not absolute. 
EFFECTS OF THIRST AND STARVATION ON THE BLOOD OF ANIMALS. 
(a ) SPECIFIC GRAVITIES, WATER, AND SOLID CONSTITUENTS OF BLOOD 
AND SERUM. 
Name of animal 
Period of starva- 
tion and thirst 
Specific.gravity 
of blood 
Specific gravity 
of serum 
Water in 1000 
parts of blood 
Water in 1000 
parts of serum 
Solid constitu- 
ents in 1000 parts 
of blood 
Solid constitu- 
entsin lOOOparts 
of serum 
id constitu- 
ts in serum of 
0 parts of 
>od 
| Sol 
en 
100 
bl< 
Kemale Alligator 
1046.0 
823.86 
909.20 
• 176.14 
90.80 
82.05 
Male Alligator 
17U days 
12 hrs. 
10 days 
57 " 
1056.0 
803.43 
909.20 
196.57 
90.80 
80.24 
1st female Emys terrapin 
2d if " 
1035.3 
1012.7 
845.28 
800.59 
956.17 
920.50 
154.72 
199.41 
43.83 
79.50 
38.75 
69.15 
3d " " 
744.78 
888.04 
255.22 
111.96 
92.82 
1st female Emys serrata 
2d " " 
# : 
1026.5 
1040.5 
1013.7 
875.41 
821.89 
956.97 
935.49 
124.59 
178.11 
43.03 
64.51 
39.36 
3d 11 " 
21 
793.72 
911.33 
206.28 
88.67 
77.49 
4th " " 
26 " 
1043.0 
801.34 
904.52 
198.66 
95.48 
84.59 
5th " 
31 " 
222.22 
6th " " 
38 
778 38 
845.00 
226.62 
141.86 
7 th male " 
49 " 
. 148.7 
800.94 
891.10 
199.06 
108.90 
97.88 
1st male Testudo polvphemus 
1030.0 
1018.0 
843.38 
933.59 
156.62 
66.41 
60.00 
2d " " 
30 days 
51 
1037.0 
1017.0 
854.77 
938.84 
147.23 
61.16 
55.55 
4 4 4 4 
1st Cur-dog 
1030.5 
829.77 
806.52 
900.50 
880.33 
170.23 
193.48 
99.50 
119.67 
91.68 
109.69 
2d " " 
96 hrs. 
1054.5 
1036.8 
770.90 
865.55 
229.10 
131.45 
117.18 
3d " 
158 " 
766.16 
855.13 
233.84 
114.87 
129.80 
(6.) CONSTITUENTS OF 1000 PARTS OF BLOOD. 
1 
Name of animal 
Period 
of star- 
vation 
and 
thirst 
Water 
Blood- 
corpus- 
cles 
(dried or- 
ganic 
constitu- 
ents) 
Albu- 
min, 
fatty 
and 
extract- 
ive mat- 
ters 
Fibrin 
Fixed 
saline 
constitu- 
ents 
823.86 
86.39 
78.03 
3.07 
8.65 
1714 days 
803.43 
106.80 
76.02 
3.41 
10.34 
12 hrs. 
845.28 
103.82 
36.01 
4.15 
10.74 
u x 
40 days 
800.59 
118.56 
64.85 
10.74 
3d " 11 
744.78 
156.98 
90.87 
1.85 
5.52 
314 " 
875.41 
80.67 
37.66 
1.04 
5.22 
2d" ~ u " 
17Z " 
821.89 
115.75 
54.68 
1.68 
6.00 
3d " " 
24 " 
793.72 
122.26 
74.49 
1.68 
7.85 
4 th " " 
26 " 
801.34 
102.97 
80.09 
4.15 
11.45 
5th a " 
31 " 
777.78 
12.56 
6th " " 
38 " 
773.38 
72.91 
134.49 
6.52 
12.70 
49 
800.94 
92.29 
93.38 
4.34 
9.05 
1st malfi Tesludo polyphemus 
843.38 
87.28 
57.78 
5.73 
5.83 
2~ " " * 
30 " 
852.77 
84.76 
53.17 
2.99 
6.13 
3d " " 
51 " 
829.77 
78.55 
1st Cur-dog 
806.52 
78.04 
106.18 
3.15 
6.11 
2d " 
4 
770.90 
102.55 
112.53 
4.92 
9.10 
3d " 
158 hrs. 
766. i 6 
96.76 
126.32 
2.92 
7.84 Actual Amount of Blood in Animals during Starvation. 
89 
(C.) MOIST BLOOD-CORPUSCLES AND LIQUOR SANGUINIS, 
Name of animal 
Period of 
starva- 
tion and 
thirst 
MOIST BLOOD-CORPUSCLES 
LIQUOR SANGUINIS 
Moist 
blood- 
corpus- 
cles in 
1000 
parts of 
blood 
Water 
in moist 
blood- 
corpus- 
cles 
. Solid 
constitu- 
ents in 
moist 
blood- 
corp ys- 
cles 
Liquor 
sangui- 
nis in 
1000 parts 
of blood 
Water 
in liquor 
sangui- 
nis 
Solid 
constitu- 
ents in 
liquor 
sangui- 
nis 
Female Alligator 
364.08 
273.06 
91.02 
635.92 
550.80 
85.12 
Male Alligator 
17^ days 
12 hrs. 
451.68 
338.76 
112.92 
548.32 
464.67 
83.65 
1st female Emys terrapin 
2d " " 
447.28 
335.46 
111.82 
552.72 
509.82 
42.90 
40 days 
500.00 
375.00 
125.00 
500.00 
425.59 
74.41 
3d 1 " 
57 
642.20 
481.65 
160.55 
357.80 
263.13 
94.67 
1st female Emys serrata 
3^ " 
336.76 
252.57 
84.19 
663.24 
622.84 
40.40 
2d " 
17 
478.00 
358.25 
119.75 
522.00 
463.64 
58.36 
3d " " 
24 " 
508.44 
381.33 
127.11 
491.56 
412.39 
79.17 
4th " " 
26 
439.68 
329.76 
109.92 
560.32 
471.58 
88.74 
6th " " 
3S " 
312.96 
387.36 
234.72 
290.52 
78.24 
96.84 
687.04 
612.64 
538.66 
510.42 
148.38 
102.22 
7th male • " 
49 
lstmale Testudo polyphemus (Go- 
pher) 
393.56 
302.67 
90.89 
606.44 
540.71 
65.73 
2d male Testudo polyphemus (Go- 
30 " 
3.55.76 
267.07 
88.69 
644.24 
585.70 
58.54 
3d male Testudo polyphemus (Go- 
pher) 
51 
314.20 
235.65 
78.55 
685.80 
594.12 
91.68 
1st Cur-dog 
322.76 
242.U7 
80.69 
677.24 
564.45 
112.79 
2d " 
4 " 
428.00 
321.00 
107.00 
572.00 
449.90 
122.10 
3d " 
158 hrs. 
402.64 
301.98 
100.66 
597.36 
464.64 
132.72 
II. Tables showing the Actual Amounts of Blood and its Constituents existing 
in Animals during different periods of Starvation and Thirst. 
(d.) WATER AND SOLID CONSTITUENTS OF BLOOD AND SERUM. 
Name of Animal 
Period of 
starve tion 
and thirst 
Amount 
of blood 
obtained 
Water of 
blood 
Solid con- 
stituents 
of blood 
Solid con- 
stituents 
of serum 
Grains. 
1st female Emys terrapin 
12 hours 
1000 
845.28 
154.72 
38.75 
2d " " 
40 days 
400 
320.23 
79.76 
27.66 
3d " " 
57 " 
200 
148.96 
51.04 
18.56 
1st female Emys serrata..... 
3J " 
2000 
1750.82 
249.18 
78.72 
2d " ~ " 
17 " 
800 
142.48 
45 26 
3d " " 
24 
500 
396.86 
103.14 
38.74 
4th " " 
"6 " 
450 
360.60 
89.40 
38.06 
6th " " 
38 
200 
154.68 
49.32 
28.37 
7th male " 
49 " 
500 
400.47 
99.53 
48.94 
Period 
of 
starva- 
tion and 
thirst: 
Amount 
of blood 
obtain'd 
Water. 
Blood 
corpus- 
cles 
Albu- 
min, 
fatty 
and 
extract- 
ive mat- 
ter 
Fibrin 
Fixed 
saline 
constitu- 
ents 
Name of animal 
1st female Emys terrapin... 
2d " 
12 hrs. 
Grains. 
1000 
845.28 
103.82 
36.01 
4.15 
10.74 
40 days 
57 " 
400 
320.23 
47.43 
25.95 
2.11 
4.29 
3d " 
200 
148.96 
31.40 
18.17 
.37 
1.10 
1st female Emys serrata 
2d " 
3^ " 
2000 
1750.82 
161.34 
75.32 
2.08 
10.44 
17 " 
800 
657.51 
92.60 
43.75 
1.34 
4.80 
3d " 
24 " 
500 
396.86 
61.13 
37.24 
.84 
3.92 
4th " 
26 " 
450 
360.60 
46.34 
36.05 
1.63 
5.15 
6th " u 
38 " 
200 
154.68 
14.58 
26.90 
1.30 
2.54 
7th " 
149 " 
500 
400.47 
46.15 
46.69 
2.17 
4.52 
(/.) CONSTITUENTS OF BLOOD. 90 
Constituents of Blood Consumed during Starvation. 
(g.) MOIST BLOOD-CORPUSCLES AND LIQUOR SANGUINIS. 
Name of animal. 
Period 
of star- 
vation 
and 
thirst. 
Amount 
of 
blood 
ob- 
tained. 
MOIST BLOOD-CORPUSCLES. 
LIQUOR SANGUINIS. 
Moist 
blood- 
corpus- 
cles. 
W ater of 
moist 
blood 
corpus- 
cles. 
Solid 
constit- 
uents of 
moist 
blood- 
corpus- 
cles. 
Liquor 
sangui- 
nis. 
Water of 
liquor 
sangui- 
nis. 
Solid 
constit- 
uents of 
liquor 
sangui- 
nis. 
1st female Emys terrapin 
12 hrs. 
Grains. 
1000 
447.28 
335.46 
111.82 
552.72 
509.82 
42.90 
2d 
40 days 
400 
200.00 
150.00 
50.00 
200.00 
170.23 
29.77 
•3d 
0/ 
200 
128.44 
96.33 
32.11 
71.56 
52.63 
18.93 
1st female Emys serrata 
2d 
3^" 
2000 
673.52 
505.14 
168.38 
1326.48 
1245.68 
80.80 
17 " 
800 
383.80 
387.85 
95.95 
416.20 
369.60 
46.60 
3d 
24 " 
500 
254.22 
190.67 
63.55 
245.78 • 
206.20 
39.58 
4th " " 
26 " 
450 
197.92 
148.44 
49.18 
252.08 
212.16 
39.92 
6 th " " 
38 " 
200 
62.60 
46.95 
15.65 
137.40 
107.73 
29.67 
7th male " 
49 " 
500 
193.67 
145.26 
48.42 
306.32 
255.21 
51.11 
The following tables have been constructed by calculations based upon 
careful comparisons of the blood of starved animals with the blood of those 
in a normal condition. They are, therefore, not absolutely correct, but 
are the nearest approximation to the truth that can at present be obtained. 
III.-Tables showing the Losses of Blood and its Constituents by Animals during 
different periods of Starvation and Thirst. 
pn.) WATER AND SOLID CONSTITUENTS OF BLOOD AND SERUM. 
Name of Animal. 
Period of 
starvation 
and thirst. 
Amount 
of blood 
consumed. 
Water of 
blood. 
Solid con- ! 'Solid con- 
stituents of stituents of 
blood. 
serum. 
2d female Emys terrapin 
3d 
... 40 davs 
Grains. 
600 
525.05 
74.95 
11.09 
... 57 " 
800 
696.32 
103.68 
20.19 
2d female Emys serrata 
... 17 " 
700 
655.60 
44.40 
13.78 
3d 
... 24 " 
1500 
1353.96 
146.04 
39.98 
4th " 
... 26 " 
1550 
1390.22 
159.78 
40.66 
6th " 
... 38 " 
1800 
1596.14 
204.86 
62.69 
7th male " 
... 49 " 
1000 
912.64 
87.36 
10.10 
(n.) CONSTITUENTS OF BLOOD CONSUMED. 
Name of animal. 
Period o; 
starva- 
tion and 
thirst. 
Amount 
of blood 
con- 
sumed. 
Blood- 
corpus- 
cles con- 
sumed. 
Albu- 
men, fat- 
ty and 
extrac- 
tive 
matter. 
Fibrin. 
Fixed 
saline 
constit- 
uents. 
Water of 
blood 
con- 
sumed. 
2d Emys terrapin 
40 days 
Grains. 
600 
56.39 
10.07 
2.04 
6.45 
525.05 
3d 
57 " 
800 
72.42 
17.84 
3.78 
9.63 
696.32 
2d female Emys serrata 
17 " 
700 
28.41 
12.74 
0.22 
3.03 
655.60 
3d 
24 " 
1500 
100.21 
38.08 
1.24 
6.52 
1353.96 
4th " 
26 " 
1550 
115.00 
39.27 
0.22 
5.29 
1390.22 
6th " 
38 " 
1800 
146.76 
48.42 
0.78 
7.90 
1596.14 
7th male " 
49 " 
1000 
74.85 
9.80 
.61 
3.31 
912.64 Moist Blood-Corpuscles and Liquor Sanguinis during Starvation. 
91 
Name of animal. 
Period 
of star- 
vation 
and 
thirst. 
Amount 
of blood 
con- 
sumed. 
MOIST BLOOD-CORPUSCLES. 
LIQUOR SANGUINIS. 
Moist 
blood- 
corpus- 
cles. 
Water of 
moist 
blood- 
corpus- 
cles. 
feolid 
constit- 
uents of 
moist 
blood 
corpus- 
cles. 
Liquor 
sangui- 
nis. 
Water of 
liquor 
sangui- 
nis. 
Solid 
constit- 
uents of 
liquor 
sangui- 
nis. 
2d female Emys terrapin 
3d " " 
40 days 
Grains. 
600 
247.28 
185.46 
61.82 
352.72 
339.59 
13.13 
57 " 
800 
318.84 
239.13 
79.71 
481.16 
457.19 
23.97 
2d female Emys serrata 
3d 
17 " 
7oO 
121.60 
91.20 
30.40 
578.40 
564.40 
14.00 
24 " 
1500 
419.28 
314.46 
.104.82 
1080.72 ' 
1039.50 
41.22 
4th " 
26 " 
1550 
475.60 
356.70 
118.90 
1074.40 
1033.52 
40.80 
6th " 
38 " 
1800 
561.56 
421.17 
140.39 
1238.44 
1174.97 
63.49 
7th male " 
49 " 
1000 
309.04 
231.78 
77.26 
690.96 
680.86 
10.10 
(O.) MOIST BLOOD-CORPUSCLES AND LIQUOR SANGUINIS. 
A careful review of the results of these analyses and experiments leads 
to the following- conclusions: 
1. In every instance, during abstinence from food and drink, the 
water of the blood diminished more rapidly than the solid constituents. 
The evaporation from the surface of the body and lungs, and the supply 
of a solvent for the excretions of the kidneys, were more rapid than the 
consumption of the solid organic and inorganic constituents of the blood 
for the regeneration and maintenance of the tissues and organs. 
2. The rapidity of this consumption of the watery element, and con- 
sequent concentration of the blood, depends upon the vital and physical 
constitution of the animal, and is most rapid amongst warm-blooded ones. 
Amongst cold-blooded animals, it is slowest in the gopher. The phy- 
sical constitution of the epidermis of this animal prevents evaporation 
from its surface. Its tissues, also, are more compact than those of other 
Chelonians. 
The character of the food of this animal, and the structure of its ali- 
mentary canal, are such, that it is able to withstand the effects of hunger 
without any physical or chemical change in the amount and constitution 
of its blood, or diminution of its powers, much longer than the Chelonians 
which inhabit the water. 
3. During thirst and starvation, the rapidity of the consumption of 
the constituents of the blood, organs and tissues is in proportion to the 
temperature, intelligence, vital force and the amount of muscular and 
nervous force expended by the animals. 
4. The blood-corpuscles waste during starvation, as well as the other 
constituents of the blood, thus proving that they, have important offices to 
fulfill in the support of the tissues and organs of the living animals, and 
the maintenance of the vital, nervous, physical and chemical phenomena. 
5. The fibrin decreases during starvation and thirst. 
Had we considered the amount of fibrin only in 1000 parts of blood, 
we would have fallen into an error committed by several observers. The 
increment of the fibrin in 1000 parts was only apparent, and corresponded 
in a great measure to the concentration of the blood by the rapid evapora- 
tion of its water from the surface of the body and lungs. 
6. During long-continued starvation and thirst, the stomach and 
intestines of cold-blooded animals do not become inflamed and ulcerated, 
as is almost universally the case with warm-blooded animals. 
7. The fat of the body wastes more rapidly than any of the tissues. 
The manner in which it re-enters the circulation is unknown. 
The following tables will serve to elucidate phenomena which have 
been but imperfectly studied by naturalists and physiologists. 92 
Chemistry and Physiology of the Blood, by Joseph Jones, M. D. 
Table of the Temperatures of Warm and Cold-Blooded Animals. 
Temperature of 
Atmosphere. 
Temperature of 
box or medium 
in which the ani- 
mal was kept. 
Temperature of 
region of 
Temperature of 
region of 
Micropogon undulatus 
(Croker Fish) 
Heterodon platyrhinos 
(Hognose Viper) 
Heterodon nig er (Black 
Viper) 
Psammophis flagelli- 
formis (Coachwhip 
Snake) 
Alligator Mississippien- 
sis( Alligator),starved 
17 days 
Chelonura serpentina 
(.Snapping Turtle)... 
Chelonia caretta (Log- 
gerhead Turtle) 
Emys terrapin (Salt- 
water Terrapin) 
Emys serrata. (Yellow- 
bellied Terrapin) de- 
prived of food and 
drink 3J days 
Emys serrata deprived 
of food and drink 17 
days 
Emys serrata deprived 
of food and drink 21 
days 
Emys serrata deprived 
of food and drink 49 
days 
Emys reticulata 
Testudo polyphemus 
(Gopher) 
Corvus ossifragus (Fish 
Crow) 
Ectopistes Carolinensis 
(Turtle Dove) 
Syrnium nebulosum 
(Barred Owl) 
Ardea nycticorax 
(Night Heron)... 
Car duel's tri st is (May 
Bird) 
May Bird 
May Bird, which had 
lost much blood from 
a bad wound 
May Bird, which had 
lost much blood from 
a wound 
May Bird, which had 
lost much blood 
Mammalia generally... 
75J° 
804° 
72° 
69° 
90° 
90° 
78° 
86^° 
74}° 
86° 
85° 
86° 
82° 
80|° 
66° 
76° 
784° 
82|° 
82f° 
82^° 
82|° 
82|° 
Water, 84° 
Box, 73|° 
" 85° 
Water, 811° 
Box, 78° 
" 74o 
" 76° 
" 84° 
" 81° 
" 80° 
/ 
Tail, 74° 
" 73|° 
Surface of body, 65° 
Muscles of thigh, 81° 
" ' 80° 
" " 80° 
" " 80° 
" " 104° 
Intestine, 106° 
Viscera, 84° 
Heart, 73° 
" 76° 
" 74° 
" 69° 
" and Liver, 82° 
" 11 81° 
" u ■ 80J° 
" " 734° 
H Y7° 
" " 754° 
" " sor 
" " 80° 
" " 804° 
" " 108° 
Pec.maj.muscle, 1064° 
" " 102° 
" " 104° 
" " 105° 
" " 106° 
" . " 98° 
" " 10^° 
" " 101° 
Heart, 100° Chemistry and Physiology of the Blood, by Joseph Jones, M. D. 
93 
Table showing the Relation between the Temperature and the Chemical Changes of 
the Molecules of the Solids and Fluids of Warm and Cold-Blooded Animals. 
Cnr-do<r 
- s' 
o 
C 
> 
Z 
z 
s 
S' 
q 
3 
h 
© 
o 
b 
3 
s 
z 
z 
•b 
a . 
S' 
3 
4 
5 
Name of animal. 
74° 
76° 
84° 
81° 
82° 
86° 
Fahr. 
78° 
Temperature of the atmos- 
phere and box in which 
the animal was kept. 
Fahr. 
Muscles of 
thigh, 80° 
" 80° 
" 80° 
Temperature of the 
region of 
Fahr. 
Heart and 
liver, 80|° 
" 731° 
" 77 0 
" 751° 
" 80|° 
" 80 4° 
" 100 ° 
Temperature of the 
region of 
Grains. 
5. i8 
6. 3 
10. 5 
10.29 
3.14 
2.41 
311.84 
Loss of weight each 
hour. 
3 7 0 4 
^At 
7At 
At 
W| w| <w 
mT w 
o| «| o 
Loss of weight each hour 
expressed in a fraction of 
the original weight of the 
animal. 
Grains. 
.032 
1.315 
0.357 
1.09 
.0277 
Amount of urine excreted 
hourly. 
846500 
TI3T7 
^42137 
TTS^TOS 
Amount of urine excreted 
hourly, expressed in a 
fraction of the original 
weight of the animal. 
Grains. 
.00114 
.0034 
.00166 
.00437 
.0012 
Amount of solid constit- 
uents in the urine excret- 
ed hourly. 
These tables show that, although the union of the oxygen of the atmos- 
phere with the elements of the solids and fluids of cold-blooded animals is 
so slow that their temperature changes with that of the surrounding me- 
dium, still they generate within themselves a certain amount of heat. This 
is proved by the fact, that, the interior of their bodies in the region of the 
heart and liver generally has a temperature a fraction of a degree higher 
than that of the parts nearer the surface. 
The fact that the temperature of their bodies ks often several degrees 
below that of the surrounding medium is readily explained by a reference 
to our investigations upon the effects of thirst and starvation upon the 
solids and fluids. The loss of weight is due, in a greater degree, to the 
evaporation of the water of the solids and fluids than to the metamorpho- 
sis and final elimination of the organic elements in the maintenance of 
animal temperature. The amount of solid' matters consumed in the main- 
tenance of the temperature of cold-blooded animals is not always sufficient 
to supply the heat abstracted by evaporation. 94 
Losses in Weights of Animals. 
Losses in the Weights of Animals during different periods of Thirst and 
Starvation. 
Name of animal. 
Period of starvation and 
thirst. 
Weight before starvation. 
Weight after starvation. 
1 , 
Loss of blood during 
starvation. 
1 
Loss of weight during 
starvation. 
Loss of weight compared 
to weight of body. 
Loss of weight each hour. 
Loss of weight per hour, 
compared to weight of 
body. 
Grains. 
Grains. 
Grains. 
Grains. 
Grains. 
Female Emys terrapin 
38 days 
14.285 
11,400 
600 
2,885 
1. 
3.317 
1 
T3 <5K 
U 4 4 
56 " 
12,280 
9.255 
800 
3,025 
2.25 
1 
TTKT 
Female Emys serrata 
12 hours 
33,417 
33,258 
• 
159 
1 
TOO 
13.25 
1 
T7TK 
4 4 4 4 
14 days 
20,873 
18,756 
700 
2,117 
1 
To 
6.3 
1 
3 3T3 
4 4 4 4 
20 " 
34,155 
28,675 
1500 
5,480 
,1 
11.41 
1 
SS9 4 
4 4 4 4 
20 " 
41,086 
34,960 
1550 
6,126 
12.76 
4 4 4 4 
39 " 
38,590 
30,142 
1800 
8,398 
4 T 
10.29 
1 
37g4 
Male Emys serrata 
45 " 
17,797 
14,400 
1000 
3,397 
3.14 
6 Emys serrata 
Testuclo polyphemus 
27 
104,698 
85,573 
19,125 
27.97 
37T3 
(Gopher) 
4 Testudo polyphemus 
25 " 
18,368 
16,922 
1,446 
1 
13 
2.41 
7 Ar 
(Gophers) 
37 " 
98,280 
86,696 
11,582 
1 
9 
13.04 
1 
TT 3 6 
Cur-dog 
6 d'ys, 14 
hours 
i 161,326 112,055 
49,271 
1 
311.84 
] 
TTT 
A careful consideration of these tables, in connection with previous 
researches, will tend to support the following conclusions:- 
1. The intellect, temperature, nervous and muscu lar forces, and organic 
development of animals, are in proportion to the rapidity of the changes 
of the elements. 
In warm-blooded animals, which are endowed with intellect of a high 
order, and possess great nervous and muscular force, and correspond- 
ingly developed organs, the changes in their elements are incessant. When 
starved, they lose weight rapidly. 
In cold-blooded animals, the temperature of which is often below that 
of the surrounding medium, and whose nervous system and intellect are 
feebly developed, the changes in their elements are correspondingly slow. 
The Cur-dog lost, in six days and fourteen hours, one-third of its 
original weight, whilst the Chelonians lived from thirty to sixty days with- 
out losing more than from one-fourth to one-thirteenth of their original 
weight. The loss in the former was from six to fifteen times more rapid 
than in the latter. 
2. The loss of weight at the time of death was very nearly equal in 
warm and cold-blooded animals. The maintenance of the short, vigorous 
life of the former, required as large a supply of organic and inorganic 
materials as the prolonged and sluggish existence of the latter. What the 
warm-blooded animal gained in intensity and power, it lost in duration. 
3. The length of life of an animal during starvation and thirst, is pro- 
portional to the rapidity of the changes of its elements, and, as a neces- 
sary consequence, stands in direct relation to its temperature, intellect and 
organic development. 
The Cur-dog wasted more rapidly, lived more energetically, and died 
in a correspondingly shorter time than the cold-blooded Chelonians. Circulation and Loss in Weights of Animals. 
95 
Amongst cold-blooded animals, the Terrapins which were most active 
in their movements, and whose nervous system was the most excited, lived 
during a time corresponding with their increased nervous and muscular 
exertions. t 
The female Terrapins, whose ovaries and oviducts were filled with hard 
and soft eggs, lost from l-2728th to l-3313th of their weight hourly, and died 
in the course of twenty-five or thirty-five days ; while the females which had 
deposited their eggs, and the males, which were free from these anxieties, 
waisted only one-half as much per hour-l-4366th to l-5667th of their whole 
weight-and lived twice the length of time-from fifty to seventy days. 
We may infer from these facts, as far as they extend, that the acts of 
life are carried on upon the same general plan, no matter what be the phys- 
ical or vital constitution of an animal. 
4. In cold-blooded animals, the organs, tissues, and apparatus are far 
more independent of the blood than in warm-blooded ones. 
This fact will explain the phenomena of the prolonged contraction of 
the heart and muscles, and the action of the nervous system, and the con- 
tinuance of life, for a great length of time after the almost complete 
removal of the blood. These functions are attended with so little waste, 
and consequent demand for a fresh supply of nutriment, that a very small 
amount of the circulatory fluid will suffice to keep them in action for a 
great length of time. 
In warm-blooded animals, on the other hand, the maintenance of the 
nervous and vital forces, and of a definite temperature, and the exercises of 
the intellect, involve more decided and constant changes in their elements. 
The circulatory apparatus filled with blood is the great laboratory in 
which these physical and chemical changes of the elements are carried on 
and the results distributed to every living molecule of matter. According, 
then, to the perfection of an animal, and the rapidity of these changes, will 
be the dependence of the organs and apparatus upon the circulatory fluid. 
It follows as a necessary consequence that the deprivation of this fluid will 
prove fatal in a length of time inversely proportional to the development 
and perfection of an animal. 
The question now presents itself: Why is the life of cold-blooded 
animals so sluggish, and all the physical and chemical changes of their ele- 
ments so tardy, and their temperature and intellect so low ? Can Nature be 
said to be uniform in her operations when all the phenomena of life are 
so dissimilar in these two classes of animals? 
A consideration of the important differences existing between the 
structure and funtions of their respiratory and circulatory systems may 
serve to settle definitely this question, as will be seen in the course of this 
chapter. 
The principal or only heart in many fishes, has but one auricle and one 
ventricle, and is traversed by venous blood alone, and corresponds with the 
right heart of the higher vertebrata. 
Although the circulatory apparatus is more highly developed in the 
reptiles, still a mixture of venous and arterial blood always takes place 
in the ventricle. 
As our experiments have been confined almost exclusively to the higher 
orders of cold-blooded animals, we shall consider briefly the circulatory 
and respiratory systems of the Ophidia, Sauria, and Chelonia. 
The ventricle of the heart in these higher orders is generally divided 
by an imperfect septum, which, in the heart of the alligator, is very strong 96 
Circulation and Loss in Weights of Animals. 
and almost complete. Just at the outlet of the ventricle, however, we find 
a communication established between the two, and thus the venous and 
arterial blood are mixed together, and the similarity to the heart of the 
rest of the reptiles, and the foetus of birds and mammals, is preserved. 
The venous blood from all parts of the body is returned to the right auricle 
of the heart through the veme cavse, the terminations of which are guarded 
by strong valves. The left auricle is appropriated exclusively to the 
lungs, from which it receives the aerated blood through the pulmonary 
veins. From the single ventricle two sets of vessels are sent off, the pul- 
monary and the aortic. The pulmonary artery divides into two branches, 
one for each lung. The aorto, immediately after its origin, divides into two 
trunks, which, winding backwards, join and form a large vessel, the 
branches of which distribute the blood to all parts of the system. The 
contraction of the right auricle forces the venous blood into the ventricle, 
whilst the contraction of the left auricle transmits the aerated blood from 
the lungs into the same common cavity. The contraction of the ventricle 
distributes a portion of the mixed blood into the lungs through the pul- 
monary artery, and the remainder to all parts of the body through the 
aorta and its branches. 
From this arrangement it is evident, that not only is partially aerated 
blood diffused, throughout the system, but, also, that a moiety only of the 
whole amount of blood is sent to the lungs and exposed to the action of the 
atmosphere at each contraction of the ventricle of the heart. 
From the consideration of the heart and circulatory apparatus of the 
Chelonia and Sauria, we pass very naturally to chat of warm-blooded ani- 
mals. 
The circulatory apparatus differs in no essential respect in the two 
great classes of warm-blooded animals, birds and mammals. 
In these higher animals we have a double heart, and two distinct and 
complete circulations of the blood. Each portion of the blood which has 
passed through the capillaries of the-system and become vitiated, is aerated 
in the lungs before its distribution over the body. This is one of the most 
important of all distinctions between warm and cold-blooded animals. 
The right heart is devoted to the circulation of venous blood, and the 
left heart to the circulation of oxygenated or aerated blood. 
The auricle and ventricle of one heart have no communication with 
the auricle and ventricle of the other except through the bloodvessels and 
capillaries. The vessels of each heart are distinct, and perform distinct 
offices. 
The right auricle receives the venous blood from all parts of the sys- 
tem and transmits it to the right ventricle. The contraction of the right 
ventricle distributes the venous blood to the lungs. The oxygenated or 
arterial blood is conveyed from the lungs to the left auricle, and thence to 
the left ventricle, and the contractions of this distributes it thorughout all 
parts of the system. 
As the circulatory apparatusis developed, the influence and importance 
of the nervous system are increased, and corresponding arrangements 
established for its perfect preservation. 
Another consideration to be taken into account is the relative size of 
the heart and the rapidity of its action in different animals. 
I obtained the following results by carefully weighing the entire body 
of an animal, and then ascertaining the weight of its heart upon a delicate 
balance capable of turning to the 1-lOOOth part of a grain. Comparative Weight of the Hearts of Animals. 
97 
Comparative Weights of the Hearts of Fishes. 
1 
Proportion toweight 
of entire animal 
Weight of the heart of female Trygon sabina (Stingray) 
lVl2 
" " foetus of Trygon sab m (otingray) 
1 
1^70 
" " Zygcena malleus (Hammerhead Shark)... 
1 
TTa6 
" " Zygoma malleus (Hammerhead Shark)... 
1 
" " female Lep sosteus osseus (Garfish) 
1 
9^7 
Comparative Weights of the Hearts of Reptiles. 
Proportion to weight 
of entire animal. 
Weight of the heart of Hana catesbceana (Bullfrog) 
'* " Heterodon niger (Black Viper) 
" " Coluber constrictor (Black Snake) 
" " Coluber guttatus (Corn Snake) 
*■ " Psammophis flagelliformis (Coach whip 
Snake) 
1 
7 7K 
1 
i 
43 a 
4^1T 
1 
11 " Crotalus durissus (Rattlesnake) 
" " Chelonura serpentina (Snapping Turtle) 
" " Chelonia caretta (Loggerhead Turtle).... 
" Emys reticulata (Chicken Terrapih) 
" " Emys serrata (Yellow-bellied Terrapin) 
" Emys serrata (Yellow-bellied Terrapin) 
" Emys serrata (Yellow-bellied Terrapin) 
" male Tostudo pulyphemus (Gopher) 
" male Testudopolyphemus (Gopher) 
" female Alligator Mississippiensis (Alli- 
gator) 
i4 
T41 
1 
407 
4 Io 
1 
420 
1 
5^ 
1 
1 
477 
1 
3 98 
Comparative Weights of the Hearts of Birds. 
Proportion toweight 
of entire animal. 
Weight of the heart of Meleagris gallopavo (Wild Turkey) 
" Meleagris gallopavo (Wild Turkey) 
" Syrnium nebulosum (Barred Owl) 
" " (Jathartes atravus (Turkey-buzzard) 
" Tantalus loculator (Wood Ibis) 
" " Tantalus loculator (Wood Ibis) 
1 
i 
Ila 
ip 
Tiur 
Comparative Weights of the Hearts of Mammals. 
1 
Proportion to weight 
oi entire animal. 
Weight of the heart of Common Sheep 
" Sciurus Carolinensis (Gray Squirrel 
' ' Didelphis Virginia nus (Oposs u m) 
" " Common Cat 
" Procyon lotor (Raccoon) 
" Procyon lotor (Raccoon) 
" " young Procyon lotor (Raccoon) 
" " Pointer Dog 
1 
HI 
28 0 
T64 
11° 
rp 
12^ 98 
Rapidity of Circulation in Different Animals. 
By comparing these tables, we see that the heart is proportionally 
smallest in Fishes and largest in Birds. 
As the organs and apparatus of the animal economy are developed and 
perfected, the circulation of the nutritive materials becomes more vigorous. 
As the temperature, intelligence, and activity of animals, with their 
corresponding physical and chemical metamorphoses of the elements of 
organic structure increase, there is a correspondingly rapid supply of those 
materials by which the wastes may be repaired, and from which the various 
secretions and excretions may be elaborated and separated. 
The next consideration is the rapidity of the circulation in different 
animals. The action of the heart may be taken as a general index of this. 
The following table has been drawn up from the researches of Dumas, 
Prevost, Muller and Simon. 
Rapidity of Circulation in Different Animals. 
Number of beats per minute 
In the Amphioxus 
1 
" Carp 
20 
" Fishes generally 
20 24 
' ' Green Toad 
77 
" Frogs generally . 
" Pigeon 
136 
Common Hen 
140 
" Duck 
110 
' ' Raven 
110 
" Heron 
200 
" Birds generally 
100-200 
" Ox 
38 
" Horse 
56 
" Sheep 
75 
" Goat 
84 
" Hare 
120 
" Guinea-Pig 
140 
" Dog 
90 95 
" Cat 
100-110 
" Ape (Simla Callitriche)...................... 
90 
" Human embryo 
150 
" just after birth 
130-140 
" Human being during first year 
130-115 
" " during second year 
115-100 
" during third year 
100- 90 
*• about seventh year 
90- 85 
" '' about fourteenth year 
85- 80 
" in the middle period of life 
75- 70 
" " in old age 
" Mammals generally 
38-140 
This table shows that the rapidity of the circulation corresponds with 
the structure, habits, age, and development of animals. 
If the vital force6* are of a low grade, either from original conforma- 
tion or the depressing influences of old age, the circulation is correspond- 
ingly sluggish and feeble. 
As the fluids and solids of animals become more highly elaborated and 
developed, the action of the heart and circulation of the blood become 
more rapid and vigorous. 
The next consideration is that of the structure of the respiratory sys- 
tem in the different orders of animals. Rapidity of Circulation and Respiration in Different Animals. 
99 
One of the essential conditions of the life of all organized beings, 
whether vegetable or anima', is a supply of oxygen. The modes in which 
oxygen is brought in contact with the fluids and solids of organized struc- 
tures, vary with the development and peculiar manner of life of the dif- 
ferent classes of animals. 
In the lowest classes of the Invertebrata, in which the digested matters 
pass directly from the stomach into the different structures of the body, and 
become integral parts of the animal, we find no special circulatory system, 
and respiration is carried on by the whole surface of the body which is 
bathed by the water. In animals still more highly developed, we find 
canals carrying water into all parts of the system. In many individuals, 
bloodvessels accompany these canals, and ramify around their walls. An 
incessant motion through this aquiferous respiratory system is main- 
tained by cilia lining their interior. These canals open upon the exterior 
of the body and into the visceral cavity. In many animals of this class, the 
digestive cavity, which is bathed continually by fresh portions of water, 
performs the functions of respiration. 
In the higher orders of the Invertebrata, the respiratory system is 
confined to a definite portion of the exterior or internal membrane, which is 
developed within a small space into a great extent of surface, so as to render 
the contact with the air or water as extensive as possible without any loss 
of room or power. 
According as the fluids are elaborated, and the solids correspondingly 
developed, the respiratory system becomes more condensed and perfected. 
In the Amphioxus, the pulmonary apparatus corresponds with the 
degraded type of the cerebro-spinal system and all the organs, and, like that 
of many invertebrate animals, is lodged in the same cavity with the liver, 
generative apparatus, kidneys, and the greater portion of the alimentary 
canal. In the Invertebrate animals and the Amphioxus amongst the Verte- 
brate, the circulation of the water through the branchiae is maintained 
principally by ciliary action. 
In Fishes, however, of higher organization, whose blood is more highly 
elaborated and circulates with greater rapidity, mere filamentous tufts 
hanging to the side of the neck will not suffice for the aeration of the blood. 
It is necessary that large streams of water be constantly and forcibly pro- 
pelled through the branchial apparatus, in order that the blood may be 
exposed as much as possible to the action of the air so scantily contained 
in the water. This is accomplished by the connection of the gills with the 
cavity of the mouth, the muscles of which send rapid currents of water 
through the branchial passages. The structure and position of the heart, 
also, is such that it propels all the venous blood through the branchitebefore 
its distribution to the body generally. 
At first sight, the circulation and respiration of Fishes appear to be 
more perfect than that of Reptiles. This, however, is not the case. By a 
reference to the table of the comparative weights of the heart in different 
animals, it will be seen that the heart of Fishes is about l-1000th, whilst that 
of Reptiles is about l-450th of the weight of the entire body. 
The heart of Reptiles is relatively more than twice as large as that of 
Fishes. 
The table of the comparative rapidity of the heart's action in different 
animals, showed that the circulation of Fishes is much slower than that of 
Reptiles. 
The aeration of the blood, also, is much slower and less perfect in 
Fishes, from the fact that the amount of air contained in the water is 
infinitely less than that of the atmosphere. 100 
Comparative Anatomy of Respiratory System. 
In several remarkable Fishes having strongly marked reptilian charac- 
ters, as the Garfish [Lepisosteus osseus) and the common Mudfish (Amia 
calvd) of our southern swamps and ricefields, we find both gills and a pul- 
monary organ. The lung of these Fishes has been considered by many 
physiologists and anatomists as analogous to the swimming-bladder of 
other Fishes. This organ is absent in some individuals, and its presence 
or absence in those which possess it, appears to make no material differ- 
ence ; in some, it communicates externally, whilst in others again it is com- 
pletely closed, and all its offices are unknown. It is, therefore, impossible, 
with our present knowledge, to decide whether the air bladder of Fishes 
should be considered as a rudimentary lung. 
The lung of the garfish [lepisosteus osseus) is a capacious sac, which 
opens by a short trachea high up in the throat, and, extending nearly the 
whole length of the abdominal cavity, terminates within a short distance 
of the anus. It lies between the posterior surface of the liver and the 
anterior surface of the kidneys. When removed from the abdominal 
cavity and inflated, its diameter is nearly equal to two-thirds of that of the 
fish. Its structure resembles that of the amphiuma means and other 
doubtful reptiles. The blood-vessels ramify upon the walls of this sac, the 
internal surface of which is increased by the development of numerous 
sacculi. 
This increased development of the respiratory system is attended by 
corresponding improvements in the structure and functions of the solids. 
The gar is a destructive and active pirate, and consequently needs 
great muscular power to outstrip and capture the swift inhabitants of the 
watery element. It is a very difficult matter to hold a recently captured 
gar, two or three feet in length, even with both hands, on account of the 
vigor and rapidity of its motion. In the possession of a lung, and in the 
general form and appearance of the viscera, this fish bears a strong 
resemblance to reptiles. 
In the Congo snake of our Southern swamps and ricefields, and the 
hellbender (menopoma alleganiensis), we find branchial arches without any 
development of the gills. 
The lungs of the congo snake [amphiuma means) communicate with the 
exterior through a short trachea, which opens by a slit in the pharynx, 
just opposite to the base of the cranium. The trachea passes down between 
the divisions of the bulbus arteriosus, and. a short distance below the posi- 
tion of the heart, divides into two short branches which open into the 
lungs. The lungs are long slender sacs, having the general structure of 
these organs in the Batrachia. The diameter of the lungs, even in their 
inflated condition, is very small, being about half an inch, whilst their 
length is very great in full-grown individuals, being about eighteen inches. 
Notwithstanding the absence of gills, the lungs are far smaller than the pul- 
monary organs of the garfish [lepisosteus osseus), which has also a large and 
well-developed branchial apparatus. This may be due in part to the fact 
that its naked skin, as in frogs and naked animals generally, whether verte- 
brate or invertebrate, performs the office of a lung. 
The chief cause, however, of these discrepancies in the development 
of the respiratory organs of the two animals is to be found in their habits 
and vital endowments. 
The gar is active and powerful, whilst the amphiuma is sluggish and 
degraded in habits and appearance. This is one of numerous instances 
which might be adduced to show that the consumption of oxygen, and the 
corresponding waste of the tissues, corresponds exactly with the develop- 
ment, habits and temperature of animals. Comparative Anatomy of Respiratory System. 
101 
The lungs of the several orders of reptiles are formed upon one type, 
being capacious sacs, whose walls are divided into sacculi, and supplied 
with blood-vessels according to the perfection of the organs and apparatus, 
and the habits of the animal. 
From the internal surface membranous septa project inwards, dividing 
the interior of the organ into numerous polygonal cells, which are them- 
selves subdivided into smaller compartments. The blood-vessels are dis- 
tributed over the internal walls of the lungs and over the sides of the pul- 
monary cells. 
In serpents one lung only is developed, and the pulmonary cells are 
most numerous in the superior portion, whilst the inferior part of the long- 
cylindrical lung is a mere membranous sac with few or no blood-vessels 
ramifying upon its walls. 
We find the greatest number of the polygonal cells and the greatest 
distribution of the blood-vessels in the pulmonary organs of the chelonia 
and sauria, thus foreshadowing the condition of the lungs in birds and 
mammals. 
In these orders the lungs are filled, more or less, by a coarse and fine 
network or areolar tissue, forming angular or rounded meshes, which rest 
partly upon the walls of the lungs, and enclose lesser meshes or air-cells. 
The blood-vessels ramify over the meshes as well as over the walls of the 
lungs. The sacculi thus formed communicate with each other, and can all 
be inflated from any one point. 
The size of the lungs differs in the different orders according to their 
structure and habits. Amongst the chelonians, we find the most capacious 
lung in the gopher (testudo polyphemus). These animals burrow deeply in 
the ground, and need large lungs as a reservoir of air. In aquatic chelo- 
nians, which remain under the water for a great length of time, the lungs 
are capable of holding a greater quantity than those of land chelonians. 
In mammals and birds the blood is abundant, and the circulation rapid, 
and the wastes and metamorphoses of the tissues correspondingly great, 
and the lungs are composed of an infinitude of minute cells containing air, 
and surrounded by a capillary network. 
The respiratory system of birds is far more highly developed than that 
of reptiles, but not so concentrated as that of the mammals. In this class 
the lungs are no longer closed bags like those of reptiles, but are spongy 
masses of great vascularity communicating with numerous air-sacs and the 
cavities of the bones. The main trunks of the bronchial tubes pass 
through the lungs and open into the cavity of the thorax. The whole 
thoracico abdominal cavity is divided by bands of serous membrane into 
numerous cells communicating with each other and the cavities of the 
hollow and spongy bones. 
In many birds, especially those of powerful flight, the air is admitted 
into the interspaces between the muscles, and between the skin and mus- 
cular system. By this arrangement, which reminds us of the tracheal 
system of insects, the air penetrates almost every part of their bodies, 
bathes all their viscera, and fills the cavities of the hollow and spongy 
bones. It follows as a necessary consequence, that the actions between the 
oxygen of the atmosphere and the organic elements of their bodies should 
be rapid and incessant, and the temperature correspondingly high. 
The minute structure of the lungs of birds resembles, in many respects, 
that of reptiles: the cells, however, are infinitely more numerous and 
minute, and the surface exposed to the action of the atmosphere corre- 
spondingly more extensive. 
The entire mass of each lung is divided into innumerable lobules or 
lunglets, the walls of which are formed by a cartilaginous network derived 102 
Rapidity of Circulation and Respiration in different Animals. 
from the bronchial tubes, and by the ramifications of the capillary vessels. 
From this arrangement, it is evident that the blood-vessels are suspended 
in air and exposed to its influence on every side. These cells or sacculi 
are never terminal cells, as in the mammalia, but open parietal cells, com- 
municating Ireely with each other through the meshes of the capillary and 
cartilaginous network. 
In the mammalia the abdominal cavity is completely separated from 
the thoracic cavity by the diaphragm, the great muscle of respiration. 
The lungs are closed bags situated in the cavity of the thorax, and are sur- 
rounded by a serous membrane, which, after lining the ribs and intercostal 
muscles and thoracic surface of the diaphragm, is reflected on the lungs 
from the point occupied by the pulmonic vessels. 
They are composed of innumerable cells communicating with the 
terminal branches of the bronchial tubes, around which ramify a delicate 
and closely woven network of blood-vessels. Collectively, these cells pre- 
sent an immense surface, over which the blood circulates and is exposed to 
the action of the atmosphere. It has been calculated that the number of 
these air-cells grouped round the termination of each bronchial tube is 
about 18,000, and that the total number in the lung of the human being is 
not less than 600,000,000. 
In the amphibia and batrachia, the lungs are filled by an action that 
resembles swallowing. In the ophidia and sauria, respiration is assisted 
by the ribs and abdominal muscles. In all cold-blooded animals the 
mechanism of respiration corresponds with the simple structure of their 
lungs and the sluggish metamorphoses of their tissue. 
The mechanism of respiration in birds is more complete than that in 
reptiles, but not so perfect as that of the mammalia. From the elastic 
character of the cartilaginous and bony framework, surrounding the tho- 
racico-abdominal cavity, the natural condition of the lungs is that of infla- 
tion. The air is expelled by the action of those muscles which bring the 
sternum nearer to the vertebral column. When these muscles cease to act, 
the extended sternum, attached to the elastic thorax, springs outwards, 
and the air rushes into the lungs to fill the vacuum thus formed. 
In the mammalia, the inspiration and expiration of the air are effected 
by the alternate movements of the diaphragm and the walls of the thoracic 
cavity. 
The relation which exists between the number of the respirations and 
the rapidity of the circulation of the blood will be seen in the following- 
table drawn up from the researches of Dumas, Prevost, and Simon : - 
Number of the beats of the 
heart in one minute 
Number of respirations 
in one minute 
Morse. 
56 
16 
Hare 
120 
36 
Goat 
84 
24 
Cat 
100 
04 
Dost 
90 
28 
Guinea-pig 
140 
36 
Ape {Simia Callitriche) 
90 
30 
Man 
72 
18 
Heron 
200 
Raven 
110 
21 
Duck 
110 
21 
Common Hen 
140 
30 
Pigeon 
136 
34 Size of the Colored and Colorless Blood-Corpuscles. 
103 
This table shows, that, as a general rule, the activity of the respira- 
tory function corresponds with the rapidity of the circulation. 
We are now prepared to understand the results of our experiments, 
and to show that the operations of nature are carried on upon the same 
great plan, however simple or complex the animal. 
Cold-blooded animals are such, not from any peculiar chemical or 
physical endowments of the organic and inorganic molecules of their bodies, 
but from the peculiarity of the structure of their circulatory and respira- 
tory systems. 
The perfection of these two systems may be taken as the index of the 
rapidity of the physical and chemical changes of the molecules of their 
fluids and solids, and the facts we have presented lead to the conclusion, 
that the intelligence and activity of the vital actions are exactly propor- 
tional to the rapidity and amount of the physical and chemical changes of 
the organic and inorganic molecules. 
Our investigations show that the heaitof warm-blooded animals is 
from two to five times as heavy as that of reptiles, and is far more rapid 
and powerful in its actions, and, as a necessary consequence, that theblood 
circulates with much greater rapidity. 
The respiratory system of reptiles is imperfectly developed, and its 
functions imperfectly performed. Only from one-sixth to one ninth as 
much blood passes through their lungs, and is exposed to the action of the 
atmosphere, as circulates through the pulmonary organs of warm-blooded 
animals. 
The blood-corpuscles, the active agents in the elaboration of many of 
the constituents of the blood, are much less numerous, and the whole 
amount of blood existing in their bodies is much less abundant in cold 
than in warm-blooded animals. 
The nervous system, the great apparatus for the generation of the 
excitor-motor powe»' of the animal economy, is imperfectly developed in 
cold-blooded animals. 
From these data we are able to calculate, with almost absolute certainty, 
that the vital actions of cold-blooded animals should be from one-ninth to 
one-fifteenth as rapid as those of warm-blooded animals. Here we have a 
conclusive demonstration that modifications in vital phenomena are accom- 
plished by peculiar modifications of the structure and arrangements of the 
various organs and apparatus, and by peculiar applications of the forces, 
and not by a suspension or alteration of the physical and chemical laws 
which govern all matter. 
SIZE OF THE COLORED AND COLORLESS BLOOD-CORPUSCLES IN MAN AND 
VARIOUS ANIMALS. 
The importance of distinguishing the colored blood-corpuscles of 
man and animals under the microscope, is of vast importance in certain 
medico-legal investigations, as will be clearly shown in a subsequent por- 
tion of this work. Human life has. in many cases, depended upon the 
power of the microscopists and chemists to distinguish human blood from 
stains of various vegetable and mineral substances, and from the blood of 
various animals. 
The possibility of distinguishing, in many eases, the nature of the blood 
by the microscope, as well as the maiked difference in size and shape 
between the red globules of cold and warm-blooded animals, will be clearly 
shown by the following engraving No. 1. 
This engraving contains ten figures or groups of corpuscles, demon- 
strating the variations in size of the red corpuscles of various animals. 104 
Variations in Size and Appearance of the Red Corpuscles. 
ENGRAVING NO. 1. 
Illustrations of the variations in size and appearance of the red corpuscles of 
various vertebrate animals. 
Fig.I red corpuscles or THE blood of various vertebrate ANIMALS 
Engraving No. 1.-Red corpuscles of the blood of various vertebrate animals: 1. Red 
corpuscles of human blood imprisoned by the febrin in coagulated blood. 2. Globules of human 
blood gathered in rolls. 3. Globules of human blood in bi-concave circular discs. 4. Globules of 
camel's blood in elliptical discs 5. Globules of pigeon blood, elleptlcal bi-convex discs. 6. Frog's 
blood, elliptic discs. 7. l oach's blood, rounded. 8. Blood of Salamander. 9. Blood of Lepido- 
siren, bi-concave rounded discs. 10. Blood of Proteus, a, front view of globules, b, side view of 
globules. 
Mr. Gulliver has accurately measured the red blood-corpuscles of 
many animals, and has shown that different orders or families of mamma- 
lia are characterized by different grades of blood-corpuscles. The largest 
blood discs among mammalia are found in the edentata. Those of the 
orycteropus, myrmecophaga and elephant are nearly of the same size, 
notwithstanding the great difference in size of the animals. In the family 
of rodents the largest occur in the family of capibara, and the smallest 
in the tiny harvest mouse. It is supposed that if a rodent existed of 
the size of an elephant, his blood-corpuscles would be of enormous size.* 
The red corpuscles present in every instance the form of a flattened 
disc; which is circular in man and most mammalia, but is oval in birds, 
reptiles and fishes, as also in a few mammals (all belonging to the camel 
tribe). In the one form as in the other, these corpuscles seem to be flat- 
tened cells, the walls of wh'ch, however, are not distinctly differentiated 
from the general substance they contain; as appears from the changes of 
form which they spontaneously undergo when kept by means of a " warm 
* Mr. Gulliver's Memoirs are published in the Proceedings of th? Zoological Society, June 
11, 1844, February 25, 1862, February 10,1870, and in other numbers. Size of Blood-Corpuscles in Mammals and Birds. 
105 
stage," at a temperature of about 100° F., and from the effects of pressure 
in breaking them up. The red corpuscles in the blood of oviparous verte- 
brata are distinguished by the presence of a central spot or nucleus; this is 
most distinctly brought into view by treating the blood discs with acetic 
acid, which causes the nucleus to shrink and become more opaque, whilst 
rendering the remaining portion extremely transparent. By examining 
unaltered red corpuscles of the frog or newt under a sufficiently high 
magnifying power, the nucleus is seen to be traversed by a network of fila- 
ments which extends from it throughout the general substance of the cor- 
puscle, constituting an intercellular reticulation. 
The red corpuscles of the blood of mammals, however, possess no 
distinguishing nucleus; the dark spot which is seen in their centre being 
merely an effect of refraction, consequent upon the double-concave form 
of the disc. When these corpuscles are treated with water, so that their 
form becomes first flat, and then double-convex, the dark spot disappears, 
whilst on the other hand, it is made more evident when the concavity 
is increased by the partial shrinkage of the corpuscles, which may be 
brought about by treating them with fluids of greater density than their 
own substance. When floating in a sufficiently thick stratum of blood 
drawn from the body, and placed under a cone glass, the red corpuscles 
show a marked tendency to approach one another, adhering by their dis- 
coidal surface, so as to present the aspect of a pile of coins; or if the 
stratum be too thin to admit of their partially over-lapping, or simply 
adhering by their edges, which then become polygonal instead of circular. 
The size of the red-corpuscle is not altogether uniform in the same 
blood; thus it varies in that of man from about the l-4000th to the 
l-2800th of an inch. But we generally find that there is an average size, 
which is pretty constantly maintained among the different individuals of 
the same species; that of man may be stated at about l-3200th of an inch. 
The following table exhibits the average dimensions of some of the most 
interesting examples in the four classes of vertebrated animals, expressed 
in fractions of an inch, selected from the measurements given by Mr. 
Gulliver in his edition of Hewson's Works, page 236 et seq. Where two 
measurements are given, they are the long and the short diameters of the 
same corpuscles. 
MAMMALS. 
Man, l-3200th. Camel, l-3254th, l-5921st. Dog, l-3542d. Llama, 
l-3361st, l-6294th. Whale, l-3099th. Java musk deer, l-12325th. 
Elephant, l-2745th. Caucasian goat, 1-7045th. Mouse, l-3814th. Two-toed 
sloth, l-2865th. 
BIRDS. 
Golden eagle, l-1812th, l-3832d. Ostrich, l-1649th, l-3000th. Owl, 
1-1830th, l-3400th. Cassowary, l-1455th, 1-2800th. Crow, l-1961st, 
l-4000th. Heron, 1-1913th, 1-3491st. Blue Tit, l-2313th, l-4128th. 
Fowl, l-2102d, l-3466th. Parrot, l-1898th, l-4000th. Gull, l-2097th, 
1-4000th. 
REPTILES AND BATRACHIA. 
Turtle, l-1231st, l-1882d. Frog, l-U08th, l-1821st. Crocodile, 
l-1231st, 1-2286th. Water newt, l-8014th, 1-1246th. Green lizard, 
l-1555th, l-2743d. Siren, l-420tli, l-760th. Slow-worm, l-1178th, 1- 106 
The White or Colorless Blbod-Corpuscles. 
2666th. Proteus, l-400th, l-727th. Viper, l-1274th, l-1800th. Amphi- 
uma, l-345th, l-561st. 
FISHES. 
Perch, l-2099th, l-2824th. Pike, l-2000th, l-3555th. Carp, 1- 
2142d, l-3429tb. Eel, l-1745th, l-2842d. Gold fish, l-1777th, l-2824th. 
Gymnotus, l-1745th, l-2599th. 
Thus it appears from the figures of Mr. Gulliver and others, that the 
smallest red corpuscles known are those of the musk deer, whilst the 
largest are those of that curious growth of Batrachia (finny tribe), which 
retain the gills through the whole of life; and one of the oval blood discs 
of the proteus, being more than thirty times as long and seventeen times as 
broad as those of the musk deer, which eciual not fewer than 510 of them. 
Those of the amphiuma of the swamps of Louisiana, are still larger, meas- 
uring in the short diameter l-345th, and in the long diameter l-560th of 
an inch. According to the estimate of Vierordt, a cubic inch of human 
blood contains upwards of eight million of red corpuscles, and nearly a 
quarter of a million of the colorless. 
From an examination of numerous specimens of fresh human blood' 
Dr. Alfred Swaine Taylor found the average diameter of the globules to be 
the l-3500th part of an inch, the maximum size being l-3000ths and the 
minimum l-5000th of an inch. According to Dr. Taylor, the corpuscles 
of human blood are larger than those of domestic animals. According to 
Dr. Taylor, the measurements in various animals are as follows: Dog, 
maximum, l-4000th, minimum, l-6000th. Hare, l-4000th average, 
maximum, l-2000th, minimum, 1-SOOOth. Rabbits, l-4000th average. 
Pig, l-4250th average- Cow, l-4000th maximum to l-4200th minimum. 
Horse, l-5000th average. Sheep, l-5333d maximum to l-6000th mini- 
mum. These measurements apply to recent blood which has not been 
allowed to become dry in animal and vegetable stuffs.* 
Dr. J. C. Richardson, of Philadelphia, in 1874, made some accurate 
measurements of the red-blood corpuscles under the l-25th of an object- 
ive, and gives the following as the mean of several observations : Pig, 
l-4230th. Ox, l-4267th. Cat, l-4404th. Horse, l-4600th. Sheep, 
l-5300th. Goat, l-6366th. Human, l-3265th. Dr. Richardson holds 
that we can, by measuring the corpuscles under the l-25th, distinguish 
human blood-stains from the blood-stains of theanimals enumerated above.f 
THE WHITE OR COLORLESS BLOOD-CORPUSCLES. 
The proportion of white to red corpuscles being scarcely ever greater 
(in a healthy man) than 1 to 250, and often as low as from one-half to one- 
quarter of that ratio, there are seldom many of them to be seen in the field 
at once. The appearance presented by the colored and colorless blood- 
corpuscles in the blood of tuberculosis is shown in the following engraving : 
*The Principles and Practice of Medical Jurisprudence, by Alfred Swaine Taylor, M. D., F. R. 
S., etc., London, 1875, p. 457-458. 
j-American Journal of the Medical Sciences, July, 1874. Structure of the Colored Blood Corpuscles in Cold Blooded Animals. 
107 
ENGRAVING NO. 2. 
Colored and Colorless Human Blood-Corpuscles-Blood of Phthisis Pxdmonalis. 
Explanation of Engraving No. 2.-Colored blood-corpuscles with central colorless corpuscle 
in centre and magnified 1300 diameters. Toles 1-50 objective No. 2 ocular. Tuberculous blood. 
From micro-photograph by Dr. E. Cutter, 1870, March 2d. 
It is worthy of note in medico-legal examinations that, notwithstanding the great varia- 
tion in the size of the red corpuscles in different species of vertebrate animals, the size of the 
white is extremely constant throughout, their diameter being seldom much greater or less than 
l-3000th of an inch in ihe warm-blooded classes, and l-2500th in reptiles. Their ordinary form 
is globular; but their aspect is subject to considerable variation, which seem to depend in great 
measure upon that phase of development. Thus, in their early state, in which they seem to be 
identical with the corpuscles found floating in chyle and lymph, they seem to be nearly homo- 
geneous particles of protoplasmic substance; but in their more advanced condition, according to 
Dr. Kline, their substance consists of a reticulation of very fine contractile protoplasmic fibres, 
beneath the inter-cellular network, in the meshes of which a hyaline interstitial material is 
included; and which is continuous with a similar network thatcan be discerned in the substance 
of the single or double nucleus, when this comes into view after the withdrawal of the corpuscles 
from the body. In their living state, however, whilst circulating in the vessels, the white cor- 
puscles, although clearly distinguishable in the slow moving stratum in contact with their walls 
(the red corpuscles rushing rapidly through the centre of the tube), do not usually show a distinct 
nucleus. The nucleus may be readily brought into view by heating the corpuscles with water, 
which causes them io swell up, become granular, and at last disintegrate, with the conversion 
of granules which may have been previously seen in active particular movement within the 
corpuscle. 
The pigmentation of the colorless corpuscles in malarial fever, by the haematin of the disin- 
tegrating colored corpuscles, is due to the power which they possess of undergoing change of 
form, of moving from place to place, and of engulfing particles of coloring matters. Thus, when 
the white corpuscles in a drop of freshly-drawn blood are carefully watched for a short time, they 
may be observed to undergo changes of form, and even to move from place to place, after the 
manner of amoebae, a creature which cannot be described by its fotm, for this is as changeable as 
that of the fabled Proteus when thus moving, the white corpuscles engulf particles which lie in 
their course-such as granules of vermilion that have been injected into the blood-vessels of the 
living animal-and afterwards eject them in the like fashion. 
STRUCTURE OF THE COLORED BLOOD-CORPUSCLES IN COLD BLOODED 
ANIMALS. 
There is a want of accordance in the descriptions of the structure of 
the colored blood-corpuscle, and its action under different chemical reagents. 
Some of the highest authorities are opposed to each other in their state- 
ments. J shall confine myself merely to the results of my own observations 
upon the structure of the nucleated corpuscles of the cold-blooded animals 
executed in the years 1854 and 1855. The size and form of the blood-cor- 
puscles vary with the animal. In most of the mammalia, they are bi-con- 
cave circular discs. In birds, reptiles and fishes, they are bi-convex, 
ellipsoidal or rounded discs. 
In the shovel-nosed shark (Zygcena malleus), and the loggerhead turtle 
(chelonia caretta), they are nearly of a circular form. In all adult mam- 
mals, as dogs, cats, raccoons, squirrels, deer, sheep, moles, etc., which I have 108 
Structure of the Colored Blood-Corpuscles in Cold-Blooded Animals. 
examined, a nucleus is absent. In birds, reptiles and fishes, a nucleus is 
always present. The convexity of the blood-corpuscle in these animals is 
due to the internal nucleus; when viewed edgewise as they roll over, this 
central prominence is rendered evident, standing out from the flattened 
disc. 
The action of acetic acid shows that the exterior cell-wall is connected 
at the centre with the interior nucleus. The first action of acetic acid, 
which is almost instantaneous, is to reverse the shape of the blood corpus- 
cles. They become expanded around the periphery, whilst they remain of 
the same diameter at the centre, thus forming an hour-glass or dumb-bell 
figure when viewed in profile. The central portion maintains its diameter, 
which is that of the nucleus plus the thickness of the attached exterior cell- 
wall. Generally, the swelling is greatest at the extremities of the ellip- 
soidal disc. In some cases, the entire circumference of the disc swelled, 
leaving a central depression, corresponding to the internal nucleus. The 
next change effected by acetic acid, is to render the exterior cell-wall per- 
fectly transparent, and in some cases to dissolve it completely, thus setting 
free the nuclei. 
Acetic acid renders the nuclei more distinct and in many instances 
renders visible a still smaller body, the original rudiment of the blood- 
corpuscle. The nucleoli are situated sometimes at the centre, and at others 
attached to the side of the nuclei. 
The blood-corpuscles of these animals, then, correspond in structure to 
many other cells, having a cell-wall, nucleus, and nucleolus. 
The best method of viewing the action of acetic acid, is to place a drop 
of blood upon a glass slide, and, having adjusted it to the focus of the 
microscope, touch its border with a drop of concentrated acetic acid, and 
observe, under the microscope, the line where the acetic acid and blood are 
mingling. Here we will see the blood-corpuscles changing from ellipsoi- 
dal, convex discs to hour-glass or dumb-bell figures and bi-concave discs, 
and almost immediately becoming transparent, and exhibiting nothing but 
the central nucleus with its nucleolus. I have verified these statements by 
examinations of the blood of numerous fishes, batrachians, ophidians and 
chelonians. 
The following figures, 1, 2, 3 and 4, engraving No. 3, will represent 
in a clear light the action of acetic acid. In order properly to illustrate 
their structure, the blood-corpuscles are represented in a much clearer 
manner and stronger light than they appear under the microscope. 
Liquor potassa dissolves the cell walls, nuclei, and nucleoli, alters the 
color of the blood to a brownish-yellow, and renders it viscid and ropy, like 
thick mucus. When treated with aqua ammonia, the corpuscles are at 
first altered in shape, sometimes elongated; and, in many cases, the cell- 
walls began to swell first toward the periphery, as in the action of acetic 
acid. In a short time, aqua ammonia, like liquorpotassa, completely 
dissolves the corpuscles. 
The colorless corpuscles are more numerous in cold than in warm-blooded 
animals. Amongst chelonians, they are most numerous in the salt-water 
terrapins {emys terrapin). In the blood of these chelonians, numerous 
minute granules also abound. These minute granules increase during a 
rapid repair of the elements of the body. They were found to be much more 
numerous in the blood of the yellow-bellied terrapins (emys serrata) which 
had been deprived of food and drink for several weeks, and then trans- 
ferred to a tub of water and liberally supplied with vegetable food for 
thirty to sixty days, than in the blood of those terrapins which had been 
deprived of food and drink for several weeks. Effects of Gases upon the Blood of Cold-Blooded Animals. 
109 
EFFECTS OF GASES UPON THE BLOOD OF COLD-BLOODED ANIMALS. 
Carbonic acid gas. 
Salt-water terrapins (emys terrapin') and yellow-bellied terrapins (em/ys 
serrato}, were placed in large receivers containing this gas. They took 
long inspirationsand expirations, resembling deep sighs. The noise made 
by the passage of the gas in and out of their lungs, resembled that often 
made by human beings dying from narcotic poisoning or congestion of the 
brain. The breathing of the rerrapins became more and more laborious 
and less frequent, occurring at intervals of from ten to thirty minutes, and 
finally ceased in from ten to twelve hours. 
The blood was of a much darker color than when the lungs were 
supplied with atmospheric air, and resembled much the venous blood of 
the mammalia. Upon exposure to the air for a length of time, it became, 
upon its exterior, of a red color. The heart and lungs, and the blood-ves- 
sels supplying the intestines, were engorged with black blood. The con- 
tractility of the muscles was completely destroyed. 
The blood-corpuscles had undergone remarkable changes. They were 
shrivelled and contorted, presenting innumerable shapes, anything but 
ellipsoidal. These changes had taken place in the colored corpuscles in all 
the organs and tissues of the body. The effects of the gas appeared to have 
been confined principally to the exterior cell wall; for, when they were 
treated with acetic acid, the nuclei were brought out unchanged. The 
appearance of the colored corpuscles of a yellow-bellied terrapin (Emys 
serrato), which had been kept in the carbonic acid gas until its death, is 
represented in figure 5, engraving No. 3. 
The urine of all these terrapins which were confined in carbonic acid 
gas, contained grape sugar, which is not normally present in the excretions 
of the kidneys of these animals. The offices of the blood-corpuscles being 
arrested, oxygen being no longer conveyed into the system, grape sugar, 
the product of the action of the liver, was not decomposed, and, accumu- 
lating in the blood, was eliminated by the kidneys. 
When terrapins were employed which had been starved for a great 
length of time, the effect of carbonic acid gas upon the blood-corpuscles 
was not so evident, on account of the concentration of the blood, and the 
sluggishness of the matamorphoses of their tissues, and the rapidity with 
which they fell victims to the deleterious influences of this noxious gas. 
The effects of carbonic acid gas in altering the shape of the blood-corpus- 
cles, were best seen in those terrapins which had been deprived of food 
and drink for several weeks, and then transferred to a tub of water, and 
supplied with vegetable food. 
These effects are not produced upon the blood-cells of warm-blooded 
animals, because they are so rapidly destroyed that the gas has not suffi- 
cient time to come in contact, in large quantities, with the corpuscles and 
materially alter their structure. Cold-blooded animals live much longer 
in carbonic acid gas than warm-blooded animals, because their muscular 
and nervous systems are far more independent of the circulatory fluid, and 
the metamorphoses of the organic and inorganic elements of their fluids 
and solids are far less rapid. 
Carbonic Oxide Gas. 
A Corn Snake {Coluber guttatas} was placed in a jar of carbonic oxide 
gas. At first, its efforts to escape were unceasing and violent. Gradually, 
its respiration became more laborious; it gasped violently for breath; its 
motions became more spasmodic, and were succeeded by intervals of appa- 110 
Effects of Carbonic Oxide Gas on Blood. 
rent exhaustion. It died in forty-five minutes after its introduction into 
the gas. 
A Bullfrog {Rana pipiens) placed in the carbonic oxide gas presented 
similar phenomena, but died in a much shorter time, about ten minutes. 
This difference of time was without doubt due to the difference in the 
structure of the tegumentary systems of the two reptiles; the naked skin 
of the frog absorbing the gas much more rapidly than tne scaly integument 
of the serpent. 
In both animals (examined immediately after their death), the con- 
tractility of the muscular system had been destroyed. The heart was the 
last portion of the muscular system to yield to the effects of the poison; it 
continued to beat feebly for a short time. 
The blood from all parts of the body was of a brilliant scarlet color, 
and coagulated into a dense, firm clot, which was unstable and dissolved 
again. After the dissolution of the fibrin, the blood-corpuscles settled to 
the bottom, and the serum above was perfectly clear and without any 
marked color. Under the microscope, the blood-corpuscles presented no 
unusual appearance when their broad surfaces were turned towards the 
eye; when, however, they were viewed edgeways, they appeared swollen, 
and the central nuclei were much less distinct than in their normal condi- 
tion, being scarcely visible. 
Acetic acid exerted its characteristic action, first rendering the blood- 
corpuscles dumb-bell or hour glass in shape, when viewed edgeways, and 
then rendering the exterior cell-wall transparent, and bringing out clearly 
the nuclei. When tiie acetic acid was neutralized with diluted liquor 
potassa, the cell-walls were again brought into view. Concentrated liquor 
potassa dissolved the blood-corpuscles with no immediate change of color. 
In a few moments, however, the color changed to a darker red, and gradu- 
ally assumed a brownish-yellow color, and. became, as usual, ropy and 
viscid. 
Vigorous streams of carbonic acid and oxygen gases, passed through 
separate and the same portions of blood, produced no change whatever in 
the scarlet color or form of the blood-corpuscles. 
Portions of this blood were kept for several weeks, and they still 
retained their scarlet color, and did not undergo putrefaction. 
These reactions show that the change in the color of the blood was due, 
not to an alteration of the forms of the blood-corpuscles, but to a perma- 
nent chemical change of their coloring matter. Another effect of the 
carbonic oxide gas was to render the fibrin unstable. 
This gas arrests oxidation, and the rapidity of its action shows the 
great importance of this process. The existence of the vital force, and the 
performance of the functions of the organs and apparatus of the system, 
are incompatible with the sudden arrest of the chemical changes and 
metamorphoses of the elements of the solids and fluids. If, however, the 
process of oxidation be slowly stopped by a gradual diminution of the 
temperature of cold-blooded animals, the existence of the vital force is not 
destroyed, although all the vital, physical and mechanical functions are 
suspended. 
When animals are poisoned with carbonic oxide, CO , or when it is 
passed through blood or a solution of oxy-haemoglobin, it displaces the 
oxygen of the blood-coloring matter and takes its place, molecule for mole- 
cule. The combination thus formed is remarkable for its stability, as we 
have just shown in the pr eceding experiments which I have repeated fre- Effects of Complete Deprivation of Air on Blood. 
111 
quently upon various birds, cold-blooded animals and mammalia; although 
contrary to what was formerly supposed, it can be reduced by an indif- 
ferent gas or in a vacuum. Its crystals are isomorphous with that of oxy- 
luemoglobin, but have a slight bluish tinge. Its spectrum is about identi- 
cal with that of oxy-hsemoglobin, but the two absorption bands are moved 
very slightly nearer the violet end. 
EFFECTS OF NITRIC OXIDE, NO. 
I have detailed a large number of experiments in the first volume of 
these Medical and Surgical Memoirs, illustrating the changes of color 
induced upon the blood of warm and cold-blooded animals, by the inhala- 
tion of chlorine, bromine, nitric oxide and other gases. Nitric oxide forms 
a still more stable compound with hmmoglobin than carbonic oxide. It 
will displace carbonic oxide. Its crystals are isomorphous with the oxygen 
and carbonic oxide compounds, and its spectrum is almost identical with 
them. 
HYDROGEN GAS. 
A yellow-bellied terrapin (emys serrata}, which had been placed in a 
large receiver of hydrogen gas, died in ten hours. 
The blood-corpuscles from all parts of the body presented an altered 
appearance, similar in many instances, to that produced by carbonic acid 
gas. The simple exclusion of the oxygen of the atmosphere by a harmless 
gas, produced remarkable alterations in the shape of the corpuscles. 
The urine contained grape sugar. 
Fig. 6 represents the appearance of the blood-corpuscles of this emys 
serrata, after it had been confined in hydrogen gas for ten hours. 
Ligatures were passed around the tracheas of yellow-bellied terrapins 
(emys serrata) and salt-water terrapins (emys terrapin}, which had been 
deprived of food and drink for several weeks, and then transferred to tubs 
of water, and abundantly supplied with vegetable food. The access of air 
to the lungs was thus completely cut off. 
These Chelonians gave signs of muscular contractility for twelve to 
twenty hours. In one instance, the stomach and intestines became greatly 
distended with gas, which consisted partly of carbonic acid. 
In all cases, the blood examined after death, was of a blackish-red 
■ color, and much darker than that of reptiles in its normal condition. It 
coagulated when abstracted. 
The blood-corpuscles had undergone important modifications. Many 
of them were shrunken, contorted and contracted; others were swollen 
assuming the forms of spheroids, and cubes, and irregular ovoids. The 
nuclei, which were rendered distinct by the action of acetic acid, in many 
cases presented corresponding changes. Many of the colorless corpuscles 
appeared altered in shape. 
A stream of oxygen gas, passed through the blood, did not change its 
color, neither were the forms of the blood-corpuscles altered. 
In every instance the urine of these terrapins contained grape sugar. 
Figure 7 represents the blood-corpuscles of these terrapins, after they 
had been deprived of air by a ligature around their windpipes. 
COMPLETE DEPRIVATION OF AIR. 112 
Structure of Blood Corpuscles. 
Structure of Blood-Corpuscles, and Effects of Gases in altering the shape of 
Blood-Corpuscles. 
ENGRAVING NO. 3. 
FIG. I 
FIG. 2 
FIG. 3 
FIG. 4 
FIG. 5 
FIG. 6 
FIG. 7 
Engraving No. 3-Structure of blood-corpuscles. Figure 1. Blood vessels of Hammerhead- 
shark {zygeena malleus) in their normal condition-magnified 210 diameters. Figure 2. Blood-cor- 
puscles of Hammerhead Shark (zygoena malleus) treated with a drop of acetic acid, showing the 
different stages of its action, magnified 210 diameters. Figure 3. Blood-corpuscles of Salt-Water 
Terrapin {Emus terrapin) in their normal condition, magnified 210 diameters. Figure 4. Blood- 
corpuscles of Salt-Water Terrapin, (Emys terrapin,) acted upon by a drop of acetic acid, show- 
ing the nuclei, nucleoli, dumb-bell or hour glass corpuscles, and beyond where the acid has not 
extended, the normal corpuscles magnified 210 diameters. Figure 5. Blood-corpuscles of a yellow- 
bellied Terrapin, (Enys terrapin) which had been kept without food or drink for several weeks, 
and then placed in a tub of water and abundantly supplied with vegetable food, for thirty or 
forty days, and finally placedin carbonic acid gas. Figure 6. Blood-corpuscles of a yellow-bel- 
lied Terrapin, {Emys terrapin) which had been destroyed in Hydrogen gas. Figure?. Blood; 
corpuscles of Salt-Water Terrapin, {Emys terrapin,) which had been deprived of air by ligatures 
around their necks. 
These experiments show that beyond all question, contrary to the 
notion that was previously entertained, that sugar can be produced in the 
animal organism without any vegetable principle being concerned. It was 
formerly supposed that sugar formed an article that was produced only by 
the vegetable kingdom, but the preceding facts showed that such a doc- 
trine could no longer be upheld. Structure of the Human Blood-Corpuscles. 
113 
STRUCTURE OF THE HUMAN BLOOD-CORPUSCEES. 
The constitution of the red blood-corpuscles, has been and still is a 
subject of discussion; before the time of Hewson, they Svere regarded as 
liquid bodies, and their shape was thought to be spherical. Hewson, in 
demonstrating that they were not spheres but discs, overthrew the theory 
of their liquid consistency, for it was considered an axiom that one fluid 
mingled with an other, in which it is not soluble will be broken up into 
globules, provided the latter fluid be in larger quantity. Thus, if a small 
amount of oil is mixed with a greater amount of water, the oil is broken 
up into globules. If, on the other hand, the oil is in larger amount, it is 
the water that assumes a globular form. From these well-known facts, 
Hewson argued that the blood-corpuscles in virtue of their shape must be 
solid.. 
Norris has lately shown that this does not necessarily follow. He 
states that there are certain combinations of organic substances which, 
when in solution in water, possess such antagonistic relations to each other 
that they refuse to remain together in the same solution, and, as a conse- 
quence, the one for which the liquid has the greatest affinity will displace 
the other. Nevertheless the displaced substance will retain to itself a por- 
tion of the water in which it was originally dissolved, and, as a conse- 
quence, by this, it does not come down in a powdery amorphous form, but 
in the shape of liquid colloid globules or discs as the case may be. By 
adding powdered gum acacia to a solution of Nelson's opaque gelatin 
Norris obtained a precipitate of bi-concave discs, the shape of which is 
identical with that of the red blood-corpuscles. 
The extensibility and elasticity of the red corpuscles are extreme, and 
may be observed in the vessels during life. In the web or mesentery of the 
frog they may be observed to yield to the least resistance and to regain 
their form the moment the resistance is removed. Outside of the body 
these physical properties of the corpuscles may be observed by mixing 
blood with a colloidal substance, such as gelatin or a solution of glue. On 
allowing the colloid to harden and making thin sections of it, the corpus- 
cles may be observed under the microscope entangled in its meshes, and 
exhibiting every possible variety of form. When freed from pressure 
they return to their original shape. The same phenomena are presented 
by corpuscles which take part in the formation of a coagulum. 
Notwithstanding their great elasticity the corpuscles may be broken 
in fragments by raising and depressing the cover glass beneath which they 
are examined. Each fragment retains the color of the original corpuscle. 
When nucleated corpuscles are thus treated, the nucleus often escapes 
entire, while the substance of the corpuscles is broken up. After the dis- 
covery of the animal-cell by Schwann, the red corpuscles were considered 
to be cellular like the other ultimate elements of the animal body. This 
view was shaken by the criticism that a vesicle with fluid contents floating 
in another liquid would assume any shape rather than that of a bi-concave 
disc. Furthermore, a double contour has never been demonstrated in the 
corpuscles of man; and after the application of these mechanical agen- 
cies which exert the most powerful distinguishing action on the corpuscles, 
such as freezing and subsequent thawing, electricity, heat and urea, no 
shreds or folds of membranes have been detected. It is still a question 
whether the shape of the corpuscle is maintained by a delicate stroma or 
framework, the oicoid of Briicke, in the meshes of which the haemoglobin 
is contained. This is the view maintained by Rollett, and ably contested 114 
Chemical Composition of Oxy-Hcemoglobin. 
by Norris. The latter regards the corpuscles as fluid and therefore desti- 
tute of a stroma. Norris considers that these different constituents are 
combined molecule for molecule, as are the carbon and steel in iron. In 
referring to the fact that the iron may be removed from steel leaving a 
framework of carbon, Norris argues that we may as well speak of a 
carbon stroma of steel as of an oicoid stroma of the red corpuscles.* 
J. Mitchell Bruce, M. D.,f of Charing-Cross Hospital, London, holds 
that the red corpuscles of the blood consist of two portions-a colorless, 
sponge.like matrix; and a colored substance of complex composition, which 
occupies the interstices of the former and accurately fills them. The 
matrix is regarded as possessing chiefly physical properties; while its con- 
tents constitute the active parts of the corpuscles, and consist of luemo- 
globin. 
CHEMICAL COMPOSITION OF THE RED CORPUSCLES. 
Oxy-haemoglobin. The most important constituent of the red corpuscles' 
both in quantity and formation, is the htemoglobin formerly called also 
haemato-globin, and luemato crystallin. The term hmmoglobin has now 
superceded the others. It is a crystallizable albuminous substance that 
always exists in the body, loosely combined with oxygen. It is therefore 
called oxy-hsemoglobin, to distinguish it from the same substance deprived 
of its oxygen by reducing agents; to this latter the term haemoglobin 
simply is applied. It may be stated that the crystals may be obtained by 
the action of the various agents which deprive the corpuscles of their 
colorless matter, and render the blood lake-colored, such as alternate freez- 
ing and thawing, electricity, a temperature of 60° C. or 140° F., powdered 
salt, either in substance or solution, chloroform and the alkaline salts of the 
bile. Putrefaction causes the formation of crystals of enormous size- 
three to five centimetres long from dog's blood-while, on the other hand, 
if the blood be conducted directly from the vein or artery into a tube in 
which the germs of putrefaction have been destroyed by heat, the forma- 
tion of microscopic crystals is prevented. It would appear as if the 
process of putrefaction destroyed substances which are preventive of crys- 
tallization. With respect to the properties and function of the red cor- 
puscle, it is to be noted that the ultimate elements of haemoglobin are 
carbon, nitrogen, hydrogen, oxygen, sulphur and iron-the last of these 
probably being the cause of its red color. 
CHEMICAL COMPOSITION OF OXY-H^MOGLOBIN. 
Crystallized haemoglobin may be dried at a temperature of 0° C. 32° F. 
without decomposition, and yields its water of crystallization at 100° C. 
Hoppe-Seyler analyzed the oxy-haemoglobin of the dog, squirrel, guinea- 
pig and goose; C. Schmidt that of the dog, and Kissel that of the horse. 
The following is the mean percentage composition of the various analyses, 
excluding that of the horse by Kissel, which has been criticised by Hoppe- 
Seyler on account of its having been made by a method different from that 
followed in his own investigations. It gives a much higher percentage of 
nitrogen than any of the other analyses. 
*A Reference Handbook of the Medical Sciences, etc., edited by Albert H. Buck, LL. D., vol. 
1885. Article: Blood, by Frederick P. Henry, M. D., pp. 542-543. 
tA Dictionary of Medicine, etc., edited by Richard Quain, M. D., F. R. S. Article : Blood, 
p. 116. Chemical Composition of the Red Corpuscles. 
115 
In 100 parts- 
Carbon 54.00 
Hydrogen 7.25 
Nitrogen J. 16.25 
Iron 0.42 
Sulphur 0.63 
Oxygen 21.45 
100.00 
It is the only proximate principle of the body that contains iron. The 
ash remaining after the combustion of oxy haemoglobin consists of pure 
oxide of iron, and since all the iron of the blood is contained in the oxy- 
haemoglobin, it follows that the percentage amount of haemoglobin in a 
given amount of blood may be determined by the amount of oxide of iron 
in its ash. This may be done by the following equation : Let M be the 
iron in the ash of 100 parts of blood, then x = 0.43 being the average 
percentage of iron in oxy-haemoglobin. 
Oxyhaemoglobin is slightly acid, as shown by its reaction to the 
litmus paper, and by its separating from the blood in crystalline form at 
the positive pole of the battery. 
Haemoglobin, which is of great physiological interest, is of an extremely 
complex nature, being a compound of two bodies, the one a proteid known 
as globulin or globin, and the other a nitrogenous derivative called 
haematin. These two substances are combined in a proportion of 87.5 of 
globulin to 12.41 of haematin (Schmidt), and the provisional formula 
according to Hoppe-Seyler of haemoglobin, is C6ooH96oN154FeS30179. If we 
estimate the red corpuscles as forming about 32 per cent, of ordinary blood, 
haemoglobin may be considered as forming from 13 to 14 per cent, of the 
same blood. 
Haemoglobin presents a singular exception to the general law of diffu- 
sion, inasmuch as, though it readily crystallizes, it will not diffuse through 
membrane as such without decomposition. Considerable variety in the 
shape of the crystals is met with in different animals; in man they occur 
as elongated prisms. 
Haemoglobin is soluble in water, forms a lake liquid, from which 
fine crystals may be obtained, and which may be variously decomposed, 
giving rise to other ''blood crystals." Most important of all its properties, 
haemoglobin combines with certain gases to form definite chemical com- 
pounds: with O to form oxy-haemoglobin, with CO to form carbonic-oxide- 
haemoglobin. These compounds, and especially the oxy-haemoglobin, are 
exceedingly unstable, being reduced even under very feeble influences to 
haemoglobin and their other constituents respectively. Alternate oxida- 
tion of haemoglobin and deoxidation of oxy-haemoglobin are constantly 
going on within the red corpuscles of the circulating blood, and the two 
changes, occurring in the pulmonary and systemic capillaries respec- 
tively, constitute the first great function of the blood-its oxygenating, or 
respiratory function. The volume of oxygen in arterial blood is 16.9 per 
cent , and in venous blood 5.96 per cent. It must be clearly understood, 
that disorders connected with the red corpuscles or respiratory elements of 
the body, whether in amount, composition or circulation, directly affect 
the oxidation-processes only. Beside its origin and its function, there is a 
third relation of the red corpuscles to the organism, namely, that of its 
products. These are eliminated by the ordinary channels; the salts, which 
are chiefly salts of potash, being excreted by the kidneys, and the colored 
material furnishing the pigments of the bile and urine. 116 
Source of, or Origin of the Red Corpuscles. 
SOURCE OF, OR ORIGIN OF, THE REI) CORPUSCLES. 
The source of the red corpuscles is of the greatest pathological impor- 
tance. In the embryo, the blood and the blood-vessels are developed from 
the same elements, and thus the two structures in their physiological aspect 
are essentially inseparable. In the fully-developed blood, the source of the 
red corpuscle is obscure; but there can be no reasonable doubt that it origi- 
nates in the colorless corpuscle, and more remotely in the lymphatic glands, 
the spleen, and the medulla of bones, and that light is of the greatest 
importance in the formation of haemoglobin-J. Mitchell Bruce.* 
The blood while retaining a definite composition, is as regards its 
ultimate elements, the most unstable of the animal tissues. Products of 
metamorphosis of the red corpuscles are continually forth-coming in the 
coloring matters of the urine and bile, while in the function of menstruation 
more or less blood is directly removed from the vessels. In pathological 
states the entire mass of the blood or one or more of its constituents, may 
be greatly diminished, and yet sooner or later if the diseased condition be 
removed, its normal amount and composition are restored. The question 
of the restoration of loss of water, albumins and salts presents little or no 
difficulty, but that concerning the manner and place of regeneration of the 
red corpuscles, has been, anti still in great part continues to be one of the 
most perplexing problems of physiology. In the earliest periods of embry- 
onic life, white nucleated blood corpuscles alone are found which very 
soon acquire a reddish tint, due to the acquisition of haemoglobin. They 
are derived from the central cells of the newly formed heart and blood- 
vessels, which are at first solid cords in the mesoblastic layer of the embryo. 
In these cords a channel is formed by the detachment of the central cells 
and the secretion of a fluid plasma. These embryonic corpuscles are spher- 
ical and average about l-2500th of an inch in diameter. They multiply 
by subdivision until the period at which lymph is poured into the blood 
by the thoracic duct, at which time they begin to be mingled with colored 
non-nucleated discs. From this time on the lymphatic system, in which 
are certainly included, so far as blood formation is concerned, the spleen 
lymphatic glands and red bone marrow, perhaps also the thymus, thy- 
roid and supra-renal glands, is the sole source of newly-formed blood- 
corpuscles. 
In 1868, Professor Neumann, of Konigsberg, first called attention to cer- 
tain cells of the red marrow, identical in appearance with the nucleated 
red globules of the mammalian foetus. A month later the observation was 
confirmed by Bizzozero, who announced besides that he had seen in the 
marrow, every form of transition between the white blood cells and the 
nucleated red marrow-cells. The fact of the existence of these cells has 
been substantiated by numerous observers, and the red marrow of the 
bones, is no tv universally regarded by histologists, as the haematopoietic 
organ. Nevertheless, there are different theories as to the origin of the 
red nucleated cells and their conversion into the red non-nucleated cor- 
puscles. 
1st. As to the latter point, Neumann considered the conversion to 
consist in a gradual disappearance of the nucleus, while Rindfleisch is of 
opinion that it is extruded. Malassez describes the process as one of pro- 
toplasmic budding from the periphery of the cells. The observation of 
Malassez has received confirmation from the domain of pathology. 
Creighton, in 1880, described a process of blood formation which he observed 
to take place in the interior of certain serosanguineous cysts of the neck. 
* Quain's Dictionary of Medicine, 1882, p. 116. Source of, or Origin of, the Red Corpuscles. 
117 
These cysts in their solid portions had all the characteristics of sarco- 
mata, but their central cavities contained red blood-corpuscles, that were 
evidently derived by germination from the embryonic cells, lining these 
walls. Creighton regards blood formation as the earliest and most deeply 
rooted function of the mesoblastic layer, of which the memory is retained, 
during the whole life of the individual. When from any cause the cells of 
this layer return to their embryonic condition, their primary blood-making 
function is renewed. 
2d. As to the origin of the red nucleated marrow cells, they were at first 
regarded by Neumann and Bizzozero as the result of a transformation of 
the white blood-corpuscles, but later, both of these observers expressed 
themselves upon this point with greater caution. Malassez demonstrates 
that with proper modes of procedure, no transitional forms are to be found, 
and that the behavior of the white blood-corpuscles towards chemical 
reagents and staining fluids is very different from that of the red nucle- 
ated cells, not to mention their different optical properties; he therefore 
decidedly rejects such a, mode of origin; and derives the red nucleated cell 
from certain larger marrow cells, containing little or no haemoglobin, and 
in which the nucleus is either barely perceptible or quite invisible; in the 
latter case, he considers the nucleus to be different throughout the proto- 
plasm. He calls this cell the primitive haemoglobic cell, or proto-haemo- 
blast. In the course of its development the nuclear substance condenses, 
and a thin layer of protoplasm encircles it. At this stage the nucleus is 
very faintly colored by staining substances, such as haematnxylen and 
picrocarmine. Gradually the nucleus contracts and at the same time stains 
more deeply, and coincident with these nuclear changes, the surrounding 
protoplasm loses its granular aspect and becomes perfectly hyaline, elastic 
and rich in haemoglobin; in short, acquires all the characters of the red 
blood-corpuscles. Malassez considers the nucleus of these cells to be of a 
fluid consistency, and therefore to take a passive part in the changes above 
described, which are all due to the activity of the protoplasm. These 
observations regarding the haematogenic function of the medullary sub- 
stance acquire a still greater significance when considered in connection 
with the discovery by Hoyer that in the red marrow the blood from the 
arteries instead of traversing a capillary system passes into the veins 
through the medium of a system of lacunae destitute of walls, and thus 
comes directly in contact with the cells above described. This anatomical 
observation of Hoyer has been confused by Rindfleisch. Another mode of 
blood formation in the marrow is by means of giant cells (myeloplaxes) in 
the interior of which red blood-corpuscles are developed. This mode of 
blood formation has been observed by Foa and Salvioli in the marrow, as 
well as in the spleen, liver and lymph-glands of the embryo and foetus. It 
has been observed and fully described by Ranvier as occurring in the 
omentum of young rabbits, and has been studied by Heitzmann in carti- 
lages in course of ossification and in inflamed bone. Malassez and Charles 
Monod have also observed the. same processes in certain myeloid tumors, 
which they term angioplastic sarcomas. There are a number of facts tend- 
ing to prove that the so-called giant cell is concerned in the new formation 
of blood, and in consequence the term angioblast has been proposed for 
these bodies by Brodowsky. 
To the spleen is also ascribed a share in haematogenesis. The same 
transition forms are ' found as in the bone-marrow, and the same lacunae 
between the arteries and veins are still more easily demonstrated. Counts 
of the blood in the splenic artery and vein show that the latter is richer in 
red corpuscles. The lymphatic glandular system, however, is probably 118 
The White or Colorless Blood Corpuscles. 
chiefly concerned in blood formation. From this source fresh elements are 
continually introduced into the circulation. 
It was observed by the late Professor J. H. Bennett, of Edinburgh, 
that in chyle taken from the thoracic duct, there are also bi-concave flattened 
discs, exactly resembling the colored blood discs in size and form, but des- 
titute of color. This observation has been confirmed and greatly exten- 
ded by Professor Richard Norris, of Birmingham, who describes these 
bodies under the name of the advanced lymph discs, that is the ultimate cellu- 
lar product of the lymphatic glands. They are the free nuclei of the 
uninuclear cells of these glands. In the blood these discs by the gradual 
acquisition of haemoglobin become converted into the red corpuscles. 
Norris claims that identical elements are furnished by the spleen, mar- 
row, thymus, and thyroid glands, and this process he terms the major pro- 
cess of blood formation. The white corpuscles of the blood he considers 
to be lymph cells which have entered the blood in an immature state. 
Their nuclei are constantly liberated, become colored and develop into 
perfect red corpuscles. This latter process he terms the minor process 
of blood formation. 
M. Hayem claims for his haematoblasts the principal share in the blood 
formation, and bases his claim upon the following facts : First, the resem- 
blance of the two in external appearance, particularly as regards the bi-con- 
cave form of the haematoblasts; second, the fact that some of the haemato- 
blasts contain haemoglobin; third, their scarcity in health, as compared 
with their great increase in certain diseases, especially in anaemic condi- 
tions and after blood-letting; fourth, the presence in the blood of minute, 
bi-concave red corpuscles, which he regards as transient forms. 
According to Hayem, the haematoblasts average in healthy blood 
255,000 per cubic millimetre, or forty times more than the white corpuscles, 
and twenty times less than the red. 
On the other hand Norris admits the presence of red nucleated cells in 
the marrow (the cellues haemoglobiques of Malassez, haematoblasts of Rind- 
fleisch,) but argues that these membranes are entirely too small to warrant 
their being regarded as anything more than the remnant of an embryologi- 
cal mode of haematogenesis. He also claims that the haematoblasts of 
Hayem (the blntplattchen of Bizzozero) are products of disintegration of 
his colorless corpuscle-Frederick P. Henry, Reference, Handwork of 
Medical Sciences, Vol. 1, pp. 555, 556. 
THE COLORLESS OR WHITE CORPUSCLES. 
The white or colorless corpuscles of the blood, also called leucocytes, 
are chiefly derived from the corpuscles of the lymph, and the cells of the 
lymphatic glands and allied organs, which they closely resemble. By 
escaping through the walls of the blood-vessels, they become identical with 
the wandering cells of tissues and with pus-corpuscles-from which they 
are indistinguishable except by locality. Such is the origin, and such are 
some of the functions of the white corpuscle, and its occasional develop- 
ment into the red corpuscle has been already mentioned. It might, there- 
fore, be expected that morbid states of the leucocytes would be associated 
with disorder of the lymphatic structures and connective tissues of the red 
corpuscles, and of the blood-vessels. The leucocytes exist in the blood of 
man in the proportion of one white to about 500 of the red corpuscles. 
These figures are merely approximative; they are diminished by fasting, and 
increased by eating. Their enumeration is made by the same instruments 
as are employed for counting the red corpuscles. The proportion of one Chemical Composition of the White Corpuscles. 
119 
white to 500 red, will give the former a number of 10,000 per cubic milli- 
metre. 
The leucocytes of the blood of man are spherical granular masses of 
protoplasm, destitute of a membrane, containing one or more neuclei, and 
sometimes a number of fat granules. Their most remarkable property as 
we have previously said, is the power which they possess of spontaneous 
movements which bring them into remarkable analogy with the unicellular 
rhizopods, known as the amoeba; the movement has hence been called 
amoeboid. They have a diameter of about ten micromillimetres, l-2500th of 
an inch. Maxschultze has described two varieties of smaller colorless cor 
puscles, one with a diameter less than that of the red corpuscles and con- 
taining one or two nuclei; the other of the same diameter as the colored cor- 
puscles and also nucleated. 
The white corpuscles are of lower specific gravity than the red, as is 
shown by their accumulation in a layer between the red corpuscles and the 
plasma in blood, in which coagulation has been delayed by a temperature 
of 0° C. Their adhesiveness is so great that in a blood preparation, the red 
corpuscles can be washed away by a stream of water, leaving the white 
corpuscles attached to the object and covered glasses. 
By means of these amoeboid movements, the white corpuscles have the 
power of penetrating animal membrane. Thus they have been observed 
to pass through the shell membrane of an egg that has been placed in con- 
tact with a suppurating surface. This phenomenon is observed in the 
living body by exposing a transparent membrane such as the mesentery, 
to the air. Inflammation is set up and the white corpscles pass gradually 
through the walls of the capillaries and veins, this migration, known as 
diapedesis, is, undoubtedly, the chief factor of the inflammatory process. It 
was observed by W. Addison, in 1842; then by Waller, in 1846, but was 
forgotten until Cohnheim discovered it anew in 1867. The latter by his 
demonstrations ofits paramount importance in the inflammatory process, 
established a new era in pathological science. 
CHEMICAL COMPOSITION OF THE WHITE CORPUSCLES. 
Owing to the comparatively small quantities of these elements in the 
blood, inquiries as to their chemical composition are attended with much 
greater difficulty than is the case with regard to the red corpuscles. The 
analyses of the corpuscles, as they exist in healthy and leukaemic blood, 
have been supplemented by analyses as they exist in pus. The mass of the 
white corpuscles is undoubtedly aproteid, and. inasmuch as it is contrac- 
tile, it is regarded by some as probably identical with the myosin derived 
from the muscle. Some of the granules contained in the corpuscles are 
soluble in ether and alcohol, and are therefore considered to be fat-drops, 
either taken up into the substance of the corpuscle from without or are a 
product of protoplasmic metamorphoses. 
They also contain cholesterin. and a fatty phosphorous containing body, 
which is, by some, regarded as protagon, by others as lecithin, another, phos- 
phorized constituent is found in the nucleus, and is called nuclein. It 
was observed by Miescher in the nucleus of pus corpuscles, afterwards by 
Lauder, Brunten and Plosz, in the nuclei of red nucleated corpuscles of birds 
and snakes. This substance closely resembles mucin, and possesses the 
peculiarity of not being acted on by gastric juice. This property affords a 
ready means of isolating it. Glycogen is also a constituent of the white 
corpuscles, and may be demonstrated by the mahogany red color induced 
by the action of a solution of iodine in potassium iodide and water. 120 
Chemical Composition of the White Corpuscles. 
The proportion of white corpuscles in the blood is subject to physio- 
logical increase, without becoming excessive, as after meals, during periods 
of growth and development, and in menstruation and p regnancy. This 
state is called Physiological Leucocytosis (Virchow), and signifies lymph- 
glandular excitement. 
Plasma.-The physiological relations of the plasma to the organism 
are extremely complex; and disturbance of these relations furnishes many 
of the symptoms of the disorder of the blood. Its mature function is 
essentially one of nutrition; it supplies the tissues with oxidizable mate- 
rial for development, growth, support, secretion and the liberation of 
force. The source of the plasma is equally extensive. It derives its 
principal constituents from the alimentary canal through the absorbent 
glands and liver; while other important albuminous substances are being 
constantly supplied from the tissues generally, through the lymphatic 
system. 
Lastly, the products of the plasma, such as carbonic acid, urea and 
water, are discharged by the regular excretory channels. Thus, the con- 
dition of the plasma is found to be most intimately associated with that of 
the organs and tissues generally, whether as regards its origin, its mature 
function, or its products; and it will therefore be affected by disorder or 
disease of every organ, whether alimentary, sanguifacient, or excretory, 
and of all the tissues. 
Morbid conditions of the blood corpuscles.-The white corpuscles 
of the blood may undergo certain morbid changes, both in number and 
appearances. 
(a.) The most remarkable of these is increase in numbers, which may 
advance to such a degree that the white corpuscles become as numerous 
as the red. This condition is known as leucocythsemia or leukaemia. 
Short of this, however, the proportion of white corpuscles in the blood 
may be appreciably increased, and to this minor condition the name of 
leucocytosis has been applied. Leucocytosis, according to Virchow, 
accompanies, almost unexceptional]y, every case of lymphatic excitement, 
such as inflammation, and tubercular, scrofulous, or cancerous enlarge- 
ment or swelling of the glands and allied structures-Peyers glands, the 
solitary follicles, the spleen and the tonsils. Leucocytosis is distinguished 
from leucocythsemia by its very moderate degree; by its evanescent course; 
by the absence of deficiency of the red corpuscles, and by the accompa- 
nying symptoms. Leucocytosis may be appreciated, even by the naked 
eye, in the clot of drawn blood, by the presence of an irregular lymphatic 
layer-crusta lymphatica-consisting of collections of white corpuscles 
between the red clot and the buffy coat which so frequently occurs along 
with it. 
(b.) A diminution in the number of white corpuscles occurs in chlo- 
rosis; and it is said in malaria, especially during the paroxysms of fever. 
(c.) With regard to the structure of the individual white corpuscles, 
the proportion of uninuclear or young cells and of multinuclear or aged 
cells may be disturbed, both in leucocytosis and leucocythaemia; while 
corpuscles may be found containing granules of various kinds, especially 
pigment-particles, bacteria, micrococci and other structures. 
Morbid conditions of the blood-plasma.-(1) Water. The limits of 
the physiological variations in the amount of water are very wide. 
(a.) Diminution of water in the blood is observed in various degrees. 
It is moderate and transitory as the result of the stimulation of the kid- 
neys, skin or bowels, but the normal proportion is speedily restored by 
absorption. This condition is found after severe purgation, sweating, Plasma. 
121 
diarrhoea, or dysentery, and its production is the rationale of several of 
the methods adopted for the relief of dropsy. If the drain of water con- 
tinues, or if the supply fail, the anhydric condition of blood increases, so 
that the fluid appears black, thick and tarry. Such is the state of the 
blood in the algid stage of cholera; the specific gravity of the serum rising 
as high as 1,080, accompanied by a comparative excess of salts, albumen 
and urea. The chief symptoms of great deficiency of water in the blood 
are intense thirst;, a shrivelled, shrunken aspect of the body generally; 
coldness and lividity of the extremities; muscular pains, and suppression 
of the excretions-phenomena directly referable to the loss of water, 
retardation of the circulation, and interference with the function of the 
red corpuscles. 
(b). Excess.-Hydrcemia.-Reference has already been made under 
the head of oligaemia to the anaemia or hydraemia that follows it. Excess 
of water in the blood is perhaps never absolute, and the change may there- 
fore be regarded with equal accuracy and greater convenience as deficiency 
of solids. 
(2). Albuminous constituents.-On reviewing what has already been 
said under the head of coagulation and fibrin, the reader will observe that 
the amount of fibrin and other expressions connected with the albuminous 
constituents, must be regarded as comparatively meaningless, in the light of 
our knowledge of the process of coagulation. Inasmuch, therefore, as 
little value can now be attached to the analyses of fibrin that have been 
made in different diseases, it follows that the estimates of the albuminous 
substances left after coagulation-that is, of the albumins of the serum, 
must also be rejected. But the total amount of albumins in the blood may 
be easily ascertained ; and this is subject to extensive variations. The 
balance between the albuminous substances, which enter the blood from 
the alimentary tract and the lymphatic system, on the one hand, and the 
products of their transformation by the tissues on the other, is represented 
by the albumins of the blood. These will increase accordingly when the 
supply is excessive, or the consumption small; and will decrease under oppo- 
site circumstances. 
(a). Hyperalbuminosis is the name given to excess oi albumins in the 
blood. The amount has been found notably increased when the activity of 
tissues is abnormally heightened, as for example in inflammatory diseases 
(acute rheumatism, tonsillitis, pneumonia and pleurisy; and when filrin- 
ogen, which is the product of this increased activity is poured abundantly 
into the blood. The amount of the albuminous fluid produced in an 
inflamed part, whether it appears as a catarrh, an infiltration, an exudation, 
or an effusion, is very great, and may be enormous ; and under favorable 
circumstances, this and much that cannot be so easily appreciated is car- 
ried into the blood, the lymphatic structures swelling en route. Hyperal- 
buminosis as a result of diminished consumption probably does not exist; 
for the effect of an insufficient supply of oxygen to the albumins-(want of 
exercise or over-feeding)-is not the accumulation of these in the blood, 
but the formation of 'lower products, such as uric acid and its allies, and 
the deposit of fat. Relative hyperalbuminosis is a necessary but transient 
effect of cholera and other severe watery fluxes. 
(b). Hypalbumin osis, or deficiency of albumins in the blood, occurs 
under exactly opposite circumstances from the preceding-whether the 
ingestion of albumins from the alimentary tract and the tissues be compara- 
tively small, or the comsumption excessive. Inanition therefore, on the 
one hand, and its multitude of causes, are associated with such poverty of 
blood ; and so, on the other hand, are loss of blood, profuse discharges of 122 
Morbid Conditions of the Blood Plasma. 
albuminous fluids, morbid growths, and other sources of waste, as well as 
excessive demands of growth and development. The albumins of the- 
plasma may fall under these circumstances from 80 to 37 parts in 1000. 
Such hypalbuminosis is, however, never simple ; the blood cannot be defici- 
ent in albuminous substancesand otherwise normal, for, as we have already 
shown, loss of albumin is always followed by absorption of water, and salts 
from the tissues in definite proportions, and anaemia is the result. The red 
corpuscles suffer at the same time, for their nutrition speedily fails in 
hypalbuminosis, and aglobulism ensues. Hypalbuminosis is thus a serious 
disease of the blood. The relations of these conditions to each other and 
to oligaemia are even more complicated clinically than they are pathologi- 
cllay ; and in this relation the whole of them are most conveniently discussed 
under the comprehensive head of anaemia. 
(3). Clot, Fibrin. However uncertain as a measure of any particular 
constituent in the blood, the amount of clot or fibrin demands a brief 
notice, as a matter of fact. 
(a.) Abundant clot has been considered as indicating an excess of 
fibrin in the blood or hyperinosis, the proportion being stated to be as 
high as 1.0 instead of 0.2 per cent. Acute rheumatism, cellulitis, pneu- 
monia and pleurisy, are the diseases in whichhyperinosis is most marked; 
but it also occurs in pregnancy, the two principal conditions of its occur- 
rence appear to be: 
1. Increased activity of the tissues-including inflammation; and 
2. Free and abundant communication of these tissues with the blood, 
through the lymphatic svstem. 
fb.) Deficiency, looseness or absence of clot-fluid blood. A small 
loose clot is frequently observed, as for example in typhous states, or in 
chronic wasting diseases, attended with loss of blood, and has been described 
as indicating hyperinosis or deficiency of fibrin. When this condition is- 
extreme, the clot may be absolutely wanting, as in certain cases of anaemia, 
the blood then separates on standing, into three layers: An upper, con- 
sisting of clear liquid; a middle, puriform, of white corpuscles; and a 
lower, red of red corpuscles. In an other and larger group of cases, non- 
coagulatorv or fluid blood, is at the same time of an intensely dark color, 
or even lake, and is commonly described as black. The circumstances 
under which this condition of blood occurs, and the cause of the remark- 
able color, requires investigation. In accounting for the fluidity we must 
consider the profound alteration of the red corpuscles, the want of oxygen, 
the interference with the production of the ferment and the changes in the 
fibrinogen and fibri noplastic substance; one and all combine to prevent 
coagulation. 
(c.) Buffy Coat. Another phenomenon connected with coagulation, 
from which erroneous and even dangerous conclusions have been drawn, is 
the so-called buffy coat. The process of coagulation is generally sufficiently 
slow, to allow of the gravitation of some of the red corpuscles, from the- 
surface of the blood; and the corresponding part of the clot is accordingly 
paler. When the pale layer is unusually large, it is known as the buffy 
coat or crusta pldogistica ; it may be seen in the blood in pregnancy, inflam- 
matory forms, hydroemia and oligocythcemia. When these cases are analysed, 
it is found that the conditions favorable to the formation of the buffy coat, 
are probably all more or less connected with the red corpuscles, namely: 
(1). Increased specific gravity of the red corpuscles, as in oligocythcemia 
and hydrcemia, allowing more rapid sinking. 
(2). Interference with the catalytic action of the haemoglobin, which 
is so powerful in determining the rapidity of coagulation, as in fevers and Salts in Human Blood. Fats in Human Blood. 
123 
oligocythcemia; and (3) want of oxygen, corresponding to the amount and 
condition of the haemoglobin, as in the same diseases. One and all of these 
states render the process of coagulation slow, compared with the descent of 
the red corpuscles, and the buffy coat is the result. It thus appears that 
the buffy coat is no indication whatever of excess of fibrin generators or of 
the opposite, and that it is found under the most diverse conditions of 
blood. 
SALTS OF THE HUMAN BLOOD. 
The salts of the plasma have chiefly sodium for their base, while 
potassium salts mostly reside in the corpuscles. 
(a.) Diminution of salts: In febrile diseases there is an increased 
discharge of compounds of both bases, but at different periods ; the 
potassium salts appearing in excess in the excretions until the crisis is 
passed, and the sodium salts during defervescence. At both periods it may 
be considered certain that the blood is the chief source of the salts 
excreted; and that it is accordingly deficient in these constituents. 
(b.) Excess of salts: On the other hand, the salts of the plasma are 
relatively in excess hypalbuminosis, replacing in the proportion already 
stated the loss of albumen. The effects on the salts of the blood of such 
drains as occur in cholera, has been variously stated; some authorities 
declaring that it is an increase, others a diminution. 
(c.) Reaction: The alkalinity of the blood is said to be diminished in 
gout, cholera and osteo-malachia. 
FATS IN THE HUMAN BLOOD. 
The normal increase of fats in the plasma that occurs after meals may 
be increased by a diet rich in oil. and it is said in chronic drunkards and 
in persons disposed to obesity. When this increase is so great that the 
serum presents a milky appearance, the blood has been called chylous. 
A cream-like scum forms on the surface of the serum; and the milky 
appearance is found microscopically to be due to the presence of fine gran- 
ules and oil globules. A marked increase of fatty matters in the blood has 
been found in some cases of chyluria. This diseased state is now known 
to be due to the existence of the parasite (filariae sanguinis hominis) in the 
blood. This subject will demand special attention in a future portion of 
this work. 
Fat may also appear in the blood as a foreign body, by the escape of 
marrow into the circulation in fracture of bones, and that in such quantity 
as to cause fatal capillary embolism.* 
FORMULA OF HUMAN BLOOD. 
The following table drawn up by Lehmannf from his own analyses, and 
from the experiments and deductions of Schmidt, presents a comparison of 
the quantitative relations of the principal elements of the blood-cells and 
intercellular fluid:- 
*J. Mitchell Bruce-Quain's Dictionary of Medicine, p. 121. 
tLehmann's Physiological Chemistry, English ed., vol. ii. p. 160; American ed., vol. i. p. 546. 124 
Formula of Human Blood. 
1000 Parts of Moist Blood-Corpus- 
cles contain- 
Water 688.00 
Solid constituents 312.00 
Specific gravity 1088 50 
Hsematin 16.75 
Globulin and cell-membrane 282.22 
Fat 2.31 
Extractive matters 2.60 
Mineral substances (without iron) 8.12 
Chlorine 1.686 
Sulphuric acid 0.066 
Phosphoric acid 1.134 
Potassium 3.328 
Sodium 1.052 
Oxygen 0.667 
Phosphate of lime 0.114 
Phosphate of magnesia 0.073 
1000 Parts of Liquor Sanguinis con- 
tain- 
Water 902.90 
Solid constituents 97.10 
Specific gravity 1028.00 
Fibrin 4.05 
Albumen 78.84 
Fat 1.72 
Extractive matters 3.94 
Mineral substances 8.55 
Chlorine 3.644 
Sulphuric acid 0.115 
Phosphoric acid 0.191 
Potassium 0.323 
Sodium 3.341 
Oxygen . 0.403 
Phosphate of lime 0.311 
Phosphate of magnesia 0.222 
The following are the physiological limits of the variations of the con- 
stituents of the blood, as established by the researches of MM. Becquerel* 
and Rodier:- 
In 1000 parts of blood- 
The Water may vary from 760.000 to 800.000 
The Specific gravity of the blood may vary " 1055. " 1063. 
The Globules may vary " 120.000 " 150.000 
The Fibrin may vary " 2.000 " 3.500 
The Solid matters of the serum may vary.... " 90.000 '' 105.000 
The Oholesterine may vary " 0.075 0.150 
The Animal soap may vary " 1.000 " 2.000 
The Serolin may vary from " 0.010 " 0.030 
The Chloride of sodium may vary " 2.000 " 5.000 
The Soluble salts " 1.500 " 4.000 
The Phosphates may vary " 0.500 " 1.000 
In 1000 parts of serum- 
The specific gravity of the serum may vary from 1027. to 1032. 
The Water of the serum may vary " 880.000 " 900.000 
The Solid matters may vary " 100.000 " 120.000 
The Albumen may vary " 70.000 " 90.000 
The following is the typical formula of the constitution of the blood in 
health, adopted by MM. Becquerel f and Rodier*- 
Analysis of 1000 Parts of Blood. 
Specific gravity of the blood 1060.000 
Water 781.600 
Globules 135.000 
Albumen 70.000 
Fibrin 2.500 
Fatty matters, extractive mat- 
ters, and free salts 10.000 
Phosphates 0.550 
Iron 0.350 
Analysis of 1000 Parts of Serum. 
Specific gravity of serum 1028.000 
Water 908.000 
Albumen 80.000 
Extractive matters and free salts 12.000 
Notwithstanding the results of these laborious investigations, we must 
acknowledge that the establishment of an absolute standard, expressing the 
constitution of the blood in health, is impracticable, if not impossible. In 
♦Pathological Chemistry of MM. Becquerel and Rodier, English ed., p. 90. 
fLoc. cit., p. 81. Amount of Blood in Living Human Beings. 
125 
the first place, we must not only establish a formula for each class and 
species of animal, and for the human race generally, but we must establish 
a formula for each temperament, and for each race and nation, under every 
conceivable circumstance of soil, climate and occupation. 
Another important field of investigation is the changes of the constitu- 
ents of the blood during thirst and starvation. 
In almost all the forms and grades of fevers the patients are deprived 
of food, either by the physician or by the condition of the digestive 
apparatus. Accompanying this condition we have rapid chemical changes, 
and often perverted nutrition. The constituents of the blood may be 
divided into two great classes, the nutritive and force elements. From the 
chemical changes of these two classes arises a third class, called the excre- 
mentitious. Now, both classes of matter, the force elementsand the nutri- 
tive elements, are consumed, chemically altered, and converted into exrce- 
mentitious offending compounds during starvation. In like manner both 
classes are converted into excrementitious compounds in fever. Now, to 
determine definitely what changes are due to fever, we must first determine 
what are due to starvation; that is, to the consumption of the blood during 
nutrition, and the generation of the forces by which the machinery is 
worked. This can only be accomplished by determining the changes of 
the blood during starvation, and the forces and products resulting from 
these chemical changes. A standard will thus be established, to which the 
changes in fever may be referred. In fever we have a pathological state 
(abnormal changes) superadded to those normally existing. We can never 
have accurate pathological knowledge until we determine the physiological 
changes. Another difficulty meets us : The elements of the blood are 
liable to variations, not only of quality, but also of quantity. We must 
determine, not merely the relative variations, but also the quantitative. 
By analyzing the phenomena carefully, and attributing to each its just 
position, we may eliminate the elements of the problem only to a probable 
issue, we may determine the character of the changes and of the morbific 
agent; but the absolute amount of these changes will be unknown, without 
some method of determining the amount of blood in the system. Here, 
then, is a great and serious difficulty in the establishment of an absolute 
standard of comparison. We have no accurate means of determining the 
amount of blood circulating through the system. It is evident that 
obscurity on this point introduces obscurity everywhere, and impairs the 
value of every standard we may erect. The truth of this proposition is 
established by looking at the great discrepancies which have prevailed 
among physiologists, with regard to the amount of blood contained in the 
bodies of warm-blooded animals. Blumenbach estimated the quantity in 
an adult man at 8.5 to 11 pounds, Beil at 44, Haller computed it at 28 to 
30, Borelli 20, Young, 40, Dumas 25, Fletcher 30, Ancell 30. M. Valentin, 
by his method of injecting water, arrived at the following results. The 
numbers represent the relation existing between the quantity of blood and 
the weight of the body- 
Large dogs (the mean of four experiments), as 1 : 4.5 
A lean, debilitated sheep, as 1 : 5.02 
Cats, female (the mean of two experiments), as 1 : 5.78 
A large female rabbit, as 1 : 6.20 
From these data he estimates the amount of human blood to be- 
Male sex, as 1 : 4.36 
Female sex, as 1 : 4.93 126 
Changes in the Amount of Human Blood in Disease. 
This would give in a man weighing 150 lbs. 30 lbs. of blood, and in a 
female weighing 130 lbs. 26 lbs. Lehmann determined the amount of blood 
in the bodies of two criminals, who were decapitated, to be from 17.5 to 
nearly 19 lbs., or one-eighth the weight of their bodies. My own observa 
tions have established the fact that the amount of blood varies with the 
different classes of animals, and corresponds with the rapidity of the 
chemical changes of the blood and tissues, and with the physical, vital and 
nervous forces. These investigations have established that the blood is 
more abundant in warm than in cold-blooded animals. These facts are 
important in their bearing upon the phenomena of health and disease. 
When we have a large supply of blood and a rapid distribution of blood, 
then we will have a rapid generation of force. 
In the present state of science we possess no method of determining 
absolutely the amount of blood existing in the animal body. Whilst we 
might determine the amount of blood contained in the large blood-vessels, 
it wTould be utterly impossible to determine the amount in the capillaries, 
because the quantity lost after fatal haemorrhage is no criterion whatever, 
and the latter portions drawn are also mixed with the fluids of the organs 
and tissues. Our knowledge on this subject is vague, and may be summed 
up in a few sentences. The young are said to have more blood than 
adults and the aged, and lean persons are said to have more blood than 
very fat persons. As in certain diseases there is a rapid destruction and 
perversion of the elements of the blood, and as it appears that these chemi- 
cal changes are destined to fulfil certain salutary offices, as the destruction 
of peculiar poisons, it is evident that an increase or diminution of the blood, 
even within the limits of health, must modify not only the course of dis- 
eases, but also the action of remedial agents. The determination of an 
absolute standard is farther impossible, because in the present state of 
science the methods of analysis are not strictly accurate. We have no 
absolutely accurate method of determining the colored blood-corpuscles. 
We have stated these difficulties, not with the design of casting doubt 
and discredit upon physiological and pathological science, but rather with 
the design of pointing out the great complexity of the phenomena, and 
defining the bounds of knowledge, and inducing caution both in investiga- 
tion and in the generalization of the results of observation and experiment. 
CHANGES OF THE AMOUNT OF BLOOD, AND OF ITS CONSTITUENTS IN HUMAN 
BEINGS, AND THEIR RELATIONS TO PATHOLOGICAL CONDITIONS. 
The effects of changes in the amount of blood has engaged the atten- 
tion of many observers, and Dr. J. Mitchell Bruce thus sums up the main 
facts of our knowledge upon the subject.* 
1. Alterations in the total amount of the blood in the body are, per- 
haps, never simple, but always associated with alterations in quality. 
(a.) Polyhsemia, or excess of blood in the body generally, maybe the 
result either of excessive ingestion of the elements of blood of the accu- 
mulations of the same by the suppression of habitual haemorrhages or 
fluxes; of the loss of the obsoleteness of a part of the body, such as 
a limb or a lung; or of insufficient exercise. It cannot be said, how- 
ever, that polyhsemia has ever been demonstrated by exact investigation, 
inasmuch as the total amount of blood in the body is still uncertain, and the 
CHANGES IN QUANTITY OF THE BLOOD. 
* Quain's Dictionary of Medicine, p. 118. Changes in Amount of Human Blood in Disease. 
127 
physiological limits in this respect are very wide. Polyhaemia is believed 
to be present in plethora, along with relative excess of the solids, and 
.especially of the red corpuscles. 
(b.) Oligaemia, or deficiency of th 3 total amount of blood is, on the 
contrary, an exceedingly frequent change, and constitutes the simplest 
form of anaemia. It is, however, probably never pure, inasmuch as alter- 
ations in quality appear to be inseparably associated with it, and the terms 
hydraemia and spanaemia have, accordingly, been used as synonymous 
with the preceding. The manner in which diminution in quantity gives 
rise to alterations in quality must be considered here. 
When haemorrhage occurs to any amount, and the whole amount of 
blood in the vessels is reduced, the pressure falls, and absorption of the 
parenchymatous plasma rapidly follows ; by which, along with vaso-motor 
stimulation, the physical relations are restored. If the loss of blood has 
been moderate, the only change in its composition may be considered to be 
oligocythaemia, or diminution of the red corpuscles, which alone of all 
the constituents of the blood cannot be rapidly restored. If the haemor- 
rhage has been more serious, the fluid absorbed into the circulation from 
the tissues, from the suppressed secretions, and from the alimentary canal, 
consists of water in ever-increasing excess, which carries with it an amount 
of salts equal to one-ninth the loss in albuminous substances. The morbid 
state of the blood is now beyond oligocythaemia; there is deficiency of albu- 
minous constituents, or hypalbuminosis, and the condition correctly called 
anaemia, is the result. The total quantity of blood probably remains for 
some time below the normal. A similar impairment of the quantity, and 
therewith of the quality of the blood, may be slowly developed by repeated 
small haemorrhages, or by any cause whatever that impoverishes the blood, 
whether of the nature of waste or of want. The condition which results 
closely resembles that just described in the acute form-oligaemia with 
oligocythaemia and hypalbuminosis, the same is known clinically as 
anaemia. 
As a therapeutic measure, oligaemia may be desirable. It may be 
induced either (1) by direct abstraction of blood, or (2) by gradual impov- 
erishment of the blood and reduction of the intra-vascular pressure. 
2. Morbid conditions of the red corpuscles. The pathology of the 
red corpuscles is still imperfectly understood. The following comprise the 
most important changes connected with them, so far as they are known: 
(a.) Polycythaemia. Increase in number of red corpuscles is never 
considerable, being generally transitory and within physiological limits; 
for example, in the newly-born and after meals. It has already been men- 
tioned as associated with polyhaemia and plethora. In the algid stage of 
cholera the red corpuscles are relatively in excess. 
(b.) Oligocythaemia. Diminution in number of the red corpuscles is, 
on the contrary, of very frequent occurrence, and of the greatest pathologi- 
cal importance. Microscopically, the number of red corpuscles in a given 
visible area of blood is diminished, and chemically the amount of haemo- 
globin in a given volume of blood, may fall from 15 even as low as 5 per 
cent. The principal circumstances under which oligocythaemia occurs, are 
(1) in anaemia or diminution in the amount of blood as a whole, from any 
cause, whether rapid or protracted, especially as the result of fever; the 
red corpuscles suffering early, seriously and persistently, as compared with 
other constituents; (2) in leucocythaemia-the development of the red cor- 
puscles being interrupted; (3) in hypalbuminosis, where the red corpus- 
cles like other elements suffer from want of albuminous material; and (4) in 
chlorosis. 128 
Changes in Amount of Human Blood in Disease. 
(c.) Oligochromaemia. Deficiency of the red corpuscles in haemoglo- 
bin, has been described by this name, and is a morbid condition of the 
greatest possible interest, inasmuch as it is one of the essential alterations 
of the blood in chlorosis. When the individual red corpuscle contains less 
haemoglobin than normal, it is said to present a pale appearance to the eye. 
A more trustworthy method of determining the richness of the red corpus- 
cles in haemoglobin, is by means of the haemoglobinometer. Or we may 
compare the amount of haemoglobin in a given weight of blood with the 
number of red corpuscles in a given microscopical area. When the former 
is small in proportion to the latter, the defect must lie in the individual 
corpuscle; and this may be so great that the proportion of haemoglobin 
falls, as in some cases of chlorosis, to 25 per cent, of the normal. 
(d.) Aglobulism. The effects of the two conditions of blood just 
described, namely, oligocythaemia and oligochromaemia, may be discussed 
together under the head of aglobulism, or deficiency of the blood in haemo- 
globin. Want of the oxygenating substance of the organism gives rise to 
symptoms at once extremely various, and of the most serious import. 
Every vital process, whether developmental, plastic, secretory, dynamic 
or nutritive, is absolutely dependent on a free and immediate supply of 
oxygen. All of these processes, therefore, will suffer in aglobulism. The 
respiratory and circulatory movements are accelerated. The complex 
process ot alimentation and secretion are performed imperfectly, and the 
results are dyspepsia, constipation and disordered sanguification-which 
intensify the abnormal blood-state. Muscular contraction is feeble, and 
cannot be sustained. Psychical force is weak; and dullness, sleepiness, 
pains and symptoms indicate imperfect oxidation within the nervous sys- 
tem. Bodily growth and development-as of the sexual organs, for exam- 
ple-remain incomplete, and puberty is deferred. Nutrition everywhere 
suffers, the materials being insufficiently oxidised; and substances inter- 
mediate to albumen on the one hand and carbonic acid, water and urea on 
the other, are formed, especially oils. Thus the organs and the connective 
tissues become loaded with fat and enlarged, instead of suffering atrophy 
as they do when the blood-plasma is deficient. Finally the excretions are 
disturbed, and the subject of aglobulism presents derangement of the 
coloring matters of the bile and urine, which are derived from haemoglobin. 
(e.) Histological changes. Alterations in the size, outline and consist- 
ence of the red corpuscle, have been frequently recorded, but such accounts 
are incomplete, and no successful attempt has yet been made to connect 
any of these changes with morbid processes in the tissues. In severe 
fevers, such as typhus, and in some rapid malignant diseases, the red cor- 
puscles appear peculiarly soft, their outline being less resistant and sharp, 
and the bodies running together into irregular heaps, instead of into rou- 
leaux with well defined lines of contact between the elements. In another 
class of cases, the corpuscles appear small and crenated or like the " thorn- 
apple." Macrocythaeinia and microcythaemia have also been described as 
temporary and variable conditions, in which the red corpuscles are abnor- 
mally large and abnormally small respectively. Transitional cells between 
the white and red corpuscle are unusually numerous in some cases of 
leukaemia. 
CHANGES OE THE BLOOD IN MALARIAL FEVER. 
It is important that we should in the first place determine the extent 
and bearing of our means of investigation, and of our knowledge. 
In the present state of physiological and pathological science, and 
methods of investigation, our knowledge of the changes of the blood Changes of the Blood in Malarial Fever. 
129 
during disease is limited to an examination of the venous blood of the 
extremities, or of the surface of the trunk. We have no means of inves- 
tigating the changes of the blood in different organs and tissues during the 
different stages of disease. 
The changes of the blood in the different organs can only be deter- 
mined by an examination of the blood remaining in those organs after 
death. The information yielded by an examination of the blood of the 
extremities and surface of the trunk during life, and of the blood remain- 
ing in the organs after death, must be imperfect, because we can only 
superficially determine the composition of the blood at different stages of 
the disease, and are wholly unable to determine its changes in different 
organs and tissues, and apparatus, and are limited to an examination of 
the blood in the organs only after a fatal termination, and must, therefore, 
remain without the facts which would enable us to determine definitely 
the various steps of the chemical changes, and the physical, chemical, 
physiological, and toxicological action of the resulting compounds. The 
examination of the blood after death must always yield imperfect and 
unsatisfactory information, even with reference to the effects of the mor- 
bific agents upon the blood, immediately preceding death, because in the 
hours of death, when the circulation and respiration are impeded, and 
the temperature diminished, and the nervous and vital influences enfee- 
bled, many physical and chemical changes of the blood may result from 
the disturbances of the circulation and respiration, and from the altera- 
tions of the process of endosmose, and from the chemical changes of the 
organs and tissues through which the blood passes, entirely independent 
of the actions of the morbific agents. 
In an examination of this kind, it would be necessary first to establish 
a standard formula of the constitution of the blood in each organ, and 
tissue, and apparatus, by an examination of the blood after death, in the 
organs, and tissues, and apparatuses of those who had died in perfect 
health, and also during starvation. In the preceding pages, we demon- 
strated that the constitution of the blood varied with each animal, and in 
the human race varied with temperament, age, previous habits, diet, occu- 
pation and previous disease and race; and hence concluded that it was 
difficult, if not impossible, to establish a universal typical formula of 
venous blood. It is evident, therefore, that the difficulties of establishing 
typical formulae of the constitution of the blood in the various organs, 
and tissues and apparatuses would be increased a thousand fold. 
Besides these difficulties, the poison or poisons which produce the 
changes of the blood in malarial fever have never been isolated, and we 
know nothing whatever concerning its physical, chemical, physiological 
and pathological relations with the elements of the blood, and nervous 
system, and organs, and tissues, by direct experiment. We can only 
infer them from the changes going on during the progress of the 
disease. So complicated are the phenomena, and so imperfect our 
knowledge of malarial fever, that we are unable to answer such impor- 
tant questions as these: Does the poison act by catalysis, by its mere 
presence in the blood, inducing a series of chemical changes, which 
result in the alteration and destruction of the elements of the blood? or 
does it undergo chemical changes itself, and during these chemical changes 
generate from its own elements, and from those of the blood, substances 
capable of preventing and arresting the secretions of the organs, and of 
interfering with the nutrition and chemical actions of the muscular and 
nervous systems, and causing aberrated muscular and nervous actions? 
Are the acceleration and disturbance of the circulation and respiration, 130 
Changes of the Blood in Malarial Eeuer. 
and the aberration of the nervous and muscular phenomena, due to the 
direct action of the poison in the blood upon the muscular and nervous 
elements, or to the action of the altered constituents of the blood? Are 
the changes in the secretions of the liver due to the direct action of the 
poison upon the secretory structures, or to the action of the altered con- 
stituents of the blood supplied for secretion; or to the action of the poison 
of the altered constituents of the blood, upon that portion of the nervous 
system which influences the secretion of the liver? fs the malarial poison 
a ferment? Is the malarial poison a living germ, bacillus, bactitium, or fun- 
gus? Is the malarial poison a ferment or germ capable of self propagation 
outside of the human organism? Does the malarial poison propagate itself 
in the living human organism? Are the paroxysms of malarial fever due 
to the mode of growth and propagation of the malarial poison and its 
periods of action and rest? We shall endeavor to examine these questions 
in the third chapter of this work, in which the results of microscopical 
examination will be recorded. 
In attempting to answer these questions, we can reason analogically, 
but not definitely and absolutely. The great difficulty is, that we have 
not, as yet, been able to isolate the poison. If we could isolate the poison, 
we would be able to watch its action, in combination with the actions 
of external agents, and compare its action with that of other known 
poisons upon the living system, under definite conditions. The relations 
of cause and effect could thus be determined, and the operation of the 
agents determined with a precision corresponding to the perfection of the 
modes of investigation. 
If the physical and chemical properties of a poison be known, and if 
it can be isolated and weighed, a definite quantity may be introduced into 
the animal body, and by carefully devised experiments the physiologist 
can determine the channels through which the poison is absorbed into the 
blood, and its effects upon the tissues with which it comes in contact, and 
its chemical and physical relations to the elements of the blood, and the 
influence of the changes produced by it in the elements of the blood, upon 
the organs and tissues, and upon the development and correlation of the 
physical, and vital, and nervous forces; and by carefully devised experi- 
ments the physiologists can determine whether the action of the poison 
be confined to one or more organs, and whether the derangement of the 
chemical actions in these organs may not be the cause of rhe subsequent 
phenomena; and by careful analyses of the excretions of the kidneys, 
intestines, skin and lungs, he can determine in what state the poison is 
thrown off; he can determine whether it has acted by its simple presence, 
or whether it has itself entered into the round of chemical change, and 
been either altered or destroyed; and by a comparison of the products of 
the metamorphoses of the elements of the living body with the alterations 
produced in the poison and in the constituents of the blood, he can form 
some definite, if not absolutely correct idea of the series of chemical 
changes leading to the alterations of the various secretions and excre- 
tions, and of the elements of the blood; and by carefully devised experi- 
ments the physiologist and pathologist may also determine the relations 
of remedial agent to the poison. Upon the results of such experiments 
and investigations a true, absolute system of pathology and therapeutics 
can alone be based. 
It is evident that the perfect knowledge of all diseases will never be 
obtained, until the physician is able to isolate the special poisons, and de- 
termine their physical, chemical, physiological, and pathological relations. 
In the case of malarial fever, although analogical reasoning leaves no doubt Color of the Blood and Serum in Malarial Fever. 
131 
in the mind that it is caused by the action of a special poison; still we are 
compelled to admit that up to the present time this poison has not been iso- 
lated, and that we possess no known tests for its presence, except the pecu- 
liar class of phenomena induced by it in the living organism. As physi- 
cians have not isolated, weighed, and experimented with the malarial poi- 
son, they have not with certainty traced the channels of its introduction 
into the blood, nor followed it through the course of the circulation, and 
determined its physical, chemical, and physiological relations to the elements 
of the blood, and secretions, and organs, and muscular and nervous systems; 
nor can they tell the form and mode in which it is eliminated from the 
body. 
Notwithstanding these imperfections of knowledge, we have derived 
valuable information from the study of the symptoms, and of the changes 
of the blood, and secretions and excretions, and of the organs and appa- 
ratuses, and from a comparison of these with the analogous actions of those, 
poisonous agents which can be isolated, weighed, and experimented with. 
COLOR OF THE BLOOD AND SERUM IN MALARIAL FEVER. 
In severe cases of malarial fever I have observed that the blood pre- 
sents, when first abstracted, a dark purple almost black color, and after 
exposure to the atmosphere the change from the venous to the arterial hue 
upon the surface of the clot is always slower than in normal blood, and in 
very severe cases it changes to a cherry-red color, and not to the bright 
red assumed by the surface of healthy venous blood. 
The blood found in the large veins after death always presented a deep 
purple and black color, and changed slowly to the arterial hue upon the 
surface when exposed to the oxygen of the atmosphere. 
The blood of the liver presented a dirty brownish red and purplish 
red color, which did not change to the arterial hue when exposed to the 
oxygen of the atmosphere. The relations of the coloring matter of the 
blood to the oxygen of the atmosphere were noted in sixteen malarial fever 
livers, and in each instance the result was the sam<-no change of color. 
The blood of the enlarged, softened, slate-colored spleen of malarial 
fever, as far as my observations extend, presents reddish brown, and pur- 
plish brown, and purplish red colors, which remain unchanged during 
exposure to the oxygen of the atmosphere. 
The serum during the active stages of the severest forms of malarial 
fever was always, whether obtained from the surface of blisters, or from 
the blood of the capillaries, or from that of the veins aud arteries, during 
life or after death, of a bright golden yellow color. I have demonstrated 
in several cases that this coloring was due, in part at least, to the coloring 
mattei- of the bile. Whether this change in the color of the serum be 
entirely due to the presence of the coloring matters of the bile, or to the 
presence of the products result ing from the decomposition of the colored 
blood-corpuscles, or to the simple increase of the normal coloring matter 
of the serum, has not as yet been determined beyond all question, and 
the change may be due to two or more causes. 
When the blood from various cases of malarial fever was allowed to 
stand in glass vessels, the rapidity of the settling and the depth of the lower 
layer of red blood-corpuscles varied within certain limits; and the said 
variations were due to several causes, as the amount of fibrin, the rapidity 
of coagulation and the relative amounts and specific gravity of the serum 
and blood-corpuscles, and the presence or absence of certain salts, or the 
existence of urea and extractive matters and the constituents of the bile in 132 
Color of the Blood and Serum in Malarial Fever. 
greater or less amounts and the temperature of the surrounding atmosphere 
at the time. In general observations on the appearance presented by the 
blood upon standing, in various diseases, and the relations of the plasma 
to the clot, the following well-known facts should be considered. 
Coagulation is hastened by heat-37.7° to 48° 9 C. or 100° to 120° F.- 
by rest, by exposure to the air, by contact with foreign substances, by the 
reception of the blood in shallow vessels, and by the addition of water in 
amount less than twice the bulk of the blood. Arterial blood coagulates 
sooner than venous. The last portions of the blood withdrawn from a vessel 
coagulates sooner than the first. Coagulation is hastened by starvation and 
other enfeebled states of the system. Within the vessels, during life, it 
is frequently caused by the drawing or roughening of the intima, due to the 
imflammatory or degenerative processes. Of all the causes which hasten the 
coagulation of the blood, the most effective is the multiplication of its 
points of contact with foreign bodies. 
Coagulation is retarded by a temperature of 0° C. Freezing the blood 
prevents its coagulation, but it will immediately coagulate when thawed ; 
the clot formed is hence loose and dark, and little or no serum exudes from 
it. The addition of strong solutions of certain alkaline and earthy salts 
will prevent coagulation. Among them are sodium sulphate, and magne- 
sium sulphate. The coagulation of blood is also prevented by the addition 
of four per cent, by weight of sodium chloride. If, after coagulation has 
been prevented by mixing a salt with blood, water be added to the mixture, 
a clot will form. This will occur also if the salt be withdrawn from the 
blood by dialysis. Contact with living tissues retards coagulation. 
The addition of water in amounts greater than twice the bulk of the 
blood, retards coagulation. Exclusion from air retards, but does not pre- 
vent coagulation, since a clot will form beneath oil or mercury. An 
apparent exception to this rule is, that coagulation occurs rapidly in vacuo; 
but this is due to the bubbling of gas, by means of which the blood is 
brought more thoroughly in contact with the walls of the vessel containing 
it. In inflammatory states of the system, the blood coagulates more slowly 
than in health, notwithstanding the fact that it is richer in fibrin than 
normal blood. In deaths from asphyxia, narcotic poisons and prussic acid, 
as I have shown by numerous experiments, recorded in the first volume of 
these Medical and Surgical Memoirs, the blood is found fluid or imperfectly 
coagulated after death. 
By artificially retarding the coagulation of the blood, a more complete 
separation of its component parts is obtained, than when it is allowed to 
coagulate spontaneously. Thus when blood is received into a long narrow 
glass cylinder, that has been cooled by a freezing mixture to a temperature 
of 0° C, and allowed to stand, there appears in it after from one to two 
hours, provided this temperature be maintained, three distinct layers-the 
lowest, dark red and opaque; the next, gray, opaque and much narrowed, 
occupying about one-fortieth the height of the entire blood column; the 
uppermost transparent, yellowish, and occupying almost one-half the entire 
column. The uppermost stratum, known as the plasma, represents the 
fluid in which, before the separation into layers, certain bodies called the 
red and white blood-corpuscles, were suspended. The former of these 
contain the coloring matter of the blood, and in virtue of their greater 
specific gravity, have accumulated at the bottom of the column. The latter 
being of greater specific gravity than the plasma, and less than the red 
corpuscles, have arranged themselves in a layer between the two, and form 
the opaque gray stratum above mentioned. They are also known as white 
cells or leucocytes. The plasma may be removed and filtered, provided, Effects of Re-Agents on the Colored Blood Corpuscles. 
133 
the same low temperature be maintained during the filtration. If the 
temperature be raised a little above 0° C, the plasma coagulates, and in so 
doing presents the phenomena which occur in ordinary coagulation of the 
blood. Serum exudes from all sides of the coagulum, which in contracting 
loses its transparency and presents a colorless clot composed of fibrin only. 
This method of allowing the blood to coagulate slowly by the reduction 
of its temperature, will prove of value in pathological investigations 
designed to establish the differences presented by the blood in various 
fevers. 
In considering the origin of the various colors presented by the serum 
of the blood in malarial and other fevers, we must consider the effects of 
various re-agents on the colored blood-corpuscles. 
EFFECTS OF RE-AGENTS ON THE COLORED BLOOD-CORPUSCLES. 
The red corpuscles in man are flattened circular discs, with rounded 
edges and depressed centres, averaging 7.74 MM. in diameter (l-3230th of 
an inch). Their greatest thickness is 1.9 MM. (l-13000th) of an inch. In 
color viewed singly under the microscope by transmitted light, they are of 
a pale amber hue, owing to the unequal refraction of light produced by their 
convex edges and concave centres, it happens t hat, when under the micro- 
scope, these edges are sharply defined, their centre appears dark; and, vice- 
versa, owing to their peculiar optical properties, the human blood-corpus- 
cles have frequently been supposed to possess a nucleus. This is disproved, 
however, thus while the substance surrounding the nucleus or nucleated 
corpuscles (of birds, reptiles and fishes) give the same reaction as does the 
entire human corpuscles; on the contrary, re-agents which affect the nucleus 
of nucleated corpuscles, have no effect whatever upon the human blood- 
corpuscles. 
The color of the blood-corpuscle is due to haemoglobin. Haematolo- 
gists, from the experiments of Hewson who added water, acids, urine, 
various salts and alcohol to human blood, have devoted much attention to 
the study of the effects of various substances upon the corpuscles. 
The peculiar change known as crenation, has been observed by many 
observers. It consists in an alteration of the contour of the corpuscles, 
which causes some of them to assume a stellate form, whilst others appear 
jagged and uneven, as if a number of minute granules projected from their 
surfaces in every direction. The projection is a passive one, due to retrac- 
tion of numerous portions of the corpuscle. The phenomenon appears 
spontaneously in blood withdrawn from the vessels, and is first observed 
under the microscope in the corpuscles near the edges of the preparation. 
The appearance is attributed to evaporation of the fluid contents of the 
corpuscles, and this is undoubtedly one of its causes, though not the only 
one, as it is occasionally observed after the addition to the blood of water. 
According to Dalton, it is produced by adding saliva to the blood. It is 
said to occur more rapidly in the blood of those suffering from febrile 
diseases. 
A number of substances have the effect of depriving the corpuscles 
of their coloring matter, leaving them pale, round, feebly refracting bodies. 
Their size is also slightly diminished. The blood becomes lake-colored, 
and much less opaque. These effects are produced by the addition of 
water, powdered salts, bile and the biliary salts, ether and chloroform, 
carbon disulphide, alcohol in the form of vapor, by freezing and thawing, 
and by the serum of other animal species. This decolorizing effect of 
ether and chloroform is important in its connection with the supposed 
haematogenous origin of the jaundice sometimes observed after the pro- 
longed administration of these anaesthetics. 134 
Effects of Re-Agents on the Colored Blood Corpuscles. 
Iii order to ascertain the action of acids and alkalies on the blood cor- 
puscles. Addison employed solutions of salts or sugar, of the specific gravity 
of blood serum to which is added acids or alkalies. He found that up to a 
certain point the effect was produced by either acid or alkali. Beyond 
this point the blood corpuscles in the acid mixture became smooth and 
brilliant, and their refractive power was increased; while the effect of the 
alkaline fluid was to render them granulated and rough. The same effects 
may be observed at the poles of a battery discharging weak currents 
through a portion of the blood. The effect of heat upon blood corpuscles is 
peculiar; at a temperature of 52" C. (125° F), a number of indentations 
appear upon their surface which develop into constrictions. These either 
become detached at once or the process continuing, they remain attached 
for some time to the corpuscle in postulated threads that have been com- 
pared to strings of pearls. Other corpuscles are beset with knob-like pro- 
jections, which are attached to them by pedicles of various lengths. When 
the projections become detached, they have a lively molecular movement. 
The separated particles at first retain their coloring matter, but ultimately 
yield it to the surrounding fluid. Similar appearances are produced by 
adding urea to blood, and have been observed in blood extravasations. 
The action of salts varies with their degree of concentration. 
In moderate strength, the effect of sodium sulphate, ammonium chlo- 
ride, borax, and magnesium sulphate is to render the corpuscles less 
extensible and elastic, and to cause them to assume a wrinkled, dentated 
appearance ; in weaker solution their effect is similar to that of water. 
When the solution is of the same specific gravity as the blood serum, the 
corpuscles may remain in it for a considerable time without alteration. On 
this account they are used instead of serum for diluting the blood for pur- 
poses of examination and especially for enumerating the corpuscles with 
the hemacytometer. Osmic acid preserves the form of the red corpus- 
cle. Norris states that its action is confined to the red corpuscles and 
in exact proportion to the amount of their haemoglobin. It not only 
fixes the form of the red corpuscle and lochs up its coloring matter, 
preventing its exudation into the surrounding liquid, but when its action is 
prolonged, it also effects certain changes in its color. These are the results 
of the conversion of the haemoglobin into a new body known as methaemo- 
globin. 
When a portion of blood is included in the arc of discharge of aleyden 
jar, and a number of discharges made to traverse it, it becomes lake-colored 
and transparent, as it does after the addition of water and various other 
substances previously mentioned. Simultaneously with this alteration in 
the gross appearance of the blood, the corpuscles undergo a series of 
changes, that terminate in their becoming colorless, feebly refracting glo- 
bules. The first stage in the process is an incurvation in the outline of the 
corpuscle, which proceeds to the formation of a rosette-like body. This, 
as the discharges are continued, comes to resemble a horse-chestnut. 
Finally, the thorn-like processes disappear, leaving a colored globule which 
ultimately yields its coloring matter to the surrounding fluid. The same 
effects are produced by induction currents The constant current on the 
other hand, is without any such effect, the only corpuscles presenting any 
alteration being those in the immediate neighborhood of the electrode. 
The positive pole brings about the same alterations in the corpuscles in its 
vicinity, as are induced by the action of acids; fhe negative pole, those 
which are caused by the action of alkalies. 
The elliptical, nucleated corpuscles of amphibia fishes, birds, and 
amongst the mammalia in the camel and auchenia, undergoes a remarkable Changes in Color of the Blood. 
135 
change on the addition of water; it retains its shape and its own outline, 
but the nucleus becomes surrounded by either a spheroidal mass or a body 
with pointed processes, which radiate like the spokes of a wheel towards 
the periphery of the corpuscle. In either case all the coloring matter 
seems concentrated around the nucleus and in the processes radiating from 
it, the remaining portions being homogenous and of a glass-like trans- 
parency. Briicke, who obtained the same appearance with a two per cent, 
solution of boracic acid, has called the transparent substance oicoid, the 
colored zooid. The latter is still further distinguishable from the former 
by its capacity of being stained with aniline blue. The separation of the 
substance of the elliptical corpuscle into oicoid and zooid, may also be 
accomplished by ammonium chloride in solution. 
The preceding well known facts, which embrace our present knowl- 
edge upon the effects of re agents on the colored blood-corpuscle, should 
enter into the study of the relations of febrile poisons to the coloring 
matters of the serum. 
After numerous examinations of the serum of the blood in the various 
forms of malarial fever (including malarial hsematuria, characterized by 
golden colored serum) and in yellow fever, I have arrived at the general 
conclusion that the coloring matter is identical with the coloring matter of 
the bile bilirubin (biliphsein cholepyrrhin bilifuloin) C16H18N2O3. 
The presence of the bilirubin and other related biliary coloring 
matters in the blood of malarial fever and of yellow fever appears, from 
my clinical and pathological examinations, to be due to the action of the 
specific poisons of these diseases upon the liver, and also to the hepatic 
congestions which they occasion. 
CHANGES IN COLOR OF THE BLOOD. 
Changes in Color.-The color of the blood is chiefly due to the red 
corpuscles, and alterations from the normal in this discussion will be 
best considered in this place, although the white corpuscles and the plasma 
may also affect the color, as will be presently shown. 
(a.) The chief determining cause of the color of the blood is the 
chemical condition of the haemoglobin. When this is united with oxygen, 
in the arteries, the blood is scarlet; as deoxidation advances, this color 
passes into n purple, and finally becomes black or venous. The dark color 
is directly due to absence of oxygen. The purest example of this change 
is seen in asphyxia, where oxygen is excluded from the blood; but it 
occurs also as the result of the action of certain injurious influences upon 
the corpuscle itself, such as extreme heat, or poisoning by phosphorous 
prussic acid and other toxic agents. If the change proceed no farther, 
the scarlet color may still be restored by oxidation. This blackness of the 
blood is generally associated with imperfect coagulation, or even a state 
of fluidity. 
(b.) Paleness of the blood is observed in oligaemia and oligocythae- 
mia, and is due to deficiency of the haemoglobin. 
(c.) The blood is not only pale, but presents streaks of a puriform 
character, even as it flows from the living vessels, as in leucocythaemia. 
The same blood will settle, on standing, into three layers-of plasma 
superiorly, loosely coagulated or not; of white corpuscles in the middle- 
a pus-like layer; and the red corpuscles at the bottom. 
(d.) The milky appearance of chylous blood has been described under 
the head of Blood-Plasma. 136 
Lake-Blood. Melancemia. 
(e.) Lake-blood. The remarkable change in the blood in which it 
becomes lake or transparent, is frequently observed as a further stage of 
that first described above; but it may occur under other circumstances than 
deoxidation, and is of the very gravest significance, inasmuch as it indicates 
complete and hopeless destruction of the red corpuscles. Lake blood is 
no longer opaque but transparent; and the haemoglobin has left the cor- 
puscles and. is dissolved in the plasma. The change can be effected experi- 
mentally by the addition to blood of water, chloroform, the bile-acids, or 
other solvents; and it is probable that some of the cases of rapid death 
after enormous draughts of water, and the destruction of red. corpuscles 
that is believed, to occur in jaundice, may be accounted for in this way. 
But the most important cause of solution of the red corpuscle is complete 
deoxidation of the haemoglobin, which is followed by its diffusion in the 
plasma. Thus drawn blood is rendered lake by the addition of sulphide 
of ammonium, phosphorus, phosphoric acid, or iron-filings; and the same 
effect is produced by the intravenous injection of salts of the bile-acids. 
This being so, it might be expected that blood would assume the lake 
appearance when exposed to the prolonged action of thecauses that render 
it black; and recent observations seem to indicate that such is the case. 
In a number of diseases which are attended with the accumulation of oxi- 
disable substances in the circulation, the blood has been described as ''fluid,'' 
"claret," or "cherry-colored," "clear," and "staining the tissues,"- 
but apparently without more exact observations on the color of the living 
plasma. Such diseases are high fevers, hyperpyrexia, insolation and pois- 
oning by malaria, phosphorus, and perhaps other agents. The effect of 
some of these influences is obviously to produce an excessive amount of 
oxidisable material in the blood, while the others may lead to the same 
result by reducing the oxygenating capacity of the corpuscles. Persons 
dying under such circumstances present great lividity, from the black or 
venous condition of the blood; death occurs with symptoms indicative of 
want of oxygen, as if so much of the haemoglobin had been diffused 
through the plasma, and post-mortem the vessels are found stained with 
the solution, the tissues are soaked with fluid lake-blood and decomposi- 
tion is early and rapid. That a similar solution or destruction of the red 
corpuscle may occur in all cases of fever, but in a much less degree, is sup- 
ported by several facts-(1) the increased discharge of potash salts in fever, 
(2) a similar increase of the coloring matter of the urine, and (3) the anae- 
mia that is found at the termination of the process. 
(f.) Other alterations in color may occur in the blood. The blood is 
bright-red after poisoning by carbonic oxide, and remains so after exposure. 
It is chocolate-colored after poisoning by the nitrites, such as nitrite of amyl; 
and other hues have been recorded. 
Melamemia. In relation with the pigment-bearing element of the 
blood may be mentioned a morbid condition which has been described 
under the name of melanaemia. In it there are found in the blood black 
and brown pigment-particles and flakes, free or contained in cells of vari- 
ous shapes. This state is especially asociated with two others, namely, 
malaria and an enlarged deeply-pigmented condition of the spleen; and it 
is highly probable that the pigment-particles are produced by the fever, 
and find their way from the spleen into the blood. They are thus deposited 
in the liver and other organs; and give rise to symptoms of visceral dis- 
turbance during life, and to the peculiar slaty or grey discoloration that is 
found post-mortem. It has been said that in melanotic cancer pigmented 
cells have been found in the living blood.* 
*J. Mitchell Bruce, M. D.-Quain s Dictionary of Medicine, page 121. Specific Gravities of Blood and Serum in Various Diseases. 
137 
SPECIFIC GRAVITY OF THE BLOOD AND SERUM. 
The specific gravity of both the blood and serum are diminished during 
the active stages of malarial fever, and duriug the slow action of the 
malarial poison. The following table will give a comparative view of the 
variation of the specific gravities of the blood in malarial fever and other 
diseases: 
SPECIFIC GRAVITIES OF THE BLOOD AND SERUM IN VARIOUS DISEASES. 
OBSERVERS. 
DISEASES. 
REMARKS. 
1 Specific 
gravity 
of blood. 
Specific 
gravity 
of serum. 
Becquerel & Rodier 
Healthy Standard { 
Established by the examination of J 
the blood of 22 healthy persons... | 
1055.0 
to 
106 tO 
1027.0 
to 
1033.0 
ll ll 
ll it 
Mean in the healthy male 
1060.0 
1028.0 
ll ll 
ll ll 
Mean in the healthy female 
1057.0 
1027.0 
Nasse 
Zimmerman 
" " 
1056.0 
Joseph Jones 
Malarial Fever 
ll ll 
Mean of » examinations of 9 men. 
1038.3 
1021.3 
Maxima of ditto 
1023.6 
ll 
ll ll 
Minima of ditto 
10 <0.5 
1018.0 
ll 
ll ll 
Seaman; intermittent fever of 12d'ys 
1012.0 
1018.0 
ll 
ll I 
Irish laborer; int. fever of 5 weeks... 
1034.0 
ll 
I. ll 
Ditto, ditto of 6 weeks 
1030.5 
1012.0 
1021.3 
ll 
ii a 
Seaman ; severe remit, fev. 16th day.. 
1022.5 
ll 
ii it 
Ditto ditto, 10th day 
1042.4 
1021.3 
ll 
Remittent and typhoid fever,11th d'y 
Re mitten t fe ver 
1035.0 
1042.4 
1021.0 
ll 
ll ll 
Intermittent, terminating in conges- 
tive fever, 2 months 
1036.6 
1023.6 
It 
K ll 
Congestive fever 
1040.0 
1022.0 
Becquerel A Rodier 
Marsh Cachexy induced 
by Malarial Poison.... 
Mean of 5 cases 
1036.7 
1040.5 
1021.2 
ll ll 
Maxima of ditto 
1024.1 
ll ll 
ll ll 
Minima of ditto 
1033.8 
1016.4 
ll ll 
Typhoid Fever 
Mean of 17 first bleedings 
1054.1 
1026.0 
ll ll 
ll ll 
Mean of 6 second bleedings 
1051.4 
1024.8 
Guenaud de Mussy 
<fc M. Rodier 
ll ll 
Typhus Fever 
Mean of 6 cases 
1047.9 
1055.5 
1041.2 
1C20.8 
Maxima of ditto 
1021.1 
ll ll 
ll ll 
Minima of ditto 
1020.0 
Becquerel & Rodier 
ll ll 
Ephemeral Fever 
Mean of 8 cases 
1056.8 
1025.5 
Cholera 
In a man 30 years of age, bled on day 
of death 
1074.1 
1050.3 
1042.2 
Acute Scurvy 
Man 48 years of age, 6 weeks 
1025.5 
Chronic scurvy 
Man 32 years of age, 15 months 
1060.3 
1026.2 
ll ll 
Anemia 
Mean of 10 cases of symptomatic 
anaemia 
1049.9 
1026.8 
1026.1 
ll ll 
Chlorosis 
Mean of 6 cases, female 
1046.3 
ll ll 
ll 
Maxima of ditto 
10.55.2 
1032.2 
ll ll 
ll 
Minima of ditto 
1035.2 
1025.0 
ll ll 
Acute Bright's Disease 
Mean of 15 cases 
1048.2 
1023.5 
ll l( 
Cachectic Dropsies 
Mean of 16 cases 
1039.6 
1022.6 
ll 11 
Phlegmasia generally 
1055.4 
1027.0 
ll .1 
Acute Bronchitis 
1056.7 
1027.4 
1026.0 
ll ll 
Pleurisy^ 
K'55.0 
ll ll 
Pneumonia 
1052.6 
1025.0 
ll ■ ll 
Acute Rheumatism 
1055.5 
1025.0 
As far as the observations (which are not only reliable, but present a 
condensed view of the most important results thus far recorded) presented 
in this table extend, they demonstrate that the specific gravity, or, in other 
words, the solid matters of the blood are more rapidly and decidedly 
diminished in malarial fever than in any other disease. 138 
Fibrin in Diseased and Healthy Blood. 
COAGULATION OF THE BLOOD. 
In severe cases of malarial fever I have always observed that the clot 
is voluminous, and much less consistent than the clot of normal blood, or 
of the blood of the pldegmasim, and that the contraction of the fibrin is 
much less, and as a necessary consequence the amount of the serum forced 
out is much less than in normal and in inflammatory blood. 
That the large size of the clot is due neither to an increase of globules, 
nor to an increase of fibrin, is conclusively demonstrated by the following 
tables;- 
Table of the Blood-Corpuscles in 1000 parts of Healthy and Malarial Blood. 
Moist 
blood-cor- 
puscles. 
Water 
of moist 
blood-cor- 
puscles. 
Solid 
matters 
of moist 
blood-cor- 
puscles. 
( 
180.000 
360.000 
120.000 
The blood-corpuscles in healthy blood may vary from 
to 
to 
to 
600.000 
450.000 
150.000 
Mean of 9 examinations of the blood of 9 cases of malarial fever 
831.397 
248.548 
82.849 
Maxima of ditto 
431.508 
323.631 
107.320 
Minima of ditto 
207.948 
155.861 
51.812 
Seaman; intermittent, fever of 12 days 
413.732 
310.219 
100.431 
Irish laborer; intermittent fever of 5 weeks 
293.620 
220.215 
70.411 
Ditto, ditto, 6 weeks 
207.948 
155.861 
51.812 
Seaman; severe remittent fever, 16th day 
401.764 
306.823 
100.409 
Ditto, ditto, 10th day 
431.508 
323.631 
107.320 
Remittent and typhoid fevers 
262.448 
196.836 
62.703 
Remittent fever terminating in congestive fever. 2 weeks 
309.936 
232.452 
73.655 
Congestive fever J 
317.748 
258.217 
76.000 
84 400 
343.872 
158.804 
Table of the Fibrin in 1000 parts of Healthy and Diseased Blood. 
OBSERVERS. DISEASES. 
REMARKS. 
Andral A Gavarret ? o„, „ ir . „ ( 
Becquerel & Rodieri J ^andard of Health j 
In healthy blood the fibrin may ( 
vary from 7 
2.000 
to 
3.500 
Joseph Jones Malarial Fever 
Mean of 9 cases of malarial fever 
2.018 
Maximum ol ditto 
2.938 
Minimum of ditto 
0.877 
Intermittent fever of 12 days 
1.900 
Ditto of 5 weeks 
2.540 
•• 
Ditto of 6 weeks 
1.925 
Remittent fever of 16 days 
2.938 
Ditto of 10 days 
1.433 
Remittent & typhoid fevers of 11 dy's 
2.380 
Remittent fever of 2 weeks 
2.710 
Congestive fever 
0.877 
Becquerel & Rodier; Marsh Cachexy induced by 
Ditto 
1.450 
the Malarial Poison 
Mean of 5 cases 
3.390 
Maximum of ditto 
4.270 
Andral & Gavarret Typhoid Fever 
Minimum of ditto 
2.360 
Mean of 41 analyses 
2.600 
Maximum of ditto 
4.2H0 
M. H. Guenaud del 
Minimum ol ditto 
0.900 
Mussy&M. RodierTyphus Fever 
Mean of 6 cases 
2.466 
Maximum of ditto 
3.900 
, " " " 
Andral & Gavarret Small-box 
Minimum of ditto 
Mean of 5 cases 
1.200 
2.400 
Maximum of ditto 
4.400 
Becquerel & Rodier Ephemeral Fever 
Andral & Gavarret Scarlatina ... 
Minimum of ditto 
Mean of 8 cases 
Mean of 4 cases 
1.100 
2.800 
4.350 
Maximum ol ditto 
6 800 
" Measles 
Minimum of ditto 
3.100 
Mean of 7 cases 
2.742 
Maximum of ditto 
3.400 
M i n i m u m o f d i tto 
2.400 Investigations of Joseph Jones. M. D. 
139 
Table of Fibrin in Blood-Continued. 
OBSERVERS. 
Becquerel &Rodier 
Popp 
Andral & Gavarret 
Witts tock 
Simon 
Becquerel & Rodier 
Andral & Gavarret 
44 it 
Becquerel & Rodier 
Glover 
Heller 
Becquerel & Rodier 
cc 44 
ll Cl 
Andral & Gavarret 
Becquerel .t Rodier 
Andral & Gavarret 
4* ll 
ll Cl 
ll li 
Becquerel & Rodier 
Andral & Gavarret 
Becquerel & Rodier 
Andral & Gavarret 
Becquerel & Rodier 
CC Cl 
ll il 
DISEASES. 
Acute Scurvy 
REMARKS. 
Man aged 48 years, sick 42 days 
Man aged 21 years, sick 30 days 
Man aged 32 years, sick 455 days 
Man aged 23 years, sick 552 days 
2.500 
2.20.0 
1.850 
1.320 
6.600 
5.676 
7.300 
3.600 
11.000 
11.000 
1.880 
6.500 
4.400 
5.900 
2.100 
4.800 
3.130 
4.945 
2.990 
3.760 
1.650 
4.340 
4.200 
3.720 
5.820 
1.620 
6.700 
10.200 
2.800 
3.800 
6.760 
7.300 
10.500 
4.000 
4.656 
5.900 
3.800 
6.100 
5.550 
7.200 
3.800 
4.800 
9.300 
5.700 
5.800 
4.800 
6.100 
7.400 
6.800 
5.800 
Chbonic Scurvy 
Erysi pklas 
Man aged 33 years. 
Mean of 8 analyses 
li 
ll 
Maximum of ditto 
il 
Minimum of ditto . 
Cholera 
1 case 
" 
Ditto 
Man, day of death 
Ditto .• 
Phthisis 
Mean of 21 cases 
ii 
Cl 
Maximum of ditto 
Minimum of ditto 
li 
Mean of 16 eases 
Scrofula 
Carcinoma 
Mean of 8 cases, males 
Mean of 7 cases 
Bright's Disease, Acute 
Mean of 15 cases 
Maximum of ditto 
Minimum of ditto 
Bright's Disease, Chronic 
Chlorosis 
Anaemia. 
Acute Rheumatism 
ll ll 
Chronic Rheumatism 
Puerperal Fever 
Pneumonia 
Pleuritis 
Mean of 13 cases 
Mean of 6 cases 
Mean of 10 cases 
Maximum of ditto 
Minimum of ditto 
Mean of 43 cases 
Maximum of ditto 
Minimum of ditto 
Mean of 10 cases 
Mean of 4 cases 
Mean of 58 analyses 
Maximun of ditto 
Minimum of ditto 
Mean 
Maximun 
Minimum 
Mean of 5 cases 
Mean of 6 cases 
Maximum of ditto 
Minimum of ditto 
Mean of 4 cases 
Maximum of 6 cases 
Minimum of ditto 
Mean of numerous observations 
Ditto, ditto 
Ditto, ditto 
Ditto, ditto, 1st bleeding 
Ditto, ditto. 2d bleeding 
Ditto, ditto . 
Angina Tonsillaris 
it 4. 
4. 44 
Acute Bronchitis 
44 »4 
il »4 
Phlegmasia generally 
Acute Bronchitis 
Pleurisy 
Pneumonia 
44 
Articular Rheumatism 
This table demonstrates : first, that the fibrin is diminished greatly in 
severe cases of malarial fever; second, that the diminution of this element 
of the blood is characteristic not only of malarial fever, but of all fevers 
(Andral and Gavarret), whilst its increase, on the other hand, is charac- 
teristic of the phlegmasife (Hunter). 
As a general rule, the diminution of the fibrin in malarial, as in the 
pyrexia? generally, cor responds to the severity of the disease, provided 
there be no inflammatory complication. 
As far as my observations extend, the diminution and alteration of the 
physical properties of the fibrin in malarial fever, to any great extent, was 
always accompanied by congestions of the spleen, liver, and brain, and seri- 
ous cerebral disturbances. Whether these phenomena stand in the relation 
of cause and effect, cannot be detei mined simply by their association in a 
single disease, or in a class of diseases, independent of an investigation of 
the offices and relations of fibrin in health and disease. 
These facts, with reference to the decrease of fibrin in malarial fever, 
are invested with interest and importance, in their agreement with the 
results of the investigations of Andral and Gavarret, and Becquerel and 
Rodier, in the changes of the blood in typhoid fever, and of Guenaud de 
Mussy and Rodier. in typhus fever. 140 
Heart Clots in Malarial Fever. 
The fibrin is not only diminished in malarial fever, but it is altered in its 
properties and in its relations to the other elements of the blood, and, to the blood- 
vessels. 
We will illustrate this proposition by the following cases and post- 
mortem ex ami n at ions:- 
Case 822.-Illustrating the Physical Changes of the Fibrin, and. the Forma- 
tion of Heart-Clots in Malarial Fever. 
Irishman-age 26; height 5 feet 11 inches ; weight 170 pounds; black hair; 
black eyes ; full, dark-brown beard and mustache. Limbs full and round, chest 
broad, and well-developed. Has been in America (New York) nine years, and in 
Savannah three moths. During this time he has followed the occupation of a 
baker. 
Sept. 11th, 12 o'clock M., 1857. Has just entered the Savannah hospital with 
remittent fever. Pulse accelerated but feeble, and his complexion shows the effects 
of malarial fever. Says that he has been sick for one week, and has been living 
near the depot of the Albany and Gulf Railroad, in a low, malarious situation. 
Under the action of sulphate of quinia and stimulants, the febrile excitement dis- 
appeared in the course of four days ; the patient, however, was left in a very feeble 
condition; complained of great weakness, his pulse was feeble, the action of the 
intellect sluggish, and he had a peculiarly disagreeable smell, which was not per- 
manently removed, either by water or by a change of clothing. 
Under the action of tonics, he recovered sufficiently to walk about the yard ; 
but continued, however, weak, low-spirited, and indisposed to action. 
27th. Complained of torpor of the bowels. A mild cathartic was administered. 
28th. Has a cough. The wind has been from the northeast for some time, and 
the weather has been cold and damp, and epidemic catarrh is prevailing. About 
two-thirds of the hundred patients now in the hospital are suffering with the 
influenza. 
This patient was up and about the wards, assisting and nursing the patients 
all day. He was up and about when I went the rounds of the wards at 9 o'clock 
P. M. Shortly after this he complained of great oppression of the lungs, difficulty 
of breathing, and loss of muscular power. 
29th, 9 o'clock A. M. During the night took a sudden and remarkable change 
for the worse. 
Respiration spasmodic, and sounds as if the air cells, bronchial tubes and tra- 
ehea contained large quantities of fluid, and is attended with a loud rattling sound 
in the throat. The churning, rattling, gurgling, crackling sounds of the lungs and 
trachea are very loud, and can be distinctly heard over the upper wards.of the hospi- 
tal. Muscular power completely exausted ; lies upon his back, and is unable to turn 
upon either side. Surface of extremities cold ; surface of trunk cool, several degrees 
below the normal standard. The temperature of the extremities does not differ 
essentially from that of the surrounding medium. The expression of his eyes and 
countenance, and his efforts to converse, show that he is intelligent; he is, how- 
ever entirely unable to articulate or expectorate. 
Sinapisms were applied to the extremities, epigastric region and chest, and 
stimulants were administered freely. These did not produce any beneficial effects, 
did notarouse the circulation, and did not increase the animal temperature, because 
the supply of oxygen necessary for the chemical changes which generated the phys- 
ical, muscular, and nervous forces'was cut off. The mustards scarcely reddened 
the skin, even after the application of several hours. 
The patient continued in this state, with a gradual diminution of power, until 
1 o'clock A. M. the next morning, when the painful respiratory sounds were hushed 
in death. 
AUTOPSY EIGHT HOUKS AFTER DEATH. 
Exterior.-Body in good condition, not emaciated ; limbs full and round ; mus- 
cles of trunk and extremities covered by a thick layer of fat; face and hands sallow 
and sun-burnt; surface of the skin which had been covered by the clothes, fair. 
Head.-Dura-mater presented the usual appearance. Arachnoid membrane 
transparent and healthy, blood-vessels of pia mater filled with blood. 
When the dura-mater was removed, an ulcer in the substance of the brain was 
discovered, occupying a position near the centre of the superior surface of the left Investigations by Joseph Jones, M. D. 
141 
hemisphere of the cerebrum. This ulcer was three-fourths of an inch in length, 
half an inch in breadth, and one-eighth of an inch in depth. The walls were 
thickened and much harder than the surrounding brain. The bloodvessels of the 
surrounding pia mater and brain were congested with blood, and a small quantity 
of bloody serum was effused between the arachnoid and pia mater in the immedi- 
ate neighborhood of the ulcer, but nowhere else. The appearance of the ulcer, and 
the congestion of the blood-vessels around, by no means accounted for the death of 
the patient. The thickened walls, the absence of pus, and the sound state of the 
structures of the brain around, show not only that the ulcer was of long standing, 
but also that it was rapidly healing. The existence of this ulcer will account, in 
part, for the dull, lethargic state of the intellectual faculties, but not for the death 
of the patient. 
The ventricles of the brain contained a small quantity of clear serum. 
The structures of the brain presented the usual consistence and appearance. 
Chest.-Heart normal in size ; the right ventricle contained a large light yellow 
fibrinous clot, attached to the chordae tendinese and carnese columnae, and extended 
through the auriculo-ventricular opening into the auricle. This clot was firm in 
texture, and weighed one ounce. The left ventricle contained a small light yellow 
clot; the aorta also contained a small, flattened, rlbbon-like, light yellow clot. 
These clots were evidently formed previous to death, when the circulation was 
exceedingly feeble. 
Lungs.-The lungs were greatly inflated, and did not collapse in the slightest 
degree when air was admitted into the pleura. They were congested wita blood, 
and resembled in appearance liver; and when handled they were remarkably 
heavy, and felt more like liver than lungs. When cut, the air-cells, a,nd large and 
small bronchial tubes, were found filled with serous fluid, and. numerous fine bubbles 
of air. When the lungs were squeezed, pints of this serous fluid floived out. In 
many portions of the lungs the serous fluid was clear; in others it was reddish. 
The fluid resembled scrum in all respects, and was not mucus. Here, then, we have 
the cause of the death of this pat ient. He was drowned. 
Abdominal Cavity.-Stomach pale and perfectly healthy in appearance; intes- 
tinal canal, from the stomach to the anus, pale and healthy in appearance. 
Liver.-The normal reddish-brown color of the liver was changed in most parts 
to a mixture of light bronze and light olive, and in several places resembled the 
normal color. In two circular spots, about three inches in diameter, the liver was 
of a dark-bluish slate color, like that of a recent case of malarial fever. The cut 
surface of the liver approached more nearly to the normal color than the exterior. 
The blood of the liver, after exposure to the atmosphere, assumed a red arterial 
color. It is evident from this examination that the structures of the liver were 
recovering from the effects of the malarial fever, and that the organ was regaining 
its normal color. 
Spleen.-Slate-colored, enlarged and softened. The pulp of the spleen presented 
a dark purplish-brown color, which did not change to the red arterial color as 
rapidly as the pulp of healthy spleens, the change of color however, was much 
greater than that of the pulp of the spleen in recent cases of malarial fever. This 
organ, like the liver, appeared to be recovering from the effects of malarial fever. 
Kidneys.-Healthy. 
We believe that we have now all the facts necessary for a rational 
explanation of the phenomena presented by this case. 
The malarious poison and its effects had produced profound alterations 
in the blood and capillaries, liver and spleen, and primarily by its direct 
action, or secondarily by the action of the altered products in the blood, 
affected the sympathetic and cerebro-spinal nervous systems. The patient 
although weak and lethargic on account of these pathological alterations 
and the ulcer upon the brain, was, nevertheless, in a fair way of recovery; 
the alimentary canal had resumed its healthy actions, and the liver and 
spleen were fast recovering, and he was gaining strength daily. We can, 
in view of these facts, safely assert that if no other disease had occurred, 
the lesion of the left hemisphere of the brain, and the effects of the mala- 
rial poison would not have proved fatal. 
In this state of slow convalescence the patient was suddenly seized 
with the prevailing influenza. The mucous membrane of the bronchial 142 
Heart Clots in Malarial Fever. 
tubes and air-cells was irritated. The irritation of the mucous membrane 
was followed by congestion of the blood-vessels and capillaries of the lungs. 
The capillaries were in an enfeebled state; the fibrin of the blood was 
diminished in quantity, and altered in physical and chemical properties; 
the colored blood-corpuscles were diminished in number, and physically 
and chemically altered; the solid matters of the blood were diminished; 
and the physical and chemical relations between the individual constit- 
uents of the blood and the capillaries were disturbed. Healthy limited 
inflammation was impossible. Diffused inflammation of all the structures 
of the lungs resulted; the serous portion of the blood poured into the air- 
cells, bronchial tubes and trachea; the supply of oxygen was in a great 
measure cut off; the chemical changes of the solids and fluids in a corres- 
ponding degree checked; the physical forces, heat and electricity, and the 
nervous force, developed by these chemical changes, were, as a necessary 
consequence, correspondingly diminished. 
The immediate cause of the death of this patient was a deprivation of 
oxygen and the retention of the carbonic acid gas. We may say with 
truth that he was drowned. 
Case 823.-lUustratiny the Changes of the Fibrin, and the Formation of Heart- 
Clots in Malarial Fever. 
Irishman-laborer and boatman ; age 30; height 6 feet; weight 150 lbs.; tall, 
spare frame, light hair, blue eyes; pale, sallow complexion. Has been running on 
flatboats and rafts, up and down the Savannah River, between Savannah and 
Augusta, for the last twelve months. Habits irregular; addicted to the use of 
ardent spirits. Says that his constitution has suffered much from the exposure to 
the hot sun and night air on the river, and also from the intemperate use of ardent 
spirits. 
September 20th, 1857. " A flat, laden with wood, which he was bringing to the 
city, was sunk in shoal water." He was all day in the water, up to his waist, Ash- 
ing out the wood; and at night had a chill, followed by fever. The fever went off 
before morning, and on the next day he was employed again in the water. The 
chill returned at night, and was followed by high fever. Has been sick from this 
time to the present time, September 27th, without any medical attendance. 
Pulse 106; respiration accelerated, labored; skin hot and dry; countenance 
distressed ; has a haggard, anxious look ; complains of great thirst, of pains in his 
back and bones, and of great exhaustion. His pulse, although rapid, is feeble, and 
his forces appear to be completely exhausted. His fever remitted slightly on the 
next day, but returned on the 29th inst. Under the action of large doses of sulphate 
of quinia, and stimulants, sinapisms, snakeroot-tea, and milk-punch, and wine- 
whey, and brandy and arrowroot, the febrile excitementsubsided, the urine regained 
its normal hue, and on the 4th inst. his pulse was 70, and respiration 18; tem- 
perature normal, and function of skin normal; and although apparently very weak, 
the patient was able to be up and about the ward. 
During this attack the saliva was acid, and the urine copious; from 20,000 to 
25,000 grains were excreted daily. The specific gravity was correspondingly low, 
from 1012 to 1014. The abundant discharge of urine was due to the large quantities 
of water which his thirst led him to take, and also to the diuretic action of the 
infusion of snakeroot. Throughout the attack his pulse was feeble and his forces 
greatly exhausted, and he required close attention, and the free administration of 
stimulants. 
October 5th. This morning escaped clandestinely from the hospital. 
8th. Has returned. Pulse 120; skin hot and dry; respiration accelerated, 
labored ; complains of great pain in the back of his head and neck ; these parts are 
swollen, and painful upon pressure. R-Cold water dressing to back of head and 
neck. 
9th. His head has been shaved, and the tissues above the occipital bone, and 
above the left temporal and parietal bones, are swollen, and the skin looks black, 
and is ulcerated in several places. The swelling extends down along the neck, and 
reaches the superior portion of the left shoulder. To the finger the swollen parts 
feel as if there was a collection of fluid beneath the skin. Says that he is suffering Investigations by Joseph Jones. M. D. 
143 
intense pain; countenance distressed and haggard; pulse 128; skin hot and dry ; 
respiration thoracic, labored, accelerated. 
10th. Pulse 160, feeble; skin hot;, respiration spasmodic and labored. In 
addition to the intense pain in the back of his neck and left side of the head, he 
complains of intense pain in his chest. The pain in the chest cuts short the respi- 
ration, and renders it spasmodic. His countenance is expressive of great agony and 
terror. 
11th. Pulse 140, rapid and very feeble; respiration 21, labored, thoracic, spas- 
modic. The pain in his chest is intense; he groans and cries at every breath, and 
the expression of his countenance is indicative of great agony, terror, and horror. 
Was restless and delirious during the night, and during his delirious visions spoke 
and acted as if he was engaged in mortal combat. Has no hope of himself, and 
refuses all medicine. The back of his neck and side of head is much swollen, and 
when pressed with the hand there is a distinct fluctuation. Hoping that discharge 
of the pus, or fluid, would afford relief, a free crucial incision was made at the most 
prominent part of the swelling. Nothing but blood issued. The haemorrhage was 
so great, that it was necessary to check it by the application to £he wound of a 
compress, saturated with the tincture of muriate of iron. 
12th. During the night was delirious; would rip out the most terrible oaths, 
and cry out that the devils were after him, had beaten him severely, and were 
endeavoring to throw him out of the windows. At other times he would speak 
and act as if he had been in mortal combat, and was wreaking vengeance on an 
imaginary antagonist. These actions excited the suspicion that the injury on the 
back and side of the head was received from a blow. 
The patient died at one o'clock A, M. this morning. 
Exterior.-Body much emaciated; back and left side of neck much swollen. 
The inferior surface of the trunk and neck presented a mottled appearance, from 
the settling of the blood by gravitation during the last hours, when the circulation 
was feeble. On the right leg there were the marks of an extensive ulcer upon the 
skin covering the tibia; the cicatrix presented a purplish, angry color. When 
incisions were made into the swollen parts of his neck, and back and side of head, 
the spaces between the muscles, the meshes of the fibrous tissue surrounding and 
•connectidg together the muscles and the fibrous tissue of the skin, were found to 
be completely filled and distended with golden-colored serum. 
Head.-Dura-mater healthy. Arachnoid membrane transparent throughout 
its entire extent over the hemispheres of the brain. Al the base of the brain it 
was slightly opalescent. 
Blood-vessels of pia mater not more tilled with blood than usual. 
The cortical and medullary substances of the cerebrum, and of the cerebellum, 
and the structures of the pons Varolii, the medulla oblongata, and superior portion 
of the spinal marrow, appeared natural in consistence and color. 
Ventricles of brain contained f 3 iv of golden colored serum. 
The superior longitudinal sinus of the dura-mater contained a golden-yellow 
elongated clot, the diameter of which was about one-half that of the longitudinal 
sinus. 
Chest.-Heart somewhat enlarged. Pericardium contained f 5 i of golden serum. 
All the cavities of the heart contained golden-colored clots. The right auricle han 
a large golden-colored clot, which was attached to the carme columme and chordae 
tendineae of the auriculo ventricular valves. The aorta, carotids, and pulmonary 
arteries contained elongated golden-colored clots, having diameters nearly equal to 
those of the arteries. All these clots were firm and elastic. 
Lungs.-The lungs did not collapse when the cavity of the chest was opened. 
Exterior surface of the pleura covering the lungs and lining the walls of the 
thorax was covered with soft coagulable lymph of a golden-yellow color. Adhe- 
sions were numerous, but as yet not strong, on account of the soft, fresh condition 
of the coagulable lymph, which was evidently but recently effused, probably 
within the last seventy hours. This inflammation of the pleura accounts for the 
severe pain in the chest during life. The lungs were much congested with blood, 
and when cut they resembled liver. 'The bronchial tubes and air-cells contained 
much serum. This serous fluid poured in large quantities from the cut surface. 
The anterior surface of the middle lobule of the right lung had a dark blackish- 
red spot, about one inch in diameter, which resembled at first sight a wound from 
a sharp instrument. An examination of the exterior of the chest, and interior 
AUTOPSY NINE HOURS AETEB DEATH. 144 
Heart Clots in Malarial Fever. 
surface of the ribs, showed neither wound nor fracture of the ribs. When closely 
examined, this portion of the lung was found to be more congested and solidified 
than the surrounding portions, and would in all probability, if the patient had sur- 
vived, been the seat of an abscess. 
Abdominal Cavity. Alimentary Canal.-The stomach, although enormously 
distended with gas, was pale and healthy in appearance; small intestines also pale 
and healthy, to the naked eye. 
Liver of a light bronze color. The color is lighter than that of the liver in the 
active stages of malarial fever, but resembles the color of a liver which was recov- 
ering from the effects of malarial fever. Cut surface of a light bronze color, and not 
of such a deep and decided bronze as the liver of the active stages of malarial 
fever. The right lobe of the liver had upon its under surface a slate-colored spot 
three inches in diameter, which resembled in all respects the liver of a recent case. 
When an incision was made across this spot, the cut surface presented for one-sixth 
of an inch the true malarial hue; below this it approached more nearly the normal 
hue. The structures of the liver did not appear to be softened. 
Spleen.-Much enlarged, of a dark-slate color, and although much softer than 
a normal spleen, it was much harder than a spleen of a recent case of malarial 
fever. Weight 31 ounces. This organ, like the liver, appeared to be just recover- 
ing from the effects of malarial fever. Kidneys appeared to be somewhat enlarged ; 
the calices, infundibula and pelvis of the kidney contained a fluid resembling pus. 
The following appears to be the cause and history of this last attack :- 
The patient left the hospital when he was in an exceedingly feeble con- 
dition, after a severe attack of remittent fever. It is probable that he 
indulged his taste for ardent spirits, for the day on which he left the hos- 
pital was election day. The wind was from the northeast, and the weather 
damp and cool, with occasional scuds of rain and mist. Exposure to this 
cool damp wind, fresh from the ocean, and the low grounds and swamps of 
Georgia and South Carolina, not only during the day but probably during 
night also, in a state of intoxication, induced a severe attack of pleuro- 
pneumonia. 
The swelling on the back of his head was due either to a blow or to 
inflammation in the cellular tissue and muscles analogous to the inflamma- 
tion of the lungs, and probably arising from the same cause. 
The large amount of serum effused into the bronchial tubes-the large 
amount of golden-colored serum effused into the cellular tissue of the neck and 
head-and the large golden, fibrous clots in the heart and arteries-the settling of 
the blood in the most dependent parts of the body-the appearance of the cicatrix, 
and the inflamed spot in the lungs, all indicate disturbances in the constitution of 
the fibrin, and of the relations between this element and the other elements of the 
blood to each other, and to the blood vessels and capillaries. 
The occurrence of the fibrous clots in the heart and blood vessels 
during malarial fever, demands a careful investigation. 
As far as my observations extend, the formation of heart-clots during life 
is very common in malarial fever. 
In fifteen post-mortem examinations I found heart clots in ten cases, and 
of the remaining five, one was a case of typhoid fever combined with 
remittent fever, another was a case of malarial fever of long standing, 
where the patient died of exhaustion, and in the remaining three no special 
examination for heart clots was instituted. The following cases, in addi- 
tion to the two just reported, will illustrate the symptoms attending the 
formation and existence of these heart-clots:- 
Case 82A-Fatal Case of Congestive Fever, terminating suddenly-Fibrinous 
Concretions in the Heart and Pulmonary Blood-vessels, and, Aorta. 
Irish laborer; height 5 feet 10 inches, weight 150 pounds; black hair, black 
eyes, dark complexion, resembles an Arab in appearance; person, dirty and filthy. Investigations by Joseph Jones. M. D. 
145 
Sept. 2d, 1857, 12 o'clock, M. Has been sick, on the bay, for ten days, with an 
abscess in the palm of his hand ; previous to this he had been working on the river 
bank. 
When first brought (this morning) into the hospital, he appeared stupid, and 
urinated in the bed. After the administration of a hot bath, and the lancing of his 
hand, he was aroused, and now appears to be entirely restored to the exercise of 
his intellect. Seems to be very weak, and complains of no pain, or trouble any- 
where, except in the palm of his hand. Skin not warmer than usual; tongue dry, 
red and glazed, and harsh and rough to the touch ; pulse 82. 
Continued sensible, and apparently convalescent, and complained of nothing, 
and manifested no striking phenomena until Sept. 3d, 3| o'clock, P. M. 
At this hour I was summoned hastily, and found this patient insensible, with 
his mouth open and groaning loudly at every breath. His groans sounded very 
much like the barking of a dog. Countenance distressed, anxious, and expressive 
of great agony ; tendons twitching violently ; teeth coated with sordes ; tongue dry, 
red and glazed, and harsh to the feeling. Respiration 40, thoracic, panting; pulse 
104. Temperature of hand 103° F. Skin hot. dry, and rough. When the attempt 
is made to arouse him, by violent shaking and loud talking, he mutters incoher- 
ently. Great tenderness upon pressure of epigastrium; cries out whenever this 
region is pressed. Cups to the temples and back of neck, a large blister over the 
epigastric region -sinapisms to the extremities, stimulants and sulphate of quinia, 
all failed to arouse this patient, and he died twenty hours after this observation. 
There was but little change in the symptoms, with the exception of an increase 
in the frequency of the respiration and pulse. 
AUTOPSY THREE HOURS AFTER DEATH. 
Head.-When the skull-cap was removed, the dura-mater presented the usual 
appearance. Serous effusion had taken place between the dura-mater and mem- 
branes, and surface of the brain, f 3 iii of bloody serum flowed from the base of the 
brain, and there had been an effusion of golden-colored serum between the arach- 
noid and pia mater. Blood-vessels of pia mater filled with blood. Blood-vessels at 
the base of the brain, and upon the medulla oblongata and spinal cord, more 
engorged with blood than those upon the superior portions of the brain. This was, 
without doubt, due solely to the effect of gravity. The substance of the brain pos- 
sessed the usual consistency, and appeared to the naked eye to be normal in struc- 
ture. 
Chest.-Lungs normal; trachea filled with froth. 
Heart, normal. The right auricle contained a large golden-colored clot, which 
filled almost the entire cavity. The left auricle contained several small yellow 
clots. 
The right ventricle contained several small clots of blood, which resembled, in 
all respects, coagulated blood. 
The main trunk of the pulmonary arteries contained a long, flattened, ribbon- 
like, yellow clot, which extended not only through the large trunk, but divided 
and sent off branches to each branch of the pulmonary artery ; and then again sub- 
divided and sent branches off to the minor branches of the arteries. When the 
main clot in the pulmonary artery was gently pulled, the branches were drawn out 
twelve inches in length, and at their extremities were not much larger than a fine 
silk thread. The clot was almost entirely free from red corpuscles, of a yellow 
color, firm, and elastic in structure, and in appearance resembled an organized 
product. 
^A similar ribbon-like, yellow, elastic clot, extended through the whole length 
of the aorta. The blood in the vena cava was coagulated, but the coagulum was 
like that of ordinary blood, and much less firm than the clots of the right auricle, 
pulmonary arteries, and aorta. 
Abdominal Cavity.-The liver presented the true malarial hue; contained no 
grape sugar, but an abundance of hepatic starch ; and its blood did not change to 
the arterial line when exposed to the atmosphere. The spleen was enlarged, soft- 
ened, and of the slate-color of malarial fever. 
Stomach, intestines and kidneys normal. 
The autopsy demonstrated this to be a case of malarial fever. 146 
Heart Clots in Malarial Fever. 
Case 825.-Case of Congestive Fever illustrating the Formation of Fibrinous 
Coagula in the Heart and Blood-vessels. 
Irish seaman, aged 24; light hair, light blue eyes, fair complexion; height 5 
feet 7 inches ; stout, well built, weight 150 pounds. 
Oct. 12th, 1857, 12 o'clock, M. Entered the hospital two hours ago. Now, he 
is out of his head, and can give no history of his case. A companion states that he 
has been watching at night on board a brig, lying in the river, below the ship-yard, 
along the low marshy shore of the Savannah River, and that he was taken sick 
with chill and fever one week ago, but did not, until two nights ago, discontinue 
watching at night. Habits intemperate. 
Pulse 137, rapid and feeble; respiration 32; skin hot and dry. Tip of tongue 
clean, and of a bright red color-the remaining portion of the tongue is coated with 
yellow fur. The tongue is dry and harsh to the touch, and feels, when the fingers 
are passed over it, like sand-paper. The patient mutters to himself continually, 
half-formed sentences and imperfect words. Continues to mutter in the same inco 
herent manner, notwithstanding strenuous efforts to arouse and attract his atten- 
tion. About one hour ago his extremities felt cooler, and his pulse was more feeble 
than it is now; mustards were applied to the extremities-they increased the tem- 
perature and rendered the pulse somewhat fuller, and aroused his intellect for a 
moment, but he again relapsed into the state of delirium. 
Mustards to the epigastrium and extremities, cut cups to the temples and back 
of neck, stimulants and sulphate of quinia and purgatives, failed to arouse the 
intellect, and at 8 o'clock, P. M., the patient lay in a profound stupor, with full 
rapid respiration and full rapid pulse. Pulse 124, and has increased in force and 
volume under the action of the stimulants and sulphate of quinia. Skin hot and 
dry ; tongue presents the same dry and rough appearance. B-Continue the stim- 
ulants and sulphate of quinia, and apply blisters to the back of the neck and over 
epigastric region. 
13th, 11 o'clock, A. M. The cut cups to the head, the sinapisms upon the 
extremities, the blisters upon the back of the neck and epigastric region, and the 
diffusible stimulants and cathartic have failed to arouse this patient, and he now 
lies in a comatose state, and passes his urine and feces in the bed. The nurse states 
that during the night, he was much more restless than at the present time, and it 
was necessary to give constant attention that he did not fall out of the bed, The 
medicine has operated freely, and the blister has drawn well. The serum from the 
blistered surface is of a golden color. 
Respiration 30, stentorous. The patient lies in a stupor, with his eyes shut and 
mouth open, and emits a suppressed groan, or whine at every breath-his appear- 
ance, and the sounds which he emits, are similar to those of'the patient described 
in the preceding case. These groans appear to be entirely involuntary, and depend 
upon the state of the organ.of voice, and the mode in which the air passes 
through it. 
Pulse 144, feeble. The sounds of the heart cannot be distinguished-they are 
both united into one, and the heart makes a short, quick, thumping sound. The 
number of the thumps of the heart corresponds to the pulse, 144 to the minute. 
Temperature of atmosphere 77° F.; temperature of hand 103°.5, temperature in 
axilla 104°.5. Skin hot and dry ; teeth coated with sordes. Cannot get a sight of 
his tongue, as his teeth are tightly closed, and he is entirely insensible. 
I have just applied mustards to his extremities-they do not arouse him-after 
remaining on one hour they scarcely redden the surface. 
9 P.M. Profound coma; respiration thirty-two, spasmodic; pulse is gone; 
heart merely flutters; head and trunk warm, extremities cold. Have again applied 
mustards to the extremities, and administered diffusable stimulants, but they do 
not produce the slightest effect, and he will die in the course of one hour. 
The patient died half an hour after this observation. 
AUTOPSY TWELVE HOURS AFTER DEATH. 
Body in good condition, apparently not at all reduced ; limbs full and round, 
muscular, well developed ; complexion fair, with a slight tinge of yellow; skin of 
the dependent portions slightly darker than that of the superior portions of the 
body ; rigor mortis remarkably strong ; it required all the force that I could exert 
to straighten his arms, and they would retrun back to the bent position with con- 
siderable force; after the right arm had been straightened out at right angles to the 
body, and while I was standing between the arm and the body, engaged in open- Investigations by Joseph Jones, M. D. 
147 
ing his abdomen and thorax, I felt the pressure of a hand and arm upon my back 
-this was the hand of the dead man. which had slowly returned to its former posi- 
tion by the contraction of the muscles. 
liead.-Dura-mater normal in appearance ; the longitudinal sinus of the dura- 
mater contained an elongated, flattened, ribbon-like, fibrinous clot, which was free 
from colored blood-corpuscles, and of a yellow co or. This, without doubt, was 
formed before death. Arachnoid membrane opalescent, pearl colored in many 
places; blood-vessels of pia mater filled with blood. The substance of the brain 
appeared to be normal in color and texture, as far as an examination with the 
naked eye extended; it was perhaps a little softer than usual, but this may have 
been due to post-mortem changes, and at any rate would not account for the symp- 
toms during life; ventricles of the brain contained no serum; blood-vessels of 
medulla oblongataand superior portions of spinal cord not congested with blood. 
Chest.-Exterior surface of the heart adherent at all points to the pericardium. 
There was no free space between the heart and the pericardium, hence no fluid 
lubricated the heart. If this lesion was the result of inflammation, it is certain 
that the inflammation had nothing whatever to do with the present attack of fever. 
Muscles of the heart paler than usual. The right auricle and ventricle contained a 
yellow clot, free from colored blood-corpuscles, which was attached to the columnae 
carnese, and chordae tendineae of the right ventricle, and extended through the 
auriculo-ventricular opening into the auricle. This clot sent off a large branch 
into the pulmonary artery. This branch of the yellow fibrinous clot, which 
almost completely filled up the pulmonary artery, subdivided and sent branches 
down the right and left pulmonary arteries, and these branches again divided and 
subdivided into numerous branches, the smallest of which were not larger than 
fine threads. These fibrinous threads passed deep into the blood-vessels of the 
lungs, probably almost to the commencement of the capillaries. The left ventricle 
contained a similar yellow fibrinous formation almost entirely free from colored 
blood-corpuscles, which was attached at one extremity to the columnar carneee, and 
chordfe tendinese, and extending through theauriculo-ventricular opening into the 
auricle, subdivided into branches, which passed up the pulmonary veins, and sub- 
divided into numerous smaller branches which occupied the smaller divisions of 
the pulmonary veins. These fibrinous bodies of the pulmonary veinsand arteries 
were very elastic-with care they could be drawn out of the smaller branches of 
the pulmonary veins and arteries, four and six inches in length, without breaking, 
notwithstanding that the smallest branches were very delicate. The aorta con- 
tained a similar clot. All these clots were of a bright yellow color, almost entirely 
free from colored blood-corpuscles, and presented almost an organized appearance, 
and were, without doubt, formed long before death. 
The large venous tracks were distended with partially coagulated black blood ; 
the heart, arteries, and pulmonary veins contained little or no blood. 
When the black blood from the large venous trunks was exposed to the atmos- 
phere, it assumed slowly and imperfectly the arterial hue. The blood appeared to 
have been collected in the capillaries and veins. If the chemical changes between 
the colored blood-corpuscles and liquor sanguinis, and between the blood-corpus- 
cles and the capillaries, and the structures and fluids surrounding the capillaries, 
be arrested, as a necessary consequence the circulation of the colored blood-corpus- 
cles through the capillaries must be greatly interfered with. 
Lungs.-Normal in appearance and structure ; lower (dependent) portions con- 
gested with blood. This was due to the action of gravitation. The trachea, 
bronchial tubes, and air-cells contained much froth. 
Abdominal Cavity.-The mucous membrane of the stomach presented to the 
naked eye no marks of inflammation or pathological alteration. 
The mucous membrane of the small intestines presented a darker color, the 
blood-vessels appeared to be more congested with blood than usual, but there were 
no marks of inflammation, and the congested state of the vessels appeared to be 
entirely due to the action of the cathartic. 
Liver.-The liver presented a much darker color upon its exterior than normal, 
but not the dark-slate color of cases of malarial fever of longer standing. When 
incisions were made into the liver, the cut surface was different in appearance 
from that of the healthy liver, and approached the bronze color of malarial fever. 
The color of the cut surface, however, was several shades lighter than that of 
malarial fever of longer standing. On the under surface of the tight lobe were 
several spots of the dark-slate color peculiar to malarial fever. The liver-cells pre, 
sented the usual appearance. In some cases they, as well as the tissues around- 
appeared to contain more oil-globules than usual. 148 
Heart Clots in Malarial Fever. 
The liver contained animal starch without a trace of grape sugar. 
Spleen enlarged, softened, disorganized, and of a dark- slate malarial color; 
when pressed gently between the lingers, the trabeculae could be felt giving away. 
After eight hours'exposure to the atmosphere, small streaks, inclining to an arterial 
hue, appeared upon the cut surface of the spleen, and probably were due to the 
change in the blood which issued from the divided vessels. 
The dark effused blood of the spleen was found under the microscope to consist 
of colored and colorless corpuscles and dark granules; some of the colored corpus- 
cles were swollen, and altered in shape. The alteration was by no means universal 
or remarkably great. 
Kidneys.-This subject had but one kidney ; this corresponded to the right kid- 
ney. The inferior surface of the kidney presented a dark slate-colored spot, two inches 
in diameter ; the color of the spot resembled in all respects the slate color of the 
malarial fever liver. When an incision was made into the substance of the kidney, 
through this slate-colored spot, the cut surface presented a bronze color to the depth 
of about one-sixth of an inch. The bronze color gradually shaded into the normal 
color of the kidney. With the exception of this slate-colored spot, the color of the 
kidney was normal. 
After a careful examination of the symptoms and the pathological 
alterations presented by these two cases of congestive fever, it appears that, 
with the exception of the heart-clots, we do not discover any pathological 
changes of the cerebro-spinal nervous system, and of the organs, which of 
themselves would account for the sudden severity of the symptoms, or the 
death of the patient. 
As far as an examination with the eye extended, we did not discover in 
the brain any structural alterations sufficient to account for the sudden and 
alarming symptoms of delirium and coma. We should not, however, in 
the present state of chemical, physiological, and pathological science, decide 
dogmatically a question of such importance, for we are wholly ignorant of 
the chemical, physiological, and pathological relations of the malarial 
. poison to the nervous elements. It is evident that a thorough knowledge 
of the phenomena of malarial fever demands, amongst many other things, a 
thorough knowledge not only of the appearance and chemical constitution 
of the structures of the cerebro-spinal and sympathetic nervous system, but 
also a thorough knowledge of the physical, chemical, and pathological alter- 
ations of these structures, when acted on by morbific agents. 
Whatever were the alterations of the nervous elements in this case, it 
was evident that they could not be reached by the most energetic and vig- 
orous treatment. It was impossible to arouse the action of the brain, not- 
withstanding that there was no inflammation, and only that congestion of 
the blood in the capillaries which resulted from the feeble action of the 
circulatory apparatus, the disturbance of the relations of the blood and 
capillaries, and the alterations of the constituents of the blood. 
We do not think that the condition of the spleen in these cases was 
sufficient to cause death, because we have seen cases where sudden death 
occurred from other diseases during convalescence from malarial fever, in 
which the spleen was apparently in a worse condition. 
The same remark applies to the alterations of the liver ; as far as our 
examination extended, they do not appeal1 to have been sufficient to cause 
death. 
The stomach and intestinal canal presented no special pathological 
alterations. The slate-colored spot upon the kidney was interesting, espe- 
cially in its bearing upon a similar change in the color of the liver, but if 
was not sufficient to account for even one of the symptoms. 
Can we, then, from this analysis of the pathological phenomena, infer 
that the immediate cause of death did not exist in the pathological altera- 
tions of the organs and tissues, but in the disturbances of the general and Heart Clots in Diseases. 
149 
capillary circulation, and especially of the function of the lungs, by the 
fibrinous coagula in the cavities of the heart and in the blood-vessels. 
It is important that we should, before deciding this question, consider the 
occurrence of these coagula. in other diseases, and the attendant phenomena. 
THE FORMATION OF HEART-CLOTS IN VARIOUS DISEASES, AND THE ATTEN- 
DANT PHENOMENA. 
Various opinions have prevailed with reference to the fibrous concre- 
tions found in the heart and bloodvessels after death, and almost up to the 
present time a dispute has been carried on concerning the time of their 
formation, some contending that they were formed during life, and others 
that they were formed after death. Apart from the evidence afforded by 
the lamellated structure of the bodies, their freedom from colored blood- 
corpuscles, and the absence of colored blood in the surrounding cavities of 
the heart and bloodvessels, we find scattered through the records of medi- 
cine numerous facts, established by independent observers, demonstrating 
in the clearest manner the formation of these concretions before death. 
Hewson1 found in the right ventricle of the heart of a dog, which had 
been killed eight hours after receiving a large wound in his neck (the 
wound had during this time inflamed considerably), a large whitish poly- 
pus, under which was a little blood, still fluid, which coagulated after 
exposure to the air. 
Baillie,' Morgagni,3 and Albinus4 have described the obliteration of 
veins by the formation of coagula during life. Mr. A. Burns5found in the 
right auricle of a human heart a large, dense, lamellated polypus (fibrinous 
concretion), which was so firmly attached to the rough surface of the 
musculi pectinati as to allow the whole mass of the heart, and a consid- 
erable portion of the lungs, to be suspended by it. Mr- J. Stewart6 has 
described a heart which contained fibrinous concretions in the right auricle 
and in both ventricles. Mr. Burns reports a case in which a polypus more 
than one inch long was attached so firmly to the septum of the heart that 
the ventricle was torn before the polypus could be torn from its attach- 
ment. He also affirms that in the centre of this polypus an abscess was 
found which discharged a teaspoonful of perfectly formed purulent matter. 
Wardrop7 and Cruwell8 have recorded similar phenomena. 
Graham,9 Stenzel,10 Meckel,11 Stoerk,12 and others have described lami- 
nated fibrinous coagula in the aorta, and Baillie13 found two coagula, lami- 
nated like the walls of the sac of an aneurism, firmly attached to the inside 
of the carotid arteries. 
M. Petit and O'Halloran have observed that the blood vessels immedi- 
ately above, and in sphacelated parts, are filled with fibrous concretions. 
Mr. Martial, in 1694, in amputating the legs of a poor woman affected 
with gangrene, found that no haemorrhage followed the amputation of the 
first leg, and that in like manner no haemorrhage would have followed the 
1 An Experimental Inquiry into the Properties of the Blood. By William Hewson. Lon- 
don, 1771, P.49. 
2 Trans, of A, Soc., vol. 1. p. 129. 
3 Annot. Academ., lib. 7. c. 2. 
4 Epist. 36, art. 10. Op. Path., p. 6, sec. 8. 
5 Diseases of the Heart, p. 197. 
6 Edinb. Med. and Surg. Journ., for 1817. 
7 Baillie's Works, vol. ii. p. 20. A. Burns on the Diseases of the Heart. 
8 De Cordis et Vasorum Osteogenesi in Quartrogenario Observata. Haise, 1765. 
9 Med.-Chir. Transactions, vol. v. p. 297. 
10 Dissertatio de Steatomatibus Aortse. 
11 Mem. de 1'Acad. R. de Berlin, 1756. 
12 Med.-Chir. Transactions, vol. v. p. 287. 
13 Transactions of the Society for the Improvement of Medical and Surgical Knowledge, 
vol. i. p. 191. 150 
Heart Clots in Diseases. 
amputation of the second leg, had not the surgeon, after catting off the 
limb, pulled out from the extremity of the artery a round, firm, and white 
clot, about three inches in length, which had been pushed a little beyond 
the cut extremity of the artery by the force of the column of blood? 
M. Baron,2 Virchow, and Mr. Paget3 first directed the attention of 
pathologists to the frequency aud danger of obstructions in the pulmonary 
artery. 
Crampton, Louis, Bougen, Desault, Duncan and others, have recorded 
cases of the obstruction of the larger blood-vessels by fibrinous coagula, 
and Dr. Reid,4 Hodgson,5 Andral,6 Tiedemann,7 Otto,8 Lobstein,9 Cloquet,1" 
Carsewell," Langstaff,12 and others, have recorded cases of, and discussed 
the origin and mode of formation of phlebolites. 
Dr. Benjamin Ward Richardson,13 after the careful examination of the 
condition of the blood after death in 543 cases, occurring in man and in the 
inferior animals, including, in the human subjects, deaths from sudden 
syncope, epilepsy, apoplexy, enteritis, croup, pneumonia, bronchitis, bron- 
chorrhoea, phthisis, mesenteric disease, purpura, acute rheumatism, dropsy 
following scarlet fever, cyanosis, haemoptysis, failure of the heart from fatty 
change, cancer, aneurism of the aorta, atheromatous and ossific disease of 
the aorta, adhesion and ossification of the pericardium, simple starvation, 
cirrhosis, degeneration of the heart from drunkenness, hydrocephalus, 
lateral compression of the chest, ulceration and stricture of the oesophagus, 
icterus, general dropsy from mitral disease, dilatation of the right side of 
the heart, senile decay, and hanging-including, in the human foetus, 
deaths in the sixth, seventh, eighth, and ninth months of development, and 
soon after delivery, from various causes, mechanical and morbific-includ- 
ing, in pigs, sheep, oxen, dogs, cats, rabbits, guinea pigs, and birds, deaths 
from haemorrhage, intestinal obstruction, poisoning from narcotic gases, 
chloroform, ether, smoke of puff-ball, carbonic acid, tobacco-smoke, anti- 
moniuretted hydrogen, and prussic acid, poisoning by solid opium, salts of 
ammonia, potassa, and antimony, strangulation, drowning, electric shock, 
simple exposure to cold, peritoneal dropsy naturally and artificially pro- 
duced, shock from blows on the head, extraction of the kidney, and inhala- 
tion of oxygen and chloroform, decided that the arguments were conclusive 
for the formation, in certain conditions of the blood, and of the circulation 
and respiration, of fibrinous masses previous to death. 
Dr. Richardson, not content with these extensive observations, demon- 
strated, by well-devised and conclusive experiments, that fibrinous concre- 
tions can be artificially produced in animals during life, by the introduc- 
tion into the blood of those substances which disturb the circulation and 
1 Memoirs of the Royal Academy for the year 1732. 
2 Recherches et Obs. sur la Coagulation du Sang dans l'Artere Pulmonaire et ses Effets, 
Arch. G6n. de M6d., sec. iii. t. ii. 
3 Pageton Obs. of Pulmonary Artery, Med. Chir. Soc. Trans., London, vol. xxvii, pp. 162 
and 280; see also Professor Simpson's Obstetrical Works, vol. ii, p. 34. 
4 Pathological Researches, 1848, p. 395. 
5 • Treatise of Diseases of Arteries, p. 521. 
6 Anatomie Pathologique, t. ii, p. 412. 
7 Journal Comp, du Diction, des Sciences M6d., t. iii. 
8 Path. Anat. Trans., by South. 
9 Anat. Pathol. 
10 Path. Chirurgical. 
11 Cyclop, of Practical Medicine, art Veins. 
12 London Medico-Chirurgical Transactions, vol. viii, p. 287. 
13 "The Fibrinous Constituent in Relation to Disease," by B. W. Richardson, Medical 
Times and Gazette, Feb. 12, 1853. Ranking's Abstract of Med. Sci., June 1853, p. 76. Am. ed. 
"Diagnosis of Fibrinous Concretions in the Heart", by B. W. Richardson, Assoc. Med. Journal, 
April 13,1855. Banking's Abstract of Med. Sci., June. 1855, No. xxi, p. 73, Am. ed. "The cause of 
the Coagulation of the Blood, the Astley Cooper Prize Essay for 1856," by Benjamin Ward Rich- 
ardson, M. D., London, 1858. " On the Diagnosis of Fibrinous Concretions in the Heart in certain 
cases of Inflammatory Croup," by B. W. Richardson Med. Times and Gaz., March 8,1856. Rank- 
ing's Abst. Med. Sci., No. xxiii., Jan.-June, 1856, p. 76, Am. ed. Conditions Favorable to the Deposition of the Fibrin. 
151 
respiration, and the relations of the constituents of the blood to each other, 
and to the capillaries, and to the processes of secretion, nutrition, and 
excretion. 
The hearts of the living animals were opened, and the fibrinous con- 
cretions withdrawn whilst the organs were still pulsating.* 
THE CONDITIONS MOST FAVORABLE TO THE DEPOSITION OF FIBRI- 
NOUS CONCRETIONS. 
The experiments and observations of numerous pathologists and phy- 
siologists have shown that the leading conditions for the deposition of 
fibrinous concretions in the circulatory apparatus during life, are actual 
and relative increase of the fibrin of the blood and impeded circulation. 
The positive increase of fibrin, which occurs in diseases of the acute 
inflammatory class, is frequently attended by a deposition of that portion 
of the fibrin which can be no longer held in solution by the blood, and 
thus causes death. In twenty-three cases of death from acute inflammation 
of the respiratory organs, and which ended fatally in the first stages by 
rapid sinking, Dr. Richardsonf found*in every case a fibrinous concretion, 
which he considered as due, in great part, to the excess of fibrin in the 
blood. 
This observer substantiated this view by a series of experiments upon 
the inhalation of oxygen, which Dr. Gairdner had shown would increase 
the quantity of fibrin in the blood. After continuing the inhalation of 
oxygen for a considerable length of time, all the symptoms of fibrinous 
deposition were produced, and an examination of the living heart showed 
the presence of the concretion. 
When the other elements of the blood are diminished, whilst the fibrin 
remains in normal amount, when compared to the previous quantities of 
the constituents and volume of the blood, but relatively increased to the 
altered proportions, the fibrin may be deposited. This kind of separation 
has been observed to occur after profuse purging, or after profuse colli- 
quative sweating, and in cases of cholera, and in the last stages of phthisis 
pulmonalis, and in anaemic conditions of the blood. 
Disturbances in the circulation arising from simple failure of the 
heart, appear to be frequently attended by the deposition of fibrinous 
concretions. 
This tendency is marked in all cases of slow death, when the action of 
the heart is enfeebled, and the struggle for life is prolonged, irrespective 
of the amount of the fibrin, whether increased or diminished, as in typhus 
and malarial fevers, and in purpura, and old age, and in debilitated states 
induced by ardent spirits and dissipation, and exposure and privations. 
The deposition of fibrin in the circulation may result from other causes 
far more obscure and difficult of demonstration and investigation than 
those just enumerated. Thus, it has been observed that these concretions 
are more common in some seasons than in others. This fact would seem 
to indicate an atmospheric cause, or certain revolutions in the human sys- 
tem, and in diseases. This fact shows the impropriety of drawing wide 
and absolute conclusions from a single series of investigations on the rela- 
tive frequency of the formation of these bodies in different diseases. 
The presence of certain foreign bodies in the blood may lead to the 
deposition of fibrin, as Gaspard and Lee conclusively demonstrated, by the 
injection of pus into the blood of living animals, whilst, on the other hand, 
* "The Cause of the Coagulation of the Blood," pp. 60-140. 
+ Loc. clt., p. 69. 152 
Relations of Malarial Feuer to Heart Clots. 
the experiments of Magendie demonstrated that the injection of putrefying 
substances may produce the opposite condition-permanent fluidity of the 
blood. 
Alterations in the constitution of the walls of the capillaries and blood- 
vessels and heart may produce the deposition of fibrin, and even the coag- 
ulation of the blood, as has been conclusively demonstrated by the experi- 
ments of Hewson,1 Thackrah,2 Sir Astley Cooper,3 and Briicke.4 
The normal reaction of the blood is alkaline, and it is a well established 
fact that the alkalies are solvents of fibrin-in fact, the theory proposed 
and ably advocated by Dr. Richardson,5 ascribes the solution of the fibrin 
in the blood, to the presence of ammonia; if, then, the alkalies of the blood 
be neutralized by an acid generated by morbific processes within the blood, 
or absorbed from without, then we would expect the deposition of the 
fibrin. Now, in malarial fever, in which these concretions are common, 
the secretions of the mouth and the urine are intensely acid. I do not feel 
warranted, however, in propounding this as even a hypothesis, as I have 
found the blood in severe malarial fever alkaline, whilst the secretions of 
the mouth and urine changed the litmus blue to red, as rapidly and decid 
edly as a strong solution of sulphuric acid. The degrees of alkalinity of 
the blood of malarial fever, are, however, worthy of careful investigation. 
OBSERVATIONS ON THE RELATIONS OF MALARIAL FEVER TO THE FORMA- 
TION OF HEART-CLOTS, DURING THE AMERICAN CIVIL WAR, 1861- 
1865, AND SUBSEQUENTLY. 
During the American Civil War, 1861-1865, the author conducted an 
extended series of investigations upon the diseases of the Confederate 
troops, and a vast number of cases of the various forms of malarial fever 
passed under his observation in the field and in the hospitals in Virginia, 
North Carolina, South Carolina, Georgia and Florida, From these records 
we select the following case, investigated by the author during the siege of 
Charleston, South Carolina. 
The following sudden and rapid case of malarial fever and typhoid 
and intestinal inflammation was examined by me in Charleston, South 
Carolina, at the First Georgia Hospital, during the month of October, 1863: 
Case 826.-John Morris, age 52 years ; complexion dark ; hair black, but now 
turning grey; beard also grey. Native of Middle Georgia. During the past 
two months has been overseeing the negroes working on the fortifications on James' 
Island, in and around Fort Johnston. Entered First Georgia Hospital, Charleston, 
South Carolina, October 18th, 1863, in the afternoon, in a dull, stupid condition. 
The patient could give but a very imperfect account of himself. His companions 
stated that he had had three chills on three successive days. The patient continued 
in this dull, stupid state during the night and the following day. October ILth, 
3 P. M.: Pulse slow and full; 80 beats per minute. Respiration 42, labored and 
rattling; constant and loud rattles in the throat and bronchial tubes. When the 
ear is placed upon the chest the sounds are so loud as to drown the sounds of the 
heart. The action of the heart appeared to be regular. The spasmodic action of 
the lungs, as well as the accumulation of the secretions in the bronchial tubes, 
appeared to be chiefly due to the want of power in the respiratory muscles, and in 
the nerves regulating the size and character of the bronchial tubes and air-cells. 
Temperature of axilla 103, and perhaps higher. It was impossible to ascertain the 
1 An Experimental Inquiry into I he Properties of the Blood, with Remarks on some of its 
Morbid Appearances. William Hewson: London, 1771. Experiments xxii. to xxvii., pp. 82-88. 
2 An Inquiry into the Nature and Properties of the Blood in Health and in Disease, by Char- 
les Turner Thackrah; first ed.. London, 1819; second ed., London, 1837, pp. 77-83. 
3 As quoted by Mr. Thackrah in his Inquiry on the Blood, second ed., 1834, pp. 83-85. 
4 An Essay on the Cause of the Coagulation of the Blood, by E. Briicke, M. D., British and 
Foreign Medico-Chirurgical Review, No. xxxvii, January, 1857, p. 141, Am. ed. 
5 Cause of the Coagulation of the Blood, pp. 229, 330. Relations of Malarial Fever to Heart Clots. 
153 
exact temperature, as the patient was very restless, and it was impossible to control 
the constant "ossing of his arms. Temperature of the extrenities elevated. Skin 
of the extremities felt hot and dry. Tongue coated with thick, clammy yellow 
fur. Careful microscopical examination showed the fur of the tongue to be com- 
posed of mucus corpuscles and epithelial cells. Lies with his mouth open, breath- 
ing in a loud rattling manner. Intellect sluggish. Pupils contracted, as in the 
action of some powerful narcotic. Throws his arms about in a wild, restless man- 
ner, and attempts to get out of bed. Passes his excrements in bed, but before 
doing so, makes signs to get up, but is too weak to make any exertion. Has lost 
the power of articulation. Is not entirely void of intelligence, for after consider- 
able entreaty and numerous signs, put out his tongue, and when still further 
aroused, points upwards and then crosses his hands over his breast as if engaged 
in the act of prayer. When I first entered the ward the patient appeared to be 
asleep, and when his eye-lids were drawn back, the pupils were found to be con- 
tracted, and did not appear to undergo any alteration in size when exposed to a 
bright light, and at first the patient appeared to slumber on, although the eyes 
were held open. After alternately shutting and opening the eyelids, and exposing 
the naked eyes to a strong light, the patient aroused somewhat, and attempted to 
remove my hands from his eyelids, and shortly after this became very restless 
The pulse is remarkably full and regular, considering the nervous symptoms ; the 
breathing, however, is that of a man in articulo-mortis, and the features of the 
face resemble the hollow, sunken, leaden features of death. Stimulants were 
administered internally and applied externally, without any other result than 
apparently prolong the unequal struggle. Bowels loose-had two foetid discharges 
in his bed during my examination. 
October 20th, 11 A. M.: 1 ulse 133. Respiration 48. Temperature of hand 101. 
Symptoms similar to those previously described, with the exception that the 
patient appears to be more rapidly sinking and near his end. The involuntary 
discharges of foeces and urine continue. 
4 o'clock P. M.: In articulo-mortis. Died October 20th, 5 P. M. 
Exterior.-Muscular man, rather spare in his make, with no surplus fat, but 
still with large, well-developed muscles. Height about six feet; weighs about 155 
pounds: rigor-mortis well-developed. Hands purple. Some settling of blood and 
mottling of the surface in the most dependent portions of the body. General 
yellowish and sallow hue of the entire body. 
Head.-When the scalp was dissected off from the bones, little or no blood 
was found either in the scalp or in the bones. As I turned the scalp back from the 
cranium, the surface of both was white, and not a drop of blood issued. When 
the skull-cap was removed, the dura-mater presented a healthy appearance; the 
blood-vessels appeared to be congested with blood. Arachnoid opalescent. Blood- 
vessels of pia-mater greatly distended and engorged with blood. They appear to 
be distended with blood to their utmost capacity. I have never seen a more marked 
congestion of the blood-vessels, even in poisoning with narcotics. Structures of 
the brain firm when cut, and not softened. Dark blood issued from various points 
in the cut surface of the brain. No effusions were found upon any portion of the 
brain; and no fibrinous exudations were discovered upon the surface of the brain. 
The blood-vessels of the cerebellum and of all the structures at the base of the 
brain, and of the medulla-oblongata were, in like manner with those of the cere- 
brum, distended with blood. I desired to make a drawing of the appearance pre- 
sented by this brain, but was unable to do so from the time necessarily consumed 
in the other parts of the post-mortem examination. The lateral ventricles of 
the brain contained about fgiii of a turbid, milky fluid, which contained 
several small, light yellow-clots, the largest of which was about one-third of 
an inch in diameter, and about one-eighth of an inch in thickness, and of an 
oval shape. These small fibrinous concretions were not attached to the surface 
of the ventricle, nor to the nutritive membrane. I examined these bodies 
carefully under the microscope, and found them to consist chiefly of numerous 
colorless corpuscles, held together by fibrin. The turbid, milky appearance of the 
fluid of the ventricles of the brain appeared to be due to the presence of colorless 
blood-corpuscles, and probably of exudation corpuscles. I examined side by side 
with these coagula from the ventricles of the brain, a fibrinous concretion from 
the right auricle and ventricle of the heart, which had prolongations into the 
pulmonary arteries, and which presented a yellow cream-color, and was almost 
AUTOPSY FIVE HOURS AFTER DEATH. 154 
Micro-Organisms in Bile and Intestines. Case 826, 1863. 
entirely devoid of colored blood-corpuscles; and the microscopical appearances of 
the colorless corpuscles were similar in all respects to those of the fibrinous concre- 
tions from the ventricles of the brain. May not the latter, as well as the former, 
have been formed under similar circumstances and from similar causes, in articulo- 
mortis? There can be but little doubt but that the fibrinous concretions in the 
heart were formed during the last hours of life ; and it would not be unreasonable 
to suppose that the fibrinous concretions in the ventricles of the brain, in like man- 
ner, were formed during the last hours of life, were not connected with the cere- 
bral symptoms during life. The causes, however, which led to the formation of 
these concretions in the cerebro-spinal fluid, may have been connected with the 
nervous symptoms during life, just as the causes which led to the formation of the 
fibrinous concretions in the blood may have been active and producing derange- 
ments in various organs, and even death itself. The blood-vessels of the spinal 
cord were congested with blood in the same manner with those of the brain, 
but there were no marks of inflammation, nor of the effusion of fibrin. It 
is, however, impossible to say what effects the clots thus formed in the cerebro- 
spinal fluid in the ventricles of the brain might have upon the nervous symptoms 
and the subsequent recovery of a patient. 
Chest.-Lungs healthy in appearance and structure. The difficulty of respira- 
tion appeared to be connected chiefly with the loss of nervous power, and the fail- 
ure of the functions of the bronchial tubes and air-cells. This loss of power 
was dependent upon the disturbed state of the cerebro-spinal system. The blood 
had settled in the most dependent portion of the lungs. This change had evidently 
taken place towards the close of life. The lungs contained quite a number of what 
felt like bony concretions, about the size of millet seed, or rather of duck shot. They 
were hard bone-like bodies, and under the microscope presented a crystalline 
structure. 
Heart normal in size and structure. Hight ventricle contained a large fibrin- 
ous concretion attached to the carnate columnse; from this main concretion a 
branch was sent off into the pulmonary artery, which divided into several minor 
branches. This concretion, as before stated, was composed chiefly of fibrin and 
colorless corpuscles, with a comparatively small number of colored blood-corpus- 
cles. We cannot conceive that this clot was formed alter death, because, first, the 
time, only five hours after death, was too short; second, the blood which was found 
in the venous vessels and even in the cavities of the heart itself, was still fluid ; and 
third, the concretion was laminated and the red corpuscles had been, as it were, 
whipped out of its fibrin during its gradual formation. Neither can we, on the 
other hand, admit that this clot was formed any great length of time before the 
death of this patient, for the pulse was too slow and regular, and the action of the 
heart was too slow and regular to admit of the existence of such, a large clot with- 
out manifest derangement in the action of the valves and the contractions of the 
heart. There was a period, however, in the history of this patient, to which we 
might reasonably refer the formation and existence of a heart-clot. When the 
pulse rose to 130 beats, and the action of the heart was fluttering and feeble, then 
it is probable that the heart-clots were in process of formation. 
Abdominal Cavity. Liver.-The liver presented a purplish color, inclining 
to slate upon the exterior; whilst the interior presented a color inclining to bronze ; 
or rather to a color between the reddish-brown of health and the olive-green and 
bronze of malarial fever. Under the microscope the structures of the liver did not 
present any abnormal appearance. I did not discover the altered blood-corpuscles 
and hiematin, so common in the liver of malarial fever, of long standing. The 
liver in one portion contained a peculiar flbrinous-looking body, which when cut 
into, presented a hard, crystalline, bone-like structure, similar to that of the con- 
cretions found in the lungs. This concretion occupied a position near the exterior 
of the liver, and resembled in this respect, also, the hard concretions of the lungs. 
Under the microscope, this body presented similar crystals and crystalline, bony 
or calcareous structures, to the bodies found in the lungs. 
Under the microscope, the cells of fie gall-bladder were filled with dark granu- 
lar matter, and several elongated, cyptogamic simple plants were discovered in the 
bile, similar to those which will be presently described as found in great numbers 
in the small intestines. 
The bile was very thick, tenaceous and ropy. 
Spleen.-This organ was enlarged, and was at least twice the natural size. The 
spleen was softened, but not to such a degree as is usual in malarial fever of longer 
duration. The great congestion of the brain and intestinal canal may have had 
something to do in diminishing the congestion of the spleen. After careful micro- Micro-Organisms in Bile and Intestines. Case 826,1863. 
155 
scopical examination, I did not discover in the spleen pulp, any of those masses of 
altered blood-corpuscles and haematin, so often found imabundance in the spleen of 
malarial fever of longer duration. The blood of the spleen in this case, as is usual 
in malarial fever, consisted chiefly of colored corpuscles, many of which were 
altered in form. The blood of the spleen, and the mud of the spleen, changed far 
more slowly to the arterial hue upon exposure to the atmosphere, than is usual in 
normal spleens, and even than in the enlarged and softened spleen of typhoid fever. 
Pancreas.-N ormal. 
Alimentary Canal. Stomach.-The blood-vessels upon the exterior did not 
appear to contain more blood than usual. The mucous membrane presented in 
most parts, the usual appearance of health-in some few and small spots the 
mucous membrane presented an ecchymosed condition. 
Small Intestines.-Upon the exterior, the small intestines appeared to be unu- 
sually contracted and firm. The blood-vessels upon the interior were not alike con- 
gested in all parts; they were more congested in the ilium than in the jejunum. 
The intestines contained thick, tenacious, ropy matter, which had the color and 
resembled in all respects, the green bile. The contents of the small intestines, 
consisted in larger measure of the green, ropy, tenacious bile, mixed with mucus 
corpuscles and cells. When this green, tenacious, grumous matter was scraped 
off, the mucus membrane of the small intestines presented a highly congested deep 
red, purplish and scarlet color. I have never seen a more intense congestion of the 
mucus membrane, even in poisoning with arsenic. Under high magnifying 
powers, the contents of the small intestines contained an innumerable number of 
small delicate rod-like and branching vegetable bodies, presenting the appearance 
represented in the following figure : 
Micro-organisms in Intestinal Canal in Fever. 
ENGRAVING NO. 4. 
Engraving No. 4.-Micro-organisms from intestinal canal in case of fever; Charleston, South 
Carolina, October 20th, 1863. Joseph Jones, M. D. 
These bodies were exceedingly minute, and in this figure were magnified 400 
diameters. These vegetable organisms existed in immense numbers all through 
the tract of the small intestines. As we have before stated, large portions of the 
ilium presented an intensely congested and red appearance. The glands of peyer 
were distinct, presenting the appearance as if black pepper had been sprinkled 
over them. They presented, however, a far different appearance from those con- 
ditions in typhoid fever. They were not elevated and contained no special deposit, 
in fact, they appeared to be less congested than the surrounding mucus membrane. 
The mesenteric glands were not enlarged. 
The large intestine (mucus membrane), was in like manner intensely congested 
and blood-red. The mucus membrane presented a deep scarlet color, and when 
the mucus and foecal matters were scraped up with a knife-blade, the matter resem- 
bled almost pure blood. Tn the contents of the large intestine, under the micro- 
scope, millions of the peculiar vegetable bodies previously described in the small 156 
Micro-Organisms in Typhoid Feuer: 1862, 1863. 
intestines, were discovered, together with numerous blood-corpuscles, mucus cells 
and mucus corpuscles. • 
When floated in water and viewed under a magnifying glass, the mucus mem- 
brane of the stomach presented no unusual appearance. When thus viewed, the 
villi of the intestines, as well as the general mucus membrane, appeared to be 
intensely congested with blood. 
So great was the injection of the large intestine, that it appeared to the naked 
eye like raw meat. 
Commentary.-The chief points of interest presented by this case were : 
(1). The cerebral symptoms during life, were capable of explanation in part, 
at least, by the condition of the brain after death. The intense congestion of the 
blood-vessels of the brain, together with the effusion of turbid serum containing 
coagula, into the ventricles of the brain, were without doubt sufficient causes to 
explain the loss of intelligence and the irregular action of respiration. This condi- 
tion of the brain resembled rather the effects of some violent narcotic poison, than 
the effects of true inflammation of the cerebral membranes and structures. The 
symptoms during life, as well as the actual condition of the brain, were probably 
the results of the action of the malarial poison upon the blood altering its physical 
and chemical properties, and thus producing derangement in the nutrition and 
circulation and functions of the cerebro-spinal nervous system ; the action of the 
malarial poison upon the liver, deranging its structures and secretions, and thus 
also, by the altered bile absorbed into the blood and not properly eliminated from 
it, acting indirectly upon the cerebro-spinal nervous system; and lastly the results 
of the direct action of the malarial poison upon the cerebro-spinal system. 
(2). The presence of these minute vegetable organisms in such countless num- 
bers, was without doubt of much interest, and it is even a question how far they 
may not have been the cause of the intense irritation of the intestinal mucus mem- 
brane. They may also have been intimately connected with the cerebral symp- 
toms. This patient presented many of the symptoms of one affected by some 
powerful narcotic poison. The presence too, of a decided diarrhoea and dysentery 
conjoined with the cerebral symptoms renders it evident that there was some great 
cause or combination of causes, producing the various phenomena, of which the 
condition of the nervous structures was only a result, and in no way a cause, 
farther than that derangements of the vital organs, however produced, in time 
manifest their deleterious effects and thus by their connection with the regulation 
of the forces moving the machinery, and by their connection with the processes of 
nutrition and secretion, intensify and aggravate, as it were, the action of the 
poison upon the blood and other important organs. 
ENGRAVING NO. 5. 
Section of surface of Payer's Gland in Typhoid Fever. 
Engraving No. 5-Section of surface of ulcerated Peyer's Gland Typhoid Fever-Confederate 
Soldier. From nature by Joseph Jones, M. D., 1862. Micro-Organisms in Typhoid Fever: 1862, 1863. 
157 
The presence of micro-organisms in the intestinal canal of this case pre- 
sented points of great interests. I have at previous times and also subse- 
quently in various portions of the Southern Confederacy in the field and 
general hospitals of Virginia, Georgia and South Carolina, endeavored to 
illustrate the pathological, chemical and microscopical changes character- 
istic of malarial and typhoid fevers, erysipelas, pyaemia and hospital gan- 
grene. The following engravings reproducing the drawings which I made 
from nature during the Civil War, in 1862 and 1863, will illustrate the 
nature of these inquiries, and show that micro-organisms and more especi- 
ally micrococci and the simple forms of vegetable life were observed in 
cases of disease as early as 1862 : 
ENGRAVING NO. 6. 
Microscopic character of enlarged Mesenteric (Hand of Typhoid Fever. 
Engraving No. 6.-Microscopical character of enlarged'and softened Mesenteric Gland of 
lyphoid Fever. Figures A, B, C, and D, illustrate the presence of oil globules, granular matter, 
and micrococci- Confederate Soldier. From nature by Joseph Jones, M. f)., 420 diameters, 1862. 
Liver Cells of Typhoid Fever. 
ENGRAVING NO. 7. 
„ SN?™AXING .No' 7' Cells iu Typhoid Fever-Confederate Soldier, 1862. Joseph Jones, 
M. D., 420 diameters. ' Micro-Organisms in Typhoid Fever-. 1862, 1863. 
158 
ENGRAVING NO. 8. 
Casts Bacilli and Micrococci in Urine of Typhoid Fever. 
Engraving No. 8.-Casts of Tubuli Uriniferi in Urine of Typhoid Fever:; also Micrococci 
and Bacilli, Confederate Soldier, 1863, Army of Northern Virginia. Joseph Jones, M. D. 
ENGRAVING NO. 9. 
Casts of Tubuli Uriniferi and Micro-Organisms in Urine of Typhoid Fever. 
Engraving No. 9.-Casts of Tubnli Uriniferi in Urine of Typhoid Fever; also Micro-Organ- 
isms, Micrococci and Bacilli-Confederate Soldier, 1863, Army of Northern Virginia. Joseph 
Jones, M. D. Micro-Organisms in Typhoid Fever: 1862, 1863. 
159 
ENGRAVING NO. 10. 
Deposits and Micro-Organisms in Urine of Typhoid Fever. 
Engraving No. 10.-Casts of Tubuli Uriniferi, Crystals of Uric Acid, Masses of Haematin 
andMycelia, Micrococci and Bacteria in Urineof Typhoid Fever engrafted on Malarial Fever, 420 
diameters-Confederate Soldier, 1863. From nature by Joseph Jones, M. D. 160 
Micro-Organisms in Typhoid Fever: 1862-1863. 
ENGRAVING NO. 1 1. 
Deposits in Urine of Malarial Dever. 
Engraving No. 11.-Urate of Soda and Triple Phosphates in Urine of Malarial Fever-Con- 
federate Srtldier, 1863,420 diameters. From nature by Joseph Jones, M. D. Micro-Organisms of Typhoid Fever. 
161 
A careful comparison of the preceding observations upon the micro- 
organisms of the intestinal contents and of the mesenteric and peyer glands 
and urine in typhoid fever with the subsequent observations of Klebs and 
others, will justify the claim of the author as one of the discoverers of the 
micro-organisms of typhoid fever. During the Civil War, 1861-1865, he had 
no means of presenting his labors to the scientific world. These labors, with 
accurate details of cases and elaborate drawings, were continuously for- 
warded to the Surgeon General's office in Richmond, Virginia, in 1862, 
1863 and 1864; and constituted three large manuscript volumes. These 
labors were destroyed at the time of the burning of the Confederate capital. 
The author retained his first and original draft of the cases and drawings, 
and from that was reproduced the above illustrations. 
ENGRAVING NO. 12. 
Micro-Organisms of Typhoid Fever. 
Engraving No. 12.-Illustrating the bacteria (micro-organisms) of typhoid fever. 
A. Vertical section of the intestine of typhoid fever, showing the border of the submersion 
infiltrated by bacilli, Hartnack Immersion No. 9, ocular 2 (Klebs). 
B. Micro-organisms of typhoid fever, from a fresh section of typhoid gland; treated with 
glacial acetic acid and glycerine mixture, Siebert's Im. No. 7, ocular 3-(Klebs). 
C. Section of a typhoid lung; fresh; treated with mixture of glycerine and glacial acetic acid. 
Siebert's Im. No. 7, ocular 3 (Klebs). 
D. Typhoid bacilli, from a lymphatic gland. Hartnack, No. 12, ocular 3-(Eberth.) 
Meyer has reported the finding of bacilli in great numbers in the 
blood of a case of typhoid fever, which resulted fatally from congestion of 
the lungs and kidneys at the end of two days. Almquist reports that he 
has occasionally found groups of microbes in the blood in small numbers. 
These were short rods, and were more abundant during the second and 
third week of sickness. Maragliano found in blood drawn from the spleen 
by means of a hypodermic syringe mobile and motionless micrococci, and 
also a small number of rolls like those described by Eberth. Letzerich also 
claims to have recognized the micrococci, which he supposes to be the 
specific germs of typhoid in the blood and in the sputum. Tigri first 
found bacteria in the blood of a man dead with typhoid fever. These 
organisms were also found by Signol (1863) and Megner (1866), in the 
blood of horses attacked by a disease called by the veterinarians typhoid 
fever. This blood, by inoculation, produced the death of some rabbits, 
with the same alterations in the blood. 162 
Micro-Organisms in Typhoid Fever. 
Coze ami Feltz (1866), having inoculated some rabbits with the blood 
of typhoid fever, have produced results which they consider analogous, 
and as accompanied by the same pathological localization in the glands of 
peyer. The blood of an injected rabbit may be used upon a second rabbit, 
with positive results, as in variola and scarlatina. The species of bac- 
terium which is found in this case, reveals the bacterium catenate, but its 
dimensions are less. The presence of micro-organisms in the local lesions 
of typhoid fever has been verified by numerous observers. According to 
Eberth, Von Recklinghausen first described micro-organisms in abdomi- 
nal-typhus. These were found in the typhoid ulcers, and consisted of masses 
of micrococci. Klein found groups of micrococci in the mucous mem- 
brane, in the lymph follicles, and in the spleen. Frische found colonies 
of micrococci in the spleen and in the lymphatic glands, in fifteen out of 
twenty-nine cases examined. Klebs found organisms-micro-organisms- 
micrococci or bacilli, in twenty-four cases examined by him. Koch found 
bacteria in half the cases which he examined; Meyer in eighteen, out of 
twenty-four; and Eberth in eighteen out of forty. The bacilli are said 
to be more numerous during the first twelve or fourteen days of sickness, 
and they are seldom met with in the fifth or sixth week; if found then 
they present evidence of having undergone retrograde change. 
The typhoid germ of Letzerich is a micrococcus, isolated, in colonies, 
or in chains, very dissimilar from those of diptheria and of infectious 
pneumonia, but which, by cultivation, may reach twice or three times the 
size of the micrococci of the last mentioned diseases. Klebs describes his 
bacillus typhosus as large-sized filaments of 50 mm. in length, and 0.2 mm. in 
breadth, without segments or ramifications. When the spores make their 
appearance, the filaments may reach 0.5 mm. in breadth. The spores are 
arranged in a line and very close together. Before they are formed the 
bacilli exist as short rods, as in the preceding figure. The morphological 
characters of the bacillus of Eberth are shown in figure I). When these 
bacilli are present in great numbers, they have the appearance of masses 
of micrococci. But when isolated from these masses, they are recognized as 
short, thick rods having rounded ends. With high powers many of the 
bacilli may be seen to contain two or three granules, which are probably 
spores. The rods are sometimes found in the juices scraped from the 
fleshy cut surface of a diseased lymphatic gland in chains of two or three 
elements. The characters by which these bacilli are recognized, are the 
rounded extremities, and the fact that they are not so deeply stained by 
the aniline dyes as are the putrefactive bacteria found in the same pre- 
paration. 
In addition to these bacilli, Eberth recognizes at least seven micro- 
organisms which he has met with in his microscopical studies, and which 
may be associated with them. But the bacillus with rounded ends is said 
to be peculiar to typhoid, and has not been found in a single instance out 
of twenty-four cases of intestinal disease of a different character, as tuber- 
culosis of the bowels, in which he has made a careful examination by the 
same methods. Similar negative results were obtained by Mayer in six 
cases of dysentery, and other diseases of the bowels. Koch is of the opin- 
ion that the bacillus of Eberth is the only one which has a specific relation 
to the disease. Coates of Glasgow, confirms Eberth as to the presence of 
the bacellus described by him, in a diseased lymphatic gland, removed 
from a case of typhoid, fatal on the ninth day. Crook has also found the 
bacillus in a case treated in the fever hospital of Leeds. 
The appearance of the brain in this case, brought forcibly to my mind 
the condition and appearance of this organ in a case which came underlay Case 827: 1861: Heart Clots. 
163 
treatment in the City Hospital of Augusta. This case with the drawings 
which I made at the time, is now presented as giving a good representation 
of the appearance of the heart clots in the preceding case. 
Case 827.-Fowler, age 55; occupation in early life, farming; height 6 feet; 
athletic, well-made man. Ten years ago, lost his right arm, and since this accident 
has been an inmate of the Augusta City Hospital. Habits intemperate. After an 
absence of several days, this man was brought to the hospital on the 1st of April, 
1860, in a miserable plight. The patient stated that he had during his absence, 
been confined in a " political pen " (this was election time for Mayor of the City of 
Augusta), and furnished with an abundance of bad drugged liquor. Says that the 
liquor after producing profound sleep, excited violent vomiting and he felt as if he 
had been poisoned. The patient says that he was " kept in the pen and supplied 
with drugged liquor in abundance, for two or three days, until he was carried to 
the poles and deposited his vote; " he was then brought to the hospital as he could 
render no further services to his country. .On the next day, his face and scalp pre- 
sented a brilliant red color, and was much swollen (his head was bald), and he was 
tormented by a severe burning sensation in the skin of the face and head. Tinc- 
ture of iodine, emolient applications and cold-water dressings, produced no arrest 
or amelioration of the erysipelatous inflammation, which affected the face, scalp 
and back of neck. Tongue dry and red, papillae enlarged, and of a brilliant scarlet 
color; root of tongue coated with brownish-yellow fur; bowels loose. Sulphate of 
quinine, stimulants and nutritious diet, with an occasional dose of some simple 
diuretic and purgative, as cream of tartar, were administered, but nothing appeared 
to arrest the disease, and the patient died on the 24th of April, the 23d day of the 
disease. His intellect did not appear to have been especially affected during his 
sickness. Twelve or fifteen hours before death, he appeared to be too feeble to 
speak. 
AUTOPSY FIFTEEN HOU.RS AFTER DEATH. 
The blood-vessels of the pia-mater were greatly congested with blood. When 
the skull-cap was removed, the blood was venous colored in most of the large 
veins. The blood-vessels were full, round and completely distended with blood. 
In one portion, there was a slight effusion of red serum under the arachnoid. 
The blood-vessels of the nutritive membrane of the spinal cord, as well as of 
the brain, were filled with blood. There were, however, no marks of inflamma- 
tion-no effusion of coagulable lymph, neither in the brain nor in the spinal cord, 
nor upon any of the cerebro-spinal membranes. The congestion appeared to be 
due in great measure to the gradual accumulation of the blood in those parts in 
which the circulation of the blood was sluggish ; as well as to certain obstacles to 
the circulation of the blood, developed during the last moments of life-heart clots. 
The heart contained clots which had evidently been formed before death. 
Heart.-Somewhat enlarged and presented marks of fatty degeneration. 
Lungs. -Superior portions of lung, pale, anaemic. . Inferior portions congested 
with blood. 
Abdominal Cavity. Liver.-Slightly paler than usual, but approaching the 
normal color and unusually free from disease, and especially from cirrhosis and 
fatty degeneration, considering the habits of this patient. 
Spleen.-Enlarged and softened, and with difficulty removed from the cavity 
of the abdomen. Weight of spleen, one pound. It presented upon the exterior a 
slate color, but not so deep as the malarial spleen. The pulp changed readily 
to the arterial hue when exposed to the atmosphere, and in this respect pre- 
sented a contrast to the malarial spleen. The mud of this spleen magnified under 
the microscope presented less alterations of fhe colored blood-corpuscles than is 
characteristic of the malarial spleen. 
Stomach.-Mucous membrane of the stomach greatly injected in many parts, 
presenting a brilliant punctated appearance. 
The red spots magnified were found to have their minute blood-vessels loaded 
with blood. 
Stomach entirely empty. The mucous membrane of the duodenum was more 
conjested than that of the stomach. Small intestines both upon the exterior and 
interior conjested with blood, and the mucous membrane presented very much the 
same appearance as the mucous membrane of the duodenum. 164 
Case 837: 1861: Heart Clots. 
The following Engraving represents heart elots from right auricle and ventricle: 
ENGRAVING NO. 13. 
Heart Clots {fibrinous concretion) from Nature, by Joseph Jones. 
(a). Portion attached to the column® carne® of right ventricle. 
(b). Portion attached to the column® carne® of right auricle. 
(cd). Branches extending into the pulmonary artery. 
The author has regarded the formation of heart clots, in malarial fever, 
of such importance that he has, upon various occasions, in his clinical 
lectures in the amphitheatre of the Charity Hospital of New Orleans, 
Louisiana, urged the consideiation of the mode of occurrence and symp- 
toms of this fatal complication, upon the consideration of the medical 
students. 
We reproduce the following outline of a clinical lecture on this sub- 
ject, delivered in the ampitheatre of the Charity Hospital, on the 29th of 
January, 1869, for whilst there are some repetitious of facts already 
recorded, the additional case, with the description of the heart clots, and 
the additional observations illustrating the relations of heart clots and 
malaria, render evident the utility of permanent preservation in this con- 
nection. 
HEART CLOT.* 
Dr. Joseph Jones exhibited to the class assembled in the amphitheatre, the 
viscera of a patient who had died suddenly from the effects of a fibrinous clot, 
formed in the heart during life, whilst the patient appeared to be in his usual 
health. 
The following is an outline of this interesting case: 
♦Outline of Clinical Lecture, delivered at the Charity Hospital, by Joseph Jones, M. D., 
Professor of Chemistry in the Medical Department of the University of Louisiana. NewOrleans. 
(Reported for the New Orleans Journal ot Medicine, July, 1869, p. 69.) Investigations by Joseph Jones, M. D. 
165 
Case 828.-Thomas L., native of Ireland, aged thirty years, laborer; during 
the past two years has been employed upon the railroads in Southern Texas, and at 
that time suffered with several attacks of malarial fever. Returning to New 
Orleans in August, 1868, and at this time was suffering with chills and fever. 
Entered Charity Hospital Ward No. 16, in the following month (October), and 
remained under treatment for the effects of chronic malarial poisoning until the 
28th of November, when he was discharged. During this period no disease of the 
heart was noticed, or suspected. Commenced work in a stable, but after a short 
period was attacked with diarrhoea, which compelled him to cease labor. The 
diarrhoea, however, appeared to be light, as the patient treated himself and did 
not call in medical aid. 
The diarrhoea was checked, and the patient was about to resume his labor, 
when he was seized on the 21st January with what he called a "chill," attended 
with difficulty of breathing. After a time the difficulty of breathing disappeared, 
and the patient, who was not confined to his bed, appeared to be relieved ; but on 
the night of the2-5th, was again attacked with "chill," attended with great embar- 
rassment of respiration. Entered the Charity Hospital the next day, January 
26th, 1869, bed No. 409. When seen at night, just after his admission, the respira- 
tion was hurried and embarrassed, and the lungs appeared to be greatly congested; 
the pulse was rapid and irregular, the action of the heart irregular and rapid, aud 
the face dark from venous congestion. 
The next morning. January 27th, Dr. Joseph Jones made a careful examina- 
tion of the patient, and diagnosed the existence of a fibrinoKS clot in the right side 
of the heart, and referred the congestion of the lungs, and of the venous system to 
the existence of the obstruction in the ciiculatory apparatus. The'opinion was 
also expressed that the case was hopeless, that drugs would exert but little effect 
upon its progress, and that the patient would die suddenly. 
The patient was a stout, muscular man, with full, well-developed limbs, and 
large capacious chest. The effects of malaria were strongly marked in his sallow, 
anaemic hue. Percussion revealed great congestion of the lungs, and some 
enlargement of the liver and spleen. The heaving, panting respiration, as the 
patient tossed from side to side, and incessantly changed his position, in his gasp- 
ings and struggles for breath, did not yield the characteristic symptoms of pneu- 
monia, when the ear was applied to the walls of the thorax. 
The peculiar and distressing dyspnoea was not caused by a check of respira- 
tion, for the respiratory murmur was audible enough, but by the arrest of the 
current of the blood in the lungs. 
The dyspnoea evidently depended upon the imperfect circulation of the blood 
through the lungs, the damming back of the blood in the venous system, and the 
imperfect supply of oxygenated (arterial) blood to the lungs, muscles and nervous 
centres. The left side of the heart being imperfectly supplied with blood, the 
arterial circulation is weakened ; the pulse is small and intermittent, and the sur- 
face of the body cold; or more correctly, the animal temperature was depressed 
from the diminished supply of oxygen. At the same time, the arrest of the circu- 
lation in the right or venous heart causes stagnation of the blood in the venous 
circuit, and this, together with the imperfect oxidization, was manifested in the 
purple, almost black hue of the lips, extremities and cheeks- 
To the diminished supply of arterial blood, to the muscles and great nervous 
centres, must be referred the general muscular prostration, and the continued rest- 
less motions. The cerebro-spinal system being imperfectly supplied with blood, 
the control and co-ordination of the muscles are to a great degree lost, and the 
phenomena resemble closely the convulsive movements during fatal and pro- 
longed haemorrhage. 
The action of the heart was tumultuous, irregular and thumping, and the 
sounds of the right auriculo-ventricular valve and of the pulmonary semi-lunar 
valves were muffled and suppressed by the fibrinous concretion. 
A blister over the region of the heart, and fifteen drops of the tincture of wild 
jessamine (gelsemium semper virens) were ordered. No rational grounds of hope, 
however, were entertained as to the benefit of these or any other remedial 
measures. 
The patient continued to grow worse; the dyspncea increased; the action of 
the heart became more tumultuous and irregular; the restlessness was progress- 
ively aggravated; the patient could obtain no rest, night or day; was compelled 
to maintain the sitting posture, and tossed his arms aoout and heaved his chest, 
and incessantly groaned and called for "more breath." 166 
Heart Clots in Malarial Fever. 
If the patient assumed the recumbent posture, the face became almost black 
from the congestion, and the struggles for breath were fearful. The patient, how- 
ever, retained some appetite for food, and was able to stand up, and even to walk 
a little. 
On the 28th. after eating his dinner, at 1 oclock P. M., the patient got up from 
his bed, walked a few steps and fell dead. 
The autopsy was performed early the next morning. 
The trunk and limbs were round and full and the muscles well developed. 
The lungs were congested with blood, but still they floated upon water; there 
was no softening of the pulmonary tissue, and no marks of pneumonic or pleuritic 
inflammation were discovered. 
A large, dense, light, yellow, firm, irregularly shaped fibrinous clot was found, 
firmly attached to the carnese columme and chordae tendineae of the right ventricle 
and extending through the auriculo-ventricular opening; it was attached to the 
valves and sent off branches which were firmly adherent to the muscular columns of 
the right auricle, and finally it sent off a long, ribbon-like, cylindrical concretion 
through the pulmonary artery, which divided and subdivided and followed the 
course, or rather the interior cavities, of the pulmonary arteries, in their larger 
ramifications through the lungs. Dr. Jones held up the entire heart and lungs by 
the attachment of the clot to the muscular columns of the heart and cords of the 
valves. 
The clot was composed of distinct fibrinous laminae, which could be peeled off, 
layer after layer, and throughout its entire structure was free from colored blood- 
corpuscles. (The clot was placed in alcohol and deposited in the Museum of the 
Medical Department of the University of Louisiana.) 
The left side of the heart was filled with dark fluid blood, but contained no 
fibrinous concretions. Nothing worthy of note was observed in the alimentary 
canal. The spleen presented a slate color upon the exterior, was somewhat 
enlarged, and contained hsematin and disintegrated blood-corpuscles. It was also 
softer, and contained dark splenic mud in greater proportion than is usual in the 
spleens of those who have not been subjected to the action of malaria. 
The liver presented a slate color upon the exterior, and a light bronze color in 
the interior. 
The changes of the spleen and liver appeared to have been of long standing, 
appeared to have resulted from the previous action of the malarial poison. 
Death, therefore, resulted in this case, undoubtedly from the formation of a 
fibrinous concretion in the right side of the heart. 
The first attachments of the fibrinous deposition, appeared co have been with 
and around the muscular columns, and valvular cords of the right auricle and 
ventricle, much after the manner in which fibrin is accumulated around the 
branches of twigs, in the process of whipping the blood after its abstraction from 
the living animal by bleeding ; and the clot after its first formation, grew by slow 
accretions, layer after layer, of fibrin being deposited, and the entire clot enlarging 
most in the direction of the current of the blood, and gradually making its way, 
by slow depositions, up along the pulmonary artery and its branches. 
As this case came under observation, only after the formation of the fibrin- 
ous concretion, within the cavities of the right side of the heart, it is impossible to 
determine to what extent this result was brought about by the action of malaria. 
The previous history of the case, as well as the results of post-mortem exami- 
nation of the liver and spleen, render it evident that this agent could not be 
excluded in the discussion of the probable cause of this sudden, distressing and 
rapidly fatal accident. No lesion of the heart or circulatory apparatus was found, 
which could in any manner explain the deposition of the fibrinous element of the 
blood, and the explanation must be sought elsewhere. 
It has been recognized by some pathologists, that certain symptoms and stages 
of acute inflammatory diseases, are attended with some risk of fibrinous deposi- 
tion. The deposition of fibrin is materially favored by the pre-existence of disease 
of the heart, either acute or chronic, as has been demonstrated upon more than one 
occasion, to the students of the University, during the present season. And in 
the records of medical cases will be found illustrations of the mode in which dila- 
tation of the heart, feebleness of its walls, and thickening and roughening of its 
valves, favors the formation of fibrinous concretions, especially when the circula- 
tion is sluggish, and the nervous and muscular forces depressed. 
As all acute, sthenic inflammations (pneumonia foremost of all), form favor- 
able pre-existing conditions for the formation of heart-clots, great light would 
undoubtedly have been thrown upon this case, if the first symptoms of this dis- 
eased state had been carefully and accurately investigated and recorded Investigations by Joseph Jones. M. D. 
167 
Malaria, by its effects in inducing sudden congestions, by its depression of the 
heart, and of the general and capillary circulations, and by its potent action on 
both the sympathetic and cerebro-spinal systems of nerves, tends to promote the 
formation of heart-clots, although there is an actual diminution of the fibrin in 
the blood during malarial fever. 
As early as 1790, Dr. Chisholm, in his " Essay on the Malignant Pestilential 
Fever, introduced into the West Indian Islands from Boullam, on the coast of 
Guinea, as it appeared in 1793, 1794, 1795, and 1796," describes a form of malarial 
fever, in which there was a most marked tendency to the deposition in the blood 
vessels of the fibrinous element of the blood. 
Dr. Chisholm even entitles the fever as " The Epidemic Polypus," at Gre- 
nada, in 1790. 
Dr. Chisholm described the town of Grenada as peculiarly situated. In the 
foreground lay the sea, perfectly open, with the extensive and burning beach of 
sand; on the left a hill of considerable and steep ascent, the base sides of which, 
in conjunction with the reflecting surface of the sea, produce in dry seasons an 
immense degree of heat. On the right the view was limited by a mountain of 
great height and magnitude ; in the background a marsh extended from the sea to 
the mountains, and formed chiefly by water rushing from a narrow stony ravine, 
and dammed up by a beach rendered impenetrable by the surge ; from this marsh 
vapors of a very deleterious nature continually exhaled ; and this was particularly 
observable in the month of October of the year 1790, in which the " epidemic poly- 
pus " prevailed, on account of the treesand brush wood which had hitherto covered 
it being cut away in order to drain the marsh. 
Immediately behind the marsh the ravine begins and runs back between the 
hill and mountain in the form of a funnel, gradually rising for upwards of a mile. 
The negro houses of the plantation were built on the left, chiefly on its slope, 
and towards the edge of the marsh. The negroes were consequently at once 
exposed to excessive heat, a cold, chilling current of air and the miasma of the 
marsh. Their diet was chiefly composed of vegetable food. They had been 
exposed immediately before the appearance of the disease in question in cleaning 
the surface of the marsh, and in hoeing land for the reception of cane plants. Like 
all other negroes placed in similar situations (marshy), they were much given to 
the destructive habit of eating a species of pipe-clay, very abundant in Grenada. 
Dr. Chisholm describes the disease as making its appearance in the plantation 
of Grand-mal, about the end of September or beginning of October; was most pre- 
valent towards the close of the latter months and disappeared totally in Novem- 
ber. The whole number of sick was about fifty, of whom seven died ; that is nearly 
one-fifth of the sick died. 
The disease in its commencement was marked by no distinguishing symptom; 
but soon after the patient complained of pain at the pit of the stomach and in the 
head, and difficult respiration. These pains were attended with a dry skin, small 
quick pulse and slight frequent dry cough. No febrile heat accompanied these 
symptoms; on the contrary, the surface was at this period remarkably cool; but a 
heaviness and dullness of the eye, a melancholy depression of spirits and features 
strongly expressive of anxiety were constant attendants. 
The state of the patient was thus characterized for three days. At the expira- 
tion of that period the pulse became extremely quick, 120 to 140, and intermittent, 
attended with a penetrating pungent heat, which produced a pricking sensation in 
the hand of the person feeling the pulse'. But this state of the pulse and heat, as 
well as the pains, anxiety and other distressing symptoms, now also intermitted, 
or rather the disease assumed something like an intermittent form, the intermis- 
sion, if it may be so called, continuing eight or nine hours. During the paroxysm 
the struggle for breath, the aggravation of all the other symptoms and the very 
quick, interrupted, and evidently visible as well as audible palpitation of the 
heart, produced a sense of uncommon horror. The paroxysm was succeeded by a 
cold clammy sweat and a state of approaching syncope. The second paroxysm 
generally put a period to the existence of the patient. The disease was also distin- 
guished during the latter stage, and even for some time previous to its commence- 
ment, by a constant, or almost constant, disagreeable clammy sweat, overspreading 
the face, the upper extremities of the body, as low down as the scorbiculus cordis, 
all below remaining arid and parched in a most remarkable degree. 
The disease seemed sometimes inclined to terminate by metastasis; oneinstance 
of this was remarkable, wherein a spontaneous absorption of the lymph deposited 
in the heart, and a deposition of it in the left arm and left thigh took place. The 
patient, in this case, after laboring under all the symptoms peculiar to the disease, 168 
Heart Clots in Malarial Fever. 
before the intermittent period, found himself all at once, and without an evident 
cause, relieved of them ; but he perceived at the same instant an excruciating pain, 
a little above the elbow, and nearly about the middle of the thigh. He continued 
ever after absolutely free of all the symptoms of the polypus, but they were suc- 
ceeded by a large abscess in the parts in which he felt the pain. That in the arm 
disappeared gradually, but the other became so large, as to occupy the whole of the 
under part of the thigh. The cure was effected, by passing a seton through the 
whole length of the tumor; by the use of two dozen of Madeira wine, a large 
quantity of bark, and a calomel pill, with opium, three times a day. The audible- 
ness of palpitation may be considered as exaggeration ; but in one instance parti- 
cularly, the gentleman (Mr. McSween) to whom the negroes belonged, heard 
distinctly the palpitation, although in an adjoining room. 
Having no suspicion of the heart being the seat of this uncommon malady, Dr. 
Chisholm did not examine that organ in the two first bodies he opened ; but find- 
ing all the other viscera, and the brain in a state of health, he found himself unable 
to account for the extraordinary symptoms the patients had been afflicted with ; 
until on opening the third body, he examined the heart, and discovered what he 
considered to be the cause of the seat of the disease. 
In the right ventricle of the heart, Dr. Chisholm found a polypus, which 
extended considerably into the pulmonary artery. On extracting it, it measured 
exactly two feet and two inches in length, and the body contained, in the ventri- 
cle, two inches in breadth. 
In the fourth body, there was a very large polypus in the right and left ventri- 
cle, besides one in the right auricle. The hearts of the fifth, sixth and seventh, 
were circumstanced precisely similar; and in five, except one where the lungs were 
morbidly affected, no other morbid appearance of any description could be per- 
ceived. 
Dr. Chisholm concluded that these extraordinary circumstances justified the 
appellation-" Epidemic Polypus." 
As to the treatment, the moment Dr. Chisholm could distinguish the disease, 
he bled, in order to render circulation through the lungs and heartless difficult and 
obstructed. This evacuation was never repeated without great caution, and the 
most evident necessity. After this he gave calomel in doses of five grains, guarded 
with opium, every fourth hour, and continued until salivation was excited. 
Under this treatment, Dr. Chisholm affirmed that he lost not a single patient, 
the fatal termination having taken place before he could carry it fully into execu- 
tion. 
Dr. Jones has himself observed, carefully noted, and recorded a number of 
cases of malarial fever, in which heart-clots were formed before death, and he illus- 
trated this important subject by the following cases investigated by himself: 
Case 829.-In the latter part of September, 1857, an Irish laborer, who had 
suffered from a severe attack of bilious remittent fever, contracted in the low malari- 
ous rice lands around Savannah, Georgia, and who although feeble was convales- 
cent, was suddenly seized during a cold change in the weather, with difficulty of 
respiration, loss of muscular and nervous force and complete prostration. 
The lungs were greatly congested, the respiration spasmodic and embarrassed ; 
the patient lay upon his back without power to turn upon either side; the surface of 
the trunk and extremities felt cold ; the expression of his eyes and countenance, 
and his efforts to converse, showed that the patient was intelligent, but he was 
entirely unable to articulate or expectorate. Sinapisms, diffusible stimulants and 
quinine, although administered freely, did not produce any beneficial effects-they 
failed to arouse the circulation, and did not increase the animal temperature, 
because the supply of oxygen necessary for the chemical changes which generate 
the physical, muscular and nervous forces were cut off. The mustard scarcely red- 
dened the skin, even after the application of several hours. 
The patient gradually sank and died in thirteen hours after this sudden and 
remarkable change. 
The autopsy performed eight hours after death, revealed the following points : 
The body was in good condition and not emaciated, with full and round limbs, 
covered by a thick layer of fat. The structures of the brain and spinal cord, pre- 
sented the usual consistence and appearance. 
The heart was normal in size and structure. The right ventricle contained a 
light-yellow, large fibrinous clot, attached to the chordae tendineae, and carneae col- 
uinnae, and extending through the auriculo-ventricular, opening into the auricle. 
This clot was firm in texture, and weighed one ounce. Investigations by Joseph Jones. M. D. 
169 
The left ventricle contained a small light-yellow clot; the aorta also contained 
a small, flattened ribbon-like, light yellow clot. These clots were evidently 
formed previous to death. 
The lungs were greatly inflated, and did not collapse in the slightest degree, 
when air was admitted into the pleura. These organs were congested with blood, 
and resembled in appearance liver, and when handled they were remarkably 
heavy, and felt more like liver than lungs. When cut, the air cells and large and 
small branches of the bronchial tubes, were found filled with serous fluid, and 
numerous bubbles of air. When the lungs were squeezed, pints of this serous 
fluid flowed out. In many portions of the lungs, the serous fluid was clear; in 
others it was reddish. The fluid resembled serum in all respects, and was not mucus 
Alimentary canal presented a healthy appearance. 
The liver and spleen exhibited the characteristic effects of the action of the 
malarial poison. Both these organs appeared to be recovering from the effects of 
the malarial fever. 
Case 830.-Observed in the same locality, and about the same time; the patient, 
a tall Irishman, aged 30 years, of irregular habits, and greatly exposed to the action 
of the malaria, along the banks of the river, after suffering nearly three weeks with 
malarial fever, suddenly grew worse, with a feeble, rapid pulse, 160 per minute, 
and spasmodic, labored respiration and wandering intellect. 
The forces progressively failed, and the patient died in about ten days after the 
manifestation of the disagreeable symptoms. 
The cerebro-spinal system presented no recognizable lesions. The spleen and 
liver exhibited the characteristic lesion of malarial fever. The lungs resembled the 
congested state described in the preceding case, with the addition of recently 
formed plastic lymph upon portions of the pleura. During the last attack the 
patient had complained of some pain in his side. 
All the cavities of the heart contained golden-colored clots. 
The right auricle had a large golden-colored clot, which was attached to the 
carnese columnie, and chordae tendineae of the auriculo-ventricular valves. The 
aorta, carotids and pulmonary arteries contained elongated, golden-colored clots, 
having diameters nearly equal to those of the auricles. All these clots were firm 
and elastic. 
As far as the observations of Dr. Jones extend, the formation of heart-clots 
during life, is very common in malarial fever. 
In fifteen post-mortem examinations, he found heart-clots in ten cases, and of 
the remaining five, one was a case of typhoid fever, combined with remittent fever, 
another was a case of malarial fever of long standing, where the patient died of 
exhaustion, and in the remaining three, no special examination for heart-clots was 
instituted. 
The following cases, in addition to the two just reported, will illustrate the symp- 
toms attending the formation and existence of these heart-clots. 
Fatal case (No. 831) of congestive fever, terminating suddenly. Fibrinous con- 
cretions in the heart and pulmonary blood-vessels and aorta. Irish laborer; height 
five feet ten inches, weight, one hundred and fifty pounds; black hair, black eyes, 
dark complexion, resembles the Arab in appearance. 
September 2, 1857, twelve o'clock, M., has been sick at the Bay, for ten days, 
with an abscess in the palm of the hand ; previous to this, he had been working on 
the banks of the Savannah River. When first brought (this morning) into the 
hospital he appeared stupid, and urinated in the bed. After the administration of 
a hot-bath, and the lancing of his hand, he was aroused, and now appears to be 
entirely restored to the exercises of his intellect. Seems to be very weak and com- 
plains of no pain or trouble anywhere, except the palm of his hand. Skin not 
warmer than usual; tongue dry, red and glazed, and harsh and rough to the touch; 
pulse 82. 
Continued sensible, and apparently convalescent, and complained of nothing, 
and manifested no striking phenomena until Septembers, at half-past three o'clock, 
P. M. 
At this time I was summoned hastily, and found the patient insensible, with 
his mouth open, and groaning loudly at every breath. His groans sounded very 
much like the barking of a dog. 
Countenance distressed, anxious and expressive of great agony, tendons 
twitching violently ; teeth coated with sordes; tongue dry, red and glazed, and 
harsh to the feeling. Respiration 40, thoracic and panting ; pulse 104 ; temperature 
of the hand 103° F.; skin hot, dry and rough. When the attempt is made to arouse 
him, by violent shaking and loud talking, he mutters incoherently. Great ten- 170 
Heart Clots in Malarial Fever. 
derness upon pressure of epigastrium; cries out whenever this region is pressed. 
Cups to the temples and back of neck, a large blister over the epigastric region- 
sinapisms to the extremities, stimulants, and sulphate of quinia, all failed to arouse 
this patient, and he died twenty-four hours after this observation. 
There was but little change in the symptoms, with the exception of an 
increase in the frequency of the respiration and pulse. 
Autopsy three hours after death: Head.- When the skull-cap was removed, 
the dura-mater presented the usual appearance. Serous effusion had taken place 
between the dura-mater and the membranes, and the surface of the brain ; 
and there had been an effusion of golden-colored serum between the arachnoid and 
pia-mater. Blood-vessels of the pia-mater filled with blood. Blood-vessels at the 
base of the brain, and upon the medulla oblongata and spinal cord more engorged 
with blood than those upon the superior portion of the brain. This appeared to be 
due to the effects of gravity. The substance of the brain possessed the usual con- 
sistence, and appeared to the naked eye to be normal in structure. 
Chest.-Lungs normal; trachea tilled with froth. 
Heart.-Normal. The right auricle contained a large golden-colored clot, 
which filled almost the entire cavity. The left auricle contained several small 
yellow clots. The right ventricle contained several small clots of blood, which 
resembled in all respects coagulated blood. 
The main trunk of the pulmonary arteries contained a long, flattened, ribbon- 
like, yellow clot, which extended not only through the large trunk, but divided 
and sent off branches to each branch of the pulmonary artery; and then again 
subdivided and sent branches off to the minor branches of the arteries. When 
the main clot in the pulmonary artery was gently pulled, the branches were drawn 
out, twelve inches in length, and at their extremities were not much larger than a 
fine silk thread. The clot was almost entirely free from red corpuscles, of a yellow 
color, firm and elastic in structure, and in appearance resembled an organized 
product. 
A similar ribbon-like, yellow, elastic clot, extended through the whole length 
of the aorta. The blood in the vena-cava was coagulated, but the coagulum was 
like that of ordinary blood, and much less firm than the clots of the right auricle, 
pulmonary arteries and aorta. 
Abdominal Cavity.-The liver presented the true malarial hue; contained no 
grape sugar, but an abundance of hepatic starch; and its blood did not change to 
the arterial hue when exposed to the atmosphere. The spleen was enlarged, soft- 
ened, and of the slate-color of malarial fever. 
Stomach, intestines and kidneys normal. 
The autopsy demonstrated this to be a case of malarial fever. 
831.-Case of congestive fever illustrating the formation of fibrinous coagula in 
the heart and blood-vessels. 
Irish seaman, aged 24: light hair; light blue eyes; fair complexion; height 
five feet seven inches ; stout; well built; weight one hundred and fifty pounds. 
October 12th, 1857, 12 o'clock M. Entered the hospital two hoursago. Now 
he is out of his head, and can give no history of his case. A companion states that 
he has been watching at night on board a brig, lying in the river, below the ship- 
yard, along the low marshy shore of the Savannah river, and that he was taken 
sick with chill and fever one week ago, but did not until two nights ago, discon- 
tinue watching at night. Habits intemperate. 
Pulse 137, rapid and feeble; respiration 32; skin hot and dry. Tip of tongue 
clean, and of a bright red color-the remaining portion of the tongue is coated 
with yellow fur. The tongue is dry and harsh to the touch, and feels, when the 
fingers are passed over it, like sand-paper. The patient mutters to himself con- 
tinually half-formed sentences and imperfect words. Continues to mutter in the 
same incoherent manner, notwithstanding strenuous efforts to arouse and attract 
his attention. About one hour ago his extremities felt cooler, and his pulse was 
more feeble than it is now; mustards were applied to the extremities-they 
increased the temperature and rendered the pulse somewhat fuller, and aroused his 
intellect for a moment, but he again relapsed into the state of delirium. 
Mustards to the epigastrium and extremities, cut cups to the temples and back 
of neck, stimulants and sulphate of quinine and purgatives failed to arouse the 
intellect, and at 8 o'clock P. M. the patient lay in a profound stupor, with full 
rapid respiration and full rapid pulse. Pulse 124, and has increased in force and 
volume under the action of the stimulantsand sulphate of quinia. Skin hot and 
dry; tongue presents the same dry and rough appearance. R -Continue the 
stimulants and sulphate of quinia, and apply blisters to the back of the neck and 
over epigastric region. Investigations by Joseph Jones. M. D. 
171 
13th, 11 o'clock A. M. The cut cups to the head, the sinapisms upon the 
extremities, the blisters upon the back of the neck and epigastric region, and the 
diffusible stimulants and cathartic have failed to arouse this patient, and he now 
lies in a comatose state, and passes his urine and faeces in bed. The nurse states 
that during the night he was much more restless than at present, and it was neces- 
sary to give constant attention that he did not fall out of bed. The medicine 
operated freely, and the blister has drawn well. The serum from the blistered 
surface is of a golden color. 
Respiration thirty, stertorous. The patient lies in a stupor, with his eyes shut 
and mouth open, and emits a suppressed groan or whine, at every breath; his 
appearance, and the sounds which he emits, are similar to those of the patient 
described in the preceding case. These groans appear to be entirely involuntary, 
and depend upon the state of the organ of voice, and the mode in which the air 
passes through it. 
Pulse 144, feeble; the sounds of the heart cannot be distinguished-they are 
both united into one, and the heart makes a short, quick, thumping sound; the 
number of the thumps of the heart correspond to the pulse, 144 to the minute r 
temperature of atmosphere, 77° F.; temperature of hand, 103.5; skin hot and dry; 
teeth coated with sordes ; cannot get a sight of his tongue, as his teeth are tightly 
closed, and he is entirely insensible. 
T have just applied mustards to his extremities ; they do not arouse him ; after- 
remaining on one hour they scarcely redden the surface. 
9 P. M. Profound coma; respiration thirty; low, spasmodic; pulse is gone; 
heart merely flutters; head and trunk warm; extremities cold ; have again applied 
mustards to the extremities but they do not produce the slightest effect, and he will 
die in the course of one hour. 
The patient died half an hour after this observation. 
AUTOPSY TWELVE HOURS AFTER DEATH. 
Body in good condition, apparently not at all reduced ; limbs full and round,, 
muscular, well developed ; complexion fair, with a slight tinge of yellow ; skin of 
the dependent portions slightly darker than that of the superior portions of the 
body ; rigor-mortis, remarkably strong. 
Head.-Dura-mater normal in appearance; the longitudinal sinuses of the dura- 
mater contained an elongated, flattened, ribbon-like fibrinous clot, which was free 
from colored corpuscles, and of a yellow color. This, without doubt, was formed 
before death. The substance of the brain appeared to be normal in color and 
texture. 
Chest.-Exterior surface of the heart adherent at all points to the pericardium.. 
There was no free space between the heart and the pericardium, hence no fluid 
lubricated the heart. If this lesion was the result of inflammation, it is certain 
that the inflammation had nothing whatever to do with the present attack of fever. 
Muscles of the heart paler than usual. The right auricle and ventricle contained a 
yellow clot, free from colored blood corpuscles, which was attached to the columnee- 
carnese and chordae tendinese of the right ventricle, and extended through the 
auriculo-ventricular opening into the auricle. This clot sent oft a large branch 
into the pulmonary artery. This branch of the yellow fibrinous clot, which almost 
completely filled up the pulmonary artery divided and sent branches down the 
right and left pulmonary arteries, and these branches again divided and sub- 
divided into numerous branches, the smallest of which were not larger than fine 
thread. These fibrinous threads passed deep into the blood-vessels of the lungs, 
probably almost to the commencement of the capillaries. The left ventricle con- 
tained a similar yellow fibrinous formation almost entirely free from colored blood- 
corpuscles which was attached at one extremity to the columna? carneaj, and chor- 
dae tendineae, and extending through the auriculo-ventricular opening into the- 
auricle, subdivided into branches, which passed up the pulmonary veins, and sub- 
divided into numerous smaller branches, weich occupied the smaller divisions of 
the pulmonary veins. These fibrinous bodies of the pulmonary veins and arteries 
were very elastic-with care they could be drawn out of the smaller branches of 
the pulmonary veins and arteries, four and six inches in length, without breaking, 
notwithstanding that the smallest branches were very delicate. The aorta con- 
tained a similar clot. All these clots were of a bright yellow color, almost entirely 
free from colored blood-corpuscles, and presented almost an organized appearance, 
and were without doubt formed long before death. 172 
Heart Clots in Malarial Fever 
The large venous trunks were distended with partially coagulated black blood ; 
the heart, arteries and pulmonary veins contained little or no blood. 
When the black blood from the large venous trunks was exposed to the atmos- 
phere. it assumed slowly and imperfectly the arterial hue. The blood appeared to 
have been collected in the capillaries and veins. If the chemical changes between 
the colored blood-corpuscles and liquor sanguinis, and between the blood-corpus- 
cles and the capillaries, and the structures and fluids surrounding the capillaries be 
arrested, as a necessary consequence the circulation of the blood-corpuscles through 
the capillaries might be greatly interfered with. 
Lungs.-Normal in appearance and structure; lower (dependent) portions 
congested with blood. This was due to the action of gravitation. The tracha, 
bronchial tubes and air cells contained much froth. 
Abdominal cavity.-Alimentary canal presented nothing abnormal. 
Liver.-The liver presented a much darker color upon its exterior than usual, 
but not the dark-slate color of cases of malarial fever of longer standing. This organ 
contained animal starch, without a trace of grape sugar. 
Spleen.-Enlarged, softened, disorganized, and of a dark-slate malarial color; 
when pressed between the fingers, the trabiculae could be felt giving away. The 
dark effused blood of the spleen, was found, under the microscope, to consist of 
colored and colorless corpuscles and dark granules; some of the colored corpuscles 
were swollen, and altered in shape. The alteration was by no means universal or 
remarkably great. 
Kidneys.-This subject had but one kidney; this corresponded to the right 
kidney. With the exception of a slate-colored spot upon its inferior surface, the 
kidney presented nothing unusual. 
After a careful examination of the symptoms and pathological alterations pre- 
sented by these tw'o cases of congestive fever, it appears that, with the exception 
of the heart clots, we do not discover any pathological changes of the cerebro- 
spinal nervous system, and of the organs, which of themselves would account for 
the sudden severity of the symptoms, or the death of the patient. 
As far as an examination with the eye extended, no structural alterations w*ere 
discovered in the structures of the brain, sufficient to account for the sudden and 
alarming symptom of delirium or coma. 
Whatever were the alterations of the nervous elements in these cases it was 
evident that they could not be reached by the most energetic and vigorous treat- 
ment It was impossible to arouse the action of the brain, notwithstanding that 
there was no inflammation, and only that congestion of the blood in the capillaries, 
which resulted from the feeble action of the circulatory apparatus, the disturbance 
of the relations of the blood and capillaries, and the alterations of the constituents 
of the blood. 
It can not be thought that the condition of the spleen in these cases was suffi- 
cient to cause death, because cases have been seen where sudden death occurred 
from other diseases during convalescence from malarial fever, in which the spleen 
was apparently in a worse condition. 
The same remark applies to the alterations of the liver; as far as our examina- 
tions extended, they do not appear- to have been sufficient to cause death. The 
stomach and intestinal canal presented no special pathological alterations. 
Can we, then, from this analysis of the pathological phenomena, infer that the 
immediate cause of death did not exist in the pathological alterations of the organs 
and tissues, but in the disturbances of the general and capillary circulation, and 
especially of the function of the lungs, by the fibrinous coagula in the cavities of 
the heart and in the blood-vessels? 
A careful comparison develops a close resemblance between the symptoms of 
concretions of fibrin in the heart and blood-vessels, and many of the symptoms of 
the cases of congestive malarial fever were recorded. 
In view of the rapid, feeble intermittent pulse; disturbed, full, panting respi- 
ration ; rapid feeble, fluttering action of the heart; cold extremities, exhaustion of 
the muscular forces, stupor, wandering of the intellect, inability to control the 
muscles and acts of excretion ; in view of the sudden onset of all these symptoms 
in malarial fever; in view of the size and structure of the coagula found in the 
heart and blood-vessels after death, in the cases presenting these symptoms; in 
view of the close correspondence of these symptoms with those characteristic of the 
deposition of fibrin in the heart and blood-vessels; in view of the observations of 
various physiologists and pathologists, we are justified in asserting that the fibrinous 
element of the blood, may be deposited in the heart and blood-vessels during life, 
in malarial fever, and not only give rise to a distinct set of phenomena, but cause 
death in eases which otherwise would not have terminated fatally. Investigations by Joseph Jones, M. D. 
173 
Dr. Jones concluded his lecture with the statement that the full discussion of 
the origin and pathology of heart-clots, involved the physiology of the coagulation 
of the blood and the effects of fibrin, and the relations of the solids to the blood. 
This complicated subject could only be treated with profit in lectures devoted 
specially to this subject. 
SYMPTOMS AND DIAGNOSIS OF FIBRINOUS CONCRETIONS IN THE 
HEART AND BLOOD-VESSELS. 
In order that the connection of these heart-clots with the phenomena 
of malarial (ever may be placed in the strongest light, we will illustrate 
this branch of our subject by the valuable observations of an able and 
experienced observer and experimenter. 
Dr. Benjamin Ward Richardson thus describes the symptoms aud diag- 
nosis of fibrinous concretions in the heart, in his model work on the cause 
of the coagulation of the blood:- 
The symptoms produced by fibrinous deposition in the heart, are strikingly 
characteristic when they are once understood. But as they are commonly super- 
added to other symptoms, and appear at the acme or near the end of a disease, they 
occasion great perplexity to all who are not prepared to read them off, and whose 
attentions are bent to some more local mischief, by which the disease perchance 
is misnamed, rather than to the grand changes which are occurring in the body 
as a whole. 
Whatever be the disease, the effects of a fibrinous deposition are in the main 
the same, according to the manner in which the deposit itself is laid down. In 
other words, the symptoms depend on the position, form and character of the 
deposit, less than on the pre-existing malady. Whenever fibrinous deposition 
takes place in the heart during the course of a disease, the pure symptoms of the 
disease are lost or masked by the new symptoms which are set up, and which take 
to themselves a general representative position. 
The advantages which I have had for tracing out the symptoms produced by 
concretion, aud for confirming, by dissection, the diagnosis instituted, have been 
confined mainly to cases where active inflammatory mischief (hyperinosis) has 
been the forerunning disorder. I write, therefore, from these sources of natural 
information. 
All symptoms of acute inflammatory diseases are attended with some risk of 
fibrinous deposition. Taking the majority of such cases, the risk is certainly 
small; but itis present in each case, and what renders the risk more serious is, that 
such risk or tendency to deposition cannot be measured by the local indications of 
inflammatory mischief in any given case, nor yet by the general symptoms which 
accompany the local. The symptoms of concretion may intervene in the mildest, 
as well as in the severest cases. They may creep on insidiously ; they may take 
effect in a sudden and unexpected outbreak. The following is an outline of a case 
in which the sy mptomsare unexpected. I write as 1 have seen, and as others have 
seen. A patient is suffering from an acute inflammatory attack. The local mis- 
chief, be it pneumonia, bronchitis, erysipelas, peritonitis, rheumatism, is not in 
itself such as to cause immediate alarm. The symptoms go on from visit to visit, 
and the patient is left on one of these occasions, not apparently in imminent dan- 
ger. Unexpectedly there is a sudden call for the practitioner. He goes, and in 
the universal change that has occurred, he reads off the death signals. The man 
will sink. The fact, as it is written in the patient, is not to be described in words, 
but is easily learned from experience; it is written in the face of the sick man, in 
the restlessness, in the expression altogether. Whoever knows disease, knows at 
once, without further comment, what I mean. It is my business to show how far 
this finale of inflammatory disorders results from fibrinous deposit, and to indicate 
how the symptoms, when studied in detail, yield the diagnosis of concretion. 
If my observation of the last symptoms, and of the pathology of the cases 
thus referred to, be correct, the origin of the symptoms is connected with obstruc- 
tion on the right side of the heart in the majority of instances. The obstruction 
may be on the left side ; but the occurrence is comparatively rare, and the symp- 
toms themselves are modified in detail by the difference in the point of obstruction. 
Taken generally, the symptoms of fibrinous obstruction on the right side are those 174 
Heart Clots in Various Diseases. 
which might be anticipated, on a priori physiological reasoning, as necessarily 
incident to obstruction of blood-making towards the pulmonic circuit. They are 
the symptoms of arrest in the nutrition and life of the body. They are character- 
ized primarily by a peculiar and distressing dyspnoea. This occurs, not because 
the respiration is checked, for the respiratory murmur may be audible enough, 
but because the current of blood to the lungs is in part cut off'. As an adden- 
dum, emphysema of the lungs, especially in children, results; and the physical 
signs of this lesion are often a valuable corroboration of the presence of concretion 
of the right side. The dyspnoea depends on the deficiency in the supply of blood 
to the lungs and the nervous centres. The left side of the heart being imperfectly 
supplied with blood, the arterial circulation is weakened; the pulse is small and 
intermittent; the surface of the body is cold, and generally white as marble : but, 
as there is stagnation of blood in the venous circuit, the more vascular parts, as 
the lips and centre of the cheeks, are often of a leaden hue. There is general mus- 
cular prostration ; and, as the brain is not supplied normally with blood, the mus- 
cles are not under the control of the will, but are in a continued restless motion. 
The mind loses its power ; the acts of excretion are performed involuntarily ; and 
death sets in, the gasping respiration outliving the paralyzed and obstructed heart. 
The symptoms thus portrayed are applicable to cases in which they last for 
several hours ; in such examples the concretion is either lodged in the right auricle, 
or is being laid down as a tube in the infundibulum and pulmonary artery, or is 
commencing at the extremities of the pulmonary circulation. But other cases 
occur, where the course of the symptoms is suddenly cut short. There may have 
been some slight premonitory symptoms, but the suddenness of the end is the 
great fact. The patient, previously exhausted, is rising in bed, or making some 
muscular movement or strain, when suddenly he reclines or falls, breathless, faint, 
feebly convulsed, dead. I have met with two illustrations of this last event. The 
cause in both cases was the same, and the cause is ordinarily the same ; the pul- 
monary artery is suddenly blocked up with a fibrin cylinder. In each of these 
cases, observed by myself, this cylinder has been hollow, and had conveyed a 
stream of blood like a tube. Its base had commenced in the infundibulum; its 
apex had ascended into the pulmonary artery. The concretion had been suddenly 
torn from its attachments, a nd* carried up into the artery. In its centre was a 
column of red clotted blood ; externally it was encased in a thin layer of blood, the 
result of a rush of blood past the concretion after its detachment. 
Once more, there are instances where the symptoms are unusually prolonged. 
In one instance which I observed, the symptoms of dyspnoea extended over many 
days, and anasarca supervened as a result of the obstruction. The concretion in 
this instance commenced in the auricula, where it had a firm attachment, and 
sent a prolongation downwards into the ventricle. In the case supplied by Dr. 
Sayer the symptoms of dyspnoea extended over many months; and Mr. H. Lee 
has recorded an instance in which a similar extension of symptoms occurred. 
When the concretion is deposited on the left side of the heart, the ventricle, 
the infundibulum, and the ascending portion of the aorta are the most common 
positions. The symptoms which characterize the presence of concretion here situ- 
ated are different in many respects from the preceding. There is a tumultuous 
action of the heart, a symptom which is strikingly indicative that the deposit is on 
the left side. There is congestion of the lungs and suffocative dyspnoea, with 
expectoration, sometimes mixed with blood. The surface of the body is of a leaden 
color, and the body is cold. The muscular perturbation lapses into powerful con- 
vulsions, and coma precedes dissolution. These symptoms may extend over many 
hours. 
I But, as in the preceding class of cases, the symptoms may also occur in a sud- 
den manner. The patient, in moving or making a straining effort, suddenly falls 
back, is seized with a violent convulsive fit, and so expires. I once saw these 
symptoms and this sudden form of death in an old lady, who had previously 
suffered from no other symptoms than a slight attack of cold. In rising from bed, 
she fell, as I have described, and died before medical assistance could be obtained. 
In this case the concretion had formed as a hollow cylinder in the infundibulum 
of the left ventricle, had become dislodged, and had been carried into the aorta, 
which it entirely occluded. 
Again, the symptoms of the concretion may extend over a long period. The 
concretion may, as I have shown, become organized. In such case the symptoms 
are those of valvular obstruction on the left side. Such cases often end suddenly 
al last. Cases may be met with in which concretions exist on both sides of the 
heart at the same time. In such instances, unless the concretion on the right side Fibrinous Concretions in the Heart and Blood-Vessels. 
175 
be small, or placed outof the direct courseof the circulation, the symptoms partake 
of the characters which belong to deposition in the right cavities. 
The pre-existence of disease of the heart, either acute or chronic, favors materi- 
ally the deposition of fibrin. We have seen in acute endocarditis how this obtains. 
Tt is easy to see, and cases abundant are on record for illustration, to what extent 
dilatation of the heart, feebleness of its walls, or induration of its valves, favors 
the formation of concretion. 
[have often been asked whether there are no reliable physical diagnostic signs 
of concretion. 1 think not. There are sometimes abnormal sounds, but it is diffi- 
cult to distinguish these from murmurs, the results of valvular lesion. The tumul- 
tuous action of the heart, taken w ith the general symptoms, is always a valuable 
diagnostic mark of concretion of the left side; but this is compatible with other 
diseased conditions. The weak, irregular action is, with the general symptoms, 
always a valuable diagnostic sign in concretion of the right side; but it is equally 
compatible with other causes. In some cases, where the concretion interferes with 
the action of either the auriculo-ventricular or semi-lunar valves, there is a muffled 
character with the sounds, dependent on the obstacle to the play of the valves by 
the tension of which the sound is produced. But as it is scarcely ever the fact that 
both sets of auriculo-ventricular valves, or both sets of semi-lunars, are affected 
simultaneously by concretion, loss of either sound is of rare occurrence. In short, 
the only physical signs of moment are, feebleness of action, tumultuous action, or 
occasionally a peculiar rumbling, fidgety, jog-trot motion, with which the two 
sounds are heard in natural sequence as regards each other, but irregularly and 
lispingly. The diagnosis must, therefore, rest upon the general symptoms, rather 
than on the physical. The nature of the case must be considered. All acute sthenic 
inflammations form favorable pre-existing conditions ; pneumonia foremost of all. 
The puerperal state is second to none in this particular, and the symptoms of con- 
cretion are often as insidious as they are sudden. 1 do not speak here of puerperal 
phelebitis, and of deposits in the veins, but of cases where there has been no out- 
ward sign, either during pregnancy or after parturition, and where the woman sud- 
denly succumbs, without any preliminary indication of acute disease. In these 
instances, unattended with pre-existing changes in the venous trunks, or evidence 
of inflammatory lesion, we can only, in the present state of our knowledge, assign 
as a cause of the deposition excess of fibrin in the blood, arising from absorption 
of the thickened uterine walls, or suppressed lacteal secretion, or neutrality or 
deficiency of the fibrin solvent. I have more than once seen a sharp inflammatory 
attack, without direct evidence of organic inflammation, end fatally by the depo- 
sition of concretion. Many cases of so-called "simple inflammatory," or perhaps 
" continued fever," are of this character. After death it is found th at th ere has 
been an inflammatory affection of some organ, butthat such affection has not been 
diagnosed. In these examples the spleen is often the organ which has suffered the 
local lesion, but the symptoms have not been sufficient to be readily detected 
during life. 
By some observers, who admit that the fibrinous deposit may be formed before 
death, an argument is sometimes used that such concretions are always formed in 
the last hour of existence, and that they are rather the sequences of the dying state 
than its precursors and final cause. To some extent this argument has weight; for 
there are cases certainly in which these concretions are found, where the inference 
is fair that death would have occurred though the concretion had not existed. On 
the other side, various instances have been given, where both the symptoms and 
the pathology show that the concretion was the inevitable cause of dissolution. In 
other words, the patient would not have died if the concretion had not been formed. 
Moreover, in all cases where the deposit occurs this is clear, that in the majority of 
cases it is the final seal and bond to the death claim. 
The question may be asked, Of what good is this knowledge concerning 
concretions in the heart? Why be anxious to learn the existence of a cause 
of death, which, by its irremediability, may be considered death itself? I 
answer, great good. I am not without hope that the day may come when science 
shall show us how the dissolution of these concretions may in some cases be 
effected : for I have seen them partly dissolved as an effect of alkaline treatment. 
But irrespective of this matter, the correct diagnosis of concretion is a guide to 
prognosis, and is a guide against many forms of meddlesome and mischievous, 
because useless, practice. Take two examples: In the latter stages of inflamma- 
tions, bleeding is notoriously bad practice. The reason is obvious; and I regret to 
say I have seen the evil too obviously and practically explained. In these cases, the 
tendency of the disease is towards fibrinous deposition ; and the tendency of hem- 176 
Fibrinous Concretions in the Heart and Blood- Vessels. 
orrhage is towards the same event. Therefore, as the practitioner bleeds, the bal- 
ance of the blood-constituents, already disturbed, is disturbed the more ; all that 
was wanting to secure deposition is secured ; the circulation is enfeebled, and the 
proportion of water and fibrin is increased. The deposit forms and the patient 
sinks. In one instance of pneumonia I saw the fatal symptoms of concretion on 
the right side follow the free abstraction of blood, as clearly as the symptoms of 
narcotism can ever be observed to succeed upon the administration of an opiate. 
For the same reason, in the latter stages of acute inflammatory affections, it is 
equally dangerous to carry the depressing system by medicines to an extreme, or to 
produce too free an elimination from the body; of all medicines, in such stages, 
purgatives and opiates should be alike avoided. Lastly, the correct diagnosis of 
concretion in the heart may prevent unnecessary surgical interference, and explain 
the reason why some measures, conducted on the most scientific surgical princi- 
ples, miss their intended object. 1'his is strikingly illustrated in the disease, true 
inflammatory croup. In this affection, as I have proved by repeated inspections, 
concretions definitely formed from blood in motion, and long before death, are 
often found in the heart after death has occurred. Further, I have been able in 
this disease to trace the symptoms of concretion as clearly as I had previously 
traced the special, local, or inflammatory symptoms of the disorder. Thus, in 
croup there may be death from one of two sources: from the obstruction in the 
larynx-asphyxia ; from the obstruction in the heart-syncope ; or from the com- 
bination of these. If, then, the symptoms are clearly those of pure asphyxia, 
dependent obviously on the obstruction in the air-passages, the operation of trache- 
otomy is the grand remedy. But if the stethoscope tells that the air enters the 
lungs with moderate freedom at each inspiration ; if indications of emphysema 
are present; if the symptoms are those of obstruction at the heart-syncope-then 
is the operation of tracheotomy as useless as would be that of phlebotomy for 
removing a solid plug from the windpipe.1 
A careful comparison develops a close resemblance between the symp- 
toms of concretions of fibrin in the heart and blood-vessels, and many of 
the symptoms of the cases of congestive malarial fever now recorded. 
In view of the rapid, feeble, intermittent pulse ; disturbed, full, pant- 
ing respiration; rapid, feeble, fluttering action of the heart; cold extremi- 
ties, exhaustion of the muscular forces, stupor, wandering of the intellect, 
inability to control the muscles, and acts of excretion; in view of the 
sudden onset of all these symptoms in malarial fever; in view of the size 
and structure of the coagula found in the heart and blood-vessels after 
death, in the cases presenting these symptoms; in view of the close corres- 
pondence of these symptoms with those characteristic of the deposition of 
fibrin in the he'irt and blood-vessels; in view of the observationsand 
experiments of Baillie,2 Morgagni,3 Albinus/ Burns,5 Hewson,® Gould, Tem- 
pleman, Haller, Stewart,7 Graham,8 Chisholm,9 Wardrop,10 Cruwell,11 Sten- 
zel,12 Petit, Martial,13 Baron,14 Virchow,15 Bouillaud,16 Meigs,17 Davy,18 Fuller, 
1 Cause of the Coagulation of the Blood, pp. 423-734. The italics are our own. 
2 Trans, of A. Soc., vol. i. 
3 Annot. Academ., lib. vii, c. 2. 
/ 4 Cpist. 36, art. 10. 
5 Diseases of the Heart. 
6 Au Experimental Inquiry into the Properties of the Blood, 1771. 
7 Ed. Med. and Surg. Journal for 1817. 
8 Med.-Chirurg. Transactions, vol. v. p. 297. 
9 An Epidemic Polypus in Grenada in 1790. 
10 Baillie's Works, vol. ii, p. 20 
11 De Cordis et Vasorum Osteogeneses in Quatrogenario Observata; Hate, 1767. 
12 Dissertationes de Steatomatibus A.orte. 
13 Memoirs of the Royal Academy for the year 1732. 
14 Recherches et Obs. sur la Coagulation du Sang dans l'Artere Pulmonaire, et ses Effets; 
Arch. G6n. de M6d., sec. 14, t. ii. 
15 On Plug Formationsand Obstructions in the Blood-vessels; Handbuch der Speciallen 
Pathologic und Therapie; Erlangen, 1854, Erstes Bande. 
16 Traitd Clinique des Malades du Cceur, Apendice, tome ii, Paris, 1835. 
17 Philadelphia Medical Examiner, No. 51,1849. 
18 Physiological and Anatomical Researches, London, 1839. Fibrinous Concretion in the Heart and Blood- Vessels. 
177 
Simon,1 Simpson,2 Paget,3 Crisp,4 Kirkes,5 Wagner,® Rokitansky,7 Richard- 
son,8 and others, we are justified in asserting that the fibrinous element 
of the blood may be deposited in the heart and blood-vessels during life 
in malarial fever, and not only give rise to a distinct set of phenomena, 
but cause death in cases which otherwise would not have terminated 
fatally. 
The evil effects of the deposition of fibrin in the blood-vessels are by 
no means confined to the period attending and immediately succeeding 
their formation. These fibrinous bodies, wherever formed, and whatever 
be their situation, are full of peril, and may remain so long after the cir- 
cumstances which gave rise to them have passed away. The observations 
of Dr. Wm. Senhouse Kirkes9 have demonstrated that the large masses 
may at any time be detached from the points to which they were originally 
attached (the valves of the heart and blood-vessels, or the carnese colum- 
ns, or chordae tendineae of the heart), and conveyed with the circulating 
blood until arrested within some arterial channel, which might thus 
become completely plugged up, and the supply of blood to an important 
part be suddenly cut off, from which serious if not fatal results would 
ensue ; or smaller masses might be detached, and pass on into arteries of 
much less size, or even into the capillaries, and produce stagnation and 
coagulation of the blood, and all the attendant changes and phenomena; 
or the masses of fibrin may soften, break up, and discharge the finely gran- 
ular material resulting from their disintegration into the circulating blood, 
and contaminating the fluid, might excite symptoms very similar to those 
observed in phlebitis, typhus, and other analogous blood diseases. The 
parts of the vascular system to which these detached masses of fibrin would 
be transmitted, will depend upon the parts of the circulatory system from 
which they are detached; thus, if detached from the left heart, they would 
pass into the aorta and its branches, and produce various disturbances in 
the nutrition, secretion and functions of the organs ; and if detached from 
the right heart, the lungs would become the primary, if not the exclusive 
seat of their ultimate deposition. 
We will hereafter record cases presenting certain symptoms, which 
might be refined to the detachment of these fibrinous concretions, and 
their subsequent lodgment in different organs. 
In affirming that death may be, and is often produced in malarial 
fever by the deposition of fibrinous concretions, we do not for one moment 
lose sight of the fact that the great questions after all to be settled are: 
What produced this state of things, favorable to the formation of these 
concretions ? What are the chemical and physical changes of the blood 
and of the blood-vessels'? What are the causes of the disturbance of the 
action of the heart and capillary circulation, which precede and determine 
the deposition of the fibrin of the blood? 
1 Animal Chemistry, 1843. 
2 Obstetrical Works. 
3 On Obstructions of the Branches of the Pulmonary Artery, Med.-Chir. Trans., vol. xxvi., 
1844. 
4 On the Structure, Diseases and Injuries of the Blood-vessels, 1847. 
5 On some of the Principal Effects resulting from Detachment of Fibrinous Deposits from 
the Interior of the Heart, and their Mixture with the Circulating Fluid, Dancet, June 5,1852; 
Banking's Abstract, 1852. 
6 Elements of Physiology. 
7 Manual of Pathological Anatomy. 
8 Cause of the Coagulation of the Blood, 1858. The Fibrinous Constituents of the Blood in 
relation to Disease, Medical Times and Gazette, Feb. 12,1853. Diagnosis of Fibrinous Concretions 
in the Heart, Assoc. Med. Journal, April 13, 1855. See also Turner, Thackrah on the Blood, 1819. 
An Essay on the Cause of the Coagulation of the Blood, by E. Briicke, British and Foreign Medico- 
Chirurgical Review, No. xxxvi, Jan., 1857, p. 141, Am. ed. 
9 On some of the Principal Effects resulting from Detachment of Fibrinous Deposits from the 
Interior of the Heart, and their Mixture with the Circulating Fluid, London Lancet, June 5,1852. 178 
Destructive Effects of Heart Clots. 
The correct answer of these questions involves the complete knowledge 
of the physical and chemical relations of fibrin to the elements of the blood, 
and to the blood-vessels and surrounding tissues; involves the complete 
knowledge of the origin and offices of fibrin in physiological and patho- 
logical conditions; involves a knowledge of the physical, chemical, physio- 
logical and pathological relations of morbific agents, not only to the fibrin, 
but to all the constituents of the blood, and to the containing vessels, and 
to the organs and tissues and apparatus. The impossibility of answering 
these important questions is immediately seen, when we review the whole 
controversy concerning the cause of the coagulation of the blood, the knowl- 
edge of which should form the starting point in the attempt to solve these 
difficulties. 
We are actuated by no disparaging or captious spirit when we assert 
that, notwithstanding the laborious investigations of Hewson, Thackrah, 
Richardson and Briicke, we have no theory which will explain satisfac- 
torily and thoroughly the coagulation of the blood under all circumstances; 
when we assert that the theories thus far proposed are expressions rather 
of necessary and attending circumstances for the manifestation of the phe- 
nomena of coagulation, than of the true causes; when we assert that not- 
withstanding the observations and reasonings of Mulder, Paget, Simon, 
Carpenter, Virchow, Briicke, and others, the origin, offices, and ultimate 
changes of fibrin are still matters of dispute, and are questions to be deter- 
mined by future observation and experiment. 
If we adopt the hypothesis of Dr. Richardson, that the fibrin of the 
blood is held in solution by ammonia, and that the coagulation of the fibrin 
is due to the escape of the ammonia, the most important questions, in a 
physiological, as well as in a pathological, point of view, with reference to 
the true causes of the coagulation of the blood, remain unsettled. 
It has not as yet been determined what are the physical and chemical 
properties upon which these relations of fibrin and ammonia are depend- 
ent ; the origin and variations in quantity of the ammonia in different 
physiological and pathological states, and its relations to the other con- 
stituents of the blood, have been only barely indicated, and not determined; 
and no hypothesis yet propounded explains the phenomenon of the more 
rapid coagulation of blood in a dead than in a living heart or blood-vessel; 
and no series of experiments have yet settled definitely and absolutely the 
question, whether fibrin exists as fibrin in the blood, or is formed by a 
chemical change at the time of coagulation. 
If we adopt the hypothesis that fibrin is held in solution in the living 
body by nervous and vital influences, and that its coagulation is due to the 
abstraction of nervous and vital influence, the questions immediately arise, 
What are nervous and vital influences? How are they produced? What 
are their relations to fibrin ? 
If we adopt the hypothesis of Dr. Richardson, that the primary and 
essential part of the process of coagulation consists in the evolution of a 
volatile principle, and that the volatile principle thus eliminated from 
blood, is ammonia, the questions immediately arise: Does this ammonia 
which holds the fibrin in solution, decrease in the latter stages of malarial 
fever, and in the latter stages of all those diseases in which fibrinous con- 
cretions are formed before death? What are the causes of the decrease of 
ammonia? What are the disturbances in the chemical changes of the liv- 
ing organism, which lead to this decrease of ammonia ? 
If we adopt the hypothesis, supported by the experiments of Hewson, 
Thackrah, Cooper, Briicke, and others, that the solution of fibrin in the 
living body is dependent upon its relations with the walls of the con- Causes of the Coagulation of the Blood. 
179 
taining heart and blood-vessels, the main question to be settled is, What 
are these relations, and upon what are they dependent, and how may they 
be disturbed ? 
If we adopt the hypothesis so ably advocated by Briicke, that the 
fibrin exists not as fibrin, but as a soluble albuminate, and is formed at the 
moment of coagulation, at the expense of a portion of the albumen of the 
blood, by a change in its atomic constitution, and that these changes are 
prevented during life by an influence exerted by the coats of the living 
blood-vessels: the cause and character of these chemical changes of the 
albumen, and the cause and character of the influence of the coats of the 
living blood-vessels upon the blood, are still unknown. 
If, with Zimmerman, we think that the coagulation of fibrin is nearly 
allied to the process of fermentation, which may be regarded in the light 
of an oxidizing process, and is brought about by a kind of putrefaction 
occurring in some of the constituents of the blood, after its removal from 
the body, the questions are still unanswered : What is this oxidizing pro- 
cess? Why does it not take place in the circulating blood, which is not 
deficient in oxygen ? What is this peculiar kind of putrefaction, and what 
previous chemical changes does it involve? What is the nature of the 
putrefactive process which leads to the deposition of fibrin in the living 
heart and blood-vessels in malarial fever, and other diseases? 
If we combine the truths of all the hypotheses of the coagulation of 
the blood thus far propounded, we will have the same number of important 
questions to be determined. 
If we say that the formation of fibrinous concretions in malarial fever 
is due to impeded circulation; while we express a valuable fact, leading to 
the development of important principles of treatment, we do not, by any 
means, explain the phenomena of the deposition of fibrin, but only state 
one of the favorable circumstances, and besides the important questions 
which we have propounded with reference to every hypothesis of coagula- 
tion, thus far advanced, the question still remains : What produced the 
retardation of the circulation ? If the retardation of the ci rculation was 
due to the effects of the malarial poison, what are those effects ? where, 
when, and how did the poison act? Did the poison act alone upon the 
structures of the circulatory apparatus ? or did the poison act primarily 
upon the blood, and through the altered constituents of the blood upon the 
nutrition and development of the forces of the circulatory apparatus ? or 
did the poison in the altered products of the blood act upon one or both 
the nervous systems, and through them produce such irregularity and 
feebleness in the circulatory apparatus, as led to the deposit of fibrinous 
concretions. 
Notwithstanding that the facts now recorded are not sufficiently numer- 
ous to warrant the assertion that fibrinous concretions are formed previous 
to denth, in every case of malarial fever; notwithstanding that the causes 
of the formation of these clots are obscure, complicated, and unknown; 
notwithstanding that the causes of death may not be connected with those 
wrhich lead to the deposition of fibrin in the living vessels; we may, 
nevertheless, assert that the knowledge that these concretions may and do 
form in many cases of malarial fever, and produce a fatal termination in 
cases which would not otherwise have thus terminated, is of the utmost 
value to practitioners of medicine in the South and Southwest, where the 
severest grades of malarial fever prevail. 
We have thus presented a general and impartial statement and analy- 
sis of the important questions relating to the coagulation of the blood, and 
the offices of fibrin in the animal kingdom up to the year 1860. 180 
Causes of the Coagulation of the Blood. 
After the close of the American Civil War, 1861-1865, during which 
period the Southern States were cut off from the surrounding world with 
its scientific and medical works, and journals; we again examined the 
questions relating to the physical and chemical properties of fibrin, and 
the coagulation of the human blood. The following statement represents 
the state of medical knowledge on these important questions in 1865. 
EPITOME OF KNOWLEDGE WITH REFERENCE TO THE PHYSICAL AND 
CHEMICAL PROPERTIES OF FIBRIN IN THE YEAR 1865. 
Fibrin is the name given to the substance which is separated in the solid state 
from blood on coagulation. A similar matter is contained in solid muscular flesh 
of animals, but differs from blood-fibrin in certain properties. Lehmann has 
named this fibrinous substance syntonin. Fibrin is also contained in lymph. 
Preparation.-Fibrin may be obtained immediately by lashing fresh blood 
with a bundle of birch-twigs, it attaches itself to the twigs in amorphous, fibrous 
filaments which obtain a red color from adhering blood globules. In order to force 
the fibrin from coloring, and other matters, it is placed on a sieve or a cloth and 
subjected to prolonged washing under a copious stream of water, and the portions 
which retain the red color most obstinately are picked out and thrown aside. It 
is finally washed with distilled water, charged with carbonic acid. A few drops 
of acetic acid may be advantageously added to last wash-waters; this causes the 
fibrin to swell up, and renders it easier to distinguish the impure portions. The 
product finally washed with pure water, assumes the semi-transparent fibrous 
aspect peculiar to fibrin, (Gerh. iv, 459). When fresh blood is allowed to stand, it 
coagulates spontaneously, the clot at the same time enclosing all the blood globu- 
les. It is therefore necessary to cut the clot into thin slices, and wash it with still 
greater care than artificially coagulated fibrin. Fibrin obtained by either method 
always contains many impurities, especially fat-globules; these may be removed 
by ether and alcohol, after the product has been dried. Gerhardt recommends the 
following method for preparing fibrin in a state approaching to purity. The blood 
as it leaves the veins, is allowed to flow upon the twelfth or fifteenth of its weight 
of moist sulphate of sodium, which prevents the fibrin from coagulating. The 
mixture is agitated and thrown on a filter, which retains by far the greater part, 
if not all the globules. If the filtrate is slightly red, it is mixed with an equal 
volume of water, and again filtered ; and this process is repeated till the liquid 
begins to deposit fibrin. The fibrin is then collected, strained off, and washed with 
water, alcohol, and ether. 
Liebig prepares muscular fibrin (syntonin) by finely mincing fresh meat, and 
exhausting with cold water. The residue is then treated with water containing 
0.1 per cent, hydrochloric acid, and the solution is filtered and neutralized with 
ammonia. The fibrin is purified in the usual manner. Baumhauer uses fish for 
preparing syntonin, (Chemische Unters. v. Mulder, German translation iii, .301,) 
but the method does not appear to be advantageous. 
Impurities.-Fibrin is generally mixed with fat globules, but only such as are 
found adhering to the different constituents of blood. Lehmann discovered choles- 
terin in this fat, also acetic acid, perhaps formed by the oxidation of ether, and 
another fatty acid (Gmelin's Handbuch, viii [2] 171). Fat always adheres to fibrin, 
and appears to consist principally of ammonia and lime-soaps (Berzelius, Lehrb. 
d. Chern, ix, 88). Schmidt extracted from 7.4 to 8.7 per cent, fat from the fibrin of 
the portal vein. Lehmann found between 3.189 and 3.218 per cent, of fat in fibrin 
(Gmelin's Handbuch, viii [2] 141). Virchow extracted by means of alcohol and 
ether, between 2.50 and 2.76 per cent, fat from venous fibrin. The fibrin of chyle 
is richer in fat than blood fibrin. Virchow found phosphoglycerate of calcium in 
blood fibrin and much phosphate of calcium in its ash. Fibrin always leaves a 
mineral residue on incineration, consisting chiefly of phosphate of calcium, 
amounting to 1.7 per cent. (Mulder), 0.66 per cent., with a little carbonate of cal- 
cium (Virchow). A little phosphate of magnesium is likewise found in the ash, 
but no iron when the fibrin has been properly purified. According to Liebig, the 
ash of syntonin always contains iron. Fibrin of the arterial blood of the horse 
contains 2.172 per cent, ash; that of the jugular blood 1.907 per cent. In chyle- 
fibrin, which had been properly freed from fat, washed and dried, 1.77 percent, 
strongly alkaline ash was found (Lehmann). Virchow thinks it probable that the 
fat adhering to fibrin contains myelin, a substance which he considers to be identi- Fibrin and the Coagulation of the Blood. 
181 
cal with nerve-marrow, and to bear a certain resemblance to cerebric acid. It is 
found in various normal and morbid structures ; when treated with water, it swells 
up like starch. 
Formation of Fibrin from Albumin.- When defibrinated serum is subjected to 
the action of a current of oxygen gas, at a temperature of 98°-100° Fahr., the albu- 
min contained in it is gradually converted into fibrin [note] (a black substance, 
analagous to, if not identical with, Virchow's haemin, is formed at the same time), 
which separates after about 36 hours in clots, and when freed from blood-cells and 
other impurities by washing with water, presents the appearance of ordinary fibrin. 
A similar result is obtained when a mixture of blood-serum and egg-albumin is 
treated with oxygen gas, time being allowed for the two liquids to mix well 
together. Egg-albumin alone, when purified by beating it up with a small quan- 
tity of acetic acid, and filtering, also yields fibrin when a stream of oxygen is passed 
through it. The introduction of coils of platinum wire into the liquid greatly 
facilitates the formation of the fibrin, which is then deposited upon the coils in 
beautiful white parallel threads. Alkalis and alkaline salts interfere with the pro- 
duction of fibrin in the manner described above, the greatest amount being obtained 
when the albumin is neutral or slightly acid. Viscidity of the liquid promotes the 
formation of fibrin by detaining the bubbles of oxygen for a longer time among the 
particles of the albumin. Albumin artificially digested in gastric juice, yields 
fibrin by oxidation, even after it has been passed through a dialyser. Gluten dis- 
solved in gastric juice also yields fibrin by oxidation, even at ordinary tempera- 
tures (A. H. Smee, Proc. Roy. Soc. xii, 399). 
Properties.- Fibrin has been said to separate from the blood in laminae. This 
is not certain, but when completely washed, it consists of soft, elastic, transparent 
filaments, which do not cohere by pressure. It is completely insoluble in cold 
water, in alcohol and in ether. Freshly prepared fibrin loses about 80 per cent, 
water in vacuo (Chevreul) and is converted into a hard, horny, transparent mass of 
yellowish or greenish color, and completely devoid of taste and smell. It takes up 
about three times its weight of water, without, however, entirely regaining its 
former appearance. When well-washed fibrin is boiled for a long time with water, 
the distillate contains much ammonia, and a peculiar substance is extracted from 
the residue by water (Dumas and Cahours). The substance extracted from fibrin 
by boiling water, has, according to Bouchardat, all the properties of gelatin; the 
proportion varies considerably, being insignificant in healthy fibrin, but increasing 
to a considerable amount in inflammatory diseases of the cellular tissue. The sub- 
stance obtained by Dumas and Cahours did not become gelatinous on cooling, but 
appeared to resemble albumin ; it was precipitated by tannin and nitric acid, con- 
tained 11 per cent, ash, and the organic part gave 47.9 per cent. C, 6.8 per cent. H, 
15.0 per cent. N, and 30.3 per cent. O. 
Heated with water in a sealed tube to 150° C, fibrin dissolves almost completely, 
leaving a slight residue. The solution produces abundant precipitates with acids, 
and even when very dilute, is precipitated by nitric acid. The precipitate produced 
by acetic acid is readily soluble in an excess of the acid. When moist fibrin is 
exposed to the air, it is gradually converted into a thick, viscid liquid, smelling 
like old cheese. This liquid coagulates by heat; the coagulum has the composition 
and properties of albumin (C, 53.9, H, 7.0, N, 15.6, S, 1.6 per cent.; ash. 0.28 per 
cent. Strecker). Putrifying fibrin also yields sulphide of ammonium, butyric and 
valeric acids ; leucine ; an oily acid precipitated by acetate of lead ; an acid syrup 
which is dissolved by acids, thereby assuming a violet color and being converted 
into tyrosine; and a erystaline, volatiles ubstance of unpleasant odor (Bopp. Ann. 
Ch. Pharm. Ixix 30). When fibrin putrefies out of contact with the air, it yields 
acetic, butyric, valeric and capric acids, as well as ammonia (Brendecke). Fibrin 
in contact with oxygen gives off carbonic acid; and fibrin which has been long 
exposed to the air, and perhaps also, fibrin from arterial blood, dissolves with diffi- 
culty, or not at all, in saline solutions. Peroxide of hydrogen is decomposed by 
fibrin. If fresh fibrin, moistened with water and saturated with oxygen, is enclosed 
in 8 times its volume of air, and maintained between 20° and 25° C, the gas after 24 
hours contains 6.81 per cent. O, 11.17 CO2, and 82.02 N. 
Fibrin has been analysed by a great many chemists ; the results are not suffi- 
ciently in accordance to lead to the conclusion of a homogeneous substance. It 
seems to vary considerably in composition, according to the source from which it 
has been obtained. 182 
Fibrin and the Coagulation of the Blood. 
FROM HUMAN VENOUS BLOOD. 
FROM BULLOCK'S BLOOD. 
Carbon 
Scherer. Dumas & Cahours. 
53.7 54.3 52.8 
Gay-Lussac 
and 
Thenard. 
53.4 
Schloss- 
berger. 
52.4 
Dumas 
& 
Cahours. 
52.7 
Ver- 
dell. 
Hydrogen 
Nitrogen 
Sulphur 
Oxygen 
7.1 7.2 
15.8 15.8 
7.0 
16.8 
7.0 
19.9 
6.9 
15.5 
7.0 
16.6 
1.6 
DUMAS & CAHOURS. STRECKER. 
DUMAS & CAHOURS. 
Carbon 
Hydrogen 
Nitrogen 
Sulphur 
Oxygen 
Arterial and venous 
blood of Sheep. 
52.8 
7.0 
16.5 
Flesh of 
Sheep. 
16.8 
1.1 
Arterial and venous blood of 
Calf. Horse. Dog. 
52.5 52.7 52.7 
7.0 7.0 6.9 
16.5 16.6 16.7 
STRECKER. 
DUMAS & CAHOURS. 
Flesh of Fish. 
Fibrin boiled 
with water. 
Fibrin dissolved in 
Potash and precipi- 
tated by Acetic Acid. 
< Jarbon 
54.7 
53.5 
53.1 
Hydrogen 
7.2 
7.1 
7.1 
Nitrogen 
15.4 
15.9 
16.8 
Sulphur 
1.5 
Oxygen 
Mulder (Chemische Untersuchungen) gives for the composition of fibrin, 52. 7 
per cent. C, 6.9, H, 15.4 N, 1.2 S, 0.3 P, and 23.5 O, comparing this result with the 
analysis of blood-albumin by the same chemist (i.67), it will be seen that the oxy- 
gen in fibrin exceeds that in albumin by 1.5 per cent., the quantities of the other 
elements being proportionally less. This difference is quite in accordance with 
the fact observed by Smee, (p. 639), that albumin is converted into fibrin by oxida- 
tion, with separation of sulphur, phosphorous and carbonic acid. On the other 
hand, it must be observed that according to the analyses of other chemists, albu- 
min and fibrin do not present any essential difference of composition, indeed, the 
analyses of each of these substances by different chemists (see above and i-67), 
differ from one another quite as much as the analyses of either substance differ 
from those of the others. If they are really identical in composition, the conver- 
sion of albumin into fibrin by the action of oxygen, must be regarded as a case of 
contact-action. According to MM. Lebonte, and Goumoens, fibrin is composed 
of two bodies; exhibiting under the microscope, yellowish-white fibres, parallel 
and wavy on the sides, as well as very numerous granulations disseminated upon 
the surface of its fibres and enclosed by them, (Gerh. iv, 464,) see p. 641. 
Decompositions.-1. Fibrin is decomposed at a high temperature, it melts, 
swells considerably, takes fire and burns with a smoky flame, leaving a residue of 
porous charcoal. By dry distillation, it yields the same product as albumin. 
2. Fibrin dissolves in caustic potash, even in very dilute solutions ; at first it 
swells up and becomes gelatinous, and between 50° and 60° C, it gradually dis- 
solves, forming a slightly opaline yellow solution, which becomes clear on filtra- 
tion. Fibrin does not neutralize the alkali, but decidedly lessens its alkaline pro- 
perties ; the solution has the characteristic of albuminate of potassium, yielding 
precipitates with acetic and with tribasic phosphoric acids, soluble in excess of the 
precipitant. According to Mulder, if fibrin is digested with very weak alkali, and 
the solution neutralized with acetic acid until it begins to be precipitated, com- 
pounds with metallic oxides may be obtained on the addition of their salts. Ger- 
hardt thinks that these precipitates are identical with the metallic albuminates 
(i.68). When fibrin is boiled with caustic potash, ammonia is evolved, and the 
liquid contains sulphide of potassium. Heated with potash-lime between 160° and 
180° C., it evolves ammonia and other volatile products, while a small quantity of 
volatile fat acid is formed, which remains combined with potash, (Wurtz). When 
fused with potash, it yields hydrogen and ammonia, leucine, tyrosine, and proba- 
bly butyrate, valerate, oxalate, etc. of potassium, (Bopp.) Fibrin and the Coagulation of the Blood. 
183 
3. Fibrin is scarcely acted upon by ammonia. 4. Concentrated fuming 
hydrochloric acid causes fibrin to swell, and dissolvesit when heated, forming a 
violet solution. When this solution is boiled in anopen vessel, it turns brown, 
and is then found to contain chloride of ammonium, leucine, tyrosine, a brown 
substance not yet examined, an uncrystallizable body, slightly soluble in water, 
and very soluble in alcohol, and a sweet syrupy matter, (Bopp). According to 
Mulder fibrin absorbs 7.1 per cent, of gaseous hydrochloric acid, yielding a com- 
pound almost insoluble in water. According to Liebig, blood-fibrin is perfectly 
insoluble in dilute hydrochloric acid; he says that fibrin macerated in water con- 
taining ten percent, hydrochloric acid, is gradually converted into a jelly, which 
shrinks on the addition of more concentrated acid, and again swells up with pure 
water, without, however, any appreciable quantity of fibrin being dissolved. Syn- 
tonin however, dissolves in the dilute acid more or less completely, according to 
the source from which it has been obtained. Dumas and Cahours found that water 
containing 0.001 per cent, hydrochloric acid caused fibrin to swell, without, how- 
ever, dissolving it after forty-eight hours' digestion. But the addition of a few 
drops of hydrochloric acid or of rennet rapidly effected its solution at 36° C. The 
experiments of Bouchardat seem the most reliable, and have since been confirmed 
by V. Baumhauer, (Ann. Ch. Pharm. xlvii, 320T); they prove that fibrin is not a 
homogeneous substance, but that it is composed of at?least two bodies. When moist 
fibrin, prepared from whipped or coagulated blood, is steeped in water, containing 
0.0005 per cent, hydrochloric acid, and therefore scarcely acid to the taste or to lit- 
mus, it immediately swells up and is converted into a mass of very bulky fiakes. 
The swollen vesicles are rent by prolonged maceration, and the greater part of the 
fibrin dissolves always leaving, however, a certain portion insoluble in excess of 
the acidulated water. The soluble portion (albuminose) scarcely reddens litmus, 
rotates the planes of polarisation to the left, is precipitated in light fiakes by heat, 
and yields a precipitate with excess of hydrochloric or nitric acid with tannin, 
mercuric chloride, ferrocyanide of potassium, and possesses generally all the charac- 
teristics of egg-albumin. (Gerh. iv, 466). The precipitate produced by carbonate 
of ammonia in the solution has the following composition, (it left no ash on 
incineration): 
V. Baumhauer. 
Verdeil. 
c 
52.9 
H 
6.9 
N 
15.9 
O 
1.6 
s 
Bouchardat terms the undissolved portion epidermose, and considers it to be 
identical with the chief constituent of the epidermis, and of horny substances. 
5. Nitric acid turns fibrin yellow, and readily dissolves it by ebullition, form- 
ing an orange-yellow acid substance xanthoproteic acid (Mulder). 
6. Concentrated sulphuric acid causes fibrin to swell, and dissolves it by heat. 
The dilute acid doesnot dissolve fibrin. 
7. Glacial acetic acid dissolves the granulation of fibrin, without attacking the 
fibrous portions (Lebonte and Goumoens). Concentrated acetic acid immediately 
converts fibrin into a colorless jelly, dissolving readily in hot water (according to 
F. Simon the gelatinous mass does not dissolve). The acetic acid solution, evapor- 
ated at a gentle heat, becomes covered with a film, and then assumes a gelatinous 
appearance; the dry residue is insoluble in water. The solution is precipitated by 
sulphuric and hydrochloric acids; also by alkalies, but the precipitate re-dissolves 
in excess of the precipitant. 
8. Tribasic phosphoric acid renders fibrin gelatinous; the jelly dissolves in 
water and is not precipitated by excess of acid. Metaphosphoric acid behaves like 
sulphuric acid. 
9. According to Lehmann and Zimmermann, the several kinds of fibrin dis- 
solve, for the most part, in alkaline salts; syntonin, however, is insoluble in dilute 
nitre solution (Lehmann). Neither arterial nor venous fibrin, when boiled in 
water or exposed to the air for some time, is soluble in nitrate of potassium (Denis, 
Scheerer). 
10. Denis employs the following process for dissolving fibrin in nitrate of 
potassium : 50 pints well-washed moist venous fibrin are triturated with | of their 
weight of nitre; water equal to four times the weight of the fibrin employed, is 
gradually added: and then L50th pint of caustic soda or potash. The whole is 
allowed to digest at about 37° C., with constant agitation. The mixture first 184 
Fibrin and the Coagulation of the Blood. 
becomes gelatinous, then viscid, and, after a few days, liquid; a small residue 
always remaining. The liquid thus obtained coagulates by boiling, like albumen, 
and is precipitated by alcohol, mercuric chloride, acetate of lead, etc. If alkali bo 
not added, the solution is precipitated by the addition of a large quantity of water 
(Gerh. iv, 46S). The solution, exposed for some time to the air, gradually becomes 
turbid, and deposits flakes which are insoluble in the mother-liquor. 
11. If fibrin be dissolved in potash, and acetic or phosphoric acid be added to 
the solution till the precipitate first formed re-dissolves, a liquid is obtained, from 
which white flakes are precipitated by neutral salts (Panum). The potash solu- 
tion is precipitated by mercuric chloride, sulphate of copper and acetate of lead. 
12. Tannin of gall-nuts precipitates fibrin from its saturated solutions; it 
combines with moist fibrin, forming a hard imputrescible mass. 
13. Ferrocyanide of potassium produces, with the acetic acid solution, a white 
precipitate, which at first re-dissolves, but afterwards becomes permanent. It is 
not dissolved by diluted acids, but is decomposed by alkalis and even by ammonia. 
14. Sulphuric acid with peroxide of manganese or acid chromate of potassium, 
yields with fibrin the same products as with albumin (i.67). 
Sources and Physiological Relations of Fibrin. -Lehmann (Gmelin's Hand- 
buch, viii [2] 167), considers that fibrin is formed from albumin in the animal 
organism, possibly by the latter taking up oxygen, a mode of formation rendered 
highly probable by the results obtained by Smee (p. 639) in the artificial produc- 
tion of fibrin from albumin. The occurrence of fibrin in the chyle is not opposed 
to this view, partly because fibrin may be conveyed to this fluid by the lym- 
phatics and blood-vessels, and partly because all the juices of the animal body 
contain free oxygen (Lehmann). Neither is the formation of fibrin from albumin 
by oxidation contradicted by the fact that in pneumonia, when a portion of the 
lung is rendered impermeable to air, and consequently the supply of oxygen must 
be diminished, the quantity of fibrin in the blood is increased. The fact is, that 
the conversion of albumin into fibrin is only the first stage in the process of oxida- 
tion, which, when further continued, transforms the fibrin into urea, and various 
other oxidized products, which pass into the excretions, so that the scanty sup- 
ply of oxygen which the blood receives in certain diseases, may be sufficient to 
convert the albumin into fibrin, but not to oxidize it further. 
Fibrin is not simply suspended in the blood, as Hunter and others supposed. 
It is not true that it is kept in solution by alkalis or alkaline salts, and that the 
coagulation is caused by the neutralization of the solvent with carbonic acid from 
the aiL since blood saturated with carbonic acid is found to coagulate much more 
slowly than blood deficient in the gas, and the additions of alkaline carbonates 
retards or entirely prevents the coagulation of blood. The cause of spontaneous 
coagulation is not known. Blood stagnated in the veins, and thus shut out from, 
the air, is always much longer in coagulating than when there is free access of air. 
Hence the presence of air seems necessary for the coagulation of the blood, as is 
rendered highly probable by numerous experiments, from which it has also been 
concluded, by trying the action of different gases, that oxygen is the principal, if 
not the sole agent. The coagulation of blood in closed vessels is probably due to 
the slow evolution of oxygen dissolved in the fluid of the blood-cells, and the rapid 
coagulation of the blood in an exnausted receiver, may arise from the sudden and 
rapid evolution of the gas (Gmelin's Handbuch, viii, [2] 155-7). 
C. Schmidt thinks that, in the circulation, fibrin is combined with neutral 
albuminate of sodium, forming an acid salt, which is resolved into its components 
on leaving the circulation. The fibrin forms the clot, while the albumin which is 
precipitated from the serum on boiling, he supposes to have been formerly in com- 
bination with chloride of sodium, which remains in the mother-liquor, together 
with the neutral albuminate (Gmelin's Handbuch, viii [2] 155). 
According to W. B. Richardson, the coagulation of fibrin is consequent upon 
an exhalation of ammonia from the blood; but this seems very doubtful. Accord- 
ing to Lister (Proc. Roy. Soc. xii, 580) the coagulation is brought about catalyti- 
cally by contact with foreign matter; whence blood remains fluid in the vessels, 
not because their walls exert any influence opposing coagulation, but because 
during life, and for some time after death, they do not act as excitors of coagu- 
lation . 
It has been supposed that blood coagulates more slowly the less fibrin it con- 
tains; but this, in many instances, is not the case, and the coagulation of blood 
appears to be modified by other causes. The blood of amphibious animals coagu- 
lates the most slowly ; that of birds the most rapidly. The blood of the small veins 
contains more fibrin than that of arterial blood, in the proportion of 6: 4, so that a Fibrin and the Coagulation of the Blood. 
185 
considerable quantity of fibrin appears to be formed in the capillaries, although it 
must be remembered that the fibrin, owing to the diminution of blood-cells, is in part 
only relatively increased. The percentage of fibrin in the blood of the vena cava 
is, even when this blood is unmixed with the liver-blood (which does not contain 
fibrin), very small in proportion to that of the arterial blood, about 214 : 410. In 
accordance with these data, Lehmann considers that fibrin is principally formedin 
the arteries, increased in the capillaries, and disappears in the larger veins (loc. cit. 
p. 699). Normal human blood contains about2.55per cent, fibrin (Nasse). Blood 
is said to yield less fibrin by agitation than by spontaneous coagulation, to the 
amount of l-5th less (Marchal de Calvi). Abbeille, however, says that more fibrin 
is obtained from blood by agitation than by spontaneous coagulation, and that 
blood heated to 60° C. yields more fibrin by agitation than at the common temper- 
ature, but that agitation has a greater effect on the quantity of fibrin than the tem- 
perature; blood coagulated at 0° C., yields less fibrin than at the common temper- 
ature. It was found that the blood of rabbits did not coagulate when carbonate of 
sodium or of potassium had previously been injected into the veins. 
Coagulating blood cools much more slowly than non-coagulating blood at the 
same temperature. The passage of fibrin from the soluble to the insoluble state, is 
either the cause of the evolution of heat, or hinders the process of cooling (Leh- 
mann). According to Nasse and Poggiale, the blood of new-born children contains 
much less fibrin than that of adults, the augmentation being especially large at the 
age of puberty. According to Nasse, the blood of women contains on the average 
2.20 per cent, of fibrin ; according to Andral and Gavarret, the proportion increased 
during pregnancy, especially during the last three months. Lehmann found more 
fibrin in his own blood when living exclusively on animal diet, than on vegetable 
diet, a result which Nasse arrived at by experimenting upon dogs (Gmelin's Hand- 
buch, viii [2] 188). The quantity increases by fasting or by blood-letting, while 
the number of blood-cells decreases. The fibrin of portal blood is described by 
Schmidt as a viscid, gelatinous mass. That of chyle is distinguished from blood- 
fibrin by a lower degree of contractility and by not gelatinising. Like the fibrin of 
many morbid secretions, and that of fish, it sometimes, and especially in warm 
atmospheres, re-dissolves a few hours after coagulation. Lymph-fibrin is exactly 
like that of blood. Gorup-Besanez (Ann. Ch. Pharm. xciv. 166-9) found a peculiar 
kind of fibrin in an infiltrated liquid, obtained from the chest of a tuberculous 
patient. It swelled up in water and then formed a turbid solution on being heated. 
The residue from the evaporated solution dissolved readily by a gentle heat in 
hydrochloric acid of 1 per cent., but was insoluble in a solution of nitre containing 
6 per cent, of the salt. Fibrin is not generally found in normal infiltrations. 
The following table contains the percentages of fibrin in the blood of different 
animals : 
Nasse. 
Poggiale. 
Andral, Gavarret 
and Delafond. 
(average) 
Ox 
3.6-4.0 
5.0 
3.6 
Cow 
3.8 
Sheep 
3.0-3.S 
3.2 
3.2 
Goat 
3.35-3.9 
3.15 
Horse 
2.4-2.85 
4.0 
Pig 
3.6-3.9 
4.6 
Dog 
1.7-1.9 
2.2 
2.1 
Fowl 
5.0 
Goose 
3.4 
Pigeon 
5.6 
(Gmelin's Handbuch, viii [2] 188). 
Fibrin is dissolved by bile free from mucus (Hiinefeld). Fibrin is more easily 
digested than coagulated albumin or casein. With dogs it appears to digest entirely 
in the course of three hours. Its digestibility, however, is naturally influenced by 
the state of aggregation ; boiled fibrin is more slowly digested than raw fibrin. 
Mulder (Jahresb. d. Chern. 1859, p. 538) remarked that fibrin placed in a full bottle 
with a little diastase, swelled up and partly dissolved, but after a time resumed its 
primitive form. He thi n ks this is owing to the fact that a given quantity of diastase 
can only affect the solution of one and the same quantity of fibrin, which after the 
diastase has performed its office, again returns to its former state. Fibrinous casts 
of the uriniferous tubes of the kidney are sometimes met with in the urine of per- 
sons suffering from Bright's disease ; moreover, the so-called chylous urine is some- 
times spontaneously coagulable, from the solidification of fibrin. Fibrin occurs in 
milk only when the latter contains blood. 186 
Fibrin and the Coagulation of the Blood. 
In inflammatory diseases of the mucous membranes (Diptheria, Pneumonia, 
Dysentery, Bright's disease, etc.) fibrin is found in the secreted mucus. Dictionary 
of Chemistry by Henry Watts, vol. 11, 1864, pp. 638-644. 
During the twenty years intervening between theclose of the Civil War 
and the re-establishinent of the United States government in the Southern 
States and the present year, namely, 1866-1886, advances have been made 
by luematologists chiefly in three directions: 
1st. The more accu rate enumeration of the colored and colorless blood - 
corpuscles in health and disease. 
2d. The application of spectroscopic analysis to the blood. The 
detection of blood stains, by the spectroscope. 
3d. The origin of the red blood-corpuscles in certain tissues, as the 
marrow of the bones. The relations of fibrin to the proteids of the liquor 
sanguinis. The fermentation of fibrin, and the nature of coagulation. We 
shall consider in this connection : 
THE STATE OF MEDICAL KNOWLEDGE WITH REFERENCE TO FIBRIN AND 
THE COAGULATION OF THE BLOOD IN THE YEAR 1886. 
Fibrin and the Coagulation of Blood. 
We may readily demonstrate the existence of fibrin by allowing a drop of blood 
to coagulate upon a glass slide, then washing it free from red corpuscles by a gentle 
stream of water, and placing upon the colorless fibrin a drop of a strong solution 
of magenta. By this process the white corpuscles are not removed, and from them 
adi ate the delicate filaments of fibrin. These filaments are so delicate and trans- 
parent that but for the staining they would be made out with difficulty. Fibrin 
is insoluble in pure water, but soluble in a six per cent, solution of potassium 
nitrate if digested with it at a temperature of 30 or 40° C (86° to 104° F.) it is 
similarly soluble in solutions of sodium chloride, and in a ten per cent, of magnesium 
sulphate. The solutions of fibrin in the neutral salts are coagulated by heating to 
■60° C. to 65° C. (140° F., to 149° F.), by the addition of acids and of alcohol, and by 
the addition of powdered magnesium sulphate. 
On the addition of acetic acid, and diluted mineral acids (5 H Cl per 1000) 
it swells up into a transparent jelly-like mass which is insoluble. In more dilute 
solutions (1 HC1 per 1000 of water), it dissolves after a digestion for a few hours at 
a temperature of 40° C. (104° F.) By this process it is converted into acid albu- 
min or syntonin. In the fresh, moist state it decomposes solutions of hydric per- 
oxide H2O2 with the liberation of O. Fibrin has the following composition: 
Coxe; Hm; Nh.<; S1.2; O21.8. 
Fibrinogen is a constituent of the plasma, but is absent from the serum. It 
is also found in the liquids of serous cavities, such as the pericardium, peritoneum 
and pleura, also in the fluid of hydrocele. The plasma is distinguishable from the 
other fluids mentioned by being spontaneously coagulable. This is due to the fact 
that besides fibrinogen, it also contains serum-globulin; whereas of the others 
serum contains serum-globulin, but no fibrinogen, and the remainder contains 
fibrinogen, but no serum-globulin. 
The fibrinogen is soluble in weak solutions (5 to 8 per cent.) of sodium chloride, 
but precipitated by solutions containing 12 to 16 per cent, of salt; whereas, serum- 
globulin is not precipitated by sodium chloride unless its solution is of a strength 
of more than twenty per cent. These properties afford a means of separating the 
two substances. 
Hammarsten's method of obtaining fibrinogen is as follows: 
Fresh blood is mixed with one-third its volume of a saturated solution of 
magnesium sulphate. It is then filtered or submitted to the action of a centrifugal 
machine, in order to free it from corpuscles. To the salted plasma is now added an 
equal volume of a saturated solution of sodium chloride, which causes an abundant 
flaky precipitate. This is separated by filtration, re-dissolved in a 6 to 8 per cent, 
solution of Na Cl, and again precipitated by adding an equal volume of a saturated 
solution of Na Cl. By repeating this process several times, fibrinogen may be 
obtained absolutely free from serum-albumin and serum-globulin, but containing 
from 1 to 5 per cent. Na Cl. Fibrin and the Coagulation of the Blood. 
187 
Solutions of fibrinogen in Na Cl, coagulate at a temperature of 52° C. to 5-5° C. 
(126.6° F. to 131 F). In a weak alkaline solution, it coagulates at 56° C. to 58° C. 
(132 8° F. to 136 4° F). 
Fr6d6rique has demonstrated that fibrinogen exists as such in the blood by 
confining blood with ligatures in a portion of the jugular vein and heating it to 
56° C. (132.8° F). A proteid substance (fibrinogen) separates, and the blood is no 
longer coagulable. The amount of fibrinogen which separates from the plasma of 
horses' blood at a temperature of 56° C. is given by Fr6d6rique as O. 4299 per cent. 
THE FORMATION OF FIBRIN. 
In 1831, Dr. Andrew Buchanan, of Glasgow, discovered that certain serous 
fluids of the healthy body, those of the pericardium pleura and peritoneum, also 
certain transudates, the products of disease, such as the fluids of hydrocele and 
ascites, all of which are not spontaneously coagulable, will coagulate on the addi- 
tion of bio d serum or washed blood clot (i. e. clot deprived of its red corpuscles by 
washing), or even pieces of muscle nerve or connective tissue. Of these substances 
he found that washed blood clot was more efficacious in inducing coagulation, and 
he states that if dried and pulverized, and placed in alcohol, it may be kept for 
many months without losing its coagulating power. Buchanan concluded that 
this property of washed blood clot, which consists of fibrin and entangled, white 
corpuscles, is inherent in the latter bodies. 
This is demonstrated by the fact that the huffy coat of the blood of the horse, 
which is very rich in white corpuscles, has a far greater coagulating power than 
equal portions taken from the lower layers of the coagulum. Buchanan compared 
this action of washed blood clot, and of the other substances mentioned, in inducing 
coagulation in liquids that do not coagulate spontaneously, to the action of rennet 
in milk. These important observations of Buchanan were entirely lost sight of 
until the facts were re-discovered independently by Professor A. Schmidt, of Dor- 
pat, in 1861. 
Schmidt endeavored to isolate from serum the substance to which is due its 
coagulating power, and believed that it was identical with the serum globulin that 
he obtained from diluted serum by passing through it CO2. He also separated 
fibrinogen from transudates, and demonstrated that mixing the two bodies in 
weakly alkaline solution, results in the production of fibrin. Hence he concluded 
that fibrin was a product of the union of these two proteids,and that when a liquid 
containing fibrinogen did not coagulate spontaneously, it was due to the absence of 
fibrinoplastin (serum globulin). He ascertained later that both bodies are present 
in the fluid of hydrocele, which is not spontaneously coagulable, and that it may 
be made to coagulate by adding to it blood or blood serum. It thus appeared evi- 
dent that a third factor was necessary to coagulation, and by further research 
Schmidt separated from the serum a soluble substance which lie designates as 
fibrin ferment. 
FIBRIN FERMENT. 
Fibrin ferment is obtained by diluting serum with from ten to twenty times 
its volume of alcohol and allowing it to stand in astoppered bottle for several weeks, 
(probably months). The effect of this is to coagulate the proteid matters of the 
serum. The coagulum is dried, powdered, treated with distilled water, and filtered. 
The filtrate contains the so-called fibrin ferment in solution. Such solution added 
to a liquid containing fibrinogen and serum-globulin, which does not coagulate 
spontaneously, such as the fluid of hydrocele, will often give rise to a coagulum. 
Schmidt ascribes the origin of the fibrin ferment to the destruction of the white 
blood-corpuscles, which, according to him, takes place with great rapidity after 
blood is withdrawn from the vessels. He adding, in support of his view, as to the 
origin of the ferment, the fact that in cooled plasma, from which the white corpus- 
cles have been removed by filtration, coagulation is retarded. That it is not 
entirely prevented, he ascribes to the supposition that an ice-cold temperature will 
not altogether prevent the decomposition of the white corpuscles and the conse- 
quent development of ferment. 
Another observation of Schmidt's, tending to prove that the coagulation of the 
blood is dependent upon the presence of the white corpuscles, is that in the blood 
of the horse in which the corpuscles have had time to settle, by the maintenance 
of a temperature of 0° C., coagulation is most complete in the portion in which 
the white corpuscles are most abundant. By counting the leucocytes in the plasma 
of the horses' blood, and afterward in the serum of the same, Schmidt has demon- 188 
Fibrin and the Coagulation of Blood. 
strated that there is a disappearance of these bodies during the act of coagulation, 
and has determined its amount. He found that the plasma contained 14,909* 
leucocytes per cubic millimetre, the maximum being 17,980, the minimum 12.320. 
These figures are based on eleven enumerations. In nine instances he counted the 
leucocytes in the serum, and found an average of 4,222, the maximum being 5,080, 
the minimum 2,000 per cubic millimetre; 77.7 per cent, of leucocytes had disap- 
peared in the coaguluin. Schmidt also counted the red corpuscles in blood before 
and after its defibrination. The average of the countsof the red corpuscles in living 
blood was 5,317,000. In defibrinated blood it was 5,156,000, a difference of only 
thirty per cent. This disappearance of the leucocytes is not, he argues, a mechani- ■ 
cal entanglement in the meshes of the fibrin, for, were this the case, there would 
be no such difference in the percentage of disappearance between the red and 
white corpuscles. Besides on examining a coagulum under the microscope, the 
red corpuscles are seen entangled in the meshes of the fibrin, while of the white, 
not a trace remains, but a few greatly altered cells; the vast majority of them have 
disappeared in the formation of the clot. 
Schmidt's theory of coagulation is, that it depends upon the union of two 
bodies, fibrinogen and fibrinoplastin, (serum-globulin), under the influence of a 
ferment, and he considers, that both the ferment and the fibrinoplastin are derived 
from the white blood-corpuscles. 
Later Hammarsten has contended that serum-globulin is not a necessary fac- 
tor in the act of coagulation, and that when coagulation follows its addition to a 
solution of fibrinogen it is because of its having contained the ferment. He has 
prepared fibrinogen entirely free from serum-globulin, and produced coagulation 
by the addition of fibrin ferment alone. He admits that the presence of serum- 
globulin increases the yield of fibrin, and will sometimes induce coagulation in a 
transudation when the addition of the ferment has failed to do so; but he has 
shown that other substances such as CaCl2 and casein will have the same effect, 
and, therefore, he considers serum-globulin to be a non-essential factor in the act. 
This theory is almost identical with that of Dr. Andrew Buchanan. 
Other views of the cause of the coagulation of the blood are those which refer 
it to changes in some of its morphological elements. L. C. Wooldridge, B. Sc. 
London, in a communication to the Royal Society, (Proc. Roy. Soc. No. 214, 1881) 
states that he found that after completely isolating the cells of the lymph ttic 
glands, by a process which he describes, and adding to them simple chemical 
re-agents, such as a ten per cent, solution of common salt, the cells were changed into 
a substance having the microscopic appearance and chemical behavior of fibrin, 
and under the microscope showed a distinctly fibrinous ground substance in which 
the nuclei of the cells were embedded, the cells as such having entirely disappeared. 
The following quotations from Wooldridge's paper will give an idea of the 
nature of his researches : 
" The two components (of fibrin) which arise from the blood-corpuscles are, 
according to Schmidt, paraglobulin and fibrin ferment. The recent researches of 
Hammarsten have made it very probable that paraglobulin is not directly concerned 
in the production of fibrin. If this is true, and if the views of Schmidt concerning 
the participation of the white corpuscles be also correct, the latter must necessarily 
play only a very subordinate part; that is, they must be mere ferment producers. 
* * * The generally received view as to the course of events in the normal 
coagulation of blood is as follows : Very soon after leaving the body, the white 
corpuscles die; as a consequence of this they break up, and thereby give rise to 
the ferment and paraglobulin. The fibrinogen is pre-existent in the plasma. 
According to this view, then, the essential element in coagulation is the death of 
the white blood-corpuscles. The results of my experiments are totally opposed to 
this view." 
Wooldridge injected a large quantity of dead lymph-cells, obtained from the 
lymphatic gland, into the blood ofa living dog, both in its normal state and after being 
peptonized ; without any marked influence upon the functions of the animal. No 
sign whatever of emboli was detected by post-mortem examination (2). A dog was 
peptonized, five minutes later a small quantity of blood was removed and divided 
into two portions; to the one lymph-cells were added. It coagulated immediately, 
exactly like normal coagulation. The other portion remained uncoagulated for hours. 
From these and other experiments, Wooldridge concludes that coagulation is caused 
by a change in the plasma, and has nothing to do with the vital properties of the 
cells, and that the conversion of the white cells into fibrin is quite independent of 
the presence of any fibrinogen substance. " Fibrinogen is present in living plasma, 
yet the dead cells produce no coagulation. Fibrinogen was absent from the pep- Fibrin and the Coagulation of the Blood. 
189 
tone plasma, which still gave practically unlimited quantities of fibrin with lymph- 
cells." There are, says he, "two essential processes in the coagulation of the 
blood, one of which has been hitherto entirely wrongly appreciated or overlooked. 
This latter process is that the dead plasma converts the white corpuscles directly 
into fibrin. At the same time, however, that this occurs, a substance is liberated 
from the cells which converts the fibrinogen also into fibrin. This is the other 
process. The substance which is liberated from the cells is fibrin fermented." Dr. 
Richard Norris, of Birmingham, ascribes the formation of fibrin to changes in 
bodies intermediate between the lymph-cells and the red blood-corpuscles, many 
of which have the same refractive index as the serum, and are, therefore, invisible 
when suspended in that fluid. When the serum is withdrawn from these bodies 
by methods fully described by Norris in his work on the " Physiology and Patho- 
logy of the Blood," they readily come into view. Norris' work is illustrated by 
photographs which show the transformation of these bodies into fibrin. On the 
other hand, Hayem and Bizzozero deny the existence of the colorless corpuscle of 
Norris, which they regard as a red corpuscle deprived of its haemoglobin by arti- 
ficial methods, and attribute the formation of fibrin to a transformation of elements 
of the blood to which they give the names respectively of: 
H^matoblasts and BlutpeATTCHEN. These bodies have been observed by 
Donne and described by him under the title of globulins, although so imperfectly 
that the term has never carried with it an exact signification ; by Andral, Zimmer- 
mann, Max Schultze, Riess, Beale, Osler, Vulpian, Ranvier, and, perhaps, others. 
They form the component parts of certain granular particles commonly observed 
in blood withdrawn from the vessels by microscopists, although first accurately 
described by Max. Schultze, and, therefore, known as Schultze's granule masses. 
They are more numerous in the young than in the adult animal, and may be 
readily seen in the blood-vessels of the young rat, as first pointed out by Osler 
(Proc. Roy. Soc., June 18, 1874), by snipping out a piece of the subcutaneous tissue 
and examining it in salt solution. 
Of the writers above mentioned, Ranvier, Hayem and Bizzozero have assigned 
to the bodies in question, a prominent part in the act of coagulation. At a meeting 
of the Soci6t6 de Biologie, held February 1st, 1873, Ranvier described them in detail 
and concluded from a study of their histo-chemical reactions, that they were parti- 
cles of fibrin which operate as centres of coagulation, just as a crystal of sodium 
sulphate placed in a solution of the same salt will act as a centre of crystalline 
deposit. He acknowledged that he was unable to determine whether the granula- 
tions, as he called them, exist as such in the circulating blood, but considered it 
highly probable that they do, since they are seen immediately after blood is with- 
drawn from the body (Gazette M6d., 1873, p. 94). At the same meeting, M. Vul- 
pian remarked that he had already called the attention of the Society to these 
bodies which he had constantly observed in the blood of patients at the Pitie Hos- 
pital, especially in cases of typhoid fever and erysipelas. In such patients they are 
far more numerous than the white cells, and in certain cases of erysipelas their 
number approached that of the red corpuscles. Similar observations as to the 
abundance of these elements in cachectic states of the system, had been previously 
made by Riess. In consequence of a movement of these bodies, which Vulpian 
believed to be of an active character, he called them grains sarcodiques. By far 
the greater portion of our knowledge concerning the blood-plates has been furnished 
by Hayem and Bizzozero; by the former in several articles in the Archives de 
Physiologic for 1878 and 1879, and by the latter in an elaborate article in Virchow's 
Archiv. Bd. 90. They can be readily seen in the circulating blood of the guinea- 
pig, by stretching a portion of the mesentery over a ring of cork fastened to a glass 
slide, the animal having been previously rendered motionless by chloral or chloro- 
form, or they may be observed in the blood of man, by placing a drop of a three- 
fourths per cent, salt solution tinted with methyl violet, upon the finger, punctur- 
ing with a needle through the fluid, and pressing the blood directly into it. The 
following fluid is also recommended by Hayem for the study of these very perish- 
able bodies. It has the property of fixing their form and preserving them unaltered 
for a considerable time. One drop of blood should be mingled with from twenty 
to one hundred of the fluid: Distilled water, 100; sodium chloride,!; sodium 
sulphate, 5; mercuric bichloride, 0.50. 
The blood-plates are not products of the degeneration of white corpuscles, as 
some have supposed, for their form is constant, not that of irregular particles of 
disintegration. Their chemical composition is also different, for while the white 
corpuscles retain their form and contractility for a considerable time, the blood- 
plates begin to alter so soon as they are withdrawn from the vessels, and in a few 190 
Theory of the Coagulation of the Blood. 
moments are unrecognizable. They appear to stand in a constant relation to the 
red corpuscles, so far as their size is concerned. Thus they are larger in man and 
the dog than in the lamb and guinea-pig, the red corpuscles being larger in the 
two first-named animals, and in animals with nucleated red corpuscles, the blood- 
plates are also nucleated. 
Scarcely are the blood-plates withdrawn from the vessels than they begin to 
change their appearance by a division into two portions, a peripheral, grayish, and 
finely granular, and a central more strongly refractive, vitreous-like portion. The 
peripheral substance is remarkable for its viscosity, through which property it 
adheres to neighboring plates, sometimes in star-shaped or chapelet-like forms, from 
the borders of which, as well as from individual plates, proceed a great number of 
exceedingly fine prolongations, which cross each other in various directions and 
form an irregular net-work of which the starting point is undoubtedly the blood- 
plates. These appearances are coincident with the coagulation of the blood; and 
those agents which prevent or retard coagulation, also prevent or retard these mor- 
phological changes of the blood-plates. Of these agencies are to be mentioned a 
temperature of 6° C. (32° F.) saline solutions, especially sodium and magnesium 
sulphates, and natural serosities, such as liquor amnii and dropsical effusions. 
In the living animal the fact that the blood-plates are the chief factors in the 
formation of a thrombus, may be readily demonstrated by puncturing or slightly 
cauterizing the wall of a mesenteric vessel. The blood-plates collect at the irritated 
portion, and speedilyform a thrombus in which are entangled a number of white 
corpuscles, the blood plates, however, being largely in excess. The same results 
are produced in larger vessels by transfixing them with ligatures. 
Both Hayem and Bizzozero, while insisting that the blood-plates are the cause 
of the coagulation of the blood, do not deny that other substances may have a 
coagulating power, although they suggest that fluids possessing this power, in 
which no blood-plates are visible, may yet contain the products of disintegration 
of these very destructible bodies. Such a fluid is saliva, and in it the blood-plates 
are speedily destroyed. Bizzozero remarks at the conclusion of his interesting 
paper that his experiments speak far more in favor of the coagulative power of the 
blood-plates than for that of the white corpuscles, but do not exclude the partici- 
pation of the latter in the process That the white corpuscles do participate seems 
incontestible to the writer in view of the experiments of Wooldridge. 
From the foregoing remarks it will appear manifest that while the subject of 
the coagulation of the blood is still incomplete, the whole tendency of modern 
research is to associate it with changes in certain morphological elements of the 
blood, particularly the blood-plates and white corpuscles. The term blood-plate 
has been employed in preference to hamiatoblast, because the latter not only 
implies a view with regard to the physiological destiny of these bodies, which is 
thus far. in need of confirmation, but, in addition has been applied to a variety of 
morphological elements, thereby giving rise to much confusion. Thus besides the 
use, to which it has been put by Hayem, it has been employed by Rindfleisch to 
designate the nucleated, red marrow cells (the cellules htemoglobiques of Melassez), 
and has been applied to the vaso-formative cellsof Ranvier, and also by Creighton, 
to the connective tissue cells, from which he observed red-corpuscles to spring by a 
process of budding in certain sero-sanguineous cysts of the neck, (Journal of Anat, 
and Phys. Vol. xiv, 1880.) Reference Handbook of the Medical Sciences, Vol. 1, 
188-5, pp. 540, 571. 
THEORY OF THE COAGULATION OF THE BLOOD. 
The preceding facts have been formulated by a practical writer.* 
The coagulation of the blood is now believed to be due to the action 
of three bodies contained in the plasma-two fibrin-generators, named, 
respectively, fibrinogen and fibrinoplastic substance, albuminous in nature; 
and the third a ferment. The amount of fibrin produced varies not only 
with the amount of these bodies, but with the amount of salts, with the 
degree of alkalinity and of heat, and with other influences; and these 
variations are subject to no law at present known. The rapidity of the 
process depends upon : 
(1.) The amount of ferment. 
♦Bruce. Theory of the Coagulation of the Blood. 
191 
(2.) Its increased activity by agitation of the blood and by elevation 
of temperature; and 
(3.) The increased number of points of contact (so-called " catalytic " 
action) by the presence of red corpuscles, hiemoglobiu, charcoal, etc. 
It thus appears that the expressions 1 i amount of fibrin " and " rapidity 
of coagulation," however important as facts, do not afford any definite 
indication of the state of the blood, as has been generally believed 
hitherto. 
Three essential factors, and a large number of accidental influences 
share in the process; they may do so in very various proportions and 
degrees; they do not vary together; the amount of fibrin is not the propor- 
tion to anyone of them; and after coagulation is complete, portions of all 
the factors probably remain uncombined. 
The part played by the red corpuscles in coagulation is a double one: 
(1.) The corpuscles as cpoints of contact," greatly increase the 
rapidity of coagulation; and 
(2.) They supply oxygen, which appears indispensable to the process. 
The leucocytes probably produce the ferment. 
RELATIONS OF MICRO ORGANISMS TO DISEASES AND TO CERTAIN PATHO- 
LOGICAL CONCRETIONS AND CHANGES OF THE BLOOD. 
The humoral pathologists used the term blood-disease as synonymous 
with dyscrasis, or anomalous crasis of the blood, and held the idea that the 
blood was the seat, almost without exception, of general diseases; and. as 
purely local disease was considered to be exceptional, the vast majority of 
diseases was referred, to dyscrases, and were classed under the head, of 
blood diseases. The condition of the blood was considered, by the humor- 
alists to depend upon the crasis, that is, the mixture of its constituents; 
and prominent among its constituents were reckoned the blastemata or germ- 
inal substances of the different tissues, which exuded through the capil- 
lary vessels in the process of nutrition. When the blood-crasis was dis- 
ordered or diseased, a dyscrasis was said to exist, and dyscrases were held to 
be in the majority of cases, primary; though it was admitted that local 
anamaties of nutrition might and did occasionally occur, and give rise to 
secondary dyscrases. V blood disease or dyscrasis being established, all 
morbid changes throughout the body were believed to be but local mani- 
festations of the same. For the purpose, therefore, of a rational classifi- 
cation of diseases, a previous classification had to be made of the dys- 
crases. The principal blood-crases were said to be : 
1. The fib rin-era sis; including the simple fibrin-crasis, the croupous 
crasis, and the tuburcle-crasis, as varieties. The local expression of the 
fibrin-crasis was inflammation in some form. 
2. The venous-crams in which fibrin was deficient. This included a 
vast number of special erases lying at the foundation of the most diverse 
diseases, as phlethora, heart disease, acute exanthemata, rickets, albumin- 
ous urine, cholera, acute tuberculosis, lardaceous disease, cancer, acute con- 
vulsive diseases, metallic poisoning, etc. 
3. The serous erases; associated with anaemia. 
4. The putrid or septic erases. 
5. Anomalous erases ; such as those of syphilis, gout, etc. 
The theory of dyscrases received a severe blow by Virchow when he 
published his cellular pathology, in which he endeavored to demonstrate that 
the blood is in every relation a dependent, and not an independent fluid, 
and that the sources from whence it is sustained and restored, and the 192 
Microscopical Characters of Blood in Malarial Fever. 
exciting causes of the changes that it may suffer, lie without it and not 
within it. Substances may enter the blood and affect the corpuscles injuri- 
ously ; the blood may act as a medium in conveying to the organs noxi- 
ous substances that have reached it from various sources ; or its elements 
may be imperfectly restored-but Virchow held that never is any affection 
of the blood itself-any dyscrasis-permanent unless new influences arise, 
and act upon the blood through some channel or through some organ. 
At the present time whilst humoralism is not preferred by many patho- 
logists, the notion of blood disease as entertained 30 years ago, still clings 
to the nomenclature and pervades some of our pathological doctrines. 
Diseases that affect the whole economy-syphilis, tuberculosis, gout and 
cancer-are frequently described as constitutional or blood diseases, and 
that whether the general manifestations are secondary to local disease as in 
syphilis and cancer, or are referable to inheritance. While the morbid con- 
ditions of the blood are real and numerous, blood diseases so called are 
regarded by many pathologists as mere abstractions, and as such a source of 
confusion and useless discussion. By many the term blood disease has been 
adandoned, and the expression morbid conditions of the blood applied to 
the pathological states of the vital fluid which can be distinctly demon- 
strated by physical, chemical or histological examination. 
At the present time medical men are no longer satisfied with elaborate 
nosologies and the minute descriptions of the symptoms and pathological 
changes of various diseases; the grand work of the present age is the prose- 
cution of investigations into the causes of disease ; and when these shall 
have been fully determined, medicine in its broadest senses as a preventa- 
tive as well as a curative art, will take its rank amongst the exact sciences. 
The investigation of the aetiology of acute infectious diseases, and the 
reference of their active agents to certain organisms known as bacteria or 
bacilli, have brought the so-called germ theory of infectious diseases out of 
the mists of conjecture and hypothesis, into the clear light of demonstra- 
tion. 
It is now demonstrated beyond dispute that pathogenic micro-organ- 
isms exist in distinct and definite forms, and are capable of inducing 
distinct diseases in the human being; and the views advanced by Beale, 
that bacteria and portions of diseased protoplasm form living tissues, and 
by Wigand, that they may spring up de novo, in organic matter, by trans- 
formation of organic molecules, are no longer held worthy of serious con- 
sideration. 
Equally unsatisfactory was the view announced by Hallier, that all 
kinds of germs, large and small moulds, ferments and bacteria are mutually 
convertible. This hypothesis, as well as that of spontaneous generation as 
applied by Wigand, was entirely refuted by de Bary of Strasburg, and by 
the accurate observations of Brefeld. 
Grawitz claimed that innocent mould, fungi, aspergillius and mucus, 
etc., could be converted into dangerous forms; but Koch and Gafl'ky, who 
carefully repeated his experiments, showed that the erroneous conclusions 
of Grawitz, were based upon Lhe use of impure cultures. 
MICROSCOPICAL AND CHEMICAL CHANGES OF THE BLOOD IN MALARIAL 
FEVER. 
The author has been led, by extended observations and investigations, 
during a period of 30 years-1855-1886-to definite conclusions, some of 
which may thus be formulated: 
1. The phenomena of malarial fever in the human organism are due to 
the introduction of a morbific ferment. Microscopical Characters of the Blood in Malarial Fever. 
193 
2. The micro-organism concerned in the production of malarial fever 
attacks chiefly the blood-corpuscles of man. 
3. The phenomena of malarial fever are due in part to the destruction 
of the colored blood-corpuscles, in part to the derangement of the normal 
chemical changes of the blood and organs, and in part to toxic action of the 
chemical compound, developed by, and resulting from, the action of the 
micro-organisms. 
4. The chemical and physical changes excited in the blood and organs 
of the human body by the action of the malarial micro-organisms are in 
their highest and final results inimical to the development and multiplica- 
tion of the essential potential elements of the malarial ferment. 
5. The active febrile phenomena of malarial fever are, in their ulti- 
mate resultsand products, antiseptic; they tend to inhibit the develop- 
ment, and even to destroy the morbific ferment of malarial fever. 
6. Many of the most destructive and fatal effects of the malarial fer- 
ment occur in cases in which there has been comparatively little elevation 
of temperature, and in which the paroxysms succeed each other in an 
almost imperceptible manner. 
7. The recurrence of paroxysms in malarial fever is due to the partied 
destruction of the micro-organisms during the active and pronounced chemi- 
cal changes of the fever. When not wholly destroyed during the febrile 
stage, the micro-organisms are reproduced, and again, at definite intervals, 
induce disturbances of the nervous system, alterations of the blood, and 
oscillations of the temperature. 
8. Such agents as quinia, arsenic, and the preparations of mercury, 
act as poisons to the micro-organisms of malarial fever, excite an antiseptic 
effect upon the blood, bind the oxygen more nearly or closely to the haemo- 
globin, and proteids, and directly promote the elimination, through the 
alimentary canal, the skin, and the kidneys, of the noxious products of the 
morbific ferment and of the increased and altered chemical actions. 
9. The changes induced by the morbific malarial ferments upon the 
blood differ chemically and microscopically from those induced by other 
morbific organisms, as those of small-pox, typhoid fever, typhus fever, yel- 
lowfever, measles, scarlet fever, relapsing fever, diptheria, Asiatic cholera, 
Oriental plague, tuberculosis, Oriental leprosy, pneumonia, pleuritis, car- 
ditis, erysipelas, rheumatism and pyaemia. 
10. The micro-organisms which we have observed in the blood of 
patients suffering from malarial fever may be thus briefly enumerated : 
(a.) Minute globular bodies from the 10,000th to the 30,000th of an 
inch in diameter, having the general appearance and chemical features of 
the spores of bacteria. 
(b.) Globular bodies of larger size than the preceding, often of a 
dark opaque character, found not only in the liquor sanguinis, but also in the 
colored blood-corpuscles and in the colorless blood corpuscles. These 
bodies, most probably true spores, appear to possess the power of invading 
and destroying the colored blood-corpuscles. These micrococci, or spores, 
are often observed in the blocd, in groups, surrounded by protoplasm con- 
stituting zoogloea. 
(c.) Ovoid, cylindrical and rose-shaped bodies, not destroyed by acetic 
acid, and stained by aniline dyes. These bodies increase during the cold 
stage, and are also more numerous in pernicious malarial fever. 
(d.) Colorless blood-corpuscles containing minute pigments, granules, 
and dark spherical bodies resembling sporules, many of them pigments, 
corpuscles, or aggregations of dark spherical bodies, surrounded by proto- 
plasm, are about twice the diameter of the colorless blood-corpuscles of 194 
Microscopical Characters of the Blood in Malarial Fever. 
normal blood ; and their behavior under the action of re-agents, and also 
during the process ot staining leads to the view that a portion at least of 
these bodies must be regarded as vegetable organisms. These large pig- 
ment cells appear to be characteristic of malarial fever. 
(e.) Masses of hsematin of various forms, irregular in size and shape, 
but most generally the sides and portions seen in profile are angular. The 
deposit of dark pigment masses in the liver and in the brain, in malarial 
fever, and especially in cases of repeated paroxysms, finds its origin in the 
changes of the colored blood-corpuscles induced by the morbific ferment, or 
micro-organisms of malarial fever. 
There is an actual destruction of the colored blood-corpuscles in the 
living blood, and within the walls of the living capillaries and blood-ves- 
sels in malarial fever ; and this destruction is not referable either solely or 
originally to the action of the bile acids accumulated in the blood as a con- 
sequence of biliary congestion or obstruction during the febrile stage of 
malarial fever. 
We can detect the process of the disintegration of the colored blood- 
corpuscles by the microscope, and detect the very inception of that great 
pathological change which constitutes one of the most distinctive features 
of malarial fever, and which must be carefully considered in any scientific 
and rational plan of treatment. 
(f.) Marked variations in the size of the colored blood-corpuscles. 
These variations, from small corpuscles to what might be called giant cor- 
puscles, twice the diameter of normal blood globules, appear to be charac- 
teristic of malarial fever. 
11. The destruction of colored blood-corpuscles does not take place with 
equal rapidity in all parts of the organism, but appears to be mostly 
marked in the spleen and liver. The blood pigment resulting from the 
hmmatin of the blood-corpuscles is frequently observed in the blood as it 
circulates in the vessels and capillaries, in masses of various sizes, and in 
the form of cellular elements. 
Without doubt local congestion may be caused by obstruction of the 
circulation in the capillaries by these pigment particles and cells ; and such 
congestion may lead to local haemorrhages. The congestions and hemor- 
rhages thus resulting are especially significant when occurring within the 
structures of the brain and spinal cord. 
The appropriation of a portion of the altered coloring matter, hematin 
of the colored blood-corpuscles, by the leucocytes, is due to the physical 
and vital endowments of these elementary bodies. 
It is now generally admitted that'the colorless blood-corpuscles are ele- 
mentary organisms, which are endowed with the power of spontaneous 
motion, this power belonging to them in virtue of the protoplasm of which 
these bodies are composed. This motion is of two kinds, consisting of 
change of form and change of place; the latter resulting from the former. 
As movements of this kind are seen in greater perfection in rhizopods and 
amoeboe, they are called amoeboid. 
The colorless corpuscles, when carefully examined in considerable 
numbers under high forms of the microscope, one-tenth to one-twentieth 
inch objective, are seen to differ from one another both in size and aspect, 
and in their properties and spontaneous movements. 
The careful experiments of physiologists have established the impor- 
tant fact that it is possible to find the colorless blood-corpuscles. It has been 
demonstrated that the colorless blood-corpuscles possess the faculty of talcing, 
by virtue of their amoeboid movements, solid particles into their substance. This 
subject is of great interest to the histologist, in affording him a means by Microscopical Characters of the Blood in Malarial Fever. 
195 
which to mark individual corpuscles so as to follow them in their wander- 
ings through the organism, and to the physiologist, in relation to the mode 
in which amoeboid cells take in nourishment; to the student of fevers it is 
of transcendent importance in giving an important point of diagnosis for 
malarial fever, which distinguishes it from all other forms, and especially 
yellow fever. 
The author demonstrated, during the progress of his pathological 
researches, extending from 1856 to 1886, the power of the colorless corpus- 
cles of human blood to feed upon and appropriate the haemoglobin, ha;ma- 
tin and haemin of the colored blood-corpuscles in the blood-vessels of 
malarial patients, before physiologists had experimentally determined, by 
employing either finely divided fatty substances or coloring matters, the 
power of the colorless blood-corpuscles of taking solid particles into their 
substance. 
We have thus traced the pigmentation of the colorless blood-corpuscles 
in malarial fever to 
(a.) The destruction of the colored blood-corpuscles by the morbific 
ferment, or micro organism of malarial fever. 
(b.) The coloration of the haemoglobin, haemin, and hamatin, and its 
appropriation by the colorless blood-corpuscles in virtue of their physical 
and vital principles and amoeboid movements. 
(c.) The invasion of the colorless corpuscles by the colored spores of 
the malarial bacillus. 
The following illustrations which the author has drawn from nature, 
will illustrate the appearance of the micro organisms of the blood in mala- 
rial fever. It should be noted that these should be regarded as micro- 
organisms selected from many specimens of blood and grouped together in 
one figure. This subject will be more fully discussed in the following (3d) 
chapter of this volume. 
ENGRAVING NO. 14. 
Microscopical Objects in Blood of Malarial Fever. 
Engraving No, 11.-Micro-Organisms in Blood of Malarial Fever. The large pigment cells, elon- 
gated bodies, Colored Blood-Corpuscles invaded by spores, and masses of Haemoglobin, are seen 
in A and B, l-10th inch objective. 196 
Microscopical Characters of the Blood in Malarial Fever. 
ENGRAVING NO. 15. 
Micro-Organisms in Blood of Malarial Fever. 
0 D 
Engraving No. 15.-Micro-Organisms in Blood of Malarial Fever. (C.) Micro-Organisms observed 
in Fresh Blood of Malarial Fever. 1-lOth inch objective. (B.) Micro-Organisms in Blood of 
Malarial Fever, prepared and stained after the method of Koch, l-10th inch objective. 
ENGRAVING NO. 16. 
Micro Organisms in Blood, of Malarial Fever. 
Engraving No. 16.-Micro-Organisms in Blood of Malarial Fever. Figures E and F: Micro- 
Organisms in Blood of Malarial Fever, prepared and stained after method of Koch and Wei- 
gert, l-10th inch. The objectives used in this, as in most of the microscopical drawings and 
preparations of this author, were made by R. & J. Beck of London. 
12. Increase of water in the blood of malarial patients.-Chemical anal- 
ysis has shown that normal healthy human blood frequently yields 150 
parts, in the 1000 parts of blood, of colored blood-corpuscles in the dried 
(anhydrous) state. The dried blood-corpuscles do not represent the true 
relations of the moist blood-corpuscles to the liquor sanguinis of the liv- 
ing human blood as it circulates through the vessels. The number of moist 
(normal colored blood-corpuscles) is obtained by multiplying the dried 
corpuscles by four. We thus obtain for healthy human blood the follow- 
ing composition: Microscopical Characters of the Blood in Malarial Fever. 
197 
1000 parts of healthy human blood contains- 
Moist red globules 600 
Liquor sanguinis 400 
In prolonged or chronic malarial fever (malarial toxiemia or cachexia) 
the author has found the dried blood-corpuscles to be reduced to 59 parts 
in the 1000 parts, and in some cases as low as 30 parts in the 1000 parts 
of blood. 
ENGRAVING NO. 17. 
Micro-Organisms in Splenic Mud of Malarial Fever. 
Engraving No. 17.-Micro-Organisms of Splenic Mud of Spleen of Malarial Fever, subjected to 
the action of strong Acetic Acid for the space of from 7 to 14 days. Magnified 1000 diameters 
ENGRAVING NO. 18. 
Fungus developed in Splenic Mud of Spleen of Malarial Fevei 
Engraving No. 18.-Fungus developed in Splenic Mud of Malarial Fever. Splenic Mud of case 
of Malarial Fever, mixed with about three parts of water, and allowed to stand in a glass 
bottle, the mouth of which was closed with antiseptic cotton, until all evidences of fermenta- 
tion and putrefaction had ceased. l-l()th objective. 198 
Spirillum of Relapsing Fever. 
If we accept the first figures, the following will represent my constitu- 
tion of the blood in chronic malarial poisoning : 
1000 parts of human blood in chronic malarial fever contains- 
Moist red globules 250 
Liquor sanguinis 750 
We have in the preceding changes of the blood, induced by the action 
of malarial poison, an explanation of the sallow, anaemic complexion, the 
feeble, irritable action of the heart, the depressed muscular power and 
mental forces, and the bloated countenance, protuberant belly, and swollen, 
anasarcous limbs. 
13. Diminution of the Fibrin of the Blood.-The persistent and uniform 
deviation of this constituent of the blood in uncomplicated cases of mala- 
rial fever distinguishes this from the true inflammation and the fever 
accompanying local inflammation; and also affords an explanation of the 
tendency to haemorrhages in many endemics of malarial fever. 
We have in the preceding profound changes of the blood in malarial 
fever an explanation not merely of many of the symptoms of the disease, 
but also of the great tendency to the formation of fibrinous clots. The 
direct action of the micro-organisms of malarial fever upon this colored 
and colorless corpuscle alters the relations of this fluid to the containing 
vessels, liberates the hsemoglobin and other constituents of the colored 
blood-corpuscles, and brings about both directly and indirectly such physi- 
cal and chemical changes, induces such aberration of the nervous system as 
promotes the separation of fibrin and the formation of heart-clots. 
This disease which appears to be due to a specific micro organism, 
which from its size, threadlike shape and active movements might be sup 
posed to be liable to cause fibrinous concretions in the human being where 
blood had been made by the spirillum obermeyer. Accordingly we find 
upon post-mortem examination, that the spleen and liver are enlarged to 
a greater extent in relapsing fever than in typhus, and typhoid fevers. In 
relapsing fevers, the spleen is usually seen at its largest size during the 
final paroxysm. But if death occurs during convalescence this organ is 
of a normal size, occasionaly pale or red, fibrinous infarctions are found in 
its substance or near its surface, they are easily broken down, have a fine 
granular fracture and are considerably firmer than the surrounding tissue 
from which they are separated by a distinct line of demarcation. The 
blood in a few cases has been found fluid throughout the body after death; 
but generally when drawn from the body during the febrile paroxysm it is 
buffed, and discolored coagula are found in the heart and large blood- 
vessels after death, as in cases of typhus and typhoid fever, the propor- 
tion of white corpuscles is increased, a point of interest in connection 
with enlargement of the spleen, and the state of anaemia so correctly 
observed. Large colorless transparent cells, in some cases from two to 
four times the size of colorless blood-corpuscles are also found in the heart 
in relapsing fevers. In some cases enlargement of the liver has been 
observed. We have thus in the enlargement of the spleen and liver and a 
diminution of the colored corpuscles, as well as the paroxysmal character 
of the disease, a close relationship between this disease and remitting and 
intermitting fevers. The analogy is still further strengthened by the fre- 
quent occurrence of jaundice in this disease which has caused it to be 
called bilious remittent fever, bilious relapsing fever, mild yellow fever. 
SPIRILLUM OBERMEYER OF RELAPSING FEVER. Spirillum of Relapsing Fever. 
199 
According to Jenner, jaundice is present in nearly a fourth of the cases, 
and is sometimes intense. The liver is generally enlarged, and the gall 
bladders filled with dark thick bile. 
In the epidemic of relapsing fever which prevailed in Berlin in 1867- 
1868, the late Dr. Obermeyer commenced to examine the blood, but with- 
out any definite results until 1872, when the fever again appeared in Ber- 
lin. He then discovered organisms in the blood, associated with the mor- 
bid process so closely, that as soon as the pyrexia disappeared, they disap- 
peared with it, re-appearing when the patient again fevered in the 
relapse. 
The observations of Obermeyer (Obermeier), have been since confirmed 
by Engel and Weigert in Berlin and Breslau, by Macnamara and Lewis in 
India. The organisms were subsequently identified by Cohn and named 
spirillum {spirochceta^ obermieri, but which does not differ apparently from 
other spirilla which appear to be harmless. It does not differ in size or 
character of members from spirillum (spirochaeta) plicatilis, found by 
Ehrenberg in water many years ago, and which Cohn previously found in 
water, and also in the mouth in the mucus surrounding the teeth. 
The view held by some that the spirillum obermieri is the essential 
cause of relapsing fever and not a non-essential epi-phenomenon, appears 
to have received strong confirmation in the experiments of inoculation. 
Those who held the view that it is a mere epi-phenomenon, attempt to 
sustain their hypothesis by the assertion that it is absent from the blood in 
some cases of relapsing fever, but spirilla precisely similar have been found 
in an abscess opening into the mouth of a fever-free patient, and also in 
connection with caries of bone. 
ENGRAVING NO. 19. 
Blood of lielapsing Fever (fHumanf 
Engraving No. 19.-Human Blood of Relapsing Fever. Blood-Corpuscles and Spirilla Ober 
meyeri. Magnifying power 700. Koch. Spirillum Obermeyeri of Relapsing Fever, is identical 
with Spirillum tenue. or Spirocheeta plicatilis of Cohn. It was discovered in great numbers 
by Obermeyer in the blood of the general circulation in persons suffering from Relapsing 
Fever. 
The spirilla disappear from the blood during the non-febrile stages, 
gradually decreasing in numbers. They are mobile. In the blood of 
patients examined by the author in the Charity Hospital, they had an 200 
Filaria in Blood of Animals and Man. 
active screw-like motion in the fresh blood previous to coagulation. It 
has been clearly established that the spirillum of relapsing fever could be 
propagated by inoculation. 
ENGRAVING NO. 20. 
Blood of Relapsing Fever (Apef 
Engraving No. 20.-Blood-Corpuscles and Spirilla of Blood of Ape (Spirillum Obermeyeri), mag- 
nifying power 700, Koch. Blood of Ape Inoculated with Blood shown in preceding figure. 
H. V. Carter (Lancet, 1879, vol. i, p. 84; and 1880. vol. i, p 662), 
succeeded in producing relapsing fever in monkeys by inoculating with 
human blood containing the spirillum obermeyeri. The blood in the 
monkey contained the same spirilla in great numbers. Koch has culti- 
vated artificially the spirilla obermeyeri, and saw them growing with long 
spiral threads. 
PARASITES IN THE BLOOD DO NOT NECESSARILY CAUSE DEPOSITION OF 
THE FIBRIN, OR THE DEVELOPMENT OF FATAL SYMPTOMS ATTENDED 
WITH HIGH FEVER, ABERRATED NERVOUS ACTION-COMA. 
While fibrin may be obtained from blood by stirring with a glass rod, 
wire, or foreign body, to which it adheres in stringy masses, at the same 
time it is worthy of note that the blood of man and animals may contain for- 
eign bodies in the form of living parasites, often of considerable size with- 
out causing the separation of the fibrin. These parasites are continually 
agitated in the blood in the living blood-vessels, by the action of the 
heart, and it would be reasonable to suppose that the parasites of relapsing 
fever, chyluria and elephantiasis would excite or cause such a separation 
of the fibrin of the blood as would prove fatal, by causing local obstruc- 
tions and functional derangements according to the organ in which they 
found lodgement. It is well known |that dysume, haemorrhage, paral- 
ysis and sudden death may be caused by the detachment of fibrinous con- 
cretions; but as far as my observations extend such results do not follow 
the existence in the blood of the following parasites, of which we present 
illustrations, in order to place the remarkable fact in a clear light. Filaria in Blood of Animals and Man. 
201 
FILARIA IN BLOOD OF ANIMALS AND MAN. 
ENGRAVING NO. 21. 
Heart of Dog, containing Filaria Sanguinis. 
Engraving No. 21.-Filaria Sanguinis Case. Joseph Jones, M. D. Heart of Pointer Dog. 
(('anis Avicularius E.): left ventricle opened by an incision, exposing a large number of 
Filaria. 
In the month of September, 1855, in Liberty County, Georgia, the 
author during the performance of a physical and therapeutical experi- 
ment, opened the abdominal cavity of a powerful pointer dog, discovered 
in its blood by means of the microscope, numerous living vigorous and 
rapidly moving filaria, in the larval condition, still included in their 
shells. When the dog was killed, large filaria were found in the cavities 
and large blood-vessels of the heart, three to twelve inches in length. The 
engraving represents a portion including the apex and left ventricle of the 
heart of the pointer dog; an incision was now made into the left ventricle 
and the long thread worms from three to fourteen inches in length are seen 
in this cavity. I still have the heart of the pointer dog, and also that of 
another dog in the blood of which the author discovered filaria, in the 
month of September, 1855. The cavities and large blood-vessels of the 
heart also contain long slender thread worms, from three to twelve inches 
in length, and from l-32d to l-64th of an inch in diameter. Similar obser- 
vations were made in other animals. In every case in which I discovered 
the living filaria in the blood and hearts of living animals,. both the 
minute larvae ranging in length from l-500th to l-600th of an inch, and 
from l-1500th to l-2500th of an inch in diameter ; and the long thread worms 
lodged in the heart and blood-vessels, varying in length from three to 
fourteen inches, were entirely free from fibrinous concretions. 
The living filaria appears to possess no power of separating the fibrin 
from the living blood in which it lives and moves. 202 
Elephantiasis Arabum. 
ELEPHANTIASIS ARABUM AND FILARIA SANGUINIS HOMINIS. 
Elephantiasis Arabum-Nature of the Disease 
This disease consists in a slow hypertrophy of the skin, areolar 
tissue, and bones. The epidermis is thickened and the papillae enlarged ; 
the true skin is immensely thickened; its fibrous structure dense, and almost 
rigid ; the areolar tissue thickened; its areolae expanded and filled 
with gelatinous-looking stuff. The microscopical appearances are those of 
hypertrophy of the tissues involved. The bones also of the affected limb 
become enlarged and heavy, and the nearest lymphatic glands are enlarged. 
Its favorite seats are the leg, which it converts into a huge pachyderma- 
tous resemblance to an elephant's leg (Barbadoes leg, Bucnemia, etc.), 
and the male genitals which it converts into a huge tumor, reaching often 
down to the knees. Elephantiasis Arabum will be illustrated as far as its 
general features are concerned by the following six illustrations, five of 
which are produced for the fii>t time direct from nature. 
ENGRAVING NO. 22. 
Elephantiasis Arabum. 
Engraving No. 22.-Elephantiasis of Penis and Scrotum in Negro; native of Southern United 
States of America. Early stages of disease, Elephantiasis Arabum. Elephantiasis Arabum. 
203 
ENGRAVING NO. 23. 
Elephantiasis A rabum. 
Engraving No. 23.-Elephantiasis Arabum in the Negro. Elephantiasis of Scrotum and Lett 
Leg. 
ENGRAVING NO. 24. 
Elephantiasis Arabum. 
Engraving No. 24.-Elephantiasis Arabum in the Negro. Elephantiasis of lower extremities. 204 
Elephantiasis Arabum. 
ENGRAVING NO. 25. 
Elephantiasis Arabum. 
Engraving No. 25.-Elephantiasis Arabum in the Negro. Elephantiasis of Scrotum and left Leg, 
before operation. 
ENGRAVING NO. 26. 
Elephantiasis A rah um. 
Engraving No. 26.-Elephantiasis Arabum in the Negro. Elephantiasis of the Scrotum after 
the operation. Filaria Sanguinis Hominis. 
205 
ENGRAVING NO. 27. 
Hypertrophy of the Scrotum and Prepuce in Elephantiasis Arabum. 
Engraving No. 27.-Hypertrophy of the Scrotum and Prepuce in Elephantiasis Arabum. (Dr. 
Weblin's Patient, Modern Surgery, Robert Druett, p. 80). The curled protuberance in the 
front of the tumor is the hypertrophied prepuce. The patient was operated on by Dr. Web- 
iin, at Southampton, in 1862. 
Such tumors grow to enormous size; Dr. Paul at Madras, cut out one 
which weighed 80 lbs., before it was drained of blood and fluid. They 
continue to increase and if left to themselves, undergo offensive ulceration 
and sloughing which destroys life. The only treatment is extirpation. 
ENGRAVING NO. 28. 
Filaria Sanguinis Hominis. 
Engraving No. 28.-Filaria Sanguinis Hominis-Lewis. Figures A and B, embryos of Filaria 
Sanguinis Hominis; C, Ova of Filaria Sanguinis Hominis. 
RELATIONS OF FILARIA SANGUINIS HOMINIS TO ELEPHANTIASIS ARABUM 
AND CHYLURIA. 
The filaria sanguinis hominis, was discovered in 1869, by Dr. Timothy 
R. Lewis of the British Army Medical Service, in the urine of patients in 
the General Hospital at Calcutta, suffering from chyluria; and in 1871, Dr. 
Lewis discovered the living filaria in human blood. Its appearance is very 
characteristic. On first being removed from the body in a drop of blood, 
it moves about incessantly, coiling and uncoiling itself unceasingly, lashing 206 
Filaria Sanguinis Hominis. 
the blood corpuscles about in all directions. Each embryonic filaria is 
enclosed in an exceedingly delicate structureless and transparent tube, 
closed at both ends, within which it is capable of elongating and shortening 
itself. That it is so enclosed is a proof that in such a stage of existence, it is 
immature, and its " home" in the blood. It has no visible means of perfora- 
ting the tissues, depending on the currents of the blood for its transmission 
from place to place. The following engravings illustrate the appearance 
of the embryo and adult filaria sanguinis hominis: 
ENGRAVING NO. 29. 
Anatomy of Mature Filaria Sanguinis Hominis. 
Engraving No. 29.-Anatomy of Mature Filaria Sanguinis Hominis. Figure 1, natural size of 
Filaria Sanguinis Hominis. Length 3^ inches; breadth, 1 line. Length of Embryo from 
l-125th to l-200th of an inch. Breadth of Embryo, l-3000th to l-2500th of an inch. Figure 2, 
Head and Neck, showing (Esophagus (A), and Vagina (B). Figure 3, Tail of the same, show- 
ing fold of tuba and termination of intestine x 55. 
Female Filaria Sanguinis Hominis, from Abscess in Human Thigh. 
ENGRAVING NO. 30. 
^^ViNGNo.SO.-Fragmentof Female Filaria Sanguinis Hominis, from Abscess in Human 
rhigln showing remains in Alimentary Canal, decomposing body* dead embrvos escaped 
from Ruptured Uterus; one ovum visible.-Manson. y escaped Bilharzia Hcematobia. 
207 
Within the past four years, the investigations of microscopists and 
pathologists, with reference to the filaria sanguinis hominis, have assumed 
great practical importance for the inhabitants of tropical and sub-tropical 
climates in which elephantiasis arabum is endemic. Ever since Dr. Lewis 
discovered the parasite in 1869, evidence has been accumulating to show 
that this hsematozoon is more or less intimately connected with several 
severe and intractable, and, unfortunately, by no means rare diseases in these 
regions. It has been shown that disorders of the lymphatic system, especi- 
ally in the tropics, are found frequently associated with, if not caused by, 
filaria. Nueboid and ordinary elephantiasis arabum, chyluria, hrematuria, 
lymph varix, and abscess, hydrocele affections of the cord and testes, 
diarrhoea, fever, cachexia, deterioration of general health, certain skin 
diseases, deafness, eye disease, have been ascribed to the existence of such 
filaria, although it is not contended that they are always so caused. A 
powerful impulse has been given towards the further investigation of the 
relations of the filaria sanguinis hominis to disease, by the discoveries of 
Dr. Manson in China, and Dr. Bancroft in Australia. The mature filaria 
has been found by Dr. Bancroft in a person suffering from lymphatic 
abscess of the arm in 1876; and Dr. Lewis found two specimens in the 
blood-clots from a young Bengalli lad who had been operated on for 
nueboid elephantiasis in 1877. 
Dr. Manson has shown by his elaborate and valuable researches in 
China with reference to the relations of the filaria sanguinis to man, that: 
1. The parent filaria live in the lymphatics. They do not live in the 
glands, but in the lymphatic trunks at the distal side of the gland. 
2. They are oviparous, their eggs are carried by the current to the 
glandsand being too large to pass, they are arrested until they are hatched. 
After hatching the free embryo passes along the lymph vessel and enters 
the general circulation, 
3. Resting in some organ during the day, it circulates with the blood 
during the night. Unless there is some disturbance as fever, interfering 
with the regular physiological rythm of the body, filaria embryos invari- 
ably begin to appear in the circulation at sunset; their number gradually 
increases till midnight; during the early morning they become fewer by 
degrees, and by 9 or 10 o'clock A. M., it is a very rare thing to find one in 
the blood. The embryos have more recently been shown to circulate during 
sleep, regardless of the night time. 
4. The mosquito abstracts the filaria from the blood and thus becomes 
an intermediary host, and a means of its propagation. 
5. In certain cases the ova or embryos produce obstruction of the 
lymph circulation through the glands, either directly by their size or 
indirectly, by causing inflammation. 
6. If the obstruction* be partial, varicosity of glands and afferent lym- 
phatics result, but by means of the anastomosis, the lymph circulation is 
continued carrying the embryos into the blood. Lymph-scrotum, or chylu- 
ria, or varicose glands with hsematozoa are therefore the symptoms of par- 
tial obstruction of the lymphatics. 
7. If the obstruction be complete, one or the other of two things 
happens: (a.) The accumulating lymph so distends the vessels that they 
rupture, and a lymphorrhagia results, which is more or less permanent, 
(b.) If the lymphatics fail to rupture, there is complete stasis of lymph 
and excessive accumulation in the tissues on the distal side of the glands: 
solidification of the glands and tissues, and elephantiasis results. London 
Lancet, vol. ii, 1880, p. 792. 208 
Bilharzia Hcematobia. 
H.EMATUR1A OF EGYPT, MAURITIUS AND THE CAPE OF GOOD HOPE, TRACED 
TO THE BILHARZIA HCEMATOBIA. 
The bi-sexual parasite (bilharzia hcematobia') first discovered by Bilharz 
of Cairo, Egypt, in the portal vein and its branches, and likewise in the 
walls of the urinary bladder, is of remarkable interest, not less from its 
peculiar anatomical structure, than from its great prevalence on the bor- 
ders of the Nile, and from the grave and characteristic symptoms to which 
it gives rise. The body of the male is thread shaped, round, white and 
flattened anteriorly. The oral sucker is triangular; the abdominal sucker 
at the end of the trunk is circular. Below this, at the curved margin of 
the abdomen, a furrowed canal exists for the reception of the female. The 
genital pore lies between the abdominal sucker and the commencement of 
the canalis gyncecophorus. The female is very thin and delicate; the fail is 
not provided with any canal. The suckers resemble those in the male; 
but the genital pore and the abdominal sucker are in contact. The length 
of the animal amounts to three or four lines, and the male is broader than 
the female. 
The following engraving presents a view of the bilharzia htematobia 
and its embryos: 
ENGRAVING NO. 31. 
Bilharzia Hcematobia. 
Engraving No. 31.-Bilharzia Heematobia. Figure A.-Three ova, magnified 50 diameters, and 
a portion of mucous membrane with eggs attached, magnified 25 diameters. B.-Eggs witli 
segmented yolk. C.-Free embryos. D.-Ruptured Egas with embryo escaping, magnified 
150 diameters, Harley. The Eggs of the Bilharzia Hsematobia, measure l-200th of an inch long 
and l-500th of an inch broad. 
According to Griesinger, the bilharzia hjem^tobia has been met with 
in Egypt 177 times in 363 necropsies, or in 33 per cent. As we have said, 
Bilharz first discovered the parasites in the portal vein and its branches, 
and in the walls of the urinary bladder; it has since been observed by 
Griesinger, Reinhart and Lautner in the veins of the mesentery, urinary 
bladder, ureter and pelvis of the kidneys, giving rise to a formidable and 
very prevalent disease. 
It is worthy of note that in the larger vessels, such as those of the mesenteric, 
this distoma gives rise to no derangement equal to those which result when it exists in 
the lining membrane of the urina»yjpassages and the intestinal canal. Thus 
it induces haemorrhage and inflammation. In the intestine they are often 
associated with appearances resembling those of dysentery, with conges- 
tion, extravasation of blood, deposits upon and beneath the mucous mem- Bilharzia Hcematobia. 
209 
brane, fungoid excrescences, and croupy exudations that occupy ulcerated 
patches of the bowel. In many of these cases the eggs of the bilharzia 
haematobia may be found wedged in long rows within the intestinal vessels, 
or in and beneath exudation in the free-surface of the mucous membrane. 
Hence it has been supposed that the dysentery endemic to Egypt was 
largely due to this parasite. In the urinary apparatus the mucous mem- 
brane appears swollen in places which are covered with a soft, sandy, rotten 
mass, firmly fixed to the subjacent tissue. The microscope shows this mass 
to consist of the full and empty shells of the parasitic ova, in a mixture of 
blood exudation, mortified epithelium, and crystals of uric acid. The 
thickening of the submucous tissue often produces stricture of the urethra, 
which is followed by retention of urine, and all its dangerous consequences 
-degeneration of the kidneys, pyelitis, dilatation of the renal pelvis, or 
atrophy of the substance; or the masses themselves become the nuclei of 
calculous deposits, and this acid in this chlorotic exhaustion these creatures 
produce in the person they inhabit, by the consumption and loss of blood 
they imply. It seems not unlikely that the dislodgement of clots into the 
general circulation sometimes brings about pneumonia in the way described 
by Virchow, and illustrated by the clinical researches of Kirke (Brit, and 
For. Med. Chir. Review, L. C. p. 125). 
The entire trunk of the portal vein is sometimes filled with this parasite, 
while their ova are found in the tissue of the liver; but the symptoms to which it 
gives rise are more referable to the urinary organs than to the liver. The urine 
is bloody, and sometimes contains the ova of the distoma; and a state of pro- 
found cachexia supervenes. Dr. John Harley, of King's College, London, 
has directed the attention of the profession to the remarkable prevalence of 
hwmaturia at the Cape of Good Hope-a condition which he found associ- 
ated with the fertile ova of the entozoon passed in the urine. After 
micturition, a little blood, never exceeding a teaspoonful, or some dark 
coagula, like "veins," appear with the last half-ounce of urine. The 
urine itself is never bloody. Sometimes the blood-coagula will block up 
the urethra, and cause obstruction for a few minutes. These are all the 
symptoms that appear in connection with the urinary apparatus; and 
numbers of people of both sexes are affected in precisely the same way in 
certain parts of the Cape-as epidemic hfematuria-especially at Niten- 
hage and Port Elizabeth. 
GENERAL CONCLUSIONS AS TO THE RELATIONS OF MICRO-ORGANISMS TO 
THE FORMATION OF HEART-CLOTS IN MALARIAL FEVER AND OTHER 
DISEASES. 
From the preceding facts, the following general conclusions may be 
drawn: 
1st. There is no necessary connection, in the relation of cause and 
effect, between the existence of micro-organisms in the blood and the for- 
mation of heart-clots. 
2d. The induction of the deposition of fibrin within the living blood 
and vessels during the progress of a disease caused by micro-organisms 
will depend upon the relations of the pathogenic organisms and their pro- 
ducts to the colored corpuscles, colorless corpuscles, and to the fibrinogen, 
librinoplastic substance and the fibrin ferment. 
3d. The presence of living animal parasites in the blood of living 
human beings, does not necessarily or usually cause the deposition of 
fibrin during life; and in fact the formation of heart-clots during the 
diseases caused by well-known animal parasites, as the filaria sanguinis 210 
Treatment of Heart-Clots. 
hominis, and the bilharzia haematobia, appears to be very rare. Living 
animal parasites appear to possess no power in themselves of causing the 
deposition of the fibrin from the living blood in which they circulate. 
When, however, they excite inflammation in any organ or tissue, the 
deposition of fibrinous clots and their subsequent injurious action may 
occur as secondary results. 
4th. Heart-clots are more common in the severest forms of malarial 
fever, than in the milder forms; and if the severity of the paroxysms of 
malarial fever be in proportion to the number and character of the patho- 
genic organisms in the blood, then there is a clear relationship between 
their existence and the deposition of fibrin within the living blood-vessels. 
5th. Heart-clots are of more frequent occurrence in malarial fever 
than in other diseases. 
6th. The formation of heart-clots in malarial fever may be referred to 
the direct action of the pathogenic organisms of malarial fever, upon the 
colored and colorless blood corpuscles. 
PRINCIPLES OF TREATMENT BEST ADAPTED TO PREVENT THE FORMATION 
OF FIBRINOUS CONCRETIONS IN THE HEART AND BLOOD-VESSELS. 
When the pulse is rapid and feeble, beating from 120 to 1G0 times in 
a minute, and feeling like the vibrations of a delicate silver thread; when 
the heart .thumps feebly and spasmodically, and rapidly against the walls 
of the thorax ; when the respiration is full, panting, labored, varying from 
30 to 50 in the minute; when the skin is hot, and parched and 
rough, or bathed in a cold clammy sweat; when the temperature of the 
extremities is far below that of the trunk, which by no means corre- 
sponds with the increased efforts at the introduction of oxygen ; when 
the circulation of the blood in the capillaries of the extremities is almost 
entirely checked; when the chemical changes of the solids and fluids are 
in a great measure arrested, and perverted, and the development of the 
nervous and physical forces arrested, and their correlation disturbed ; 
when the altered blood stagnates in the capillaries of the brain, and the 
intellect is either abnormally excited or depressed; when the altered 
blood stagnates in the capillaries of the tongue and stomach, and the bril- 
liant red, dry, rough tongue, is but a fit index of the consuming thirst of 
the restless patient tossing from side to side, and pleading for a drop of 
water ; we have all the disturbances necessary for the formation of fibrin- 
ous concretions, and the treatment must be energetic and prompt. 
The torpid nervous centres must be aroused ; the feeble, general and capillary 
circulations must be aroused; oxygen must be rapidly introduced and corre- 
spondingly rapidly distributed through all parts of the system ; the chemical 
changes by which the muscular and nervous forces and heat are developed and 
maintained, must be excited and maintained with energy, by the rapid distribution 
of the elements of chemical change; the products resulting from these chemical 
changes, and from the changes induced in the constituents of the blood and organs, 
by the malarial poison, must be removed. 
Those remedies should be employed, which excite the general and capillary 
circulation; promote the introduction and distribution of oxygen; increase the 
chemical changes, and. excite the development of the muscular and nervous forces. 
Sulphate of quinia and diffusibile stimulants, brandy and carbonate of 
ammonia, should be freely and promptly administered, and sinapisms 
freely applied. Bottles of hot water, or better still, the hot bath, should 
be used to impart heat, and stimulate the capillary circulation and relieve 
he engorgement of the large organs. Brandy and red pepper may be Treatment of Heart-Clots. 
211 
applied to the surface with advantage. The sulphate of quinia may be 
administered to adults in doses of 5 to 30 grains, every one, two, or three 
hours, according to the urgency of the symptoms, up to from 30 to 80 
grains during the twenty-four hours. The best method of administering 
the sulphate of quinia, is dissolved in a weak solution of citric or acetic 
acids, or in lemon-juice. It is much more readily and rapidly absorbed, in 
the soluble form. If the stomach rejects the sulphate of quinia, it should 
be administered in solution with starch, by the rectum. Every practitioner 
of medicine in the Southern and Southwestern districts of the United States 
who has employed the sulphate of quinia in large doses, is aware of the 
surprising rapidity with which, in many cases, the most alarming symp- 
toms of congestive fever will be dissipated by the action of sulphate of 
quinia in large doses. The patient will frequently be snatched from the 
very jaws of death, and be blessed with a recovery as rapid as his attack. 
In such cases, we must conclude that the action of sulphate of quinia alone 
is able to prevent the formation of fibrinous concretions. The sulphate of 
quinia prevents the deposition of fibrin in the blood, bv its direct action 
upon the sympathetic and cerebro-spinal nervous systems, or by its excite- 
ment of the general and capillary circulations, either directly, or through 
the nervous system, or by its relations to the chemical changes of the ele- 
ments of the blood and malarial poison, or by its action in all these modes 
combined. Diffusible stimulants should be administered because they act 
more rapidly in exciting the nervous systems and in arousing the circula- 
tion, than the sulphate of quinia. 
If the formation of fibrinous bodies in the heart and blood-vessels be 
common in malarial fever, and if the statement of Dr. Benjamin Ward 
Richardson, of London, that the fibrin is held in solution in the liquor 
sanguinis of the living blood-vessels by ammonia be true, and if, as we 
shall hereafter demonstrate by numerous facts and cases, the action of the 
malarial poison is depressing, and not inflammatory, then carbonate of 
ammonia should be administered freely in malarial fever. It should be 
administered freely in congestive fever when there is a feeble, rapid action 
of the heart, and diminished, aberrated forces, because it excites the gen- 
eral and capillary circulation ; excites the chemical changes in the capil- 
laries, necessary for the development of the muscular and nervous forces ; 
arouses the sympathetic and cerebro spinal nervous systems; promotes 
secretion and excretion ; and furnishes the volatile alkali to the blood, 
which holds the fibrin in solution. We do not advocate the carbonate of 
ammonia as a substitute for sulphate of quinia. The carbonate of 
ammonia does not cure the disease. The carbonate of ammonia merely 
arouses the system, prevents a distressing and fatal accident, and prolongs 
life until the sulphate of quinia can act. Stimulants and sinapisms also 
arouse the nervous system and circulation, and lead to an increased supply 
and distribution of the great element of chemical change (oxygen), and 
thus furnish the conditions of an increased development of the physical, 
chemical, muscular, and nervous forces; but they cannot cure the disease, 
they cannot directly remove, or chemically alter, or destroy the poison; 
they cannot, then, take the place of the sulphate of quinia. To prevent 
the formation of fibrinous concretions in malarial fever, we must admin- 
ister the sulphate of quinia in full doses, in conjunction with the car- 
bonate of ammonia, stimulants, and the free use of sinapisms and the hot 
bath. 
This course of treatment may be instituted regardless of the dry, red 
tongue, tender epigastrium, and wandering and torpid intellect, and dis- 
tracting pains in the head. I have observed in numerous cases, that under 
the free use of stimulants, sinapisms, and large doses of the sulphate of 212 
Composition and Changes of the Blood in Malarial Fever. 
quinia, the dry, harsh, hard, red, glazed tongue became moist, soft, and pale; 
the pulse diminished in frequency, and increased in fulness ; the dry, harsh 
skin rendered moist; the cold clammy skin restored to its normal state ;the 
relations between the circulation in the trunk and extremities restored ;the 
correlation between the physical, chemical, vital and nervous forces restored; 
and the wild delirium succeeded by calm intelligence. Whilst on the other 
hand, in more cases than one, I have seen active purgation, and the admin- 
istration of alterative doses of calomel, convert cases of ordinary inter- 
mittent and remittent fever into the dangerous congestive type, resulting 
in the formation of heart-clots and speedy death. When stimulants and 
sulphate of quinia have been withheld, I have seen the patient die from 
complete exhaustion of the nervous and vital powers consequent upon the 
action of the malarial poison, either directly upon the nervous ganglia of the 
sympathetic system, presiding over the circulation and respiration, or by 
disturbances of the relations existing between the sympathetic and cerebro- 
spinal nervous systems; or primarily upon the cerebro spinal system and 
sympathetic system simultaneously; or by such changes in the elements of 
the blood (especially of the blood-corpuscles), as resulted in the perver- 
sion of the nutrition of the nervous ganglia; or by the generation of com- 
pounds in the blood, and in the secretions of the liver, spleen and alimentary 
canal, which acted as poisons upon the sympathetic and cerebro spinal 
nervous systems; or by the simultaneous action of the poison in all these 
different modes. 
PHYSICAL AND CHEMICAL CHANGES OF THE CONSTITUENTS OF THE 
BLOOD IN MALARIAL FEVER. 
The method of analysis* employedin these investigations is similar in 
many respects to that employed by MM. Becquerel and Rodier, Bowman, 
and others. In the present state of physiological and pathological chem- 
istry, objections may be alleged against every method of analysing the blood, 
thus far proposed. All physiological chemists have failed to ascertain 
with absolute accuracy the amount of solid matter in the serum of 1000 
parts of blood ; and there is no method by which the colored blood-corpus- 
cles can be separated from the surrounding liquor sanguinis, and the chem- 
ical constitution and relative proportions determined with absolute accu- 
racy. It is evident, therefore, that when we attempt to calculate the moist 
blood-corpuscles by the formula of C. Schmidt, whatever error entered 
into the calculation of the solid matters of the moist blood-corpuscles, 
will be increased fourfold, whilst the error in the calculation of the con- 
stituents of the liquor sanguinis will increase, not only in a direct ratio 
to the errors in the calculation of the blood-corpuscles and solid matters 
of the serum of 1000 parts of blood, but also in a definite ratio to the actual 
increase or decrease of the moist blood-corpuscles. That error exists in 
this method of analysis is rendered evident when we calculate the con- 
stituents of 1000 parts of liquor sanguinis from the data obtained by sub- 
tracting the moist blood-corpuscles from 1000 parts of blood, and consider- 
ing the remainder liquor sanguinis. The results thus obtained, do not 
correspond with those obtained from actual analysis of 1000 parts of liquor 
* Pathological Chemistry, by MM. Becquerel and Rodier. Translated by S. T. Speer, M. D. 
London, 1857, p. 19 et seq. Bowman's Medical Chemistry, pp. 145-194. Philadelphia, 1850. 
Simon's Chemistry of Man, p. 142. Philadelphia, 1846, Lehmann's Physiological Chemistry. 
Trans, by G. E. Day. Cavendish Society pubs., vol. ii, pp. 153-280. London, 1851-1854. See also 
American ed., edited by Prof. Rogers, vol. i, pp. 541-648. Manual of Blood and Urine, by Griffith, 
Reese, and Markwick. Philadelphia, 1848. Physical. Chemical, and Physiological Investigations 
upon the Vital Phenomena, Structure, and Offices of the Solids and Fluids of Animals, by Joseph 
Jones (American Journal of Medical Sciences, July. 1856, p. 46). Investigations, Chemical and 
Physiological, relative to certain American Vertebrata, by Joseph Jones. Smithsonian Contri- 
butions to Knowledge, 1856. Anleitung zur Qualitative!! und Quantitativen Zoochemischen 
Analyse, von E. von Goriip Besanez. Nurnberg, 1854. Investigations by Joseph Jones, M. D. 
213 
sanguinis. To render this error evident, I have in the succeeding analy- 
ses, stated the actual analysis of 1000 parts of liquor sanguinis, and that 
calculated from the constitution of the liquor sanguinis determined in 
1000 parts of blood, by the subtraction of the moist blood-corpuscles. The 
former, by actual experiment, is marked (1); the latter, by calculation, is 
marked (2). A perfect method of analysing the blood will never be 
obtained, until it be possible to obtain the moist, colored, and colorless 
blood-corpuscles entirely free from the intercellular fluid, and without the 
loss of any of their constituents, or the introduction of any foreign bodies. 
As yet the method first employed by Figuier, and improved by Dumas and 
Hofe, the method of F. Simon, and the method of direct measurement and 
enumeration of the blood-corpuscles in a definite portion of blood, and, in 
fact, every method thus far proposed, is imperfect, and they have one and 
all failed to yield absolutely accurate results. While these failures should 
lead to caution, and the extension of experiments and investigations, they 
shoidd by no means lead to the entire distrust and abandonment and con- 
demnation of these observations; they should lead to an appreciation of 
the difficulties of the investigations, and of the exceeding complexity of 
the fluid substances to be examined; they should lead to an appreciation 
of the causes of the differences in the results obtained by different obser- 
vers. The table on the next page will illustrate the changes of the blood 
in malarial fever. 
The blood in case No. 832 was abstracted from a stout, muscular Eng- 
lish seaman, who had been exposed to the malarial poison in Jacksonville, 
Florida, and in Savannah. Before the commencement of the bloodletting 
the skin was hot and dry, face flushed and red, respiration thoracic, pulse 
106, temperature of hand 105, temperature under the tongue 106. The 
pulse was full, and the respiration deep and rapid. There was a rapid 
introduction and distribution of oxygen, and a corresponding increase of 
temperature, denoting an increase of chemical change. The patient com- 
plained of great pain in the head. The patient appeared to be alarmed by 
the preparations for bloodletting, and when I appeared with the specific 
gravity bottles, beaker-glasses, and capsules to receive the blood, he fell 
back (he was standing) into the arms of the assistant, and in a few moments 
before the lancet was applied the perspiration stood in large drops upon 
his face and hands. During the bleeding he perspired freely, and fainted 
before f.^x were abstracted. The pulse and respiration were diminished in 
frequency and force, and the patient fell into a profound slumber, during 
which his clothes were saturated with a profuse perspiration. The tem- 
perature in the course of three hours was reduced to the normal standard 
and the pulse and respiration diminished in frequency and force. This 
case yielded readily to the action of sulphate of quinia, and was discharged 
three days after this observation. The fact that the mere preparations for 
bleeding caused the patient ''to break out into a profuse perspiration," 
may be accounted for in two ways. Either the cerebro spinal system 
acted upon the sympathetic nervous system, and thus influenced the cir- 
culation, respiration and skin, and through the circulation and respiration 
the chemical changes; or the sweating stage was nigh at hand, and the 
bleeding was the occasion and not the cause of its appearance. In this case, 
the true explanation which we will endeavor to substantiate hereafter by 
numerous facts, appears to be that the malarial poison excites the sympa- 
thetic and cerebro-spinal nervous systems, either by a direct action upon 
the nervous apparatus, or by an indirect action, by inducing chemical 
changes in the blood, especially in the blood-corpuscles, the altered pro- 
ducts of which act as excitants to the nervous systems. Through the 
agency of these two systems, especially of the sympathetic, the respira- 214 
Composition and Changes of the Blood in Malarial Fever. 
Case. 
832 
833 
834 
835 
836 
837 
838 
839 
840 
specific gravity of blood 
1012 
1034 
1030.5 
1042.0 
1042.4 
1030.5 
1042.4 
1036.6 
1040.0 
" serum 
1018 
... 
1021.3 
1022.5 
1021.3 
1021.0 
.. 
1023.6 
1022.0 
Water- 
In 1000 parts of blood 
830.509 
850.888 
877.553 
831.294 
827.901 
860.976 
839.589 
840.511 
833.449 
" serum 
929.287 
920.820 
927.757 
927.8,53 
928.370 
923.786 
912.779 
913.950 
912.386 
(1) " liquor sanguinis 
927.194 
918.072 
925.7-25 
921.664 
926.937 
921.233 
909.839 
912.665 
910.798 
(2) " " 
887.328 
892.859 
911.124 
887.265 
887.034 
900.473 
879.813 
882.723 
875.813 
8olid Matters - 
In 1000 parts of blood 
169.491 
149.112 
122.447 
168.706 
172.099 
139.024 
160.411 
159.489 
166.551 
" serum 
70.713 
79.180 
72.243 
72.147 
71.630 
76.214 
87.221 
87.614 
(1) " liquor sanguinis 
72.806 
81.928 
74.275 
75.336 
73.297 
78.767 
90.169 
86.978 
89.203 
(2) " . " 
112.672 
107.424 
88.876 
112.735 
112.965 
99.527 
120.147 
117.277 
124.187 
In serum of 1000 parts ot blood 
64.158 
73.167 
68.435 
64.464 
62.789 
71.032 
80.227 
79.135 
80.033 
Fixed Saline Constituents- 
In 1000 parts of blood 
7.532 
7.692 
3.316 
4.310 
4.041 
7.317 
7.500 
5.796 
6.314 
(1) " liquor sanguinis 
5.332 
5.120 
3.328 
3.299 
4.015 
5.480 
4.066 
2.647 
6.620 
(2) " " 
8.245 
6.696 
3.965 
1.885 
6.246 
6.489 
5.405 
3.498 
8.759 
" solid matters of blood 
44.439 
51 586 
27.083 
25.906 
23.202 
52.631 
46.7.54 
36.341 
37.909 
(1) " " liquor sanguinis 
77.931 
64.648 
45.901 
45.576 
56.338 
71.902 
46.387 
30.178 
" " blood corpuscles 
28.500 
40.351 
3.240 
14.047 
4.584 
42.751 
51.046 
42.914 
6.595 
" moist blood-corpuscles 
7.258 
10.087 
0.841 
3.511 
1.119 
10.649 
12.131 
10.728 
1.648 
In blood-corpuscles of 1000 parts of blood 
3.002 
2.962 
0.175 
1.432 
0.490 
2.795 
3.770 
3.409 
0.567 
In serum of 1000 parts of blood 
4.530 
4.730 
3.141 
2.938 
3.551 
4.522 
3.730 
2.387 
5.747 
1000 parts of Blood contained- 
Moist blood-corpuscles 
413.732 
293.620 
207.948 
407.764 
431.508 
262.448 
309.936 
317.748 
343.872 
Water ot moist blood-corpuscles 
310.219 
220.215 
155.861 
306.823 
323.631 
196.836 
232.452 
238.271 
258.804 
Oranic matters of moist blood-corpuscles 
100.431 
70.411 
. 51.812 
100.409 
107.320 
62.703 
73.655 
76.000 
84.400 
Mineral matters of moist blood-corpuscles 
3.002 
2.962 
0.175 
1.432 
0.490 
2.795 
3.770 
3.409 
0.567 
Liquor sanguinis 
586.268 
706.380 
792.052 
592.236 
568.492 
737.552 
690.064 
682.252 
656.128 
w ater of liquor sanguinis 
Organic matters 
520.210 
630.705 
721.692 
525.471 
504.270 
664.140 
607.124 
602.240 
574.646 
58.328 
68.405 
65.194 
61.500 
59.210 
66.400 
76.387 
76.708 
74.1.-5 
Mineral matters 
4.760 
4.730 
3.141 
2.301 
3.551 
4.522 
3.730 
2.387 
5.747 
Fibrin 
1.900 
2.540 
1.925 
2.938 
1.433 
2.380 
2.710 
0.877 
1.450 
1000 parts of Moist Blood-corpuscles contained- 
Water 
749.996 
750.000 
749.519 
750.000 
750.000 
750 000 
750.224 
749.873 
752.646 
Organic residue 
242.746 
239.803 
219 154 
246.468 
248.709 
239.296 
237.645 
239.284 
245.239 
Mineral matters 
7.258 
10.087 
0.841 
3.511 
1.119 
10.649 
12.131 
10.728 
1.648 
Table illustrating the Charges and Composition of Venous Blood in Malarial Fever. Investigations by Joseph Jones. M. D. 
215 
tion and circulation are increased in frequency and force. In other 
words,, the elements and conditions of chemical change are rapidly sup- 
plied to all parts of the body; hence the heat of fever. During these 
changes the poison is drawn into the round, altered, and rendered no 
longer an irritant to the nervous system. The same thing may be true of 
the altered, offending compounds of the blood; during these chemical 
changes they may be broken up and thrown off, or so altered as to be no 
longer excitants to the nervous systems. The nervous systems, when 
these offending compounds are removed, no longer excite the respiration 
and circulation. Another reason why nervous action may be diminished 
periodically, is found in the chemical changes going on in the nervous 
apparatus itself. If nervous force result from chemical change, and if the 
amount of nervous force corresponds to the chemical changes of a definite 
amount of matter placed in a definite position, then vigorous nervous 
action must always be attended by rapid alteration of the elements of the 
nervous system, and by a correspondingly rapid exhaustion of nervous 
force, and the action then would cease for the same reason that the action 
of an engine ceases when all the fuel is consumed. These views are sub- 
stantiated by the fact, that in malarial fever a high temperature is almost 
invariably attended by a remission or intermission, and is a favorable 
symptom; whilst the want of a high temperature, as in congestive fever, 
is always a dangerous symptom, signifying profound alterations in the 
nervous system, and in the muscular structures of the heart. 
The blood of this patient presented a dark, almost black color, which, 
upon the surface of the clot, changed to a bright red arterial hue after two 
hours' exposure to the atmosphere. The coagulation appeared to be a little 
slower than usual. The color of the serum was light golden. The color 
was not of the bright, deep golden yellow, which, as far as my experience 
extends, is the invariable color of the serum in the severer cases of mala- 
rial fever. This patient had been sick but five or six days, and the fever 
was intermittent and of a mild type, and the changes of the blood were 
correspondingly small. The blood-corpuscles, and albumen, and fibrin 
were slightly diminished, and the extractive and coloring matters increased, 
and the mineral matters were normal in amount. 
The blood in case No. 833 was abstracted from a thin, sallow, anaemic 
French laborer, who had been living and working in a.low miasmatic situ- 
ation on Thunderbolt road, and had been sick with chills and fever for five 
weeks, without any medical attendance. The effects of the miasmatic fever 
were well marked in the reduced flesh, feeble forces, sallow anaemic com- 
plexion, and pale lips and gums, and in the neuralgic pains of the head. 
The pulse and respiration during the intermissions were normal, whilst the 
respiration was slightly increased, and the temperature of the trunk and 
extremities slightly diminished. The blood coagulated in the usual time, 
and the clot was firm. After' standing four days in a stoppered bottle, in 
the heat of summer, the clot appeared firm, undecomposed, and the serum 
clear. The blood of a patient who was suffering fr om the effects of remit- 
tent fever and severe salivation, placed by the side of this, in the same 
time, and under the same circumstances, had its clot completely disinte- 
grated and commenced to putrify. This analysis confirms the statement 
that the malarial poison (either directly or indirectly) destroys the colored 
blood-corpuscles. They are diminished one half, the dried corpuscles being 
only 73.405, and the moist corpuscles 293.620; whilst in health the dried 
corpuscles generally average 135.000. and the moist corpuscles 540.000. 
The fibrin and mineral matters existed in the usual propor tion. 
The blood which furnished the analysis, case No. 83f was drawn from the 
arm of a thin, sallow, anaemic Irish laborer, who had been living and 216 
Composition and Changes of the Blood in Malarial Fever. 
making bricks in a low miasmatic situation, and had suffered with chill 
and fever for six weeks. Flesh reduced; complexion sallow, amemic; lips, 
gums and tongue pale. This patient is exhausted by slight exertions, and 
complains of great weakness. Inferior extremities slightly (edematous. 
The pulse, respiration, and temperature were variable; sometimes above 
and at others below the normal temperature. 
Sept. 16th. 
Sept. 17 th. 
Sept. 18th. 
Sept. 19th. 
Sept. 20th. 
Pulse 
88 
72 
7 9 
Qft 
Respiration 
24 
20 
90 
94 
91 
Temperature of atmosphere 
87.5° F. 
86° F. 
88.0° F. 
89° F. 
83 F. 
" of hand 
100..5 
90 
98 5 
98 
100 
" under tongue.. 
101.25 
98 
99.5 
99 
102 
The reduction of the nervous and physical forces was attended by a 
reduction in the solid constituents of the urine. Thus, upon Sept. 17th, 
16.027 grains of light-colored urine were excreted during the twenty hours, 
which contained only 68.432 grams of solid matters, composed of 42.681 
grains of urea, 1.280 of uric acid, 18.776 grains of extractive and coloring 
matters, and 5.696 of mineral matters. Under the action of sulphate of 
quinia, and infusion of Virginia snakeroot, the solid matters of the urine 
increased rapidly in amount, and soon corresponded to the normal amount. 
The blood of this patient was watery in appearance, and coagulated slowly. 
Reaction decidedly alkaline. After standing twenty hours the clot con- 
tracted but little, and it was soft, possessing but little consistency. In the 
specific gravity bottle the colored blood-corpuscles gravitated towards the 
bottom, and left above a transparent, light yellow clot. Serum of a light 
yellow color. This examination of the blood shows, that the continued 
action of tne malarial poison had reduced the colored blood-corpuscles to 
54.987 dried, or 207.948 moist, which is only a little more than one-third 
of the normal standard The fixed saline constituents of the colored blood- 
corpuscles were not only correspondingly, but absolutely diminished in 
amount, whilst the fixed saline constituents of the liquor sanguinis were 
normal in amount. Notwithstanding the formation of the huffy coat, the 
fibrin was diminished, as well as the colored blood-corpuscles. 
The blood in case No. 835 was abstracted from the arm of a muscular, 
well built English seaman, who had been exposed to the malarious influence 
when sleeping aboard his vessel, lying in the Altamaha river, opposite the 
town of Darien, and when running up and down the Savannah river, from 
its mouth to the city of Savannah, in a steam tug. The fever was preceded 
by a chill, and was of the remittent type. The symptoms were indicative 
of great danger-tongue red, dry, harsh and rough; skin hot, dry and 
harsh; pulse accelerated; respiration panting, thoracic and greatly accele- 
rated; thirst intense; expression of countenance anxious; intellect dull and 
often wandering; urine high colored, concentrated, and rich in coloring 
matters and urea. The diy, red, glazed tongue; the dry skin; the panting, 
accelerated respiration, and the wandering intellect, were dangerous symp- 
toms, indicating the decided action of the poison upon the cerebro-spinal 
and sympathetic nervous systems, and upon the circulatory and respira 
tory apparatus. The elevated temperature, and high-colored urine, rich 
in solid matters, were, on the other hand, favorable symptoms, because 
they indicated the existence of chemical actions which would result in the 
modification of the malarial poison, and the destruction of the noxious 
compounds formed in the blood. The following table will illustrate the 
prominent symptoms: Investigations by Joseph Jones, M. D. 
217 
35 ,, 
1 W ; 
GT „ 
ST „ 
ZT 
9i 
91 „ 
CT 
CT „ 
M >> 
" 12 
" 12 
" 13 
" 13 
Tl 
0T "Plas 
DATE. 
1857. 
' ' ' ' g&f ggs 
12 M. 
DP. M. 
11 A. M. 
6 P. M. 
K 'V IT 
'Pi HZ 
Hour of 
Day. 
Tongue dry, red, superior portion 
coated with black fur; skin hot 
and dry; intellect dull. 
Tongue dry, red and glazed, feels 
rough ; skin dry, harsh and hot; 
' intellect dull; countenance anx- 
: ious. 
Tongue-tip clean and red, superior 
portion coated with dark fur; 
skin moist and hot. 
Tongue cleaner and nioister, still 
red at tip and edges; skin moist. 
Tongue moist, still redder than 
normal. 
do. do. do. 
Tongue slightly coated with light 
yellow fur, soft and moist; skin 
i normal. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
do. do. do. 
State of Tongue, Skin and 
fc: as a 8 
8 
S 
Pulse. 
8= 
Ml 
I 
Respiration. 
o: oi oil occ b c: 
oo ® o 
80.1° 
Temperature of 
atmosphere. 
Si ss^sss^si 
8 = gggggggg1 
104.00 
100.75 
99.16 
97.00 
103.25 
joOO-gOT 
Temperature of 
hand. 
g: 
to- ooooooco- 
H I! 
105.0 
105.0° 
Temperature un- 
der tongue. 
iuz2.u 
1025.0 
1016.5 
1018.2 
1022.2 
1020.0 
1018.0 
ibioio 
1008.0 
HI! 
! 
Specific gravity 
of urine. 
iiiirtiS 
H If 
I 
~ 7 
Grains 
Urine excreted 
during 24 hours. 
H H Iwhi i 
14294 
19240 
11428 
Grains 
Water excreted 
during 24 hours. 
H n smsi i 
mi 
666 
2 
Grains 
Solid matters ex- 
creted during 
24 hours. 
H H 
H 8 8 
§ 
Grains 
Urea excreted 
during 24 hours. 
• • : • cssgss; 
4.35 
7.45 
8 
Q 
Uric acid for 24 
hours. 
i i i i i 
H § I 
8 
Grains 
Extractive and 
coloring mat- 
ters excreted 
in 24 hours. 
H H gssas&'i 
ri 8 2 
8 
Grains 
Fixed saline con- 
stituents in the 
urine excreted 
in 24 hours. 
Table Illustrating Changes in Malarial Fever. 218 
Composition and Changes of the Blood in Malarial Fever. 
The blood of this patient was abstracted upon the 16th day after the 
commence in ent of the attack of remittent fever, and during convalescence. 
The blood coagulated in the usual time, and the clot was firm. During 
the coagulation, the blood corpuscles settled, and left above a transparent 
clot, about ith of an inch in depth, and of a light yellow color. Color of 
serum, light yellow. This analysis shows that the dried organic residue, 
and especially the fixed saline constituents of the colored blood-corpuscles, 
have diminished. The moist blood-corpuscles are less than the normal 
number, by near 100 parts in the 1000 parts of blood. The fixed saline 
constituents of the colorefl blood-corpuscles were less than one-half the 
normal amount. This patient was treated with large doses of sulphate of 
quinia, stimulants, and nutritive diet; and this mode of treatment, com- 
bined with the vigorous chemical actions, as indicated by the high tem- 
perature, were, without doubt, the causes which preserved, to a great 
extent, the integrity of the blood. 
The blood in case No. 836 was abstracted from a young Scotch seaman, 
aged fourteen years, with light hair, blue eyes, florid complexion, and san- 
guine nervous temperament. This patient had been much exposed to the 
sun and the night air, upon the light-ship lying at the mouth of the Savan- 
nah river. During the height of the fever the face was as red as scarlet; 
the tongue dry, red, and rough; tip and middle clean, and of a bright red 
color; posterior portion coated with dry yellow fur; surface as dry and 
harsh as a rough board; lay in a stupor, it was almost impossible to arouse 
him; manifested great tenderness of epigastrium; pressure here causes 
him to cry out. The following table will illustrate the condition of the 
pulse, respiration, temperature, skin, tongue, and intellect : 
Date 
Sept. 16 
1857. 
" 17 
" 18 
" 18 
" 19 
11 20 
21 
" 22 
" 22 
Hour 
of day 
7 P.M. 
11A.M. 
12 M. 
8 P.M. 
11A.M. 
12 M. 
1P. M. 
12 M. 
7P.M. 
State of Tongue, Skin, 
and Intellect 
Skin of face as red as scar- 
let, skin of body in a pro- 
fuse perspiration; tongue 
rough and perfectly dry; 
intellect in a stupor; can- 
not be aroused. 
Skin and tongue moist and 
relaxed; intellect clear. 
Tongue coated with yel- 
low fur; much dryer than 
normal; intellect wan- 
dering. 
Tongue bright red, dry, 
rough and harsh; lies In 
a profound stupor. 
Tongue moist, red at tip 
and edges, and coated 
with white fur; intellect 
bright. 
Tongue moist; intellect 
clear. 
Tongue moist and pale; in- 
tellect continues clear. 
Tongue, skin, and intel- 
lect normal. 
® 
w 
S 
Ph 
100 
86 
98 
90 
Respiration 
ex bo oo S I 
oo oo oo Temperature of 
£ £, o o' atmosphere 
~ o 1 
p P 5 p Temperature of 
£ g § g hand 
« Q 
- _ i_. 1 
P go o । Temperature 
is o g £ under tongue 
bi o o 
0 1 
5 g O j Specific gravity 
P « of urine 
Am't of urine 
excreted 
Characters 
of 
the urine 
Light 
orange 
color. 
Light straw 
color; urea 
and uric 
acid dimi- 
nished. 
Light 
orange 
color. 
Light 
yellow 
color. 
Deep 
orange 
color. 
Normal'in 
color. 
Light 
colored. 
12078 
1004.0 
1001.0 
1006.0 
1004.0 
1003.0 
30013 
10000 
20800 
21063 
66 
65 
57 
18 
18 
16 
83.0 
84.5 
81.0 
98.00 
98.00 
98.00 
100.00 
99.50 
99.05 Investigations by Joseph Jones. M. D. 
219 
The pulse throughout was much feebler than in u healthy cases" of 
malarial fever. It is worthy of note, that the urine excreted during the 
delirious state was light colored, and of low specific gravity. In this case, 
as in the preceding one, we cast aside the advice of many of the older 
writers, and administered the sulphate of quinia and stimulants freely in 
the first stages of the disease, regardless of the glowing parched tongue, 
tenderness upon pressure of the epigastrium, severe headache, high fever, 
rapid pulse, thoracic full respiration, hot, dry skin, and wandering intel- 
lect. Under the action of sulphate of quinia, cut cups, stimulants, and 
sinapisms, the dry, red tongue became moist, clean and pale; the circula- 
tion and respiration abated in force and frequency, the dry, harsh skin was 
covered with perspiration, the intellect returned to its normal actions, and 
all the symptoms subsided. In the present case, sinapisms, blisters, cut 
cups, and purgatives, diminished the apparant congestion of the brain 
temporarily, but not permanently. Stimulants and sulphate of quinia, so 
far from increasing the cerebral disturbance, diminished it permanently, 
and relieved the intellectual faculties. Under their action, the red, dry, 
rough tongue became pale, moist, and soft-under their action, the circula- 
tion and respiration were equalized, and diminished in frequency; the tem- 
perature was diminished, and the intellect restored to its normal exercise. 
The blood was drawn on the 10th day after th« commencement of the 
malarial fever, during convalescence. The clot appeared to be softer than 
normal. Serum of a light yellow color. The chemical examination of the 
blood showed that the organic matters of the colored blood-corpuscles were 
diminished slightly, whilst the mineral matters were greatly diminished. 
The fibrin was considerably below the normal standard, and appeared to 
be softer than normal. The organic matters of the serum were somewhat 
below the normal standard 
When we consider that this patient was in a state of almost complete 
starvation, during the height of the disease, it is evident that the malarial 
poison acted but slightly upon the constituents of the blood. The malarial 
poison appeared to act almost entirely upon the brain and nervous system. 
During the height of the disease, I had no hopes whatever of his recovery, 
so alarming were the cerebral symptoms. Long after the pulse and respi- 
ration, skin and digestive functions were restored to their normal actions, 
the patient was scarcely able to stand or walk, on account of the condition 
of the brain. His first efforts at walking resembled those of an infant, 
just learning to stand and walk alone. This was not due to the loss of 
muscular power, for there had been but a slight reduction of the size of 
the muscles. It was due rather to the disordered state of the cerebro- 
spinal and sympathetic nervous systems. The action of the malarial 
poison upon the brain and nervous system was, without doubt, greatly 
increased by peculiarities of constitution, irregularities of habit, and con- 
tinued exposure to the hot sun on the light-ship. I was afterwards 
informed that this boy was in the habit of using ardent spirits freely. It 
is probable that one or all these causes may have predisposed the brain 
and nervous systems to derangement, and interfered with the healthy 
action of the organs, and converted a light attack into a severe and dan- 
gerous disease. It is probable that the dose of malaria was small, and 
aside from these circumstances, would have produced only a mild disease. 
We are led to this conclusion by the fact that its effects upon the blood and 
excretions were comparatively slight. 
The blood marked case No. 837. was drawn from the arm of an Ameri- 
can seaman, six hours before death. This patient had been running up 
and down rhe Savannah river in a steam tug, and was attacked with chill 220 
Composition and Changes of the Blood in Malarial Fever. 
and fever, which assumed the remittent type after four days' recurrence of 
the chill. During his sickness, the disease bore a blended likeness to both 
remittent and typhoid fevers, and after death the organs exhibited the 
existence simultaneously of both diseases. 
The following table will give a condensed view of the symptoms :- 
Date. 
Hour 
OF DAY. 
State of Tongue, Skin, 
and Intellect. 
1 Pulse. 
- Respiration. 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Characters of Urine. 
Aug. 7, 
1857. 
8 
11 A. M. 
9 A. M. 
Skin hot, but in a profuse 
perspiration ; tongue coated 
with light yellow fur; respi- 
ration hurried, thoracic; 
chest heaving; intellect stu- 
pid, torpid; it is difficult to 
arouse him, and then his an- 
swers are incoherent; bowels 
loose. 
Skin hot and dry; continues 
stupid; bowels loose. 
Skin moist; body has a pecu- 
liar offensive smell; breath 
offensive; stools very offen- 
sive; intellect stupid; low 
muttering delirium. 
All symptoms much worse; 
passes his urine and foeces in 
bed; has a pustular eruption 
over the surface of the trunk 
and limbs; surface of blister 
red and raw; tne stools dark 
colored and fetid. 
No improvement of symp- 
toms; tongue dry; blister dry 
and red; bowels loose; skin 
not sowarm; pulse weaker. 
Continues to grow worse. 
Do. do. 
112 
129 
38 
81.0° 
103.0° 
104° 
Urine clear, limpid, and of a 
deep orange color. 
Urine reddish orange, sp. gr. 
1013; 1000 parts contained- 
water 957.282, solid matters 
42.618, urea 7.108, uric acid 
0.394, extractive and color- 
ing matters 32.570, fixed 
salts 2.621. 
Urine of a bright reddish- 
brown color, cloudy, with 
epithelial cells from the 
mucous membrane, blad- 
der and urethra, and with 
mucous corpuscles and 
spermatozoa. 
" 8 
" 9 
" 9 
11 A. M. 
11 A. M. 
6 P. M. 
112 
112 
104 
36 
40 
80.0 
80.0 
103.0 
103.5 
104 
" 10 
9 A. M. 
Urine of a bright red color, 
sp. gr. 1012.6; contains albu- 
men; reaction strongly acid. 
Urine bright red color, after 
standing 12 hours, a heavy 
deposit of triple phosphate 
fell; contains albumen. 
Urine a shade higher than 
normal; reaction acid; sp. 
gr. 1013.2; after 12 hours, let 
fall a light yellow deposit 
of triple phosphate, urate 
of soda and spermatozoa; 
1000 parts contained-water 
961.112, solid matters 38.888, 
urea 12.304, uric acid 0.592, 
extractive and color'g mat- 
ters 22.259, fixed saline con- 
stituents 3.333. 
Urine, passed just before 
death, normal in color; sp. 
gr. 1011.3; reaction acid; 1000 
parts contained-water 972. 
728, solid matters 27.272, urea 
5,228, uric acid 0.158, extrac- 
tive and coloring matters 
18.543, fixed saline constitu- 
ents 3.030. 
11 A. M. 
120 
40 
. 
" 11 
" 12 
10 A. M. 
8^ A. M. 
Almost entirely insensible; 
lies with mouth and eyes 
open; his elbows, shoulders, 
and hips, upon which the 
weight of his body has rest- 
ed, are of a dark purple color, 
and the skin is commencing 
to slough at those parts most 
exposed; tongue dry and 
rough; teeth coated with 
sordes. 
Died. 
132 
47 
80.0 
104.0 
105 
The body was examined four hours after death. The exterior was of a 
universal sallow color. The muscles were full and well developed, and 
appeared to have lost but little flesh during the progress of the disease. Investigations by Joseph Jones, M. D. 
221 
The membranes of the brain presented a normal appearance, and the sub- 
stance was firm, and not more congested with blood than normal. The 
appearance of the structure and condition of the brain, and its blood-ves- 
sels and membranes, did not correspond to the condition of softening which 
the cerebral symptoms led us to expect. The brain was not examined 
microscopically, and there may have been minute changes in the delicate; 
structures, chemical or physical, which escaped the observation of the naked 
eye. This is possible, but not probable. It is hardly probable that pro- 
found alterations could take place in so delicate an organ as the brain, 
without some changes in its color or consistence, palpable to the naked 
eye. Heart and lungs normal. The liver presented the true malarial hue; 
slate-colored upon the exterior, and dark bronze in the interior. The bile 
was of a greenish-black opaque color when seen in mass, and of a gamboge- 
yellow color when spread out in thin layers. The structures of the liver 
presented the usual consistence. The liver-cells, under the microscope, 
appeared to be a shade darker than usual; but presented the usual shape 
and appearance. No trace of grape-sugar was discovered in the liver. The 
blood of the liver was dark, and did not change to the arterial hue when 
exposed to the oxygen of the atmosphere. The filtered decoction of the 
liver presented a bright golden color, similar in all respects to the color of 
the serum of the blood. The spleen was slate-colored, enlarged, and soft- 
ened. The tissues gave way readily under gentle pressure. The dark, 
reddish-brown pulp of the spleen consisted of numerous colored and color- 
less corpuscles, and did not change to the arterial hue when exposed to the 
oxygen of the atmosphere. The mucous membrane of the stomach was 
colored yellow with bile, and the blood-vessels were filled with blood, and 
several spots of the mucous membrane were more engorged with blood than 
the rest of the surface; but to the naked eye there was no softening or 
marks of inflammation, and no pathological alterations beyond the mere 
stasis of blood in the capillaries. The color of the intestines, externally 
and internally, was darker than usual. The small intestines contained 
foecal matters, epithelial cells, mucous corpuscles, and mucus colored yellow 
by bile. Blood-vessels of the mucous membrane of the small and large 
intestines injected with blood. The mucous membrane was most injected 
with blood, and presented a purplish color in the last eight feet of the 
inferior portion of the ileum, and the engorgement of the blood vessels 
was greatest in the immediate region of the ileo-caecal valve. The 
solitary glands were numerous, enlarged, elevated, and distinct, and of 
a brown color. When the intestines were held up to the light, blood-ves- 
sels engorged with blood were seen passing to each gland. The blood- 
vessels supplying the solitary and Peyer's glands were more engorged with 
blood than those supplying the mucous membrane generally. These soli- 
tary glands were most numerous in the neighborhood of theileo-caecal valve, 
anti were found scattered over the superior portion of the colon, and over 
the caecum, and over eight feet of the inferior portion of the ileum. Peyer's 
glands were enlarged and elevated. These glands were of various sizes, 
from one quarter of an inch to three inches in length, and from a quarter 
of an inch to half an inch in breadth. They occurred at intervals of from 
one to two inches from each other, and extended from the ileo-ca?cal valve, 
along the mucous membrane of the ileum, for about nine feet. The blood- 
vessels around these glands were engorged with blood. This part of the 
mucous membrane of the ileum, studied with the solitary and Peyer's 
glands, was far more injected with blood than the stomach, jejunum, or 
superior portion of the ileum. Although these glands were enlarged, ele- 
vated, and injected with blood, still they could not by any means be com- Composition and Changes of the Blood in Malarial Fever. 
222 
pared to the condition of these glands in an advanced stage of typhoid 
fever. 
From this examination we are now able to present a condensed state- 
ment of the prominent symptoms and alterations of the solids and fluids. 
The pulse was feeble, and varied from 104 to 132 beats in the minute; 
the respiration was hurried, thoracic, and varied from 36 to 47 in the min- 
ute; the temperature under the tongue varied from 104° F. to 105°; the 
temperature of the extremities varied from 103° to 104°; the temperature 
of both the trunk and extremities was remarkably uniform; the state of the 
skin varied, sometimes dry, and at others bathed in perspiration; the 
tongue was dry and coated with fur; and towards the termination of the 
disease, the tongue and teeth were coated with sordes. It is evident from 
these facts that there was no distinct remission of the febrile excitement. 
The urine was copious; of low specific gravity ; of higher color than nor- 
mal in the earlier stages of the disease; but twenty hours before death it 
changed back to its normal color. The urine contained small quantities of 
albumen. The urea was diminished relatively to the extractive matters; 
we cannot say absolutely, because the whole amount of urine excreted was 
not determined. The extractive matters were increased relatively to the 
other constituents of the urine. The uric acid was normal in amount. The 
blood exhibited profound alterations; the dried colored corpuscles were 
only 65.612, and the moist colored corpuscles 262.448, in the thousand 
parts; many of the colored corpuscles were altered in shape and appear- 
ance, and had in a great measure lost the power of changing from the 
venous to the arterial color, and many of them united together and formed 
rolls, as in the blood of inflammation ; the color of the venous blood, when 
first abstracted, was dark purple, almost black, and after exposure to the 
oxygen of the atmosphere the surface of the clot changed to a cherry-red 
color, and not to the bright red color assumed by the surface of healthy 
venous blood when exposed to the atmosphere; the serum was of a golden 
color, and low specific gravity; the albumen was diminished, whilst the 
extractive matters of the serum were increased ; the mineral matters of 
both the blood-corpuscles and liquor sanguinis were diminished relatively 
but not absolutely ; that is, their diminution corresponded with, but did 
not exceed the diminution of the other elements of the blood. The pustu- 
lar eruption, the offensive smell, the stasis of the blood in the parts of the 
body exposed to pressure, and the tendency of these parts to slough, all 
indicated alterations in the constitution of the blood, and derangement of 
the capillary circulation. The loss of muscular power, exhaustion, stupid- 
ity, coma, low muttering delirium, insensibility to pain, all indicated 
derangement of the cerebro spinal system. The alterations in the actions 
of the capillary and general circulations, and of the respiration; the pro- 
found alterations in the blood; the alterations of the secretions and excre- 
tions, and of the structures of the liver and spleen, and of Peyer's, and of 
the solitary glands of the intestines, were all indicative of derangements of 
the sympathetic system of nerves. 
Our knowledge of the early symptoms, and pathological changes of 
this case, do not permit an arbitrary decision as to which system of nerves 
was affected primaril y. The fact that the post-mortem examination revealed 
(to the naked eye) no prominent lesions of these two systems of nerves, 
would seem to indicate that the poison or poisons acted primarily upon the 
blood, destroying and altering the blood-corpuscles, the active agents in the 
elaboration of the elements of the secretions, and of the muscular and ner- 
vous systems. When the proper chemical changes in the blood were 
altered, when the compounds for the secretions and nutr ition of the nervous Investigations by Joseph Jones. M. D. 
223 
system were altered, or not elaborated, then both the cerebro-spinal and 
sympathetic systems, manifested aberrated action. As the circulation and 
respiration, and the secretions and excretions, and the action and integrity 
of the organs depend, in great measure, upon the integrity of the nervous 
system, it is evident that the derangement of the cerebro-spinal and sympa- 
thetic systems, through the derangement of the blood and secretions and 
excretions, would in t urn act in concert with the disturbing agent or agents, 
and thus still greater derangements of the solids and fluids would be pro- 
duced. Still a fourth theory may be advanced to account for the changes; 
that the poison or poisons acted primarily upon one or both the grand por- 
tions of the nervous systems, and the cerebro-spinal and sympathetic sys- 
tems, singly or combined, in turn altered the actions of the organsand 
apparatus, and the secretions and excretions, and chemical and physical 
actions over which they presided. 
We will discuss these questions more fully hereafter, when we consider 
the nervous phenomena. Before, however, dismissing the subject, we 
would state that in the present state of medical science, wre cannot decide 
dogmatically upon the truth of these theories. What is the poison or 
poisons which we have assumed to exist, and act upon the organs and tis- 
sues, and solids and fluids'? What is the relation of these substances, 
physically, chemically, physiologically and pathologically to the cerebro- 
spinal and sympathetic systems, to the blood-corpuscles and elements of 
the blood, organic and mineral, and to the organs, tissues, and secretions 
and excretions? In other words, what physical, chemical, physiological 
and pathological changes, are they capable of producing in the solids and 
fluids of the human body, and what effects would these changes have upon 
the development and action of the vital and nervous forces? Until these 
questions are definitely answered, our opinions must be speculative, and 
not absolute, and the results of our analogical reasoning must be expressed 
as hypotheses and not as laws. 
The destruction of the colored corpuscles ; the golden color of the 
serum ; the slate color of the liver upon the exterior, and bronzed color in 
the interior; the color of the bile; the absence of grape-sugar from the 
structures of the liver ; the slate color of the spleen, and the disorganized 
state of its tissues, and the inability of its pulp to change from the dark 
reddish-brown to the arterial color, gave decided evidence that this was a 
case of malarial fever. There weie, however, other symptoms and other 
lesions, which indicated that there was something besides malarial fever. 
The cerebral and nervous symptoms; the continued febrile excitement 
without intermission ; the loose state of the bowels; the unusual action of 
a small dose of castor oil ; the enlarged and congested glands of Peyer, and 
solitary glands of the intestines, indicated the presence of typhoid fever. 
The history of the case (the recent attack of remittent fever), and the fact 
that the glands of Peyer showed the marks of recent, only partially developed 
inflammation, and pathological changes, and not the changes produced by 
typhoid fever of long standing, lead us to the conclusion that the remit- 
tent fever preceded, or was, at least, simultaneous with the appearance of 
the typhoid fever. 
The blood in case 838 was abstracted from an Irish laborer, who had 
been reduced by an attack of remittent fever, diarrhoea, and salivation, 
from 200 pounds to 100. At the time of this analysis, he was suffering 
with foul ulcers in his mouth, and over the surface of the body, especially 
upon the back ; and his body had a most disgusting nauseous smell. 
Complexion sallow and anaemic; and forces completely worn out with pain 
and loss of sleep. Blood coagulated slowly. In the specific-gravity bottle, 
the colored corpuscles settled to the bottom, leaving above a clear golden- 224 
Composition and Changes of the Blood in Malarial Fever. 
yellow clot. In a small, shallow porcelain capsule, the superior central 
portions of the clot appeared transparent for several lines in depth. A 
portion of the blood was set aside in a glass vessel. In twelve hours the 
clot commenced to disintegrate and liberate its colored blood-corpuscles, 
and in twenty-four hours the blood gave forth a putr id smell, and the serum 
was filled with the liberated colored corpuscles presenting the appearance 
of blood. A specimen of blood drawn at the same time from a patient who 
had recovered from an attack of intermittent fever three weeks before, was 
placed in the same room, in a similar bottle, by the side of this specimen. 
The clot, serum, and odor of this remained unaltered for fifty hours. Serum 
of a golden-yellow color. The colored blood-corpuscles were diminished 
nearly one-half, and the fibrin was slightly increased. The golden color of 
the serum, and the foul ulcers, and the readiness with which the blood 
underwent putrefaction, all pointed to alterations in the constituents of 
the blood and nutritive fluids. Stimulants, tonics, and alteratives pro- 
duced but little effect. The patient continued dull, stupid, anxious, dis- 
tressed, and feeble. His body continued to exhale the disgusting stench. 
Four days after bleeding, his left arm swelled enormously. Eleven days 
after the abstraction of the blood, he took a sudden and remarkable change 
for the worse. Lay in a stupor, with mouth and eyes open, with every 
tendon and muscle of his body twitching and jumping violently. Respira- 
tion 42, labored, thoracic, spasmodic like that of a man during a severe 
chill. At every inspiration and expiration, emits a sound like the hoarse 
bark of a thirsty and starved dog. The muscles of the face contract and 
relax, and contort in every possible manner, making the most awful 
grimaces. During these contortions of the muscles of the face, every 
expression of ridicule, sarcasm, joy, pain, agony, malice, revenge, and 
hatred are depicted in rapid succession. The jerkings of the muscles 
appear to be paroxysmal; they are very violent for a few moments, and 
then moderate for a few moments. The patients in this large hospital 
ward, state that they were kept awake during the whole night, by his bark- 
ing and shaking, Pulse 144, feeble. It was very difficult to count the 
beats of the pulse, on account of the violent twitchings of the tendons of 
the forearm. Temperature of trunk and extremities, several degrees above 
the normal standard. Skin covered with clammy sweat, which resembles 
bloody serum, and stains his clothes and bed just as bloody serum would do. 
Odor of his body intolerable. Passes his fieces and urine in bed. This 
patient continued in this condition forthree days, and finally died. Unfor- 
tunately, no post-mortem examination was performed, on account of the 
earnest entreaties of his superstitious friends. This second attack was, in 
all probability, either a relapse, or a fresh attack of malarial fever. 
This case illustrates in a forcible manner the effects of the malarial 
poison in altering the constitution of the blood, and of the organs and 
tissues, and in causing aberration of the muscular and nervous, and physi- 
cal and vital forces. 
The blood in case No. 839, was drawn from the arm of a German butcher, 
who had suffered for two months with chill and fever, without any medi- 
cal attendance, and who entered the hospital in a comatose condition, 
reduced in flesh from 180 pounds to 110 pounds, with feeble forces. Com- 
plexion sallow, anaemic; nervous and muscular forces very feeble. Pulse 120, 
feeble. Respiration 24, labored. Tongue perfectly dry, and rough. Skin 
dry and rough over all parts of the body. Although revived and partially 
relieved by sinapisms, stimulants, and sulphate of quinia, the malarial 
poison had induced such profound alterations in the blood and organs, that 
the effects were followed by the most distressing suffering, and finally 
death. The blood drawn shortly after his entrance into the hospital, Investigations by Joseph Jones, M. D. 
225 
whilst he was in this comatose condition, coagulated rather slowly. In one 
specimen, the coagulation was remarkably slow, and the blood-corpuscles 
gravitated towards the bottom of the vessel, and left above a clear, golden- 
colored clot. The transparent portion of the clot was about one-fourth of 
an inch in thickness. Serum of a deep golden color, reaction alkaline. 
The fibrin was greatly deficient. The deficiency of the fibrin in the blood 
was further demonstrated by the fact that the blood oozed from the cut-cups 
upon the temples for eighteen hours, and it was finally necessary to check 
the flow by cold affusions. The colored blood-corpuscles were greatly 
diminished; the dried corpuscles being 79.434, and the moist corpuscles 
317.748. The fixed saline constituents were correspondingly reduced in 
amount. The albumen was also diminished. It is worthy of note that, in 
the different forms of malarial fever, the serum is alkaline, whilst the saliva 
and urine are intensely acid. 
The following table will illustrate the prominent symptoms :- 
Date. 
1857. 
Hour 
of day. 
State of Skin,Tongue, Intellect, etc. 
| Pulse 
| Respiration. 
Temp, of 
I atmosphere. 
Tern perature 
of hand. 
Temperature 
under tongue. 
Sept. 28 
7 P. 
M. 
Lies in a stupor; tongue dry and rough ; skin dry 
and rough. 
120 
24 
" 29 
11 A. 
M. 
Intellect brighter, but still very dull; tongue slightly 
coated with yellow fur and dry. 
Pulse very feeble, feels like the vibrations of a deli- 
cate silver thread; tongue and skin dry and rough. 
Tongue moister and softer; surface of blister red, 
raw and dry; urine bright red, sp. gr. 1016. 
Restless and stupid; tongue dry and rough; teeth 
coated with sordes. 
Intellect more active, but still dull; patient has a 
disagreeable smell; tongue coated with brownish- 
yellow fur, and harsh, dry, and rough; the inci- 
sion in the arm where he was bled has not healed, 
limpid serum issues from it; side of head swollen 
and painful. 
Tongue moist and soft; arm in which he was bled 
greatly swollen, veins of surface filled with blood; 
swelling of arm due to pressure. 
Swelling of arm and upon leftsideof face continues 
to increase; blister purplish red, with dry raw 
surface; boils and ulcers are appearing upon dif- 
ferent parts of the body; tongue red, dry, and 
glazed at tip; root covered with brownish-yellow 
fur. 
112 
18 
80° 
95.12° 
" 29 
7 P. 
M. 
145 
34 
" 30 
2^ P- 
M. 
112 
17 
73 
91.00 
Oct. 1 
" 2 
2P. 
2P. 
M. 
M. 
100 
124 
16 
18 
79 
88.05 
94.5° 
" 3 
2^ P. 
M. 
120 
24 
" 4 
2P. 
M. 
120 
24 
76 
100.05 
• 
" 5 
2P. 
M. 
Swelling of arm stationary; swelling upon side of 
face continues to increase. 
118 
73 
100.00 
" 6 
4 P. 
4 P. 
M, 
M. 
Skin hot and dry; complains greatly of his head; 
carotid arteries throbbing violently; since the 
commencement of the inflammation, the pulse 
has been fuller and stronger. 
When the arm is bent, much serum issues from the 
lancet wound; surface of blister red and raw, and 
shows no disposition to heal. 
Abscess upon side of head has been lanced; it dis- 
charged much pus, 
Skin hot and dry; tongue dry and rough, abscess in 
angle of jaw continues to discharge much pus and 
masses of cellular tissue; arm looks badly; skin 
of arm greenish yellow. 
Surface of blister has commenced to suppurate, and 
discharge unhealthy offensive pus; the ulcers 
upon various parts of the body steadily increase 
in size, and, like the blister, discharge offensive 
matter. 
104 
24 
72 
101.00 
102.00 
104.0 
104.0 
" 9 
4 P. 
M. 
168 
" 10 
" 12 
4 P. 
44 
M. 
130 
28 
70 
103.75 
104.5 
" 13 
14 
The arm looks dreadfully; skin over biceps muscle 
black and gangrenous; bowels loose; digestion 
bad. 
" 17 
44 
The skin over the entire region of the biceps has 
sloughed away,and left the red quivering muscles; 
no hsemorrhage; body emits a disgusting stench. 
Continues to grow worse; impossible to give any 
idea of his distressing, offensive, and disgusting 
situation! 
" 21 
44 
Died October 22d. 226 
Investigations by Joseph Jones. M. D. 
Ill this report of the symptoms of this patient, we have a demonstra- 
tion of the powerful effects of the malarial poison when unchecked. We 
see that a few days after his entrance into the hospital, a large abscess 
formed upon the side of his head, in the region of the ear, and joint and 
angle of the inferior maxillary bone. Notwithstanding that this abscess 
was lanced, the pus formed an entrance into the external meatus audito- 
rius. Large masses of cellular tissue and muscles sloughed away, and the 
angle and superior portion of the inferior maxillary bone were almost 
completely stripped of flesh. The abscess compelled him to lie upon the 
opposite side of his body, and finally the skin over the biceps muscle 
changed to a black color, and sloughed off in a single night, leaving the 
red quivering muscles entirely exposed. The biceps muscle sloughed 
entirely off from its lower attachment. 
After death, his liver presented a color a shade lighter than the slate 
color of the malarial fever liver, and in many parts it was regaining its 
normal hue. Spleen enlarged ; surface covered with effused coagulable 
lymph, and bound to the liver and diaphragm by bands of coagulable 
lymph. A large quantity of pus of a greenish-vellow color issued from the 
anterior border of the spleen. Whether the abscess had opened and dis- 
charged this pus before death, or whether the abscess was accidentally rup- 
tured during the opening of the chest and abdomen, I was unable to deter- 
mine. The structure of the spleen felt firm, and very unlike the soft, 
yielding structure of the spleen of the active stages of malarial fever. 
When cut, many portions of the spleen resembled the cut surface of a dark, 
bronzed malarial liver. The pulp of these portions was not soft, and did 
not pour out like the .pulp of the spleen of the active stages of malarial 
fever. The liver-like substance of the spleen was found to consist, under the 
microscope, of fibrous tissue and numerous colored corpusc'es and flakes, 
composed of granules resembling the dark-colored flakes of black-vomit. 
These flakes were, without doubt, composed of altered colored corpuscles. 
The colorless corpuscles of this portion of the spleen appeared to be more 
numerous than normal. This dark liver-like substance appears to be noth- 
ing more than the pulp and effused blood of the spleen, from which the 
serum has in a great measure been removed, and in which alterations of 
the blood-corpuscles have taken place, and fibrous tissue formed. After 
many hours exposure to the oxygen of the atmosphere, the color of this 
portion of the spleen remained unchanged. In addition to the abscess 
opening upon the surface of the spleen attached to the liver, the substance 
of the spleen contained numerous other abscesses of various sizes (the 
three largest were of the size of a bullet, and the smallest of the size of an 
English pea), filled with thick greenish-yellow pus. Portions of the spleen 
especially surrounding the abscesses, were altered into a cheese-like sub- 
stance. Under the microscope, these cheese-like portions consisted almost 
entirely of pus-corpuscles and large cells, containing granules and other 
smaller cells, thus resembling cancer-cells ; and also black masses composed 
of granules (probably altered colored corpuscles), like those from the 
denser portions of the spleen ; and also numerous oil-globules. The bodies 
resembling cancer-cells were not numerous. The pus issuing from the 
large abscess resembled ordinary pus under the microscope, and contained 
a few of those peculiar cancer-like cells. The bile presented a brownish- 
yellow opaque color when seen in mass, and a gamboge-yellow in thin 
layers. The bile contained numerous irregularly-shaped yellow masses of 
various sizes, from an English pea to a grain of sand. These yellow masses, 
which were soft and readily crushed between the fingers, formed about two- 
fifths of the contents of the gall-bladder, and were found, under the micro- Cases of Gangramopsis. 
227 
scope, to consist of numerous cells from the mucous membrane of the gall- 
bladder. and a yellow amorphous matter. The cystic duct appeared to be 
choked up with these cells and this yellow matter. The stomach, and 
small and large intestines were greatly contracted. ' The mucous membrane 
of the stomach presented an appearance resembling that of chronic in- 
flammation. The exterior of the large and small intestines was of a pur- 
plish color. The mucous membrane did not appear to the naked eye to be 
altered in structure. The glands of Peyer were enlarged and distinct; 
some of them were several inches in length. They were paler than usual, 
and did not present the appearance of active inflammation. The lym- 
phatics of the mesentery were much enlarged. 
This case demonstrates that the action of the malarial poison is chiefly 
through the sympathetic nervous system, and that its effects, even after the 
direct action is checked, result in a further perversion of the blood, and 
organs, and tissues. Whilst the cerebro-spinal nervous system had recov- 
ered in a great measure from the effects of the poison, and sensation, and 
motion, and intelligence were restored, the pathological alterations of the 
spleen and alimentary canal, and of the liver and blood, continued. 
Many, if not all, the nervous affections and neuralgias occurring after 
attacks of malarial fever, or after the long-continued action of the malarial 
poison, in miasmatical situations, are connected with the altered state of 
the blood, and organs, and secretions. 
Alterations of the solids, similar to the one just recorded, have been 
observed by Dr. Samuel Jackson, of Northumberland, Pa. The following 
cases of gangrsenopsis, or grangrenous erosion of the cheek, following mala- 
rial fever, are quoted from his interesting article, published thirty-two 
years ago, in the American Medical Recorder : 
Case No. 841.-Mary, aged six years, daughter of John Eisely, of Sunbury, 
was seized, in September, 182'2, with an epidemic remittent fever, which, in a few 
days, and before they obtained medical aid, had resolved itself into the intermittent 
form. I was called about the tenth day of her disease, when one side of her face 
was greatly swelled, pale, and shining ; eyelids of the same side so oedematous as 
to close the eye entirely; lips, and particularly the upper one, tumefied; saliva 
streaming from her mouth ; breath highly offensive. My first impression was that 
she was affected with mercury ; but they assured me, as indeed they always did 
afterwards, that she had taken no other medicine than the common purging salts, 
which they had given without medical advice. Upon opening the mouth, I found 
on the inside of the tumefied cheek a patch of gangrene, about as large as a crown 
piece, and without anything like a line of separation. It exhibited a singular ash- 
color, approaching to whiteness; but it was plainly the substance of the cheek, 
which was dead and disorganized to a considerable depth. The teeth were all fast, 
the gums sound and not the least sore on pressure, nor did her breath smell pre- 
cisely like that of a salivated patient. This affection had begun two or three days 
before, and had been steadily increasing. The disease was totally unknown to me ; 
but the mere indications of cure were not supposed to be at all mysterious, though 
I am far from certain of having fallen on the most successful means of fulfilling 
them. An epispastic was applied to the cheek ; the mouth was very frequently 
washed with a succession of gargles, strong alum-water, Huxham's tinct., diluted 
muriat. acid; and bark, wine, elixir vit., and tonic diet were given as freely as tho 
patient could bear them. The intermittent was checked at once, and the patient's 
health began to improve before the swelling of the cheek subsided in the least, or 
any line of separation could be seen. The tonic medicines and diet were continued 
and another blister drawn as soon as the first healed. But the state of the cheek 
meliorated slowly, and I was particularly struck with the obstinacy of the swelling, 
and the inability of the system to form a line of separation. At the twentieth day 
from the time I was called the slough came away, leaving a healthy ulcer, which had 
nearly penetrated the cheek. The teeth and gums were not the least affected at 
any period of the disease. 228 
Cases of Gangrcenopsis. 
Case No., 842.-About the same time, George Gaus, of Sunbury, called me to 
visit his family, three of whom were ill of intermittent fever and dysentery. His 
daughter, about four or live years old, had also the cheek disease, precisely similar 
to that of the above child, unless that there was very little, if any discharge of 
sali va. The father assured me that she had not taken one particle of mercury in 
any form ; nor can I possibly believe that either he or Eisely deceived me, or that 
they were deceived themselves; nor, indeed, ought this cause of itself to have 
excited any inquiries concerning this mineral, since it was not attended with any 
flow of saliva; and, moreover, as in the above case, the teeth and gums were in a 
healthy state. Her dysentery was cured with large doses of calomel, jalap, and 
other purgatives ; and at the same time a sufficient quantity of bark was given to 
check the fever. During this time, probably, not less than a hundred and fifty 
grains of calomel were given, notwithstanding the state of the cheek. For thegan- 
grene she was treated precisely as Eisely's daughter. She soon recovered her 
health, but with a frightful ulcer, which, however, did not quite penetrate the 
cheek. How the ulcers in these two cases healed I know not, as I was soon taken 
with the epidemic myself, and confined for several weeks. I went to see these 
patients since writing the above; Eisely's daughter is dead; but the other is a 
blooming girl, without the least deformity, ft is not probable that these sphacela- 
tions could have been arrested wtihout medical aid, though it must be confessed 
that their character appeared to be rather indolent and obstinate, than inflamma- 
tory and phagedenic. They gave me no uneasiness at the time, but subsequent 
experience has convinced me that had the debilitation of the primary diseases pro- 
ceeded a few days longer, the patients might have been brought into the utmost 
danger. 
Case No. 843.-This occurred September, 1823, in a child of Hannah Smith, 
of Northumberland. He was a robust boy of three years old, who had been taken 
with epidemic remittent fever, for which he was treated with vene-section, cathar- 
tics, antimonials, cold water to the head, and probably with something more that 
I cannot now recollect. He appeared to be going on well till the tenth day, when 
he was taken with an incessant agitation of all his limbs, his brain and mind at 
the same time apparently quite unaffected. An epispastic was applied to each 
limb, and nauseating doses of tartar emetic, conjoined with laudanum, were given 
every hour, with the hope of obtaining both an antispasmodic and diaphoretic 
effect; the exact dose I do not recollect. This troublesome symptom subsided in 
about forty-eight hours, when the dreadful disease of which we are treating was 
observed in the cheek. Its prima facies is so peculiar that we recognized it in one 
moment as the same disease we bad seen before in the two preceding cases; a swell- 
ing and hardness of one cheek, with the upper lips lightly tumid, led us at once to 
suspect the existence of mischief within ; nor were we disappointed. A little cine- 
ritious spot, or rather tumor, was seen behind the opening of the Stenonian duct, 
without any symptom of inflammation near it, or in any part of the mouth. As 
we were alive to the operations of mercury, it was not a little gratifying to find the 
teeth and gums apparently quite sound, and not the least sore on pressure; and 
also that the saliva was not increased, nor the breath offensive. The fever con- 
tinued, and therefore general tonics were not admissible. A blister was drawn on 
the cheek, and the mouth washed frequently with a strong solution of alum. At 
this time the swelling was very moderate, and the mortification confined to a point. 
But the face swelled rapidly on that side, and the gangrene proceeded without 
giving any hopes of a line of separation. In two days, the pulse became soft and 
slow, and the fever being now arrested, we forthwith used tonic diet, bark, and 
elixir vit., with the bark poultice to the face. The mouth was washed alternately 
with Huxham's tincture and muriatic acid, diluted with four times its weight of 
water, and the sphacelated part was circumscribed twice a day with the nitrate of 
mercury, according to the plan of Mr. Kirkland, until it was fairly ascertained to 
be utterly useless. The disease continued its deadly progress till the poor child 
was relieved of life, about the twenty-fifth day of the gangrene. During all this 
time, he suffered very little, if any, pain and he had a ravenous appetite till the 
last two or three days, though much poisonous matter must have been continually 
passing into the stomach. In fact, we were greatly surprised to find him living so 
long, when we consider the deleterious effects of mortification on the general sys- 
tem ; which, in this case, we did nothing to counteract, after we found it impossi- 
ble to preserve a tolerable visage. One side of this poor child's face was literally 
destroyed as high as the frontal sinus; the teeth, maxillary, malar, palate, nasal, 
and orbitar bones were cast off or were picked away by the patient. One whole 
side of the face, including the mouth, chin, nose and one eye were eaten away-a Cases of Gangrcenopsis. 
229 
horrible sight, which even to name is a revolting duty. Yet, even in this deplora- 
ble state of things, many parts of the face put on signs, of healing, and, as the 
patient had a good appetite, we felt no little alarm lest he might continue to live 
in this deplorable condition.' This child had taken some purges of calomel, jalap, 
and scammony, in composition, all which operated freely. The breath was not 
that of a salivated patient; there was no flow of saliva, as in the first case, nor did 
he take any calomel which was not combined with the above mentioned active 
cathartics. We gave him large doses of laudanum, in order that he might sleep 
away in comfort the remainder of his life, and that the mother might attend to the 
rest of her family, all of whom were sick ; and it is a little surprising that, towards 
the last, he would take more than half an ounce in twenty-four hours, without 
procuring more than ordinary sleep. 
Case No. 844.-In August, 1825, we saw a case exactly similar to this in the 
town of Milton, twelve miles above us. It was in a boy four or five years old, the 
son of one Miller, who still resides in that borough. The patient had been treated 
for bilious fever, and had, like the little Smith, taken purges containing calomel; 
and like him, too, nearly the whole face was eaten away, after the sphacelation 
had lasted several weeks. We believe that no calomel was given which had not 
been combined with more active cathartics; but we have no means of getting at 
the exact history of the case. 
Case No. 845.-This was the next that came under my own care, and, horribile 
dictu, it was in my own child. This little girl, less than two years old, was debili- 
tated by a variety of diseases in too rapid succession; an attack of habitual inter- 
mittent, cynanche tonsillaris, measles, inflammation of the lungs, influenza, and 
finally her intermittent again; all of which confined her about ten weeks, and had 
nearly brought her to the grave. When she was in a state of extreme weakness, 
we observed one side of her face a little swelled. I recognized the tumor at once, 
and heard, with the utmost dismay, the little sufferer say, " Cheek, cheek!" while 
at the same time she put her hand to the affected part. On opening her mouth, I 
found the characteristic gangrene; but it was not larger than a dime piece, and was 
nearly circumscribed with a healthy periphery. Her catenation of maladies hav- 
ing ended in her old intermittent, we were ready to give quinine and tonic diet. 
This case was attended with an odor of the breath altogether peculiar and inde- 
scribable. Only one dose of calomel had been given as a purge, and there was no 
affection whatever of the teeth and gums, nor any flow of saliva. 
Dr. Samuel Jackson gives other cases of this remarkable affection, and proves 
that the affection was not due to the action of mercury. 
That rule of philosophizing, therefore, which refers the same phenomena to 
the same cause, excludes calomel as a direct agent in gangraenopsis. All the eases 
that we have seen were preceded by bilious fever, a disease that generally has a 
tendency to spend its violence in some particular part;'and, therefore, if any irri- 
tation, and particularly one that debilitates, should attract and fix the morbific 
influence, a mortification may be the consequence. In one case of this fever, we 
knew blisters to mortify, and in several instances we have known a lingering 
sphacelation of the soft parts covering the lumbar vertebrse. Upon this principle, 
then, can mercury have an indirect agency in the gangrtenopsis ? It is well known 
that children cannot be easily salivated; but it is not reasonable to suppose that 
mercury has, even in them, its specific tendency to the jaws ; and, if so, may itnot 
predispose these parts to this fatal gangrene, and create that morbific attraction that 
brings upon them the whole weight of general disease? Pars dolens tr a hit is a 
maxim in medicine as true as any of the Newtonian Principia, and is of wonder- 
ful efficacy in explaining the mysteries of morbid catenations. For our own part, 
we believe that mercury has no direct agency in gangrtenopsis. It may possibly 
irritate and predispose the part, and thus establish a catenation of morbid attrac- 
tion, and so may any other local and debilitating irritation. Upon this principle, 
we have supposed that the disease may arise from any injury done to the part, 
while the system is pervaded by a sphacelating influence, as no doubt it is in many 
cases of fever. 
The following interesting account of the fatal effects of malarial dis- 
eases at Fort Gibson, in the fall and winter of 1834, were communicated 
to me by General G. F. Rains, of the Confederate Army. It is evident that 
this fatal form of malarial fever was attended in many cases by extensive 
sloughing gangrenous ulcers of the face. 230 
Investigations by Joseph Jones. M. D. 
" In the year 1833, the Arkansas river rose an unprecedented height, overflowed 
all the bottom lands, and while it benefited some few places, it piled the sand three 
feet deep on others, before fruitful, and rendered them barren and desolate. 
During the year succeeding this great rise, September, 1834, I joined my company 
at Fort Gibson, fifty-seven miles west of Arkansas. I had been on duty in the 
Indian department at the Choctaw agency, in about thirteen miles from Fort 
Smith, and about three from the Arkansas river, a thick growth of timbered land 
intervening. The malaria had reached the agency before I left, and I had been 
severely sick with fever, and was convalescing, when I went to Fort Gibson, 
already noted, from medical statistics, as the most unhealthy post in the United 
States occupied by troops. The post of Fort Gibson is situated on the east bank of 
the Neosho river, about two and a half miles from its confluence with the Arkansas, 
having a bottom land south and southeast, in juxtaposition to that post, extending 
to the river, having stagnant pools, and a pond or lake, of about one-half mile in 
extent, in a thick canebrake, in about three-fourths of a mile distant, south. In an 
easterly direction were the dragoon barracks, occupied by four or six companies of 
dragoons, and Fort Gibson, with six companies of infantry, composed of officers 
and men, fifty-two each in number when full. The garrisons were found sickly 
and sickness increasing rapidly, mainly congestive fever and dysentery. We 
began to bury the dead with martial honors, until the musicians became sick, and 
notice made that the music and dead-marches were going almost all the time. 
When that was stopped, our whole business was to dig graves, make coffins, and 
bury the dead. Out of about thirty officers there were soon but three for duty, viz : 
Adjutant Miles, who, I think, had been sick, and was afterwards General Miles, 
killed at Harper's Ferry, fighting against us, Captain Dawson, who, cadaverous- 
looking, was said to take daily a dose of charcoal, and your humble servant, con- 
valescing as said, with diarrhoea, a check to which immediately brought on fever. 
A singular case I must here mention. Lieutenant West, of the Seventh 
Infantry, some three or four years before, had taken the venereal disease from an 
Indian squaw, and had been apparently cured by Surgeon Pitcher, since of the 
Medical College at Detroit, Michigan; had married, and his wife had one child, 
diminutive and sickly. He was down with the dysentery, and Dr. Hawkins 
informed me that his old disease had again broken out with all its violence, and it 
hastened his death. 
Finally, we were burying the men all day, and the grave-yard between the two 
commands had the prisoners of both dragoons and infantry, with other details, 
almost continually employed digging graves, and these accused one another of 
hooking their graves, the term they used, as the first that came with a corpse put it 
into the prepared pit. Coffins were soon out of the question, only rough boxes 
were made, and to supply plank for this purpose, all at the post was used up, and 
the ceiling taken down from some of the rooms in the barracks, for the boards. 
The dragoons suffered, if possible, worse than the infantry, being nearer the 
swampy land, which was just back of them, and I heard a discussion between 
Colonel, afterwards General Mason, and Captain Johnston, of the Quartermaster's 
department, concerning a requisition made from the War Department for the num- 
ber of deaths, which was stated, could not be told, .as the dragoon officers were all 
sick, and some men, notjuiown, who had deserted. It often occurred that two bodies 
were put into the same grave together, the upper not being more than a foot from 
the surface of the ground, and occasionally these deposits were made after night, 
by candle or torchlight. I have seen battle-scenes, but none so horrible as this, 
where it seemed a man's business was to die. The diseases were of three-fold char • 
acter, viz: dysentery, fever congestive, and a nameless disease, which would com- 
mence in apparently a healthy subject, as a very small aphthe inside the upper lip, 
which soon became a sloughing ulcer, of portentous magnitude, before it destroyed 
the man. 
The cause of this singular disease was attributed falsely to Surgeon Finley 
giving enormous doses of calomel to soldiers a few months previous, when out on 
the Western prairies, as I had several attacks myself, which I found in my case 
yielded to application of sulphate of copper, and Cherokee Indians in the vicinity 
of tiie fort had it also. An estimate of the number of deaths may be inferred from 
a remark of Surgeon Bailey to me, that from the building which lie afterwards had 
fitted up, and occupied as quarters for himself and family, more dead bodies, of 
dragoons alone, had been carried out of that house that season than, if brought 
back again, would chink it to the roof. I examined the locality, the evident 
source of this malaria, and found numerous ponds of stagnant water left by the 
river the year before, with much decaying vegetable matter all through the woods Classification of Phenomena of Mortification. 
231 
-the water, the earth, and the air replete with organic formations in a state of 
decomposition, and the air visited by perfumes, the most perceptible to the olfac- 
tory nerves being something like that of the cucumber. The stagnant air, loaded 
with millions of dead infusoria, actually conveyed the idea that there was no such 
thing'as malaria proper, but that, so-called, was loaded with death, to come in con- 
tact with the living fibre in the lungs and body of man. To go in bathing, 
or in any manner to check insensible perspiration for however short a time, 
was the certain passport to a fever. If remembered aright, calomel was the 
sheet-anchor in this storm of death, and Surgeon B. M. Byrne, U. S. army, once 
told me that he had never lost a patient from dysentery, which he always treated 
with a dose of calomel, and demulcent food and drinks, and he had probably a 
thousand cases in his time. He considered the liver the locale of the disease, and 
a vitiated secretion of bile the cause. In the winter the diseases most prevalent 
were severe influenzas and pneumonias-the former epidemic, the latter endemic, 
if not contagious, as it seemed to pass rapidly from patient to bunk-mate, so that 
but two or three days would elapse before the death of both. During the prevalence 
of the severe malarious diseases during the fall and winter of 1834, at Fort Gibson, 
it was observed that the livers of both men and animals presented, after death, a 
dark, slate color. The livers of all the animals slaughtered were thrown away by 
the butchers, on account of their dark, unhealthy appearance." 
It is important that the cause and nature of the gangrene accompanying 
malarial fever, as well as the same ulcerations of the lower extremities 
frequently present in this disease, should, in this connection, receive 
especial attention. 
We have conceived that the labor of future investigators of the clini- 
cal history, and pathological phenomena of malarial fever, would be facili- 
tated by presenting the following consolidated statement of the results of 
our investigation of the phenomena of mortification : 
OBSERVATIONS UPON THE METHOD OF INVESTIGATION AND CLASSIFICA- 
TION OF THE PHENOMENA OF MORTIFICATION.* 
By Joseph Jones, M. D. Communicated for the St. Louis Medical Reporter. 
The classification of the varieties of mortification should be based upon the 
knowledge of the causes producing the degeneration and death of the tissues or 
organs, and of the nature and relations of the physical, chemical and nutritive 
changes of the affected tissues in health and during the different stages of disease 
and mortification, and upon the knowledge of the effects of these changes, and their 
organic products upon the surrounding tissues and upon the vegetable and animal 
functions. The correct comprehension of the complicated phenomena of gangrene 
includes a knowledge of, first, the physical and chemical constitution and physi- 
ological functions of the tissue, structure or organ involved; the physical and 
chemical constitution, and relations of the blood circulating through the affected 
part; and the relations of the tissue, structure or organ to the respiration and circu- 
lation, and to the cerebro-spinal and sympathic nervous systems. 
2. The condition of the general system at the time of the appearance of the 
symptoms of mortification. It is well established that certain modes of life, and 
certain substances taken as food, induce such a state of the system as is favorable 
to the origin of gangrenous inflammation upon the reception of trivial injuries, or 
they may even induce mortification without any local injury. In such cases we 
need something more than a mere description of symptoms, and of the progressive 
appearances of the gangrenous parts; and we can not claim a thorough knowledge 
of the phenomena until we understand the changes of nutrition during tho pro- 
gressive degeneration of parts. This subject is involved in numerous and great, if 
not insurmountable difficulties. In most cases of gangrene it is difficult, if not 
impossible, to determine the point at which the tissues commence to degenerate, 
and even after it has been well established that the nutritive and vital functions 
are defective, it is almost impossible to distinguish between degeneration and 
death. Thus, a part may degenerate to death, whilst the surrounding tissues, 
although greatly degenerated and altered, may still present signs of life, and 
neither be cast off'nor absorbed; so, also, whilst a certain diminution of arterial 
*The St. Louis Medical Reporter, a semi-monthly record of Medicine and surgery, edited by 
J. S. B. Alleyne, M. D., and 0. F. Potter. M. D. St. Louis, May 15,1868, vol. iii. No. 6. 232 
Investigations by Joseph Jones, M. D. 
blood may lead only to deranged nutrition and degeneration, a greater diminution 
may lead to death ; and a certain degree of inflammatory action has always a defec- 
tive nutrition, and consequent degeneration, whilst in an increase of the inflam- 
mation, the death of the same part may ensue. 
3. The nature of the causes producing gangrene: if mechanical, the nature 
and extent of the injury; if chemical, the properties of the substance, and its 
actions upon and chemical and physical relations with the living tissues; if a 
mineral, vegetable, or animal poison, its chemical affinities and relations, not 
merely to the tissues or organs involved, but to the circulatory, respiratory and 
nervous systems, and to the vegetable and animal functions. 
4. The chemical constitution of the various products formed at the different 
stages of the mortification, and the effects of these organic compounds upon the 
constitution of the blood, upon the nutrition of the surrounding tissues and of the 
system generally, and upon the actions of the circulatory, respiratory and nervous 
systems. 
The organic compounds formed during the putrefaction of animal matters 
removed from the living body, must, without doubt, differ in chemical constitu- 
tion and physiological action from those formed during mortification in the living 
body. Putrefaction under these different conditions must necessarily yield different 
products, from the differences of temperature, and the presence of surrounding liv- 
ing tissues and fluids in the one case, and their absence in the other. In like man- 
ner the products formed will vary with the different varieties of mortification. 
When inflamed parts, with a large amount of exudation pass into mortification, 
from a loss of vitality, or from the obstruction of the circulation, caused by the 
exudation, or from both causes combined, the products formed during the death 
and decay of the moist distended tissues will differ from those formed when the 
parts undergo little or no inflammation, and simply die, shrivel up, and become 
black, as in senile gangrene. The rapidity of the putrefaction of organic substances 
is, in general, in proportion to the degree of the temperature, and the supplies of 
oxygen and water. The character of the compounds formed will vary with the 
manner in which these essential conditions are fulfilled. If the supply of oxygen 
be deficient, an excess of carbon and carbonaceous compounds will be found in the 
dead mass, which otherwise would have been transformed and removed, chiefly 
in the form of carbonic acid gas. Some of these compounds, formed under pecu- 
liar circumstances, both without and within the living body, are capable of acting 
the part of ferments, and of exciting decomposition in neighboring masses. We 
can, in this manner, find an explanation of the rapid and progressive destruction 
of the surrounding tissues in hospital gangrene, cancrum oris, nema, and some 
other malignant forms of mortification. The extent to which the general system 
will suffer from the infection of the dead matterand poisonous compoundswill 
depend, in great measure, upon the condition and the constitution of the surround- 
ingtissues. When the constitution is robustand the vascular system well developed 
and active, with rich, healthy blood, active inflammation is excited around the 
dead part, and an effusion of coagulable lymph surrounds and limits the local dis- 
ease, and tends to protect the general system from infection. In these cases in 
which mortification is thus circumscribed, the predominant symptoms will be 
those of inflammation and inflammatory fever, but if the constitution be previously 
enfeebled and the blood be defective in its constitution and vital properties, or if 
the forces be secondarily depressed, and the nutrition impaired and the blood dete- 
riorated during the progress of the inflammatory fever, the general system will 
suffer from the absorption of the poisonous compounds. The absorption of the 
poisonous animal matterswill be announced by the increased feebleness and fre- 
quency of the pulse, the pallor and duskiness of the complexion, the distressed, 
anxious countenance, with collapsed, pinched features, cold sweats the dry or 
clammy brown coated tongue, restlessness and agitation, low muttering delirium, 
hiccup, foetid diarrhoea, coma or syncope, and death. The rapidity with which the 
products of mortification will be absorbed and affect the system depends not only 
upon the condition of the blood and forces, and of the general constitution, but also 
upon the organ or tissue involved, the absorption being, as a general rule, most 
rapid and deleterious in its effects when the dead part is in the interior of the body, 
in some vital organ, and surrounded by an extensive vascular web work. 
5. The relations of the different stages of mortification to the different stages 
of other diseased actions : as the stages of inflammation and fever. 
6 The process by which nature limits or arrests the destructive progress of 
mortification. Classification of Phenomena of Mortification. 
233 
It is evident that the thorough investigation of the relations of mortification 
here pointed out would not only necessitate immense labor, but also the discovery 
and invention of methods of experiment, and of tests and apparatus unknown to 
pathological science. The varieties of mortification may be arranged under the 
following heads: 
1. Mortification arising from Mechanical Injuries, and the Local Action of 
Physical and Chemical Agents.-As severe mechanical injury, great heat, or power- 
ful chemical agents, may kill the structures and contained blood at once, without 
any preceding inflammation, we are justified in classing this as the most simple 
and uncomplicated form of mortification. When, however, these agents are 
applied in small measure, they may fail to cause mortification directly, but may 
excite an inflammation which, added to the damage that the part has sustained, 
may result in an indirect or secondary mortification. 
This first division may be subdivided into mortifications resulting from- 
a. Mechanical injury of blood-vessels. 
b. Mechanical injury of nerves. 
c. Mechanical injury of all the structures. 
d. Effects of heat. 
e. Effects of cold. 
f. Effects of destructive corrosive chemical agents : as the mineral acids, etc. 
The extent and character of the mortification arising from mechanical injuries, 
and the local action of physical and chemical agents, will depend not merely upon 
the nature of the injury, but, in a large degree, upon the condition of the constitu- 
tion. Thus, slight injuries, not sufficient to excite gangrenous inflammation in 
healthy persons, will be attended with extensive and even fatal mortification in 
habitual drunkards, and in the enfeebled, depressed state of the system, often 
found in old age, and after long continued fever. The rapid destruction of tissues 
in parts exposed to pressure (bed sores) following fevers of a low type, appears to 
be due to the depressed state of the forces and to imperfect nutrition, as well as to 
the action of morbific agents. An excess or deficiency of blood, as well as varia- 
tions in the constitution and relative proportions of the constituents of this fluid, 
will influence the extent and character of the inflammation and mortification fol- 
lowing local injuries. Although mortification arising from the action of mechani- 
cal and physical causes may at first appear to be strictly local, at the same time the 
constitution, even in the most simple and favorable cases, is more or less involved. 
Thus, if the life of a large portion of the tissues in the middle of a leg be destroyed 
by a grape shot, which fractures the bone, divides the arteries, or renders them 
incapable of carrying on a sufficient circulation of the tissues which they supply, 
mortification may take place in the injured tissues or in the foot, imperfectly sup- 
plied with blood, immediately; or there may be first an inflammatory action 
established in the parts above and around the injured tissues, and at the same time 
an imperfect mortification of the phenomena of inflammation in the foot. As 
soon as inflammation is established in any part, either in the parts in and around 
the wound, or in the foot imperfectly supplied with blood, the action of the circu- 
lation and resriration is increased, the chemical changes become more active, the 
temperature of the entire body is elevated, the appetite fails, the urine becomes 
high colored, the nervous system manifests signs of sympathetic derangement, and 
the constitution is involved. After the parts pass into the gangrenous state various 
abnormal organic products result from their decomposition, which, entering into 
the circulation, disorganize the blood, derange the nutrition of the surrounding 
parts, and of the body generally, depress and derange the actions of the circulatory 
and nervous systems, and still farther aggravate the constitutional systems. 
2. Mortification arising from and following Inflammations of Important 
Organs and Structures, without any External Injury.-'The extent and character of 
this variety of mortification will manifestly depend, in great measure, upon the 
functions of the organs or structures inflamed, as well as upon the causes, character 
and extent of the inflammation. The causes of the irritation and inflammation 
of internal organs are various, as changes of temperature, derangements of the 
circulation, derangements of the nutrition, resulting from bad diet, impaired diges- 
tion, improper habits, exposure, the depressing effects of moisture, heat and cold, 
and from derangements of the physical and chemical properties of the blood, ner- 
vous derangements, imperfect elimination of excretory substances, as uric acid and 
other noxious compounds, resulting from the imperfect action of the skin and kid- 
neys, and the action of various morbific agents introduced from without or gene- 
rated within the system upon the organs directly or through the blood and nervous 
system. 234 
Composition and Changes of the Blood in Malarial Fever. 
Ill inflammations, when a very large amount of blood plasma is thrown out, 
the capillaries are ruptured, the blood, with its red corpuscles, is mixed with the 
exuded liquor sanguinis, and the exudation thus formed compresses the parts, para- 
lyzes the nerves, obstructs the blood-vessels, and arrests the circulation; whether 
such products of inflammation with the injured tissues will pass into mortification 
will depend upon the extent to which the powers of the general system have been 
prostrated, and upon the extent to which the circulation and nutrition of the parts 
have been deranged. If the vital powers are too much depressed to organize the 
exudation into living cells, or are incapable of the slow removal of the products of 
inflammation by absorption, the physical and chemical forces are no longer 
directed by the vital force to the constant destruction and repair ol the structures, 
and a new set of chemical changes are set up, resulting in mortification ; the con- 
stituents of the blood are altered in their physical and chemical properties, the 
blood-corpuscles assume a dark purple and blood color, and finally break down and 
disintegrate, the tissues of the part enter into the general change, the fat and 
fibrous cellular and muscular tissues are detached and finally decomposed into 
amorphous granular masses, and various deleterious and offensive gases, as sulphu- 
retted hydrogen and compounds of ammonia, with many organic compounds are 
formed. Whilst in this manner inflammation may terminate in gangrene, we 
should not regard the various results of inflammation, as adhesion, exudation, sup- 
puration and absorption, as connected with mortification, or as forming necessary 
steps leading to gangrene. We may have mortification without any of the inter- 
mediate stages of inflammation, as in the case of the action of certain animal poi- 
sons, as the poison of the rattlesnake, which produces almost instant death of the 
blood and tissues into which it is injected. Nevertheless, we cannot understand 
mortification following inflammation without considering the preceding process, 
with its various products ; for inflammation, however produced, may cause morti- 
fication from the complete suspension of the circulation of the parts, resulting from 
the congestion and stagnation of the blood, or from the pressure of the inflamma- 
tory products, or from inflammation of the internal coats of the artery ; from the 
derangement and depression of the powers of the general system as well as of the 
part especially involved by the exhausting effects of the preceding inflammatory 
fever, and from the degeneration of the blood and tissues dependent upon the 
defective nutrition consequent upon the inflammatory actions. The death of an 
inflamed part, therefore, is a highly complex matter. 
3. Mortification arising from Constitutional Derangements, and Alterations 
in the Circulatory Apparatus without any Local Injury or Internal Inflammation. 
Under this head may be classed mortification arising from- 
a. Derangements in the quantity, composition and circulation of the blood: 
as in scurvy. 
b. Deficient and perverted nutrition : as in the mortification of the feet and 
toes, described by Percival Pott, which he affirmed to be unlike the mortification 
from inflammation, from external cold, from ligature, or bandage, or from that 
which proceeds from any known and visible cause. 
c. Decay of the powers, feeble action of the heart, and structural alterations 
of the circulatory apparatus, resulting from deficient and perverted nutrition : as 
in senile gangrene. 
d. Deficient and perverted nutrition, and feeble forces and altered blood, 
resulting from the prolonged action of disease, and especially of fever. 
4. Mortification arising from the Action of Special Poisons, either Developed 
within the System or Introduced from without, through the Alimentary Canal, 
Respiratory System or' Skin, or throuoh the Blood, or through Wounds and Ulcers. 
Under this head may be classed mortifications arising from- 
a. The action of various mineral bodies : as arsenic and mercury. 
b. Vegetable poisons ; as in the gangrene, produced by spurred rye, (gangre- 
nous ergotism, necrosis ustalaginia, sauvages, gangrene des Solognois.) 
c. Poisonous animal secretions: as the poison of the rattlesnake (crotalus 
adamanteus and durissus), and of the copper-head (trygeno-cephalus contortrix), 
and of the European viper and other reptiles. 
d. Fever poisons : as in certain forms of typhus fever. 
e. Deleterious agents generated in animals in a state of disease : as in malig- 
nant pustule (pustule maligne, charbon, milz-brand.) 
f. Poisonous compounds generated during the decomposition of dead animal 
matters : as in dissecting wounds. 
g. Poisonous decomposing animal matters formed in the gangrenous wounds 
of living men. capable of infecting the system either through the lungs or through 
the surface of woundsand ulcers. Investigations by Joseph Jones, M. D. 
235 
To this last variety belongs hospital gangrene (phagedena gangrenosa.) The 
previous condition of the constitution will be especially influential upon the course 
and results of gangrene, arising from the action of the products of animal decay. 
This might be supported by numerous facts, as the comparative immunity of 
American medical students from poisoning in dissecting wounds during the early 
part of the course of lectures, when their systems are in vigorous health ; and the 
more frequent occurrence of poisoned wounds in the latter portion of the course, 
after their forces have been exhausted, digestion impaired, and blood impoverished 
by want of exercise, excessive application, poor diet, and thefoul atmosphere of the 
dissecting room, and of the crowded and badly ventilated lecture rooms. During 
the recent American Civil War, previous exposure, bad diet, crowding and foul air, 
were effective not only in the origin, but also in the spread and character of hospi- 
tal gangrene amongst the soldiers in hospital and prison. 
The blood in case No. 840 was abstracted from a young American sea- 
man, aged 21 years, with a moderately well-developed muscular system, who 
had been exposed to the malarious influence in the Savannah river, when 
sleeping on the deck of the ship in the open air. The ship was lying along 
the low marshy shore below the city. This patient was brought into the 
hospital in a comatose condition, with rapid, feeble pulse, and rapid respira- 
tion, with no corresponding elevation of the temperature. This patient lay 
in this comatose condition, passing his urine and foeces for several days, 
until aroused by cut-cups, sinapisms, stimulants, and sulphate of quinia. 
The blood was obtained, whilst he was in this conidition, three days after 
his entrance into the hospital, and six days after the commencement of the 
attack. Blood coagulated more slowly than usual. Serum of a deep 
golden color. Nitric acid showed that this color was due to the presence 
of bile. Reaction of serum alkaline. The colored blood-corpuscles were 
greatly diminished; the dried corpuscles being 85.968, and the moist 
343.872, in 1000 parts of the blood. The fixed saline constituents of the 
colored blood-corpuscles were greatly diminished in amount, whilst those 
of the liquor sanguinis were increased. The fibrin was diminished in 
amount. The following table will present a condensed view of the promi- 
nent symptoms :- 
Date 
1857 
Hour 
of day 
State of Skin, Tongue, Intellect, etc. 
Pulse 
Respiration 
Temperature of 
atmosphere 
Temperature of 
hand 
Temperature 
under tongue 
. .. . 
Characters of 
urine 
Sept. 26 
" 27 
Tongue dryer than normal; coated with 
yellow fur; complexion sallow; has fe- 
ver, is very weak and dull. 
Comatose; passes urine and excrements 
in bed. 
Restored to the temporary and partial use 
of his intellect by a blister. 
The action of the blister has been only tem- 
porary; pulse is so feeble that it is with 
difficulty counted; tongue coated with 
yellow fur, dry ana rough. 
Lies in a stupor, with mouth and eyes 
partially open; teeth coated with sordes; 
tongue coated with black and light yel- 
low fur, perfectly dry and rough; surface 
of blister red and raw. 
Stimulants and sulphate of quinia have 
aroused him, and excited the chemical 
changes; is still very weak, and has a 
great tendency to sleep; skin of head and 
trunk feds a little warmer than normal, 
and is slightly moist; tongue presentsthe 
same dry, coated, rough appearance; re- 
action of saliva decidedly acid. 
" 28 
" 28 
7 P.M. 
120 
22 
" 29 
11 A.M. 
" 29 
7J P. M. 
98 
IS 
80° 
98.0° 236 
Composition ancl Changes of the Blood in Malarial Feuer 
Bate 
1857 
" 30 
Oct. 1 
" 3 
" 5 
" 6 
" 7 
" 8 
" 9 
Oct. 10 
" 10 
« 17 
Hour 
of day 
2 P.M. 
1 P.M. 
1 P.M. 
1P.M. 
2 P.M. 
1P.M. 
3 P.M. 
2JP. M. 
2 P.M. 
4 P.M. 
State of Skin, Tongue, Intellect, etc. 
Intellect clear, and there is less tendency 
to sleep; tongue is still very dry, rough 
and black in the centre; it appears, how- 
ever, softer; reaction of saliva decidedly 
acid. 
Tongue moister, softer, and cleaner; says 
that he feels better, and is hungry; com- 
plexion sallow, anaemic. 
The expression of countenance is better, 
and the surface of the blister looks much 
better; tongue still coated with dark- 
brown fur, but moister and softer; the 
sordes around the teeth and the disagree- 
able smell are rapidly disappearing; ab- 
domen tumid; was able to walk across 
the ward. 
Has taken a change for the worse; inclined 
to stupor; goes to sleep whilst convers- 
ing; countenance anxious and distressed; 
bowels costive; during the last four days 
has taken 100 grs. of sulphate of quinla. 
Anxious expression of countenance; bow- 
els costive; abdomen tumid; tongue a 
little softer and cleaner, butstill much 
dryer, harder, and rougher than normal; 
there is still an almost complete cessa- 
tion of the secretions of the mouth. 
Tongue clean, and much moister and 
softer, the moisture, however, varies 
greatly; pulse very weak, feels like the 
vibrations of a spider's thread; greatly 
exhausted by the action of a purgative 
administered the night before. 
Under the action of stimulants has im- 
proved, and looks better; tongue softer 
and moister than it has been during his 
sickness; pulse stronger, but still watery 
and feeble. 
Complains of great weakness; pulsefeeble 
and watery; bowels Inactive and tumid. 
Complains of great weakness; his sallow 
complexion, anaemic lips and gums, 
feeble pulse, and feeble forces, demon- 
strate that his feelings are founded upon 
the effects of the malarial poison. Ap- 
plied large mustards to the extremeties, 
and administered stimulants; in JO min- 
utes after the application, the temper- 
ature of his extremities had risen 6° 
(from 86° to 92°), and his pulse had be- 
come much fuller, and increased 8beats 
(from 92 to 100). In half an hour after 
the application of the mustards, the 
temperature of his extremities had risen 
16° and remained stationary. 
Hal fan hour afterwards, the temperature 
still continued elevated. 
Much better; temperature of the extremi- 
ties corresponds with that of the trunk. 
Appetite good; tongue moist; convales- 
cent. 
Able to walk about the hospital grounds; 
reaction of saliva very slightly acid. 
o 
M2 
80 
90 
88 
94 
90 
100 
92 
96 
92 
100 
104 
91 
100 
76 
8 
g 
0) 
£ 
14 
20 
18 
IS 
15 
13 
Ki 
16 
Hi 
Hi 
16 
16 
14 
o 
h 8 
1g a 
£ 02 
CD O 
a- 
<D 05 
71.0 
73.0 
77.0 
77.0 
71.0 
70.5 
72.5 
73.0 
73.0 
73.0 
71.0 
69.5 
67.0 
o 
o 
O'O 
Q 
r- 
97.0 
98.75 
102.0 
102.5 
96.0 
97.0 
97.25 
86.0 
92.0 
102.0 
102.0 
101.0 
97.25 
Q 
s s 
5 5 
ft'S 
as 
A 
101° 
103.0 
103.0 
102.5 
103.0 
103.0 
103.2 
103.0 
102.5 
102.0 
Characters of 
urine 
High colored; 
sp, gr. 1016; uric 
acid in 1000 p'ts 
0.59. 
Deepjorange col- 
or; sp. gr. 1016; 
uric acid in 1000 
parts 0.659. 
Orange colored; 
sp. gr. 1016; uric 
acid in 1000 p'ts 
0.511, deposited 
a heavy light- 
yellow deposit 
after standing. 
Light orange co- 
lor; sp. gr. 1006: 
uric acid in 1000 
parts 0.238. 
Sp. gr. 1006; re- 
action alkaline 
after standing 
24 hours; uric 
acid in 1000 p'ts 
0.078. 
Deep orange co- 
lor; sp. gr. 1014; 
12,168 grs. pass- 
ed in 24 hours, 
contain'g urea 
209 520 gr., uric 
acid 12.60 grs. 
This case presents many points of exceeding interest, which will be 
fully noticed hereafter under the proper heads. It illustrates in a striking 
manner, the effects of the malarial poison in producing profound altera- Investigations by Joseph Jones. M. D. 
237 
tions in the blood and secretions, and demonstrates that such changes are 
attended by aberrated nervous and physical phenomena. Throughout this 
case there was a want of correspondence between the temperature of the 
trunk and extremities. The temperature of the extremities was often 
several degrees below the normal standard, whilst the temperature of the 
trunk was several degrees above the standard of health. Accompanying 
this loss of animal heat in the extremities, and exaltation in the trunk, 
there was rapid, feeble pulse, normal respiration, dry, harsh skin, dry 
mouth, feeble digestion, torpid bowels, sluggish intellect and feeble forces. 
These facts, taken in connection with the analysis of the blood, show that 
the malarial poison has produced profound alterations in the constituents 
of the blood, interfered with the formation of the secretions, interfered 
with the chemical changes of the blood and nutritive fluids, inter- 
fered with the development and correlation of the physical, vital, 
and nervous forces. The dry, harsh tongue, the scanty acid secre- 
tions of the mucous membrane of the mouth, the torpor of the bow- 
els, the high colored acid urine, the dry, harsh skin, the feeble circulation 
in the capillaries of the extremities, the elevation of the temperature of 
the trunk, the loss of harmony between the actions of the circulatory and 
respiratory system, all point to profound disturbances in the domain over 
which the sympathetic system presides. The sluggish intellect indicated 
derangement of the cerebro-spinal system. The feeble forces point to 
derangements in both the sympathetic and cerebro-spinal systems. A 
careful comparison of the symptoms of this patient with those of fatal 
cases, shows that this was a case of such great severity that any careless- 
ness or neglect would have been attended by a fatal termination. Not- 
withstanding the administration of the most active tonics, and of the most 
nutritious diet, this patient exhibited, for a great length of time, the effects 
of the bilious remittent fever, in hi« pale, sallow, anaemic countenance, pale 
lips and gums, and tottering gait. The violent nature of the malarial 
fever, contracted by sleeping in the open air in the low marshy land bor- 
dering our fresh water rivers, is forcibly illustrated by the subsequent 
history of the crew to which this patient belonged. I was informed, upon 
reliable authority, that one week after the admission of this patient into 
the hospital, his captain weighed anchor and sailed for New York. The 
crew consisted of the men whom he had compelled to sleep on board the 
vessel lying along the low, marshy shore. Several of the crew were unwell 
at the time of sailing. Before getting well out to sea, the captain and the 
whole crew were taken sick- In a few days, there was not a man with 
strength to navigate the ship. Fortunately, a small vessel perceived their 
signal of distress, and towed them into Darien. Before reaching this port, 
the captain and five out of seven of the crew had died. There were but 
two remaining of eight, and these were extremely ill. The severity of the 
disease, in this case, resembles the accounts of African fever. 
We will now, from these observations and others, present a generalized 
statement of the changes of the blood in malarial fever. 
1. The caref ul comparison of the table of the changes of the blood in mala- 
rial fever with the formula of the blood, established, by laborious investigations, 
reveals the fact, that the colored blood-corpuscles are diminished during malar- 
ial fever. 
2. The careful comparison of these analyses with each other, reveals the 
fact, that the extent and rapidity of the diminution of the colored corpuscles, cor- 
responds to the severity and extent of the disease. 
A short but violent attack of congestive or of remittent fever, in its 
severer forms, wfill accomplish as great a diminution of the colored blood- 
corpuscles, as a long attack of intermittent fever, or the prolonged action 238 
Composition and Changes of the Blood in Malarial Eever. 
of the malarial poison. These statements are borne out in the main, by 
the researches of Andral and Gavarret, upon the blood in intermittent 
fever. If their analyses be compared with those just recorded, it will be 
seen that whilst the blood-corpuscles are diminished, the diminution is less 
than in the blood of the severe cases recorded by myself. When we con- 
sider that the climate was much more healthy, and that the fevers examined 
by Andral and Gavarret were only of the intermittent type, and in all 
probability, much lighter than the intermitteuts of the marshes, swamps, 
and low-grounds of the Southern States, which generate a malaria scarcely 
less deadly than that of Africa, it is evident that the results of the investi- 
gations in America upon malarial fever, agree with those of Europe. The 
following table presents the results obtained by Andral and Gavarret, from 
the examinations of the blood of six persons suffering with intermittent 
fever :- 
Number of 
case. 
Water in 
1000 parts 
of blood. 
Solid 
residue of 
1000 parts 
of blood. 
Moist blood-corpuscles. 
Fibrin. 
Solid 
residue of 
serum of 
1000 parts of 
blood. 
Moist blood- 
corpuscles in 
1000 parts of 
blood. 
Water in 
moist blood- 
corpuscles of 
1000 parts of 
blood. 
Solid residue 
in moist 
blood-corpus- 
cies in 1000 
p'ts of blood. 
1 
511.6 
383.7 
127.9 
3.7 
2 
441.6 
331.2 
110.4 
3.5 
3 
438.0 
328.5 
109.5 
3.5 
4 
423.2 
317.4 
105.8 
3.4 
5 
420.0 
315.0 
105.0 
3.3 
6 
275.2 
206.4 
68.8 
3.0 
91.0 
Maxima 
847.9 
221.9 
511.6 
373.7 
127.9 
3.7 
Minima 
778.1 
152.1 
275.2 
206.4 
68.8 
3.0 
71.6 
Mean 
811.4 
188.6 
417.2 
309.4 
104.3 
3.3 
80.0 
MM. Leonard and Foley, of Algiers, concluded from their examina- 
tions of the blood in intermittent fever, that the proportion of globules 
tends either to remain stationary or to diminish.* 
MM. Becquerel and Rodier have demonstrated that in that peculiar 
condition of the system called marsh cachexia, accompanied by a remark- 
able decoloration of the skin, and not unfrequently by dropsy, and pro- 
duced by the long continued influence of malaria, there is the greatest 
decrease of both the albumen and the globules. The following table pre- 
sents the analyses of marsh cachexia, executed by MM. Becquerel and 
Rodier: 
* Pathological Chemistry in its Application to the Practice of Medicine. Translated from 
the French of MM. Becquerel and Rodier, by S. T. Speer. M. D. London, 1857, pp. 172-174. Investigations by Joseph Jones, M. D. 
239 
composition of human blood in marsh cachexia. 
Analysis of 1000 Parts of Blood. 
- - JO 
2. a S' 
• 
Specific gravity 
Water 
lid matters of moist globules 
£ 
q 
3" 
X 
r of moist gio 
matters of se 
n. 
bul 
run 
6).10 
2.36 
1035.40 
869.34 
268.40 
67.10 
201.30 
A man aged 50, 
suffering from 
marsh cachexia 
and general 
dropsy. 
to 
41.84 
305.61 
1040.00 
853.75 
407.48 
101.87 
A man aged 48, 
suffering from 
marsh cachexia 
and general 
dropsy. 
- 
3.13 
869.71 
269.12 
67.28 
201.84 
59.88 
A man aged 48. 
suffering from 
marsh cachexia 
and general 
dropsy. 
168.66 
63.83 
4.27 
1033.85 
875.67 
224.88 
56.22 
A man aged 23, 
suffering from 
marsh cachexia 
and general 
dropsy. 
251.66 
62.32 
4.15 
GO CO 
r19° 
tc co 
to 00 
1040.51 
846.31 
A man aged 18, 
suffering from 
marsh cachexia 
and general 
dropsy. 
Analysis of 1000 Parts of Serum. 
Specific gravity 
1020.37 
1016.40 
1021.61 
1024.15 
1023.56 
Water 
936.40 
953.29 
930 08 
926.75 
922 98 
Albumen 
55.68 
37.26 
50.20 
60.20 
63.25 
Extractive matters and salts 
7.92 
9.45 
13.72 
13.05 
13.77 
The mean composition of the blood in marsh cachexia may be repre- 
sented thus :- 
Analysis of 1000 Parts of Blood (Mean Composition of in five Cases of 
Marsh Cachexia)- 
Specific gravity , 1036.76 
Water 962.38 
Moist globules 303.76 
Dried residue of globules 75.94 
Water of globules 227.82 
Solid matters of serum j 57.79 
Fibrin 3.39 
Mean Composition of 1000 Parts of the Serum. 
Specific gravity 1021.22 
Water .' 935.10 
Albumen 53.32 
Extractive matters and salts 11.58 
The following interesting remarks with reference to the cause of the 
dropsy, are made by MM. Becquerel and Rodier :- 
" The dropsy has been attributed to the mechanical obstacle afforded by the 
enlarged condition of the spleen, so common in these cases. We do not deny the 
possibility of such a sequence ; but it is certain that in many instances we fail to 
discover such an amount of splenic enlargement as would suffice to explain the 
occurrence of an increasing and general anasarca. In only one of the preceding- 
analyses of the blood in marsh cachexia, did we notice a marked degree of splenic 
enlargement; it was, however, insufficient to account for the serous infiltration 
present."* 
We will, in the next place, compare the changes of the blood in mala- 
rial fever, and in the state of marsh cachexia produced by the continued 
action of the poison, with the changes of the blood in the different forms of 
dropsy. The following tables present a resume of the valuable investiga- 
tions of MM. Becquerel and Rodier :- 
* Pathological Chemistry, p. 172. 240 
Acute Dropsy. 
MECHANICAL DROPS!'. 
Analysis of 1000 Parts of Blood. 
-- - O 
Solid matters of moist globules 
Water of moist globules 
Solid matters of serum 
Fibrin. 
2? 
* 
c 
T 
r. 
Spt cific gravity 
Wafpr 
1057.01 
802.79 
424.92 
106.23 
318.69 
i 80.20 
1 1.78 
A female aged 
65; anasarca, 
dependent on 
cancer of the 
stomach and 
pancreas. 
361.30 
90.30 
1 270.90 
85 50 
4.00 
1053.45 
810.20 
A female aged 
36; anasarca of 
the lower ex- 
tremities, due 
to an abdomi- 
nal tumor. 
1 1060.75 
828.30 
360.08 
90.02 
270.04 
86.03 
• 5.55 
A female aged 
24; ascites 
and anasarea, 
due to abdo- 
minal tumors 
1043.56 
842^0 
285.48 
71.37 
214.11 
81.85 
5.38 
A female aged 
61; anasarca, 
dependent on 
cancer of the 
stomach. 
Analysis of 1000 Parts of Serum. 
Specific gravity 
1032.51 
1033 00 
10^8 73 
10^6 69 
Water 
900 00 
894 53 
905 83 
913 68 
Albumen 
73.26 
82 62 
70 80 
Extractive matters and salts 
26.74 
22.85 
17.33 
15.68 
In the blood of mechanical dropsy we have a decrease of the globules; 
but the diminution is less than that of the severest forms of malarial fever, 
and in marsh cachexia. It is worthy of note that other causes than 
mechanical operated in two of these cases. It is probable that the cancers, 
and the peculiar state of the system favorable to the development of can- 
cers, may have had much to do with the pathological changes of the blood. 
These cases, then, are not without objections; nevertheless, the objections 
only place in a still stronger light the profound alterations of the blood- 
corpuscles in malarial fever. 
ACUTE DROPSY. 
Analysis of 1000 Parts of Blood.* 
Mean. 
Maxima. 
Minima. 
Specific gravity 
1045.84 
1053.30 
1037.55 
Water 
830.78 
Moist globules 
414.32 
539.52 
280.40 
Dried residue of moist globules 
104.58 
134 88 
70 10 
Water of moist globules 
309.74 
404.64 
210 30 
Solid matters of serum 
57 24 
Fibrin 
2.77 
4.10 
1.25 
Analysis of 1000 Parts of Serum. 
Specific gravity 
1022.61 
928.47 
58.52 
13.01 
1024.28 
1020.05 
Water 
Albumen 
63.18 
17.14 
51.12 
7.74 
Extractive matters and salts 
* The above table is drawn up from eleven analyses of the blood; nine of the patients were 
males and two females. In all, the disease set in rapidly under the following circumstances: In 
one case, it followed a sudden suppression of the catemenia from violent emotion; in a second, 
it occurred at the fifth month of pregnancy, without any appreciable cause; in a third, it fol- 
lowed an attack of scarlatina; in four other cases, it followed prolonged exposure to cold; in 
another, it resulted from sleeping on the ground in the open air, during the month of June; 
lastly, in three cases, the cause was inappreciable. In two of these latter, the patients were suf- 
fering from a relapse of the disease. Of these eleven patients, none entered the hospital before 
the fourth, or after the eleventh, day of the disease. In six cases, dropsy was the only symptom; 
in two, it was accompanied by fever ; in two others, there was a slight fever; while in another 
there was vomiting, coupled with a mild attack of jaundice. Cachectic Dropsy. 
241 
" The globules are less liable to decrease than in cachectic dropsy ; they, never- 
theless, fell in one case to 70, and in another to 72. In three cases they were above 
120 per 1000 ; in three others between 10) and 120; and in five cases between 100 
and 110. The fibrin underwent a marked diminution in two cases only, viz., 
between 1 and 2 per 1000; in six cases it varied from 3 to 6, while in three others >t 
rose above 3 per 1000. The albumen of the serum was always diminished, and in 
some instances this diminution was considerable ; it ranged from 60 to 66 in four 
cases, and from 55 to 60 in six others, while in one case it fell as low as 51.02. It 
is almost needless to add, that the specific gravity of both the blood and serum was 
always found to have fallen below the standard of health." 
From a careful historical analysis and examination of these cases, Bec- 
querel and Rodier drew the conclusion that acute dropsy was the result of 
albuminuria following congestion of the kidney. 
"Under the influence of some cause or other, congestion of the kidney 
is produced. The congestion is indicated, along with other symptomatic phe- 
nomena, by the escape of a certain amount of albumen with the urine; this, ere 
long, diminishes the natural proportion of the albumen of the blood, and the latter 
condition in its turn gives rise to a greater or less degree of dropsy. But the con- 
gestion of the kidney is generally of much shorter duration than the modification 
of the blood, and its consecutive dropsy; it disappears, therefore, long before these 
latter phenomena; and if the patients are not examined until a certain time after 
the onset of the disease, they alone are observed, the escape of albumen with the 
urine having altogether ceased." 
Now, with reference to the diminution of the blood-corpuscles and 
albumen in malarial fever, we can state positively that it is not due in 
most cases to the escape of albumen through the kidneys. J have examined 
specimens of urine in all the various forms and stages of malarial fever in 
many cases ; but seldom detected albumen in the urine, and we have 
already reported the case of a seaman suffering with remittent and typhoid 
fevers combined. We know that albumen does appear in the urine of 
typhoid fever; so this case forms no exception to the previous statement. 
The diminution of the blood-corpuscles and albumen in malarial fever 
appear to be due to one or both of two causes. Either the organs destined 
to elaborate and prepare the blood-corpuscles and albumen do not perform 
their office with sufficient energy to replace the constant destruction, or 
else the albumen and blood-corpuscles are destroyed during the chemical 
changes of fever, and by the catalytic action or fermentation of the mala- 
rial poison. 
CACHECTIC DROPSIES. 
Analysis of 1000 Parts of Blood. 
Solid matters of serum 
Fibrin 
Solid residue of moist globules 
Water of moist erlohnles 
3 
2. 
£ 
r 
£ 
» 
( 
z 
z 
3 
825.94 
407.84 
101.96 
305.88 
68.50 
3.60 
5 
A man aged 60, weakened 
by want, and suffering from 
dropsy not referable to any 
appreciable organic cause. 
1031.05 
876.82 
259.84 
64.96 
194.88 
55.04 
3 JR 
A man aged 64, suffering pri- 
vations of every kind7 and 
laboring under cachectic 
dropsy. 
1043.55 
864.45 
334.52 
83.63 
250.89 
49.88 
,2.04 
A woman aged 26, laboring 
under cachectic dropsy, fol- 
lowing chronic diarrhoea. 
J043.82 
847.28 
363.36 
90.84 
272.52 
59.87 
2.01 
A man aged 58, suffering 
from anaemiaand cachectic 
dropsy, following chronic 
diarrhoea. 
1045.01 
824.55 
414.08 
103.52 
310.56 
68.20 
3.73 
A woman aged 25, suffering 
from anaemia, chronic diar- 
rhoea, and cachectic dropsy. 
216.80 
54.20 
162.60 
63.83 
2.42 
I 1034.13 
1 870 Ad. 
A man laboring under can- 
cer of the stomach and 
general dropsy, the result 
of cancerous cachexia. 
1041.04 
888.24 
188.00 
47.00 
141.00 
62.50 
2.26 
An anaemic female withan 
Incessant haemorrhoidal 
flux of three months' du- 
ration. 
1039.66 
939.85 
306.68 
76.67 
230.01 
60.48 
3.00 
Mean composition of the 
blood in cachectic dropsies 
generally. 242 
Dropsical Effusions of Malarial Fever. 
Specific gravity 
1025.10 
1020.51 
10-7.75 
1023.89 
1023.35 
1023.32 
1023.03 
1022.67 
Water 
923.50 
937.36 
946.55 
935.13 
923.63 
938.09 
923.00 
932.65 
Albumen 
65.43 
51.30 
45.61 
53.38 
64.05 
60.81 
61.40 
11.40 
Extractive matters and salts 
11.07 
10.84 
7.84 
11.49 
12.35 
11.01 
15.60 
55.95 
Analysis of 1000 parts of Serum. 
A careful examination and comparison of these results, demonstrate 
that the destruction of the colored blood-corpuscles in the severest forms 
of malarial fever, and in the dropsical anaemic condition called marsh 
cachexia, produced by the long-continued action of the malarial poison, is 
greater than in mechanical and acute dropsies, and equal to destruction of 
these important constituents of the blood in cachectic dropsies, resulting 
from repeated losses of blood, exhausting discharges from the bowels, long- 
continued exposure and privations, hunger and thirst, and from that pecu- 
liar state of the system sometimes manifested in those suffering from can- 
cers. These investigations establish, without the shadow of a doubt, the 
fact that the malarial poison, or the peculiar train of chemical changes 
which it excites, destroys the gland-cells of the blood. This fact is further 
sustained by the greater abundance of iron in the urine of malarial fever 
than in that of health. This increase of iron in the urine corresponds to 
the destruction of the colored blood-corpuscles, and the elimination of the 
products resulting from their physical and chemical changes. 
THEORY AND TREATMENT OF DROPSY ARISING FROM THE ACTION OF THE 
MALARIAL POISON. 
The prolonged action of the malarial poison, not unfrequently induces 
such changes in the composition of the blood and such derangements of the 
liver aud spleen, as to lead to the effusion of serous fluid into the areolar 
tissue and peritoneum. The changes of the blood induced by malarial 
fever, appear to be the chief cause of the dropsical effusions, although in 
some cases this symptom may be attributed to the mechanical obstacle, 
afforded by the enlarged spleen and liver. Several well marked cases of 
dropsy resulting from the prolonged action of the malarial poison have 
been from time to time presented to the Medical Class of the University of 
Louisiana, in which no albumen could be detected in the urine, nor any 
diminution of this secretion, nor any very great enlargement of the liver 
and spleen. Such cases were uniformly characterized by a sallow, amemic 
complexion, and watery blood, poor in solid constituents. 
CAUSES WHICH LEAD TO THE DROPSICAL EFFUSIONS OF MALARIAL FEVER. 
(a.) In malarial fever the specific gravity of the blood. and serum is dimin- 
ished. The specific gravity of the blood ranges in this disease from 1030.5 
to 1042.4, and the specific gravity of the serum from 1018. to 1023.6. In 
health, on the other hand, the specific gravity of the blood varies from 
1055. to 1063., and the specific gravity of the serum from 1027. to 1032. 
(b.) In malarial fever the colored blood-corpuscles are greatly diminished. 
In health the dried corpuscles may vary from 120. to 150. parts in the 1000 
of blood, and the moist blood-corpuscles from 480. to 600. In malarial 
fever, on the other hand, the dried colored corpuscles range from 51.98 
parts to 107.81; and the moist blood-corpuscles from 207.92 to 323.63. The 
careful comparison of these analyses of malarial blood with each other, 
reveals the fact, that the extent and rapidity of the diminution of the col- 
ored corpuscles, corresponds to the severity and duration of the disease. Comatose Cases of Malarial Feuer. 
243 
A short but violent attack of congestive or of remittent, fever, in its severer 
forms, will accomplish as great a diminution of the colored blood-corpus- 
cles. as a long attack of intermittent fever, or the prolonged action ot the 
malarial poison. 
(c.) In malarial fever, the relation between the colored corpuscles and 
liquor sanguinis is deranged. Thus in healthy blood the relative proportions 
of moist, blood-corpuscles in the 1000 parts and liquor sanguinis may vary 
from 480.00 to 600.00 of the former, and from 520.00 to 400.00 of the latter ; 
whilst in malarial fever, the globules vary from 207.92 to 323.63, and the 
liquor sanguinis from 792.08 to 676.37. 
(d.) The Fibrin of Blood is diminished to a marked extent, in some cases 
of malarial fever, and is altered in its properties and, in its relations to the other 
elements of the blood, and to the blood-vessels. 
(e.) The Organic matters of the Liquor Sanguinis, and especially the 
Albumen, is diminished in malarial fever. Thus the solid matters of the 
serum may vary in health, from 90.00 to 105.00 ; whilst in malarial fever, 
they vary from 62.78 to 80.22 parts, in the 1000 parts of blood. It ischiefly 
to this latter change, viz : the diminution of the albumen of the blood in 
malarial fever, that the dropsical effusions are to be traced. The other 
changes of the blood, without doubt, lead to congestions of the liver and 
spleen, and to derangements of the capillary circulation and nutrition of 
the organs and tissues, but a careful examination of those diseases as ame- 
mia, chorea, and pyaemia, in which the colored blood-corpuscles are 
greatly diminished, will show that this course alone will not induce dropsy. 
In the watery state of the blood induced by the action of paludal poison, 
comparatively slight obstructions of the circulation in the spleen and liver 
might lead to dropsical effusion. It would appear also, that from the 
derangement of nutrition caused by the action of the malarial poison upon 
the blood and nervous system, that certain effete products are not sufficiently 
and properly eliminated, and then as in the case of urea, may be active in 
the production of dropsy. 
FATAL RESULTS OTTEN OCCUR IN CHRONIC MALARIAL POISONING FROM 
SUDDEN EFFUSION OF LIQUOR SANGUINIS INTO THE VENTRICLES OF 
THE BRAIN. SUCH CASES MANIFEST SYMPTOMS OF SUDDEN PROSTRA- 
TION, FOLLOWED BY PROFOUND COMA. 
The sudden changes characteristic of chronic malarial poisoning, 
attended, with extreme amemia and more or less general oedema, were 
illustrated by the examination of several cases of a iatal form of malarial 
cachexia, which occurred in the months of February and March, 1863, 
amongst the Confederate troops assembled for the defense of Savannah, 
Georgia. 
During the prosecution of investigations upon camp diseases amongst 
Confederate troops, stationed along the coast of Georgia and South Caro- 
lina, my friend and colleague, Dr. H. V. M. Miller, chief surgeon of the 
military district of Georgia, requested me to examine some sudden and 
severe cases of disease, which had occurred in the Thirty-second Regi- 
ment of Georgia Volunteers, at that time camped near the southern 
boundary of Savannah, at Camp William Duncan Smith. According to 
the testimony of Surgeon Hugh A. Blair, of the Thirty-second Regiment, 
almost the entire command of an average mean strength of one thousand 
men, had suffered with malarial fever, and many of the men whom I saw 
on regimental parade showed, in their sallow anaemic faces, the effects of 
malaria. In the Field Hospital of the Thirty-second Georgia Regi- 244 
Comatose Cases of Malarial Eever. 
ment, which was crowded with cases of typhoid fever, pneumonia and 
malarial fever, I observed three cases suffering with a form of disease 
which had been sudden in its inception and violent in its symptoms. In 
the latter part of February, a few days before my visit, five of these cases 
had occurred and two proved fatal. Three of the five cases commenced 
with strong convulsions, followed in a short time by delirium. In four 
of the cases the pupils were dilated, and the conjunctiva was congested in 
all. In one case the pupil was alternately dilated and contracted. Res- 
piration apparently natural at the commencement of the disease, but 
gradually became stertorous and irregular. Coma rapidly supervened, 
and the patients died in from twelve to eighteen hours. 
The three cases which I examined in the Field Hospital presented an 
anaemic and sallow hue, as if the patients had been subjected to the pro- 
longed action of malaria; and upon inquiry I found that they bad, in each 
case, suffered previously with chill and fever. 
These cases presented somewhat the symptoms of severe concussion 
of the brain; the patients lay with the eyes open, without perceiving or 
noticing anything passing around them, and whenever attempts were 
made to arouse them they gave little or no sign of intelligence. There 
was no contraction or rigidity about the muscles of the neck or spine, and 
in fact all the muscles appeared to be perfectly flaccid. These cases, after 
lingering some time, finally terminated fatally. These cases appeared to 
be the result of the action of malaria. It might, with some reason, be 
supposed that the continued action of malaria had produced such changes 
in the constitution of the blood of the cerebro-spinal structures, that at 
length, during the congestive stage of the disease, accompanied also by 
the action of cold and some irritation of the meninges of the brain and 
cord, sei ous effusions took place into the ventricles of the brain and around 
the brain and spinal cord. 
Similar cases occurred about the same time in the General Hospital 
in Augusta, Georgia. Six cases, the entire number, proved fatal. All of 
them were soldiers, who had been suffering with malarial fever in Savan- 
nah, and had been transferred, in the latter part of the fall, to Augusta. 
In each one of these six cases the malarial fever had not been arrested, 
and the patients exhibited its effects in their pale, sallow, anaemic hue. 
They were all put upon the preparation of arsenite of potassa (Fowler's 
solution, eight drops three times a day) at the time of the fatal attacks. 
In most of these cases the disease was ushered in with an intense pain in one 
of the eyes, which was speedily followed by coma and death in from eighteen 
to fifty hours. Surgeon Blair informed me that a case similar in some 
respects to those previously described occurred as early as September. 
The patient had had chill and fever for some time, and looked sallow and 
amemic. Had missed his chill for several days, and had taken no quinine 
for two days. On the 10th of September fifteen grains of quinine io three 
doses were administered early in the morning, the last dose having been 
taken at 8 AM. This was given with a view to prevent a recurrence of 
the chill. This morning the surgeon found the patient in apparent good 
health, with the exception of the effects of malaria. At 6 o'clock, P. M., 
whilst attempting to put on his shoes, the patient suddenly fell, became 
insensible, and never rallied. In two hours he was jaundiced-even his 
tears were yellow. Pupils largely dilated; breathing natural; pulse not 
accelerated, but weak. The patient died at midnight of the same day 
upon which he was seized. 
The total number of deaths occurring amongst 2885 cases of the various 
forms of malarial fever treated by the author in the Charity Hospital of Effusion of Serum into the Ventricles of the Brain in Malarial Fever. 
245 
New Orleans, January, 1869 to April, 1886, was 88. Of the total number of 
deaths caused by malarial fever, during the period named, the number 
due to each form of malarial fever was as follows: intermittent fever, 5; 
remittent, 17; pernicious or congestive malarial fever, 56; chronic mala- 
rial poisoning, 14; malarial hmmaturia, 6. In the numerous post-mortems 
which I examined in malarial fever, I determined the important fact that 
in some cases of sudden coma occurring in the anaemic patients who had 
l»een subjected to the prolonged action of the malarial poison, the promi- 
nent neurotic symptoms were referable to the effusion of large quantities 
of serum into the ventricles of the brain. 
In such cases I have seen at least four fluid ounces of clear limpid 
serum in the lateral ventricle of the brain. In such cases death had been 
preceded by coma and general paralysis. With the exception of the 
deposit of pigment matter, and of the pigment cells of malaria, and pig- 
mented leucocytes, no distinct structural alterations were observed in the 
cerebral structures, and the effusion of serum into the ventricles of the 
brain appeared to be due to the same changes of the blood as those which 
induced general malarial dropsy. A large number of fatal cases of the 
various forms of malarial fever, however, are not complicated with serous 
effusion into the ventricles of the brain; and many cases of violent delirium 
and great general disturbance of the circulation and respiration which 
may be referred to various causes; and, for example, the action of the 
malarial ferment, both mechanically, chemically and physiologically upon 
the blood, and the poisonous effects of the products of the chemical 
changes excited in the blood and nervous system by the malarial micro- 
organisms. TIip difficulties and scope of this most important inquiry are 
shown by the following observations: 
In many cases of malarial fever, various disturbances of the cerebro- 
spinal nervous system occur, as active delirium and even coma, which 
sometimes disappear without leaving any manifest alterations of function 
or structure, or are quickly and entirely relieved by the free and energetic 
administration of stimulants and sulphate of quinia. It is evident that in 
such cases there is neither structural alteration nor inflammation of the 
cerebro-spinal nervous system. The term irritation even, cannot, with 
any propriety, if the term be used in its ordinary sense, as related to 
inflammation, be applied to such phenomena. In many cases of malarial 
fever which prove fatal, no lesions are discovered in the cerebro-spinal 
structures, which will account for the symptoms during life, or for the 
fatal termination. The truth of this assertion has been established by the 
post-mortem examinations which I have at various times published in the 
Southern Medical and Surgical Journal, and in the Transactions of the 
American Medical Association. The action of the malarial poison upon 
the cerebro spinal nervous system in such cases may be compared to that 
of a violent alkaloid or even mineral poison. It is well established that in 
death from various violent poisons, which produce great disturbances in 
the functions of the nervous system, we are in many cases unable to dis- 
cover any lesions in the structures of the cerebro-spinal nervous system 
which could at all account for the nervous manifestations during the action 
of the poison. Other causes and agents are also active in producing the 
nervous disturbances in malarial fever. This will be noticed before leav- 
ing the subject. 
In some cases of malarial fever, the severe nervous symptoms remain; 
stimulants and revulsives and sulphate of quinia exert no effect in arrest- 
ing the disease, or in arousing the patient from the state of coma, or in 
relieving the convulsions and wild delirium. Such cases may occur at any 246 
Direct Action of Malarial Poison on Nervous System. 
period of the year in those who have been subjected to the action of mala- 
ria; but as far as my experience extends they occur most frequently in the 
fall and winter. Cold appears to have much to do with the production and 
termination of such cases, as we shall presently show. Individuals who 
have the seeds of malaria in them may even remove to healthy regions, 
and spend months with only an occasional chill or headache, and then 
suddenly be seized with fatal symptoms, which appear to be referable 
chiefly to the cerebro-spinal nervous system. In such cases when the 
cerebro-spinal symptoms are persistent and terminate fatally, the true 
causes are found in the lesions of the blood as well as of the nervous 
structures. We have just seen that in the preceding post-mortem exami- 
nations we did not discover, even in those cases which manifested during 
life the symptoms of cerebritis and meningitis, fibrinous effusions coating 
the membranes of the brain and spinal cord; but, on the other hand, the 
ventricles of the brain and the sub-arachnoid space were, in some cases, 
distended with fluid. It is but reasonable to suppose that this effused fluid 
may, in some cases of malarial fever, cause death. It is not necessary to 
suppose that this effusion of fluid in and around the cerebral structures is 
due to the presence of inflammation. The explanation which I have before 
given of the mode in which pneumonia produces death from malarial fever 
may, with equal truth, be applied to explain this phenomenon. After the 
colored blood corpuscles have been destroyed, and the fibrin and albumen 
diminished, and the blood thus rendered watery and altered in its most 
essential properties, by the rapid or more slow action of the malarial 
poison, it is evident that an effusion of the watery elements of the blood is 
liable to occur from the blood-vessels of any organ and tissue in which 
there is an active determination or congestion of blood. A prolonged 
chill, in itself, or in conjunction with the action of cold, which still farther 
increases the internal congestions may be attended with such effusions of 
the liquor sanguinis of the blood as permanently to impede the functions 
of important organs. In like manner, as we have shown in the case of the 
lungs, the irritation or inflammation of a comparatively small portion of an 
organ, in the body upon which the malarial poison has exerted its charac- 
teristic effects, may be attended with large serous effusions, not only from 
the parts immediately involved by the inflammation, but by surrounding 
parts. This explains the sudden supervention of symptoms of compression 
of the brain appearing suddenly, and without any apparent inflammation 
of that organ, in those laboring under the action of the malarial poison. 
The functional and structural derangements of the cerebro-spinal nervous 
system in malarial fever and under the action of the malarial poison with- 
out those symptoms characterized as fever, are referable to several causes. 
THE DIRECT ACTION OF THE POISON UPON THE NERVOUS STRUCTURES. 
We have regarded the action of the malarial poison in most cases as 
depressing, and not inflammatory and analogous in its action and relations 
to certain alkaloid vegetable poisons. We must admit, however, that to 
determine accurately the alterations of the nervous apparatus, under the 
action of various morbific and remedial agents, it is absolutely necessary 
that the structures of the different parts of the nervous apparatus should 
be submitted to a rigid chemical and microscopical analysis. Numberless 
insuperable difficulties lie in the way of complete microscopical and chemi- 
cal analyses. It is impossible to obtain the substances for analysis until 
several hours after death, and. in substances so liable to change, impor- 
tant alterations may take place even in this short time. It is impossible Direct Action of Malarial Poison on Nervous System. 
247 
to separate the blood from the nervous elements; and the presence of a 
varying amount of blood, of varying constitution, would, of itself, be suffi- 
cient to vitiate the results of every analysis which had for its object the 
determination of the chemical changes induced by a most subtle poison. 
Notwithstanding this imperfect state of pathological science, we may by 
an analysis of those phenomena which can be investigated, form at least a 
reasonable system of belief. We will endeavor to do this. 
As far as my observations extend, in most cases of malarial fever, the 
pathological alterations of the brain and spinal marrow do not correspond 
with the severity of the symptoms during life. The most universal phe- 
nomenon appears to be the stagnation and accumulation of the blood in the 
blood-vessels and capillaries of the brain and pia-mater. This accumula- 
tion of the blood in the vessels of the brain and pia-mater appears to be 
due neither to inflammation nor to irritation, but simply to a stagnation of the 
blood, similar to the stagnation and accumulation of the blood in the vessels 
of the large organs. Such a stagnation of the blood signifies clearly a depres- 
sion rather than an exaltation or irritation of the nervous forces. These 
views are sustained by the results of treatment. In numerous cases I have 
seen the wildest delirium calmed, the intellect aroused into full vigor from 
the most profound coma, and the most alarming cerebral symptoms vanish 
under the free use of the sulphate of quinia. When the sulphate of quinia 
was withheld, the effects of the stimulants and sinapisms would be but 
temporary; whilst, when it was administered in sufficient quantities, the 
restoration of the intellectual functions and the removal of the cerebral 
symptoms were permanent. Now, is this the action of stimulants or of 
sulphate of quinia upon an irritated or inflamed brain ? 
These facts alone demonstrate conclusively that the cerebro-spinal system is 
not usually the seat of irritation or inflammation in malarial fever, if we limit 
irritation and inflammation to the meaning universally adopted; and, that if irri- 
tation and inflammation of the cerebro-spinal system do arise in the progress of 
malarial fever, they are by no means universal phenomena dependent upon the 
definite and universal action of the malarial poison. 
Nevertheless the malarial poison does appear to exert a direct influ- 
ence upon the nervous structures, and especially upon the sympathetic sys- 
tem. This influence is manifested not merely in the disturbed cerebro- 
spinal functions and in the disturbances of the circulation and respiration, 
and in the disturbances of the muscular force generally, but also in the 
derangement of the nutritive processes of the nervous structures. Thus, 
during the chill and earliest period of the hot fit, the oxidization of phos- 
phorus in the nervous structures is either arrested or so modified that the 
products of this important change do not appear in the urine, as the hot 
stage, however, progresses, and during the active changes of fever the 
elements of the nervous system are rapidly oxidized and phosphoric acid 
increases largely in the urine. Although the increase of phosphoric acid 
necessarily attends all active changes in the structures, and is a character- 
istic of most fevers, still this fact compels us to doubt one or the other of 
two suppositions. The cessation of the excretion of phosphoric acid and 
its compounds, and its subsequent increase during the different stages of 
malarial fever is either due to the direct action of the malarial poison upon 
the cerebro-spinal and sympathetic nervous systems, or to the effects of 
the changes excited by this poison in bringing about that change which we 
denote fever-the results of the increased chemical changes of fever being 
manifested in the excretion of increased amounts of phosphoric acid and 
of all other compounds necessarily resulting from the changes in the 
structures. 248 
Direct Action of Malarial Poison upon the Blood. 
THE DIRECT ACTION OF THE MALARIAL POISON UPON THE BLOOD. 
The colored blood-corpuscles are not only greatly and rapidly dimin- 
ished in malarial fever, but they also often lose a portion of their mineral 
constituents. We have every reason to believe that the blood-corpuscles, 
taken collectively, perform the offices of an immense gland for the elabo- 
ration of the materials for the nutrition of che muscular and nervous sys- 
tems. The coloring matters of the serum are increased, and the coloring 
matters of the bile retained, in the blood of malarial fever. The retention 
of the coloring matters of the bile in the blood as well as the absorption of 
the altered bile must produce disturbing and injurious effects upon the 
nervous system. 
The constitution of the urine is greatly altered in the severest forms of 
malarial fever, and some of its most important constituents are either not 
formed at all, or, if formed, are not eliminated. The retention of such con- 
stituents as urea and uric acid as well as of the excrementitious matters in 
a partially oxidized form in like manner must disturb the normal action 
of the nervous system. 
The fibrin of the blood is altered both in quantity and quality. We 
have seen that in the fatal cases of malarial fever heart clots, free from 
colored blood-corpuscles, and in some cases sending off long branches into 
the pulmonary arteries were formed before death. This coagulation of the 
fibrin during life signifies loss of vitality in the blood and a great change in 
its physical properties and relations to the containing vessels. The pres- 
ence of these bodies especially in the pulmonary arteries derange the 
actions of the heart and of the general circulation, and in like manner 
derange the respiration, and the absorption and distribution of oxygen. 
These disturbances must necessarily be attended by similar disturbances 
in the actions of the nervous and muscular systems. Here, then, we have 
profound alterations of the blood which must induce corresponding disturb- 
ances in the muscular and nervous systems, and in all the organs and tis- 
sues which derive their nutrition from the blood. Here. then, we have 
profound alterations in the constituents of the blood which must produce 
corresponding disturbances in the general and capillary circulations, and 
in the chemical changes in the capillaries and surrounding tissues upon 
which depend the capillary circulation, and, in fact, the development and 
maintenance of all the forces-physical, muscular and nervous. 
As a general rule, the general and capillary circulations are greatly 
disturbed in congestive fever. These disturbances are manifested in the 
quick, thumping action of the heart, the small, feeble, rapid pulse, the 
panting full respiration, the want of correspondence between the tempera- 
tures of the trunk and extremities, the aber r ation of the physical, chemi- 
cal, muscular', and nervous phenomena, and in the stagnation of the blood 
in the different organs and tissues. The stagnation of the blood in the 
organs, tissues, and apparatus, is due to disturbances in the sympathetic 
and cerebrospinal systems, disturbances in the general circulation, dis- 
turbances in the quantities and qualities of the const ituents of the blood, 
and arrest or perversion of the chemical changes of the capillaries. It is 
well established that the circulation of the blood through the capillaries 
depends upon the relations, quantitative and qualitative, physical and 
chemical, of the individual constituents of the blood to each other, and to 
the capillaries and the surrounding tissues ; and that disturbances of their 
relations will be attended by arrest of the capillar y circulation, and stag- 
nation arrd congestion of the blood, notwithstanding that the general circu- 
latory apparatus may receive a sufficient supply of nervous force, and per- Treatment of Malarial Dropsy. 
249 
form its offices with sufficient vigor. When the general circulation is 
impeded, either by the direct action of the malarial poison, or of the altered 
blood upon the fibres of the heart, or by the withdrawal or perversion of 
the nervous forces supplied by the sympathetic nervous system, or by the 
cerebrospinal nervous system, through the sympathetic, consequent 
upon the action of the altered blood, or of the malarial poison, or of both : 
it follows, as a necessary consequence, that the introduction and distribu- 
tion of oxygen will be retarded and the chemical changes in the capillaries 
will be impeded, and the blood will stagnate and accumulate in the capilla- 
ries. As chemical change is necessary for the development of muscular 
and nervous force, and for the manifestation of intellectual phenomena; 
whenever, therefore, the normal chemical actions of the blood are disturbed, 
aberrated nervous action, both in the cerebro-spinal and sympathetic ner- 
vous systems, may result. The following practical conclusions may be 
drawn concerning the treatment and prevention of this singular and fatal 
form of malarial fever which we have thus examined. 
PRINCIPLES OF THE TREATMENT OF MALARIAL DROPSY. 
The indications in the treatment of dropsy arising from the action of 
the malarial poison, are : 
1st. The removal of the cause, giving rise to the phenomena of mala- 
rial fever, and causing a simultaneous decrease of the globules and albumen, 
with congestion of the liver and spleen. The patient must be removed 
from the influence of the paludal poison. In many cases, even after the 
removal of the patients to elevated, healthy non-miasmatic regions, the 
attacks of ague will recur again and again with obstinacy. 
2d. The prevention of the recurrence of the malarial paroxysms, 
and the removal, neutralization or elimination of the cause. This indica- 
tion may, be fulfilled by the persistent use of cinchona, in various forms, 
and especially sulphate of quinia. To prevent the recurrence of the 
paroxysm, quinine should be given in doses varying from five to ten grains 
every two or three hours, until from twenty to thirty grains have been 
taken before the time of the expected paroxysm. In the intermission, and 
in fact throughout the continuance of the dropsy, the patient should be 
kept gently under the influence of quinine, from two to four grains being 
administered three times a day. The iodide of quinia (from one to three 
grains dissolved in a wineglass of water), has proved highly beneficial in 
my hands in such cases. As the blood is impoverished, good results are 
obtained by giving iron in combination with the sulphate of quinia. 
3d. The removal of the dropsical effusion. This will best be accom- 
plished by the judicious use of purgatives, diuretics, the hot air bath, and 
stimulant frictions of every kind, as dry friction, and aromatic, alcoholic 
and ammoniacal frictions. Purgatives judicially used not only causeabsorp- 
tion of the serous effusion, but they also diminish the congestion of the 
liver and spleen. The blue pill (pilulse hydrargyri), in doses of from five 
to ten grains, occasionally may be administered with marked benefit. The 
cream of tartar and juniper berry infusion is one of the best diuretics in 
such cases, m the employment of purgatives and diuretics, great care 
should be exercised not to exhaust the patient, or to weaken and derange 
the digestive function. If possible, we should avoid impoverishing the 
blood further by the use of these remedies. In many cases, the free perspi- 
ration, induced by the hot air bath, will prove of essential benefit. When 
the kidneys are congested, and the urine is scant and loaded with albumen, 
and the patient suffers with fever, general uneasiness and gastric 250 
Changes in Saline Constituents of Bloocl-Corpuscles in Malarial Fever. 
derangement, both general and local blood-letting may be practised with 
benefit. Leeches and cut-cups over the region of the kidneys will prove 
beneficial in relieving the congestion. Af(>er the albumen has disappeared 
from the urine, and in those cases in which its presence has never been 
detected, blood-letting is not indicated. The diet should be light but 
nutritious, and composed largely of vegetable and farinaceous articles. 
Various measures may be instituted to procure the removal of the effused 
fluid , as purgatives, hot air baths, diuretics and stimulating frictions, 
When the kidneys are congested, stimulating diuretics should be 
avoided, and the saline diuretics should be employed. The bitartrate of 
potassa (cream of tartar), employed in the proportion of one ounce dis- 
solved, or rather suspended in one pint of the infusion of juniper berries 
(j uniperi fructus), may be administered during the twenty-four hours. If 
the gentle stimulant effect of the volatile oil and resin of the juniper ber- 
ries be contra-indicated, the cream of tartar may be given suspended in one 
pint of water. A wineglassful of this mixture may be taken every two or 
three hours. After the relief of the kidneys, and the establishment of the 
excretion of the urea in its normal amount, good diet, together with tonics, 
especially cinchona and the vegetable bitters, may be employed to restore 
the blood to the normal standard. 
4th. The improvement of the blood. Nitrogenized food, especially 
good beef-steak, if the digestive powers are sufficiently strong, fresh milk, 
and soft boiled eggs, with a moderate quantity of generous wine, will tend, 
not only to improve the digestive powers, but also to furnish the materials 
for healthy, rich blood. The digestive powers and the nervous system may, 
in like manner, be invigorated by the use of the vegetable bitters, and 
especially of gentian and strychnine. It is best to administer the strych- 
nine in doses of one-twentieth of a grain dissolved in water acidulated with 
citric acid. In many cases it is found thatthe dropsical effusion diminishes, 
just as the blood recovers its normal composition. Iron is almost uni- 
versally indicated, by the marked decrease of the blood globules, and on 
account of its valuable effects in restoring the digestive function. One of 
the best combinations in such cases, is a pill composed of three grains of 
precipitated iron (iron by hydrogen), two grains of sulphate of quinia, and 
one grain of the extract of rhubarb. The extract of rhubarb is used in 
proportions just sufficient to overcome the astringent effect of the iron. 
This pill may be taken three times a day and persevered in for weeks and 
months. In this combination, we likewise obtain the prophylatic action 
of sulphate of quinia. The cure of this form of dropsy is tedious and pro- 
longed in most cases, and the iron and bitter tonics should be used with 
perseverance. 
5th. Hygienic Measures. A healthy, well ventilated residence in an 
elevated non-malarious region, gentle but regular exercise iu open air, and 
the wearing of warm clothing, as flannel next to the skin, are valuable 
adjuvants to treatment. Dropsy may also arise from the changes of the 
blood, induced by insufficient and salt food (as in scurvy), by repeated 
haemorrhages (as the haemorrhoidal flux); by chronic diarrhoea, and by the 
effects of the absorption of cancerous matter. 
OUR RESEARCHES SHOW THAT THE FIXED SALINE CONSTITUENTS OF THE 
BLOOD-CORPUSCLES ARE OFTEN DIMINISHED IN MALARIAL FEVER. 
Numerous examinations of the urine in different stages of malarial 
fever, have convinced me that the proportion of phosphates are increased 
after an attack of malarial fever. If the urine excreted during conva- Changes in Saline Constituents of Blood-Corpuscles in Malarial Fever. 
251 
lescence be set aside for a few hours, it will rapidly change from the 
acid to the alkaline reaction, and a heavy deposit of prismatic (most gen- 
erally) and stellate crystals of triple phosphate, and light yellow granules, 
and acicular crystals of urate of ammonia, will be thrown down. So 
abundant are the crystals of the phosphates in the urine of convales- 
cence, that if, after standing until the reaction is decidedly alkaline, it be 
held in the sunshine, thousands of these crystals of the triple phosphate 
will be seen, like small spangles of silver. It is probable that a portion 
of these phosphates, at least, has been derived from the dead, disinte- 
grated, chemically altered, colored blood-corpuscles. The bearing of these 
facts upon pathological and therapeutical science; is placed in a clear 
light by a consideration of the phenomena and offices of the colored blood- 
corpuscles. 
The specific gravity of the colored blood-corpuscles varies with the 
quantity of hsematin which they contain, and with the state of concen- 
tration or dilution of its contents. The density of the fluid contents will 
depend upon the character and rapidity of the mutual interchanges of 
the cellular fluid of the blood-corpuscles and the surrounding liquor san- 
guinis. Constant action and reaction are kept up between these two 
great elements of the blood. Each corpuscle is a cell, resembling in its 
nutrition, growth and general structure the active agents in the formation, 
elaboration, and separation of all secretions and excretions. Their cell- 
walls possess the property of separating from the surrounding medium 
certain organic and mineral compounds. If a blood-corpuscle be placed 
in water, it swells up and finally bursts. If it be placed in a solution 
denser than its internal contents, they pass out more rapidly than the 
exterior solution passes in, and the cell-wall swells up. The same 
physical laws of endosmose are at work in the animal economy. A 
mutual action and reaction is incessantly carried on between the interior 
contents of the blood-corpuscles and the exterior liquor sanguinis. When- 
ever water or liquids of low specific gravity are introduced into the circu- 
latory system they dilute the serum, and immediately there is an endos- 
mose of the less dense fluid into the denser contents of the corpuscles. 
Whenever water is withheld, the liquor sanguinis continually loses this 
element by evaporation from the surface of the lungs and skin, and by the 
action of the kidneys becomes denser than the contents of the corpuscles, 
and exosmose takes place into the surrounding medium. The cell-wall 
modifies the physical and chemical properties of every molecule of liquor 
sanguinis that passes through its structure. 
In pathological conditions the cell-wall may be altered in chemical 
and physical condition. This alteration will necessarily be attended by 
disturbance of the physical and chemical relations of the exterior liquor 
sanguinis to the interior cellular fluid. In pathological conditions (as we 
have.just demonstrated in malarial fever) any one or all the mineral and 
organic constituents of the blood-corpuscles may be altered physically and 
chemically. These alterations will be attended by corresponding altera- 
tions in the minute actions and reactions of the liquor sanguinis and cellu- 
lar fluid. In pathological conditions, any one or all the constituents of 
the liquor sanguinis may be altered, physically and chemically, and exist 
either in deficiency or excess; or some new constituent may be introduced. 
These alterations may interfere with the physical and chemical alterations 
of the blood-corpuscles; and may even prevent the development and nutri- 
tion of the blood-corpuscles; may be attended by a perversion of all the 
chemical and physical actions, and final death of the blood-corpuscles. 
These views are borne out by the fact, that whilst in healthy human blood 252 
Blood-Letting in Malarial Fever. 
the density of the blood-corpuscles varies in man from 1088.5 to 1088.9, 
and in woman from 1088.0 to 1088.6, in diseases the density is not confined 
to these limits; for in cholera Schmidt found that the specific gravity of 
the blood-corpuscles was increased to 1102.5, or even to 1102.7; whilst in 
dysentery it was diminished to 1085.5, in albuminuria to 1085.5, and in 
dropsies to 1081.9. 
Any alteration in the constituents of the blood-corpuscles must alone, inde- 
pendently of any actual destruction, produce disturbances in the muscular and 
nervous systems. The truth of this assertion is evident, when we reflect 
that one of the most important results demonstrated by the researches, 
which we have recorded was that the development of the muscular 
and nervous systems was always attended by an increase of colored 
corpuscles in the animal kingdom. The researches of C. Schmidt have 
shown that the fluid contents of the blood-corpuscles contain, in addition 
to peculiar organic matters, a preponderance of the phosphates and 
potash salts; whilst the liquor sanguinis contains the chloride of sodium in 
large amount, with a little chloride of potassium and phosphate of soda. 
In the blood-cells the fatty acids and globulin are combined both with 
potash and soda; whilst in the plasma the organic materials are combined 
only with soda. The researches of Liebig, confirmed by those of Schmidt, 
have shown rhat the fluid contained in the tubules of muscles is like that 
of the blood-corpuscles, exceedingly rich in the phosphates and potash 
salts. The phosphates also exist in large amount in the brain. These 
facts not only show that the blood-corpuscles may separate and elaborate 
from the liquor sanguinis those organic and inorganic compounds which 
constitute the most important part of the structures of the muscles and 
brain, but they also show that alteration or destruction of the colored cor- 
puscles must be attended by aberrated muscular and nervous action. 
Numerous physiological and pathological facts might be brought forward 
to support these views. They not only throw light upon many of the phenomena 
of malarial fever, especially those connected with the circulatory, muscular, res- 
piratory, and nervous systems, but they also indicate certain important principles 
of treatment. 
BLOOD-LETTING SHOULD BE AVOIDED, ASA GENERAL RULE, IN MALARIAL 
FEVER. 
This principle applies to general, and not local blood-letting. I have 
used local blood-letting (cut-cups) in scores of cases of malarial fever, and 
always with apparent benefit. Over the epigastrium, it ofteu arrests 
obstinate vomiting, and over the temples and back of neck and over the 
spine, it often relieves distressing pain. Local differs from general blood- 
letting in two essential degrees. First, the quantity of blood abstracted is 
much less, and second, the number of colored blood-corpuscles is less in 
proportion to the amount of blood abstracted in local, than in general 
blood-letting. The colored blood-corpuscles rush along in the centre of the 
streams, and in general blood-letting they are lost more rapidly than the 
other constituents of the blood. The malarial poison, whatever it be, 
destroys rapidly the colored blood-corpuscles. Whatever, therefore, dimi- 
nishes the colored blood-corpuscles, acts in concert with the malarial 
poison. The ma'arial poison reduces rapidly the forces. General blood- 
lettingfreduces rapidly the forces. The two in this particular, again act in 
concert. We would not for one moment deny that circumstances may 
arise, when blood-letting would be beneficial in malaiial fever. Whenever 
it is used, it should be borne in mind that it does not, and cannot cure the Blood-Letting in Malarial Fever. 
253 
disease. Its beneficial action is only temporary, and so far from caring the 
disease, the relief which it has temporarily afforded will vanish, if other 
remedies, especially the sniphate of quinia, be not used, and as a general 
rule, without these remedies, the patient will be in a much worse condition 
than if the blood-letting had not been employed. In the use of blood-letting 
in malarial fever, we should ever remember that the cerebral symptoms, 
the delirium and the torpor of the intellectual faculties, and the congestion 
of the internal organs, are not inflammatory; they are not due to an exal- 
tation of the functions, or to an irritation of the congested organs, but 
rather to a loss of power in the circulatory apparatus, heart, arteries, capil- 
laries and veins, and to disturbances of the physical, chemical and nervous 
forces. The blood stagnates, and accumulates in the capillaries of impor- 
tant organs, because the blood has been altered by the malarial poison, and 
the changes which it induces; because the relations between the blood and 
its containing vessels, especially the capillaries, have been disturbed; 
because the regular, normal, chemical changes necessary for the develop- 
ment of the forces which work the machinery, are not generated with suffi- 
cient energy, or if generated with even increased energy, they are not 
generated in the right position and in the proper quantities, and the corre- 
lation of the physical, chemical, nervous and vital forces is thus deranged; 
because the action of the sympathetic nervous system which accompanies 
the blood-vessels, and regulates the circulation, and respiration, and secre- 
tion, and nutrition, and excretion, and relates them to each other and to 
the cerebro-spinal system, has been disturbed by the direct and indirect 
action of the poison, by the direct action of the poison upon the sympa- 
thetic and cerebro-spinal nervous systems, or by the relations of the chem- 
ical changes induced, or the products generated in the constituents of the 
blood, by the malarial poison, to the sympathetic and cerebro-spinal ner- 
vous systems. We will illustrate these principles of treatment by a single 
case of congestive fever, selected from a multitude, every one substantiat- 
ing these statements. 
Case No. 8^6.-Illustrating the Effects of Blood-letting in Malarial Fever. 
German, aged 27 ; height 5 feet 9 inches ; weight 160 pounds ; brown hair, blue 
eyes, florid complexion ; thick-set, stout ami muscular; thick, short neck ; person 
filthy ; habits intemperate. Last winter and spring he was in the hospital with a 
large ulcer upon the leg. Has been working for three weeks in a malarious locality, 
near Lover's Lane, on Thunderbolt road. Has been much exposed to the hot sun 
and cold night air. August 21st, 1 o'clock, P. M., 1857. Entered the Savannah 
Hospital yesterday afternoon, at 4 o'clock, P. M. The nurse states that during the 
night he appeared to be out of his head, and would frequently start out of bed with 
a loud shout. Complained bitterly of his head. Had two convulsions during the 
night, one at 12 P. M., and the other at 2 A. M. Now. 1 o'clock, P. M., this patient 
appears to be suffering intense agony in his head, and has a hot fever. Both hands 
are clasped around his head, and he tosses violently about in his bed. Every 
breath is accompanied with a deep groan, and an exclamation about the pain in his 
head. He is unable to givea coherent answer. Applied immediately four cut-cups 
to his head (two to back of neck, and two to temples) ; also a large mustard plaster 
over his epigastrium, and one to each leg. Abstracted f^xviij of blood in the 
standing posture, until he fell back upon the bed, completely exhausted. The loss 
of blood was attended with almost immediate relief of the pain in his head. The 
burning heat of the head and skin was almost immediately diminished, and the 
dry and parched skin was soon covered with perspiration. The pulse and respira- 
tion were diminished in frequency. Respiration, 39; pulse, 92. Temperature of 
atmosphere, 80° F.; temperature of hand, 89 ; temperature under tongue, 97. The 
temperature under the tongue is 3°, and the temperature of the extremities is 9° 
below the normal standard. The temperature was not ascertained by the ther- 
mometer before the abstraction of blood, owing to the great suffering and restless- 
ness of the patient, but judging by the sense of touch, it is evident that the temper- Blood-Letting in Malarial Fever. 
254 
ature has diminished rapidly since the abstraction of blood. The wild and restless 
glances of his eye, and the violent tossing of his body, have ceased, the piin in his 
head has almost entirely disappeared, his intellect is calm, and he converses ration- 
ally. Tongue thickly coated with yellow and black fur, tip and edges clean andof 
a scarlet color. Previous to the bleeding, the tongue was dry, rough, and where 
the fur was absent, glazed ; now it is more moist, but still much dryer than nor- 
mal. He is now able to give an account of his case, and states that the fever came 
on three days ago, with a chill, and pain in the head; and that it has continued 
unabated, up to the present time. Says that he took blue pills and oil yesterday 
morning, before entering the hospital, which operated freely. Complains of great 
thirst. 
R.-Citra'e of potassa ; bicarbonate of potassa jj ; water f^xxviij. Sig.- 
Drink ad libitum. 
22d, 12 o'clock, M. Head is well. Has not complained of his head since the 
abstraction of blood. Superior portion of tongue coated with thick, dry, yellow 
fur, inclining to black in the centre. Tip of tongue clean, bright red, dry and 
glazed. Complains of an unquenchable thirst. Lies quietly. Respiration 52, 
hurried, labored, thoracic, striking the attention of the most casual observer. Pulse, 
112; respiration, 52. Temperature of atmosphere, 81° F.; temp, of hand, 99; temp, 
under tongue, 104. Skin of trunk feels hot to the hand. Epigastrium very tender 
under pressure. 
R.-Blister six inches by six inches over epigastric region. R.-Calomel gr. v ; 
rhubarb gr. viij. Mix. Gruel and flaxseed tea. 
23d, 12 o'clock, M. Says that his head is much better, and he feels perfectly well. 
Blister has drawn ; serum from the blistered surface of a golden color. Medicine 
operated four times; evacuations small. The tongue presents the same appear- 
ance. Tenderness of epigastrium greatly diminished. Pulse, 72; respiration. 34, 
thoracic, labored. Temperature of atmosphere, 78° F.; temp, of hand, 89; temp, 
under tongue, 96 to 96.5; skin feels cool. The temperature under tongue is 3°, and 
the temperature of the hand 8° below the normal standard. There is great want of 
co-ordination between the circulation, respiration, and chemical changes. R.- 
Calomel gr. xij ; James' powder (pulvis antimonii compositus) gr. xxij. Mix and 
divide into six powders, and administer one powder every three hours, in a table- 
spoonful of snakeroot tea. Sponge skin with salt dissolved in dilute alcohol. Diet, 
gruel and gum water. 
24th, 9i o'clock, A. M. The nurse states that he has been restless during the 
night, and apparently out of his head. Several times he sprang out of bed with a 
loud shout. At one time he insisted that he was perfectly well, and affirmed that 
he was going down to the hotel to get a cup of coffee, some boiled eggs, and a good 
drink of brandy. Now, his respiration is spasmodic, 40 to the minute. Pulse can- 
not be felt. Have administered brandy, but he is unable to swallow, or to articu- 
late. He died fifteen minutes after this observation. His death struggles were 
.severe and distressing. Deep and violent inspirations and expirations; mouth 
filled with froth which was scattered in every direction, with the violent expira- 
tions. The examination of the body four hours after death, demonstrated, that 
whilst the blood was congested, stagnated in the capillaries and veins of the brain, 
and lower dependent portions of the lungs and skin, and organs, and muscles 
generally, and of the intestines, there were no marks of inflammation. 
The slate-colored liver; the dark greenish-brown bile; the absence of grape 
sugar, and the presence of animal starch in the liver ; the slate-colored, enlarged, 
engorged, softened spleen; demonstrated that this was a case of malarial fever; 
the rapid, feeble pulse; rapid, labored respiration ; and depressed temperature of 
the trunk and extremities, marked this case as belonging to that type of malarial 
fever called congestive fever. After the abstraction of blood, there was no corres- 
pondence between the circulation, respiration, and chemical changes. Before the 
abstraction of blood, there was a rapid pulse; rapid, full,'thoracic, labored respira- 
tion, and dry, hot skin, and dry, red tongue, accompanied by violent pain in the 
head. After the abstraction of blood, and the application of mustards, there was a 
slight reduction of the temperature of the trunk and extremities; the temperature 
of the extremities was reduced 9° below that of health; the pain in the head 
vanished; the tongue became a little more moist, but none the less red. 
To the casual observer, the disease would appear, in a great measure, 
to have been conquered by the abstraction of blood ; the symptoms how- 
ever, were only moderated. The congested blood-vessels of the brain were Blood-Letting in Malarial Fever. 
255 
relieved, and the pain arising from the chemical changes, and stagnation, 
and engorgement of the altered blood in the blood-vessels and capillaries 
of this delicate organ, was correspondingly diminished. The temperature 
of the trunk rose 5' above the normal standard, on the next day, whilst 
that of the extremities just reached the normal standard. This increase 
was attended by a far greater acceleration of the respiration and circula- 
tion than was necessary in health, to produce this increased chemical 
change. We shall show, in a subsequent chapter, that if the functions of 
the organs and apparatus be proper ly performed, a full, rapid and vigor- 
ous circulation and respiration, must be attended by the rapid absor ption 
and distribution of oxygen, and corresponding rapid chemical changes. 
In this case we had the rapid circulation and respiration, but a 
deficiency of corresponding chemical change, and hence conclude that the 
malarial poison has acted, either by inducing directly such changes in the 
blood as to prevent its absorption of oxygen, or to prevent the rapid action 
of the oxygen absorbed, or by interfering with the metamorphoses of the 
solids and fluids of the organs and tissues, and nutritive fluids, or by a 
direct action upon the structures or nerves of the heart, thus deranging the 
circulation of the blood, and through it all the chemical changes of nutri- 
tion, secretion, excretion, and the development of the forces, or by a direct 
action upon the nervous centres of the sympathetic nervous system, which 
preside over and relate to the circulation and respiration, and through 
them the chemical changes in the lungs, and heart, and blood-vessels, 
and capillaries, and organs, and tissues, and cerebro-spinal nervous system. 
The rapid but feeble action of the heart; the rapid but feeble pulse; 
the depressed temperature of the trunk and extremities; the dry red 
tongue; the acid, light-colored urine; the feeble general and capillary 
circulation gradually overcome by the action of gravity ; the gradual set- 
tling of the blood previous to death in the blood-vessels of the most 
dependent parts of all the organs and tissues ; the alterations of the blood- 
corpuscles of the liver and spleen; the alterations in the color and consti- 
tution of the bile ; the destruction of the special ferment in the blood 
which converts the animal starch into grape-sugar; demonstrated that the 
malarial poison had acted chiefly upon the sympathetic nervous system, 
and produced profound alterations in the structure of the nutritive fluids, 
and correspondingly interfered with the chemical changes, and develop- 
ment of the forces, and the formation of the secretions and excretions. 
The theory then suggested, and most strongly supported bv the case, 
is, that the malarial poison acted primarily and simultaneously upon the 
blood, and spleen, and liver, and sympathetic nervous system, and secon- 
darily upon the cerebro spinal nervous system. We shall show presently 
that the blood in fevers is altered before the manifestation of aberrated 
-cerebro-spinal nervous action. The same thing may be established with 
reference to the organs. We shall also show that the symptoms and aber- 
rated phenomena manifested by the sympathetic nervous system precede 
those of the cerebro-spinal system. Nevertheless, in the present state of 
medical science; whilst we are ignorant of the chemical and physical pro- 
perties and relations of the malarial poison; whilst we are unable to observe 
the first aberrations of sympathetic and cerebro-spinal nervous phenomena, 
manifested either in an excess or deficiency of secretion, and nutrition, 
and chemical change, or in a disturbance of the mutual relations of the two 
systems to each other, and to the respiration and circulation, and to the 
organs and tissues; the interests and extent of science forbid the dogmatic 
location of the origin of malarial fever in one system of nerves or the other, 
or in both, exclusive of the blood or in the blood and organs exclusive of 
the two nervous systems. 256 
Treatment of Malarial Fever. 
The treatment of this case was radically defective. The blood-letting 
was proper as a means of relieving the brain, but not as a remedy applied 
alone, to combat the action of the malarial poison. The blood-letting 
relieved the brain, but the poison went on acting, altering the chemical 
relations of the elements of the blood, and liver, and spleen, more rapidly 
than ever. Here we have the cerebro spinal difficulty apparently relieved; 
whilst the war is raging in the domain over which the sympathetic system 
is said especially to preside. There was a calm, but it was the calm of 
conquest; the calm of exhausted nature. The mighty foe carried forward 
the work of destruction without noise or confusion, because all opposition 
was levelled, all resistence subdued. This state of things demanded prompt 
and vigorous action O" the part of the physician. Those remedies should 
have been administered which would have aroused the capillary circulation; 
aroused the sympathetic and cerebro-spiual nervous systems, and accele- 
rated the absorption, and distribution, and action of oxygen, and the chemi- 
cal changes of the nutritive fluids, and organs, and tissues, which are the 
sources of all the forces which work the machinery, and without which we 
can have the manifestation of no vital phenomena. Brandy, sulphate of 
quinia in large doses, and carbonate of ammonia should have been promptly 
and freely administered, and sinapisms applied. 
ACTIVE AND EXCESSIVE PURGATION SHOULD BE AVOIDED IN MALARIAL 
FEVER. 
We should avoid excessive purgation in malarial fever, for the same 
reasons that general and excessive blood-letting should be avoided. In 
malarial fever, the blood-corpuscles are altered and destroyed to a great 
extent, and the fibrin and albumen are in a measure altered in quality and 
quantity, These alterations are attended by aberration and exhaustion of 
the forces, and although the alteration and destruction of the constituents 
of the blood may appear small, still they are sufficient to produce serious 
alterations in the secretions and excretions, and serious disturbances in the 
forces. It is an established fact that excessive purgation exhausts the 
forces and diminishes the volume of blood. Excessive purgation, then, 
acts in concert with the malarial poison. Judiciously used, purgatives 
are of essential service in all those cases of malarial fever where there is a 
dry, hot skin, dry, red tongue, moderately accelerated full bounding pulse, 
and moderately accelerated respiration, and high temperature in the trunk 
and in the extremities. In such cases our plan has been to administer to 
an adult from eight to ten grains of calomel in combination with seven 
grains of sulphate of quinia, and follow with castor oil in four hours, and 
commence with five grains of sulphate of quinia as soon as the purgative 
has operated once or twice freely, and continue five grains every three 
hours up to twenty-five or forty grains, according to the symptoms of the 
case. I have in scores of cases seen the hot dry skin become relaxed and 
moist, and the dry harsh tongue become soft and moist, and the restless- 
ness and pain in the head vanish, under the action of the calomel and sul- 
phate of quinia. I have in scores of cases seen the most obstinate parox- 
ysms yield without any return to the vigorous administration of the sul- 
phate of quinia after the bowels have been opened, the skin relaxed, 
the secretions of the mouth and liver promoted, and the portal system 
unloaded. 
On the other hand, I have seen simple cases of remittent fever, con- 
verted into the congestive type, by the injudicious admnistration of pur- 
gatives, and the neglect of sulphate of quinia, stimulants and sinapisms. Treatment of Malarial Fever. 
257 
The efficacy of this mode of treatment, as well as the true indications and 
methods for the employment of purgatives, will be fully discussed and 
illustrated by cases in a subsequent chapter. 
SUPPORT THE STRENGTH, DURING THE SEVERE ATTACKS OF MALARIAL 
FEVER, WITH NUTRITIOUS DIET AND STIMULANTS. 
If the action of the malarial poison be depressing and not inflamma- 
tory; if the action of the malarial poison be destructive and not exciting, 
then nutritious diet and stimulants are indicated. I have administered 
milk punch, wine whey, beef soup, mutton soup, and soft-boiled eggs, 
with positive benefit in all the foims of malarial fever. The advantage of 
this mode of treatment is especially evident in congestive fever, and in the 
severer forms of remittent fever, and in convalescence from all the various 
forms of malarial fever. 
The nutritious diet supplies the elements of the blood which have 
been destroyed, and the stimulants arouse the nervous systems, and 
through them excite the action of the circulatory and respiratory systems, 
and promote the introduction and distribution of the elements of nutrition 
and secretion, and of the chemical changes by which the forces are gener- 
ated, and also preserve the elements of the blood and tissues from too 
rapid chemical change, by taking their places and themselves undergoing 
those chemical changes which are necessary for the development of the 
physical forces which work the machinery. We should never be deterred 
by the cerebral symptoms in malarial fever from the use of stimulants. 
They are due to the stagnation and congestion of the altered blood in the 
capillaries of the brain, as much, if not far more than to the direct action 
of the malarial poison. Hence, whatever will quicken the circulation and 
remove this congestion and stagnation, will promote the normal action of 
the brain and nervous system. Under the action of stimulants and sul- 
phate of quinia, I have seen the delirious subject, with parched skin, 
tongue, and lips, become quiet and rational, with relaxed moist skin and 
mucous membrane. The efficacy of this mode of treatment will be illus- 
trated more fully hereafter. 
ADMINISTER THE SALTS WHICH ARE DEFICIENT IN THE COLORED BLOOD- 
CORPUSCLES, AS SOON AS THE DESTRUCTION OF THE COLORED BLOOD- 
CORPUSCLES HAS BEEN ARRESTED, AND THE MALARIAL POISON RE- 
MOVED OR DIMINISHED. 
I have derived great benefit from the administration of the phosphates 
of iron, lime, soda, and potassa, in the stage of convalescence from malarial 
fever. 
IF AFTER THE ACTIVE STAGES OF MALARIAL FEVER THE DIGESTIVE FUNC- 
TIONS ARE ENFEEBLED, PEPSIN SHOULD BE ADMINISTERED. 
Cases of neglected or badly treated malarial fever frequently run into 
what is commonly called the typhoid state, in which the digestion is 
enfeebled and perverted, the liver deranged, the spleen disorganized and 
in many cases degenerated, the blood-corpuscles diminished and altered, 
and the whole constitution of the blood profoundly altered. In these cases 
we have employed pepsin with benefit. If the gastric juice does not per- 
form its offices, 'the active and essential principle of the gastric juice should 
be supplied. If pepsin and an acid be supplied, digestion will take place 
in a weak, diseased stomach as well as in the healthy stomach. The truth 
of this assertion has been established by the experiments of Dr. L. Corvi- 258 
Treatment of Malarial Fever. 
sart/of Paris, to whom the profession is indebted for the introduction of 
pepsin into the practice of medicine. Andral, Longet,2 Rilliet, Barthez,3 
Grisolle, Herard, Vogel, Schiff, Josi, Lecointe,4 Ballard,5 Bertholet,6 Cahag- 
net,7 Parise,8 Huet,9 Chambers,10 Nelson,11 and others,12 have testified to the 
efficacy and value of pepsin in various diseases. 
When pepsin can be obtained pare from the apothecaries, or when the 
physician has time to prepare it himself, the poudres nutrimentives of 
Corvisart is by far the most elegant and portable preparation. Chambers13 
and others14 have shown that much of the pepsin now sold possesses but 
feeble transforming powers, and it is important that the physician should 
be able to prepare it when needed. The following are the directions given by 
M. Boudalt15 for the preparation of the medicine : ' ' Take a sufficient number 
of rennet bags (the fourth stomach of the ruminants), open and reverse them, 
and wash them under a thin stream of cold water; scrape off the mucous mem- 
brane, reduce it to a pulp, and macerate it in distilled water for twelve 
hours ; filter ; add to the liquor a sufficient quantity of acetate of lead, and, 
after separating the precipitate, pass through it a current of sulphuretted 
hydrogen ; filter again ; evaporate at a low temperature to the consistence 
of a syrup, which is mixed intimately with starch, pulverized, and dried at 
a temperature of 100° Cent. In this state the gentle application of heat 
will reduce it to a dry mass, readily reducible to a powder of uniform effi- 
cacy." The power of the pepsin thus obtained varies, and before the use of 
a specimen we should first test its transforming power. The standard dose 
is that quantity of the powder which, when acidulated with three drops of 
lactic acid, and added to fifteen grammes (225 grains) of water, would 
transform (digest) six grammes (90 grains) of fresh fibrin, finely cut up, 
and kept in a bottle, at a temperature of 40° Cent., for twelve hours, with 
occasional shaking. The average dose of the " poudre nutrimentive" is fif- 
teen grains. It may be taken dry or in solution, in un fermented bread, or 
in a spoonful of soup, or in sweetened water. It should always be taken 
with, or at the commencement of, the meal on which it is to act. 
The following mode, adopted and recommended by Dr. James Gray,1B 
for the preparation of rennet, is far less complicated and tedious, and at 
the same time yields a valuable preparation of pepsin : 
1 " Dyspepsie et Consomption- Usage de la Pepsine." By Dr. L. Corvisart. Paris, 1854. 
" Recherches ayant pour but, d'administrer aux Malades qui ne digSrent point des Aliments 
tous digfirSs par le Sue Gastrique des Animaux;" Comptes Rendus, Aug. 16, 1852-Sept. 6,1852 
ktudes sur les Aliments et Nutriments-Nouvelle Mgthode pour le Traitement des Malades don^ 
1'Estomac ne dig6re point;" L'Union M6dicale, 1854, p. 17. 
2 In typhoid fever. Bulletin G6n. de Th6rap., tom. xlvii, p. 320. 
3 " Sur 1'Apepsie (une absence de digestion) chez les Enfants, et sur le Traitement de cette 
Maladie par la Pepsine;" L'Union Medicale, Jan. 12, 1856 
4 " Observation d'un Cas de Consomption ultime, traitSe par la Poudre Nutrimentive;" Bul- 
letin G6n. de Thfirap., tom. xlix, p. 268. 
5 Artificial Digestion as a Remedy in Dyspepsia, Apepsia, and their Results. By Edward 
Ballard, M. D. London, 1857. This valuable work contains the method of preparing pepsin, and 
also reports of numerous cases of disordered digestion successfully treated with pepsin by Dr. 
Ballard and other practitioners of medicine. 
6 In dyspepsia of a year's duration. 
7 In dyspepsia and vomiting of several years' duration. 
8 In dyspepsia of early pregnancy. 
9 Gastralgia of several years' duration. 
10 " Practical Lectures on the Management of Digestion in Disease," by T. K. Chambers, M. 
D.; London Lancet, Aug., 1857, p. 101, Sept., 1857, p. 180, Am. ed. 
11 "On Mellitic Diabetes, in reference to its Treatment by Rennet or Liquor Pepticus Prsep.;" 
by David Nelson, M. D.; London Lancet, Aug., 1857, p. 118, Am. ed. 
12 "Rennet in Diabetes Mellitus," by Dr. Janies Gray; Glasgow Medical Journal, Oct. 1856, 
See also American Journal of Medical Sciences, Jan., 185.', p. 25. "Case of Diabetes Mellitus. 
treated by Joseph Jones, M. D.;" Southern Medical and Surgical Journal, May, 1858. 
13 "Experiments upon Artificial Digestion," by T. K. Chambers, M. D.; London Lancet, Aug. 
1857, p. 133, Am. ed. 
14 "Experiments upon the Action of Pepsin," by Edward H. Sleveking, Medical Times and 
Gazette, April 4, 1857. See also American Journal of the Medical Science, July, 1857, p. 212. 
15 Ballard on Artificial Digestion, p. 10. See also "MSmolre sur le Principe Digestif, les Prepa- 
rations Natrimentives, et les Moyens propres a recon naitre eta mesurer leur Action ;" Acad. 
Imp. de M6d., Stance du 14 Fevrier, 1854. 
16 Glasgow Medical Journal, Oct., 1856. See abstract of paper in American Journ. of Med. 
Sciences, Jan, 1857, p. 215. Treatment of Malarial Fever. 
259 
The stomach of a calf (and the younger it is the better) is gently washed with 
water, taking care not to injure the mucous membrane; it is then salted, tied up, 
and allowed to dry. After this it is cut in small pieces, macerated in a pint and a 
half or two pints of water, according to the size of the stomach, for four days or 
longer in winter, shaking it at intervals ; the fluid is then poured off and bottled, 
and to test its power a spoonful may be added to a pint of warm milk, which, if it 
curdles, it is now fit for use. A little spirits, or decoction of sparrow-grass, may 
be added to make it keep. The dose of rennet thus prepared is a tablespoonful, 
three, four, or six times a day, about half an hour after each meal, and during the 
process of digestion, followed shortly after by an alkali, to neutralize the lactic acid 
formed. That which I recommend is the alkaline tribasic phosphate of soda : but 
the carbonate of potash will answer very well, either alone or combined with the 
tincture of nux vomica, in five or ten drop doses. 
The stomach of the pig may also be employed. It may be prepared 
in the way recommended by Dr. Gray in the preparation of rennet, or it 
may be cut in thin slices and treated with vinegar, and the digested mass 
added to mutton or beef soup. Pepsin is not the only substance concerned 
in the digestion of albumen and flesh. The connective tissues and muscu- 
lar fibres are disintegrated and softened, but never completely dissolved by 
the gastric juice. The ultimate fibrillae of muscles, which have escaped 
the action of the gastr ic juice, pass into the small intestines, and are there 
digested by the pancreatic juice. Whenever, then, meat passes entirely 
through the alimentary canal without being dissolved, we conclude not 
only that the pepsin is deficient, but also that the pancreatic juice has lost 
its power of digesting the ultimate fibrillae of the muscles, which have 
escaped the action of the gastric juice. Whenever the ultimate fibrillae 
alone are dischar ged by the rectum, we must conclude that the pancreatic 
juice, and not the gastric juice, is at fault. In distinguishing derangements 
of the pancreatic from the gastric digestion, the microscope, applied to the 
matters thrown off from the rectum, is absolutely necessary. As far as my 
observations extend, the pancreas is less affected during the process of 
malarial fever, than the liver, spleen, or stomach and intestinal canal. Not- 
withstanding these negative results, it is important that we should know 
the value of treatment in derangements of the pancreatic digestion. 
M. L. Corvisart* communicated to the Imperial Academy of Sciences, 
April 6, 1857, a memoir " On the Power of the Pancreas to Digest Azot- 
ized Food," in which he not only confirmed the assertion of Purkinge and 
Pappenheim, that the secretion of the pancreas is endowed, like the gastric 
juice, with the property of dissolving azotized food; and demonstrated 
that the pancreatic juice in disintegrating albuminoid elements effects in 
them a transformation identical or analogous to that which the stomach 
produces ; but also showed that the pancreatic juice acts only on those por- 
tions of the food which have escaped the action of the gastric juice and at 
the same time has no effect upon the digested products of the stomach. 
When separated, the pancreatic and gastric fluids exercise their functions 
in full, and, when mingled in their pure state, the two digestions are 
arrested. The two ferments, pepsin and pancreatin, destroy each other. 
In the alimentary canal, this is prevented, 1st. By the pylorus which sepa- 
rates the two ferments. 2d. By the gastric digestion during which the 
pepsin is destroyed. 3d. By the bile which destroys in its course the 
activity of the pancreatin. It is evident, therefore, that the pancreatin, or 
the pancreatic juice, so far from assisting digestion, would retard it. M. L. 
Corvisart states that he had failed to receive any benefit from the adminis- 
tration of pancreatin for the relief of derangement of the digestion in the 
intestinal canal. 
* Moniteur des Hopitaux, April 21, 1857. See also American Journal of Medical Sciences, 
July, 1857, p. 206. 260 
Treatment of Malarial Fever. 
My own limited experience with pancreatin sustains the statements of 
M. L. Corvisart. It is evident, therefore, that in the present state of 
science we are unable to reach, by medicines, the derangements of the pan- 
creatic digestion of tlesh. Nevertheless, the determination of the relative 
frequency, extent, and effects of derangements of the pancreatic digestion, 
is of great value. As far as my observations extend, these derangements 
are exceedingly rare in malarial fever. 
THE EXCRETION OF THE PRODUCTS RESULTING FROM THE DEAD DISIN- 
TEGRATED BLOOD CORPUSCLES SHOULD BE PROMOTED BY DIURETICS 
AND DEPURANTS. 
The necessity for the removal of these productsis indicated by the fact 
that the urine in congestive fever is deficient in the compounds resulting 
from the chemical changes of the blood and tissues ; whilst in intermittent 
and remittent fevers, in which the elevation of temperature and the chemi- 
cal changes correspond to the acceleration of the respiration and circula- 
tion, the urine is loaded with the matters resulting from rhe chemical 
changes of the blood, and organs, and tissues, and apparatuses The sul- 
phate of quinia appears not only to exert a direct effect upon the actions 
of the sympathetic and cerebro-spinal systems, and upon the action of the 
heart and capillary circulation, but it also promotes the removal of the 
products of the metamorphoses of the tissues. The infusion of Virginia 
snakeroot is valuable as a stimulant and diuretic. The bicarbonate, 
citrate, and acetate of potassa, and the carbonate and acetate of soda, 
are valuable depurants, both in the active stages and in convalescence. 
THE LIVER AND SPLEEN SHOULD BE ROUSED TO ACTION IF TORPID, AND 
THEIR PERVERTED SECRETIONS THROWN OFF, AND THEIR NORMAL 
RELATIONS TO THE BLOOD RE-ESTABLISHED. 
In addition to the depurants just mentioned, we may employ the vari- 
ous preparations of iodine, especially the iodide of quinia ; and, in some 
cases, rhe preparations of mercury in small dose*. I have witnessed the 
beneficial action of the iodide of quinia ; both upon myself and upon others; 
and, as far as my experience extends, it appears to act more powerfully 
upon the kidneys, and depurate the blood more thoroughly, and restore 
the stomach, liver, and spleen more rapidly to the exercise of the normal 
functions, than either of those substances uncombined. The iodide of 
quinia is worthy of the examination of the profession. The citrate of iron 
combined with the sulphate of quinia and the carbonate of soda, dissolved 
in the infusion of quassia, appear not only to assist in the restoration of 
the colored blood-corpuscles, and depuration of the blood, but they 
also appear to exert decided beneficial influences upon the liver and spleen. 
THE DETERMINATION OF THE PLACE OF THE DESTRUCTION OF THE COL- 
ORED BLOOD-CORPUSCLES, AND THE DISCUSSION OF THE QUESTION 
WHETHER THEIR DISAPPEARANCE BE ENTIRELY DUE TO THE CES- 
SATION OF THEIR BIRTH. 
Do they diminish simply because new ones do not take their place? 
With reference to the place of the destruction of the colored blood-corpus- 
cles, it may be affirmed that they undergo important alterations in the 
spleen and liver, during th$ active stages of malarial fever. In examina- 
tions of the organs after death from all the forms of malarial fever, inter- 
mittent, remittent, and congestive, I have observed that the dark blood of Treatment of Malarial Fever. 
261 
the spleen and liver does not change to the arterial hue when exposed to 
the oxygen of the atmosphere. After death from phthisis, cirrhosis of the 
liver, organic disease of the circulatory apparatus, apoplexy, and mechani- 
cal injuries, so far as my observations extend, the blood of the spleen and 
liver always change to the arterial hue upon exposure to the action of the 
oxygen of the atmosphere. Chemical examinations of the blood of the 
liver during health have shown that the blood-corpuscles are more numer- 
ous in the blood passing out of this organ than in the portal blood. 
The colored blood-corpuscles appear to originate to a certain extent in 
the liver, and undergo certain important chemical and physical changes 
in this organ. In malarial fever, important changes take place in the 
blood passing through the liver; many of the colored blood-corpuscles are 
destroyed, and the coloring matters infiltrate the structures, and, together 
with the altered bile, impart the slate color to the exterior, and the bronze 
color to the interior, of the malarial fever liver. In some cases the color- 
ing matter derived from the disintegrated blood-corpuscles, exists in the 
form of granules in the tissues of the liver. These granules, however, are 
by no means necessary to the slate and bronze color. I have discovered a 
similar change of color in the kidneys of several patients, which presented 
several spots upon their surface of a dark slate color without, and bronze 
color within. If the blood-corpuscles were destroyed in the capillaries of 
the kidney, then the destruction was circumscribed, and the peculiar color- 
ing matter resulting from the changes of the coloring matters of the blood, 
infiltrated only those parts of the kidney adjoining the blood-vessels and 
capillaries in which they were destroyed. This curious phenomenon has 
been also witnessed in the livers of patients who had died suddenly in the 
earliest stages of malarial fever. In these eases the greater portion of the 
livers have presented a color but a few shades deeper than the Spanish 
brown ; whilst one or more spots were found presenting the true malarial 
slate and bronze color. These facts illustrate two points. First, they show 
that the destruction of the colored blood-corpuscles in the liver commences 
at an early day in the liver; and second, that this destruction in some 
cases, at least, is confined at first to circumscribed portions of the liver. 
Whilst the facts as yet accumulated are too few to warrant any very gen- 
eral or dogmatic assertions, they certainly incline our minds to the belief 
that the destruction of the colored blood corpuscles in the liver are depend- 
ent upon the disturbance of the relations of the liver to the blood, rather 
than to the destruction of the colored blood-corpuscles in the capillaries 
and blood-vessels, independent of the action of the liver, simply by the 
directaction of the malarial poison. The changes of the blood in the liver 
are not confined to the destruction of the colored blood-corpuscles. 
ANIMAL STARCH ACCUMULATES IN THE MALARIAL FEVER LIVER; WHILST 
GRAPE SUGAR, AS FAR AS MY OBSERVATIONS EXTEND. IS ABSENT. 
I have made numerous 2)ost-mortem examinations in all the forms of 
malarial fever, and tested the livers carefully for animal starch and grape 
sugar. The result was the same in every instance ; an abundance of ani- 
mal starch without a trace of grape sugar. When the malarial fever livers 
were washed, and small particles spread upon a glass-slide, and treated 
with tincture of iodine, and viewed under the microscope, numerous 
beautiful blue and purple masses of this animal starch, colored by the 
iodine, could be seen. When the fibrous capsules of the livers were torn 
off from the surface of the liver, and spread upon a glass-slide, and treated 
with tincture of iodine, these blue masses were seen scattered amongst the 
meshes of the fibrous tissue. The livers were set aside and examined after 262 
Treatment of Malarial Fever. 
intervals of twelve hours. The last examination was made thirty-six 
hours after the first. At every examination the result was the same ; an 
abundance of animal starch, and no grape sugar. These facts are impor- 
tant, not only in their bearing upon malarial fever, but also in their bear- 
ing upon other diseases. M. Cl. Bernard has demonstrated that the trans- 
formation of glycogenic hepatic matter (animal starch), formed by the 
liver, into glucose, is the result of the action of a special ferment, which is 
formed and exists in the blood, independent of the liver. From these facts 
it is probable that in malarial fever this ferment is destroyed ; whilst the 
liver still possesses the power of transforming the nitrogenized and non- 
nitrogenized elements into animal starch. 
THE BLOOD AND BLOOD-CORPUSCLES UNDERGO REMARKABLE ALTERA- 
TIONS IN THE SPLEEN DURING MALARIAL FEVER. 
Upon the exterior the malarial spleen presents a dark slate color, 
resembling the color of the malarial liver. When held in the hand the 
malarial spleen feels like a bag of soft mud. The capsule and trabeculae 
break upon the slightest pressure, and the fingers will often plunge into 
the organ, even during the most careful handling. The reddish-brown 
mud (pulp) of the malarial spleen consists almost entirely of colored cor- 
puscles in various stages of alteration and disintegration. With the 
microscope I have found that in many cases, especially those of long-stand- 
ing, the mud of the spleen contained numerous granules of a reddish-black 
color. These black granules were frequently conglomerated together, 
forming dark flakes, like the coffee-ground sediment of the black vomit of 
yellow fever, and were without doubt altered colored blood-corpuscles. In 
many spleens the colored blood-corpuscles have presented swollen, and 
distorted, and irregular forms. 1 have found this alteration of the spleen 
in all cases and in all periods of malarial fever. In one case, in which the 
patient died in thirty hours after the commencement of the attack, the 
spleen presented the same enlarged and softened condition; whilst the liver 
presented only spots of the slate and bronze color. When we reflect that the 
malarial fever spleens often weigh one, and two, and three or more pounds, 
and that their principal weight is due to the presence of colored blood-cor- 
puscles; when we further reflect t hat the whole amount of blood existing in 
the body of a grown man is about twenty pounds, and that not more than 
nine pounds of this exist in the form of moist colored blood-corpuscles, it 
is evident that the spleen in malarial fever forms a grand sepulchre for the 
colored blood-corpuscles. We will show in the chapter upon the changes 
of the organs and apparatus in malarial fever, where these subjects will be 
more fully discussed, that the mud of the spleen is not reabsorbed to any 
great extent. We have before discussed the alterations of the fibrin, and 
the changes of the color of the serum; it remains now to state that the 
albumen is diminished in malarial fever; whilst the extractive matters of 
the serum are increased. Professor Cozzi has also shown that tlm choles- 
terin was increased in the blood; whilst the phosphates, and fat, and albu- 
men were diminished. Whether the cholesterin was derived from the bile 
oi- from the brain, or from both, has not been determined. We will now 
compare the changes of the blood in malarial fever with those of other 
diseases. 
The following table, constructed from a minute and laborious exami- 
nation, and calculation, and classification of the most important researches 
upon the changes of the blood in disease, will give a condensed resum6 of 
this department of pathological chemistry: Constitution of the Blood in Various Diseases. 
263 
OBSERVERS. 
DISEASES. 
REMARKS. 
No. of observa- 
tions. 
Day of disease. 
No. of bleed- 
ings. 
1000 PARTS OF BLOOD CONTAINED 
Water. 
Solid 
matters. 
MOIST BLOOD-CORPUSCLES. 
Albu- 
men. 
Solid 
mat- 
ters of 
serum. 
Fixed 
saline 
constit- 
uents. 
Fibrin. 
Moist 
blood- 
corpus- 
| cles. 
Water. 
Solid 
matters. 
Becquerel & Rodier 
Typhoid Fever 
Mean 
Mean 
[ 
1 
11 
11 
1 
2 
801.0 
814.5 
199.0 
185.5 
498.0 
454.0 
373.5 
340.5 
124.5 
113.5 
64.4 
62.0 
96.1 
92.4 
6.744 
6.555 
1.3 
Andral & Gavarret 
ll ll 
5 
7 
1 
2 
756.3 
243.7 
230.3 
581.2 
543.2 
435.9 
407.4 
145.3 
135.8 
2.3 
2.1 
U Cl 
11 ll 
1 
Case 1 - ■( 
8 
3 
785.2 
214.8 
504.8 
378.6 
126.2 
116.2 
91.7 
143.6 
86.8 
83.9 
79.9 
87.4 
1.6 
1.3 
1.0 
2.5 
U *c 
ll ll 
... 
10 
4 
798.6 
201.4 
464.8 
348.6 
Ci cc 
ll ll 
15 
5 
827.4 
272.6 
366.8 
275. J 
430.8 
...... 
IC ti 
Ll L 
1 
766.5 
233.5 
574.4 
U U 
ll ll 
Case 2 
9 
2 
777.6 
222.4 
544.8 
408.6 
136.2 
134.5 
139.3 
129.7 
127.1 
123.6 
82.5 
79.8 
88.1 
87.6 
85.5 
80.7 
3.7 
3.6 
5.0 
5.7 
5.0 
4.0 
cc cl 
ll ll 
12 
782.1 
217.9 
538.0 
403.5 
CC 16 
I* ll 
8 
1 
767.6 
232.4 
5a7.2 
417.9 
389.1 
ll ll 
,1 ll 
Case 3 | 
10 
2 
777.3 
222.7 
518.8 
cl • c 
ll ll 
11 
3 
782.4 
217.6 
508.4 
381.3 
< I L . 
LL L L 
14 
4 
791.7 
208.3 
494.4 
370.8 
CL a 
ll ll 
f 
1 
9 
J 
769.5 
230.5 
598.4 
448.8 
149.6 
125.3 
77.3 
87.1 
3.6 
2.9 
I I L L 
LL LL 
10 
2 
784.7 
215.3 
501.2 
375.9 
cc cc 
ll ll 
1 
Case 4..... < 
12 
3 
804.3 
195.7 
494.8 
371.1 
123.7 
103.0 
79.6 
102.4 
105.0 
93.9 
86.3 
76.0 
93.1 
146.7 
69.7 
64.0 
71.2 
83.9 
79.8 
78.2 
75.2 
74.6 
86.3 
98.0 
98.0 
66.8 
77.9 
79.0 
2.3 
1.9 
3.7 
3.4 
3.5 
2.3 
1.7 
2.1 
0.9 
2.4 
4.2 
0.9 
2.6 
cc cc 
ll ll 
15 
4 
831.1 
168.9 
412.0 
309.0 
238.8 
Cl IC 
ll ll 
33 
5 
845.5 
154.5 
318.4 
ll Cl 
ll ll 
9 
1 
810.3 
189.7 
409.6 
307.2 
ll ll 
ll ll 
10 
2 
816.2 
183.8 
420.0 
315.0 
271.7 
259.9 
228.0 
278.3 
ll ll 
ll ll 
Case 5 < 
12 
3 
825.6 
174.4 
375.6 
ll Cl 
ll ll 
17 
4 
836.8 
163.2 
345.2 
ll ll 
24 
5 
847.8 
152.2 
304.0 
Case 6 
1 
1 
819.7 
180.3 
372.4 
ll ll 
ll I I 
Case 7 
5 
1 
752.9 
247.1 
586.7 
440.0 
Cl ll 
ll Ci 
Maxima 
41 
862.3 
243.7 
598.4 
448.8 
149.6 
Cl ll 
ll It 
Minima 
41 
756.3. 
137.7 
266.8 
200.1 
66.7 
116.0 
115.0 
104.8 
132.8 
92.4 
112.2 
146.5 
113.5 
138.1 
97.0 
126.8 
95.6 
ll ll 
ll ll 
Mean 
41 
796.0 
204.0 
464.0 
348.0 
Lecanu 
Simon 
Popp 
ll 
2 
805.2 
194.8 
460.0 
345.0 
80.33 
2.61 
5.00 
1.71 
3.26 
2.3 
1.2 
2.8 
3.9 
2.5 
2.1 
1 
792.3 
207.6 
419.2 
86.1 
71.3 
77.7 
75.4 
71.1 
60.1 
72.0 
70.0 
71.7 
Maxima 
8 
827.0 
208.5 
531.2 
398.4 
ll ll 
Minima 
8 
791.5 
173.0 
369.6 
277.0 
ll 
ll ll 
Mean 
8 
806.2 
244.2 
448.8 
336.6 
M. H. Guenaud de 
Typhus Fever 
Male, Case 1 
1 
755.8 
586.0 
439.5 
341.5 
314.3 
291.0 
380.4 
286.8 
Massy & M. Rodier 
it ii 
Male' Case 2 
814.2 
185.8 
454.0 
452.4 
388.0 
507.2 
382.4 
:: " 
Male, Case 3 
Male, Case 4 
799.0 
826.9 
201.0 
173.1 
ll u 
*1 ll 
Female, Case 5.. 
800.7 
199.3 
ll ll 
Female, Case 6.. 
830.6 
169.4 
Becquerel & Rodier 
Ephemeral Fever (Sim- 
ple Continued Fever) 
Small-Pox 
8 
781.6 
218.4 
569.6 
427.2 
142.4 
120.6 
110.2 
94.6 
65.7 
103.5 
106.1 
82.1 
5.8 
2.8 
4.3 
2.9 
3.2 
Andral & Gavarret 
1 
771.5 
228.5 
482.4 
440.8 
378.4 
361.8 
330.6 
283.8 
Case 1 -f 
780.8 
219.2 
3 
820.2 
179.8 
Constitution of the Blood in Various Diseases. 264 
Constitution of the Blood in Various Diseases. 
> 
CD 
02 
cS 
1000 PARTS OP 
BLOOD CONTAINED 
- 
OBSERVERS 
DISEASES 
REM RKS 
No. of obse 
| tions 
X 
CD 
CD 
MOIST BLOOD-CORPUSCLES. 
Solid 
Fixed 
J Day oi 
No. of 
Ings 
Water 
Solid 
matters 
Moist 
blood 
cor- 
puscles 
Water 
Solid 
matters 
Albu- 
men 
matters 
of 
serum 
Saline 
constit- 
uents 
Fibrin 
Andral & Gavarret 
Small-Pox 
1 
791.3 
803.9 
208.7 
106.1 
188.2 
182.7 
218.6' 
457.2 
370.4 
353.6 
348.0 
511.6 
342.9 
277.8 
265.2 
261.0 
383.7 
114.3 
92.6 
88.4 
87.0 
127.9 
91.4 
100.3 
96.8 
92.4 
88.1 
3.0 
3.2 
3.0 
ll ll 
n 
Case 2 | 
3 
811.8 
817.3 
781.4 
H ll 
ll 
4 
H ll 
ll 
1 
2.6 
ll 
Case 4 | 
2 
1 
792.0 
796.0 ' 
208.0 
204.0 
207.3 
195.0 
238.5 
217.4 
497.6 
506.0 
499.6 
395.2 
584.0 
497.2 
•544.4 
448.8 
578.0 
587.8 
586.4 
563.6 
548 1 
372.2 
379.5 
374.7 . 
296.4 
438.0 
372.9 
408.3 
336.6 
433.5 
441.0 
439.8 
122.7 
411.3 
412.5 
394.8 
255.8 
279.9 
438.3 
124.4 
126.5 
124.9 
98.8 
146.0 
124.3 
136.1 
112.2 
144.5 
146.8 
146.6 
140.9 
137.1 
137.5 
131.6 
118.6 
93.3 
146.1 
126.6 
142.8 
125.0 
152.9 
80.1 
76.4 
80.4 
92.3 
89.4 
89.1 
84.1 
82.7 
78.9 
82.7 
90.6 
89.2 
78.7 
73.4 
70.1 
86.9 
80.1 
3.5 
4.1 
2.0 
2.9 
3.1 
4.0 
ll ll 
ll 
2 
792.7 
ll ll 
ll 
Case 5 
1 
805.0 
ll ll 
Scarlatina 
Case 1 j 
1 
It ll 
2 
782.6 
I I ll 
ll 
Case 2 
1 
776.3 
223 7 
tl ll 
ll 
Case 3 . 
1 
798.3 
201.7 
(Ts 
Lecanu 
ll 
ll 
776.5 
223 5 
ll 
770.4 
229.6 
Andral & Gavarreb 
Measles 
Case 1 
1 
760.2 
239.8 
233.1 
2.6 
3.0 
2.6 
2.5 
2.7 
2.4 
3.4 
2.8 
3.8 
2.5 
2.2 
1.85 
ll ll 
Case 2 
1 
766.9 
11 ll 
ll 
Case 3 
1 
781.6 
218.4 
ll ll 
ll 
Case 4 j 
1 
786.7 
213.3 
550.0 
526.4 
474.4 
ll ll 
ll 
2 
795.8 
204.2 
I. ll 
ll 
Case 5 | 
1 
792.1 
207.9 
It ll 
ll 
2 
823.8 
176.8 
373.2 
Becquerel & Rodier 
ll 
Man, Case 1.... j 
1 
584.4 
ll 
2 
506.4 
379.8 
428.4 
375.0 
458.7 
ll ll 
Acute Scurvy 
Man aged 48 
42 
786.8 
213.2 
571.2 
500.2 
611.6 
67.88 
89.00 
81.69 
ll ll 
Man aged 21 
30 
783.7 
216 3 
ll ll 
Chronic Scurvy 
Man aged 32 
455 
763.5 
236.5 
ll ll 
4 i 
Man aged 23, be- 
fore treatment 
After treatin'nt 
ll ll 
" 
552 
612 
765.9 
778.0 
234.1 
222.0 
704.8 
542.8 
191.2 
528.6 
407.1 
143.4 
176.2 
135.7 
47.8 
56.59 
84.02 
1.32 
1.14 
6 5 
Busk 
849.9 
150.1 
84.6. 
76.6 
74.2 
57.6 
9.5 
ll 
1I 
835.9 
164.1 
• 153.8 
289.2 
242.8 
511.2 
206.9 
182.1 
72 3 
60.7 
127.8 
11.5 
10.9 
4.5 
5.9 
6.6 
ll 
ll 
Popp 
Erysipelas 
Male aged 33 
807.9 
192.1 
383.4 
Andral & Gavarret 
ll 
Case 1 | 
2 
1 
826.6 
173.4 
303.6 
227.7 
75.9 
64.4 
108.4 
101.9 
83.2 
87.3 
78.9 
78.2 
83.0 
80.7 
80.5 
80.2 
90.4 
7.3 
6.2 
6.8 
6.4 
721 
ll ll 
Cl 
3 
836.0 
164.0 
193.2 
6.1 
6.7 
7.3 
5.0 
4.7 
5.0 
3.6 
5.45 
11,00 
ll ll 
ll 
Case 2 | 
2 
1 
799.2 
200.8 
433.6 
325.2 
ll ll 
ll 
3 
2 
806.2 
193.8 
407.6 
305.7 
220.8 
357.3 
332.1 
418.2 
425.1 
*1 ll 
ll 
Case 3 
1 
831.2 
168.8 
294 4 
73.6 
119.1 
ll I, 
ll 
Case 4 
5 
1 
788.7 
211.3 
476.4 
6.8 
6.9 
7.2 
ll ll 
ll 
8 
2 
J 
796.9 
203.1 
442.8 
110.7 
it tl 
ll 
Case 5 
3 
762.9 
230.4 
557.6 
139.4 
141.7 
Heller 
ll 
762.4 
237.5 
Wittstock 
Cholera 
740.0 
260.0 
597.6 
473.2 
124.4 
110.02 
14.1 
Constitution of the Blood in Various Diseases-Continued. Constitution of the Blood in Various Diseases. 
265 
OBSERVERS. 
DISEASES. 
! 
REMARKS. % . 
°C 
Day of disease. 
leed- 
1000 PARTS OF BLOOD CONTAINED 
Solid 
matters. 
MOIST blood-corpuscles. 
1 
Solid , Fixed 
Albu- mat- saline 
men. ters of constit- 
serum.i uents. 
Fibrin. 
& 
° & Water. 
a 1 
Moist 
blood- 
corpus- 
cles. 
Water. 
Solid 
matters. 
No 
t 
Simon 
Becquerel & Rodier 
Ci CC 
Popp 
i1 
Cl 
Cl 
ll 
it 
c. 
ll 
Becquerel & Rodier 
ll 4. 
Cl ll 
Andral & Gavarret 
It ll 
Glover 
I. 
ll 
ll 
ll 
ll 
U 
ll 
ll 
Heller 
Cholera 
... 
i 
2 
3 
i 
2 
3 
750.5 
740.0 
722.5 
753.9 
806 2 
818.0 
786.9 
802.2 
791.5 
771.1 
819.0 
806.0 
845.8 
794.8 
79.1.8 
821.0 
845.8 
775.0 
809.7 
816.4 
803.4 
790.0 
798.0 
776.1 
806.0 
764.0 
791.9 
785.4 
824.2 
783.7 
796.1 
832.4 
864.0 
852.6 
859.5 
820.0 
809.9 
853.7 
801.9 
838.7 
811.4 
807.3 
249.4 
260.0 
277.4 
245.0 
193.8 
182.0 
213.1 
197.8 
208.5 
228.9 
181.0 
194.0 
154.2 
205.2 
200.2 
179.0 
225.0 
154.2 
190.2 
183.6 
196.5 
210.0 
202.0 
223.8 
194.0 
233.9 
208.0 
214.6 
175.8 
216.3 
203.8 
167.5 
136.0 
147.4 
140.4 
179.9 
194.0 
146.2 
198.1 
161.1 
188.6 
192.7 
434.0 
' 497.6 
758.4 
640.8 
495.2 
378.8 
5(12.0 
323.6 
502.4 
606.4 
306.1 
415.6 
274.0 
500.0 
490.8 
414.0 
488.4 
306.8 
402.0 
400.0 
409.2 
478.0 
397.2 
532.0 
408.4 
561.6 
469.2 
440.0 
410.0 
506.0 
459.2 
308.0 
227.6 
244.0 
232.0 
397.6 
416.0 
242.0 
516.0 
388.4 
515.2 
492.4 
586.0 
342.0 
ROS H in« K 
114.1 
110.4 
51.8 
69.39 
66.2 
65.0 
62.0 
85.0 
89.3 
65.5 
81.5 
85.9 
110.6 
80.5 
75.7 
100.9 
82.7 
80.2 
105.4 
65.1 
85.3 
73.9 
84.4 
80.4 
94.7 
83.3 
S3.5 
84.7 
81.3 
94.0 
61 1 
81.2 
78.6 
74.0 
75.8 
80.97 
78.0 
99.4 
84.9 
77.6 
66.4 
61.4 
55.5 
64.4 
76.53 
55.15 
10.6 
2.47 
ll 
373.2 
568.8 
480.6 
371.4 
284.1 
376.5 
242.7 
376.8 
454.8 
229.8 
311.8 
205.5 
375.0 
367.2 
310.5 
366.3 
230.1 
301.5 
300.0 
306.9 
358.5 
297.9 
399.0 
306.3 
421.2 
351.9 
330.0 
307.5 
379 5 
344.4 
231.0 
170.7 
183.0 
174.0 
298.2 
302.0 
181.5 
387.0 
291.3 
386.4 
369.3 
439.5 
256.5 
124.4 
189.6 
160.2 
123.8 
94.7 
125.5 
80.9 
125.6 
151.6 
76.6 
103.8 
63.5 
125.0 
122.7 
103.5 
122.1 
76.7 
100.5 
100.0 
102.3 
119.5 
99.3 
133.0 
102.1 
140.4 
117.3 
110.0 
102.5 
126.5 
114.8 
77.0 
56.9 
61.0 
58.0 
99.4 
104.0 
60.5 
129.0 
97.1 
128.8 
123.1 
146.5 
85.5 
14.1 11.00 
1.88 
ll 
Man, d'y of d'th 
Male aged 22 
16 
16 
16 
21 
21 
21 
ll 
5.4 
5.7 
6.6 
5.0 
6.5 
6.3 
6.8 
6.2 
7.27 
6.5 
6.4 
6.6 
6.50 
4.06 
5.16 
1.864 
6.10 
2.30 
2.12 
3.29 
7.43 
5.30 
4.80 
4.20 
3.60 
5.90 
2.10 
4.40 
4.30 
4.00 
3.50 
3.00 
1.41 
2.10 
4.00 
3.13 
3.30 
4.70 
2.20 
3.58 
16.44 
3.30 
5.42 
4.42 
3.31 
5.10 
8.12 
2.70 
2.80 
4.30 
5.20 
3.76 
1.65 
Phthisis 
Male aged 22 
Male aged 22 
4 4 
44 
Male aged 21 
ll 
Female aged 26. 
Male aged 27 
ll 
ll 
Male aged 36 
il 
Male aged 40... . 
ll 
Male aged 39 
ll 
44 
44 
44 
Maxima 
44 
Minima 
44 
Mean 
Scrofula 
Male 
44 
Male 
44 
Male 
44 
Male 
44 
Male 
44 
Male 
44 
Male ,. 
Mean 
44 
44 
Female 
44 
Female 
44 
Female 
44 
Mean 
Carcinoma 
u 
ll 
»» 
is 
15 
44 
ll 
ll 
ll 
44 
44 
4. 
Becquerel & Rodier 
ll ll 
ll ll 
ll ll 
ci 
Bright's Disease, Acute 
44 44 
4 4 IV 
4 4 44 
CC 11 
Case 1 
Case 2 | 
Maxima 
Minima 
Constitution of the Blood in Various Diseases.-Continued. 266 
Constitution of the Blood in Various Diseases. 
OBSERVERS. 
DISEASES. 
REMARKS. 
No. of observa- 
tions. 
Day of disease 
No. of bleed- 
ings. 
1000 PARTS OF BLOOD CONTAINED 
Water'. 
Solid 
matters. 
moist blood-corpuscles 
Albu- 
men. 
Solid 
mat 
ters of 
serum. 
Fixed 
saline 
constit- 
uents. 
Fibrin. 
Moist 
blood- 
corpus- 
cles. 
Water. 
Solid 
matters. 
Becquerel & Rodier 
it a 
Bright's Disease acute 
Bright's Dis'e, Chronic 
Mean 
Maxima 
Minima 
Mean 
15 
13 
13 
13 
814.4 
832.6 
J 85.6 
167.4 
468.8 
546.4 
209.2 
432.0 
351.6 
409.8 
146.9 
324.0 
117.2 
136.6 
52.3 
108.0 
65.3 
78.8 
55.5 
63.9 
2.99 
6.50 
2.59 
4.34 
Chlorosis 
778.2 
776 6 
221.8 
223.4 
567.2 
556.4 
425.4 
417.3 
141.8 
139.1 
78.2 
80.9 
l.M) 
3.24 
783 1 
216.9 
553.2 
414.9 
138.3 
75.7 
2.73 
u " 
Popp 
*• 
Cl 
Anaemia 
Il 
Simple Rheum'c. Fever 
Maxima 
Minima 
Mean 
Maxima 
Minima 
Mean 
Male aged 24 
Male aged 26 
Male aged 46 
6 
6 
6 
10 
10 
10 
828.3 
822.4 
772.9 
798.4 
791.4 
171.5 
177.6 
227.1 
201.6 
208.6 
436.4 
181.2 
344.8 
436.0 
327.2 
400.4 
566-8 
429.8 
472.0 
327.3 
135.9 
258.6 
327.0 
135.4 
300.3 
322J 
354.0 
109.1 
86.2 
169.0 
81.8 
100.1 
141.7 
107.7 
118.0 
92.8 
74.1 
80-2 
88.1 
69.2 
73.7 
82.1 
89.8 
88.5 
5.01 
3.06 
4.: 0 
5.82 
1.62 
3.72 
3.17 
4.02 
1.93 
u 
Feb. Arthr. Rheut'm 
Il ll 
Female aged20 < 
Female aged20^ 
... 
... 
2 
1 
1 
801.4 
816.1 
802.3 
822.8 
790.4 
198.6 
183.9 
197.7 
177.2 
209.6 
400.8 
308.4 
463.6 
346.0 
461.9 
300.4 
231.3 
347.7 
259.5 
345.9 
100.2 
77.1 
115.9 
86.5 
115.3 
86.4 
93.7 
75.9 
82.6 
82.8 
11.89 
12.97 
5.76 
8.92 
11.40 
" 
" " 
Male aged 22... 
2 
3 
817.2 
830.7 
182.8 
169.3 
394.4 
368.1 
295.8 
276.0 
98.6 
9 ;.O 
76.1 
67.9 
7.91 
9.25 
Andral & Gavarret 
Becquerel & Rodier 
Acute Rheumatism 
Chronic Rheumatism.... 
Puerperal Fever 
Female aged 19. 
Male aged 40 
Male aged 24 
Maxima 
M inima 
Mean 
Maxima 
Minima 
Mean 
Mean 
43 
43 
43 
10 
10 
10 
4 
859.7 
789.8 
785.6 
839.6 
771.6 
805.4 
826.8 
741.1 
782.7 
791.0 
833 8 
140.3 
210.2 
214.4 
160.4 
228.4 
194.6 
259.9 
173.2 
217.3 
209.0 
165.1 
236.4 
472.8 
481.2 
520.0 
280.4 
404.0 
517.2 
296.0 
432.8 
563.6 
332.0 
177.3 
354.6 
360.9 
390.0 
210.x 
3 03 0 
362.9 
222.0 
324.6 
422.7 
254.5 
59.1 
118.2 
120.3 
130.0 
70.1 
101.0 
154.3 
74.0 
1<8.2 
140.9 
67.7 
84.9 
85.7 
104.8 
76.9 
86.0 
102.0 
77.1 
95.2 
61.2 
77.4 
6.00 
13.34 
7.06 
8.21 
10.20 
2.80 
6.70 
5.10 
2.60 
3.80 
6.76 
5.16 
Heller 
Andral & Gavarret 
Pneumonia 
t 
1 
a 
2 
818.0 
81s 5 
182.0 
181.5 
445.2 
430.8 
333.9 
323.1 
111.3 
107.7 
66.7 
68.3 
4.00 
5.50 
.. « 
" 
Case 1 < 
5 
7 
3 
4 
820.9 
834.4 
179.1 
165.6 
404.4 
332.8 
303.3 
249.6 
101.1 
83.2 
71.5 
73.4 
6.50 
9.00 
Cl 
Case 2 । 
3 
4 
5 
6 
1 
2 
3 
4 
773.0 
782.3 
795.0 
800.4 
227.0 
217.7 
205.0 
199.6 
551.2 
502.0 
469.6 
446.0 
413.4 
376.5 
352.2 
334.5 
137.8 
125.5 
117.4 
111.5 
84.0 
84.9 
80.7 
80.6 
5.20 
7.30 
6.90 
8.00 
Constitution of the Blood in Various Diseases-Continued. Constitution of the Blood in Various Diseases. 
267 
OBSERVERS. 
DISEASES. 
REMARKS 
N o. of observa- 
tions. 
Day of disease. 
i 
ft 
1000 PARTS OF BLOOD CONTAINED 
Water. 
Solid 
matters. 
MOIST BLOOD-CORPUSCLES 
Albu- 
men. 
Solid 
mat- 
ters of 
serum. 
Fixed 
saline 
constit- 
uents. 
Fibrin. 
Moist 
blood- 
corpus- 
cles. 
Water. 
) 
Solid 
matters. 
Andra I & Gavarret 
Pneumonia 
( 
... 
4 
1 
7*1.5 
218.5 
519.2 
389.4 
129.8 
83.2 
5.50 
Case 3 < 
... 
5 
2 
788.3 
211.7 
465.2 
348.9 
116.3 
88.6 
6.80 
it a 
n 
( 
9 
3 
823.9 
176.1 
382.8 
287.1 
95.7 
74.0 
6.40 
ll . l 
I. 
Maxima 
... 
... 
831.4 
229.5 
551.2 
413.4 
137.8 
95.2 
10.50 
n n 
ll 
Minima 
... 
... 
770.5 
165.6 
332.8 
249.6 
83.2 
..... 
66.7 
4.00 
ll Cl 
ll 
Mean 
... 
... 
799.0 
201.0 
456.4 
342.3 
i 114.1 
..... 
81.0 
7.30 
Becquerel & Rodier 
ll 
Mean 
5 
... 
1 
801.1 
199.0 
490.0 
367.5 
122.5 
61.1 
7.40 
Mean 
5 
... 
2 
808.0 
192.0 
455.6 
341.7 
113.9 
59.7 
6.30 
A ndral & Gavarret 
Pleuritis 
... 
1 
802.6 
197.4 
429.6 
107.4 
85.0 
5.0 
ll kC 
ll 
Case 1 < 
... 
... 
2 
807.6 
192.4 
410.0 
307.5 
102.5 
84.9 
5.0 
Cl ll ■ 
. 
( 
... 
... 
1 
783.5 
216.5 
515.2 
386.4 
128.8 
. • . •• 
83 8 
3.9 
li ll 
Case 2 s 
... 
2 
780.3 
219.7 
475.6 
336.7 
118.9 
... .. 
95.0 
...... 
5.8 
ll ll 
1 
783.0 
217.0 
541.6 
406.2 
135.4 
78.1 
3.4 
ll I, 
-• 
l ase o « 
... 
... 
2 
798.5 
201.5 
496.8 
372.6 
124.2 
73.1 
4.2 
ll ll 
... 
... 
774.2 
225.8 
510.8 
383.1 
127.7 
92.2 
5.9 
ll ll 
... 
845.6 
154.4 
273.2 
204.3 
68.3 
81.1 
5.0 
Becquerel & Rodier 
ll 
Mean 
5 
... 
798.6 
201.1 
481.6 
361 2 
120.4 
65.4 
6.1 
Andra1 & Gavarret!Peritonitis 
... 
787.2 
212.8 
491.2 
368.4 
122.8 
84.5 
5.5 
ll 11 
ll 
... 
i 
822.9 
177.1 
353.2 
264.9 
88.3 
83.4 
5.1 
Cl ll 
ll 
Case 2 
... 
... 
2 
831.6 
168.4 
294.4 
220.8 
73.6 
89.5 
5.3 
ll Ci 
ll 
... 
3 
851.0 
149.0 
242.0 
189.5 
60.5 
84.9 
3.6 
Cl ll 
ll 
1 
789.4 
210.6 
480.0 
360.0 
120.0 
86.8 
3.8 
ll ll 
Case 3 
... 
2 
802.7 
197.3 
438.0 
328.5 
119.5 
83.1 
4.7 
ll Cl 
... 
3 
813.5 
186.5 
401.2 
300.9 
100.3 
80.1 
6.1 
ll ll 
Angina Tonsillaris 
4 
1 
782.6 
217.4 
444.0 
333.0 
111.0 
100.3 
...... 
6.1 
ll ll 
5 
2 
793.6 
206.4 
421.2 
315.9 
105.3 
93.9 
7.2 
ll ll 
Case 2 
6 
1 
777.9 
222.1 
504.0 
378.0 
126.0 
.. .. 
90.7 
5.4 
ll ll 
ll ll 
2 
1 
819.5 
180.5 
360.0 
276.0 
90.0 
88.1 
4.4 
ll ll 
ll ll 
Case 3 j 
... 
3 
2 
830.2 
169.8 
318.0 
238.5 
79.5 
..... 
83.9 
...... 
6.4 
Becquerel & Rodier 
Acute Bronchitis 
Males, mean 
I 
... 
... 
793.7 
206.3 
516.8 
387.6 
129.2 
64.9 
4.8 
u ll 
Females, mean 
4 
... 
... 
803.4 
196.6 
451.2 
335.9 
115.3 
68.8 
...... 
3.5 
Andral & Gavarret 
Cl ll 
... 
... 
1 
763.3 
236.7 
595.2 
446.4 
148.8 
80.6 
...... 
7.3 
11 Cl 
ll ll 
case i * 
... 
2 
793.6 
206.4 
440.8 
330.6 
110.2 
86 9 
...... 
9.3 
Leca n u 
Carditis 
. 
... 
821.0 
178.9 
405.2 
303.9 
1(4.3 
77.5 
..... 
ll 
... 
880.4 
119.5 
167.6 
125.7 
4'.9 
77.6 
I 4 
4* 
807.2 
192.7 
385.2 
288.8 
96.3 
96.3 
ll 
... 
847.4 
154.8 
276.0 
207.0 
69.0 
85.8 
Becquerel & Rodier 
Pericarditis 
... 
... 
1 
831.0 
169.0 
420.0 
315.0 
105.0 
53.0 
2.3 
ll I. 
ll 
... 
3 
847.0 
i53.0 
312.0 
234.0 
78.0 
60.4 
3.4 
Popp 
Inflammation of Brain 
... 
1 
811.2 
188.8 
421.6 
316.2 
105.4 
76.8 
6.4 
11 
ll ll 
Case 1 
2 
797.5 
203.5 
454.0 
340.5 
113.5 
82.4 
6.3 
ll 
Glanders 
Case 1 
1 
823.5 
176.5 
428.8 
321.6 
107.2 
62.8 
6.37 
ll 
... 
2 
822.0 
178.0 
457.6 
343.2 
114.4 
53.0 
10.48 
ll 
Lead Poisoning 
... 
... 
... 
822.5 
177.5 
338 0 
253.5 
j 84.5 
86.7 
• 
6,13 
Constitution of the Blood in Various Diseases-Continued. 268 
Destruction of Colored Blood-Corpuscles in Malarial Fever. 
The comparison of the character, progress and duration of the diseases 
in those cases from which these observations were derived (so far as the 
records extended), with the character, progress, and duration of the cases of 
malarial fever observed and recorded by ourselves, and the comparison of 
the results of the chemical examination of the blood in various diseases 
(allowing due weight to the different methods employed by different 
observers) with the results of our chemical examination of the blood in 
malarial fever, have forced upon my mind, the conclusion that, so far as 
these observations extend, the colored blood-corpuscles are more uniformly and 
rapidly destroyed in severe cases of malarial feves than in any other acute disease. 
When not merely the facts of the destruction or alteration of the con- 
stituents of the blood in all diseases have been determined, but also the 
causes of their destruction and alterations, and the methods and results,, 
chemical, physical, physiological and pathological, have been definitely 
determined, then will it be possible to draw broad lines of distinction 
between diseases, based upon the chemical, and physical, and physological, 
and pathological alterations of the blood. Nevertheless, the first step in 
the right direction is to perceive and appreciate the extent and bearing of 
the established facts. In comparing these results, it should be remem- 
bered that the individuals whose blood I examined were, as a general rule,, 
stout, athletic seamen and laborers, who had never before been attacked 
by the malarial lever, and who had been exposed but a short time to the 
malarial poison. This table further shows that in certain states of the 
system--as the cancerous and cachectic, and in such as are induced by 
long starvation, and exposure, and improper habits, and by haemorrhages, 
scurvy, and Bright's disease-the blood-corpuscles are greatly diminished. 
These results do not invalidate the conclusion that blood-corpuscles are 
most rapidly destroyed in severe attacks of malarial fever, because the 
destruction accomplished by the slow action of the causes inducing these 
states of the system required months or even years, whilst an equal or 
even greater destruction may take place in a few days or weeks in mala- 
rial fever. 
W e affirm, and our affirmation is borne out by the results here recorded,, 
that the colored blood corpuscles are diminished during the progress of all 
acute diseases. Andral & Gavarret have shown that the idea which they 
promulgated in their earliest researches, that the blood-corpuscles are 
increased in the earlier stages of typhoid fever, was erroneous, and arose 
from the fact that this disease most frequently attacks those whose blood is 
rich in colored blood-corpuscles. The suspension of the process of diges- 
tion, and the perversion and partial suspension of secretion and nutrition, 
and the rapid chemical changes and corresponding rapid metamorphosis of 
matter-the universal attendants, or rather phenomena of acute diseases, 
must necessarily be attended by a destruction, to a greater or less extent, 
according to the severity of the disease, of one or all the constituents of 
the fluid which supplies the elements for secretion, nutrition, and chemical 
change. These causes produce destruction of the colored blood-corpuscles 
in all acute diseases; but in malarial fever we have an increased destruction 
which cannot be referred to these causes. We have before shown that the 
blood-corpuscles suffer profound alterations in the liver and spleen during* 
the active stages of malarial fever; and, in attempting to account for the 
different degrees of destruction of the colored blood-corpuscles in differ- 
ent diseases, this fact leads us to institute an examination and comparison 
of the lesions of these organs in different diseases. In typhoid fever, the 
spleen is almost always more or less altered in appearance. Its volume is 
augmented, in many cases, to three or four times the natural size, and the Lesions of Organs in Malarial Fever. 
269 
parenchyma reduced to a soft pulpy mass. The cases of typhoid fever in 
which the size of the spleen is most augmented, and the tissues most soft- 
■ened and broken down, are those which terminate most rapidly. In forty 
six examinations of the bodies of those who had died with typhoid fever, 
Louis found this organ in its natural condition only four times. This 
-enlargement and softening of the spleen appear to be in typhoid, as well as 
in malarial fever, the result, not of inflammation, but of congestion. 
Whether this congestion be the result of disturbances in the circulatory 
apparatus and nervous system and contiguous organs, or of the direct 
action of the malarial or typhoid poisons upon the spleen, will be more 
fully discussed hereafter, and do not bear directly upon the question now 
under consideration. This source of the destruction of the colored blood-cor- 
puscles exists, then, in both typhoid and malarial fevers. The enlargement of 
the spleen, however, is greater in malarial fever. Whilst, therefore, there 
should be a destraction of colored blood-corpuscles in the spleen in both 
typhoid and malarial fevers, this destruction should be somewhat greater 
in the malarial spleen. 
We will next compare the lesions of the liver in these diseases. So 
far as pathological investigations (which, it must be confessed, have been 
confined almost exclusively to the mere physical alterations of this organ, 
the color and consistence) extend, nothing has been discovered in the con- 
dition or secretion of the liver peculiar to typhoid fever. According to 
Andral, the liver almost constantly presents a healthy appearance. Louis* 
found slight softening in about one-half of the. cases of typhoid fever 
examined by him. It is probable that the softening of the liver in these 
cases resulted from commencing decomposition. Pathological investiga- 
tions, then, indicate that the blood-corpuscles are not destroyed in the liver 
of typhoid fever, as they are in this organ during malarial fever. Here, 
then, is a marked. difference between typhoid and malarial fever, and the cause 
why the destruction of the colored blood-corpuscles is more rapid in the latter 
than in the former. Dr. Gerhard,f in his observations upon typhus fever, 
states that the spleen was of the normal aspect in one-half the cases; in 
the other half it was softened, but not enlarged; and in one case out of five 
or six, enlarged and softened. Dr. Jenner examined the spleen in thirty- 
four subjects above the age of fifteen, who died before the termination of 
the fourth week of the disease, and foqnd the average weight to be seven 
ounces and five drachms. According to the observations of Dr. John 
Reid, the weight of normal spleens ranges from 2187 to 3062 grains. It is 
evident that in these cases, reported by Dr. Jenner, the spleen was but 
slightly, if at all, enlarged. Dr. John Home examined after death one 
hundred and one cases of typhus fever, and found that the spleen was gener- 
erally larger than usual, soft, and in some cases almost diffluent. In one 
instance this organ weighed eleven, and in another fourteen, ounces. These 
observations, together with those of many other investigators, demonstrate 
that the lesions of the spleen are neither constant nor of any great extent. 
In some cases of typhus fever the liver has been found engorged with dark 
fluid blood, in others spotted with ecchymosis, and in many cases it was 
the seat of no appreciable lesion. 
All observers agree that one of the most striking facts in the patho- 
logical anatomy of typhus fever, is the absence of any constant and charac- 
teristic lesions. The most uniform and important alteration appears to be 
* Anatomical, Pathological, and Therapeutical Researches upon the Disease known under the 
names of Gastro-Enteritis, Putrid Adynamic, Ataxic and Typhoid (Fever, by P. Ch. A. Louis, 2 
vols. Paris, 1829. 
t Am. Journ. of Med. Sci., Feb., 1837. 270 
Alterations of the Blood in Pyrexice and Phlegmasia?. 
that of the blood, which is manifested not only in its appearance, physical 
properties, and chemical constitution, but also in the rapidity with which 
the color of the skin changes after death, and the body undergoes decom- 
position, and the frequent occurrence of cold abscesses in various parts of 
the body after an attack of typhus fever. If there be no destruction of the 
blood-corpuscles, independent of the liver and spleen in typhus fever, or if the 
destruction of the blood-corpuscles in the blood-vessels and capillaries, independ- 
ent of the spleen and liver, be not more rapid in typhus than in typhoid and 
malarial fever, then the destruction of the colored blood-corpuscles should be less 
rapid in typhus fever than in typhoid and malarial fever. The observations 
thus far recorded do not enable us to settle this question definitely, for the 
patients from whom the blood was abstracted (the analyses of which are 
recorded in the table) were hospital patients, natives of Ireland, whose 
disease appeared (from the accounts of the authors) to have been aggra- 
vated by previous want. We know that this fever most frequently attacks 
those whose constitutions have been worn down, and their solids and fluids, 
especially the blood deranged by foul air and poor diet. 
In malarial fever, and in fevers generally, the fibrin is rarely increased, 
and either remains within the limits of health, or is diminished, and, as far as 
my observations extend, the diminution of fibrin corresponds with the severity of 
the disease. This fact corresponds with the results established by Andral 
in his splendid researches upon the blood. The distinction between the 
alterations of the blood in the pyrexite and phlegmasiae is thus pointed out 
by Andral:- 
In my first memoir upon the alterations of the blood I have proved that the 
fibrin never augments in the pyrexise, supposing them divested of all phlegmasial 
complication; that it often remains in normal quantity, and that sometimes it 
diminishes to a point at which we do not find it in any other acute disease. I have 
shown that the pustules of variola, and the dothinenteric plaques of typhoid fever 
do not have the power of increasing the cipher of fibrin; and finally I have shown 
that with all the possible proportions of the globules, whether they were very 
abundant, or whether they have become very rare, a pyrexia could equally arise 
with all its varieties of form and gravity. But is it indifferently, and as it were by 
chance, that the fibrin shows itself in the pyrexia?, either in normal quantity, or in 
a proportion infinitely more feeble than in the physiological condition ? No, with- 
out doubt, and with regard to this, very clear general principles may be laid down. 
At every period of clinical observation, and upon whatever point of view the 
observer was placed, it has been recognized that amongst the pyrexia? there were 
some unattended by any grave symptoms, which marched naturally towards a 
favorable termination; while there were others which, either at their commence- 
ment, or during their course, were accompanied by accidentsof such a nature, that 
if seemed as though the forces which rule the organism were either vanquished, or 
profoundly disordered to such an extent that the extinction of life must be the con- 
sequence; and at the same time it was found that in such cases the blood presented 
an altogether peculiar appearance; it was observed that as it became less consistent, 
it seemed to tend towards a sort of dissolution. Admitted at all periods, but differ- 
ently explained according to the prevailing theories, this condition, which may 
develop itself in any pyrexia, and towards which several seem to tend naturally, 
has been called, turn by turn, putrid, adynamic, and typhoid state; it is in its greatest 
development in the typhus fevers, properly so called, but is in some sort inherent 
in them; it is, as it were, their essence, The pyrexia, now called typhoid fever, 
presents it in a slight degree from the invasion, and the grave cases of this disease 
are its marked representation. It does not ordinarily exist in the eruptive fevers, 
but it often complicates them, qnd constitutes one of their dangers. Finally, in 
addition to the pyrexia?, with well-marked characters, and which have a fully 
developed place in nosological systems, there are others to which no name has 
been given, which may yet present in a high degree the different symptoms to 
which the ancients attached the idea of the putrid state. This is because there 
may exist in effect, in all the pyrexise, a common alteration of which the blood is 
the seat, and whose existence constantly coincides with the appearance of those Alterations of the Blood in Pyrexice and Phlegmasice. 
271 
phenomena always the same, attributed by vitalism to adynamia, by solidism to 
relaxation of the fibre, and by humorisin to putridity of the humors. This altera- 
tion of the blood consists of a diminution of its fibrin. It is consequently an 
alteration the inverse of that which betrays in the blood the phlegmasial condi- 
tion. * * * Since the diminution of the fibrin does not exist necessarily in any 
pyrexia, it is perfectly clear that it is not in this alteration of the blood that we 
should place the point of departure of this class of diseases. But what seems to 
me incontestible is, that the specific cause which gives them birth acts upon the 
blood in such a way that it tends to destroy its spontaneously coagulable matter, 
while thecause which produces the phlegmasise tends, on the contrary, to create in 
that fluid a fresh proportion of that matter. If this cause act with slight energy, 
or if the economy resist it, the destruction of the fibrin is not accomplished. If, on 
the contrary, the cause continue to act with all its intensity, and the forces of the 
organism be in fault, the destruction of the fibrin will commence either at the very 
beginning of the disease-which is very rare-or at a certain period after its com- 
mencement. All this applies itself equally well both to typhoid fever, and to the 
eruptive fevers. For me, there is in all these cases a true intoxication; if it be 
slight, its effect must, to be sure, always exist, but it is not appreciable; if the 
intoxication be stronger, the effect which it has produced upon the blood becomes 
visible, and is marked, in that fluid, by a diminution of the fibrin. Whilst, then, 
we establish, in certain forms of typhoid fever or scarlatina, that alteration of the 
blood which consists in a tendency to the destruction of its spontaneously coagu- 
lable matter, we no more attain by this means the true cause of the disease, than 
we do by studying the alterations of which the tegumentary membranes are the 
seat. But, as these alterations of the mucous membrane or of the skin, once pro- 
duced, bear their part in the production of symptoms, just so does the peculiar 
alteration of the blood which may then arise bear its part.* 
With this quotation, confirmatory in a great measure of our own views, 
we close the examination of the nature and extent of the changes of the 
blood in malarial fever; not because we have by any means exhausted the 
subject, or even pointed out the full bearing of all the facts established by 
our own investigations, but because we are disinclined to pursue a subject 
so imperfectly investigated and developed; because we wish to avoid 
unprofitable discussions, which may be overturned by the first investigator 
who shall penetrate beneath the surface, or may lead to the adoption of 
erroneous principles of practice. We candidly confess that the unknown 
vastly exceeds the known, and that the great body of facts in this branch 
of pathological chemistry, are only surface facts, relating to the most super- 
ficial, exterior phenomena, and not to the relations and causes of pheno- 
mena. After we have established that the blood-corpuscles, and the fibrin, 
and the saline matters of the blood in malarial fever, or in any other fever, 
have been destroyed or altered, questions of great importance immediately 
arise. How are they destroyed ? Are they destroyed by an actual, direct 
physical and chemical action of a special poison, or by the suspension of 
the functions of the organ or organs in which they are born, or by the 
chemical and physical changes of the liquor sanguinis in which they float? 
What are the physical and chemical changes which the elements of the 
blood and organs and apparatuses undergo, under the action of morbific 
agents? 
The imperfection of pathological chemistry is strikingly shown in the 
state of our knowledge with reference to the fixed saline constituents of the 
blood-corpuscles and liquor sanguinis. Notwithstanding the brilliant 
researches of Becquerel, Rodier and others, we still need, amongst many 
other things, a comprehensive and laborious investigation of the changes 
of the saline constituents of the blood-corpuscles and liquor sanguinis. It 
is not sufficient that the saline constituents of the entire blood, or of the 
liquor sanguinis, should be examined. The advancement of medical 
* An Essay on the Blood in Diseases, by G. Andral. Translated by J. F. Meigs, M, D. and 
Alfred Stille, M. D. Philadelphia, 1844. 272 
Diseases of Malarious Districts. 
science demands that the relations between the fixed saline constituents of 
the blood-corpuscles and liquor sanguinis should be determined; demands 
that the variations and relations of the fixed saline constituents of every 
element of the blood should be determined in heath and in disease. An 
important question now presents itself. 
DO THESE CHANGES OF THE BLOOD PRECEDE, OR SUCCEED, OR ARE 
THEY SIMULTANEOUS WITH, THE ABERRATION OF THE PHYSICAL, 
CHEMICAL, VITAL, AND NERVOUS PHENOMENA DENOMINATED FEVER? 
This question can be settled only by an appeal to nature. I have 
resided for many years in a malarious district, in the southern part 
of Georgia, and speak from observation. It is known to practitioners in 
malarious districts, that the constitution is sometimes undermined silently 
by the malarial poison, without the manifestation of febrile phenomena 
sufficiently marked to attract the attention of the patient or his friends. 
It is further known to the practitioners in our Southern States, that the 
phlegmasise, especially pneumonia and pleurisy, and even the irritative 
fever succeeding amputations and severe wounds, will assume the inter- 
mittent, remittent, and even congestive types of malarial fever. That 
these types of inflammatory fevers are due to a state of the system perma- 
nently induced by the malarial poison, and also to the direct action of the 
poison during the inflammatory disease, is conclusively demonstrated by 
the mode of treatment most successful in these districts, and by the com- 
parison of the results of this practice with that of healthy, non-malarious 
districts. It is an established fact, that bleeding and active purgation will 
not be borne in the pneumonia and pleurisy of malarious districts as well 
as in these diseases occurring in the primitive, non-malarious, middle 
regions of Georgia and other States, ft is an established rule with many 
practitioners in the malarious districts of our Southern States, to avoid 
large bleedings and active purgation in pneumonia and pleurisy, whilst the 
reverse rule has prevailed in non-malarious districts, having the same cli- 
mate and relations to heat and moisture. It is known that the sulphate of 
quinia may be used with the greatest benefit and success in the treatment 
of pneumonia and pleurisy, and of the phlegmasue generally, and even of 
the irritative fever following amputations and severe wounds, in malarious 
districts ; whilst no such beneficial effects attend the use of this remedy in 
these diseases occurring in non-malarious districts. 
These facts demonstrate that the malarial poison is capable of altering the 
constitution of the solids and fluids, and, modifying and altering the type and, 
progress, phenomena and effects of diseases, even when no symptoms of aberrated 
physical, chemical, vital and nervous actions ivere manifested sufficient to attract 
the attention. 
The author has carefully noted the antecedents of three attacks of 
malarial fever in his own person, occurring within eighteen months, and 
separated from each other by intervals of perfect health. The first was 
an attack of bilious remittent fever, contracted in a malarious district, 
during repeated exposure to the night air at late hours of the night, and 
aggravated by exposure to the hot sun in the early part of August. For 
two weeks before the supervention of fever, the complexion assumed 
a sallow appearance, evident to observers. The only unusual sensations 
at this time were those of irritability and excitement of the nervous 
system. In this state there appeared to be an increase rather than a 
diminution of mental and physical force, and I was surprised to find 
the strength sufficient for twelve hours of hard labor in the conduction of Alterations Produced by Malarial Poison. 
273 
pathological, physiological and chemical investigations and hospital prac- 
tice, notwithstanding that the rest at night was exceedingly imperfect. 
Several days before the commencement of the fever, the bowels were 
deranged; the discharges were copious and frequent, and appeared to 
contain much altered bile, resembling that so often found in the gall- 
bladder of the malarial liver after death. Notwithstanding the superven- 
tion of this affection of the bowels, I was able to continue for three days, 
during the usual time (twelve hours daily), pathological investigations and 
hospital practice. The fever which followed was high; full rapid pulse, 
full moderately accelerated respiration, high temperature, dry skin, dry 
tongue, high-colored urine, and, at one time, aberration of the intellect, 
preceded by intense pain in the head and cold extremities. The fever 
yielded'readily to the action of the sulphate of quinia, and shortly after 
its removal I recommenced my labors; and, notwithstanding frequent 
exposure to the night air at all hours, perfect health was enjoyed for two 
months, at the end of which time I was troubled by periodical headaches, 
attended with derangement of digestion, the generation of much acid in 
the stomach and high-colored urine, and, at times, with slight exacerbation 
of the pulse and slight increase of temperature. There was never any 
chill, nor anything approaching a chill, either at the commencement or 
during the continuance of these periodical disturbances of the system, 
which returned every seven, nine, eleven or fifteen days, and lasted from 
twelve to forty hours. The headaches appeared to be often relieved, and 
always benefitted, by the free administration of the bicarbonate of potassa. 
It was frequently noticed that uric acid and urate of soda were deposited 
in the urine excreted just after the disappearance of the headache. During 
the winter, I took up my residence in the town of Athens, situated 
upon the granite and gneiss hills of middle Georgia. The town and 
environs of Athens are without a single source of malaria, and its bills of 
mortality and the appearance of its inhabitants, and the exemption of the 
students attending the University of Georgia from disease, show that it is 
one of the healthiest localities in the world. 
In this healthy locality, contrary to expectation, the headache increased 
in severity, and the strength of the muscular system diminished, and the 
nervous system became more excitable, and the person lost flesh. Up to 
the 1st of March, six months from the commencement of the periodical 
disturbances of the system, I had never been incapacitated a single day 
for the regular discharge of my professional duties and investigations. At 
this time, after unusual anxiety and fatigue, a chill came on in the evening 
of the day previous to the anticipated headache. Duiing this chill the 
pulse was rapid, but feeble, the respiration was accelerated, full and labored, 
the muscles trembled and shook, and the temperature of the extremities 
was many degrees below the normal standard, whilst the temperature 
of the trunk was elevated several degrees above the usual point of health. 
As we shall hereafter show, these were the phenomena of a true malarial 
chill. The succeeding hot stage was well marked by a full, rapid pulse, 
rapid respiration, and corresponding equalization and elevation of the 
temperature of the trunk and extremities, and by suppression of the secre- 
tions of the mucous membrane of the tongue and mouth, loss of appetite, 
derangement of digestion, severe pain in the head and high-colored, 
strongly acid urine. Thinking that it was not only improbable, but 
impossible, that chill and fever could arise in Athens, and failing to infer 
the connection of the periodic disturbances with the operation of malaria 
(because, up to the present time, they had never been attended by a well- 
marked chill and febrile excitement), I neglected to use the sulphate of 274 
Alterations Produced by Malarial Poison. 
quinia. After the intermission of one week, the ehill and fever returned 
with increased violence. The free administration of the sulphate of 
quinia, after this paroxysm, prevented a subsequent return, and, with the 
disappearance of the chill and fever, the headaches vanished, and I was 
free from them for the period of one year. 
Several of the students who had residedin malarious districts, previous 
to their residence in Athens, were attacked with intermittent fever, which, 
previous to the attack, appeared to have destroyed, to a considerable 
extent, the colored blood-corpuscles. I examined these cases, and inquired 
into their previous history carefully, and am convinced that they were 
genuine cases of malarial fever, induced by the action of a poison which 
had been received into the system months previous to their residence in 
this healthy climate and locality. The third attack from which I suffered, 
was contracted during a visit to the swamps of Georgia, in the month of 
September. Although much more severe than the two which I have 
recorded, the preceding symptoms did not differ essentially from those of 
the first attack, with the exception, that there was no affection of the 
bowels preceding the fever. These cases demonstrate conclusively that the 
malarial poison can exist in the system, and induce slow alterations in the blood, 
without the appearance of those phenomena characteristic of fever, and without 
any marked aberration of nervous action. Many other facts might be brought 
forward to support this statement. Thus the serum of the blistered sur- 
faces, in all the stages from the beginning to the end of severe cases of 
malarial fever, has always (as far as my observations extend) presented a 
golden-yellow color. Post-mortem examinations have revealed the fact 
that the livers of those residing in malarious districts have presented the 
peculiar slate and bronze color, although the patients had, at no previous 
time, manifested the phenomena of fever. The spleen of a large stout man, 
who was seized suddenly with coma whilst exposed to the malarial influ- 
ence on the Savannah River, and who died after forty-three hours' sickness 
was enlarged, softened, and of a slate color; the liver was changed to the 
slate and bronze color in several places, and the bile was concentrated and 
of a brownish-black color, with greenish reflections, and poured like 
molasses. Under the microscope the colored corpuscles of the splenic mud 
appeared swollen and altered; the solitary glands of the intestines were 
enlarged; and the heart contained a fibrous clot. In this case the changes 
were at least simultaneous with the manifest disturbances of the physical, 
chemical, vital and nervous phenomena. 
Dr. Stevens* ascertained that in the marsh fevers, both of America and 
of the West Indies, the blood is diseased before the attack; it was found to 
be dark in color, and evidently deranged in its physical properties; its 
serum, instead of being translucent, presented a muddy or brown color, 
and sometimes an oily appearance. During this altered state of the blood, 
previous to its effects upon the nervous system, by which alone the patient 
would be aware that the healthy functions of the body were disturbed, the 
temperature of the body would frequently be reduced several degrees 
below the normal standard, and the pulse becomes less frequent. It has 
been asserted that the seasoning fever of the West Indies (endemic yellow 
fever) is preceded by a morbid condition of the blood. Dr. Ch. W. Balli- 
observed that whilst the fainting fever of Persia was at its height in Tehe- 
ran, the blood, even of those not sensibly attacked, presented a dark, dusky, 
reddish brown color, very different from that of healthy venous blood; and 
* Stevens on the Blood, pp. 214-219. 
f British and Foreign Med. Kev., xvi, p. 521. Alterations Produced by Malarial Poison. 
275 
that in general the serum did not separate from the clot. Dr. John Mit- 
chell,* of Virginia, Salvagnoli, Dr. Archer,f of Norfolk, and Dr. Porter of 
Baltimore, and others, have recorded similar observations with reference 
to the changes of the blood previous to the manifestation of aberrated 
nervous action. Dr. Potter, J in the fever which prevailed in Baltimore in 
1800, demonstrated this fact conclusively by the following examinations: 
xt To ascertain the appearance of the blood in good health, I drew it from 
five persons who had lived, during the whole season, in the infected parts 
of the city, who were in every external appearance and inward feeling in 
perfect health. The appearance of the blood could not be distinguished 
from that of those who labored under the most inveterate grades of the 
disease. A young gentleman having returned from the western part of 
Pennsylvania on the 10th of September in good health, I drew a few ounces 
of blood from a vein on that day; it discovered no deviation from that of 
other healthy persons. He remained in my family till the 26th of the 
month, and on that day I repeated the blood-letting. The serum had 
assumed a deep yellow hue. and a copious precipitate of red globules had 
fallen to the bottom of the receiving vessel." 
* Medical and Philos. Register, vol. iv, p. 188. 
f History of the Yellow Fever of Norfolk in 1821, Med. Recorder, vol. v, p.?68. 
J A Memoir on Contagion, p. 54. CHAPTER III. 
COMPARISON OF THE CHANGES OF THE BLOOD IN MALARIAL FEVER AND OTHER 
DISEASES, PYKEXIAL AND PHLEGMASIAL. MICROSCOPICAL CHARACTERS AND 
CHANGES OF THE BLOOD IN VARIOUS DISEASES. MICRO-ORGANISMS IN MALA- 
RIAL FEVER AND OTHER DISEASES. 
Comparison of the changes of the blood In various diseases. Analysis of the blood in diabetes 
mellitus and malarial fever. Reports of cases illustrating the phenomena of diabetes mellitus 
and malarial fever, with original investigations and practical observations on the digestion of 
albumen and flesh and oleagenous matters, and the comparative anatomy and physiology of the 
pancreas. 
Qualitative and quantitative determination of sugar in the urine, blood and organs of man 
and animals. Chemistry of the carbohydrates, chemical, physiological and pathological rela- 
•tions of glucose. Qualitative and quantitative tests for sugar. Specific gravity. Balance Urino- 
meter. Liquor-potassa tests. Reduction tests for the qualitative determination of sugar. Feh- 
ling's solution of cupric oxide. Volumetric method of analysis of sugar in animal and vegetable 
fluids. Description of apparatus. Baby's cupro-potassic test solution for sugar. Dr. Piffard's 
formula for Fehling's solution. Fermentation test. Quantitative estimation of sugar by fermen- 
tation. Polarimetry diabetometer of Robiquet. 
Relations of lycocythaemia to malarial fever. Outline of lecture by the author on lycocy- 
thaemia. 
Relations of the changes of the blood in malarial fever, to the phenomena, progress and treat- 
ment of pneumonia. 
Microscopical characters of the blood in malarial fever and in various diseases. History of 
the investigation of the microscopical changes of the blood in endemic and epidemic diseases. 
Statistics illustrating the nature and mortality of the various forms of fever, malarial, yellow, 
typhus and typhoid, treated by tbe author in the Charity Hospital of New Orleans, and in various 
portions of the Southern States. Investigation of the microscopical characters of the blood in 
the malarial fevers of Central America. Detail of cases illustrating the changes of the pulse and 
temperature in the fevers of South America. Essential conditions for the establishment of the rela- 
tions of micro-organisms and morbific ferments, to the causation and phenomena of certain 
diseases. Importance of examiningthe blood microscopically and chemically, immediately after 
its removal from the blood-vessels of healthy and diseased human beings. 
Method of observation and research-entozooa hominis.-Investigations of various micro- 
scopists and naturalists, as Leeuwenhoek, Ehrenberg, Dujardn, Diesing, Robin, Joseph Leidy 
and others, with reference to the origin, comparative anatomy and physiology and pathology of 
vegetable and animal parasites. Classifications of micro-organisms, micrococci, bacilli and bac- 
teria, by Cohn, Dayaine, Robin, Nageli, Billroth. Klein and other microscopists and physiologists. 
Results of the microscopical examination of the blood in the various forms of malarial paroxys- 
mal fever. Outline of results of experiments and observations on the microscopical appearances 
of the fluids and solids of malarial fever, under the action of water and certain re-agents. Medico- 
legal evidence concerning the chemical, microscopic and spectroscopic detection of human blood. 
Detection of blood on the clothing of a man accused of murder; said blood presented the appear- 
ance of the blood of a human being suffering with malarial fever. Testimony of tbe author in 
the case of Narcisse Arrieux. murdered near Donaldsonville, Louisiana, December 27th, 1876. 
Comparison of human blood in health and disease. Relative size of the blood globules in man and 
animals. Influence of the malarial poison in human blood. The spectroscope and spectroscopic 
analysis. The employment of the spectroscope in medico-legal investigations. Comparison of 
the micro-organisms of malarial fever with well-known mibrocci, bacilli, bacteria, spirilla and 
spirochsetae which have been described and delineated by many observers, as associated with 
septic processes and various diseases. Micrococci. Zymogenic micrococci. Pathogenic micro- 
cocci. Micrococcus varioiae. Micrococcus erysipelatous. Micrococcus pneumoniae. Micrococcus 
gonorrhoea. Schizomycetes; bacteria; bacilli. Bacillus anthracis. Bacterium. Microbacterium. 
Septic bacteria. Zymogenic bacteria. Pathogenic bacteria. Bacillus. Bacillus subtilis. Bacil- 
lus septicus. Zymogenic bacilli. Pathogenic bacilli. Bacilli of septicaemia, of typhoid fever, 
of diarrhoea, of malignant oedema, of anthrax, of tuberculosis, of oriental leprosy and other dis- 
eases as Asiatic cholera. Septic spirilla. Pathogenic spirilla. Micro-organism of relapsing fever. 
Observations of Koch, Klein and others on micro-organisms. Investigations of Prof. A. Kelsch 
on the destruction of the colored blood corpuscles by theimalarial poison. Numerical determina- 
tion of the colored blood-corpuscles in the various forms of malarial fever. Morbific ferments. 
Relations of bacteria to putrefaction. Theory of the author as to the origin and production of 
malarial fever. General conclusions drawn from the preceding observations on the constitution 
and changes of the blood in malarial fever. Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
277 
The institution and execution of such investigations and chemical and 
microscopical examinations of the blood in various diseases as will furnish 
the necessary data for careful comparisons, comprehension, generalizations, 
and. practical therapeutic conclusions, involve the expenditure of much 
time and labor ; we will, therefore, present only a few fragments of our 
incomplete labors in this vast and intricate field of pathological research. 
ANALYSES OF THE BLOOD IN DIABETES MELLITUS AND MALARIAL FEVER; 
REPORTS OF CASES ILLUSTRATING THE PHENOMENA OF DIABETES 
MELLITUS AND MALARIAL FEVER, WITH ORIGINAL INVESTIGATIONS 
AND PRACTICAL OBSERVATIONS ON THE DIGESTION OF ALBUMEN AND 
FLESH AND OLEAGENOUS MATTERS AND THE COMPARATIVE ANATOMY 
AND PHYSIOLOGY OF THE PANCREAS. 
The following observations were made in 1855, 1856 and 1857 ; the 
pathological observations were made in the last named year. 
COMPARISON OF THE CHANGES OF THE BLOOD IN VARIOUS DISEASES. 
Case No. 847. Irish laborer, entered the Savannah Marine Hospital 
and Poor House, July 17th, 1857; age 24; height 5 feet 7 inches ; light hair, 
blue eyes, scanty reddish yellow whiskers; greatly emaciated-arms and 
legs resemble those of a skeleton; ankles cedematous. Weight, in health, 
140 pounds; now, it cannot be more than 90 pounds. Complained of con- 
tinued pain in his head and bones, loss of strength, a voracious appetite, 
insatiable thirst, disordered digestion and a continued and exhausting 
diarrhoea. Hml no fever and no enlargement of liver or spleen. Upon 
physical exploration the action of the heart and lungs appeared to be nor- 
mal. The attempt was made to arrest the diarrhoea. Hope's mixture pro- 
duced a temporary effect, but did not arrest the waste of tissue. Opium, 
chalk mixture, and the usual, remedies for diarrhoea were administered. 
They checked the diarrhoea temporarily, but did not arrest the waste of 
tissue and loss of muscular and nervous force. His diet was strictly 
guarded. It was found that the greater portion of the meat which he ate 
passed entirely through the alimentary canal and was voided in the form 
of foetid undigested masses. 
The patient was placed upon farinaceous diet-arrow-root, rice, and 
boiled milk and rice. Under this regimen, the stools became less numer- 
ous, and improved in appearance, but the destruction of tissue and loss of 
power was not arrested. External applications had no effect whatever 
upon the pain in his head and limbs. Strychnia, in small doses, failed to 
strengthen his digestive apparatus and nervous system. This treatment 
was continued for three weeks, and during this time his progress was 
steadily downwards. His tissues continued to waste away, and his strength 
every day grew less. 
DIABETES MELLITUS: HISTORY OF CASE ; ANALYSIS OF BLOOD*. 
August 7 th. Pulse 70. 
Respiration 19. 
Temperature of atmosphere, 81°F. 
hand, 961° 
li under tongue, 100° 
August 8th. Pulse 64. 
Respiration 18. 
Temperature of atmosphere, 81°F. 
" hand, 971° 
" under tongue, 100° 
Examination of urine.-Reaction slightly acid. 
Specific gravity 1040. 
* Case of Diabetes Mellitus treated by Joseph Jones, A. M., M. D., Professor of Physicsand 
Natural Philosophy in the University of Georgia, Athens; Professor of Chemistry and Pharmacy 
in ihe Medical College of Georgia, Augusta; formerly Professor of Chemistry in the Medical 
College of Savannah. From the Southern Medical and Surgical Journal, Augusta, Ga., May, 1858. 278 
Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
Of a light straw color, clear limpid, resembling the urine of a female 
suffering with hysteria. The resemblance extended only to the color and 
amount passed. The high specific gravity of the urine of this patient, at 
once distinguished it from the abundant light colored urine often passed 
by hysterical females. The amount of urine passed by this patient during 
the twenty-four hours varied from one to one and a half gallons-an enor- 
mous quantity, considering his reduced state, and the large amount of 
solid matters held in solution in the urine. Trommer's, Moore's, and the 
fermentation tests and the rapid formation of the Torula Cerevisise, gave 
unequivocal evidence of the presence of grape sugar in large amount. 
Chemical analysis showed that the specific gravity of the urine was due, in 
great measure, to the large amount of grape sugar which it held in solu- 
tion. 
Examination of blood.-Specific gravity of blood, 1043.2 
Specific gravity of serum, 1022.2 
Coagulation of the blood commenced in a few minutes after it was drawn, 
and the clot was firm. 
Under the microscope, the colored corpuscles were normal in color 
and form. They had a great tendency to stick together and form rolls, as 
in the blood of inflammation, and in the blood of the horse. This phe- 
nomenon resembled, in all respects, that which occurs in well marked 
cases of inflammation. The colorless corpuscles appeared to be deficient 
in numbers. Serum of a light straw color. When the serum was mixed 
with an equal quantity of water, and treated with a few drops of hydro- 
chloric acid, sufficient to neutralize its alkaline reaction, no coagulation 
took place, even after prolonged boiling. Nitric acid produced prompt 
coagulation of the albumen of the serum. 
WATER. 
In 1000 parts of blood 838.510 
In 1000 parts of serum 922.341 
(1) In 1000 parts of liquor san- 
guinis 919.039 
(2) In 1000 parts of liquor san- 
guinis 887.339 
SOLID MATTERS 
In 1000 parts of blood 161.490 
In 1000 parts of serum 77.659 
(1) In 1000 parts of liquor sangui- 
nis 80.961 
(2) In 1000 parts of liquor sangui- 
. nis 112.661 
FIXED SALINE CONSTITUENTS 
In 1000 parts of blood 9.061 
In 1000 parts of serum 5.319 
(D In 1000 parts of liquor sanguinis 5,325 
(2) In 1000 parts of liquor sanguinis 7.181 
In blood-corpuscles of 1000 parts of blood 4.443 
In 1000 parts of dried blood-corpuscles 47.916 
In 1000 parts of moist blood-corpuscles 11.981 
In 1000 parts of dried residue of blood 56.108 
In 1000 parts of dried residue of serum 68.488 
(1) In 1000 parts of dried residue of liquor sanguinis 68.493 
(2) In 1000 parts of dried residue of liquor sanguinis 63.739 
In solid matters of serum of 1000 parts of blood 4.519 
1000 PARTS OF BLOOD CONTAINED 
Water 838.510 
Dried organic matters 88.259 
Fixed saline constituents 4.443 
Dried blood-corpuscles 92.702 
Fibrin 2.806 
Albumen 49.539 
$ Dried organic matters 48.157 
I Fixed saline constituents 1.382 
Extractive matters 16.003 
Dried organic matters 12.866 
Fixed saline constituents 3.137 Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
279 
1000 PARTS OF BLOOD CONTAINED 
Water 278.106 
Dried organic residue 88.259 
Fixed saline constituents 4.443 
Moist blood-corpuscles 370.808 
Water 560.404 
Albumen, 
Dried organic residue 48.157 
Fixed saline constituents 1.382 
Liquor 
Sanguinis.... 629.192 
Extractive and 
coloring matters, 
Dried organic matters 12.866 
Fixed saline constituents 3.137 
Fibrin 2.806 
Water 750.001 
Dried organic matters 238.018 
Fixed saline constituents 11.981 
1000 PARTS OF MOIST BLOOD-CORPUSCLES CONTAINED 
Water 919.039 
(1) 1000 PARTS OF LIQUOR SANGUINIS CONTAINED 
Albumen 59.737 
Organic residue 58.110 
. Fixed saline constituents 1.620 
Extractive and coloring matters 17.345 
Organic residue 13.670 
Fixed saline constituents 3.682 
Fibrin 3.302 
(2) 1000 PARTS OF LIQUOR SANGUINIS CONTAINED 
Water 886.740 
Albumen 78.733 
Organic residue 76.537 
Fixed saline constituents 2.196 
Organic residue 24.484 
Fixed saline constituents 4.985 
Extractive and coloring matters 29.469 
Fibrin 4.459 
The method of analysis employed in these investigations has been 
described by the author1 in his Inaugural Dissertation for the degree of 
M. D. in the University of Pennsylvania, and in his Chemical'2 and Phy- 
siological Investigations, published by the Smithsonian Institution, and is 
similar in many respects to that employed by MM. Becquerel3 and 
Rodier, Bowman,4 and others.5 
If we carefully compare the analysis of the blood of our patient with 
analyses of normal human blood, we will find: 
1. The specific gravities of the blood and serum are much lower than 
the normal standard. 
2. The colored corpuscles are diminished in numbers, the dried cor- 
puscles being only 92.702, and the moist blood-corpuscles 370.808, whilst 
in health the dried corpuscles generally average 135.000 and the moist 
corpuscles 540.000. 
3. The albumen of the liquor sanguinis is much less than normal, 
being only 49.539 in the 1000 paits of blood, whilst in health, it ranges 
from 70 to 90. 
4. The extractive and coloring matters are 12.866, and are greater in 
amount than normal. When we compare the extractive matters with the 
1 Physical, Chemical and Physiological Investigations, upon the Vital Phenomena, Struc- 
ture, and Offices of the Solids and Fluids of Animals. By Joseph Jones. (American Journal of 
Medical Sciences, July, 1856. p. 46.) 
2 Investigations, Chemical and Physiological, relative to certain American Vertebrata. By 
Jos. Jones. Smithsonian Contributions to Knowledge. 1856. 
3 Pathological Chemistry, by MM. Becquerel and Rodier. Translated by S. T. Speer, M. 1). 
London : 1867, p, 19, et seq. 
4 Bowman's Medical Chemistry, pp. 145-194. Philadelphia: 1850. 
5 Simon's Chemistry of Man, p 142. Philadelphia: 1846. Lehmann's Physiological Chem- 
istry. Translated by G. K. Day. Cavendish Society pub vol. ii, pp. 153-2*0. London: 1851-1854. 
See also American ed., edited by Prof. Rogers, vol. 1, pp. 541-618. Manuals of Blood and Urine. 
By Griffith Reese and Marwick. Philadelphia: 1848. 280 
Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
diminished albumen and blood-corpuscles, it is evident that they are far 
mere abundant than normal. 
5. The fixed saline constituents are normal in amount as compared 
with normal blood, but increased when compared with the diminished 
albumen and blood-corpuscles. 
It is important that we should, in the next place, compare the blood 
of this patient, reduced in flesh and strength to the last degree, with the 
blood of individuals whose blood has been depraved, aud forces exhausted 
by other diseases. The following examples are selected from numerous 
analyses of the blood of patients suffering with malarial fever, which I 
conducted in the Savannah Marine Hospital and Poor House, during the 
summer and fall of 1857: 
Case 848. Intermittent Fever, neglected.-Irish laborer, entered the 
Savannah Poor House September 23d; age 22; height 5 feet 8 inches. Had 
been, working in the marshes along the Savannah river, and suffered with 
chill aud fever for two months, during which time he had no medical attend- 
ance. Complexion sallow; tongue, lips and gums pale; digestion impaired. 
Complains of great weakness. Flesh not much reduced, but feels soft and 
unnatural. 
Examination of Blood.-Blood watery in appearance-coagulated slowly 
in 30 minutes. Reaction decidedly alkaline. In the specific gravity bottle 
filled with blood, the colored corpuscles gravitated towards the bottom and 
left above a light yellow transparent clot. After standing 20 hours, the 
clot had contracted but little, and its consistency was very weak. Serum 
of a light yellow color. 
Specific gravity of blood . 1030.5 
Specific gravity or serum 1021.3 
WATER 
In 1000 parts of blood 877.553 
In 1000 parts of serum 927.757 
(1) In 1000 parts of liquor san- 
guinis 925.725 
(2) Tn 1000 parts of liquor san- 
guinis 911.124 
SOLID MATTERS 
In 1000 parts of blood.........122.447 
In 1000 parts of serum 72.243 
(1) In 1000 parts of liquor san- 
guinis 74.275 
(2) In 1000 parts of liquor san- 
guinis 88.876 
In serum of 1000 parts of 
blood 68.435 
In 1000 parts of blood 3.316 
In 1000 parts of serum 3.326 
(1) In 1000 parts of liquor sanguinis 3.328 
(2) In 1000 parts of liquor sanguinis 3.965 
In serum of 1000 parts of blood 3.141 
In 1000 parts of the solid matters of blood 27.083 
In 1000 parts of the solid matters of serum 45.901 
In 1000 parts of the solid matters of blood-corpuscles 3.240 
'1) In 1000 parts of the solid matters of liquor sanguinis 44.779 
(2) In 1000 parts of the solid matters of liquor sanguinis 44.612 
In blood corpuscles of 1000 parts of blood. 0.175 
In 1000 parts of moist blood-corpuscles 0.841 
FIXED SALINE CONSTITUENTS 
Water 877.553 
1000 PARTS OF BLOOD CONTAINED 
Dried blood-corpuscles 51.987 
Dried organic residue 51.812 
Fixed saline constituents 0.175 
Albumen and extractive and col- 
oring matters 68.335 
Fibrin 1.925 
Dried organic residue 65.194 
Fixed saline constituents 3.141 Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
281 
1000 PARTS OF BLOOD CONTAINED 
Water 155.861 
Organic residue 51.812 
Fixed saline constituents 0.175 
Moist blood-corpuscles 207.94S 
p Water 721.692 
I Albumen and extractive and col- 
oring matters 65.194 
| Fixed saline constituents 3.141 
t Fibrin 1.925 
Liquor sanguinis 792.052 
1000 PARTS OF MOIST BL JOD-CORPUSCLES CONTAINED 
Water 749.519 
Dried organic matters 249.154 
Fixed saline constituents 0.841 
(1) 1000 PARTS LIQUOR SANGUINIS CONTAINED 
Water 925.725 
Albumen, extractive and coloring matters 68.817 
Fibrin 2.032 
Fixed saline constituents 3.326 
(2) 1000 PARTS LIQUOR SANGUINIS CONTAINED 
Water 911.167 
Albumen, extractive and coloring matters 82.312 
Fibrin 3.965 
Fixed saline constituents 2.430 
The urine of the patient was of low specific gravity, diminished in 
amount, aud contained no grape sugar. 
Case 849. Intermittent fever, neglected-terminating in bilious remit- 
tent fever, and apparent alteration of the chemical constitution of the blood and 
tissues. German butcher, entered the Savannah Poor House September 25th; 
age 23 ; height 5 feet 10 inches; weight, in health, 180 lbs. His present 
weight cannot be more than 110 lbs. Has been suffering from chill and 
fever for two months, and has had no medical attendance. Sallow, anae- 
mic complexion ; flesh and strength greatly reduced ; nervous and muscu- 
lar forces very feeble. Was brought into the hospital in a comatose state. 
Stimulants, sinapisms, cut-cups to the temples and back of neck, and 
blisters to the epigastrium and back of neck, aroused him from this coma- 
tose condition. A few days after his entrance into the hospital, a large 
abscess formed upon the side of his head, in the region of the ear, and 
joint and angle of the inferior maxillary bone. Notwithstanding that this 
abscess was lanced, the pus formed an entrance into the external meatus 
auditorius. Large masses of the cellular tissue and muscles sloughed 
away, aud the angle and superior portion of the inferior maxillary bone 
were almost completely stripped of flesh. The abscess compelled him to 
lie upon the opposite side of his body, and the arm upon which the weight 
of the body rested swelled enormously, until it appeared to be ready to 
burst, and finally the skin over the biceps muscle changed to a black color, 
and sloughed off in a single night, leaving the red quivering muscles 
entirely exposed. The biceps muscle sloughed entirely off from its lower 
attachment. Large ulcers appeared in various parts of his body. The 
patient lingered, supported by tonics, nutritive diet and stimulants, for 
three weeks, After death, his liver presented a color a shade lighter than 
the slate color of the malarial fever liver, and in many partsit was regain- 
ing its normal hue. The spleen was enlarged and in many parts com- 
pletely degenerated in structure, being converted into pus and a substance 
resembling cheese. The surface of the spleen was covered with effused coag- 
ulable lymph, and bound to the liver by bands of coagulable lymph. The 282 
Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
border next to the liver contained an abscess about the size of a walnut, 
filled with pus. The whole substance of the spleen was consolidated, and 
those portions which were not degenerated, resembled, when cut, the liver 
of malarial fever. The stomach showed the marks of chronic inflamma- 
tion. The glands of Peyer, in the lower portion of the intestinal canal, 
were enlarged, but pale, and not more congested with blood than usual. 
Examination of the blood of this patient four days after his entrance into 
the hospital.-Blood coagulated slowly. In one specimen, the coagulation 
was remarkably slow, and the blood-corpuscles gravitated towards the bot- 
tom of the vessel and left above a clear, golden colored clot. This trans- 
parent portion of the clot was about one-quarter of an inch in thickness. 
Serum of a deep golden color. Reaction of serum, alkaline. 
Specific gravity of blood 1036.6 
Specific gravity of serum 1023.6 
WATER 
In 1000 parts of blood 840.511 
In 1000 parts of serum 913.950 
(l)In 1000 parts of liquor san- 
guinis 912.665 
(2) In 1000 parts of liquor san- 
guinis 882.723 
SOLID MATTERS 
In 1000 parts of blood .159.489 
In 1000 parts of serum 86.050 
(1) In 1000 parts of liquor san- 
guinis 86.978 
(2) In 1000 parts of liquor san- 
guinis 117.277 
Solid matters of serum of 1000 parts 
of blood 79.135 
FIXED SALINE CONSTITUENTS 
In 1000 parts of blood 5.796 
In 1000 parts of serum 2.647 
(D In 1000 parts of liquor sanguinis 2.658 
(2) In 1000 parts of liquor sanguinis 3.498 
In 1000 parts of solid matters of blood 36.341 
In 1000 parts of solid matters of serum 30.178 
(1) In 1000 parts of solid matters of liquor sanguinis 30.205 
(2) In 1000 parts of solid matters of liquor sanguinis 29.850 
In 1000 parts of solid matters of blood-corpuscles 42.914 
In 1000 parts of moist blood-corpuscles 10.728 
In blood-corpuscles of 1000 parts of blood 3.409 
In serum of 1000 parts of blood 2.387 
1000 PARTS OF BLOOD CONTAINED 
Dried blood-corpuscles 79.437 
Water 840.511 
Dried organic residue 76.028 
Fixed saline constituents 3.409 
Fibrin 0.877 
Albumen, extractive and coloring 
matters 79.096 
Dried organic residue 76.708 
Fixed saline constituents 2.387 
1000 PARTS OF BLOOD CONTAINED 
Water 238.271 
Dried organic residue 76.028 
Fixed saline constituents 3.409 
Moist blood-corpuscles 317.748 
Liquor sanguinis 682.252 
Water 602.240 
Dried organic residue 76.708 
.Fixed saline constituents 2.387 
Fibrin 0.877 
1000 PARTS OF MOIST BLOOD-CORPUSCLES CONTAINED 
Water 749.873 
Dried organic residue 239.284 
Fixed saline constituents 10.728 
(1) 1000 PARTS OF LIQUOR SANGUINIS CONTAINED 
Water 913.022 
Albumen, extractive and coloring matters 83.303 
Fixed saline constituents .- 2.647 
Fibrin 0.928 Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
283 
Water 882.723 
Albumen, extractive and coloring matters 112.433 
Fixed saline constituents 3.498 
Fibrin ' 1.285 
(2) 1000 PARTS OF LIQUOR SANGUINIS CONTAINED 
Case 850. Bilious Remittent Fever. -American seaman, native of Bos- 
ton, entered the Savannah Marine Hospital September 26th; age 21; weight 
150 lbs.; height 5 feet 10 inches. Muscular system moderately well devel- 
oped. This is his first trip to Savannah. Has been sleeping at night on 
the deck of the ship in the open air. ^The captain compelled all his men 
to sleep on board the ship, which was lying along the low marshy shore 
below the city. This patient was brought in comatose, and has been pass- 
ing his urine and fceces in bed. 
September 29th. Lies in a stupor; complexion sallow; teeth coated 
with sordes; tongue perfectly dry and as rough to the feeling as the sur- 
face of a newly-sawed board. Pulse 120; respiration 22. 
Examination of Blood. Blood coagulated slowly. Serum of a deep 
golden color. Nitric acid showed that this color was due to the presence 
of bile. Reaction of serum, alkaline. 
Specific gravity of blood 1040 
Specific gravity of serum 1022 
WATER 
In 1000 parts of blood 833.449 
In 1000 parts of serum 912.386 
(1) In 1000 parts of liquor san- 
guinis 910.798 
(2) In 1000 parts of liquor san- 
guinis 875.813 
SOLID MATTERS 
In 1000 parts of blood 166.551 
In 1000 parts of serum 87.614 
(1) In 1000 parts of liquor san- 
guinis 89.203 
(2) In 1000 parts of liquor san- 
guinis 124.187 
In serum of 1000 parts of 
blood 80.033 
In 1000 parts of blood 6 314 
In 1000 parts of serum 6.620 
(1) In 1000 parts of liquor sanguinis 6.630 
(2) In 1000 parts of liquor sanguinis 8.759 
In 1000 parts of dried blood-corpuscles 6.595 
In 1000 parts of moist blood-corpuscles ' 1.648 
In 1000 parts of dried residue of blood 37.909 
In 1000 parts of dried residue of serum 75.558 
In serum of 1000 parts of blood 5.747 
FIXED SALINE CONSTITUENTS. 
Water 833.449 
1000 PARTS OF BLOOD CONTAINED 
Dried blood-corpuscles 8-5.968 
Fibrin 1.450 
Dried organic residue 84.400 
Fixed saline constituents 0.567 
Albumen, extractive and coloring 
matters 80.033 
Dried organic residue 74.186 
Fixed saline constituents 5.717 
1000 PARTS OF BLOOD CONTAINED 
Moist blood-corpuscles 343.872 
Water 258.804 
Dried organic residue 84.400 
Fixed saline constituents 0.567 
Water 574.646 
Albumen, extractive and coloring 
matters 74.185 
Fixed saline constituents 5.747 
Fibrin 1.450 
Liq nor sangu i n is 6-56.128 284 
Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
Water 752.646 
Dried organic residue 245.239 
Fixed saline constituents 1.648 
1000 PARTS OF MOIST BLOOD-CORPUSCLES CONTAINED 
Water 910.797 
Albumen, extractive and coloring matters 80.996 
Fixed saline constituents 1.587 
Fibrin 6.620 
(1) 1000 PARTS OF LIQUOR SANGUINIS CONTAINED 
(2) 1000 PARTS OK LIQUOR SANGUINIS CONTAINED 
Water.... 875.813 
Albumen, extractive and coloring matters 113.064 
Fixed saline constituents 8.758 
Fibrin 2.209 
Under the use of stimulants, sulphate of quinia, and nutritious diet, 
this patient recovered slowly. He was confined to his bed three weeks, and 
at the end of this time exhibited the effects of the bilious remittent fever, 
in his pale, sallow, anaemic countenance, pale lips and gums, and tottering 
gait. The violent nature of the malarial fever, contracted by sleeping in 
the open air in the low marshy land bordering our fresh water rivers, is 
forcibly illustrated by the subsequent history of the crew to which this 
patient belonged. 
A lew days after his admission into the hospital, the captain weighed 
anchor and sailed for New York. Before getting well out to sea, himself 
and the whole of his crew were taken sick. There was not a man with 
strength to work a pump or furl a sail. Fortunately a small vessel per- 
ceived their signals of distress, and towed them into Darien. Before reach- 
ing this port the captain and five out of seven of the crew had died. There 
were but two remaining out of eight, and these were extremely ill. If we 
compare the blood of these cases with that of health, and with the blood 
of the patient suffering with diabetes mellitus, we will observe the follow- 
ing points of agreement and disagreement: 
1. The colored blood-corpuscles are diminished greatly and rapidly 
in malarial fever. This destruction of the colored blood-corpuscles is far 
more rapid in malarial fever than in diabetes mellitus. 
2. The salts of the colored blood-corpuscles are diminished to a 
remarkable extent in malarial fever-whilst they are normal in amount in 
the blood of diabetes mellitus. 
3. The blood coagulates slowly, and the clot is soft, in malarial fevers 
-whilst the reverse was the case in this specimen of diabetic blood. 
4. The fibrin is often diminished in malarial fever, and the serum 
presents a golden color-whilst in this case of diabetes mellitus the fibrin 
was slightly increased and the color of the serum was normal. That the 
poison of malarial fever induces profound changes in the colored blood- 
corpuscles, and other constituents of the blood, I have demonstrated by 
the following facts : 
(a.) The urine of patients suffering with malarial fever contains an 
increased quantity of iron. The increase of the iron in the urine is subse- 
quent to the destruction of the colored corpuscles in the blood. 
(b.) In examinations of the organs after death, from all the forms of 
malarial fever-intermittent, remittent and congestive-I have observed 
that the dark blood of the spleen and liver does not change to the arterial 
hue when exposed to the action of the oxygen of the atmosphere. After 
death from phthisis, cirrhosis of the liver, organic disease of the circula- 
tory apparatus, and apoplexy, and mechanical injuries, as far as my obser- Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
285 
vations extend, the blood of the spleen and liver always change to the 
arterial hue when exposed to the action of the oxygen of the atmosphere. 
(c.) Animal starch accumulates in the malarial fever liver-whilst 
grape sugar, as far as my observations extend, is absent. I have tested 
the livers of malarial fever for grape sugar and starch. An abundance of 
starch* was obtained, without a trace of grape sugar. The livers were set 
aside, and examined after intervals of twelve hours. The last examination 
was made thirty-six hours after the first. At every examination the result 
was the same-an abundance 01 animal starch, and no grape sugar. These 
facts are important, not only in their bearing upon malarial fever, but also 
in their bearing upon diabetes mellitus. M. Cl. Bernardf has demonstrated 
that the transformation of glycogenic hepatic matter (animal starch) formed 
by the liver, into glucose, is the result of the action of a special ferment, 
which is formed and exists in the blood, independent of the liver. From 
the facts which we have previously stated, it is evident that in malarial 
fever this ferment is destroyed, whilst the liver still possesses the power of 
transforming the nitrogenized and non-nitrogenized elements into animal 
starch. We have now facts sufficient to draw important distinctions 
between malarial fever and diabetes mellitus. In both diseases, the blood- 
corpuscles may be greatly diminished. In both diseases the nervous and 
muscular forces may be correspondingly diminished. Here the analogy 
ceases. The destruction of the colored corpuscles is rapid in severe types 
of malarial fever, and slow in all the forms of diabetes mellitus. The salts 
of the blood-corpuscles are normal, if not increased in this case of diabetes 
mellitus, whilst they are greatly diminished in malarial fever. In mala- 
rial fever, the blood loses its power of changing its color in the spleen and 
liver. In malarial fever, the color of the liver and the character of the 
bile is altered, and the spleen is enlarged, softened and filled with a pur- 
plish brown mud. In diabetes mellitus, all the organs are normal in 
appearance. In malarial fever, the blood has lost its power of converting 
animal starch into glucose. In diabetes mellitus this power is greatly 
increased. The following table affords a comparison of normal, diabetic 
and malarial blood : 
- 
Normal 
Normal 
Diabetic 
Malarial 
Malarial 
Malarial 
blood 
blood 
blood 
blood 
blood 
blood 
Solid matters in 1000 parts of blood 
200.000 
240.000 
161.490 
122.447 
159.489 
166.551 
Solid matters in 1000 parts of liquor san- 
guinis 
100.000 
120 000 
80.961 
74.275 
86.978 
89.203 
Dried blood-corpuscles in 1000 parts of 
blood 
120.000 
150.000 
92.702 
51.987 
79.437 
85.968 
Moist blood-corpuscles in 1000 parts of 
blood 
180.000 
000.000 
370.8(18 
207.948 
317.748 
343.872 
Liquor sanguinis in 1000 parts of blood... 
Fibrin In 1000 parts of blood 
400.000 
2.000 
520.000 
3.500 
629.192 
2.806 
792.052 
1.925 
682.252 
0.877 
656.128 
1.450 
Fixed saline constituents in 1000 parts of 
moist blood-corpuscles 
8.120 
10,500 
11.981 
0.841 
10.728 
1.648 
Fixed saline constituents in lOOo parts of 
dried blood-corpuscles 
65.000 
70.000 
49.916 
3.240 
42.914 
6.595 
Fixed saline constituents in 1000 parts of 
dried blood 
70.000 
80.000 
56.108 
27.083 
36.341 
37.909 
Fixed saline constituents in 1000 parts of 
solid matters of liquor sanguinis 
Fixed saline constituents in 100() parts of 
88.053 
95.000 
68.488 
44.779 
30.205 
75.558 
liquor sanguinis 
8.550 
10.100 
5.320 
3.326 
2.647 
6.630 
*So abundant, is this animal starch in the malarial fever liver, that if a small particle of the 
substance of the liver be mashed upon a glass slide, treated with a saturated solution of iodine in 
alcohol, and viewed under the microscope, numerous beautiful blue masses of this animal starch, 
colored by the iodine, will be seen. If the fibrous capsule be torn off from the suface of the liver, 
spread upon a glass slide, and treated withtincture of iodine, these blue masses will be seen 
scattered amongst the meshes of the fibrous tissue. With reference to the discovery of animal 
starch, see American Journal of Medical Sciences, Oct., 1857, p. 549. 
fMoniteur des Hopitaux, April 14, 1857; also, American Journal of Medical Sciences, July, 
1857, p. 203. 286 
Analyses of the Blood in Diabetes Mellitus and Malarial Fever. 
We have now all the necessary facts for the intelligent treatment of 
this case. The indications in the treatment of this case of diabetes melli- 
tus are - 
(1.) To strengthen digestion. His stomach fails to digest the nitro- 
genized elements-the very substances which he needs to supply the rapid 
waste of his tissues. 
(2.) To afford the organic and inorganic materials of structure. 
(3.) To quiet and strengthen the nervous system. 
(4.) To arrest the destruction and transformation of the elements of 
the blood, tissues and food, into animal starch and grape sugar. 
(1.) To Strengthen Digestion.-Meat passed entirely through the alimen- 
tary canal, without being digested. This is clear evidence that the gastric 
and pancreatic juices do not perform their offices. The active and essential 
principle of the gastric juice being pepsin, this must first be supplied. 
If pepsin and an acid be supplied, digestion will take place in a weak, 
diseased stomach, as well as in a healthy stomach. The fourth stomach 
of ruminants (rennet bag) is generally recommended as a source of pepsin. 
In hospital practice, however, I preferred to employ the stomach of the pig, 
for two reasons: the pig is an omniverous animal. Its food and digestive 
process resembles more nearly that of man, and consequently its gastric juice 
must be better adapted to his wants. For hospital purposes the stomach 
of the pig can be much more readily obtained and prepared than that of 
the cow or sheep. When pepsin can be obtained pure from the apotheca- 
ries, or when the physician has time to prepare it himself, the poudres 
nutrimentives of Corvisart is by far the most elegant and portable prep- 
aration. 
R. Cut a pig's stomach into thin slices and pour upon it one pint of 
vinegar, and preserve from decomposition (if the weather be warm) by sur- 
rounding with ice. The pepsin and vinegar will reduce the tissues of the 
stomach to a uniform mass, or rather fluid. Dose, f §j three times a day, 
mixed with cold mutton or beef soup. This preparation is useful for hospital 
purposes, because it is easily prepared and at the same time is more effica- 
cious than the pepsin ordinarily sold in the shops. Chambers and others 
have shown that much of the pepsin now sold, possesses but feeble trans- 
forming powers. Pepsin is not the only substance concerned in the diges- 
tion of albuminoid substances. The connective tissues and muscular 
fibres are disintegrated and softened, but never completely dissolved by 
the gastric juice. The ultimate fibrilla? of muscles which have escaped 
the action of the gastric juice pass into the small intestines, and are there 
digested by the pancreatic juice. M. L. Corvisart communicated to the 
Imperial Academy of Sciences, April 6th, 1857, a Memoir on the Power 
of the Pancreas to Digest Azotized Food, in which he confirmed the asser- 
tion of Purkinge and Pappenheim, that the secretion of the pancreas is 
endowed, like the gastric juice, with the property of dissolving azotized 
food, and demonstrated that the pancreatic juice, in disintegrating albu- 
menoid elements, effects in them a transformation identical or analogous 
to that which the stomach produces. 
The pancreatic juice acts only on those portions of the food which 
have escaped the action of the gastric juice, and at the same time it has no 
effect upon the digested products of the stomach. When separated, the 
pancreatic and gastric fluids exercise their functions in full, and when 
mingled in their pure state, the two digestions are arrested. The two 
ferments, pepsin and pancreatine, destroy each other. In the alimentary- 
canal, this is prevented. 1st, by the pylorous which separates the two fer- 
ments. 2d, by the gastric digestion, during which the pepsin is destroyed. Treatment of Diabetes Mellitus. 
287 
-3d, by the bile, which destroys in its course the activity of the pancrea- 
tine. It is evident, therefore, that the pancreatine, or pancreatic juice, 
so far from assisting digestion, would retard it. M. L. Corvisart states 
that he had failed to receive any benefit from the administration of pan- 
creatine for the relief of derangement of the digestion in the intestinal 
canal. In this case of diabetes mellitus, I employed a preparation of the 
pancreas of the pig, prepared in the same manner with the stomach. No 
beneficial results were produced, and it was abandoned and the pepsin 
retained. 
(2.) To afford the organic and inorganic materials of structure. As 
usual in the treatment of diabetes mellitus, the patient was furnished 
principally with animal food-eggs, mutton, beef, etc. Bread and rice 
were allowed more frequently, however, than in the practice laid down in 
the books. 
R. Phosphate of iron grs. ij. 
44 44 lime 44 iv. 
4 4 4 4 soda 44 vi. 
4 4 4 4 potassa 44 iv. 
Mix and administer three times during the day, in the soup containing 
the pepsin. These salts were given because they form important con- 
stituents of the blood-corpuscles, muscles and brain, and nervous system. 
R. Cod-liver oil, tablespoonful three times a day. Cod-liver oil is 
indicated in the treatment of diabetes mellitus for two reasons: to supply 
the fatty matters which have been consumed. There is a close connection 
between phthisis and diabetes. Writers upon this disease state that, in 
the majority of cases, phthisis makes its appearance before death. 
(3.) To strengthen and quiet the nervous system. The depressed 
spirits, fretful, peevish temper, impaired memory and intelligence, loss of 
sexual propensity, and complete exhaustion of nervous power, call for 
those remedies which will act both as tonics and sedatives to the nervous 
system. To accomplish these objects, opium and strychnia should be 
given simultaneously. 
R. Strychnia grs. ij. 
Extract of gentian 44 $ij. 
Mix and divide into 100 pills; one pill three times a day, to be gradually 
increased, according to the strength of the patient and effects upon the 
nervous system. Strychnia not only exerts a tonic influence upon the 
digestive organs, and muscular and nervous systems, but also exerts a 
direct influence in diminishing the amount of sugar formed. 
R. One grain of opium at bed-time, and one grain in the morning, at 
9 o'clock. 
Opium quiets the nervous irritability of the patient and controls the 
diuretic influence of the sugar in the blood. It checks the excessive 
discharge, but does not prevent the production of sugar. Nevertheless, 
its action upon the nervous system renders it one of the most valuable of 
the secondary means. As a stimulant and tonic to the digestive organs, 
f §ij of brandy were administered, three times a day, in a cup of the officinal 
effusion of quassia and soda. 
August 10th. Pulse, 74. Temperature of atmosphere, 88° F. Tem- 
perature under tongue, 98°. 
August 11th. Pulse, 78. Temperature of atmosphere, 81° F. Res- 
piration, 16. Temperature under tongue, 994°. 
August 12th. Slight improvement of digestion. Bowels are not 
moved so frequently. He is exceedingly weak, and complains of pain in 
his head and bones. 288 
Treatment of Diabetes Mellitus. 
August 19th. Complains of great weakness ami thirst; is in a profuse 
perspiration ; says that his digestion improves, but his strength does not 
increase. The brandy causes him to sleep and perspire too freely, and is 
probably the cause of the increased flow of the urine and loss of strength. 
The experiment of George Harley, M. D.,* and M. Bernard,f have 
demonstrated that alcohol, ether, chloroform, methylated spirit, and 
ammonia, introduced into the duodenum, or injected directly into the por- 
tal vein, will excite an increased secretion of sugar. Healthy animals thus 
operated on were rendered for a time diabetic. This fact is important, 
not only in the treatment, but also in its bearing upon the causes of> dia- 
betes mellitus. Drunkards are said to be peculiarly liable to this dis- 
ease. Pulse 84; respiration 17; temperature of atmosphere, 90°F., tempera- 
ture under tongue, 104°. 
The acceleration of the pulse may be due to the action of the alcoholic 
stimulants. We will discontinue the brandy and substitute 10 grains of 
carbonate of ammonia, three times a day, in a cup of the infusion of quas- 
sia and soda. The carbonate of ammonia is administered, first, as a stimu- 
lant, and second, as a means of diminishing the amount of grape sugar. 
Some chemists! have supposed that the occurrence of alkaline carbonates is 
necessary for the decomposition of sugar in the animal economy, and that 
in diabetes the passage of glucose into the urine is due to a want of alkalin- 
ity in the blood. Direct experiment does not support this theory, for the 
researches of C. G. Lehmann,§ Bouchardat and Bernard] |, have proved on 
the contrary, that the blood of diabetic persons preserves its alkalinity, 
and that the alkalies of the blood do not promote the oxidation of sugar to 
the extent asserted. Direct experiment and clinical facts, on the other 
hand, have shown that, in certain derangements of the nervous and cir- 
culatory systems and of the constituents of the blood, the production of 
grape sugar is increased, and it passes into the urine; and farther, that 
the alkaline carbonates diminish the proportion of sugar in the urine of 
diabetic patients. We may then employ the alkaline carbonates in the 
*" Contributions to the Physiology of Saccharine Urine. On the Origin and Destruction of 
Sugar in the Animal Economy, by George Harley, M. D."-British and Foreign Medico-Chir. 
Review. July, 1857, p. 144. 
t Gazette Medicale de Paris, Mai 10, No. 19,1856, and Schmidt's Jahrb., vol. xciii, 24,1857. 
t Chimie appliquOe a la Physiologie et d, la Therapeutique, Par M. Ie Docteur Mialhe, Phar- 
macien de 1'Empereur. Paris, 1856. 
In this work, Mialhe, after examining various hypotheses which have been proposed to 
explain the nature of diabetes mellitus, comes to the conclusion that its true cause is a deficiency 
of alkali in theblood. To theobject.ion that the blood of diabetic patients is never either neutral 
or acid, but always alkaline in its reaction, Mialhe answers that it is difficult to determine the 
amount of the alkalinity of the blood; and again, that part of the alkaline reaction of this fluid is 
derived from the presence of alkaline phosphates which possess no power of decomposing glucose. 
He is inclined to consider that the alkaline carbonates are deficient or absent, the phosphates 
remaining intact, thus preventing the fluid from exhibiting anything but an alkaline reaction. 
In the treatment of diabetes he acts strictly upon these indications, and prescribes lime 
water, magnesia, vichy water, bicarbonate of soda, alkaline and vapor baths, flannel, friction, 
exercise, animal diet, and sometimes sudorifles. M. Mialhe relates the case of an Italian pro- 
fessor of music, afflicted with diabetes mellitus. Under the alkaline treatment the sugar rapidly 
■diminished and the patient recovered. 
g Professor C. G Lehmann injected a solution of grape sugar, prepared from starch, into the 
veins of thirty-seven dogs and rabbits, and in every instance grape sugar appeared in the urine; 
and the reaction of the urine was acid. The sugar passed so rapidly into the urine, that it was 
frequently detected five minutes after its injection, and then when only 0.1 of a gramme was 
injected. 
Caustic, alkalies and their carbonates, associated with grage sugar, were also injected into the 
veins of rabbits. 
Notwithstanding the caustic, alkalies and the carbonates, the urine not only coniained 
grape sugar, but also exhibited an acid reaction. 
Professor Lehmann also injected dilute solutions of tartaric and citric acids into the stomachs 
of rabbits and dogs, fed on food poor in alkalies. Although the blood was thus rendered poor in 
alkalies, while at the same time vegetable acids were introduced, still not a trace ol'sugar appeared 
In the urine.-Physiological Chemistry, by Prof. C. G. Lehmann. English Ed., vol. iii, p. 233. 
American Ed., vol. ii, p. 357. 
These experiments have been repeated by Uhle, with similar results.-Dis. Inaug. Med. Lips., 
1852, p. 19. 
|| Moniteur des Hopitaux, May 14,1857. x Treatment of Diabetes Mellitus. 
289 
treatment of diabetes mellitus, although their action upon glucose in the 
animal economy is not well understood, and probably differs both in degree 
and kind from that asserted by Mialhe. 
August 20th.-Feels very weak, and complains of a pain in the region 
of his liver. Bowels are still irregular, but improving. 
Pulse 72. Temperature of atmosphere, 83°F. 
Respiration, 14. " hand, 97° 
" under tongue, 1001° 
August 26th.-Improving in strength and spirits. Digestive function 
restored. Slowly gains flesh. Digests large quantities of meat with ease. 
B.-Cane sugar §xij, during the twenty-four hours. 
Hoppe's* Investigations upon the action of cane sugar upon the ani- 
mal economy have established the following facts: 
1. No trace of grape sugar was found in the urine or foeces during 
continued feeding with cane sugar. 
2. When sugar and meat were given together, the weight of the ani- 
mal increased much more rapidly than when meat alone was given. 
3. When sugar and meat were consumed, urea was excreted in smaller 
quantity than when meat alone was taken. 
4. By exclusive sugar diet, the excretion of urea was depressed to its 
lowest' amount. 
5. By the presence of much sugar in the blood, the albuminous sub- 
stances are preserved from oxidization. The albumen thus stored up 
appears to be decomposed during the development of fat. In this manner 
sugar produces fattening, only when, at the same time, albuminous sub- 
stances are liberally supplied. 
6. The temperature of the body was not increased, by the addition of 
sugar to the allowance of meat. 
7. The health of the animals experimented on, was in no way injured 
by feeding on large quantities of cane sugar, in addition to a liberal supply 
of meat. 
September 23d. Has continued to improve steadily in health and 
strength, and is now able to walk about the hospital grounds and assist in 
nursing the patients. The amount of urine voided daily has diminished. 
October 20th. His muscular and nervous forces have increased greatly. 
His face and limbs have filled out. His spirits are excellent; and he says 
that he is now as fleshy as in health. He is able to act as assistant nurse, 
and often sits up all night with those patients who require his services. 
The amount of urine excreted daily has greatly diminished, and ranges 
from seventy to ninety fluid ounces. The grape sugar has diminished 
greatly in amount, but has not entirely disappeared. At this date I 
resigned the charge of the Savannah Marine Hospital and Poor House. It 
is evident that sufficient time had not elapsed to warrant the assertion that 
this case was cured; nevertheless, the remedies used produced decided 
beneficial effects, and were the means, in Providence, of arresting the 
disease, when the patient appeared to be in the last stages of diabetes 
mellitus, and upon the borders of the grave. I have endeavored to give a 
simple statement of the facts observed in this case, the plan of treatment 
pursued, and the reasons which led me to the adoption of this mode of 
treatment. Although this is but a single case, the treatment of which was 
not even conducted to its termination in complete health, or death, still, I 
am persuaded that, in the present state of medical science, every success- 
ful effort to arrest so formidable a disease as diabetes, even for a few 
*F. Hoppe, on the Inflence of Cane Sugar in Digestion and Nutrition. Virchow's Archiv., vol. 
x, pp. 144, S. S., 1856. 290 
Digestion of Albumen and Flesh. 
months, will be considered worthy of an examination by practitioners of 
medicine. 
I regard it of importance in a practical point of view that the results 
of my physical, physiological and anatomical investigations relative to the 
digestion of albumen and flesh should be recorded in connection with the 
preceding investigations. The administration of the proper kind of nutri- 
ments in the proper quantity, and at the proper time, is of the greatest 
importance in the treatment of fevers. Our practice in the administra- 
tion of nutriment in disease must be based upon sound physiological 
knowledge; and the neglect of the laws which govern the animal economy 
in the digestion of the various kinds of food, has been the occasion of 
more failures in the treatment of fevers than even the improper adminis- 
tration of drugs. 
DIGESTION OF ALBUMEN AND FLESH, AND THE COMPARATIVE ANATOMY 
AND PHYSIOLOGY OF THE PANCREAS.* 
The process of digestion has been the subject of numerous careful and labori- 
ous investigations, since Spallanzani first demonstrated it to be a chemico-physical 
process, and after the researches of Spallanzani, Magendi, Tiedeman, Gmelin, 
Prout, Beaumont, Mulder, Dumas, Liebig, Biondot, Bernard, Lehmann, Bidder 
and Schmidt, and many others, it seems impossible that it should still remain in 
obscurity. It has been the unanimous opinion of all physiologists, that flesh and 
the protein bodies generally were digested entirely in the stomach. Recently, 
however, this fact has been denied by physiologists of the highest authority. By 
recent experiments, Bidder and Schmidt have convinced themselves that one of 
the important offices of the intestinal juice is to dissolve and render fit for absorp- 
tion, not only starch, but also flesh ami other protein bodies. They assert that the 
intestinal juice not only metamorphoses starch with as great rapidity as saliva and 
pancreatic juice, but also, that the intestine exerts as powerful a digestive influence 
on flesh and albumen as the stomach. Frerichs, on the other hand, has been 
unable in his experiments to detect any change exerted by the intestinal juice upon 
the protein elements of the food. Protein bodies, gelatinous substances, fat and 
starch, remained unchanged, and he denies positively that the intestinal juice has 
any action as a direct digestive agent. Professor Lehmann, in a series of experi- 
ments upon the intestinal fluid collected from a loop of a gut from a human being, 
with a fistulous opening into the small intestine, found that it possessed, in a high 
degree, the power of converting starch into sugar, whilst protein bodies and fats 
were not affected in any appreciable manner. Professor Lehmann, however, 
attaches little importance to these experiments performed by himself, from the fact 
that the fistulous opening was in the lower portion of the ileum, and probably near 
the caecum. He adopts the experiments of Bidder and Schmidt, and by an argu- 
ment drawn from the amount of gastric juice secreted in a given length of time, 
and the amount of protein substances which it is capable of digesting, concludes 
that a large portion of flesh and albumen and the other protein bodies pass out of 
the stomach undigested, and are finally dissolved by the intestinal juice. 
According to Professor Lehmann, the amount of gastric fluid secreted by a dog- 
in twenty-four hours, equals one-tenth the weight of the whole body. 100 grains 
of recent gastric juice are capable of dissolving from three to five grains of coagu- 
lated albumen. A dog needs daily, for the perfect maintenance of all the physio- 
logical functions, 50 grains of flesh (containing 10 grains of albuminates) for every 
1,000 grains of its weight. It secretes, however, only 100 grains of gastric juice for 
every 1,000 grains of its weight, only one-half the amount capable of dissolving 
the albuminates of the flesh. Hence, a large portion of the protein bodies must 
pass out of the stomach undigested. Careful experiments have shown that the 
gastric juice is deprived, in the duodenum, of its free acid, and with it of its power 
of digestion, by the bile and pancreatic fluid. Hence, other fluids must flow into 
the intestines which are capable of dissolving the protein bodies. 
The only method of deciding accurately upon the truth of these conclusions, 
drawn by Professor Lehmann, from the preceding argument is to appeal to the 
*The Medical Examiner. New series-No. cxxxvii-May, 1856. Original communications. 
By Joseph Jones, M. D., of Georgia. Digestion of Albumen and Flesh. 
291 
physico-chemical process of digestion, as it is performed in a normal condition in 
the animal economy. I have enjoyed numerous opportunities of examining the 
contents of the stomachs of fishes, reptiles, birds and mammalia, in every stage of 
the digestive process, and never have I discovered undigested particles of flesh in 
the small intestines. The following observations were made during the prosecu- 
tion of various researches upon the blood, urine, relative weights of the organs, 
and comparative anatomy, and minute anatomical structure of the organs of differ- 
ent animals, without any reference whatever to the maintenance of a theory. The 
stomach of an alligator (alligator mississippiensis) contained the bones, teeth, 
hoofs and hair of a pig. The meat had been entirely digested, leaving the bones 
as clean as those of a prepared skeleton, In the stomach of other alligators we have 
found fishes, snakes, crabs, etc., in different stages of digestion, some but slightly 
acted upon by the gastric juice, others partially dissolved, whilst of others little 
more than their bones remained. The stomach of a bull-frog, (rana pipiens,) 
which had been captured 24 hours, contained several craw fish (astacus bartoni) 
and a long slender grass snake (tropidonotusordinatus) about three feet in length. 
Although this food had been swallowed for more than 24 hours, only the exterior 
parts of the body of the serpent showed the evidence of the action of the gastric 
juice, and the shell of the invertebrate animals was of a red color, resembling that 
which they assume after they have been acted upon by boiling water. In the 
stomachs of serpents we have found smaller serpents, lizards and mice, in all stages 
of digestion, whilst the smaller intestines contained not a particle of meat. These 
observations were also verified by an examination of the contents of the stomachs 
of fishes, carnivorous birds, as the buzzards, hawks, cranes, herons, etc., and also 
of carnivorous mammalia, as raccoons and dogs. 
If one-half of all the meat received into the stomach passes into the small intes- 
tines, and if the process of digestion, is, according to the statement of Bidder and 
Schmidt, as slow as that of the stomach, why is it that its presence always eluded 
observation when the intestinal canal was laid open? In the case of animals 
which swallow their prey whole, without any mastication, how could portions of 
meat with large bones attached pass out of the capacious stomach into the con- 
tracted intestines, without being evident to the observer. All the observations 
thus far made convince me that meat is entirely digested in the stomach. Another 
fact worthy of note, is, that in the stomach of all animals, whether cold or warm- 
blooded, which I have examined during the process of digestion, the amount of 
fluid, containing the digested matters in solution, was exceedingly small, ofttimes 
amounting to only a few drops, and in many cases, especially amongst cold-blooded 
animals, it appeared to be almost entirely absent. This proves that, in the normal 
process of digestion, the matters dissolved by the gastric juice are almost immedi- 
ately absorbed or pass into the duodenum. 
The idea that a solution of the albuminous matters accumulates in the stomach, 
which has been called chyme bv writers, is erroneous. This fact shows the fallacy 
of Professor Lehmann's argument. He calculated the amount of flesh which could 
be digested by a given quantity of gastric juice out of the body. In nature the pro- 
cess is far different from that of artificial digestion. A portion of gastric juice dis- 
solves a definite amount of flesh, and the solution is then absorbed, or passes out 
into the small intestines. Another portion of gastric juice is secreted and acts upon 
the fresh exposed surface of the flesh, and the products of its action are in turn 
absorbed. It is evident to every candid observer, that this process is far more 
energetic than that of artificial digestion, and consequently the one cannot be the 
measure of the other, and the argument founded upon artificial digestion falls to 
the ground. Even granting that artificial and normal digestion are precisely simi- 
lar as far as the rapidity of their actions is concerned, how is it possible for Pro- 
fessor Lehmann to determine the amount of gastric juice secreted by the stomach 
in a given time, when absorption is almost as rapid as secretion. In the considera- 
tion of the digestion of protein bodies, he leaves this fact entirely out of view. The 
absorption and passage of the digested matters out of the stomach immediately 
after their solution, is true also of gran ivorous and frugivorous animals. I have 
examined the stomach of numerous squirrels, rats and birds, fed upon grain, 
acorns, nuts and berries, and in every instance there was no fluid which corres- 
ponded to the chyme of writers. Even in those animals which subsist upon grasses, 
and green buds, and leaves, which contain a larger amount of fluid, the contents 
of the stomach are comparatively dry. Almost every one has it in his power to 
verify the truth of these observations, by simply walking to the butcher pens and 
examining the contents of the stomachs of cows and sheep. Amongst cold-blooded 
animals, the only frugivorous animal which I was able to examine, was the 292 
Digestion of Albumen and Flesh. 
gopher, (testudo polyphemus). In this animal the grasses and vegetable matters 
appear to be principally digested in the colon. The colon of the gopher enlarges 
into a receptacle for food, 30 inches in length and four inches in circumference. 
In one instance, after 30 days' starvation, the undigested vegetable contents of the 
colon and caecum amounted to 1460 grains. The gopher has the power of retaining 
in its intestines vegetable food without either digesting it, or allowing it to putrefy 
or ferment. When, however, it is removed from the jntestinal canal, in the course 
of a few days it putrefies and becomes filled with numerous worms. This is a pro- 
vision of the Creator, adapting this animal to the habitation of a sandy and bar- 
ren country, where it is often impossible to obtain water, and where vegetation is 
scarce. The colon contains a store of vegetable food, which replaces the wastes of 
the blood and tissues during long seasons of drought and starvation, and supplies 
the place of the masses of fat found in the abdominal cavities of many chelonians, 
ophidians and saurians, which are consumed during long fasting. 
COMPARATIVE anatomy and physiology of the pancreas. 
In the invertebrate kingdom no lymphatic system has been discovered, and 
the existence of a pancreatic gland has not as yet been satisfactorily demonstrated. 
Siebold considers two thick-walled ceeca, lined with ciliated epithelium and open- 
ing into the beginning of the stomach, in many Rotatoria, a rudimentary pancreas. 
Hunter, Grant, Owen, Siebold and Rhymer Jones, consider the pale yellow, rami- 
fied tubes, which in many species of Cephalapoda are appended to the hepatic 
ducts, as true representatives of the pancreatic glands of higher animals. These, 
however, have not been certainly demonstrated to be pancreatic glands, for no 
comparative anatomist or physiologist has as yet described the special character 
and offices of their secretion. A rapid review of the character of the digestive 
apparatus and circulatory system of these animals, will show why the lymphatic 
system and pancreas should be absent. 
In the lowest forms of the protozoa, which are simple cells provided with 
vibratile cilhe resembling closely the sporules of vegetables, we find neither organs 
nor a circulatory system. The highest members of this group have contractile 
pulsatory cavities situated in the denser and outer layers of the parenchyma of 
the body. No blood-vessels communicate with these cavities, and no special walls 
have been found surrounding them. In the polypi, inarticulate, fleshy bodies, 
having a simple visceral cavity, with a single opening at the centre above, without 
intestines, without glands separate from the walls of the visceral cavity, with no 
distinction of sex, and an imperfectly developed nervous system in the highest, and 
none whatever in the lowest, the circulatory system is rudimentary, and the fluid 
which it distributes nothing but the digested matters of the visceral cavity. 
The tubular axis of the collonial polyps communicates with the visceral cavi- 
ties of all the individuals which compose the colony, and an oscillatory movement 
of the products of digestion which it contains, without any elaboration by special 
organs, and without any special organs of circulation, reminds us strongly of the 
motion of the fluid contents of the cells in the vegetable kingdom. In most of 
the invertebrata, the digestive sac is surrounded by a cavity or sac called the 
visceral cavity. In many polyps these two cavities communicate freely. In the 
higher invertebrate animals, these two cavities are separated from each other, and 
the nutritive materials pass into the exterior visceral cavity only by transudation 
through the walls of the stomach and intestinal tube. In certain Crustacea and 
the lowest mollusca, the movement of these nutritive matters backwards and for- 
wards, by the irregular contractions of their bodies, constitutes the only means by 
which their tissues are supplied with nutriment, and even in the higher mollusca, 
insects and Crustacea, the circulatory system is in free communication with the 
visceral cavity. In all these animals, there is no other absorption but that which 
takes place through the walls of the alimentary canal into the digestive cavity. 
Even in the echinodermata and annelida, which have a closed circulatory system, 
the principal channel for the transmission of the nutritive materials through the 
system appears to be from the visceral cavity. In these animals, however, absorp- 
tion must also take place, to some extent, from the blood-vessels, minutely dis- 
tributed over the intestinal tube. 
From this hasty review of our knowledge of the invertebrate animals, we see 
that their circulatory apparatus, organs and tissues are not sufficiently developed 
and perfected, to call for the existence of a lymphatic system. One office of the 
lymphatics is the absorption of the fatty matters after they have formed an emul- 
sion with the pancreatic fluid. In most invertebrate animals, the conditions for Researches of Joseph Jones, M. D. 
293 
the formation of this emulsion and its absorption do not exist, because the digested 
matters pass directly from the alimentary canal and visceral cavity into the blood- 
vessel system, without absorption. 
In the four great classes of vertebrate animals the circulatory system is com- 
pletely separated from the digestive cavity, all the organs and apparatuses are 
highly developed, and the existence of a special system of absorbents appears to be 
absolutely necessary for the preservation of the integrity of the fluids of the animal 
economy, and also for the absorption of fatty matters, which are of great importance 
in the maintenance of animal temperature. In fishes, the development and perfec- 
tion of the pancreas correspond in no degree with the position occupied by differ- 
ent individuals in the classification of naturalists. The most superficial examina- 
tion of the gland under consideration will show that many animals of an exceed- 
ingly simple construction often have individual organs more highly developed 
than animals which stand far above them in physical and mental constitution. 
Thus, in the lowest orders of the cartilaginous fishes-the cyclostomi and plagiostomi 
-it resembles in all respects this gland in the most highly organized mammalia. 
In the sturiones, its structure is somewhat simplified, and in the majority of 
osseous fishes it is reduced to its rudimentary form, consisting of caeca varying in 
number in different species, and opening into the duodenum, below the circular 
valve of the stomach; whilst in others, as observed by Cuvier in the conger eel, 
pike and carp, and by Muller in the ophisurus serpens, it is intimately associated 
with the intestinal mucous membrane, consisting of simply follicular depressions, 
lined with the peculiar cells constituted to secrete the pancreatic fluid. It cannot, 
therefore, be asserted, as a universal law without any exception, that there is a 
regular progression in the development of the different organs in animals corre- 
sponding to the position which they occupy in the scale of creation. It matters 
not whether we view the pancreas in its earlier stages of development in the 
higher animals, or in its permanent condition in many of the osseous fishes, its 
structure is the same. By classifying this organ according to its development in 
fishes, we have an exact history of the changes which occur during the develop- 
ment of this gland in the higher animals. The permanent forms of the pancreas of 
the former are but transitory conditions, forming the stages in the development of 
this organ in the latter. According to Muller, Weber and Wharton Jones., in 
higher animals, which have a perfect pancreas, its development, like that of the 
salivary glands, commences by a simple diverticulum, or caecum, from the walls 
of the duodenum. This subdivides into bud-like processes. As the development 
of the gland advances, the canal and its branches become more and more ramified 
and subdivided, until the compound racemose lobulated gland is formed. Pre- 
cisely the same stages of development, in a permanent form, are discernible in 
the different orders, genera and species of fishes. Mere cells or follicular depres- 
sions in the mucous membrane of the small intestines, according to the observa- 
tions of Cuvier, Muller and Solly, perform the offices of the pancreas in several 
species, as the hyppoglossus rondeletus, conger eel, pike and carp, and ophisurus 
serpens. In the ammodytes tobianus there is a single caecum prolonged into a 
pouch, representing this gland in its rudimentary condition. In the octopus the 
single pancreatic appendage is prolonged and specially convoluted. Five of these 
caeca occur in salmo spirinchus, six in perca lucioperca and sargus annularis, 
seven to eight in the bass (corvina ocellata), and ten to thirty and more in many 
salmons and herrings, and from eighty to ninety in the common salmon. Several 
species of plaice have two, whilst others have three, like the river perch and com- 
mon loach, whilst the platessa oblongata has four of these caecal pouches, which 
open into the pylorus and duodenum. In gadusand scomba the number is greatly 
augmented, and the complexity of the gland increased by the division of the 
caeca. In scomber thynnus four large trunks arise from the intestine and divide 
into branches, each of which subdivide and terminate at length in a tuft-like fas- 
ciculus of narrow tubular caeca. 
In the salt-water garfish (lepisosteus osseus), of Georgia, the pancreas is situ- 
ated with its superior convex border in contact with the inferior concave border of 
the liver, which resembles in shape and appearance this organ in serpents. The 
inferior border is in contact with the spleen. Upon the exterior it consists of 
numerous short caeca, which radiating inwards, unite together, forming several 
branches, which again unite and constitute one short duct, having a diameter 
almost equal to that of the small intestine into which it opens. The duct branches, 
and caeca generally contain, especially after a meal of fish, a cream-like fluid, 
which, under the microscope, is found to be a true emulsion, containing innumer- 
able minute globules of oil in a transparent fluid. The large opening of the duct 294 
Comparative Anatomy and Physiology of Pancreas. 
of the pancreas is so situated just at the bend of.the duodenum, that all the digested 
food, after passing the stomach, must be submitted to the influence of its secretion, 
and much passes into the duct and caeca. All the oleaginous matters must, there- 
fore, be brought into contact with the pancreatic juice, and in this manner an 
emulsion is formed and prepared for absorption. The emulsion is not found in the 
stomach above the opening of the duct of the pancreas, but exists in greatest 
abundance in its immediate vicinity and within the caeca. The structure of this- 
gland in the fresh-water garfish of the swamps of'Georgia, is constructed on a 
similar plan; its caeca, however, are longer, and the branches more distinct. The 
duct branches and caeca contained in every instance, after a full meal, a similar 
fatty emulsion. 
In the sword-fish (ziphias gladius), this organ is very large, and Professor Grant 
states, in his lectures upon comparative anatomy, that it weighs six ounces more 
than the liver. It consists of innumerable small caeca, connected together by cel- 
lular tissue, in which ramify the capillary vessels. These caeca form a reniform 
mass, which is surrounded with a muscular tunic and the peritoneum. When 
opened, the innumerable component caeca are found to be formed by the successive 
divisions of the single great duct, into which they all pour their secretions into the 
duodenum immediately below the pyloric valve. 
In the sturgeon, the structure of the pancreas is similar to that of the ziphias 
gladius. The hundreds of caeca ramified from one common duct, are enclosed in a 
muscular and peritoneal coat. The contraction of the muscular tunic compresses 
the caeca and forces their secretion into tbe intestinal canal. The excretory duct 
opens close to the pyloric valve, and the termination of the ductus communis 
choledochus. In the eel, pike, and fresh-water trout, we find a yellowish white 
compact and glandular pancreas, having from two to three excretory ducts, which 
are frequently accompanied in their course to the intestine by the biliary ducts. 
In the trout and some others there exists both pyloric appendages and a compact 
pancreatic gland. In the hammerhead shark (zygsena malleus), we find an elon- 
gated, narrow, flattened, light yellow, compact pancreas, with little lobulation. 
In the stingray, this organ is of a yellow color, well defined, lobulated form, 
resembling in all respects the perfectly developed pancreas of the mammalia and 
other vertebrata. The pancreas of the doubtful reptiles assume the appearance 
presented by that of the sturgeon, shark, and warm-blooded animals. 
In the menobranchus maculatus it is an irregularly shaped gland, having four 
principal lobes, diverging from each other at right angles, thus presenting a stel- 
lated arrangement. The pancreas of the hellbender (menopoma alleganensis), is a 
long delicate light yellow gland, which commences near the pyloric extremity of 
the stomach, and extends down along the duodenum and small intestine for about 
three inches. Its inferior portion is more expanded than the superior. The pan- 
creas of the congo snake (amphiuma means-, is similar in structure and appear- 
ance to that of the menopoma alleganensis, with the exception that it is broader and 
thicker. 
In the batrachia, the pancreas presents a developed appearance, and generally 
commences by a small slender lobe, at the pyloric extremity of the stomach, and 
passing downwards and forwards expands into a broad lobulated mass. As in 
many other cold-blooded animals, it is not in contact with the spleen. In all the 
American ophidia which I have had the opportunity of examining, as the banded 
rattlesnake (crotaius durissus), the water rattlesnake (crotaius adamanteus), ground 
rattlesnake (crotalophorus miliarius), water moccasin (trigonocephalus piscivorous), 
copperhead (trigonocephalus contortrix), hognose viper (heterodon platyrhinus), 
black viper (heterodon niger), grass snake (tropidonotus ordinatus), (tropidonotus 
fasciatus), green snake (leptophis sestivus,) coach-whip snake (psammophis flagelli- 
formis), indigo snake (coluber couperi), chicken snake (coluber quadrivittatus), 
corn snake (coluber guttatus), black snake (coluber constrictor), the pancreas is a 
compact ovoid gland, often kidney-shaped, situated in contact superiorly with the 
gall bladder, and inferiorly attached to the duodenum. The spleen, which is very 
small in these animals, is attached to the antero-superior surface of the pancreas. 
The hepatic and cystic ducts perforate the substance of the pancreas, and, uniting 
with its duct, enter the duodenum. 
In the carnivorous chelonia, the pancreas is a large, well-developed, light yel- 
low lobulated gland. In the soft-shelled terrapin (trinonyx ferox), it commences 
opposite the pyloric valve of the stomach. The principal lobe extends down along 
the small intestine about three inches. At the inferior portion it sends off two 
lobes. The inferior one short and broad; the superior longer, and passing down- 
wards conies in contact with the spleen and passes along the anterior surface of this Comparative Anatomy and Physiology of Pancreas. 
295 
organ. The structure, position and appearance of this gland does not differ in any 
essential respect in the alligator cooter (chelonura serpentina), loggerhead turtle 
(chelonia caretta), salt-water terrapin (erays terrapin), chicken terrapin (emys reti- 
culata), yellow belly terrapin (emys serrata), and other carnivorous terrapins. In 
the gopher, however, which is the only herbivorous chelonian in Georgia, the size 
and appearance of the pancreas is far different. It is a long, delicate gland, consist- 
ing of several slender and thin lobes, sub-divided into numerous small lobules. Its 
size is far smaller than that of carnivorous terrapins. The reason of this will be 
readily understood when we consider the functions of the gland. 
In birds the pancreas is a conglomerated gland, generally of large size, and is 
invariably lodged within a loop formed by the duodenum. It generally consists 
of two portions or lobes, united by a slender isthmoid partition. In some individ- 
uals it is single, and in others consists of three lobes. From each lobe an excretory 
duct is given off'. These ducts terminate separately in the intestine near the open- 
ing of the biliary canals. The color and appearance are similar to that of the well- 
developed pancreas in all animals, cold or warm-blooded, and it is remarkable how 
constant is the color of the different glands in vertebrate animals. Any one fami- 
liar with comparative anatomy and physiology, will distinguish the different 
organs in any animals at a single glance. How uniform must be the operations of 
nature, when even the color of organs are definite and immutable, and have 
remained thus from the creation. 
The pancreas of the omnivorous and carnivorous mammalia, resembles in 
appearance and structure that of man, and its secretion enters the duodenum at the 
same point as that of the liver. In the apes, the ruminantia, and most carnivora 
and rodentia, it has but one duct, which usually unites with the biliary. In some 
individuals, as the horse, hog, otter and beaver, it has two ducts, one of which 
unites with the biliary duct, and the other enters by itself, farther behind into the 
duodenum. In the rabbit, the biliary and pancreatic ducts are separated from each 
other by a considerable interval. The pancreas of all the carnivorous mammalia, 
which I have thus far examined, is much larger than that of the frugivorous mam- 
malia. This illustrates an important physiological fact, and will be demonstrated 
by numerous comparative weights of the organ, accurately ascertained. 
Having considered the development, structure and comparative anatomy of 
the pancreas in the four great classes of vertebrate animals, we will next study its 
use in the animal economy. Although Mayer, Magendie, Tiedeman, Gmelin, 
Leuret, Lassaigne, and other physiologists and chemists had investigated the phys- 
ical and chemical properties of the pancreatic fluid, still one of its important offices 
was entirely unknown, until the researches of M. Cl. Bernard," demonstrated 
that it is indispensable for the formation of chyle and the absorption of fatty mat- 
ters. Previous to this discovery, it was considered similar to the fluid secreted by 
the salivary glands, and its principal use was affirmed to be the conversion of 
starch into glucose. 
The investigations of M. Cl. Bernard, demonstrated that the limpid chyle 
(formerly called vegetable chyle), is the product of the digestion of materials which 
contain no fatty matters, and the white chyle (called formerly animal chyle), con- 
tains fatty matters in the state of an emulsion, and the lymphatics of the mesentery 
are found to contain a white milky fluid, only after the absorption of fatty matters, 
and that this emulsion and modification of the fatty matters were effected by the 
agency of the pancreatic juice. These conclusions were derived from the results of 
numerous ingenious experiments. If dogs are fed upon oleaginous matters and 
killed at different periods, oil will be found unaltered until it comes in contact with 
the pancreatic fluid, and if the pancreatic ducts be tied, all alteration is prevented 
and the oil remains transparent. The most conclusive and beautiful of all Dr. 
Bernard's experiments were performed upon the rabbit. In this animal, the pan- 
creatic duct opens into the intestine very low down, from six to fourteen inches 
below the hepatic duct; and if fatty matters be introduced into the stomach, and 
the animal killed in three or four hours, they will be found to have become emul- 
sioned, and the lymphatics of the mesentery filled with white chyle. M. Cl. Ber- 
nard further showed, that if fatty bodies be exposed to the pancreatic fluid out of 
the body, a complete emulsion is formed; and if it be allowed to remain long 
enough, the fatty substances will be decomposed into glycerine and fatty acids, and 
in the case of butter, butyric acid. Parallel experiments instituted with other 
fluids, as bile, saliva, gastric juice, serum of the blood, produce no such effects on 
fatty bodies. It is probable that M. Bernard supposed that fats were in the animal 
*Annales des Sciences Natur., Sept., 1848. 296 
Comparative Anatomy and Physiology of Pancreas. 
economy resolved into glycerine and fat acids. This process, however, would be 
very complicated, and involves many difficulties, and it is more reasonable to sup- 
pose that the action of the pancreatic juice is limited to the formation of an emul- 
sion, which is nothing more than the mechanical division of the fat into minute 
globules, coated with a thin film of the albuminoid elements of the pancreatic juice. 
That this is really the case in living animals, I have enjoyed many opportunities 
of demonstrating whilst examining the pancreas of the garfish (lepisosteus osseus). 
In this fish, the duct of the pancreas has a diameter almost equal to that of the 
intestine, and is so situated that all the digested matters which pass out of the 
stomach must come in contact with its secretion, and often pass in considerable 
amount into the duct and cteca of the gland. When the emulsion is squeezed out 
of the duct and caeca, and subjected to the microscope, it is found to consist of 
innumerable minute globules of oil, surrounded by a transparent fluid. 
The correctness of M. Bernard's observations have been called in question by 
Dr. Bence Jones, Lenz, Frerichs, Bidder, Schmidt, Lehmann, Bonders and Her- 
bert. It is asserted that the bile and intestinal juice are even more active and effi- 
cient than the pancreatic juice in the preparation of fatty matters for absorption. 
It is objected to Bernard's experiments, that he delayed his examination of the 
animals too long, and allowed the emulsion formed with the bile to pass down and 
be absorbed before inspecting the viscera of the rabbits. Dr. Samuel Jackson,* 
Professor of the institutes of medicine in the University of Pennsylvania, has 
recently examined this subject carefully, and repeated the experiments of Bernard, 
avoiding every source of error, and especially that of time, by causing oleaginous 
matters to enter the digestive apparatus constantly, until the moment of observa- 
tion. In every instance, the results of his experiments confirmed the correctness 
of Bernard's conclusion that the emulsion of fatty matters is produced by the action 
of the pancreatic juice. After exposing the errors of the experiments upon which 
the German physiologists found their opposition to this doctrine, the Doctor con- 
cludes his valuable paper by the following summary of the present state of our 
knowledge: 
1. " Liquid fats are not miscible with the aqueous albumino-saline fluid- 
liquor sanguinis-with which all the vascular tissues are saturated ; it cannot enter 
their pores, and consequently cannot be absorbed. 
2. "Liquid fats, when emulsified by albumen, are reduced to minute particles, 
each coated with albumen. In this state they are miscible, with the liquor sangui- 
nis moistening the tissues, can enter their pores, and are then capable of absorp- 
tion. This is the sole condition requisite for the absorption of fats. 
3. " 'rhe white, milk-like fluid named chyle is this emulsion of the fatty mat- 
ters of the food, mixed with the ordinary lymph, always contained in the lympha- 
tics of the alimentary canal and other abdominal organs and mesentery. The 
molecular base of Gully is the microscopic appearance in the chyle of the minute 
globules of fat coated with albumen. 
4. " Albumen forms a perfect and persistent emulsion with oils. The pancre- 
atic fluid is a saturated albuminous solution, and forms with oils an emulsion 
equally as perfect and permanent as that of albumen. 
5. " The pancreatic juice is the only highly albuminous fluid in the alimen- 
tary canal, and can accomplish the formation of a perfect emulsion ; .and the 
opinion of M. Cl. Bernard, that this process is one of its functions, is, it appears to 
me, sustained. 
6. " The observations of M. Cl. Bernard, that the formation of the emulsion 
of fats in rabbits, is at and below the pancreatic duct, and not above it, is confirmed 
by the experiments reported in this communication. And, further, that the 
experiments upon rabbits are the most reliable, as being a true exemplification of 
the natural process, unattended with violence and torture to the animals, more or 
less disturbing in their effects, 
7. " That M. Cl. Bernard's view of the decomposition of fats by the pancreatic 
juice is not proved, is opposed by the nature of the process and by analogy with 
other emulsions ; it is unnecessary to the accomplishment of the absorption of fats, 
and introduces other and complicated processes that are unknown to exist, and are 
mere hypotheses." 
Whilst engaged, in 1855, in the investigation of the physical and chemical 
constitution of the fluids, and the comparative anatomy and physiology of cold- 
blooded animals, it occurred to me that the pancreas of cold-blooded animals should 
be larger than that of the frugivorous or granivorous animals, because it is much 
* American Journal of Medical Sciences, October, 1854, page 307. Digestion of Albumen and Flesh. 
297 
more incessantly exercised in the secretion of a fluid for the emulsifying of fats. 
Accordingly, I ascertained accurately the weights of the body and pancreas of 
every animal that fell into my possession. Dividing the weight of the former by 
that of the latter, we obtain the weight of the pancreas in relation to that of the 
body, and the relative size of this organ in different animals is thus ascertained. 
The weights of the animals were taken upon a pair of scales capable of turning to 
half a grain, and the weights of the organs were taken up<m a delicate balance, 
capable of turning to one-thousandth of a grain. 
The following table contains the most important results thus obtained. 
Comparative weight of the Pancreas of Carnivorous Fishes and Reptiles. 
Times the weight 
of its Pancreas. 
Weight of Female Stingray {Trygon sabina) 
1071. 
4 4 
TTarnmAfhpad Shark {fry (jcnna itlcMcus^ 
1045. 
4 4 
TTanimprhpa.d Shark{Tlygcr.na, malleus) 
1563. 
4 • 
Female Garfish ( Dept-sost eus osseus) 
193. 
4 4 
Female Garfish ( Tjepisosteus osseus)...................... 
219! 
44 
Bullfrog {Rana pipiens) 
1088. 
4 4 
Black Viner {Heterodon niger) 
537. 
4 4 
Coach whip Snake {Psammophis flagelliformis)... 
1353. 
44 
Corn Snake {Coluber gutta us) 
1371. 
4 4 
Black Snake {Coluber constrictor)........................ 
472. 
4 4 
Banded Snake {Orotalus durissus) 
965. 
• 4 
Loggerhead Turtle {Chelonia carctta) 
518. 
44 
Alligator Cooter {Chelonura serpentina) 
630. 
44 
Salt-water Terrapin {Emys terrapin) 
994. 
4 4 
Chicken Terrapin {Emys reticulata) 
763. 
44 
Yellow-bellied Terrapin {Emys serrata) 
1067. 
4 4 
Male Yellow-belly Terrapin) Emys serrata) 
1200. 
4 4 
Female Yellow-belly Terrapin {Emys serrata) 
1343. 
Comparative weight of the Pancreas of Frugivorous Chelonians. 
Times the weight 
of its Pancreas. 
Weight of Male Gopher (Testudo Polyphemus') 
" Male Gopher (Testado polyphemus) 
3500. 
3061. 
Comparative weight of the Pancreas of Carnivorous Mammalia. 
Times the weight 
of its Pancreas. 
Wei sr 
ht of Female Raccoon (PrGcyon lotor) 
241. 
11 
Female Raccoon (Procyon lotor) 
155. 
4 4 
Foetus of Raccoon (Procyon lotor') 
583. 
44 
Common Cat 
402. 
4 4 
Pointer Dog 
337. 
4 4 
Opossum (Didelphis Virginianus) 
192. 
Comparative weight of Pancreas of Frugivorous and Cranivorous Mammalia. 
Times the weight 
of its Pancreas. 
Weight of Common Sheep 
" Grey Squirrel (Sciurus Caro Linens i.s) 
1125. 
3026. 
By comparing these numbers carefully, we are taught the following facts and 
conclusions: 
1. The pancreas of the garfish, {lepisosteus osseus), a powerful, voracious and 
active fish, is much larger than that of more sluggish fishes. The garfish consumes 
large numbers of small fishes, which itreadily captures with its long and well-armed 298 
Digestion of Albumen and Flesh. 
jaws. The tissues and organs, especially the liver of fishes, contain much oil, and 
consequently a large gland is needed to afford a sufficient amount of the peculiar 
matters absolutely requisite for the preparation of the oleaginous matters for 
absorption. We have previously stated that, in the pancreas of this remarkable 
fish, we have an absolute demonstration of the function of this gland. 
2. The pancreas of carnivorous fishes and reptiles is relatively much larger 
than that of frugivorpus chelonians. This difference in the relative size of this 
organ in these two classes, is evident at a glance. In the ophidians it is a compact 
ovoid gland, and in the carnivorous chelonians it is a broad lobulated, well 
developed, conspicuous gland, whilst in the frugivorous gopher (testudo polyphemus) 
it is a thin, delicate, obscure gland, composed of several slender lobes, subdivided 
into numerous small lobules. 
3. The pancreas of carnivorous mammalia is much larger than that of the 
frugivorous or granivorous. The strongest exception to this assertion appears to be 
in the beaver, which is stated to have an unusually large pancreatic gland. A con- 
sideration of the character of the food of this animal, will, we think, explain this 
anomaly. In this animal the stomach, and more especially the caicum, is stated 
by observers to be plugged up with fragments of bark and wood, which appear to 
constitute its chief aliment. The experiments of Mitscherlich have shown that 
alkaline solutions are capable of converting cellulose into starch even more readily 
than concentrated acids. It is therefore highly probable that the great office of the 
alkaline pancreatic fluid in these animals, is the preparation of cellulose for absorp- 
tion by converting it into starch. 
4. The pancreas of carnivorous fishes and reptiles is larger than that of 
frugivorous and granivorous mammalia, notwithstanding that the digestion of the 
former is much slower than that of the latter, and the amount of nutritive matters 
necessary to sustain the economy much less. 
5. The pancreas of carnivorous mammalia is larger than that of carnivorous, 
cold-blooded animals, because the digestive process is much more rapid, and corres- 
pondingly larger glands are needed to supply the secretions necessary for the 
proper preparation of the food for absorption. The difference between the weights 
of the organ in these two classes of animals, does not correspond exactly witfi the 
disparity of their respective digestive processes, because the sluggish circulation 
and aeration of the blood, and the small amount of nervous force possessed by cold- 
blooded animals, require much larger organs to accomplish precisely the same 
results. As circulation and respiration are developed and perfected, and all the 
acts of life rendered correspondingly active and energetic, the more perfect and 
condensed become the organs and apparatuses. These results were demonstrated, 
as far as simple dissection and inspection could show them, upon other animals 
killed in swamps and woods, and at periods when it was impossible to ascertain 
their weights. Our investigations upon birds have not been sufficiently extended 
to warrant general conclusions. Whilst experimenting upon the effects of starva- 
tion and a change of diet upon the blood of carnivorous terrapins, I found that the 
pancreas of many of those which had been deprived of food and drink for a length 
of time, and then placed in a tub of water and liberally supplied with vegetable 
food, (purslain, portulacca oleracea), was diseased. Parts of the gland were of a 
black color and hard texture, and under the microscope contained cancer cells and 
crystals, which resembled in appearance those of the triple phosphate. It is prob- 
able that the gland, not being normally exercised, degenerated in structure. 
In the first of a series of experiments which have not as yet been completed, I 
ascertained the correctness of M. Cl. Bernard's statement, that fatty matters are 
not altered in the stomach or intestines of dogs, if the pancreatic duct be tied. The 
abdominal cavity of a remarkably large and voracious pointer dog, noted tor his 
powerful digestive powers was opened along the linea alba, and fgiiof lard oil 
secured in the stomach, by ligatures above and below, and f^i were injected and 
secured in the same manner, in the intestines. The viscera were then carefully 
returned and the wound sewed up. At the expiration of six hours, the dog was 
killed, and the contents of the stomach and intestineshad neither increased nor dimi- 
nished, and were changed neither in physical or chemical properties, and the lym- 
phatics of the mesentery did notappear to contain any milky emulsion. Under the 
microscope, the lard oil presented an appearance differing in no respect from that of 
ordinary oil. Lard oil was enclosed separately in the stomach and intestines of a 
dog, and immersed for eighteen hours in the serum of this animal. At the end of 
this time neither endosmose of the serum, nor exosmose of the oil had taken place. 
In the living dog, the blood-vessels of the stomach and intestines retained their 
natural size and appearance. When saline solutions of high specific gravity were Digestion of Albumen and Flesh and Determination of Sugar. 
299 
enclosed in a similar manner in the stomach and intestines of dogs and cats, the 
blood-vessels were congested with blood, and the internal surface of the mucous 
membrane presented a pinkish purple color. The following general conclusions 
have been drawn from this study of the comparative anatomy and physiology of 
the pancreas. 
1. In the invertebrate animals, this gland and the lymphatic system do not 
exist, because the character of the circulatory system and the manner in which it 
receives the digested matters from the visceral cavity, are such, that the conditions 
requiring their presence do not exist. 
2. In fishes we may study the development of the pancreas, the permanent 
forms being but the transient conditions in the development of this gland in the 
higher animals. 
3. The assertion of M. Cl. Bernard, that the chief office of the pancreas, is to 
prepare fatty matters for absorption is sustained by the following facts. 
(a.) In the garfish (lepisosteus osseus), the emulsion of the fatty matters takes 
place in the duct and cseca of the pancreas, and their immediate vicinity, and 
nowhere else in the alimentary canal. 
(b.) The pancreas of carnivorous animals is relatively much larger than that 
of frugivorous and granivorous animals. The amount of oil consumed by the for- 
mer is much greater than that consumed by the latter. It is reasonable to infer 
from these facts, that the principal office of the pancreatic juice, is the preparation 
of fats for absorption. This is farther sustained by the fact that the size of the pan- 
creas amongst carnivorous animals is in a measure proportional to the amount of 
oleaginous matters consumed. The pancreas of the active, voracious garfish who 
destroys large numbers of small fish, is larger than that of the more sluggish fishes. 
(c.) The pancreas of carnivorous chelonians, fed upon vegetable matters, 
degeneratedin its structure. 
We have so often alluded to the detection of grape sugar, and 
will also consider theglycogenous function of the liver when treating of the 
pathological changes of this organ in malarial fever, that we shall give an. 
outline of the analytical processes which we have employed from the year 
1856 to the present moment, September 6, 1886, when this portion of the 
second volume of the Medical and Surgical Memoirs is in the hands of 
the printer. 
We give this detailed account of the general chemical and physiologi- 
cal relations of glucose (animal sugar) for the double purpose of fur- 
nishing such a consolidated statement of our knowledge as will illustrate 
the nature of the investigations on fever, and at the same time furnish the 
practitioner and student of medicine with an illustrated and useful guide 
in the prosecution of the future investigations into the chemistry of fevers. 
QUALITATIVE AND QUANTITATIVE DETERMINATION OF SUGAR IN THE 
URINE, BLOOD AND ORGANS OF MAN AND ANIMALS. 
Of the varieties of sugar enumerated by the chemist glucose or grape sugar 
is that which the pathologist and physician has to deal with. The general name 
of sugars, by some regarded as polyatomic alcohols, is given to bodies which are 
capable of fermenting, that is of decomposing directly or indirectly into different 
products, of which the principal ones arealcohol and carbon dioxide. Fermentation 
requires the presence of certain microscopic plants, and according to Pasteur is a 
phenomenon correlative with the vital development of these organisms. Sugar 
may be divided into three classes. In the first are those in which the proportion 
of hydrogen is more than sufficient to convert the whole of the oxygen into water. 
It contains: 
Mannite, CcH14O, extracted from manna. 
Dulcite or melampyrite, C6H14O6, found in Madagascar. 
Pinite, C6H12O5, extracted from a Californian pine tree. 
Quercite, C0H12O5, extracted from acorns. These bodies do not ferment with 
beer-yeast alone, but in presence of certain ferments and calcium carbonate they 
furnish alcohol, carbon dioxide, and hydrogen. 
Sugars of the second and third class, contain hydrogen and oxygen in the pro- 
portion to form water. 300 
Determination of Sugar in Animal Fluids. 
The second class includes the glucoses, isomeric bodies, whose general formula 
is, CsHj 2O6. Among these are: Ordinary glucose or grape sugar. Lcevulose, asso- 
ciated with glucose in the form of inverted sugar. Maltose, obtained .from malt. 
Galactose, obtained by treating sugar of milk, or gums with dilute acids. 
Eucalin. obtained by the action of maltose on beer-yeast. Sorbin exists in the 
berries of the mountain ash. Inosite is found in the embryo of young plants and 
in the fluids of flesh. 
CARBOH YD RATES. 
These substances are composed of C, H and O ; they all contain C6, or some 
multiple thereof; and the H and O which they contain is always in the propor- 
tion of H2 to O. Their constitution is still unknown ; probably some are alde- 
hydes, others alcohols and others ethers. Most of them are constituents of animal 
or vegetable organisms, and have not been obtained by complete synthesis. 
They are divisible into three groups, the members'1 of each of which are iso- 
meric with each other: 
I. GLUCOSES. 
II. SACCHAROSES. 
III. AM'YLOSES. 
n(C6H]2O6.) 
n(Ci 2H2 2^1 1 •) 
n(C6H1 0O5.) 
+Glucose. 
+Saccharose. 
+Starch. 
(Dextrose.) 
+Lactose. 
4-Glycogen. 
-Leevulose.) 
-j-Maltose. 
-j-Dextrin. 
Mannitose. 
+Melitose. 
-Inulin. 
+Galactose. 
-I-Melezitose. 
Tunicin. 
Inosite. 
i-Trehalose. 
Cellulose. 
-Sorbin. 
-j-Mycose. 
Gums. 
-Eucalin. 
Synanthrose. 
+Parasaccharose. 
• 
Glucose-Grape-sugar-Dextrose - Liver-sugar - Diabetic sugar. - The sub- 
stance from which this group takes its name exists in all sweet and acidulous 
fruits ; in many vegetable juices ; in honey ; in the animal economy in the contents 
of the intestines, in the liver, bile, thymus, heart, lungs, blood, and in small 
quantity in the urine. Pathologically it is found in the saliva, perspiration, fseces 
and largely increased in the blood and urine in diabetes mellitus It may also be 
obtained by decomposition of certain vegetable substances called glucosides. 
It is prepared artificially by heating starch or cellulose for 24 to 36 hours with 
a dilute mineral acid (iSO4H2). Glucose obtained by this method is liable to con- 
tamination with traces of arsenic, which it receives from the SO4H2. Starch is 
also converted into gh»;cose by the influence of diastase, formed during the ger- 
mination of grain. 
Glucose crystallizes with difficulty from its aqueous solution, in white, opaque, 
spheroidal masses containing 1 aq.; from alcohol in fine, transparent, anhydrous 
prisms; at about 60° (140° F.) in dry air the hydrated variety loses H2O. It is 
soluble in all proportions in hot H2O; very soluble in cold H2O; soluble in alcohol. 
It is less sweet and less soluble than cane sugar. Its solutions are dextrogyrous: 
[a] d= + 52°.85. At 170° (338° F.) it loses H2O and is converted into glucosan, 
C6H10O5. Hot dilute mineral acids convert it into a brown substance, ulmic acid, 
and, in the presence of air, formic acid. It dissolves in concentrated SO4H2, 
without coloration, forming sulphoglucic acid. Cold concentrated NO3H converts 
it into nitro-glucose: hot dilute NO3H oxidizes it to a mixture of oxalic and oxy- 
saccharic acids. With organic acids it forms ethers. Its solutions dissolve potash, 
soda, lime, baryta, and the oxides of Pb and Cu, with which it forms compounds. 
When its solutions are heated with an alkali they assume a yellow or brown color, 
and give off a molasses-like odor, from the formation of glucic and melassic acids. 
Glucose in alkaline solution exerts a strong reducing action, which is favored by 
heat; Ag, Bi, and Hg are precipitated from their salts; and cupric are reduced to 
•cuprous compounds with separation of cuprous oxide. In the presence of yeast, at 
suitable temperatures, glucose undergoes alcoholic fermentation. 
GLUCOSES, C6H12O6. 
PHYSIOLOGICAL. 
The greater part of the glucose in the economy in health is introduced with 
the food, either in its own form or as other carbohydrates, which by digestion are 
converted into glucose; a certain quantity is also produced in the liver at the Determination of Sugar in Animal Fluids. 
301 
expense of glycogen, a formation which continues for some time after death. In 
some forms of diabetes the production of glucose in the liver is undoubtedly greatly 
increased. The quantity of sugar normally existing in the blood varies from 0.81 
to 1.231 part per thousand; in diabetes it rises as high as 5.8 parts per thousand. 
Under normal conditions, and with food not too rich in starch and saccharine 
materials, the quantity of sugar eliminated as such is exceedingly small-so small, 
indeed, that some observers have contested the fact of any being eliminated in 
health. It is oxidized in the body, and the ultimate products of such oxidation 
eliminated as CO2 and H2O. Whether or no intermediate products are formed, is 
still uncertain; the probability, however, is that there are. The oxidation of sugar 
is impeded in diabetes. Where this oxidation, or any of its steps, occur, is at 
present a matter of conjecture merely; if, as is usually believed, glucose disappears 
to a marked extent in the passage of the blood through the lungs, the fact is a 
strong support of the view that its transformation into CO2 and H2O does not 
occur as a simple oxidation, as the notion that sugar or any other substance is 
" burned " in the lung, beyond the small amount required by the nutrition of the 
organ itself, is scarcely tenable at the present day. So long as the quantity of 
glucose in the blood remains at or below the normal percentage, it is not eliminated 
in the urine in quantities appreciable by the tests usually employed; when, how- 
ever, the amount of glucose in the blood surpasses this limit from any cause, the. 
urine becomes saccharine, and that to an extent proportional to the increase of 
glucose in the circulating fluids. The causes which may bring about such an 
increase are numerous and varied; many of them are entirely consistent with 
health, and the mere presence of increased quantities of sugar in the urine is no 
proof, taken by itself, of the existence of diabetes. Sugar is detectable by the ordi- 
nary tests in the urine under the following circumstances: 
(1.) In the urine of pregnant women and during lactation. It appears in the 
latter stages of gestation and does not disappear entirely until the suppression of 
the lacteal secretion. 
(2.) In small quantities in sucking children from eight days to two and one- 
half months. , 
(3.) In the urine of old persons (seventy to eighty years). 
(4.) In those whose food contains a large amount of starchy or saccharine 
material. To this cause is due the apparent prevalence of diabetes in certain locali- 
ties, as in districts where the different varieties of sugar are produced. 
PHYSIOLOGICALLY. 
PATHOLOGICALLY. 
(1.) In abnormally stout persons, especially in old persons and in women at 
the period of the menopause. The quantity does not exceed 8 to 12 grams per 
1000 c.c. (3.5-5.5 grains per ounce), and disappears when starchy and saccharine 
food is withheld. This form of glycosuria is liable to develop into true diabetes 
when it appears in young persons. 
(2.) In diseases attended with interference of the respiratory processes-lung 
diseases, etc. 
(3.) In diseases where there is interference with the hepatic circulation- 
hepatic congestion, compression of the portal vein by biliary calculi, cirrhosis, 
atrophy, fatty degeneration, etc. 
(4.) In many cerebral and cerebro-spinal disturbances-general paresis, demen- 
tia, epilepsy; by puncture of the fourth ventricle. 
(5.) In intermittent and typhus fevers. 
(6.) By the action of many poisons-carbon monoxide, arsenic, chloroform, 
curari; by injection into an artery of ether, ammonia, phosphoric acid, sodium, 
chloride, amyl nitrite, glycogen. 
(7.) In true diabetes, the elimination of sugar in the urine is constant, unless 
arrested by suitable regulation of diet, and not temporary, as in the conditions 
previously mentioned. The quantity of urine is increased, sometimes enormously, 
and it is of high sp. gr. The elimination of urea is increased absolutely, although 
the quantity in 1000 c.c. may be less than that normally existing in that bulk of 
urine. The quantity of sugar in diabetic urine is sometimes enormous; an elimi- 
nation of 200 grams (6.4 ounces) in twenty-four hours is by no means uncommon; 
instances in which the amount has reached 400 to 600 grams (12.9-19.3 ounces) are 
recorded, and one case in which no less than 1376 grams (45 ounces) were discharged 
in one day. The elimination is not the same at all hours of the day; during the 302 
Determination of Sugar in Animal Fluids. 
night less sugar is voided than during the day; the hourly elimination increases 
after meals, reaching its maximum in four hours, after which it diminishes to 
reach the minimum in six to seven hours, when it may disappear entirely; this 
variation is more pronounced the more copious the meal. It is obvious from the 
above that, in order that quantitative determinations of sugar in urine shall be of 
clinical value, it is necessary that the determination be made in a sample taken 
from the mixed urine of twenty-four hours. The relation existing between the 
quantity of sugar in the blood and its elimination-by the urine in diabetes is well 
shown by the following results of Pavy, which also show the beneficial effects of 
restricting the diet: 
Urine 
Blood 
Quantity in 
24 hours 
Specific 
gravity 
Sugar excreted 
in 24 hours 
Sugar in 
1000 parts 
Sugar in 
1000 parts 
Case I. Mixed diet 
6608 c.C. 
1040 
751.6 grams. 
109.91 
5.763 
Case II. Mixed diet 
6474 c.c. 
1041 
633.0 grams. 
94.08 
5.545 
Case II. Restricted diet 
3407 C.c. 
1031 
245.2 grams. 
61.34 
2.625 
Case III. Mixed diet 
5878 c.c. 
1036 
567.7 grams. 
93.39 
4.970 
Case III. Restricted diet 
2470 c.c. 
1033 
115.8 grams. 
45.49 
2.789 
Case IV. Partly restricted diet 
1704 c.c. 
1036 
21.81 grams. 
48.11 
1.848 
Case IV. Partly restricted diet, 3J 
months later 
852 c.c. 
1034 
14.40 grams. 
31.76 
1.543 
ANALYTICAL CHARACTERS. 
A saccharine urine is usually abundant in quantity, pale in color, of high sp. 
gr., covered with a persistent froth on being shaken, and exales a peculiar odor; 
when evaporated it leaves a sticky residue. The presence of glucose in urine is 
indicated by the following tests : If the urine be albuminous, it is indispensable 
that the albumenbe separated before any of the tests jor sugar are applied; this is 
dbne by adding one or two drops of acetic acid, or if the urine be alkaline, just 
enough acetic acid to turn the reaction to acid, and no more, heating over the 
water-bath until the albumen has separated in flocks, and filtering. 
(1.) When examined by the polarimeter it deviates the plane of polarization 
to the right. 
(2.) When mixed with an equal volume of liquor potassse and heated, it turns 
yellow, and, if sugar be abundant, brown. A molasses-like odor is observable on 
adding NO3H (Moore's test). 
(3.) The urine, rendered faintly blue with indigo solution and faintly alka- 
line with sodium carbonate, and heated to boiling without agitation, turns violet 
and then yellow if sugar be present; on agitation the blue color is restored (Mulder- 
Neubauer test.) 
(4.) About 1 c.c. of the urine, diluted with twice its bulk of water, is treated 
with two or three drops of cupric sulphate solution and about T c.c. of caustic 
potassa solution; if sugar be present the bluish precipitate is dissolved on agita- 
tion, forming a blue solution; the clear blue fluid, when heated to near boiling, 
deposits a yellow, orange, or red precipitate of cuprous oxide if sugar be present 
(Trommer's test). In the application of this test an excess of cupric sulphate is to 
be avoided, lest the color be masked by the formation of the black cupric oxide. 
Sometimes no precipitate is formed, but the liquid changes in color from blue to 
yellow; this occurs in the presence of small quantities of cupric salt and large 
quantities of sugar, the cuprous oxide being held in solution by the excess of glu- 
cose; in this case the test is to be repeated, using a sample of urine more diluted 
with water. In some instances, also, the reaction is interfered with by excess of 
normal constituents of the urine, uric acid, creatinine, coloring matter, etc., and 
instead of a bright precipitate, a muddy deposit is formed; when this occurs the 
urine is heated with animal charcoal and filtered; the filtrate evaporated to dry- 
ness; the residue extracted with alcohol; the alcoholic extract evaporated; the resi- 
due re-dissolverl in water, and tested as described above. 
(5.) Four or five c.®. of Fehling's solution are heated in a test-tube to boiling; 
it should remain unaltered. The urine is then added guttatim; if it contain sugar, 
the mixture turns green, and a yellow or red precipitate of cuprous oxide is formed, 
usually darker in color than that obtained by Trommer's test. The absence of Determination of Sugar in Animal Fluids. 
303 
glucose is not to be inferred until a bulk of urine equal to that of the Fehling's 
solution used has been added, and the mixture boiled from time to time without 
the formation of a precipitate. This test is the most convenient and the most reli- 
able for clinical purposes. 
(6.) A few c.'c. of the urine are mixed in a test-tube with an equal volume of 
solution of sodium carbonate (1 pt. crystal, carbonate and 3 pts. water), a few gran- 
ules of bismuth subnitrate are added, and the mixture boiled for some time (until 
it begins to "bump," if necessary). If sugar be present, the bismuth powder 
turns brown or black by reduction to elementary bismuth (Boettger's test). No 
other normal constituent of the urine reacts with this test; a fallacy, is, however, 
possible from the presence of some compound, which, by giving up sulphur, may 
cause the formation of the black bismuth sulphide; to guard against this, when an 
affirmative result has been obtained, another sample of urine is rendered alkaline 
and boiled with pulverized litharge; the powder should not turn black. 
,(7.) A solution of sugar, mixed with good yeast and kept at 25° (77° F.) is 
decomposed into CO2 and alcohol. To apply the fermentation-test to urine, take 
■three test-tubes, A, B, and C, place in each some washed (or compressed) yeast, fill 
A completely with the urine to be tested, and place it in an inverted position, the 
mouth below the surface of some of the same urine in another vessel (the entrance 
of air being prevented, during the inversion, by closing the opening of the tube, 
with the finger, or a cork on the end of a wire, until it has been brought below the 
surface of the urine). Fill B completely with some urine to which glucose has 
been added, and C with distilled water, and invert them in the same way as A ; 
B in saccharine urine, and C in distilled water. Leave all three tubes in a place 
where the temperature is about 25° (77° F.) for twelve hours, and then examine 
them. If gas have collected in B over the surface of the liquid, and none in A, the 
urine is free from sugar ; if gas have collected in both A and B, and not in C, the 
urine contains sugar; if gas have collected in B, the yeast is worthless, and 
if any gas be found in C, the yeast itself has given off CO2. In the last two cases 
the process must be repeated with a new sample of yea,st. 
QUANTITATIVE DETERMINATION OF GLUCOSE. 
(1.) By the polarimeter.-The filtered urine is observed by the polariscope 
and the mean of half a dozen readings taken as the angle of deviation; from 
this the percentage of sugar is determined by the formula in which 
p- the weight, in grams, of glucose in 1 c.c. of urine ; a - the angle of deviation ; 
I - the length of the tubes in decimeters. The same formula may be used for other 
substances by substituting for 52.85 the value of [a]D for that substance. If the 
urine contain albumen, it must be removed before determining the value of a. 
(2.) By specific gravity ; Robert's method.-The sp. gr. of the urine is carefully 
determined at 25° (77° F.), the yeast is then added, and tile mixture kept at 25° 
(77° F.) until fermentation is complete. The specific gravity is again observed, and 
will be found to be lower than before, each degree of diminution represents 0.2196 
grains of sugar in 100 c.c. (1 grain per ounce of urine.) 
We shall proceed to give the more important processes and analytical 
procedures, more at length, for the use of the student and practitioner of 
medicine. 
SPECIFIC GRAVITY. 
The specific gravity simply indicates the amount of solid matter that is con- 
tained in solution, but gives no definite information as to the chemical nature of 
the suspended matters. When diabetes mellitus exists, sugar is added to the solid 
matter naturally present, and the specific gravity is raised above its natural range. 
To determine the specific gravity of urine in anj other animal liquid; the physi- 
cian may use the balance as in engraving No. 32 or the hydrometer (urinometer) 
as in engraving No. 33 or little bulbs or beads, represented in engraving No. 34. 
Weighing supplies the most precise information, and should be resorted to, in all 
cases for taking the specific gravity of a fluid where minute accuracy is required. 
The specific gravity bottle is used for the purpose of holding the liquids ; and 
consists of a thin glass flask, provided with a perforated glass stopper. Bottles 
are furnished of any capacity, containing 100 grains, 500 grains, or 1000 grains of 
■distilled water .; or they may be made to hold a certain number of cubic centimetres 304 
Determination of Sugar in Animal Fluids. 
of distilled water, at a definite temperature, as 60° F. A weight exactly equal to 
that of the bottle, and another weight equal to that of the distilled water at a defi- 
nite temperature, accompany the measured bottles. When filled with a heavier 
liquid and placed in the balance, the weight, will of course, be more. The counter- 
poise of the flask must be placed in the opposite scale with the weights. See the 
following engraving No. 32 : 
ENGRAVING NO. 32. 
Balance with Specific Gravity Bottle. 
Engraving No. 32.-Balance with Specific Gravity Bottle for determining the specific gravity by 
weighing. 
Suppose for illustration, the 1000-grain bottle to be used, and to have been filled 
with urine. The glass stopper of the bottle being perforated, allows it to be filled 
without introducing any air bubbles. Urine having been poured in completely to 
the top, the stopper is applied and will be permitted to sink into its proper place by 
the displacement of fluid through its perforated centre. The bottle is then wiped 
dry upon its exterior, and placed in the balance with the counterpoise in the oppo- 
site scale. The weight observed, let it be say, 1040 grains, represents the specific 
gravity. If a flask holding 500 grains of distilled water has been used, the weight 
observed requires to be doubled, to obtain the figures as they are given. The spe- 
cific gravity may also be determined by the use of any sized bottle, irrespective of 
any exact measurement in grains, or cubic centimetres. The bottle is weighed 
and its weight noted ; it is then filled with distilled water at a definite temperature, 
and again weighed. Subtract the weight of the bottle from that of the bottle and 
water, and we have remaining the weight of an equal bulk of water. The differ- 
ence between the weight of the glass bottle and that of the urine or blood, divided 
by the weight of the same bulk of water, will give the specific gravity. In the 
ordinary examination of urine and saccharine liquids, when such minute precision 
is not required, the hydrometer or urinometer is employed. Engraving No. 33 will 
give an accurate representation of the hydrometer or urinometer : Determination of Sugar in Animal Fluids. 
305 
ENGRAVING NO. 33. 
Urinometer. 
Engraving No. 33.-Urinometer. 
The hydrometer (urinometer) is to be procured in both glass and metal, but 
on the score of greater cheapness glass instruments are preferred. The operation 
of the urinometer depends upon the principle that bodies floating in a liquid dis- 
place a bulk equal in weight to themselves. The lower bulk is weighted so as to 
cause the instrument to sink nearly to the top of the limb when placed in the dis- 
tilled water. In a heavier liquid it does not sink so far ; so much of the limb, in 
other words is not immersed, or so much fluid displaced. The descent of the 
instrument thus varies according to the density of the liquid in which it is 
immersed, and the limb is provided with a scale representing the various degrees, 
within the range that is likely to be encountered. 
In using the urinometer, the instrument should be immersed into the specimen 
of urine to be examined, and when it is floating steadily, to note the degree on the 
scale that is in a line with the surface of the liquid. This denotes the specific 
gravity of the urine. Should the degree for instance be 25, then the specific 
gravity will be read off as 1025. 
The specific gravity bulbs or beads furnish another means of ascertaining the 
density of a liquid as in the following figure. 
ENGRAVING NO. 34. 
Specific Gravity Bulb. 
The specific gravity bulbs or beads, are made of glass and present the form 
shown in the preceding sketch. Each bead serves only for indicating the particu- 
lar density which it has engraved upon it. When plunged into a liquid of this 
density, it neither sinks to the bottom nor floats upon the top, but swims at any 
height that it may chance to settle. 
Engraving No. 34.-Specific Gravity Bulb. 306 
Determination of Sugar in Animal Fluids. 
LIQUOR POTASSA (MOORE's) TEST FOR GRAPE (DIABETIC) SUGAR. 
The liquor potassa test is also called Moore's test, from the name of the pro- 
poser, and is founded on the decomposition that sugar undergoes at a boiling tem- 
perature in contact with an alkali; glucic acid is first formed, and afterwards 
converted intomelassic acid, the solution of which presents a dark brown, or in a 
concentrated form, a black color. Mix a little of the suspected urine in a test-tube, 
with about half its volume of liquor potassa, and boil the mixture gently for a 
minute or two. If sugar is present, the mixture will assume a brownish or bistic 
tint, while little or no heightening of color takes place when the urine is free from 
saccharine matter. For the mere detection of sugar in the urine, this test may 
answer, but it is not adapted to the prosecution of physiological research ; and it is 
also open to a serious fallacy when the liquor potassa happens to be contaminated 
with lead, which is not unfrequently the case, and may be derived from the flint- 
glass bottle containing the solution of potassa. 
REDUCTION TESTS FOR THE QUALITATIVE DETERMINATION OF SUGAR IN 
THE URINE. 
The action of grape sugar on a number of metallic salts is attended with a 
reduction of the oxides which they contain, to a lower degree of oxidization, or to 
the metallic state. Accordingly, some of these salts are resorted to as valuable 
sugar tests, both qualitative and quantitative. The salts best adapted for this pur- 
pose, are those of copper, bismuth, silver, chromium and tin; but the oxide of 
copper is the most universally known, and with proper precautions is the most 
striking and sensitive. 
Trommer's test.-This excellent test is founded on the circumstance that when 
a solution containing diabetic or grape sugar, is boiled with a mixture of potash 
and sulphate of copper, the oxide of copper contained in the latter becomes reduced 
to the state of suboxide, which is precipitated in the form of a reddish or ochre- 
colored granular powder. A little of the urine suspected to contain sugar, is placed 
in a tolerably large test-tube, and mixed with a drop or two of a solution of sul- 
phate of copper, which should be added only in sufficient quantity to give the 
mixture a very pale blue tint. This will probably cause a slight precipitation of 
pale blue phosphate of copper, owing to the presence of soluble phosphates in the 
urine. This, however, need not be regarded, as it will not afterwards interfere 
with the indications of the test. A solution of potash is now added in large excess, 
or in quantity equal to about half the volume of urine employed ; this will first 
throw down a pale blue precipitate of hydrated oxide of copper, which, if sugar is 
present, will immediately re-dissolve, forming a purplish-blue solution, something 
similar to that caused in a very dilute solution of copper, by ammonia. The mix- 
ture is now to be carefully heated over a lamp, and gently boiled ; when, if sugar 
is present, a reddish or yellowish-brown precipitate of suboxide of copper will be 
deposited in the liquid, generally before the boiling point is reached. If no sugar 
is present, a black precipitate of the common oxide of copper, will be thrown down, 
totally distinct in appearance from the suboxide. It is important in this experi 
ment, not to add too much of the sulphate of copper, because in that case, the sub- 
oxide might be mixed with some of the black oxide (the sugar being capable of 
reducing only a certain definite quantity), which would more or less mark the 
characteristic color and appearance of the suboxide. This test is extremely deli- 
cate and is capable of detecting very small traces of sugar in the urine. If very 
much sugar be present, the action of the potash upon it will produce a very dark 
brown color, which may disguise the suboxide of copper. If this be the case, 
another portion of the urine may be diluted before being tested. Since other sub- 
stances are occasionally found in urine, which reduce the oxide of copper, this test 
cannot be considered as conclusive, except as to the absence of sugar. Since the 
presence of ammonia in any considerable quantity interferes with this test, recourse 
must be had to the yeast tests, if much ammonia be smelt in this experiment. 
FEHLING'S STANDARD SOLUTION FOR THE DETERMINATION OF THE 
PRESENCE OF DIABETIC SUGAR. 
Fehling found that one equivalent of grape sugar, or 180 parts, decomposed 
exactly ten equivalents, or 12,468 parts of sulphate of copper. Accordingly, he 
prepared'a solution of copper, of standard strength, and applied it to fluids containing 
grape sugar; and the quantity of these required to decompose a fixed volume of the 
standard solution furnished an exact measure of the sugar they contained: sul- 
phate of copper, 90£ grains ; neutral tartrate of potash, 364 grains ; solution of caus- 
tic soda, sp. gr. 1.12, four fluid ounces. Add water to makeup exactly six fluid 
ounces. 200 grains of this solution are exactly decomposed by one grain of sugar. Determination of Sugar in Animal Fluids. 
307 
More exactly, in grammes and cubic centimetres, Fehling's solution stands as fol- 
lows : 40 grammes-crystals of sulphate of copper; 160 grammes-neutral tartrate 
of potash; 750 grammes-caustic soda, sp.gr. 1.12. Add water up to 1154.5 cubic 
centimetres. Each 10 c.c. correspond to 0.05 gramme of sugar. This test is more 
delicate, when the solution of Fehling is tested in a test tube, and the urine is added 
gradually. 
Mdumene's test.-This test is founded on the circumstances that when sugar is 
moderately heated in contact with the bichloride of tin (SnCl2)•, it is decomposed, 
and a brownish-black compound, somewhat resembling caramel, is formed. The 
most convenient method of applying this test is to saturate strips of merino, flannel, 
or some other woolen tissue, with a solution of bichloride of tin, prepared by dis- 
solving the salt in almost twice its weight of water, and filtering, after which they 
may be dried at a gentle heat on a water-bath, and kept ready for use. On moistening 
one of these strips with urine, or any other liquid containing sugar, even in a 
highly diluted state, and holding it near a fire or overa lamp, so as to heat it almost 
270° or 300° Fahr., it immediately assumes a brownish-black color. This is a deli- 
cate test. 
QUANTITATIVE DETERMINATION OF DIABETIC SUGAR (GLUCOSE) OF URINE 
AND OTHER ANIMAL AND VEGETABLE FLUIDS. VOLUMETRIC METHOD 
OF ANALYSES. 
In dealing with accurate quantities, the first essential is the use of accurately 
graded glass vessels. 
ACCURATE MEASURES OF LIQUIDS. 
The following illustrations will give accurate views of the most important glass 
measures of liquid capacity employed by the analytical chemists and the physio- 
logists in the determination by volumetric analysis of the amount of sugar in ani- 
mal and vegetable fluids. 
ENGRAVING NO. 35. 
ENGRAVING NO. 36. 
ENGRAVING NO. 37 
Engraving No. 35.-Graduated glass for dilution. Engraving No. 36.-Pipette for dilution 
Engraving No. 37.-100 minim graduated pipette. 308 
Determination of Sugar in Animal Fluids 
ENGRAVING NO. 38. 
ENGRAVING NO. 39. 
Engravings Nos. 38 and 39.-Graduated Burettes 
QUANTITATIVE DETERMINATION BY THE VOLUMETRIC METHOD OE DIABE- 
TIC SUGAR. 
This method is deduced from the reaction occurring in employing Trommer's 
tests for grape sugar. It is well known that grape, or diabetic 'sugar, possesses 
the power of reducing the oxide of copper to the state of yellowish-red suboxide. 
Preparation of the solution.-An alkaline solution of sulphate of copper is prepared 
with the aid of tartaric acid and potash. The former prevents the precipitation 
of the oxide of copper by the potash. 40 grammes=617.76 grains of crystallized sul- 
phate of copper are dissolved in about 160 c.c.=2,471.04 grains of water. Next J60 
grammes=2,471.04 grains of neutral tartrate of potash are to be dissolved in a lit- 
tle water, and from 600 to 700 grammes, about 9,-500 grains, of a solution of soda, of 
1.12 sp. gr. are to be mixed with it. The solution of the sulphate of copper is 
added gradually, and the whole diluted with water to a. volume of 1154.4 e.c.= 
17,82S.5 grains ; 10 c.c.=154.4 grains of this solution correspond to 0.05 grammes= 
0.772 grains of sugar Performance of the analysis.-10 c.c.=154.4 grains of the 
copper solution are diluted with 40c.c.=617.7 grains of water and placed in a por- 
celain dish. About 20 c.c.=308.8 grains of the urine is diluted with from 10 to 
20 times its bulk of water, so as to produce, for instance, 300 c.c.=4633.2 grains. 
This is to be poured into the burette and adjusted so as to fill it to the 0. of the 
scale. The dish with the copper solution is arranged in a sand-bath, placed on a 
tripod stand, at a convenient distance beneath the orifice of the burette. A spirit 
or gas lamp is applied until the copper solution approaches the boiling point, when 
the urine is allowed to flow in gradually, until suboxide of copper ceases to be pre- 
cipitated, and the solution no longer possesses a blue color. This is ascertained by 
removing the lamp, and allowing the deposit to settle, when the blue tinge may be 
observed if the whole has not been precipitated by tilting the basin a little and 
observing the color of the clear fluid as it flows against the white porcelain. If 
the solution has still a blue tinge, more urine is to be added, and the mixture again 
boiled for a minute. This operation is to be repeated as long as any unreduced 
oxide remains in solution. When the process is finished, the proportion of sugar 
contained in the urine is easily calculated. Suppose 24 e.c.=270.6 grains of the 
diluted urine have been required to reduce the 10 c.c.=154.4 grains of the copper 
solution, these 24 c.c. contain .05 grammes=0.772 grains of sugar. But since 300 
c.c. of the diluted solution, contain only 20 c.c.=308.8 grains of urine, the 24 c.c. 
contain only 1.6 c.c.=24.7 grains. Therefore 1.6 c.c.=24.7 grains of urine, con- 
tain .05 grammes = 0.772 grains of sugar, or in 100 c.c.=1544.4 grains of urine, 3.12 
grammes=48.18 grains of sugar are present. Determination of Sugar in Animal Fluids. 
309 
There are various forms of copper solutions employed as tests for sugar. They 
all, however, consist essentially of oxide of copper held in solution by an alkali 
through the medium of organic matter, which unlike sugar has not the property 
of exerting a deoxidizing influence at the temperature of ebullition. Barreswel's 
liquid, which constitutes a much used form of sugar test on the continent, is made 
with sulphate of copper, bitartrate of potash (cream of tartar) and bitartrate of soda, 
potash and water. The carbonate of soda is introduced to neutralize the excess of 
acid in the bitartrate of potash. By taking at once the neutral tartrate instead of 
the bitartrate of potash the call for the use of the carbonate of soda is dispensed 
with ; and as we have seen Fehling's solution, which is made with sulphate of 
copper, tartrate of potash and caustic soda forms a liquid of this kind. 
The solution which Dr. F. W. Pavy, has been for many years in the habit 
of using in his physiological experiments is a modification of Fehling's caustic pot- 
ash being substituted for the caustic soda, as in the following formula : 
p avy's cupro-potassic test solution for sugar. 
Sulphate of copper, 320grains; tartrate of potash (neutral), 640 grains ; caustic 
potash, (potassa fusa), 1280 grains ; distilled water, 20 fluid ounces. 
In making the solution the sulphate of copper is dissolved separately in ten ounces 
of the water, and the tartrate of potash and the potash together in the remain- 
der. The solution of sulphate of copper is then poured into that of tartrate of pot- 
ash and potash. In this way no precipitate is produced, as happens, should the 
mode of mixing be reversed. The liquid obtained is clear and bright, and of a 
beautifully blue color. It is capable of being employed for estimating the amount 
as well as for detecting the presence of sugar. 
The cupro-potassic solution accurately prepared according to the directions 
given is of such a strength that 100 minims are just decolorized by half a grain of 
grape sugar; or in other words, the oxide of copper contained in 100 minims of 
the solution is all just reduced to the state of suboxide by the half grain of sugar. 
METHOD OF PERFOBMING THE VOLUMETBIC ANALYSIS. 
As a general rule, ordinary diabetic urine is too concentrated and highly 
charged with sugar to operate with conveniently, and therefore, it requires in the 
first place, to be diluted to a known extent with water. For the purpose of dilu- 
tion and for accurate measurement, we may employ as we have stated. The 
amount and specific gravity of the urine passed during twenty-four hours, should 
be accurately noted. A certain aliquot part is then taken for analysis. The solid 
matter in a certain weighed or accurately measured portion of the urine, should be 
determined and recorded. The balance,'the pipette, burette, etc., will each in turn 
be employed during the prosecution of an accurate analysis in which it is necessary 
to note the exact amount of sugar excreted during any given period of time. A 
convenient way of dilution is with graded pipettes. These pipettes are graduated 
to deliver a specific quantity, which is measured in them ; one holding 5 c.c., another 
10 c.c., and another 20 or 40 c.c. One hundred minims of this cupro-potassic solu- 
tion are now measured out into a small porcelain capsule. Into the measured 
liquid a fragment of caustic potash about twice the size of a pea is dropped, for the 
purpose of causing the reduced oxide to fall in a denser form, so that the liquid may 
remain clear and allow the change of color to be more readily seen. The capsule 
is then placed over the flame of a spirit lamp or gas on a retort stand, or what is 
better, on a piece of iron gauze adapted to the top of a stoneware cylinder, as in the 
engraving on the next page. 
The cylinder protects the flame from draught, and the gauze distributes and 
regulates the heat, and causes the contents of the capsule to boil more steadily. 
The 100 minim graduated pipette, is again brought into use for ascertaining the 
amount of the liquid being examined, that is required to decolorize the cupro- 
potassic solution contained in the capsule. It is tilled so as to start on a line with 
O on the scale; and directly boiling has commenced in the capsule, its contents 
are allowed to fall drop by drop into the copper solution, which must be kept quietly 
boiling all the while, and moved about gently by tilting the capsule from side to 
side with a glass rod, until all appearance of blue has been removed. What is 
wanted is just to get a removal of all trace of blue, and no more; and as soon as 
this has been attained, the escape of liquid from the pipette must be stopped, and 
the amount that has been used read off from the graduated scale. 310 
Determination of Sugar in Animal Fluids. 
ENGRAVING NO. 40. 
Arrangement for Estimating the Amount of Sugar by the Cupro-Potassic 
Solution. 
Engraving No. 40.-Arrangement for estimating the amount of Sugar by the Cupro-Potassic 
Solution. 
DK. PIFFARD'S FORMULA FOR FEHLING'S SOLUTION. 
I. Cupric sulphate (pure, crystals 51.98 grams. 
Water..... 500.0 c.c. 
II. Rochelle salt (pure, crystals) 259.9 grams. 
Sodic hydrate solution, sp. gr. 1.12 1000.0 c.c. 
When required for use, one volume of No, I is mixed with two volumes of 
No. II. The copper contained in 20 c.c. of this mixture is precipitated as cuprous 
oxide by 0.1 gram glucose. To use the solution, 20 c.c. of the mixed solutions are 
placed in a flask of 250-300 c.c. capacity, 40 c.c. of distilled water are added, the 
whole thoroughly mixed and heated to boiling. On the other hand, the urine to 
be tested is diluted with four times its volume of water if poor in sugar, and with 
nine timesits volume if highly saccharine (the degree of dilution required is, with 
a little pratice, determined by the appearance of the deposit obtained in the quali- 
tative testing) ; the water and urine are thoroughly mixed and a burette filled with 
the mixture. A few drops of aqua ammonite are added to the Fehling's solution 
and the diluted urine added, in small portions toward the end, until the blue color 
is entirely dischaiged-the contents of the flask being made to boil briskly 
between each addition from the burette. When the liquid in the flask shows no 
blue color, when looked through with a white background, the reading of the 
burette is taken ; this reading, divided by five if the urine was diluted with four 
volumes of water, or by ten if with nine volumes, gives the number of c.c. of 
mine containing 0.1 gram of glucose ; and consequently the elimination of glucose 
in twenty-four hours, in decigrams, is obtained by dividing the number of c.c. of 
urine in twenty-four hours by the result obtained above. 
Example.-20 c.c. Fehling's solution used, and urine diluted with four vol- 
umes of water. 
36 5 
Reading of burette: 36.5 c.c. -=7.3 c.c. urine contain 0.1 gram glucose* 
5 2,436 
Patient is passing 2,436 c.c. urine in twenty four-hours, -y-g-^333.6 decigr.=33.36 
•grams glucose in twenty-four hours. 
The accuracy of the determination may be controlled by filtering off some of 
the fluid from the flask at the end of the reaction ; a portion of the filtrate is acid- 
ulated with acetic acid and treated with potassium ferrocyanide solution ; if it turn 
reddish brown the reduction has not been complete, and the result is affected with 
a plus error. To another portion of the filtrate a few drops of cupric sulphate solu- 
tion are added and the mixture boiled ; if any precipitation of cuprous oxide be 
observed, an excess of urine has been added, and the -result obtained is less Determination of Sugar in Animal Fluids. 
311 
than the true one. This method, when carefully conducted with accurately pre- 
pared and undeteriorated solutions, is the best adapted to clinical uses. The cop- 
per solution should be kept in the dark, in a well-closed bottle, and the stopper and 
neck of the No. II bottle should be well coated with paraffin. Gravimetric method. 
When more accurate results than are obtainable by Fehling's volumetric process 
are desired, recourse must be had to a determination of the weight of cuprous 
oxide obtained by reduction. A small quantity of freshly prepared Fehling's solu- 
tion is heated to boiling in a small flask ; to it is gradually added, with the precau- 
tions observed in the volumetric method, a known volume of urine, such that at 
the end of the reduction there shall remain an excess of unreduced copper salt. 
The flask is now completely filled with boiling H2O, corked, and allowed to cool. 
The alkaline fluid is separated as rapidly as possible from the precipitated oxide, 
by decantation and filtration through a small double filter, and the precipitate and 
flask repeatedly washed with hot H2O until the washings are no longer alkaline ; 
a small portion of the precipitate remains adhering to the walls of the flask. The 
filter and its contents are dried and burned in a weighed porcelain crucible; when 
this has cooled, the flask is rinsed out with a small quantity of NO3H; this is 
added to the contents of the crucible, evaporated over the water-bath, the crucible 
slowly heated to redness, cooled, and weighed ; the difference between this last 
weight and that of the crucible + that of the filter ash, is the weight of cupric 
oxide, of which 220 parts = 100 parts of glucose. 
FERMENTATION TEST. 
When grape and cane sugars are brought in contact with yeast, and exposed to 
moderate warmth, they undergo fermentation, and are converted into alcohol and 
carbonic acid. The agent endowed with the power of producing this change con- 
sists of living cells constituting a low form of vegetable growth, which has received 
the name oxtorula cerevisiae. Through the influence of the changes attendant 
upon the growth of these cells, an alteration in the grouping of the elements of 
grape sugar ensues; in other words, a re-arrangement, unattended with either loss 
or gain, takes place, which results in the production of alcohol and carbonic acid. 
The researches of Bertholet and other chemists have shown that several substances, 
as glycerine, mannite, dulcine and sorbine, are capable of undergoing the alco- 
holic fermentation in contact with yeast; therefore, the occurrence of the alcoholic 
fermentation cannot now be looked upon as affording an infallible indication of the 
existence of sugar. For the application of the process of fermentation as a test for 
sugar, the contrivance illustrated in the following engraving will be found useful. 
ENGRAVING NO. 41. 
Fermentation Apparatus for the Detection of Sugar 
Engraving No. 41.-Fermentation Apparatus for the detection of Sugar, 
To an ordinary test-tube a tightly-fitting cork is adapted, through which a 
piece of bent glass tube passes, as is shown in the skbtch. The urine or other 
liquid to be examined is mixed with a moderate quantity of yeast, and poured 
into the test-tube, until it is completely filled. The cork is then applied and forced 
into its place, taking care that no air is allowed to remain within the test-tube. As 
represented in the drawing, one limb of the piece of bent tubing passes through 312 
Determination of Sugar in Animal Fluids. 
the test-tube until it very nearly touches the bottom. The apparatus thus arranged 
is now to be immersed in a vessel of tepid water. Should sugar be present evidence 
of fermentation will be very soon apparent. Carbonic acid gas is produced, and, 
rising to the top, drives out the liquid through the bent glass tube into a vessel 
placed for its reception. For ordinary purposes the evolution of gas may be taken 
as sufficient evidence of fermentation having occurred; but if actual demonstration 
be required, both the alcohol and the carbonic acid may be determined by the fol- 
lowing method : The test-tube in which the experiment has been carried on, and 
in which the gas supposed to consist of carbonic acid has been collected, is to be 
inverted and the cork removed whilst its mouth is immersed under water. A small 
fragment of caustic potash is then to be introduced, and the thumb applied so as to 
close it. It is then removed from the water and shaken freely. Carbonic acid gas 
being absorbed by potassa, it follows that if this should constitute the gas, a vacuum 
will be formed in the interior of the tube; and thus on immersing the mouth of 
the tube a second time under water and removing the thumb, the water will rush 
up and occupy the space in the interior. 
To detect'the alcohol, the liquid in which the supposed fermentation has taken 
place is kept in a warm situation for the completion of the process. It is then placed 
in a suitable apparatus and subjected to distillation. When about a third has 
passed over, this is mixed with unslaked lime, and placed in a test-tube, fitted with 
a perforated cork, througn which a piece of glass tubing drawn out atone end to a 
pointed extremity passes. On the application of heat any alcohol that may be 
present, is drawn off in a tolerably pure form, and may be set light to as it escapes 
from the pointed extremity of tlie fine glass tube, when it will be found to burn 
with a pale blue flame, which is almost invisible in bright day-light. The water is 
detained by the lime within the test-tube. 
The bichromate of potash and sulphuric acid is a more delicate test for the 
detection of alcohol. To a moderately strong solution of the bicromate of potash, a 
little concentrated sulphuric acid is to be added. Chromic acid is liberated, and a. 
deep red-colored liquid produced. The first few drops of the products of distilla- 
tion from the liquid supposed to contain alcohol are allowed to fall into the pre- 
pared fluid, and should alcohol be present, it will assume, with the aid of warmth, 
a beautiful emerald-green tint. The alcohol exerts a deoxidizing influence on the 
chromic acid which the test contains. In these fermentation tests the yeast should 
be first carefully washed, and counter experiments should be made to detect any 
source of fallacy in the fermentation of the yeast itself. 
Urine containing sugar, sooner or later, according to the temperature, under- 
goes fermentation ; which process is dependent upon the vegetable growth or fun- 
gus which constitutes the yeast plant, or torula cerevisiae, the microscopical 
appearance of which is shown in the following engraving: 
PRESENCE AND GROWTH OF THE TORULA CEREVISIA3. 
Sporules of Torula Cerevisiae. 
ENGRAVING NO. 42. 
Engraving No. 42.-Sporules of Tomia Cerevisiae. Estimation of Sugar by Polarization. 
313 
Fermentation may be applied to the quantitative determination of sugar in two 
ways. Either the amount of carbonic acid evolved, which will be in proportion to 
the amount of sugar present, may be ascertained by weight or volume; or, as 
suggested by Dr. Roberts, the loss of density occurring as the result of the dis- 
appearance of the sugar may be turned to account for estimating its amount. The 
weight of the carbonic acid evolved may be ascertained by causing it to pass 
through a solution of potash in a Liebig's potash tube, after being dried by passage 
through a chloride of calcium tube or a tube containing fragments of pumice stone 
moistened with strong sulphuric acid, and noticing how much increase in weight 
the potash tube acquires. Another plan for determining the weight of the carbonic 
acid, is by allowing it to escape and ascertaining the amount of loss that occurs. 
To estimate the amount of carbonic acid by volume, fermentation must be performed 
in a graduated tube over mercury. Each cubic inch of gas evolved may be taken 
as representing, in round numbers, one grain of sugar ; forty-seven cubic inches of 
gas being the precise volume, according to Dr. Christison, produced by forty-five 
grains of grape sugar. 
QUANTITATIVE ESTIMATION OF SUGAR BY FERMENTATION. 
ESTIMATION OF SUGAR BY POLARIZATION. THE DIABETOMETER, ALBU- 
MINOMETER, SACCHAROMETER. 
In order to understand the structure and mode of using these instruments, 
which are of great value to the physician, in his clinical investigations, in 
enabling him to determine with facility the amount of sugar and albumen in the 
urine, there must be a preliminary knowledge of the polarization of light. To 
enter into an elaborate disquisition on the properties of polarized light, to describe 
minutely the polariscope, would be foreign to the present practical demonstration 
of facts, instruments and processes, which will at all times and under all circum- 
stances prove of value to the student and practitioner of medicine. 
A ray of light passing from one medium into another of different density, at 
an angle other than 90° to the plane of separation of the two media, is deflected 
from its course, or refracted. Certain substances have the power, not only of 
deflecting a ray falling upon them in certain directions, but also of dividing it into 
two rays, which are peculiarly modified. The splitting of the ray is termed double 
refraction, and the altered rays are said to be polarized. When a ray of such 
polarized light meets a mirror held at a certain angle, ora crystal of Iceland spar 
peculiarly cut (a Nichol's prism), also at a certain angle, it is extinguished. The 
crystal which produces the polarization is called the polarizer, and that which 
produces the extinction the analyzer. If, when the polarizer and analyzer are so 
adjusted as to extinguish a ray passing through the former, certain substances are 
brought between them, light again passes through the analyzer; and in order again 
to produce extinction, the analyzer must be rotated upon the axis of the ray to the 
right or to the left. Substances capable of thus influencing polarized light are said 
to be optically active. If, to produce extinction, the analyzer is turned in the 
direction of the bands of a watch, the substance is said to be dextrogyrous; if in 
the opposite direction, Icevogyrous. 
The distance through which the analyzer must be turned depends upon the 
peculiar power of the optically active substance, the length of the column inter- 
posed, the concentration if in solution, and the wave-length of the original ray of 
light. The specific rotary power of a substanc is the rotation produced, in degrees 
and tenths, by one gram, of the substance, dissolved in one cubic centimetre of a 
noo-active solvent, and examined in a column one decimetre long. The specific 
rotary power is determined by dissolving a known weight of the substance in a 
given volume of solvent, and observing the angle of rotation produced by a column 
of given length. Then let p - weight in grams of the substance contained in 1 cc. 
of solution; I the length of the column in decimetres; a the angle of rotation 
observed; and [a] the specific rotary power sought, we have 
a 
[a] = -. 
pl 
In most instruments monochromatic light, corresponding to theDline of the solar 
spectrum, is used, and the specific rotary power for that ray is expressed by the 
POLARIMETRY. 314 
Estimation of Sugar by Polarization. 
sign [a]D. The fact that the rotation is right-handed is expressed by the sign +, 
and that it is left-handed by the sign -. It will be seen from the above formula 
that, knowing the value of [<z]D for any given substance, we can determine the 
weight of that substance in a solution by the formula 
a 
P =. 
X I 
The polarimeter or saccharometer is simply a peculiarly constructed polariscope 
used to determine the value of [«]D. 
When a ray of polarized light is made to pass through certain solutions, it is 
found to emerge still in a polarized state, but polarized in a plane different from 
that which belonged to it before entering. With some solutions the plane of polar- 
ization is turned to the right, with others to the left. This constitutes the phe- 
nomenon to which the name of circular polarization h^s been given. Diabetic 
sugar possesses the property of turning the plane of polarization to the right, and 
the extent of rotation produced is in proportion to the amount of sugar that is 
traversed. The power of the solution of sugar to turn the plane of polarization 
to the right will depend upon two conditions: the length of the column of liquid 
employed, and the degree of concentration of the solution. By maintaining either 
of these conditions constantly, any variation observed must be dependent upon a 
difference in the other. Hence, if a ray of polarized light be transmitted through 
tubes of equal length filled with different specimens, say of saccharine urine, and 
a variation in the extent of rotation is noted, it must be upon a difference in 
degree of saturation that such variation is dependent. Not only will the rotation 
be influenced by the degree of saturation, but the two will be in a direct ratio to 
each other. A certain number of degrees of rotation, for instance, will be pro- 
duced by a specimen containing a given amount of sugar, and double the number 
of degrees of rotation by another specimen that is charged with double the amount 
of sugar. Instruments are constructed by which the rotation of the plane of 
polarization is rendered susceptible of easy observation, and a scale as in the dia- 
bStomhtre of Robiquet. The diabStombtre-Robiquet is illustrated in the following 
■engravings, Nos. 43, 44, 45: 
THE DIABETOMETER OF ROBIQUET.* 
Practical Description. 
Engraving No. 43. 
Engraving No. 44. 
* An instrument constructed for the measurement of the sugar in diabetic urine, constructed 
(by S. Duboscq, 21 Odeon street, Paris. Diabetometer of Robiquet. 
315 
Engraving No. 45. 
Figure 1. A. Simple lens, which can be advanced or withdrawnrectilinearly, 
by means of the cap a a, which thus permits the vision to be fixed upon the double 
quartz crystal or prism, E. 
B. Prism of Nichol, performing the office of an analyzer. 
C. Graduated (divided) wheel, capable of revolving vertically and carrying 
in its rotation the analyzer, B. The mode of communicating motion to the Nichol 
prism is readily seen by an examination of figure 3. 
D. Small triangular index, serving to point out the number of degrees of the 
graduated circle. 
E. Plate of quartz of double rotation, composed of two half discs, each having 
a thickness of 7 mm 60, giving a sensible or decided violet blue, or purple color or 
tint, when that instrument is regulated at zero. 
F. Central tube, designed to receive the liquid to be analyzed. The ends are 
closed by two flat immovable glasses. A metallic diaphragm is placed in its inte- 
rior to regulate the passage of the polarized rays. 
G. Prism of Nichol, serving as a polarizer, and only allowing the passage of 
the extraordinary ray. 
J. Cap of pale green glass, to be removed at pleasure, when not worked by, 
day-light. 
Figure 2. Represents, in prospective, diabetometer, mounted on its box, S S, 
serving as a fork. 
1st. Determination of the zero point, corresponding to the uniform violet-blue 
tints given by the plates of double quartz.-Place the instrument on the box SS ; put 
in place the central tube F, and examine the instrument in the full light of a 
bright flame. Placing the eye of the observer at a a, elongate or shorten, according 
to the nature of the sight, the movable tube containing the lens A, until a circular 
image is clearly perceived divided into two equal parts, by a black vertical ray, and 
having between its two halves an equality of color. At this movement the zero of 
the graduated circle ought to be placed at the point of the indax D. However 
slightly the zero point may be moved, either to the right or the left, the equality 
and uniformity of the color will be broken. Therefore physicians have given 
to the violet-blue or purple color, the name of sensitive color, corresponding to the 
zero of the scale. If by too violent a movement or agitation the analyzer is dis- 
placed from its first position, the equality of the color will also be disturbed, but 
this accident can easily be remedied by loosening the screw L, and by lightly mov- 
ing from right to left the cap a a, until the equality of the color is reproduced. At 
this moment, adjusting again the screw L, the instrument is found regulated. It 
is very essential that by practice the eye should become habituated to determine 
the uniformity of the color, corresponding to the zero of the instrument, as well as 
the least difference which could be produced between the two halves of the colored 
disc. 
2d. Preparation of the liquid to be analyzed.-The instrument being regulated 
to zero, and the eye of the observer perfectly exercised in determining the sensitive 
blue-violet or purple color, it only remains to prepare the liquid for examination. 
In order to do this, measure in a graduated glass vessel 25 cubic centimetres of the 
diabetic urine, 1 cubic centimetre of the solution of acetate of lead, and 1 c.c. of 
liquid ammonia; add water to complete the volume to 50 c.c. The liquid is stirred 
with a glass rod. and after several minutesof rest, is filtered in a glass vessel. The 
first portions of liquid which pass are not clear, but a refiltration will obtain a per- 
fectly limpid fluid. 
METHOD OF USING THE INSTRUMENTS. 316 
Relations of Leucocythcemia to Malarial Fever. 
3d. Filling the central tube.-Unscrew the two caps of the central tube F, then 
pour in the filtered fluid, which has been discolored, very gently, so as to avoid 
forming bubbles. Then slip the plate over the open end of the tube, and screw on 
the caps. Owing to the diaphragm placed in the centre, the tube can rarely be 
tilled too full. Reverse the instrument slowly, unscrew the second cap and operate 
at the other extremity of the tube, in the same manner as at the first. The tube is 
easily seen to be full, when, on placing it between the eye and the light the column 
of liquid presents the appearance of a clear, transparent solid column ; on the con- 
trary, if the tube contains the least portion of air, the liquid will appear troubled, 
and often the rays of light not being able to pass, causes complete obscurity, 
Place the tube in the centre of the instrument and readjust the flame of the 
lamp, if the urine to be tried does not contain sugar, the equality of the tint given 
by the plate of quartz at a double rotation is not troubled. If, on the contrary, 
there is diabetic sugar, the two halves of the plate are differently colored, accord- 
ing to the nature and quantity of the saccharine matter in the liquid to be anal- 
yzed. However different these colors may be, the difference disappears altogether 
by turning the graduated disc in the order indicated by the point of the index D, 
until an equality of color is established. Look now and ascertain what degree of 
the circle is marked by the index D. Suppose it to be 20°, this signifies that the 
urine under trial contains 21 grammes of diabetic sugar. Thus every degree of the 
divided circle corresponds to one gramme of diabetic sugar for one litre of the urine.. 
The instrument can be used by day-light, but it is then necessary to remove the 
green glass cap. There is butone thing to be observed of secondary importance, 
but none the less useful; that is, after each operation to clean the tube and glass 
rod with water acidulated with acetic acid or vinegar. All the pieces now being- 
cleansed by the acids, they are ready for use. 
THE RELATIONS OF LEUCOCYTHJEMIA TO MALARIAL FEVER. 
The relations of leucocythiemia to the various forms of malarial 
cachexia, are of great interest and importance. The following questions are 
worthy of the most careful investigation : 
1. What are the relations of the profound anaemia induced by the 
prolonged action of the malarial poison to leukaemia or leucocythaemia? 
2. What are the relations of pernicious anaemia to the action of the 
malarial poison? 
At various times cases of leukaemia have come under my observation^ 
and we propose upon the present occasion to present the outline of a lec- 
ture delivered in the amphitheatre of the Charity Hospital in 1869. 
LEUCOCYTH2EMIA OR LEUKAEMIA (WHITE-CELL BLOOD OR WHITE BLOOD). 
After the presentation of patients suffering with acute rheumatism, chronic 
diarrhoea, constitutional syphilis, typhoid and malarial fevers, Dr. Jones exhibited 
to the class the viscera of a patient who had died with leucocy thiemia ; and reviewed 
the history of the case. 
Case 851.-The case had been daily examined in the wards under the charge 
of Dr. Jones, and had also been brought before the students in the amphitheatre 
by the lecturer upon several occasions ; microscopical examination of the blood had 
also been made in the presence of the class assembled in the wards, and each stu- 
dent in turn was enabled to verify the correctness of the diagnosis during the life 
of the patient, by witnessing under the microscope, the great diminution of the col- 
ored corpuscles, and the marked and wonderful increase of colorless corpuscles. 
The patient, C. F., a German, aged twenty-four years, of full size and height, had 
been laboring in a malarious district near Galveston, Texas, during the last two- 
years, where he contracted chills and fever. At the time of his admission into 
Charity Hospital (ward 29, bed 429), January 5th, 1869, the patient was pale and 
sallow with a yellowish greenish tinge to the surface, and with pale bloodless lips 
and tongue. The anaemia was so great that little or no difference could be discov- 
ered between the color of his lips and cheeks; very weak; the slighest exertion 
Outline of clinical lecture delivered at the Charity Hospital. by Joseph Tones, M. D., Profes- 
sor of Chemistry in the Medical Department of the University of Louisiana, New Orleans. 
(Reported for the New Orleans Journal o> Medicine, 1869.) Relations of Leueocythcemia to Malarial Fever. 
317 
caused prostration. Action of the heart irregular, and at times tumultuous with a 
decided bruit de souffle (bruit de diable), as in the most marked cases of anaemia. 
The abnormal sounds of the heart were referred by Dr. Jones entirely to the impov- 
erished condition of the blood, notwithstanding that the patient at times com- 
plained of great uneasiness and of a dull pain about the heart. This opinion was 
based not only upon the characteristics of the sounds of the heart, but also upon 
the evident anaemic condition, and upon the fact, that the patient never suffered 
with any irregularity of the heart, or uncomfortable feelings and pains in its 
neighborhood, until the red corpuscles had been greatly reduced apparently by the 
action of malaria. Liver and spleen both enlarged. Appetite pretty good ; bowels 
torpid ; the patient has at times complained of cramps in the bowels. The bowels 
were kept open by an occasional purgative, as blue mass or the compound cathar- 
tic pills of the U. S. P., generous, nutritious diet was ordered, and the effort was 
made to enrich the blood by the continuous use of iron, in combination with the 
sulphate of quinia. Arsenious acid was in like manner given in small doses for 
its tonic and alterant properties, as in the following formula: R-Precipit. iron 
(iron by hydrogen), 3iv; sulphate of quinia, 3 ij ; arsenious acid, grs. ij ; extract 
of rhubarb, 3 ij ; mix, and divide into one hundred pills; one pill three times a 
day. After taking the preceding, and other preparations of iron, the patient was 
placed upon nitro-muriatic acid, with the intention of exciting the action of the 
liver, and at the same time for the benefit of its tonic and anti-periodic properties. 
These measures were productive of no perceptible beneficial results-the blood 
remained in the same anaemic state, and mercurialsand nitro-muriaticacid exerted 
310 beneficial effect whatever upon the liver, and the patient retained the same sal- 
low, greenish-yellow hue ; the pain and distress about the heart, and in breathing 
also, so far from being relieved, continued to increase. Other cases of chronic 
malarial poisoning in the same ward recovered slowly but steadily under this gen- 
eral mode of treatment, even when the diseased state was complicated with 
chronic diarrhoea and dysentery. These facts confirmed the view that this was 
inot a simple case of malarial poisoning, but an example of that comparatively rare 
form of disease, characterized by a great diminution of the colored corpuscles, and 
a marked increase of the colorless or white blood cells. The correctness of the 
■diagnosis was confirmed by subjecting the blood of the patient to careful micro- 
scopical examination ; and this was done in the presence of a large number of 
the medical students of the University of Louisiana, assembled in the ward ; and 
the opportunity was thus embraced of making comparative examinations with the 
blood of healthy individuals. In the patient laboring under leucocythaemia, the 
red blood-corpuscles were not more than one-fourth as numerous as in health, and 
■did not perhaps exceed thirty parts in the thousand of blood, whilst the colorless 
■corpuscles were proportionately increased in numbers. The tonics, with nutri- 
tious diet, and small portions of wine and brandy, were continued, and the 
strength of the patient, as well as the fullness of his flesh appeared to remain the 
same; the only distressing symptom was the dull pain in the region of the heart, 
accompanied at times with palpitation, irregular action and difficult respiration, 
restlessness and a feeling of prostration. 
On the evening of the 13th of February, the patient finding the gate of the 
hospital yard open, and the attention of the watchmen engaged, slipped out, and 
wandered about the city, drinking and eating. Next morning the patient was 
brought to the hospital in a state of prostration. The marks of death were evident 
in his pale, ghastly countenance, widely dilated pupils, heaving irregular respira- 
tion, irregular palpitating heart, thread-like pulse, and the utter prostration of the 
muscular system. The patient had just strength sufficient to communicate an 
account of the imprudence by which lie had forfeited his life, and to state the fact 
that he had eaten a great mixture of oranges, oysters, and sweet-meats, and drunk 
largely of whisky and beer, and that he had vomited freely and was suffering with 
pains and cramps in his bowels. Revulsives and stimulants failed to cause reac- 
tion, and he died at four o'clock P. M. The lungs are healthy, without any 
adhesions. The heart is pale and flabby, or more correctly amende, but no struc- 
tural alteration can be discovered in the cavities, walls, or valves. The correctness 
of the view, that the sounds of the heart were due not to structural alterations, but 
to the watery condition of the blood, is thus confirmed by the autopsy. The peri- 
cardium was neither inflamed nor thickened, although it contained about three 
fluid ounces of golden-colored serum, which had evidently been effused on account 
of the watery condition of the blood. Light-colored, pinkish clots were found in 
the cavities of the heart, closely attached to the muscular columns. The mucous 
membrane of the stomach was congested, and exhibited marks of irritation. The 318 
Relations of Leucoiythamia to Malarial Fever. 
mucous membrane of the small intestine was greatly congested and of a deep red 
color, and its surface was coated with bloody mucus. In the watery state of the 
blood, the irritation of the mucous membrane of the small intestines, by the undi- 
gested and acid matters of the stomach, was attended with a haemorrhage from the 
mucous membrane. Mucous membrane of colon congested to much less extent 
than that of the small intestines. The lesions of the stomach and small intestines 
were, in connection with over-exertion, sufficient to account for the sudden termi- 
nation of this case. The liver was in a state of incipient cirrhosis, enlarged and 
hardened, and the lobules of the liver started from the fibrinous capsules when 
sections were made. This condition of the liver was referrable to the former use of 
ardent spirits by this German laborer, and was in no manner connected with the 
leucocythaemia. Gall bladder filled with dark-green bile. The spleen was enlarged 
four times its natural size, softened, and under the microscope, its dark, almost 
black pulp was discovered to be composed in large measure of disintegrating and 
disintegrated colored blood-corpuscles, and the haematin of the blood was found in 
the state of angular dark-brown and red masses. The lymphatics of the mesentery 
were enlarged and softened. The lymphatic glands of the mesentery were 
almost completely disorganized, and broken down into a soft diffluent pus- 
like mass. Under the microscope, the softened structures of the lymphatic glands 
were found to consist of oil globules, granular matter, and the altered tissues of 
the glands. The fluid blood from all the venous trunks, resembled most nearly 
colored water. The muscles, and the trunk and extremities generally, appeared 
full and round, and there was no special loss of fatty matters. 
This case presents the following points of interest to the student: 
1. The colored blood-corpuscles were greatly diminished ; ivhile there appeared 
to be no special increase or diminution of the fibrin. The diminution in different 
degrees of the globular elements of the blood, whilst the fibrin preservesits normal 
proportion, is the fundamental character of anaemia. In anaemia, the diminution 
of the principles of the blood becomes, independent altogether of the solids, the 
point of departure and sole appreciable element of the disease. This state may arise 
from the action of various causes, as of certain poisons (lead, mercury and malaria), 
insufficient diet, and exhausting labors in dark damp situations, In the descrip- 
tion of anaemia, amongst the laborers in the mine at Auzm, given by the celebrated 
Hallb, the most remarkable symptoms were the blanching of the whole surface of 
the body, a wan-yellowish tint, not only of the skin, but also of the conjunctiva, 
the inner side of the lids, the interior of the lips and of the mouth, and of the 
tongue itself. No ramifying of capillary vessels upon conjunctiva or the gums, no 
vein apparent upon the arm, forearm, or back of the hand. At the autopsy there 
proved to be a general deficiency of blood, and an universal paleness of all the 
parts naturally red. The treatment which succeeded best, was the use of chaly- 
beated tonics. This anaemia was attributed to the residence of the workmen in a 
subterranean gallery, where the ventilation was imperfect. In this damp atmos- 
phere, the respiration was impeded, and the water which trickled through the mine 
exhaled an odor of sulphuretted hydrogen. The invalids having pain in the abdo- 
men, it was at first supposed that the disease was analogous to the painter's colic ; 
but the treatment prescribed under this impression proved unsuccessful. In the 
present case, the general fullness of the body and limbs remained, notwithstand- 
ing the great loss of colored corpuscles ; and the same embonpoint has been recorded 
as existing in some patients who have died suddenly in the anaemic state. As the 
disease was unaccompanied by any marked febrile excitement, and as there was 
no special failure of the appetite, and as the watery elements of the blood and tis- 
sues were not diminished, there appeared to be no cause for the rapid or even appre- 
ciable wasting of the tissues of the body, notwithstanding the great diminution of 
the colored corpuscles. The most prominent symptoms of this case, as the great 
muscular prostration, debilitated and irregular action of the heart, and tendency 
to syncope upon exertion, appeared to be directly referable to the diminution of the 
colored blood-corpuscles. The gases of the blood, carbonic acid, nitrogen, and oxy- 
gen, are, for the most part, contained in the colored blood-corpuscles ; and Davy, 
Nasse, Scherer, Magnus and others have ascertained that the serum possesses in a 
far less degree than the defibrinated blood, the capacity of absorbing oxygen and 
carbonic acid, and Lehmann has convinced himself, that at least twice as much 
air is developed from a volume of whipped blood, tn vacuo, as from an equal vol- 
ume of serum, that has been strongly stirred or shaken with atmospheric air. Van 
Maack has found that a solution of haematin possesses a decided power of attracting 
oxygen ; and Scherer has not only convinced himself of the accuracy of this obser- 
vation, but at the same time ascertained that a little carbonic acid is developed Relations of Leucocythcemia to Malarial Eever. 
319 
after the absorption of the oxygen. Water absorbs only 0.925 per cent, of its vol- 
ume of oxygen, whilst according to Magnus, from ten to thirteen percent, may be 
taken up by the blood; this greater force of absorption in the blood can only depend 
upon certain conditions, and principally upon the red corpuscles ; only from one-four- 
teenth to one-eleventh of the.oxygen absorbed by the blood, and which varies from 
ten to thirteen percent, can be absorbed mechanically, that is to say, by the water, 
or can consequently exist free in the blood ; the remaining oxygen, that is to say 
from thirteen-fourteenths to ten-elevenths, must therefore be fixed by certain blood 
constituents; but this is only conceivable through the agency of some chemical 
attraction, however slight that may be; and the blood-corpuscles must be regarded 
as the chief agents in affecting this loose or unstable combination of the oxygen 
absorbed during respiration. These facts, established by the labors of various 
chemists sustain the view which ascribes to the blood-corpuscles the function of 
absorbing oxygen, and giving it partly off in the capillaries. It is well known, 
that the uses of oxygen in the animal economy are four-fold 
First.-To build up the structures and prepare the nutritive materials. The 
nitrogenized matters of vegetables, which form the elements of the structures, 
although similar in constitution to the nitrogenized animal structures, must still 
pass through certain chemical and physical changes before they become integral 
parts, in which oxygen plays the most important part. 
Second.-Oxygen aids in the constant metamorphosis of structure', and in the 
removal of the waste products. Under the action of the oxygen, introduced 
through the lungs, the nitrogenized elements are broken down into the simple 
compounds as urea and uric acid, and the simple elements as phosphorus, sulphur 
and carbon, are converted into acids, as phosphoric, sulphuric and carbonic acids. 
Third. One of the most important uses of oxygen is to sustain animal tem- 
perature. Oxidization is often so slow and imperceptible in its process, that we do 
not notice the development of heat, because being developed in very small quantity, 
it is almost instantly radiated away to surrounding bodies, and never accumulates. 
Thus the oxidation of iron and other metals in the atmosphere, is unattended with 
heat sensible to the casual observer. If, however, we examine this process of oxi- 
dization, which is continually going on upon the surface of our globe, we will find 
that the whole amount of heat developed during the oxidization of a given amount 
of matter is the same, whether the process of oxidization be slow or rapid. Oxidi- 
zation may also go on with a sufficient degree of rapidity to cause a sensible eleva- 
tion of temperature without flame or open combustion, as in the case of fermenta- 
tion, and the smouldering combustion of iron pyrites. Oxidization may also goon 
at a dull red heat, as in the case of spongy platinum, heated and held over alcohol. 
It is capable of demonstration, not only that oxygen is absolutely essential to the 
commencement and continuance of the life actions of all animals, and that the 
animal temperature is sustained mainly by the union of oxygen with the various 
elements of organic structure; but also that a definite temperature is absolutely 
necessary to and is an active agent in promoting the essential changes of nutrition 
and secretion and excretion, and that the intelligence and activity of animals depend 
absolutely upon the constant action of oxygen. Oxygen in its free state, issupplied 
to animals during respiration; the essential act of which is an interchange between 
the carbon and oxygen of the fluids and solids of living beings. In an animal of 
homogeneous structure, as the simple cell animalcule, every part of the exterior 
surface, and internal surface, exposed to the medium in which it lives, performs 
the functions of respiration. Animals having this simple form of respiration, have 
no special organs and apparatus, have no means or power of rapidly generating 
heat, and consequently their temperature depends upon, and varies with that of 
the surrounding medium. As we ascend in the scale of created beings, the appa- 
ratus of respiration becomes more complicated, the chemical and physical changes 
of the molecules of their solids and fluids become more rapid and energetic, 
and all the organs and apparatus are correspondingly developed. In the higher 
orders of animals, the respiratory system is confined to a definite portion of the 
exterior, or internal membrane, which is developed within a small space, into 
a great extent of surface, so as to render the contact with the air or water, as 
extensive as possible, without any loss of room or power. In fish, the blood goes 
out to meet the oxygen contained in the atmosphere, dissolved in the water. In 
land animals, the atmospheric air is introduced into their lungs, which maybe 
regarded as membranous bags, divided into a greater or less number of compart- 
ments or cells according to the rapidity of the respiratory process, and consequent 
chemical and vital changes. By the division of the lungs into a great number of 
cells, over and around which the blood-vessels ramify, nature acquires an immense 320 
Relations of Leucocythcemia to Malarial Fever. 
surface, so that the blood spread over this surface may be rapidly oxygenated. A. 
large amount of air must be introduced into the lungs, and hence the respiratory 
apparatus for expanding the cells. The perfection of this apparatus as a general 
rule corresponds with the development of the lungsand circulatory apparatus, the 
number of colored blood-corpuscles and the general perfection of the animal. Any 
change in the temperature of an animal is uniformly attended with disturbances in 
the functions of the nervous and muscular systems, and in the nutrition and secre- 
tion and excretion. The more simple and rudimentary the construction of an ani- 
mal, the less power will it possess of generating sufficient heat to resist the changes 
of the surrounding atmosphere, and if its temperature falls below a certain point, 
the nervous and muscular actions become deranged or depressed, and the animal 
becomes torpid. The fourth office of oxygen, is to aid in the generation of the 
physical forces by which the muscular and nervous systems perform their peculiar 
functions or acts. The oxygen absorbed into the blood during respiration, as well 
as the blood itself, and the heat which is produced in this complex fluid, by the 
unceasing chemical changes, must be carried to every molecule of living organized 
matter. If the molecules be not supplied with oxygen, heat and the elements of 
structure, death will take place, i'o accomplish tnis essential condition of life 
action, nature again compresses the natural, physical and mechanical laws into her 
service. A powerful apparatus is needed to propel the elaborated blood, with its 
oxygen, heat and elements of structure to every part of the organized tissues. 
Hence we have the heart, a powerful muscle, which incessantly acts, propelling 
and returning to and from all parts of the system, the nutritive fluid. The funda- 
mental, the essential condition and object of circulation, is the bringing of the 
blood, with its oxygen, heat and elements of structure, into intimate connection or 
contact, with the organic molecular elements of all the fluids and solids of the 
■organs and tissues of organized beings. The perfection of the circulatory appa- 
ratusin the various members of the animal kingdom corresponds with the develop- 
ment of the cerebro-spinal nervous system, with the activity and intelligence, and 
with the perfection of the respiratory and muscular apparatus. Respiration-the 
.introduction of oxygen, therefore, is the great cause of the circulation-and the 
distribution of the blood by the circulatory apparatus is the great source of the 
mechanical forces of living animals. The objects of the circulation are, therefore, 
-the distribution of the materials of nutrition, the introduction and distribution of 
oxygen, and the removal of the products of the waste of the tissues. The perfec- 
tion of the organs and apparatus, and the rapidity of the life actions, and the power, 
temperature and intelligence of animals, depend, therefore, in great measure, upon 
the rapidity with which the element oxygen is introduced into the circulatory fluid, 
and distributed to every living molecule of matter. If this chain of reasoning be 
admitted, the student is enabled upon physiological grounds, to understand why a 
diminution of the colored blood-corpuscles, as in this case of leucocythcemia, is 
attended with loss of nervous aud muscular force, and with debility in the action of 
the heart, and consequent oppression in breathing. The blood-corpuscles must not 
be regarded solely in the light of oxygen carriers, but collectively as an immense 
gland which elaborates materials for the nutrition of the nerves and muscular tis- 
sues. Each blood cell exerts important chemical and physical changes upon the 
surrounding liquor sanguinis, and elaborates products which are destined to fulfill 
distinct offices in the nutrition of the organs and tissues. On this account also 
diminution of the colored blood-corpuscles is attended by depressed and deranged 
nervous and muscular actions. 
2.- The diminution of the colored-blood corpuscles in this case of leucocythcemia, 
appeared to be referableprimarily to the action of malaria. The patient had lived 
in a low malarious region, and had suffered with malarial fever for months. In a 
case observed by Dr. Jones, at Franklin, Tennessee, in 1868, to which he was 
called in consultation with Professor Paul F. Eve, M. D., the leukaemia was in like 
manner, subsequent to and coincident with intermittent fever, and the prolonged 
action of malaria. In this case as in the one now under consideration, quinine and 
the preparations of iron, exerted no marked beneficial effects; the palor was 
extreme, no difference could be noted between the color of the lips and that of the 
forehead; there was great muscular debility and distressing oppression in breath- 
ing at times, especially upon slight exertion. This case terminated fatally in like 
manner. As far as the results of the observations and investigations of Dr. Jones 
extend, the colored blood-corpuscles are more uniformly and rapidly destroyed in 
some cases of malarial fever than in any other acute disease, with the exception, 
perhaps, of pyaemia, in which case an organic poison is directly introduced into 
the blood-vessels, and rapidly destroys the blood-corpuscles. And it is worthy of Relations of Pneumonia to Malarial Fever. 
321 
note that in pyaemia we have, as in malarial fever, chills and a sallow jaundiced 
hue. The suspension of the process of digestion, and the perversion and partial 
suspension of secretion and nutrition, and the rapid chemical changes and corres- 
ponding rapid metamorphosis of matter-the universal attendants, or rather phe- 
nomena, of acute diseases, must necessarily be attended by a, destruction, to 
a greater or less extent, according to the severity of the disease, of one or all the 
constituents of the fluid which supplies the elements of secretion, nutrition, and 
chemical change; these causes produce destruction of the colored blood-corpuscles 
in all acute diseases, but in malarial fever we have an increased destruction which 
cannot be referred to these causes. It is certainly of interest to determine the place 
of the destruction of the colored blood-corpuseies, and to consider the question, 
whether their disappearance be entirely due to the cessation of their birth? Do 
they diminish simply because new ones do not take their place? With reference 
to the place of the destruction of the colored blood-corpuscles, it may be affirmed 
that they undergo important alterations in the spleen and liver, during the active 
stages of malarial fever. In examinations of the organs after death, from all the 
forms of malarial fever, intermittent, remittent and congestive, Dr. Jones has 
observed that the dark blood of the spleen and liver does not change to the arterial 
hue when exposed to the action of the oxygen of the atmosphere. After death 
from phthisis, cirrhosis of the liver, organic disease of the circulatory apparatus, 
apoplexy, tetanus, and mechanical injuries, etc., so far as his observations extend, 
the blood of the spleen and liver always changes to the arterial hue, upon 
exposure to the action of the oxygen of the atmosphere. Chemical examina- 
tions of the blood of the liver during health, have shown that the blood-corpus- 
■cles are more numerous in the blood passing out of this organ, than in the portal 
blood. The blood-corpuscles appear to originate, to a certain extent, in the liver, 
and undergo certain important chemical and physical changes in that organ. In 
malarial fever, important changes take place in the blood passing through the 
liver; many of the colored blood-corpuscles are destroyed, and the coloring matters 
infiltrate the structures, together with the altered bile, impart the slate-color to 
the exterior, and the bronze color to the interior, of the malarial fever liver. In 
somecases the coloring matter derived from the disintegrated blood-corpuscles, exists 
in the form of granules in the tissues of the liver. These granules, however, are by 
no means necessary to the slate and bronze color. Whilst the facts as yet accumu- 
lated are too few to warrant any very general or dogmatic assertions, they certainly 
incline our minds to the belief, that the destruction of the colored blood-corpuscles 
in the liver, is dependent upon the disturbance of the relations of the liver to the 
blood, rather than to the destruction of the colored blood-corpuscles in the capil- 
laries and blood-vessels, independent of the action of the liver, simply by the direct 
action of the malarial poison. The blood and blood-corpuscles undergo remark- 
able alterations in the spleen during malarial fever. Upon the exterior, the mala- 
rial spleen presents a dark-slate color, resembling the color of the malarial liver. 
When helcl in the hand, the malarial spleen feels like a bag of soft mud. The 
capsule and trabecula break upon the slightest pressure, and the lingers will often 
plunge into the organ, and during the most careful handling. The reddish-brown 
mud (pulp) of the malarial spleen, consists almost entirely of colored corpuscles in 
various stages of alteration and disintregation. With the microscope it has been 
demonstrated that in many cases, especially those of long standing, the mud of the 
spleen contained numerous granules of a reddish black color. These black gran- 
ules were frequently conglomerated together, forming dark flakes, like the coffee- 
grounds sediment of the black vomit of yellow fever, and were, without doubt, 
altered colored blood-corpuscles. In many malarial spleens, the colored blood cor- 
puscles have presented swollen and distorted and irregular forms. This alteration 
of the spleen has been found by Dr. Jones, in all cases, and in all periods of mala- 
rial fever. In one case, in which the patient died in thirty hours after the com- 
mencement of the attack, the spleen presented the same enlarged and softened con- 
dition, whilst the liver presented only spots of the slate and bronze color. When 
we reflect that the malarial fever spleens often weigh one and two, and three or 
more pounds, and that their principal weight is due to the presence of colored 
blood-corpuscles; when we farther reflect that the whole amount of blood existing 
in the body of a grown man is about twenty pounds, and that not more than nine 
pounds of this exist in the form of moist colored blood-corpuscles, it is evident that the 
spleen in malarial fever, forms a grand sepulchre for the colored blood-corpuscles. 
In the present case of leucocytluemia, the spleen was enlarged, softened and filled 
with disintegrating colored blood-corpuscles, as in the true malarial spleen ; and 
the changes of the blood in this organ appeared to have been undoubtedly due to 322 
Relations of Pneumonia to Malarial Fever. 
the action of malaria, which is capable of inducing this state of the spleen suddenly 
as in acute attacks of malarial fever, or slowly and almost entirely without the 
phenomena characteristic of fever, and without any aberrated nervous action. 
3. Not only were the colored blood-corpuscles grecdly diminished in this case of 
leucocythcemia, but the colorless corpuscles were greatly increased. The increase of 
the colorless corpuscles, in an inverse ratio to the decrease of the colored corpuscles 
is the distinctive characteristic of this disease, distinguishing it from simple 
anaemia. If the origin and offices of the colorless corpuscles, as well as their true 
relations to the colored corpuscles were fully established, a great advance would be 
made in the natural history of this singular and almost universally fatal dispase. 
Dr. Jones discussed the origin and development of the colorless and colored corpus- 
cles, and endeavored to determine whether the diseased state of the blood was due 
to the simple arrest of the development of the colored corpuscles, or to an actual 
increase of the colorless globules ; and closed his lecture with a succinct account of 
the history vf this disease. 
RELATIONS OF THE CHANGES OF THE BLOOD IN MALARIAL FEVER TO THE 
PHENOMENA, PROGRESS AND TREATMENT OF PNEUMONIA. 
We have, in the first volume of these Medical and Surgical Memoirs, 
chapter xviii, page 694-747, fully discussed the relations of malaria to 
pneumonia, aud the relative value of the autiperiodic or abortive method 
of treating pneumonia. This subject was illustrated by numerous statis- 
tics aud detailed cases, which it is unnecessary for us to reproduce. It is 
important, however, that we should, in this connection, produce the out- 
line of this most important inquiry into the effects of the malarial poison 
upon the progress of the pneumonic inflammation.* 
Southern physicians have, for a number of years, used quinine in the 
treatment of pneumonia; and previous to the recent Civil War, a number of 
articles have from time to time appeared in the various medical journals, 
extolling the virtues of quinine in the treatment of this disease, and more 
especially in malarious regions. By many of the advocates of the power 
of quinine to greatly modify and even arrest the progress of pneumonia, 
the doctrine is held that the disease arises from the same causes, is inti- 
mately associated with malarial fever, and in fact is nothing more than 
one of the forms of periodic fever. The remark is not unfrequently heard, 
that pneumonia should be treated as a malignant remittent. Those who 
adopt the view of the identity of paroxysmal fever and pneumonia, believe 
that quinine, in full doses, is capable of arresting the latter, in the same 
manner that it arrests or aborts the former. 
We might bring forth numerous quotations from the older writers, to 
prove that the belief in the identity of the causes and ultimate nature of 
pneumonia and paroxysmal fever, as well as the treatment by bark and 
quinine founded upon this view, are by no means so novel as some of the 
modern writers, and especially American medical writers, would have us 
believe. Our limited space, however, will permit only brief reference to 
some of the most trustworthy authorities. Jean Senac,f in his celebrated 
and unsurpassed treatise on the "Hidden Nature and Treatment of Inter- 
mitting and Remitting Fevers," discourses in several chapters upon the 
conversion of intermittent fever into pleurisy and pneumonia; and in his 
observations upon the method of detecting or distinguishing intermittents, 
when disguised under the mask of other diseases, relates a case of inter- 
/ 
* Relations of Pneumonia and Malarial Fever: with Practical Observations on the Antipe- 
riodic or Abortive Method of Treating Pneumonia. By Joseph Jones, M. D., Professor of Chem- 
istry in the Medical College of Georgia. Southern Medical and Surgical Journal, September,, 
1866, p. 220. 
t De Recondita Febrium Intermittent! um, turn Remittentium Natura et de earum Cura- 
tione: Variis experimentis et observationibus illustrata. 1769. Relations of Pneumonia to Malarial Fever. 
323 
mittent pleurisy, cured by febrifuge remedies- Galateus, nearly seventy 
years ago, in a work on Peruvian bark, pointed out the efficacy of this rem- 
edy in the cure of pneumonia occurring in intermittent fever, and which 
he considered as one of the manifestations of paroxysmal fever. George 
Cleghorn, in his "Observations on the Epidemical Diseases of Minorca, 
from the year 1744 to 1749," describes a fatal form of pneumonia and 
pleurisy, with instinct remissions. "When those pleurisies," says Cleg- 
horn, "first became epidemical, their quick progress and uncommon mor- 
tality surprised me greatly. I attempted to cure them by bleeding, once 
or twice a day, if the complaints were violent, as I had always used to do 
in inflammatory fevers; but the remissions in the mornings sometimes 
induced me to omit the operation; and the cessation of the symptoms, 
which generally happened about the third day, made me imagine that the 
danger was over; so that before the patients were blooded above two or 
three times, the exacerbation came on upon the fourth or fifth day, and 
defeated all attempts by bleeding, blistering, or otherwise to relieve them. 
Those unforeseen events startled me greatly, and led me to review the 
whole progress of the disease, its symptoms and issue. I had observed 
that some escaped by means of expectoration and purulent urine, without 
much assistance from phlebotomy; and considering the periodical revolu- 
tions of the fever, the quick transition of the stitches from one part to 
another, together with the prevailing color of the blood, as well as that of 
the spitting, and other excretions, I was apprehensive that those were 
what authors call bilious pleurisies, which they allege are exasperated by 
large evacuations;* particularly Duretus,f who exclaims with great vehe- 
mence against those physicians who trust principally to bleeding in the 
care of those diseases, without waiting for the natural evacuations." Loc. 
cit., p. 164-5. 
Morton appears to have frequently detected the malignant intermit- 
tent concealed under the mask of pneumonia and ifieurisy. This physi- 
cian relates, among others, the case of a man who was seized in the morn- 
ing with a violent shivering, and a pain in the thorax of so severe a 
character as to render respiration scarcely practicable. The pulse of the 
patient was small and rapid, his weakness was extreme, and universal 
coldness overspread all the limbs. Notwithstanding these symptoms, 
blood-letting from the arm was employed as the necessary and proper 
remedy for this spasmodic state of the respiration. When, however, from 
the nature and return of the paroxysms, Morton detected a fever of a malig- 
nant character, masked under the appearance of a peripneumony, he made 
the bark the principal foundation of his treatment, and succeeded in arrest- 
ing the disease. 
Lautter, as quoted by Alibert, in his treatise on malignant intermit- 
tents, has recorded two similar cases in his Hist. Medic, bienn. morb. rural, 
etc. ; Casus v and ix. A laborer of Luxembourg, thirty years of age, of a 
dry temperament, being engaged in threshing corn, was seized, first with 
a trembling, and then with a violent coldness, to which succeeded a short 
hot fit, and great thirst. The principal symptom was an excessive pain in 
the left side, which considerably impeded respiration. Being obliged to 
quit his work, he took to his bed; the fever continued nearly eighteen 
hours in the same state, and then underwent a perceptible remission. On 
the morning of the day following, the patient was still better. Although 
* Ballon. Epid. Sparsim. Bianch Hist. Hep. p. iii, gviii, etc. Bagl.Prax. Med. 1. i. c. ix. Lan- 
ds Epid. Rom. c. vi. 
t O homines republicae calamitosos atque funestos! ipsam pleuritidem, quae sua sponte nul- 
lius operis indigens cum tali sputo quiesceret, ex eventur reddunt mortiferam. Duretin Praenot. 
Coac. 324 
Relations of Pneumonia to Malarial Fever. 
lie was rather feeble, the stitch in his side continued, and he was certainly 
in some degree feverish, yet he went to work again, but all the symptoms 
returning toward evening, he again took to his bed. Lautter was called 
in; he found his patient laboring under a high fever, his pulse was hard, 
his respiration laborious, painful, and almost suppressed; the pain in the 
side was extremely acute; there was no cough. From the history of the 
disease, the physician discovered immediately that it wfes a malignant 
intermittent, masked by the predominant symptom of pleurisy ; not being- 
able to strike immediately at the root of the disease, because the exacer- 
bation was then at its height, he employed himself in moderating the vio- 
lence of the symptoms. He drew from the arm of the affected side ten 
ounces of blood, which was covered with an inflammatory crust, and 
ordered an emollient cataplasm to be applied to the part where the pain 
lay, and to be frequently renewed. Internally he administered barley- 
water with oxymel and nitre; the patient experienced relief, his respiration 
became easier, and the pain in his side abated; yet he passed a sleepless 
night with heat and great thirst. On the day following, his pulse was 
indeed less frequent, and was not hard, yet he had a high fever; the pain 
in the side continued, the urine, which was very high colored, deposited 
a lateritious sediment; the symptoms were now much milder, but as they 
had not altogether disappeared, the foregoing remedies were continued. 
In the evening, the disease resumed completely its first state and appear- 
ance. On the morning of the following day, there was no remarkable 
change, except that the acute pain in the right side disappeared for a short 
time, but soon returned again ; the urine had undergone no change since 
the day before, the skin was constantly cold, etc. Lautter discovered 
immediately the malignant character of the fever. He took advantage of 
the remission to administer an ounce of the bark in the space of twenty- 
four hours; the next paroxysm was a very moderate one: and by continu- 
ing the use of the same remedy, the disease was radically cured. 
A woman, sixty years of age, having her system greatly heated by 
exercise, exposed herself imprudently to the coolness of the evening. She 
was attacked by a cold fit, which was followed by a fever of great intensity. 
A severe pain occurred in the right side, extending round to the spine; a 
dry and frequent cough added to its acuteness; the respiration was short 
and laborious, and the succeeding night was passed without sleep. Laut- 
ter was called in; he found the pulse greatly agitated, full and hard, the 
tongue white and dry. Taking the disease for a pleurisy, he drew blood 
from the arm of the side affected, and laid an emollient cataplasm on the 
part where the pain was situated; the blood was covered with an inflam- 
matory crust. The symptoms became milder. On the same day, at one 
o'clock in the afternoon, the shivering returned with a slight degree of 
coldness; the febrile heat, the cough, the pain, etc., were all augmented; 
the pulse was as full and as hard as at first; blood was consequently drawn 
a second time, and exhibited again an inflammatory crust. There was now 
a remission of the febrile symptoms. On the evening of the day following, 
the cold fit returned; the pain, the heat, the cough, etc., increased con- 
siderably, in consequence of which the patient passed a very bad night. 
Next day there was a remission; afternoon, another exacerbation, ushered 
in by a cold fit. The physician contented himself with repeating the 
application of cataplasms, and administering cooling drinks. He had no 
further recourse to blood-letting, because the patient's strength was greatly 
exhausted, and from the progress of the disease and the copious sediment 
of the urine, it was easy to discover a double tertian remittent lurking 
under the mask of pleurisy. Lautter gave an ounce of a mixture of bark Relations of Pneumonia to Malarial Fever. 
325 
to be taken previously to the return of the paroxysm which was very near 
at hand. During the succeeding night, the patient experienced only a 
great heat, but the cough and the pain in the side did not increase. On 
the following day, the same medicine was continued, and there was scarcely 
even the shadow of an exacerbation. By the continued use of the bark, 
the patient was very soon restored. (A treatise on malignant intermit- 
tents, by J. L. Alibert, translated by Charles Caldwell, M. D.; Philada., 
1807 : pp. 46-50). Alibert in the same connection recounts a similar case 
of intermittent pneumonia, occurring in a student of medicine in Paris, 
which was successfully treated by wine and bark. 
Laennec observed the existence of intermittent malarial pneumonia 
(pernicious pneumonic fever) in a muscular, robust man, who had entered 
t he hospital with a recent syphilis. On the sixth day of his admission, the 
patient suffered with a paroxysm of intermittent fever of considerable vio- 
lence, and he stated that he had had a paroxysm two days before. A third 
paroxysm occurred on the third day after, but it was entirely different 
from the preceding paroxysm; it commenced with a more considerable 
chill, was accompanied with a violent headache, extreme dyspnoea, and 
haemoptysis. Upon exploring the chest during the middle of the paroxysm, 
the respiratory murmur was found unaltered except at the root of the lungs, 
where it was masked by a rede crepitant well characterized, principally on 
the right side. Laennec, without hesitation, declared the disease a double 
pneumonia in its initial stage: tartar emetic, six grains; sulphate of qui- 
nine, eighteen grains, to be taken in three doses. The patient vomited a 
little and had but one stool; the next day he thought himself cured. But 
as the rede crepitant had not entirely disappeared with the cessation of the 
febrile paroxysm, the two prescriptions were continued. The following 
paroxysm was very short; the rale crepitant was slightly developed, and the 
haemoptysis reappeared; but the fever had scarcely ceased, when all the 
symptoms disappeared (that is to say, as soon as the disease ceased, it no 
longer existed). The tartar emetic was discontinued on the fifth day, the 
respiration having become pure and natural; the sulphate of quinine was 
continued for some days. The patient was now cured of the fever, and the 
anti-syphilitic treatment, which had been suspended, was resumed. Three 
weeks after, the intermittent fever reappeared; it was now simple and 
benign, and a few doses of the sulphate of quinia entirely arrested it; the 
patient remained six weeks longer in the hospital, and left in good health. 
In like manner M. Fleury records a remarkable case of tertian pneumonia, 
which was attended with almost complete disappearance of the distressing 
pneumonic symptoms during the intermission of the fever, and which was 
arrested by quinine and bark. (See Physiological Pyretology; or a Trea- 
tise on Fevers, etc., by F. G. Boisseau, trans, by J. R. Knox, M. D.; Phila., 
1832; pp. 433-436.) We might present the testimony of many other 
writers, as Ramazini, Lancisi, Sydenham, Hunham, Sauvages, and Brous- 
sais, to show that the notion of the production of pneumonia, by the same 
causes which generate the various forms of malarial fever, has been not 
only long, but widely held by the medical profession; but the authors 
already cited are believed to be sufficient for the establishment of this 
proposition. 
Without attempting at this time to settle the question as to whom 
belongs the honor of first giving bark and quinine in pneumonia and 
inflammations generally, we have shown conclusively that the former 
remedy has been freely used in the treatment of all fevers and inflamma- 
tions for at least a century ; and as the principles which led to its adminis- 
tration did not differ materially from those which now lead to the use of 326 
Relations of Pneumonia to Malarial Fever. 
quinine, and as the bark necessarily included this constituent, if any credit 
is due to this method of treating inflammations, it rests with the older 
writers. We will endeavor in the next place to determine the relations of 
malarial fever to pneumonia, by the application of those facts and princi- 
ples which have been developed by our own investigations. We shall con- 
tent ourselves with the expression of only those general results of our 
investigations which bear upon the treatment of pneumonia. 
1st. There is no necessary connection between pneumonia and malarial 
fever. In healthy, elevated non-malarious regions, pneumonia is almost 
never complicated with malarial fever. In malarious regions on the other 
hand, pneumonia is frequently complicated with malarial fever. The local 
inflammation frequently appears in those who are laboring under the 
action of the malarial poison, and the disease partakes of the paroxysmal 
character. If the.system of healthy individuals be reduced in malarious 
regions, by any depressing agent or disease, as by the amputation of a 
limb, or by the inflammation of some organ, as of the lung in pneumonia, 
the malarial poison is most likely to exert its effects. In such cases the 
paroxysmal character of the inflammatory disease is due not to the pre- 
existing action of the malarial poison, but to the fact that the system has 
been so depressed as to be unable to resist the action of the malarial 
poison. 
2. The malarial poison induces profound alterations in the constituents of 
the blood. Under its action, the colored blood-corpuscles are more rapidly, 
and to a greater extent, destroyed than in other disease. The fibrin is 
diminished and altered in quality. The albumen is in like manner dimin- 
ished. The extractive and coloring matters of the blood are frequently 
increased. The unhealthy hue of the complexion in malarial fever, 
appears to be due to both the destruction of the colored blood-corpuscles 
and the presence of coloring matters in the blood. 
3. During the active stages of malarial fever, phosphorus and the com- 
pounds of phosphorus in the nervous structures and in the colored blood-corpus- 
cles, as well as sulphur and the compounds of sulphur in the muscular structures, 
undergo more rapid changes than in the normal state, and phosphoric acid and 
the phosphates, and. sulphuric acid and the sulphates, appear in increased quanti- 
ties in the urine. The waste of phosphorus and its compounds in the blood 
corpuscles and nervous structures during the active stages of the fever, is 
far greater than the supply of these elements through the food. The nerv- 
ous disturbances and debility characteristic of malarial fever are in a 
measure, if not entirely, due to these rapid changes in the phosphorescent 
materials of the nervous structures and especially of the central ganglionic 
cells. 
4. During the slow action of the malarial poison, as well as during the 
active stages of the paroxysm, important changes take place in the liver and spleen. 
In both organs, the colored blood-corpuscles are destroyed in large num- 
bers, and the coloring matter, resulting from the disintegration of the red 
corpuscles, accumulates in them, and in conjunction with other changes in 
the nutritive processes of these organs, produce those characteristic alter- 
ations of the normal color. In fatal cases, cellulose is found in both the liver 
and spleen, whilst grape sugar is absent from the liver. The bile is altered 
both in chemical constitution and physical properties. 
5. That the chemistry of the body is still f urther deranged in malarial 
fever, is evidenced by the changes in the excretions. During the chill, and at 
the very commencement of the hot stage, phosphoric acid disappears 
almost entirely from the urine ; as the hot stage progresses, and the febrile 
action and the heat commence to decline ; there is an augmentation of phos- Relations of Pneumonia to Malarial Fever. 
327 
phoric acid. But what is still more important in its bearings upon pneu- 
monia, the uric acid is either increased, or remains at the normal standard, 
during the chill; disappears almost entirely during the fever ; and then 
increases rapidly, and rises to a high figure, after the subsidence of the 
febrile excitement, and often continues for days, two, three, and even six 
times more abundant than in the1: normal state. If it be true that the pres- 
ence of a morbific material in the blood, as uric acid, in gout and rheuma- 
tism, will often prove an excitant to inflammatory action, this tendency in 
malarial fever to the generation of large quantities of uric acid during the 
intermissions, and even during the period of convalescence, is important 
in its bearings, not only upon pneumonia, but also upon neuralgic affec- 
tions. I have in my own case observed changes in the urine, and especi- 
ally in the uric acid, during severe headaches of malarial origin, similar 
to those observed in well-defined cases of paroxysmal fever. 
6. One of the most marked and important of the phenomena of malarial 
fever, in its connection with inflammations of internal organs, is the congestion of 
important organs at stated intervals. It would even appear that, aside from 
the gener al depressing effects of the malarial poison upon the heart and 
■circulatory system at stated periods, and the consequent stagnation of the 
blood in the central portions of the circulatory system, the altered blood 
corpuscles, and the products of their death and disintegration, as the color- 
ing matter, may under certain conditions obstruct the smaller- vessels, and 
give rise to local and circumscribed congestions and even effusions. 
It results from these effects of the malarial poison : 
(a.) When inflammation is excited from any cause, in a system subjected to 
the influence of the malarial poison, the natural tendency is for the inflammation 
to assume a low form, from the altered condition of the constituents of the blood 
and structures, and from the derangements in the processes of nutrition, and of 
those physical and chemical acts by which the nervous and muscular forces are 
developed. It is well known that the causes which are most influential in 
the production of inflammation are such as enfeeble the heart, impair the 
tone of the arteries, r educe the activity of the secreting organs, and debili- 
tate the muscular and nervous forces. Imperfect, nourishment also, either 
in consequence of the defect in the quantity or quality of the food, or of 
incapacity of the digestive powers, impairs the powers of the system to 
resist the effects of deleterious and depressing agents, as cold ; and pro- 
duces a liability to low forms of inflammation and fever, and to various 
epidemic and contagious disorders. In malar ial fever1, even when thediges- 
tion is unimpaired, the action of the poison, by impairing the constitution 
of the blood, and by deranging the nutritive processes of the different 
organs and tissues, and by deranging and depressing the chemical actions 
concerned in the development of the physical and nervous forces, produces 
similar results to those witnessed in ill-fed and ill-conditioned beings. 
The process of inflammation, whilst including both congestion and 
determination of blood, is essentially more complex than either or both of 
these conditions, and includes changes of the blood within the vessels, and 
changes of the relations of the capillaries to the blood, and of the blood to 
the surrounding tissues. The character of these changes, as well as the 
■extent and progress of the inflammation, will depend upon the constitu- 
tion of the blood, the forces moving that blood, and the condition of the 
forces active in the nutrition of all the organs, as well as of the forces 
especially active in the inflamed tissue. Thus, when the character of the 
blood has been altered and the forces depressed, the solid products of 
inflammation are less capable of organization, the lymph effused possesses 
inferior plasticity, and the effects ot the local inflammation upon the gen- 328 
Relations of Pneumonia to Malarial Fever. 
eral system, in causing inflammatory fever, are more depressing* and dan- 
gerous. As therefore the tendency of the malarial poison is to derange 
the conditious upon which the maintenance of healthy nutrition depends^ 
viz : the regular supply of healthy blood possessing a definite composition 
and relation of its elements, and of a certain supply of physical and ner- 
vous force, and the healthy constitution of the organs and tissues, it is evi- 
dent, not only that inflammation engrafted upon the system laboring under 
the effects, or under the direct action of the poison, must be correspond- 
ingly altered from its progress in the healthy constitution, but also that 
the state of the system induced by the action of the malarial poison is con- 
ducive to the origin of inflammation. 
(ft.) From the destruction of the fibrin and. red blood-corpuscles, consequent 
upon the action of the malarial poison, the tendency of inflammations excited in 
systems under the influence of the malarial poison is to diffusion. The increase 
of fibrin in the blood, and in the inflamed structures, appears to be des- 
tined, in the economy of nature, to limit and circumscribe the inflamma- 
tory action, by the fibrinous matter thrown out within and around the 
inflamed part. The colored blood-corpuscles, which crowd the inflamed 
part, appear to contribute by the chemical changes which they excite, and 
especially by the increased oxidization of the protein elements, to the for- 
mation of fibrin, which in this view may be considered as one of the con- 
trolling and limiting elements of inflammation. Whatever therefore tends 
to diminish the red corpuscles and fibrin, tends to interfere with the natu- 
ral processes employed by nature in the limitation of inflammation, and 
directly promotes the diffusion of the inflammation over a greater extent 
of tissue, and in a corresponding degree renders it more severe and dan- 
gerous. We have in these facts an explanation of the sudden and fatal 
character of many cases of pneumonia occurring in those who have been 
for some time under the influence of the malarial poison. We have had 
under treatment, and recorded at length elsewhere, cases which were sud- 
denly seized with pneumonia during the period of convalescence from 
malarial fever. These patients were destroyed, or rather drowned, by the 
rapid pouring out of serous fluid into the air cells and bronchial tubes of 
the lungs. In such cases, the capillaries of the blood, being in an enfeebled 
state, the fibrin of the blood being diminished in quantity and altered in 
physical and chemical properties, the colored blood corpuscles being dimin- 
ished in number and physically and chemically altered, the solid matters 
of the blood having been diminished, and the physical and chemical rela- 
tions between the individual constituents of the blood and capillaries hav- 
ing been disturbed by the action of the malarial poison, healthy limited 
inflammation was impossible. Diffused inflammation of all the structures of 
the lung resulted, the serous portion of the blood poured into the air cells, 
bronchial tubes and trachea ; the supplies of oxygen were in a great meas- 
ure cut off; the chemical changes of the solids and fluids were in a corres- 
ponding degree checked; and the physical forces, heat, and electricity, 
and the nervous force, developed by these chemical changes, were, as a 
necessary consequence, correspondingly diminished. Broussais, in his his- 
tory of chronic phlegmasise, has recorded several analogous cases of fatal 
pleuritic and pulmonic affections attacking those suffering with malarial 
fever; and Andral, in his '' Clinique Medicale," has given at length a fatal 
case of pneumonia, with pulmonary oedema and double pleuritic effusion 
following and supervening upon intermittent fever. 
(c.) The liability of persons who have suffered with malarial fever in the 
summer a,nd fall, to be seized with pneumonia, in the winter and spring, and 
the danger of these inflammatory attacks following or engrafted upon paroxysmal Relations of Pneumonia to Malarial Fever. 
329 
fever, has long been knoivn to the public as well as to the profession. In many 
cases, these inflammations engrafted upon malarial fever, or following its 
effects, are clearly dependent for their excitation upon the vicissitudes of 
the weather, and especially upon the agency of cold. In healthy beings 
exposed to cold, there is at first, through the stimulating effects of the cold 
air inspired, and of the change of temperature upon the exterior, an 
increase in the circulating and respiratory actions, more oxygen is intro- 
duced and distributed, the chemical changes of the system become more 
rapid, and the temperature of the body, notwithstanding the increased 
radiation and loss of heat, is maintained at the normal standard by the 
increased chemical actions. As long as the fixed normal temperature of 
health is maintained in the trunk and important organs of animal and 
vegetable life, no evil results follow. If, however, through the prolonged 
action of the cold, the materials capable of keeping up the temperature be 
exausted, or if the nervous and muscular forces be so depressed that the 
respiratory and circulating actions are so impaired, that the materials are 
not distributed with sufficient volume and celerity to maintain the neces- 
sary chemical changes to preserve a fixed temperature, the heat of the body 
gradually descends, not only by progressive conduction and radiation, from 
the exterior to the centre, as in an inanimated cooling body, but the chilled 
blood circulating in the vessels of the exterior, and in the capillaries of the 
lungs, mingles with the mass of blood in the interior, and still farther and 
more rapidly reduces the temperature of the great central organs. At the 
same time, the contraction of the vessels distributed through the superfi- 
cial structures, under the prolonged action of cold, forces the blood inward 
toward the largest venous receptacles, and thus induces a state of conges- 
tion in the central organs. 
It is a well established fact that a fixed temperature is absolutely 
necessary to the maintenance of the healthy nutrition of the tissues, to the 
proper performance of the functions of secretion and excretion, and to the 
regular and active development of the nervous and muscular forces. Not 
only by the congestion of the internal organs, but also by the disturbances 
induced in the chemical and physical processes concerned in secretion and 
excretion, by the loss of that amount of heat or physical force, which is 
one of the essential conditions to those actions, do those changes in the 
mutual relations and constitution of the blood, and capillaries, and organs 
ensue, which frequently result in the establishment of inflammation. And 
it is not unreasonable to suppose that, during such disturbances, chemical 
products may be formed, of a totally different character from those of the 
healthy organism; just as in the laboratory, with the same organic materi- 
als, different products are formed under different degrees of heat; and also, 
that the excrementitious matters necessarily resulting from the nutrition 
of the organs and development of the forces may be retained in the blood 
and structures, from the congestion of the kidneys, and the impairment, if 
not total cessation of the function of the skin consequent upon the con- 
striction of its pores and vessels, and diminution of its nervous supplies,, 
following the reduction of temperature; and still farther, that these altered 
products and excrementitious matters may irritate certain organs and 
excite in them inflammation. As, therefore, the malarial poison destroys 
those constituents of the blood and nervous system most intimately asso- 
ciated with, and necessary to, the generation of heat, and of all the nerv- 
ous and physical forces; and as it farther depresses the nervous and 
muscular forces, and the action of the heart, and the tonicity of the arter- 
ies, and tends of itself to induce congestions of the internal organs, it is 
evident that it renders its victims, when exposed to the vicissitudes of 330 
Relations of Pneumonia to Malarial Fever. 
weather, and especially to the prolonged action of cold, exceedingly liable 
to inflammations. 
(d.) The action of the malarial poison is attended, not only with derange- 
ment in various nutritive processes, hut also with the generation of increased 
quantities of the urates. In like manner, in inflammations existing in healthy 
organizations, when resolution takes place, there is an increased excretion 
of the urates. If, therefore, the existence in the blood, and. non-elimina- 
tion of these excrementitious bodies in certain diseases, as gout and rheu- 
matism, tend to excite local inflammations, it is but reasonable to suppose 
that their nomelimination from any cause, as from the effects of cold, pre- 
viously described, may, in like manner, tend to excite local inflammations 
in those suffering from the effects of the malarial poison. 
(e.) After the excitation of pneumonic inflammation from any cause, the 
periodic changes, and especially the periodic congestions of the internal organs, 
induced by the action of the malarial poison, tend to aggravate and increase the 
inflammation. During the cold stage, the blood stagnates, and accumulates 
in the capillaries of important organs, because the blood has been altered 
by the malarial poison and the changes which it induces: because the rela- 
tions between the blood and its containing vessels, especially the capillaries, 
have been disturbed; because the regular normal chemical changes neces- 
sary for the development of the forces which work the machinery are not 
generated, with sufficient energy, or if generated, with even increased 
energy, they are not generated in the right position and in the proper 
quantities, and the correlation of the physical, chemical, nervous and vital 
forces is thus deranged; because the action of the sympathetic nervous 
system which accompanies the blood-vessels, and regulates the circulation, 
and respiration, and secretion, and nutrition, and excretion, and relates 
them to each other, and to the cerebro-spinal system, has been disturbed 
by the direct and indirect action of the poison, by the direct action of the 
poison upon the sympathetic and cerebro-spinal nervous systems, or by the 
relations of the chemical changes induced, or the products generated iuthe 
constituents of the blood by the malarial poison, to the sympathetic and 
cerebro-spinal nervous systems. From these facts and considerations, we 
arrive at the following practical conclusions : 
First. Whilst the malarial poison cannot be said directly to produce pneu- 
monia, still it is capable of inducing such changes in the blood, and in the nutri- 
tive and excretory processes, as to predispose the system to this and other 
inflammations. And, therefore, 
Secondly. The physician should never in the treatment of pneumonia, in 
those who have been exposed to the action of malaria, lose sight of its effects in 
complicating inflammation of the lungs, and of the consequent necessity of arrest- 
ing at once, if possible, the further action of the malarial poison. As no remedy 
can compare with quinine for the accomplishment of this result, its use 
would in the present state of our knowledge appear to be imperatively 
demanded in the treatment of pneumonia arising in malarious regions, and 
presenting well-marked and recurrent paroxysms. This remedy may be 
indicated even when the patient has exhibited none of the symptoms of 
malarial fever, before the appearance of the inflammation, for it is well 
established that the malarial poison may be present in the system without 
manifesting any effects sufficient to excite the attention of the physician 
or patient. Thus, mechanical injuries in those who have been exposed to 
the action of malaria are frequently attended with the appearance of parox- 
ysmal fever. Whilst the strength was unimpaired, the system resisted the 
morbid influences of the poison; but when the forces were reduced, by the 
injury and the consequent inflammation, then the effects of the poison Relations of Pneumonia to Malarial Fever. 
331 
were manifest. In like manner the depressing effects of the pneumonic 
inflammation may so weaken the forces as to bring the system under the 
dominion of a poison, which it had before resisted. 
Thirdly. In the treatment of pneumonia in malarious districts, the physi- 
cian should never forget the similarity, in some important respects, between the 
effects of the malarial poison and general blood-letting. The malarial poison, 
whatever it be, destroys rapidly the colored blood-corpuscles. Whatever, 
therefore, diminishes the colored blood-corpuscles, acts in concert with the 
malarial poison. General blood-letting more rapidly diminishes these 
important constituents of the blood, so essential to healthy nutrition, to 
the maintenance of the nervous and muscular forces, and to the successful 
progress and resolution of inflammation; because the colored blood-cor- 
puscles rush along chiefly in the centre of the vessels, and are evacuated 
more abundantly than the other constituents of the blood. The malarial 
poison also reduces rapidly the forces. General blood-letting reduces 
rapidly the forces. The two, in this particular, again act in concert. We 
would not, however, deny that circumstances may arise where blood-letting, 
and especially local blood-letting, would be beneficial in malarial fever, and 
in pneumonia complicating this disease. Whenever blood-letting is used, 
it should be borne in mind that it does not, and cannot, cure malarious dis- 
ease; its beneficial action is only temporary, and so far from curing the 
disease, the relief which it has temporarily afforded will vanish, if other 
remedies, especially the sulphate of quinia, be not used; and as a general 
rule, without these remedies, the patient will be in a much worse condition 
than if the blood-letting had not been employed. 
In considering the use of general blood-letting in malarial fever, we 
should ever remember that the cerebral symptoms, the delirium and the 
torpor of the intellectual faculties, and the congestion of the internal 
organs, are not inflammatory; they are not due to an exaltation of the 
functions, or to an irritation of the congested organs, but rather to a loss 
of power in the circulatory apparatus, heart, arteries, capillaries and veins, 
and to disturbances in the physical, chemical and nervous forces. Hence, 
therefore, in pneumonia, complicated with malarial fever, we will best 
guard against those dangerous periodic changes and congestions, not by 
depleting, but by stimulating and anti-periodic remedies. 
Fourthly. It results from all this, that stimulants and nutritious diet are 
■especially indicated in pneumonia, complicated with paroxysmal fever. The 
nutritious diet supplies the elements of the blood which have been des- 
troyed; and the stimulants not only arouse the depressed nervous system, 
and through the sympathetic and cerebro spinal ganglia, excite the circu- 
latory system to a full and salutary action for the introduction and distri- 
bution of the elements of nutrition and secretion so necessary to the favor- 
able progress and termination of all inflammations, but they also preserve 
the elements of the blood and tissues from too rapid chemical change and 
•destruction, by taking their places, and themselves undergoing the chemi- 
cal changes which are for the development of the physical forces which 
work the machinery. 
Fifthly. Quinine may arrest inflammations, or promote their resolution by 
other modes than its anti-periodic poicers, as by its sedative and excretory powers, 
or by its influence upon the nervous system and capillary and general circulations. 
If the value of this agent in the treatment of inflammation depends upon 
some such powers other than its anti-periodic effects, then the important 
result is reached, that this remedy is valuable in non-malarious, as well as 332 
Relations of Pneumonia to Malarial Feuer. 
in malarious regions. Upon this question, however, we need definite 
experiments and investigations. We hope at some future time to present 
the results of experiments upon the effects of quinine, both upon the 
healthy and diseased organism, designed to elucidate those important 
questions concerning its mode of action. 
Finally. We need, above all things, careful records of the results of the 
treatment of pnetimonia with quinine in full doses. As far as my knowledge 
extends, no well established data exists by which we may determine the 
relative merits of this agent in the treatment of pneumonia. I have heard 
experienced and intelligent physicians affirm that, in private practice, 
when this drug was used energetically in the early stages of the disease, 
not more than one case in fifty would prove fatal. This is surely an extra- 
ordinary result, and far different from the results of the treatment of 
pneumonia in the Confederate hospitals, which, it must be confessed, as 
shown by the hospital records themselves, are bad enough; and in fact, no 
better, and even worse, than the heavy mortality characteristic of the rigid 
anti-phlogistic method with bleeding, blistering, calomel and opium, and 
tartar emetic. The Confederate surgeons did not use blood-letting to any 
extent in the treatment of pneumonia, and in many cases of this disease 
employed quinine, stimulants and nutritious diet. Jn our own practice, 
civil and military, we have used quinine freely in the treatment of pneu- 
monia, and especially in those cases which were complicated with malarial 
fever, and apparently with marked benefit and highly favorable results, 
but we are inclined to the opinion that a large share of this success was 
due to two facts, viz: quinine, a comparatively innoxious, and at the same 
time a tonic medicine, was substituted for the heroic and poisonous drugs 
so extensively employed in the treatment of pneumonia, and our patients 
were supplietl with nutritious diet, and the strength was supported; in 
other words, depressing agents were withheld, the strength was supported, 
and nature was allowed to have her perfect work. 
The Confederate statistics demonstrate that but little confidence can be 
placed in the dogmatic assertions of practitioners, apart from a careful 
record of cases and the preservation of the actual statistics. The careful 
determination of the value of quinine in the treatment of pneumonia, as 
well as the best mode and period of its administration, as well as the rela- 
tive action of this agent in malarious and non-malarious regions, should 
engage the careful attention of Southern physicians. In the institution of 
any investigations into the relative value of quinine in the treatment of 
pneumonia, the following well-established facts are worthy of constant 
consideration. Uncomplicated pneumonia, especially in young and vigor- 
ous constitutions, almost alw'ays gets well, if instead of being lowered, the 
vital powers are supported, and the excretion of effete products assisted. 
From the accounts which have been published concerning the natural pro- 
gress of pneumonia, it would appear that very slight cases of limited 
inflammation may be convalescent on the seventh day; that the majority 
of cases of medium intensity recover between the seventh and fourteenth 
days, and very severe ones between the fourteenth and twenty-first days. 
In the report of the cases, the extent and character of the inflammation, 
together with the symptoms, progress, complications, and termination of 
the disease, as well as the exact period of its commencement and the estab- 
lishment of convalescence, should be noted with scrupulous accuracy. 
Without the careful record of these points, the value of such investigations, 
will be greatly impaired. History of Investigations by Joseph Jones, M. D. 
333 
HISTORY OF INVESTIGATIONS IN THE MICROSCOPICAL CHARACTERS OF THE 
BLOOD IN MALARIAL AND OTHER ENDEMIC AND EPIDEMIC FEVERS. 
The investigations of the author on the physical, chemical and micro- 
scopical characters and changes of the blood in health and disease, were 
•commenced in 1854 ; and were conducted on the blood of cases of malarial 
and other fevers and diseases, in the Savannah Hospital, 1856-1857, Augusta 
Hospital, 1858-1861, in the Confederate army, in various portions of the 
Southern States, amongst the troops in the field and in the military hos- 
pitals in Virginia, North Carolina, South Carolina,Georgia and Tennessee, 
.and amongst the Federal prisoners confined in Richmond, Virginia, and 
Andersonville, (Camp Sumpter), Georgia, 1861-1865. The great military 
hospitals of the Confederate armies, located at Gordonsville, Charlottes- 
ville, Lynchburg, Staunton and Richmond, Virginia; at Charleston. South 
Carolina; Savannah, Augusta, Atlanta, Marietta, Macon, Vineville and 
Andersonville, Georgia, afforded the grandest field ever offered to a South- 
ern physician and surgeon for the investigation of the various forms of 
endemic, epidemic and contagious fevers, and of the gun-shot wounds, casu- 
alties, and diseases incident to the campaigns and battles of great armies. 
The Charity Hospital of New Orleans, has, from the time of my removal 
to this city, in the winter of 1868, up to the present moment, furnished 
an extended field for observation in therapeutics and pathology upon all 
subjects relating to etiology, pathology and treatment of fevers, during a 
period extending from 1869-1886. The nature and relations of the various 
forms of fever treated by the author in the wards of the Charity Hospital, 
will be illustrated by the following table : 
Table illustrating the cases and deaths occurring in the medical service of 
Joseph Jones, M. D., in the Charity Hospital of New Orleans, 1869-1886. 
History of Investigations by Joseph Jones, M. D. 333 
HISTORY OF INVESTIGATIONS IN THE MICROSCOPICAL CHARACTERS OF THE 
BLOOD IN MALARIAL AND OTHER ENDEMIC AND EPIDEMIC FEVERS. 
The investigations of the author on the physical, chemical and micro- 
scop i cal characters and changes of the blood in health and disease, were 
•commenced in 1854; and were conducted on the blood of cases of malarial 
and other fevers and diseases, in the Savannah Hospital, 1856-1857, Augusta 
Hospital, 1858-1861, in the Confederate army, in various portions of the 
Southern States, amongst the troops in the held and in the military hos- 
pitals in Virginia, North Carolina, South Carolina,Georgia and Tennessee, 
.and amongst the Federal prisoners confined in Richmond, Virginia, and 
Andersonville, (Camp Sumpter), Georgia, 1861-1865. The great military 
hospitals of the Confederate armies, located at Gordonsville, Charlottes- 
ville, Lynchburg, Staunton and Richmond, Virginia; at Charleston. South 
Carolina; Savannah, Augusta, Atlanta, Marietta, Macon, Vineville and 
Andersonville, Georgia, afforded the grandest field ever offered to a South- 
ern physician and surgeon for the investigation of the various forms of 
endemic, epidemic and contagious fevers, and of the gun-shot wounds, casu- 
alties, and diseases incident to the campaigns and battles of great armies. 
The Charity Hospital of New Orleans, has. from the time of my removal 
to this city, in the winter of 1868, up to the present moment, furnished 
an extended field for observation in therapeutics and pathology upon all 
subjects relating to etiology, pathology and treatment of fevers, during a 
period extending from 1869-1886. The nature and relations of the various 
forms of fever treated by the author in the wards of the Charity Hospital, 
will be illustrated by the following table : 
Table illustrating the cases and deaths occurring in the medical service of 
Joseph Jones, M. D., in the Charity Hospital of New Orleans, 1869-1886. 
GENERAL SUMMARY. 
Cases. Deaths. 
General diseases 4034 276 
Diseases of the nervous system 442 59 
*■ " heart and blood-vessels 91 36 
" " absorbent system ; 3 1 
u ■" respiratory system 493 82 
" " alimentary canal 709 123 
" " liver 85 38 
" " spleen 4 1 
" •" kidneys , 88 26 
" bladder and male organs 70 1 
" " female organs of generation ; 20 
" " organs of locomotion 15 
" *• cutaneous system 15 1 
" u eye, nose and ear 25 
Injuries, ulcers and wounds 96 8 
Poisons 21 2 
Conditions not necessarily associated with local or general diseases.. 89 14 
Parasites.... J 11 
Total 6311 668 
GENERAL SUMMARY. 
Percent, of deaths from all causes, 10.5. 
Ratio of deaths per 1000 cases, 10.5. 
One death in 9.44 cases. 
Practical conclusions of value may be obtained by a general review of 
the results of medical service extending over a series of years. The nature 
of such conclusions and their relations to the practice of medicine must 
evidently depend not merely upon the number of the observations, but also 
upon the mode in which they were recorded. 334 
Statistics of Fevers in Charity Hospital. 
Cases. 
Deaths.. 
Intermittent fevers, including quotidian, tertian and quartan 
2327 
5 
Remittent malarial fever 
Pernicious congestive malarial fever, including tbe comatose, algid 
247 
7 
and other varieties (a large proportion of the cases were brought 
into the hospital in a moribund condition) 
87 
5€> 
Chronic malarial poisoning (malarial toxaemia cachexia), with various 
complications, as enlarged liver and spleen, contracted liver and 
hardened spleen,anaemia anasarca 
212 
14 
Malarial haematuria 
12 
6 
Total, malarial, endemic, non-contagious fevers 
2885 
88 
MALARIAL, PAROXYSMAL, ENDEMIC, NON-CONTAGIOUS FEVERS. 
Per cent, of deaths in the various forms of malarial fever, 3.05. 
Ratio of deaths in 1000 cases of the various forms of malarial fever, 30.5. 
One death in 32.8 cases of the various forms of malarial fever. 
CONTAGIOUS AND INFECTIOUS FEVERS AND DISEASES. 
Cases. 
Deaths. 
Dengue 
15 
Yellow fever 
76 
35 
Typhoid fever 
16 
3 
Measles 
10 
2 
Scarlatina 
4 
1 
Diphtheria 
2 
Mumps 
3 
Small-pox .• 
Asiatic cholera 
18 
1 
2 
2 
Total 
146 
44 
Per cent, of deaths in contagious and infectious fevers and diseases 30.1. 
Ratio of deaths in 1000 cases of contagious and infectious fevers and diseases 
30.1. 
One death from contagious and infectious fevers and diseases in 3.37 cases. 
Grand total general diseases, including all the forms of malarial and 
other fevers, phthisis and other constitutional diseases 4034 276 
Per cent, of deaths in general diseases, 6.83. 
Ratio of deaths per 1000 cases of general diseases, 68.3. 
One death from general diseases in 14.6 cases. 
It is evident from the preceding figures that, whilst the malarial 
(paroxysmal fevers) numbered 2885 cases out of a total of 4034 cases of 
constitutional diseases, or about 71.2 per cent., on the other hand the mor- 
tality occasioned by malarial fevers was only 88 out of 268 deaths from all 
general diseases. The mortality occasioned by the various forms of mala- 
rial fever was only about 31 per cent, of the mortality occasioned by all 
general diseases, including the former. 
BLACK PIGMENT PARTICLES AND PIGMENT CELLS IN THE BLOOD OF MALA- 
RIAL FEVER. 
The presence of black pigment particles in the blood of malarial 
patients has been frequently demonstrated as in the following cases, in 
which chemical and microscopical examinations of the blood were executed 
in the year 1876. 
Case 852.-Malarial Fever, diminution of Colored Blood-Corpuscles ; Black 
Pigment Particles in Blood. 
M. Murphy, age 21; native of Liverpool; of Irish parentage; heights 
feet, 8 inches; weight in health, about 154 pounds; brown hair, brown 
eyes, red beard; fair, florid complexion in health. Arrived from East Black Pigment and Pigment Cells in Malarial Blood. 
335 
Indies three months before entering Charity Hospital. September 12th, 
1876, obtained employment on Jackson railroad. 27 miles above New 
Orleans. Labored in the swamp, standing in water and mud up to hi& 
knees. On the 17th of September, was attacked with high fever (malarial 
remittent}, which continued ten days. On the third day after the appear- 
ance of the fever, returned to New Orleans, and being destitute and with- 
out a home, he slept in the open air, on the boards of the levee, suffering 
with thirst, hunger and severe fever, for the space of five days. Entered 
Charity Hospital, ward 13. bed 198, September 25th, 1876, in a state of 
destitution and with high fever. In this case, starvation and thirst were 
added to the sufferings occasioned by fever. Quinine arrested the fever, 
the patient, however, was feeble and anaemic. On the 20th of October, the 
patient was seized with a violent trembling, dizziness and spasms of the 
voluntary muscles, which were succeeded by vomiting of large quantities 
of yellow biliary matter, and high fever. Sinapisms were applied to the 
back of the neck, extremities and epigastrium, the bowels were evacuated 
by a mercurial purgative, and quinine was freely administered. On the 
21st, high fever, restless, vomiting. October 22d, M. P. 93, T. 104°. 23d, 
M. P. 88, R. 20, T. 100°. 24th, M. P. 84, R. 19, T. 99°. Pale, anaemic, 
yellowish and greenish hue of skin. Tongue pale, flabby, voluminous, 
with indented edges. The mucous membrane of the tongue, mouth and 
gums, although anaemic, presents a purplish hue. General prostration of 
muscular and nervous forces. Action of heart irritable-distinct anaemic 
murmur. October 25th, continues in much the same condition; M. P. 94, 
R. 19, T. 99°. 
Examination of Urine.-Amount of urine passed during twenty-four 
hours, October 24th, 10 A. M. to October 25th, 10 A. M., 975 c.c. Light 
red color; acid reaction, clear, without deposit. Specific gravity 1010. 
No albumen or casts. 975 cubic centimetres of urine passed during twenty- 
four hours, contained: 
Grains. 
Urea . 277.20 
Uric acid 18.50 
Chloride of sodium 64.05 
Sulphuric acid 22.73 
Phosphoric acid 8.52 
26th. M. P. 80, R. 20, T. 98.5°. Continues to improve slowly. Amount 
of urine excreted during twenty-four hours, October 25th, 10 A. M. to 
October 26th, 10 A. M., 1350 c.c. Orange color; specific gravity, 1009. 
Reaction acid, clear, no deposit. No albumen. The feet of this patient, 
as well as the legs, became cedematous. 1350 cubic centimetres of urine 
excreted during twenty-four hours, contained: 
Grains. 
Urea 311.85 
Uric acid 40.50 
Chloride of sodium 124.74 
Sulphuric acid 24.08 
Phosphoric acid 25.98 
October 27th. M. P. 82, R. 21, T. 99°. 28th. M. P. 94, R. 18, T. 
99°. 29th. M. P. 86, R. 16, T. 101.5°. E. P. 72, R. 20, T. 101°. Continues 
to improve; has been up and around the ward since the 27th. 
October 30th. Examination of Blood. Venous blood changed to arte- 
rial hue on standing. Coagulum large and soft. Under the microscope 
blood-corpuscles pale, and dark granular masses, varying from 1-10,000th 
to 1-20,000th of an inch in diameter were observed in the blood. 
Many of the colorless corpuscles also contained numerous dark granules, Black Pigment and Pigment Cells in Malarial Blood. 
336 
as if they had fed upon the altered blood-corpuscles and appropriated 
them. The colorless corpuscles were not relatively more abundant, but 
they were peculiar in containing numerous pigment particles. In some 
instances these pigment cells were much larger than the normal colorless 
corpuscles of health. Small, oval, colorless, vibrating and rotating parti- 
cles were also observed; the motion of these particles may have been 
nothing more than the Brownien movement, but they resembled closely 
the smallest varieties of the rotatoria. The blood of this patient was com- 
pared with that of a stout butcher, who had entered in a comatose and 
apparently dying state, and with bruises about the head and arms. Blisters 
to the back of neck, cut cups to temples, and quinine and brandy by the 
rectum, appeared to arouse the patient. In twelve hours, however, he 
was seized with a convulsion, and remained rigid with contracted pupils 
and labored respiration for several hours. Bromide of potassium and 
nourishment at regular intervals relieved these symptoms. It was subse- 
quently ascertained that this patient had fallen suddenly in a violent con- 
vulsion whilst in the act of hitching a horse in the wagon. The health of 
this powerful man appeared to have been perfect at the time of his seizure, 
and I abstracted blood, immediately after his entrance into the hospital, 
and within a few hours after the occurrence of the first fit, and within the 
same hour as in the present case of malarial fever. All the conditions 
were, therefore, fulfilled for the careful comparison of malarial blood with 
that of a man seized with convulsions whilst enjoying apparently perfect 
health. The contrast between the two specimens of blood was most marked. 
The blood of this man. under the microscope, presented bright colored, well 
formed colored corpuscles-normal colorless corpuscles. The colored cor- 
puscles ran together, forming roulleaux as in the blood of inflammation. In 
the malarial blood, on the other hand, the colorless corpuscles were in many 
cases filled with dark granules-the colored corpuscles were large, pale, 
and many masses of altered hsematin were found in the blood. Upon 
analysis, the malarial blood yielded the following results : 
1000 parts of blood contained- 
Water 815.72 
Solid matters 184.28 
Saline maters 9.99 
1000 parts of serum contained- 
Water 913.05 
Solid matters 86.95 
Saline matters 1.72 
1000 parts of blood contained- 
Water 815.72 
Colored blood-corpuscles (dried) . 100.36 
Fibrin 2.50 
Albumen 81.42 
Saline matters... 9.99 
November 1st. Continues to improve. Color returning to lips and 
cheeks. Effects of iron, quinine and bitter tonics manifest. 
The blood was again abstracted, and carefully examined. Scarlet color. 
Coagulum voluminous but firm. Dark granules and granular masses still 
present, varying in diameter from 1-10,000th to 1-20,000th of an inch, but 
less numerous. The colorless corpuscles still in many instances contain 
colored particles, but they are not so numerous as in the blood abstracted 
on the 30th. The large conglomerations of the dark granules, about four 
times larger than the colorless corpuscles, were also seen, but in consider- 
ably less quantity. A few rotating particles were seen. The patient 
continued to improve, and was discharged November 4th. Black Pigment and Pigment Cells in Malarial Fever. 
337 
Case No. 853.-Intermittent Fever. Chemical and Microscopical examination 
of the Blood. Accumulation of Figment Particles and, Cells in Blood. 
Michael Maher, aged 23, ward 39, bed 422; native of Ireland; came to 
America two years ago, and lived one year in Kentucky and one year in 
Louisiana. Cook by occupation. Large, well-formed, robust man. Was 
healthy during his residence in Kentucky, with the exception of one attack 
of fever. During the past three months has been cooking in the swamps 
of the Mississippi river, about eighty miles above New Orleans. Drank 
bad swamp water, which produced, upon several occasions, pain in his 
bowels. During the past two months has had but indifferent nourishment, 
and was often exposed to wet and cold. In the middle of September he 
had an attack of high fever, which lasted six days; he recovered partially 
and resumed his occupation. The same fever re-appeared October 8th, 
and continued until October 22d. He again convalesced, and felt well for 
some time, but had a relapse November 6th, and there was an exacerbation 
of the fever, every day at 10 A. M. until the 9th, when the rise of fever 
was preceded by a severe chill. The chills recurred each day, and on the 
morning of his admission to the Charity Hospital, ward 29, bed 422. Novem- 
ber 13th, he had a severe chill followed by high fever. 
November 13th. 1876. Morning, pulse 113, respiration 32, tempera- 
ture of the axilla 107. °5. Patient states that during the three mornings 
which preceded his admission into the hospital, he suffered with attacks 
of vertigo, and once fell suddenly whilst standing. Complexion of agreen- 
ish-yellow; tongue tremulous, large, flat, thick and furred, with indented 
edges. Conjunctiva of eyes of a pale greenish-yellow. (Edema of lower 
extremities. No appetite. Spleen and liver enlarged. Vomiting of bili- 
ary matters. Evening, pulse 107, respiration 32, temperature 104. °6. 
November 14th. M. P. 88, R. 21, T. 101°. Remission in the fever. 
Amount of urine passed during twenty-four hours, November 13th, 10 A. 
M., to November 14th, 10 A. M., 825 cubic centimetres, red color, and acid 
reaction, specific gravity 1019, deposit of urates-825 cc. of urine passed 
during twenty-four hours of paroxysmal fever, contained : urea, grains, 
418.43 ; chloride of sodium, grains, 38.29 ; phosphoric acid, grains, 15.59. 
Evening, increase of fever, pulse 106, respiration 34, temperature, 106.°4. 
November 15th. 8 A. M. Pulse 87, respiration 24, temperature 102.°2. 
Amount of urine passed during fever in twenty-four hours, November 14th, 
10 A. AL, to November 15th, 10 A. M., 605 c.c, deep red color, specific 
gravity 1022, acid reaction. Upon standing, deposits of the urates; nitric 
acid threw down a deposit of uric acid which was dissolved by heat. 605 
e.e. of urine excreted during twenty-four hours, contained: urea, grains, 
354.04 ; chloride of sodium, grains, 38.37 ; phosphoric acid, grains, 15.30. 
Evening, pulse 102, respiration 22, temperature 1O6.°2. Notwithstanding 
the free administration of quinine, (fifteen, grains daily), the fever has not 
been arrested. November 16th. This morning the following was ordered : 
R. Quinise sulph. ^i; pulv. piperime, gr. x; pill hydrargyri, extract rhei, 
extract aloes, aa grs. x. Mix and divide into ten pills, sig: one pill every 
four hours. M.,P. 96, R. 25, T. 100. °2; E., P. 72, R. 22, T. 100.°4. Novem- 
ber 17th. M., P. 87, R. 18, T. 100. °2; E., P. 77, R. 10, T. 100. °4. Continues 
to take fifteen grains of quinine daily, and with the subsidence of the 
fever, there has been an improvement in all the symptoms. 
November 18th. patient able to be up and dressed. M., P. 75, R. 15, 
T.100.°4 ; E., P. 60, R. 15, T. 100.°2 ; November 19th. M., P. 75, R. 20, T. 
100. °6 ; E.. P. 75, R.20. T. 100.°4. November20th. M., P. 70, R. 20,T.99°; 
E., P. 72, R. 20, T. 101° ; November 21st, M., P. 72, R. 21, T. 101° ; Novem- 
ber 22d, 76. Continues to improve. 338 
Black Pigment and Pigment Cells in Malarial Feuer. 
Examination of Blood : 
1000 parts of blood contain- 
Water 892.00 
Solid matters 188.00 
Saline matters 12.00 
1000 parts of serum contain- 
Water 922.02 
Solid matters 77.98 
Saline matters • 6.84 
1000 parts of blood contain- 
Water 892.00 
Solid matters { corpuscles 109.19 
I Solid matters of serum 75.46 
Fibrin 3.35 
Albumen 75.46 
Saline matters 
Under the microscope, the blood was seen to contain a large number of 
dark granules and granular matter, and colorless corpuscles containing 
granular matter, also dark pigment cells, exceeding the colorless corpuscles 
in size. 
I made careful drawings of the appearances presented by the blood in 
this case of malarial fever ; and also demonstrated the changes under the 
microscope to the medical class of the University of Louisiana. 
Case No.854.- Malarial fever; chemical and microscopical examination of 
hlood; blood pigment and pigment cells in blood; chronic malarial poison- 
ing ; greenish-yellow dark bronze skin; continued elevation of temperature. 
Alexander Du Buisson, age 33, native of France, height 6 feet, weight 
in health about 180 pounds, brown hair, dark-brown eyes. After leaving 
France, resided in Havana. Cuba, for two and a half years, where he 
suffered with the vomito, (yellow fever), otherwise enjoyed good health 
during his sojourn in the Antilles. After leaving Havana he spent seven 
months in New York. From New York he moved to Alabama, and after 
a few months emigrated to Louisiana. Enjoyed good health up to the 
time of coming to Louisiana. Has resided eight months in Louisiana. The 
first two mouths he spent in the swamps of Terre Boeuf. Was seized with 
malarial fever in April, 1876. The fever was of the intermittent variety, 
and lasted about twenty days. Whilst in the swamps of Terre Boeuf took 
quinine, but had no medical attendance. Came to New Orleans about the 
latter part of April and entered the Charity Hospital, in which he remained 
twenty-two days. He had been working for about a month in the swamps 
of St. Landry's parish, in water up to his waist, when he was attacked with 
chills and fever. The attack lasted five days, after which he felt better, 
and was free from fever for one week. He had a second attack, which 
lasted eight days, until his admission into the Charity Hospital, ward 27, 
in the latter part of May, 1876. He was discharged after twenty-two days, 
but did not feel that his disease was cured. After leaving the hospital, he 
went down the Mississippi river, thirty-five miles below New Orleans, and 
was employed in cutting willows, on the marshy banks of the river, for the 
gabiens of Eads' jetties. This employment necessitated the standing in 
water of various depths, from his knee to his neck. Du Buisson was thus 
engaged up to the 15th of July, at which time he was forced to intermit 
work from the reappearance of malarial fever, of the remittent type. 
Returned to the Charity Hospital. He remained in ward 21, twelve days, Black Pigment and Pigment Cells in Malarial Fever. 
339 
and although the fever disappeared during this time, he suffered with 
severe and often recurring headache, and great muscular and nervous pros- 
tration. After leaving the hospital in August, again went down the river, 
and engaged in cutting willows in the same manner, in the water and in 
the same locality. Was again attacked with malarial fever, and was 
incapacitated for work of any kind, and returned to New Orleans, and 
entered the Charity Hospital, ward 13, bed 189, September 30th, 1876. 
From the repeated attacks of fever, and the exposure to cold and wet, 
and from bad diet and water, Du Buisson has been greatly reduced in flesh 
and strength, and presents a truly deplorable appearance. Countenance 
bloated; lower extremities swollen; complexion that of extreme anaemia; 
lips of very nearly the same color as that of the skin of the face; color of 
skin of face a greenish-yellow and bronze color of surface generally green- 
ish-yellow; tongue full, flabby, with edges deeply indented by the teeth, 
coated with light fur; mucous membrane of tongue and mouth presents a 
pale, anaemic and purplish hue. Pulse accelerated and irregular; respira- 
tion in like manner accelerated and irregular. Loud anaemic murmur in 
heart and large arteries. Murmur connected with first sound of heart and 
heard loudest between second and fourth ribs, in the position of the auri- 
culo-ventricular valves. Second sound of heart distinct and abrupt. Tem- 
perature above the normal standard, and subject to inordinate diurnal 
variations. Spleen and liver enlarged and tender on pressure. 
October 21st. Morning-pulse 91. Temperature of axilla, 99° F. 
October 22d. M. P. 99, T. 100°. 23d. M. P. 89, R. 30, T. 99°. 24th. M. 
P. 86, R. 24, T. 99°. Patient, notwithstanding the free use of quinine, and 
nutritious diet, continues pale, sallow, anaemic. Great muscular debility, 
although able to walk about the ward, is oppressed by the slighest exer- 
tion. When he attempts to go up the stairs, his heart beats rapidly and 
irregularly and the breathing becomes hurried and oppressed; pants for 
breath and after ascending one or two steps, is compelled to sit down and 
rest. Greenish-yellow, bronze hue. Tongue large, flabby and pale, with 
indented edges and of a purplish and bluish cast. When the tongue is 
protruded, it trembles incessantly. The bronzed and copper color of the 
skin, gives the impression of profound lesions of the circulatory fluid. 
Features and extremities oedematous. Action of heart irritable, with loud 
anaemic murmur. The cardiac murmur appears to be clearly referable to 
the watery condition of the blood. 
October 25th. M. P. 190, R. 28, T. 101°. Continues in the same state. 
Amount of urine passed during twenty-four hours, October 24th, 10 A. M., 
to October 25th, 10 A. M., 1380 cubic centimetres. Specific gravity, 1012; 
acid reaction, light red color. 1380 cubic centimetres of urine passed 
during twenty four hours (October 24-25), contained: 
Grains. 
Urea 426.58 
Uric acid 13.85 
Chloride of sodium , 106.64 
Sulphuric acid 35.20 
Phosphoric acid , 15.93 
October 26th. M. P. 80, R. 36. Continues in the same state. The 
patient has been placed upon tincture of bark, and citrate of iron and qui- 
nine. B.-Quini® sulph. $ss. Ferri et quinise citratis, siv. Acid citric, 
5ii. Aquae menthae pip. fgviii. Mix: Sig. Teaspoonful three times a 
day. Amount of urine passed during twenty-four hours, October 25th, 10 
A. M. to October 26th, 10 A. M., 2800 c.c. Specific gravity, 1012. Reac- 
tion acid, orange color; no deposit. No albumen or casts. 2800 cubic 
centimetres of urine (twenty-four hours, October 25th to 26th), contained: 340 
Grains. 
Urea 852.40 
Uric acid 28.00 
Chloride of sodium 103.85 
Sulphuric acid 78.77 
Phosphoric acid 97.02 
Black Pigment and Pigment Cells in Malarial Fever. 
The appetite of this patient is good, and that a considerable amount of 
food is consumed, is evident from the large amount of chloride of sodium 
excreted. 
October 27th. M. P. 80, R. 28. October 28th. M. P. 96, R. 36, T. 
101.°5. October 29th. M. P. 90, R. 28, T. 102. °2 October 30th. Con- 
dition the same. 
Blood abstracted for analysis: Blood thin and watery, serum golden 
colored. Clot voluminous and soft. The blood, under the microscope, 
presents marked characteristics. Colored corpuscles greatly diminished 
in numbers and very pale. The microscope revealed the presence of 
numerous small, dark granular pigment particles, varying from 1-7,000th 
to 1-18,000th of an inch in diameter; also conglomerations of these dark 
pigment particles, varying in diameter from 1-1,000th to 1-2,000th of an 
inch. Also colorless corpuscles containing the same dark pigment parti- 
cles. Small vibrating and rotating particles, about 1-10,000th of an inch in 
diameter, were also observed. The blood in this case was carefully com- 
pared with that of the butcher Hagge, who had been seized with convul- 
sions in perfect health. Marked differences were observed. In the blood 
of the butcher, the colored corpuscles were normal, of a deep color, and 
ran together, forming roulleaux, and the colorless corpuscles, as well as the 
blood generally, were entirely free from dark pigment granules. The blood 
of Hagge, was also entirely free from vibrating particles. 
1000 parts of blood contained- 
Water 892.10 
Solid matters 107.90 
Saline matters 6.78 
1000 parts of serum contained- 
Water , . 934.33 
Solid matters 65.67 
Saline matters 1.50 
1000 parts of blood contained- 
Water 892.10 
Red corpuscles, (dried) 43.57 
Fibrin 2.97 
Albumen 61.36 
Saline matters.... 6.78 
November 1st. M. P. 90, R. 32, Temp. 101.°25. Blood again 
abstracted and examined. Pale, watery, like carmine. Colored corpus- 
cles very pale. Some of the colored corpuscles contain dark pigment par- 
ticles, which are also conglomerated together, presenting a dark reddish- 
brown color. A few of the vibrating animalcules (or particles) were also 
observed. The serum has lost the golden color. Appetite of patient good, 
and he was able to walk slowly down one flight of stairs to the ampithea- 
tre. Returned with great difficulty being compelled to rest by the way. 
November 2d. M. P. 90, R. 36, T. 99. °5. 
November 3d to November 7th, condition unchanged. 
November 8th, M. P. 70, R. 30, T. 100°. November 9th, M. P. 81. R. 
25, T. 102°; E. P. 84, R. 31, T. 102°. November 10th, M. P. 97, R. 34, T. 
102. °4; E. P. 90, R. 37, T. 102. °4. November 11th, P. 95, R. 33, T. 102°, 
E. P. 95, R. 37, T. 103.° November 12th, P. 93, R. 36, T. 1O2.°2. Novem- 
ber 13th, M. P. 95, R. 36. T. 102. °2; E. P. 99, R. 36, T. 103. °0. Blaeh Pigment and Pigment Cells in Malarial Blood. 
341 
Amount of urine passed during tw'enty-four hours, November 12th, 10 
A. M. to November 13th, 10 A. M. 1100 c.c. red color, acid reaction sp. gr. 
1012. No albumen upon standing, deposit of urates. 1100 c.c. of urine 
contained : urea, grains, 589.62; chloride of sodium, grains, 110.11; 
phosphoric acid, grains, 44.46. 
November 14th, M. P. 98, R. 32. T, 102°. E. P. 94, R. 31, T. 102. °8 
Amount of urine passed during twenty-four hours, November 13th, 10 
A. M.to November 14th, 10 A. M. 1525 c.c. sp. gr. 1015, red color, acid 
reaction, upon standing deposit of urates, granular and acicular crystals. 
1525, c.c. of urine (twenty-four hours) contain : urea, grains, 575.38; 
chloride of sodium, grains. 139.30; phosphoric acid, grains, 45.20. 
November 15th, M. P. 93, R. 31, Temp. 101.2°; E. P. 98, R. 39, T. 
102°. ' Amount of urine passed during twenty-four hours, November 14th, 
November 15th. 10 A. M., 1300 c.c., red color. Acid reaction. Sp. gr. 
1015.5. Clear when passed. Upon standing, deposit of urates and lozenge- 
shaped crystals of uric acid. 1300 c.c. of urine excreted during twenty- 
four hours, November 14th-15th. contained- 
Urea Grains, 520.52 
Chloride of sodium...,. " 159.16 
Phosphoric acid " 23.02 
November 18th, M. P. 89, R. 27, T. 101.4°; E. P. 93, R. 37, T. 1O2.°6. 
November 19th, M. P. 90, R. 26, T. 101. °2; E. P. 90, R. 26, T. 100-°4. 
November 20th, M. P. 86, R. 30, T. 101. °25; E. P. 80, R. 30, T. 102°. 
November 21st, M. P. 80, R. 24. T. 101. °5; E. P. 85, R. 35, T. 99.°5. 
November 22d, M. P. 80, R. 29, T. 102°; E. P. 86, R. 38, T. 102°. 
November 23d, M. P. 82, R. 28, T. 1O1.°2; E. P. 85. R. 39, T. 102°. 
November 24th, M. P. 90. R. 23, T. 102°. November 25th, M. P. 82, R. 
30, T. 101. °6. 
November 26th. Continues in the same state. Complexion becoming 
darker and more of the bronze. Pale anaemic. Tongue the same. Con- 
tinued headache. Palpitation of the heart when the patient attempts to 
stand or walk. Anorexia. Tenderness and dullness upon percussion over 
region of liver and spleen. The splem descends about three inches below 
the left hypochondrium and extends about three inches to the right of the 
left hypochondrium. The liver overruns the border of the cartilages of the 
ribs about one inch. Anaemic murmur of heart heard most intense, about 
one inch to the left of the sternum, and between the second and third ribs, 
connected chiefly with the anaemic blood and closure of auriculo-ventricu- 
lar valves. 
November 27th. Patient has been placed for some time on chloride of 
ammonium and tincture muriate of iron and sulphate of quinia (10 grs. 
chloride of ammonium three times a day), (10 drops tincture iron three 
times a day), (5 grs. of quinia three times a day). Still continues feeble 
with irritable action of heart, anaemic murmur and enlarged spleen. Com- 
plexionassuming more of the bronzed appearance. 
Blood Examined.-November 27th, 1876. Blood contained dark gran- 
ules and pigment cells, and colorless corpuscles filled with pigment cells. 
Blood-corpuscles regular in outline, but pale. A few vibrating ovoid par- 
ticles about 1-10,000th of an inch in diameter. 
1000 parts of blood contained- 
Water 881.33 
Solid matters 118.67 
Saline matters 6.32 
Fibrin 5.09 342 
Black Pigment and Pigment Cells in Malarial Blood. 
1000 parts of serum contained- 
Water 924.02 
Solid matters 75.98 
Saline matters 4,90 
1000 parts of blood contained- 
Water 924.02 
Colored-corpuscles (dried) : 41.92 
Fibrin 5.09 
Albumen 71.68 
Fixed saline constituents „ 6.32 
Numerous microscopical examinations and careful drawings were 
made of the blood in this and in other cases of malarial and yellow fever; 
and the blood of these cases was allowed to putrify, and the microscopical 
examinations continued daily at regular intervals. In 1876, we observed 
the development of fungi in the malarial blood, and also of the same 
species and delicate mycelium in the yellow-fever blood, which we isolated 
and studied in the epidemic of 1878, in New Orleans. 
During this period, 1869-1886, I treated a large number of cases of 
malarial fever in private practice, and without any fatal issue in uncompli- 
cated cases ; the conditions of ventilation and nourishment were, as a rule 
more favorable in private than in hospital practice. 
The service as President of the Board of Health of the State of Loui- 
siana, 1880-1884, necessitated the careful scientific examination of subjects 
relating to the nature, causation and control of yellow and malarial fevers; 
and certain questionsarising during the progress of medico-legal investiga- 
tions, also required the thorough and continual use of the microscope in the 
determination of the physical and minute characters of human blood, in 
health and disease. 
The entire subject of the microscopical characters of the blood in mal- 
arial fever in its various forms, received careful revision and careful 
demonstration, during my term of service in the Charity Hospital of New 
Orleans, extending from 1st October, 1884, to 1st April, 1885. 
The wards under my immediate care, located on the second door of 
this hospital (Nos. 13, 15, 16, 17 and 18), on either side of the elevator and 
stair-way, received at my request during the six months specified, all the 
serious cases of fever entering the Charity Hospital. I sought to accom- 
plish three objects by my labors by the bed-side of the patients in the 
Charity Hospital. 
1st. The treatment of the various forms of febrile diseases, and the 
relief of suffering humanity. 
2d. The daily clinical instruction of medical students by the bed-side. 
3d. The actual demonstration under the microscope of the characters 
of the blood in all cases of fever. 
The blood was abstracted from the patients suffering with fever, with 
care, and subjected at the earliest practicable moment to microscopical 
examinations. 
The large number of laborers upon the railroads leading to the city ; 
the strangers that flocked to New Orleans to find employment and support 
at the World's Industrial and Cotton Centennial Exposition furnished many 
interesting cases of fever, which were subjected to investigation in the 
wards of the Charity Hospital under my medical care. A large number 
of men suffering from the severest forms of the malarial fever of Central 
America entered my wards and were subjected to treatment and scientific 
investigation. Hospital Practice of Joseph Jones, M. D. 1884-1885. 
343 
Some estimate of the amount of clinical labor performed during the six 
months specified. 1st October, 1884, to April 1st, 1885, may be gathered 
from the following brief statement of gross results : 
Diseases. Cases. 
Deaths. 
Intermittent fever (quotidian, tertian and quartan) 
218 
Malarial haematuria 
5 
2 
Malarial fever of long standing, with enlarged spleen and liver, 
anaemia and albuminaria 
4 
1 
Malarial fever of long standing, complicated with anaemia, general 
anasarca and cirrhosis of the liver. 
3 
3 
Pernicious malarial fever; the majority of these cases were character- 
ized by the prolonged action of the malarial poison; watery blood 
containing melanaemic particles and cells, minute spores and cells; 
jaundice, rapid pulse, rapid respirations; elevated temperature. 
102°-103°.5 F., paralysis of sensation and locomotion, closely con- 
tracted or else widely dilated pupils; twitching of tendons, involun- 
tary discharges of urine and foeces ; profound coma ; often brought 
to the hospital in a moribund condition 
10 
10 
Malarial remittent fever 
19 
1 
Dengue 
2 
Typhoid fever 
J 
Phthisis pulmonalis 
29 
8 
Cancer of pylorus and pancreas 
1 
1 
Constitutional syphilis 
8 
Syphilitic rheumatism 
4 
Rheumatism (articular) 
14 
Gonorrhoea 
o 
Erysipelas 
4 
Dysentery (acute) 
17 
5 
Dysentery and diarrhoea (chronic) 
52 
11 
Eczema 
2 
Psoriasis 
1 
Opium habit 
4 
Alcoholism (delirium tremens) 
13 
2 
Asthma.; 
9 
Asthma with chronic bronchitis 
1 
1 
Bronchitis (acute) 
Bronchitis (chronic) 
12 
10 
Pneumonia (double with pleuritis) 
4 
4 
Pneumonia (single) 
8 
Pleuritis (double engrafted on malarial fever) 
2 
1 
Pleuritis 
4 
Gangrene of lung 
1 
1 
Laryngitis, complicated with abscess of pharynx and pyaemia 
1 
1 
Abscess of pectoral muscle complicated with pyaemia 
1 
1 
Valvular disease of heart; hypertrophy; dilatation and aneurism of 
large arteries 
3 
3 
Aneurism of aorta 
3 
Insufficiency of mitral valve 
2 
Functional derangement of heart; irregular action and palpitation due 
chiefly to the anaemic condition of the blood, caused by the pro- 
longed action of the malarial poison 
20 
Apoplexy 
1 
i 
Epilepsy 
4 
Haemaplegia (result of self-abuse) 
1 
Haemaplegia 
2 
Paraplegia 
2 
Sclerosis of spinal cord 
1 
Progressive muscular atrophy 
1 
Dementia 
4 
Dementia caused by self-abuse 
2 
Tetanus (traumatic) 
1 
Cephalalgia 
5 
Acute Bright's disease 
2 
i 344 
Hospital Practice of Joseph Jones, M. D. 1884-1885. 
Chronic Bright's disease 
Cirrhosis of liver, complicated with 
4 
aneurism of abdominal aorta 1 
1 
Cirrhosis of liver 
1 
Abscess of liver 
1 
1 
Hepatitis 
4 
1 
Abscess of parotid 
................................................... 1 
Gastritis 
4 
Tonsilitis 
1 
Gastro-enteritis 
4 
Taenia solium (tapeworm) 
g 
Grand total, cases and deaths in medical service of Joseph Jones, 
M. D.. Charity Hospital, six 
months, 1st October, 1884-April 
1st, 1885 
547 
63 
The great body of the patients were natives of foreign countries, and 
of the various States of the American Union; thus, only 42 were natives 
of Louisiana (18 natives of New Orleans and 24 of the Parishes of Louisi- 
ana, outside of Orleans); in like manner, the deaths occurred chiefly 
amongst foreigners, and the natives of the United States; thus, of the 18 
natives of New Orleans, only two died, and both from the same disease, 
phthisis puhnonalis; and of the 24 natives of the other Parishes of Louisi- 
ana, four died from the following causes: Chronic Bright's disease, 
chronic dysentery, pernicious malarial fever, and malarial fever of long 
standing, with enlarged spleen, anaemia and general anasarca. The natives 
of Louisiana constituted only 7.6 per cent, of all the cases treated, and the 
mortality amongst the natives of Louisiana, constituted 9.2 per cent, of the- 
deaths from all causes. The clerk of the Charity Hospital, in charge of 
the distribution of the patients, having been requested to keep my ward 
always filled with the severest cases of disease, and in virtue of the location 
of these wards, on either side of the stair-way and elevator, it happened 
that a large number of the patients were brought in apparently in the last 
extremities of severe and protracted illness. 
If the deaths of patients entered in a moribund condition, be subtracted 
from the 63 deaths, the rate of mortality would be greatly reduced. Thus, 
more than two-thirds of the Italians, entered the wards in a most deplora- 
ble condition, from the effects of malarial fever and chronic dysentery and 
diarrhoea; and of 26 of these unfortunate men, nearly one-third, or more 
exactly, 8 died within short periods, varying from 6 hours to 100 hours 
after admission to my wards in the Charity Hospital. The greater portion 
of these Italians had not resided longer than from 6 to 36 months in Louisi- 
ana, and had been employed in the cultivation of rice on the plantations 
above and below New Orleans. Bad diet, bad water and exposure to the- 
desolating malaria of the swamps, rapidly reduced these destitute and 
ignorant and superstitious foreigners to the verge of destruction. One- 
half of the 26 Italians were at the time of their admission, suffering with 
the various forms of malarial fever, contracted in the swamps and rice 
fields, and of the malarial cases, one-third, or more exactly, 4 perished 
within the first 72 hours after admission. The remaining thirteen (13) 
were afflicted with dysentery and diarrhoea of the most intractible char- 
acter, aggravated by the action of the malarial poison; of this number, 4 
died. We have thus a mortality of 8 in 26; or one death in 3.25'cases. 
These Italians not only were unable to speak English, but they were greatly 
reduced in flesh and strength, in some cases, mere skeletons; and at the 
same time they manifested the greatest aversion to take medicine, and 
refused to aid in their own treatment. Hospital Practice of Joseph Jones, M. D. 1884-1885. 
345 
Guatemala and other Central American States, also furnished a most 
interesting group of cases: the patients were natives of France, Ireland, 
Germany and the United States of America, and had been employed in 
building railroads ami canals in this semi-tropical region. The total num- 
ber of cases presenting well-marked symptoms of malarial fever originat- 
ing in Central America and in the Isthmus of Panama, was thirty, and of 
this number, two proved fatal. The Central American malarial cases, were 
characterized by great anaemia ; sallow, puffy, light greenish and bronzed 
complexion. When the blood of these patients was extracted from the 
blood-vessels and spread out on glass slides, it presented a thin watery 
yellow hue. wholly unlike the bright red healthy blood of the medical 
students gathered around their beds in the Avar ds of the Charity Hospital. 
Before being fully under the influence of quinia, the chills were well 
marked and returned at regular intervals. The malarial facies were well 
marked; complexion of a sallow greenish yellow hue; tongue large, pale 
anaemic, flabby and deeply indented along the edges; bowels constipated 
in some cases, in others loose ; oedema of lower extremities ; rapid feeble 
pulse, upon exertion great cardiac action, difficulty of breathing and muscu- 
lar prostration; anaemic bruit over cardiac region and along track of aorta, 
pulmonary, subclavian and carotid arteries. Six of these cases suffered 
with large flabby intractible ulcers of the lower extremities. These ulcers 
like those observed in other cases of chronic malarial poisoning, varied in 
their appearance in the different stages of the disease ; as a general rule 
they were, aggravated by the febrile paroxysms. These ulcers did not heal 
until the malarial fever had been arrested by arsenic and quinine, and the 
function of the liver regulated by mercurials or nitro-muriatic acid, and the 
constitution of the blood restored to the normal standard, by nutritious 
diet, and the preparations of iron. Quinine, arsenic and the tincture of 
the sesqui-chloride of iron were the most efficient remedies. The liver and 
spleen were involved in all cases. 
In the two cases which proved fatal, the pernicious paroxysm was sud- 
den and unexpected in its onset; the patients were seized with chill fol- 
lowed by febrile excitement, temperature 103° F., pulse 120, delirium fol- 
lowed by coma, with contracted pupils and paralysis of motion and sensa- 
tion. The blood of these cases was subjected to careful microscopical exam- 
ination and presented appearances and micro-organisms similar to those of 
the blood in the various forms of malarial fever of the Mississippi Valley. 
The paroxysmal character of the malarial fevers treated October 1st, 
1884, to April 1st, 1885, is well shown by the data contained in the follow- 
ing tables drawn up from the clinical records of the wards during the 
period indicated. 346 
Temperature, Pulse and Respiration: Malarial Fever. 
Temperaiure, Pulse and Respiration Recorded in cases of Paroxysmal Malarial Fever Treated in Charity Hospital, New 
Orleans, July 1st, I884, April 1st, 1885; Medical Service of Joseph Jones, M. I). 
1st Observation 
2d Observation 
3d Observation 
4th Observation 
5th Observation 
Number of 
case 
Temp. 
Pulse 
ResJ?. 
Temp. 
Pulse 
Resp. 
Temp. 
Pulse 
Resp. 
Temp. 
Pulse 
Resp. 
Temp. 
Pulse 
Resp. 
M. 
;E- 
M. 
|e. 
M. 
|e. 
M. 
E. 
E. 
M. 
|e. 
| M. 
E. 
M 
E, 
M. 
1 E' 
M. 
E. 
M. 
E'l 
M j 
E. 
M.|E. 
M 
l£ 
M. 
|E. 
855 
105 
132 
36 
98.5 
98.5 
78 
72 
24 
18 
85ij 
101.5 
102 
34 
100 
102.8 
981 
120 
30 
36 
99 
99.8 
96 
96 
24 
24 
857 
104 
120 
30 
98 
96 
18 
858 
164 
108 
32 
98 
98.5 
72' 
78 
18 
24 
ibo 
98.5 
72 
72 
30 
is 
97.5 
98 
70 
66 
24 
24 
i 
859 
102.5 
146 
36 
98 
103 
72 
120 
18 
36 
97 
98 
78 
72 
18 
18 
98.4 
98.5 
72 
84 
72 
18 
18 
98.5 100 
72 
90 
18 
18 
860 
104.8 
120 
24 
98 
98 
961 
84 
18 
18 
99 
99 
96 
78 
18 
18 
99 
98.5 
84 
18 
18 
98 1 98 
84 
60 
18 
18 
861 
103.8 
114 
32 
98 
98.5 
102 
84 
20 
20 
98.5 
72 
72 
18 
18 
98.5 98.5 
862 
ibi .5 
102.3 
96 
114 
24 
24 
99 
100.5 
84 
96 
18 
24 
102 
100.8 
ioo 
78 
72 
24 
18 
99 
99 
84 
72 
18 
18 
78 
78 
18 
18 
863 
102.5 
102 
24 
101.5 
102.6 
78 
108 
24 
24 
99 
78 
96 
24 
18 
98 
72 
18 
864 
J 03.4 
102 
42 
865 
ibi 
102 
98 
78 
18 
18 
98.5 
103 
78 
90 
18 
18 
98.4 
98 
78 
78 
18 
18 
1 
866 
102. 
102 
30 
97 
97.5 
78; 
102 
28 
30 
97.4 
76 
30 
867 
103.6 
102.4 
114 
102 
30 
30 
98.5 
100 
78 
78 
18 
18 
868 
103.5 
102 
150 
30 
98 
102 
90 
130 
18 
24 
98.5 
98.5 
90 
90 
18 
18 
98.5 
78 
78 
18 
18 
i 
869 
102 
97.5 
90 
24 
24 
100.2 
100 
96, 
72 
90 
24 
24 
98 
98.5 
100.8 
100 2 
84 
84 
18 
18 
98 
98.2 
99.2 
100 
84 
90 
72 
18 
18 
98.4 98.5 
98.3 99.2 
72 
72 
IS 
18 
18 
870 
99 
1015 
96 
92 
20 
24 
98.5 
99 
78 
18 
18 
100 
96 
90 
18 
21 
98 
72 
18 
24 
90 
72 
18 
871 
101.5 
100 
75 
78 
18 
24 
99.6 
99.9 
66 
76 
20 
14 
99 
72 
60 
18 
18 
99 
97 
72 
60 
18 
18 
872 
98.5 
97 
96 
102 
18 
30 
97 
104 
90 
124 
18 
22 
98 
97 
114 
84 
18 
18 
97 
84 
72 
78 
18 
18 
sr 1:::::: 
61 
is 
873 
102.6 
102 
24 
99 
99.2 
92 
78 
18 
18 
98.5 
97.5 
72 
66 
18 
18 
97.5 
18 
874 
102 
103 
108 
120 
24 
30 
100 
100 
96, 
96 
24 
24 
98.5 
84 
18 
875 
102 
104 
96 
102 
26 
36 
99.7 
101 
78; 
86 
18 
18 
101 
99 7 
80 
78 
18 
18 
876 
100 
101.5 
96 
102 
24 
30 
98.4 
90 
18 
■ ■ 'I 
877 
103.8 
78 
24 
99 
ibo 
66 
84 
18 
24 
98 
60 
18 
878 
102 
103.8 
96 
30 
98.5 
104 
72 
102 
18 
24 
97 
97 
68 
18 
14 
18 
98 
98 
90 
6S 
24 
20 
14 
879 
100.5 
96 
18 
99.6 
103.5 
114 
118 
24 
42 
99 
98.6 
102 
102 
18 
98.5 
101.9 
90 
96 
20 
880 
104.b 
120 
24 
98.5 
98.5 
84 
78 
24 
18 
102 
100 
102 
96 
18 
20 
1 
881 
103.8 
120 
24 
100 
98.5 
96 
86 
24 
24 
98.5 
98.5 
72 
72 
18 
18 
98.5 
98 5 
72 
72 
18 
18 
1 
882 
103.6 
120 
36 
98.5 
90 
18 
883 
105 
135 
36 
99.5 
102 
100 
95 
25 
22 
884 
104 
96 
26 
103 
102.6 
96 
98 
24 
28 
98.3 
104 
84 
114 
i8 
18 
98 
99 
72 
18 
18 
885 
101 
103.2 
102 
90 
24 
26 
98.5 
99 
102 
96 
24 
26 
97 
97 
72 
72 
29 
18 
98 
86 
20 
104 
100 
114 
102 
30 
30 
98.5 
98.5 
90 
102 
24 
18 
97 
97 
72 
72 
96 
■ 
887 
108.8 
102 
102 
96 
30 
36 
98.5 
100.3 
96 
84 
26 
18 
98.4 
100.7 
96 
is 
18 
888 
104 
120 
30 
98.4 
18 
1 
889 
103 
103.7 
106 
24 
99.2 
96 
: 
890 
104.4 
98.5 
89] 
103 
101.4 
114 
108 
30 
30 
98.5 
78 
80 
18 
892 
103.5 
102 
30 
98.5 
20 
893 
103.8 
ibi 
108 
ibb 
36 
24 
10<>.8 
103.6 
120 
120 
24 
24 
101.8 
104.8 
120 
120 
26 
26 
101.5 
101.5 
120 
120 
24 
24 
1 
894 
103 
78 
24 
101 
103 
76 
112 
24 
30 
100.5 
100.5 
84 
96 
24 
30 
100 
103 
108 
96 
30 
30 
98.5 101.5 
72 
96 
24 
21 
895 
104 
114 
36 
103 
103.5 
108 
108 
24 
36 
102.5 
103.5 
96 
102 
18 
24 
102.8 
103.5 
102 
108 
24 
24 
100.2 102.4 
89 
102 
24 
24 
896 
102.5 
102 
24 
101 
103 
108 
108 
24 
24 
101 
101.5 
108 
108 
24 
24 
100 
102.8 
96 
98 
18 
24 
100 1103.4 
96 
109 
18 
24 
897 
104.0 
..... 
108 
36 
100.8 
104.5 
96 
114 
32 
36 
100.5 
102.5 
96 
96 
26 
30 
101.2 
104 
94 
96 
30 
48 
104 | 99 
90 
96 
30 
36 
898 
102 
103 
72 
84 
24 
24 
100 
103 
72 
76 
24 
24 
103.5 
103.5 
72 
72 
24 
24 
100.5 
101 
72 
120 
96 
78 
72 
24 
18 
100 102 
102 103.6 
100.5 103 
100.5 103 
72 
18 
24 
899 
104 
102 
118 
136 
36 
24 
100.6 
103.6 
120 
120 
24 
24 
101.2 
104.5 
120 
120 
24 
40 
101.2 
101.2 
120 
24 
30 
24 
120 
96 
120 
96 
24 
30 
900 
100.5 
102.6 
96 
108 
24 
30 
100.4 
102.6 
98 
100 
18 
24 
101.8 
103.6 
96 
101 
18 
24 
100 
104 
118 
18 
18 
24 
901 
100 
120 
32 
103 
102 
108, 
114 
18 
18 
100.4 
101.5 
90 
102 
18 
18 
99.5 
101 
90 
18 
18 
90 
90 
18 
18 
902 
100.5 
102 
102 
108 
24 
24 
102 
103.2 
96 
102 
24 
28 
99.5 
103.7 
96 
104 
24 
24 
100 
103 
96 
114 
18 
24 
101 102.3 
96 
96 
24 
24 Parasites in Man and Animals. 
347 
Case No. 897 was complicated with pleuritis. Cases Nos. 898, 899, 
900, 901 and 902 were of the remittent type:-the bowels were not tympani- 
tic, neither were they loose as in typhoid fever, and although, in these and 
in similar cases, the fever lasted with various remissions from seven to 
twenty days, no death occurred, and the fever was finally in every case 
arrested by sulphate of quinia, adminisiered both internally and externally. 
The cases of intermittent fever were as a rule, promptly arrested by the 
use of the alkaloids of peruvian bark, as will be seen in the report of the 
first forty-two cases of the preceding table. 
A large number of the cases were brought to my ward in the Charity 
Hospital, from the swamps along the railroads of Central America, Ten- 
nessee, Mississippi, Texas, and Louisiana, after they had suffered from the 
prolonged action of the malarial poison. These anaemic jaundiced bronzed 
laborers, suffering with enlarged livers and spleens, and with muscular 
and nervous prostration, were successfully treated and restored to health, 
and to productive labor by the continuous and careful use of quinia, arsenic 
and iron. Many cases were benefitted and restored to health, by ten drops 
of Fowler's solution of arsenic, one hour after each meal (three times a day), 
and five grains of sulphate of quinia, with ten drops of the tincture of the 
sesquichloride of iron, one hour before each meal (three times a day). 
ESSENTIAL CONDITIONS FOR THE ESTABLISHMENT OF THE RELATIONS OF 
MICRO-ORGANISMS AND MORBIFIC FERMENTS TO THE CAUSATION AND 
PHENOMENA OF CERTAIN DISEASES. 
We must admit with the leading microscopist Koch, that in all inves- 
tigations, of the relations of micro-organisms to disease, in no instance 
can it be said to have been satisfactorily found, that a particular infectious 
disease is due to a particular micro-organism if any one of the following 
conditions remains unfulfilled: 
(1.) It is absolutely necessary that the micro-organism in question is 
present either in the blood or the diseased tissues of man, or of an animal 
suffering or dead from this disease. In this respect great differences exist, 
for in some infectious diseases, the micro-organisms, although present in the 
diseased tissues are not present in the blood; while in others they are pre- 
sent in large numbers in the blood only, or in the lymphatics alone. 
(2.) It is necessary to take these micro-organisms from their nidus? 
from the blood or the tissues as the case may be, to cultivate them artifi- 
cially in suitable material or media, outside the animal body, but by such 
methods as to exclude the accidental introduction into their media of other 
micro-organisms; to go on cultivating them from one cultivation to another 
for several successive generations, in order to obtain them free of every 
kind of matter derived from the animal body from which they have been 
taken in the first instance. 
(3.) After having thus cultivated the micro-organisms for several 
successive generations, it is necessary to re introduce them into the body 
of a healthy animal, susceptible to the disease, and in this way to show 
that this animal becomes affected with the same disease as the one from 
which the organisms were originally derived. 
(4.) It is necessary that in this so affected new animal, the same 
micro-organisms should again be found. 
A particular micro organism may probably be the cause of a particular 
disease, but that really and unmistakably it is so, can only be inferred with 
certainty, when every one of these conditions has been satisfied. 348 
Parasites in Man and Animals. 
GENERAL OBSERVATIONS ON PARASITES, BACTERIA AND PATHOGENIC 
ORGANISMS, PRELIMINARY TO THE CONSIDERATION OF THE MICROS- 
COPICAL CHARACTERS OF THE BLOOD IN MALARIAL PAROXYSMAL 
FEVER. 
The vast number and great varieties of the lower forms of animal and 
vegetable life found in the gutters and swamps of the City and Parish of 
Orleans, as well as in the mouths and intestines of man, in this hot and 
moist climate, renders a search for any specific form of bacteria, bacilli, 
micrococci or fungi, in their relations to specific diseases, difficult, if not 
absolutely unsatisfactory and fruitless. The direct chemical and micros- 
copical examination of the blood, immediately after its removal from the 
living bodies of human beings, both healthy and suffering from the effects 
of febrile poisons, promises the most important and trustworthy results. 
It would be difficult to conceive that certain diseases might be caused by 
living organisms in the blood and tissues, capable of rapid increase and 
endowed with powerful toxic properties, and yet at the same time, be inca- 
pable of detection by the highest powers of the microscope. 
GENERAL RESULTS AND METHOD OF INVESTIGATION; SUMMARY OF KNOW- 
LEDGE RELATIVE TO NATURE OF BACTERIA. 
In the investigation of the microscopical characters of the blood in 
malarial and other fevers and diseases, the author examined for com- 
parison, numerous specimens of healthy blood, with various powers, rang- 
ing from one-fourth to one-twentieth of an inch objective. After numer- 
ous careful examinations of normal blood and normal tissues, I have been 
unable to detect bacteria. Healthy medical students furnished good sub- 
jects for the abstraction and immediate microscopical examination of the 
blood of healthy living beings. This proposition, however, will not hold 
good with reference to the mouth and alimentary canal, generally, of man. 
The existence of entozoa, or of animals living within other species, 
has, from the most remote times, attracted attention on account of the 
peculiarity of their position, the unpleasant ideas associated with them, 
the sufferings they frequently induce, and the difficulty of explaining their 
mode of origin; but the existence of vegetable parasites within animals, or 
of entophyta from their minuteness, remained unknown, until the micros- 
cope of Leeuwenhoek detected the algoid filaments of the human mouth. 
This branch of Natural History was placed upon a firm and broad scien- 
tific basis, by the works of Dujardin (Histoire Naturelie des Helmenthes, 
Paris, 1845), Diesing (Systema Helminthum Vindobome, 1850), Robin 
(Des Vegetaux qui croissentsur Phomme etsur les animaux vivants, Paris, 
1847). Joseph Leidy, M. D.; Flora and Fauna within Living Animals, 
Smithsonian Contributions to Knowledge, 1851. 
Thirty-five years ago, twenty-six entozoa, thirteen ectozoa, and ten 
entophyta had been studied and described and figured as parasites of man, 
namely: 
ENTOZOA HOMINIS. 
Filaria medinensis, Gmelin: subcutaneous areolar tissue. Filaria 
bronchialis, Rudolphi: Bronchial glands. Filaria oculi humani, Nord- 
mann: Eye. Tricocephalus dispar, Rud: Large intestine. Strongylus 
gigas, Rud: Kidneys. Ascaris lumbricoides, Lin: Small intestine. Ascaris 
alata, Bellingham: Small intestine. (Ireland.) Oxyuris vermicularis,. 
Bremser: Rectum. Spiroptera hominis, Rud: Urinary bladder. Ancyclos- 
tomum duodenale, Dulimi: Small intestine. Trichina spiralis, Owen: Parasites of Man. 
349 
Muscles. Pentastomum constrictum, Siebold: Small intestine and liver. 
(Egypt.) Bothriocephalus latus, Bremser: Intestines. Taenia solium, Lin: 
Small intestine. Taenia nana, Siebold: Small intestine and liver. (Egypt.) 
Monostomum lentis, Gescheidt: Crystalline lens. Distomum hepaticum, 
Abilgaard: Gall-bladder and portal vein. Distomum lanceolatum, Mehlis: 
Hepatic duct. Distomum oculi humani, Gescheidt: Capsule of crystalline 
lens. Distomum haematobium, Bilharz: Portal vein. (Egypt.) Distomum 
heterophyes, Siebold: Small intestine. (Egypt.) Tetrastomum renale, 
Chiaje: Kidney. Hexathyridium pinguicola, Treutler: Ovary. Hexa- 
thyridium venarum, Trent.: In the venous blood. Cysticercusc ellulosae, 
Rud: Areolar tissue of various organs. Echinococcus polymorphus, 
Diesing: Various viscera. 
ECTOZOA HOMINIS. 
Phthirius inguinalis, Leach: Crab-louse. Pediculus capitis, Nitzsch: 
Head-louse. Pediculus vestimenti, Nitzsch: Body-louse. Pediculus tabes- 
centium, Burmeister. Sarcoptes scabiei, Latreille: Itch-insect. Demodex 
folliculorum, Owen. Dermanyssus Boryi, Gervais. Ixodes americanus, De 
Geer: Tick. Argas persicus, Fischer. Pulex irritans, Lin: Common flea. 
Pulex penetrans, Gmelin: Chiggo. (South America.) Cimex lectularius, 
Lin: Bed-bug. Oestrus hominis, Say. (South America.) 
Alga of the mouth. Achorion Schbnleinii, Remak: In porrigo favosa. 
Achorion Lebertii, Robin. In porrigo scutulata. Microsporium Audouini, 
Gruby. In porrigo decalvans. Mycoderm of Plica Polonica. Mycoderm 
of Mentagra. Mycoderm of Muguet. Mycoderm ata of ulcerated and 
mucous surfaces. Sard na ventriculi, Goodsir: Stomach. Torula, Stomach. 
At the present day, the recognized human parasites classed under the 
sub-divisions entozoa, ectozoa, entophyta and epiphyta, numbered about 
sixty, without including in the list various parasitic vegetations, which 
have been reported under the names of algae, fungi, mycoderma, aphthae, 
etc., the characters or the existence of which as causes of disease, are still 
the subject of inquiry. 
Within living beings, that is within their cavities or the parenchyma 
of the organs, all the indispensable conditions of life exist, and conse- 
quently we cannot wonder at their being infested with other living beings, 
adapted to their parasitic position: nevertheless, living beings frequently 
do not contain parasites. There are many circumstances besides those 
essential to life in general, which influence the existence or non-existence 
of such forms. One of the most important of these circumstances is the 
convenience or ease of access, or of entrance to the living body infested. 
Within the living organic closed cell parasites very rarely or never exist, 
because it is liquid matter only which can endosmose through cell-mem- 
branes, and therefore, solid germs cannot enter, and hence, the infre- 
quency of true entozoa in vegetables. In some experiments upon the 
endosmosis of solid matter through organic cell-membrane, Dr. Joseph 
Leidy found that particles of carmine, diffused in water, which he estimated 
to measure about the 52,000th of an inch, would no more penetrate the 
cell-membrane than the larger masses. Entozoa may and do penetrate 
through living tissues, but it is entirely by the mechanical process of bor- 
ing. The intestinal canal of animals is most frequently infested by ento- 
parasites, on account of the ease with which these germs enter with the 
food. A low degree of organic activity and slowly digestible food, favor 
ENTOPHYTA HOMINIS. 350 
Parasites of Man. 
the development of entoparasites. Comparatively indigestible food and 
such as contains but a small proportion of nutritive matter, from its long 
retention in the alimentary canal, favors the development of entozoic and 
entopytic germs, more than that in which the contrary conditions prevail. 
If liquid food be open to the air, parasitic germs may be readily introduced 
into the mouth and alimentary canal; and food swallowed in large morsels 
favors the introduction of attached parasites. 
Cooking food is of advantage in destroying the germs of parasites, and 
hence, man, notwithstanding his liability to them, is less infested than 
most other mammalia. No part of the body, in vertebrated animals, is 
free from the attacks of entozoa. The most inaccessible situations, such as 
the interior of the eye, the brain, and the spinal cord, are sometimes 
affected by these parasites; and even the medullary cavity of the bones has 
furnished instances of their invasion. 
As a general rule, entozoa of the same species are not found in differ- 
ent organs; the small intestines of man is the habitat, of the ascaris lumbri- 
coides, of the taenia solium, and of the bothriocephalus latus, but neither of 
these species is normally met with in the stomach or in the large intestine. 
The principal viscera of the body are affected by special worms; for 
instance, the caecum is infested by the tricocephalus, the rectum by the 
oxyuria, the biliary passages, by the diastomum hepaticus, and the urinary 
organs by the strongylus gigas, filaria sanguinis hominis and the bilhar- 
zia hiematobia. Like the viscera, the other parts of the body have their 
peculiar entozoa; the trichina spiralis is found in the voluntary muscular 
tissue, the coenurus is found in the central nervous system, and the cysti- 
cerus and the echinococcus are met with only in natural or adventitious 
cavities. The limitation of certain worms to certain regions, is observed 
with such regularity, that it may be considered as the result of a general 
law. 
The development and propagation of entozoa are influenced by various 
conditions, which are sometimes external, such as the geographical position, 
the climate and the seasons, and sometimes peculiar to the individual 
affected, such as the age and the sex. Of all the influences which bear upon 
the existence of entozoa, that of geographical position is the most evident, 
indicating that there exist in certain countries entozoa which are not 
observed elsewhere; and that the number of persons affected by worms, is 
much more considerable in some countries than in others. Since the begin- 
ning of the present century, when Rudolphi published his systematic work 
on the entozoa (1808) almost every year has contributed new and important 
facts. The records of history furnish numerous examides of periods of 
blight in the vegetable kingdom associated with epidemics affecting the 
human family. Many important diseases have been supposed to originate 
from parasitic animals and vegetables. The former are not the true ento- 
zoa, for these are too large and may be detected by the naked eye; but they 
are considered to be animalculse so small that they cannot be discovered 
with the highest powers of the microscope. 
The production of certain diseases, through the agency of entophyta is 
no longer a subject of doubt; as in the case of muscardine in the silk-worm, 
the my coderm of porrigo favosa in man, etc.; and the theory of the " cryp- 
togamous origin of malarial and, epidemic fevers," so ably advocated by the 
late Dr. J. K. Mitchell, of Philadelphia, is at the present time being sub- 
jected to the most rigid examination at the hands of competent observers, 
armed by the most perfect and powerful microscopes. The objection urged 
by Professor Joseph Leidy, of Philadelphia, in 1851, still confronts the 
laborer in this difficult and uncertain field that " none of the well-known Parasites of Man. 
351 
animalculse are poisonous. At various times I have purposely swallowed 
large draughts of water containing myriads of monas vibrio, euglenia, volvox 
leucophyrys, paramecium, vorticella, etc., without ever having perceived 
any subsequent effect, * *. rThat malarial and epidemic fevers have their 
origin in cryptogamic vegetables or spores requires but a single proof. If 
such were the case, these minute vegetables and spores, conveyed through 
the air, and introduced into thebody in respiration, could be detected. The 
minutest of all known living beings is the vibro lineola of Muller, measur- 
ing only the 36,000th of an inch, and the smallest known vegetable spore is 
very much larger than this, whilst particles of inorganic matter can be dis- 
tinguished the 200,000th of an inch in size. I have frequently examined 
the rains and dews of localities in which intermittents were epidemic upon 
the Schuylkill and Susquehanna rivers, but without being able to detect 
animalculfe, spores, or even any soli dparticles whatever. "Flora and 
Fauna withinLiving' Animals." Smithsonian Contributions to Knowledge, 
1851, p. 14. 
This statement was made by Dr. Joseph Leidy, thirty-five years ago, and 
during thistime the instrumentsof research have been greatly perfected, and 
the means of experiment and observation by culture and staining pro- 
cesses have been greatly perfected and the views of many laborious meu have 
undergone a. great change, and they are ready to demonstrate the existence 
of low organisms as bacteria and bacilli in certain endemic, epidemic, con- 
tagious and infectious diseases. 
MICRO-ORGANISMS. 
Bacteria. 
Bacteria may be regarded as representing, in a general way, micro- 
organisms, the relations of which to the infectious diseases is admitted to 
be very intimate. Bacteria have acquired an importance in connection 
with Pasteur's theory of fermentation, as the objective points supposed to 
designate spontaneous generation, and in connection with the origin and 
propagation of some of the specific infectious maladies affecting man and 
animals. The genera were first distinguished by Ehrenberg into (a) bac- 
terium; (b) vibrio; (c) spirochteta; (d) spirillum. Systematic writers 
represent bacteria as chlorophyll free cells, of spherical, oblong or cylin- 
drical forms, sometimes twisted or bent. They multiply exclusively by 
transverse division, and occur either isolated or in cell families. Their 
existence in fluids renders the fluids milky or opalescent, but in fluids of 
equal refractive powers in themselves, such as lymph or serum, their 
existence is not to be distinguished without a microscope. They are not 
destroyed by potash, ammonia or acids. They never branch. The divi- 
sion may separate at once (unicellular bacteria^ or may remain attached 
as strings or threads (filamentous bacteria). By swelling up of these cell 
membranes, they form a jelly-like mass or colony (zooglcea). The fila- 
mentous and screw* form never form jelly masses. Bacteria frequently 
form an oily scum or stratum near the surface of a liquid, attracted by 
oxygen (the mucor of Pasteur); also as a tough pellicle, in which the bacteria 
are closely packed in rows (the mycoderm of Pasteur). They may also form 
a pulverulent precipitate, when they have exhausted the nutriments in a 
fluid; and, as in the parallel case of yeast, they are then in a resting phase. 
They also present a motile and a motionless condition. The motile condi- 
tion is said to be connected with the presence of oxygen. In certain fila- 
mentous bacteria (bacteridia) movement has never been seen. As bacte- 
ria multiply by fission, they have been called schizomycetes. They are com- 352 
Parasites of Man. 
posed of a kind of protoplasm, the my cop rotein of Nencki, and are invested 
with a membrane, which is composed chiefly of cellulose, and a certain 
amount of mycoprotein. Their contents are transparent and clear, but 
sometimes contain minute bl ight granules of sulphur. Owing to the cellulose 
membrane they resist the action of acids and alkalies. Many species of bacte- 
ria-micrococcus, bacterium, spirillum-are able by rapid multiplication 
to form colonies, the individuals are then embedded in a hyaline gelatinous 
matrix produced by them; this is also mycoprotein. Some species are 
possessed of one or two straight nr slightly spiral cilia , or flagelli and 
thereby they are capable of locomotion, darting through or spinning round, 
in the fluid in which they are suspended. Such is the case with many 
kinds of bacteria, bacilli and spirilla. 
Bacteria grow best when left undisturbed ; movement of the vessels in 
which they grow is not advantageous. Light and electricity do not appear 
to have a decided influence, since most of them grow well in the light. 
According to Cohn and Mendelssohn, strong electric currents have a nox- 
ious influence on the growth of micrococci. Some bacteria require free 
access of oxygen, and are called aerobic; others grow without free oxygen, 
and are anaerobic (Pasteur.) All bacteria require for their growth certain 
nourishing materials containing carbon and nitrogen. Water is an essen- 
tial element for them, and a certain temperature is a stimulant of their 
growth. Most pathogenic bacteria require for their propagation, a tem- 
perature varying in the different cases between 18° and 40° C. 
The bacteria obtain their nitrogen from organic compounds, some are 
capable of obtaining it from compounds as simple as ammonium tartrate, 
others especially pathogenic organisms, require much more complex combi- 
nations, such as occur in the animal body. Carbon they obtain likewise from 
organic compounds, such carbohydrates, amongst which sugar is the chief, 
and vegetable acids combined as salts are also to be mentioned. It is essen- 
tial for all, that certain inorganic salts, phosphates, potassium, and sodium 
salts, should be present since their own substance contain a large percentage 
of salts-four to six per cent. 
While all are capable of disintegrating organic combinations contain- 
ing nitrogen, they in their turn help to produce certain chemical products 
which in some cases are definite, for a definite species. Such is the case 
with the various bacteria connected with the fermentations producing lactic 
acid, butyric acid, and acids belonging to the aromatic series. On many 
bacteria connected with putrefaction, and also on some pathogenie organ- 
isms these chemical products have a deleterious effect. Small quantities 
impede their growth, and sufficiently large quantities kill them altogether. 
Most bacteria are killed by heat below the temperature of boiling- 
water, many of them when exposed for some hours to a temperature above 
50°-60° C. Exceptions are the spores of bacilli, which in some instances 
(spores of hay bacillus) require exposure to the heat of boiling water for as 
much as half an hour. By raising the boiling point above 100° C., it does 
not require more than a few minutes to kill them. Dying destroys most 
bacteria, except the spores of bacilli. Freezing destroys likewise most 
bacteria, except the spores of bacilli, which survive exposure to as low a 
temperature as 15° C., even when exposed for an hour or more. No spores 
survive exposure to a temperature of 120° C. 
Amongst the substances which inhibit the growth of or altogether 
destroy the bacteria, are carbolic acid, salicylic acid, thymol, etc., corro- 
sive sublimate is the most powerful, since even solutions as weak as 1 to 
300,000, are said by some experimenters to inhibit the growth of bacillius 
anthtacis. The influence of certain substances and conditions on micro- Micro-Organisms: Bacteria. 
353 
organisms, may be two fold. (1.) The condition may be unfavorable to 
the growth of the organism in question. (2.) The condition may be fatal 
to the life and existence of the micro-organism. The second condition 
invites the first; but the reverse is not the case. 
Professor E. Klein, M. D., F. K. S., a most accomplished and learned 
■microscopist and sanitarian, has placed the subject of antiseptics in a clear- 
light in his recent publications on Micro-Organisms and Disease. 
This acute observer says : By sowing any micro-organism into a 
nourishing solution to which has been added a certain substance, as car- 
bolic acid, to the amount of 1 per cent., and exposing this medium to the 
conditions of temperature and moisture otherwise favorable to the growth 
of the organism, if it is found that after the lapse of a due period the 
growth is retarded or altogether inhibited, the conclusion is reached that this 
substance, namely, the carbolic acid of one per cent, is an antiseptic. There 
is nothing more fallacious than this mode of reasoning; a great many micro- 
organisms can be exposed to a one per cent, solution of carbolic acid for 
hours without in the least being affected, for on being then transferred to a 
suitable nourishing medium, they grow and thrive well. Similarly by 
placing the spores of bacillus anthracis in a proteid medium containing 
perchloride of mercury of the strength of 1 to 300,000, it is found (as Koch 
has shown) that the spores are absolutely incapable of germinating. But 
if from this the conclusion is drawn that perchloride of mercury of the 
strength of 1 to 300,000 is a germicide, Dr. Kline most strongly dissents, 
for perchloride of mercury, even of the strength of one per cent., is not 
a germacide, any more than vinegar; for on placing the spores of bacillus 
anthracis in a proteid medium, to which so much vinegar or any other acid 
has been added as makes it decidedly acid, it will be found that the spores 
do not germinate. In order to pronounce a certain substance an antiseptic 
in the strict sense of the word, it is necessary to place the organisms in 
this substance for a definite time, then to remove them thence, and to place 
them in a suitable nourishing medium; if they then refuse to grow, the 
conclusion is justified that the exposure has injured or destroyed the life 
of the organism. In the case of pathogenic organisms, a substance to be 
pronounced a germicide must be shown to have this power, that when the 
organism is exposed to the substance and then introduced into a suitable 
artificial medium, it refuses to grow; and it must also be shown that when 
introduced into a suitable animal it is incapable to produce the disease 
which the same organism unexposed to the substance in question, does 
produce. 
Dr. E. Klein has made many observations on the influence of antiseptics 
on micro-organisms, both putrefactive and pathogenic, and has found that 
many assertions hitherto made on this subject, treated in the above light are 
absolutely untrustworthy and erroneous. According to this observer, vari- 
ous species of putrefactive micrococci, bacterium termo, bacillus subtilis, 
various pathogenic micro organisms as bacillus anthracis, bacillus of swine 
fever, absolutely refuse to grow in media to which is added phenyl-propi- 
onic acid, or phenyl-acetic acid, to an amount so small as 1 in 1600; but if 
the same organisms are exposed to these substances in much stronger solu- 
tion, 1 in 800, 1 in 400, or even 1 in 200, and then transferred to a suitable 
nourishing material, it is found that they have completely retained their 
vitality; they multiply as if nothing had been done to them. Dr. Klein has 
exposed the spores of bacillus anthracis to the above acids of the strength 
of 1 in 200 for forty-eight hours, and longer, and then inoculated guinea- 
pigs with them, and found that the animals died of typical anthrax in 
exactly the same way as if they had been inoculated with pure spores of 354 
Micro-Organisms: Bacteria. 
the bacillus anthracis. Koch has published a 1 arge series of systematic obser- 
vations made in testing the influence on spores of bacillus anthracis of a 
large number of antiseptics (thymol, arsenite of potassium, turpentine, 
clove-oil, iodine, hydrochloric acid, permanganate of potassium, eucalyptol, 
camphor, quinine, salicylic acid, benzoic acid, and many others), and 
amongst them he found perchloride of mercury to be the most powerful, 
since even a solution of 1 in 600,000 is capable of impeding, one of 1 in 
300,000 of completely checking the germinating power of the spores. 
Klein has shown that to regard these substances from these observa- 
tions of Koch, in any way as antiseptics, for the spores of bacillus 
anthracis, would be no more justifiable than to consider weak vinegar as 
such. Perchloride of mercury, a solution of 1 in 300,000, is no more capa- 
ble of interfering with the life and functions of the spores of bacillus anthra- 
cis than water or salt solution, for the spores may be steeped in this solu- 
tion for any length of time, and yet on being transferred to a suitable 
medium they grow and multiply rapidly, and when inoculated into 
rodents they produce fatal anthrax with absolute certainty. In common 
with Dr. Blyth, Medical Officer of Health for the Marylebone District, in 
London, Dr. Klein tried the action of a number of substances in common use 
as antiseptics, namely, Calvert's fluid, pure terebene, phenol ten per cent., 
perchloride of mercury one per ceut., on the spores of bacillus anthracis, 
exposing them in comparatively large quantities of the above fluids, (the 
two being well mixed) for twenty-four hours, and then inoculating 
guinea-pigs with them (spores and antiseptic.) The animals died with 
symptoms of typical anthrax, the blood teeming with the bacillus anthra- 
cis. These substances then are no more antiseptics and still less germi- 
cides, for the spores of bacillus anthracis than water is. 
In all these enquiries, particularly in those upon pathogenic organisms 
capable of forming spores, the influence of the substances must be judged not 
merely by their action on the organisms, but also on the spores, for in this 
very case of the bacillus anthracis, the bacilli taken from the blood of an 
animal dead of anthrax, are killed after an exposure of say ten minutes to 
a solution of phenyl propionic acid of the strength of 1 in 100, or even 1 in 
800, whereas the spores of the bacilli (produced in artificial cultures) with- 
stand complete exposure to this acid of any strength and for any length of 
time.* Bacteria belong to the vegetable kingdom. Ammonia dissolves 
the eggs, the embryos of all animals, the bodies of all the inferior infusoria, 
attacks the spermatozoa, etc., whilst it leaves absolutely intact all the 
varieties of cellulose, and the reproductive elements of plants whether it is 
used cold or boiling. Concentrated acetic acid, causes all animal tissues to 
become pale, whilst it is without action on bacteria: hematoxylin and 
fuchsin color the bacteria deeply. We should therefore no longer give to 
the bacteria the names of microscopic animalcuke, infusoria, microzoa and 
other names which imply their animal origin, nature and functions. 
Bacteria resemble green plants in taking up nitrogen from ammonia 
compounds, which animals are unable to do ; and urea or nitric acid may 
replace ammonia as sources of nitrogen. But they require carbo- 
hydrates or their derivatives to supply carbon, which they are unable to 
take from carbonic acid, and in this respect they differ from green plants. 
Thus, succinic, acetic, and lactic acid, tartaric acid, sugar, glycerine, cellulose 
may become for them sources of carbon. 
Are bacteria algce, or are they fungi 1 
Bacteria exhibit affinities with alga?, and Sir Joseph Hooker has 
thrown out the suggestion that just as yeast may be a degraded form of 
* Micro-Organisms and Disease. The Practitioner, Oct 1884, pp. 211-253. Micro-Organisms: Bacteria. 
355 
some higher fungus, bacteria may be degraded allies of the oscillatoriae 
which have adopted a purely sarophytal mode of existence. It is very 
difficult to find a characteristic of these two classes of vegetables, both hav- 
ing, in a general manner, identical forms and similar reproductive appar- 
atus ; and if it is impossible to confound a basidiomycete with a floridea*, 
this is not true when a comparison is instituted with the inferior species. 
When we consider the diverse opinions entertained by such distinguished 
naturalists as O. F. Muller, Bory de Saint Vincent, Ehrenberg, Dujar- 
din, M. Davaine, Hallier, Hoffmann, Cohn, M. Ch. Robin, M. Pasteur, 
Billroth, Nageli, Antoine Magniu and E. Klein, we may say with Cohn : 
"So long as the makers of microscopes do not place at our disposal much 
higher powers, and as far as possible, without immersion, we will find our- 
selves in the domain of the bacteria, in the situation of a traveler who 
wanders in an unknown country at the hour of twilight, at the momeut 
when the light of day no longer suffices to enable him clearly to distinguish 
objects, and when he is conscious that, notwithstanding all his precautions 
he is liable to lose his way." The only character which appears general is 
the presence of chlorophyll in the algm, and its absence in the fungi, but if 
we adopt this as a distinct difference, we are obliged to separate in the 
inferior algae, some forms very nearly related, and which do not differ in 
their relations except in this particular. The bacteia, although entirely 
without chlorophyll, have numerous affinities as to form, movement, etc., 
with the oscillatoriacce, and according as one or the other of the characters 
have appeared to predominate, the bacteria have been classed as agla* or as 
fungi. 
Davaine, Rabenhorst and Cohn, struck by the resemblance of form 
mode of grouping and of multiplication, have placed the bacteria 
amongst the algae. Cohn insists upon the affinity of the filiform bacteria 
with the beggiatoa and the leptothrix; of the micrococcus and of the bacte- 
rium, with the chroococcacete. He at first placed them at the commence- 
ment of the last series, but in his last publication, he has disseminated 
them among the oscillatoriacem and the chrooeoccacea*. Robin and Nageli, 
on the other hand, insist upon the affinities of the bacteria with the 
yeast plants, which are undoubtedly fungi, and they include them in this 
class. 
According to Robin, all the corpuscles described under the name of 
bacterium termo, B punctum, etc., zoogUea, micrococcus, and many others, 
are vegetable cells, spores of fungi of several distinct Species; spores or 
reproductive bodies of the first order, derived one from another, either by 
germination, fission or from a mycelium: in a word, reproductive bodies of 
the order of those which Tulasne has arranged under the name of conidia, 
etc. 
Nageli establishes in the inferior fungi which produce decompositions 
three groups: (1) The mucorini, or mould fungi. (2) The saccharom- 
ycetes, or budding fungi, which produce the fermentation of wine, beer, 
etc. (3) Schizomycetes, or fission fungi, which produce putrefactive pro- 
cesses. This last group is formed of the bacteria (micrococcus, bacterium, 
etc.) Sachs solves the problem by uniting the algse and the fungi into a 
single group, the thallophytes, in which he establishes two series exactly 
parallel-one composing the forms with chlorophyll; the other the forms 
which are deprived of it, and preserving in a transverse direction the 
morphological affinities of these organisms. 
M. Th. Billroth, in 1874, in his researches upon the coccobacteria septica, 
held, in opposition to Cohn, that the bacteria differ considerably in form, 
according to the medium in which they are placed, and diverse conditions 356 
Micro-Organisms of Malarial Fever. 
to which they are subjected. Billroth claims that the bacteria constitutes 
but a single species, the coccobacteria septica; a vegetable organism which 
presents itself under the form of globular particles (coccos), or under that 
of rods {bacteria'). These two forms may reproduce themselves by becom- 
ing elongated and dividing transversely, or may pass the one into the 
other. 
Billroth claims to have found both forms united in a single filament, 
which, in his opinion, demonstrates their relationship. Each of these 
two forms can also present variations of size, in accordance with which he 
establishes the following divisions: Micrococcos-microbacteria. Meso- 
coccos-mesobacteria. Megacoccos-megabacteria. Varieties of asso- 
ciation gave rise to the following names: Monococcos-monobacteria. 
Diplococcos-diplobacteria. Streptococcus-streptobacteria. Gliacoccos 
-gliabacteria. Petalococcos-petalobacteria. Ascococcos. In the pres- 
ent work, and with the present condition of oif knowledge upon this 
difficult subject, I shall adopt, mainly, the classification of Dr. Ferdinand 
Cohn: 
1. Spherobacteria, or micrococci. 
2. Bacteria, or microbacteria. 
3. Bacilli, or desmobacteria. 
4. Spirilla. 
5. Spirochfetm. 
There are also various kinds which approach one or the other of 
these, as ascococcus, sarcina, leptothrix (Beggiotoa), cladothrix, strep- 
tothrix, etc. 
RESULTS OF MICROSCOPICAL EXAM [NATIONS OF THE BLOOD IN THE VARI- 
OUS FORMS OF MALARIAL PAROXYSMAL FEVER. 
During our investigations of the blood secretions, excretions, organs 
and tissues in malarial fever, yellow fever, relapsing fever, small-pox, 
leprosy, tuberculosis and other diseases, we have employed for the detec- 
tion and study of micro-organisms, the high powers furnished by the most 
reliable instrument-makers in this country and Europe. We have worked 
with satisfaction with the various powers of B. & J. Beck, of London, 
ranging from l-5th to l-20th of an inch; of G. & L. Merz, l-8th to l-3d of 
an inch. I have also employed all the powers of Nachet, of Paris, and 
others. The l-10th of an inch of Beck, of London, I have found to be one 
of the most satisfactory powers lor the investigation of micro-organisms. 
When the blood was the subject of examination, the specimen was care- 
fully collected on glass-slides, in the wards of the hospital; portions were 
subiected to immediate examination, and other specimens were subjected 
to the action of various agents and coloring matters. Examinations of the 
numerous specimens of blood collected were carried on daily so that a 
series of investigations sometimes embraced months before their final com- 
pletion. It is unnecessary to enter into any detail as to the method of 
employing the various analine dies (methyl-blue, methyl-violet, vesuvin, 
Bismarck-brown, magenta, fuchsin, rosanilin, gentian-violet. Spiller's pur- 
ple, eosin, dahlia, purpurin and iodine-green), which are known to have a 
great affinity for micro-organisms, and have been used with great success 
by Koch and many other observers to demonstrate their presence. We 
employed with satisfactory results the method of Weigert and Koch, for 
the demonstration and preservation of microscopical specimens of micro- 
organisms in blood and in the various fluids and structures of the human 
body. In presenting drawings of the micro organisms observed in various Micro-Organisms of Malarial Fever. 
357 
diseases, we have sought to employ the micro-photograph; but found this 
method of illustration too tedious and expensive for practical purposes. 
In the following views of the micro-organisms in the blood of malarial 
fever, we have sought to present in each figure the results of the examina- 
tions of the blood in many tspical cases of the various forms of malarial 
fever. Each figure, therefore, represents a far larger number of the vari- 
ous organisms than could be discerned in any one examination of a small 
poition of blood under the microscope. The object is to show the nature 
of the micro-organisms in malarial fever, rather than to present a view of 
a single specimen or of several specimens under the microscope. This 
explanation is of importance to future observers, who might be led astray, 
and form erroneous conclusions, if they looked for a smaller number of 
micro-organisms in each drop of blood examined. 
The following illustrations should, therefore, be regarded as presenting 
the various bodies observed in the blood in various cases, and in various 
stages of malarial fever. 
ENGRAVING NO. 46. 
Engraving No. 46.-Figures A. and B, microscopical appearance of fresh Mood of malarial fever 
Blood spread in thin layers on glass-slide and examined under microscope. l-10th of an inch, 
objective. R. & J. Beck, London. Joseph Jones, M . ii 
ENGRAVI\(r N<>. 47. 
Engraving No. 47.-Figure 0, Microscopical appearance of fresh blood of malarial fever. 
Blood spread upon glass-slide. l-10th objective. R. & J. Beck, London. D, Micro-organisms 
in blood of malarial fever, prepared and stained after method of Koch. l-10th objective. R. 
& J. Beck, London. Joseph Jones, M. B. 358 
Micro-Organisms of Malarial Fever 
ENGRAVING NO. 48. 
Engraving No. 48.-Figures E and F, Micro-organisms in blood of malarial fever, prepared and 
stained after method of Koch and Weigert. i-10th inch objective. Joseph Jones, M. D. 
We have observed in the blood of patients suffering from malarial 
fever the following abnormal micro-organisms, not present in the blood of 
healthy human beings : 
1st. Minute globular bodies, distinguishable with high powers, not 
dissolved by concentrated acetic acid, and not removed during the process 
of staining, as recommended by Koch. These g'obules present the char- 
acter of minute spores, varying in diameter from 1-10,OOOth to 1-30,000th 
of an inch in diameter. 
2d. Globular bodies of larger size than the preceding, often of a dark 
opaque character, found not only in the liquor sanguinis, but also in the 
colored blood-corpuscles and in the colorless blood corpuscles. These 
bodies appear to possess the power of destroying the colored corpuscles. 
In Figures A and B, the rings of globules represent the colored blood- 
corpuscles, apparently undergoing destruction by these micrococci. Many 
of the colorless corpuscles are invaded by these bodies. Staining demon- 
strates that these micrococci are surrounded by protoplasm and constitute 
masses of zoogloea. 
3d. Ovoid and cylindrical and rod-shaped bodies. These bacteria 
are not destroyed by strong acetic acid, and also become more distinctly 
visible during the process of staining. They increase during the cold 
stage of malarial fever, and are also numerous in the blood during the 
hot stage of pernicious and remittent fever. Careful and numerous exam- 
inations of the blood will also reveal their presence during the stage 
of chronic malarial poisoning, attended with pernicious anaemia. 
4th. Colorless corpuscles, containing numerous pigment particles 
and pigment cells. Many of these pigment corpuscles are twice the size 
of the normal colorless corpuscles of healthy blood, and their behavior 
under the action of re-agents, and also during the process of staining, 
demonstrates that a portion at least of these bodies must be regarded as 
abnormal vegetable organisms. These large pigment corpuscles are char- 
acteristic of malarial fever, and I have upon various occasions announced 
their uniform presence in the blood of well-marked malarial fever. 
5th. Masses of hammtin. These masses are frequently of an irregular 
form, as shown in the figures. The deposit of dark pigment masses in 
the liver and in the brain in malarial fever, and especially in cases of Micro-Organisms of Malarial Fever. 
359 
repeated paroxysms, finds its origin in the changes of the colored blood- 
corpuscles, induced by the morbific ferment or micro-organism of mala- 
rial fever. There is an actual destruction of the colored blood-corpuscles 
in the living blood and in the walls of the living capillaries and blood- 
vessels in malarial fever. We can detect this process of disintegration of 
the colored blood-corpuscles by the microscope, and detect the very incep- 
tion of that great pathological change which constitutes one of the most 
distinctive features of malarial fever, and which must be considered in 
any scientific and rational plan of treatment. 
6th. We also observe variations in the size of the colored blood-cor- 
puscles in malarial fever greater than those in any other disease. 
In order still farther to determine the presence of micro organisms in 
the blood of malarial fever, the different organs of the human body after' 
death from per nicious malarial fever were subjected to the prolonged action 
of various agents as : 
1st. Atmospheric air in glass vessels. The blood, bile and splenic 
mud and muscular and nervous structures, heart, brain, liver and kidney 
were placed in clean glass vessels, cor ked and allowed to putrify. 
2d. Wafer in glass vessels. The blood, bile, splenic mud and nerves 
and muscular structures, heart, brain, liver and kidneys were placed in 
clean glass vessels and carefully stopped with cork stoppers. The amount 
of water added was about four-fold the bulk of the or ganic matters sub- 
jected to its action. 
3d. Similar experiments were performed with concentrated acetic 
acid. 
4th. The blood and liver and splenic mud were similarly treated with 
Koch's staining liquid in glass vessels. 
OUTLINE OF RESULTS OF EXPERIMENTS AND OBSERVATIONS ON THE MICRO- 
SCOPICAL APPEARANCES OF THE FLUIDS AND TISSUES OF MALARIAL 
FEVER UNDER THE ACTION OF WATER AND CERTAIN RE AGENTS. 
Splenic Mud from Enlarged Softened Spleen of Pernicious Malarial Fever, 
placed in a Clean Class Bottle and Corked. 
In this experiment the splenic mud was simply confined in a definite 
space of air without the addition of water or any chemical agent. The 
splenic piud thus enclosed underwent a certain degree of putrefaction, and 
when the cork was removed emitted a foul odor due to the generation of 
sulphuretted hydrogen. The odor did not differ from that emitted by a 
rotten egg. This experiment was continued during the months of Novem- 
ber, December, January, February, March, April, May, June and July. 
During the winter months the splenic mud was kept in a warm room, and 
during the summer months the splenic mud experienced those changes of 
temperature which are supposed to be favorable to the development of the 
malarial ferments. The splenic mud in its natural state was thus subjected 
to very much the same conditions that the spleen would experience in the 
body aftpr death from malarial fever. During the progress of the experi- 
ment the splenic mud formed a dark, almost black, thick tar-like semi- 
liquid mass. No distinct fungous mass was observed under the microscope 
corresponding to the fully developed yeast plants. High powers of the 
microscope, ranging from l-5th to 1-20th inch objective (Beck's, of Lon- 
don), revealed in this putrid mass or semi-liquid, great numbers of minute 
micrococci, minute, rod-shaped bacilli, bacteria, and pigment cells filled 
with globular dark pigment particles or sporules, similar to those observed 360 
Micro-Organisms in Splenic Mud. 
in the blood in malarial fever. Also minute chains of micrococci. It 
would thus seem that the process of putrefaction in a confined space of air 
tended to arrest the full development of the micro organisms existing in 
the splenic mud of malarial fever. 
Splenic Mud of Enlarged Softened Spleen of Pernicious Malarial Fever, placed 
in a clean Class Bottle and Diluted with about 5 {Five) parts of Distilled 
Water. 
The details of this experiment with reference to temperature and length 
of time, were similar to those recorded in the preceding experiment All 
putrid odor gradually disappeared from the splenic mud thus diluted with 
water, and it appeared to undergo a species of fermentation, attended with 
the development of an organism resembling a fungus with mycelium, 
leptothrix and spore cells enclosed in distinct walls. The dark cells con- 
tained globules and granular pigment matter and resembled in all respects 
the pigment cells of the blood of malaria, only that they were in many 
cases larger, and were apparently connected with the cellular branches. It 
is worthy of note that the re action of the splenic mud thus diluted with 
water, and allowed to stand, was slightly alkaline. Under various powers 
of the microscope, ranging from l-5th to l-20th inch objective, the splenic 
mud thus treated with water and allowed to stand, contained large pigment 
corpuscles filled with oval pigment particles or sporules, fragments of 
blood-vessels and cellular tissue, minute micrococci, fungus plant, or 
mycelium with cellular branches and dark pigment cells which were filled 
with dark granules or spores, and appeared to be the patent cells and 
reproductive organs of the plant. The leptothrix branches contained spo- 
rules. Numerous chains of minute cells or cellular bodies about the one- 
forty-thousandth (1-40,000) of an inch in diameter. Spores inclosed in 
the mycelium; these minute bodies were distinctly seen under high powers. 
The splenic mud and water presented numerous dark aggregations of 
various sizes, from l-10th to l-4th of an inch of this fungus. rl he fol- 
lowing figure presents the appearance of the fungus or micro organism of 
the malaria! spleen, as viewed under l-10th inch objective (BecFsf 
ENGRAVING NO. 49. 
Engraving No. 49.-Splenic mud of case of pernicious malarial lever. Mud with about three 
parts of water, and allowed to stand until all evidences of fermentation and putrefaction had 
ceased. The peculiar plant or fungus in the dark spore cases reseinbling those seen in the 
blood of malarial fever are shown. 1-IOth Inch.-Beck. Micro-Organisms in Splenic Mud. 
361 
Splenic Mud of Enlarged Softened Spleen of Pernicious Malarial Fever placed 
in a clean Glass Bottle and. subjected to the action of strong, chemically pure 
Acetic Acid. The amount of the Acetic Acid was about five times that of 
the Splenic Mud. 
The conditions as to temperature and length of time in the experiment 
were similar to those previously recorded. The acetic acid absorbed out 
the colored blood-corpuscles; the black pigment corpuscles on the other 
hand, although reduced in numbers still were discernible. Numerous 
minute spores and nucleated cells were observed under high magnifying 
power l-5th to l-20th inch objective. Many particles of black pigment mat- 
ter were also observed. Many of the dark pigment granules were spheri- 
cal in form and resembled spores. Numerous cells inclosing dark spherical 
bodies were observed. The dark particles or spores were enclosed in an 
outer hyaline membrane. The following figure represents the microorgan- 
isms in the splenic mud of pernicious malarial fever subjected to the action 
of concentrated acetic acid. 
ENGRAVING NO. 50. 
Engraving No. 50.-Micro-organisms of splenic mud from spleen of pernicious malarial fever, 
subjected to the action of strong acetic acid. Magnified 1000 diameters. 
When the bile from the gall-bladder of pernicious malarial fever was 
subjected to the prolonged action of an excess of strong acetic acid and 
subjected to the microscope, numerous minute ovoid cellular bodies, in 
chains of two or three or more, resembling in all respects similar bodies in 
the malarial blood were observed. The smallest of these bodies were not 
more than one^thirty-thousandth of an inch in diameter. Pigment granules 
and pigment cells were also present. 
The blood from the liver subjected to the prolonged action of concen- 
trated acetic acid, yielded under the microscope numerous pigment parti- 
cles, granules and cells filled with pigment granules and ovoid bodies 
resembling spores. The pigment cells were at least (in many instances) 
twice the size of the colorless blood-corpuscles and many of the darkgrann- 
ies which they contained were round and resembled spores. There were 
also numerous minute spherical bodies resembling micrococci, which 
were not acted on by the acetic acid, there were also large irregular 
masses of dark hematin which were without any marks of organic structure. 
The prolonged action of acetic acid on the cerebral structures, revealed 
under high powers of the microscope the deposit of dark pigmentary mat- 362 
Micro-Organisms in Splenic Mud. 
ters in the walls of the blood-vessels, and around the nerve tubules and 
commissures ; pigment cells were also observed in the blood-vessels of the 
cerebrum and cerebellum. Similar results were obtained, with the struc- 
tures of the kidney and heart. 
When the micro-organisms of the splenic mud and of other organs, 
and of the blood which had resisted the prolonged action of concentrated 
acetic acid as previously described, were subjected to the action of Koch's 
staining liquid, the microscope revealed masses of zoogloea, enveloping 
dark colored spores and ovoid bodies similar to those observed in the blood 
when treated in a similar manner. The smallest nucleated cells resembled 
somewhat colorless corpuscles, but were smaller in size, and were stained 
of a blue color, by Koch's liquid. Under the staining fluid, these cells 
presented the reactions of vegetable organisms, after having resisted the 
prolonged action of concentrated acetic acid. It is necessary in this con- 
nection to recall the previous statement, that the splenic mud of pernicious 
malarial fever, when subjected to the prolonged action of strong acetic acid, 
yielded numerous nucleated cells, about one-half the size of the colorless 
blood-corpuscles, also numerous small cells not more than from 1-10,OOOth 
to 1-30,OOOth part of an inch in diameter. Some of these cells contained 
nuclei, and nucleoles, also, round pigmentary bodies, which presented 
the reactions of sporules, resisting the prolonged action of acetic acid, and 
staining with Koch's and other staining liquids. We have already pre- 
sented the appearance of these bodies in Engraving No. 50. 
We have been led by the preceding observations to hold- 
1st. That the phenomena of malarial fever in the human organism 
are due to a specific poison or morbific ferment. 
2d. The micro-organisms concerned in the production of malarial 
fever, attack chiefly the red blood-corpuscles of man. 
3d. The phenomena of malarial fever are due in part to the destruc- 
tion of the colored blood-corpuscles, in part to the derangement of the 
normal chemical changes of the blood and organs, and in part to the toxic 
action of the chemical compounds developed by and resulting from the 
action of the micro-organisms. 
4th. The chemical and physical changes excited in the blood and 
organs of the human body by the action of the malarial micro-organisms 
are, in their highest and final results, inimical to the development and mul- 
tiplication of the essential potential elements of the malarial ferment. 
5th. The active febrile phenomena of malarial fever are in their ulti- 
mate results and products antiseptic; they tend to inhibit the development 
and even to destroy the morbific ferment of malarial fever. 
6th. Many of the most destructive and fatal effects of the malarial fer- 
ment occur in cases in which there has been comparatively little elevation 
of temperature, and in which the paroxysms succeed each other in an 
almost imperceptible manner; as, for example, in malignant anaemia. 
7th. The recurrence of paroxysms in malarial fever is due to the par- 
tial destruction of the micro-organisms during the active and pronounced 
chemical changes of the fever. When not wholly destroyed during the 
febrile stage the micro-organisms are reproduced, and again induce dis- 
turbance of the nervous system, alterations of the blood and oscillations of 
temperature. 
8th. Such agents as quinine, arsenic and the preparations of mercury 
act as poisons to the micro-organisms of malarial fever, exort an antiseptic 
effect upon the blood, bind the oxygen more nearly or closely to the haemo- 
globin and proteids, and directly promote the elimination through the ali- 
mentary canal, intestinal canal, the skin and the kidneys of the noxious Medico-Legal Evidence relating to Human Blood. 
363 
products of the morbific ferment and of the increased and altered chemical 
actions. 
9th. The changes induced by the malarial ferment upon the blood 
differ chemically and microscopically from those induced by other morbific 
organisms, as those of small-pox, typhoid fever, typhus fever, yellow fever, 
measles, scarlet fever, relapsing fever, diphtheria and Asiatic cholera, Ori- 
ental plague, tuberculosis and leprosy, pneumonia, pleuritis, carditis, ery- 
sipelas, rheumatism and pyaemia. 
We shall discuss in extenso several of these propositions, not however, 
in the exact order in which we have stated them, for we shall consider in 
the first place, the ninth and last proposition. 
If it be true that the malarial poison produces distinct and specific 
microscopical changes in the blood of human beings, it is evident, that we have in 
such changes valuable data for diagnosis. It will be admitted by experienced 
and competent observers, that medico-legal investigations fur nish the most 
difficult and important opportunities for- the crucial test of the nature and 
value of changes of the human blood, under the action of certain poisons, 
and in certain casualties, as revealed by microscopical and chemical 
analysis. 
The author, in the discharge of certain responsible duties imposed, 
upon him by the legal authorities of the State of Louisiana, was compelled 
to recor d his observations upon the changes of the blood irr malarial fever-. 
As far as our information extends, this is the only case in which, the patho- 
logical changes of the blood found upon the garments of a man charged 
with the crime of murder, was determined and announced officially, in 
advance of any knowledge of the history and condition of the murdered 
man. Regarding this subject as of importance to medical as well as to 
legal science, we reproduce irr full, the report of this case, as originally 
published. 
Medico-Legal Evidence relating to the Detection of Human Blood presenting the 
Alterations characteristic of Malarial Fever, on the Clothing of a Man 
Accused of the Murder of Narcisse Arrieux, December 27th, 1876, near 
Donaldsonville, LouisianaA 
The value of life and propertv in every country, depends not merely 
upon the number and character of its laws, but chiefly upon a learned and 
incorruptible judiciary, supported by an intelligent, law-abiding ami vir- 
tuous people. The great ends of good government, the security of life, 
liberty, property, and the pursuit of happiness to all alike, irrespective of 
birth, condition or occupation, can be secured solely by the impartial 
administration of just laws and the certain and prompt punishment of thei r 
infraction. Holding these views, the writer has upon various occasions in 
several Southern States, responded to the calls of outraged humanity and 
offended justice, and assumed the painful and responsible task of institut- 
ing those post mortem examinations, and chemical and microscopical pr o- 
cesses, which could best detect and reveal the modes and causes of death 
and thus aid justice by furnishing an important link of evidence. Although 
during the past twenty years, I have been engaged in the investigation of 
over fifty cases of poisoning by various agents, as arsenious acid (arsenic), 
strychnia, morphia, opium and its preparations, lead audits salts, sulphate 
of iron, cyanide of potassium, the seeds of the Jamestown weed and other 
*State of Louisiana, Parish of Ascension, 4th Judicial District Court, State of Louisiana vs. 
(No. BS) Wilson Childers et als. By Joseph Jones, M. D., Professor of Chemistry and Clinical 
Medicine, Medical Department University of Louisiana, Visiting Physician Charity Hospital, 
New Orleans, etc. N.jU. Med. and Surg. Journal, 1S78. 364 
Medico-Legal Evidence relating to Human Blood. 
poisons, and although these medico-legal investigations have resulted in 
the conviction of a number of criminals; as the processes employed were 
similar to those practiced by experienced toxicologists; and as the facts as 
a general rule, are well known and carefully recorded, I have refrained 
from burdening the current medical literature with the details. I am 
induced, however, to publish the following details under the belief that 
they will prove of interest to those who may conduct similar examinations, 
and also in two particulars to the medical profession generally. The phe- 
nomena manifested by the deceased after the reception of the blows upon 
the head, as well as the detection of the peculiar effects of malarial fever 
upon the blood spattered on the clothing of the accused, and also upon the 
floor, walls and furniture of the room in which the murder was committed, 
appear to be worthy of record and consideration. 
Circumstances of the Murder. 
Narcisse Arrieux, was found on the morning of December 28th, 1876, 
dead in his store situated on the banks of the Mississippi, near the south- 
western border of the town of Donaldsonville, Louisiana. The head, face, 
beard and clothing of the old man, Narcisse Arrieux, were covered with 
clotted blood. It was evident from an extensive compound comminuted 
fracture of the cranium extending on the right side from the occiput across 
the right parietal bone and frontal bone to the internal canthus of the left 
eye, and from several other contused wounds on the head, that death had 
been caused by blows inflicted by heavy blunt instruments. The small 
house occupied by Narcisse Arrieux as a store and dwelling, contained 
three apartments. The largest apartment which faced the Mississippi river 
and opened by a door upon the common road or highway, leading up and 
down the road behind the broad levee, which protects this region from 
overflow, was used as a store for the sale and barter of various kinds of 
merchandise, food and spirits. This store was divided into two unequal 
portions by a counter running directly across in front of the door, the space 
behind the counter was much less in area than that in front. Back of the 
counter and communicating with the main room or store were too smaller 
rooms, one of which was used as a sleeping apartment, and the other as an 
office and sitting room. According to the testimony of the coroner and 
other witnesses, the dead body of Narcisse Arrieux was found on the morn- 
ing of the 2Sth of December. 1876, lying near the stove on an overturned 
chair in the small office. The doors communicating between the store and 
the sleeping room, and office and between this office and the sleeping room 
were open. The door opening from the store into the public road was 
shut and locked. A pool of blood lay on the floor behind the counter, 
near a barrel of alcoholic spirits. Traces of blood were also found upon 
the floor of the store and marks of bloody hands were also upon the walls 
and upon the trout door, and upon the floor of the office and sleeping room. 
Marks of bloody hands were found upon the walls and door posts and upon 
the bed. Blood was also found upon two desks and in the drawers, in 
which the deceased kept his money and books. Several four pound iron 
weights containing blood and the grey hairs of the deceased were found 
behind the counter, in the office and sleeping apartment. One of these 
heavy iron weights thrown at the head of the deceased had crashed through 
a window in the back part of the sleeping room and was picked up in the 
yard. 
According to the statement of Dr. John E. Duffel, an intelligent and 
accomplished physician of Donaldsonville, who held the post-mortem at 
the coroner's inquest, the wounds oberved upon the head of Jsarcisse 
Arrieux. were as follows: Medico-Legal Evidence relating to Human Blood. 
365 
11 Left Side: Contused wound about half an inch in length near inner 
canthus of left eye. Contused wound one half, inch in length at root of 
nose on the left side, penetrating and fracturing the frontal bone. Great 
ecchymosis of both eyes. Contused wound over left eye, but extending 
diagonally towards the left temple, penetrating to the bone. Contused 
wound in left temple, in line with margin of left eye. Contused wound 
on posterior part of the head penetrating to the bone. Contused wound 
four inches from left ear, extending backwards towards occiput, two 
inches, fracturing and depressing the occipital bone. 
Right Side: Contused wound on forehead, penetrating to the bone, 
about three inches across the root of the nose. Contused wound about one 
inch to the left of the ear penetrating to the bone. Contused wound start- 
ing from the outer margin of the eyebrows, ranging downwards, towards 
the temporal bone, about three inches in length, ending in a line with 
the top of the right ear, penetrating, fracturing and depressing the 
right temporal bone. 
Scalp Removed: Extensive fracture, extending from the inner canthus 
of left eye, extending upwards in a curve and ranging across the right 
side of the frontal bone, and around across the temporal and parietal bones 
to the occiput." 
It appears from the condition of the premises at the time of the 
inquest, that notwithstanding the extensive wounds and fractures of the 
cranium, the deceased after the infliction of the injuries and after the flight 
of the assassins and robbers, had partially regained his senses and the use 
of his limbs; had closed his door, examined his money drawers, had at- 
tempted to light a fire in his stove, had placed a newspaper on the floor, 
unbuttoned and pulled down his pantaloons, and evacuated his bowels, 
had staggered around the walls steadying himself with his bloody hands 
and after seating himself in a chair had died and fallen upon the floor, 
overturning the chair and lying upon the floor with his legs bent. He 
appears to have died in the sitting posture and after death and even after 
the establishment of the rigor-mortis the body had fallen upon the floor. 
It appears from the testimony, that, between the hours of 9 and 11 
o'clock, P. M., on the night of the 27th (a dark and stormy night), four 
powerful stalwart negro men entered the store of Narcisse Nrrieux and 
called for ardent spirits. A.s the old man turned his back to draw the 
liquor from the barrel he was struck by one or more of the robbers, with a 
four pound iron weight on the back of the head. This blow not having 
the effect desired by the assassins, the weights upon the counter were 
hurled in rapid succession against his head. The powerful leader of the 
robbers sprang over the counter and inflicted repeated blows upon his 
head with a short hickory stick, armed with a leaden head, which had 
been carried concealed in the sleeve of his coat. 
It is probable that the victim lay unconscious during the robbery of 
the store and after the assassins had withdrawn, the profuse haemorrhage 
(as shown by the large pool of blood behind the counter, where he fell), 
relieved the congestion of the brain temporarily; and upon the return of 
consciousness, he was able to stagger to the door and close it and to visit 
his office and sleeping room and even to examine the desks in which he 
kept his money and books. 
Prosecution of the Accused by the State. 
Certain parties suspected of the murder were arrested: four negro men 
were incarcerated in the city jail, charged with the murder of Narcisse 366 
Medico-Legal Evidence relating to Human Blood. 
Arrieux. Spots of blood were observed by the sheriff, upon the coat of 
Wilson Childers, a powerful negro man, who was known to have been at 
the store of Narcisse Arrieux, on the night of the 27th. 
Upon his arrest on the 28th, Wilson Childers affirmed that these spots 
on his coat, were caused by red paint, which was rubbed off from a barrel 
of whiskey which he had handled for a merchant. 
By the order of the court an examination by physicians and druggists 
of these spots was made in Donaldsonville, on or about the 29th of 
December, 1876. There being no microscope of sufficient power in the 
town and its vicinity, the Court ordered Mr. T. A. Landry, to proceed to 
New Orleans with portions of the coat and shirt of the accused, Wilson 
Childers, and to secure the services of a competent chemist and micro- 
scopist for their careful and thorough analysis. 
Early in the morning of January 2d, 1877, 1 received the following- 
note from Dr. F. B. Gaudet, late President of the Board of Health, State 
of Louisiana: 
New Orleans, January 2d, 1877. 
Joseph Jones, M. D., Professor of Chemistry, Medical Department, University of Louisiana, 
New Orleans. 
Dear Doctor:-Mr. T. A. Landry, of the parish of Ascension, has 
been appointed custodian of a sealed package containing three pieces of 
woolen stuff, cut from the coat of one Wilson Childers, accused of having- 
on Wednesday (27th December., 1876) murdered a man, and he was ordered 
to proceed to New Orleans to submit the above to a chemist and microsco- 
pist of well known reputation, for analysis and examination. The report 
must be officially made to the judge of the parish. I have of course sug- 
gested your name. * * You know that you must first take the oath 
before a justice of the peace, and swear to the report which you will 
prepare. * * 
Very respectfully, your obedient servant, 
F. B. GAUDET. 
liesuit of Chemical and Microscopical Examination of Stains on the Coat and 
Shirt of Wilson Childers. 
Upon careful chemical and microscopical analysis and examination, I 
determined that the stains on the coat and shirt of the accused, were not 
paint, but were human blood. I also determined the fact that the blood was 
that of a human being who had suffered and was probably suffering at the moment 
when the blood was abstracted, with malarial or paroxysmal fever. My written 
statement of the general result of the chemical and microscopical analysis 
and examination, sworn to before a justice of the peace, together with the 
pieces of cloth carefully sealed, were forwarded through Mr. T. A. Landry, 
to the Honorable Court, Fourth Judicial District, State of Louisiana. I 
did not introduce into this statement any allusion to the pathological state 
of the blood, but simply announced these results, namely: 
1st. That the stains were not due to red paint nor to any form of 
paint. 
2d. That the stains were blood. 
3d. That the blood presented all the characteristics of human blood. 
I informed Mr. Landry, however, of the conclusion to which I had 
arrived, that the blood was that of a human being who had suffered and 
was suffering at the moment of its abstraction, with malarial or paludal 
fever. Medico-Legal Evidence relating to Human Blood. 
367 
On the 29th of June, 1877, I received a peremptory summons, to appear 
in person in the Fourth Judicial District Court, Ascension Parish, State of 
Louisiana, signed by the Honorable M. Marks, Judge. I repaired forth- 
with, by steamer and railroad to Donaldsonville, and found that the Hon- 
orable Court had continued the case. Subsequently I was furnished by 
John H. Ilsley, attorney at law, with pieces of wood stained with blood, 
cut from the drawers which contained the money of Narcisse Arrieux. 
Chemical and microscopical analysis showed that this blood which was 
beyond a doubt that of the deceased, presented the same pathological 
change as that found on the shirt and coat of Wilson Childers, the accused. 
After the examination the particles of wood were carefully preserved about 
my person. 
On the 27th of May, 1878, I received at the hands of the Deputy 
Sheriff, in the City of New Orleans, the following: 
The State of Louisiana, 
vs. 
Wilson Childers, et als. 
The State of Louisiana. Parish of Ascension. 
Fourth Judicial District Court. 
To Dr. Joseph Jones : You are hereby summoned, in the name of the 
State of Louisiana, to appear before the Fourth Judicial District Court of the 
Parish of Ascension on the 29th day of May, in the year of our Lord, 1878, 
at 10 o'clock, A. M., to testify the truth according to your knowledge, in 
a certain case now pending before this Court, in which the State of Louis- 
iana is plaintiff, and Wilson Childers et als. is defendant; and hereof fail 
not under penalty of the law. Witness the Honorable H. D. Duffel, Judge 
of said Court, 23d day of May, 1878 
L. E. BENTLEY, Clerk of said Court. 
In accordance with this summons I appeared in the Fourth District 
Court, Parish of Ascension, Wednesday, May 29th, but I was not placed 
upon the witness stand until 9 o'clock, Friday night, May 31st. Through 
the courtesy of the accomplished clerk of the court, Mr. L. E. Bentley, 1 
was furnished with the following report of my testimony as elicited by the 
examination of the State, represented by D. B. Earhart, District Attorney, 
and R. N. Sims, Edward N. Pugh, and John H. Ilsley, Jr., attorneys at, 
law, and of the defenseas conducted by Col. Winchester, of St. James. In 
the following report, the questions propounded by the State as plaintiff, are 
indicated by the letter S, those by the defense, for the prisoner, by the let- 
ter D, and the answers which I returned relating to the chemical and 
microscopical examination of the blood found upon the clothing of the 
prisoner, and in the house of Mr. Narcisse Arrieux, by the letter J. The 
counsel for the State after a minute examination as to the time which I had 
practiced medicine,* held the professorship of chemistry,f and devoted 
special attention to the chemical and microscopical examination of the 
blood of animals and man|, in health and disease and under various con- 
ditions, proceeded as follows : 
* Commenced the practice of Medicine in 1855. 
t Filled the chair of Chemistry, Toxicology and Pharmacy in the Savannah Medical College, 
1856,1857; in the Medical College of Georgia, at Augusta, 1858, 1861; served as surgeon in the Pro- 
visional Army of the Confederate States, up to the close of the civil war in 1865, and resumed the 
Professorship of Chemistry in 1866; have held the chair of Chemistry and Clinical Medicine in the 
Medical Department of the University of Louisiana, and have served as visiting physician of 
Charity Hospital, New Orleans, 1869 to present time, May 31st, 1878. 
t Physical, Chemical and Physiological Investigations upon the vital phenomena, structure 
and offices of the solids and fluids of Animals. The American Journal of the Medical Sciences, 
vol. xxxiii, July, 1856, pp. 13, 63. 
Investigations Chemical and Physiological relative to certain American vertebrata. Smith- 
sonian Contributions to Knowledge, Washington, D. C., 1856. 
Diabetes Mellitus, Constitution of Blood; Southern Medical and Surgical Journal, N. 8., 
vol. xiv, No. 5, May, 1858, p. 291. Observations on Malarial Fever, Southern Medical and Surgical 368 
Medico-Legal Evidence relating to Human Blood. 
Examination on part of State of Louisiana. 
S. Was a sealed package, containing particles of a coat and shirt at 
any time delivered to you officially by this Court for chemical analysis and 
microscopical examination? 
J. On or about the 2d of January, 1877, a small sealed package con- 
taining particles or pieces of cloth, was delivered into my hands, with an 
official warrant for a chemical analysis and microscopical examination, 
signed by Judge Marks, of this Honorable Court. 
S. Is the following communication to this Court in your handwriting? 
Is the signature appended yours ? If so read the communication to the 
Honorable Court. 
J. The report is in my handwriting, and the signature is genuine. 
The paper reads as follows : 
Medical Department University of La., 
New Orleans, January 2d, 1877. 
On the 2d of January, 1877, a sealed package was placed in my hands 
by T. A. Landry, acting under rhe order of M. O. Marks, Parish Judge, of 
the Parish of Ascension. Upon breaking the seal, two smaller packages were 
found ; namely, one marked "from left sleeve of coat," containing two 
pieces of cloth; the other marked "from left breast," containing three 
pieces of cloth. The said pieces of cloth contained spots of a red and 
brownish red color. Careful microscopical and chemical examinations 
showed that the textures of the cloth, in the discolored portions have been 
saturated with blood. The colored and colorless corpuscles were distinctly 
seen under a magnifying power of 420 diameters. The colored and color- 
less corpuscles, resembled in size and structure those of man. II rematin 
and albumen were also present in the matters extracted from the discolored 
spots. 
Joseph Jones, M. D., 
Professor of Chemistry, Medical Department University of Louisiana. 
Sworn to and subscribed before me, this January 2d, 1877. 
Wm. H. Holmes, 
Second Justice of Peace, Parish of Orleans. 
S. Did you destroy the pieces of cloth containing the stains during 
your chemical and microscopical examination, or did you redeliver them 
to Mr. T. A. Landry, duly sealed? 
J. I carefully preserved the pieces of cloth, and after sealing them 
carefully, delivered them to Mr. T. A. Landry, in the presence of Wm. H. 
Holmes, Second Justice of the Peace, Parish of Orleans. 
' S. Can you identify this package, with its seal, direction and con- 
tents ? 
J. I can : the direction is in my hand writing; the seal is mine ; the 
particles of cloth resemble in all respects those which were delivered to me 
by Mr. Landry, and which I examined in my laboratory, on or about the 
2d of January, 1877. 
S. Did the pieces of cloth when delivered to you by Mr. Landry, con- 
tain any spots, or present anything peculiar? 
Journal, N. S., vol. xiv, pp. 363, 435, 507, 579, 6'1, 723, vol. xv, 1859, pp. 75, 147, 218. Observations on 
some of the Physical, Chemical, Physiological and Pathological Phenomena of Malarial Fever, 
Trans. Am. Med. Association, Philad., 1859, pp. 1-419. Relations of Pneumonia to Malarial Fever, 
Southern Medical and Surgical Journal, ;Sept. 1866, p. 220. Observations on various diseases, 
as Cerebro Spinal Meningitis, Pneumonia, Typhoid Fever, Malarial Fever, Small-Pox, Pyjemia 
and Hospital Gangrene. Sanitary Memoirs, New York, 1867, vol. 1, Medical, pp. 383, 483, 612, vol. 
ii, Surgical, pp. 145, 580. Various articles on Blood, Malarial Fever, Yellow Fever, and other di s- 
eases in New Orleans Medical and Surgical Journal, 1869,1878. etc. Medical and Surgical Memoir s, 
New Ofleans, 1876, vol. 1 p. 820. Medico-Legal Evidence relating to Human Blood 
369 
J. They did. Each piece of cloth contained spots of a red and red- 
dish brown coolr. 
S. Were these spots caused by red paint ? 
J. They were not caused by paint of any color or description. 
S. How would you detect spots of paint on any texture as cloth or 
clothing ? 
J. Paint consists of oil mixed with various metallic, earthy or vege- 
table or animal substances, according to the nature of the paint and the 
purposes to which it is applied. The oil may be extracted from paint, by 
certain agents, as sulphuric ether and sulphuret of carbon. The oil may 
be recognized by its physical and chemical properties and also by the pres- 
ence of globular masses of various sizes under the microscope. The color- 
ing matters of paint under the microscope as a general rule present a 
granular appearance, and in no kind of paint do they resemble the colored 
blood-corpuscles of man and animals. In the case of red paint, some form 
of the oxide of iron, or of the oxide of lead, or the sulphuret of mercury 
(vermilion) may be used. After the extraction of the oil from the paint 
by sulphuric ether these oxides specified may be rendered soluble by the 
action of the mineral acids and especially by hydrochloric and nitric acids. 
The solutions thus obtained may be subjected to several tests. The salts 
of iron give blue and bluish-green precipitates with ferricyanide and ferro- 
cyanide of potassium, and black with solution of tannic acid, and the per- 
salts of iron give a brownish red precipitate with aqua ammonia, and a 
deep red color with sulpho-cyanide of potassium. If the color of the paint 
be due either to the oxide or the sulphuret of mercury, after the abstrac- 
tion of the oil in the manner specified, the metallic mercury may be 
reduced by heat, or a nitrate, sulphate or chloride formed by the action of 
the respective acids, and the soluble salt thus formed may be subjected to 
various re-agents, as iodide of potassium (green precipitate with proto-salt 
of mercury, and red precipitate with per-salt of this metal); lime water 
and solution of potassa, black precipitate with proto-salt and yellowish 
red with per-salt; a plate of polished copper plunged in solution of soluble 
salt of mercury is quickly coated with metallic mercury, which may be 
removed by sublimation dissolved in the mineral acids and subjected to the 
tests just specified. If the color be due to the red oxide of lead, the metal 
may be reduced from the paint by means of the blow-pipe; the oxide may 
also be separated from the oil and subjected to the action of nitric acid, and 
the solution subjected to the action of various chemical re-agents, as iodide 
of potassium (yellow iodide of lead), chromate of potassa (yellow chromate 
lead), sulphuretted hydrogen (black sulphuret of lead), sulphuric acid, and 
soluble sulphate of soda (white sulphate of lead). 
S. What did you determine these spots to be by chemical and micro- 
scopical examination, and state fully to this honorable court the ground 
upon which your statement was based, and the processes by which you 
arrived at your conclusions'? 
J. Chemical and microscopical examination, showed the spots to be 
those of blood. The presence of blood was determined by the following 
processes and re-agents : When the stains were examined in a strong light, 
with a low power of the microscope, the fibres were not merely colored, 
but presented a shining glossy appearance, and the individual fibres were 
observed to be invested with portions of dried coagulum or clot. Certain 
chemical processes as the following established presumptively, that the 
matter which imparted the color to the spots on the clothing of the accused, 
was blood. It readily combined with cold distilled water, forming a 
bright red solution; this color was not changed to a crimson or a green tint 370 
Medico-Legal Evidence relating to Human Blood. 
by a few drops of a weak solution of ammonia, but when this agent in concen- 
trated form and large amount was added, the red liquid acquired a brown- 
ish tint. The red liquid obtained from the particles of blood in the tex- 
tures of the cloth, by means of cold water, coagulated when it was boiled, 
the color was destroyed and a muddy brown flocculent precipitate was 
formed. When the coagulum was collected on a filter and dried, it formed 
a black resinous substance quite insoluble in water, but readily dissolved 
by boiling caustic potash, forming a solution which was of a greenish color 
by reflected, and reddish by transmitted light. When the solution of the 
clots in cold water was subjected to the action of strong nitric acid, the red 
coloring matter of the blood and its albumen, were coagulated, and a dirty 
brown precipitate was thrown down. When examined under the micro- 
scope with various powers ranging from 400 to 1800 diameters, the red 
matter causing red stains was found to consist of numerous circular disc- 
like or flattened globules, having an average diameter of l-3200th of an 
inch. The white or colorless corpuscles of the blood were also clearly 
distinguished. 
S. Did you observe anything which would indicate the state of the 
health of the individual from whom the blood had issued upon the clothes 
of the accused I And if so, state your observations to this honorable court. 
J. I observed changes in the blood obtained from the pieces of cloth 
which lead me to infer that the person from whom it was abstracted had 
suffered and was most probably at that time suffering with paroxysmal, 
paludal or malarial fever. This opinion was based chiefly upon the fol- 
lowing abnormal substances observed in connection with the colored and 
colorless or white blood-corpuscles; black pigment or melamemic corpus- 
cles, varying from 1-10,000th to l-1000th of an inch in diameter; conglom- 
erations of these melanaemic particles, in masses of various sizes; colorless 
corpuscles or leucothytes which contained small granular masses of black 
pigment. Many of the particles of the melamemic pigment .were spherical, 
others irregular and angular, some entirely free, others incased in a hya- 
line mass; others incorporated with cellular elements which are more or 
less related to the white corpuscles of the blood. These black pigment 
particles indicated the destruction or alteration of the blood-corpuscles and 
the escape of the luematin of the red globules which is characteristic of 
malarial fever. 
S. How long have you been engaged in the microscopical and chem- 
ical investigation of the blood of man in disease, and upon what facts do 
you base the preceding statement ? 
J. My investigations upon the chemical and microscopical changes of 
the blood in fevers, and especially in malarial and yellow fevers were com- 
menced in 1856, and have been pursued continuously up to the present 
moment; and during the past ten years I have treated in the wards of the 
Charity Hospital of New Orleans, over four thousand cases of various 
diseases, more than one-half of which were due to the action of the malaria 
of the swamps and marshes of the Mississippi valley. The blood in a large 
number of these cases has been subjected to microscopical and chemical 
examination, and in fatal cases post-mortem examinations performed. The 
result of these investigations, which throw light upon the inquiries of this 
honorable court are as follows: 
1st. The malarial poison produces profounder alterations and more 
rapid destruction of the colored blood-corpuscles than any other known 
febrile agent. 
2d. The destruction of the colored corpuscles takes place chiefly in 
the spleen and liver. Medico-Legal Evidence relating to Human Blood. 
371 
3d. The black pigment resulting from this haematin of the blood-cor- 
puscles, is frequently observed'in the blood as it circulates in the vessels and 
capillaries in masses of various sizes and in the form of cellular elements. 
4th. The black pigment is deposited in the capillaries of various 
organs and tissues, as those of the liver, medulla of the bone, brain and 
subcutaneous tissue. 
5th. The peculiar sallow, greenish-yellow and bronzed hue, which 
characterizes those who have been for a length of time subjected to the 
prolonged action of the malarial poison or to its powerful action in perni- 
cious remittent fever and in malarial haematuria, is due not merely to 
hepatic and splenic derangement, but also to the deposit of pigment parti- 
cles in the subcutaneous capillaries. 
S. Did you make any further examinations of blood in this case or in 
connection with the deceased ? If so state the result. 
J. I examined bits of wood brought to New Orleans, and placed in 
my hands by John H. Jlsley, attorney at law and counsel for the State. 
These pieces of wood, the one of cedar and the other of mahogany, were 
spotted and coated upon the smooth side with blood. Microscopical and 
chemical examination revealed that it was human blood, and human 
blood, presenting similar pathological alterations to that examined 
on the particles of cloth, cut from the coat and shirt of the prisoner, 
as previously described. The blood as in the first examination 
contained numerous black particles, and pigment cells and colorless cor- 
puscles, containing round black pigment particles. Upon arriving in 
Donaldsonville, through the kindness of Dr. John E. Duffel, I visited the 
house formerly occupied by the deceased and found that the particles of 
wood fitted exactly into the front portions of two drawers belonging to two 
desks. Undeniable testimony established the fact that the blood on these 
pieces of wood was that from the deceased after the infliction of the blows 
on the head. 
S. Have you preserved these pieces of wood? and if you have pro- 
duce them before the jury, aud fit them into the places from whence they 
were cut, in the drawers which have been brought to this court. 
J. I have carefully preserved the pieces of wood upon my person 
from their first reception to the present time. They correspond exactly to 
the missing portions of wood in the drawers exhibited by the State before 
this honorable court. 
S. Have you examined the blood of various animals, as for instance, 
reptiles, birdsand domestic animals ? And if you have state the general 
results of your examinations, and if the blood of these animals can be dis- 
tinguished from that of man? 
J. 1 have examined microscopically and chemically the blood of a 
large number of the indigenous fish, amphiuma, sirens, batrachians, ophi- 
dians. saurians, birds and wild mammalia, and also the blood of domestic 
fowls and animals, and can state that in fish,* amphibians, batrachians, 
saurians and birds, the blood-corpuscles can be distinguished at once and 
beyond all question under the microscope, on account of the elliptical 
* The blood dises of fishes are commonly of a full elliptic shape; they present the largest 
size in the sharks, but are smaller in them in proportion to the body, or mass of blood than in 
the batrachia. The white corpuscles are in less proportion in the blood of fishes, than in sauri- 
ans, birds or mammals. In my physiological and chemical researches, published by the Smith- 
sonian Institution in 1856, I endeavored to establish the comparison of main physiological 
importance between the blood in different groups of vertebrates, namely, that which relates to 
the proportion of the organic matters contained in the water. It was then clearly shown that 
the blood varied in the different classes of animals in physical and chemical properties. The 
blood of reptiles has red corpuscles of a flattened sub-biconvex elliptical shape; proportionally 
smallest in ophidia, roundest in chelonia and largest in batrachia. 
In birds the blood discs are more abundant than in the cold-blooded vertebrates; they are 
nucleated, elliptic and flattened in form ; averaging in size, in long diameter l-2100th to l-3306th 
of an inch. 372 
Medico-Legal Evidence relating to Human Blood. 
shape and nucleated centre ; but in the case of the domestic and indigenous 
mammalia, a more critical examination is required ; for in this class of ani- 
mals the size of the globules varies within comparatively narrow limits, 
they have a flattened or disc-like form, and with the exception of the camel 
tribe, the outline of the disc is circular. The valuable aid afforded by the 
microscope iu medico-legal investigations, and the power which this instru- 
ment gives of deciding the character of the blood in many animals is clearly 
established by the following demonstrations, and comparisons of human 
blood, with that of the living animals. 
ENGRAVING NO. 51. 
Engraving No. 51-Human blood-corpuscles, colored and colorless, magnified 1300 diameters. 
ENGRAVING NO. 52. 
Comparative Size of Red Blood-Corpuscles. 
Engraving No. 52-Comparative size of red blood-corpuscles. Nos. 1. Man. 2. Elephant. 3. 
Musk-deer. 4. Dromedary. 5. Ostrich. 6. Pigeon. 7. Humming-bird. 8. Crocodile. 9. 
Python. 10. Proteus. 11. Turtle. 12. Pike. 13. Shark. Medico-Legal Evidence relating to Human Blood. 
373 
ENGRAVING NO. 53. 
Engraving No. 53.-Red Corpuscles of the Blood of various Vertebrate Animals : 1. Red corpus- 
cles of human blood imprisoned by the flbriri in coagulated blood. 2. Globules of human 
blood gathered in rolls. 3. Globules of human blood in bi-concave circular discs. 4. Globules 
of camel's blood in elliptical discs. 5. Globules of pigeon blood, elliptical bi-convex discs. 6. 
Frog's blood, elliptic discs. 7. Loach's blood, rounded. 8. Blood of salamander. 9. Blood of 
lepidosiren, bi-concave rounded discs. 10. Blood of proteus. a, front view of globules, b, side 
view of globules. 
Examination on the part of the Defence. 
D. Are you absolutely certain that the stains on the pieces of cloth, 
placed in your hands for microscopical and chemical analysis were caused 
by human blood ? 
J. The substances causing the stains presented all the chemical and 
microscopical properties of human blood or blood presenting a special 
pathological alteration. 
D. Can you by means of chemical and microscopical examination of 
the blood determine any form of disease? 
J. By chemical and microscopical examination, 1 am not able to 
determine every form of disease. 
D. You would then be in doubt concerning the result in certain dis- 
eases of the chemical and microscopical examination; please state, there- 
fore, if there are any diseases, the nature of which may be revealed by the 
microsope ? 
J. The microscope enables us to distinguish clearly the changes 
induced in the blood by malarial fever. That condition of the blood known 
as leucocythmmia or leukaemia can be accurately determined by micro- 
scopical exam nation There was no doubt in my mind that the blood 
examined was human blood, from one who had sufiered and perhaps was 
at the time suffering with malarial fever. 374 
Medico-Legal Evidence relating to Human Blood. 
D. What did you say was the average siz-e of the colored blood-cor- 
puscles in the stains upon the cloth ? and whilst giving this measurement, 
give those also of the dog, horse, rat, cat, rabbit, ass, ox, cow, pig, sheep 
and goat. 
J. The average of the diameter of the blood-corpuscles from the stains 
was about l-3200th of an inch. The corpuscles of human blood are larger 
than those of domestic animals. Thus the average diameter in the dog, is 
about l-3540th of an inch; horse, l-4600th of an inch; in the rat, l-3814th 
of an inch; in the cat, l-4400th of an inch; in the rabbit, 1-4000th of an 
inch; in the ass, l-4000th of an inch; in the ox, l-4267th of an inch; in 
the cow, l-4200th of an inch; in the pig, l-4230th of an inch; in the 
sheep, l-5300th of an inch; in the goat, l-6366th of an inch. 
D. Do not those individual blood-corpuscles in man and animals vary 
in their diameter in the same specimen of blood? and if so, state to the 
honorable court the causes of these variations. 
J. The blood-corpuscles of man and animals vary in their diameters 
within certain limits; thus those of a man may vary from l-2000th to 
l-4000th; of the dog from 1-4000th. to 1-6000th; of the hare from l-2000th 
to l-8000th; in the ox from l-4878th to l-4444th; in the sheep l-5333d to 
l-6000th of an inch. 
D. Difficulty, therefore, exists in distinguishing between the blood 
of man and domestic animals; and in view of this fact do you assert 
absolutely, that the stains in the pieces of cloth were human blood ? 
J. I admit that difficulties exist in such examinations. I affirmed 
that the human blood-corpuscles upon an average were larger than that of 
the domestic animals named. I. also affirmed that the stains upon the 
pieces of cloth presented all the characteristics of human blood. I went 
a step further, and affirmed that this blood presented pathological appear- 
ances which, as far as my investigations extend, are peculiar to human 
blood in a certain diseased state, and that I have never observed such a 
condition in the blood of animals; and that the blood from the house in 
which the deceased was murdered presented similar chemical and micro- 
scopical characters. 
D. Can the colored blood-corpuscles be detected with accuracy in 
dried blood ? 
J. They can be detected in many cases; and they were detected accu- 
rately in the case now before this honorable court. 
D. Can you distinguish between the blood of a woman and the blood 
of a man ? 
J. I cannot. 
D. Can you distinguish the blood of a foetus from the blood of its 
mother ? 
J. I cannot. 
D. Can you distinguish the blood of the different races of men? for 
example, can you chemically and microscopically distinguish the blood of 
a white man from that of a negro ? 
J. Different races are said to have distinct odors; sulphuric acid 
applied to blood will liberate the peculiar odor of the animal; I have upon 
many cases satisfied myself of the possibility of developing the peculiar 
odor of the blood in different animals by means of sulphuric acid. I can- 
not, however, speak positively, with reference to the blood of the different 
races of mankind. 
Verdict of Jury. 
' By the testimony of several witnesses, two of whom were practicing 
physicians, it was clearly established that, for some weeks before and up to the Spectroscopic Analysis in Medico-Legal Investigations. 
375 
time of his murder, Narcisse Arrieux was suffering with intermittent malarial 
fever (chills and fever). The judgment of the jury rested to a certain 
degree upon the presence of blood on the clothing of the accused Wilson 
Childers. We have been informed by John H. Ilsley, Jr, one of the 
attorneys for the prosecution, that an important witness who was concealed 
in the house at the time of the murder, and saw the murderer, testified as 
to the guilt of the four negroes accused of the murder of Narcisse Arrieux. 
The jury rendered the verdict, guilty of murder with capital punishment. 
THE SPECTROSCOPE. 
The application of the Spectroscope and Spectroscopic Analysis to Physiology 
and Patho'ogy and to the Solation of Certain Difficult Medico-Legal 
Questions. 
I applied the spectroscope and spectroscopic analysis to the blood of 
yellow fever and of malarial fever and malarial hsematuria in 1870, and 
the following years. 
The determination of the presence of blood in animal fluids, and the 
spectroscopic analysis of spots and stains of blood on wood, leather, 
cloth, weapons and clothing of various kinds and in various medico-legal 
investigations demands the employment of the spectroscope. At the same 
time, I have endeavored to place this subject in a clear light before the 
medical students, and before the various juries charged with the conduct of 
cases in which the evidence hinged, to a great extent, upon the nature of 
certain stains and coloring matters. 
The following questions, amongst many others, were involved in those 
trials in which the author represented the cause of Justice in behalf 
of the State : 
1. Individuals accused of murder affirm that certain spots on their 
clothing were caused by red paint and paint of various colors. 
2. The nature of stains, whether blood or other coloring matter, 
upon worn garments, leather, etc. 
3. The murderer, after killing his victim by cleaving the head open 
with a hatchet, walks in the blood which has freely flowed upon the floor. 
The bloody tracks are measured and noted. The shoes of the murderer are 
obtained and correspond to the tracks. But they have been washed. The 
stains which were supposed to be due to the blood., still remain. The 
grand question is:-can we detect with accuracy, the presence of the 
constituents of the blood in the meshes of the leather '! 
4. The murderer admits the presence of blood spots upon his gar- 
ments, but affirms that they were caused by the blood of a chicken, of a 
pigeon, of a fish, or of an alligator. The following outline, with reference 
to our knowledge, with reference to spectroscopic analysis, will, we be- 
lieve, prove of material benefit to investigators of our Southern fevers, as 
well as to those engaged in medico-legal investigations. 
THE SPECTROSCOPE AND SPECTROSCOPIC ANALYSIS. 
Amongst all the discoveries of modern science, none has deservedly attracted 
more attention, or called forth more general admiration, than the results of the 
application of spectrum analysis to chemistry. Nor is this to be wondered at, when 
we remember that a new power has thus been placed in the hands of the chemist, 
enabling him to detect the presence of chemical substances with a degree of deli- 
cacy and accuracy hitherto unheard of. and thus to obtain a far more intimate 
knowledge of terrestial matter than he formerly enjoyed. So valuable a means of 
research has this new process of analysis proved itself to be, that since its first 376 
Spectroscopic Analysis in Medico-Legal Investigations. 
establishment no less than four new chemical elements have by its help been dis- 
covered. By the application of the simple principles of spectrum analysis the 
chemist is able to overstep the narrow bounds of our planet, and extending his 
intellectual powers into almost unlimited space, to determine, with as great degree 
of certainty as appertains to any conclusion in physical science, the chemical com- 
position of the atmosphere of the sun and far-distant fixed stars. He has even suc- 
ceeded in penetrating into the nature of those mysteries of astronomy, the nebulae; 
and of ascertaining not only the chemical composition, but likewise the physical 
condition, of these most distant bodies. By the aid of the spectroscope, the chem- 
ist is now able to state with certainty, as thelogical sequence of exact observations, 
that bodies common enough on this earth are present in the atmosphere of thesun, 
at a distance of ninety-one million miles, and still more extraordinary, he has 
ascertained beyond the shadow of a doubt, that such metals as iron and sodium 
exist in the stars. The only means of communication which we possess with the 
sun, planets, or far-distant stars, or by which we can ascertain anything respecting 
their chemical constitution, is by means of the life-supporting radiation, which 
they pour down upon the earth, producing the effects which we call light and heat. 
It will, therefore be our business, in the first place, to investigate the composition 
of the radiations which these bodies give off, and next to notice, as our field of 
observations enlarges, the applications to which the properties of the light thus 
emitted lead us. 
In 1675, Sir Isaac Newton discovered the decomposition of white light. New- 
ton allowed the sun to shine through a round hole in a shutter, and he then 
examined the character of this light by means of a triangular piece of glass, called 
a prism. He found that the white light, after passing through the prism, was 
bent, or refracted out of its course, and split up into a colored band, which, when 
received on a white screen, exhibited all the colors of the rainbow in regular suc- 
cession, passing from red, through all the shades of orange, yellow, green and blue 
to violet. Newton termed this colored band the solar spectrum, and came to the 
conclusion that thelightof the sun consists of rays of different degrees of refrangi- 
bility. He also showed that all the various portions of this colored band, when 
again brought together, produce upon the eye the effect of white light; whilst on 
the other hand the simple colors passed unchanged through a prism. There are 
rays extending beyond the visible red and the visible blue, which do not produce 
on the retina the impression which we call light; and yet the existence of these 
invisible rays, which play so important a part in the nature of the solar light, may 
be demonstrated by certain devices. The maximum heating effect is produced at 
a point, beyond that at which we can see any red light; the maximum of the 
luminous rays as affecting the eye exists in the yellow. Passing on from the red 
towards the violet portion, we find, by means of a thermo-pile and a delicate gal- 
vanometer, that the quantity of heating effect produced in the yellow and green 
portions of the spectrum, gradually diminishes, and sinks down to a very insig- 
nificant amount in the violet part of the band. In the violet and blue portion of 
the spectrum, so slightly endowed with heating power, we have moreover to notice 
the existence of a new and striking peculiarity, that of producing chemical action; 
that is, of causing the combination and decomposition of certain chemical sub- 
stances, as for instance, the decompsition and blackening of silver salts, upon 
which the art of photography is based. 
We must carefully observe, however, that there is really no difference in kind 
between those rays which are called heating rays, those which are called light rays 
and those which are called chemically active rays. These differ, one from the 
other, in exactly the same way that the visible yellow rays differ from the green 
rays, or as the green rays differ from the blue; only in wave length and intensity 
of vibration. 
The solar spectrum has fixed dark lines, which serve as land marks, by which 
to ascertain the position of any given portion of the spectrum. The first person 
who observed these dark lines, was Dr. Wollaston. These dark lines are always 
found in the same position in tne sunlight, whether we take direct, diffused or 
reflected sunlight. 
The exact mapping and observation of these lines in the solar spectrum is a 
matter of as great importance to astronomy and to physical science, generally, as 
the mapping of the stars in the heavens, because by knowing exactly the position 
in the solar spectrum of these dark lines, we can ascertain that iron, sodium and 
other well-known substances, exist in the solar atmosphere. We are indebted for 
the first careful examination of these lines, to a German optician, Fraunhofer, 
whose name has been attached to these lines. Fraunhofer mapped no less than Spectroscopic Analysis in Medico-Legal Investigations. 
377 
576 of these lines in the year 1814. Upon an examination of one of these charts of 
the solar spectrum, it will be seen that an immense number of lines intersect and 
almost appear to make the solar spectrum dark. Many of these lines are as fine as 
a spider's web, so that they occupy but a small portion of I he whole area of the 
spectrum-that is, the portion which is filled with light is tar greater than the 
portion which is filled with these shadows, although the number of these shadows 
is so exceedingly large. 
Fraunhofer first ascertained that these lines are present in every kind of sun- 
light ; that moonlight, as well as the light of the planet Venus, exhibits the same 
dark lines. Fraunhofer measured the refractive indices of those lines-that is, 
determined their relative positions in the solar light; and he found that the rela- 
tive distances between any given lines remained constant, whether he took direct 
sunlight, or sunlight reflected from the moon or planets. 
Another important observation was made by Fraunhofer-namely, that the 
light from the fixed stars, which as you know, also contains dark lines, but differ- 
ent lines from those which characterize the sunlight, the light of the planets, and 
that of the moon ; and hence in 1814, Fraunhofer came to this remarkable conclu- 
sion : that whatever produced these dark lines-and he had no idea of the cause- 
was something which was acting beyond and outside our atmosphere, and not any- 
thing produced by thesunlight passing through theair. This conclusion of Fraun- 
hofer has been borne out by subsequent investigation, and the observations upon 
which it was based, may truly be said to have laid the foundation-stone of solar 
and stellar chemistry. 
The first thing we observe when a solid body is heated, is that it becomes red 
hot, and that as we increase the temperature, the light which it gives off increases 
in refrangibility, so that it ends by emitting lights of every degree of refrangibility. 
It has been found that all solid and liquid substances act in this same way with 
regard to increase of heat; they all begin to be visibly hot at the same tempera- 
ture, and the spectrum thus produced, is in every case a continuous one. Do gases 
when they become incandescent, all emit the same kind of light, like solids, or 
does each chemically different gas emit a characteristic and peculiar kind of light? 
Careful experiments have shown, that every different chemical element in the 
state of gas, when heated until it becomes luminous, gives off a peculiar light; that 
the spectrum of every element in the state of glowing gas is totally different from 
that of any solid body, inasmuch as, instead of giving a continuous spectrum, it 
presents a broken or discontinuous one containing bands or lines, indicative of the 
presence of the particular elementary gas in question. It has long been known 
to chemists that certain substances have the power, when brought into a colorless 
flame, of producing peculiar tints. Thus, for instance, if we bring various bodies 
into the flame, such as the alkalies, soda and potash, we observe that the flame 
becomes colored in the first instance of a bright yellow, and in the second case of a 
pale violet tint; whilst the salts of strontium color the flame crimson, and those of 
barium produce a green tint, and calcium compounds impart a red color to flame. 
The combustion of coal gas mixed with air in the Bunsen burner, produces a 
beautiful non-luminous gas flame. The mixture burns with a light blue flame, 
which we can tinge with the peculiar colors of the alkalies, by bringing a small 
fused bead of salt into the outer mantle of the flame, on a loop of thin platinum 
wire. If we bring the slightest trace of a lithium salt into the flame, it at once 
imparts a magnificent crimson tint to the flame ; whilst in other burners, we may 
observe the colors due to the salts of potassium, calcium, strontium and barium. A 
most important observation has now to be made-namely, that all the salts of 
sodium give off this yellow light when brought into the flame; so too, all the 
lithium compounds tint the flame crimson ; and this property of emitting a pecu- 
liar kind of light, is one of the means by which the presence of those various 
chemical substancescan be detected. 
The quality of the light emitted by gaseous bodies, however, with certain 
exceptions, does not vary under changes of temperature. The flame of burning 
sulphur (one of the coldest flames we can obtain) has a temperature of only 1,820° 
Centigrade; of burning disulphideof carbon 1,295° C.; of coal gas, 2,350° C.; carbonic 
oxidegas, 3,042° C.; of hydrogen, 3,259° C., andyetwhen webring a littlesodium in 
each one of these flames, we have the same yellow flame produced; in other words, 
we cannot get sodium vapour either red hot or blue hot, it always remains yellow 
hot; that is to say the first moment that the sodium vapor becomes luminous, it 
gives off this peculiar yellow light, and if we heat it more, the effect is not to alter 
the refrangibility of the rays, but merely to increase their intensity. The tem- 
perature of the oxy hydrogen flame is8,06i°(\, and yet when soda is subjected to this 378 
Spectroscopic Analysis in Medico-Legal Investigations. 
intense ignition, there is still only the yellow light, no blue light. This indicates to- 
ns, that when a body becomes gaseous, the light which it gives off is of a particular 
kind, and does not alter when we increase the temperature. The temperature of 
the electric spark is so high that it has never been measured, but it is certainly 
infinitely higher even than the temperature of the oxyhydrogen flame; still, if the 
sodium is brought into the electric spark, the same thing occurs; viz: the appear- 
ance of the yellow colored light, so also, if some other substance as lithium be 
subjected to the electrical spark, the permanent red color will be clearly seen. 
The methods by means of which we can obtain bodies in the state of luminous 
gas, vary with the nature of the substance. The property of affecting the flame, 
is not confined to sodium, but it belongs to matter in general; it belongs to every 
chemical element, and if we can by any method get the vapor of a chemical 
element so hot as to become luminous, we find that the light emitted by it is 
peculiar to itself, and is distinctive of that special body, whether under the ordi- 
nary circumstances the element be gaseous, solid, or liquid. These then are the 
principles upon which the science of spectrum analysis is based, by means of 
which we can detect the presence of any of the elementary bodies when they can 
be obtained in this state of glowing gas. We must consider the various methods 
by which the elements can beobtained as luminous gases. We will first, however,, 
briefly refer to the construction of the spectroscope. 
ENGRAVING NO. 54. THE SPECTROSCOPE. 
Engraving No. 54 Spectroscope.-Duboscq's arrangement, one prism, horizontal tel- 
escope and transparent micrometer, gas burner, and forceps, or adjusting stand. 
The simplest form of spectroscope which Bunsen first adopted, consisted 
simply of a common hollow prism, placed in a box ; a telescope at the end, and a 
slit placed on a tube with a lens at the other end, in order to obtain a pure 
spectrum, and to render the rays parallel. The substance to be examined, is placed 
in the colorless Bunsen's flame, and the light passing through this slit falls upon 
the prism and having thus been split up into its constituent parts, the differently 
colored rays passing through this telescope are magnified and then fall upon the 
retina. In the preceding figure, we have the more perfect instrument, as made by 
Steinhil, of Munich, and J. Duboscq, of Paris. 
With this we are enabled to use two flames, and the apparatus is so arranged 
that we can see the two spectra placed one above the other. The object of this 
superposition of the spectra is evident; it is to enable us to see whether the sub- 
stance under examination really is the body which it is supposed to be. For 
instance, putting a small quantity of the substance we know to contain sodium in 
this flame, we place a substance supposed to contain sodium in the other flame, 
and then by means of a small reflector placed on the end of the slit, we have the 
spectra of these two flames sent into the telescope, one above the other, so that we 
see at the same time the spectrum of the pure sodium, and the spectrum suppose d Spectroscopic Analysis in Medico-Legal Investigations. 
379 
to be that of sodium ; and we can readily observe whether the lines coincide. If 
they coincide, and the two spectra have these lines exactly continuous one below 
the other, then we are quite certain that sodium, or any other substance we may 
have been investigating, is present. Mr. Browning makes a variety of spectro- 
copes, one with two, one with three, and one with four prisms. The more prisms 
employed, of course the greater dispersion of light into its special varieties; and of 
course also the greater is the intensity of the light which it is necessary to employ 
in order to get the light to pass through this greater number of prisms. 
The sodium flame when observed by means of the spectroscope exhibits only 
one bright yellow line; in other words, this light is monochromatic ; sodium vapor 
gives off light of only one degree of refrangibility, and the spectrum is confined to 
one very narrow yellow band. 
ENGRAVING NO. 55. MAP OF SOLAR SPECTRUM. 
Engraving No, 55. Map of Solar Spectrum, showing Fraunhofer's lines. Upper half Map of 
Solar Spectrum, showing Fraunhofer's lines. Lower half, Absorption Spectrum, showing 
position of bands in relation to lines. 
The red light, which we have stated is due to the presence of lithium, when 
seen through a prism, gives a beautiful red line, together with a paler orange 
line. The spectra of calcium, strontium and barium, are more complicated, but 
they each yield peculiar bright bands, perfectly characteristic of the metal in 
question. For the purpose of enabling any observer unacquainted with the spectra, 
to identify with certainty the presence of any of the foregoing metals by means 
of their bright bands, and to lay down their positions in his own instrument, the 
following method of mapping the spectra has been devised by Bunsen: 
The millimetre scales represent the illuminated divisions seen with the scale 
of the spectroscope: the exact position of the bright lines in any spectrum is shown 
by the black marks below the divisions; whilst their breadth, intensity and grada- 
tion are indicated by the breadth, depth and contour of their blackened surfaces. 
When the spectrum contains a continuous portion of light, this is shown by a con- 
tinuous black band above the divisions. The positions of the fixed solar lines are 
given on the first horizontal scale, and those of the most prominent bands in seve- 
ral of the elements are placed as fiducial or guiding points at the bottom of the 
map. 
We may now ask, " What improvement is this method of analysis upon our 
ordinary chemical methods? What benefit is it to us that barium gives us these 
peculiar bands, that strontium yields certain different bands, that calcium pro- 
duces others again ? We know already that the chemical reactions of these bodies 
are very different, and we can detect these substances by ordinary chemical anal- 
ysis." The answer to this is, that the new method is far more delicate than any- 
thing which we have hitherto employed, so delicate, indeed, as almost to pass 
belief, so that we have hereby the means of examining the composition of terres- 
trial matter with a degree of exactitude hitherto unknown. 
The reaction of sodium is so delicate and sensitive that we can detect the pres- 
ence of sodium in everything. There is not a speck of dust or a mote in the sun- 
beam which does not contain chlorideof sodium. Sodium is a prevailing element 
in the atmosphere; we are constantly breathing in portions of this elementary sub- 
stance together with the air which we inhale. Two-thirds of the earth's surface is 
covered with saltwater, and the fine spray which is continually being carried up 
into the air evaporates, leaving the minute specks of salt which we see dancing in 
the sun-beam. This constant reaction of sodium puzzled the old observers very 
much. They thought this reaction must be due to the presence of water, for there 380 
Spectroscopic Analysis in Medico-Legal Investigations. 
was no other substance which was so commonly diffused, and it is only recently 
that this yellow reaction has been found to be due to this metal sodium. Formerly 
lithium, which gives the beautiful red flame, and the one bright red line in the 
spectrum, was only known to exist in three or four comparatively rare minerals. 
The moment, however, that substances were examined by the spectrum analysis, 
it was found that the brilliant red line, which is characterestic of the presence of 
lithium, occurs very frequently. The red flame was not noticed before, because 
when the light was examined by means of the eye alone, the red colored flame was 
masked by the presence of scda salts and other substances affecting the flame, so 
that the red tint produced by the small quantity of lithium was unseen. But 
when we examine the flame with the prism, then all these lines range themselves 
into due order, no one interfering with the other. The presence of lithium may be 
thus easily detected, though it may be mixed with ten thousand times its bulk of 
sodium compounds, because, as will be seen by reference to the chart, the sodium 
line occurs in a different position from the lithium line, according to the different 
degrees of refrangibilities. And it has thus been shown, that this supposed rare 
substance is found to be most widely distributed-rot. it is true, in very large 
quantities, but still that it is one of the most widely diffused of the elementary bodies. 
Lithium not only occurs in very many minerals, but also in the juice of plants, in 
the ashes of the grape, in tea, coffee and milk, in human blood, and in muscular 
tissue. It has also been found in meteoric stones, in the waters of the Atlantic 
Ocean, as well as in most mineral springs and many rivers. It is present in the 
ashes of tobacco, and if we hold the end of a cigar in the colorless flame, we may 
always notice the red lithium line when the light is examined with a spectroscope. 
The following table shows the great delicacy of the spectrum analytical method. 
Sodium.-1-180,000,OOOth part of a grain of soda can easily be detected. Lith ium.- 
1-6,000,000th p*rt of a grain can be easily detected. Strontium.-1-1,000,OOOth of a 
grain of strontia is easily detected. Calcium.-6-100,OOOth of a grain of lime is easily 
detected. Caesium and rubidium.-These new alkaline metals were discovered by 
Bunsen in the mineral waters of Baden and Durkheim. Forty tons of mineral water 
yielded two hundred grains of salts of the new metals. Thallium.-A. new metal, 
discovered by Mr. Crookes, in 1861, distinguished by the splendid green line which 
its spectrum exhibits. It is found in iron pyrites, and resembles lead in its prop- 
erties. Indium.- Discovered in zinc blende, by Professors Reich and Richter, 
found in very minute quantities. It is distinguished by the two indigo bands seen 
in its spectrum. If we have a mixture of compounds of all these substances which 
are capable of being volatilized, namely, potassium, sodium, lithium, barium, stron- 
tium and calcium, and if we expose this mixture to such a temperature that all the 
salts become volatilized, one after another, we shall see, in the first place, that those 
substances which are the most volatile appear first; that then, when these have 
been burnt out those next in volatility make their appearance, and those which 
are the least volatile come out last. Thus we have the beautiful appearance of 
what may be called a natural dissolving view. 
The volatilization of the heavier metals, as gold, silver, zinc and iron, is accom- 
plished by voltaic electricity. The first person who examined the nature of the 
electric spark was Wollaston who also first pointed out the existence of the 
important dark lines in the solar spectrum. But it was Faraday who first declared 
that the electric spark consists solely of the material particles of the poles, and the 
medium through which it passes. It was originally supposed that electricity had 
some existence apart from matter; but Faraday, by a most elaborate series of experi- 
ments, discovered that when the electric spark passes from one knob of the electric 
machine to your hand or knuckle, a quantity of matter passes, too, partly consist- 
ing of brass of the knob, and partly of the air and moisture. He speaks, in his 
experimental researches of the electric spark as being produced by a current propa- 
gated along, and by, ponderable matter, and heated in the same manner, and 
according to the same laws, as a voltaic current heats and volatilizes a metallic wire. 
So that which we see and call the spark is really the ignition of the matter which 
exists in this arc; and when we take a spark from the electrical machine, the par- 
ticles of the brass are actually carried over from the one pole to the other. The 
color of the spark varies with cast metal; aqd if we examine the light of such a 
spark with a spectroscope, we find that there are two superimposed spectra; the one 
spectrum produced by the very bright points of light lying close to the poles, and 
the other by the less luminous portion of the arc lying farther from the poles. 
The spectrum of the bright points is that of the metals present; the light from the 
less luminous portion in the centre exhibits the spectrum of incandescent air, and 
shows the particular lines produced by the gases present in the atmosphere, viz : Spectroscopic Analysis in Medico-Legal Investigations. 
381 
nitrogen, oxygen and hydrogen (for in the atmosphere we have constantly the 
vapor of water present). Each gas gives us lines peculiar to itself; and in some 
cases, when the quantity of carbonic acid present in the air is considerable, we may 
even get the carbon lines. 
Sir Charles Wheatstone, in the year 1835, first pointed out that the spectra 
produced from the sparks of different metals were dissimilar; and he concluded 
that the electric spark resulted from the volatilization and not from the com- 
bustion of the matter of the poles themselves; for he observed the same phenomena 
in vacuo and in hydrogen, in which no combustion can occur; and in 1835 he 
wrote as follows : " These differences are so obvious, that one metal may easily be 
distinguished from another by the appearance of its spark; and we have here a 
mode of discriminating metallic bodies more readily than that of chemical exami- 
nation, and which may hereafter be employed for useful purposes." The spectra of 
the metals have been carefully studied and mapped out. Substances, not only, 
such as the metals of the alkalies and alkaline earths, when heated up to a gaseous 
state, give off a light peculiar to themselves, but bodies which are invisible to the 
ordinary eye, such as atmospheric air, or nitrogen, oxygen and carbonic acid, can 
also be made to give off a peculiar light when heated up by means of the electric 
spark. When we pass the electric spark through a gas, it becomes heated up to a 
temperature far higher than anything we can obtain by means of flames, and when 
thus heated the gas gives off the light which is peculiar to itself. Thus we find that, 
according to the nature of the atmosphere which surrounds the spark, the color of 
the spark varies. If we seal up a quantity of hydrogen gas, of carbonic acid gas, 
of nitrogen gas, in separate tubes, and allow an electric spark to passthrough these 
tubes, the spark which passes through the hydrogen has a red color, and that which 
passes through the nitrogen has a yellow color; while that which passes through 
the carbonic acid gas has a blue color; and these differences of color are duesimply 
to the effect of the gas enclosed in the tube. Each of the non-metallic elements 
yields a characteristic spectrum, when its vapor is heated to incandescence 
Spectrum analysis has been applied to the manufacture of steel, in the Besse- 
mer process. In this process, five tons of cast iron are in twenty minutes converted 
into cast steel. Steel differs from cast-iron in containing less carbon, and by the 
Bessemer process the carbon is actually burnt out of the molten white hot cast-iron 
by a blast of atmospheric air. The oxygen of the air burns out the carbon and 
silicon which the cast-iron contains, and the heated gases issue in the form of a 
flame, from the mouth of the large wrought-iron receiver, during the time that the 
iron is being burned. The flame varies in appearance, and it is of the utmost 
importance that the operation should be stopped instantly when the proper 
moment has arrived. If the blast has been continued for ten seconds after the 
proper moment has been ascertained, or if it be discontinued ten seconds before 
that point is reached, the charge becomes either so viscid that it cannot be poured 
from the receiver into the ladle from which it is to be transferred into the moulds, 
or it contains so much carbon, as to crumble up like cast-iron under the hammer. 
By the help of the spectroscope, this point can at once be ascertained beyond the 
shadow of a doubt, and that which previously depended upon the quickness of 
vision of a skilled eye, has become a simple matter of exact scientific observation. 
At first the following substances may be detected in the spectrum of the Bessemer 
flame, sodium, potassium, lithium, iron, carbon, hydrogen, nitrogen, at a certain 
stage, all at once the carbon lines disappear and we gel a continuous spectrum ; 
this is the moment at which the air must be shut off. 
We find that certain substances-not only gases, but liquids, and even solid 
bodies-exert at the ordinary temperature of the air, a selective absorption power 
upon white light when it passes through them. An important application of this 
fact has been made in the examination of the absorption spectra, obtained by the 
study of various colored gases and liquids, especially of blood and other animal 
fluids. It has long been known that certain bodies have at the ordinary tempera- 
ture, the power of selecting a kind of light and absorbing it. The solutions of 
many metallic salts and of colored gases, possess the property of yielding definite 
absorption lines, and it has been found, that with very few exceptions, all the 
compounds of the same base or acid have the same effect upon the rays of light. If 
a solution of blood be taken and placed*n acell, containing it, before the slit in the 
tube of the spectroscope, we get distinct absorption bands due to the presence of 
blood. Red blood and deoxidized blood give different appearances. From the 
experiments of Professor Stokes, we learn that the coloring matter of blood, like 
that of indigo, is capable of existing in two states of oxidization, distinguishable 
by a difference of color, and a fundamental difference in the action of the spectrum. 382 
Spectroscopic Analysis in Medico-Legal Investigations. 
These two forms may be made to pass one into the other, by suitable oxidizing, 
and reducing agents, and they have been termed red and purple cruorine. By the 
action of an acid on blood, the cruorine is converted into haematin yielding a dif- 
ferent absorption spectrum';; and this haematin is capable of reduction and oxida- 
tion like cruorine. It is an interesting and important point, that when the blood 
contains very small quantities of carbonic acid gas in solution, it exhibits a very 
peculiar set of bands. And the poisoning by carbonic oxide-for, as is well known, 
the poison of burning charcoal is due to this carbonic oxide-can be readily de- 
tected by the peculiar bands which the blood containing carbonic oxide in solution 
exhibits; and hence we have these absorption lines coming out as a most valu- 
ble aid in toxicological research. 
An instrument has been constructed, by which these beautiful absorption 
phenomena can be observed with delicacy and accuracy. It is simply a spectro- 
scope placed in connection with a microscope. Such spectroscopes are termed 
direct-vision instruments. This instrument (the micro-spectroscope), in the hands 
of Mr. Sorby has taught us how to detect l-1000th part of a grain of the red 
coloring matter in a blood stain. The method of microscopic spectrum analysis, 
must every year become a more and more trusted and valuable means of research 
in medico-legal questions. 
We will examine in the next place, briefly, the facts of solar and stellar 
CHEMISTRY. 
Professor Kirchoff, concludes with certainty, that in the solar atmosphere, at a 
distance of about ninety-one millions of miles, substances such as iron, sodium, 
magnesium and hydrogen, which we know well on this earth are present in the 
state of luminous gas. We have already pointed out the fact, that sun-light differs 
from the light given off by solid and liquid substances, as well as from the light 
given off by gaseous bodies. We have seen that the solar spectrum is cut up by a 
series of dark lines and shadows, which as they were first discovered by Fraun- 
hofer in 1814, have been called Fraunhofer's lines. Fraunhofer measured the dis- 
tances between these lines, and found that they remained perfectly constant in the 
sun-light; that they are fixed lines which always appear in sun-light; he also 
examined the light of the moon and planet Venus, and found that the same lines 
occur in moonlightand in planet light, which is simply reflected sun-light, and he 
found that the relative distances between these lines were the same in light from 
these three sources. He then examined the light from some fixed stars, from Sirius 
and others, and he found that, although in some of these fixed stars some lines 
existed which occur in sun-light, yet that other lines, always present in sun-light, 
are absent from the light of the stars. Fraunhofer concluded that these lines were 
caused by some absorptive power existing in the star or in the sun. These lines 
have been carefully and exactly mapped out by various observers. 
So long ago as 1814, Fraunhofer discovered that the dark lines in the sun-light 
were coincident with the bright sodium lines. Wishing to test the accuracy of 
this asserted coincidence of the bright sodium line and the dark solar lines with 
his very delicate instrument, Professor Kirchoff made the following very remark- 
able experiment, which is memorable as giving the key to the solution of the pro- 
blem concerning the presence of sodium and other metals in the sun. "In order," 
says Kirchoff, "to test in the most direct manner possible the frequently asserted 
fact of the coincidence of the sodium lines, with certain lines of the solar spectrum, 
1 obtained a tolerably bright solar spectrum, and brought a flame colored by sodium 
vapor in front of the slit. I then saw the dark lines, corresponding to the yellow 
lines of sodium, change into bright ones. The flame of a Bunsen's burner threw 
the bright sodium lines upon the solar spectrum with unexpected brilliancy. In 
order to find out the extent to which the intensity of the solar spectrum could be 
increased, without impairing the distinctness of the sodium lines, I allowed the 
full sun-light to shine through the sodium flame, and to my astonishment I saw 
that the dark lines appeared with an extraordinary degree of clearness. I then 
exchanged the sun-light, for the Drummond's or oxyhydrogen lime-light, which 
like that of all incandescent solid or liquid bodies, gives a spectrum containing no 
dark lines. When this light was allowed to fall through a suitable flame colored 
by common salt, dark lines were seen in the spectrum in the position of the sodium 
lines. The same phenomena was observed if, instead of the incandescent lime, 
a platinum wire was used, which being heated in a flame was brought to a tempera- 
ture near its melting point by passing an electric current through it. The pheno- 
menon in question is easily explained upon the supposition that the sodium 
flame absorbs rays of the same degree of refrangibility as those it emits, while it 
is perfectly transparent for all other rays". Kirchoff had in fact, as far as he had Spectroscopic Analysis in Medico-Legal Investigations. 
383 
gone, produced artificial sun-light, because he had obtained the two double dark 
lines in the continuous spectrum. Kirchhoff thus describes the development of 
this great discovery. "As soon as the presence of one terrestrial element in the 
solar atmosphere was thus determined, and thereby the existence of a large num- 
ber of Fraunhofer's lines explained, it seemed reasonable to suppose that other ter- 
restrial bodies occur there, and that by exerting their absortive power they may 
cause the production of other Fraunhofer's lines. For it is very probable that ele- 
mentary bodies which occur in large quantities on the earth, and are likewise dis- 
tinguished by special bright lines in their spectra, will, like iron, be visible in the 
solar atmosphere. This is found to be the case with calcium, magnesium and 
sodium." Kirchhoff, after -careful investigation, concluded that the following 
metalsexist in the sun, as they have their dark representations in the sun-light. 
1. Sodium; 2. Calcium; 3. Barium; 4. Magnesium; 5. Iron; 6. Chromium; 7. 
Nickel; 8. Copper; 9. Zinc; 10. Strontium; 11. Cadmium; 12. Cobalt; 13. Hydro- 
gen; 14. Manganese; 15. Aluminium; 16. Titanium. 
The following metals appear to be either altogether absent, or present in very 
small quantity in the solar atmosphere: 1 Gold; 2. Silver; 3. Mercury; 4. Ru- 
bidium; 5, Caesium; 6. Potassium; 7. Lead; 8. Antimony, 9. Arsenic; 10. Lithium; 
11. Silicium; 12. Glucinum ; 13. Cerium; 14. Lanthanum; 15. Didymium; 16. 
Ruthenium; 17. Iridium; 19. Palladium; 18. Platinum; 20. Thallium. 
Professor Kirchoff came to the following conclusions, with reference to the 
physical constitution of the sun : "In order to explain the occurrence of the dark 
lines in the solar spectrum, we must assume that the solar atmosphere encloses a 
luminous nucleus, producing a continuous spectrum, the brightness of which 
•exceeds a certain limit. The most probable supposition which can be made 
respecting the sun's constitution is, that it consists of a solid or liquid nucleus 
heated to a temperature of the brightest whiteness, surrounded by an atmosphere 
■of somewhat lower temperature. This supposition is in accordance with Laplace's 
celebrated nebular theory respecting the formation of the planetary system. If 
the matter now concentrated in the several heavenly bodies existed in former 
times as an extended and continuous mass of vapour, by the contraction of which, 
sun planets and moons have been formed, all these bodies must necessarily possess 
mainly the same constitution. Geology teaches us that the earth once existed in a 
state of fusion; and we are compelled to admit that the same state of things has 
occurred in the other members of our solar system. The amount of cooling which 
the various heavenly bodies have undergone, in accordance with the laws of the 
radiation of heat, differs greatly, owing mainly to the difference in their masses. 
Thus, while the moon has become cooler than the earth, the temperature of the 
surface of the sun has not yet sunk below a white heat. Our terrestrial atmosphere 
in which now so few elements are found, must have possessed when the earth was 
in a state of fusion, a much more complicated composition, as it then contained all 
those substances which are volatile at a white heat. The solar atmosphere, at this 
time, possesses a similar constitution." It has been found by Mr. Nasmyth, that 
the well known mottled appearance of the sun's surface is due to the presence of 
peculiar willow-leaf-shaped masses, which are constantly moving with great 
velocity over the surface of the sun. When an eclipse is total some wonderful pro- 
tuberances or red flames are found to dart out from the surface of the sun to the 
enormous height of some 80,000 or 90,000 miles. These flames prove that the sun's 
atmosphere extends to a great height above the ordinary and visible portion. 
STELLAR CHEMISTRY. 
Although the moon and planets, shining by borrowed light, do not reveal to 
the spectroscope the nature of the material of which they are composed, like the 
sun and stars; yet something may be learned by the examination of the spectra of 
these bodies. Some of the dark lines in the solar spectrum are caused by absorption 
in our own atmosphere; now if an atmosphere of a similar kind exists round the 
moon or planets, the atmospheric absorption lines must appear more intense in the 
light reflected from these luminaries than they do in the light which passes through 
our air alone. The careful investigations of Dr. Miller and Mr. Huggins, have 
shown that the moon is devoid of any appreciable atmosphere. 
In the spectrum of Jupiter lines are seen which indicate the existence of an 
absorptive atmosphere about this planet. These lines plainly appeared when 
viewed simultaneously with the spectrum of the sky, which at the time of obser- 
vation reflected the light of the setting sun. One strong band corresponds with 
some terrestrial atmospheric lines, and probably indicates the presence of vapors 384 
Spectroscopic Analysis in Medico-Legal Investigations. 
similar to those which float about the earth. Another band has no counterpart 
amongst the lines of absorption of our atmosphere, and tells us of some gas or 
vapor which does not exist in the earth's atmosphere. From observations upon 
Saturn it appears probable that aqueous vapor exists in the atmosphere of this 
planet, as well as in that of Jupiter. 
In Venus no intensifying of the atmospheric lines could be observed; butsome 
remarkable groups of lines, corresponding to those seen when the sun is low, were 
noticed in the Mars spectrum, and these indicate the existence of matter similar to 
that occurring in our own atmosphere. It appears to be probable that the vapor of 
water exists in the planetary atmospheres. 
By the help of the beautiful instruments of Mr. Huggins, we are in possession 
of facts respecting the composition of the atmosphere, and the physical constitu- 
tion of the fixed stars, as accurate as the knowledge we possess concerning the 
composition of the solar atmosphere. In these investigations the spectroscope is 
placed at the end of the telescope, and by very accurate adjustment the image of 
the star is brought on the slit of the spectroscope. The great difficulties of such 
investigations may be imagined, and the extreme delicacy of the researches com- 
prehended, when we remember that the light of the fixed star under observation 
emanates, as it were, from a point; that is, that it has no sensible magnitude; that 
the image of the star has to be kept steadily upon a slit only the l-300th part of an 
inch in breadth; and, moreover, that the effects of the earth's motion has to be 
counteracted; and add to this, that the amount of light which even the brightest 
stars give is excessively feeble, and that this line of light must be still farther 
weakened by being spread out by a cylindrical lens into a band. 
In order to get a knowledge of the chemical composition of the stars, or to 
ascertain what chemical elements are present in them, it is necessary to use exces- 
sively delicate arrangements, by which not only the light from the star is allowed 
to pass through the prisms and to be received on the retina, but also that emitted 
by the various substances, the presence or absence of which in the stellar atmos- 
phere it is desired to ascertain. These rays must pass together with the beam of 
starlight, or rather over or under the starlight, into the eye-piece, through the same 
prism, so that we may be able to compare the position of the dark lines in the 
stellar spectrum with that of the bright lines of the spectrum of the body under 
examination. As early as 1814, Fraunhofer showed that the stellar spectra were 
not the same, and that they did not contain the same lines as the spectrum of the 
sun. Philosophers have executed careful maps of the spectra of the different fixed 
stars and compared them with those of the sun, and with the electric light and of 
various bodies. Thus in the fixed star Aldebaran, Mr. Hugginsand Dr. Miller 
have found that we have evidence of the presence of no less than nine elements; 
namely, 1. Hydrogen; 2. Sodium; 3. Magnesium; 4. Calcium; 5. Iron; G. Bis- 
muth; 7. Tellurium; S. Antimony; and 9. Mercury. Thus the element tellurium, 
whose name implies a purely earthly origin, is found in the star, although it does 
not exist in the sun, and is very rare on this earth. 
The results at which philosophers have arrived with reference to the fixed 
stars, is that the star light, although not identical with the light given off by the 
sun, is yet similar; that is to say, the light of a fixed star gives off a continuous 
spectrum, interspersed by dark shadows or bands; and hence the conclusion that 
the constitution of the fixed stars is similar to that of our sun, that their light also 
emanates from intensely white-hot matter, and passes through an atmosphere of 
absorbing vapors-in fact that the stars are suns of different systems. They have 
thus arrived at a distinct understanding of the physical constitution of the fixed 
stars; they consist of a white-hot nucleus, giving off a continuous spectrum, sur- 
rounded by an incandescent atmosphere, in which exist the absorbent vapors of 
the particular metals. These results are interesting as bearing on Laplace's nebular 
theory, because they show that the visible universe is mainly composed of the same 
elementary constituents, although certain of the stars differ from one another 
widely in their chemical constitution. 
Spectrum analysis has even given an explanation of the fact that the stars are 
variously colored ; some showing with a bright white light, others with a yellow 
light, and others with a blue light, and in the case of the twin stars, there is invari- 
ably a difference of color, the blue, green and purple stars being faint telescopic 
stars, never found alone, but associated under the protection, as it were, of a brighter 
red or orange star. It is possible, as has as been done by Padre Secchi, under 
the clear skies of Rome, to arrange all these stars into different groups. Spectrum 
analysis has shown that these differences are dependent upon the different chemi- 
cal constitution of the nucleus and luminous atmospheres of the fixed stars. In Spectroscopic Analysis in Medico-Legal Investigations. 
385 
the month of May, 1866, it was observed that all at once in the constellation of the 
Northern Crown, a star which was entirely or almost entirely unknown, suddenly 
blazed out and attained a magnitude almost equal to that of the largest star seen in 
the heavens. Spectrum analysis showed that this change was due to the combus- 
tion and presence of certain gaseous bodies and more especially of hydrogen. As 
this star made its appearance suddenly, so it soon gradually began to diminish in 
brilliancy, and at last died out, returningas it was, to its original telescopic dimen- 
sions, of about the tenth magnitude. The cause of the diminution was revealed 
by the spectroscope, inasmuch as the bright lines due to the incandescent hydro- 
gen, were found to dwindle and fade away, and it was observed after the lapse of 
twelve days, when the star had diminished in brilliancy from the second to the 
eighth magnitude, that the bright lines became quite invisible. 
The conclusion to which philosophers came with regard to this sudden out-burst, 
was that it was probably due to the sudden conflagration of hydrogen ; that hydro- 
gen gas was, in some way, in a state of ignition, either through some chemical or 
other change; and that the existence of these bright lines was due to the star 
being, so to speak, on fire. It is also interesting to notice, that the spectra of the 
fixed stars contain, like the solar light, invisible active chemical rays, and may be 
photographed ; that is, they will produce decomposition of chemical compounds. 
It has also been shown by Mr. Huggins that those singular astronomical phe- 
nomena, the nebulae, do not consist of a white hot nucleus envelopedin an atmos- 
phere in passing through which the light is absorbed, but on the contrary, that 
these nebulae are in the condition of luminous gases, and that it is really nebulous 
matter of which they are composed. The spectrum of the nebulae is distinguished 
by three bright lines. Mr. Huggins finds that the brightest of the lines of the 
nebulae coincides with the strongest lines which are peculiar to nitrogen, whilst 
the faintest of the lines coincide with hydrogen, and the middle line does not coin- 
cide with that of any known element. 
We are, therefore, justified by these careful investigations to adopt the decision 
that nitrogen and hydrogen exist in the nebulae. This opinion or decision shakes 
our opinions formerly held as to the great distance of the nebulae. 
The spectroscope has also demonstrated the existence of luminous gases in 
comets; but as yet it has been impossible to identify them with any known gases 
or substances known on this earth. So that we really do not know of what the 
comet consists. More recent observations, however, have shown the existence of 
luminous carbon in the comet of 1868. The spectroscope has thus revealed grand 
and important facts, and established a uniformity of composition throughout the 
universe. 
THE SPECTRUM-MICROSCOPE APPLIED TO PHYSIOLOGICAL INQUIRIES.* 
The application of the spectrum-microscope to physiological questions will 
probably lead to a number of important conclusions. Much remains to be learned, 
and what has been done so far merely serves to show what may be expected. 
Hitherto the coloring matters of the blood and bile have attracted the most atten- 
tion, but those found in urine and faeces are equally deserving of careful study: and 
when we come to comparative physiology, those found in eggs, hairs, feathers, 
scales, or other tissues, open out an extremely wide field for investigation, and 
have even already yielded remarkable facts. 
A considerable number of different colored products may be formed by the 
oxidation or other changes of the haemoglobin of blood. At least eight well- 
marked decomposition products can be thus formed, and it is remarkable that, 
like haemoglobin itself, most of them can exist in an oxidized and deoxidized state. 
They can be arranged in two series, viz: one in which there are three different 
modifications, according as they are deoxidized, oxidized, or, so to speak, peroxi- 
dized, and the other in which they occur only in a deoxidized and oxidized state. 
The former includes haemoglobin and products derived directly from it, and the 
latter haematin and products of its decomposition. 
Since this peculiarity in uniting with loosely combined oxygen is so character- 
istic of products derived from haemoglobin, and is comparatively so uncommon in 
the case of other animal and vegetable coloring matters, it becomes an important 
character in forming an opinion, as to whether one which occurs in the urine is or 
is not derived from the transformation of the haemoglobin of the blood, normal 
urine appears to contain the principal colored constituents which may be called 
* The Microscope in Medicine; by Lionel S. Beale, M. B., F. R. S. 386 
Spectroscopic Analysis in Medico-Legal Investigations. 
uroxanthine and urohsemin. This latter can easily be changed into a product 
which exists in an oxidized and deoxidized state, and very closely, if not actually, 
agrees with one that can be formed artificially from hiematin. 
The principal coloring matter is, however, the uroxanthine, and the source 
from which it is derived still remains to be determined. In the case of some indi- 
viduals the relative amount of these two does not vary materially, but in the case 
of others it varies very considerably, and there is a very close relation between 
this variation and the conditions of the body at the time of the secretion. Assum- 
ing that the amount of urohsemin is constant at all times of the'day, there is a 
great falling off in the uroxanthine during sleep and continued fasting, but a con- 
siderable increase soon after taking food, reaching a maximum four or five hours 
after, and then declining. There is also a rapid increase when a moderate amount 
of violent exercise is taken in the middle of the day, but after a certain amount 
there is a subsequent decrease. The effect of different kinds of food remains to 
be determined. The difference between maximum and minimum is far less in 
hot weather than in cold. 
Normal healthy faeces contain a yellow coloring matter, soluble in alcohol and 
in water, which, like uroxanthine, is very fluorescent, but easily distinguished 
from it by giving a spectrum with a well-marked absorption band. The connec- 
tion between this substance and bile, and the changes which occur in various 
abnormal conditions, are questions well worthy of further investigation. 
In jaundice, and probably in some other diseases, the yellow substance in 
faeces, which rapidly passes into an orange-colored substance by exposure to the 
air, is not excreted in the normal manner, but occurs in large quantity in the 
urine in the oxidized state, and can be easily recognized by means of the well- 
marked absorption band seen in the blue end of the green part of the spectrum. 
It is probably a product derived from bile, by some change not yet fully under- 
stood. 
THE SPECTROSCOPE IN ITS APPLICATION TO MEDICO-LEGAL INVESTIGATIONS. 
Dr. Beale, in his valuable work, " The Microscope in Medicine," cites 
Mr. Sorby's memoir, which we here reproduce. 
On some Improvements in the Spectrum method of Detecting Blood. By H. 
C. Sorby, F. R. S., etc. 
Spectrum analysis of blood.-1 shall give a condensed account of what I have 
been, able to learn in connection with this subject, and omit everything which does 
not bear directly on determining whether any stain is, or is not, due to blood. There 
does not appear to be any probability of our being able to decide by this means 
whether it is, or is not, human. Spectrum-Microscope and cells for examining 
blood.-The spectrum-microscope used in these inquiries should have a compound 
prism, with enough but not too great dispersive power, or else the bands would be, 
as it were, diluted, and'made less distinct. A combination of two rectangular 
prisms of crown glass, with a rectangular of very dense flint, and another of less 
dense, of such an angle as to give direct vision, turned towards the slit, as lately 
made for me by Mr. Browning, appears to be the proper medium, and has other 
important advantages. 
The cells used for the experiment should be made from barometer tubing, and 
be about one-eighth an inch in internal diameter, and half an inch long, one end 
being fastened to a piece of plate glass with purified gutta-percha, like an ordinary 
cell for mounting objects in liquids. It is, however, a very great advantage to insert 
between the plate and the cell a diaphragm of platinum foil, having a circular hole 
about two-thirds of the internal diameter of the tube fixed so that its centre corres- 
ponds with that of the cell. This prevents any light passing upwards that has not 
penetrated through the whole length of the solution, which is very important 
when using direct concentrated sunlight to penetrate through turbid or very opaque 
liquids. 
Of the reagents required.-A small spatula made of stout platinum wire, flat- 
tened at the end, is very convenient for adding small quantities of the reagents, and 
they should be stirred up in the cells with a platinum wire, fattened and turned 
up square at the end, like a small hoe. The reagents commonly employed are a 
somewhat diluted solution of ammonia, citric acid, the double tartrate of potash 
and soda, used to prevent the precipitation of oxide of iron, and the double sul- Spectroscopic Analysis in Medico-Legal Investigations. 
387 
phate of the protoxide of iron and ammonia, employed to deoxidize; but in some 
special cases diluted hydrochloric acid carefully purified boric acid, and sulphate 
of soda are required. 
ENGRAVING NO. 56. 
FIG. 2 
MR.SORBY S SPECTRUM EYE PIECE FOR TEH 
MICROSCOPE WITH MMMEMENT FOR 
PRODUCING TWO SPECTRA FOR 
COMPARISON 
Engraving No. 56.-(a.) Elongated opening, (b.) Circular stop, (c.) Achromatic lens 
(d.) Slit, (e.) Right angled prism which extends half over the slit, and the light transmitted 
through this from the side stage f, passes througn the slit a little on one side of the centre, 
while the light which comes through the body of the microscope, passes through the slit a 
little on the other side of the median line, as shown by the line gh. (i.) Analysing prism. 
Varying Characters of the Stain and of the Effects of Reagents.-The character 
of a stain varies much with its age, and with the nature of the substance on which 
it occurs. If quite recent, and if the substance has no immediate influence on 
blood, the stain would contain little or no coloring matter but haemoglobin. This 
is easily dissolved by water, and when properly diluted-neither too strong nor too 
weak-it gives the well-known spectrum, with two dark absorption bands in the 
green. The addition of very little ammonia and a small quantity of the double 
tartrate produces no change, but on adding a small piece of the ferrous salt, about 
one-fortieth of an inch in diameter, and carefully stirring, so as to mix without 
much exposure to the air, these bands gradually fade, and are replaced by the sin- 
gle broad and fainter band of deoxidized haemoglobin. When stirred up so as to 
expose well to the air, the two original bands of oxidized haemoglobin can be seen 
again. On gradually adding a little citric acid, until the color begins to change, 
these bands slowly fade away ; and, if the amount of blood was considerable a faint 
band would make its appearance in the red. When previously deoxidized, this 
solution may be turbid, but not so as to interfere with the result. The addition of 
excess of ammonia makes all clear again, but doesnot restore the original bands or 
only to a slight degree, thus showing that a permanent change is produced by cit- 
ric acid, the haemoglobin is changed into hsematin. This alone serves to distin- 
guish blood from by far the greater number of colored substances, which after being 
changed by acid, are restored by alkalies to the original state. On deoxidizing with 
the ferrous salt, we obtain the well-marked spectrum of deoxidized heematin, with 
one very dark, and another much fainter band in the green, almost or quite invi- 
sible when the quantity is small. If too much citric acid or double tartrate had 
been added, this solution might be turbid ; but, if all had been properly managed, 
it would be quite clear. Since the deoxidization takes place rather slowly, especi- 
ally in cold weather, it is well to slightly stir up the ferrous salt at' the bot- 
tom, completely fill up the cell, cover it with a piece of thin glass, remove the excess 
of liquid with blotting paper, and mix the solution by turning the tube upside 388 
Spectroscopic Analysis in Medico-Legal Investigations. 
down, over and over again. On reoxidizing the solution by stirring, the bands of 
deoxidized haematin disappear, and the two bands of haemoglobin will probably be 
recognized owing to citric acid not changing the original merely into haematin, but 
also giving rise to some methaemoglobin. The whole of these facts may be seen 
with a single cell, containing about 1-lOOth of a grain of blood, and any experi- 
menter should become quite familiar with them before applying this method to 
suspected stains in cases of importance. Very faint bands are best seen by lamp 
light. On exposure to the air in a damp place, a blood stain may be completely 
decomposed by the growth of mould, but when not thus destroyed it is partly 
altered into haematin. If, however, kept dry, the haemoglobin gradually changes 
into a variable mixture of methaemoglobin, haematin, and a brown substance not 
yet much studied. This change takes place far more rapidly in the acid atmos- 
phere of towns and houses, especially when gas is burned, than in the open coun- 
try, but it does occur even in the purest air, and in glass tubes hermetically sealed. 
The presence of a weak acid in perspiration may also cause a stain on a worn gar- 
ment to be completely changed in a very short time, and the presence of a stronger 
acid on dirty clothes may at once alter the haemoglobin into haematin. 
ENGRAVING NO. 57. 
ABSORPTION BANDS ARTERIAL & SCARLET CRUORINE 
ABSORPTION BANDS VENOUS BLOOD & PURPLE CRUORINE 
ABSORPTION BANDS BLOOD TREATED WITH ACETIC ACID 
ABSORPT/ONBANDS SOLUTION OF HAEMATIN 
On digesting in water a stain that has been kept until all the haemoglobin has 
disappeared, the methaemoglobin dissolves When the solution is sufficiently 
strong, this shows a band in the red, and two fainter in the green. The addition 
of ammonia removes that in the red, makes those in the green much darker, and 
develops a special very narrow band in the orange. When deoxidized this so- 
lution gives deoxodized haemoglobin. Since methaemoglobin is formed at once 
from haemoglobin by the action of a great number of different oxidizing reagents, 
and since it can be reconverted into oxidized haemoglobin by slight deoxidization, I 
am inclined to look upon it as a peculiar oxidized modification. On adding a little 
of the double tartrate and of the ferrous salt to even a dilute solution from an old 
stain, the methaemoglobin is deoxodized, and the well-marked spectrum of fresh 
blood can be seen. If left too long, rhe spectrum of deoxidized haemoglobin is 
developed, but, on well stirring that of the oxidized re-appears, and the various 
other spectra may afterwards be obtained, as described above. That part of the 
stain, insoluble in water, which is chiefly haematin, may be dissolved in dilute 
citric acid or ammonia, and when deoxidized, the spectrum is seen to even greater 
advantage than when fresh blood is employed, because there is no general shading 
in the green, due to there having been methaemoglobin mixed with .the haematin. 
We may thus obtain an excellent spectrum from a blood stain nearly fifty years 
old. In very old stains all the methaemoglobin has disappeared, and sometimes Spectroscopic Analysis in Medico-Legal Investigations. 
389 
even a considerable part of the haematin has been altered into another brown 
coloring-matter, which does not give any well marked spectrum. When a blood 
stain has been made sufficiently hot to coagulate the albumen, neither water, citric 
acid, nor cold ammonia will dissolve it; but by heating in dilute ammonia, the 
haematin is easily dissolved, and may be detected either before or after concentra- 
ting the solution by evaporation. I may here say that the spectrum of deoxodized 
haematin can in no way be better seen than by deoxidizing a solution of fresh 
blood that has been boiled with dilute ammonia, which gives rise to very pure 
haematin. 
Directions for Practical Examination.-In applying these principles to the 
detection of suspected stains, it is desirable, in the first place, to examine a portion 
of the unstained fabric, to ascertain whether any color is dissolved from it by 
water, and whether the solution has an acid or alkaline reaction. It is important 
to ascertain whether color is dissolved from the fabric by dilute citric acid or dilute 
ammonia, and if so, to determine whether this would in any way interfere with 
the recognition of blood by the processes described above. In the case of scarlet 
cloth and of some other red fabrics, much color is dissolved out by ammonia, but 
not by citric acid, which ought, therefore, to be used, whereas, in other cases, 
ammonia is the best solvent. Unless the stain is faint, a portion should be soaked 
in a few drops of water in a watch-glass, the liquid squeezed out, allowed to stand 
a short time in the glass, so as to deposit any small portions of the fabric, and 
poured into one of the experiment cells. If the stain had been recently made, and 
had not been changed by any special action, a solution of haemoglobin would be 
obtained, and the various spectra could be seen one after the other, as already 
described. If, however, the stain were a few days or a few weeks old, we should 
obtain a mixture of haemoglobin and methaemoglobin, or the latter alone. The 
various spectra could then be developed, and compared side by side with those 
from fresh blood, to be sure that there is complete correspondence in the position 
and relative intensity of the bands. The residue, insoluble in water, should then 
be dissolved in dilute citric acid or ammonia, according to the nature of the fabric, 
and the spectrum of deoxidized haematin developed. If insoluble in cold citric 
acid or ammonia, hot ammonia should be tried, since the stain might have been so 
heated as to coagulate the albumen. If it be desirable to keep the specimen of 
deoxidized haematin for subsequent reference, the cell may be covered with a piece 
of thin glass, and after removing the excess of liquid, the edge of the cover painted 
round with gold-size. When properly managed, such an object will show a per- 
fectly good spectrum, even after many weeks. 
Of the most important Spectra peculiar to Blood.-If, therefore, we have a 
sufficient amount'of a moderately old stain, we may easilyisee in succession the seven 
very different spectra of the following solutions: 1. Neutral methaemoglobin; 2. 
Alkaline methaemoglobin; 3. Deoxidized haemoglobin; 4. Oxidized haemoglo- 
bin; 5. Acid haematin; 6. Alkaline haematin; 7. Deoxidized haematin. If the 
amount was very small, only Nos. 4 and 7 would show distant bands, and the 
rest would be characterized rather by their comparative absence; and it must 
always be borne in mind that Nos. 1 and 2 may be modified by the presence of 
unaltered haematin, No. 3 by that of dissolved haematin, and Nos. 5, 6 and 7 by 
that of undecomposed haemoglobin or methaemoglobin. It would be easy to obtain 
other preparations, and to see several other spectra derived from blood; but it 
appears to me unnecessary, since the above are so remarkable and unique in the 
manner in which they are produced, one after the other, especially deoxidation 
and reoxidation on stirring, which seldom occurs in other coloring matters that 
they afford as satisfactory a test for blood as could be desired, and still more so 
when we consider not only the general character of the spectra, but also the exact 
position of the absorption bands, and that some are unusually distinct. 
Precautions necessary in Examining very faint Blood Stains, etc.-The above 
directions apply to simple cases, where the amount of material at command is 
amply sufficient, and the fabric on which the stain is found does not contain any- 
thing that makes the blood insoluble, or interferes with the various tests. I shall, 
however, now describe what should be done in cases which are made specially 
difficult by various causes. If the stain was very faint, from the presence of very 
little blood, or if the greater part had been removed by washing with water, it might 
be desirable not to divide the material, but to examine the whole at once. The 
stained portion should therefore be digested in a few drops of dilute citric acid or 
ammonia, and the presence of haematin determined, as already described. If faint 
and spread over a considerable surface, it might be well to digest in nitric acid or 
ammonia diluted with much more water than would fill the experiment cell, and 390 
Spectroscopic Analysis in Medico-Legal Investigations. 
afterwards concentrate the solution by gentle evaporation. By this means blood 
could be detected, even when considerable effort has been made to remove it, and 
only a faint brown tinge left, just visible on white linen. There would generally 
be no difficulty in the case of a stain on cloth which had been sponged, for enough 
blood solution would be left in the fabric. 
The Effects of Mordants on Blood Stains.-The presence of mordants in cloth 
or prints may require us to somewhat modify our proceedings, especially if the 
stain had been made wet and to a great extent removed, so that we have only the 
dried-up solution of blood, thoroughly incorporated with the mordant. Certain 
kinds of brown cloth are of such a character, and about seven years ago portions 
of a wetted stain were sent by me to a number of the highest authorities in the 
detection of blood, and they said that neither they nor any one else could recog- 
nize it. However, by proper care, I found that after the lapse of six years it could 
be detected by the spectrum method. The best plan was to digest a portion of the 
cloth in dilute ammonia, and to squeeze it well over and over again with a pair of 
forceps, and finally with the finger and thumb, so as to obtain as much of the 
solution as possible. This was very turbid, but when deoxidized in the same 
manner and illuminated by concentrated light direct from the sun itself, the band 
of deoxidized hsematin was quite distinct. When the cell was kept for a while, so 
that the insoluble part settled to the side, no band was visible, and therefore the 
hsematin was evidently combined with the mordant. It will thus be seen that 
it may be most important not to filter or allow the insoluble matter to subside, but 
to overcome the opacity by means of a sufficiently intense light. If the sun could 
not be made use of, the lime or electric light would no doubt be the best substitute.. 
Effects of Vegetable Soil on Blood Coloring Matters.-When fresh blood solu- 
tion is agitated in a test-tube with vegetable soil, and left until quite clear, the 
coloring matter is completely carried down with the earth. Dilute ammonia, how- 
ever, dissolves out Inematin, and therefore, in testing portions of soil, they should 
be digested in considerably more of that solvent than will fill an experiment cell, 
and after the solution has become quite clear it should be concentrated by evapora- 
tion. The spectrum of deoxidized hsematin may then be seen by following the ordin- 
ary method. The same process should be adopted in examining stains on cloths 
impregnated with earth or earthy dust, and marks on iron contaminated with 
much rust, if water will not dissolve out unaltered blood or methaemoglobin. 
Of Detecting Blood Stains on Leather.-The importance of being able to detect 
blood stains on leather was prominently brought before me by a case in which the 
trial of a suspected person depended on the nature of certain dark marks on his 
gaiters. The presence of tannic acid so completely mordants the blood, that 
neither water nor citric acid will dissolve it, and ammonia gives rise to a most 
inconveniently dark solution. If the stain is on the surface, and has never been 
wetted, a thin shaving should be cut off so as to have as much blood and as little 
leather as possible, and the blood should be dissolved off without exposing the 
solution to the action of the leather itself. This may be accomplished by taking 
one of the experiment cells, nearly filled with water, bending the shaving and 
inserting it in the upper part of the tube, so as to touch the water, being careful to 
arrange it so that the stain may be on the convex side of the leather, and in con- 
tact with the water When a drop of blood falls on leather, many red globules are 
filtered out from the serum and left on the surface, and, when thus treated 
they dissolve, and the colored solution sinks at once to the bottom of the cell, 
without coming in contact with the leather. The various spectra may then be 
observed in the usual manner. This method would be of little or no use if the stain 
had been wetted, and for a long time I concluded that after such treatment it would 
be impossible to recognize blood. However, after many experiments, and after hav- 
ing again and again almost given up the inquiry in despair, I found that the diffi- 
culty could be overcome in a very simple manner. The best solvent for the inso- 
luble compound of the coloring matter of the blood with tanic acid, is hydrochloric 
acid, diluted with about fifty times its bulk of water. If stronger or weaker, the 
result is not good. When a portion of unstained common brown leather is 
digested in this dilute acid, the solution is scarcely tinged yellow. On adding 
excess of ammonia the color become pale purple, or neutral ti nt, made deeper when 
the double tartrate and the ferrous salt are added, but remaining nearly clear. This 
gives a spectrum very dull all over, but without any trace of definite bands in any 
part. The depth of color varies much with differentspecimens of leather. A por- 
tion of similar material soaked with wetted blood, gives a yellow solution, made 
brown-purple and turbid by the double tartrate and ammonia, and remains so. 
when deoxidized. The band of deoxidized Inematin can, however, be distinctly Spectroscopic Analysis in Medico-Legal Investigations. 
391 
seen with a light sufficiently strong to penetrate the turbid and strong solution. 
Before examining the suspected stain, it would be well to make out how much of 
the unstained leather could be used without giving too dark a solution, and to use 
no more of the stained. If the deoxidized solution be too turbid, the cell may be 
kept for a while horizontal until the deposit has subsided sufficiently to allow the 
principal absorption band to be seen, but it is not so distinct, when all have sub- 
sided as though the greater part of the hsematin still existed, as a compound 
insoluble in dilute ammonia. The presence of tannic acid in wood and other sub- 
stances might make it necessary to employ a similar process, if the relativeamount 
of blood were so small that none could be dissolved out by water or dilute citric 
acid. 
Of preventing the injurious effects of other Coloring Matters.-Cases might 
occur when it would be necessary to decide whether blood were present, along with 
some other colored substance soluble in water. The method to be employed would 
depend much on the nature of this impurity. If it were a coloring matter, belong- 
ing to what I have described in former papers as group A, in which the absorption 
is removed by sulphite of soda, in an alkaline solution, there would be no difficulty 
in seeing all the spectra. Thus, for example, it is easy to add so much magenta 
to the solution of aTittle blood, that its absorption bands are entirely hid; but a 
small quantity of sulphite of soda so completely removes the color of the magenta 
that the various spectra of the blood may be seen almost as well as if it had been 
pure. The coloring matters of my group B, that are most likely to occur, are those 
of fruits, and in them the presence of the free acid would be almost certain to have 
changed the haemoglobin into hsematin. The best plan would then be to add 
excess of ammonia, and if the solution were made too dark, to dilute it with so 
much water that the strongest light at our command would show the green part of 
the spectrum sufficiently bright to prove that no absorption-band occurred there 
On deoxidizing in the usual manner, the solution may be made somewhat darker 
by the presence of tannic acid, but the darker band of deoxidized hsematin could 
be recognized without material difficulty. By far the greater number of the color- 
ing matters belonging to my group 0 are yellow and orange-colored; and since 
these chiefly absorb the blue rays, they do not interfere with our seeing bands of 
the blood spectra which occur in the green. Cochineal is one that requires special 
attention. The addition of ammonia to its solution in water gives rise to two bands 
in the green; which, though differing materially from those of blood, are yet so 
nearly in the same situation that they completely disguise the presence of a small 
amount of blood. However, on adding a small excess of boric acid, the bands of 
the cochineal are made more faint, and very considerably raised towards the blue 
end, so as to leave the red end of the green clear, whilst those of oxidized haemo- 
globin are not changed, and the nearer the red end, if not both, can be seen per- 
fectly well. By proceeding in the usual manner, tnere is no great difficulty in 
recognizing the darker band of deoxidized hsematin. 
Undecomposed Hcematin, if present, may always be detected.-Other special 
difficulties might occur in particular instances, but I trust that these exampleswill 
suffice to show how they may be overcome. Ido not now know of any that require 
special remarks; and, as far as I am able to judge, we need never despair of detect- 
ing blood, so long as any haematin remains undecomposed. Fortunately it resists 
decomposition so well that this would rarely happen in ordinary circumstances; 
but yet there are cases in which it does occur, as, for example, when acted upon by 
strong ozone, or other powerful oxidizing reagents. It is quite possible thats*tained 
garments might have been washed, and some of the water employed might be 
obtained for examination. If soap had beer used, this water could be exam- 
ined in a long tuhe of thick glass, ten inches or more in length, and a quarter of an 
inch in internal diameter, permanently closed at one end with a circular piece of 
plate-glass. For examining solutions in such tubes a small spectroscope, such as 
recently made for me by Mr. Browning, is extremely convenient and suitable in 
every respect. If only two or three days old, the bands of oxidized haemoglobin 
might be seen; but if the solution had been kept longer, and they could not be 
detected, it should be concentrated by evaporation at a gentle heat, and tested for 
haematin, and the soap makes the solution inconveniently turbid and opaque. It 
is best in such a case to agitate the suspected soap and water with ether, remove it 
with a pipette after the two liquids have completely separated, and repeat the pro- 
cess over and over again, with fresh ether, until the aqueous solution at the bottom 
has become quite clear and free from soap. It should then be concentrated by 
evaporation, and examined for hsematin as usual. Of course in all such cases it 
would be desirable to test the solution as soon as possible, lest decomposition should 392 
Comparison of Micro-Organisms of Malarial Fever, 
occur, but by these means a very small quantity of blood, that would show on 
color, might be recognized within a week or two, but probably not after. 
Method of detecting Blood in Urine--For the detection of blood in urine, a 
tube about ten inches long is very suitable. If turbid it should be filtered; but 
since a considerable number of red' globules might be separated, the deposit on the 
filter should be washed with a little water and this solution either examined by 
itself, or added to the filtered urine. If the depth of color in the ten-inch tube be 
so great that the yellow end of the green part of the spectrum is absorbed, the 
urine may be somewhat diluted or examined in a shorter tube. When the depth 
of color is about an average, I find that by this means as little as l-10000th part 
of blood can easily be detected in fresh urine, which is equivalent to about one drop 
in a pint. 
COMPABISON OF THE MICRO-ORGANISMS OF MALARIAL FEVER, WITH WELL- 
KNOWN MICROCOCCI, BACTERIA, BACILLI, SPIRILLA AND SPIROCHAETAE, 
WHICH HAVE BEEN DESCRIBED AND DELINEATED BY MANY OBSERVERS, 
AS ASSOCIATED WITH SEPTIC PROCESSES AND VARIOUS DISEASES.* 
MICROCOCCI. 
Micrococcus (spherobacterium) : a minute spherical or slightly oval organism: 
like otherjbacteria divides by fission (schizomycetes) ; not possessed of any special 
organ of locomotion as cilium or flagellum: capable of Brownian, or molecular 
movement when suspended in fluid ; propagates by simple division, never by gem- 
mation and spores ; possesses a delicate membrane of cellulose, which enables it 
to resist the action of alkalies and acids: contents homogeneous and highly 
refractive when active, pale when inactive, and consists of micoprotein. The 
size of micrococci varies within considerable limits 0.0008 to 0.002 millimetres: 
they vary greatly as to size and mode of growth ; they multiply by slightly 
elongating and then dividing by a transverse constriction into two, a dumb-bell; 
each of these again divides into two either transversely or in the same direction as 
before : the new elements of successive divisions may' remain connected and thus 
form a chain or micothrix (torulaform strings): or they separate into single 
organisms or dumb-bells, called diplococci by Billroth. Between the individuals 
of a dumb-bell there is noticeable a short, pale, intervening bridge. Some species 
are characterized by dividing into a dumb-bell and each of the elements dividing, 
again transversely into a dumb-bell, a group of four (tetrade or sarcina-form) is 
thereby produced. When pressed closely together they assume the shape of a 
cube, a true sarcina. 
In many instances individual members resulting from division, remain closely 
adhered,without any definite arrangement, and thus form smaller or larger contin- 
uous masses, zooglaa or colonies, in which the individuals appear embedded in a 
hyaline gelatinous matrix, the amount of this varies in the different species; in some 
there is little of the matrix actually visible, the micrococci being in close juxtapo- 
sition; in others it is easily recognized, the interstices between the individuals 
being measurable. In some of the pigmented species the interstitial mass or matrix 
contains the pigment. Zoogloea masses present themselves as uniformly granular, 
the granules or micrococci being of the same size. These micrococci never elongate 
to forms rods, although in certain rod-like bacteria, the individual elements some- 
times assume the shape of spherical elements. The species of micrococci which 
form a pellicle of zoogloea, on the surface, are aerobic, that is, they require large sup- 
plies of free oxygen which they receive from the air to which they are exposed 
on the surface of the nourishing material; other species do not require free oxygen, 
and have been called anaerobic; they grow well in the depth, and do not form a 
superficial pellicle. There is a marked difference between different species. The 
micrococci occurring in connection with disease are anaerobic. The following 
figures, engraving No. 58, illustrate the appearance of micrococci, and will serve a 
useful purpose for study and comparison. 
*The materials classified and consolidated in this section of 'his chapter relating to the pro- 
duction of certain diseases by specific micro-organisms, have been the products of the labors 
of many observers, as Koch, Billroth, Friedlander, Klebs, Cohnheim, Eklund, Pasteur, Davaine, 
Beale, Burden, Sanderson, Lewis, Mansen, Klem and other eminent microscopists during the 
past twenty years. We are, however, largely and chiefly indebted to the elaborate and compre- 
hensive series of articles on micro-organisms, by Professor Klein, published in the Practitioner 
of 1884-1885. With well-known Pathogenic Forms 
393 
ENGRAVING NO. 58., 
Engraving No. 58.- A. Micrococci of putrid human sputum. 1. Single micrococci and dumb- 
bells; 2. Short chains; 3. Long chains; 4. Zooglcea. B. From the same putrid sputum the 
micrococci are larger. 1. Dumb-bells; 2. Sarcinee; 3. A small zooglcea in reality consisting of 
four sarcina groups. C. Part of a convolution of a chain of micrococci; from an artificial 
cultivation started from the serum of a blister of a rabbit's ear. D. Giant micrococci from 
same putrid sputum. 1. Dumb-bells; 2. Division of dumb-bells into sarcina. 3. Incomplete divi- 
sion into sarcina. E. Sarcina micrococcus from an artifical cultivation. 1. The elements of 
each sarcina group of four appears single; 2. The elements incompletely divided into secon- 
dary groups; 3. Each element of the preceding groups has divided into four micrococci. Klein. 
Micrococci have been divided according to their chemical and physiological 
formation into septic, zymogenic, chromogenic, pathogenic. 
Septic micrococci occur with other septic bacteria, wherever there is decompo- 
sition of organic matter in solids or fluids; the numerous species are widely dis- 
tributed in the air; they occur in the body of men and animals when there is dead 
tissue, in which they grow copiously, and of this kind are the micrococci found in 
ordinary pus, in the normal oral cavity (on the filiform papillae of the tongue and 
on the mucous membrane), in the bronchial secretions in ordinary catarrhal exu- 
dations (nasal cavity, bronchi, etc.), and on the free surface of intestinal and 
other ulcerations. 
Zymogenic micrococci are associated with definite chemical precesses, as micro- 
coccus urce causes the ammoniacal ferment of urine (aerobic); occurs singly, as 
dumb-bells, or chains, and as zoogloea. The micrococcus of the mucoid wine fer- 
mentation produces a peculiar mucoid change in wine and beer, and occurs chiefly 
in chains. The micrococcus causing phosphorescence in putrid meat and fish forms 
chiefly zoogloea (aerobic}. 
Chromogenic Micrococci-, are characterized by their power of forming pigment 
of various colors. They grow well at ordinary temperatures, and occur chiefly as 
zoogloea ; they differ from one another in forming different pigments, either soluble 
or insoluble in water. They are all aerobic and produce this pigment only when 
there is free access of air. The cells are spherical (micrococcus prodigiosus, chlori- 
nus, fulvus) or slightly elliptical (M. luteus, auriantiacus cyaneus, violaceus.) 
They grow on boiled potatoes, bread, paste and boiled-egg albumen; when trans- 
planted they always produce the same pigment; but when growing and kept in 
the depth of a solid nourishing material, removed from the surface exposed to the 
air, they grow as colorless micrococci, they abound in the air, but vary in num- 
ber of species in different localities and at different seasons of the year. 
Micrococcusprodigiosus is blood-red. the color being lodged not in the micro- 
coccus but in the interstitial substance, and is insoluble in water, soluble in alcohol; 
it occurs chiefly as zooglcea, in the shape of smaller or larger droplets ; the cells 
are the smallest of all pigment-micrococci. 
Micrococcus luteus, is yellowish, and the pigment is insoluble in water; occurs 
in fluid nourishing material, forming a pellicle. 
Micrococcus auriantiacus grows on boiled-egg albumen, chiefly as zoogloea; 
the pigment is soluble in water. 
Micrococcus cyaneus, violaceus, chlorinus, and fulvus, produce blue, violet 
green and brown pigment respectively ; the first two grow well as zoogloea of ellip- 
tical cells on boiled potatoes, the third on boiled-egg albumen, and the last is met 
with on horses' dung. 
Clathrocystis roseo-persicina, pearl-colored bacterium, is an organism of about 
0.0025 millimetres in diameter, spherical or oval and of a bright red color ; the 
cells differ from micrococcus prodigiosus, not only in their greater size, and their 394 
Pathogenic Micrococci. 
PATHOGENIC MICROCOCCI. 
intrinsic color, but also, in that having formed zoogloea-masses, there are gradu- 
ally developed cavities or cysts therein, which are filled with water, while the 
colored cells occupy their periphery. The cysts ultimately break up. Together 
with this organism occur other-pink-colored organisms described by Cohn as 
Monades. Monas Vinosa, spherical cells about 0.002-0.003 millimetres in diame- 
ter. Monas Okenii, cylindrical cells, 0.008-0.005 millimetres long, 0.005 milli- 
metres broad, flagellate, lihabdomonas rosea, spindle-shaped 0.004 millimetres 
broad, 0.02-0.03 millimetres long, flagellate. Monas Warmingii, spindle-shaped 
0.008 millimetres broad, 0.015-0.020 millimetres long, flagellate. 
Ascococcus, spherical oval or knobbed masses of minute micrococci found by 
Billroth in putrid meat infusion ; each of the masses is enveloped in a resistent firm 
hyaline capsule of about 0.010 to 0.015 millimetres thickness: The masses are of 
various sizes, from 0.02 to 0.07 millimetres in diameter, and are composed of small 
spherical micrococci. Cohn also found them in his nourishing fluid, where they 
produce the peculiar smell of cheese; and Cohn called the organism ascococcus 
Billrothi. They are capable of changing acid nourishing material into alkaline. 
Sarcina Ventriculi, peculiar groups of four cubical cells, with rounded edges, 
closely placed against each other, first described by Goodsir in the vomit of some 
patients; diameter of the individual cells, about 0.004 millimetres; they are of a 
greenish or reddish color. Sarcinse ventriculi are found in the contents of the 
stomach of men and brutes in health and disease, where the groups of four cells 
form smaller and larger aggregations : Occasionally .small sarcinae, occur on boiled 
potatoes, egg albumen and gelatine exposed to the air; they are considerably 
smaller than the sarcina ventriculi, and when in large quantities have a yellow- 
ish tinge: Klein has cultivated them through many generations in pork broth,, 
beef broth, and mixtures of gelatine and broths at ordinary temperatures. 
Many of the pathogenic micrococci are connected with disease ; in the pus of 
open wounds, and in that of closed abscesses, in the secretion of open ulcers, of the 
skin and mucous membranes, in ulcerations of the throat due to scarlatina, in 
every ulceration of the internal mucous membrane, in the lymph of the vesicles of 
the skin and the mucous membranes of the mouth occurring in various kinds of 
inflammation, micrococci are almost always present, singly or in dumb-bells or in 
beautiful chains. There are, however, certain acute inflammations as that pro- 
duced by the subcutaneous injection of turpentine, the pus of which does not con- 
tain micrococci or any other organism. In the ulcersand abcesses micrococci often 
form continuous masses or zooglcea, encroaching on the tissue of the base of the 
ulcer, as in the caseof the minute micrococci, about 0.0005 millimetres in diameter, 
(microsporon septicum Klebs) found in and around wounds. In infantile diarrhoea 
the secretions of the bowels swarm with micrococci; in typhoid fever clumps of 
micrococci may be found very extensively on the ulcerations of the bowels, and 
in the mucous membrane surrounding the ulcerations, and may be even traced into- 
the mesenteric glands and the spleen ; in dead tissues within the living body, such 
as occur after embolism, and in the case of various infectious maladies, they may 
be found in colonies in the blood-vessels and in the parts around, and in the dis- 
seminated abscesses and necroses of surgical pyaemia, masses of micrococci have 
been found in many of the affected organs. 
In pneumonia, accompanying certain infectious maladies as typhoid fever, 
tuberculosis, and even in severe catarrhal pneumonia, large masses of micrococci 
may occur in the air cells, and even growing into the blood-vessels in which stasis 
has set in; such, also, is the case in pleuro-pneumoniaof cattle, and in the pneu- 
monia of swine fever. Micrococci occur always normally in large quantities in the 
fluids (saliva and mucus) of the nasal and oral cavities, pharynx, larynx, and 
trachea, and are, without doubt, derived from the atmosphere. The experiments 
of Pasteur with the inoculation of the saliva of a child suffering with hydrophobia, 
have been repeated; his cultivation experiments have not positively determined 
the existence of a special microbe or micrococcus as the cause of hydro- 
phobia; for Senator had previously shown that, the saliva of man and of the 
healthy dog when inoculated subcutaneously were capable of producing death, 
and Sternburg subsequently proved that his own saliva was poisonous to rabbits. 
Aside from any part which micrococci may play in the saliva when injected 
subcutaneously, there is no secretion of the blood more liable to septic poison or 
more capable of producing septicaemia, from the presence of decaying teeth, from 
the accumulations of putrefying fragments of animal and vegetable matters 
between and around the teeth. The poisonous nature of the bites of men and ani- Pathogenic Micrococci. 
395 
mals, even when not afflicted with rabies or any other known disease, has long 
been known to practitioners of medicine and surgery, and the only wonder is that 
any living being could survive the subcutaneous injection of such'a complex fluid 
so liable of contamination by food and by the septic organisms of the atmosphere 
as saliva is known to be. There are well authenticated examples to show that 
secondary syphilis has been communicated by a kiss, and by the use of the stem of 
a pipe with the saliva of secondary syphilis upon it. It has not yet been fully 
determined whether these micrococci stand in a definite relation to the respective 
maladies or are only of secondary importance. The micrococci which are con- 
sidered to stand in an intimate relation to specific diseases, are : 
Micrococcus Variola; et Vaccinia;.-The micrococci of variola, vaccinia, and sheep, 
horse and cow-pox are very minute, 0.0005 millimetres and less in diameter, single 
or in dumb-bells, or in shorter or longer chains, or in small groups; when cultivated 
in the warm stage they form very long chains and colonies. Similar micrococci 
occur also in the fluid contents of vesicles in the skin produced by various non- 
infective inflammations. Until the micrococci of small-pox are artificially culti- 
vated through several generations, and then the reproduction of small-pox caused by 
inoculating the essential microbe the evidence of its being the essential cause of the 
disease is wanting. 
Micrococcus Erysipelatosus.-'Vhe erysipelatous micrococci are very minute, 
smaller than those of vaccinia; in the margin of an erysipelatous zone, when the 
disease is progressing, marked by redness and swelling, the lymphatics of the skin 
are filled with zoogloea of micrococci, and the injection of these vessels keeps pace 
with the progress of the erysipelatous process. These micrococci have been arti- 
ficially cultivated through many generations in peptonized meat extract gelatine 
and solid serum (Lukomsky, Oth, Fehleisen), and when re-inoculated produced 
the disease not only in beast but in man. 
Micrococcus Diphtheritica*.-The diphtheritic micrococci are about 0.00035- 
0.001 millimetres in diameter, slightly oval, occur singly or in dumb-bells, or in short 
chains, they form also continuous masses of zoogloea in the shape of spherical or 
cylindrical clumps, and as such they penetrate and destroy the surrounding connec- 
tive and muscular tissues in diphtheria. Buhl, Htiter and Oertel have shown 
that micrococci are found in large numbersnot only in the diphtheritic membranes 
of the organs of the throat and in that neighborhood, as well as in the surrounding 
lymphatics, but also in the blood of the general circulation, in the kidneys and in 
the muscles. In severe cases they are found blocking up the capillaries of the 
glomeruli and the uriniferous tubules of the kidneys. The exact relationship of 
this micrococcus to the causation of diphtheria has not yet been determined by 
series of pure cultivations and inoculations. 
Micrococcus Pneumoniae.-Friedlander first pointed out the micrococci of 
acute crupous pneumonia, and described them as oval of a peculiar nail-like shape, 
about 0.001 millimetres long, and as occurring in the sputum singly, but especially 
as dumb-bells or diplococci, as chains, and as zoogloea. Ziehl found them in very 
large crowds in the sputum, giving to this in the early stages, the peculiar char- 
acteristic brownish " prune-juice " tint. According to this observer, they are very 
numerous only in the beginning of the illness; after the critical stage they decrease 
in numbers. Griffini and Cambria observed the micrococci also in the blood; and 
Salviali found that their numbers increased after the third day; on the ninth or 
tenth day they quite disappeared. G. Giles found them in many cases of pneu- 
monia in India, both in the sputum and in the blood. Cultivation in boiled 
potatoe yielded good crops. These cultivated micrococci, injected into the subcu- 
taneous tissue of rabbits produced pneumonia. Salviali and Zaslein cultivated the 
micrococci derived from blood in meat broth, meat extract solution, etc., at 37°- 
39° C., and obtained good crops of the micrococci, with which they produced 
by inoculation in seven rabbits, and six white mice, typical pneumonia yielding 
the characteristic micrococci. These statements have been confirmed by the care- 
ful experiments of Friedlander and Frobenius; these observers not only communi- 
cated pneumonia to dogs, rabbits and mice bv injecting into their lungs and by 
inoculation of the micrococci pneumoniae cultivated in gelatine mixture, but they 
also found that when mice shut up in a chest were compelled to breathe an 
atmosphere contaminated and saturated by means of a spray with the miciococcus 
pneumoniae, a number of them died from pneumonia and pleurisy, but not till the 
fourth or fifth day. M. T. Poels and Dr. W. Nolen assert that the pulmonary 
exudations of the pleuro-pneumonia of cattle contain micrococci which in their 
morphology and mode of growth in artificial cultivation are identical with the 
micrococci of human pneumonia; and artificial culture of the micrococci derived 396 
Pathogenic Micrococci. 
either from human pneumonia or from pleuro-pneumonia of cattle, produce in 
cattle the typical pleuro-pneumonia. 
Micrococcus Gonorrhoea.-The micrococci of the pus of gonorrhoea are described 
as spherical organisms, of about 0.008 millimetres in diameter, generally forming 
dumb-bells, or sarcina-like colonies of four. Several such groups form a zoogloea. 
They adhere to the pus-corpuscles and epithelial cells. Bockhart has succeeded in 
artificially cultivating these micrococci, and in producing the disease by inoculation 
with the cultivated organisms. 
Micrococcus Endocar diticus.--Micrococci in the form of zoogloea have been seen 
in endocarditis ulcerosa; and they sometimes form plugs in the blood-vessels of the 
muscular tissue of the heart. 
Micrococcus Scarlatinas.-Coze and Feltz have described micrococci as existing 
in the blood of scarlatina, and Klein has seen them in the ulcerations of the 
throat, and Pohl-Pincus has described very minute micrococci adhering to the 
scales of the epidermis in scarlatina, and also in the throat discharge. They form 
small colonies, and their diameter is very small, only about 0.0005 millimetres. 
In Puerperal lever Heiberg found micrococci in the form of zoogloea, in all 
affected organs-endocardium, lung, spleen, cornea, in a case of panophthalmitis 
puerperalis, and in the kidneys, forming casts in the uriniferous tubules, and 
emboli in the blood-vessels. 
Pernicious Anosmia-Frankenhauser described the occurrence of micrococci? 
in the blood of pregnant women suffering from pernicious anaemia, not uncommon 
in Zurich. These micrococci were very large, about one-tenth of the broad diameter 
of a red blood-corpuscle, and some were provided with a flagellum,? Some were 
divided in two. In the blood of the liver they occurred in large numbers. He also 
states that these micrococci were probably derived from decayed teeth, from which 
all of his patients suffered. 
Acute Yellow Atrophy of the Liver.-Eppinger describes micrococci as occurring 
in acute yellow atrophy of the liver. 
Syphilis.-Aufrecht found in the syphilitic mucous patches of several patients a 
micrococcus forming generally dumb-bells, and staining very deeply in fuchsin. 
This has been confirmed by Birch-Hirschfeld. 
Micrococcus of Acute Infectious Osteomyelitis.-Dr. Becker has made in the 
laboratory of the Berlin Imperial Sanitary Office, a series of important experi- 
ments on the micro-organisms discovered' by Schuller and Bosenbach. He col- 
lected pus from five cases of acute osteomyelitis in which the abscesses had not 
been opened, and cultivated the micrococci contained in it in sterilized potatoes, 
coagulated serum, and gelatinous peptone. In the latter case the pus was intro- 
duced by means of needles into the mass, which was then kept at the temperature 
of the room during three to five days. After that time the puncture made by the 
needles assumed the appearance of white streaks, around which the gelatine liqui- 
fied gradually and took an orange color. After a few days more the mass gave out 
a smell like sour paste, and the microscope revealed the presence of large numbers 
of micrococci, having the same appearance as those found in the pus. A small 
quantity of the mass was mixed with sterilized water and injected into the peri- 
toneal cavity of some animals; they died in a short time of acute peritonitis. The 
same fluid injected into the jugular vein, caused acute septicaemia and death; but 
nothing abnormal was found in the bones in either case. Dr. Becker then injected 
a small quantity of the same fluid into the jugular vein in fifteen rabbits, after 
having some days before fractured or bruised the bone of one of the hind legs. On 
the day after the injection, weakness and loss of appetite were noticed; but after a 
short time the symptoms passed away, and the animals seemed to have recovered. 
At the end of the first week, however, a swelling formed at the seat of the bruise 
or fracture, the animal lost flesh and died after a few days. On dissection, large 
abscesses were found around and in the bones, and in several cases metastatic 
abscesses had formed in the lungs and kidneys. Numerous colonies of micrococci 
were discovered in the blood and pus of the animals upon which the experiment 
was made. 
The following figure, engraving No. 59, will present illustrations of several of 
the most important pathogenic micrococci, which will serve a valuable purpose for 
comparison. Schizomycetes. 
397 
ENGRAVING NO. 59. 
Pathogenic Micrococci. 
Engraving No. 59.-A. From the base of an ulcer of the mucous membrane of the larynx in a 
child that died of acute scarlatina. 1. Nuclei and fibres of the tissue; 2. Zoogloea of micro- 
cocci. B. From a preparation of the blood of a child ill with infantile diarrhoea. 1. Blood 
discs; 2. Dumb-bells of micrococci. C. Micrococcus in the fresh lymph of human small- 
pox. 1. Singly; 2. In dumb-bells; 3. In short chains. D. Lymphathic vessel from the skin, 
of a pock in sheep-pox. The vessel is filled with micrococci. E. Portion of a diphtheritic 
membrane. Numerous micrococci present. The micrococcus diphtheriticus varies from 0.00035 
to 0.001 millimetres in diameter. F. Two large scaly epithelial cells of gonorrhoeal pus. 
The epithelial cells are covered with micrococci, chiefly in dumb-bells, some in sarcina 
forms.-Klein. 
SCHIZOMYCETES: Bacteria, Bacilli. 
ENGRAVING NO. 60. 398 
Life History of Bacillus Anthracis. 
Engraving No. 60.-Schizomvcetes: Bacteria, Bacilli. A. Bacterium termo, each cell furnished 
with a single flagellum, magnified 4000 diameters, (first figure) Bacterium lineola. each cell when 
separate, having a flagellum at either end. Magnified 3000 diameters, second, third, fourth and 
fifth figures. B. Bacillus Subtilis: each cell when separate biflagellate. Magnified 4000 diam- 
eters. C. Matted rods of bacilli anthracis extending in rows between connective tissue-fibres 
of subcutaneous tissue. D. Four individuals of vibrio rugula, each showing flagellum at one or 
both ends. Two other individuals separated from each other and drawing out protoplasmic 
filaments to form second flagella. Magnified 2000 diameters. E. Spirillum undula showing 
flagellum at each end. Magnified 3000 diameters. The last elongated figure represents spiri- 
llum volutans. Magnified 2000 diameters. Figure A. Bacterium termo and bacterium lineola 
after Dallinger. Bacterium termo. Each cell furnished with a single flagellum, magnified 4000 
diameters, first figure. Bacterium lineola; each cell when separated having a flagellum at 
each end. Magnified 3000 diameters. Second, third, fourth and fifth figures. Bacteria are thus 
seen to be minute oblong cells, which are usually seen to be in pairs end to end, but not unfre- 
quently present themselves singly, the pairs being produced by the self-division of solitary 
cells. They are usually seen in vascillating movements produced by the action of their .flagella, 
of which in their paired state, each cell bears one at its free extremities, whilst the solitary cells 
bear a flagellum at each extremity. 
The formation of the second flagellum seems to take place by the drawing out of a filament 
of protoplasm between two cells that are separating from each other, the rupture of which gives 
a new flagellum to each. Two pieces of this type differing considerably in size, have been 
specially studied. The cells of bacterium termo (figure A) which seem to be the ferment of ordinary 
putrefactive change, have a diameter of about l-20,000th of an inch, and are somewhat longer 
than they are broad. Their flagella are so minute as to be among the most difficult of all 
microscopic objects, their diameter being estimated by Mr. Dallinger, at not more than l-2u0,000th 
of an inch (Ewart, Proceedings of Royal Society, June 20,1878.) 
The bacillus lineola which is the special ferment that turns milk sour, occasioning the con- 
version of its sugar into lactic acid, has about three times the length and diameter of the pre- 
ceding, and exhibits much stronger to and fro movement. 
The special peculiarity of bacillus consists in the extension of its cells into straight rods, some- 
times of considerable length, which break up by transverse subdivision int o separate cells, each 
of which hasa flagellum at either end, though when the cells are paired (like those of bacteria), 
each carries a flagellum at its free end alone. 
The bacteriumswbZiZis, (vibrio subtilis of Ehrenberg), found in stale boiled milk that is under- 
going the butyric fermentation, is a slender, suple thread, figure B, whose cells average about 
1-5,000th of an inch moving in a pausing manner "like a fish forcing its way through reeds." 
Figure B.-Bacillus subtilis: Each cell when separated, bi-flagellate, magnified 4,000 diameters; 
after Dallinger. 
The bacillus ulna, found by Cohn in a stale infusion of boiled eggs is distinguished from the 
preceding by the greater thickness of its filaments and by its rigidity. 
C.-Matted rods of bacillus anthracis, extending in rows between connective tissues of subcu- 
taneous tissue; after Ewarts. 
The bacillus anthracis which is found in the blood and tissues of animals effected with car- 
buncle and splenic fever, usually presents itself in straight, slender, rods, of from 1-2,000th to 
1-10,000th of an inch in length (figure C); these so long as they are imbedded in living tissues, 
seem to multiply indefinitely by transverse division, thus continuing to produce short, mottled, 
filaments, wthout extending themselves into larger filaments or giving origin to spores. 
Figure D.-Four individuals of vibrio rugula. each showing flagellum at one or both ends; two 
other individuals separated from each other, and drawing out protoplasmic filaments to form 
their second flagella. Magnified 2,000 diameters-after Dallinger. 
The vibriones, although being long known, have not been studied with the same completeness 
as other ischizomycetes. They resemble bacilli in the slenderness of their form ; but instead of 
being straight and rod-like, are flexible, with more or less of S shaped curvature. They pre- 
sent themselves abundantly in infusions of decomposing organic matter in combination with 
other bacteria forms, from which they are distinguishable by their wavy serpentine movement. 
The length of one of the commonest species, vibrio rugula (figure D), is usually from 1-1,200th to 
1-2,500th of an inch. 
Figure E.-Spirillum undula, showing flagellum attach end, and magnified 3000 diametrs, 
the last elongated figure represents spirillum volutans magnified 2000 diameters.-After Dallin- 
ger. Spirilla, which are the largest of the whole group, are characterized by the spiral coiling 
of their cells, (figure E), and by their cork-screw like movements ; and are found not so much in 
newly decomposing infusions of organic matter, as in stale liquids which have passed through 
the active stages of putrefaction. Nothing has been certainly known until recently, of their life 
history; but the observations of Messrs. Geddes and Ewart (Proceedings of the Royal Society, 
June 20th, 1878), seem to render it clear that they pass through a series of stages closely resembling 
bacillus. Life History of Bacillus Anthracis 
399 
ENGRAVING NO. 61. 
Life History of Bacillus Anthracis.-After Ewart. 
Engraving No 61.-Bacillus Anthracis. The bacillus anthracis which is found in the blood 
;and tissues of animals affected with carbuncle and splenic fever, usually presents itself in straight, 
slender rods, of from 1-2,000th to 1-10,000th of an inch in length, (figure C), these, so long as they 
are imbedded in living tissues seem to multiply indefinitely by transverse division, (Nos. 5, 6) 
thus continuing to produce short, motile filaments, furnished with flagella, without extending 
themselves into longer filaments, or giving origin to spores. When, however, these are cultivated, 
at about the temperature of 90° F., they lengthen out (after alternation of restand motion) into very 
long filaments, (22) whose endoplasm divides into numerous segments, (9) which may again divide 400 
Schizomycetes. 
(10,11) and then rapidly contract to form spores, (12,13.) These spores escaping by the disintegra- 
tion of the filaments, (14,17) and presenting themselves (1) as micrococcus forms, may either 
multiply as round or oval cells by binary subdivision (2) aggregating into a zooglcea (3); or they may 
at once develop themselves (4, 5) into tne straight rods characteristic of the type. The sporulifer- 
ous filaments (20, 21) are of very much smaller diameter than theordinary rods, and are disposed 
to break up and aggregate themselves eitner into an ordinary zoogloea (19); or into a double spiral 
rope work, (23). It appears from Mr. Ewart's later observations (proceedings of Royal Society, 
June 20th, 1878), on a bacillus from sea-water, resembling bacillus anthracis in size and form, that 
by the continued subdivision and aggregation of the spores (or possibly by the emission of their 
contents), granular masses of considerable size are produced, the rupture of which by pressure 
diffuses over the field their component granules, every one of which seems capable when placed 
in a drop of sea-water of germinating into a rod. 
Figure 1. Spores which have escaped from the filaments. Figure2. Division of spores into four 
sporules. 3. Sporules forming a zoogloea. 4,5. Sporules developing into a rod, which at a divides 
into two fragments. 6. A rod undergoing segmentation, and the segments showing flagella. 7. 
Rods with corpuscles (vacuoles or nuclei ?). 8. A newly developed filament. 9. Filament in 
which the endoplasm has divided into somewhat long segments. 10. Further segmentation of a 
filament. 11. First appearance of spores as minute specks in the endoplasm near the ends of the 
segments. 12. Fully developed spores formed by contraction of the endoplasm. 13. Granular 
matter in spaces between spores, indicative of disintegration of filaments. 14. Almost complete 
disappearance of filament. 15. Filament from which spores have escaped. 16. Filament broken 
into short segments of which some still contain spores. 17. Filament Stillmore disintegrated, 
with one of the spores, a, in process of division. 19. Rods forming a zoogloea. 20. Rod under- 
going segmentation. 21. Rod lengthening into filament. 22 Filament containing spores becom- 
ing granular at one end, with transverse lines between spores. 23. Spore-bearing filaments form- 
ingrope-work. 24. Part of filament containing a spore in process of division. 25. Difterent 
stages of development of spores into rods. 26. Short filaments containing spores. 
LIFE HISTORY OF SCHIZOMYCETES. 
The whole of the group of bacteria, bacilli, vibriones and spirilla (schizomycetes) so far as is 
yet known multiply either by transverse cell division, or by the breaking up of their endoplasm 
into spores, the production of which is entirely non-sexual. Nothing like conjugation, or any 
other form of sexual generation, has yet been witnessed in any of them; and until such shall 
have been discovered no confidence can be felt that we know the entire life history of any one 
type. It is a fact of great importance in the physiology of the schizomycetes, that in certain 
stages of their lives they can resist very high (115° to 248° F ) and very low (0° Fahrenheit) degrees of 
temperature, and also the action of many poisonous and destructive agents in highly concentrated 
solutions. When these facts are allowed their due weight, no difficulty is felt in admitting the 
action of bacteria in producing decomposition under conditions wh ich migh t at first view be fairly 
supposed to preclude the possibility of their presence. This action is analogous to that of the 
yeast-plant to produce saccharine fermentation. The experiments of Pasteur appear to estab- 
lish that-1. Putrefactive fermentation does nottake place even in liquids which are peculiarly 
disposed to pass into it, except in the presence of bacteria germs. 2. Neither bacteria germs, 
norany others, arise in such liquids de novo, but are all conveyed into them by the air, when not 
otherwise introduced. 
RELATIONS OF SCHIZOMYCETES TO DISEASES. 
Strong evidence in favor of the excitement of specific diseases by different species of schizo 
mycetes (bacterium, bacillus, etc.), is afforded by the facts now accumulated in regard to the 
transmission of special forms of disease by inoculation in some instances with bacillus germs, 
and in others with very minute germinal particles termed microzymes, whose nature is still 
unknown. Thus splenic fever is producible by the inoculation of bacillus anthracis, and the 
typhoid fever of the pig by inoculation with another species of bacillus; the plants having been 
in both cases cultivated so as to be free from contaminating matter. The dried blood of horses 
that bad died in India of " loodiana fever," having been sent to the Brown Institution, a crop of 
bacillus anthracis was grown from it, which reproduced the disease in healthy animals. It was 
also discovered at the same institution that the " brewers' " grains, largely used as food for cattle,, 
afford a soil which is peculiarly favorable for the growth and development of the spore-filaments 
of bacillus; and thus an explanation was given of an epidemic of anthrax in a previously unin- 
fected district, destroying a large number of animals, all of which had been fed with grain, 
obtained from a particular brewery. 
It has been ascertained by careful microscopical examination of the fluid of the vaccine 
vesicle, that it is charged with a multitude of minute granules not above 1-20,000th of an inch in 
diameter; and it has been demonstrated that these, rather than the fluid in which they are sus- 
pended, are the active agents in the production of a similar vesicle in the skin in which they are 
inserted. 'This vesicle must contain hundreds or thousands of " mycrozymes," for everyone 
originally introduced; and it is obvious that their multiplication has so strong an analogy to that 
of bacteria, as to suggest the idea that it must take place by a like process of cell-development. 
Similar observations have been made upon glanders, sheep-pox and cattle-plague, so that an 
animal suffering under either of these terrible diseases, is a locus of infection to others, for pre- 
cisely the same reason that a tub of fermenting beer is capable of propagating its fermentation 
to fresh wort.* A most notable instance of such propagation is afforded by the propagation of 
the disease termed " pebrine " among the silkworms of the south of France; the mortality caused 
by it being estimated to produce a money loss of from three to four millions sterling annually,, 
for some years following 1853, when it first broke out with violence. It has been shown by micro- 
scopic investigation that, in silkworms strongly affected with this disease, every tissueand organ 
in thebody is swarming with minute cylindrical corpuscles about l-6000th of an inch long; and 
that these even pass into the undeveloped eggs of the female moth, so that the disease is heredi- 
tarily transmitted. And it has been further ascertained by the researches of Pasteur, that these 
corpuscles are the active agents in the production of the disease which is engendered in healthy 
silkworms by their reception into their bodies; whilst if due precautions be taken against their 
transmission, the malady may be completely exterminated. 
* See Prof. Burdon Sanderson "On the Intimate Pathology of Contagion, in the Privy Coun- 
cil ' Report on thePublic Health, for 1870.' " The Microscope and its revelations, by William B. 
Carpenter, C. B., M. D., LL. D., etc.,- 6th ed. London, 1881, pp. 367-375. Bacteria. 
401 
BACTERIUM (MICROBACTERIUM). 
Bacterium designates a class of minute schizomycetes, slightly elongated and 
oval, or short and cylindrical with rounded edges. Bacteria divide by fission, like 
the micrococci, the individuals elongating and becoming constricted in the middle; 
they are capable of spontaneous locomotion, being possessed of a flagellum at 
one or both ends, with which they perform active spinning or darting movements; 
they are also found as dumb-bells when in the act of dividing, and then appear 
as rods constricted in the middle; occasionally, after rapid division, several 
remain connected, forming a short chain, the terminal elements being flagellate. 
Bacteria, like micrococci, are capable of forming zoogloea, the interstitial gelati- 
nous substance being as a rule more copious than in the zoogloea of micrococci; in 
this state they form pellicles, in which the elements are without flagella; but from 
the margin of the pellicle elements continually separate, becoming flagellate and 
moving away. In some species the zoogloea is dendritically ramified (zooglwa ram- 
igera), as seen on the surface of fluids containing decomposing alg;e. 
SEPTIC BACTERIA. 
Bacterium termo. Elements short and cylindrical, about 0.0015 millimetres 
long, a third less in breadth, and appear generally as dumb-bells; common in 
putrefying fluids, being the true saprogenous ferment; invested in a thick mem- 
brane, and are flagellate; with the end of putrefaction they disappear. Found in 
unflltered water, whether in the natural state or distilled. A drop of unfiltered 
distilleu water is sufficient to start a copious growth of bacterium termo in pork 
broth, Agar-Agar, etc. 
Bacterium lineola: differs from bacterium termo in being thicker and longer; 
the cells are about 0.003 to 0.005 millimetres long, about 0.0015 millimetres thick. 
They occur in well water and stagnant water, where no distinct putrefaction is 
going on, and form zoogloea, and pellicles on the surface of potatoes and various 
infusions. 
Bacterium lactis: 0.0015 to 0.003 millimetres long, constricted in the centre; 
form short chains or even zoogloea, and are motile; they produce the lactic acid 
fermentation, transforming lactic sugar into lactic acid. 
Bacterium Aceti (mycoderma aceti): smaller than bacterium lactis, being 
about 0.0015 millimetres in length ; motile; often forms chains and also pellicles 
on the surface of the fluid ; Pasteur maintains that it is the ferment of the acetic 
acid fermentation. 
ZYMOGENIC BACTERIA. 
Bacterium xanthinum: about 0.007 to 0.01 millimetres long; motile; single; 
also in dumb-bells or short chains; it produces the yellow color of yellow milk ; 
its pigment is soluble in water and insoluble in alcohol or ether. When intro- 
duced into boiled milk of neutral reaction, it multiplies with great rapidity; the 
milk coagulates after twenty-four hours ; it is soon teeming with them and turns 
yellow ; the reaction is at first acid, but soon becomes alkaline, and the alkalinity 
of the yellow milk grdually increases. 
Bacterium Aeruginosum. Discovered by Schroeter in green pus. The pigment 
is greenish and not lodged in the cells themselves ; it is easily diffusible. 
PIGMENT BACTERIA. 
PATHOGENIC BACTERIA. 
Bacterium Septicwmice. Rods somewhat pointed at both ends, measuring 
about 0.0014 millimetres in length : when stained they show at each end a deeply 
tinted granule, the middle part remaining unstained; for this reason they are 
easily mistaken for a diplococcus. Generally, these rods occur singly; occasion- 
ally, they form a chain, of two or more than three. Koch produced a rapidly fatal 
septicaemia, injecting into rabbits the water from putrid mutton: the blood of all the 
organs contained very numerous bacteria; the spleen and lymphatic glands were 
enlarged, and the lungs congested. But there were no extravasations and no 
peritonitis. The smallest quantity of this blood inoculated into the skin or cornea of 
another rabbit produced after an incubation of ten to twelve hours distinct rise of 
temperature and death after sixteen to twenty hours. The conditions after death 402 
Bacilli. 
were the same as those described; everywhere the blood contained the bacteria. 
They have been cultivated successfully in beef broth, blood serum, gelatine and a 
mixture of gelatine and broth and peptone: the cultures have the same virulent 
properties as the original blood. Klein suggests that the microbe found by Pasteur 
in human saliva, which he cultivated and with which he produced septicaemia in 
rabbits, may perhaps be a bacterium identical with the above. 
Bacterium of Davaine's Septiccemia. Originally derived by Davaine from putrid 
ox-blood in the warm season, injected into rabbits it produces rapidly fatal septicaemia 
of the same nature as in the preceding case: the blood teeming with a similar kind 
of bacterium as in Koch's septicaemia. The smallest quantity of the blood is 
again rapidly fatal in its action. When such blood is sterilized it has no longer 
any infective power. Blood of animals dead of this form of septicaemia bears an 
enormous amount of dilution, without the minutest quantity losing its pathogenic 
properties : this is easily explained by the enormous number of bacteria present in 
every drop of the blood. There is, however, no increase in the virulence of the 
virus when it is passed through successive animals. 
BACILLUS (DESMOBACTERIUM). 
Bacilli are cylindrical or rod-shaped bacteria, which are rounded or square cut 
at their extremities; they are longer in proportion to their thickness than bac- 
terium termo, and divide by fission, forming straight, curved, or zigzag chains of 
two, four, six or more elements. Many species of bacilli, in suitable nourishing 
materials grow by repeated division into longer or shorter chains of bacillus-fila- 
ments, or leptothrix; these appear straight, or wavy and twisted, isolated or in 
bundles, and although in the fresh condition they appear of a homogeneous aspect, 
when suitably prepared, as by drying and staining with aniline dyes, they show 
themselves composed of shorter or longer cubical, cylindrical, or rod-shaped proto- 
plasmic elements, contained in linear series, without the general hyaline sheath; 
between many of the elements is a fine transverse septum. The isolated bacilli are 
likewise composed of a membrane and protoplasmic contents. These latter appear 
homogeneous, or finely granular, and when stained with aniline absorb the dye 
very easily and retain it better and longer than the membrane. According to the 
stage and rapidity of their growth the bacilli vary much in length ; this is the case 
not only with the single bacilli and short chains, but also in an eminent degree with 
the elements of a bacillus-filament, or leptothrix. In each case it is possible to 
ascertain that all lengths occur from the cubical or spherical element to the cylinder 
or rod: the former elongate into the latter and then divide. According to whether 
division occurs in a short or long element, the daughter-elements are cubical or 
spherical in the former, cylindrical or rod shaped in the latter case. This applies 
to the single bacilli, the short chains and to the leptothrix forms. There are a 
great many species of bacilli differing from each other in the shape of these ele- 
ments, in motility and in the power of forming filaments or leptothrix, and par- 
ticularly in the thickness and length of the elements. Bacilli possessed of a flagel- 
lum are capable of forming zoogloea. In those species in which the bacilli are 
capable of forming leptothrix the filaments may form dense convolutions, when in 
these convoluted filaments spores are formed, and the sheaths of the filaments, 
swell up and become agglutinated into a hyaline jelly-like substance, the spores 
appear to form a sort of zooglcea. 
One of the most striking phenomena in the growth of bacilli is their power of 
forming spores. These are generally oval when fully developed, spherical when 
immature; they are always of a bright glistening appearance, and take dyes either 
with difficulty or not at all; they are generally a little thicker than the bacilli 
within which they have developed. The formation of the spores takes place thus: 
in one or other elementary cubical, spherical or rod-like mass of protoplasm there 
appears a bright dot; this enlarges at the expense of the protoplasm until in its. 
fully developed state it has an oval shape, the whole of the protoplasm of an ele- 
ment is not consumed in this process, a small trace always remaining around at 
one or both ends. The sheath enlarges and the bacillus looks much thickened; 
then the sheath breaks and the spore with the remains of protoplasm becomes 
free. Soon this remnant disappears, if it had not disappeared while the spore was 
still contained within the sheath, and the spore becomes free. Under the most 
favorable circumstances a spore may be formed in each elementary mass of proto- 
plasm, or it may be only in a small number. In the first case a consecutive series 
of spores is present in the bacilli; two spores if the bacillus is composed of two 
elementary cells, four in a chain of four elementary cells, or a vast number in a Bacilli. 
403 
leptothrix. In the second case, a bacillus composed of two or four elementary 
cells, may contain only one spore at one end, or in the middle, or one at each end, 
or two together in the middle; in the leptothrix spores are seen only at com- 
paratively long intervals. The position of the spore in the bacillus is generally 
so that the long axis of the spore is parallel to that of the bacillus; but excep- 
tionally it may be placed obliquely or even transversely. The bacilli in which 
spore formation has set in are always much thicker, twice or more, than those in 
which no spore formation has occurred; the sheath swells up and remains for 
some time as a hyaline gelatinous capsule around the spore, but sooner or later 
this is also lost and the space becomes quite free. When spore-formation has 
taken place in a convolution or in a mass of leptothrix, and after the sheath of the 
bacilli has become swollen up into a gelatinous matrix, it looks as if we had a 
zoogloea, in which the bright oval spores form the particular elements embedded 
in a more or less hyaline gelatinous matrix. But even in these cases on careful 
analysis it is noticed that the spores have a linear or serial arrangement, being 
originally developed in filaments. 
This spore-formation occurs in all species of bacilli, and it closes the cycle of 
the life-history.of the bacilli; but it does not take place under all circumstances; 
in the case of many bacilli, spore-formation only occurs when there is an ample 
supply of oxygen. This spore-formation is not due to the exhaustion of the nour- 
ishing material; for if the conditions of spore-formation are given, amongst them 
particularly the exposure to the air, bacilli will commence to form spores long 
before the nourishing material is exhausted, as has been clearly shown by Klein. 
It is a rule that when the spores are formed they germinate into bacilli, if they 
have access to a nourishing material; but if not, or if the nourishing material is 
exhausted, they remain as spores. The spores represent the seeds capable of 
retaining life and of germinating into bacilli, even after what would appear the 
most damaging influences (that is, damaging to all other kinds of organisms and 
to the bacilli themselves, such as long lapse of time, drying, heat, cold, chemical 
agents, etc.) Spores retain the power to germinate into bacilli after the lapse of 
long periods, and there is no reason to assume that these periods have any limit. 
It makes no difference whether they are kept dry or in the mother liquid. The 
temperature of boiling water, while it kills micrococci, bacteria and bacilli them- 
selves, does not affect the vitality of the spores; freezing does not kill the spores ; 
that is, within limited periods of time. 
Antiseptics, such as carbolic acid (5-10 per cent.), strong solutions of phenyl- 
propionic acid and phenyl-acetic acid and corrosive sublimate (1:300,000), although 
the spores were kept in these fluids for twenty-four hours, did not kill them. 
Pure terebene, phenol (10 per cent.), corrosive sublimate (1 per cent.) does not 
kill the spores of bacillus anthracis. This great resistance of spores to low and 
high temperature, to acids and other substances, is due to the fact that the sub- 
stance of each spore is enveloped in a double sheath ; an internal sheath, probably 
of a fatty nature, and an external one, probably of cellulose; both are very bad 
conductors of heat. Owing to the fact that spores resist the action of boiling water 
if not prolonged for ten minutes, and that the other bacteria (such as micrococcus, 
bacterium and bacillus itself), are killed by the temperature of boiling water if 
kept at this temperature for a few seconds, it is possible to separate the spores of 
bacilli from the other organisms. 
In the germination of spores, which commences in a few hours after their 
introduction into the nourishing liquid, the spore increases in thickness, it then 
loses its dark contour at one pole or at one of the long sides, and at this point a 
pale projection appears. This projection increases in length, and gradually 
becomes as long as a bacillus, the investment of the spore gradually fading away. 
This new bacillus soon divides into two, and so on. The spores are capable of 
germinating independently of the free access of air. 
Bacillus Subtilis {Hay Bacillus'}.-The elementary rods are of various lengths, 
from 0.002 to 0.006 millimetres, and are about 0.002 millimetres in thickness. The 
bacilli are capable of forming leptothrix filament; when single they are possessed 
of one flagellum, or sometimes two, one at each end. After division the individual 
bacilli remain connected, each possessing a flagellum at the free end. Each of 
these again divides into four, so that a chain of four is formed of which the end 
members possess a flagellum. But they may separate again, or may go on dividing, 
remaining united, and thus forming a longer or shorter filament. Spore formation 
BACILLUS. NON-PATHOGENIC FORMS. 404 
Bacilli. 
is independent of any deficiency of nourishing material. The spores are oval, of 
about 0.001 to 0.002 millimetres in length, and about 0.0006 to 0.001 millimetres in 
thickness. They do not stain in dyes, and hence form a good contrast to the bacilli. 
This bacillus is very common and widely distributed: it occurs in almost every 
organic substance rich in nitrogenous compounds, which is left exposed to the air 
to decompose. The spores of the hay bacillus are widely distributed in the air, 
and most contaminations by air are due to its spores. 
Bacillus Ulna.-Cohn designates by this name certain species of bacilli, stiffer 
and thicker than those of bacillus subtilis; the individual elements are about 0.01 
millimetres long and 0.002 millimetres thick; motile like bacillus subtilis; they 
form chains, but do not form proper leptothrix. They occur in putrid fluid. 
They are very common in the ichor, produced by injecting ammonia or other sub- 
stances producing sloughing and necrosis in the subcutaneous tissues of the guinea- 
pig- 
Bacillus Septicus occurs in earth, in putrid blood, and in many putrid albu- 
minous fluids; non-motile; is capable of forming leptothrix; thickness varies from 
0.004 to 0.01 millimetres, and its length depends upon the number of elements con- 
tained in a row, the shortest are about 0.004 millimetres. Th'ere are various species 
differing from each other in the thickness of the elements. They are all anaerobic. 
The elements, whether in the short rods or in the leptothrix filaments are cubical 
or rounded. It forms spores independently of free access of air. The spores are 
oval and differ in thickness according to the thickness of the bacilli they are 
found in. 
Bacillus septicus is found occasionally in the blood-vessels of man and animals 
after death. In a nourishing fluid in which micrococcus, bacterium termo, or bacil- 
lus subtilis grows, they have no chance of growing, and even when numerous at 
first, they soon disappear. 
STREPTOTHRIX AND CLADOTHRIX. 
Cohn found in a concretion of the human lacrimal canals, long pale smooth 
apparently branched threads, either straight or twisted ; they were finer than the 
threads of leptothrix buccalis; he called them Strepttolhrix Foersteri. Klein regards 
them as identical morphologically with eladothrix dichotoma. This latter occurs 
in pond-water containing decomposing organic matter. It consists of long white- 
ish threads fixed on chlorophyll containing algre. The threads when fresh appear 
smooth, pale, occasionally granular, and on staining they are seen to be composed of 
shorter or longer bacilli, like the leptothrix form of bacillus subtilis, but they are 
thicker than the bacillus subtilis. 
Bacillus Amylobacter, has the same morphological character as regards 
length and thickness of the rods, as regards power to form leptothrix, and as regards 
motility, as the bacillus subtilis. It is capable of forming zoogloea and is anaerobic, 
since it grows well and forms spores copious even when not exposed to the air. 
In solutions of starch, dextrin, and sugar this bacillus forms butyric acid. The 
fermentation of butyric acid in old milk and in ripening cheese is due to this 
bacillus. Cellulose is decomposed by it, and hence its great importance in the 
digestive process of herbivorous animals, in whose stomach and intestines it is 
very common. It is very common also in substances containing starch. 
ZYMOGENIC BACILLI. 
PIGMENT BACILLI. 
Bacillus ruber; minute rods, isolated or in twos and fours, and motile; its color 
is red and contained in the bacilli themselves-found in boiled rice by Frank. 
Bacillus erythrosporus-motile, isolated rods and leptothrix ; found in meat 
extract solutions and on decomposing albumen, and forms pellicles. In the rods 
are found oval spores. 
Bacillus syncyanus, causes the blue color in milk after the milk has become 
acid, and grows well in ammonium lactate. It consists of motile rods single or in 
short chains. 
PATHOGENIC BACILLI. 
Bacillus of Septiccemia of Mice. Koch found that by injecting ordinary house 
mice with minute quantities of putrid fluids, occasionaly one of these animals Bacilli. 
405 
showed signs of,conjunctivitis and sopor, and finally death followed in from forty 
to sixty hours. In these cases slight oedema is found at the seat of inoculation; 
the spleen is large; in the oedematous tissue and in the blood-vessels large and 
small, numbers of minute bacilli are found chiefly contained in the white blood- 
corpuscles, but also free. They are very minute about 0.0008 to 0.001 millimetres 
long, 0.0001 to 0.0002 thick, isolated or in couples, or in chains of four or more. 
BACILLI OF SEPTICAEMIA OF MAN. 
In several cases of human septicaemia Klein has found in the blood-vessels of 
the swollen lymphatic glands large numbers of minute bacilli, slightly thicker than 
those just mentioned. They form continuous masses, both in the capillaries and in 
the minute veins, amounting in some cases to veritable emboli. Klein describes 
them as occurring isolated or in short chains, their length about 0.001 to 0.0025 
millimetres, their thickness about 0.0003 to 0.0005 millimetres (see Figure A, 
Engraving No. 62). Arloing and Chauveau, found in gangrenous septicaemia 
around wounds short bacilli, some containing one or two spores which they con- 
sider as the triie cause of the gangrene. 
Klebs described in the inflamed Peyer's glands, in the mesenteric glands, 
larynx and lungs of patients dead of typhoid fever, certain bacilli, which are about 
0.0002 millimetres thick and of various lengths, forming filaments up to 0.05 milli- 
metres long. These bacilli form spores. Eberth found in about 50 per cent, of 
cases of patients dead of typhoid fever, in the mesenteric glands and spleen, pecu- 
liar short bacilli, rounded at their ends and occasionally slightly constricted in 
the middle, some of them containing spores. These bacilli stain very freely with 
methyl-violet. See Engraving62, B. The bowels in typhoid fever always contain 
innumerable masses of micrococci in colonies ; and these micrococci are found not 
only in the tissue of the intestinal mucous membrane, but also in the mesenteric 
glands and spleen. Before the publication of Eberth's first paper, Koch had 
observed the typhoid bacillus in sections made from thespleen and liver of typhoid 
cases, and had made photomicrographs from these sections. The name of Koch 
has therefore been associated by some writers with that of Eberth as one of the 
observers of the typhoid bacillus. The characters which serve to distinguish 
this bacillus are given by Eisenberg, as follows : Morphology . Bacilli, three times 
as long as broad, with rounded ends, may grow to long threads, and are also 
found as very short rods : are motile and probably possess flagella; take the analine 
colors less intensely than most similar organisms. Growth- Upon Gelatine Plates: 
superficial, grayish, white, colonies with serrated margins; under a low power 
they resemble glass wool and have a brownish lustre. Stock culture in gelatine: 
growth for the most part, superficial in the form of a grayish-white layer with 
serrated margins; but little growth along the track of the needle. Upon agar-agar: 
superficial growth of whitish color. Upon potato: invisible growth along the 
track of the needle; after forty-eight hours the pieces of potato have a moist appear- 
ance : when the surface is disturbed with a platinum needle, one receives the 
impression that it is covered with a cohering film; under the microscope this is 
found to consist of large spore-bearing threads of typhus-bacilli. Upon blood serum: 
grows only along the track of the needle as a milk white layer ; grows slowly. 
Spore formation : at 32° to 40° C., spores are formed in the course of three or four 
days; these are located at the ends of the rods: at 20° G. spores are formed after a 
longer period : at lower temperature than this, spores are no longer formed. The 
peculiar growth on potato, first pointed out by Gatfky, is the most diagnostic of all 
the characters given ; and seems to distinguish the typhoid bacillus from similar 
organisms, which in their morphology and growth on gelatine or upon agar-agar 
closely resemble it. The rounded ends of the rods as first pointed out by Eberth are 
by no means peculiar to the typhoid bacillus: they vary greatly in length, and 
whilst the prevailing form is that of a short rod three or four times as long as broad, 
filaments of considerable length are developed in cultures made in gelatine or upon 
potatoes. The researches of Koch, Klebs, Eberth, W. Meyer and Gatfky strongly 
support the view that this bacillus bears a casual relation to typhoid fever. Frankel 
and Simmonds have recently demonstrated that the bacilli multiply in thespleen 
after death, and that numerous colonies may be formed in portions of this organ 
kept from twenty-four to forty-eight hours after death : and these authors confirm 
the assertion of Gaftky as to the presence of the bacillus after death in the spleen. 
BACILLUS OF TYPHOID FEVER OF MAN. 406 
Micro-Organisms of Typhoid Fever. 
Bacillus of Choleraic Diarrhoea from meat poisoning.-In J uly, 1880, there 
occurred in Welbeck, Notts, an extensive outbreak of diarrhoea among some 
seventy-two persons who had partaken of beef and ham sandwiches sold at Wel- 
beck on the occasion of a sale of timber and machinery on the estate of the Duke of 
Portland, The infection showed itself after an incubation period varying from 
twelve hours or less to forty-eight hours or more. The first symptoms were a sud- 
den feeling of languor, nausea, griping in the abdomen, in some cases giddiness 
and fainting and pain in the trunk. Then followed pain in the abdomen, diar- 
rhoea and vomiting, the diarrhoea being most consta t. Four cases ended fatally. 
Co post-mortem examination enteritis and pneumonia were most prominent. Part 
of the kidney was examined in microscopic sections, and it was found that many 
of the tubuli uriniferi contained hyaline easts ; that the capillaries of theglorheruli 
of the malpighian corpuscles and the afferent arterioles contained numbers of 
bacilli, some of the capillaries being distended by, and plugged with masses of 
bacilli densely aggregated. (See figure 62, C and D.) 
In February, 1881, a similar but less extensive outbreak occurred at Nottingham, 
among fifteen persons that had partaken of certain baked pork. The symptoms 
were similar to those in the Welbeck outbreak. One case ended fatally. Post-mor- 
tem: Bloody exudation, in pericardium, intense pneumonia, mesenteric glands 
enlarged, enteritis, Peyer's glands enlarged. Bacilli similar to those of the above 
case were found in the pericardial exudation, in the juice, and in the bloody fluid 
filling the alveolar cavities of the inflamed lung, in the vessels of the kidneys, in the 
submucosa of the inflamed Peyer's glands of the small intestines, in the blood-vessels 
of the spleen and around them. The bacilli vary in length to between 0.003, and 
0.009 milimetres, their thickness is about 0.0013 millimetres. They are rounded at 
their extremities, single or in chains of tw'o, and some contain a bright, oval spore, 
situated in the centre or at one end, and about 0.001 millimetres thick. This was 
the case with the bacilli in the glomeruli of the kidney of the Welbeck case. The 
bacilli containing spores were thicker than those without them. Experiments with 
feeding and inoculating and cultivation of the diseased ham, Welbeck, and pork, 
Nottingham, resulted in the reproduction of similar symptoms in dogs, cats, rab- 
bits, guinea-pigs and mice, and similar pathological conditions after death and 
the appearance of the bacilli in the diseased textures and blood. In cultivating 
lung juice and blood from these cases, a crop of bacilli was produced which on 
inoculation was found very poisonous. The following illustrations present the 
characteristic appearance of the bacilli of septicaemia, typhoid fever and meat 
poisoning. 
ENGRAVING NO. 62. Micro-Organisms in Typhoid Fever. 
407 
Engraving No. 62.-A. From a section through a lymphatic gland of man dead of Septi- 
ceemia. I. A blood-vessel which at one place is distended by, and tilled with minute bacilli. 2. 
Lymph corpuscles. 3. Degenerated lymph corpuscles, magnifying power 700 diameters (stained 
with gentian violet.) B. From a section through the mesenteric gland of a person who died of 
typhoid fever. 1. Capillary blood-vessel filled with blood corpuscles. 2. Large lymph cell. 3. 
Nuclei. 4. The bacilli, magnifying po a er 700. C. From a section through the kidneys of a case 
that died after meat poisoning, at Welbeck. The figure represents part of a glomerulus of a 
malpighian corpuscle in which some of the capillary blood-vessels are filled with the bacilli. 
1. Capsule of malpighian corpuscle. 2. Capillaries filled with bacilli. 3. Capillaries empty. 
4. Bacilli contained between capillaries, magnifying power 700. D. Isolated bacilli in a small 
artery of the same kidney as in preceding figure. Same bacilli contain spores. Klein. 
ENGRAVING NO. 63. 
ENGRAVING NO. 65. 
ENGRAVING NO. 64. 
ENGRAVING NO. 66. 408 
Micro-Organisms of Typhoid Fever. 
Engraving No. 63.-Micro-organism from bile and intestinal canal, from case of fever observed 
by Joseph Jones, M. D., during the siege of < harleston, South Carolina, October 20th, 1863. See 
Chapter II, Case 826,152-157. 
Engraving No. 04.-Casts of tubuli uriniferi in urine of typhoid fever; also micrococci and 
bacilli. Confederate soldier, 1863, Army of Northern Virginia. Joseph Jones, M. D. See page 
158. This case to be reported in memoir relating to typhoid fever. 
Engraving No. 65.-Casts of tubuli urin feri in urine of typhoid fever; also micro-organisms,, 
micrococci and bacilli-confederate soldier, 1863, Army of Northern Virginia. Joseph Jonesr 
M. D. See page 158. This case to be reported in full in the memoir on typhoid fever. 
Engraving No. 66.-Illustrating the bacteria (micro-organisms) of typhoid fever. 
A. Vertical section of the intestine of typhoid fever, showing the border of the submucosa 
infiltrated by bacilli, Hartnack Immersion No. 9, ocular 2 (Klebs). 
B. Micro-organisms of typhoid fever, from a fresh section of typhoid intestine; treated with 
glacial acetic acid and glycerine mixture, Siebert's Im. No. 7, ocular 3 (Klebs). 
C. Section of a typhoid lung; fresh; treated with mixture of glycerine and glacial acetic acid.. 
Siebert's Im. No. 7, ocular 3 (Klebs). 
D. Typhoidbacil.i, from a lymphatic gland. Hartnack, No. 12 occular 3 (Eberth). This engra- 
ving, as well as the nature of the bacillus of typhoid fever, have been fully discussed in the 
second chapter of this work. See pp. 162-164. 
Bacillus of Malignant (Edema (Eoch) Vibrion Septique (Pasteur).-When a 
comparatively large quantity of earth or of putrid fluid is inoculated subcutane- 
ously into mice, rabbits and guinea-pigs, death occasionally results in from twenty- 
four to forty-eight hours, at the seat of the inoculation, and spreading from it into 
the subcutaneous tissue of adjacent parts there is much discoloration and occasion- 
ally haemorrhage; a putrid, offensively-smelling ichor fills the spaces of the subcu- 
taneous tissue, and in it are found large numbers of bacilli, some motile, others not. 
The lungs are hypenemic and have small haemorrhagic spots. The spleen is 
invariably enlarged and haemorrhagic spots are often noticed in the peritoneum of 
the abdominal organs, and there is some peritoneal exudation. The blood of the 
spleen, of the liver, lungs, intestines, the serous coating of the abdominal organs, 
and peritoneal exudation, contain the same bacilli as the subcutaneous exudation. 
Many of these include spores. By injecting the bacillus into the peritoneal cavity 
of guinea-pigs death is produced rapidly, especially after passing it through two gen- 
erations, the animals often die within sixteen hours. In all these instances a viscid 
transparent but spontaneously coagulable exudation, poor in white and red corpus- 
cles, is found in the peritoneal cavity, and the peritoneum of all parts is highly 
inflamed. Bacilli are present in it in enormous numbers, many of them contain- 
ing spores. The blood of the heart does not contain bacilli immediately after 
death, but has them some hours after. The bacilli are about 0.003 to 0.005 milli- 
metres long, and a little over 0.001 millimetre thick; they are rounded at the ends; 
they form chains of two and more; and these chains are straight or broken. They 
also form leptothrix, straight or more commonly curved. The bacilli have been 
artificially cultivated by Pasteur in blood-serum, and in neutral solution of Liebig's 
meat extract. The artificial culture is capable of producing the malignant oedema, 
but it is always necessary to inject more than minimal quantities. The bacilli 
grow in fluids outside and inside the body from spores without free supply of air, 
and are therefore anaerobic. In human faecal matter there are always present 
innumerable masses of bacteria-micrococci, single and in dumb-bells, and in 
clumps of zoogloea, bacterium termo, and various species of bacilli, varying in 
thickness, length and in motility, some being motile, others not. It has recently 
been stated that a bacillus can be cultivated from normal human faeces, which in 
many respects resembles the bacillus of malignant oedema; it produces death in 
mice, but without the symptoms of malignant oedema. 
Bacillus Anthracis. -Various observers have recognized in the blood of animals 
dead of malignant anthrax, the presence of stiff' short and long rods, which 
Davaine called the bactSridie du charbon. They were identified by Cohn as bacilli 
in morphological respects similar to bacillus subtilis, except that the bacillus anthra- 
cis are non-motile. Koch showed the universal distribution of these bacilli in the 
blood of the organs, and especially of the spleen; he cultivated these bacilli artifi- 
cially, taking a piece of spleen of a mouse and watching the growth of the bacilli 
microscopically, he determined that the rods multiply by division, and that they 
grow into long homogeneous-looking, straight or twisted filaments, in which, after 
some time and with free access of air, bright oval spores make their appearance, 
while the filaments become homogeneous and swollen. These spores become free, 
and when artificially cultivated or injected into a rodent animal germinate into 
the characteristic bacilli; these elongate and.divide, and in artificial cultures 
again grow into the long leptpthrix filaments, which again form spores. The ger- 
mination in culture fluids and in the incubator, commenced in three or four hours. 
The single bacilli as they present themselves in the blood, measure between 0.005 
and 0.02 millimetres in length, and from 0.001 to 0.0012 millimetres in diameter; Bacillus Anthracis. 
409 
they are truncated; the spores produced by growing the bacilli with free access of 
air, are about 0.001 millimetres thick and about 0.002 to 0.003 millimetres long; they 
are not stained by dyes, and differ herein from the bacilli. In the human subject, 
malignant anthrax occurs as Woolsorter's disease. All rodents and herbivorous- 
animals are susceptible to anthrax. Infection of animals can be produced by 
inoculating into the skin and subcutaneous tissue, intravascular injections, and by 
inhalation of spores. In Woolsorter's disease, the usual mode of infection is by 
inhalation of spores adhering to the wool of the fleeces of animals (sheep, goats) 
dead of anthrax. As in rodents affected with anthrax, so also in man, the blood- 
vessels of all organs contain the bacilli, and extravasations of the infected blood 
are frequent in many parts of the body. The presence of bacilli in the extrava- 
sations into the mucous membrane of the trachea and bronchi does not necessarily 
mean that these parts represent the points of entrance of the bacilli into the sys- 
tem. As a matter of fact, in every lung of mouse, rabbit or guinea-pig, dead after 
subcutaneous inoculation with anthrax, bacilli anthracis are found in the alveolar 
cavities, and in the smaller and larger bronchi Injestion of bacillus containing 
material is sometimes followed by anthrax, but in these cases abrasions in the 
mucous membrane of the mouth, pharynx, or gut, may have been the real place of 
entrance. Rodents inoculated with the bacillus of the'blood or spleen of an animal 
dead of anthrax, or with the bacillus or spores of an artificial culture die generally 
within forty-eight hours; in some instances in twenty-four to thirty hours, in 
other exceptional instances after forty-eight to sixty hours. The blood in all 
instances containing the bacilli, the spleen is large and full of bacilli, and so are 
the blood-vessels of most other organs, the exudations and the urine. Subcutane- 
ous inoculation or injection into the cutis of the minutest quantity of bacillus con- 
taining material, blood or artificial culture, invariably produces death. Subcu- 
taneous injections of bacillus containing material, almost always in the guinea-pig 
produce characteristic oedema, spreading sometimes over a large area. The oedo- 
matous fluid is clear and contains only a few bacilli. Any fluid containing proteid 
material is a suitable nutrient medium for the bacilli; they grow abundantly at all 
temperatures between 15° and 43° C., best between 2o°tand 40° C., they elongateand 
divide rapidly, and the bacilli grow into long curved and peculiarly twisted fila- 
ments which often form bundles, the individual filaments being twisted round one 
another like the strands of a cable. The bacillus anthracis grows best in neutral 
fluids, bwt to a limited extent also in acid and alkaline fluids, containing proteid 
material. When growing in neutral nourishing fluids it forms on the bottom of 
the fluid characteristic fluffy whitish masses which are convolutions of the char- 
acteristic filaments. These appear homogeneous in the fresh state, their ends being 
slightly thicker and rounded. Examined in preparations made after the Weigert- 
Koch method (drying of a thin layer, and staining it with analine dyes, washing 
in water, then in spirits, then again in distilled water, and then drying and mount- 
ing in Canada balsam solution), all the bacilli and their filaments are seen to be 
composed of a thin hyaline sheath, and in this is a row of cubical or rod-shaped 
masses of protoplasm, taking the dye very readily. According to the length of the 
bacilli the number of these elementary masses of protoplasm varies. Some of the 
rod-shaped elements appear constricted in the middle preparatory to division. 
Between each two elements is a fine septum. 
In the various experiments with the inoculation of the anthrax bacillus, the 
important fact has been established that by passing the bacilli through different 
species of animals, they become endowed with different qualities, and that bacilli 
which are fatal to some are not fatal to all animals. The value of the labors of 
Pasteur with the modification of the virulence of the anthrax bacillus by suc- 
cessive cultures, and the amount and length of protection afforded by his vaccina- 
tion, have not yet been fully demonstrated; we will, however, allude to this ques- 
tion more fully hereafter. From the various experiments the conclusion has been 
established that as regards virulence the bacilli anthracis differ in the different 
species of animals, and in them acquire different qualities. Bacillus anthracis is 
capable of growing well outside of the body of man and animals, and is also 
capable, when well supplied with oxygen from the air, of forming spores which 
represent the permanent seeds. Thus if animals, such as sheep and cattle, die of 
anthrax in a field, the bacilli of the effusions from such animals, as the urine, 
blood, effluvia from the mouth and nostrils, always contain numbers of the bacilli, 
and these will be able to grow indefinitely on tiie surface of the soil, there being 
always present a large amount of suitable nourishing material, like vegetable and 
animal decaying matter, and as free access of air is always ensured they will even- 
tually form spores. Such soils, owing to the presence of these spores, will remain 
a permanent source of infection to sheep and cattle sojourning on them. 410 
Bacillus Tuberculosis. 
Bacillus Tuberculosis (Koch).-In all cases of tuberculosis in man, cattle and 
monkeys, of tuberculosis artificially produced with inoculation of human or bovine 
tuberculous matter, in cats, guinea-pigs, rabbits and rats, and in spontaneous tuber- 
culosis in birds, Koch found in the fresh state, and particularly after staining with 
methylene-blue and vesuvin, peculiar fine bacilli, some with bright oval spores, 
some without, some smooth and homogeneous-looking, others more of a beaded 
appearance. One cubic centimetre of a concentrated alcoholic solution of methy- 
lene-blue is mixed with 200 cubic centimetres of distilled water; to this are added 
two cubic centimetres of a two percent, solution of caustic potash. In this solution 
the fresh or dried sections or particles of tubercles are kept for half an hour, if 
heated up to 40° C. or for twenty-four hours if not heated. 
After this the preparation is stained for two minutes in a filtered concentrated 
watery solution of vesuvin, then washed in distilled water. On examining with 
a l-12th oil immersion, and Abbfi's condenser, it will be found that all the elements 
are stained brown with vesuvin except the bacilli, which are blue. Other staining 
methods, similar to those of Ehrlich, or those of Weigert and Gibbes are equally 
efficacious. In all cases of human tuberculosis, particularly in the sputum, in 
caseating scrofulous glands, in bovine tubercles, in artificially induced tubercles 
and caseating glands of rodents, the tubercle bacilli have been shown to exist. 
The tuberculosis bacilli do not show any motility and often include spores; 
they are thus capable of forming spores within the body; owing to these spores, 
human phthisical sputum retains its virulence even after drying for considerable 
periods. Koch cultivated the bacilli artificially, that is, outside the body, and by 
carrying on the cultivation for several successive transmissions, succeeded in isolat- 
ing, and clearing them from the tuberculous tissue ; and the results of his experi- 
ments go to show that these pure bacilli, no matter how many times they have 
been transferred, no matter how far removed from their original breeding ground, 
always produce the characteristic disease when inoculated into suitable animals. 
The cultivation succeeded equally with material derived from human tubercles, 
from bovine tubercles, and from the artificially induced tuberculosis of guinea-pigs. 
The bacilli grow well at a temperature varying between 37° and 39° C. Owing to 
the fact that the tubercle bacilli require for their growth high temperatures (38-40° 
C.) it is evident that, unlike some other pathogenic organisms they do not thrive in 
the outside world in temperate climates. Inoculations of the tuberculosis bacillus 
and its cultures, into the subcutaneous tissue, peritoneal or pleural cavity of 
guinea-pigs and rabbits produces after three, four or more weeks, the typical 
lesions characteristic of artificial tuberculosis, namely, swollen lymphatic glands, 
near the seat of inoculation, with subsequent caseation and ulceration; enlargement 
of the spleen due to numerous whitish tubercles, the larger ones caseous; enlarge- 
ment of the liver, which is mottled by the presence of uniformly distributed 
whitish points and streaks, which bye and bye become confluent and caseous; 
tuberculosis of the peritoneum; isolated tubercles in the lungs, at first grey and 
transparent, then caseating in the centre; enlargement and subsequent caseation 
of the bronchial glands. Inoculation with the pure bacilli into the anterior chamber 
of the eye of rabbits and guinea-pigs produces the characteristic tuberculosis des- 
cribed by Conheim and Solomonsen. After an incubation of from two to three weeks 
there appears on the iris a crop of minute gray tubercles enlarging and undergoing 
caseous degeneration. Later on general tuberculosis of the eyeball and other organs 
follows. So that Conheim's assertion that only tuberculous matter implanted into 
the anterior chamber of the eye can produce the outbreak of a crop of tubercles on 
the iris is by Koch's observations strengthened in the highest degree; the tubercle 
bacilli present in, and characteristic of, true tubercles are thus manifestly con- 
nected with the real cause of their morbid growth. The following engravings 
will illustrate the appearance of the bacillus tuberculosis in human tuberculous 
sputum, in the human lung in acute miliary tuberculosis, and in section of the 
kidney of a rabbit dead of artificial tuberculosis. 
A large number of competent observers have fully verified Koch's statement 
that the tubercle-bacilli are specific and different from other bacilli except those of 
leprosy, as regards their chemical nature ; and that whenever they are present in the 
sputum, we have to deal with real tuberculosis, when after repeated examinations 
they are found to be absent, there is no tuberculosis. 
The other equally important part of Koch's discovery, namely, the a rtificial 
cultivation of the tubercle-bacilli, and the production with them of tube rculosis, 
has also been verified by Weichselbaum, who also ascertained that in acute tuber- 
culosis of man the blood contains the bacilli. Mr. Watson Ch eyne, has shown by 
.a series of observations that the organs of rabbitsand guinea-pigs suffering from ENGRAVING NO. 67. 
411 
Engraving No. 67.-A. From a preparation of human tuberculous sputum, stained after the 
Ehrlich-Weigert method. The nuclei are stained blue, the tubercle bacilli pink; magnifying 
power 700. B. From a section through a tubercle of the lung, from a case of acute miliary 
tuberculosis in a child, several alveoli are seen filled with debris; in the centre of this are 
numerous nuclei and amongst them the tubercle-bacilli; magnifying power, about350. 
ENGRAVING NO. 68. 
Engraving No, 68-A. From a section through the kidney of a rabbit dead of artificial 
tuberculosis, a. Blood-vessel filled with caseous matter, and in it numerous tubercle-bacilli, 
b. Nuclei of cells of tuberculous new growth, c. Capillary vessels in cross-section, magnifying 
power, 700. 
B. From the same kidney as in preceding figure, a. Large artery filled with caseous mat- 
ter, and in it numerous tubercle-bacilli, b Coat of artery, c. Nuclei of the tuberculous new 
growth, d. A malpighian corpuscle, magnifying power, about 500. 412 
Comma-Bacillus of Asiatic Cholera. 
the tuberculosis induced by Toussaint's cultivations from the blood of tuberculous 
animals, which cultivations Toussaint considered to be those of micrococci, turned 
outon careful microscopical examination and suitable staining, to contain the typi- 
cal tubercle-bacilli; that inoculation with cultures of Toussaint's pure micrococci 
not containing any tubercle-bacilli did not produce tuberculosis in animals ; that 
Koch's assertions as regards the constant occurrence of the tubercle-bacilli in the 
tubercles of animals artificially tuberculized are quite correct: that material 
other than tuberculosis, does not produce tuberculosis, that is to say that the cases 
of artificial tuberculosis in guinea-pigs observed by Wilson Fox and Burdon 
Sanderson, and iu the older experiments of Cohnheimand Fraenkel, namely, those 
in which chronic inflammation and caseation (artificial tuberculosis) was thought 
to have been induced by other than tuberculous matter, by non-tuberculous caseous 
matter, setons, indifferent substances like bits of gutta-percha inserted into the 
peritoneal cavity, were really due to accidental contamination with tuberculous 
material. 
Bacillus Leprae. Armauer Hansen, first ascertained the existence of large num- 
bers of minute bacilli in the peculiar large leprosy cells of Virchow which occur in 
the nodules of leprous patients. Neisser confirmed the observations of Hansen, and 
extended our knowledge of the bacilli of true leprosy, showing that they can be 
readily stained pink with fuchsin or with Ehrlich's acid solution of eosin-haema- 
toxylin. The bacilli are fine rods about 0.004 to 0.006 millimetres long, and less 
than 0.001 millimetre thick. They are pointed at their ends, and always occur in 
masses within the large leprosy-cells of the leprous tubercles of the skin and inter- 
nal organs. But they are also present in the interstitial tissue of the nervous 
branches, in the anaesthetic variety of the disease. Some bacilli are motile, others 
are not; some possess bright oval spores, and others are more or less beaded, 
owing to local collections of protoplasm within their sheath. Neisser and Armauer 
Hansen have cultivated them artificially in blood-serum, and in solutions of meat- 
extract. Neisser has also shown that the characteristic leprosy-cells are only wan- 
dering cells modified by the growth and multiplication in them of the bacilli. In 
the blood the bacilli do not occur, but they spread probably only by way of the 
lymphatics. 
The Bacillus Leprae will be illustrated by the following engraving (Engraving 
No. 69), and accompanying explanations. 
ENGRAVING NO. 69. Comma-Bacillus of Asiatic Cholera. 
413 
Engraving No. 69.-Bacillus Lepra.-Armauer Hansen (Virchow's Archiv., Vol. Ixxix, and 
Quart. Journ. of Micro. Sci., 1880) first ascertained the existence of large numbers of minute 
bacilli in the peculiar large leprosy cells of Virchow, which occur in the nodules of leprous pati- 
ents. Neisser confirmed this, and considerably extended oui- knowledge of the bacilli, showing 
that they can be readily stained pink with fuchsin or with Ehrlich's acid solution of eosin- 
hsematoxylin. A. From a section through the larynx of a patient dead of leprosy. Huge cells 
in fibrous connective tissue; the cells are filled with the leprosy bacilli. Magnifying power 600. 
{Stained with magenta and vesuvin.) 
B. Bacilli of the same preparation as in preceding figure, more highly magnified, 1000. 
C. Cells of the leprosy nodules of man, filled with the leprosy bacilli after Neisser. 
D. Two cells of the leprosy nodules in the liver of a bird (Rhea). The cell substanceis 
crowded with minute bacilli, similar to leprosy bacilli. Magnifying power 700 (stained with 
magenta). 
The bacilli of Oriental leprosy (elephantiasis gracorum) are fine rods about 0.004 to 0.006 milli- 
metres long, and less than 0.001 millimetre thick. They are pointed at their ends, and always 
occur in masses within the large leprosy cells of the leprous tubercles of the skin and internal 
organs. But they are also present in the interstitial tissue of the nervous branches in the anaes- 
thetic variety of this disease (Cornil Union Medicale, 1881, Nos. 178,179. Babes, Archives de Physi- 
ologic, July, 1883). Some bacilli are motile, others are not; some possess bright oval spores, and 
others are more or less beaded owing to local collections of the protoplasm within their sheath. 
Neisser and Armauer Hansen have cultivated them artificially in blood serum, and in solutions 
of meat extract. Neisser has also shown that the characteristic leprosy cells are only wander- 
ing cells modified by the growth and multiplication in them of the bacilli. In the blood the 
bacilli do not occur, but they spread probably only by way of the lymphatics. Inoculation 
experiments in domestic animals and monkeys have hitherto failed (Kobner, Virchow's Archiv., 
Vol. Ixxxviii; Hansen, ibidem. Vol. xc). 
Damsch (Virchow's Archiv., Vol. xcii), maintains, however, that he was able by inoculation 
with leprous tissue into the peritoneal cavity and into the skin, to produce in cats a distinct 
increase and sprouting of the bacilli. Preparations of leprous nodules of the larynx and skin 
made by Mr. A.I.ingard, and stained with Weigert's solution of magenta and vesuvin, showed 
the leprosy bacilli completely filling all the cells, small and large, spherical and spindle-shaped, 
contained between the connective tissue bundles. 
In a section through the liver of a bird (Rhea) that died in the Zoological Gardens in London, 
prepared by Dr. Gibbes after the method of staining for tubercle-bacilli; there were seen innu- 
merable aggregations of large and small pink masses (visible to the naked eye as dots of the 
size of a pin's point to that of a pin's head or millet seed and larger). Under the microscope the 
pink masses were seen to be composed of cells of various sizes, each filled with an enormous 
number of what appeared under a high power very short bacilli, much shorter than tuber- 
cle-bacilli. But they gave the same reaction as tubercle-bacilli. Here and there isolated 
cells of various sizes could be seen filled with the bacilli. In the large cells the cell outline was 
becoming indistinct, and in some the cell-substance was seen to break down, whereby the 
bacilli became free. In these respects, in the size, distribution and character of the bacilli, there 
exists a remarkable similarity between the nodules in leprosy and the nodules just mentioned. 
Micro-Organisms and Disease. E. Klein, M. D. Practitioner, June, 1884, pp. 420-423. 
COMMA-BACILLUS OF ASIATIC CHOLERA (KOCH). 
The comma-bacilli are present amongst'crowds of other putrefactive bacteria, in 
very varying numbers in the choleraic evacuations, sometimes very scarce, some- 
times numerous; in the mucous flakes taken from the cavity of the lower part of 
the ileum of typical rapidly fatal cases of cholera very soon after death, they are 
present in small numbers, in the upper part of the ileum, and in the jejunum they 
are either very scarce or altogether absent. The longer the examination is delayed 
of course within certain limits, the more likely are the comma bacilli found 
numerously in the flakes, but not to the exclusion of other bacteria. They are 
generally absent from the mucous membrane itself, inclusive of the epithelium of 
the surface, loosened but not detached. No organisms of any kind appear to have 
been found in the tissue of the intestine, in the blood, and other tissues; putrefac- 
tive bacteria, including comma-bacilli, are capable of growing after death into the 
clefts and spaces of the intestinal wall from the internal cavity. In the reports 
from India by Dr. Koch, as the head of the German Commission sent to investi- 
gate the recent outbreak of cholera in Egypt, we notice that, like the French Com- 
mission, they failed to communicate the disease to animals; that the German Com- 
mission failed to discover any specific organism in the blood of patients suffering 
from cholera; that the intestines contained in their cavity and wall numerous 
peculiar " comma-shaped " bacilli which Koch considers to have a special relation 
to the disease. From the artificial cultivation of these comma-shaped bacilli Koch 
learned that it is necessary that the nourishing medium should have an alkaline 
reaction, and that the bacilli are easily killed by drying. Koch found these comma- 
shaped bacilli in linen soiled with the cholera dejecta, also in the water of a tank 
that had produced cholera in several people who had partaken of it. As soon as 
the bacilli disappeared from the water cholera cases disappeared. We shall exam- 
ine the labors of Koch in extenso, as soon as we have presented practical illustra- 
tions of the comma-shaped bacillus of Asiatic cholera, as furnished by this able 
observer and Klein. The mucus-flakes of the small intestine, taken from a 
typical rapidly fatal case of Asiatic cholera immediatety after death, contain, 
besides detached epithelial cells, numbers of lymph corpuscles, some perfect, 414 
Comma-Bacillus of Asiatic Cholera. 
others swollen up and disintegrated. Soon after death all disintegrate. These 
lymph corpuscles or mucus-corpuscles contain, in varying numbers within their 
protoplasm, straight minute bacilli, much smaller than the comma-bacilli, being 
only half or a fourth their length, and more or less pointed. These small, straight 
bacilli are non-motile; they are never missed in a free state in the mucus-flakes, 
and when grown artificially they form spores. Both the comma bacilli and small 
straight bacilli grow well in alkaline and neutral media, and are not killed by 
weak acids, although they do not show growth in them, or only to a very limited 
degree. Comma-bacilli of various species have been discovered in other diseases of 
the alimentary canal; in the fluid of the mouth of normal persons (Lewis); in old 
cheese (Denike). The comma-bacilli found by Fin kier and Prior in cholera nos- 
tras, differ in mode of growth from Koch's comma-bacilli of cholera. So do those 
found in diarrhoea due to other causes. But those of the fluid of the mouth and 
those in old cheese are regarded by Klein and others as identical with Koch's- 
comma-bacilli in their mode of growth. 
ENGRAVING NO. 70. 
Comma-Bacillus of Asiatic Cholera. Koch. 
FIG. C 
FIG. A . 
FIG. B 
Engraving No. 70. Comma-bacillus of Asiatic cholera, Koch. The comma bacillus of Koch 
is a curved rod of almost uniform thickness, sometimes slightly pointed at the extremities, its 
length being about half that of tubercle-bacillus, its thickness about the same as that of the 
latter. But the comma-bacilli vary in curvature and length within considerable limits, some 
being just curved, while others are almost semi-circular, some being twice and three times as 
long as others. They are motile, and divide transversely. The type is represented by a single 
curved rod. For this reason it is not correct to speak of them as comma bacilli, nor as spirilla, 
since they correspond to what is generally considered a vibrio. 
Figure A. From an artificial cultivation of choleraic comma-bacilli in gelatine peptone. 
Magnifying power 7<i0. Most of these are single curved bacteria; a few are joined end to end in 
twos, thus forming S shaped organisms; and a few are in chains placed end to end. 
Figure B. From a preparation of mucus flakes of the fluid in the ileum of a case of typical 
cholera. Magnifying power about 700. Numbers of comma bacilli of different lengths are 
shown, amongst numbers of small straight bacilli. 
Figure C. From an artificial cultivation of choleraic comma-bacilli in Agar-Agar peptone at 
the ordinary temperature of the room after several weeks. The comma-bacilli change by vacuo- 
lation into planconvex, then bi-convex, and finally circular organisms; these, by division, give 
origin to two semi-circular comma-bacilli. Magnifying power about 700. Comma-Bacillus of Asiatic Cholera. 
415 
ENGRAVING NO. 71. 
Comma-Bacillus of Asiatic Cholera. 
Engraving No. 71.-Comma bacillus of Asiatic cholera. From a preparation of mucus flakes of 
the ileum of a case of typical cholera. Comma-bacilli and minute straight bacilli, singly and. 
in masses. Three lymph corpuscles containing in their interior numerous small straight 
bacilli.* 
RELATIONS OF THE COMMA-SHAPED BACILLUS OF KOCH TO THE ORIGIN 
AND SPREAD OF ASIATIC CHOLERA. , "'"''T 
Professor E. Klein holds that, considering the state of the intestine in Asiatic 
cholera, the presence of the comma-bacilli, however peculiar in its role, is in itself 
not convincing proof of its specific nature; considering also that rodents and car- 
nivorous animals and monkeys are altogether insusceptible to cholera, artificial 
cultivation of these bacilli successfully accomplished by Koch cannot be tested; 
neither the comma-bacilli nor the straight small bacilli can be considered as con- 
nected with the cause of cholera. The result of the experiments performed by 
Nicat and Bietsch, by Koch and others, namely : death following in some of the 
animals after the injection of choleraic mucus-flakes, or of cultivations of comma 
bacilli into the cavity of the small intestine are regarded by Klein as not due to 
cholera, but either to the operation or to septicsemic poisoning. "There is direct evi- 
dence that the water contaminated with choleraic evacuations only, and of course 
with comma-bacilli, when drunk by a large number of persons did not produce 
cholera; there is no deflnite evidence that a cholera patient elaborates cholera virus 
and passes it out with the evacuations." As this subject is of vast importance to 
the welfare of the human race, we will present the present state of our knowledge 
as fully as our space and means will permit, giving the facts, observations and con- 
clusions of the learned observers. 
ON THE COMMA-SHAPED BACILLUS OF CHOLERA, f 
Being convinced as to the distinctive characters of the comma bacillus, the 
next thing is to determine the relation in which it stands to the cholera process, 
and whether it ever occurred in non-choleraiccases. In ten examinations made in 
Egypt this point was only tested microscopically, no cultivations having then been 
made. In India the intestines were examined in fifty-two cases, both microscopi- 
cally and by cultivations, and in notone was the bacillus absent; in very acute 
cases it was found almost unmixed. Choleraic dejecta from thirty-two observations- 
yielded similar results, but in only two out of many observations on vomited matter 
were bacilli found. It was probable that in these two cases the vomit contained 
fsecal matter. One of the Toulon cases was that of a sailor attacked with cholera 
when convalescing from malarial fever; he died four hours after the seizure, and 
the autopsy was made half an hour after death, it being always an object to make 
such an examination as soon as possible. In this, as in other acute cases, the intes- 
* Micro-Organisms and Diseases, etc. E. Klein, M. D., F. R. S. 'Second Ed. London: 
Macmillan £ Co., 1885. Chapters!, p. 126; appendix to chapter xi, pp. 193-198. 
+ By Dr. Koch. 416 
Comma-Bacillus of Asiatic Cholera. 
tines contained almost a pure growth of the comma bacillus. The comma bacillus 
has now been found in nearly one hundred cases of cholera, occurring in a con- 
stant relation to the cholera process, being most abundant in the lower end of the 
ileum, where the changes are most intense, and being most pure in the acute 
uncomplicated cases. On these grounds the comma bacillus may be considered as 
specific to cholera. Many observations were made in other diseases, and in sub- 
jects who had recently passed through attacks of cholera, without finding these 
bacilli in the dejecta or in the bowels. These observations included cases of dysen- 
tery. typhoid fever, bilious typhoid fever, and infantile diarrhoea; the secretions 
of the mouth, which are so rich in bacterial life; the intestines in arsenical pois- 
oning; but although bacteria of all kinds were met with, the comma bacillus was 
conspicuous by its absence. The cholera process and the comma bacilli are 
intimately related, and there is no other conceivable relation, but that the bacilli 
precede the disease and excite it. "For my own part," said Dr. Koch, " the 
matter is proved that the common bacilli are the cause of cholera." 
In cholera we have instances amounting to actual experimental infection of 
man-e. ^., the infection of those who are engaged in washing linen soiled by chole- 
raic dejecta. Such linen contains the bacilli often in a pure form, and if infection 
occur through this medium, it must be by means of the comma bacilli, the only 
micro-organism present. The hands may be soiled and the bacilli introduced 
into the mouth by direct contact or through the food, or drops of the washing water 
may come in contact with the lips, and thus in some way the human being is fed 
with a small quantity of a pure culture of comma bacilli. Another instance was 
found by Koch in the case of a tank of which the water was used for drinking and 
other purposes by many people among whom cholera was raging. He found the 
comma bacilli iii this tank, and learned that the linen of the patients were washed 
in it. Around the tank were some thirty or forty huts, inhabited by two hundred 
or three hundred people ; of these seventeen died, the number taken ill not being 
ascertained. The tank also received the refuse from the dwellings. The Hindoos 
bathe in the tank, wash their utensils in it, and deposit excreta on its shore ; and if 
a hut has a latrine, its outflow is into the tank. Now, it was found that after a 
time the bacilli became less abundant in this water, and coincidently the cholera 
declined ; whereas, had the epidemic been the cause of their presence, and not the 
result, the number of bacilli should have increased in it. The whole etiology of 
cholera suggests the view taken as regards the comma bacilli. They multiply rap- 
idly, soon reach their term, and are supplanted by other bacteria. So in the intes- 
tine they multiply, set up irritation and diarrhoea, and all the typical symptoms of 
the choleraic seizure. Under normal conditions-in animals at least-the bacilli 
are destroyed in the stomach, and this harmonises with the important part played 
by predisposition, and the liability of those to be attacked who are suffering from 
gastric or intestinal catarrh, or who have overladen the stomach with undigested 
food, conditions which would facilitate the passage of the bacilli unchanged into 
the intestine. But the bacillus is limited to the intestine ; it is not found in the 
mesenteric glands or in the blood. How, then, can it destroy life? Probably from 
the production of a poisonous substance, such as is produced by bacteria in putre- 
faction. 
That the virus can be reproduced and multiplied outside the body is apparent, 
since the bacillus can be cultivated artificially, and its growth is not affected by 
comparatively low temperatures. Probably it does not grow in streamsand rivers, 
where owing to the current, a sufficient concentration of nutrient substance does 
not occur: but in stagnant water and at the mouths of drains, etc., vegetable and 
animal refuse may accumulate and afford the necessary nutriment. Tnus is 
explained the propagation of cholera by the subsoil water, and the increase of epi- 
demics with the sinking of its level, which lessens the flow and diminishes the 
amount of surface water. Indubitable instances of local epidemics arising outside 
India are not known, and everything confirms the view gained by experience that 
the cholera is due to a specific organism having its home in India. It used to be 
thought that the disease had started from Ceylon, Madras, or Bombay, but there is 
now general concurrence in regarding Bengal, the delta of the Ganges, as the origi- 
nal source. This is the only region where the disease never varies from year to 
year; for although some other regions, as Bombay, are never free from it, yet it is 
highly probable that this is due to its continued reintroduction. The upper region 
of the Ganges delta is thickly populated ; the lower district, Sondarban, covering 
an area of 7,500 English square miles, is uninhabited, and here the Ganges and 
Bramahpootra break up into a network of watercourses. The district abounds in 
luxuriant vegetation and in animal life, and is the seat of inundationsand the home Recent Observations on Cholera. 
417 
of pernicious fevers. Here it is probable, where the vast amount of decomposing 
vegetable and animal life affords a suitablesoil, that the cholera bacillus flourishes. 
All great epidemics begin with an increase of cholera in South Bengal. 
In conclusion, Dr. Koch adverted to the subject of treatment, and reminded 
those who say that such discoveries do not enable us to cure the disease better than 
formerly, that a rational treatment of most diseases, and especially of infectious 
diseases, cannot be adopted until their cause and nature are known. But even yet 
the discovery of the cholera bacillus is important, as furnishing an aid in diagnosis 
which would facilitate the detection of the first case occurring in a district, and the 
adoption of measures to prevent its spread. Knowing also the nature and proper- 
ties of the bacillus, and especially the readiness with which it is killed by drying, 
the right direction of prophylaxis is assured and the lavish expenditure of disin- 
fectants checked, so that there will not be a repetition of what happened in the last 
epidemic, when millions of gallons were poured into the gutters and sewers with- 
out the slightest need. Even therapeutically the knowledge of the comma bacillus 
may be of value. Diagnosis will be possible in mild cases and in the early stages 
of the disease, when treatment is of most avail.-Lancet, August 16, 188 p. 292. 
RECENT OBSERVATIONS ON CHOLERA.* 
Dr. Lewis found a comma-like bacillus in the mouth and feces of healthy per- 
sons, identical in size, form, and reaction to dyes with the cholera bacillus of Koch. 
From further observations it would appear that the bacillus which Dr. Lewis 
describes is no other than the spirillum found constantly in the saliva of healthy 
persons, and well known to any one who has ever examined saliva or sputum for 
the detection of micro-organisms. It is impossible that such an excellent observer 
as Koch, whose researches, more than any others, have stood the test of time, 
could have made such a mistake. We are quite willing to believe that the comma- 
like bacillus is not exclusively found in cholera dejections, and that, therefore, in 
itself it is of no diagnostic importance; but Koch has based his views on the culti- 
vation of this comma bacillus, and in his report lays especial stress on the 
importance of cultivating these organisms. Dr. Lewis lias made no such cultiva- 
tions with the organisms which he described, and therefore cannot be said to have 
refuted Koch's observations. 
Finkler and Prior describe observations which they made on the dejections of 
patients suffering from ordinary English cholera (cholera nostras). Within a very 
short time twenty-nine persons, all living in Bonn, were affected with the charac- 
teristic symptoms, and all recovered. The dejections were at first those of ordinary 
diarrhoea, then they became paler and more fluid and rice-water like, though they 
were never quite colorless. Examining the rice-water stools for micro-organisms, 
they found only micrococci, and these in chains of four, six or more. The exami- 
nation of feces passed' earlier in the disease, when the stool would resemble 
more that of ordinary diarrhoea, showed, besides other micro-organisms, abundant 
masses of comma-like bacilli, of size, appearance, etc., identical with those described 
by KoCh in the Asiatic cholera. Cultivation of the bacilli and inoculation gave 
negative results. The authors expressly state that they never found these bacilli 
in healthy feces. In their second communication, Finkler and Prior state that, by 
modifying their cultivation experiments, they obtained positive results of even a 
more complete nature than was the case with Koch's cultivation experiments on 
the dejections from patients suffering from Asiatic cholera. If a small particle of 
feces from a case of English cholera is planted upon any one of the ordinary culti- 
vating media and kept at a temperature of 25° to 35° C., the comma bacilli appear 
in two to three days; if kept longer the bacilli disappear, for they undergo further 
development. The authors have, after cultivation, described a permanent spore, 
and they give as a proof of its resistance an experiment where a perfectly putrid 
fecal mass from a case of English cholera, which contained only spore-like bodies 
and micrococci, developed on cultivation a crop of perfect comma bacilli. 
How far the bacilli described by these observers are identical with those seen 
by Koch in Asiatic cholera remains yet to be seen; the observations, however, 
clearly show that the comma bacillus as such has no diagnostic value without 
further cultivation, and that, even with cultivation, matters are not so simple as 
was at first supposed. Without wishing to express an opinion on the merit of 
these observations, we cannot help thinking that the organisms seen by Prior and 
* By lullus Dreschfeld, M. D., F. R. C. P., B. Sc., Professor of Pathology, Victoria University, 
.Manchester. 418 
Septic Spirilla. 
Finkler are not those described by Koch, who, after several months' patient work, 
did not succeed in finding permanent spores, or in tracing the development of the 
spirilla from the comma bacilli. 
Koch believes the bacilli described by Lewis to be simply the well-known organ- 
isms seen in saliva and in the mucus round the teeth. These bacilli are easily dis- 
tinguished from Koch's cholera bacilli, as they do not grow in a neutral or slightly 
alkaline meat-infuse-pepton-gelatine, in which the cholera bacilli develop so well. 
Finkler's bacilli, obtained from cases of English cholera, Koch had an opportunity 
of examining, and finds them not like those seen in Asiatic cholera. Koch had 
the opportunity of examining recently three cases of English cholera, two of 
which ended fatally, and in none of them could any comma bacilli be detected 
either on microscopic examination or on cultivation. Numerous observations 
made in his laboratory (in which a number of medical men are now pursuing bac- 
teriological research) have so far shown the absence of the comma bacillus in the 
excrement of healthy or diseased persons in diarrhoeic and dysenteric stools, in the 
saliva, and in many other substances examined. 
Koch repeated the exoeriments of Bietsch and Nicati, by injecting a dilute 
pure cultivation of the comma bacillus into the duodenum of dogs and guinea-pigs, 
without, however, ligaturing the ductus choledochus. With but few exceptions- 
the animals so operated on died in one and a half to three days. The mucous mem- 
brane of the small intestines was found reddened and the contents watery, color- 
less, or with a slight red tinge, and at the same time flocculent, showing an extra- 
ordinarily large number of comma bacilli. Koch does not state that the animals 
died of cholera, and therefore a sceptical mind would look upon these experiments 
as merely showing that the duodenum of the animals operated on formed a favor- 
able soil for the growth of the comma bacillus.-Medical Chronicle, November and 
December, 1884, pp. 152, 257. 
VIBRIO. 
Vibriones are characterised by being rod-shaped, but not straight; they are 
more or less wavy and they are 'motile. Vibrio rugula consists of rods of about 
0.008 to 0.016 millimetres in length, and are curved either like a U, or like an 
They are single or form chains of two. Their protoplasm is always slightly granu- 
lar. They are found in putrefying organic substances, and often form continu- 
ous masses, the individuals interlacing in all directions. Vibrio serpens.-This is 
also a septic organism, much thinner and longer than vibrio rugula, more wavy, 
as a rule curved into a single or double wave. The length varies between 0.011 and 
0.025 millimetres. It is motile, and also forms continuous masses, the individuals 
interlacing in all directions. 
SPIROBACTERIUM (SPIRILLUM.) 
Spirilla, are filaments of a spiral shape, motile, and owing to their shape follow 
a spiral course when moving. They are probably capable of forming minute 
bright spores. 
SEPTIC SPIRILLA. 
Found in all kinds of putrefying organic substances. Spirillum tenue.- This- 
is much finer and more wavy than vibrio serpens, the turns being closer together 
and spiral. Its length varies between 0.002 and 0.005 millimetres ; it often forms 
continuous felted masses ; it is motile. Occasionally the spirilla grow to a great 
length-two, three and more of them forming a chain ; the individual spirilla are 
not arranged in a linear series, but folded into a zigzag; this form, which, in reality, 
is not a special kind of spirillum, is called by Cohn\spirochceta plicatilis: the spiril- 
lum found in the tartar of the teeth is of this form, spirochceta denticola. But there 
exist all intermediate forms between a single spirillum tenue and a Spirochaeta. 
In stained specimens the construction of the Spirochaeta from several spirilla tenua 
is very distinct. Spirillum undulu.-Much thicker and shorter than spirilla tenue; 
there are all forms between such as are only half a turn to such as are of a whole 
turn of a spiral. It is motile, and forms chains of two or more elements, occurring 
also in continuous masses, occasionally held together by a hyaline interstitial subs- 
tance. Spirillum volutans.-These organisms are giant spirilla, long and thick, 
with a granular protoplasm, 0.025 to 0.03 millimetres long, motile and with a flagel- 
lum at each end. Spirilla of Relapsing Fever. 
419 
PIGMENT SPIRILLA. 
Klein has observed on paste a spirillum morphologically identical with 
spirillum undula; it is of a pale pink or rosy color. It is motile, and forms a kind 
or zoogloea, the individuals being closely placed and therefore producing a rosy 
color of a more decided tint. Where they form continuous masses, the naked eye 
can detect the rosy tint. Spirillum sanguineum, {ophidomonas sangui.nea.-This 
was observed by Cohn and Warming, in pond water, morphologically, it is identi- 
cal with spirillum volutans. It is motile, with a flagellum either at one or both 
ends. Warming occasionally saw two and three flagella at one end. It is about 
0.003 millimetres thick; all forms occur between such as have half and such as 
have two and a half turns of a spiral. Lankester also observed the same kind of 
organisms amongst the peach-colored bacteria. 
PATHOGENIC SPIRILLA. 
Spirillum Obermeyeri of relapsing fever.-This micro-organism of relapsing 
fever is identical with spirillum tenue (or spirochseta plicatilis of Cohn). It was 
discovered in great numbers by Obermeyer in the blood of the general circulation 
in patients suffering from relapsing fever. In the following figure the apnearance 
of the spirillum Obermeyeri in the human blood of relapsing fever is represented 
(Engraving No. 72). I have since the year 1874, demonstrated the existence of this 
organism in the cases of relapsing fever which have come under my care in the 
Charity Hospital of New Orleans. 
ENGRAVING NO. 72. 
F1 Engraving No.72.-Blood of relapsing fever-human. Blood-corpuscles and spirilla Obermeyeri. 
Magnifying power 700 diameters, after Koch. The spirillum Obermeyeri of relapsing fever is mor- 
phologically identical wiih spirillum tenue (or Spirochaeta plicatilis of Cohn). It was discerned 
by Obermeyer in great numbers in blood of the general circulation of patients suffering from 
relapsing fever. The spirilla disappear from the blood during the non-febrile stages, gradually 
decreasing in numbers. They are motile; they come out well in specimens of blood made after 
the Weigert-Koch method of drying the blood in a very thin layer and then staining with 
methyl-violet or bismark-brown. 
GENERAL RESULTS OF THE LABORS OF THE AUTHOR WITH REFERENCE TO 
THE DISTINCTIVE CHARACTERS OF THE MICRO-ORGANISM OF MALARIAL 
FEVER. 
We have thus presented the results of labors of the investigators who 
have thrown the greatest light upon this important subject, in a condensed 
and available form, following the classification of Cohn and the masterly 
and comprehensive labors of such experienced and learned observers as 
Koch and Klein. Such an outline forms the necessary field for the com- 
parison of our own researches, which have not only embraced all the diseases 420 
Distinctive Characters of Bacillus Malarice. 
ENGRAVING NO. 73. 
Engraving No. 73.-Blood of ape inoculated with blood, shown in preceding figure. Blood' 
corpusclesand spirilla. Magnifying power 700 diameters. After Koch, Vandyke Carter succeeded 
in producing relapsing fever in monkeys by inoculation with human,£lood, containing the 
spirillum Obermeyeri. The'blood in the monkey contained the same Spirilla in great numbers. 
Koch has cultivated artificially the spirilla Obermeyeri and saw them growing into long spiral 
threads. 
just considered in their relations to micro-organisms, as leprosy, tuber- 
culosis, erysipelas, small-pox, vaccinia, scarlatina, syphilis, gonorrhoea, 
typhoid fever and relapsing fever, but have been more especially extended 
to yellow-fever and the various forms of malarial fever. 
A careful analysis and comparison of the results thus far obtained and 
recorded, as far as they relate to the microscopic characters of human blood 
in various diseases, leads to the following conclusions : 
1st. The microscopical characters of the blqod in malarial paroxysmal fever 
differ essentially from those observed in all other diseased states. 
2d. The micro-organism {bacillus malaria:) differs from all other known 
pathogenic organisms in its direct destructive effects upon the colored blood-cor- 
puscles of those suffering from the various forms of malarial fever. 
3d. The secondary results induced upon the colorless blood-corpuscles in 
virtue of the preceding alteration and destruction of the colored blood,-corpuscles, 
consisting of the appropriation of the heematin of the colored blood-corpuscles, 
and the development or germination of colored dark particles or spores within the 
colorless corpuscles, is also peculiar to malarial paroxysmal fever, distinguishing 
it from uncomplicated yellow-fever and from all other uncomplicated diseases. 
By uncomplicated yellow-fever, 1 mean this disease as it occurs in healthy 
individuals who have not been subjected to the action of the malarial 
poison, and have not received the malarial ferment or micro-organism into 
their blood. We have observed the actual destruction of the colored 
blood-corpuscles by the malarial micro-organisms, and especially by its 
spores, under the microscope, and we have by actual chemical analysis 
determined the rapid destruction of the colored blood-corpuscles under the 
action of the malarial poison; we have also by numerous examinations 
been led to the conclusion that the colorless blood-corpuscles were not 
altered and destroyed in a similar manner as the colored blood-corpuscles, 
but that in a certain proportion of malarial cases, there might be an actual 
increase of the colorless blood-corpuscles. These views expressed in 1857 Distinctive Characters of Bacillus Malarie. 
421 
(Southern Medical and Surgical Journal, 1857-1860), and fully enunciated 
before the American Medical Association at its meeting in Louisville, Ken- 
tucky, in 1859, and published in its Transactions for 1859, received an 
important confirmation by the microscopical and clinical labors of A. 
Kelsch, Professor in the College of Val-de-Grace in the years 1874 and 
1875. 
THE DETERMINATION OF THE DESTRUCTION OF THE COLORED BLOOD-COR- 
PUSCLES DURING THE PROGRESS OF MALARIAL FEVER, BY DIRECT 
MICROSCOPICAL ENUMERATION. 
From the middle of August, 1874, until the 1st of July, 1875, at which 
time Mr. Kelsch was attached to the Military Hospital of Phillippeville, 
he received into his wards 1181 patients affected with acute and chronic 
malarial disease, and collected with reference to the special object of his 
studies, about 180 observations, chosen from the typical forms of the dis-, 
ease. During the same time he held fifty-nine post-mortems upon patients, 
who had died either during the pernicious attack or during the cachexia, 
or from the result of intercurrent disease supervening upon malarial fever. 
The method of Dr. Malassez for the enumeration of the colored and color- 
less blood-corpuscles under the microscope was employed, and applied to 
the blood of about seventy patients, which was examined from day to day 
from the first attack of the malarial fever to the complete establishment of 
anaemia. It was thus possible to determine with precision the rapidity 
and extent of the malarial oligocythemia, and the immediate action of a 
simple and pernicious attack upon the blood globules; and finally the con- 
ditions which a secondary influence exerts upon, and whether it is inti- 
mately associated with, the rapidity and manner of the decrease of the 
globular elements of the blood. 
The first point of interest in such an inquiry and in forming an accurate 
estimate of the nature of the results is the establishment of a standard 
estimate of the number of blood-corpuscles in health. Haematologists are 
generally of the opinion that no method yet devised for estimating the 
amount of the red corpuscles can compare with that of counting them in 
a given dilution of blood. The words of Kolliker* upon this subject retain 
their original force. In speaking of the composition of the blood, that 
well-known authority remarks : "However important it would be to know 
accurately the proportions of the blood-globules to the plasma, their 
number and their volume, all researches hitherto have failed, owing to the 
difficulty of the subject, and even the most recent statements of Schmidt, 
according to which 47 to 54 parts of moist globules exist in 100 parts 
of human blood, can only be described as approximate. One method only 
can be successful, consisting in the direct enumeration of the globules in 
accurately determined quantities of blood." The above was written at a time 
when Vierordt was making the first counts of blood-corpuscles by a method 
which, in comparison with the improvements since made upon it, may 
fairly be called primitive. In spite, however, of the imperfections of his 
method, Vierordt's conclusions as to the number of the red blood-corpuscles 
are still almost universally accepted. He determined their number to be 
for healthy blood (his own), 5,174,000 per cubic millimetre and the extraor- 
dinary amount of labor required to obtain sufficient data on which to found 
an average, may be inferred from his statement that, in order, by his 
method, to complete a single enumeration nearly one week was required. 
Vierordt's method consisted in spreading a known quantity of blood diluted 
^Manual of Mic. Anat. (Am. Ed.), p. 704. 422 
Number of Blood-Corpuscles in Health. 
with a gummy solution, upon a slide, allowing it to dry and then counting 
all the cells by means of a micrometer placed directly upon it. He also 
diluted the blood with a known quantity of salt or sugar solution, but 
appears to have always counted all of the corpuscles contained in the 
mixture. The labor of this method, as above stated, is immense. 
Welker, like Vierordt, first obtained a known quantity of blood by 
means of a capillary tube. He then diluted it with from six hundred to 
fifteen hundred times its volume of a solution of sodium chloride, took of 
this solution a small quantity by means of a graduated capillary pipette, 
mingled it with mucilage upon a cover glass and allowed it to dry. He 
then placed the cover glass upon a stage micrometer ruled with lines 
crossing each other so as to contain a number of oblong fields, each one of 
which was numbered so as to facilitate the counting. Welker's modifica- 
tion, it will be observed, is two-fold, consisting (1) in the use of a stage 
micrometer, on which the blood is placed previous to counting the corpus- 
cles, and (2) in counting the corpuscles in a fractional portion of a large 
dilution, and by an arithmetical process calculating the number of cor- 
puscles in a millimetre of pure blood. It would be foreign to our purpose 
to describe in detail the methods of enumerating the colored and colorless 
blood-corpuscles employed by Malassez, Gowers, Thoma and Zeiss, 
Hayem, Abbe and others, or to enter into an elaborate description and 
delineation of the various forms of the various hematemetres or instru- 
ments for determining the relative richness in colored and colorless blood- 
corpuscles of given amounts of blood. Ample details and illustrations 
sufficient for the guidance of the student, will be found in the systematic 
manuals and hand books of the day relating to physiology and pathology, 
and we shall preface the labors relating to the actual counts of the colored 
and colorless blood-corpuscles in malarial fever, with a brief presentation 
of the present state of our knowledge as to the number of blood-corpuscles in 
healthy human blood. A standard will thus be afforded to the practical 
student and physician by which to estimate the nature and rapidity of the 
effects of the malarial poison upon the most important constituents of the 
human blood. 
NUMBER OF BLOOD-CORPUSCLES IN HEALTH. 
Many observations have been made to determine this point. Vierordt 
gives the number for his own blood as 5,174,000 per cubic millimetre; 
Welker, as somewhat under 5,000,000-about 4,950,000 ; Cramer as 
4,726,000; and Malassez gives a mean of observations upon eight strong, 
healthy males, living in Paris, of 4,310,000. Hayem and Gowers both 
adopt a standard of 5,000,000, but Gowers states that " in a healthy adult 
man the number may be a little higher, in a woman a little lower." Keyes 
regards the standard of 5,000,000 as too high. On the contrary, the obser- 
vations of Dr. F. P. Henry would lead him to regard it as about the mini- 
mum of a healthy male. A number of observations were made by Dr. C. 
B. Nancrede and Dr. F. P. Henry to determine this point.* For one of 
them an average of twenty-one counts gave 5,556-272; for the other, twenty- 
six counts gave an average of 5,935,862, the difference seeming to depend 
upon weight and size. Dr. Henry's experience, in common with that of 
most observers, is that the number of blood-corpuscles in woman is some- 
what below that of man. The effect of age upon the number of blood- 
corpuscles has been studied chiefly with reference to the periods of infancy 
and adult life. The blood in old age has not received so much attention. 
* See paper on Blood-cell Counting, in the Boston Medical and Surgical Journal, April 10th, 
1879. Drs. F. P. Henry and C. B. Nancrede. Destruction of Blood-Corpuscles in Malarial Fever. 
423 
Lupine observed in the neonatus an increase in the number of corpuscles 
during the first twenty-four hours of life; after the second day, a decrease. 
Hayem finds the average number of corpuscles in the new-born child 
greater than in the adult, which agree with the observations of Duperie. 
At the suggestion of Dr. James C. Wilson, that an enumeration of the 
corpuscles in the blood of the neonatus might throw some light upon the 
pathology of icterus neonatorum,* Dr. Henry undertook a series of obser- 
vations at the Maternity Hospital, Philadelphia, from which he concluded 
that the number of red corpuscles may either increase or diminish during 
the first few days of life, and that, in the new-born as in the adult, there 
are great individual variations. The function of lactation performed by a 
healthy woman with abundant nutritious food, does not reduce the number 
of red corpuscles. 
Dr. Henry made twelve counts of the blood of a nursing woman whose 
child, then fourteen months old, had been almost exclusively nursed until 
it was a year old, and at the time of the counts was nursed eight or nine 
times in the twenty-four hours. The twelve counts gave an average of 
5,034,583. Menstruation slightly reduces the number of the corpuscles, but 
the loss is more than made up on the day following its cessation.! 
The observations of Professor A. Kelsch were divided into three clas- 
ses : 1. Simple fever. 2. Pernicious fever. 3. Cachexias. We will 
reproduce typical cases of each group of illustrations. 
THE RAPID AND PROGRESSIVE DESTRUCTION OF THE COLORED BLOOD-COR- 
PUSCLES IN MALARIAL FEVER, AS DETERMINED BY ACTUAL ENUMER- 
ATION UNDER THE MICROSCOPE. (QUANTITATIVE ALTERATIONS ; GLO- 
BULAR ANEMIA, OLIGOCYTH2EMIA, ANAEMIA, MELAN^EMIA, MALARIAL 
MELANOSIS. )| 
SIMPLE MALARIAL FEVER. 
Observation I. F , aged 23, twenty-one months from Africa. For the first 
time fever in the middle of the month of August, 1874. Three attacks daily. 
Entered the hospital on the 24th of August, for an organic affection of the heart. 
The fever returned on the 2d September, at the hospital; severe attack between 
the hours of 11 A. M. and 3 P. M. September 3d, morning; apyrexia, red glo- 
bules, 4,273,240; at 10 A. M., chill followed by warmth ; at 3 P. M., P. 120, T. 
4O.°2; red globules, 3,441,160. 4th September, morning-P. 96, T. 37°; red globules, 
3,209,724. Sulphate of quinia in repeated doses ; no more attack from the begin- 
ning of this day. Dismissed on the 25th. In twenty-four hours the patient lost 
more than one million globules; the influence of the attack upon the blood has 
been very evident and very powerful. 
Observation II. L , six months from Africa. Subject stout and sanguine; 
never had the disease before ; entered on the 1st of September. Fever quotidian 
for three days, red globules, 4,892,500. From the 2d of September to 22d October, 
fever remittent and quotidian, interrupted by two intervals of apyrexia. from 7th 
September to the 25th September, and from 30th September to 6tb October. 
October 22d. Red globules, 1,430.398; white globules, 3,055;Apyrexia 
from 22-27 October, 27th, evening, P. 112, T. 39.°6 C.; 28th, morning, P. 88, T. 38°; 
28th, evening, P. 96, T. 38°. red globules, 1,353,600; white globules, 2820; ^o. 
From this moment the fever appeared no more. In the interval which preceded 
the dismissal, on the 14th November, three numerations. 29th October, red glo- 
bules, 1,461,042; white globules, 1,175; 8th November, red globules, 1,999,662; 
white globules, 1,410; 13th November, red globules, 2,452,084; white glo- 
bules, 2,444, 1-°^. We see in this observation that one-twentieth of the days of 
* See paper entitled: A Contribution to the Study of Icterus Neonatorum, by Frederick P. 
Henry, M. D. Archives of Medicine, October, 1883. 
+ Reference Handbook of the Medical Sciences, vol. i, pp. 543-547. 
i Contribution a 1'anatomie pathologique des maladies palustres, end6miques. Observations 
■url'angmie, la m61an6mie et la melanose palustre, par A. Kelsch. professeur agr6g6 libre du Val- 
de-Grace. Archives Physiologic Normale et Pathologic; publies par M. M. Brown-S6quard, Char- 
cot, V ulpian. Deuxifime serie, tome deuxi&me, SeptiSme annge, 1875, pp. 690-734. 424 
Destruction of Blood-Corpuscles in Malarial Fever. 
the fever have sufficed to lower the number of globules from 4,892,500, to 1,430,398 
The following observationswill show the intermediate phases of this decrease. 
Observation III. T , age 24 years; of the Third Zouaves; has,been in Algiers 
two years; strong, good constitution, never had fever before.. Attacks daily from 
6th September, 1874. Entered the hospital on 11th September. Apyrexia in the 
morning, ipecac-stibiated evening, warmth and headache, slight diarrhcea for two 
days. 
Quotidian dever.-12th September, M., P. 84, T. 39.°6 C.; red globules, 5,202,900; 
E., P. 80, T. 38.°8; white globules, 5,640; 13th, M., P. 60, T. 36.°6; diarrhoea 
has ceased; E., P. 84, T. 4O.°6; red globules, 4,131,800; white globules D. 14th, M., 
P. 84, T. 37.°4 ; red globules, 3,914,536 ; E., P. 80, T. 38.°4. 15th, M., P. 64, T. 35.°8 ; 
E., P. 92, T. 39.°6. ' . 
Tertian Trever.-September 16th, M., P. 76, T. 36.°8; 2 grammes sulphate of 
quinine; E., P. 72, T. 37,°2; red globules, 3,359,748. 17th, M., P. 76, T. 37.°4; E., 
P. 84, T. 38.°8 ; accession of fever. 
Tertian dever.-18th September. M., P. 80, T. 37.°0 ; red globules, 3,179,550; 
E., P. 64, T. 36.°0. 19th, M., P. 100, T. 39.°0 ; red globules, 2,695,920; white glob- 
ules, 7,520 ; E., P. 96, T. 37.°8 ; one gramme sulphate of quinine. 20th, M., P. 
64, T. 36.°0; E., P. 72, T. 35.°8. 21st, M., P. 80, T. 38.°2; E., P. 72, T. 38.°8 ; red 
globules, 2,402,556; white globules, 5,640; 
Quotidian Fever.-Apyrexia from 21st to 27th September. 27th, E., P. 84, T. 
39.°2. 28th, M., P. 64, T. 36.°8 ; red globules, 1,994,492; white globules, 3,760; 
E., P. 100, T. 40.°8; red globules, 1,884,042; white globules, 4,700; 29th, M., 
P. 80, T- 37.°0; one gramme sulphate of quinine. E., P. 76, T. 37.°0 30th, M., P. 
70, T. 37.°2. 1st October. E., P. 56, T. 36 °6 ; red globules, 1,681,566; white glob- 
ules, 2,611; I 
Remittent Fever.-Apyrexia from 1st to 7th October. 7th October. M., P. 72, 
T. 39.°0; E., P. 92, T. 39.°8; red globules, 2,099,960; white globules, 3,760; 
8th, M., P. 92, T. 38.°4; E., P. 96, T. 40.°0 ; red globules, 2,156,360 ; white globules, 
4,230; 9th, M., P. 80, T. 37.°2; E., P. 88, T. 38-°0. 10th, M., P. 84, T. 38.°0; 
E., P. 72, T. 39.°0. 11th, M., P. 80, T. 37.°0; one gramme sulphate of quinine. 
E., P. 88, T. 39.°2; red globules, 1,984,904; white globules, 2,350; 8f4. Dismissed 
on 16th October. 
We will notice in this observation, the progressive decrease of the globules, and 
its relations to the febrile movement, and also the manner of this decrease, as much 
more rapid as the attacks are nearer, and the patient removed from the beginning 
of the fever. Thus, during the days of the quotidian attacks, which open the obser- 
vation, the patient lost in four days about 2,000,000 globules. Then follows six days 
of tertian fever, during which the globules fell only about 900,000. From 21st Sep- 
tember to 1st October, only two attacks, in this interval the globules fell 720,000. 
The numeration of the 28th; let us notice it in passing, plainly sets forth the 
influence of the attack upon the composition of the blood. This patient here loses 
100,000 globules, a great deal less than in the quotidian attack from the beginning. 
The numeration of the 7th October, although made in the midst of an attack of 
remittent fever, gives a sensible increase, caused without doubt by the six days of 
apyrexia which have preceded, but interrupted again by a retrograde movement, 
not well marked however, but fully established on the 11th. We will observe, 
from the beginning of the 28th, the attacks, although very intense in respect to 
elevation of temperature, influenced only in a small degree the number of globules. 
This oscillates in one direction or another, but no longer undergoes those enormous 
diminutions noticed at the beginning. In conclusion, we can distinguish in the 
whole of the observation three periods : 1st. During which the diminution of 
the globules is exceedingly rapid, in four days the patient having lost about 
2,000,000 of them. 2d. In which the daily decrease is a great deal smaller than in 
the preceding period, and tends to diminish each day, it extends from 16th Septem- 
ber to 7th October. 3d. Where the number of globules oscillates. There is still a 
loss undej1 the infiuenceof the attack ; but with a tendency, at the same time, to 
regeneration which seems to be wanting in the 1st and 2d periods. 
Observation IV. D , 3d Zouaves; age 21 years; fourteen months from 
Africa, entered the hospital 25th August, 1874, indisposed for five days. 
Tertian Fever.-25th August, E., P. 124, T. 41.°5. 26th, M., P. 68, T. 36.°5; E. 
F. 88, T. 36.°8. 27th, M., P. 84, T. 37.°7; E., P. 104, T. 41.°0. 28th, M., P. 72, T. 
36.°0; E., P. 64, T. 36.°8._ 29th, M., P. 64, T. 37.°0; E., P. 120, T. 41.°4; numeration 
gt the beginning of the attack-red globules, 4,273,920; white globules, 1,269; i3]65. 
30th, M., P. 92, T. 36 04; E., P. 76, T. 37,°4; red globules, 3,295,640. 31st. M , P. 80, 
T. 36.°7; E., P. 120, T. 40.^5. 1st September, M., P. 108, T. 38.°0; E., P. 100, T. 37.°4. 
2d, M., P. 88,Ft/$7.°6; E., F. 88, T. 38°1. Destruction of Blood-Corpuscles in Malarial Fever. 
425 
' Continuous Fever.-3d September, M., P. WO, T. 39.°4; red globules, 2,468,440; 
E., P. W2; T. 38.°8; red globules, 2,321,800. 4th, M., P. 88, T. 38.°1; red globules, 
2,169,050; E., P. 104, T. 38.°0. 5th, M., P. 72, T. 37.°2; E., P. 76, T. 36.°8; red glob- 
ules, 2,084,450. 
Dismissed on 9th October, very anaemic; has taken many doses of sulphate of 
quinine during his stay in the hospital. We have hereto deal with a strong sub- 
ject. With the third attack of tertian fever, the enumeration gives: red globules, 
4,273,920; white globules, 1,269; From the evening of the 29th to the evening 
of the 30th, the result of a severe attack, the number of globules falls about 
1,000,000. Finally, instead of these violent attacks in which the temperature is 
higher than 41°, the fever diminishes and the loss in globules is also very small. 
From the 30th August to 3d September, two tertian attacks, which cost the patient 
827,000 globules, a number smaller than that which represents the loss during a 
single paroxysm from the 29th to 30th August, From 3 to 5, it fell in proportions 
still smaller during the day of the fever. In conclusion, the decrease of the glob- 
ules becomes smaller and smaller as we go away from the beginning. It is very 
rapid at this moment, then it decreases daily in the last paroxysms. 
Obs. V. G-. Aged twenty-two years; Third Zouaves; twenty-two months' 
sojourn in Algiers. Entered on 9th October, 1874. Attacked for the second time, 
since the beginning of the summer, with quotidian fever; sick for four days. 
Remittent Fever.-9th October, E., P. 90, T. 39.°0; red globules, 3,056,880. 10th, 
M., P. 88, T. 38.°8; E., P. 90, T. 39.°8. 11th, M., P. 100, T. 39.°7; has had copious 
sweats during the whole night; red globules, 3,169,116; E., P. 80, T. 37.°0. 
Tertian Fever.-12th October. M., P. 88, T. 38.°6; E., P. 112, T. 40.°0. 13th, M., 
P. 80, T. 36.c0; red globules, 2,528,600; E., P. 70, T. 36.°4. 14th, M., P. 100, T. 38.°3; 
E., P. 80, T 39.°0. On 15th and 16th complete apyrexia. 
Quotidian Fever.-17th October, M., P. 68, T. 36,°2; E., P. 80, T. 38.°0. 19th, 
M., P. 80, T. 37.°0; E., P. 100, T. 39.°0. 20th, M., P. 88, T. 37.°0; red globules. 
2,429,900; white globules, 6,815; 21st, M., P. 76, T. 37.°5; E., P. 96, T. 39.°0. 
22d, M., P. 76, T. 36.°2; E., P. 64, T. 37.°2. 23d, M., P. 92, T. 38.°0; E., P. 96. T. 
■39.°0. 24th, M., P. 60, T. 36.°2; red globules, 3,196,000; white globules, 3,760; 
Dismissed. 
Repeated doses of sulphate of quinine. Upon his entrance into the hospital, 
the oligocythemia was already sufficiently advanced. From 9 to 11. although there 
was remittent fever, the numeration gave an increase of more than 100,000 globules; 
but this increase is illusory, due to the condensation of the blood by copious and 
prolonged sweats. The numeration of 13th only permits us to estimate the deficit 
produced, to which is added that of the paroxysm of the 12th, a deficit which for 
the three days rose to 528,000. From 14th to 20th, there was fever each day, save 
the 15th and 16th; nevertheless the patient in this interval lost only 100,000 glob- 
ules, another suitable example to show that the globular decrease'diminishes in 
proportion as the anaemia increases, although the fever has ceased. From the 20th 
to 24th the patient recovers more than he has lost from the 10th to 20th; it is rare 
that we see such a rapid recovery. 
Obs. VI. P .Third Zouaves; aged twenty-four years; three years' sojourn 
in Algiers. Entered the hospital on the 15th October, 1874. Has had the remittent 
fever since 11th. Administered one gramme sulphate of quinine as soon as he 
entered. The numeration made the same day gives: red globules, 3,891,600. 
Remittent Fever.- October 16th, M., P. 96, T. 38.°0; sensible enlargement of the 
spleen; E., P. 88, T. 38.°0; chill at 9 A. M,; copious sweating at 3 P. M. 17th, M., 
P. 72, T. 38.°0; chill yesterday at 7 P. M., then warmth and sweat during the whole 
night; red globules, 3,086,960; E., P. 76, T. 37.°0; sweat during the whole day. 
18th, M., P. 80, T. 37.°0; abundant sweating during this night; red globules, 
3,160,480. Without doubt we must attribute this small increase upon the preceding 
numeration to the sweats of these last two days. Apyrexia to 29th October. 
Quotidian Fever.-29th October, M., P. 72, T. 37.°0; E., P. 80, T. 38.°0. 30th, 
M., P. 76, T. 36.°6; E., P. 104, T. 38.°4. 31st, M., P. 96, T. 39.°8; E., P. 92, T. 39.°0. 
1st November, M., P. 88, T. 38.8; red globules, 2,860,232; E., P. 92, T. 40.°0. 2d, 
M., P. 84, T. 37.°4; red globules, 2,839,834; E., P. 92, T. 39.°4. 3d, M., P. 88, T. 
38.°8; red globules, 2,784,280; E., P. 96, T. 39.°4. 4th, M., P. 80, T. 37.°6; E., P. 76, 
T. 38.°6. 5th, M., P. 72, T. 37.°2; red globules, 2,667,516; E., P. 80, T. 39 °2. 6th, 
M., P. 76. T. 37.°6; E., P. 60, T. 37.°0. 7th, M., P. 68, T. 36.°8; red globules, 2,649- 
578. 9th, M., P. 68, T. 38.°6; E., P. 72, T. 37.°0. 10th, M., P. 64, T. 36.°8; E., P. 
92, T. 38.°4. 11th, M., P. 80, T. 37.°0; E., P. 104, T. 40.°0. 12th, M., P. 80, T. 36.°8; 
copious sweats; 2,836,920. Apyrexia until 17th. 17th. M., P. 72, T. 36.°4; E., P. 92, 
T. 39.°4. 18th, M., P. 120, T. 38.°0; red globules, 2,594,400; E., P. 88, T. 39.°0. 19th, 
M., P. 72, T. 36.°1. Apyrexia on the 20th, 21st and 22d. 426 
Destruction of Blood-Corpuscles in Malarial Fever. 
Tertian Fever.- 23d October, M., P. 80, T, 37.°4; E., P. D., T. 39°.0. 24th, M.. 
and E., Apyrexia. 25th, M., P. 84, T. 38°.4, red globules, 2,793,116; E., P. 100, T. 
38°.4. 26th', M., P. 80, T. 35°.8; K., P. 92, T. 36.°0. 27th, M., P. 96, T. 38°,2; E., P.. 
88, T. 38.°0. 28th, M., P. 80, T. 35.°4; E., P. 100, T. 38°.8. 29th, M., P. 104, T. 
39°.4; E., P. 96, T. 36°.4. 30th, M., P. 88, T. 37°.4; red globules, 2,883,544. Apyrexia 
until the 6th December. 
Quotidian Fever.-0th December, M., P. 84, T. 37°.8; E., P. 104, T. 38°.4;. 
paroxysm since 9 A. M.; red globules, 2,582,850. 7th, M-, P. 76, T. 36°.6; E., P. 100,. 
T.'37°'.8. 8th, M., P. 100, T. 38°.O; E., P. 1^6, T. 38°.6; red globules, 1,958,772. 
Apyrexia during this interval: 9th, M., P. 76, T. 36°.2; E., P. 80, T. 36°.6; red 
globules, 2,170,742. 20th, M., red globules, 2,599,476. 26th, M., red globules, 
2,869,068. 
Numerous doses of sulphate of quinine, we have again in this subject very 
strong in the beginning, three phases in the globular variations. 
The first, acute, which lasts until the 17th October, marked by a mean in- 
tensity of the fever, and yet from the evening of the 15th to the morning of the 
17th, about forty hours, the patient lost more than 800,000 globules. From thel8th 
October to the 6th November, a period of apyrexia, followed by eight days of re- 
mittent and quotidian fever. In this interval the number of globules still falls, but 
in all not more than 500,000. From the beginning of the 6th the fever loses its 
acuteness; it returns at intervals, more or less distant, under the form of quotidian, 
tertian or isolated; during this time the number of globules does not undergo any 
sensible modification ; it oscillates between 2,500,000 and 2,800,000. Once, as the 
result of a serious quotidian paroxysm, it descends to 1,958,772, but it rises almost 
immediately by means of an apyrexia, interrupted by one or two paroxysms, and 
from the 8th to the 26th December it ascends from 1,958,772 to 2,869,068. 
Obs. VII. G. , Third Zouaves; aged twenty-one years; fourteen months from 
Africa; entered on the 22d September for the third attack of quotidian fever. 
Slight paroxysms from the 1st of August, each paroxysm lasting three or four days.. 
Quotidian paroxysms on the 23d and 24th September. Apyrexia to the 5th Octo- 
ber. Quotidian paroxysms on the 6th and 7th; Apyrexia on the 8th. 
9th October, M, P.'lOO, T. 40°.0, red globules, 3,280,600; E., P. 70, T. 37.°8. 10th, 
M., P. 92, T. 41°.0; E., P. 96, T. 39°.6; 11th, M., P. 96, T. 40°.8, red globules, 2,560,372; 
white globules 1,707 1^; 12th, M., P. 72, T. 37°.6; E., P. 72, T. 38°.0. 13th, M., 
P. 72, T. 37°.8, red globules, 2,532,360. 
From the 13th of October to 28th November, the day of dismissal, the number 
of globules slowly increase, momentarily stopped by erratic paroxysms. 18th Octo- 
ber, red globules, 2,733,368. 22d, red globules, 2,756,832. 3d November, E., red 
globules, 3,111,400. 4th, M., red globules, 2,876,400. 28th, M., red globules, 3,362,850, 
white globules, 2,350, i-4/-. 
When the numeration is begun, the subject, in bis third attack of fever, light 
it is true, is already passively anaemic. He has passed the period of acute anaemia. 
Nevertheless, the period of quotidian fever, which commenced on the 9th and 
terminated can still be divided into two phases. First. From the 9th to the 11th 
characterized by the intensity of the paroxysms. During this interval the patient 
lostof red globules, 720,228. Second. From the 11th to 13th in which the paroxysms 
are scarcely observed, and the number of globules falls in an almost imperceptible 
degree. The correlation between the intensity of the paroxysms and the globular 
decrease is here manifest. 
Obs. VIII. D. Aged 22 years, Zouave, has been in Algiers since March, 1874. 
First attack of fever on August 21, 1874. Quotidian paroxysms which last until 
2d of September. Apyrexia until the 7th. Tertian fever from 7th to 11th; 12th 
September, M., P. 72, T. 37°.4; E., P. 96, T. 38°.0. 13th, M., P. 112, T. 41.°0; 
E., P. 92, T. 38°.8. 14th, M., P. 112, T. 39°.O; red globules 2,594,400; E., P. 84, 
T. 38°.4. 15th, M., P. 120, T. 41°.3; red globules, 1,883,760. Apyrexia until the 29th. 
On the 26th, the numeration gives: red globules, 2,491,000, white globules, 3910; ifK 
29th, E., P. 92, T. 49°.O 30th, M., P. 76, T. 37°.0; red globules, 2,662.080; white 
globules, 940; E. Apyrexia. October 1st, E., P. 80, T. 37°.3; M., 84, T. 40.°0; red 
globules, 2,544, 204, white globules, 4230; Dismissed on 11th October, improved. 
Repeated doses of sulphate of quinine. At the end of twenty-four days of quoti- 
dian fever, tertian and remittent, interupted by an apyrexic period from the 2nd 
to the 7th of September. The numeration made on the 14th, during the full period 
of remittent fever gives 2,594,000. The fever continues until the next day, strong 
and severe, and in these twenty-four hours, during which the thermometer rises, 
to 41^3, the patient loses 710,640-a loss proportional to the intensity of the fever. 
The ten days of apyrexia which follow, supply this deficit by degrees, in bringing Destruction of Blood-Corpuscles in Malarial Fever. 
427 
back the number of globules to 2,491,000. From this moment the blood enters a 
period of restoration, which can still be interrupted by a certain severe paroxysm, 
notwithstanding that from the 30th September to 1st October, which still cost 
117,876 globules (a deficit much smaller than that of a paroxysm at the beginning), 
but which is not less clearly designed in its uniformity (ensemble). 
Observation IX. G , Zouave; aged 22 years; very strong at the beginning ; 
entered the hospital on the 22d September, 1874. Tertian pai oxysms for eighteen 
■days. From 23d September to 9th October only five paroxysms. 9th October. 
Apyrexic stale; red globules, 1,780,350. 10th, M., P. 76, T. 37.°0; E., P. 76, T. 38.°6. 
11th, M., P. 72, T. 39.°4; red globules, 1,751,596; E., P. 84, T. 38.°0. 12th, M., P. 
100, T. 38.°4; E., P. 84, T., 40.°0. 13th, M., P. 84, T. 37.°0; red globules, 1,692,000; 
E., P. 100; T. 39.°0. 14th, M., P. 128, T. 4O.°4; red globules, 1,277,648; E., P. 104, 
T. 38.°2. 15th, M., P. 76, T. 36.°0 ; has perspired agreat deal during the night; E., 
P. 100, T. 39.°0; red globules, 1,524,868. 16th, M., P. 116, T. 39.°2; E., P. 96, T. 37.°4. 
17th, M., P. 80, T, 36.°6 ; E., P. 80, T. 38.°0; red globules, 1,416,298. Apyrexia from 
the 17th to 25th; uninterrupted quotidian fever from 25th October to 3d November. 
Temperature in the morning, normal. That of the evening oscillated between 
38.°5 and 39.°5. Four numerations in this period have given: 29th October, red 
globules, 1,264,300 ; white globules, 1,445 ; s-p, 30th, red globules, 1,391,025 ; white 
globules, 1,343; 2d November, red globules, 1,358,300; white globules, 3,525; 
3P. 3d, red globules, 1,447,600; white globules, 1,762; . Dismissed on 2Sth 
November. In this interval, some light erratic paroxysms, save one, which caused 
the temperature to rise to 40°. 
On the day of dismissal, red globules, 2,426,110; white globules, 3,525; 
numerous doses of sulphate of quinine. The first numeration made on the 9th 
October. The fever lasts a little more than a month, and already the oligo- 
cythsemia is very great, 1,780,350. Then commences a period of quotidian and 
remittent fever, serious enough by the elevation of the temperature, and which 
lasts until the 17th. Very good for this long febrile period, the diminution of the 
number of glqbules is only 364,052; it is very small if we compare it with what a 
febrile movement of the same intensity costs the patient during a fever of the first 
invasion. The more the blood is weakened by previous fevers, the less it loses in 
the last paroxysms. This will be more clearly shown in the following febrile move- 
ment from the 25th October to 3d November. We have there eleven days of quo- 
tidian fever, and, nevertheless, there is rather a tendency to an augmentation than 
to a diminution of the globules. 
Observation X. M , aged 29 years; patient originally very vigorous; four 
years' sojourn in Algiers; has had the fever each year, during the epidemic season. 
Entered the hospital 18th September, 1874. The patient had paroxysms from time 
to time during the last year. Profound anaemia, enormous hypertrophy of the 
spleen. 
22d September, globules red, 942,350 ; globules white, 940 ; 10T0^. 25th, globules 
red, 849,380; globules white, 940; Apyrexia up to this day. From 26th 
September to 12th October, light quotidian fever, febrile temperature, oscillating 
between 38.°0 and 38.°6. In this interval five numerations : 
26tb. September, globules red, 740,015; globules white, 940; 28th, globules 
red, 600,000; globules white, 470; 29th, M., globules red, 583,270; globules white, 
470; -2r-; E., globules red, 666,930; globules white, 470; i-4^. 12th October the 
fever is arrested. 13th, globules red, 639,632; globules white, 1,175; From 
13th October to 7th November, day of dismissal, constant apyrexia, and progressive 
improvement, sulphate of quinine, cinchona, ferruginous. 30th October, globules 
red, 1,826,138; globules white, 940; 1!'r42. 7th November, globules red, 2,669,600; 
globules white, 1,175; 
This observation shows us to what a degree the paludal anaemia can injure. 
583,000 globules red per cubic millimetre is a little less than one-tenth of the nor- 
mal number. We also here see how little the number of globules is influenced by 
the paroxysms which follow the completed anaemia. About twenty days of quo- 
tidian fever cause it to fall to only 300,000. What a difference with that which we 
observe in the fevers of the first invasion! 
The following observation is another example of this peculiarity : 
Observation XT. M ; aged 27 years ; two years' sojourn in Algiers; strong 
and sanguine, when he was first attacked with fever; remittent fever from 18th to 
25th August, tertian from 26th August to 11th September, quotidian from 11th 
September to 17th September. 
14th September, globules red, 1,789,760 ; globules white, 2820 ; Apyrexia 
from 18th to 27th September. 22d September, globules red, 1,534,832; globules white, 428 
Destruction of Blood-Corpuscles in Malarial Fever. 
2820; -f4. From 27th September to 4th October, quotidian fever. In this inter- 
val four numerations. 3d October, globules red, 1,330,100; globules white, 1645 
From the 4th October to 20th October, an apyrelic period, interrupted by a 
renewal of remittent fever from 18th to 21st of October. 2d November, globules 
red, 1,679,498; globules white, 4935; Dismissed on the 30th of November, 
improved. Sulphate of quinine, ferruginous tonics. Thus, in less than a month 
of remittent and tertian fever, the number of the globules falls, in the case of this 
originally vigorous man, to 1,789,760, and about six weeks after, the 29th of Octo- 
ber, notwithstanding the continuation of the fever, interrupted from time to time- 
by periods of apyrexy, we still find 1,679,498 red globules: it is true that during 
that interval, they at one time fell to 1,330,100, which shows that during that long 
period of fever they oscillated within a numerical compass, barely represented by 
about 300,000. 
We reproduce a few numerations made with subjects affected by complete 
cachexia, with enormous hypertrophy of the spleen. They are extreme types of 
the paludial oligocythsemia. The restoration of globules is in this case much more 
difficult than in the wane of simple or even pernicious fevers, though there may be 
only rare attacks of fever. 
Observation X11. M - ; 53 years old ; entered 19th December, 1874 ; com- 
plexion pale, dull; hypertrophy of the spleen ; paludial fever of a year's standing. 
22d December, globules red, 952,690; globules white, 2115; 4f°. 28th December, 
globules red, 1,040,298. 2d January, globules red, 966,850. 
Obs. XIII. Ch-. Aged fifty. For three months intense fevers during the 
epidemic season. Enters the 16th of September, 1874. Earthy complexion; enor- 
mous hypertrophy of the spleen. Permanent prostration. 
20th September, globules red, 1,024,600; globules white, 6580; 25th, glob- 
ules red, 1,024,600; globules white, 5170; If-8-. Take 2 grammes of sulphate of quinine. 
26th, globules red, 957,860; globules white, 3760; 29th, globules red, 1,011,440; 
globules white, 2820; -3-|-8-. 24th October, globules red, 1,955,200; globules white, 
4500; Dismissed 24th October, without having had a single attack of fever; 
quinquina, ferruginous tonic alimentation. 
Obs. XIV. D . Aged thirty. Enters the 24th of September, 1874. Fever 
since the commencement of the summer. Cachexia, complexion earthy, yellow- 
ish; enlargement of the spleen of four fingers' breadth. 
25th September, globules red, 1,555.042; globules white, 1880; 8f . 27th, glob- 
ules red, 1,518,852; globules white, 2350; 28th, globules red, 1,582,302; globules 
white, 1880; 8p. 3d October, globules red, 1,621,970; globules white, 5640; 7th, 
globules red, 1,750,880; globules white, 2350; if®. No fever during his stay in the 
hospital. Cinchona ferruginous. 
Obs. XV. V . Sergeant; in Algiers for two years. Entered on 5th Novem- 
ber, 1874. Has had fever for three months. Earthy paleness, enormous spleenr 
severe cachexia. 
9th November, globules red, 1,350,498; globules white, 1880; if-8-. 17th, globules 
red, 1,632,874; globules white, 1410; -Lt-5-0-. 27th, globules red, 1,673.85S; globules 
white, 1645; uni. Free pigments in the blood; some erratic paroxysms during his 
stay in the hospital; sulphate of quiuine, cinchona ferruginous. 
Obs. XVI. M . Aged twenty-two years. In Algiers two years. Entered 
on 23d September, 1874. Tertian fever in July and August. No fever for six 
weeks; nevertheless earthy paleness of the face and hypertrophy of the spleen. 
9th November, globules red, 1,760,902; globules white, 3290; Pigment 
globules in the blood. 15th, globules red, 1,599,598; globules white, 2115; if®-. 29th, 
globules red, 1,835,914; globules white, 5170; 3f-\ Dismissed this day. The blood 
drawn from the finger presents still some pigmented (pigmentis) white corpus- 
cles. No fever during his stay in the hospital. Repeated doses of sulphate of qui- 
nine, and ferruginous cinchona. 
CACHEXIA MALARIAL. 
There are few affections which produce so rapid and so complete oligocythe- 
mia as paludial fevers in the endemic native land (foyers). From twenty to thirty 
days of simple, remittent, quotidian, or tertian fever are sufficient to reduce the 
number of red globules from 5,000,000 to 1,000,000 per cubic millimetre, and some- 
times even to 500,000 per cubic millimetre. 
The study of the different phases of this very rapid decrease, and its relations 
to the paroxysms, furnishes a series of facts rendered conspicuous in reference 
CONCLUSIONS. Destruction of Blood-Corpuscles in Malarial Fever. 
429 
to each observation, and which we here consolidate in the following proposi- 
tions : The paroxysms of simple fever exercise an immediate and direct influence 
upon the number of red globules. Undoubtedly this is less after the paroxysm 
than before, and the difference ordinarily ranges from one to many hundreds of 
thousands, sometimes a million. (This proposition can be frustrated by profuse 
sweats and severe diarrhoeas, which, by momentarily thickening the blood, con- 
ceal for some time the real number. Here, then, is a source of error that we must 
avoid.) The difference is, however, greater as the paroxysm in question is nearer the 
beginning of the invasion. The intensity of the fever influences, without doubt, 
the loss in a certain measure; but the first condition removes a great many of 
them. It is thus that a vigorous and robust subject loses at the beginning of a 
fever (quotidian or remittent) of the first invasion 2,000,000 globules per cubic mil- 
limetre in four days, and even 1,000,000 in twenty-four hours. If we follow with 
these the variations that the blood goes through, with the last evolution of the fever, 
we ascertain that from the commencementof a certain moment, ordinarily when the 
number of globules is lowered to 300,000 per cubic millimetre, we ascertain, I say, 
that the losses experienced by the blood, under the influence of paroxysms, are a 
great deal smaller than at the beginning; we see the number of globules fall 50,000, 
80,000, 100,000 per day, wholly during the initial period, when the febrile move- 
ment was at its height, and the composition of the blood was scarcely contaminated, 
the decrease was ten times greater. Under other circumstances, the decrease is 
greatest at the beginning of a fever of the first invasion, when the blood still pre- 
sents its normal globular richness, and it is impaired in proportion as we depart 
from this moment, when the blood becomes poorer, and the paroxysms tend to be 
further apart. 
Once that the paludal anaemia is complete, that the number of globules has 
fallen to its minimum from 2 000,000 to 1,000,000 per cubic millimetre (this varies 
with the individual), this number is no longer sensibly lowered, or it falls only a little 
and slowly, even during a severe paroxysm. Sometimes it ascends a little, although 
the fever continues under the form of paroxysms more or less distant. Most gen- 
erally it presents oscillations which are the result of a tendency towards restora- 
tion during the apyretic interval, interrupted almost immediately by a retrograde 
movement, which causes an intercurrent paroxysm, but the deficits produced in 
this period of complete anaemia are less marked than in the proceeding periods, 
although these tardy paroxysms are often severe from the elevation of the temper- 
ature and general symptoms. Also often this period of oscillation of the number 
of red globules constitutes, in itself, a period of restoration; that is to say, that 
the deficit produced by the paroxysms is exceeded by the augmentation superven- 
ing in the intervals. Unfortunately it sometimes happens that the number of 
globules having fallen to 1,000,090 per cubic millimetre, remain stationary for weeks 
with variations more or less insignificant; there is here little or no tendency to 
restoration, notwithstanding that full doses of cinchona and iron have been given, 
and although the paroxysms of fever are rare. This is the case with individuals 
profoundly cachectic, who have considerable hypertrophy of the spleen. 
Sometimes we have seen the red globules diminish in a very apparent manner 
in the intervals of the paroxysm, that is to say. independent of all elevation of 
peripheric temperature. This rare fact in simple fevers, is met with in many 
pernicious paroxysms, as we will soon see. In the history of particular observa- 
tions, I have said nothing of the white globules, which have almost always been 
comprised in my numerations. The numbers that we have found indicate a 
constant diminution of these elements, but it is necessary that they be proportional 
to those of the red globules ; almost always their number falls more than those of 
these last, although the spleen increases in volume. What we record from some 
of our observations (II, IV, X,) we will see that the fractions which express the 
relations of the white globules to the red discs are generally much inferior to the 
minimum given for the physiological state, a peculiarity which is often more 
marked in very profound anaemias and complete cachexias (observation), and 
where it surprises us still more when this arrest in the seat (genise) of the lymphatic 
elements of the blood contrasts with hypertrophy of the spleen, often enormous. 
There are, however, some exceptions to this proposition; in three or four- 
cases of profound anaemia, passing through, all at ones, grave phenomena ; prostra- 
tion of forces, comatose somnolence, the number of white globules is raised to that 
point in which we reckon one white globule to 192,118,112 red globules, (see 
observations XVIII and XXII). Independently of this diminution the white 
globules undergo in simple fevers, numerical oscillations so extended, so numerous 
and so unexpected, that it is impossible to suspect the conditions which regulate 430 
Destruction of Blood-Corpuscles in Malarial Fever. 
them. During the physiological state, however, they are subject to similar varia- 
tions; from the numbers carefully recorded in these observations, we concluded that 
paludal amemia enlarges the limits of their normal oscillations. In conclusion, 
when we notice the variations of the globules of a vigorous subject from the first 
paroxysm until the period of complete anaemia, we observe: 
First. That this anaemia comes on in a very rapid manner. In a month and 
even less, the globules fall from 6,000,000 per cubic millimetre to 1,500,000 and below. 
Second. That there is in the numerical modifications of the red globules, three 
periods, which correspond well enough with the clinical transformations of the 
fever. A first, short, in which the globular deficit exceedingly rapid, amounts to 
many hundreds of millions per day. This is the initial period* of the fever, strong 
febrile power (effervescence) from continuous or remittent with a train of symp- 
toms more or less grave. A second, longer than the first, during which the deficit 
by paroxysm is a great deal smaller than in this one; febrile movement still very 
intense, but the intermittent! type (quotidian or tertian) is substituted by the 
remittent type. 
In the two first periods the numerical decrease of the globules is continuous. 
Finally, a third, in which the number of the globules cease to fall; it oscillates for 
sometime in the neighborhood of a minimum; the blood still undergoes losses 
under the influence of the paroxysms; but these losses are a great deal less sensible 
than in the two first periods, and which tend to be compensated by the salutary 
influence of apyretic intervals, during which there is a regeneration more or less 
marked of blood-corpuscles. This is very often wanting in the two preceding 
Deriods. In a clinical point of view, this last phase is marked by paroxysms 
of isolated or quotidian fever, between which, intervenes some periods of apyrexia 
more or less distant. 
2. QUALITATIVE ALTERATIONS OF RED GLOBULES. MACROCYTHEMIA. 
During life the red globules, independently of their numerical diminution, 
undergo qualitative alterations which deserve our attention. When we study the 
blood diluted in artificial serum, we find three varieties of appearance in the glob- 
ules. There are, 1st. Pale globules, voluminous; 2d. Smaller globules, strongly 
colored, more or less crenellated (cr6nel6es); 3d. Polished globules, high-colored and 
very refractive. For observation has demonstrated to us that the more pro- 
found theoligocythemia, the more thenumber of globules of the first variety prevail 
over that of the two others; these sometimes constitute almost by themselves the whole 
mass of the globules, while they diminish little by little to make room for the 
globules of the two last varieties, when the blood is regenerated. With persons 
little amemiated, the pale, voluminous globules arealways few in number with 
respect to the others. The knowledge of a modification of volume in the red glob- 
ules naturally suggested to me the idea of measuring the dimensions of these last 
with my fever patients, an idea which is not new, for Mr. Malassez, in France, 
Manassein, in Germany, and a great many others have already made interesting 
studies in a pathological point of view, in this direction. For reasons independent 
of our wishes we could only execute it very slowly, after the endemo-epidemic 
period, .when we no longer had in our possession the most perfect types of palu- 
dal anaemia. Nevertheless the results to which we have arrived suffice to charac- 
terize the significance of the alteration. On the next page is a table of some obser- 
vations upon patients more or less amemiated, with considerable hypertrophy of the 
spleen. 
If we glance over this table, we see that the mean diameter of the discs oscil- 
lating between eight and nine-thousandths of a millimetre tend to augment as the 
red globules diminish; save in one or two cases, we have not had to deal with very 
profound amemics, if such had been the case, it is probable that we would have 
had everywhere a mean of 9, as in observations XVIII and XXII. 
This macrocythemia causes the blood of our anaemic patients to be similar to 
that of inferior animals. Its pathological cause is obscure; we would be tempted 
to attribute it to hydremia and to consider it as a kind of aedemia of the globules. 
But this interpretation remains doubtful in the presence of the researches of Manas- 
sein (Ueber die Dimensionen der rothen Blutkorperchen unter verschiedenen 
Einflussen, Berlin, 1872), who has shown that cold, alcohol, the salts of quinine, 
and hydrocyanic and many other influences were equally sufficient to cause an 
augmentation of the mean diameter of the red globules. Destruction of Blood-Corpuscles in Malarial Fever. 
431 
1 
Numeration 
Mensuration 
Thousandth of a 
millimetre 
Observation XVII 
Globules red, 2,972,280 । 
Globules white, 5,875 
Globules red, 910,860' 
Globules white, 3,407; 
15 days later: 
Globules red, 527,366 
Globules white. 4,817. 
5 days after: 
Globules red, 674,4501 
Globules white. 5,992 
Globules red, 2,624,950 
Globules white. 7,050 
Globules red, 893,752 
Globules white. 4,824 
Globules red, 3,337,600 
Globules white, 3,055 
Globules red, 1,028,360 
£ 0 6 
Minimum, 7. 
Maximum, 11. 
Mean, 8.704 
Observation XVIII 
Observation XIX 
► ip 
xp 
. 3 J 3. 
. .206 
Minimum, 7. 
Maximum, 12. 
Mean, 9.429 
Minimum, 7. 
Maximum, 10. 
Mean, 8.476 
Minimum, 6.75 
Maximum, 12. 
Mean, 8.61 
Minimum, 6.75 
Maximum, 10. 
Mean, 8.548 
Minimum, 8. 
Maximum, 12. 
Observation XX 
Observation XXI 
J-09 2. 
Observation XXII 
. 397 
Observation XXIII 
Ciioouies wnite, j 1 
5 days after: 
Globules red, 869,876 ) 
Globuler white, 2,350 > ap 
10 days later : J 
Globules red, 589,286 ) ia2 
Globules white, 3,055 / 1 
Died four days after this last 
observation. 
Mean, 9.106 
Minimum, 8. 
Maximum, 13. 
Mean, 9.776 
Minimum, 7.5 
Maximum, 10. 
Mean, 8.52 
Minimum, 6. 
Maximum, 10. 
Observation XXIV 
Globules red, 2,109.360 
Globules white, 5,875 
Globules red, 2,754,200 
Globules white, 7,050 
Globules red, 2,291,720 
Globules white, 2,256 
Globules red, 2,342,480 
Globules white, 1,645 
Globules red, 3,160,844 
Globules white, 1,627 
Globules red, 2,433,888 
Globules white, 3,760 
Globules red, 3,785,687 
Globules white, 4,230 
, 8. A9 
Observation XXV 
► 3.6.6. 
Mean, 8.64 
Minimum, 6.5 
Maximum, 12. 
Observation XXVI 
. 1_P is. 
Mean, 8.442 
Minimum, 6.5 
Maximum, 10. 
Observation XXVII 
t 1424 
Mean, 8.442 
Minimum, 6. 
Maximum, 11. 
Observation XXVIII 
L 1.^42 
Mean, 8.54 
Minimum, 6.5 
Maximum, 10. 
Observation XXIX 
> -6-44 
Mean, 8.01 
Minimum, 6.25 
Maximum, 10. 
Observation XXX 
Mean, 7.889 
Minimum, 7. 
Maximum, 10. 
Mean. 8.38 
Note.-Each mean is furnished by 100 mensurations made upon globules taken indiscrimi- 
nately in the extent of the field of preparation. 432 
Destruction of Blood-Corpuscles in Malarial Fever. 
The number of these in which the numeration of the globules has been care- 
fully made, amounts to 17. We will reproduce here only some types : 
Obs. XXXI.-B , aged twenty-four years, vigorous Zouave, four years 
from Africa, no anterior fever. Taken with remittent fever on the 10th August, 
1874; entered on 28th ; two grammes sulphate of quinine. 
28th August. T. 40. °4, P. 124; 29th, M., T. 38.°2, P. 104, two glasses sedlitz 
water; E., T. 40.3, P. 112, four liquid stools; globules red, 2,870,520; globules white, 
2,820; 30th, M., T. 40.°0, P. 112; many stools during the night, tongue fuligin- 
ous, complexion sombre, clayey; respiration slow; aforesaid (pr^cit<5e) extreme 
prostration of powers, grave state; globules red, 2,774,200; globules white, 7,050; 
30th, E., T. 38°8, P. 100, globules red, 2,716,600; globules white, D. 
The blood taken from the finger presents in the field of the microscope two 
leucocytes impregnated with black granular pigment. 
31st, M., T. 37.°4, P. 76, state very grave; face dark brown, cadaveric; urine 
high colored, without any reaction with nitric acid, sclerotic yellow (jaundice hema- 
pheique), prostration extreme. 31st, E., T. 39.°4, P. 100; no more stools since yes- 
terday evening. 
The temperature oscillates between 36.°6 and 37.°2. 1st September, M., same 
state, globules red, 1,434,440; globules white, 7,050; E., samestate, globules red, 
1,467,340; globules white, 10,850; 2d, M., globules red, 1,253,020; globules white, 
10,340; -Lp; 3d, M., prostration with tossing, incessant vomiting, globules red, 
1,551,000; globules white, 10,310; 4th, M , general condition (ensemble) im- 
proved ; globules red, 1,486,760; globules white, 9,400; 
Temperature oscillates between 36.°6 and 37.°. 5th, M., globules red, 1,193,800; 
recovers little by little from 6 to 9; had no fever. 9th, E., globules red, 1,269,000; 
globules white, 3,290; 
Temperature oscillates between 37° and 37.°8. 11th, E., globules red, 1,472,604; 
globules white, 4,230; 16th, M., globules red, 2,109,360; globules white, D. 19th, 
M., globules red, 2,072,700; globules white, 3,290; izs. 27th, M., globules red, 3,280,600; 
globules white, 8,460; Has taken six grammes sulphate of quinine during his 
stay in the hospital. 
I notice in this observation : 1st The extreme rapidity in the decrease of red 
globules. Thus from the evening of the 30th August to the morning of 1st Sep- 
tember, that is, in forty hours, the blood lost 1,282,160 red globules per cubic milli- 
metre. 2d. The prompt restoration of the blood at the issue of the pernicious 
paroxysms. 3d. Finally, the interesting fact, the absolute and relative augmen- 
tation of the white globules. These peculiarities are found in almost all perni- 
cious paroxysms. 
Observation XXXII. H. , aged thirty years, a man of athletic consti- 
tution, entered the 5th October; quotidian fever for fifteen days; diarrhoea for three 
days; paroxysms 6th and 7th October; two grammes sulphate of quinine. On the 
morning of the 8th apyrexia, but remarkably changed since yesterday; extreme 
adynamia, sombre, clayey complexion of the skin; diarrhoea; vomited greenish 
matters; one gramme sulphate of quinine; globules red, 3,891,600; globules white, 
20,608; -fA Many melansemic leucocytes on the field of observation. E., T. 37.°2, 
P. 100; miserable pulse; prostration and adynamia; diarrhoea continues. T. 37.°0, 
P. 96; coma; some involuntary stools during the night; globules red, 3,002,924; 
globules white, 34,914, ^r4; died during the night of 9th and 10th. 
Obs. XXXIII. P , aged 24 years; Third Zouaves; very vigorous subject 
and well during the whole summer. Was attacked with remittent fever on 30th 
August, 1874 ; jaundice the second, entered the hospital on the third day ; 1st Sep- 
tember, 1874, apyrexia, intense jaundice, urine dark, nothing alarming in general 
condition. Ipecac stibiated (stibiS) at 7 A. M.; 1 gramme sulphate of quinine at 
3 P. M. 2d September, apyrexia, complexion darker from the coloration of the 
jaundice. 3d September, morning, great warmth, bilious diarrhoea. 5th Septem- 
ber, morning, P. 116, T. 39.°2, sudden development of grave symptoms; intense 
cephalalgia, profound prostration, incessant moaning, bilious vomitings, spleen 
voluminous and tender. Evening, P. 112, T. 37.°0, same condition, diarrhoea has 
disappeared; 1 gramme sulphate of quinine. 6th September, morning; P. 76, T. 
37.°0, sleeplessness, tossing about, intellect obscure, tongue dry, brown, jaundice 
very dark, urine resembles dark beer. Evening, P. 100, T. 37.°'6 ; same condition. 
7th September, morning, P. 76, T. 35.°8, hiccups, tendency to delirium, incessant 
tossing and somnolence, fuliginous buccal mucous, vomiting of a brown matter as 
of dark bile, diarrhoetic stools of the same color; globules red, 2,462,800; white, 
PERNICIOUS FEVERS. Destruction of Blood-Corpuscles in Malarial Fever. 
433 
35,015; i1Q. Melanaemic leucocytes in the blood drawn from the finger. Died 
during the night of 7th and Sth. 
Obs. XXXIV. P , aged 24 years; in Algiers for 3 months; simple fever 
for one month, was taken with a paroxysm of pernicious fever of a comatose form, 
on the 9th November, 1874. 10th November, morning; T. 38°, P. 84; comatose 
state, face of a bistre tint, spleen swollen ; 1 gramme sulphate of quinine adminis- 
tered by the probang. 
11th November, morning, T. 37.°6, P. 80, same state; globules red, 3,026,800, 
white, 0,110; ^p. In the field of the microscope, some melanaemic leucocytes and 
three small clumps of free pigment. 
From 11th to 14th, normal temperature, same general condition. 
14th November, M., P. 76, T. 36°; globules red, 1,827,736, white, 5,875; ^p. E., 
P. 76, T. 36.°8, 1 gramme sulphate of quinine. 
Normal temperature.-15th November, M., globules red, 2,191,328; white, 8,460; 
^p. E., globules red, 1,983,400. 16th, M., bilious vomiting; E., 1 gr. sulph. of 
quinine; globules red, 2,198,425. 19th, M., gets better and better; globules red, 
2,751,004; white, 9,400; 
From 20th to 24th, three tertian paroxysms which cause the number of globules 
to fall slightly, for we find: 22d November, globules red, 2,621,660; white, 4,465; 
25th, globules red, 2,222,724; white, 3,055; 
From this moment there was no more fever, the blood is restored rapidly 
enough ; we find : 27th November, globules red, 2,320,390; white, 1,645; 4th 
December, globules red, 3,207,750; white, 4,700; ^p. 
There had been one paroxysm on the 5th; temperature 39.°8. 6th, globules 
red, 3,058,384; white, 4,700; ap. 13th, globules red, 2,978,484; white, 5,175; ^p. 18th, 
globules red, 3,362,004; white, 5,127; ~p. Dismissed this day. 
Obs. XXXV. R , aged 34years; entered thehospital on the 22d June, 1875. 
Incomplete information. General condition grave; prostration of powers, som- 
nolence with tossing about; tongue and gums fuliginous; appearance cadaveric; 
jaundice darker and darker, although the urinegave no reaction with fuming nitric 
acid; temperature constantly below normal; incessant bilious stools and vomiting; 
swelling of the spleen and liver. Died on 28th June, three days after his entrance, 
in the midst of very severe nervous phenomena. Full doses of sulphate of quinine. 
The following is the table of my mensurations. The incessant diarrhoea and vomit- 
ing of this patient explain the oscillation of numbers. 
23d June, M., globules red, 2,288,748; globules white 13,395; ip. 24th, M., 
globules red, 1,927,700; globules white, 10,810; xp. 25th, M., globules red, 
1,318,632; globules white, 13,160; ip; 2 P. M., globules red, 1,415,358. 26th, 2 P. 
M., globules red, 1,807,432; globules white, 13,160; -p; 6 P. M., globules red, 
1,206,302; globules white, 10,966; ip. 27th, M., globules red, 1,769.550; globules 
white, 10,575 ; xp. 28th, M., globules red, 1,847,100; globules white, 11,515; ip. 
During each numeration, melanaemic leucocytes and free pigments in the field of 
observation. 
Observation XXXVI. D , aged 43 years; formerly cachectic; taken with 
a pernicious paroxysm, comatose form, on 1st December, 1874. 6th December, no 
change at two hours; E., globules red, 1,914,216; globules white, 7,708; s^. 
Melanaemic leucocytes in the field of observation. 7th, M., globules red, 1,791,264; 
globules white, 10,716 ; *p. Died on the 8th. 
Observation XXXVII. B , Third Zouave; brought into my service on the 
30th October, 1874. Pernicious paroxysm, comatose form, superveningin the midst 
of a profound paludal paroxysm ; during the whole time of the observations 
the temperature was rather below than above normal. Clayey bistre complexion 
of the face. 
The following is the result of my numerations: 31st October, E., globules red, 
1,090,400; globules white, 2,585; ip. 1st November, M., globules red, 931,540; 
globules white, 1,980; ip. 2d, E., globules red, 668,210; globules white, 2,820; 
238. From 2d to 5th condition improved. 5th, M., globules red, 631,210; glo- 
bules white, 4,073; ip. Recovered slowly from the beginning of this day. 8th, 
M., globules red, 1,022,438: globules white, 2,350; ip. 13th, M., globules red, 
1,610,502; globuh s white, 3,055 ; ®p. 25th December, globules red, 1,544,232 ; glo- 
bules white, 3,995; ip. Melanaemic leucocytes and some blocks of free pigment 
in the field of observation. 
Conclusions. These observations are divisible into two categories: The first 
embraces those subjects who, at the moment of being attacked, having had but little 
fever anteriority, find themselves consequently only at the beginning of paludal anae- 
mia. In the second may be arranged the patients, according as the pernicious par- 434 
Destruction of Blood-Corpuscles in Malarial Fever. 
oxysm has seized them in the midst of profound anaemia, determined by long anterior 
fevers. With the first the globular decrease is very rapid and profound, it ranges by 
the mean number from 500,000 to 1,000,000 per day. With the second, although the 
quotidian deficit is considerable, it is nevertheless smaller, it rises from 100,000 or 
200,010, i. e. that here as in simple fevers, all other things being equal, the destruc- 
tive influence of the paroxysm upon the blood is as much more limited as this one 
is already more ansemiated. Independently of the extent of the globular deficit in 
pernicious paroxysms, we there notice other peculiarities, common to both cate- 
gories of patients, but always better-expressed in those of the first category. It 
is thus that the globules fall, and often many hundreds of thousands per day 
although the axillary temperature be normal. If then we have been able to say 
for simple fevers, that the decrease of the globules is generally in relation to the 
intensity of the febrile movement and the rapidity of the succession of the par- 
oxysms we cannot establish the same proposition for pernicious paroxysms. 
Another fact which is found more or less with almost all of the pernicious par- 
oxysms, and which really constitutes an interesting peculiarity, is the relative 
and absolute augmentation of the white globules, another difference from simple 
fevers, where these elements are always diminished in an absolute manner, and in 
relation to the red globules. Whilst the number of red globules falls 1,000,000 and 
more, that of the white is considerably increased ; with cachectic subjects, it ordi- 
narily attains the normal (which we suppose to be in mean numbers 8,000 per cubic 
millimetre). In those who were not cachectic, when they were attacked, it would 
pass beyond a great deal more. I have counted 10,000, 20,000, 35,000, etc., white 
globules per cubic millimetre, two or three times more, consequently, than in 
physiological conditions. The relation of white globules to red ones thus increases 
considerably, it becomes tsw, tis, 84, Vo, Vo- Those of my patients who 
have survived their pernicious paroxysms, have generally repaired promptly 
enough the deficit of red globules produced during this paroxysm, with respect to 
white globules; as soon as the grave symptoms are dissipated, they diminish, and 
their proportion in relation to the red ones, returns within normal limits. 
The numeration of the olood globules in severe feverscan lend a useful co-opera- 
tion (concours) to the diagnosis in certain delicate cases. I have had to treat, 
during the season of fevers, some cases of epidemic tubercular inflammation of the 
meninges, which raised the question of differential diagnosis. The numeration 
made and repeated for red globules and also for white ones, did not give me, in 
these cases, those variations so extended as for pernicious fevers. This is, then, 
one source of information which is permitted to be recommended in difficult cases. 
But there is in the diagnosis of pernicious fevers another sign furnished by the 
examination of the blood, a really precious sign, for it has been constant in 
almost all of the observations, namely, melamemia. 
3d. qualitative alteration oe the blood in paludal fevers. 
The last classical treatises upon paludal diseases have not failed topointout 
the existence in the blood of white globules impregnated with black pigment 
under the form of round granules or more voluminous masses. I intend to insist 
here upon the frequency of this fact, I will mention its constancy upon its 
diagnostic and nosological importance with reference to twenty-four cases of per- 
nicious fever where the blood was examined with special regard to the pigment 
matter, I have met this twenty-four times during life, in the blood taken from the 
finger, and after death in that taken from the median veins, crural, jugular, infe- 
rior and superior cava, pulmonary arteries and veins, renal vein, especially the 
portal and splenic veins. If from pernicious fevers I turn to the cachectics, 
in fifty-seven observations collected with care, forty-seven of which have been 
studied with reference to the blood, either during life or after death, I find twenty- 
one negative results and twenty-six cases of melamemia. In the case of these 
twenty-six melamemia, I have noticed on twelve occasions pigment at once, during 
life in the peri ph eric vessels (blood from a puncture of the finger), and after death, in 
the central veins, cava, pulmonary, renal, and especially in the portal and splenic 
veins. 1 have never found pigment cells at the periphery of the vascular system, 
except that the blood of the portal and splenic veins and those of the liver, spleen, 
and of the bony marrow (moelle osseuse) were saturated with it. On the other 
hand, in the fourteen other cases, which concern only the death (supervened with 
old cachectics by intercurrent diseases, pneumonia, abscess of the liver, dysentery, 
peritonitis, meningitis), no pigment has been found in the peripheric vessels; this 
was exclusively massed in the splenic and portal veins, the spleen, the liver, the Destruction of Blood-Corpuscles in Malarial Fever. 
435 
marrow of the bone. In conclusion, melanremia has been observed in more than 
half of the cases of cachexia, and this proportion ought, in reality, to be greater, 
if we consider that the negative results concern patients whose blood from the 
abdominal vessels and organs has remained for me literally closed; for these might 
have central melanaemia, hepato-splenic without peripheric melanaemia, since 
fourteen of the decided cachectics have shown the first without the second. 
For in the case of subjects attacked by simple fever in course of evolution (en voie 
devolution), 1 have made but few researches upon the pigment, the numeration of 
the globules consuming too much time. Nevertheless, the blood of eight patients, 
taken from a puncture of the finger, has been studied immediately after a parox- 
ysm. I have found on five occasions white globules impregnated with black pig- 
ment. There results from information furnished by my three categories of patients 
(pernicious fevers, cachexia and simple fevers, in course of evolution/: 
1st. That melansemia has been constant in the pernicious forms of fever; that 
the pigment was there not only massed in the voluminous blood glands (glandes) 
of the abdomen, but that it circulates also in the vessels of the periphery, where it 
can be observed by aid of the microscope. Its presence becomes thenceforth a 
diagnostic sign, which can be utilized when it becomes a question to distinguish 
the pernicious paroxysm from certain severe •'encephalopathies," often observed in 
hot countries, and to a subject whose nosology has not yet been determined. We 
will speak of the apoplexy of warmth (l'apopiexie de chaleur), which some impute 
exclusively to heat, others consider it the highest type of malaria. 
2d. That melansemia has frequently been noticed in paludal cachexia; that 
the pigment is there shown sometimes in the circulation and incorporated in 
the tissue of the spleen, of the marrow of the bones, and of the liver (melansemia 
and melanose); sometimes localized exclusively in these last organs; and finally, 
in some cases, it is absolutely wanting. On comparing together my observations 
of cachectics, I find that melanose with melanaemia is met with in profound 
cachexias, traversed at each instant by intense attacks of fever; that the paludal 
pigment is shown exclusively in the tissue of the sp.'een and of the bony marrow, 
or that it is entirely wanting in cases of old cachectics, who for a long time have not 
had fever on awakening. 
We are led to believe that the pigment is a constant product and characteristic 
of endemic paludal diseases, grave or of long standing; that this pigment, in like 
manner when it is experimentally injected into the blood, disappears by degrees 
from peripheric circulation to bury itself in the tissue of the special organs, whence 
it is slowly eliminated, and it is for this reason that with a certain number of our 
old cachectics freed for a long time of their fevers, or taken away from the paludal 
cause, we have seen the pigment totally wanting, or we have found it shut up in 
the hypertrophies of the spleen and liver, as well as in the bony marrow. 
THE MANNER OF THE DISTRIBUTION OF THE PIGMENT IN THE BLOOD. 
The form in which it is found there.-The more we go from the sphere of the 
portal vein to advance towards the vessels of the periphery, the rarer the pigment 
becomes. The portal and splenic veins enclose a very rich blood in melanific 
cells. The cava veins, the renal, the pulmonary veins and arteries present a great 
deal less of it. Finally, in peripheric vessels, veins and capillaries of members and 
the jugular vein, the pigment, or pigmented cells are rare, and demand a very 
minute research to be recognized. 
The melanific pigment presents itself sometimes under the forms of small, 
irregular, angular masses, entirely free or encased in a hyalin mass; but oftener, 
almost always, it is incorporated with cellular elements, which are more or less 
related to the white corpuscles of the blood. 
The melanific cells do not differ only numerically in the three preceding 
vascular groups; they are also distinguished by their forms, their size and the 
abundance of pigment matter that they enclose. 
CONCERNING MELANIFIC CELLS IN THE CRURAL AND JUGULAR VEINS, IN 
THE BLOOD OBTAINED BY A PUNCTURE OF THE FINGER. 
They are very rare, and demand much patience for their discovery; some 
practice with the microscope, and certain technical precautions are necessary to 
prevent them from escaping the observer. They are ordinarily spherical, measur- 
ing from 1-7,OOOth to l-12,000th of a millimetre in diameter. I have rarely seen 436 
Destruction of Blood-Corpuscles in Malarial Fever. 
them pass beyond these dimensions; rarely, also, they enclose pigment in as much 
abundance as those of the portal vein. Often there are from three to six round, 
black granules, l-1000th of a millimetre in thickness, enclosed in. the protoplasm, 
arranged towards the periphery of this element. Sometimes these grains are sur- 
rounded with a sort of greenish yellow or brownish gangue, finely dotted, probably 
with the melanic substance in a state of extreme division. This aspect, moreover, 
is a great deal oftener met with in the pigmented cells of the spleen and liver. 
Independently of the leucocytes, we have often seen, as well in the living as in 
the dead, white corpuscles, which have appeared to me to be the first degree of 
pigmentation. There are leucocytes which, instead of being pale, present a brown- 
ish reflection marked especially on the marginal zone, bometimes I have seen in 
this zone, a black pointing (punctuation) extremely fine, as if the protoplasm was 
impregnated by a powder scarcely distinguished by the eye. But oftener the 
coloring matter is found in brownish tint without distinct pigmented granula- 
tions. We will say that the leucocyte takes some part in the serum, the coloring 
matter being in a state of dissolution, and that once incorporated with protoplasm, 
this is condensed and precipitated in the form of granulations. 
PIGMENTED CELLS IN THE SUB-HEPATIC VEINS, SUPERIOR AND INFERIOR 
CAVA AND RENAL, AND BLOOD FBOM THE LUNGS. 
They are, especially in the blood which flows from the lungs, more numerous 
than from the periphery, but incomparably less still in the portal and splenic 
veins. They all are, however, always of a round form, measuring from l-7000th 
to 1-15,OOOth of a millimetre in diameter. The smallest of these elements scarcely 
enclose two or three very fine black granulations; the most conspicuous contain 
large grains of pigment, often confused in the brownish yellow detritus and in the 
fatty granulations. 
In conclusion, we can say for this class of vessels, especially for the blood 
which fills the lungs, that there is at the same time more pigmented cells and more 
pigment in the corpuscles than in the periphery; but the number of pigmented cor- 
pusclesand the abundance of pigment in all these always remain much below that 
which we see in hepato splenic veins. 
CONCERNING PIGMENT IN THE PORTAE AND SPLENIC VEINS. 
The blood of the portal vein, especially of the intra-hepatic portion, that of 
the splenic vein constitute the truesources (foyers) of pigment. This is here incom- 
parably more abundant than in any other part of the vascular system. It is some- 
times free, oftener incorporated with the cellular elements. A small drop of blood 
taken from the trunk of the portal vein, shows, besides red globules. 1st. A con- 
siderable quantity of white globules from l-7000th to l-12^000th of millimetre in 
diameter without pigment. 2d. Fusiform cells, much drawn out, tapering, some- 
times rolled upon themselves, with a nucleus placed eccentrically, without pigment. 
They resemble completely the endotheliales which cover the venous veins of the 
spleen. 3d. Rare free pigments, and a prodigious quantity of pigmented cells, the 
field of observation is obstructed by them ; the voluminous cells are always vari- 
able in their shape and size. They are spherical, polyhedric, irregular, ovoid, 
drawn out (allonggs en boyau), or tapering to both extremities, renfiSs en massue, 
en raquette, on Strangles an milieu en forme de biscuit. Those of the these cells 
which are spherical present from 1-12,OOOth to 1-24,000th of a millimetre in diam- 
eter, often their volume exceeds 1-18,OOOth of a millimetre. The pigment is much 
more abundant in these cells than in the melanific corpuscles of the peripheric 
vessels. Instead of three or four isolated melanic grains, they are oftener consider- 
able granular masses which are heaped up in the body of the cell. The protoplasm 
is only visible at some points : The element resembles a large block of black pig- 
ment and it is necessary to move it round in the field of the microscope in order tn 
see the clear parts of the protoplasm. Nevertheless, in a great many d'entre elles, 
the picrocarminate renders the nucleus apparent; in the largest it is completely 
concealed by the pigment and fatty granulations. A great many of these cells, 
enclose besides the black pigment, one or more red corpuscles more or less altered, 
and sometimes a kind of dark greenish yellow gangue that we can consider as the 
caput mortuum of the destroyed globules. Destruction of Blood-Corpuscles in Malarial Fever. 
437 
OF THE ORGANS CONSIDERED IN RESPECT TO THE PIGMENT. 
In their relation with melansemic pigment, the organs act absolutely in a con- 
trary manner from that of artificial pigments, (V. Ponfick, Studien uber die 
Schicksale Korniger Farbenstoffe im Organismus. Virchow's Arch., xliii.-Hoff- 
man et Langerhans, ibid., xlviii.) The ones the most numerous, retain the pig- 
ment in a transitory manner in their capillary systems; others, in small number, 
.arrest it in a durable manner and incorporate it in their tissues. From this point 
of view, it can be arranged in four distinct categories: 1st. The spleen and the 
bony marrow, where the pigment is always found from its development until its 
■definite disappearance incorporated in the elements proper of the tissue. 2d. In 
the liver where the pigment is as constant as in the preceding organs, but where 
it is always found enclosed, not in the elements proper, but in the capillaries of this 
organ. We meet with it slowly, a little in the interlobular conjunctive tissue, pro- 
bably in the lymphatic vessels. 3d. In a third series of organs, we find the pig- 
ment only in a transitory manner, at the moment of the fever, during the melan- 
•semic period ; it is here always intravascular. I have never seen it in the elements 
proper of the tissue. The organs are: the brain, lungs, kidney, heart, muscles, 
intestinal walls. The pigment is not slow in disappearing from these in order to 
retrench itself in organs mentioned under numbers one and two. 4th. Finally, 
■the lymphatic glands, which form a separate class of organs; I have never found 
the pigment anywhere but in the capillaries, with the exception however of the 
ganglions of the Assure of the liver, which in two cases of intense melanose 
have presented numerous, free, melanific cells mixed with the lymphatic elements 
of the reticulum. 
1ST. THE SPLEEN-SPLENIC MELANOSE. 
The dissociation of the pulpe gives: 1st. Epithelial cells of the capillary veins. 
2d. Lymphatic cells, colorless or impregnated by fine melanic granulation 
(7-10,OOOths of a millimetre in diameter). 3d. Ceils very voluminous, rounded 
(10-14,OOOths of a millimetre in diameter), or irregular, drawn out, ovoid, biscuit 
shaped, club shaped. 4th. Finally large cells, measuring 14-24,OOOths of a milli- 
metre in diameter, enclosing the debris of the red globules. These two last varie- 
ties of cells contain a very considerable quantity of pigment. Some very fine 
plates (coupes), colored by picrocarrninate and examined at first with a low magni- 
fying power, gave, on the whole, a view already very instructive. The capillary 
veins are more or less filled with blood, especially with white globules and melan- 
ific globules. The corpuscles of malpighi and the lymphatic walls of the arteries, 
better coloied than the travees pulpaire, are generally deprived of pigment. At 
best, we observe some black grains towards the periphery of the malpighian 
-enlargement, or entirely against the walls of the small arteries. The largest mass 
of pigment lies in reality in the travOes pulpaire. The following is a detailed 
examination of the constitutional parts of the organ : 
(A.) Travees pulpaires.-The reticulum which serves as their frame work, 
encloses: • 1st. Free red globules, in more or less considerable quantity. 2d. 
Nuclei. 3d. Small lymphatic cells with a central nucleus. These two last varie- 
ties of elements are always without pigment. 4th. Cells more voluminous, irreg- 
ular, enclosing granulations or enormous masses of pigment; sometimes, but 
seldom, there are free pigments. Generally the meshes (maille) of the pulp which 
rests upon fibrous trav6es, enclose more pigment than the pulpaire cordons them- 
selves. 'khe free red globules are sometimes mixed without order with the paren- 
chymatous cells, at other times they are placed with a certain regularity, each 
placed alongside the other. They form very evident trains, immediately in rela- 
tion with the parenchymatous cells. I have often met with such images in my 
observations. They incline in favor of the existence in the travCes pulpaire of a 
lacunary circulation, admitted by some, contested by others. 
(B.) Capillary veins.-I have nothing to say of these, unless it be that often 
they do not enclose any trace of pigment, when the travOes pulpaire are saturated 
with it. They are generally stuffed with white globules. 
(C.) Follicles of malpighi.-When the splenic melanose is slight, they are 
absolutely devoid of pigment. In the mean melanose we see this appear, always 
incorporated with cells, in the elongated meshes of the reticulum, situated on the 
periphery of the follicle, and in theadSnoide tissue, which borders immediately the 
wall of the artery which supports it. In regard to the follicular mass itself, it is 
always without pigment or it presents only some scattered melanifie cells, when 
there is very intense melanose of the travCes pulpaires. 438 
Destruction of Blood-Corpuscles in Malarial Fever. 
(D.) Lymphatic sheaths of the arteries.-They always contain, even in slight 
cases, melanific cells placed in the meshes of the reticulum, which immediately 
borders the arterial wall. The peripheric zone of the sheath does not enclose any 
of it. I have examined spleens where the travdes pulpaire were exceedingly poor 
in pigment, and where, nevertheless, the lymphatic sheath of the arteries, in the 
meshes which immediately border the external coating, were passively devoid of 
it. Let us observe in passing, that the melanic pigment is absolutely distributed 
in the spleen as the coloring matter injected into the blood (V. Panfick, Hoffman, 
et Langerhans, loc. cit.) 
It is as richly and as constantly endowed with pigment as the spleen and the 
liver. It appears in the spongy bones under the form of a thick pulp, having the 
color of the lees of wine, which is not in analogy with that of the spleen, 
and which by dissociation shows : 1st. Red globules. 2d. Adipose vesicles. 3d. 
Lymphatic cells and cells which measure even twenty thousandths of a millimetre- 
in diameter. Between these two extremes we find all the intermediates. All these 
elements enclose black granulations disseminated under the form of very fine 
points or in conglomerates more or less voluminous. Among the most voluminous 
melanific cells, there is a certain number which besides the pigment enclose one 
or more red globules more or less altered, or some yellowish detritus, sometimes 
fatty granulations. On very fine plates (coupes) observed (pratiqudes) in the 
sternum and the vertebres decalcified in the acid pdcrique, I found melanific cells, 
not only in the capillary veins, but also and especially in the intravascular tissue 
in the midst of the cells which fill the meshes of the vascular system. 
BONY MARROW. 
2d. the liver. 
The hepatic ceils are often greasy, still oftener impregnated by an excess of 
biliary pigment; but they never enclose the least trace of melanic pigment. This is 
met with almost exclusively in the intralobular capillaries, and not in the lymphatie 
sheaths which surround them. It is incorporated in masses more or less grand 
with the voluminous cells already described, which in a great many of my prepara- 
tions have obliterated the capillaries. The arrest of blood which results from it, 
leads to the distension of these last (La stase sanguine qui en resulte ambne la 
distension de ces derniers) and the atrophy of the travdes of the intermediate hepatic 
cells, as in chronic hypersemia of the liver. This very frequent alteration is 
observed especially at the centre of the lobules. 
This one is sometimes modified to such a degree that we can only see capil- 
laries distended by colossal melanific cells, limited simply by slight fibroid bind- 
ing (liseres) yellowish, vestige of the travde cellulaire atrophiee. (Celui-ci est 
quelque fois modifid au point qu'on n'y voit plus que des capillaires distendus par 
des cellules mdlanifbres colossales et limitdes simplemeut par de mince liserds feb- 
roides, jaunatres, vestige de la travde cellulaire atrophide). The interlobular con- 
junctive tissue is rarely intact. Sometimes, without being thick, it is literally 
stuffed with nuclei and young embryonic cells, arranged in a longitudinal series in 
the plasmatic spaces or reunited in irregular masses; at first these cells infiltrated 
a hypertrophied fundamental tissue, amorphous or fibroid, which interpolates 
between the majority of the acini; finally, in some cases, these are sensibly atro- 
phied by fibrous interlobular hyperplasia. To be brief, the majority of livers that 
I have studied presented a certain degree of interstitial hepatitis. Is this due to 
the pigment or to use of alcoholics so prevalent in this country ? I cannot decide. 
Often the interlobular portal vein, and sometimes the conjunctive tissue that 
accompanies it encloses the pigment. In the last case, it is probably enclosed in the 
lymphatic vessels. The young cells which infiltrate the conjunctive, hyperplasied 
tissue, the cubic cells which cover the biliary ducts never contain any of 
it. Constantly in those subjects who succumbed in the midst of a pernicious 
fever, and with intense melansemia, I have found the liver loaded with bile, the 
vesicle enormously distended, and the intestine itself inundated by this product, 
ordinarily thick and of a very dark black. The biliary ducts were always free. 
The constant co-existence between this polycholia (polycholie) and the hepatic 
melanose in severe paludal fevers, has often made me think that it is more than a for- 
tuitous coincidence. The hypothesis which should accrue the first from thesecond 
is indeed conformable to our knowledge of physiology, but, in fine, it is nothing 
but an hypothesis. Destruction of Blood-Corpuscles in Malarial Fever. 
439 
3d. THE BRAIN, LUNGS, KIDNEYS, HEART, MUSCLES, MUCOUS MEMBRANES. 
While the spleen, the bony marrow, and the liver store the pigment until its 
complete elimination from the organism, they incorporate it, at least the two first 
organs, in their tissue proper; the organs of this group contain it only temporarily, 
during or a short time after the paroxysm of fever; it is always enclosed in the 
capillaries of these organs, never in their elements proper; it is brought there by 
the blood, and then drawn on and fixed in their focus of election (foyers d'elec- 
tion). These propositions are founded upon the following facts : 
In eighteen autopsies of pernicious fever, where the capillaries of all the 
organs were filled with melanific cells, we have found pigment sixteen times in 
the capillaries of the gray substance of the brain; twice it was absent, although 
the other organs were inundated with it; in twenty-seven autopsies of cachectics, 
ten times the pigment was completely wanting (subjects freed for a long time from 
fever), eight times we have found it exclusively in the liver, spleen and bony mar- 
row; and finally, nine times all the organs were impregnated with it, with the 
exception of the brain, which six times has given me negative results. These two 
last categories of cachectics have had paroxysms of fever some time before their 
death. Finally, in fourteen autopsies of persons carried off by intercurrent diseases, 
and who have had, at some time more or less remote, simple fevers, the autopsy has 
shown eight times exclusive melanose of the liver, spleen and bony marrow; six 
times it has given us negative results with reference to the pigment. As a com- 
plement to these last mentioned, let us recall here that with some patients attacked 
with simple fever, the examination of the blood during life at the moment of the 
paroxysm has revealed melanific leucocytes in the vessels of the periphery. 
4th. lymphatic glands. 
With a certain number of subjects, we have studied the lymphatic glands of 
the principal regions: crural, inguinal, axillary, sub-axillary, mesenteric, and of 
the fissure of th£ liver. Everywhere these organs enclose a few melanific 
cells, always shut up in the vessels which penetrate them. Two regions have 
made an exception to this rule, and it is on this account that I have grouped the 
lymphatic glands separately. These are the glands of the fissure of the liver, 
and of the mesentery; these two cases we have abundantly provided with pig- 
mented cells, situated outside of the vessels and mixed with the elements proper 
of the organ. The pigment, incorporated in voluminous masses with large cells 
more or less regular seated especially towards the periphery, in the follicles and 
the neighboring lymphatic canals. These free melanific cells were remarkably 
abundant in the glands of the fissure of the liver, infinitely less in those of 
the mesentery. Weare induced to believe that they were brought by the lym- 
phatic vessels of the liver, where we have found pigment incorporated in the inter- 
lobular conjunctive tissue. 
WHERE AND HOW THE PIGMENT IS FORMED. 
Here we depart from the domain of facts to that of conjectures. According to 
the classic teaching, (Vircnow, Gesam, Abh. 201,1856. Pathol. Bellul., Trad, de 
Picard, 1861,185, Frerich, Maladies du Foie), splenic melanose should be first, 
melamemic second. This idea rests upon no certain foundation, it is noteven 
probable. In acute and intense melansemia, such as is developed in pernicious 
paroxysms, the pigment is spread with profusion in all the organism, and yet when 
at this very moment we examine the spleen with the microscope, we find'nothing, 
we come upon nothing that can be interpreted as the prime source of this product. 
This organ is simply saturated with it, as the liver and marrow of the bones. Still 
more, in two subjects who died quickly after the beginning of the pernicious par- 
oxysm. I have found but little pigment in the spleen, although the blood was 
richly provided with it. On the other hand, the conclusions of experimental path- 
ology are not favorable to the primitive melanose of the spleen ; thus in the intra- 
vascular injections of cinnabar, this organ cannot be considered as the prime source 
whence the ulterior infiltration of the other organs proceeds, since with dissected 
frogs, the liver, the marrowofthe bones, and the kidneys, behave with cinnabar in a 
manner directly opposite to that in live frogs. (Panfick, loc. pit.) If the place 
where the pigment is formed remains still to be determined, the manner even of 
this formation is not better known. The opinion which makes this pigment 
come from the source of the extravasated capillaries, (Van Grohe, Tur. Gesch, 440 
Destruction of Blood-Corpuscles in Malarial Fever. 
der Melanemie, Arch, fur path. Anat., Ed. XX, Heft. 3 and 4; and Bd. XXII; 
Eleft. 5 and 6), or from the metamorphosis of stagnant blood in the capillary 
veins of the spleen (Frerich, Diseases of the Liver, page 497), is not confirmed 
by the histological researches of the organs. It is rational to admit that the pig- 
ment derives its coloring matter from the destroyed red •globules, but it remains to 
determine the intimate process (processus) which gives it birth. Pathological 
physiology however, is not wanting in interpretations, it is probable that the 
mdlaniflc corpuscles are nothing but the stroma (stroma) of colorless red corpus- 
cles with the formation of granular pigment at the expense of the haematin. Hen- 
sen, (Teitschr, f. wiss, Zoologie, Bd. XI, p. 253), and more recently Arnold (Arch, 
de Virch., t. Iviii, p. 250), have studied this transformation upon the red globules 
of the frog. But how is it that we never see the intermediate steps of this regres- 
sive work? Disagreeing with the preceding opinion, there should be nothing 
but the red discs absorbed by the white globules which were transformed into the 
pigment. The formation of this would be only intra-cellular. (Langhans.) If it 
were thus in the melanaemia, why do we not find free pigment in the blood? 
Eberth has observed in the work upon the pigmented liver of the frog and mela- 
naemia (Arch. f. path, Anat. u. Physiol, 40), that this, perhaps, was a disease of the 
development of the elements of the blood, in which black particles were formed in 
the white globules instead of and at the expense of the blood pigment; the white 
globules instead of forming red globules, were metamorphosed into melanic cells. 
A third opinion which scarcely complies better than the preceding with the 
pathogeny of the paludal pigment. Perhaps the melanic matter exists at first in a 
state of dissolution in the serum. This, certainly, encloses, in severe paludal fevers 
coloring principles which are not normal to it and which proceed from the red 
globules so rapidly destroyed. How else can we explain that pale, sombre com- 
plexion, almost copper-colored, so different from that of simple anaemia? This 
pigment, once in a state of saturation in the serum, is precipitated under the form 
of granules, which are immediately absorbed by the white globules, like cinnabar 
injected into the blood. Or else these are impregnated directly by the haematin in 
a state of diffusion in the serum and ultimately this substance is condensed and 
precipitated in the interior of the globular mass. I have met with in the blood 
white globules with a brownish reflection that I have considered as impregnated 
by the pigment in a state of diffusion. Whatever be the origin of this pigment, my 
observations show that this appears in the blood at the moment of the paroxysms, 
that it is rapidly absorbed by the leucocytes like artificial pigment, and that 
from this moment the melaniflc leucocytes, t ehave absolutely with reference to 
their dissemination in the organs like ceils impregnated with cinnabar. They are 
heaped up in the capillaries of the organs, where the circulation is rendered 
slower; in the liver which interposes in the circulation of the blood a 
capillary system; in the bony marrow and the spleen, where the capillaries come 
together into very large veins, a circumstance suitable to render the flow 
of the blood slow. The smallest melaniflc cells momentarily escape the 
splenic and hepatic filter and bury themselves in the capillary system of the 
lungs, brain and of the kidneys; the most tenuous succeed even in traversing 
these organs to circulate for some time in the periphery. In the spleen and the bony 
marrow, the accumulated pigment leaves by degrees the capillaries, thanks to the 
lacunes which the circulatory channels present and is incorporated in the tissue 
proper of these organs, where it ends by burying itself exclusively, as well as in the 
liver until its complete elimination. It is by this process that the blood is purged of 
melaniflc elements, absolutely as it is from cinnabared corpuscles; the melan- 
remia disappears gradually and is replaced by melanose of certain organs. It 
is not necessary to be astonished if it is not constant during life. Each paroxysm 
of fevgr brings back the same series of operations. If death supervenes during a 
paroxysm, the corpse will show us the pigment in all the vessels and in the capilla- 
ries of all the organs ; if it supervenes during a cachexia free from fever, the table 
of the amphitheatre will present nothing but the melanose of the liver, of the spleen, 
and of the marrow of the bones. Often when the fevers have lasted for a long 
time, we find no pigment. Such are, as we have seen above, the conclusions of 
my observations. 
Professor A. Kelsch, in his contribution to the Pathological Anatomy of 
Endemic Malarial Diseases, relating chiefly to anaemia. melaemia and mala- 
rial melanosis, does not discuss the question as to the final destination of 
the pigments incorporated in the organs, his histological researches remain- 
ing absolutely silent thereon. Destruction of Blood-Corpuscles in Malarial Fever. 
441 
The rapidity with which anaemia is developed in paludal fevers, and 
the marked and profound and progressive deterioration of the blood, are 
facts now patent to those who observe these diseases in the localities where 
they originate and are endemic. The observations of Professor Kelsch 
give another important demonstration of the fact, that if malarial fever 
destroys rapidly, or injures the organism slowly, without leaving recog- 
nizable structural alterations in the organism, it imparts, on the other 
hand, deej) modifications upon the blood, which testify to its direct action 
upon this liquid, as the febrile movement alone is not sufficient to explain 
them. 
These modifications of the malarial poison consist in- 
1st. Numerical diminution of the red corpuscles of the blood ^quan- 
titative alterations of globules, globular ancemia, oligocytluemia). 
2d. Augmentation of the volume of red globules. 
3d. Development of a black pigment foreign to the normal compo- 
sition of the blood. 
Dr. A. Kelsch, in a second paper published in the Archives of Physi- 
ology for 1876, endeavors to establish, by actual enumeration of the blood- 
corpuscles under the microscope, that the colorless corpuscles of the blood 
are progressively diminished in numbers during the successive paroxysms 
and progress of simple intermittent and pernicious malarial fevers, and 
that electrization of the spleen causes the contraction of this organ, and a 
consequent restoration of the colorless blood corpuscles to the blood. 
He concludes from the augmentation of the colorless corpuscles follow- 
ing electrization of the spleen, that during the paroxysms of marsh or 
malarial fever, fhe colorless corpuscles accumulate in the spleen and are 
not destroyed by the poison of this disease.* 
The following statements embrace the more important conclusions of 
Professor Kelsch with regard to the colorless corpuscles in the various 
forms of malarial fever : 
During the crisis tlie colorless corpuscles diminish to a greater extent 
than the red globules, and the disappearance corresponds with the enlarge- 
ment of the spleen. The diminution is not only profound, but it is rapid 
and continuous; that is to say, during the first hours of the attack the 
leucocytes diminish without ceasing and their numbers diminish to one- 
half and even to one-third of the normal number. When the paroxysms 
cease the number of the colorless corpuscles increases much more slowly 
than their decrease during the active stages. In general, from fifteen to 
twenty hours, and even from one to two days elapse before their physio- 
logical proportion is re-established. 
1. SIMPLE INTERMITTENT FEVERS. 
2. CACHEXIA WITH CHRONIC HYPERTROPHY OF THE SPLEEN 
Iii chronic toxaemia, with chronic hypertrophy of the spleen, the white 
globules are in relative and absolute diminution in comparison with the 
red globules. This diminution does not always correspond with the degree 
of hypertrophy of the spleen, but is influenced to a certain extent by the 
degree of activity of the lymphatic ganglia which act vicariously in sup- 
plementing ihe deficient action of the spleen. 
*Nouvelle contribution A i'Anatomie Patholoyiique des maladies palustres endemiques. Ob- 
servations sur les variai ions des globules blancs du sang, dans les diverses formes de i'intoxica- 
tion paludeenne, par le Dr. A. Kelsch, Professeur agrdgd libre de I'ecole du Val-de-Grace. 
Archives de Physiologic normale et pathologique, lb76, pp. 490-550. 442 
Destruction of Blood-Corpuscles in Malarial Fever. 
The electric current applied to the parietes of the abdomen over that 
portion of the spleen below the false ribs, causes an immediate diminution 
of the size of the organ, and causes a temporary augmentation of the num- 
ber of the leucocytes in the blood. There are some exceptions to this 
statement; thus, in forty-two electrizations of the spleen, in which the 
enumeration of the globules was taken immediately before and after the 
seance in thirty-two, or four-fifths of the cases, the globules were augmented 
to a marked degree; in one case the number was not augmented, and in 
nine cases thej7 were very slightly diminished. This augmentation is only 
temporary, as in the course of one or two hours after the electrization, the 
spleen regains its former dimensions, and it is found upon enumeration of 
the white globules that they again diminish in proportion to the enlarge- 
ment of the spleen. This appears to establish the fact that the diminution 
of the colorless corpuscles is due to their reception and retention in the 
enlarged spleen. Continuous electrization of thesiMeen at stated intervals 
during from two to three weeks, causes very gradually, permanent dimi- 
nution of the volume of the spleen, and at the same time the number of 
colorless corpuscles slowly rises, approaching the normal standard. The 
same result is attained by the red globules in a similar manner. 
Electricity thus restores the tenacity of the spleen and excites its phy- 
siological activity, and enables it to discharge into the general circulation 
more easily, the lymphatic elements elaborated within its cells. Elec- 
tricity is therefore a valuable therapeutic adjunct in the treatment of 
splenic cachexia. The red globules which are always diminished m the 
active stages of malarial fever, and in the chronic or cachectic states, 
increase in like manner with the colorless corpuscles during the progressive 
dimin utioi^of the volume of the spleen, under repeated electrization. The 
diminution of the volume of the spleen indicates its return to its functional 
and normal activity. It appears from these results that the colorless cor- 
puscles as well as a certain proportion of the colored corpuscles, are 
mechanically retained within the vascular sinews of the spleen, during the 
acute and chronic stages of malarial fever. Those colorless corpuscles 
which have absorbed the altered coloring matter of the colored blood-cor- 
puscles, do not appear to be restored again to the current of the blood by 
the electrization of the spleen, they must, therefore, be permanently 
retained in the meshes of this or other organs. In the enlarged malarial 
spleen there is at once atomic dilatation of the vessels and fibrous hyper- 
trophy which differs materially from leucaemic hypertrophy, in which 
the function of this organ is increased as far as the genesis of the white 
globules is concerned. The functional deficiency of the enlarged malarial 
spleen, therefore, finds its explanation in the pathological alterations of its 
anatomical elements-thickening of the canals, transformation of the pulp 
into fibroid cords, poor in lymphatic glands and atrophy of the follicles 
and lymphatic glands. Such changes greatly reduce the functional activity 
of the spleen as a lymphatic gland, and all the clinical observations of this 
result of the action of the malarial poison, correspond with the observa- 
tions of physiologists upon the effects of extirpation of the spleen in 
animals. 
Mosier has shown that when the spleen is removed from dogs, the 
white corpuscles diminish notably. He has shown that the function of the 
removed spleen is performed by other lymphatic ganglia and also by the 
marrow of the bones. These facts explain the anomalous condition 
observed in a comparatively few cases in which the enlarged spleen of 
chronic malarial toxaemia was not attended with very marked diminution 
of the colorless corpuscles; and the conclusion is justified that the function Morbific Ferments-. Contagia. 
443 
of this organ was, in such cases, assumed by the lymphatic ganglia and 
marrow of the bones. This deficiency of the function of the spleen accounts 
for the diminution of the colorless corpuscles in all fevers attended with 
enlargement and alteration of the spleen. 
MORBIFIC FERMENTS. CONTAGIA 
Morbific ferments, or contagia, have been defined to be matters which 
are not gaseous, but have their essence in certain solid elements which in 
their largest sizes are but very minute microscopic objects, in their least 
sizes are probably unseen, even with the highest powers of the microscope: 
Organisms which in virtue of their vitality are indefinitely self-multiplying within 
their respective spheres of operation, and which, therefore, in contrast with com- 
mon poisons, can develop indefinitely large ulterior effects from first doses which 
are indefinitely small. 
Morbific ferments have been divided into two great classes according 
to their origin : 
(1.) Morbific ferments of which man's body is the sole birthplace, 
and which multiply their respective types in as successive and definite a 
manner as do the higher orders of animal or vegetable life. Small-pox 
poison may be taken as the type of this class of morbific ferments or 
contagion. 
(2.) Morbific ferments whose birthplace is exterior to man-a birth- 
place amid the common putrefactive changes of organic matters. To this 
latter class has been referred the cause-agent or microphyte of paroxysmal 
malarial fever./ 
Each morbific ferment and each particular contagion has a power 
peculiar to itself of producing a particular modification of the chemical 
processes which constitute the life of the organism it attacks. Morbific- 
microphytes possess a two-fold vital activity, the one relating to their evo- 
lution and development; the other to the dynamic chemical changes 
which constitute the physiological and pathological processes of their life. 
The vital activities of pathogenic micro-organisms, must be gauged by th& 
determination of the ultimate products of their vital metabolism; in other 
words, by determining that the chemical changes go on continuously 
between them and their environments. 
Three questions of great importance present themselves with reference 
to these morbific ferments, such as the malarial poison, which have a birth- 
place exterior to man amid the common putrefactive changes of dead 
organic matter. 
1st. Is it possible to determine the existence and mode of propaga- 
tion of the mycrophytes of malarial fever in the air, waters and soil of 
malarial regions'? 
2d. Is it possible to introduce agents within the animal economy 
which will arrest the development, or neutralize the effects of the chemical 
changes induced in the living being by the microphytes of malarial fever ? 
3d. Are the actions of morbific ferments in the blood and tissues of 
living human beings definite and self-limited? 
With reference to the first question it may be stated that by the appli- 
cation of the discoveries of Dr. Koch, and by the extensive prosecutions 
of the methods of culture experiments and microscopical examinations of 
air, water, prepared by J. Burdon Sanderson, Angus Smith and others, we 
must look for important advances in our knowledge of the origin, develop- 
ment, natural history and physiology of the morbific ferment of malarial 
fever. At the same time it must be admitted that the progress which has. 444 
Morbific Ferments: Contagia. 
been made during the past twelve years in associating certain apparently 
specific forms, when met with in the diseased being only with particular 
pathological processes (such as those of anthrax, of leprosy or of tubercu- 
losis), has not yet made it possible to recognize these very forms as they 
occur in drinking water, or in any other ordinary soil. With reference to 
the second question, it must be admitted that whilst our knowledge of the 
colytic action of chemical agents within the organism is very scanty, and 
whilst there is no known instance in which the contagion of any disease 
■communicable from person to person, or from animal to animal can, after 
the development of its organism, be controlled or inhibited in its morbific 
action by introducing along with it an antagonistic drug ; at the same 
time, it will be admitted that we can oppose the development of malarious 
fever by an administration of quinine, or that of rheumatic fever by the 
administration of salicylic acid, and the salicylates. 
We may substitute vaccinia for variola, by rhe substitution of closely 
related morbific ferments, but we cannot prevent a person who has taken 
the variolous poison or that of rabies, from getting small-pox or hydropho- 
bia. We must admit here that the first aim of preventive medicine is to 
understand the specific modifications produced by each particular kind of 
morbific ferment, and in the second place to learn how to control them. 
With reference to the third question our present information may be 
thus expressed : 1st. All contagia, owe their power to their continued 
chemical action on the living substance of the organism they attack, and 
this action is, in the chemical sense, a fermentation, analogous to the chemi- 
cal changes produced outside of the living body by the bodies called fer- 
ments on the substance which each ferment is capable of modifying. This 
resemblance of the contagia to the microscopical bacteria or microphytes 
which occasion putrescence, in their being able to produce that particular 
disturbance of the functions of the human or animal body, attended by 
diminished chemical stabilitv of the substance, and increased temperature 
which we call fever ; secondly on their being able to act locally, so as to 
induce disintegration or inflammation of tissue, whereon they are actually 
present; and lastly, in their tendency to determine their own activity 
after the lapse of a limited period of active existence. These properties 
which the specific contagia possess in common with the septic are, however, 
manifested by them with the greatest possible diversity, both as regards 
the relative intensity of the local and general effects, and more particularly 
as to the order of time in which these succeed each other. For, whereas, 
the symptoms of septic infection follow immediately on the invasion of the 
septic poison, and as rapidly subside, the specific poison acts more slowly 
until a definite period of incubation has lapsed, and retains its hold on the 
infected organism for a period equally definite ; the duration of the initial 
delay and of the pathological disturbance and the accompanying chemical 
changes which follow the period of incubation being, in general, character- 
istic of the particular species. 
The microphytes of the specific contagia, in contrast with those of sepsis, 
are of necessity adapted to a life inside the affected organism, an adapta- 
tion which, in the case of the acute infections (as is strikingly seen in 
relapsing fever) ceases alter a limited time. Obviously this cessation must 
be due to the coming into existence of antagonistic conditions not before 
present; and if it were possible to determine in what these consist, we 
might thus find the key to their inhibition. 
Dr. J. Burdon Sanderson* has recently thrown out the supposition, that 
♦Memorandum on Lines of Research, concerning infection and disinfection : twelfth annual 
report of the Local Government Board, 1882-1883. Supplement containing the report of the medical 
■officer for 18s2, p. 219. Morbific Ferments: Contagia. 
445 
in the successive evolution of contagia, the septic infection which is 
dependent on conditions which are relatively so simple must have preceded 
the rest in time ; in other words, that all contagious microphytes are 
related by descent to the common microphyte of sepsis, and consequently 
that whatever properties belong to the parent are likely to be represented 
more or less modified in those of the succession. "If, for example," says 
Dr. Sanderson, "it can be certainly stated that the instrument or agent by 
which the septic microphyte produces its toxic effect is a ferment in the 
chemical sense, we are justified in assuming that the morbific action of 
the microphyte of small-pox, is of the same nature ; and if it can be shown 
that the septic fermentation is necessarily brought to an end by the develop- 
ment of an antagonistic chemical action, theie is at least ground for the 
surmise that the mechanism by which the variolous fermentation brings 
itself to an end, may be of ti.e same nature and consequently within 
reach of investigation." 
Recent researches relating to the chemical characters and products of 
the septic decomposition of proteids have shown that the development of 
microphytes in an albuminous fluid undergoing sepsis at a favorable tem- 
perature is a terminable process, reaching its greatest activity a few days, 
after the impregnation of the liquid with septic ferment; and that it is 
during this period of active vegetation, that the liquid acquires its greatest 
toxical activity. After the culmination of the process the organisms cease' 
to multiply and eventually die. As this takes place long before all of the 
proteid malarial is used up, it cannot be attributed to want of nutriment, 
and there is good reason for regarding the result of the coming into exist- 
ence of chemical bodies in the liquid, as the result of the breaking up of 
the proteid molecule, which possesses the power of arresting the growth 
of ferment organisms. The bodies in question belong to the aromatic 
group, and are represented at an early stage in the septic process by acids 
of the acetic series in which an atom of hydrogen is replaced as in phenyl- 
acetic and phenyl-propionic acids, by an aromatic group. The latter of 
these has been found by experiments to be destructive of the vitality of 
microphytes in a degree which is twenty times greater than that in which 
carbolic acid acts, and is such as to bring it into equality in this respect 
with the most powerful antiseptics known. Under conditions of sepsis 
slightly different, other analogous series of aromatic compounds are pro- 
duced which have not yet been subjected to physiological investigation. 
Chemical bodies belonging to the aromatic group, some of which are spe- 
cifically identical with the aromatic products of sepsis, take part in the 
normal exchange of material of the living human or animal body. Their 
appearance in the urine in unnaturally large amounts when, as in cases of 
ileus, septic products are absorbed from the accumulated intestinal con- 
tents, indicates their relation to sepsis, and affords ground for the inference 
that they normally come into existence as products of a similar disintegra- 
tion of the proteid molecule. That this is so, is confirmed by the observa- 
tion that the proteid disintegration of tissue which takes place in the 
animal body, in poisoning by phosphorus, occasions a prevalence of aro- 
matic bodies as indicated by the discharge of phenyl compounds by the 
kidneys, similar to that determined by the absorption of septic products. 
The property which so many of the aromatic bodies possess of arrest- 
ing the vitality of ferment organisms must for the present be regarded as 
purely organoliptic, for we can only define it by reference to the particular 
effects which the bodies in question produce in particular kinds of living 
protoplasm. Their production as fruits of the operation of the very life, 
which, from the moment of their constitution they tend to annihilate, may 446 
Relations of Bacteria to Putrefaction. 
be satisfactorily explained on the hypothesis that an aromatic remainder 
takes part in the constitution of the proteid molecule, and consequently 
that aromatic bodies are to be looked for among the products of disinte- 
gration. 
RELATIONS OF BACTERIA TO PUTREFACTION. 
Experiments tend to establish that putrefaction never' occurs when the 
access of bacteria is prevented. Putrescence is believed to be a chemical 
process excited by the growth of bacterium termo, and it ceases when those 
present have been destroyed or die, when the nutrient material becomes 
exhausted. Their precipitation then takes place as a sediment to the 
bottom of the fluid. The relations of bacteria to the process of putrefac- 
tion of albuminoids have not as yet been fully determined. The following 
suppositions have been advanced : 
1st. Bacteria may assimilate albuminoid substances as animals do, 
and break them up into waste products in their own substance. 
2d. Bacteria may give or shed out a peculiar substance (comparable 
to diastase), which acts so as to break up albuminoid substances. 
3d. Bacteria may act as oxygerr carriers, and so break up albuminoid 
substances as oxidizing ferments. 
4th. Bacteria may act as deoxidizing or reducing ferments, taking 
oxygen from albuminoid substances, and so pulling down their- complex 
fabric. 
As with all "protoplasm," so with bacteria-repair- and waste only go 
on in the presence of oxygerr, and with the excretion of carbonic acid. 
But the oxygen has to be got irr many circumstances (as in the living 
human blood and tissues) elsewhere than from the atmosphere ; and Pas- 
teur has shown that from the breaking up of organic molecules, the organ- 
isms of the butyric fermentation (bacillus) multiply in the absence of 
atmospheric air, and are checked by its presence. 
The peculiar smells of putrescence are produced independently of oxi- 
dizing or deoxidizing action on albuminoid substances. The peculiar 
smells of putrescence indicate peculiar or specific products of sapr ogenous 
(putrid or rancid generating) bacterise. These peculiar smelling products 
are generated when the bacteria are altogether nourished by tartrate of 
ammonium and ash salts. So also the color-producing (chromogenous) bac- 
teria are abundantly produced in culture experiments of this same kind. 
The internal phenomena of nutrition in bacteria are, therefore, the same 
"whether albuminoid or ammoniacal food is supplied ; and the supposition 
is very probable that bacteria, always take their nitrogen in an ammoniacal 
form; andthe material featureof putrefaction is the splitting upor reduction 
of the albuminoid molecule into ammoniacal ammonia salts and other 
fluid and gaseous products. But it is here very difficult, if not impossible, 
to separate and identify the special or specific products of bacterial life 
(the excreta of bacteria) from the by-products of the splitting up of the 
albuminoid molecule, which produces the assimilation of the nitrogen 
from the ammonia. The explanation of the power of bacterium to split up 
albuminoid molecules is overwhelmed in a mist of speculation. (Dr. Fer- 
dinand Cohn, Jour. Micros. Science, 1873, p. 156.) 
CHEMICAL PRODUCTS OF PUTREFACTION. 
Pasteur, in 1862, established the doctrine that putrefaction in common 
with other fermentative processes, is identical with the life of the concomi- 
tant organisms. Whether this theory expresses the whole truth or only Chemical Products of Putrefaction. 
447 
part of it, the process remains as it was before, a chemical one; for whether 
we consider the changes which bacteria produce in the substance in which 
they grow, or the conditions upon which they themselves depend for their 
existence, these are alike chemical. Thus, bacterial life is a middle term 
between chemical antecedents and consequents. In consequence of the 
imperfections of our knowledge of the structure of the proteid compounds 
which afford septic bacteria their soil, the chemical investigation of the 
process of putrefaction is difficult. Some light is thrown on its nature by 
the better knowledge we possess of processes evidently analogous to it, to 
which, bodies of known constitution are liable under corresponding condi- 
tions. As good examples of these, chemists have referred to the decompo- 
sition of calcium formate and acetate, under the influence of septic ferment, 
the former yielding CO2 and H, the latter CO2 and CH4, and the decompo- 
sition of lactic acid yielding butyric acid and hydrogen, the most remarkable. 
The putrefaction of proteid begins by the transformation of the proteid 
material itself, first into albuminates, soluble either in liquids of acid or 
alkaline reaction, but precipitated by neutralization; second, into pep- 
tones, by which term is meant a proteid body which is soluble in all aque- 
ous liquids, acid, alkaline or neutral, and at all temperatures. The second 
stage in putrefaction consists in the breaking up of these soluble proteids, 
so as to give rise to compounds more simple and definite in composition, 
of which the most important are the well-known substances, leucin, tyro- 
sin and indol. 
Indol, and tyrosin with its derivatives, belong to the aromatic group, 
and may be chemically characterized as derivatives of a common nucleus 
of six atoms of C, each of which has a free affinity. The members of this 
group are linked together, not only by their chemical structure and rela- 
tions, but als6 by the physiological property of antagonism to the life of 
ferment organisms (microzymes). 
In the septic process the initial material is proteid and the end pro- 
ducts are ammonia and carbonic acid (CO,), there is therefore an obvi- 
vious resemblance between it and that of the exchange of material in the 
animal body, the difference being in the intermediate stages ; but even 
here the analogy holds good in certain important respects. It is alike 
characteristic of both, that organic acids belonging to the Acetic Series, 
having the constitution H (CH2 ) (COOH) are produced in such quantity 
as to represent a large proportion of the initial material. 
In the metabolism of the higher animals these occur as glycerides of 
the higher fatty acids, in the bacterial process in the form of compounds 
of acids of the same series in the constitution in which n has a lower value 
with the alkali metals or ammonium. Dr..Burdon Sanderson has directed 
attention to the fact that the analogy which has just been referred to 
derives its importance from the consideration that in the production of all 
infective diseases from inflammation to the specific infections, the two pro- 
cesses are concomitant, and at the same time antagonistic ; whatever hope 
we may entertain of eventually acquiring a complete understanding of the 
nature of this antagonism must be founded in the knowledge which we now 
possess, or may in future possess of the relations between the two proces- 
ses, and of the influences which they mutually exercise on each other in the 
living organism of men, and of the higher animals. 
Bacterial life regarded from a chemical point of view', with reference 
to the question of the initial proteid material, and the final products, car- 
bonic acid water and ammonia, corresponds closely with that of animal life 
in general ; while bacteria feed on proteid and convert its material into 
these simple forms, the higher animal organisms in their processes of diges- 448 
Relations of Bacterial Life to Aromatic Compounds. 
tion and assimilation arrive eventually at the same result. The difference 
lies chiefly in the intermediate stages; in both, bodies belonging to the 
acetic acid series, are produced in such quantity as to represent a large pro- 
portion of the initial material, in the first the bodies include the lower 
members of the fatty acid groups, whilst in the second the higher members 
appear as glycerides or fats. It is because the vital processes of the bac- 
terium so closely resemble those of the animal with which it associates 
itself that the one comes into such relation with the other as to exercise a 
modifying or disease producing influence upon it. Whatever the nature of 
its influence may be, it is obviously chemical. 
AROMATIC COMPOUNDS AS PRODUCTS AND CONCOMITANTS OF BACTERIAL 
LIFE. 
1. Phenol or Carbolie acid as a product of Sepsis. 
Professor Salkowski, in 1876, during an investigation of the condition 
of the urine in several cases of ileus with reference to the occurrence of 
indican in this pathological condition, observed a peculiar smell which 
reminded him of chloride of phenol ; on distilling a quantity of urine after 
making it acid with hydrochloric acid, the distillation gave an abundant 
precipitate of tribromophenol with bromine water amounting to3.01 gram- 
mes in 200 CC. Similar results were obtained in a second case of ileus. 
Hoppe-Seyler had previously shown that in the urine of the horse, when 
distilled after acidulating with hydrochloric or sulphuric acid, the pres- 
ence of phenol can always be shown in the distillation. It was also found 
in human urine, and in that of the dog, but from the smallness of the 
quantities obtained, it was concluded that it was probably chiefly 
derived from the constituents of vegetable food. It was not, however, 
supposed that pure phenol existed in the urine in any of these cases, but 
rather a phenol-forming substance which, when acted on for a sufficient 
time by dilute mineral acids yielded carbolic acid in the distillate. The 
nature of this phenol-producing substance, and particularly its relation to 
the sulphates of the urine, was shown by the subsequent researches of 
Baumann, who found that coincidently with the appearance of phenol in 
the distillate a considerable increase took place in the inorganic contained 
in the residue. About the same time Brieger made at Berne, in the labora- 
tory of Professor Nencki, researches respecting the aromatic constituents 
of faeces which led to the new discovery of shatol. Along with skatol, he 
also found phenol, a body with which it is closely related. Naret followed 
his important investigation of the conditions which affect the excretion by 
the kidneys of phenol compounds in different diseases. He indicated that 
their prevalence was entirely independent of the nature of the diet or of 
the existence in it of such constituents as might give rise to the production 
of phenol. Brieger observed that among fifty clinical cases of various 
kinds which were investigated, three alone were distinguished from the 
rest by the abundant excretion of phenol in which the patients suffered 
from septic diseases particularly suppurating wounds, discharging empye- 
mas and the like ; whence he inferred that the fact of the excretion of 
phenol in abnormally large quantities in septic conditions would afford the 
key to the understanding of its cause. It had been further found that 
indol as a product of artificial intestinal digestion outside of the body, is 
exclusively due to bacterial action, that is, to the presence of bacteria in 
the experimental liquids used. Salkowski had found that the paired acids 
in his cases of ileus were closely associated with the presence of an unusual 
amount of indigo-producing substance in the urine, which Jaffe's Relations of Bacterial Life to Aromatic Compounds. 
449 
researches had proved to be derived from indol. There was, therefore, 
every reason to infer the origin of phenol from sepsis. 
The direct proof, that phenol, the substance which is generally regarded 
as antiseptic par excellence, is itself a product of putrefaction, is contained 
in the first of the long series of papers published by Baumann, of Berlin, 
on the Aromatic Bodies of the Organism. 
INDOL AS A PRODUCT OF SEPSIS. 
Indol receives its name from its being the nucleus from which the 
indigo group of compounds is derived- In Kiihne's earlier experiments on 
pancreatic digestion, when allowed to proceed without exclusion of septic 
organism, he noticed the peculiarity of the penetrating smell, which he 
compared with that of naphthyl ami ne. After the discovery of indol by 
Bayer in 1866, it was recognized that the odor was that of indol. The rela- 
tions of this body to sepsis were fully elucidated in 1874 by Nencki. In 
the same year Kiihne discovered that indol could be obtained by heating 
proteid with caustic potash. In 1878 Nencki repeated Kiihne's experi- 
ments on the action of caustic potash in albumin, and found that the high 
melting point of the substance obtained by Kiihne was due to its consist- 
ing largely of another aromatic body closely related to it in property and 
chemical constitution, which had shortly before been discovered by Brieger 
in freces, and called by him in consequence skatol. The remarkable physio- 
logical facts relating to the behavior of indol in the organism point to a 
closeness of relation between it and the other products of sepsis, of which 
no chemical explanation can at present be given. Kiihne found in 1875, 
that in experiments in artificial digestion indol does not appear unle 
septic bacteria are present, that it is not produced by the action of an 
albuminous compound of the digestive ferments, whether gastric or pan- 
creatic. 
In the observations of Brieger relating to the aromatic constituents of 
fieces, it was found that on the whole there was a close relation between its 
prevalence and that of septic decomposition. The substance derives its 
chief interest from the facts, discovered by Jaffe, that it is not only capable 
of being absorbed from the intestines aud thus entering the circulation, 
but that it undergoes in the organism a very remarkable oxidation, in con- 
sequence of which it appears in the urine, not as indigo, but as the indigo- 
producing body, which was long known as indican. Since this important 
discovery was made, indigo even when it appears in the small quantities 
in which we are accustomed to find it in human urine, has been regarded 
as probably an exclusively septic product, dependent, not of course on the 
penetration of bacteria into the living organism or into the blood, but on 
their action in the intestines. In its relation to the urinary secretions and 
the mode of its discharge, it very clearly resembles phenol, or the indigo- 
producingsubstance of the indigo plant (indican}, as was formerly imagined, 
and is a paired sulphuric acid, analogous to the phenyl sulphuric acid. 
SEPTIC DERIVATIVES OF TYROSINE. 
Until a comparatively recent period, tyrosine was the only known 
representative of the aromatic group among the products of septic or 
internal decomposition of proteid. It was well known to be always present, 
and could be easily recognized by its characteristic reaction. The rela- 
tion of tyrosine to phenol is indicated first, by the fact that phenol may be 
split off from it by the action of caustic potash; and secondly, by its 450 
Aromatic Acids of the Acetic Series. 
chemical constitution. Tyrosine is an amido-acid belonging to the oxy- 
phenylacetic acid series, that is, to a series of acids which correspond to 
the acetic acid series, with this difference, that the aromatic group, C6H, 
OH., has taken the place of hydrogen. 
The remarks of Baumann, Weyl and others have established the fol- 
lowing series, beginning from tyrosine; tyrosine, hydroparacoumaricacid, 
paroxyphenylacetic acid, parakresol, paroxybenzoic acid and carbolic 
acid, all of which may be regarded as steps in the septic process. 
AROMATIC ACIDS OF THE ACETIC SERIES. 
In 1879 it was discovered by E. and H. Salkowski that in the sepsis of 
proteid substance, volatile aromatic acids were produced which do not 
belong to the same series as those referred to in the preceding paragraph 
as derivatives of tyrosine, but to the series in which an atom of hydrogen 
is replaced in the fatty acid by CJL or phenyl. Of these, the first dis- 
covered as a septic product was hydrocinnamic or phenylpropionic acid 
It was obtained by subjecting a liquid in which proteid was dissolved or 
suspended, made slightly alkaline with carbonate of sodium to prolonged 
sepsis. The alkaline liquid having been concentrated by evaporation was 
extracted by alcohol; the alcoholic extract was then evaporated, acidu- 
lated with dilute sulphuric acid and shaken with ether. The oily residue 
which the ether left on evaporation contained, in addition to the higher 
fatty acids, the lesser members of the series, along with their aromatic 
relatives, particularly when fibrin or muscle was used, phenylpropionic acid; 
when blood albumen was used, phenylacetic. 
In consequence of these facts, Dr. Wernich made experiments which 
had for their purpose to ascertain first, whether they were antiseptic; 
secondly, whether they had the power of rendering a cultivation liquid 
unfit for the growth of bacteria, and if so, in what proportion ; and lastly, 
whether they possessed the property of annulling the vitality of septic 
organisms when allowed to act on them for a limited time, and, if they had 
this power, in what degree 1 
With reference to the second and third of these questions, it was found 
that both bodies were decidedly superior to carbolic acid, and that of the 
two, phenylpropionic acid was the more active. Their value as disinfect- 
ants was subsequently investigated by Dr. Klein, who determined that 
although both of the bodies in question possess in a high degree, the power 
of killing morbific germs or microphytes, the higher of the two acids is the 
most powerful; and that phenylpropionic acid must be preferred as a dis- 
infectant. As a product of sepsis, the quantity in which phenylpropionic 
is produced, is exceedingly minute. In the laboratory it was obtained for 
use in Dr. Klein's investigation by the action of sodium amalgam on cin- 
namic acid, so that it is at present an expensive product. Notwithstanding 
this, Dr. Burdon Sanderson believes that it might be used as a colytic with 
success, and states that it has been administered continuously to rabbits in 
considerable doses without disturbance of their health, and has lately been 
taken in repeated doses by several workers in the physiological laboratory 
at Oxford. As was proved experimentally by Salkowski, it is converted 
in the organism, in the first instance into benzoic acid, and discharged in 
the urine as hippuric acid. Professor Burdon Sanderson, F. R. S., Sup- 
plement to the Thirteenth Annual Report of the Local Government Board. 
Also, "The Practitioner," a Journal of Therapeutics and Public Health 
January, 1885, pp. 23-39. Cadaveric Alkaloids. 
451 
CADAVERIC ALKALOIDS. 
It is not alone by invading the blood or tissues that bacteria exhibit 
pathogenic power ; chemical products evoked during their chemical 
activity, external to the body or in abscesses and suppurating wounds, or 
in the alimentary canal, may doubtless be absorbed and exercise an inju- 
rious effect upon the animal economy. There is experimental evidence to 
show that most potent poisons are produced during the putrefactive 
decomposition of organic matter. The poisons resembling the vegetable 
alkaloids in their reactions, called ptomaines by Selmi, who first obtained 
them from a cadaver, are fatal to animals in extremely minute doses. These 
ptomaines have also been obtained by Gautier from putrid blood and from 
the normal secretions of healthy persons-saliva, urine, blood, etc. The 
properties of the alkaloid compounds which are formed during the decom- 
position of animal tissues, have also been the subject of investigation by 
MM. Brouardel and Boutmy, who found the ptomaines iu the bodies of 
individuals who had died a natural death, and also in those who have been 
poisoned. 
The ptomaines come into the general class of organic alkaloids, and 
many of them are most energetic poisons, others being quite innocuous. 
Although there are many distinct substances in this class, identical bodies 
are found under very different conditions of putrefaction. The same alka- 
loid, for instance, was found in two individuals who were poisoned, the 
one by prussic acid, the other by carbonic oxide. A few are fixed, but 
the majority are volatile. A substance closely analogous to veratrin was 
found in a bqdy which had been eighteen months in the Seine, and another 
in a goose which had been subjected to the heat necessary for cooking. 
Certain of these substances are clearly poisonous to man, and appar- 
ently cause the toxic effects which occasionally result from eating decom- 
posing meat. Symptoms of serious poisoning occurred, for instance, in 
twelve persons who had partaken of a putrid goose, which had contained 
a peculiar alkaloid, and one of these persons had died in a few hours after, 
nausea and vomiting. These poisonous substances may be quickly formed, 
for in the case alluded to the goose had been purchased in the market, on 
the morning of the day on which it was eaten. 
The soluble poison, sepsin, which has been shown by the researches of 
Bergmann, Panum, Burdon Sanderson, and others, to exist in putrid 
blood, is fatal to animals when administered in a sufficient dose, which, 
however, is very small. 
According to Koch, five drops of blood, which has not putrefied too 
long, is sufficient to kill a mouse within a short time. After receiving an 
injection of this blood the symptoms of poisoning are developed immedi- 
ately, and the animal dies in from four to eight hours. The experiments of 
physiologists have shown that in such a case the greater part of the fluid 
injected is found in the subcutaneous cellular tissue of the back in much 
the same condition as before it was injected. It contains bacteria of the 
most diverse forms, irregularly mixed together, and as numerous as when 
examined before injection. No inflammation can be observed in the neigh- 
borhood of the place of injection. The internal organs are also unaltered. 
If blood taken from the right auricle be introduced into another mouse, 
no effect is produced. Bacteria cannot be found in any of the internal 
organs or in the blood of the heart. An infective disease has, therefore, 
not been produced as the result of the injection. On the other hand, there 
can be no doubt that the death of the animal was due to the soluble poison, 
sepsin. This supposition is confirmed by the fact that when less fluid is 452 
Agency of Products of Putrefaction in the Production of Disease. 
introduced into the animal the symptoms of poisoning which follow are 
less marked, and are quite absent when one or at most, two drops have 
been injected. Traumatic Infectious Diseases, Sydenham Society's translation. 
London, 1880, p. 35.. 
In the summer of 1859, I commenced a series of investigations with 
the design of determining: 
1st. The effects of poisons on animal temperature, secretion and 
excretion, and on the nervous and muscular forces. 
2d. The effects of poisons on the blood and organs. 
3d. The effects of poisons upon the physical and chemical changes 
after death. 
4th. The relations of the changes produced by poisons, with patho- 
logical states, and especially with the pathological conditions produced by 
fevers and inflammations. In the first volume of my "Medical and Swgical 
Memoirs f published in 1876, I recorded 401 (four hundred and one) 
experiments, the greater portion of which related directly to the action of 
poisons. In 1870, 1873, 1878, 1880 and 1882, I performed various experi- 
ments to determine, if possible, the effects of injecting the blood and black- 
vomit of human beings suffering with yellow fever,* upon living animals; 
and also examined the air and waters which were evidently the vehicles 
for the conveyance of the material causes of yellow and malarial fevers. 
The results of these researches and experiments will be recorded in their 
appropriate places in the present work; we will, however, direct in this 
connection, especial attention to the fact that I demonstrated experiment- 
ally, that the blood taken almost immediately after death from the heart of 
yellow fever patients, was capable of destroying the life of living animals, 
and that a vast number of bacteria appeared in the blood of the animals 
thus destroyed. 
In the epidemic of 1878, in New Orleans, I demonstrated the existence 
of sporules and bacteria in the yellow fever atmosphere, and in the blood 
of yellow fever patients. A question of great importance with reference to 
the results of putrefaction in its relations to the propagations of diseases, 
is related to the extent to which micro-organisms are multiplied during 
the decomposition of animal matters and bodies. 
The following propositions embraced the most important results of a 
series of experiments which I have instituted with reference to the effects 
of putrefaction in the development and multiplication of micro-organisms. 
1st. The rapidity of putrefaction and the rapidity of the development 
of septic and fermentative micro-organisms depend upon certain con- 
ditions as: a, temperature ; b, position of putrefying bodies whether 
exposed upon the surface of the earth, to the sun and rain, or confined in 
graves, cases or vaults ; c, state of dilution, or in other words, the amount 
of water mixed with the putrefying mass. We are not now concerned 
with the effects of disinfectants and antiseptics (such as bi-chloride of mer- 
cury, chlorides and nitrates of lead, zinc, tin, iron and other metals, the sul- 
phates of iron, zinc, copper and of other metals, carbolic acid, sulphate of 
quinia, etc.), but solely with the effects of the process and products of 
putrefaction in the development of micro-organisms. 
2d. When animal matters putrefy in a confined space, and when there 
is no continuous renewal of the air and moisture, such products as sulphur- 
etted hydrogen, carburetted hydrogen, phosphuretted hydrogen, carbonic 
oxide, carbonic acid, ammonia, carbonate of ammonium, sulphuret of 
* New Orleans Medical and Surgical Journal; Medical and Surgical Memoirs, contaihing 
investigations on the Geographical Distribution, Cause, Nature, Relations and treatment of 
Various Diseases, 1851-1876, by Joseph Jones, M. D., vol. 1, pp. 529, 530, 531. Agency of Products of Putrefaction in the Production of Disease. 
453 
ammonium, ptomaines, phosphoric acid, sulphuric acid, indol, tyrosine, 
phenol or carbolic acid, skatol, the aromatic acids of the acetic series, and 
the various cadaveric alkaloids or ptomaines effectually arrest the devel- 
opment of micro-organisms. In bodies buried in the ground, and in air- 
tight coffins, and in closed vaults built above or below ground, there is not 
an indefinite development of micro organisms. The results of my investi- 
gations on this subject conform to those of Dr. E. Klein. As this subject 
is one of vast importance in a hygienic as well as a medical point of 
view, the results obtained by Dr. E. Klein are worthy of careful analysis. 
In his report to the Local Government Board for 1881, Dr. Klein 
pointed out that artificial cultivations of bacillus anthracis, not containing 
any spores, after from several days to a few weeks lose the power to infect 
white mice with anthrax, but retain their full power in guinea-pigs and 
rabbits; and this power in the last named animals is retained as long as 
there exists in the culture living non-degenerated bacilli. The white mice 
not affected by such cultivations have no general refractory power against 
anthrax or bacillus anthracis, and do not obtain by these unsuccessful 
inoculations any kind of immunity against active cultures. The results 
of Dr. Klein were not quite in accordance with the genera!statements of 
M. Pasteur. 
Dr. Klein, in his "Further report on the Relations of Pathogenic to Septic 
Bacteria, as illustrated by Observations on Bacillus Anthracis f Twelfth Annual 
Report in the Local Government Board, 1882-83, Supplement containing the 
Reports of the Medical Officers for 1882, pp. 201-212, not only tested these 
cultivations on sheep and tested the value of M. Pasteur's observations on 
his " Vaccin Charbonneux,"* but investigated the question of the final 
disposition of the bacillus anthracis before and after the death of animals. 
From M. Pasteur's address before the International Congress in London, 
1881, re-printed from the Transactions of the International Medical Con- 
gress, vol. I, and circulated at the instance of the Local Government Board, 
and from M. Pasteur's statement in other places, every one had understood 
that this "vaccin charbonneux," knows no difference of species, breed 
or country; that it confers its salutary powers on all alike. Dr. Klein 
obtained through M. Bontroux, the agent of M. Pasteur in Paris, two lots 
of this " vaccin," and after conducting a series of experiments upon vari- 
ous animals, as guinea-pigs, sheep and mice, established that this vaccin 
charbonneux of Pasteur produced in the animals experimented on in 
England typical anthrax. Mr. Klein found in his experiments, recorded at 
length in the Report of the Medical Officer for 1882, Twelfth Annual Reports 
of the Local Government Board, 1882-1883, pp. 206-208, that the vaccin 
charbonneux was altogether different from what it was represented to be by 
M. Pasteur in his address to the International Congress. Mr. Klein says: 
"I still now (1883) possess the remains of the vaccin charbonneux 
employed in the above experiments, and I use it with good results when- 
ever I wish to produce fatal anthrax in rodents." After performing a 
series of experiments to ascertain what this vaccin charbonneux really 
contained, Mr. Klein says : "These experiments sufficiently satisfied me 
* As is well known, this " vaccin charbonneux," is manufactured in large quantities in the 
laboratory of M. Pasteur, and is sold by the agent, M. Bontroux, in Paris. It is sold for twenty 
francs per two tubes "vaccin premie'-," and "vaccin deuzieme." each containing aclear fluid with 
a minute quantity of a powdery precipitate; the fluid is said to be sufficient for the inoculation 
of 100 sheep or 50 cattle. According to the present directions, the premier vaccin is introduced 
first, after the lapse of about a fortnight the deuxieme vaccin is used, and then the animals are 
said to be immure against any further inoculations with anthrax. No constitutional disturbance 
is said to be observable in the animals during or after the experiment. M. Pasteur claims that 
these cultures of bacillus ant.hracis made in his laboratory, give animals inoculated with them, 
immunity from further inoculation with the most virulent anthrax material. 454 
Agency of Products of Putrefaction in the Production of Disease. 
that M. Pasteur's assertion to the effect that a vaccin charbonneux gives 
again origin to a crop of the mitigated and modified bacillus anthracis, and 
that animals thus treated are protected against further attack by bacillus 
anthracis is not borne out by actual observation." 
A question of importance that presented itself several times in the 
course of this inquiry was: Is a cultivation in which in course of time the 
bacillus anthracis, at first forming a copious growth, degenerates, and in 
which no spores had been formed, and further, which cultivated loses its 
power to infect, with virulent anthrax, animals when inoculated, is such 
a cultivation perfectly ineffective in giving the animal some sort of immu- 
nity against further inoculation with virulent material? The answer is 
simply yes, it is perfectly ineffective. Thus, in several instances, guinea- 
pigs were inoculated repeatedly with cultures in which the thread of the 
bacillus anthracis had become degenerated, large numbers of their sheaths 
and large amount of granular matter being present, but no effect was pro- 
duced. The animals were soon after (from several days to several weeks) 
inoculated with fresh cultures of anthrax bacillus or blood of an animal dead 
of anthrax, and invariably and promptly succumbed to fatal anthrax. 
The next question of great practical importance was this: It having- 
been established by cultivation experiments, that bacillus anthracis when 
growing in the depths of a liquid, is not capable of forming spores, and 
gradually undergoes degeneration; it having been further determined by 
the observations of Koch and Klein, that within an organ of the body of 
an animal dead of anthrax, the bacillus anthracis is not capable of forming 
spores, what becomes of these multitudes of the bacillus anthracis that 
crowd the blood-vessels in the different organs, notably the spleen of an 
animal dead of anthrax ? Klein has shown by numerous observations, that 
the bacilli, however numerous they are in an organ of an animal at the point of 
death, go on after death to degenerate till they have altogether disappeared ; and 
consequently the organs are perfectly harmless when this degeneration has become 
complete. With this process of degeneration of the bacilli in the blood and 
organs, goes hand in hand, the important fact of the gradual loss of infec- 
tive power of the organs of an animal dead of anthrax. 
Dr. Klein has made a great many observations with reference to this 
point from its obviously great practical importance, and has no doubt 
about the fact that the blood and, organs kept in an animal dead of anthrax grad- 
ually lose the po wer to communicate the disease by inoculation. 
This result is in harmony with the observations of Gerlach (die Blut- 
sinche die Schafe, 1876), aud Bollinger (Zur Pathologic die Milzbrandes), 
who found that putrefaction destroys the infectivity of the blood and organs 
of an animal dead of anthrax. The loss of infective power of the organs 
depends on the rapidity with which putrefactive changes set in; thus, for 
instance, while the liver and spleen are the first to lose this power, the 
kidney is later, and still later are the lungs. 
Dr. Klein concludes from his experiments that 41 it is quite clear that 
there is no reason to attribute any correctness to the statement of M. Pas- 
teur, viz.- that in animals dead of anthrax and buried, the bacillus 
anthracis retains infective power for a long time (several years); that 
probably this prolonged infective power is due to the bacilli forming 
spores, and that they are brought up to the sur'ace by earth-worms, and 
that hereby such fields become permanent localities of infection, and ani- 
mals grazing there are liable to be infected with anthrax. On the contrary 
direct experiment proves that an animal dead of anthrax loses its infec- 
tive power within a short space of time,-in the case of small animals like 
guinea-pigs and mice it is already lost in live days-the bacilli undergoing Mortuary Statistics of New Orleans. 
455 
degeneration and are not capable of forming spores within the organs '7 
Report of the Medical Officer lor 1882, p. 212. 
The question of the multiplication or destruction of pathogenic 
organisms in the human body dead of endemic, epidemic, infectious and 
contagious diseases, is of vast importance to all countries and cities ; but 
it is of incalculable importance to New Orleans, in which city, corpses of 
those dead of all diseases, whether contagious or not, are interred above 
ground, in brick or stone tombs built above the ground, and fully exposed 
to the hot rays of the sun, the rain and the surrounding atmosphere. 
If the pathogenic bacteria or micro-organisms of yellow fever, 
small pox and Asiatic cholera are rapidly multiplied within the dead 
body, it would seem that no more dangerous plan of burial could be devised 
for the multiplication and dissemination of these germs of disease than 
the intra mural sepulture of New Orleans. 
During my term of service as President of the Board of Health, of the 
State of Louisiana, during a period of four years, 1880-1883, I gave to this 
subject the most careful consideration, and endeavored by an extended 
investigation of the condition, history and statistics of the various intra- 
mural cemeteries to arrive at definite conclusions. We present the fol- 
lowing general results bearing upon the important question now under 
consideration: 
Table Illustrating the Relations of the Population of New Orleans to the Total 
Mortality from all Causes, during a period of Ninety four Years, compiled 
by Prof. Joseph Jones, M. D. 
VITAL STATISTICS OF NEW ORLEANS, LOUISIANA. 
Year. 
Population. 
No. of Deaths. 
Death Rate 
per 1000 
Inhabitants.' 
Year. 
Population. 
No. of Deaths. 
Death Rate 
per 1000 
Inhabitants. 
1787 
5,284 
338 
63.98 1 
1844.... 
86,632 
4,620 
53.33 
1796 
8,756 
638 
72.86 
1845.... 
89,261 
2,783 
31.17 
1808 
17,081 
773 
45.25 
1846.... 
102.070 
4,220 
41.34 
1810 
17,242 
963 
55.85 
1847.... 
108,699 
9,043 
83.19 
1811 
18,235 
1,239 
67.94 
1848.... 
115,503 
7,407 
64.12 
1812 
19,229 
624 
32.50 
1849.... 
122,511 
9,862 
80.49 
1813 
20,212 
939 
46.45 
1850.... 
129,747 
7,819 
60.26 
1814 
21,216 
926 
43.69 
1851.... 
138,599 
7,275 
52.48 
1815 
22,209 
1,252 
56.36 
1852.... 
147,441 
8,693 
58.95 
1816 
23,303 
651 
27.93 
1853.... 
154,132 
15,287 
102.42 
1817 
24 196 
1,772 
73.27 
1854 . . 
156,556 
11,347 
72.47 
1818 
25,190 
1,106 
43.90 
1855.... 
158,980 
10,096 
63.50 
1819 
26,183 
2,138 
81.65 
1856.... 
161,404 
5,689 
35.24 
1820 
27,176 
1,766 
64.98 
1857.... 
163,828 
5,581 
34.07 
1821 
29,441 
1,165 
39.57 
1858.... 
165,450 
11,720 
70.83 
1822 
81,706 
2,734 
86.22 
1859.... 
166,500 
6,849 
41.13 
1823 
33.971 
1,662 
48.92 
I860...- 
168 670 
7,341 
43.52 
1824 
36,236 
1,748 
48.23 
1861.... 
169,907 
5,772 
33.97 
1825 
38,501 
2,177 
56.54 
1862.... 
171,134 
6,278 
36.10 
1826 
40,766 
1,248 
30.61 
1863.... 
172,361 
7,172 
41.61 
1827 
43,031 
1,057 
24.56 
1864. .. 
173,588 
8.498 
48.95 
1828 
45,296 
1,490 
32.89 
1865.... 
174,8i5 
7,016 
40.13 
1829 
47,561 
2,520 
52.98 
1866.... 
178,042 
7,754 
43.55 
1830 
49,826 
2,022 
40.58 
1867.... 
181,269 
10,096 
55.57 
1831 
52,455 
1,926 
36.71 
1868.... 
184,496 
5,343 
28.96 
1832 
55,084 
8,099 
147.01 
1869.... 
187,723 
5,593 
29.79 
1833 
57,71:'. 
4,976 
86.22 
1870.... 
191,418 
6,942 
36.26 
18:34 
60,342 
3,687 
61.10 
1871.... 
193,412 
6.059 
31.24 
1835 
62,971 
3,873 
61.50 
1872.... 
196,406 
6,588 
33.54 
1836 
65,600 
2,734 
41.67 
1873.... 
198.900 
7,995 
40.19 
1837 
68,229 
4,807 
70.45 
1874.... 
201,394 
7,193 
35.71 
1838 
70,858 
2,606 
36.77 
1875.... 
203,888 
6,535 
32.05 
1839 
73,487 
3,934 
53.53 
1876.... 
206,382 
5,585 
32.39 
1840 
76,116 
2,977 
39.11 
1877.... 
208 876 
7,169 
34.32 
1841 
78,745 
4,549 
57.76 
1878.... 
211,371 
10,717 
50.70 
1842 
81,374 
3,375 
41.47 
1879...- 
213,865 
5,122 
23.94 
1843 
84,003 
4,050 
48.21 
1880.... 
216,359 
... 
5,623 
25.98 456 
Vital and Mortuary Statistics of New Orleans. 
Table Illustrating Deaths and Death Rate from all Causes and from Yellow 
Fever in the City of New Orleans during a Period of Sixty-four Years. 
Compiled by Prof. Joseph Jones, M. D. 
Year. 
Deaths 
from all 
causes. 
Deaths 
from 
Yellow 
Fever. 
Death Rate Per 1000 
Year. 
Deaths 
from all 
causes. 
Deaths 
from 
Yellow 
Fever. 
Death Rate Per 1000. 
From all 
causes. 
From Yellow 
Fever. 
From all 
causes. 
From Yellow 
Fever. 
1817.... 
1,772 
823 
73.27 
3.40 
1819.... 
9,862 
769 
80.49 
6.20 
1818.... 
1,106 
115 
43.90 
0.40 
1850.... 
7,819 
107 
60-26 
0.80 
1819.... 
2,138 
425 
81.65 
1.60 
1851.... 
7,275 
17 
52.48 
0.10 
1820.... 
1,766 
400 
64.98 
1.40 
1852.... 
8,693 
456 
58.95 
3.09 
1821.... 
1,165 
39.57 
1853-... 
15,787 
7,849 
102.42 
50.90 
1822.... 
2,734 
808 
86.22 
2.50 
1854.... 
11,347 
2.425 
72.47 
15.40 
1823.... 
1,662 
1 
48.92 
0.01 
1855.... 
10,096 
2,670 
63.50 
16.80 
1824.... 
1,748 
108 
4 8.23 
0.30 
1856.... 
5,689 
81 
35.24 
0.50 
1825.... 
2,177 
49 
56.51 
0.10 
1857.... 
5,581 
200 
34.07 
1.20 
1826.... 
1,248 
5 
30.61 
0.01 
1858.... 
11,720 
4,855 
70.83 
29.30 
1827.... 
1,057 
109 
24.56 
0.20 
1859.... 
6,849 
92 
41.13 
0.50 
1828.... 
1,490 
130 
32.89 
0.30 
I860.... 
7,341 
15 
43.52 
0.09 
1829.... 
2,520 
900 
52.98 
1.90 
1861.... 
5,772 
33.97 
1830.... 
2,022 
117 
40.58 
0.20 
1862.... 
6,278 
2 
36.10 
0.01 
1831.... 
1,926 
2 
36.71 
0.01 
1863 ... 
7,172 
2 
41.61 
0.01 
1832... 
8,099 
400 
147.01 
0.70 
1864.... 
8,498 
6 
48.95 
0.03 
1833.... 
4,976 
1,000 
86.22 
17.30 
1865.... 
7,016 
1 
40.13 
0.01 
1834.... 
3,687 
95 
61.10 
1.50 
1866.... 
7,754 
10,096 
185 
43.55 
1.00 
1835.... 
3,873 
284 
61.50 
4.50 
1867.... 
3,107 
3 
55.57 
17.10 
1836.... 
2,731 
5 
41.67 
0.08 
1868.... 
5,343 
28.96 
0.02 
1837.... 
4,807 
1,300 
70.45 
19.00 
1869.... 
5,593 
3 
29.79 
0.02 
1838.... 
2,606 
17 
36.77 
0.20 
1870.... 
6,942 
588 
36.26 
3.10 
1839.... 
3,934 
800 
53.53 
10.80 
1871.... 
6,059 
54 
31.24 
0.20 
1840.... 
2,977 
3 
39.1 J 
0.04 
1872.... 
6,588 
39 
33.54 
0.20 
1841.... 
4,549 
1,325 
57.76 
16.80 
1873.... 
7,995 
226 
40.19 
1.10 
1842.... 
3,375' 
211 
41.17 
2.60 
Is74.... 
7,193 
11 
35.71 
0.05 
1843.... 
4,050 
487 
48.21 
5.70 
1875.... 
6,535 
61 
32.05 
0.30 
1844.... 
4,620 
148 
53.33 
1.70 
1876.... 
6,.585 
42 
32.39 
0.20 
1845.... 
2.783 
2 
31.17 
0.01 
1877.... 
7,193 
1 
34.32 
0.01 
1846.... 
4,220 
160 
41.34 
1.50 
1878.... 
10,717 
4,056 
50.70 
19.20 
1847.... 
9,043 
2,804 
83.19 
25.80 
1879 ... 
5,122 
19 
23.94 
0.09 
1848.... 
7,407 
872 
64.12 
7.50 
1880.... 
5,623 
2 
25.98 
0.009 
POPULATION AND MORTALITY OF NEW ORLEANS 1880-1883-VITAL STA- 
TISTICS OF NEW ORLEANS DURING FOUR YEARS, 1880-1883 INCLUSIVE. 
Population of New Orleans. 
WHITE 
COLORED 
YEAR 
Males 
Females 
Total 
YEAR 
Males 
Females 
Total 
1880 
75,693 
82,702 
158,395 
1880 
25,247 
32,501 
57,748 
1881 
76,451 
83,844 
160,295 
1881 
25,740 
32,816 
58,556 
1882 
77,224 
84,994 
162,218 
1882 
26,246 
33,129 
59,375 
1883 
77,986 
86,178 
164.164 
1883 
26,756 
33,450 
60,206 
1884 
78,753 
87,372 
166,125 
1884 
27,277 
33,771 
61,048 
Total Whites and Colored. 
YEAR 
Males 
Females 
Total 
1880 
100,990 
115,203 
216,143 
1881 
102'190 
116 660 
218 850 
1882 
103,471 
118,122 
221*593 
1883 
104,742 
119 628 
224 370 
1884 
106,030 
121,143 
227,173 Vital and Mortuary Statistics of New Orleans. 
457 
Death-Bate of New Orleans per 1000 Population. 
WHITE 
COLORED 
Year 
Males 
Females 
Total j 
Year 
Males 
Females 
Total 
1880 
26.8 
19.0 
22.82 
1880 
39.34 
30.09 
34.10 
1881 
31.4 
20.2 
25.59 
1881 
45.32 
33.36 
38.31 
1882 
27.1 
17.1 
21.88 
1882 
46.22 
33.49 
39.14 
1883 
35.1 
21.8 
27.56 
1883 
60.47 
49.78 
49.00 
Mean 
30.1 
... ... 
19.5 
24.46 
Mean 
47.84 
34.18 
40.14 
Total Whites and Colored. 
YEAR 
Males 
Females 
Total 
1880 
30.03 
22.16 
25.86 
1881 
34.94 
23.96 
29.08 
1882 
31.97 
21.81 
26.60 
1983 
40.71 
26.84 
33.32 
Mean 
34.41 
23.67 
28.71 
Death-Bate of Neio Orleans per 1000 Population exclusive of Deaths from 
Small-Pox. 
1880 , 
1881 '. 
25.85 
29.06 
1882 
24.69 
27.71 
1883 
Vital and Mortuary Statistics of New Orleans, 1849-1881, Monthly Mortality. 
I 2 
1849 
1850 
1853 
1855 
1856 
1857 
18.58 
1859 
1860 
1861 
1867 
1869 
1870 
1871 
1872 
1873 
1874 
1875 
1876 
1877 
1878 
1879 
1880 
1881 
YEARS 
erage Monthly) 
lortality. j 
: 
j 
1,182 
582 
581 
9 
379 
372 
448 
504 
567 
518 
397 
328 
471 
443 
447 
642 
583 
572 
436 
571 
403 
574 
446 
443 
January 
i g 
CD 
X 
g 
CH 
600 
425 
463 
339 
371 
362 
472 
514 
635 
36.' 
292 
429 
347 
630 
556 
4.81 
454 
160 
.589 
511 
360 
418 
466 
February 
12.456 
1 1,307 
833 
456 
9 
342 
498 
518 
4'>8 
567 
448 
401 
408 
600 
491 
430 
60! 
452 
461 
.559 
788 
1B7 
376 
462 
551 
March 
11,735 
968 
491 
532 
? 
334 
.530 
482 
479 
633 
411 
350 
555 
545 
440 
418 
600 
609 
5^2 
447 
555 
475 
.369 
461 
529 
April 
s 
-< 
g 
1.007 
601 
671 
851 
390 
504 
576 
621 
646 
510 
316 
602 
621 
411 
713 
930 
548 
403 
601 
738 
•535 
509 
581 
683 
May 
gj 
870 
459 
656 
1,316 
797 
497 
531 
525 
730 
657 
561 
525 
673 
535 
572 
562 
517 
551 
653 
633 
427 
402 
573 
733 
June 
15,667 
' 
435 
•E84 
2,216 
1,052 
583 
429 
813 
701 
779 
463 
551 
551 
497 
488 
483 
773 
700 
622 
536 
•504 
492 
422 
422 
571 
July 
2 
iss'gg 
485 
916 
6,201 
1,747 
569 
482 
1,826 
503 
557 
485 
1,039 
421 
480 
551 
.569 
498 
708 
447 
469 
516 
1,784 
422 
407 
472 
August 
891 Tg 
666 
. 653 
1,627 
1,4.54 
497 
417 
3,069 
056 
622 
395 
2,498 
422 
858 
451 
425 
624 
440 
675 
503 
439 
2,5.58 
327 
4-50 
427 
September 
17,065 
910 
620 
674 
502 
481 
510 
1,775 
611 
520 
431 
1,942 
474 
681 
441 
432 
713 
636 
473 
477 
417 
1.84.5 
49-> 
466 
442 
October 
572 513 
13,726 11, SOI 
712 630 
899 756 
712 811 
321 448 
489 ? 
602i 369 
834 476 
788i 549 
535; 671 
496 ? 
959 72o 
452 563 
465 512 
568 429 
430 473 
500 504 
527 597 
443 494 
524 592 
543 415 
4921 3-59 
410; 459 
517 [ 460 
508 481 
November 
December 
7,430 
178,325 
1 9,862 
7,819 
15,638 
7,691 
5,200 
5,581 
11,710 
6,847 
7,341 
5.449 
10,096 
5,593 
6,932 
5.595 
6,122 
7,505 
6,798 
6,117 
6,257 
6,708 
10,318 
5,122 
5,623 
6,406 
Total 
From 1849 to 1867 includes Still-born. 
From 1869 to 1881 excludes Still-born. 458 
Vital and Mortuary Statistics of New Orleans. 
Mortality of New Orleans. 
WHITE 
COLORED 
Year 
Males 
Females 
Total 
Year 
Males 
Females 
Total 
1880 
2,050 
1 587 
2 637 
1880 . 
1 003 
983 
1 989 
1881 
2,419 
1,708* 
4J27 
1881.. . 
1 178 
1 101 
2,279 
1882 
2'104 
1,478 
3,582 
1882 . 
1 225 
1 115 
2,340 
1883 
2,657 
1>95! 
4,552 
1883 
1,634 
1,337 
2,971 
Total 
9,230 
6,668 
15,898 
Total 
5,040 
4,536 
9,576 
Total Whites and Colored. 
YEAR 
Males |Females 
Total 
1880 
3,053 
2,570 
5 623 
1881 
3,593 
2,813 
6,406 
1882 
3^329 
2,593 
5,922 
1883 
4,291 
3,232 
7,523 
Total 
14,266 
11,208 
25,474 
Deaths from Zymotic and Epidemic Diseases (Small-Pox, Measles, Scarlatina, 
Typhus Fever, Typhoid Fever, Yellow Fever, Malignant or Asiatic Cholera, 
Diphtheria, Whooping Cough), and from all Diseases, with Death Rate per 
1000 Inhabitants, from Epidemic and Zymotic Diseases, from Endemic 
Diseases and from all Causes. 
ff 
• 
: 
Deaths from Small- 
Pox and Varioloid. 
g 
ssj sass^-^^s^ssi B= g352§§ 
5 
Deaths from 
Measles. 
8 
gSggg 
Deaths from 
Scarlatina. 
: h-: fe>-totot^c1^^2cncnSLOC3^^o>o-icoote: 8: "82722 
w 
Deaths from 
Typhus Fever 
1 
1= OSBi 
3 £ 
Deaths from Enteric 
or Typhoid Fever. 
1 28,739 
2 ssfigHil sin 
bOGC 
Deaths from 
Yellow Fever. 
H j H • : - - ~0;~ 
H H H 
Deaths from Malig- 
nant or Asiatic 
Cholera. 
§ 
gsgg&sss&ssxss^sH&ifsd H H JH1 J j 
Deaths from 
Diphtheria. 
■§ 
: - ; : 
SggS£S^®22^S2E§gZc!2^£ig: £■ 
to 
K 
Deaths from 
Whooping Cough. 
1 58,447 
^eiihSghsiBSiWgrfs^^^ 
Total Deaths from 
Zymotic and Epi- 
demic Diseases. 
8 
£ 
Is 
Total Deaths from 
all Other Diseases. 
I 
Grand Total Deaths 
from all Causes. 
'5,957,750 
f^BISlSssXsasASsa^ 
K 
Population of the 
City of New Or- 
leans. 
CO 
22 
t- r,® .=.® wP t- p ®® r r r ® P Pb= .* P J° S £ ® 5 § g g 
is 
Death Rate per 1000 
per Annum from 
Zymotic and Epi- 
demic Diseases. 
CO 
£ 
SSggbgg35i2gfe5Sg£g£gfcgg^£3ag,^g5SSg; 
It 
Death Rate per 1000 
per Annum from 
all other Diseases. 
3? 
^^s.gs^^sessssgfegss^^sg^sssss 
2g£2E7j§gj:S^SSaggSS2£ = Sg^Sg£^^g^SSgg 
Death Rate per 1000 
per Annum from 
all Causes. Vital and Mortuary Statistics of New Orleans 
459 
VITAL AND MORTUARY STATISTICS OF NEW ORI.EANS, LA. 
Table illustrating Comparative Mortality of the White and Black Races in New 
Orleans, during a series of years, 18Jf-1881, inclusive. Consolidated from 
the records of the Board of Health, under the direction of Joseph Jones, 
M. D. 
YEARS. 
Population of New 
Orleans. 
No. of Deaths in New Orleans 
Death-rate per 1000, 
per annum. 
Total. ! 
1 
White, j 
Colored. 
Total. 
White. 
Colored. 
Total. 
White. 
Colored. 
1845 
114 142 
79 698 
34 744 
2 783 
2 001 
782 
24 32 
25 10 
22 50 
1847 
120,890 
88*530 
39360 
7 499 
6'274 
1 225 
62 03 
70 86 
37*08 
1849 
127,340 
97,362 
29'978 
9 862 
7'976 
I *886 
81.92 
62 91 
18,50 
130,565 
101J78 
28 787 
' 7 819 
6319 
1 500 
59 88 
6° OS 
52 10 
1852 
138,187 
110,342 
27,845 
8,693 
7'499 
1'199 
62 90 
67 91 
43 04 
1853 
141,988 
114,621 
27,374 
15,633 
14,292 
1 '341 
110 09 
124 68 
4898 
1856 
153,431 
127,470 
25,961 
5^200 
4,274 
926 
33.89 
32 98 
35*66 
1857 
157'242 
131,753 
25,489 
5,581 
4,593 
988 
35 49 
34 86 
38*07 
1858 
161^053 
136,036 
25,017 
11,710 
9 474 
2,236 
72.70 
69.64 
89 37 
1859 
164 864 
140,319 
24 545 
4'712 
2 135 
41 53 
33 58 
86 98 
I860 
141,601 
24'074 
7,341 
6 070 
1 '271 
43.51 
41 99 
52*79 
1861 
170,949 
144 £33 
26,716 
5,449 
993 
31.87 
31 58 
37.16 
1863 
175,497 
143,497 
32,000 
7,258 
1,905 
41.35 
37.30 
59.53 
1864 
177,768 
143'129 
34 639 
8,864 
6 032 
2'832 
49.86 
42 14 
81.75 
1865 
180,043 
142,761 
37,282 
7,020 
4 756 
2,264 
38.99 
60.88 
I860 
182,318 
142,393 
39 925 
<930 
2'5i8 
42.52 
36.77 
65 56 
1867 
184,593 
142,025 
42,568 
10.096 8 006 
2,030 
54.69 
56.79 
47*80 
1868 
186'068 
141,657 
44,411 
5'343 
3'61.2 
1,731 
28.60 
25.49 
38 97 
1869 
189 143 
141,290 
47',853 
6,001 
3,857 
2'144 
31.73 
27.29 
44 80 
1870 
191,418 
140,923 
5O',495 
7'391 
4,755 
2'636 
38.61 
33.74 
52 20 
1871 
193,412 
142,695 
6,059 
3'890 
2,169 
31.32 
27 26 
42 76 
1872 
196',406 
144^437 
51'969 
6 J 22 
3,943 
2,179 
31.17 
27.29 
41.93 
1873 
198,900 
146,179 
52'721 
7,505 
4,794 
2,711 
37.73 
32.79 
51 42 
1874 
201,394 
147,921 
53^473 
6,798 
4,368 
2330 
33.75 
29.53 
45.44 
1875 
203/188 
149^663 
51/225 
6'117 
3,934 
2j 183 
30.00 
26.28 
40.25 
206,382 
151,406 
54,976 
6,257 
■3,917 
2,340 
30.31 
25.87 
42.56 
1877 
208,876 
153,149 
55,727 
6,708 
3,976 
2,732 
32.11 
25.96 
49.02 
1878 
211.371 
154,892 
56,47S 
10,318 
8,062 
2,256 
48.81 
52.05 
39.94 
1879 
213,865 
156,635 
57',230 
5j 122 
3,267 
1'855 
23.95 
20.85 
32.41 
1880 
216,140 
158,379 
57,761 
5,623 
3,637 
1,986 
26.01 
22.96 
34.88 
1881 
218,500 
i6o;ooo 
58,500 
6306 
4,127 
2J279 
29.31 
25.79 
38.95 
Total 
5,485,618 
4,219,777 
1,265,841 
227,179 
167,517 
59,662 
41.41 
39.69 
47.13 
The mortality from 1845 to 1871, inclusive, comprises "Still-born." 
The mortality records from 1S69 to 1876 give a certain number of deaths. " Color not stated.-' 
These have been divided in the above table by estimating two-thirds to be white, and one-third 
colo red. 
The figures of " Population " are laken from the United States census of 1840, 1850,1860, 1870 and 
1880, and those of the intermediate years have been derived from these by calculation. 
Population of 1881 is estimated. 
INFLUENCE OF SEX UPON THE MORTALITY OF NEW ORLEANS. 
In the following- table, the relative mortality amongst the different 
seres (males and females) in New Orleans, during a period of twenty-six 
years (1849-1881) is given. The per cent, relates to the relations of deaths 
in the two sexes to the total deaths, and not to the population. We observe 
that the mortality during the entire series of years has been relatively 
greatest amongst the males. This is due to several causes: 1. The 
greater exposure of the male race to the changes of climate, and to violent 
deaths by accidents, by contagious and infectious diseases. 2. The large 
number of seamen and merchants frequenting New Orleans from all parts 
of the habitable globe. 3. The large number of paupers and sick labor- 
ers, transported from surrounding States to the Charity Hospital. 460 
Intra-Mural Sepulture in New Orleans. 
Vital and Mortuary Statistics of New Orleans-Table illustrating the Number 
of Deaths and Percentage of Deaths, among the different Sexes {Male and 
Female} in New Orleans. 
Year. 
Number of Deaths. 
Per cent of Deaths. 
Total. 
Males. 
Females. 
Males. 
Females. 
1849 .. 
.... 9.8G2 
6,458 
3,404 
65.5 
34 5 
1850... 
7,819 
4,802 
3,017 
61.4 
38.6 
1853... 
.... 15,633 
9,973 
5,660 
63.8 
36.2 
1856... 
...,| 5,200 
3,108 
2,092 
59.7 
40.3 
1857... 
5,581 
3 245 
2,336 
58.1 
41.9 
1858... 
.... 11,710 
7,675 
4,035 
65.5 
34.5 
1859... 
.... 6,847 
4,193 
2,654 
61.2 
38.8 
1S60... 
7,341 
4,440 
2,901 
60.4 
39.6 
1863... 
7,258 
4,543 
2,715 
62.6 
37.4 
1864... 
8,864 
5,010 
3,854 
56.5 
43.5 
1865... 
7,020 
7,754 
3,952 
3,068 
56.3 
43.7 
1866... 
4,537 
3,217 
58.5 
41.5 
1867... 
10,090 
6,485 
3,611 
64.2 
35.8 
1868... 
.... 5,343 
2,948 
2,395 
55 2 
44.8 
1869... 
6,001 
3,339 
2,662 
55.6 
43.4 
1870... 
7,391 
4.510 
2, SSI 
61.0 
39.0 
1871... 
6,059 
3,554 
2.505 
58.6 
41.4 
1872... 
6.122 
3,540 
2,582 
57-8 
42.2 
1873... 
7,505 
4.416 
3.089 
58.« 
41.2 
1874 .. 
....: 6.798 
3,991 
2,807 
58.7 
41.3 
1875... 
6.117 
3,434 
2,683 
56 1 
43.9 
1876... 
6,t57 
3,508 
2,749 
50.0 
44.0 
1877... 
.... 6,708 
3,650 
3,058 
54 4 
45.6 
1878... 
10,318 
6,193 
4,125 
60 0 
40.0 
1879... 
5,122 
2,969 
2,153 
57 9 
42.1 
1880... 
5 623 
3,053 
2,570 
54.4 
45.6 
1881... 
3.593 
2,813 
INTRA-MURAL SEPULTURE IN NEW ORLEANS, EFFECTS OF THE MODE 
AND PLACE OF BURIAL OF THE DEAD UPON THE HEALTH OF THE 
INHABITANTS. 
The subject of the effects of Intra-Mural sepulture, is of the greatest 
importance to the health and welfare of the citizens of New Orleans, not 
only from the deleterious effects of the products of putrefaction in all 
places, under all circumstances, but more especially from the peculiar 
topographical situation, the great commercial importance, and the warm, 
moist climate of the delta of the Mississippi. 
In order to obtain data for intelligent action upon this important 
subject for the General Assembly of Louisiana, and the Common Council 
of New Orleans, the author, as President of the Board of Health iu 1883, 
instituted a careful inspection of all cemeteries within the limits of the 
parish of Orleans. 
The following public and private cemeteries and burial grounds are 
located on the east bank of the Mississippi river, within the parish of 
Orleans : 
St. Louis No. 1, second district, bounded by North Basin, North Liberty, Conti 
and St. Louis streets. St. Louis No. 2, second district, bounded by Customhouse, 
St Louis, Claiborne and Robertson streets. St. Louis No. 3, second district, 
bounded by North Basin, St. Louis. Conti ami North Liberty streets. One square 
called American Cemetery. Lafayette No. 1, fourth district, bounded by Wash- 
ington, Prytania, Coliseum and Sixth streets. One square. Lafayette No. 2, 
fourth district, bounded by Washington, South Basin, St. Denis and Sixth Mode of Burial in New Orleans. 
461 
streets. One square. Valence Street Cemetery, sixth district, bounded by 
Valence, Bordeaux, Rampart and Dryades streets. One square. Carrollton 
Cemetery, seventh district, bounded by Adams, Lower Line, Seventh and 
Eighth streets. Four squares. St. Joseph, fourth district, bounded by Wash- 
ington, St David, South Liberty and Sixth streets. Two squares. St. Vincent, 
sixth district, bounded by St. David, Green and St. Patrick streets. Three 
squares. Locust Grove Cemeteries, Nos. 1 and 2, fourth district, bounded 
by Locust, Freret, Sixth and Seventh streets. St. Vincent de Paul, third 
district, bounded by Louisa, Piety, Urquhart and Villere streets. One square. 
Girod Cemetery, first district, bounded by South Liberty, Perilliat. Cypress 
and Magnolia streets; 250 feet wide anil 400 feet deep. Holt's Cemetery, 
five to six acres, first district. Hebrew Cemetery, first district, bounded by 
Elysian Fields and Gentilly road. One square. Hebrew Cemetery, called Dis- 
persed of Israel, first district, on Canal street, between Anthony and Metairie Ridge; 
250 feet square. Polish Hebrew, called also Jewish Rest, first district, on Canal 
street, opposite Dispersed of Israel. Hebrew, called Hebrew Place of Prayer, sixth 
district, on Joseph street. German Lutheran, sixth district, on Canal, between 
Anthony and Bernadotte streets. One square and four lots for burial rest. Odd 
Fellows, corner Canal and Metairie streets ; 360 feet square. Charity Hospital No. 
1, on Canal, between Anthony and Metairie streets, 200 feet wide, 1600 feet long, 
exclusively for Hospital. Charity Hospital No. 2, Metairie Road, between Bienville 
and Canal streets. One square. Masonic, on Bienville, between Metairie and 
Anthony streets. Three squares. St. Patrick's No. 1, on Canal, between Anthony 
andMetairie streets; 400 feet wide and 1500 feetlong. St. Patrick's No. 2, on Canal, 
between Anthony andMetairie streets, opposite No. 1. St. Patrick's No. 3, on 
Metairie, between Canal and Bienville streets. Two squares, opens from St. Patrick 
No. 2. Firemen's, on Metairie Ridge and Canal street. Cypress Grove, on Metairie 
Ridge and Canal streets. Greenwood Nos. 1 and 2, on Metairie Ridge and New 
Canal. Chalmette National, one mile below Barracks on river; 108 acres for 
burial of Union soldiers. Olivier, sixth district, corner of Verrett and Market 
streets. St. Bartholomew Cemetery, fifth district, De Armas and Lapeyrouse 
streets. William Tell, Franklin and Hancock streets, Gretna, Tenth, between 
Laroesier and Noveta streets. The Hebrew Cemetery, belonging to the Hebrew 
Association, opened in 1828, was closed in 1860. 
It is evident from the preceding table that there are thirty-five ceme- 
teries and burial grounds in New Orleans, many of which, as St. Louis 
Nos. 1, 2 and 3, Lafayette Nos. 1 and 2, St. Vincent de Paul and Girod 
Cemetery, are situated in the heart of populous districts. 
The removal, or rathe.i establishment of a large number of cemeteries, 
as the Firemen's, Cypress Grove, Greenwood, Odd Fellows, Masonic, St. 
Patrick's Nos. 1, 2 and 3, Metairie Ridge Cemetery, beyond the bounds of 
the thickly populated portion of the city has, without doubt, diminished 
the diseases referable to the emanations from the putrefying corpses of the 
dead. 
Owing to the saturation of the soil of New Orleans and its environs 
with water, and the rapidity with which excavations fill with water, the 
custom was early introduced of interring bodies in brick or stone tombs 
constructed upon ground. 
At the present time, with the exception of the destitute burials at the 
public expense, only Israelites are buried under ground. Graves are dug 
from three to four feet deep, except at the cemeteries on Metairie Ridge, 
where, the ground being higher than in the other parts of the city, it 
is possible to dig to a depth of seven feet. 
All other interments are made in vaults of brick, stone or iron, which 
are built on the surface of the ground; the bodies, after being introduced 
into the vaults, are walled in by brick or mortar. 
There is no means of escape for the foul gases arising from the decom- 
position of the corpses, except through the pores of the brick and mortar. 
MODE OF BUKIAL. 462 
Mode of Burial in New Orleans. 
Of course, whenever a vault, or a division of a vault, is opened, before 
putrefaction is completed, there is an immediate escape of noxious gases. 
Girod Street Protestant Cemetery fronts on South Liberty, between Perilliat 
and Cypress streets, and in the rear bounded by the City Workhouse, 600 feet in 
length by 260 feet in width, Sexton Mr. Peter Barr, since 1865. There are no records 
to show when the cemetery was started. The oldest tomb dates from 1817. Number 
of vaults and tombs: 5736 vaults and 1099 tombs. Drainage good. Drains into- 
the street gutters. Sanitary condition good. The vaults and tombs are in general 
good condition ; the walls are good, having been repaired two years ago. There 
have not been any interments in the ground since April, 1835, being prohibited by 
law. Total interments, 22,899; yellow fever, 1266; small-pox, 618; cholera, 511. 
St. Patrick's Cemeteries are located, No. 1 in the First District, No. 2 in the 
Second District, No. 3 in the Second District. St. Patrick's No. 1 is very much 
crowded, and it is almost impossible to dig a new grave without coming into contact 
with an old grave. Sexton J. H. Healy. When opened: No records previous to 
September, 1841. Number of vaults and tombs : 269 vaults and 163 tombs. Drain- 
age fair; sanitary condition good. Total interments 31,375; died of yellow fever 
4,253; of small-pox 186; of cholera 1214, making a total of 56-53. Cypress Grove 
Nos. 1 and 2 are located-No. 1, bounded by Canal street, Metairie Road and 
Charity Hospital cemeteries. No. 2 adjoins No. 1. Sexton J. B. Faget. When 
opened : Cypress Grove No. 1, no records previous to July, 1841. No. 2, no records 
previous to June, 1846. Cypress Grove No. 1, number interred in vaults and tombs 
5591; in the ground 3783; total 9374. Whites 9327; colored 47. Deaths from yellow 
fever 820; small-pox 144; cholera 348, making a total of 1312. Cypress Grove No. 
2: total interments, 34,412. Deaths from yellow fever 5308; small-pox 700; cholera 
2466; total 8474. Drainage good; sanitary condition good. Washington Ceme- 
temeries-The preceding table comprises five cemeteries, viz : Lafayette Nos. 1 and 
2, Locust Grove, Valence and Carrollton; as near as the records show that the 
Carrollton interments were included from the year that Carrollton was annexed 
(1874) to New Orleans up to January 1, 1883; Valence Cemetery from 1874 to Janu- 
ary 1, 1884; Locust Grove Cemetery from 1865 to 1879, when it was closed; Lafa- 
yette No. 2 from 1840 to 1884. Lafayette No. 1-the records of the cemetery previous 
to 1843 were destroyed ; the oldest record is a receipt dated 1829. Lafayette No. 1- 
Located on Washington street, between Coliseum and Prytania, and bounded in 
the rear by Sixth street. Size 300 feet square; opened about the year 1829; con- 
tains 1778 lots and about 600 vaults. Drainage good; sanitary condition good, with 
the exception that the walls of the vaults fronting on Washington street are 
cracked; these cracks must be refilled with cement each year. Lafayette No. 2- 
located on Washington street, and bounded by St. Patrick street, St. David and 
Sixth streets. Size 295 by 348 feet long; opened in 1840; contains 480 lots and 2201 
vaults. Drainage and sanitary condition good; tombsand walls in better condi- 
tion than those of Lafayette No. 1. Valence Cemetery-located on Valence street, 
bounded by St. Denis, St. Patrick and Bordeaux streets; opened in 1872; size 300 
feet square; contains 800 lots. Drainage and sanitary condition good. Total inter- 
ments Washington Cemeteries, 44 366. Sextons: B. S. Quinman from 1832 to 1844; 
H. G. Hicks from 1844 to 1861; Philip Harty 1861; Oliver Rice 1862; D. F. Simpson 
from 1862 to 1865; James Hogan, 1865 to 1867; J. F. Callico, 1867 to 1869; Jim 
Tracey, 1869 to 1871; J. F. Callico, 1871 to 1874; Cornelius Donovan, 1874 to 1876; 
Denis Irvin, 1876 to 1878; P. Gallagher, 1878 to 1879; J. F. Birchmier, 1879 to date.. 
Charity Hospital Cemeteries Nos. I and 2. Location-Charity Hospital Cemetery 
No. 1, bounded by St. Patrick's Cemetery No. 1 and Cypress Grove Cemetery No. 
1, and fronts on Canal street. Charity Hospital Cemetery No. 2, bounded by St. 
Patrick's Cemetery No. 3 and Metairie Road. Interments in Charity Hospital 
Cemeteries commenced May, 1850; previous to this date interments from Charity 
Hospital were made in Cypress Grove No. 2. Interments in Charity Hospital No. 
1 commenced May, 1850, and ended January, 1872. Interments in Charity Hospital 
No. 2 commenced January, 1872, and continue to date. Sexton, Charles Rolling. 
Interments-Charity Hospital No. 1, from May, 1850, to January, 1872: Whites, 
21,418; colored, 1104; total, 22,522. Charity Hospital No. 2, January, 1872, to date, 
interments, 6864; whites, 4128; colored, 2736. Grand total, 29,386. Total inter- 
ments from yellow fever, 6939; small-pox, 15; cholera, 1572; total, 8526. St. Vin- 
cent de Paul Nos. 1 and 2-No. 1 bounded by Louisa, Villere, Piety and Urquhart 
streets; No. 2 bounded by Villere, Piety, Desire and Urquhart streets; No. 3 
bounded by Louisa, Robertson, St. John the Baptist and Piety streets. These 
cemeteries were opened in 1840, but all records previous to 1851 have been destroyed. Statistics of Cemeteries of New Orleans. 
463 
Sexton, V. Suarez, 1851. Contains-No. 1, 1501 vaults, 211 tombs; No. 2, 1580 
vaults. Total interments : Whites, 26,053; colored, 6879; total, 32,932. Total inter- 
ments from yellow fever, 3263; small-pox, 1127; cholera, 1261; total, 5651. St. 
Joseph's Cemetery No. 1, located on Washington street; bounded by St. David, 
Liberty and Sixth streets; opened in 1855; size 300 by 250 feet, and contains 522 lots 
and 422 vaults. Drainage and sanitary condition good. St. Joseph's Cemetery 
No. 2, located on Sixth street, and bounded by St. David, Liberty and Seventh 
streets; same size as No. 1; contains two tombs, no vaults and 522 lots. Drainage 
and sanitary condition good. Sexton: Wm. Maura, for both cemeteries. Total 
interments, 14,912; died of yellow fever, 1088; small-pox, 191; cholera, 105. Asso- 
ciation Tememie Derich Cemetery, located on Canal street; opened in 1858; all 
interments in the ground. Total interments, white, 378; died of yellow fever, 69; 
small-pox, 6; cholera, 10; total, 85. St. Louis Cemetery No. 1, bounded by St. 
Louis, Basin, Treme and Conti streets. Sexton, M. Rodrigue. Records previous 
to 1855 have been lost; number vaults,.352; number tombs, 836. Total interments, 
white, 6128; colored, 2950; total, 9078. • Died of yellow fever, 388; small-pox, 159; 
cholera, 121; total, 668. St. Louis Cemetery No. 2 (comprises three block), (a) 
bounded by St. Louis, Conti, Robertson and Claiborne streets; (b), bounded by 
Bienville, Conti, Claiborne and Robertson streets; (c), bounded by Bienville, Cus- 
tomhouse, Claiborne and Robertson streets. St. Louis Cemetery No. 2 opened 
about 1825; no records previous to 1843. Records from September 1, 1847, to Janu- 
ary 1, 1865, were stolen; records from January 1, 1861, to February 28, 1869, lost or 
destroyed. Sexton, J. F. Callico, since 1881. Drainage and sanitary condition 
good. Number of tombs, 1794; number of vaults, 2347; total number of inter- 
ments, 13,768. Died of yellow fever, 298; small-pox, 612; cholera, 248; total, 1158. 
New St. Louis Cemetery, or Potter's Field, bounded by Esplanade and Jockey 
Club Park; opened June, 1856. Sexton, Hypolite Bienvenue; number of tombs 
and vaults, 637; total number of interments in vaults and tombs, 634; in the 
ground, 8760; total, 9394. Died of yellow fever, 656; small-pox, 199; cholera, 112; 
total, 967. Drainage and sanitary condition good. Greenwood Cemetery-Records 
from 1855 to date. Sexton, Daniel Merritt. Drainage and sanitary condition good. 
Interments in (ombs and vaults, 2190; graves, 4042; total, 6232. Died of yellow 
fever, 419; small-pox, 133; cholera, 42; total, 6826. Grand Lodge Masonic Ceme- 
tery, bounded by Bienville, Metairie, Anthony and Conti streets. Opened in 1867. 
Sextons, J. L. Lippe from 1867 to 1876; William Tell from 1876 to date. Sanitary 
condition and drainage good This location is very high; it is necessary to dig 
eight (8) feet before striking water. Number of vaults, 48; number of graves, 50; 
total interments, 509. Died of yellow fever, 62; small-pox, 6; cholera, 1. Odd 
Fellows Rest Cemetery, bounded by Canal, Metairie and St. Patrick's Cemetery 
No. 2; opened in 1849. Sextons : D. Merritt, 1849 to 1868; D. Quinn, 1868 to 1870; 
F. A. Bradley, 1870 to 1881; E. Barrett, 1881 to date. Size, 237 feet long by 340 feet 
wide. Drainage and sanitary condition good. Number of vaults, 640; tombs, 44; 
graves, 20; total number interments, 2563. Died of yellow fever, 236; small-pox, 
27; cholera, 59. Congregation Dispersed of Judah Cemetery, bounded by Canal, 
St. Helena, Customhouse and Antonia streets; opened in 1846; size, 180 feet front 
on Canal street. Sexton, Adam Eisenhauer. Drainage and sanitary condition 
good. Total number of interments, all in the ground, 518, all whites. Diseases 
not stated. First German Evangelical Lutheran Cemetery of St. John's Church, 
bounded by Canal, Customhouse, Anthony and Bernadotte streets; opened Sep- 
tember, 1867. Sexton, Otto Burandt. Drainage and sanitary condition good. 
Number of tombs, 8. Total interments, 171. Died of yellow fever, 11; small-pox 
1; cholera, none. Cemetery of the Congregation Gates of Prayer, Joseph street, 
Sixth District; opened in 1850. Records previous to 1867 were destroyed by fire. 
Sexton, L. Rosenbaum. Drainage and sanitary condition good. All interments 
in the ground. Total interments previous to 1867, ; total interments since 
1867, 169. Died of yellow fever, 18; small-pox, 4; cholera, 2. Cemetery Waters of 
Israel-Cemetery records from 1865. Sexton, H. Bonart. Drainage and sanitary 
condition good. All interments in graves. Total interments, 33. Died of yellow 
fever, 10; small-pox, 1; cholera, none. Hebrews' Rest Association Cemetery. The 
cemetery of this name, located on Jackson street, was opened in 1828 and closed in 
1866. Hebrews' Rest was then removed to Elysian Fields street. Records from 
1866 to date are complete. Drainage and sanitary condition good. All interments 
in graves. Total interments, 917. Died of yellow fever, 118; small-pox, 5; cholera, 
14. Metairie Cemetery. Sexton, Wm. H. Benson; cemetery opened in 1874. 
Drainage and sanitary condition good. Total interments, 603. Died of yellow 
fever, 32, small-pox, none; cholera, none. Holt's Cemetery opened May, 1879. 464 
Statistics of Cemeteries of New Orleans. 
Drainage and sanitary condition good. Interments, white, 407; colored 1617. 
Total interments (all grave), 2054. Died of yellow fever, none; small-pox, 422; 
cholera, 2. Of those interred as died from small-pox in 1883, 127 died at Luzenberg 
Hospital, 71 died at Beard's City Hospital, 111 died at their residences; total 300 
cases in 1883. Campo Santo Cemetery. Located on Washington Avenue, between 
Prosper and Solidelle streets, Third District. Sexton, Father Trevis. This eeme- 
temery opened July 1, 1875. Drainage and sanitary condition good. Interments, 
whites, 843; colored, 1341; total, 2331. Died of yellow fever, 50; small-pox 124; 
cholera, none. Firemen's Cemetery (Algiers), right bank of the Mississippi River. 
Located in Algiers. Sexton, J. Peterson. This cemetery opened in the latter part 
of 1878. The drainage and sanitary conditions are good. Interments, all white, 
67. Died of yellow fever, 1; died of small-pox, 10; died of cholera, none; total 11. 
St. Bartholomew's, Catholic Cemetery, Algiers, right bank of Mississippi river, 
Sexton, Father Brady. Opened 1857. Drainage and sanitary condition good. 
Total interments, 2129. Sex, color and diseases not stated. Gretna Firemen's 
Cemetery, Gretna, Parish of Jefferson, right bank of Mississippi river, opened 
1866. Drainage and sanitary condition good. Total interments (all whites), 455. 
In 1878 there were 29 interments from yellow fever. This was the only year in 
which a record of diseases was kept. Great Samaritan Colored Society Cemetery; 
located in Gretna, Parish of Jefferson. Sexton, James Sparks. Cemetery opened 
in 1871. Drainage and sanitary condition good. Total interments, 50, all colored. 
Died of yellow fever, none; small-pox, 9; cholera, none. Union Benevolent Col- 
ored Cemetery. Location, Gretna. Sexton, C. F. Brown. Cemetery opened in 
1867. All records previous to 1874 are lost. Drainage and sanitary condition good. 
Total interments (all colored), 45. No record of diseases. U. S. Government, Camp 
Chalmette National Cemetery. Located on left bank of Mississippi river. Parish 
of St. Bernard. Drainage and sanitary condition good. Total interments, 12,461. 
Known, 6844; unknown, 5617. No records of diseases, except that in 1878 there 
were 18 interments from yellow fever. The records of this cemetery extend from 
1866 to 1884. In the execution of the inspection of the cemeteries of New Orleans, 
valuable service was rendered by the intelligent and faithful sanitary officers, 
Emanuel Bohner and Loring D. Allen, who acted immediately under the direction 
and supervision of the President of the Board of Health. 
Interments in the various Cemeteries of New Orleans by Years-Total Deaths 
and Deaths from Contagious and Infectious Diseases, according to Records. 
J 853 
1854 
J 8' jo••••••••»••••««•••«•• 
1856 
1857 
18A« 
i i H i i i ii = 
HhHHH 
o 
: 
: 
: 
1836. •■••••••*•••••••.••• 
1837 
1838 
1889 
1833 
18^4 
1835 
YEAR 
iis 
Total Deaths 
§ J 
: : 
i = 
Deaths from 
Yellow Fever 
: : : 
S^-g^SS^g^ J UI 05 to: 
HH 
Deaths from 
Small-pox 
Mslsisss&J H H 
:;:::::: 
HHhH 
Deaths from 
Cholera 
i 
fegiiSstBls? egss- 
: : 
StcLL 
i : 
; ; 
Total Deaths 
from Contagi- 
ous and Injec- 
tions Diseases 
1 Grand total... 
1868 
1869 
1870 
1871 
1872 
1873 
1874 
1875 
1876 
1877 
1878 
1879 
1880 
1881 
1882 
1883 
0 
I 
: 
: 
1862 
1863 
1864 
1865 
Bl 
H 
11 
: : 
YEAR 
L - 
6W'S2Z 
Total Deaths 
c© 
§ 
" «: " O> 
la 
-^5 
Deaths from 
Yellow Fever 
s 
bid 
i 
Deaths from 
Small-pox 
600'01 
: 
: tCMCno^CDCXOi^^Qi^ioiCoo^^^-fecoi- 
: 
Deaths from 
Cholera 
a 
B 
^CMsatgm3^iss&s.u„ 
Total Deaths 
from Contagi- 
ous and Infec- 
tious Diseases Statistics of Cemeteries of New Orleans. 
465 
The above recapitulation does not include the U. S. Government Cemetery, or 
the cemeteries on the right bank of the Mississippi, as their records are very 
imperfect. 
The city of New Orleans embraces a vast extent of territory, extending from 
the slaughter house to the upper line of Carrollton, taking in Algiers on the right 
bank, reaching to Rigolets connecting Lake Pontchartrain with Lake Borgne; 
but the more densely populated portions lie along the course of the Mississippi 
river; there is, therefore, ample room for the removal of the dead out of the 
inhabited portions of the city. It is important to note that there has been for many 
years, a progressive removal of the grave yards beyond the crowded limits of the 
city, to the Metairie Ridge ; so that at the present time only nineteen cemeteries 
may be regarded as strictly intra-mural, viz : First District, one graveyard, Amer- 
ican, on Basin street, near Girod ; Second District, four graveyards, St. Louis 
No. 1, Basin, between Conti and St. Louis streets ; St. Louis Nos. 2, 3 and 4, Clai- 
borne, from Customhouse to Ht. Louis streets; Third District, four graveyards, 
New St. Louis, Esplanade, near Bayou St. John; Hebrew, Gentilly Road; St. 
Vincent de Paul, Louisa and Urquhart; Campo Santo, Urquhart, near Girod 
street; Fourth District, Lafayette No. 1, Washington, near Prytania street; Lafa- 
yette No. 2, Washington and St. Patrick streets; St. Joseph No. 1, Washington, 
near St. Patrick streets; St. Joseph No. 2, Sixth, near St. Patrick streets; Fifth 
District, two graveyards, St. Bartholemew, Algiers; Hughes, Algiers; Sixth Dis- 
trict, two graveyards, Valence, Valence street;" St. Vincent's," St. Denis street; 
Seventh District, two graveyards, Catholic, Carrollton ; City, Carrollton. The 
remainder of the cemeteries, including Holt, Metairie, Odd Fellows, Masonic, 
Lutheran, Cypress Grove, Greenwood, Potter's Field, Hebrew and St. Patrick's, 
are situated at a considerable distance from the city proper, and are not strictly 
intra-mural. Without doubt the General Assembly of Louisiana should give the 
most careful consideration to the subject of intra-mural sepulture, and should frame 
such laws as would effectually close the cemeteries in the populous portions of New 
Orleans and confine the burials to localities removed ^s far as possible from the 
thickly populated portions. 
The question as to the influence of intra-mural sepulture upon the health of the 
citizens of New Orleans, has never been fully or satisfactorily investigated, and 
unfortunately the medical history of the city is sadly deficient in past times in the 
monthly and yearly observations upon the relations'of the soil, climate, commerce 
and epidemics upon, the public health. A thorough investigation of the subject of 
the deleterious effects of cemeteries upon human beings, should embrace the fol- 
lowing inquiries: 1. Mode of burial. 2. Number of burials. 3. .Nature of 
diseases causing deaths. 4. When burials take place in the ground, the nature of 
the soil and the character, depth and origin, and periodic changes of the sub-soil 
water. 5. The effects of the different seasons, and of the degrees of heat and 
moisture upon the nature and rate of the putrefactive process. 6. ('hemical and 
physical properties of the gases exhaled. 7. The nature of the organisms devel- 
oped during the putrefaction of the dead bodies. 8. The effects of the products of 
putrefaction in general upon the nature and composition of the surrounding atmos- 
phere. 9. Effects of the putrefaction of the bodies of those who have died of 
infectious and contagious diseases, as small-pox, scarlet fever, measles, Asiatic 
cholera and yellow fever. 10. To what distances can the deleterious gases and 
organized bodies developed during putrefaction penetrate, to the detriment of liv- 
ing human beings? 11. In what manner is this deleterious product of putrefac- 
tion chiefly disseminated? By diffusion and multiplication in the soil and sub- 
soil waters ? By progressive aerial diffusion from the foci of infection in all direc- 
tions, laterally as well as upwards ? By volitization upwards, in the atmosphere 
there by condensation in combination with water, at night or during the period of 
rain, fog or mist, thus contaminating our drinking water. 
HISTORICAL. 
After* a careful examination of the mortuary and historical records of New 
Orleans, the earliest reference to the injurious effects of intra-mural sepulture was 
found in the manuscript records of the Old Cathedral, and relate to the year 1788. 
During a period of seventy years after the foundation of New Orleans, we have no 
reliable data by which to form an opinion of the effects of the mode and place of 
burial upon the health of the inhabitants. 
The great fire of 1788, which broke out on Good Friday in the month of March, 
in a chapel of a Spaniard on Chartres street, about three o'clock in the afternoon, 
and which being fanned by a high wind, destroyed nine hundred houses before it 
was extinguished, was followed by pestilence. 466 
Intra-Mural Sepulture in New Orleans. 
Through the courtesy of Mr. T. O. de Jaham, custodian of the records of the 
Cathedral, I have been furnished with the following extracts from the manuscript 
volumes: 
" I, brother Antonio de Sedella, Capuchin priest of the very holy Church 
Cathedral of the City of New Orleans, certify on the faith that I have: That 
because of the epidemic that the inhabitants of the city and neighbourhood suffered 
after the great tire which took place the 21st of March of the year 1788, the governor 
of these colonies, who was then Don Esteban Miro, after consulting those empow- 
ered, and with the consent of the Administration (Agustamiento), gave the power 
to remove the cemetery or Holy Grounds in the rear of the Charity Hospital, far- 
ther than the other from that city, to which I consented because of the reasons that 
they gave me, and which related to the public health. I also certify that it was 
then said to me, and I never heard anybody say, that they intended taking from 
this church the ancient right of property and possession that they had, and have, 
on those grounds ; and I also certify that in the above great fire perished, several 
books, and many parcels of documents concerning the same church, from its foun- 
dation or establishment; and to make this legal, I, with superior orders, have 
given this in New Orleans, 9th of April, 1801. 
" (Signed) Fr. Antonio de Sedella." 
" Your Highness-The cemetery of this city is situated in the center of the last 
block, which I have thought a long time since prejudicial to the public health, 
which was really shown this year, everybody having been sick in the colony, with 
putrid and deadly fevers, and specially dysentery, so that a large number of people 
died. I have myself experienced that loathsome smell emitted by the cemetery." 
The remainder of this paper consists of a prayer to have the cemetery removed. 
The paper is in the handwriting of Father de Sedella. The petition was accom- 
panied by a plan, illustrating the position of the old cemetery 
" Your Highness : The cemetery of this city is situated in the center of the 
last block, and has always been prejudicial to the public health. The deleterious- 
effects of this cemetery have been visibly felt this year, which has been very 
unhealthy, for all the Province in general, suffered from putrid and deadly fevers, 
and especially dysentery. Many people have died. Whilst passing the cemetery, 
having myself perceived a foetid smell, I sought information from the neighbors, 
and they affirmed that these foul odors have been very often perceived this year. 
Their complaints I have referred to the Cabildo which I enclose under Nos. i and 
2, with certificates from doctors and surgeons (Nos. 3 and 4), and my own observa- 
tions (No. 5). The consequence is that we are looking for another burial ground, 
out of the city, where the dead will produce no deleterious effects, and the corpses 
will begin to be buried there inside of eight days. This arrangement meets with 
the approbation of the people, and will consequently be agreeable to his Majesty. 
We pray your Excellency to authorize the City Administration (Cabildo) to pro- 
vide bricks so that the new cemetery be permanent, and the old one be condemned, 
the bones in it to be removed to the new one, so that in about two years houses 
will be built where it now stands. The old cemetery comprehends twelve lots, of 
70 feet front, 120 feet deep, which his Majesty might give away to citizens on con- 
dition to contribute to the City Treasury six dollars annually. So God help your 
Excellency many years. New Orleans, 12th November, 1788." This is a copy, 
not signed, but the handwriting appears to be that of the Bishop's Secretary. 
The circumstances which caused the parish government to remove the ceme- 
tery grounds on three different occasions were probably the same as those which 
occasioned the removal on the 17th and 24th of October, 1788; said removal having 
been proposed in the spring, the number of corpses buried there being already so 
large that there was no more space to bury the dead. On opening the new graves 
underground, bodies were found, which occasioned the emission of foul smells, 
destructive to the health of the city, and more especially after the epidemic which 
the people suffered that summer, and were then suffering. These facts illustrate 
in the strongest manner the necessity of abolishing so dangerous a proceeding, 
and at the same time of establishing a cemetery in another locality remote from 
the city." The preceding extracts from the Spanish were translated by Mr. Car- 
rouche, No. 39 Chartres street. The preceding records are of great interest, not 
only in establishing the proposition that yellow fever and pestilential fevers have 
desolated New Orleans in past times before the epidemic of 1796, which many wri- 
ters have regarded as the first appearance of this disease in New Orleans, but also 
as affording incontestable proof that the custom of burying the dead within the 
limits of the city was prejudicial to the health of the citizens. Intra-Mural Sepulture in New Orleans. 
467 
Doctor M. Michel Halphen, in his " Memoire sur le Cholera-Morbus Compli- 
que d'une Epidemic de Fievre Jaune qui a r6gn6 Simultan6ment & la Nouvelle 
Orleans en 1833," (Paris, 1833), gives a dreadful description of the filthy condition 
of the city of New Orleans, and of the terrible ravages of the Asiatic cholera. In 
1832 New Orleans received the cholera from St. Louis, by the arrival of the steam- 
boat Constitution on the 24th of October. With the accustomed ignorance, indif- 
ference and incompetence of the civil authorities of New Orleans, the cholera found 
this city in a filthy condition; gutters reekingin filth, the streets quagmires of 
mud and filth, the houses built upon low, ill-drained sites, the privies overflowing 
with urine and excrement; the drainage canals choked; the cemetery located in 
the heart of the city, badly constructed, badly drained, and crowded with corpses. 
The ignorant and credulous people seized with avidity upon nostrums of every 
description. The Mayor and Common Council resorted to such means as burning 
tar and the firing of cannon to disinfect the disease. Neverin any country had 
pestilence been 'more swift or fatal, and out of a population of 35,000, 6,000, or more 
than one-sixth, perished in less than twenty days. The air was polluted by the 
unburied and putrefying corpses, which accumulated in piles in the cemeteries 
across the streets, Trenches could not be dug with sufficient rapidity to secure the 
putrefying and mouldering corpses, and frequently putrid corpses were exposed in 
digging the graves. The stagnant water became contaminated, and the ditches 
ami gutters were reeking with the foul putrid drainings from the graveyard. 
A careful examination and comparison of the preceding statistics 
establishes the following conclusions: 
1. There are no facts to show that the corpses of those who die of 
yellow fever are capable of preserving, multiplying and carrying on the 
especial cause or poison, or micro-organism, from the summer and fall in 
which the disease prevailed, through the winter months to the next summer. 
2. If the preceding proposition be true, it would appear that during 
the process of putrefaction in the vaults and tombs of New Orleans, the 
yellow fever microbes lose their infective or virulent properties. It is 
difficult to form an accurate conjecture as to the exact length of time 
necessary to render the corpses of those perishing with yellow fever incapable 
of propagating the disease. The rapidity of the putrefaction of human 
bodies confined in the tombs of New Orleans and other cities will depend 
upon several conditions: 
(a.) The location of the body, whether below or above ground, and 
if a tomb is built above ground, with many chambers, in two or more rows, 
those bodies which rest in the uppermost layer of vaults or rows, must be 
subjected to a higher degree of heat during the shining of the sun, and to 
greater changes of temperature during the falling of rain, and during the 
night than those bodies which occupy the lower rows. 
(b.) The roof of the tombs must, during the shining of the sun in sum- 
mer, be subjected to a direct heat, under the direct rays of the sun of not 
less than 150° F. The effects of this heat upon the bodies confined will 
depend upon not merely the nature of the disease or morbid ferments caus- 
ing death, and the size, weight and condition of the dead body at the 
moment of dissolution, but also upon the nature and thickness of the walls 
composing the tombs. 
(c.) The absolute amount of material, as well as its physical and 
chemical constitution, composing the human body after death, enter as 
factors into the nature and rapidity of the putrefactive process. Thus the 
changes excited during putrefaction, differ in amount, character and rela- 
tive duration in obese and emaciated corpses. Anasarcous corpses of 
those who have perished from malarial fever of long standing, or from 
heart disease, or Bright's disease of the kidneys, putrify more slowly than 
the emaciated cadavres of phthisis. So far as my observations extend, the 
bodies of those who have died of yellow fever in the full vigor of health after 468 
Views of Joseph Jones, M. D., on the Action of the Malarial Poison. 
the brief but virulent action of the yellow fever poison undergo the most 
rapid putrefaction. 
3. There are no facts to show that the cause of malarial fever is mul- 
tiplied and rendered more virulent during the putrefactive changes of the 
human body. The prevalence of yellow-fever in New Orleans has been 
shown to be intimately associated with its foreign importation, rather than 
with any local cause or causes; on the other hand, malarial fevers have 
prevailed in this city, varying somewhat in intensity with different locali- 
ties, being less in the thickly settled and well-paved portions of the city. 
No relationship can be established between the origin and prevalence of 
the various forms of malarial fever and the location and number of burials 
in the various intra mural sepulchres of New Orleans. The various forms 
of malarial paroxysmal fevers, do not have their origin in, neither are 
they propagated by the putrefaction of the corpses of those who have 
perished by the malaria of the swamps and marshes. 
4. The length of time which the germs of small-pox and Asiatic 
cholera may infest a corpse, or may remain in a confined locality or place, as 
a tomb, vault, or infected house, or spot of gound, has not been determined, 
but there are facts to show that the pathogenic organisms causing these 
diseases, may retain their virulent and distinctive properties for great 
lengths of time. The opening of vaults and the disinterment of the bodies 
of those who have died of small-pox and Asiatic cholera, may be fraught 
with danger to the living, even after the lapse of considerable periods of 
time. 
THE ACTION OF THE MALARIAL POISON UPON THE BLOOD AND ORGANS, 
RESEMBLES THAT OF A FERMENT. 
I have established this proposition by the following facts: In 1856 and 
1857, I instituted numerous post-mortem examinations and executed 
numerous chemical analyses and microscopical examinations of the blood, 
urine and organs in the various forms of malarial fever and yellow fever, 
in the United States Marine Hospital of Savannah, Georgia, which received 
also the indigent sick of this city. The details of these experiments have 
been published elsewhere, and we will in this connection present those 
results which bear directly upon this important subject, now under con- 
sideration: 
(aj Glycogen is diminished in the liver of malarial fever. 
(b.) Glucose disappears from the liver of malarial fever; the oleage- 
nous matters are not increased. 
(c.) Glycogen is increased in the liver of yellow fever. 
(d.) Glucose and oleagenous matters are increased in the liver of 
yellow fever. 
From the preceding facts, we are justified in holding that the poison 
of both diseases behaves like ferments in altering the chemistry of those 
substances which are known to be capable of rapid fermentation. 
(e.) A rapid and remarkable destruction of the colored corpuscles 
occurs during the acute stages of malarial fever, and this rapid change is 
shown by the great increment of the coloring matters of the urine. 
These coloring matters are proportionate in amount to the extent and 
character of the chemical and physical changes induced by the malarial 
ferment or microzymes in the blood. 
(f). The bile acids and bile coloring matters are in many cases 
increased in the urine in malarial fever, and said increment as well as the 
greatly increased secretion of bile as shown by the profuse bilious vomit- Views of Joseph Jones, M. D., on the Action of Malarial Poison. 
469 
ings and discharges from the stomach and bowels, and the great disten- 
sion of the gall-bladder and ducts with dark grumous bile after death, are 
due to this action of the malarial ferment upon the blood. 
(g). In yellow fever, on the contrary, there is no marked destruction 
of the colored corpuscles in the various organs, and there is no incre- 
ment of bile, but, on the contrary, in fatal cases the secretion is very 
scanty and is sometimes wholly wanting. 
(h). The preceding facts point to a profound and radical chemical 
and vital difference between the ferments and fermentative changes in 
malarial and yellow fevers. 
(i). The changes of the urine in malarial fever are of the most pro- 
found and important character, and in the height of the paroxysm of 
fever during the hot stage the urine of malarial fever patients possesses 
marked antiseptic qualities. The high colored acid urine of the hot stage 
of intermittent and remittent fever does not readily undergo decomposition 
after its removal from the body, but may be kept for days and even weeks 
without decomposing, without losing its acid reaction or without throwing 
down a deposit. This antiseptic property of the urine of the febrile stage 
of malarial fever is not due to any want of urea; on the contrary, the 
urine is concentrated, of high specific gravity and rich in urea, as I have 
shown by numerous analyses. 
(j). The urine excreted during the intermissions of malarial fever 
rapidly undergoes change and rapidly becomes alkaline, and throws down 
a large deposit of the phosphates and urates. This change is not due to 
any increment of urea, for this constituent of the urine is in far less 
amount in many cases than during the hot stage. This is a fermentative 
change in t^ie urine, and is clearly due to the elimination of the malarial 
fever ferment and its products by the kidneys during the intermission of 
the malarial paroxysm. 
(k). I have determined in 1856 and 1857 the following to be the char- 
acteristic changes of the urine in malarial fever. 
CHANGES OF THE URINE IN MALARIAL FEVER. 
Intermittent Fever. 
The amount of urine excreted during the active stages and during the 
earliest stage of the intermission, is less than that of health, and this 
diminution relates to the water and not to the solid constituents. During 
convalescence, and especially under the action of depurants, the amount of 
urine is increased. The color of the urine varies from light orange to deep 
red. During the active stages the free acid is increased, but diminishes 
during convalescence. The urea is increased during the active stages 
above the standard of health, and especially during similar conditions of 
rest and starvation. The uric acid is diminished both with and without 
the action of the sulphate of quinia, during the active stages, when the 
pulse is full and rapid and the respiration full and accelerated, and the 
temperature elevated. As a general rule when the fever declines, the 
uric acid increases above the standard of health, both with and without 
the action of the sulphate of quinia. In some cases the uric acid is 
increased to fourfold the normal amount during convalescence. The urine 
of the intermission of malarial fever is characterized by heavy yellow 
deposits of urate of soda, and triple phosphates, the former, in the form of 
granular and acicular masses, and the latter as beautiful prismatic crystals. 
Phosphoric acid is greatly diminished and may have entirely disappeared 
during the chill and first stage of the febrile excitement. The phosphates 470 
Constitution of the Urine in Malarial Fever. 
are more abundant in the stage of convalescence than during the active 
stage. The deposits (so-called critical discharges), so common during con- 
valescence, consist chiefly of the urates of soda and ammonia, and the 
phosphates, most generally in the form of triple phosphates. The chloride 
of sodium is abundant during the cold and hot stages. The sulphuric acid 
is increased during the height and decline of the hot stage. The urine 
excreted during the fever is generally deficient in uric acid and the earthy 
salts, while its acidity and power of resisting decomposition is greatly 
increased, and it will remain for a great time without undergoing decom- 
position. On the other hand, during convalescence the urine rapidly 
undergoes change, and deposits of the urates of soda and ammonia, and 
the precipitation of the triple phosphates, by the ammonia generated dur- 
ing the decomposition of the urea, form the so-called critical discharges of 
malarial fever. Albumen is almost universally absent from the urine of 
uncomplicated malarial fever; it is present, however, in that form called 
malarial hannaturia, characterized by intense jaundice and congestion of 
the kidneys, and passive haemorrhage. In such cases the urine contains 
blood-corpuscles and casts of the tubuli uriniferi filled with granular 
matter, detached uriniferous tubes and colored blood-corpuscles. 
Remittent Fever. 
The changes of the urine in remittent fever, are the same in kind, but 
different in degree from those of intermittent fever. The urine is higher 
colored, more concentrated and richer in urea, phosphoric acid and sul- 
phuric acid. If the case be protracted, the chloride of sodium diminishes 
as in typhoid fever. When the temperature falls below the normal stand- 
ard in the early stage of convalescence, the urea, as in the similar stage of 
intermittent fever, decreases in amount. During the period of remission 
and convalescence, the uric acid, which had suffered decrease in the active 
stages, increases above the normal standard. The formation of deposits of 
the urates of soda, and of ammonia, and of the triple phosphates (critical 
discharges) in the urine of remittent fever, is similar in all respects, takes 
place at analogous periods, and is due to the same causes as in the urine of 
remittent fever. 
Plate 11, Figure 46, represents the appearance under the microscope 
of the deposits of urate of soda and triple phosphate often observed in the 
urine during the remission of malarial fever and granular urates and 
lozenge shaped crystals of uric acid are also represented in this figure. 
The deposit of uric acid in many cases of malarial fever is abundant; the 
lozenge-shaped crystals of uric acid being large, well-formed and highly 
colored. The color of the crystals of uric acid in malarial fever varies 
from a light red to deep red, and from light brown to deep brown. As a 
general rule albumen and urinary casts are absent in the ordinary varie- 
ties of malarial fever; but in the severe grades they are frequently present. 
Albumen and casts have been observed in cases of malarial fever, both in 
the acute stage and in the chronic form in the urine of laborers brought 
directly from the swamps of the Atchafalaya and other parts of the delta 
of the Mississippi river. I have also observed the occurrence of albumen 
and casts in the urine of inhabitants and natives of New Orleans, who in 
previous epidemics suffered with yellow fever, when they were subse- 
quently attacked with malarial fever. This symptom is most likely to 
occur in the lowest and undrained portions of the city, bordering on the 
swamp, and extending back to Lake Pontchartrain. Whilst yellow fever 
has almost invariably made its first appearance on the river front and Investigations by Joseph Jones, M. D. 
471 
around the new and old basins, these severe cases of malarial fever attended 
with renal congestion and albuminuria occur in the opposite direction. In 
Plate 13, Figures 53 and 54, we have the microscopical appearance of the 
urine in malarial haematuria, showing the highly colored casts of the tubuli 
uriniferi and the presence of pigmentary matter and pigment cells. The 
following is an outline of the cases of malarial haematuria, from which the 
specimens of urine were taken: 
J. E. Easterland, aged 21, native of Carrollton, Alabama, has suffered 
with repeated attacks of malarial fever. Admitted to Charity Hospital 
November 29th, 1876. Intense jaundice; incessant vomiting of dark green 
bilious matters; pulse 144; respiration 30; temperature of axilla 102. °5; 
urinary suppression. November 30th, 9 A. M.-Pulse 132; respiration 
16; temperature of axilla 98.®5; continues to vomit large quantities of 
dark biliary matters; urinary suppression. 7 o'clock P. M.-Pulse 134; 
respiration 22; temperature 99. °5. The kidneys have resumed their func- 
tions, and the urine presents a deep brownish red color and contains blood. 
The vomiting has ceased. December 1st, 8 A. M.-Pulse 122; respiration 
22; temperature 100. °5. Chemical and microscopical examination of urine 
passed. November 30th, 9 A. M., and December 1st, 9 A. M., 1876: Amount 
of urine passed during twenty-four hours, 1560 cubic centimetres. Up to 
November 30th, 9 A. M., the urinary excretion had been almost entirely 
suspended. Heavy deposits of casts of urinary tubes, excretory cells, 
blood-corpuscles and urates of ammonia, giving to the urine a muddy 
brownish red color. This deposit settled very slowly, and the clear urine 
then presented a deep brown and greenish black color. The deposits con- 
tained blood, and stained bibulous paper of a red and yellowish red color. 
Small coagula of blood were visible. Chemical analysis revealed the pres- 
ence of both biliary coloring matter and bile, and also blood and albumen, 
blood-corpuscles and casts. Under the microscope, the casts of the tubuli 
uriniferi were stained of a deep orange yellow and reddish brown color from 
the presence of the coloring matter of the blood and bile; instances of altered 
haematin of dark brown and black color were also observed in the urine. 
The appearance presented by the urinary depositsis represented on plate 13, 
figure 53. Reaction of urine, acid; sp. gr. 1044. 1560 cubic centimetres 
of urine passed during twenty-four hours contained urea, grains 528.5; uric 
acid, grains, 18.7; phosphoric acid, grains, 120.1; sulphuric acid, grains, 
51.3; chloride of sodium, grains, 24. Amount of blood not determined. 
As this patient was in a state of starvation, taking little or no nourish- 
ment, we observe a great increase of the urea, uric acid, and especially of 
the phosphoric acid. 7 o'clock P. M.-Pulse 110; respiration 21; temper- 
ature 100®. December 2d, 8 A. M.-Intense iaundice; surface of a bright 
golden color; conjunctiva of eyes of a deep golden color; saliva and mucus 
from nose of a deep golden color; pulse 80; respiration 20; temperature of 
axilla 99. °5. Urine abundant, reddish, charged with heavy deposits of 
urates and casts. Amount of blood in urine diminished. Urinary depos- 
its similar to those in preceding sample, but casts and urinary tubes less 
abundant and not so highly colored. The microscopical appearance of the 
deposits is represented on plate 13, figure 54. The urine contained bile pig- 
ments and biliary acids and blood. Upon standing, the deposits fell and left 
a brownish greenish black color. Amount of urine passed during twenty- 
four hours (December 1st, 9 A. M., to December 2d, 9 A. M.)( 1520 cubic 
centimetres; contained urea, grains, 585.2; uric acid, grains, 18.2; phos- 
phoric acid, grains, 87.7; sulphuric acid, grains, 25,9; chloride of sodium, 
grains, 23 2; blood not determined. This patient recovered and was dis- 
charged from the Charity Hospital. 472 
Constitution of the Urine in Malarial Fever. 
To the belief held by many physicians, that a malarial germ would be 
found in the bodies of those suffering from malarial poisoning, because the 
malarial poison is evolved under circumstances which favor the develop- 
ment of low organisms, and that its production is associated with the decom- 
position of organic material of vegetable or animal origin, which depends 
upon the presence and action of bacterial organisms ; the superficial objec- 
tion has been opposed that in intermittent fever, it would seem, a priori, 
that the hypothetical parasite would not be likely to find a suitable culture- 
medium in the blood of a living animal because its normal habitat is in 
swamps, where its development is associated with the decomposition of 
vegetable matters, and because many parasitic micro-organisms which 
multiply freely in the blood of living animals, as the anthrax bacillus and 
the spirillum of relapsing fever, produce infectious diseases communicable 
from one individual to another. Such objections are merely theoretical, 
and as we shall show, by numerous facts, are without foundation. Actual 
observations have shown the existence of micro-organisms in the blood of 
malarial fever patients, and it has also been established that the blood of 
individuals suffering with malarial fever is capable of inducing a similar 
form of disease when injected into the blood-vessels of healthy beings. 
The position of those writers who pretend that no parasitic organisms 
exist in the blood, is not at all strengthened by the gratuitous assumption 
that conditions more nearly approaching those which form the develop- 
ment of the poison external to the body, may be found in the alimentary 
canal, or that its action is restricted to the production of a volatile chemical 
poison which is evolved as a result of the vital activity in the localities 
where it abounds external to the human being, and that this volatile 
chemical poison infects the atmosphere in the vicinity and produces 
malarial poisoning in those who respire the atmosphere. An extended 
series of experiments with various poisons (see Medical and Surgical 
Memoirs, vol. 1, pp. 271, 331) and gases, (Medical and Surgical Memoirs, 
vol. 1, pp. 509, 534), including hydrocyanic acid, cyanide of potassium, 
strychnia, chlorine, nitrous acid, hyponitrous acid, hydrogen, bromine, 
oxygen, carbonic acid, carbonic oxide, nitrogen and carburetted hydrogen 
established the fact that the action of the malarial poison differs from that 
of all known organic or inorganic chemical compounds and gaseous 
products in the paroxysmal character of its effects and in the power which 
it possesses of multiplying and in reproducing itself in the animal organism. 
The experiments and observations recorded in the Medical and Surgical 
Memoirs, including a small portion of my observations and studies, which 
have embraced a critical clinical study of the poisonous effects of a large 
number of toxic agents, as lead, arsenic, opium and its preparations, aconite 
and various other mineral and vegetable poisonous compounds; the results 
have all tended to confirm the view that the malarial poison is not a simple 
chemical element or combination of elements, solid, fluid or gaseous, but 
rather that it is a living organized ferment of one or more species, capable 
of inducing profound alterations in the chemical and morphological 
constituents of the blood, and capable of reproduction and multiplication and 
of periodical development and change in the living human body. According 
to this view the phenomena of malarial fever and malarial poisons are due 
to the introduction into the human body by respiration, or by the injection 
of malarious waters or food of living micro-organisms originally produced 
in the soil, waters and atmosphere of malarious regions. 
The living micro-organisms constituting the ague poison or ferment, 
unlike the small-pox or scarlatina or measles or typhus fever ferment, 
instead of protecting the body by making it incapable of undergoing the Experiments on the Micro-Organisms of Malarial Fever. 
473 
same action again, makes the nervous system and the blood more ready 
on the slightest renewal and increment of the poison, to undergo the same 
morbid actions and to manifest the same pathological changes again. In 
each febrile paroxysm septic changes result in antiseptic products, just 
as in the fever of small-pox, but with the difference that the check to the 
growth of the malarial organisms may be only partial and they may be 
only in part eliminated, whilst a certain number of spores may remain 
dormant, as it were, until the antiseptic products are fully removed from 
the blood, organs and tissues, or the powers of resistence against their 
action be enfeebled by over fatigue, change of climate, exposure to cold, 
depressing emotions, and indiscretions in diet, or the infliction of mechani- 
cal injuries or the supervention of an inflammatory disease. 
We can thus understand the value of such a nervine tonic and anti- 
septic agent as quinine in arresting the action of these micro-organisms, 
and thus curing the malarious disease. We can thus also understand the 
mode in which the pre existence of these living malarial germs in the body 
may modify the progress and results, and treatment of pneumonia and 
other inflammatory diseases. According to this view malarial poisoning 
is not simply an intoxication ; nor is the action of the malarial poison 
primarily or wholly upon the centres of the nervous system and especially 
upon the sympathetic ganglia. The paroxysms are not wholly due to the 
disturbances of innervation rather than to the presence of a ferment in the 
blood ; either directly or indirectly the micro-organisms produce profound 
changes upon both the cerebro-spinal and sympathetic systems, but these 
changes are preceded by and accompanied with profound changes in the 
morphological constituents and proteids of the blood and corresponding 
derangements in the nutrition of all the organs and systems of organs in 
the living body. 
This theory rests upon important experimental data, and not merely 
upon microscopical examinations of the blood, but upon chemical analysis 
of the blood organs and tissues, and what is of great importance upon the 
following actual demonstrations. 
EXPERIMENTS ILLUSTRATING THE ACTUAL EXISTENCE OF THE MALARIAL 
FERMENT OR LIVING MICRO-ORGANISMS IN THE SOIL OF MALARIOUS 
REGIONS. 
The view that the malarial poison is particulated and organized, in 
the language of the microscopists of this day, appears to have been 
announced by Lucretius in the year 95, B. C.; Linnaeus held a similar 
opinion; in 1695 the Italian Lancisi, demonstrated that malarial fevers 
are caused by a material substance, In our own country various phy- 
sicians, and especially the learned Dr. Mitchell, of Philadelphia, have 
advocated the view that malarial fever is caused by a living germ. Organic 
matter was discovered in 1810 to 1811, by Vauquelin in the air collected 
over the Languedoc marshes, by De Lisle, and again by Moscati (1818) in 
the air of a Lombardy rice-field; and the organic matter of the air of 
malarious localities has been examined by Boussingault (1829, 1830), Gigot 
(1859), and Beechi, 1861. Dr. Hempstead suggested that hydrocyanic acid 
is probably the cause of malarial fevers; Professor Daniel, in 1841, inferred 
that sulphuretted hydrogen gas might be the noxious ingredient of the air 
of marshes; and Wilson supposes that ammonia united with a ferment is 
the agent in question. 
Dr. Salisbury, of Cleveland, Ohio, in 1865 (Am. Jour. Med. Sci., Jan- 
uary, 1866), attempted to solve this problem by direct observation and 474 
Experiments on the Micro-Organisms of Malarial Fever. 
experiment; and he concluded from his microscopical observations that a 
unicellar alga belonging to the genus palmella was the micro-organism which 
caused malarial fever. Dr, Salisbury found this alga on the surface of 
marshy localities; he detected its spores in the atmosphere; and he found in 
the sputa of patients suffering with malarial fever, cells which he believed 
to be identical with the spores of the alga. Dr. Salisbury also alleged the 
production of typical attacks of intermittent fever in four individuals, as 
a result of exposure in a bed chamber in the open window of which fresh 
clods from the marshy soil containing this palmella were placed; the attacks 
followed each exposure at intervals of ten, twelve and fourteen days, and 
were arrested by quinine. 
M. Bolestra, in 1870, reported the results of his examination micro- 
scopically of the water of the Pontine marshes of Ostea and of Mecearebe, 
in the vicinity of Rome : they were filled with infusoria of different 
species, varying with the condition of the water, and the degree of its cor- 
ruption; amongst them a little plant abundant in the waters of marshes in 
a foul putrid condition, resembling slightly the cactus peruvianus, attracted 
his particular attention. This alga rests upon the surface of the water; it 
is mixed with a quantity of greenish-yellow, transparent spores l-1000th 
millimetre in diameter; there are also sporangia of l-100th to l-300th 
millimetre in diameter, in which these spores are imbedded. This alga 
grows rapidly in the presence of oxygen, under the influence of the direct 
solar rays, and especially in the presence of decaying vegetation. These 
spores were found in the air of Rome, and they were still more abundant 
in moisture condensed from the atmosphere in the vicinity of marshes. M. 
Bolestra came to the conclusion that these spores, or some toxic principle 
connected with them, constitute the cause of the malarial fevers which 
have prevailed from time immemorial in and around Rome. 
Dr. Lanzi, of Rome, in 1876, reported the discovery of a peculiar 
alteration which algse of the Pontine marshes and of the Roman Cam- 
pagna are subject to : the cells become filled with dark granules, which 
become more abundant as the algae die and pass into a state of putrefac- 
tion; the chlorophyll disappears as these granules increase in number, and 
finally the cells become quite black from the accumulation of these dark 
colored bodies. Lanzi believes these dark colored granules to possess the 
poison of a ferment, and to be identical with the bacteridium brunneum of 
JSchroeter. They are found in abundance in the dust of the Campagna, 
and can be cultivated by using this to inoculate a culture medium. Lanzi 
holds that the pigment-granules found in the spleen and liver of persons suffering 
with malarial fever are identical with the granules found in decaying algce. 
Eklund, of Sweden, in 1878, announced the discovery of a micro- 
organism in the moisture condensed from malarious marshes, which he 
named limnophysalis hyalinia, which is said to have been previously 
observed by Gratiolet in 1867, and Cauvet in 1876. Eklund describes the 
parasite as a fungus which developes directly from a mycelium, which is 
simple or dichotomous, hyaline, and extremely slender; in presence of 
heat, moisture and decomposing vegetable matter the mycelium grows in 
length, and sporangia or conidia are formed; these are transparent at first, 
but when the sporangia are entirely ripe the spores have a brown color. 
Eklund affirms that the limnophysalis hyalinia is found in the blood of those 
attacked with intermittent fever; to demonstrate this fact he draws blood 
by puncture with a needle from the superficial capillaries in the region of 
the spleen; this is received in capillary tubes, which are hermetically 
sealed ; before being examined under the microscope the blood is diluted 
with a solution of nitrate of potash. Tn every case the blood of patients Experiments on the Micro-Organisms of Malarial Fever. 
475 
with intermittent fever was found to contain the limnophysalis hyalinia; it 
was also found in the urine, when its presence indicates that the patient is 
liable to a relapse. 
Klebs and Tommasi-Crudeli announced in 1S79 the discovery of the 
bacillus malaria?. According to these observers, numerous shining, oval 
mobile spores, .95 of a micro-millimetre in diameter; in culture fluids 
these spores develop in long threads, at first homogeneous but subsequently 
dividing into segments; the spores are at the two extremities of the seg- 
ments, and in some cases a third spore is seen in the middle of a rod. The 
results of the experiments of Klebs and Tommasi-Crudeli in the vicinity 
of Rome have been summarized as follows : The poison is contained in 
great quantities in malarial districts at seasons when fever is prevalent; 
at such seasons it can be collected from the air immediately above the soil 
by an aspirator; stagnant water does not usually appear to contain organ- 
isms peculiar to malaria. 
Rabbits inoculated with washings of soil, or with fluids in which the bacillus 
had been cultivated, suffered from intermittent fever, the interval being in some 
cases eighty hours. Filtered liquids caused very slight symptoms, even if five 
times the original quantity was used. All the animals with intermittent 
fever thus produced, had marked splenic enlargements, nine or ten times 
the normal size. Many of the spleens contained black pigments, especially 
those from graver cases, in all respects like the spleens of persons suffering 
from ague. The bacilli was found in the spleen and marrow of animals 
as well as in the soil. They were at first ovoid, mobile, shining spores, 
which developed in the body as well as in the cultivation apparatus into 
long threads, homogeneous at first, but soon dividing into sections, each 
of which gives rise to a new thread. These bacilli could not develop 
without oxygen, and required a richly nitrogenized medium for their growth 
and cultivation. The bacillus was also found in the blood of the animals 
experimented on, taken after death. The position of the spores, which are 
found either at the poles or in the middle of the segment, serves as a mark 
ol distinction between this and other pathological bacilli. M. Corradi 
Tommasi-Crudeli, professor in the Royal University of Rome, in his 
address before the International Medical Congress at Copenhagen, 1884, 
presented a brief summary of his own studies, with reference to the nature, 
prevention and treatment of malarial affections, from which we consolidate 
the following facts bearing upon the nature of the cause of malarial fevers: 
Professor Tommasi-Crudeli holds that the idea so long held by the 
medical profession that there is a necessary connection between malarial 
fever and marshes or marshy soils, is thoroughly exploded ; the cause of 
malarial fevers he declares to be a specific ferment, which is not of exclu- 
sively palustral origin and still less the product of putrefactive processes. 
In every part of the globe situate between the two polar circles there are 
marshes, stagnant waters in which flax and hempare macerated, and places 
where the mixture of fresh with salt water takes place on a vast scale, and 
which are not malarious; whilst there are others which are not and never 
were marshy, and where there is no trace of putrefactive processes, which 
are malarious in the highest degree. Malaria exists in soil of every con- 
ceivable variety and of every age in geological time, and it is impossible to 
point to any micrological or chemical condition of the soil, which can be 
said to be essential. From this he argues that all soils have become 
infected, so to speak, and he defines the word malarious as expressing a soil 
or locality infected by "the malarial ferment." The idea that intermit- 
tent fever was caused by some minute organism is as old as Varro, and 
independently of the reasons which induced Raseri, and later Henle, to Experiments on the Micro-Organisms of Malarial Fever. 
476 
adopt the notion of contagium vivum-, and before the microscope revealed 
the actual existence of organisms there were circumstances which pointed 
to the idea, even in very remote times. 
As malaria exists in soils of the most diverse composition, the chemi- 
cal origin of the poison is not admissible, and the persistent identity of the 
product is chemically impossible; whilst in the hypothesis of -x ferment, which 
finds suitable conditions for its existence in every variety of soil the wide 
distribution of the disease is readily explained. The author and Klebs in 
1879, were, he says, the first to examine a large number of malarial and 
non-malarial soils, with the result that an organism, a kind of bacillus, 
was discovered and minutely described ; these researches and those of later 
observers have put it almost beyond doubt that an organism of this kind 
is concerned in the production of malarial fevers ; more recently Marchia- 
fava and Celli have demonstrated that this parasite directly attacks the 
red corpuscles of the blood, causing characteristic changes. 
Many observations made lately in Rome tend to show that this para- 
site does not always assume the perfect bacillar form described by himself 
and Klebs. It is a mistake to suppose that all soils containing this fer- 
ment poison the superjacent atmosphere, for it is known that outbreaks 
of fever occur when soil, malarious in ancient times, is stirred up by culti- 
vation or excavation. From this he argues that any ferment can remain in 
a latent state, or state of inertia for centuries. The long time during 
which the seeds of plants may lie dormant is used by the author as an 
argument in favor of the possibility of this latency or suspended acti vity. 
The conditions necessary for the development of the malarial poison 
are thus stated : 1. A temperature not less than 20° C. 2. A moderate 
amount of permanent moisture in the soil. 3. Ready access of oxygen to 
the strata which contain the ferment. Natural causes tend to diminish or 
suspend the activity of the ferment. In winter condition No. 1 is wanting, 
though a few very hot days have often been known to be followed by out- 
breaks of fever even in winter. In summer condition No. 2 fails if the 
heat be sufficiently prolonged. This, he says, occurred in the Agio 
Romano in 1881-82, though a single heavy shower of rain causes the reap- 
pearance of the disease with even greater force. Condition No. 3 is 
affected favorably for man when- 
1 The malarious soil is covered by natural top dressing (colinate) 
formed by alluvial deposits; or, 
2. By the felting together of the roots of the grass in a strong pasture. 
Both these circumstances prevent the access of oxygen to the soi 1 which 
contains the ferment. The efforts of man must of necessity be confined to 
the distinction of two of the conditions, by (1) excluding the oxygen by 
means of the dressings (colinate), and (2) removing the subsoil water by 
drainage. 
Subsequent to the investigations of Klebs and Tommasi-Crudeli, Mar- 
chiafava and Cuboni, in Italy, examined microscopically the blood of men 
ill with malarial fever, and found spores and bacilli, which they declared to 
be identical with those described by the former observers. According to 
Marchiafava and Cuboni, the spores included in the white blood-corpuscles 
were sometimes so numerous as to seem to fill them completely. The 
investigations of malarial patients by Lanzi and Poroneito led to the same 
conclusions. Marchand published in April, 1882, some observations really 
made in 1876, to the effect that there exists in the blood in the cold stage 
of intermittent fever, mobile and flexible rods, presenting slight swellings 
at their ends and sometimes also at the middle. These end swellings he 
thought also might be of the nature of spores. Experiments on the Micro-Organisms of Malarial Fever. 
477 
In the same year, 1882, Professor Ceri, of Camerioni, Italy, published 
his culture experiments with organisms found in malarial and other soils, 
■experiments on animals, and culture-experiments with quinine. They 
resulted in proving that the spores could be cultivated (the terms natural 
germs were applied to those found in the atmosphere and soil, and artificial 
germs to those which result from their culture); that animals could be 
infected by their injection into the blood, though to a less degree by the 
cultivated than the natural germs, the former growing weaker in success- 
ive generations; and that the infecting properties could be retarded by the 
application of heat to culture-fluids, and the introduction of quinine into 
them, certain degrees of the former and strengths of the latter (1 to 800) 
of the latter making the culture of the spores impossible, and arresting 
the putrid fermentation induced by them. 
Dr. Franz Ziehl, in the course of the year 1882, tested these results 
clinically in three typical cases of malaria, in all of which the spleen was 
enlarged. In all these the bacilli were found in the blood taken from any 
part of the body by the prick of a needle and examined in the fresh state 
or dried in a thin layer upon a cover glass, by simply passing the latter 
over a flame. The, bacilli thus observed by Dr. Ziehl, were of different 
lengths, but usually were from one-fourth to the entire diameter of a red 
blood-corpuscle. The majority of those measured were about four micro- 
millimetres long and seven broad. Their ends were swollen and rounded. 
Laveran announced in 1881 the discovery of the oscillaria malaria?, and his 
discovery has been confirmed by Richard. 
According to Laveran, there exists in the blood of patients attacked 
with malarial fever pigmented parasitic elements which present themselves 
under those principal aspects. The parasitic elements are only found in 
the blood of patients sick with malarial fever, and they disappear when 
quinine is administered. They are of the same nature as the pigmented 
bodies which exist in great numbers in the vessels and organs of patients 
dead with pernicious fever, and which have been heretofore described as 
melanotic leucocytes. This parasite is said to be a kind of animalcule 
which exists at first in an encysted state. In the blood these organisms 
present themselves as motionless, cylindrical, curved bodies, which are 
pointed and transparent and have a pigment spot; also as cylindrical 
bodies, about the diameter of a red blood-corpuscle, showing active move- 
ments and containing in their interior numerous pigment granules. The 
movements of these bodies are due to the action of elongated filaments 
attached to their circumference-flagella. A third form in which these 
parasites present themselves in the blood is as motionless, spherical, or 
irregularly shaped bodies containing dark red, rounded, pigment grains. 
These bodies have no nuclei, and do not stain with carmine; they appear 
to be the ultimate stage of development of the above. The blood also con- 
tains fine pigment granules, pigmented leucocytes and vacuolated red cor- 
puscles which contain pigment granules. These parasitic elements have 
only been found in the blood of persons sick with malarial fever, and they 
disappear when quinine is administered. They are of the same nature as 
the pigmented bodies which exist in great numbers in the vessels and 
organs of patients dead with pernicious fever, which have been described 
as melanotic leucocytes. Laveran, at the time his report was published, 
had found these bodies in 180 out of 192 patients examined in Algeria and 
in Tunis, who were affected with various symptoms of malarial poisoning. 
M. Richard, in 1882, confirmed the statements of Laveran, as to the 
existence of the parasite in the blood of persons suffering from malarial dis- 
eases at Phillipeville, France, where malarial fevers abound. He invari- 478 
Experiments on the Micro-Organisms of Malarial Fever. 
ably found the parasite of Laveran in malarial fever patients, and has 
never seen it in the blood of persons suffering from other diseases. Its 
special habitat in the blood is the colored blood-corpuscles in which it 
develops and which it leaves when it reaches maturity. During the attack 
of fever many red blood-globules are seen which possess a perfectly round 
spot: otherwise they preserve their normal appearance. They are simply 
so to speak stringy or pierced. Other globules are observed in which the 
evolution of the microbe is more advanced ; the clear spot is larger and is 
surrounded by the black granules: the surrounding haemoglobin forms a 
ring which decreases as the parasite increases in volume : and after a time 
only a colorless zone remains at the margin. This corresponds to the body 
described by Laveran having almost the diameter of a red corpuscle and 
inclosing an elegant collarette of black granules. This collarette is the 
microbe which has arrived at its perfect state, and which is provided with 
one or several slender prolongations, measuring twenty-five micro-milli- 
metres or more in length. Richard affirms that he has several times seen 
the fully developed parasite emerge from its shell, the remnants of the 
invaded red corpuscle, to which it may remain attached, and which can 
only be seen with great difficulty. Sometimes only the motile filaments 
penetrate the envelope in which the body of the parasite remains enclosed. 
In both cases the filament is seen to undergo active movements, and when 
its extremity is caught in the fibrinous reticulum the body itself oscillates. 
This movement may last for an hour. Usually, however, no movement is 
observed, and the corpuscles containing very small parasites never move. 
The infected corpuscles become decomposed, the pigmentary collarette is 
broken down, and a grayish mass enclosing some black granules remains. 
The pigment granules when set free are rapidly picked up by the leuco- 
cytes : the membranous leucocytes are therefore epi phenomena. M. Lave- 
ran has also described elongated bodies which M. Richard has often seen 
in the blood of old cases, and which he believes to be red corpuscles con- 
taining parasites which have become deformed by pressure in the smaller 
capillaries, in which the parasites are arrested in their development. 
Acetic acid added to a drop of blood does not destroy the parasites, but 
destroys the normal blood globules, so that by treatment with this re agent 
the parasites are more readily found when few in number. 
The question of the effects of inoculating healthy individuals with the 
blood of a person suffering with intermittent fever, has recently been inves- 
tigated by C. Gerhardt. This observer took the blood at the commence- 
ment of the paroxysm and the following precautions were observed: The 
place in which the experiment was performed was free from malaria; the 
patient from whom the malarial blood for inoculation was obtained, was 
free from other communicable diseases, as for example, syphilis. The per- 
sons inoculated thoroughly understood the nature of the experiment, the 
march of temperature of those inoculated, was observed for a long time 
before the inoculation of the malarial blood, and showed an absence of 
fever. The experiments gave the following results : 
(a.) Thecause of the fever is transmissible by means of the blood 
drawn at the commencement of the paroxysm. 
(b.) The intermittent fever produced by such inoculation of blood 
differs from that arising in the usual manner in having an irregular 
subsidence. 
(c.) After a number of single attacks, or groups of attacks, a some- 
what regular quotidian fever is developed on the twelfth day in one case, 
and on the twenty-fifth day in the other. The type of the fever corres- 
ponded with that of the original case. Effects of the Pathogenic Organisms of Malarial Fever. 
479 
(d.) The intensity of the disease was in both cases so great (temper- 
ature 105. °9 lasting twenty-four hours), that the experiment had to be cut 
short by the administration of quinine. 
(e.) The attacks commenced, with few exceptions, in both persons at 
the hour of inoculation, or else attained their acme at this time. It was 
difficult to determine the time of incubation; the first febrile movement 
appeared in one case on the seventh, and in the other on the twelfth day; 
the severest attack of fever began on the seventeenth and twenty-fifth days 
respectively. The preceding results obtained by Professor Gerhardt, have 
been recently confirmed by the experiments of Drs. Mariotti and Ciarrochi. 
Drs. Mariotti and Ciarrochi were able to secure as subjects of experi- 
ment, patients who had either not had malaria, or had not suffered from it 
for so long a time previous, that no trace of the disease remained. The 
precaution was taken of registering their temperature for a month before 
the experiments commenced, and the blood of the subjects of experiment 
was submitted to accurate microscopic and spectroscopic analysis by Mar- 
chiafava and Rossini. The arms of the malarial subjects and of the experi- 
mental subject having been first washed with a weak solution of corrosive 
sublimate, a Pravaz's syringe, sterilized at a temperature of 150° C, and 
kept up to the moment of experiment, sealed in a glass tube, was used to 
withdraw the malarial blood, which was then injected into the experi- 
mental subjects, first into the subcutaneous tissues and then into a vein. 
The quantity of blood injected was each time a gramme, taken either in 
the apyrectic state preceding an attack, or in the febrile access. In the 
choice of malarial subjects the investigators were guided by the researches 
made into the blood of malarial subjects by Professor Marchiafava and 
Professor Celli, those cases only being chosen where the alterations in the 
blood described by them, were distinct (pigment bodies, etc.). The experi- 
mental subjects were: (1) A youth, aged 16 years, suffering from trans- 
verselum bar myelitis. (2) A man, aged 32 years, affected with sclerosis 
in patches. (3) A man, aged 47, who also had sclerosis in patches. 
These three had not previously had malaria. 
(4) A man aged 60, affected with hemichorea. This man had 
had malaria ten years before, but not since. The subcutaneous tissue was 
the first site of injection, but no results following, the injections were made 
direct into a vein. In all malarial fever amenable to quinine followed, 
though not perhaps from the first injection of malarial blood. The conclu- 
sions arrived at were. 
(1). Malaria is transmissible from man to man by inoculation of mala- 
rial blood. 
(2). So far as these cases go, it would appear that subcutaneous injec- 
tion is less effective than intravenous. 
(3). The quantity of blood injection should amount at least to one 
Pravaz's syringeful. 
(4). In whatever period of malarial disease the blood is withdrawn, 
fever is produced in most instances. 
(5). The rapidity with which the induced malaria appears, depends 
often on the quantity of blood injected, and on the individual resistance of 
the experimental subject. 
(6). In the blood of the subject of induced malaria, the characteristic 
alterations of malarial blood can be made out in a relatively short time. 
(7). The induced type of fever is often that of the inducing, not only 
in a clinical but also in a therapeutic sense. 480 
Effects of the Pathogenic Organisms of Malarial Fever. 
THEORY OF THE CAUSATION OF THE PATHOLOGICAL PHENOMENON IN 
THE LIVING HUMAN BEING, KNOWN AS MALARIAL FEVER. 
We are justified by our own observations as well as those of observers 
who have recorded posifwe results, in the conclusion, that malarial fever is 
caused by a specific living pathogenic micro-organism. 
This micro-organism ahd its spores exist in the soil, waters and atmos- 
phere of malarial regions. It gains access to the blood of human beings, 
where it commits its greatest ravages, through the lungs and through the 
skin and alimentary canal, but it is chieflly through the respired air and 
the ingested water that it finds the media for its penetration into the 
capillaries and circulatory fluids. 
The condition of the individual at the time of exposure, whether of 
health or ill health, and the integrity of the pulmonary alimentary and 
cutaneous surfaces, without doubt modify or influence the rapidity of the 
introduction and the subsequent action of the malarial pathogenic micro- 
organism. After the introduction of the pathogenic micro-organisms into 
the circulation, they cause the splitting up of complex nitrogenous com- 
pound (proteids, colloids as well as crystalloid bodies) into compounds of 
comparatively low or simple composition ; they cause the disintegration 
of nitrogenous compounds by withdrawing from the compounds certain 
molecules of nitrogen, building up with these their own protoplasm : Sim- 
ilarly carbohydrates and inorganic salts are dissociated by them, inasmuch 
as they require a certain amount of carbon, phosphorus and potassium for 
building up their own bodies. 
The profound and remarkable changes of the amount and character of 
the constituents of the blood and urine, which we have detailed 
in the preceding pages are thus shown to have their origin in the 
chemical changes excited by the life acts of the pathogenic malarial 
micro-organism. In this process of decomposition, certain alkaloid 
bodies closely related to the ptomaines are produced and act upon 
the ganglionic centres of the nervous system, inducing aberrated nervous 
and muscular action, causing capillary congestion, deranged secretions 
and other toxic effects. It is probable that in the most malignant cases 
a compound or compounds, resembling the septic poison (sepsin) is one 
of the products of decomposition of animal substances. It will be readily 
admitted that putrid intoxication or poisoning may occur as a pyaemic 
affection in the human subject, when a large ulcerating surface exists, in 
which it is well known that large numbers of putrefactive organisms are 
growing and are producing the septic poison or sepsin, which can be isolated 
by various chemical processes destructive of every living micro-organism. 
Gaspard Burdon Sanderson, Panum, Bergman, Billroth, Guttmann, Semmer 
and many others have shown that sepsin injected into the vascular system 
of animals, produces a marked febrile rise of temperature, and is capable 
of causing death with the symptoms of acute poisoning, showing vomiting 
and purging, spasms, torpor, collapse and death. On post-mortem there are 
found changes similar to those observed in the most malignant of fevers 
and especially of haemorrhagic malarial fever and yellow fever; namely, 
severe congestion and haemorrhage of the stomach, duodenum and rectum ; 
haemorrhage in thepleura, lungs, pericardium and endocardium; congestion 
and haemorrhage in the peritoneum ; congestion of the liver ; congestion of 
the kidneys and bloody urine. Thispwb-id infection leads to death in twelve 
to twenty-four hours or even less: on injecting smaller quantities only a 
febrile disturbance is noticed, severe symptoms and death only following- 
after injection of considerable quantities such as several centimetres of Effects of the Pathogenic Organisms of Malarial Fever. 
481 
putrid fluid. This sepsin is known to be one of the products of the 
chemical changes excited in nitrogenous bodies, by the multiplication, 
growth and life actions of septic bacteria. 
By holding that the micro-organism of malarial fever develops or pro- 
duces by its action on the proteidand morphological elements of the blood, 
bodies related to the animal alkaloids (ptomaines) and to sepsin, we have 
an explanation of the violent vomitings, sudden haemorrhages and profound 
coma characteristic of the severest forms of malarial disease. At the 
same time it should be observed that in the growth and chemical action of 
certain micro-organisms, the products of the decomposition started and 
maintained by them, have a most detrimental influence on themselves, 
inhibiting their power of multiplication; in fact, after a certain amount of 
these products has accumulated, the organisms become arrested in their 
growth, and finally may be altogether killed. We have already dwelt 
upon the importance, of the fact that indol, skatol, phenol, and other bodies 
belonging to the aromatic series, which are produced in the course of putre- 
faction of proteids, have a most detrimental effect on the life of many 
micro-organisms. Whilst it has not been as yet clearly determined whether 
in these instances the organisms produce the chemical effect by creating a 
special zymogen or ferment, and through it causing the chemical disturb- 
ance, or whether they merely dissociate the compounds by abstracting for 
their own use certain molecules; it is on the contrary well established that 
in consequence of this chemical disturbance definite chemical substances 
are produced. 
In view of the fact that the micro-organism of malarial fever acts with 
greatest energy and most destructive effects upon the colored blood-cor- 
puscles; ^nd in view of the fact that there appears to be no practical limit 
to the alteration and destruction of the red globules; we must refer the 
temporary cessation of the actions of the micro-organism (the intermissions 
and remissions of malarial feverf not to the exhaustion of any special 
chemical substance in the blood and organs, but rather to the effects of the 
elevated temperature; and the formation of antiseptic compounds, in 
arresting the development, and in destroying large numbers of the micro- 
organisms. In certain diseases as small-pox, vaccinia and typhus fever 
the chemical changes resulting from the action of the pathogenic micro- 
organisms, as well as the elevation of temperature, are such as to cause the 
complete destruction and elimination of the germs originally producing 
the disease. 
In the paroxysms of malarial fever, there is in like manner a destruc- 
tion and elimination of the pathogenic micro-organisms, but in many cases 
the destruction and elimination of the germs of the disease is not complete, 
and those remaining in the blood reproduce their kind, and after a definite 
period the same phenomena are repeated. The paroxysm of malarial fever 
with its elevated temperature and antiseptic products, must to a certain 
extent be regarded as curative in its effects; and it is well established that 
a considerable number of cases of malarial fever end spontaneously and 
pass into recovery after one or more paroxysms without the employment of 
any antiseptic or any remedies whatever; in such cases the febrile changes 
excited by the pathogenic organisms have resulted in their death and elimi- 
nation. On the other hand, the most destructive and incurable forms of 
malignant anaemia, ending finally in hepatic and splenic enlargement, gen- 
eral anasarca and failure of the heart and nervous centres, often result 
from the continuous and almost unobserved action of the malarial micro- 
organism upon the constituents of the blood, and more especially upon the 482 
Explanation of the Action of Antiseptics in Malarial Fever. 
colored blood-corpuscles; in such cases the antiseptic products of high 
fever have not been formed. 
We must look to chemical knowledge to guide us in our contests with 
the specific agents of malarial and other diseases, and we accept the doc- 
trine, with but slight modification, that no chemical or other agents can be 
rightly regarded as disinfectants, in respect of any disease, unless it can be shown 
to have the power of inhibiting or arresting the development and growth of the 
particular species of microphyte ivhich is the constant concomitant of the morbid, 
process; and that inasmuch as all specific microphytes are endowed, with the power 
of midtiplying in the blood and living tissues of the organism they infest, and 
of there playing their part in the morbid process; all specific disinfectants must, 
in order to encounter the organisms they are intended to destroy, be of such a 
nature that they can, without prejudice, be mixed with the circulating blood, and 
come into direct contact with the tissues. 
In the case of malarial fever we have in quinine such a disinfectant, 
which is not only poisonous to the pathogenic micro-organism of malarial 
fever, but is also of such a nature that it can, without prejudice, be mixed 
with the circulating blood and come into direct contact with the tissues. 
Quinia may be taken in large doses without danger'; it is eliminated slowly 
with little or no change by the skin and kidneys; it circulates freely in 
the blood, and passes into the organs, and is thus br ought into contact 
with all pathogenic micro-organisms; its action as a disinfectant is greatly 
increased by the rapidity of the circulation, and its action is also favored 
and supplemented by the antiseptic products developed during the febrile 
paroxysms. Professor Ceri, of Camerino, has shown that the infecting 
power of the organisms of malarial soils by the introduction of quinine 
into the infecting fluids, one part of quinia to 800 of the culture fluids 
prevented the development of the malarial spores, and arrested the putrid 
fermentation induced by them. Administered to healthy men quinine 
reduces the urea twenty-five per cent, and the sulphuric acid forty per 
cent.; it diminishes the amount of uric acid; it slightly increases the 
amount of water; it does not diminish the amount of carbonic acid excreted 
by the lungs. The spleen of warm-blooded animals contracts under the 
influence of quinia within a few hours; it becomes tougher and its surface 
is thrown into folds; these phenomena are not prevented by the previous 
section of the afferent nerves. In healthy persons and in most febrile 
patients, it is not decomposed in passing through the blood, but is entirely 
excreted by the kidneys and bowels; notwithstanding that it does not 
directly take part in the chemical changes of the body, it produces giddi- 
ness and ringing in the ears, disturbances of hearing and vision, depres- 
sion of reflex irritability, depression or impairment of the heart's action; 
diminished frequency of the pulse; diminished arterial pressure, prostra- 
tion and reduction of animal temperature. Solutions of albumen are 
converted into peptones if shaken up in an atmosphere of nascent oxygen, 
but this change is prevented if quinia is present. Even in relatively small 
quantities it prevents the putrefaction of nitrogenous substances, as well as 
several simpler fermentative processes; in both cases it acts directly on 
the protoplasm, of which the substances or their germs are composed. Ou 
the other hand it is of importance in the administration of quinine in 
large or continuous doses, that other amorphous ferments, such as ptyalin 
and pepsin, have their properties very slightly, or not at all, arrested by 
quinia, and there are several protoplasmatic organisms on which it 
has no poisonous effects whatever, whereas it reacts on the others with 
unexpected vigor. Explanation of the Action of Antiseptics in Malarial Fever. 
483 
The poisonous action of many putrid fluids upon warm-blooded ani- 
mals, may be neutralized, either completely or as far as certain symptoms 
are concerned, by the simultaneous administration of quinia. Owing to the 
energy with which it paralyses certain kinds of protoplasm, quinia 
diminishes the absolute number of white blood-corpuscles in the body; the 
lymphatic glands under its action become small and are found on section 
to be abnormally dry, while splenic enlargements, due to hyperplasia of the 
lymphatic follicles, and to the increased tissue-change within the organ, by 
which it is accompanied, are reduced or prevented. 
The escape of white blood-corpuscles from the vessels, and the suppu- 
ration which ensues, can be distinctly limited in animals by quinia; its 
effect in this instance, is in the main, independent of the condition of actual 
pressure. It is due to a lowering of the affinity of the corpurcles, for the 
oxygen of the haemoglobin, this oxygen being the stimulus which excites 
the independent movements by which emigration from the veins and capil- 
laries is partly effected. Fresh vegetable juices containing protoplasm, 
and also healthy pus, both of which ordinarily give the reaction of nascent 
oxygen with tincture of guiacum or indigo, lose this property when mixed 
with relatively weak solutions of quinia; this alkaloid preventing the pro- 
toplasm from absorbing oxygen from the atmosphere, and undergoing the 
special alteration to which the reaction is due. 
Phosphorescent infusoria, or those which are continually undergoing 
powerful oxidation, completely lose their phosphorescence on the addition 
of minute quantities of quinia. The addition of quinia to blood which has 
been recently drawn, not only diminishes the physiological production of 
acid which occuis immediately after its removal from the body, but also 
its power of transferring active oxygen to oxidizable bodies; this effect 
also takes place with pure haemoglobin without its being possible to detect 
any decomposition of the latter spectroscopically during the presence of 
the quinia. On the contrary, when blood which contains quinia is heated, 
the lines which indicate oxygen disappear at a higher temperature than 
the same lines in pure blood used for comparison. The penicillium fungus, 
when mixed with haemoglobin outside the body, withdraws oxygen from 
it, and this process is arrested by quinia. 
From the preceding facts established by the labors of eminent observers 
as Dr. C. Binz, Mosier, Boeck, Rossbach and Preyer, and taking into consid- 
eration the alterations in size which the red blood-corpuscles undergo 
under its influence, it seems probable that while the quinia renders certain 
cells within the human organism still less fitted than before for the absorption of 
oxygen, it binds that element more firmly to the hcemoglobin. The fall of 
temperature which quinia so frequently produces in fever (0° 5, 4°.O and 
more, Centigrade) is independent of the heart and also of those portions of 
the nervous system which take origin in the brain and pass downward 
through the spinal cord, for it still takes place after the cervical portion of 
the latter has been completely divided ; nor does it appear to depend upon 
an increased emission of heat from the skin. The reduction of temperature 
appears to be largely due to some inhibitory effect exerted by quinia over the 
functional activity of the protoplasmatic cells of the heat-producing organs. 
Even the normal cells become slightly depressed by its action, especially 
when they are producing an unusual amount of heat under the stimulus of 
pyretic substances; and those infective poisons (whether they be organized 
or merely in solution), which are capable of self-multiplication in the body 
after a more or less period of incubation and of acting as irritants to their 
cells, are either rendered by quinia incapable of further development, as in 
malarial fever, or have their energy paralyzed, as happens to some extent 484 
General Conclusions relative to Cause and Nature of Malarial Fever. 
in typhoid fever. Quinia essentially differs from chemically allied mole- 
cules, such as morphia, strychnia and veratria, in the fact that it does not 
meet with any albuminous body in the nervous system, on which it has a 
marked effect. Quinia circulates unchanged through the blood, and it is 
an error to attribute its specific antipyretic properties to its stronger affinity 
for one or more pyretic poisons, and especially for that form which malaria 
originates. The power of quinia to arrest malarial fever, is due chiefly to 
(a) its antiseptic properties, (b) its power to bind the oxygen more firmly 
with the colored blood-corpuscles and thus to avert the destructive action 
of the malarial germ in micro-organism, (c) its poisonous effects upon the 
micro organisms of malarial fever, (d) its tonic effect upon the cerebro- 
sninal and sympathetic ganglia. 
GENERAL CONCLUSIONS DRAWN EROM THE PRECEDING INVESTIGATION 
RELATIVE TO THE CONSTITUTION AND CHANGES OF THE BLOOD IN 
MALARIAL FEVER. 
Changes of the Blood in Malarial Fever. 
The malaria] poison is capable of altering the constitution of the solids 
and fluids, and of modifying and altering the type and progress and effects 
of various diseases, even when no symptoms of aberrated, physical, chemi- 
cal and nervous actions have been manifested sufficient to arrest the atten- 
tion of the patient. 
The colored blood-corpuscles are diminished during malarial fever ; the 
extent and rapidity of the diminution of the colored corpuscles correspond 
to the severity and extent of the disease. The fixed saline constituents of 
the colored blood-corpuscles are often diminished in malarial fever. 
The colored blood-corpuscles are destroyed both in the liver and the 
spleen. The colored blood-corpuscles are more uniformly and rapidly 
destroyed in severe cases of malarial fever than in any other acute disease, 
with the exception, perhaps, of pyaemia. 
In the severe forms of malarial fever, the serum presents a golden 
yellow color. I have shown by numerous analyses that this color in the 
various forms of malarial fever, and even in the so-called malarial haema- 
turia, is due to the coloring matter of the bile, and not. as has been erro- 
neously stated, upon superficial observations, to the escape of the hcematin of the 
colored blood-corpuscles. 
The fibrin is diminished greatly in severe cases of malarial fever ; the 
diminution of this element of the blood is characteristic, not only of mala- 
rial fever, but of all the fevers; while its increase, on the other hand, is 
characteristic of the phlegmasiae. As a general rule, the diminution of 
the fibrin in malarial fever; as in the pyrexiae, generally corresponds with 
the severity of the disease, provided there be no inflammatory complica- 
tion. The diminution and alteration of the physical properties of the 
fibrin in malarial fever to any great extent, was always accompanied by 
congestion of the spleen, liver and brain, and serious cerebral disturbances. 
The fibrin is not only diminished in malarial fever; but it is altered in its 
properties, and its relation to the other elements of the blood and to the 
blood vessels, and in severe cases, heart clots (fibrinous concretions), are fre- 
quently formed before death. 
The albumen is diminished during the active stages, but such diminu- 
tion is not due to any loss of this constituent of the blood in the urine. 
As a general rule, albumen is absent from the urine in malarial fever, and 
when present, as in malarial hsematuria, it is accompanied with blood- 
dorpuscles, and with casts of the tubuli uriniferi containing colored blood- 
corpuscles. General Conclusions relative to Cause and Nature of Malarial Fever. 
485 
The results of my microscopical investigations upon the blood of 
malarial fever pursued during the past thirty years, may be thus formu- 
lated : 
1st. The malarial poison produces more rapid destruction of the 
colored blood-corpuscles than any other known febrile agent. 
The results of microscopic investigations have led us to refer the 
changes of the colored blood-corpuscles in malarial fever to the action of 
micro-organisms which should be regarded as morbific fermentshaving a 
special affinity for the colored blood corpuscles. The micro-organisms 
which we have observed in the blood of patients suffering from malarial 
fever, were: 
(a). Minute globular bodies from 1-10,OOOth to 1-30,000th of an inch 
in diameter, having the general appearance and chemical reactions of the 
spores of bacteria. 
(b.) Globular bodies of larger size than the preceding, often of a dark 
opaque character found not only in the liquor-sanguinis, but also in the 
colored blood-corpnscles, and in the colorless blood-corpuscles. These 
bodies most probably true spores, appear to possess the power of invad- 
ing and destroying the colored blood-corpuscles. These micrococci of 
spores are often in groups surrounded by protoplasm constituting zoogloea. 
(c.) Ovoid, cylindrical and rod-shaped bodies not destroyed by acetic 
acid, stained by analine dies. These bodies increase during the cold stage 
and also are more numerous in pernicious malarial fever. 
(d.) Colorless blood-corpuscles, containing minute pigment granules 
and dark, spherical bodies resembling spores. Many of these pigment 
corpuscles, or aggregations of dark spherical bodies or spores surrounded 
by protoplasm are twice the diameter of the colorless blood-corpuscles of 
normal blood ; and their behaviour, under the action of re-agents, and 
also during the process of staining, leads to the view that a portion at least 
of these bodies must be regarded as vegetable organisms. These large 
pigment cells appear to be characteristic of malarial fever. 
(e.) Masses of hmmatin, of various forms, irregular in size and shape 
but most generally the sides and portions exposed in profile are angular. 
The deposit of dark pigment masses in the liver and in the brain, in mala- 
rial fever and especially in cases of repeated paroxysms finds its origin in 
the changes of the colored blood-corpuscles induced by the morbific fer- 
ment or micro-organism of malarial fever. There is an actual destruction 
of the colored blood-corpuscles, in the living blood and within the walls of 
the living capillaries and blood-vessels in malarial fever. We can detect 
the process of the disintegration of the colored blood-corpuscles by the 
microscope and detect the very inception of that great pathological change 
which constitutes one of the most distinctive features of malaiial fever, 
and which must be carefully considered in every scientific and rational 
plan of treatment. 
(f.) Marked variations in the size of the colored blood-corpuscles. 
These variations, from small corpuscles to what might be called "giant" 
colored corpuscles, twice the diameter of normal globules, appear to be 
characteristic of malarial fever, to a certain extent. 
2d. The destruction of the colored blood corpuscles, does not take 
place with equal rapidity in all parts of the organism, but appears to be 
most marked in the spleen and liver. 
3d. The black pigment resulting from the hsematin, of the blood-cor- 
puscles, is frequently observed in the blood as it circulates in the vessels 
and capillaries in masses of various sizes, and in the form of cellular ele- 
ments. 486 
General Conclusions relative to Cause and Nature of Malarial Fever. 
The appropriation of a portion of the altered coloring matter 
(hsematinj of the colored blood-corpuscles by the leucocytes is due to the 
physical and vital endowments of these elementary bodies. It is now 
generally admitted that the colorless blood-corpuscles are elementary organ- 
isms which are endowed with the power of spontaneous motion ; this 
power belonging to them in virtue of the protoplasm of which these 
bodies are composed. Their motion is of two kinds, consisting of change 
of form and change of place, the latter resulting from the former. As 
movements of this kind are seen in greater perfection in rhizopods and 
amoeboe they are called amoeboid. The colorless corpuscles, when carefully 
examined in considerable numbers under the high powers of the micro- 
scope, 1-10 to 1-20 inch objective, are seen to differ from one another, both 
in size and aspect, and in their property of spontaneous movements. The 
researches of comparative anatomists and physiologists, '.have made us 
acquainted with the very active amoeboid movements of the colored blood- 
corpuscles of some of the lower vertebrata, as the newt, in which the cells 
are large and easy of observation, and there is no doubt but that all these 
observations thus far made upon the movements and functions of the 
colorless blood-corpuscles apply to those of man, in whom they are much 
smaller and more difficult of careful study and protracted observation. 
These bodies are so transparent that if one of them be observed as they 
roll over in the liquid in the field of the microscope, a single granule imbedded 
in its substance may be kept constantly in view. If one of the common 
large colorless corpuscles be kept under observation it will be noticed that 
the surface at first smooth gradually becomes uneven; the surface is beset 
with a greater or less number of filamentous appendages, varying in length 
and distributed over the surface with variable uniformity, and consisting 
of the same material as the body of the corpuscle. When short they may 
be compared to prickles; when longer they are often bent at the point. 
Sometimes one of the processes lengthens itself, while another disappears; 
sometimes a whole group of processes push out on one side, while others 
are retracted on the opposite side. Occasionally from the smallness and 
great number of the processes it is difficult to follow the changes as they 
occur. Some parts of the protoplasm are hyaline, or contain at most a 
few minute granules; in others there are clear spots with well defined con- 
tents, which differ indefinitely in size and have no definite arrangement; 
many of them are so clear that they look like perforations. These vacuoles 
are constantly undergoing change, both as to their relative position and 
relative distinctness, some coming into view while others are fading; they 
are, therefore, cavities filled with liquid, the origin of which is due to the 
constant commotion of the protoplasmic mass. It is easy, therefore, to 
understand why the vacuoles of the colorless corpuscles appear and disap- 
pear so rapidly. As some part of the corpuscles often but not always 
connects the centre, one or more bodies may be distinguished of rounded 
ovoid or irregular form, and tolerably distinct contour, somewhat less sepa- 
rate than the surrounding protoplasm, and containing one or more gran- 
ules. The nuclei are subject to continual change, both as regards form 
and relative position, and appear to take part in all the various divisions 
and subdivisions to which the colorless corpuscles are subject during their 
continual changes of size, shape and position. 
We observe two kinds of changes in the colorless corpuscles, one of 
these consisting of alterations in the form of the protoplasm, from the sur- 
face of which processes shoot out in ail directions; in the other the nuclei 
divide, as well as the cell substance itself, thus leading to the multiplica- 
tion of the colorless blood-corpuscles by self-division. The cell substance General Conclusions relative to Cause and Nature of Malarial Fever. 
487 
exhibits atranverse furrow; this becomes deeper and deeper, so that even- 
tually two masses are formed, each containing one or more ol the original 
nuclei. These two masses are for a time united by a neck of protoplasm, 
which gradually lengthens and thins out. and by final rupture of the 
isthmus, the two corpuscles come apart. The nuclei take au active part, 
both in the change of form and in the division of the colorless corpuscles. 
In all cases of real division, the young cells produced exhibit very active 
movements, changing thereby in form and place. The human colorless 
blood-corpuscles, are smaller than those of the newt, and exhibit less 
variety in their appearance. They are either quite pale, or they contain 
a variable number of dark granules. Their movements are less active than 
those of newt's blood, but sometimes are comparable with them; when 
they are more active than usual, the mode in which their processes are 
thrown out and retracted, and the characters of their progressive move- 
ments, correspond with the facts already stated. On one occasion, Dr. 
E. Klein observed movements which were even more lively than those com- 
monly seen in the newt, and resembled those of rhizopods, in the extreme 
rapidity with which the successive profusions of processes and correspond- 
ing interstitial fluxion of the protoplasm occurred. This happened in the 
case of a patient suffering from haemorrhagic anaemia. The careful experi- 
ments of physiologists have shown the important fact that it is possible to 
FEED THE COLORLESS BLOOD-CORPUSCLES. 
It has been demonstrated that the colorless blood-corpuscles possess the 
faculty of taking by virtue of their ameboid movement, solid particles into their 
substance. This subject is of great interest to the histologist, affording him 
a means by which to mark individual corpuscles so as to follow them in 
their wanderings through the organism, and to the physiologist in relation 
to the ihode in which amoeboid cells take in nourishment; to the student 
of fevers it is of transcendent importance, as giving an important point of 
diagnosis for malarial fever, which distinguishes it fr om all other fevers, and 
more especially from yellow fever. It is worthy of note that the author 
demonstrated the power of the colorless blood-corpuscle of man to feed 
upon and appropriate the hiemoglobin, haemin and haematin of the col- 
ored blood-corpuscles in the blood-vessels of the malarial patient, before 
physiologists had experimentally determined, by employing either finely 
divided fatty substances or coloring matters, the power1 possessed by the 
colorless blood-corpuscles of taking solid particles into their substance. By 
the direct addition of finely divided fatty and coloring matters to 
the blood under the microscope, or by the injection of these matters 
into the veins of living animals, it is alike possible to demonstrate 
that the colorless blood-corpuscles not only take in foreign bodies, but 
that they have the faculty of discharging them, and further, that 
when one cell comes into coirtact with another, it often gives up the 
solid bodies which it had itself before ingested. In general, the 
tendency to injestion varies with the activity of the amoeboid movement, 
for the first thing observed is an adhesion, either of the surface of the cen- 
tral part of the corpuscle, or of a process of the foreign body, followed by 
a retroaction of the adherent part into its substance. We have thus traced 
the pigmentation of the colorless blood-corpuscles in malarial fever1 to- 
(a.) The destruction ' of the colored corpuscles by the morbific fer- 
ment or micro-organism of malarial fever. 
(b.) The liberation of the haemoglobin, haemin and haematin, audits 
appropriation by the colorless blood-corpuscles in virtue of their physical 
and vital properties and amoeboid movements. 
(c.) The invasion of the colorless blood-corpuscles by the colored 
spores of the malarial bacterium. 488 
General Conclusions relative to Cause and Nature of Malarial Fever. 
4th. In the malarial blood we observe frequently black pigment or 
melamemic corpuscles, varying from the one ten-thousandth to the one- 
thousandth of an inch and even less in diameter; conglomerations of these 
melansemic particles, in masses of various sizes; colorless corpuscles or 
leucocytes which contain granular masses of black pigment; pigment 
cells containing ovoid bodies resembling sporules, and in all respects simi- 
lar to the brownish red pal melhe obtained by passing the air of malarial 
regions through melting ice. Many of the particles of melamemic pig- 
ment are spherical, others irregular and angular, and some entirely free, 
others encased in a hyaline mass, others incorporated with cellular ele- 
ments, which are more or less related to the white corpuscles of the blood, 
and to certain forms of alg®. Plate 13, figure 51, represents the appear- 
ance of a drop of blood from a patient suffering with malarial hiematuria, 
when placed upon white bibulous paper. Figure 52 represents the micro- 
scopical appearance of the blood in malarial fever and malarial hsematuria. 
The pigment particles and pigment corpuscles are shown in this figure. 
The following is a brief outline of the case of malarial luematuria, from 
which the blood was abstracted, and furnished the illustrations, figure 
51 and figure 52, plate 13: J. E. Easterland, aged 21 years; native of Car- 
rollton, on Tombigby river, Alabama; entered the Charity Hospital, New 
Orleans, November 29th, 1876. Described Carrollton as a low, marshy, 
swampy locality; informed by his parents that he suffered with chills 
and fever in infancy, and continued to suffer thus until he left the 
locality at the age of 10 years. Spleen had been enlarged during this 
period. Between the ages of 10 and 19 years, lived in Jasper county, Mis- 
sissippi, a healthy locality; enjoyed good health, but his spleen continued 
to be enlarged. From his 19th year, until a short time before entering the 
Charity Hospital, was employed as carpenter, near Greenville, Washing- 
ton county, Mississippi, in a malarious locality. Suffered with a severe 
attack of malarial fever in August, 1875, and was not fully restored to 
health until May, 1876- In the early part of June, 1876, attacked with 
severe chills and fever; on 1st of July had a congestive chill. Desiring to 
immigrate to Texas, he arrived in New Orleans on the 27th of November, 
but was compelled by illness to discontinue his journey. On the 28th 
was seized with a congestive chill, which lasted for two hours, and was fol- 
lowed by intense jaundice and high fever. Admitted to the Charity Hos- 
pital November 29th, 1876. At the time of admission presented the fol- 
lowing symptoms : Intense jaundice; pulse, 144; respiration, 30; tem- 
perature of axilla, 102. °5; nausea, vomiting a large quantity of dark green 
bilious matter. November 30th, 9 A. M.: Pulse, 32; respiration, 16; tem- 
perature, 98.°1; vomits large quantities of dark green bilious matter. Has 
passed no urine since entering the hospital. Jaundice intense, even the 
saliva is a golden color. Amemic appearance. Spleen and liver enlarged. 
7 o'clock P. M.: Pulse, 134; respiration, 22; temperature, 99.°5. Kidneys 
have resumed their functions. The urine presents a dark brownish red 
color, and contains blood, and casts disclosed by the coloring matter of 
the blood. December 1st, 8 A. M.: Pulse, 122; respiration, 22; tempera- 
ture, 100° F. Jaundice and bloody urine continue. 
CHEMICAL AND MICROSCOPICAL EXAMINATION OF BLOOD. 
Serum of the blood of a deep golden and yellow color. When the 
blood was dropped on white bibulous pap^r, the central carmine spot con- 
taining the red corpuscles was surrounded by a deep orange-yellow-colored 
border, due to the absorption of the colored serum. This appearance General Conclusions relative to Cause and Nature of Malarial Fever. 
489 
is represented in plate 13. figure 51. Careful tests revealed the 
presence in the serum of the coloring matters and acids of the bile. 
The deep golden hue of the serum was caused by the bile pigments, and 
imparted the golden hue to the skin and conjunctiva. Coagulum firm, 
separation between clot and serum perfect. The clot floated in golden 
colored serum. Under a magnifying power of 420 diameters, numerous 
dark granular masses and pigment cells were observed in the blood. Many 
of the colorless corpuscles contained numerous pigment particles. The 
appearance presented by the blood under the microscope is represented in 
plate 13, figure 52. 
One thousand parts of this blood contained: Water 820.50; dried 
colored blood-corpuscles 86.47: fibrin 4.50; saline and extractive matters 
88.53 ; fixed saline constituents 7.18. The extractive matters of the serum 
contained some of the coloring matters and acids of the bile. The moist 
blood-corpuscles in this case were 353.13 in the thousand parts of blood; 
and the liquor sanguinis, 616.86. In healthy blood the dried globules may 
vary in the thousand parts from 120.06 to 150.00, and the moist globules 
from 480.00 to 600.00; and the liquor sanguinis from 520.00 to 400.00. It 
is evident, therefore, that in this case of malarial Haematuria, the blood 
contained, relatively, a much greater proportion of liquor sanguinis, aud 
a less number of globules than in health. It is also worthy of note, that 
the fibrin was increased and reached 4.5 parts per thousand of blood. The 
blood also coagulated firmly, and there was no appearance of the destruc- 
tion of the colored blood-corpuscles in the serum. The formation of the 
dark, pigmentary particles in the blood is not peculiar to malarial haema- 
turia, and it is probable that a large proportion of them was derived from 
the changes of the blood in the spleen and marrow of the bones. The 
increment of the fibrin in the blood in this case is of great interest, as indi- 
cating an inflammatory condition of the fluid, as well as of the organs most 
deeply involved, namely, the kidneys. 
Such results overthrow entirely the view that malarial haematuria is 
the result of the action of some sudden or potent agent upon the blood-cor- 
puscles, which causes their dissolution in the blood-vessels, and the escape 
of the haematin through the excretory structures of the kidneys. 
5th. Black pigment particles indicate the destruction or alteration of 
the blood-corpuscles, and the escape of the haematin of the red globules. 
The large quantity of dark, thick bile excreted in malarial fever, 
appears to have its origin in, and intimate association with, the escape of 
the haemoglobin from the colored blood-corpuscles. The thick, dark, gru- 
mous bile of malarial fever, abounds with bile pigments, the sodium salts 
of the bile acids and cholesterin. Bilirubin (Bilifulvin, Biliphaein, Chole- 
pyrrhin, haematoidin) abounds in the malarial bile, and is often associated 
with bilirudin, a product of the oxidation of bilirubin, and with biliprasin. 
The great abundance of bilirubin in the bile of malarial fever, in which 
disease as we have shown, there is a marked and rapid destruction of the 
colored blood-corpuscles, sustains the view that the bile pigments are 
formed from luemoglobin. This view is also sustained by the apparent 
identity of bilirubin, and the pigment called haematoidin, found in old 
extravasations of blood, and-the observation that bile pigments appear in 
the urine after the injection of haemoglobin. or of any substance which will 
dissolve the blood-corpuscles and liberate haemoglobin, such as water, bile 
acids, or ether. They also appear in the urine after the prolonged inhala- 
tion of ether or chloroform. This view is also supported by the destruc- 
tion of haemoglobin, which appears to take place in the blood during its 
passage through the liver. 490 
General Conclusions relative to Cause and Nature of Malarial Fever. 
\ 
6lb. The black pigment is deposited in the capillaries of various 
organs and tissues, as those of the liver, medulla of the bone, brain and 
subcutaneous tissue. A portion of the pigment also finds its way into the 
urine. That which is thus eliminated by the kidneys is probably first 
subjected to the action of the liver and converted iuto bile pigments, and 
more especially iuto bilirubin. In some cases of pernicious malarial fever, 
the coloring matter of the blood, haemoglobin and hematin, are directly 
excreted by the kidneys without the intervention of the liver. The high 
color of the urine in malarial fever may be due to the following causes: 
(a.) To the increase of the normal coloring matters of the urine known 
most generally and described by various writers as urohwmatine. 
(b.) To the presence of the constituents of the bile and more especially 
to the presence of the bile pigment. 
(c.) To the elimination of haemoglobin, methaemoglobin, and haematin 
from the malarial blood by the kidneys. 
(d.) To the actual escape of blood, blood-corpuscles and liquor san- 
guinis through the congested and ruptured capillaries of the kidneys in 
malarial haematuria. High colored urine, or even very dark almost black 
■colored urine in malarial fever doesnot necessarily indicate the presence of 
blood. Chemical and microscopical analysis and examination, can alone 
settle this question definitely as to the presence or absence of blood in the 
urine in malarial fever. Black urine (melanuria) is not necessarily 
haematuria. 
7th. The peculiar sallow, greenish-yellow and bronze hue, which char- 
acterizes those who have been for a length of time subjected to the pro- 
longed action of the malarial poison, or to its powerful action in pernicious 
remittent fever, and in malarial haematuria, is due not merely to the hepa- 
tic and splenetic derangement, but also to the deposit of pigment particles 
in the subcutaneous capillaries. 
8th. During the epidemic yellow fever, of 1878, in New Orleans, I 
endeavored by the condensation of the organic and organized, and inorganic 
and particulate matters of the air in various portions of the city to deter- 
mine whether the living particles found in the air, differed in accordance 
with the locality whether malarious or non-malarious. After a minute 
■examination of the solid, organic, organized, living, inorganic and inanimate 
particles of the air in residences in which yellow fever was prevailing, it 
was observed : 
a. In the well paved and well drained non malarious portions of New 
Orleans, the solid matters of the air examined not only during the preva- 
lence of the yellow fever, but also at various intervals during a period of 
six to eight months, I discovered no form which could be referred to such 
microscopical plants, as the chloro-coccum, vulgare, proto coccus, viridis, 
palmella, cruenta, coccochloris, brebinonii and other confervoidae, or uni- 
cellar algae capable of producing chlorophyl. Certain granular cells 
observed in the blood of malarial fever, resemble most nearly the resting 
spore of bulbochaete intermedia, and the granular cells of palmella cruenta; 
but no such cells were observed in the atmosphere of the houses situated 
in well paved and well drained sections of the city. The forms of the non- 
malarial, sick-rooms (rooms containing yellow fever patients) were referable 
to those most nearly connected with putrefaction and fermentation, as the 
bacteria and toruhe, penicillus and micrococci and cryptococae. The 
absence of any of the known forms of algae in the air of yellow fever, col- 
lected in the non-malarious, well drained and well paved portions of the 
city of New Orleans, is important, in that this class of plants is thus 
excluded from the consideration of the question relating to the origin and 
causation of yellow fever. General Conclusions relative to Cause and Nature of Malarial Fever. 
491 
b. The water obtained by passing the air through ice and melting ice 
and ice cold water, was preserved, and portions added to solutions of sugar. 
The water from the rooms in which yellow fever patients lay, caused the 
development in solution of sugar of a delicate fungus, th > spores of which 
were distributed in regular rows, within the thallus. This plant, as well 
as that developed in the yellow fever blood, assumed a distinct yellow 
color. Both penicillium and torulte were observed in these solutions. 
The microscopical objects observed in the air during the yellow fever 
epidemic of 1878 in New Orleans are represented in plates 15 and 16, 
figures 66 to 75. First group of cases occurring in the brick house, on second 
floor, 363 Magazine street, within the area of the infected district, including the 
cases on Constance and adjacent streets. The street in front of 363 Magazine, 
paved with square block pavement, and side street with cobble stones- 
dry, non-malarious situation. Plate 15, figure 66. Microscopical objects 
in urine of Miss C. H. The urine was carefully examined upon the three 
last days of illness on the 8th, 9th and 10th of August, 1878, and uni- 
formly presented a clear, light color. Under the microscope it contained 
a few granular casts with bacteria, cells of torulie and penicillium, and 
very delicate thread-like bodies, most probably a form of bacteria; also 
minute particles resembling spores, possessing a rotary or vibratory 
motion. Figure 67. Microscopical objects in air of room of Joseph 
Oliver, 363 Magazine street. Air passed through ice and ice water. Attacked 
with yellow fever August 10th, 1878. Figure 68. Crystaline bodies and 
spores from evaporated water-from room of Joseph Oliver-August 11th, 
1878. Figure 69. Microscopical objects from air of room of Miss Rhodes, 
363 Magazine street, August 16th, 1878. Attacked with yellow fever 
August 12th; died August 16th. Figure 71. Crystaline bodies, spores 
and bacteria in residue of evaporated water through which the air of the 
room of Miss Rhodes, 363 Magazine street, had been passed. Figure 70. 
Microscopical objects from air of room of F. Vonderburg, 363 Magazine 
street. Attacked with yellow fever August 12th; died August 21st, 1878. 
II and III. Groups of cases, 46 and 44 South Villere and 47 South Robert- 
son streets ; low, unhealthy locality. 495 St. Charles street. Plate 16, 
Figure 72. Microscopical objects in air of yellow fever, 495 St. Charles 
street. Figure 73. Microscopical objects in air of yellow fever, 44 South 
Viller6 street, August 2d, 1878. Figure 74. Microscopical objects in air 
of yellow fever, 44 South Viller6 street, August 6th, 1878. Figure 75. 
Microscopical objects in air of yard, 46 South Villere street, during yellow 
fever epidemic of 1878, August 7th, 1878. 
9th. It is difficult to trace the chemical changes induced by the mala- 
rial ferment upon the albuminous substances or proteids of the blood. If 
the albuminoid substances or proteids, which play so important a part in 
biological phenomena in general, and in the nutrition of ferments in par- 
ticular, represented chemical species well defined and correctly classed 
among organic compounds, and if their constitution were thoroughly known, 
the pathological chemist might hope to determine many important points 
in the action of morbific fermentsand poisons during the manifestation of 
various diseases. But unfortunately the history of proteids is still one of the 
most obscure subjects of organic chemistry, and at the same time one of the 
most import ant desiderata of biological science. Until the question of the 
constitution of the immediate principles <>f animal tissues has been deter- 
mined, it will be in vain for pathological chemists to investigate by the 
most careful direct analysis the different elements of an organ or of a 
liquid, whether in a normal or pathological condition. The value and 
importance of this subject in its relations to pathological as well as to 492 
Products of Fermentation of Albumen. 
physiological processes, is clearly illustrated by the fact, that the many 
and various reactions which take place in the organism may be regarded as 
true fermentations, in which the fermentable bodies are partly represented 
by proteids. The existence of a certain number of albuminoid sub- 
stances, considered as distinct species, has been admitted, being founded 
on more or less important differences in their physical or chemical prop- 
erties, or in their elementary components; it cannot, however, be said that 
substances to which a special name has thus been given, as the albumen of 
the egg, casein, and fibrin, are immediate, well defined principles, for here 
especially we have no criterion, by means of which we are able to establish 
a chemical species. We may suppose, with a certain amount of proba- 
bility, that they are only mixtures, of variable proportions, of bodies very 
nearly allied, the separation of which from each other would be very diffi- 
cult if not impossible. The natural fatty bodies furnish an instance of 
the complicated combination of products very similar in their composition 
and character, and which direct analysis has scarcely any power to sepa- 
rate. 
Albumen, which was long considered as an immediate principle, is, in 
fact, only compounded of many albumens, having very nearly the same 
composition, and which can only be distinguished from each other by their 
rotatory power, and by the temperature at which they coagulate. The 
question of the composition and relations of these bodies can only be 
settled by a careful study of the products of the analysis and decomposi- 
tion of albuminoid substances, as the nature of fatty bodies has only been 
understood by examining the products of their saponification, which are 
more easily separated than the original bodies. The nitrogenous prin- 
ciples which enter essentially into the constitution of the organs and 
liquids of the animal and vegetable economy are naturally divisible into 
various families. The first includes albuminoid substances, properly so 
called; that is to say, bodies the most nearly allied, by their chemical com- 
position and by the whole of their properties, to the albumen of the egg. 
The second is formed of many remote products, usually less rich in carbon 
and containing more nitrogen. They enter into the composition of less 
vital tissues; that is to say, those in which the phenomena of nutrition and 
the changes are more restricted, of those which do not work, that is, do 
not develop much force, such as bony, cartilaginous, elastic, fibrous, 
cellular, horny or epidermic tissues. In this family are included horny 
tissue or keratrin, ossein, epidermose, elasticin, mucin or the gelatines, 
and the fibroin of silk. 
The soluble ferments, the peptones, are products of the decomposition 
of albuminoid substances and should be classed separately. We find in 
the organism, besides these, certain mixed principles placed between 
hydro-carbons and proteids true complex nitrogeneous glucosides, decom- 
posing into glucose and other nitrogenous principles, such as chondrin 
and chitin. Albuminoid substances, even those of the first family, contain 
in small proportions, cellulose amides, as an integral part of their molecule. 
The distinction established between the albuminoids and chitin is there- 
fore not absolute. The latter contains, it is true, a greater proportion of 
cellulose amide. Into the family of albuminoid substances properly so-called 
chemists admit the following compounds. 1. Albumen of the egg, the 
albumen of serum and (serine) vegetable albumen ; these substances are 
soluble in water. 2. Casein, vegetable casein, paralbumin, syntonin, myco- 
sin, legumin, amandin, the proteids or albuminates of the German chemists,, 
paraglobin, metaglobin or fibrinoplastic or fibrinogenous substances. 3. 
Blood-fibrin, coagulated albumen, amyloid matter and vegetable fibrin. Products of Fermentation of Albumen. 
493 
Albuminoid substances are very similar to each other in their centesimal 
composition ; yet the analyses do not agree sufficiently to allow the conclu- 
sion that their composition is identical, or that they are isomeric. These 
bodies have a very high molecular weight: thus for albumen 1612 has been 
arrived at for the molecular weight, and when the results of the elementary 
analysis are translated into a chemical formula, we are led to very high 
numbers in the expression, as in that proposed by Lieberkuhn C72 
H112N18SO22. With reference to the ultimate constitutions of these 
bodies, whilst some questions are still in suspense, at the same time the 
results thus far achieved by chemists give hopes of a full and speedy solution. 
Thus, in 1820, Braconnot observed the production of the sugar of 
gelatine or glycocoll C2H5NO2 (amido-acetic acid) by boiling gelatine in 
sulphuric acid moderately diluted ; by substituting muscle for gelatine he 
obtained under the same conditions leucine C6H131NO2. Liebig afterwards 
showed that another crystallizable product is formed at the same time, 
tyrosine C9HX1NO3 (oxyphenyl-amido-proprionic acid). Erlenmeyer and 
Schaeffer, by extending these researches (the action of boiling sulphuric 
acid) to most of the albuminoid substances, observed the constant forma-- 
tion of leucine and tyrosine. They obtained for 100 parts of dried matter: 
Leucine. 
Tyrosine. 
fibrin 
14 
0.8 
Albumen 
10 
1.0 
Sy n ton in 
18 
1.0 
Casein gives leucine and tyrosine and a syrupy residuum. Ritthau- 
sen obtained by the same kind of reaction from products formed by the 
action of boiling dilute sulphuric acid on vegetable nitrogenous substances 
such as gluten, two well defined crystallizable acids. Coaglutin yielded an 
acid of the formula C5H9NO4 (glucamic acid), homologous to aspartic acid. 
Legumin yielded under the same circumstances legumic acid. C8HUN2O6. 
According to Hlasiwetz and Haberman, the greater parts of animal and 
vegetable proteids are capable of producing these nitrogenous acids (aspar- 
tic, glutamic), when boiled with dilute sulphuric and hydrochloric acid. P. 
Schutzenberger has recently studied with great cate and in all its details a 
reaction which allows the albuminoids to be almost entirely resolved into 
crystallizable principles ; and demonstrated that albumen must contain in 
eighteen atoms of nitrogen, about four belonging to the urea group. 
Although the researches of P. Schiitzeuberger are not entirely completed, 
the following important results have been obtained : 
1. Barium hydrate decomposes albuminoid substances by simple 
hydration, the experiments being made in the absence of oxygen. 
2. The principal products of this reaction are-the elements of urea 
(ammonia and carbon dioxide in the proportion of 1:29) ; traces of sul- 
phurous acid, of sulphuretted hydrogen, and of oxalic and acetic acids, 
tyrosine C9HUNO3 (oxyphenyl, amido-propionic acid), in very small quan- 
tities, two or three per cent, of the albumen at most. 
3. The amido acids of the series CnH2mtiNO2, corresponding to the 
fatty acids CnH2nO2, form amido-oenanthylic acid C7H13NO2 to amido-pro- 
pionic acid; leucine C6H13NO2; butalanine C5HUNO2 and amido-butyric 
acid C4H7NO2 abound in this mixture. 
4. One or two acids nearly allied to aspartic acid and glutamic acid C5 
H9NO4 and C4H7NO4; one or two acids, analogous, and very nearly similar 
to the legumic acid found by Ritthauseu O8HUN2O6- A small quantity 
of a substance analogous to dextrin, which by being boiled in acids is con- 
verted into a body which energetically reduces Fehling's liquid; nitric 
acid changes it into oxalic acid. With the exception of these bodies, 494 
Products of Fermentation of Albumen. 
nothing of importance is found either as a chemical compound or as an 
amorphous mass. Most of the definite compounds formed by this reaction 
are similar to those which have already been mentioned among the products 
of the splitting up of the albuminoid substances, under the influence of 
acids ; but the importance of the research of Schiitzenberger consists espe- 
cially in the demonstration that these compounds alone constitute the 
albuminoid molecule; and in the proof that the elements of urea or carba- 
mide form an integral part of this molecule.* 
The albumen is not split up all at once in this manner into compara- 
tively simple products; by stopping the reaction at different periods of 
the development, or by using occasionally less elevated temperatures, we 
meet with intermediate compounds, uncrystallizable, or crystallizable with 
difficulty, the thorough study of which will be of great importance in 
relation to the phenomena of nutrition and of biological reactions and 
pathological changes. The products which are obtained under the influ- 
ence of the alkalies melted in their water of crystallization (ammonia, 
hydrogen, ammoniacal compounds, methylamin, saniline, picoline, peti- 
nine, leucine, tyrosine, glycocol, carbon-dioxide, formic velerianic, buty- 
ric, and oxalic acids), are derived from a more energetic action exerted in 
the first series of compounds, formed by the action of baryta. It is the 
same for the compounds which originate under the influence of oxidizing 
agents, such as a mixture of dilute sulphuric acid and potassium bichro- 
mate (formic, acetic, butyric, valerianic, caproic, and propionic acids, with 
their corresponding aldehydes, benzoic acid, and benzol hydride, hydro- 
cyanic acid and butyl cyanide). 
All albuminoid substances heated for some time with alkalies, dissolve 
and give up sulphur to the alkali under form of sulphide and hyposulphite; 
the neutralization of the liquid by an acid causes a voluminous floccose 
white precipitate, soluble in dilute lye-water; this precipitate has the same 
composition, whatever may be the albuminoid matter employed. 
Mulder relying on these facts, considered this precipitate as the base 
of albuminoid bodies, and gave it the name of protein. This German 
chemist thought at first that his protein no longer contained sulphur; later 
experiments have shown that in reality it still contains some, but that this 
sulphur cannot be removed by alkalies under the form of sulphides. 
According to Mulder's theory, all albuminoid substances are combina- 
tions of protein with variable quantities of sulphur, phosphorus and min- 
eral matter. This opinion, admitted very generally at first, was by degrees 
abandoned, on account of the great number of contradictory observations. 
Liebig considered albuminoid substances as having the same elementary 
composition i. e., as isomeric compounds. This view, which admits of dis- 
cussion, throws no more light than that of Mulder on what is now called 
the chemical constitution of these compounds, considering that protein is 
almost as complex in its character as the organic products. 
Sterry-Hunt considered albuminoid substances as amides or nitrites of 
cellulose, dextrin, gum or sugar. The objection to this simple explana- 
tion, is that it does not agree with known facts; tyrosine, leucine, and 
aspartic acid are not considered as derived from sugar, from cellulose or 
from their nitrites. These latter bodies (nitrites of hydro-carbon sub- 
stances) have been also little studied, and are imperfectly understood. 
Berthelot, in his treatise on elementary chemistry (1872), conceded 
from the whole of the facts then known, albuminoid substances to be 
complex amides, formed by the union of amido acids of the series of 
*See the Memoir of Schiitzenberger on Albumi nous Substances, Bulletin de la Soc. Chim. de 
Paris, February 15th, March 5th, and March 15th, 1875. Chemical Actions of the Malarial Ferment. 
495 
CnH2n4iNO2 (such as glycocoll and leucine), of tyrosine with certain oxygen- 
ated principles, some of which belong to the acetic series, and others to 
the benzoic series. Berthelot thought that the nature of the amides, and of 
the oxygenated bodies which generated them, as well as their relative- 
proportions, was the cause of the differences which exist between the vari- 
ous albuminoid bodies; and that chitin and chondrin contained in addition,, 
the elements of glucose. 
The results of Schiitzenberger, obtained by means of the decomposi- 
tion by baryta, show that the albuminoids are formed by the association, im 
different proportions of the urea and amido-acid combinations, some belong- 
ing to the series of leucine CnHn2+1NO2, the others which are more highly 
oxygenized, belonging to the series <'nH2n.i NO, (aspartic and glutamic acids); 
the more complex acids as the legumic, may be considered as the products- 
of an incomplete decomposition. Tyrosine (C9HnNO3) represents the aro- 
matic series; it is from this that benzoic acid and paroxy-benzoic acids- 
and bromanil are derived, being obtained under different conditions. 
GENERAL CONCLUSIONS RELATIVE TO THE CHEMICAL ACTION OF THE 
MALARIAL FERMENT. 
In malarial fever we observe a marked increase of the following con- 
stituents in the urine during the paroxysm considered in its complete cycle 
of changes: Urea, uric acid, phosphoric acid, sulphuric acid, phosphates 
of ammonia and lime, urates of ammonia and soda, and coloring matter 
(urohaematin). Tn pernicious and haemorrhagic forms of malarial fever, 
we may have the presence of haemoglobin, methaemoglobin, haematin, 
haematoin, and blood-corpuscles and albumen. We should regard the 
destruction of the colored blood-corpuscles by the morbific ferment of 
malarial fever, as the chief cause of the increment of the coloring matter 
in the urine; and it is reasonable to suppose that in all simple uncompli- 
cated cases of intermittent and remittent fever, the coloring matter of the 
blood is first acted on by the liver and transformed into the coloring matter 
of the bile. The urinary pigment in all simple uncomplicated cases of 
malarial fever, appears, like that of normal urine, to be derived from that 
of the bile, as a substance which presents similar spectroscopic characters 
can be extracted from the bile, or produced by deoxidation from bilirubin. 
Urine, especially when high-colored, exhibits the band at F, though not 
very distinctly; but it may be clearly seen by precipitating the urine with 
lead acetate, decomposing the precipitate with an acid, and examining the 
filtrate spectroscopically. The addition of sodium hydrate causes the other 
band faintly to appear, and when heated with chloroform in the same way 
as bile, the solution and the position of the band seen in the chloroform 
solution is altered in a similar manner. A substance presenting a similar 
band, is obtained by acting on a solution of bilirubin, in liquor potassic or 
liquor sodse with sodium amalgam, for several days with exclusion of air. 
Whilst it has not as yet been clearly determined whether in malarial 
fever, the micro-organisms produce certain chemical effects by creating a 
special zymogen or ferment, and through it causing the physical and chem- 
ical disturbances; or whether they merely dissociate the compounds by 
abstracting for their own use, certain molecules; it is on the contrary, 
well established, that in consequence of this chemical disturbance, definite 
chemical substances are produced. 
In view of the fact that the micro-organism of malarial fever, acts with 
great energy and most destructive effects upon the colored blood-corpus 
cles, and in view of the fact that there appears to be no practical limit to Products of Fermentation and Action of Quinine. 
496 
the alteration and dest ruction of the red globules, we must refer the tem- 
porary cessation of the micro-organism (the intermissions aud remissions 
of malarial fever), not to the exhaustion of any special chemical substance 
in the blood and organs, but rather to the effects of the elevated tempera- 
ture, and the formation of antiseptic compounds in arresting the develop- 
ment, and in destroying large numbers of the micro-organisms. 
In the paroxysms of malarial fever, there is a destruction and elimina- 
tion of the pathogenic micro organisms; but in many cases the destruction 
and elimination of the germs is not complete ; and those remaining in the 
blood, reproduce their kind, and after a definite period the same phenomena 
are repeated. 
The paroxysm of malarial fever with its elevated temperature and 
antiseptic products, must to a certain extent be regarded as curative in its 
effects; and it is well established, that a considerable number of cases of 
malarial fever, end spontaneously, and pass into recovery after one or more 
paroxysms, without the employment of any antiseptic or any remedies 
whatever; in such cases the febrile changes excited by the pathogenic 
organism, have resulted in their death and elimination. On the other 
hand, the most destructive and incurable forms of malignant malarial 
amemia, ending finally in hepatic and splenic enlargement, general anasarca 
and failure of the heart and nervous centres, result from the continuous 
and almost unobserved action of the malarial micro-organism upon the 
constituents of the blood, and more especially upon the colored blood cor- 
puscles; in such cases the antiseptic products of high fever have not been 
formed. 
We must look to chemical knowledge to guide us in our contests 
with the specific agents of malarial fever' and other diseases. No chemical 
or other agents can be regarded as disinfectants in respect of any disease, 
unless it can be shown to have the power of inhibiting or arresting the 
development and growth of the particular species of microphyte which is 
the constant concomitant of the morbid process. Inasmuch as all specific 
microphytes are endowed with the power of multiplying in the blood and 
living tissues of the organism which they infest, and of there playing 
their part in the morbid process, all specific disinfectants must, in order to 
encounter the organism they are intended to destroy, be of such a nature that 
they can, without prejudice, be mixed with the circulating blood, and come 
into direct contact with the tissues. In the case of malarial fever, we have 
such a disinfectant, which is not only poisonous to the micro-organism of 
malarial fever, but is also of such a nature that it can without prejudice 
be mixed with the circulating blood and come into direct contact with the 
tissues. Quinine circulates freely in the blood and passes into the organs; 
and is thus brought into contact with all pathogenic organisms. The action 
of quinine as a disinfectant and anti-malarial remedy, is greatly increased 
by the rapidity of the circulation; and its action is also favored and sup- 
plemented by the antiseptic products developed during the febrile parox- 
ysms. The power of quinine to arrest the malarial fever is due chiefly to 
(a.) Its antiseptic properties. 
(b.) Its power to bind the oxygen more firmly with the colored blood- 
corpuscles, aud thus to arrest the destructive action of the malarial germ 
or micro-organism. 
(c.) Its poisonous effects upon the micro-organisms of malarial fever. 
(d.) Its tonic effects upon the ganglionic cells of the cerebro-spinal 
and sympathetic nervous systems. 
The profound changes induced in the blood by the malarial poison 
induces a condition of the organism which may alter and modify the Treatment of Malarial Fever. 
497 
course of all supervening diseases. The practitioner of medicine is com- 
pelled to regard the existence and modifying influences of the underlying 
malarial constitution, which like constitutional syphilis or tuberculosis 
constitute one of the so-called diatheses or " cachexias" The duty of the 
physician does not end with the arrest of the malarial paroxysms; he must 
as far as possible rectify the effects of the malarial poison, primarily upon 
the blood and secondarily upon the spleen, liver and heart. Such reme- 
dies as arsenic (Fowler's solution) and iron (tincture of the sesqui-chloride, 
tartrate of iron andpotassae, citrate of iron and quinia, phosphate of iron, 
etc.), should, in many cases of chronic malarial poisoning, be used per- 
sistently after the paroxysms have been arrested, to restore the normal 
condition of the blood. This subject of practical medicine will be more 
fully considered in the section of this work devoted to the treatment of 
malarial fever. CHAFTHR IV. 
HAEMORRHAGIC MALARIAL FEVER. MALIGNANT FORMS OF MALARIAL PAROX- 
YSMAL FEVER. MALARIAL HaEMATURIA. 
Malignant forms of malarial paroxysmal fever. Extensive prevalence of malignant parox- 
ysmal fever, including haemorrhagic fevers in the alluvial regions, in tropical, semi-tropical and 
temperate countries in both hemispheres. Wide-spread and destructive effects of the malaria of 
the swamps and rice-fields of the Southern States. Area of the Mississippi Valley. Area of 
alluvium of the Mississippi Valley. Area of the delta. Extensive prevalence of the various 
forms of malarial fever in the valley of the Mississippi during the Summer and Autumn of 
}880. The wide-spread and destructive effects of malarial fever in other Southern States, as the 
great state Georgia. Mortuary statistics of Midway Church, Liberty county, Georgia. Deaths 
amongst the whites in Savannah, Georgia, from 1804 to 1818. Medical statistics of Oglethorpe 
Barracks, Savannah, Georgia. Cases of malarial fever and of all diseases occurring during a 
period of fifteen months, October, 1862, to January, 1864, in the Confederate troops serving in and 
around Fort Jackson on the Savannah river. The prophylactic properties of quinine. 
Experience of the author as to the power of sulphate of quinia, administered daily to ward off 
malarial paroxysmal fever. Wide-spread and destructive effects of the malarial fevers of the 
alluvial regions of tropical and semi-tropical Africa. Testimony of various travellers, as Mungo, 
Park, Ledyard, Captain Cook and others, as to the unhealthy nature of the coast of Africa. 
Destructive effects of the malarial fevers of Africa in the expedition to the Congo, commanded 
by Captain Tuckey. Destructive effects of the climate of Sierra Leone. Numerous examples of 
the deadly effects of the malarial fever of the coast of Africa, as recorded by the Deputy Inspec- 
tors of the English Navy. Prophylactic powers of quinine in warding off the malarial fever of 
the coast of Africa, as shown by the experience of the surgeons of the British Navy. Haemor- 
rhagic fevers dependent upon the peculiar constitution of the blood, as induced by salt meats, 
sameness of diet and the concurrent action of febrile poisons. Investigations of Andral and 
Magendie on the constitution and changes of the blood m low forms of fever. Causes which 
destroy the coagulability of the blood in diseases. Investigations of the Italian physician, 
Bufalini, on the changes of the blood in fevers. Observations of Grant on the effects of the 
peculiar hygienic conditions of the people of Europe before the eighteenth century, on the com- 
position of the blood and the nature of pestilential and haemorrhagic fevers. 
Observations of John Huxham, in 1757, on putrid, malignant and petechial fevers. Descrip- 
tion of the epidemic of Naples in 1764, by Sarcone. Description of the changes in the types of 
fever in India, by Surgeon Janies Raynald Martin. History of haemorrhagic malarial fever. 
Malignant, intermittent and remittent fevers, accompanied with vomiting of black bile, with 
petechiae and haemorrhages, have from lime immemorial been frequent and fatal in the various 
marshy countries bordering on the Mediterranean and Black seas. Description of haemorrhagic 
and malignant fe vers by Hippocrates. Observations by Galen, Aretaeus, the Cappadocian, Celsus, 
Paulus AEgineta, Rufus, Burserius, Lancisi, Ramazini, Lauter, Alibert, Torti, Lind, Jean Senac, 
William Hillary, R. B. Todd. McLean, Dr. Charles Faget, of New Orleans, Berranger, Ferrand 
and others on haemorrhagic fevers 
Haematuria (bloody urine) and malarial haematuria. Causes of haematuria (bloody urine). 
Idiopathic and vicarious haematuria. Illustrative cases, reported by Drs. Willis, Barsham, Cho- 
part and others. Haematuria resulting from the action of febrile poisons, and irritating and 
poisonous substances introduced into the circulation. The haematuria of certain febrile diseases, 
as scarlet fever, small-pox, typhus fever, pyaemia, malarial and yellow fever, referred both to a 
general haemorrhagic condition, and to structural changes of the kidneys. Observations of Dr. 
John Johnson on structural alterations of the kidneys. Investigations of Dr. Daniel Blair on the 
haematuria of yellow fever. St ite in which the blood escapes from the kidneys in haematuria 
resulting from the action of febrile poisons and irritating substances; observations of Vogel, 
Thudichum and others; observations of the author. Haematuria caused by living organisms in 
the blood. Haematuria induced by the bilharzia haematobia; observations of Chapotain, Lalisse, 
Griesinger, Bilharz, Cobold and John Harley. Parasitical haemoptysis caused by the distoma 
ringeri; observations of Dr. Patrick Manson. 
Paroxysmal haematuria. History of a case of periodical discharge of blood from the urethra, 
by Charles Stewart, in 1794. Case of haematuriaassociated with disease of the heart, reported by 
Dr. John Elliottson. Cases of haematuria reported by various observers, as Beale, Bigbie, Dick- 
inson, Druitt. Greenow, Hassall, Harley, Murchison, Pavy, Southey, Stevens, Tyson and others. 
Importance of the microscopical examination of the urine in haematuria. Paroxysmal haema- 
turia has some symptoms in common with the haematuria caused by the malarial poison. Causes 
of bloody urine. 
History of malarial haematuria. Absence of critical and scientific observations upon the 
physical and chemical characters of the urine of fevers, in the writings of American physicians, 
up to the middle of the nineteenth century. Malarial haematuria was observed by Dr. C. G. 
Young, of Louisiana, in 1843. Observations of Dr. R. H. Day, of Baton Rouge, on malarial haema- 
turia. Observations of F. W. Baird, M. D., J. L. Deslattes, M. D., L. H. Anderson, M. D., F. M. 
Hall, M. D., J. C. Oxamendi, M. D., James Copeland, M. D., William Roberts, M. D., Fried Theod. 
Frerichs, M. D., Joseph Jones, M. D., Francis Barnes, M. D., S. F. Starley, M. D., H. C. Ghent, Malignant Forms of Malarial Paroxysmal Fever. 
499 
M. D., D. S. Joynes, M. D., Edward H. Sholl, M. D., T. C. Osborn, M. D., Benjamin H. Riggs, M. D., ' 
E. S.Sharpe, M. D., R. F. Michel, M. D., M. H. Taylor, M. D., U. S. A., and many other Southern 
physicians, on the symptoms, pathology and treatment of malarial haematuria. 
Cases investigated by Joseph Jones, M. D., il lustrating the symptoms, changes of temperature, 
pulse, respiration, composition of the blood and urineand treatment. 
Jaundice, its phenomena and symptoms in malarial haematuria and in other forms of malig- 
nant fevers. Historical account of jaundice. Physical and chemical properties of human bile 
in health and disease. Physical and chemical properties of the bile in man and animals. Com- 
position of the bile in man and animals compared. Relations of the coloring matters of the bile 
to the colored blood-corpuscles. Constituents of the colored blood-corpuscles. Relations of the 
coloring matters of the bile to those of the urine. Effects of ligature of bile ducts. Classification 
of the causes of jaundice. General conclusion relative to malarial haematuria. 
Extensive Prevalence of Malignant Malarial Fever, including Harmorrhagic 
Fevers, in the Alluvial Regions in Tropical, Semi-Tropical and Temperate 
Countries in both Hemispheres. 
As the delta of the Mississippi river, and in fact of all the rivers of 
the United States, have been at various times subject to the different forms 
of remittent, intermittent and malignant malarial fevers, including the 
haemorrhagic variety, it is important that the profession and the public 
should be prepared for such endemic visitations in the future, in order 
that the most egregious, if not criminal blunder may not be committed of 
confounding an endemic malarial fever of local origin with an infectious 
disease capable of transportation. We will endeavor to illustrate the 
relations of the endemic malarial fever of the delta of the Mississippi 
river during the summer and autumn of 1880, by the record of facts relat- 
ing to the various forms of malarial fevers, under the following divisions : 
1. The wide-spread and destructive effects of the malaria of the swamps 
and rice-fields of the Southern States. 
2. The wide-spread and destructive effects of the malarial fevers of the 
alluvial regions of tropical and semi-tropical countries. 
3. Haemorrhagic fevers dependent upon the peculiar constitution of the 
blood, as induced by salt meat, sameness of diet and the action of febrile poisons. 
4- History of hcemorrhagic malarial fever. 
5. General outline of the symptoms and pathological anatomy of haem- 
orrhagic malarial fevers. 
6. Treatment of malarial hcematuria. 
MALIGNANT FORMS OF MALARIAL PAROXYSMAL FEVER. 
WIDE-SPREAD AND DESTRUCTIVE EFFECTS OF THE MALARIA OF THE 
SWAMPS AND RICE-FIELDS OF THE SOUTHERN STATES. 
The Mississippi Valley comprises an area of 2,455,000 square miles, 
extending through thirty degrees of longitude and twenty-three degrees 
of latitude; and is composed of several subordinate basins, whose area 
and elevation are as follows: Upper Mississippi elevation, above sea 1680 
feet; area of basin 169,000 square miles; Missouri, 6800 feet, 518,000square 
miles; Ohio, 1649 feet, 214,000 square miles; Arkansas, 10,000 feet, 189,000 
square miles; Red River, 2450 feet, 97,000 square miles; Yazoo, 210 feet, 
13,850 square miles; St. Francis, 1150 feet, 10,500 square miles; Lower 
Mississippi, 416 feet, 1,244,000 square miles. In such vast regions, reach- 
ing through such zones of climate and varying to such marked extent in 
soil and elevation, diversities must exist in the diseases of different sec- 
tions; but it may be affirmed that throughout this vast valley every form 
and variety of malarial paroxysmal fever prevails with greater or less 
intensity, according to the climate and soil, the heat, moisture, rainfall 
and peculiar climatic conditions associated with the annual revolutions of 
the seasons and the greater astronomical cycles. It is chiefly in the Lower 500 
Extensive Prevalence of Hemorrhagic Malarial Fever. 
Mississippi that the full force at once of the waters and the destructive and 
varying nature of the malarial fevers are witnessed. The Mississippi first 
assumes its characteristic appearance of a turbid and boiling torrent, 
immense in volume and force, at the mouth of the Missouri; and from this 
point its waters pursue their devious way for more than 1300 miles, destroy- 
ing banks and islands at one locality, reconstructing them at another, 
deluging with its united floods vast tracts of alluvial land, absorbing 
tributary after tributary, without visible increase in size, until, at length, 
it is in turn absorbed in the great volume of the Gulf. The shores of the 
Gulf, so far as relates to the Louisiana coast, are bordered for fifty miles 
inland by swamps, bayous and lakes. The swamps generally consist of an 
oozy mass of mud, from twenty to forty feet in depth, resting on blue 
clay. When in flood, the Mississippi river extends to a width of thirty 
miles, and the surplus waters find their way to the ocean, through deep 
forests and almost interminable swamps. 
AREA OF ALLUVIUM. 
A wide, belt of recent alluvium borders the Mississippi river from the 
mouth of the Ohio to the Gulf, seventy-five miles wide in its greatest 
expansion at Napoleon, and twenty-five miles in its greatest contrac- 
tion at Natchez and Helena. The area of the alluvial tract above the 
delta is 19,450 square miles. The depth of the alluvial deposits, from 
Cairo to New Orleans, ranges between twenty-five to forty feet. 
AREA OF THE DELTA. 
The area of the delta, assuming that it begins where the river sends 
off its first branch to the sea, namely, at the mouth of Bayou Atchafalaya, 
is estimated at 12,300 square miles. This would be at the mouth of Red 
River, in latitude 31°, whilst the mouth of the Mississippi is in latitude 
29°, so that the delta extends through two degrees of space. The entire 
delta is elevated but a few feet above the level of the Gulf of Mexico, and 
from its fertile soil and proximity to the Mississippi river and bayous is 
suited to the cultivation of rice. Rice culture, the most unhealthy of all 
forms of agriculture, has greatly increased of late years, and large num- 
bers of settlements in the delta are literally situated in the midst of rice 
fields. The preceding well known facts should be carefully considered by 
any one, even the most profound observer of disease, before deciding upon 
the character of the endemics of fever which have so often prevailed in 
the delta of the Mississippi, which presents such uniform, geological,, 
physical and climatic features. 
EXTENSIVE PREVALENCE OF THE VARIOUS FORMS OF MALARIAL FEVER 
IN THE VALLEY OF THE MISSISSIPPI DURING THE SUMMER AND 
AUTUMN OF 1880. 
It is well known that the several grades of malarial fever, often 
attended with haemorrhage from the bowels, stomach and kidneys, and 
jaundice, prevail at various points along the Mississippi River and its- 
tributaries. The rains of the spring and early portion of the summer del- 
uged the rice fields and swamps of the delta with water, and in the months 
of August were succeeded by burning suns. The several types of the remit- 
tent, intermittent and congestive fevers of the delta of the Mississippi 
appeared to be due to the preceding causes, and especially to the drying 
up of the stagnant waters of the rice fields, and the death and putrefaction Extensive Prevalence of Hcemorrhagic Malarial Fever. 
501 
of numerous tad poles and small fish. Epidemics of the so-called putrid 
and adynamic fevers have been observed and traced to similar causes in 
the countries of Europe, Asia and Africa bordering on the Mediterranean 
Sea, from the earliest ages, and centuries before the discovery of insular 
and Central America, to which sections of the earth have been referred the 
origin of yellow fever. It is of importance to the public welfare that the 
endemic fever of 1880, in Plaquemine parish, Louisiana, should be 
regarded in its true relations to similar febrile diseases which have pre- 
vailed at different times and in widely separated countries. It is admitted 
by disinterested observers, that the notoriety attached to the malarial fever 
which prevailed in the parish of Plaquemine (and in the delta of the Miss- 
issippi and its tributaries) during the fall of 1880, was clearly due to the 
extraordinary statements emenating from the National Board of Health ; 
and not to anything peculiar or different in its origin, nature and effects, 
from similar endemics of various times and countries, and even in remote 
portions of the earth, where yellow fever has been wholly unknown. The 
absurd proposition was advanced that the nature of a fever could be deter- 
mined by the rate of mortality. To state the proposition more definitely : 
Four children died of fever in a single family near Point Michel : Yellow 
fever often proves very fatal in families ; therefore the fever which 
destroyed these children was yellow fever. 
The malarial nature of the fever of Plaquemine parish, in 1880, was 
fully established, and the entire subject, with all the reliable facts and 
reports were published in the official reports of the author in his capacity 
as President of the Board of Health of the State of Louisiana, in 1880, 
1884. 
Full statistics illustrating the nature of the fevers of the Valley of the 
Mississippi as well as of the cases of disease treated in the Charity Hospital 
of New Orleans, and the causes of death in the City of New Orleans, have 
been given in the preceding chapter of the second volume of these Medical 
and Surgical Memoirs. 
The action of the author as President of the Board of Health of the 
State of Louisiana, on this, as upon subsequent occasions in 1881, 1882, 
1883, in exposing the sensational statements, and defeating the malignant 
designs of the self appointed guardians of the public health, with their 
hordes of spies and calumniators in New Orleans, Memphis, Galveston, 
and other points in Mississippi. Ohio, Illinois, and other States tributary 
to the Mississippi, preserved the people of Louisiana, and of the entire 
Mississippi Valley from the distressing and disastrous effects of senseless 
panics and cruel and remorseless quarantines. 
We shall also examine the subject of the relations of drainage and 
agriculture to the origin and spread of malarial fevers, more fully in the 
third volume of these Medical and Surgical Memoirs. 
THE WIDE-SPREAD AND DESTRUCTIVE EFFECTS OF MALARIAL FEVER IN 
OTHER SOUTHERN STATES, AS THE GREAT STATE OF GEORGIA. 
The climate of the rich low plain, clothed with a luxuriant sub-tropical 
vegetation, which forms a belt along the Atlantic Ocean and Gulf of 
Mexico of varying width, from thirty to one hundred miles, and which is 
intersected with numerous swamps which discharge their waters into slug- 
gish, muddy streams, surrounded on all sides by extensive swamps and 
marshes, is necessarily hostile to the white race. To the pestilential exha- 
lations of stagnant swamps and rich river deposits, excited and dissemi- 
nated by the burning rays of the sun in this hot climate during the summer 502 
Extensive Prevalence of Hcemorrhagic Malarial Fever. 
and fall months, no process of acclimation has ever accustomed the white 
man. In the early settlement of South Carolina and Georgia, the inhabit- 
ants in most instances resided the whole year upon their rich rice and indigo 
plantations; many, however, soon fell victims to the climate, or dragged 
out a miserable existence, with constitutions broken and rendered prema- 
turely old, by repeated attacks of climate fever. The clearing of the 
forests, of the swamps and rich lowlands, and the consequent exposure to 
the sun of the vegetable matter which had been accumulating for ages, 
rendered the climate so deleterious to the white race, that the planters 
were compelled to seek health during the summer and fall months in sea 
island, or in pine barren, or mountainous retreats; and with the most effi- 
cient precautions the mortality of these regions is far greater than in the 
more elevated portions of the Southern States. 
The following facts will illustrate the effects of the climate of the 
swamps, rice-fields and river bottoms, upon the mortality of the white race: 
In the Midway Congregational Church of Liberty County, Ga., (formerly 
St. John's Parish) the number of births from 1754 to 1804 was 600, whilst 
the number of deaths during this period was 628, thus showing an actual 
decrease during fifty years of 28. In 1817 there were 49 deaths io this con- 
gregation, which did not number more than 340 whites, showing a mortality 
of one in every seven of the inhabitants (14.4 per cent.); of the 49 deaths, 
34 occurred in four months (July, August, September and October), and 
were in almost every case the effects of climate fever; and other years might 
be cited in which, if the mortality did not rise to so high a figure, it still 
rose to such alarming figures as from one in every ten to one in every seven- 
teen inhabitants. This heavy mortality was clearly referable to climate, 
for it is believed that no body of citizens in the Southern country excelled 
this congregation in intelligence and virtue, or in the careful regard for 
the substantial comfort and health of its families. Before the Revolutionary 
War, whilst Sunbury, on the coast of Georgia, was in a highly prosperous 
condition, seventy emigrants came from the Bermuda Islands: of this num- 
ber fifty died the first year from climate fever. 
Savannah, situated on a sandy plain, terminated on the north by a 
turbid, sluggish stream, and flanked on the east and west by extensive tide 
swamps, afforded during the period that these lowlands were cultivated in 
rice, a good field for the determination of the probable mortality of troops 
exposed to the climate of rich river-bottoms and inland swamps. The dry 
culture system was commenced with the lands surrounding Savannah, in 
1818; we shall, therefore, for our present purpose, deal with the mortuary 
records of the city, and during the wet culture system, as far as they 
extend back from 1818; premising, however, that after the institution of 
the dry culture system the health of Savannah, excepting the years when 
yellow fever prevailed, has progressively improved, and will now compare 
favorably with cities situated in the same latitudes, and surrounded by 
similar alluvial deposits. After a careful examination of the records of the 
city, I have been able to discover no record of date earlier than 1804. The 
deaths of the blacks are excluded from the following statistics. The sum 
of the deaths of the foreigners and natives does not always correspond with 
the total deaths from climate fever, because in some instances, the nativi- 
ties are not given in the record. Mortality from Malarial Fever in Georgia. 
503 
DEATHS AMONGST THE WHITES IN SAVANNAH FROM 1804 TO 1818. 
1804 
1805 
1806 
1807 
1808 
1809 
1810 
1811 
1812 
1813.., 
1814 
1815 
1816 
1817 
118 
141 
120 
124 
103 
98 
79 
114 
132 
109 
185 
140 
161 
283 
Deaths during 
July, August, 
Septem'r and 
October. 
os <-* i-* >-* i-* 
W®O0!^OSaWMOb5WM 
Deaths from 
Climate Fever 
63 
78 
43 
71 
67 
52 
38 
73 
92 
45 
138 
104 
91 
236 
Deaths of for- 
eigners from 
Climate Fever 
Cn OS LO tO LO 1 
M X a 1: C 4- W 7. XXO C I C +■ 
Deaths of Na- 
tives from Cli- 
mate Fever. 
tO to OS tO bO to h-1 LO to ►-* tO tO 
aMWO - Ni-'OSOOHWCnWO 
HbOW04i05tOWW©0®<»<l 
Total Deaths 
from all dis- 
eases. 
The population of Savannah in 1800 was 5,166; of these 2,799 were 
whites and 2,367 slaves. In 1808 the population was 6.464; of these 3,010 
were whites and 3.454 slaves. In 1810, the entire population was 5,215; in 
1820, entire population 7,523. Whilst the records of the population of 
Savannah at different periods are not as full and explicit as could be 
wished, still from the data now presented we may institute comparisons, 
and determine the average mortality for each year with a very close 
approximation to the absolute numbers: thus in 1804, the proportion of 
deaths in round numbers of the whites to the white population was 1 in 13; 
1805, 1 in 12; 1806, 1 in 18; 1807, 1 in 12; 1808, 1 in 13; 1809, 1 in 16; 1810, 
1 in 18; 1811, 1 in 14; 1812, 1 in 13; 1813, 1 in 14; 1814, 1 in 10; 1815, 1 in 
14; 1816, 1 in 13; 1817, 1 in 9. 
If we compare the mortality from climate fever, of the strangers and 
foreigners, under which class we include the seamen, who form a large part 
of the transient population of Savannah, we will see that the deaths amongst 
this class were more than four times as numerous as the deaths of the 
natives. This fact illustrates still more strongly the great risks and sick- 
ness, if not heavy mortality, which must attend the transportation of troops 
or emigrants from Middle Georgia, and from any part of the high moun- 
tainous tracts of the Southern States to the swamps and rich rice grounds, 
during the months of July, August, September and October ; for without 
doubt the observation was made by the reader as he reviewed the preceding 
figures, that the rate of mortality in Savannah during the wet culture sys- 
tem, frequently rose to a figure which in healthy regions would have been 
considered as the results of pestilence; and the correctness of this observa- 
tion is placed in the clearest light, when it is known that the annual mor- 
tality in England* is 1 in every 45 of the living; in France 1 in every 42; 
in the New England States, 1 in every 64 ; in the Middle States, 1 in 73; 
Coast planting States, 1 in 73; Northern States, 1 in 80f. Whilst we will 
readily grant that the improved method of medical treatment of the present 
day would greatly diminish the rates of mortality, we would on the other 
* Sixth Annual Report of the Registrar General of England, 1847. 
t Census of United States, 1850. 504 
Mortality from Malarial Fever in Georgia. 
hand affirm that these improvements in practice would have little to do 
with the prevention of disease. We have therefore presented this view of 
the rates of mortality in these localities, rather to demonstrate the liability 
of men exposed in"this climate to disease, and thus to establish the impor- 
tance of the present inquiry; for the laborers and citizens may be rendered 
almost as ineffective by sickness as by death. 
The medical statistics of Oglethorpe Barracks during the period they 
were situated one mile south of the city of Savannah, just back of the pres- 
ent jail, illustrates still more forcibly the sickness and mortality of troops 
encamped in localities surrounded with rice fields and marshes. In 1828, 
during the months of July, August and September, there occurred 23 deaths 
in a command of 95 men ; and during the month of October, November and 
December, 18 deaths in a strength of 85 men ; the total deaths for the year 
was 52, besides 19 women and children-Remittent fever and dysentery 
were the fatal diseases which caused the high mortality. During 10 years, 
from 1829 to 1839, the annual ratio of mortality was 5^ per cent.; the 
annual ratio of intermittents was 67 per cent., and that of remittents 22 per 
cent.; and every man was on an average during this period, reported in a 
little less than every five months. So prevalent and fatal were the diseases 
in summer and fall seasons, that this post was finally abandoned. 
The medical statistics of the Augusta Arsenal whilst it was situated on 
the banks of the Savannah river, correspond with those of the Oglethorpe 
Barracks; disease prevailed to so great an extent that it was necessary to 
abandon the post iu the summer season ami encamp on the Sand Hills. 
These observations might be still further strenthened by the presentation 
of the rates of mortality of rice plantations; this subject, however, will be 
treated more fully hereafter, and we will merely state the result of an 
extended personal examination of the mortuary statistics of rice planta- 
tions , the number of births in proportion to inhabitants does not differ 
materially from the number in the healthiest regions, but the mortality, 
especially amongst the young, is far greater-iu fact so great that during 
many years instead of an increase, there is either a stationary condition, or 
an actual decrease.* 
* The facts which have now been presented are sufficient to justify the attempt to devise 
some means to ward off the climate fever. During the study of the relations of climate and soil 
to disease,'the collection of the mortuary statistics and the investigation of the causes of diseases 
upon the rice and cotton plantations: and during the discharge of the duties of chemist to the 
Cotton Planters' Convention of Georgia, the author has necessarily been greatly exposed to the 
agents which produce climate fever, and the results of his experience now presented, cannot, 
therefore, be said to be wanting the test of actual experiment.. Under these exposures I have 
found that sulphate of quinia taken in from 3 to 5 grains twice during the day would, in most 
cases, prevent the occurrence of malarial fever, and if it failed to ward it off entirely', the attack 
would be of very slight character. I have still further observed that when the climate fever first 
appeared with a sense of lassitude, headache and excitement of the pulse, with alternate flush- 
ings, it might be arrested by a dose of from five to ten grains of sulphate of quinia, in combination 
with bicarbonate of potassa and Hiffman's anodyne. From 5 to 15 grains of the sulphate 
of quinia may be given, according to the urgency of the symptoms, united with 15 grains 
of bicarbonate of potassa, and two fluid drachms of Hoffman's anodyne. From 5 to 15 
grains of gum camphor; the whole to be dissolved in six fluid ounces of water. The feet should 
be placed in hot water immediately after, or before the administration of the remedies, and the 
patient alter this bath should be covered up in bed, so as to promote free perspiration and induce 
quiet sleep. I have frequently gone to bed in a feverish, restless state, with a severe headache, 
excited pulse, and pain in the limbs, and dry, warm skin, and under the action of these remedies, 
arose in the morning refreshed and able to resume active operations. 
We would recommend the use of quinia as a preventive of climate fever, in the following 
manner: 
R. Sulphate of quinia grains, iii. 
Dilute aromatic sulphuric acid.... drops, v. 
Brandy teaspoonful, 1. 
Water ...wineglassfuls, ii. 
Drop the diluted aromatic sulphuric acid upon the sulphate of quinia, and then add the 
brandy and water. Administer twice during the day, after rising in the morning, and just before 
bed time. Destructive Effects of Malarial Fever in Warm Climates. 
505 
Cases of Malarial Fever and of all Diseases occurring during a period of Fifteen 
Months (October, 1862, to January, 186f), in the command serving in and 
around Fort Jackson, on the Savannah Fiver. 
MONTH AND YEAR. 
Congestive 
Fever. 
Intermittent 
Fever Quoti- 
dian. 
Intermittent 
i Fever Ter- 
tian. 
Intermittent 
Fever Quar- 
tan. 
Remittent 
Fever. 
To lai eases of 
these forms of 
malarial fev or. 
Total cases thr 
all other dis- 
eases. 
Total cases of 
all Diseases. 
Aggregate sick 
each month. 
Mean strength 
of command- 
Officers & men. 
October, 1862 
262 
71 
12 
345 
126 
471 
583 
872 
November, " 
67 
24 
5 
96 
44 
140 
• 218 
913 
December, " 
128 
58 
11 
197 
118 
315 
350 
913 
January, 1863 
42 
88 
5 
135 
172 
307 
331 
1,144 
February, " 
85 
104 
9 
198 
149 
347 
428 
913 
March, " 
78 
133 
33 
2 
246 
143 
389 
458 
913 
April. " 
37 
157 
4 
198 
226 
424 
489 
913 
May, 
62 
76 
2 
140 
184 
324 
360 
878 
June, " 
July, 
66 
66 
10 
142 
131 
273 
316 
878 
77 
177 
67 
321 
137 
458 
504 
878 
August, " 
99 
149 
134 
380 
103 
483 
533 
890 
September, " 
149 
127 
134 
410 
98 
508 
588 
822 
October, " 
97 
108 
. 
62 
267 
133 
400 
485 
660 
November, " 
1 
47 
54 
22 
124 
60 
184 
235 
789 
December, " 
1 
41 
62 
10 
114 
111 
225 
279 
800 
- 
- 
- 
- 
- 
- 
- 
- 
Total 
2 
1,335 
1,444 
33 
489 
3 313 
1,935 
5,248 
In an average command of 878 men, stationed at Fort Jackson and the 
surrounding river batteries, nearly one-half, or 410, on an average were on 
the sick list each month; and the new cases of malarial fever averaged 
each month 220. During this period of fifteen months 3,313 cases of mal- 
arial fever, in the form of congestive fevers, quotidians, tertians, quartans and 
remittents occurred; whilst all other diseases, including also those diseases 
as neuralgia, which might be traced in a measure to the action of malaria, 
numbered 1,935 cases, or only a little more than one-half of the number of 
the cases of malarial fever. Throughout the entire period, more than one- 
fourth of the command were unfit for duty; and during the fall months 
more than one-half of the garrison was on an average incapable of perform- 
ing military duty. In case of an attack during the sickliest season of the 
year, the effective force of the command instead of being 878, would have 
been less than five hundred. 
WIDE SPREAD AND DESTRUCTIVE EFFECTS OF THE MALARIAL FEVERS OF 
THE ALLUVIAL REGIONS OF TROPICAL AND SEMI-TROPICAL AFRICA. 
The endemic climate fever of the coast and alluvial lands of Central 
Africa does not differ in any essential manner, except, perhaps, in its 
severity, either in its causes, symptoms or effects, from the malarial fever 
of North America. The celebrated traveler, Mungo Park, suffered from 
two severe attacks of fever, upon his first tour through the interior of 
Africa, and at the conclusion of his journey the color of his skin was so 
altered by the disordered state of his liver induced by African fever, that 
he could scarcely be distinguished from a Moor ; and upon his second visit 
to Africa, not only was he brought to the borders of the grave bv climate 
fever, but thirty-two out of the thirty-eight men who left with him the banks 
of the Gambia, fell victims to African fever in less than two months. The 
vessel sent out in 1618, to relieve the English Explorer, Thompson, on the 506 
Malarial Fever in Africa. 
banks of the Gambia, lost almost the entire crew with fever and at the very 
outstep failed to accomplish the desired object. The enterprising traveler, 
Ledyard, who had spent his life in traveling, and had sailed around the 
world with Captain Cook, had lived for several years with the North Amer- 
ican Indians, and had traveled from Stockholm, round the Gulf of Bothnia, 
and thence to the remotest parts of Asiatic Russia, died of African fever, 
in the very commencement of his journey to explore this continent- 
Numerous other travelers might be mentioned, as Nicholls, Morrison,. 
Pearce, Clapper ton, and the active, athletic and temperate Frederic Hor 
neman, who fell victims to the endemic climate fever of Africa. 
The splendid expedition to the Congo, under command of Captain 
Tuckey, provided with a crew of fifty active individuals, and with a 
botanist, zoologist, comparative anatomist, and a most competent physi- 
cian, melted away under the influence of the damp and burning climate, 
and ended with the loss of the captain, all the officers and scientific men. 
A similar termination closed the expedition of Major Peddie, for the 
discovery of the Niger. The average mortality amongst the better classes 
in Sierra Leone, according to the testimony of Dr. Nichol, Deputy Inspector 
of Hospitals, was formerly about one in twelve, or very nearly nine per cent. 
According to Mr. Tidlie, acting Staff Surgeon at Cape Coast Castle in 
1819, all the new-comers from England were seized with fever, and one-half 
died, more than one-third of the resident Europeans who had been there 
more than one year were seized with fever, and one-eighth died ; in 1820, 
all the new-comers were seized with fever, and one-half of them died, and 
of the older residents one-ninth died ; in 1821 all the new-comers were 
seized with fever, and one-third died, whilst of the older residents near one- 
sixth died; thus making an average of one death out of every two and 
two-thirds, of the new-comers during the first twelve months after their 
arrival, and one death out of every eight of the resident Europeans who 
had been there more than one year. From the report of Dr. Barry, Deputy 
Inspector of Hospitals in 1822, we learn that twelve white sergeants from 
the Isle of Wight, selected as good and healthy men of regular habits, were 
attacked with fever upon their arrival upon the coast of Africa, and within 
a few months after their arrival, eight paid the debt of nature, and the 
constitutions of three of the remaining four were permanenly injured,, 
whilst the sickness and mortality amongst their wives and children were 
nearly in the same proportion. 
According to Mr. William Ferguson, Surgeon to the Royal African 
Colonial Corps, in the third quarter of 1824, the mean strength of British 
soldiers in Sierra Leone, was 585; of this number 386 were attacked with 
this African climate fever ; 161 died, showing one death to 3.63 of the 
strength, and one death to 2.39 cases treated ; at Gambia during the same 
period, the strength was 108, cases of malarial fever 92, deaths 74, giving 
a proportion of one death to 1.45 of the original srength, and one death to 
1.24 of the cases treated; at the Isle de Los, during the same period the 
mean strength was 103 ; cases of malarial fever 99, deaths 23, showing one 
death in 4.47 of the strength and one death in 4 3 of the cases treated. 
Captain W. F. Owen ot the Royal Navy, in his attempt in 1827 to found a 
settlement at Fernando Po, lost almost his entire colony from the endemic 
fever of Africa; and Colonel Nicholls who followed him in a similar attempt 
had one attack of remittent fever, and eleven attacks of intermittent fever,, 
and lost twenty-five out of thirty individuals who composed the company. 
Numerous other examples might be brought forward to show the 
dreadful effects of the climate of Africa upon foreigners, unprotected by 
the sulphate of quinia; we will, however, allude to but one more-the Malarial Fever in Africa. 
507 
expedition of H. B. M. ships Wilbeforce, Albert and Soudan during the 
years 1841 and 1842, up the Niger, with the leading object of promoting 
the abolition of the slave trade. When the expedition entered the Nun 
branch of the Niger, on the thirteenth of August, its complement of men 
and officers consisted of-officers, including civilians and engineers, 5.3; 
white seamen, 63 ; mariners and sappers, 29; total number of white, 145 ; 
men of color entered in England, 25; Kroomen and liberated Africans 
entered on the coast 110; blacks for model farm, 23; total black, 158; 
grand total, 303. The health of the expedition continued good until the 
ship had proceded 250 miles from the mouth of the river, on the fourth of 
September, when a most malignant fever appeared in all the vessels, and 
spread with great rapidity. The first death took place on the ninth ; and 
on the seventeenth there were 69 sick, 63 of whom were whites ; and seven 
whites had died. The expedition was so disabled that it was deemed 
advisable to send two of the ships back to sea ; on the nineteenth the 
Soudan started for the mouth of the river with forty cases of fever, and was 
followed by the "Wilbeforce, with nearly an equal number of sick, on the 
twenty-first. The Albert continued up the river, the officers believing that 
the violence of the fever was in a measure exhausted, and that the climate 
of the more open country higher up the Niger, would be found more 
healthy. The result proved otherwise. When the ship had arrived at 
Egga, 340 miles from the sea, not less than twenty more of the crew had been 
attacked, of whom two had died; and on the third of October there 
remained capable of doing any duty, only one white seaman, the sergeant 
and one private of marines, the geologist, the mate, one hospital attend- 
ant, and the surgeon, Dr. McWilliam. The entire enterprise was now 
abandoned, and the Albert steamed down the river to Fernando Po. Of 
the 145 whites who entered the Niger in good health, 139 were attacked 
with fever and 42 died ; of the 158 blacks, only 11 had the fever, and that 
in its mildest forms, and not one died. The ratio of the men attacked by 
fever in the Albert was 1 in 1.127, the ratio of deaths in total number 
victualled was 1 in 2.696, and in the number of cases 1 in 2.391 ; the ratio 
of the men attacked by fever in the Wilberforce was 1 in 1.666, ratio of 
deaths in number victualled 1 in 8. rario of deaths in number of cases 1 in 
6.857 ; the entire crew of the Soudan were attacked with fever ; the ratio 
of deaths in total number victualled was 1 in 2.7.* 
* We will now compare these facts and rates of mortality with the health of the British 
squadron, employed for the suppression of the slave trade on the west coast of Africa, since the 
systematic employment of t lie sulphate of qninia as a prophylactic. The observations which we 
will now present, are from the most reliable of all sources : the Statistical Report of the Health 
of the Royal Navy." and weshall refer especially to the reports for 1856 and 1857. printed by the 
House of Commons, July, 1858, and August, 1859. In 1856, the squadron employed for the sup- 
pression of the slave trade on the west coast of Africa consisted of twenty-one vessels, with a 
mean force, including Kroomen and African boys, of 1630 men of all ranks and ratings. The 
number of men daily inefficient from wounds and sickness on the west coast of Africa, averaged 
about 55 per 1000 of mean force. 
The following summary taken from the nosological ret urns, will not only show that the great 
source of malarial fever in the squadron is exposure to effluvia or miasmata, while on shore, or 
in boats near the shore, or by the entrance of the cruisers into the. large tidal rivers, but also 
that the great means of warding off the epidemic climate fever, and of moderating its violence 
and duration, was the daily administration of the sulphateof quiniato the men during exposure 
to the noxious miasmata. The Bloodhound remained during the entire year on the northern 
division of the station. In March she steamed about 300 miles up the Benin river; while in the 
river and for fourteen days afterwards, from three to six grains of the disulphate of quinine 
were given to each of the ship's company as a preventive of fever, and although they were 
exposed to the emanations from the mangrove swamps for twenty-seven days, only six suffered 
slightly from fever. Some time afterwards they were again exposed to miasmata in the Bonny, 
New Calabar, and in the Sherbro, the last one of the most dangerous rivers for Europeans on 
the whole station; but quinine in solution was invariably used as a prophylactic, and with good 
effect, as only one case occurred after the vessel had been for a week in the Sherbro, and the 
patient was the only person who did not take the quinine regularly. No death occurred in this 
vessel from fever, but one man was invalid for its sequela. The Childers was employed almost 
constantly cruising, for the first six months in the year off the coast, in the Gulf of Guinea, and 
during the remaining months, off the coast, between Loango and Benguela. With the exception 
of a few unimportant cases, her crew entirely escaped fever, until three boats were sent on 508 
Malarial Fever in Africa. 
detached service up the Lagos river; in these there were twenty-seven white men and five officers. 
They remained absent for two nights one of which was spent at anchor, off the town of Lagos. 
The surgeon accompanied the expedition and gave quinine wine, which was continued after 
they returned on board; still notwithstanding, nine out of the thirty-two persons who formed 
the party, were attacked with fever; two in five days after their return to the ship, one on the 
•sixth day, one on the eighth, one on the ninth, one on the thirteenth, two on the sixteenth, and 
one on the seventeenth. The disease in all was the same, differing only in its degree of intensity; 
some were convalescent on the eighth or ninth day, and others not before the twenty-eighth; one 
had a Jaundiced appearance. The surgeon thought the fever would have assumed a worse form, 
but for the quinine wine which had been taken as a preventive. No other febrile disease of any 
consequence occurred in t he Childers for several months subsequently, nor in fact until she had 
been for some time stationed on the southern division of the command, when four cases took 
place, after she had been eight days at anchor in the river Congo. The Firefly did not arrive on 
the station until August. Shortly afterwards she proceeded on a cruise off' the river Pongas, 
while her boats armed with while men, were sent up the river. They took quinine-wine night 
and morning while absent, and continued its use for ten days after they returned, and all 
escaped fever. Subsequently a few eases were contracted from long continued exposure to the 
miasmatous exhalations in the river Lagos. Eighteen cases of remitting and fourteen of inter- 
mitting fever occurred in the Hecate-the majority of the former were contracted on shore; two 
ended i n death. The subject of one of the latter was a marine, who accidentally drifted away in 
the life-boat over the bar at Lagos; slept one night on shore, and was not attacked until fourteen 
days afterwards. In the other case, the patient, an officer, slepttwd nights on shore, and exposed 
himself to the full glare of the sun during the day time, by rowing about in a boat, without an 
awning, in the lagoon off Lagos; he declined taking quinine as a preventive, and was attacked 
about fourteen days after he returned on board. 
The Merlin arrived on the station about the middle of July, and after cruising a short while 
off the rivers Nunez and Congas, proceeded to the Bight of Biafra. She was then ordered on special 
service up the rivers Bonny, New Calabar and Brass; while thus employed, the following precau- 
tionary measures were adopted against fever. The crew were turned up at 5:30 a. M., after dress- 
ing, took half a wineglassful of quinine wine ; they breakfasted at 6. The decks were washed 
with water (warm) from the boilers at 0:30; they took dinner at noon, and supped at 5 P. M. No 
white men were sent away in boats. Serge frocks and white trousers were worn during the day, 
and blanket dresses during the night. No water was allowed to be drawn from alongside for any 
purpose whatever. Quinine wine was administered to the whole crew for fourteen days after 
leaving the rivers, in which they remained altogether twelve days. Whether it was owing to the 
above measures it is impossible to state, but no sickness of any kind followed the several expedi- 
tions into these notoriously unhealthily localities. Although twenty-three cases occurred in this 
vessel, only one out of the whole number was of a severe character, and it was the result of intem- 
perance and exposure on shore on the Isles of the Los. The records of the other vessels all sub- 
stantiated the great value of quinine as a prophylactic. 
It thus appears, that in all these vessels, with a mean force of about 1680 men, there were only 
■ seven deaths from fever, being in the ratio of about a little more than four to the thousand; a 
mortality so small compared with that of former years, seems almost incredible, and might well 
lead to the belief that the coast, like some of the cleared portions of the North American Conti- 
nent, is becoming more healthy; but, with the exception of the non-appearance of yellow fever, 
which does not depend on terrestrial emanations alone, the climate has undergone no salutary 
change. The seemingly interminable forests which fringe the estuaries of every tidal river, are 
still as prolific of the fever poison as they were in times gone by, when the death-rate in the 
squadron was ten times greater. How then, it may be asked, are we to account for this improve- 
ment? Simply by the change which has taken place in the mode of conducting the duties of the 
station. By a wise and humane regulation, the deadly pract ice of sending boats away on detached 
service to watch or intercept slaves, has been interdicted, or at all events, greatly restricted. 
Prize crews are no longer turned adrift to wander through the streets of Sierra Leone, when the 
vessels they navigate from distant parts of the station are delivered up to the authorities of the 
Mixed Commission Court; the orgies of the "barn," which lowered the character of the white 
man in the eyes Of the black, have long since ceased ; and last, though not least, the introduction of 
quinine wine os a preventive of fever has not only reduced the number of febrile attacks, but has les- 
sened ihe severi'y of those which do occur, and thus the mortality has also been reduced to a level which 
does not materially exceed the dei th-rate from fever on some of the more healthy stations 
There has also been a great change in the medical treatment of febrile diseases: the so-called 
active measures which were in vogue but a few years since have given place to others of a more 
rational character. Blood-letting is no longer carried to an extent which leaves the patient but 
little chance of recovery when the fever terminates, and the rash and empirical use of calomel in 
large and frequently repeated doses, to produce ptyalism, has been abandoned-not only on 
account of the impossibility of producing ptyalism while the fever lasts, but because mercury, 
given to excess in any form, has a most injurious effect on the constitution. If these changes 
have had no effect in reducing the mortality they, at all events have lessened the sufferings and 
misery entailed on patients, who though they survived the fever, lingered long in a state of debil- 
ity from the effects of blood-lett ing and mercury.-titadstical Report of the Health of the Royal Ravy 
tor the yea>-1856, ordered bu /he House of Commons to be printed twenty-sixth July, 1X58 :p/<. 110-116. 
In 1857 there were nineteen vessels employed on the African station, with a mean force, cor- 
rected for time, of about 1620 men, including Kroomen and liberated Africans. The number daily 
ineffective from woundsand sickness averaged 112, or in the ratio of 69.3 to the 1000 of mean 
force, which exceeds the ratio of the preceding year by seven. The total number of dead, exclu- 
sive of those lost by shipwreck, amounted to thirty-six-twenty-seven from disease, one from 
poison, and eight from accidental causes; on the whole, therefore, the mortality was somewhat 
greater than in 1856. During the year eleven cases of endemic fever terminated in death; the 
ratio per 1000, 6.7: and although nearly a third gr ater than in 1856, it is still not greater than the 
mortality of some of the healthiest stations, and incomparably lessthan the mortality upon the 
African station before the use of quinine wine. The following summary, taken from themedical 
journals of the squadron, affords additional proof of the usefulness of quinine as a prophylactic: 
In the Trident there were forty cases of fever, but no death occurred; the greater number of 
these cases were contracted in the rivers which enter the sea in the Bight of Biafra. Quinine 
wine was freely used as a preventive. On two occasions, when boats were sent up the Congo, the 
white men took quinine while in the river, and for fourteen days after they left it. and no fever 
■of any consequence followed. Fourteen cases occurred in theSappho; they were nearly all con- 
tracted in boating expeditions up the river Congo. Quinine wine was administered to the men 
•on these occasions, but several who did not take it regularly were attacked. Twenty men were Malarial Fever in Africa. 
509 
employed off and on between the 30th of April and the 11th of May on this service, watching a 
suspected vessel in the Congo. The medicated wine was administered carefully, according to the 
printed circular. Only .four men were attacked by fever, the disease showing itself about three 
weeks after they ceased taking the wine In the Myrmidon and Pluto there were but few cases 
of fever, though they were employed on some of the most unhealthy places on the station; the 
former was laid on the beach at Sierra Leone, to be repaired, meanwhile her crew took up their 
abode in an old hulk which lay in the harbor, some of the men, however, together with several 
of the Pluto's crew, were employed, both by day and night, as their work depended upon the 
tide, in patching up the hull of the vessel. To these men quinine wine was administered twice 
daily, and the executive officers took care that they did not straggle into the town or bush, conse- 
quently no case of serious illness followed. The gig and pinnace of the Alecto, manned by four- 
teen white men and six Kroomen, « ere sent about 150 miles up the Congo, late in December, with 
presents for one of the petty chiefs; they returned on the 6th of January, and between the 12th 
and 18th every white man, with two exceptions, was attacked with fever. The same boats were 
again sent up the river to the same place on the 14th, when the two persons who had escaped 
fever formerly were now attacked, though one of them was not taken ill until thirty days after- 
wards. With the exception of these two persons the boat's crew on the second expedition were 
made up of Kroomen, who, as usual, entirely escaped, on these expeditions an ounce of quinine 
wine was given to the white men daily during their absence from the ship; but it appears to have 
been discontinued on their return. In January the boats of this vessel were again aetached to 
cruise in the Congo, but did not proceed more than forty miles up the river. Quinine was given 
to the men during their absence and for fourteen days after their return. The same precaution 
was adopted after any subsequent exposure to the malaria in the river, and no case of fever 
follow'ed. The Bloodhound was employed in January in the river Benin, and during July in the 
Congo; as long as she remained within these rivers, and for ten days afterwards, four grains of 
quinine in a quarter of a gill of rum, was administered to every white man on board. One case 
only resulted from these two expeditions; and iu that instance the person attacked had exposed 
himself in a most imprudent manner whilst shooting wild fowl amidst the slimy ooze in the 
mangrove thickets on the banks of the Beniu; whether the patient took quinine as a preven- 
tive is not mentioned. Three boats from the Childers went up the Congo as far as Punto da 
Linha, and were absent for several days; quiniue was administered to the white men, and no 
fever resulted. 
In May, two boats were sent from the Hecla up the river Nunez, and returned on the follow- 
ing day. Quinine wine was issued in the usual manner, and no febrile disease followed. In July 
the same vessel entered the Sherbro, and subsequently her boats, containing flfty-six seamen 
and marines, with the usual number of officers, ascended the river to the village Victoria ; they 
returned the same evening^and rejoined the vessel, wnich remained in the river for a few days 
longer. Quinine in rum (the quinine wine having been all used) was given to the crew while she 
remained in the river, and for fourteen days after she went to sea. " Eight cases of intermittent 
fever," the surgeon remarks, "were added to the list a few days after our departure; they were, 
however, all mild, and terminated favorably, after an average of seven days' treatment. To the 
regular and timely administration of quinine, I think our immunity from fever may be fairly 
ascribed; the cases that did occur were no doubt modified by the prophylactic. That this was 
the case, the mortality amongst the crews of the merchant shipping frequenting the river, and 
by whom no preventive is used, bears ample testimony." On the 23d of May three officers landed 
at Lagos from the Hecate, intending to return on board on the following morning; but, as fre- 
quently happens on this coast, the surf rose suddenly, and continued so long that they could not 
return to the vessel until the 29th. Again, on the 2d of August, the pinnace, with seven white 
men in it, was detached to cruise in-shore beween Little Popoe and Whydah, where she 
remained until the 8th, Quinine was given on both these occasions, and no fever resulted. On the 
evening of the 27th of November, the same boat and a gig, with nine white men on board, were 
left off Shark's Point to guard the entrance to the Congo. An ounce of quinine wine was given 
to the men each morning. The boats remained in the same position until the morning of the 
30th, when they took advantage of a sea breeze, and proceeded up the river to Punto da Linha. 
The gig, with one officer and two white men, returned on the 2d, and the other boat on the 5th of 
December. During their absence they had fine weather, and all returned apparently in good 
health. Quinine was now substituted for quinine wine; four grains were given daily to each 
person at seven in the morning; but, notwithstanding this, nineoutof the eleven were attacked 
by remitting fever. 
The Merlin, between the 1st of January and the 30th of September entered the rivers Calabar 
and Cameroons, in the Bight of Biafra; she also entered the Nunez several times while on the 
northern division ot the station. During the time she was in these rivers, and for some time after 
she had left them, quinine wine was duly administered to the white men on board, and nofebrile 
disease of much importance took place; but in November, after having entered the Nunez and 
Pongas for the purpose of communicating with the native chiefs, her crew suffered most severely 
from remitting fever. Quinine wine was given to the crew for some time, but the supply being 
exhausted, quinine in ruin was substituted. When the change took place is not specified; but in 
connection with the substitution of quinine purchased on the coast and issued in the same man- 
ner in the Hecla, the quality of the alkaloid in both instances may be doubted. The Myrmidon 
was employed in the River Bonny, and afterwards lay a long time in Clearance Cove, Fernando- 
Po; during the entire period quinine wine was given in the prescribed form ; only one slight case 
of climatorial fever occurred. At Sierra Leone, while the vessel was under repairs, the whole- 
crew took quinine once a day, and those who were engaged on the shore, twice ; still though the- 
latter were at work night and day, only one case of remitting fever resulted. In the same man- 
ner the Pluto was laid on the beach at Sierra Leone early in March for repairs. The carpenters,, 
together with the carpenters of the Hecla, and a number of bluejackets who were employed on 
her, took the prescribed measure of quinine wine before going to work, and on leaving off; but 
the men who remained on the hulk took one measure only every morning until the 28th. Two- 
men who had not been out of the ship were subsequently attacked with fever, but so long after 
the vessel had gone to sea, that the disease can hardly be ascribed to miasmata from the land at 
Sierra Leone. 
It is worthy of notice that in the preceding instances, when quinine wine was administered 
according to the instructions issued with it, no fever of any consequence followed exposure to 
land or swamp miasmata; but on two occasions, when quinine purchased on the coast was sub- 
stituted, and once when the wine was suddenly discontinued after the exposure, a considerable 
number of men were attacked owing, it is to be supposed, to the discontinuance of the quinine- 
wine in one instance, and to its bad quality in the other, for it is well known that, like other 
high priced remedies, it does not escape adulteration when it falls into the hands of dishonest 
traders.-Statistical Report of the Health of the Royal Navy, for the year 1851. Ordered by the House 
of Commons to be printed, 2d August, 1859, pp, 78-85. 510 
Hemorrhagic Feuers Dependent on the Constitution of the Blood. 
HEMORRHAGIC FEVERS DEPENDENT UPON THE PECULIAR CONSTITUTION 
OF THE BLOOD, AS INDUCED BY SALT MEAT, SAMENESS OF DIET, 
AND THE CONCURRENT ACTION OF FEBRILE POISONS. 
The relation which may be shown between the dissolved state of the 
blood, and certain morbid phenomena, is one of the most important facts 
in medicine, a fact very carefully studied by the observers of preceding 
ages, and from which the exclusive Solidists doctrines of this century have 
diverted attention. G. Andral, in a work published in 1823 (Clinique 
Medicale, t. 1), admitted and described this state of the dissolution of the 
blood in certain cases of low fever, and pointed it out as capable of playing 
a part in the production of several of the symptoms of these diseases, and 
especially of the haemorrhages which so often accompany them. The inves- 
tigations of M. Magendie,* threw important and additional light upon this 
important question of etiology. Andral established the important fact 
that this state of dissolution of the blood uniformly coincided with a 
diminution of the quantity of fibrin, and sought to determine whether 
this be the ultimate alteration weare permitted to arrive at ? Before the 
fibrin decreases, has there not been some other change of composition in 
the blood, of which the depression of the fibrin below its normal average, 
is itself only the consequence ? in answer to these questions, some facts 
may be cited : thus M. Magendie on throwing into^the veins of living ani- 
mals a concentrated solution of sub-carbonate of soda, found an almost 
fluid blood in the bodies of these animals when dead, and that during life, 
their symptoms were analogous to those observed in diseases, in which 
the older writers admitted a state of dissolution of the blood, attended 
with petechia: and haemorrhages from the mouth, stomach, intestines and 
kidneys; some authors have declared that they have found an excess of 
alkaline matters in the imperfectly coagulated blood of persons who died 
of low fevers or scurvy; and Andral in the investigation which he pursued 
in regard to the variations in the proportion of the inorganic constituents 
of the blood, found amongst other things, that the blood most highly 
charged with free alkali belonged to scorbutic patients. And it has beeu 
supposed with reason, that the different virulent and miasmatic substances 
which, on being introduced into the blood, diminish its coagulability, may 
then act upon the fibrin like the alkaline substances just alluded to. Thus, 
too, the venom of the viper may act, which, according to Fontana, pro- 
duces a dissolution of the blood. 
Whatever may be the truth regarding the number and the nature of 
the causes which render the blood less coagulable, it is not the less certain 
that there are some diseases in which the blood shows a strong tendency to 
dissolution, while there are others in which the blood becomes more coagu- 
lable. Bufalini, an Italian physician, even regarded these two states of 
the blood of such importance as to make use of them for dividing all dis- 
eases into two great classes: to one of these he assigns as cause what he 
terms the phlogistic process, and to the other an opposite state of the sys- 
tem, which he designates by the term process of dissolution. This division 
is equivalent to that established by Andral, into diseases with an excess of 
fibrin in the blood, and those with less than the natural quantity of this 
principle; for in the latter there is evidently a cause whose effect is .neces- 
sarily to make the blood less coagulable. 
Grant, who practiced medicine and wrote towards the close of the last 
century, suggested the inquiry whether the peculiar hygienic condition of 
the people of Europe before the eighteenth century must not have caused 
* Lemons sur Ies PhSnom&nes physiques de la vie, 1837. Hcemorrhagie Fevers Dependent on the Constitution of the Blood. 
511 
them to be frequently attacked with diseases, one of the principal elements, 
if not their starting point, being a state of dissolution of the blood ? It is 
certainly worthy of note, that the observers of preceding ages constantly 
speak of dissolved and incoagulable blood in their histories of epidemics. 
It is well established that certain hygienic influences, even at a period not 
very far distant, gave birth to and maintained in Europe these general dis- 
eases in which the alteration of the blood seems to play so important a 
part. Even those unfamiliar with the practice of medicine were them- 
selves struck by it. Erasmus, the philososopher, who flourished towards 
the close of the sixteenth century, wrote that in his day the inhabitants of 
London were every year, from spring to harvest, attacked by a malignant 
fever, which committed the greatest ravages in that city, and especially 
amongst the poorer classes. Erasmus gives the following details as to the 
causes to which he attributed the fever : 
The supply of water fails the inhabitants; they have to seek it at a great dis- 
tance from the city; the river water is carried upon their backs, and is so dear that 
the poor cannot procure enough of it to wash themselves and keep their houses 
clean. Their houses are of wood and are very cold in winter, which makes it 
necessary to fill the rooms with straw. But as this cannot be often renewed it 
becomes spoiled and very injurious. 
John Huxham,* in his Essay on Fevers, published in 1757 (one hun- 
dred and twenty-nine years ago), says with reference to the putrid, malig- 
nant, petechial fevers : 
That in general they attack with much more violence than the slow nervous; 
the rigors, if any, are greater (sometimes they are very great), the heats much 
sharper and permanent, yet at first sudden, transient and remittent; the pulse 
more tense or hard, but commonly quick and small, though sometimes slow and 
seemingly regular for a time, and then fluttering and irregular. The head aches, 
giddiness. Nausea and vomiting are much more considerable, even from the very 
beginning, sometimes a severe fixed pain is felt in one or both temples, or overone 
or both eyebrows, frequently in the bottom of and orbit of the eyes. The eyes 
always appear very full, heavy, yellowish, and very often a little inflamed. The 
countenance seems bloated and more dead-colored tnan usual. Commonly, the 
temporal arteries throb much. * * The prostration of spirit, weakness and faint- 
ness are often surprisingly great and sudden, though no inordinate evacuation 
happens; and this, too, sometimes when the pulse seems tolerably strong. The 
respiration is most commonly laborious, and interrupted with a kind of sighing or 
sobbing, and the breath is hot and offensive. Few or none of these fevers are 
without a sort of lumbago, or pain in the back and loins; always a universal weari- 
ness, a soreness is felt, and often much pain in the limbs. Sometimes a great heat, 
load and pain affect the pit of the stomach, with perpetual vomiting of porraceous 
or black color, and a most troublesome singultus; the matter discharged is fre- 
quently of a very nauseous smell. The tongue, though only white at the begin- 
ning, grows daily more dark and dry; sometimes of a shining livid color, with a 
kind of dark purple at the top; sometimes exceeding black; and so continues for 
many days together. At the height of the disease it generally becomes vastly dry, 
stiff and black, or of a dark pomegranate color, hence the speech is very inarticu- 
late, and scarce intelligible. The thirst in the argument of this fever is commonly 
very great, sometimes unquenchable; and yet no kind of drink pleases, but all 
seem bitter and mawkish; at other times, however, one is amazed to find no thirst 
complained of, though the mouth and tongue are exceedingly foul and dry; this is 
always a dangerous symptom, and ends in a frenzy or coma. The lips, and teeth 
especially in this state, are furred up with a very black tenacious sordes. 
At the outset of the fever the urine is often crude, pale and vapid, but grows 
much higher colored in the advance, and frequently resembles a strong lixivium, 
or c trine urine tinged, with a very small quantity of blood; it is without the least 
sediment, or even cloud, and so continues for many days together; by degrees it 
grows darker, like dead and strong, high-colored beer, and smells very rank and 
offensive. I have frequently seen the urine, in petechial fevers, almost black and 
* An Essay on Fever, London, 1757, pp. 92-97 Haemorrhagic Fevers Dependent on the Constitution of the Blood. 
512 
very foetid; particularly that of one Mr. Shirley, a sea surgeon, was almost quite 
black, with a sediment as black as soot; he had abundance of very black spots, 
vibices, bloody dysentery and comatose phrenzy, and died about the thirteenth day. 
The stools, especially near the state, or in the decline of the fever, are of the most 
part intolerably stinking, green, livid or black, frequently with severe gripes and 
blood. * * When black, livid, dun or greenish spots appear, no one doubts of 
the malignity; the more florid, however, the spots are, the less is to be feared. It 
is a good sign when the black or violet petechice become of a brighter color. The 
large black or livid spots are almost always attended with profuse haemorrhages. 
The small dusky brown spots, like freckles are not much less dangerous than the 
livid or black; though fluxes of blood do but seldom accompany them; excessive, 
profuse, cold, clammy sweats are often concomitants, by which also they some- 
times vanish, though without any advantage to the patient. The eruption of the 
petechice is uncertain; sometimes they appear the fourth or fifth day, sometimes 
not till the eleventh, or even later. The vibices, or large livid or dark greenish 
marks, seldom appear till very near the fatal period. We frequently meet with an 
efflorescence like the measles or malignant fever, but of a more dull and lurid hue, 
in which the skin, especially on the breast, appears as it were marked or variegated. 
This in general is an ill symptom, and I have often seen it attended with very 
fatal consequences. 
In his fifth chapter, entitled " Of the Dissolved and Putrid State of the 
Blood,v John Huxham details facts and observations which illustrate in a 
forcible manner the effectsof salt meat and sameness of diet in the pro- 
duction of that state of the blood, which not only induced that peculiar 
state characterized as scurvy, but also established the haemorrhagic diathe- 
sis, which underlay and affected all diseases, whether belonging to the 
great class of phlegmasiae or pyrexiae. Thus Huxam described a state of 
the blood which immediately tends to dissolution and putrefaction of the 
blood : 
This is evidently the case in some scorbutics (as they are called) when, without 
any considerable antecedent sensible disorder (more than perhaps a period of lassi- 
tude and languor), persons have on a sudden an eruption of violet-colored livid, 
or even black and blue spots, all over the body, and forthwith fall into profuse, and 
sometimes dangerous and even fatal hcemorrhages, when they have scarce thought 
themselves, or been thought by others, to be under any manner of disorder. 
Abundance of instances of this kind happen. I have seen a great many, both in 
children and grown persons, and frequently foretold the ensuing haemorrhages. 
When women have such eruptions, or black or blue vibices, or large irregular spots, 
like bruises, they are always subject to a vast overflow of the catamenia, if not to 
often profuse haemorrhages. Nay, when persons of either sex are affected with 
these appearances, they are apt to bleed excessively from the slightest wound, and 
very often without any, from the gums, nose, guts or urinary passages. The blood 
of such persons, when it hath been drawn, in order to prevent the further progress 
of the haemorrhages, always appears a mere gore, as it were, not separating into 
cr assamentum and serum as usual, but remaining in an uniform half coagulated 
mass, generally of a livid or darker color than usual, though sometimes it continues 
long very florid, but it always putrefies very soon. * * * 
That I am persuaded the above mentioned haemorrhages most commonly arise 
from an acrimonious state of the humors, which breaks the crasis of the blood and 
corrodes the extremities of the capillary arteries, yet they sometimes also happen 
from a too loose contexture of the blood globules, not sufficiently compacted by the 
action of the heart, arteries, etc., for want of which they become oblate spheroids 
or irregularly formed moleculce, instead of regular spheres, and of course of a greater 
diameter and a less firm compayes than natural. But it appears from microscopical 
observations (especially those made with the solar microscope) that the blood 
globules, in passing through the minutest ramifications of the sanguineous arteries, 
change their globules into a very oblong figure frequently, in order to pass through 
these exceeding small vessels. And it is easy to conceive bow these loosely cohering 
globules may be broken in their passage, as their enlarged bulk makes their transit 
more difficult. Now, as these broken parts are of much less diameter than the 
original globules, they may readily enter and even pass through some of the excre- 
tory ducts, and transude per diapedesin, as the ancients called it. That this is so 
in fact seems to appear from the bloody urine, stools and other haemorrhages, Hcemorrhagie Fevers Dependent on the Constitution of the Blood. 
513 
•which sometimes happen without any manner of pain, violence of motion, or the 
least suspicion of the rupture of any vessel. Nay, I have more than once or twice 
seen in malignant fever, and that too -when the motion of the blood was far 
from being very rapid, a kind of bloody sweat from the axilice, tinging the linen 
almost of a Burgundy wine color. * * * 
The Petechice, Vibices or livid stigmata tljat very often attend these haemor- 
rhages, show that the blood globules are dissolved or broken down, and enter into 
the serous arteries, vosa exhalantia, etc., where, sticking fast, they form these 
appearances. And I have particularly noted, in some putrid, malignant fevers a 
kind of yellow or rather dun Petechice, vastly numerous, and of not less fatal 
omen than the others. Here the blood globules were broken into such small par- 
ticles as to have quite lost their original color when combined. Perhaps the fuli- 
gerious sweats, and dark-colored, or black urine, with a lurid sediment, which 
sometimes happen in fevers of the malignant kind, arise from a broken, corrupted 
state of the blood globules. I have seen several times the urine rendered almost 
quite black, depositing an immense quantity of matter nearly of the color of coffee- 
grounds. And we are sometimes surprised to see the face and hands of the sick 
grow dirty and sooty, as it were, though all imaginable care was taken to keep 
them clean. Besides there are some things that seem to destroy the copula of the 
blood globules, and greatly promote the secession of the six serous globules that 
compose them, one from another, particulary Laurel-water, which makes the 
crassamentum vastly less dense, and exceedingly more soft and tender than natural, 
and turns the serum red, or of the color of Burgundy wine, as appears from the 
curious experiments of Dr. Nicholls and Dr. Zangrish. 
The bite of the serpent hsemorrhous, causes such a dissolution of the blood 
that it breaks forth from all parts of the body, even the very pores, and kills by an 
universed hcemorrhage. Perhaps profuse sweats, diarrhoea, diabetes, and spontane- 
ous salivations may arise from a kind of dissolution of the serous^globules. A long 
and large use of mercury will turn the whole mass of blood into a mere watery 
colluvies. Sal volatile oleosum mixed with the blood fresh drawn, destroys or dis- 
solves the globules in less than a minute: spirits of hartshorn taken in large quan- 
tities will produce haemorrhages; and so will frequent and large doses of aloetics, as 
I have again and again observed. Indeed, such a state of blood is commonly 
brought on by acrimonious diet, medicines, etc. Thus the salt and half-rotten 
provisions of sailors, in long voyages, cause such a sharpness and corruption of the 
humors that they are rendered almost unfit for the common uses of life; producing 
great weakness, languor, wandering pains and aches, stinking breath, corroded 
spongy gums, black, blue and sallow spots, sordid, dark, livid fungus, ulcers, gan- 
grenes, etc., and surely scorbutics frequently fall into petechial fevers, bloody 
dysenteries, haemorrhages, etc. What is mentioned by the Rev. Dr. Walter, in 
Lord Anson's voyage, is very surprising, viz: that the blood burst forth from the 
wound of some of these scorbutics after they had been cicatrised for twenty or 
thirty years. I have known many a ship's company set out on a cruise in high 
health, and yet in two or three months return vastly sickly, and eaten out with the 
scurvy, a third part of them being half rotten, and utterly unfit for service. About 
four or five weeks after they have been out they begin to drop down one after 
another, and at length by dozens, till at last scarcely h tlf the complement can 
stand to their duties; particularly I remember, some few years since, from a squad- 
ron under Admiral Martin, we had nearly 1200 men put on shore sick at one time, 
though they went out very healthy and returned in about twelve or thirteen 
weeks. Those who accustom themselves to take largely of volatile and fixed 
alcalious salt, spices and aloetics, are always subject to these maladies. Not a few 
of those who took the alcalious saponaceous hotch-potch of Mrs. Stephens, and the 
soap lees for a long time together, fell into hectical heats, a hot scurvy, haemor- 
rhages, dysentery, etc. 
t?ome kinds of poison, as particularly the bite of the viper, and some other 
venomous animals, bring on a very sudden corruption and dissolution of the 
blood and turn it into a yellowish sanies. Pestilential effluvia also soon destroy 
the crasls of the blood, and produce an universal gangrenous disposition in the 
humors. This is evident from the frequent and fatal haemorrhages, excessively 
foetid sweats, vomitings and stools, and the general necrosis that follows, which 
have been observed in the plague and pestilential fevers by the best authors. The 
haemorrhages in particular are often vastly profuse and obstinate in the plague, 
and I have many times noted the same in pestilential and petechial fevers; and 
the blood, thus issuing, dark and coagulated, as usual. All arguments of the 
highest acrimony and dissolution of the blood. The contagion of the small-pox 514 
Causes of Hemorrhagic Fevers in Different Countries. 
seems to affect some constitutions much in the same manner, producing spots; 
putrefaction and vast effusions of blood from several parts- of the body, sometimes- 
even at one and the same time. T have seen many instances in this disease when, 
within four or five days from the seizure, pimples have appeared all over the body 
and haemorrhages from several parts in a profuse manner, particularly the uterus, 
urinary passages and nose, and the pustules have turned quite black, a bloody ichor 
issuing from them in abundance, and this too when no violent symptoms of any 
kind had preceded. Essay on Fevers, by JohnHuxham. London, 1757: pp. 41-53. 
Huxham says that it is a fatal prognostic when spots and haemorrhages 
appear at the very eruption of the small-pox, and the sick seldom or never 
survive the ninth day of the disease ; the ''blood running into immediate 
dissolution and putrefaction. I am persuaded scarce one in a thousand 
recovers under these dreadful circumstances, especially if the spots are 
very livid, black and numerous." 
Sarcone, in his history of the epidemic of Naples in 1764, has spoken 
of the difference between the blood drawn at the commencement and that- 
drawn towards the termination of the disease : 
"The blood," says this author, "was tenacious and huffy during the first week 
and the first days of the second ; at the end of the second week its aspect changed, 
and it appeared to be most distinctly altered ; the clot could be easily divided-a 
slight pressure was sufficient to break it up. * * Lastly, these alterations still 
increased in the course of the third week, and especially that tendency to dissolu- 
tion which appeared at the close of the second (Week. The blood drawn from a 
vein was converted into a thin, black coagulum, swimming in a dirty and bloody 
serum." 
The disease in which Sarcone-observed this alteration of the blood 
was one of the last remnants of those great epidemics which continually 
prevailed in Europe during the middle ages, and whose incessant reappear- 
ance seemed attributable to the bad ventilation and food peculiar to those 
times. In those endemics which, indeed, often became epidemics, nothing 
was more common than to observe gangrene, haemorrhage from various 
parts, extensive ecchymoses, or thousands of petechiae covering the skin, 
while the general symptoms of typhus and typhoid and remittent fevers- 
developed themselves with a high degree of intensity and the greatest 
rapidity. 'These pyrexise, with their assemblage of dangerous symptoms, 
and especially their haemorrhagic fevers, rarely appear in these times, and 
when observed are usually results of penury or the hardships and priva- 
tions of war. Scurvy, as an endemic disease, has disappeared, and it is 
only in great wars, like that which convulsed the North American Conti- 
nent, 1861-1865, that its effects are manifested in the great increase of 
secondary haemorrhage, pyaemia, foul sloughing, gangrenous wounds and 
ulcers, and haemorrhagic and petechial fevers. 
As these different affections are the external manifestations of the inter- 
nal condition of the blood, it must be admitted that in consequence of the 
change in the nature of the influences, which receives before the solids the 
impression of the greater part of these influences, must present changes in 
its constitution proportioned to those undergone by the agents which oper- 
ate upon it. It would appear then, that in former times a peculiar consti- 
tution of the blood engendered maladies, which in certain respects may have 
differed from those now observed, and may not have required the same 
treatment. In weighing such facts, Andral has well observed, that thus it 
is, that at different periods of the existence of the human race, and through 
the diversity of influences to which it may be subjected, diseases of very 
different types may arise and undergo changes in their essential nature 
which are revealed to the physician by the specific character of their symp- 
toms. And this is one amongst many reasons why, according to the times. Causes of Hemorrhagic Fevers in Different Countries. 
515 
some theories may be received with peculiar favor, and explains how the 
development of these theories must be favored by the very nature of the 
facts observed. 
Surgeon James Ranald Martin,* F. R. S., etc., has given in his great 
work on the " Influence of Tropical Climates on European Constitutions," 
the following valuable illustration of the change in the type of the remit- 
tent fever of Bengal, which places in an equally clear light with the obser- 
vations of Huxham, Andral and others the effects of salt diet, crowding 
and other sanitary neglects upon the nature and effects of the malarial 
poison: 
The remittent fever of Bengal has been long known to and carefully described 
by the British writers of the East. Some of the old observers termed it putrid 
intestinal remitting and putrid remitting marsh fever, perhaps without being 
sufficiently aware, that in those days, owing to the salt diet, crowding ana other 
sanitary neglect in their long voyages, a general scorbutic taint existed amongst the 
newly arrived, Europeans especially. Since then, under the various designations 
of jungle, hill, terrace, bilious remittent, marsh remittent, or malarious fever, it has 
been described by more modern writers : Robert Jackson terms it gastric, or bilious 
remittent, and describes it as a fever belonging to all countries, but as endemic in 
the West Indies at all seasons of the year. Though common to all countries, and 
observed occasionally at all seasons of the year, he justly adds that it prevails more 
generally in warm countries, on extensive alluvial plains, and the autumnal season. 
Remittent fevers will be found almost everywhere throughout the East Indies, 
varying in their intensities and in their complications, as they may occur in the 
deltas, along the marshy banks, or in the embouchures of rivers; in the plains 
extending from the basis of mountain ranges, termed terraces; in partially inunda- 
ted or irrigated lands, or in such as are traversed by percolating streams, or by 
canals ; in wooded districts termed jungles ; or in certain hilly districts. The sea- 
board, especially when there is jungle or salt marsh, and the adjacent island when 
of a jungly or marshy nature, are peculiarly pestilential; and so are often found the 
drying up marshes, and the drying up of beds of rivers. 
The British army has often been fever stricken, and occasionally destroyed, in 
low dry looking plains, such as those of Walcheren and of Rosendaal; in the ele- 
vated, rocky and dry-looking countries, and in the half dried water courses of Por- 
tugal ; on the plains of Spain, along the courses of the Gaudiana ; but everywhere, 
there was water to within a few inches of the surface; the rivers were always " half 
dried," and the Guadiana itself consisted of but " lines of detached pools." Whether 
on the coast of Kent, about Dungeness, " during the hot summer and autumn of 
1807," or in the West India Islands, the same topographical conditions were found 
to exist by William Fergusson ; there was generally the presence of actual marsh, 
or damp ; and always the antecedents of heavy rain, or of *' flooding, in the rainy 
season." " The fevers of Cadiz, Carthagena, Gibraltar, and Zealand," says Dr. 
James Robinson, " may compete in respect to virulence and fatality, with those of 
Batavia. Bengal, St. Domingo, and Philadelphia." Varying somewhat in type 
and in complication, each depending on locality, on constitution, and on habit of 
life, the essential characters of the remittent fevers are still everywhere the same; 
and whether as cause or effect, this disease has much to do with almost all the 
derangements of health of Europeans in the East. It is also by far the most preva- 
lent of Indian endemic diseases ; and on the right understanding of its movements, 
peculiar nature, complications, and just treatment, will always, and in a great 
measure depend the usefulness of the Indian medical officer. 
According to a table furnished to me by Colonel Tulloch, out of an aggregate 
European force of 25,431 men, of her Majesty's army serving in periods of eight 
and ten years respectively, between 1823 and 1836, in the stations of Calcutta, 
Chinsurah and Buhampew, all in Bengal proper, 13,596 cases of fever, remittent, 
intermittent and continued, occurred. Whereas, out of the same aggregate force, 
8499 cases of dysentery and diarrhoea occurred, thus establishing the far greater 
prevalence of the malarious fevers over diseases of the bowels. In the history of 
the remittent fever of Bengal during the last hundred years, the first observation 
* The Influence of Tropical Climates on European Constitutions, including practical obser- 
vations on the nature and treatment of the diseases of Europeans, on their return from tropical 
climates. By James Ranald Martin, F. R. S., Surgeon Bengal Army, retired, etc. New edition. 
London, 1856: pp. 140-145. 516 
Causes of Haemorrhagic Fevers in Different Countries. 
that presents itself is the great difference as to its intensity in the present as 
compared to former times; and, secondly, the causes of this difference. The earliest 
accounts we possess of the state of public health and of the season of greatest 
mortality in Calcutta, is that of Captain Hamilton (1688-1723), wherein he mentions 
460 burials out of 1200 British inhabitants, from August to the ensuing January. 
Of Major Kilpatrick's detachment of 240 men, mostly Europeans, stationed at 
Fultah, Ives tells us that not thirty of the whole were left alive between August and 
December, 1756, by one of these epidemics. He adds that the number of men 
buried in Bengal amounted to more than half of all who died in the several hospi- 
tals in India during the whole term of Amiral Watson's command, a period of three 
years and one month. Dr. Bogue, who also served in Watson's fleet, says that out 
of three ships of the line and a twenty-gun ship, and these not full manned, we 
lost in six months upwards of 200 men, thirty of whom died of this fever. 
Dr. James Lind was surgeon of the Drake Indiaman, and writes of the fever 
which raged in Bengal in the year 1762, and which he terms putrid and remitting 
marsh fever. This fever raged more or less in different places, according as the 
soil was more or less swampy, and became so violent during the rainy season 
especially, as to end in death during the third fit, which is generally the case. 
Others, he says, were exposed to the danger of dying at every fit, and' when the 
disorder continued for any time without a change, it generally ended in death; 
while the weather grew hotter, it sometimes in the space of a few days from a 
common fever became an intermittent one, and the patient recovered, unless his 
liver, which was sometimes the case, happened to be affected. Staverenas, the 
Dutch naval commander, speaking of "the sort of sickness or fever," which pre- 
vailed amongst the European inhabitants of Calcutta, during his visit to that city 
in 1766-71, says that it "generally sweeps away those who are attacked by it in the 
space of three days." 
Dr. John Clark, who visited Calcutta between 1768 and 1771, says that "the fever 
and flux were very fatal in the former year." Of the fever, he states that "it fre- 
quently carries off the patient in twelve hours." * * "During the sickly season 
in Bengal, the uncertainty of life is so great that it frequently happens that one 
may leave a friend at night in perfect health who shall not survive the following 
day. There have been several melancholy instances of persons who have returned 
home in a state of perfect health, from performing the last duties to a deceased 
friend, and have next day been numbered with the dead." The same authority 
records that out of 189 cases treated in ships travelling to the various ports in the 
East, 105 recovered and 84 died. Again, "out of 876, the complement of men 
belonging to eightships, seventy-eight died in Bengal, and fifty-five at sea, or nearly 
one jn six. Both the fever and flux, if obstinate, have an equal tendency to 
terminate in abdominal obstructions, particularly in fatal swelling and suppuration 
of the liver." From this truthful record, and looking to the sanitary condition of 
the sufferers and to the result of the treatment by bark, we are constrained to 
infer that the ultimate recoveries must have been few, out of all who were the 
subjects of the fever or flux. 
Mr. Magennis states that in 1784, out of a crew of his ship, the Valentine and 
six others stationed at Khidgeree, there died of fever and dysentery 170 men ; the 
usual period of their stay in the Hoogley being from August to January. Curtis 
writes that about the same time, out of two companies of the Ninety-eighth and 
One Hundredth Regiments embarked in England for India, there died during a suf- 
fering and tedious passage of exactly eleven months, seventy-five men, forty of them 
being from fever, eighteen from dysentery and the remainder from scurvy and 
cachexy. It was on this occasion that the second batallion of the Forty-second 
Regiment alone suffered a loss by the time it lauded in Calcutta, of five officers and 
116 men, all from fevers, bowel complaints and the scurvy. It would appear that 
the unfortunate companies referred to by Curtis had some occasional fillings up 
from the other ships as the numbers decreased ; but making allowance for this 
circumstance, the loss of life was horrible, especially when we reflect that each ship 
in a fleet shared a like mortality. 
The ships, were in the language of Clere, crammed with soldiers, so that along 
with salt rations, there was crowding and consequent filth and want of ventilation, 
making altogether a combination of the most unfavorable circumstances to the 
soldiers' health. That a scorbutic taint was very general in these times, may, I 
think, be admitted; and this circumstance will account for the general term 
putrid, as applied by the older writers, to the endemic fevers and dysenteries. This 
unfavorable complication will go far also to account for the enormous mortality. 
Curtis states that in the opeu, well ventilated Naval Hospital at Madras, contaiu- History of Hemorrhagic Malarial Fever. 
517 
ing from 400 to 500 men, the great bulk of the cases were ulcers; indeed, he constantly 
refers to the scorbutic taint, as prevalent amongst both soldiers and seamen, a 
fact almost entirely overlooked by modern writers when treating of the earlier 
results of treatment in tropical diseases. 
Dr. James Lind, in his excellent treatise on Putrid and Remittent Marsh Fever 
of Bengal in 1762, refers expressly to the prevalence of scurvy amomzst the crews 
of all the ships off Calcutta. So recently indeed as the beginning of the present 
century, Janies Johnson states that in the small portion of the river running 
between Calcutta and Khidgeree, full 300European seamen, or more than a fourth 
of the ships' crews, fell annually victims to the ravages of remittent fever. But 
happily we have no longer to record any such fearful ravages by endemic diseases 
in the capitol of the East; neither do such sweeping epidemics as that recorded by 
Clark in 1770, with its cold stage of twelve hours, occur, carrying off 80,000 natives 
and 1500 Europeans. Such pestilences seem to have gone from us; and we find 
that here, as in the Western Hemisphere, the malignant fevers of former days, if 
they have not disappeared, are at least mitigated. Even in Jamaica, although 
severe epidemic fevers sometimes occur, they do not now as formerly destroy its 
white inhabitants once in five years. 
With all the advantages of modern medical science no one could, even now, 
pretend to any very great success in the cure of Europeans suffering at once from 
the united influences of the marsh poison and of the blood depraved beforehand 
by a salt diet, and by crowding in ships and barracks; the seamen and soldiers 
were destroyed by fever and dysentery within a few hours of their admission into 
the hospital. Such men were in truth almost beyond any and all medical means 
of cure; no amount of cinchona could have cured them; but very easily devised 
and very obvious means of prevention might have preserved them in health. 
The causes of the present comparative improvement in public health must be of 
the highest interest and importance, especially to communities living within the 
tropics; and, with all just confidence in modern medicine, guided by the lights of 
an improved physiology, and those also of pathology, I cannot yet agree with 
those who would ascribe the whole of the difference here spoken of to superior 
modes of medical treatment, great as these confessedly are. It is not through 
modern improvements in the treatment of disease, as contrasted with the older 
modes, that public health has been so much amended, as through the great meas- 
ures of prevention of disease consequent on the progress of improvement of locali- 
ties, institutions of police, etc. It is to the preservative power of knowledge, to 
the reciprocal actions of the social state, and of political events upon each other, 
and upon medical science, that the advancement of public health is most indebted; 
and so it will continue to be, although these circumstances are not sufficiently 
weighed by some of us when, in our hurry to praise ourselves, we forget what is 
due to our predecessors of old, and that these last had frequently to treat a violent 
and complicated form of disease which we have never seen, and with whose fatal 
severity we are consequently unacquainted. It is justly observed by a popular 
writer, that there were never any specifics discovered against the plague, the 
sweating sickness, or the leprosy; and yet the leprosy, the sweating sickness and 
the plague are now among the things unknown to us. They disappeared not before 
any marvels of medicine or any perfection of chemical science, but before the 
gradual amelioration of our condition through sanitary improvements.-The influ- 
ence of Tropical Climates on European Constitutions, etc. By James Ranald 
Martin, F. R. S., etc. London : 1856, pp. 140-145. 
Malignant intermittent and remittent fevers, accompanied with vomit- 
ing of black bile, with petechise and with haemorrhages, have from time 
immemorial been frequent and fatal in the warm marshy countries border- 
ing on the Mediterranean and Black Seas. In some parts of Italy, and in 
other tracts of the same latitude, these fevers have appeared with such 
dangerous and putrid symptoms as not only to have been called pestilential, 
but were even confounded with the plague itself. The more frequent refer- 
ence to one form of this disease (malarial hsematuria) by modern writers, 
is due rather to the employment of the microscope and chemical agents in 
testing the urine, than to any actual increase in the number of the cases of 
this disease which, in certain latitudes, has afflicted mankind from the 
earliest ages. 
HISTORY OF HEMORRHAGIC MALARIAL FEVER. 518 
History of Haemorrhagic Malarial Fever. 
Although Hippocrates omits the discussion of many subjects of import- 
ance, as sphygmology* and contagion, on the other hand he made most 
important observations on the state of the urine in fevers, and especially at 
the epoch of the crisis in fevers. It is certainly remarkable that the obser- 
vations of Hippocrates on the state of the urine in febrile diseases, and 
with reference to certain critical deposits occurring at certain definite 
periods or changes in diseases, should until a comparatively recent period 
have been lost sight of in this age when the chemical characters of the 
urine have been so much studied. In section second, of constitution 
second, of the First Book on Epidemics, Hippocrates states that during 
autumn, and at the commencement of winter, of all the fevers which 
attacked great numbers: 
The ardent fevers attacked the smallest numbers, and the patients suffered the 
least from them, for there were no haemorrhages, except a few and to a small 
amount, nor was there delirium. * * The tertians were more numerous than the 
ardent fevers, and attended with more pain; but those all had four periods in regu- 
lar succession from the first attack, and they had a complete crisis in seven, with- 
out a relapse in any instance. The quartans attacked many at first, in the form of 
regular quartans, but in no few cases a transition from other fevers and diseases 
into quartans took place, they were protracted, as is wont with them, indeed, more 
so than usual. Quotidian, nocturnal, and wandering fevers attacked many per- 
sons, some of whom continued to keep up, and others were confined to bed. In 
most instances these fevers were prolonged under the Pleiades and till winter. 
Many persons and especially children, had convulsions from the commence- 
ment. * * * 
Persons died of all these diseases, but mostly of these fevers, and especially 
infants just weaned, and older children, until eight or ten years of age, and those 
before puberty. * * The only favorable symptom, and the greatest of those 
which occurred, and which saved most of those who were in the greatest 
danger, was the conversion of it to a strangury, and when in addition to this 
abscesses were formed. * * With regard to the strangury itself, the symptoms 
were protracted and painful; their urine was copious, thick, of various characters, 
red mixed with pus and was passed with pain. * * With regard to the dangers 
of these cases, one must always attend to the seasonable concoction of all the evacu- 
ations, and to the favorable and critical abscesses. The concoctions indicate a 
speedy crisis and recovery of health; crude and undigested evacuations, and those 
which are converted into hard abscesses, indicate either want of crisis, or pains, or 
prolongation of the disease, or death or relapses; which of these it is to be deter- 
mined from other circumstances. 
The physician must be able to tell the antecedents, know the present, and foretell 
the future-must meditate these things, and have two special objects in view with 
regard to diseases, namely, to do good, or to do no harm. The art consists in three 
things-the disease, the patient aud the physician. The physician is the servant of 
the art, and the patient must combat the disease along with the physician. 
The preceding extract indicates in a clear manner the accuracy with 
which Hippocrates observed the changes of the urine in fevers; and the 
following observation recorded in the third constitution of the First Book 
on Epidemics, clearly relates to malignant malarial or congestive fevers, 
attended in certain cases with scant black urine, as in the malarial htema- 
turia of the present day. 
About the equinox, and until the season of the Pleiades, and at the approach 
of winter, many ardent fevers set in; but great numbers at that season were seized 
with phrenitis, and many died; a few cases also occurred during the summer, 
't hese then made their attack at the commencement of the ardent fevers, which 
* Galen declares that Hippocrates paid no attention to the characters of the arterial pulse, 
and that thesubject was not at all studied until after his time. Herophilus appears to have been 
the first observer that made any progress in this study. That Hippocrates should omit all allu- 
sion to the subject of contagion, appears remarkable, as the contagiousness of certain diseases, 
as the plague, was held by his contemporary, Thucydides, and appears to have been the popular 
belief of his age. History of Hemorrhagic Malarial Fever. 
519 
were attended with fatal symptoms; for immediately upon their setting in, there 
were acute fevers and small rigors, insomnolency, aberration, thirst, nausea, insig- 
nificant sweats about the forehead and clavicles, but no general perspiration; they 
had much delirious talking, fears, despondency, great coldness of the extremities, 
io the feet, but more especially in the hands; the paroxysms were in the even days; 
and in most cases on the fourth day the most violent pains set in, with sweats, gen- 
erally coldish, and the extremities could not be warmed, but were livid and rather 
cold, and they had then no thirst; in them the urine was black, scanty, thin, and 
the bowels were constipated; there was an haemorrhage from the nose in no case 
in which these symptoms occurred, but merely a trifling epistaxis, and none of 
them had a relapse, but they died on the sixth day with sweats. 
Hippocrates has thus given a most striking account of malarial or par- 
oxysmal fever in the warm climate of Greece, running its course unchecked 
by such remedies as are now known to moderns, as the preparation of 
Peruvian bark. Hippocrates records several cases of paroxysmal fever in 
which the urine was black, and the following observations will sustain the 
view that he was not unacquainted with the so-called malarial hsematuria 
of the present day. 
"Philiscus, who lived by the Wall, took to bed on the first day of acute fever : 
he sweated ; towards night was uneasy. On the second day all the symptoms were 
■exacerbated; late in the evening had a proper stool from a small clyster, the night 
quiet. On the third day, early in the morning and until noon, he appeared to be 
free from fever; towards evening acute fever, with sweating, thirst, tongue parched; 
passed black urine ; night uncomfortable, no sleep; he was delirious on all subjects. 
<)n the fourth, all the symptoms exacerbated, urine black ; night more comfort- 
able, urine of a better color. On the fifth almost mid-day, had a slight trickling of 
pure blood from the nose ; urine varied in character, having floating in it round 
bodies, resembling semen, and scattered, but which did not fall to the bottom; a 
suppository having been applied, some scanty matter was passed ; night uncom- 
fortable, little sleep, talking incoherently; extremities altogether cold, and could 
not be warmed ; urine black ; slept a little towards day ; loss of speech, cold sweats ; 
extremities livid ; about the middle of the sixth day he died. The respiration 
throughout like that of a person recollecting himself, was rare and large ; the spleen 
was swelled up in a round tumor, the sweats cold throughout, the paroxysm in the 
even day." 
In the preceding case the fever had regular exacerbations on the even 
day and slight remissions on the uneven; the spleen was enlarged, the 
extremities livid and covered with cold sweat, the urine black, and the res- 
pirations were rare or few in number, and the patient seemed like a person 
who forgot for a time the besoin de respirer, and then, as it were, suddenly 
recollecting himself. 
Galen, in his commentary, remarks that the fatal issue of this case 
might have been anticipated after the return of the fever on the third day, 
with a complication of bad symptoms, such as great thirst, dry tongue, 
black urine, delirium, coldness of the extremities, and so forth. 
Cholera morbus and dysenteric discharges in malarial fever constitut- 
ing the li hepatic or atrabiliary state of the malignant intermittent'1 of Alibert, 
has been forcibly described in the epidemics of Hippocrates. Although 
this variety has been observed to occur in individuals of robust constitu- 
tions, who have survived its attacks, yet it is to be considered as a disease 
for the most part mortal, unless the ablest medical assistance be procured 
at its very commencement. The predominant symptom is a copious and 
frequent discharge from the bowels of a matter resembling the washings of 
raw flesh, and denominated by the ancients the hepatic flux. At its first 
onset, this disease produces apparently no great inconvenience to the 
patient, but in a short time it prostrates the strength to an extreme degree. 
The pulse becomes small and feeble ; the voice is sharp, and at times is 
entirely suppressed. There is a remarkable coldness of the body and 520 
History of Hemorrhagic Malarial Fever. 
extremities. The patient has such a tendency to syncope that he is unable 
to sit erect in bed. The intellectual functions remain notwithstanding 
unimpared. Sometimes the matter discharged from the bowels is a black- 
ish colored blood, liquid or solid, half coagulated, or half dissolved. If the 
discharge, so often spoken of by Hippocrates, and vulgarly denominated 
atrabiliary, be excessive, it is soon accompanied by the most alarming 
symptoms, such as an obliteration of the pulse, coldness and lividity of the 
bowels, and the facies hippocratica. 
Areteeus, the Cappadocian, in his work on the "Causesand Symptoms 
of Chronic Diseases," says with reference to the kidneys, that- 
Many and complicated diseases are formed, partly acute, proving fatal by 
haemorrhage, fever and inflammation, but partly chronic, wearing out the patient 
by wasting, and although not of a fatal character, incurable and persisting until 
death. 
He also affirms that- 
Certain persons pass bloody urine periodically; this affection resembles that 
from hemorrhoids, and the constitution of the body is alike; they are very pale, 
inert, sluggish, without appetite, without digestion ; and if the discharge has taken 
place, they are languid and relaxed in their limbs, but light and agile in the head. 
But if thejperiodical evacuations do not take place, they are affected with headache; 
their eyes become dull, dim and rolling, hence may become epileptic; others are 
swollen, misty, dropsical; and others again are affected with melancholy and 
paralysis. These complaints are the offspring of the stoppage of a customary 
discharge of blood. If, then, the blood flow pure and unmixed with urine, for the 
most part the blood of the urine flows from the bladder. Sometimes it is dis- 
charged in great quantity from rupture of the kidneys ; sometimes it is coagulated 
and a thrombus is formed of extravasated blood ; sometimes it is coagulated in the 
bladder, when dreadful ischuria comes on. 
Celsus affirmed that the bilious and malignant fever is the disease of 
the latter part of the summer and of autumu, when the air is thickest and 
most foggy, and that it is most frequent in low and marshy countries.-Cels, 
de Medecine, lib. 1, cap. x, lib. iii, cap. viii. 
Cornelius Celsus, in his work on medicine, alludes to the presence of 
blood in the urine excreted during severe fevers as portending danger and 
a fatal termination. This author, as well as Aretfeus and many others, 
clearly distinguished between the haemorrhages from the kidneys and blad- 
der, and appears to have been fully informed as to the effects of calculi in 
the kidney inducing various effects, as bloody urine. 
Paulus JEgineta says : 
That the kidneys often getting into a relaxed state cannot retain the urine, but 
becoming dilated they allow the blood and other thick matters to escape from the 
veins. The kidneys often discharge blood periodically like hemorrhoides. and 
when evacuated they are relieved, in which cases we must not rashly interfere if the 
bleeding immediately stops; but if it continue, we must bleed in the arm, and use 
for haemorrhage of the kidneys and bladder those remedies which are recommended 
for hemoptysis and other haemorrhages; and more especially we must give the 
root of comfrey and tragacanth macerated in wine, the juice of knotgrass and plan- 
tin with oxycrate, or bitter almonds with must, or this medicine : Of fissile alum, 
dr. j ; of tragacanth, dr. ij ; of gum oboli, v; with must, And we must apply a 
cataplasm of raw barley meal with oxy crate or rose-oil, or that from dates, and 
bread of siligo acacia, or hypocistis boiled in an astringent wine or oxycrate. In 
haemorrhages from the bladder, we must apply cupping instruments to the loins 
and ischium ; and we must ascertain the part from which the blood flows by the 
pain in the place, and whether the blood be mixed with the urine or no, as was said 
with regard to pus. If there be coagulated blood in the bladder (which you may 
know from the flow of urine being suddenly stopped after a discharge of bloody 
urine, and from certain clots of bloody fluids being probably passed), give the 
decoction of mugwort to drink and the seed of shrubby-everlasting, of fleabane. History of Hcemorrhagie Malarial Fever. 
521 
or of radish, or the juice or laserwort, or the cyrenaic juice, or the juice of parsley, 
each mixed with vinegar, or the rennet of a hare, or of a hind, or of a kid, in oxy- 
mel, or strained lye with oil, and externally sponges out of hot salt water, or 
strained lye must be applied. But if they are not dissolved, we must make an 
incision in the perineum, as in the cases of calculus ; and having removed the clots 
of blood accomplish the cure in the proper manner.-Book iii, section iii, xlv. 
Rufus, one of the oldest writers on diseases of the kidneys, who lived 
according to Suidas, in the days of Trajan, so that he was prior to Galen, 
and perhaps to Aretaeus and Cadius Aurelianus, thus details the symptoms 
of inflammation of the kidneys. 
Pains below the loins, so that the patient cannot stand erect nor walk, but is 
obliged to lie upon his back, which position affords him most relief; the pains 
extending to the bladder and testicles; the extremities cold, more especially the 
legs and feet; frequent and painful desire to make urine, which is at first thin and 
watery, but afterwards becomes redder. 
Theophilus, Actuarius, and many other ancient writers on medicine 
in addition to those quoted above, described with surprising minuteness 
the deposits in the urine, including every imaginary shade of color; and 
connected these changes with the morbid conditions of the system which 
gave rise to them. 
Rome was often afflicted with malignant malarial fevers, and Galen 
calls the hemitritce, the epidemic of that city, and speaks of its moist air (de 
temperam, let ii.). In the beginning of the Republic, before the Romans 
seem to have been aware of the noxious effects of stagnating water, or at 
least before they had perfected the arrangements fordraining the marshes, 
and stagnant pools : Rome appears to have been so sickly, that from the be- 
ginning of the State to the year U. C. -159, fifteen plagues are mentioned by 
Livy, which from various circumstances, appear to have been only so many 
malignant and destructive epidemics, occasioned by the putrid effluvia 
from the neighboring marshes. When drains and common sewers were 
made and the Pontine marshes drained, Rome became more healthful, and 
then only the lower and marshy places of Latium remained sickly. When 
the city fell into the hands of the Goths, the drains being stopped and the 
acqueducts cut, the Roman territory became one continued marsh, and for 
a series of years malignant malarial fevers occasioned incredible destruc- 
tion. Though these evils have since been partially remedied, yet still by 
neglecting to draw off the stagnating and corrupted water (after inunda- 
tions by the Tiber, succeeded by great heats), the malignant remitting and 
intermitting fevers became both general and fatal. The malignant and so- 
called putrid nature of these fevers has been well shown by Lancisius in 
his dissections and in his excellent account of these epidemics (De Nox 
Palud Effleo, lib. ii. epid i, cap. vi). 
Prosper Alpiuus observes that the pestilential fevers are both epi- 
demic and fatal at Alexandria in autumn after the recess of the Nile. They 
begin with a nausea, great sickness at the stomach, extraordinary inquiet- 
ude, and a vomiting of acrid bile, and many have bilious and putrid stools. 
That the hmmaturia, as a symptom in certain fevers was carefully noted 
by the older writers, is evident from the following description of the appear- 
ance of the urine of exanthematous typhus, by Burserius (Institutes, 
vol. iii): 
At first it is at one time thin and watery ; at another time natural, and exhi- 
bits a globular, unequal palish cloud floating in it. Sometime also, at the beginning 
it is whitish but copious; shortly after it grows confused like pomegranate wine, 
or yellowish, thick, turbid, and deposits a sediment. It sometimes likewise grows 
black, as if it were mixed with soot, or turns red, being slightly tinged with blood. 522 
History of Hcemorrhagic Malarial Fever. 
Sometimes during the increase and at the height of the complaint, it is nearly sup- 
pressed, which must be considered as a fatal symptom, unless it quickly comes off 
thick, and deposits a sediment. Trollius, in his patients, always found it proper 
in quantity, seldom thin and pellucid, but generally free of sediment; sometimes 
of a dusky red, but never concocted or having a proper sediment. Pinaroli, how- 
ever, found the urine, in the first days of the complaint, pale, clear and scanty; 
during its increase, somewhat red and confused ; at its decline, turbid, and thick, 
but not uniformly so." 
We cannot fail to recognize the congestive and pernicious fevers in these 
various manifestations, with coma, convulsions, suppression of urine, con- 
gestion of various organs, as the lungs, kidneys, brain, liver and spleen, 
and haemorrhages from the bowels and kidneys, in the descriptions of Senac, 
Lancisi, Ramazzini, Lautter, Torti, Tissot, Cleghorn, Sarcone and others. 
Lancisi, in his account of the malignant tertian that prevailed in many 
parts of Rome in the year 1695 (De Nox Palud Effluv, lib. 2), says : 
That on the fifth day the disease inclined towards a continued type; on the 
seventh or eleventh the patient died; they seldom lived till the fourteenth day, 
unless where the disease was converted occasionally into a chronic fever or into a 
dysentery, which in that case continued during the whole autumn, or even during 
the winter. The countenances of those attacked became at first yellow; the sick 
experienced a disrelish for food, and dull pains in the head ; these were followed 
by a severe chill and a discharge from the stomach of a watery fluid mixed with 
vitiated bile of different colors. Oftentimes, after two paroxysms, accompanied by 
profuse sweats, the fever was marked by such a remission, that the sick consider- 
ing themselves out of danger, not only rose from bed on the fourth day, but began 
to walk abroad. During this time, however, the urine was saffron-colored, thick 
and turbid. On the fifth day the fever returned, with great anxiety about the 
prsecordia, which completely developed its malignantcharacter; the tongue, besides, 
was dry and dark colored, the pulse varied ; it was oftentimes small and unequal. 
The limbs having become cold were agitated with convulsive motions; there were 
livid blotches on the skin, the face cadaverous, frequent fainting fits, delirium, 
abdomen tense and tumifled; stools foetid and consisting of dark colored bile, often- 
times mixed with blood, and containing dead worms at the commencement of the 
disease; at length came on great drowsiness, cold sweats, limpid urine and swell- 
ings of the parotids. The patient sunk on the seventh or ninth day. Until the 
proper remedy for the disease was discovered they seldom survived till the tw'elfth 
day. 
On opening the dead bodies Lancisi found great ravages in the vis- 
cera of the abdomen, which were almost all livid; the liver was of a very 
dark brown; the cystic bile was black; the intestines sphacelated in vari- 
ous parts, contained excrements extremely foetid, and a great quantity of 
worms. 
Lancisi also described a second epidemic prevalence of malignant 
intermittents, which lasted for several years, which put on the tertian 
type, were ushered in by a cold fit or a profuse sweat, accompanied with 
bilious vomitings, copious evacuations by stool, pain in the head and 
loins, cardalgia, tension of the hypocondriac regions and lower part of the 
abdomen. Although these fevers pursued nearly the same course, the 
heat increased and the sweat diminished; the debility became at' length so 
great that the patient, growing colder all over, died on the fifth or seventh 
day. 
With these epidemic constitutions of Lancisi may be classed that 
which prevailed at Turin in 1720, and of which Riche (Thom. Sydenh, op. 
tom. ii., fol. 38,) has given a description. Some of the sick were afflicted 
with excruciating pains in the head; others complained of burning heats 
and lassitude throughout the whole body; some were tormented by thirst, 
and distressed by a constant want of sleep; many were overwhelmed by 
a deep and unconquerable drowsiness; an eruption of the petechim made History of Haemorrhagic Malarial Fever. 
523 
its appearance on the fourth or seventh day; and in some cases copious 
stools of black grumous blood were discharged. 
Ramazzini mentious having seen at Modena malign ?nt tertian fevers, 
which prevailed with the greatest violence-towards the fourth or fifth 
paroxysm the cold fit was so intense that the patients never became warm 
again: the 'whole body was like ice; the pulse was incapable of expanding, 
and death soon closed the scene. 
Lautter in describing the malignant intermittent, which prevailed in 
Luxembourg in 1759 and 1760, says that the fevers of the first year were 
peculiarly acute and inflammatory, and those of the second highly putrid 
and malignant; they all resembled each other in their most essential char- 
acteristic. that is, they were intermittent, and yielded only to the action 
of bark. The unfavorable symptoms which accompanied these fevers 
were great anxiety about the prtecordia, a painful oppression of the breast, 
a continued and very troublesome nausea, a laborious rejection of yellow 
green bile, a vomiting of grumous blood, violent hysterical and convul- 
sive motions, a vehement cardalgia, which brought on faintness and at 
length true syncope. All these symptoms increased and diminished with 
the paroxysms. 
Alibert has described the malignant malarial fevers 'which prevailed 
at Pitkivius, in the department of Loiret, in the year x, and M. Boullon 
those which ravaged the environs of Abbeville, in the years viii, ix, x and 
xi. of the French Republic. LeRoy observes that choleraic tertians were 
epidemic at Montpelier in the autumn of 1765 (Memoires sur les fievres 
aigues), and Sydenham hasalsotaken notice of epidemic constitutions, when 
intermittents with cephalalgic affections predominated (Epist. at Rob. 
Brady); Thomas Bartholni (Hist. Anat. rar. Cent, ii; Hist. Ivi,) says that the 
epidemic which prevailed at Copenhagen in 1652, was characterized by 
delirium and excruciating cephalalgic affections and petechial blotches 
which appeared during each paroxysm and disappeared during the inter- 
mission, also debilitating diarrhoae; and Sylvius de Leboe, in his account of a 
similar fever which raged at Lyden in 1669, makes mention of livid blotches 
on the skin, haemorrhages from the nose, and hiemorrhoidal veins, and 
foetid urine (Prax. med. append, tract x). George Cleghorn has described 
many of the forms assumed by paroxysmal fevers, and says that the 
utmost danger is to be apprehended- 
If black matter, like the grounds of coffee, is discharged upwards or down- 
wards ; if the urine is of a dark hue and of a strong, offensive smell; if the whole 
skin is tinged with a deep yellow, or anywhere discolored with livid spots or suf- 
fusions; if a cadaverous smell is perceptible about the patient's bed ; if in the time 
of the fit he continues cold and chilly, without being able to recover heat; or if 
he becomes extremely hot. speechless and stupid; has frequent sighs, groans, or 
hiccoughs, and lies constantly on his back, with a ghastly countenance, his eyes 
half shut, his mouth open, his belly swelled to an enormous size, with an obstinate 
costiveness, or an involuntary discharge of the excrements.* 
Torti is one of the first who ventured to deviate from the established 
custom of purging and bleeding, previously to the exhibition of the bark, 
and Grant judiciously remarks that every fever accompanied with parox- 
ysms ought to be arrested in its course as soon as it manifests the smallest 
signs of malignity. 
Lind also insisted upon this mode of practice, in consequence of hav- 
ing derived such important advantages from it in the destructive epidemics 
which prevailed in England in the years 1765, 1766 and 1767. He found 
* Observations on the Epidemical Diseases of Minorca from the year 1744 to 1749, by George 
Cleghorn, M. D., with notes by Benjamin Rush, M. D. Philadelphia, 1812: p. 1U1. 524 
History of Haemorrhagic Malarial Fever. 
from experience, in his own person and in the persons of two hundred 
patients, that as often as he succeeded in arresting the course of the fever 
by a prompt administration of the bark, its disappearance was attended 
by no bad consequences. But if on the contrary the use of the remedy 
was neglected or delayed, dropsy, jaundice, habitual headache, etc., inevit- 
ably succeeded. Lind observes that it is often necessary to administer the 
bark from the time of the first intermission. He speaks of some intermit- 
tents appearing with such violence in certain sickly parts of England as 
oftentimes to terminate fatally on the second paroxysm. Alibert also held 
that the most pressing indication is to arrest at once, by the free use of 
bark, the progress of the disease. 
Jean Senac, who flourished in the reign of Louis XV, and held the 
position of first physician to that monarch, not only describes with force, 
elegance and accuracy the various forms of malignant and non-malignant 
intermittents, and explains the causes of the haemorrhages characterizing 
these fevers, and dwells upon the deleterious effects of the bile retained in 
the blood, as dissolving the grosser (or red parts) of the blood and thus 
causing haemorrhages and anaemia ; but also thus records his observations 
on the characters of the urine in intermittent fever: 
The change in the humors appear also from the urine itself. During the feb- 
rile action that fluid is flame colored ; but as the paroxysm declines becoming 
thick, frothy and very red; it puts on at length a brick-dust color. This color 
appears in particular in the sediment, which is generally copious. This earthy 
sediment is apt to lodge and create a temporary obstruction in the vessels of the 
kidneys. 
This kind of urine belongs so peculiarly to intermitting fever, that, provided 
the disease be genuine, it is seldom wanting. Indeed there is no solid reason to 
believe that the system is free from the forms of the fever, while the urine retains 
its lateritious color, oris in any measure tinctured with red. This phenomenon does 
or can prove fallacious only in cases where the sick labor under some hepatic affec- 
tion. If at any time the urine should exhibit a white matter settling copiously to. 
the bottom of the vessel, this is to be considered as a favorable symptom, and even 
a sign of a crisis in the disease. I must confess however, that the phenomenon has 
but seldom fallen under my observation. In some intermitting fevers the urine 
does not assume a lateritious color. I allude particularly to certain vernal inter- 
mittents, or to those that change into continued or remitting fevers. Even in these, 
however, the urine does exhibit something of a lateritious appearance during their 
remission. At :hese times, when the secretory vessels of the kidneys are suffered 
to relax in consequence of an abatement of the febrile spasm, the grosser and red 
colored particles are allowed to escape. Whence it appears, that at the commence- 
ment of the disease, if it be very severe, the urine does not depart from its natural 
color, but assumes a red and lateritious cast when the symptom abates.* 
Dr. I. L. Alibert f in his treatise on Malignant Intermittents says, that: 
The state of the urine in malignant fevers demands great attention. Thus a 
diminution of that excretion, and its assuming a black color, are very alarming 
symptoms. M. Boullon, in his account of the epidemic of Abbeville, says that the 
sick were usually in very great danger, while their urine exhibited a membriform 
sediment of a mucous nature, forming a convex covering to a glairy matter placed 
beneath it. 
Malignant and haemorrhagic malarial fevers also prevail in Java lying 
between 5 and 10 degrees of south latitude, also in the southern and marshy 
portions of India, and in the British settlements on the Gold Coast of Gui- 
nea which are as near the line, on one side as Java is on the other. Numer- 
* De Recondita Febrium Intermitentium turn Remittentium Natura-et de carum curatione 
-Geneve, 1769. 
t A treatise on Malignant Intermittents. by I. L. Alibert, Physician to the Hospital of St. 
Louis, etc., Third Edition. Philadelphia., 1807, p. 156. History of Hcemorrhagic Malarial Fever. 
525 
ous authorities might be quoted also to show that in addition to yellow fever, 
the severest grades of malarial fever attended with incessant vomiting of 
dark bile and haemorrhages, have prevailed in the British, French, Span- 
ish and Portuguese settlements in Insular and Continental America. Dr. 
James Lind, states that Sardinia was formerly so remarkable for its 
unwholesome air, that the Bomans used to banish their criminals thither, 
and that it is at present thinly peopled, owing to the mortality occasioned 
by autumnal fever. (Diseases incident to Europeans in hot climate. Lou- 
don, 1768, p. 34.) With reference to the destructive effects of fevers in hot 
climates, Dr. James Lind has recorded the following striking observations: 
The recent example of the great mortality in hot climates ought to draw the 
attention of all the commercial nations in Europe towards the important object of 
preserving the health of their countrymen, whose business carries them beyond 
seas. It is found that sickly or unhealthy settlements require a constant supply of 
people, and, of course, drain their mother country of an incredible number of 
inhabitants, and some of these, too its most useful individuals. Of this the Span- 
ish dominions abroad have furnished us with striking proofs ; and even at this day, 
many Spanish merchants, adventurersand others, who yearly take their departure 
from Europe, die at Porto-Bello or Carthagena, soon after their landing. The Dutch 
settlements at Surinam, St. Eustatia and Curacoa, and in several places in India, 
have proved as fatal to the Hollanders, as the islands of Marti nico, St. Domingo, 
and lately the climate of Cayenne, have done to the French settlers. Great Britain 
itself, has its Jamaica, where the number of English sacrificed to the climate is 
hardly credible, and only to be guessed at, from the common computation, that this 
island buried to the amount of the whole number of its white inhabitants once in 
five years, until lately, that it has become more healthy. It is now a well known 
and 'most certain truth, that of such Europeans as have fallen victims to the tem- 
perature of foreign climates, nineteen in twenty, have been cutoff by fevers and 
fluxes ; these being the prevailing and most fatal maladies in unhealthy countries, 
in all parts of the world. In my Essay on Preserving Seamen (p. 49, 2d Ed.) I 
have said, that a malignant fever, of the remitting or intermitting kind, most fre- 
quently a double tertian, is the genuine product of heat and moisture, is the autum- 
nal fever of all hot countries, and is the epidemic disease between the tropics. To 
which I may add, that it is also the disease most fatal to Europeans in all hot and 
unhealthy climates.-[Diseases Incident to Europeans in Hot Climates, p. 9.] 
With reference to the diseases of the southern colonies of North Amer- 
ica, Dr. Lind adds : 
In the latitude of South Carolina we find these diseases much more obstinate, 
acute and violent. In that colony, especially during the growth of the rice, in the 
month of July and August, the fevers which attack strangers are very anomalous, 
not remitting or intermitting soon, but partaking of those distempers which are 
so fatal to the newly arrived Europeans in West I ndian climates. The same may 
be said of Georgia and East Florida during those two months ; as in West Indian 
islands.-[p. 37.] 
Dr. William Hillary, in his "Treatise on such diseases as are most 
frequent in, or are particular to. the West India Islands, or the Torrid Zone, 
says, with reference to to the ''putrid bilious fever, commonly called the 
yellow fever 
I mentioned haemorrhages before, for in the latter stage of this fever, the blood is 
so attenuated and dissolved, that we frequently see it flowing, not only out of the 
nose and mouth, but from the eyes, and even through the very pores of the skin ; 
also great quantities of black, half baked, or half mortified blood is frequently 
voided, both by vomiting and by stool, with great quantities of yellow and black 
putrid bile, by the same ways; and the urine, which was before of a high icteri- 
cious color, is now almost black, and is frequently mixed with a quantity of half- 
dissolved blood.-[Phald. 1811, p. 111.] 
In a work published in 1845, ''On the climate and maladies of Brazil," 
M. Sigaud mentions an epidemic disease attended with the discharge of 
bloody urine, and for which the best treatment was found to be generous 
diet, with a combination of iron and quinine. 526 
History of Hoemorrhagic Malarial Fever. 
Dr. R. B. Todd, in a clinical lecture, published January 19, 1849, in 
the London Medical Gazette, says: 
A state of general cachexia, such as occurs in scurvy, may bring on hfematu- 
ria; or such as results from an anguish state, brought on by the malaria of marshy 
districts. Nothing is more prejudicial to haematosis, or the healthy elaboration of 
the blood than the influence of the paludal poison. 
In his clinical lectures Dr. R. B. Todd records three cases of haematu- 
ria, in one of which the haemorrhages were accompanied with rheumatic 
fever, and severe pericarditis ; the second case was one of catarrhal haema- 
turia, which appeared in a laborer, aged 40 years, during a depressed state 
of health, attended with abscesses in the axilla, and was probably induced 
by exposure to cold ; the third case was that of a boy, who was laboring 
under dropsy, after scarlet fever. 
That the haemorrhagic form of malarial fever is not unknown in the 
East Indies, is evident from the following statement by Dr. McLean : 
Of the symptoms, nausea and vomiting are the most constant, and the most 
exhausting; the vomited matters at first consist of any food that may be in the 
stomach, then of a watery fluid, often in a surprising quantity. Soon bilious 
regurgitation takes place, and the rejected matters become of a greenish yellow 
color, then brown, and finally in extreme cases, black, resembling the vomit of 
yellow fever. The resemblance will be more striking if, as sometimes happens, 
the skin assumes a yellow tinge and haemorrhagic tendency be evinced. I have 
seen two cases at Madras, both in officers of the Forest Conservancy Department, 
in which the haemorrhagic range was most extensive, the patient passing blood 
from the stomach, bowets and kidneys. 
Dr. McLean states that he has notes of three other cases, in which the 
urine was bloody. He also observed cases of what the older writers describe 
as putrid remittent. These occurred on soldiers landed on the shores of 
Bengal, who had scurvy from protracted sea voyages, and the mortality 
was shocking. An entire regiment 900 strong was almost destroyed by 
malarial fevers and bowel complaints in a few weeks, and those who sur- 
vived, bore testimony to the truthfulness of the description of putrid 
remittent fevers, given by the older authors. Dr. McLean also says: 
That without any scorbutic taint, we may have remittent fever, presenting 
from the commencement an adynamic character in which the skin was yellow and 
covered with petechise, the pulse exceeding 12 ), with a disposition to haemorrhages 
from nose, mouth and bowels. He was familiar with cases of this kind when 
serving in the immediate vicinity of Hyderabad in Decan. 
Dr. Charles Faget, in his "Memoirs and Letters, published in 1859, 
quotes Dr. Dutrouleau, former physician in chief of the French marine, tn 
the effect that the borders of the Danube, which, with regard to its medi- 
cal topography aud endemic fevers, presents many analogies with those of 
the Mississippi, is the theatre, at the end of the warm season, of quotidian, 
double-tertian and bilious fevers, in which jaundice and black urine appear 
from the first paroxysms, with difficulty of respiration, delirium, gastric 
irritation and nervous and muscular prostration. The prominent anato- 
mical lesions are enlargement of the liver and spleen. Dr. Dutrouleau 
terms this disease the haemitritoea of the paludal climate of the Danubian 
Provinces. Dr. Faget also quotes the following from articles of Dutrou- 
leau, in the Archives Generales de Medecine of October and November, 
1858, illustrating the nature of the hoemorrhagic malarial fever of bilious 
haemorrhagic form, as it appears at Madagascar, Cayenne and in the West 
Indies: 
1. Madagascar.-(Here follows the description of a jaundical paroxysm at 
Madagascar, by Dr. Lebeau). History of Haemorrhagic Malarial Fever. 
527 
The scene is opened by a chill; it is followed by vomitings of the green color 
of arsenite of copper; to the vomitings are often added stools of the same nature; 
I have seen patients passing blood by this passage. Sometimes also the vomit has 
a black color, a color which the urine partakes of, the green tint being so deep set 
that it resembles ink. Reaction soon takes place, and lasts about twenty hours.. 
When the remission takes place, an icterical suffusion is spread over the whole 
body, which becomes of a deep orange hue.-(p. 388). 
Anatomical lesions-Softening of the gastric mucous membranes, alteration 
of the color of the liver, which presents the general yellow cast of the other tis- 
sues ; spleen hypertrophied-(p. 389). 
Two other observers, Gelineau and Guilasse, insist upon the importance and 
danger of the passive haemorrhages, particularly of the haematuria and epistaxis, 
which are very rebellious in these fevers-(p. 393). Guilasse describes a yellow- 
paroxysm, with intermitting type, and a yellow continuous paroxysm, one synco- 
pal, and one soperose-p(. 393). Finally, Daull6, after a long residence at Mayotte, 
chose as the subject of his inaugural theme in 1857, this very fever of Madagascar, 
which he calls pernicious icteric. "It assumes," says he, "the three paludal types 
of fever, oftener, however, intermittent than remittent, and seldom continuous1'- 
(p. 395). 
In 1851 an occurrence took place in Guiana, bearing much analogy to what 
has been observed since 1853, in the parishes of Louisiana, and in the epidemic 
yellow fever at Cayenne in 1850. But we must come to the end of 1851, to the trans- 
portation of European convicts in Guiana, to the increase of the European popu- 
lation and its dissemination at various points of the plains or marshes of rivers, 
which are all intense hot-beds of paludal emanations, to observe the re-appearance 
of fevers of a grave type. Here are a few extracts from the reports of the physi- 
cian in chief, Dr. Laure, from 1851 to 1853: "The sick have almost invariably, 
from the first day, a continued fever with delirium, irregularity of pulse, jaundice, 
urine scant, yellow blood, in a word, the symptoms of the yellow disease (icteric 
pernicious fever of Madagascar) ignored until the present day, area great deal more 
fatal than the epidemic yellow fever of 1850. 
" The icterus," observed Dr. Laure, "attains its highest degree ; the urine and 
stools contain a great quantity of black blood and yellow materials, ascertained by 
analysis. There exists petechise and sudamina." Laure considers malarial intox- 
ication as the first and essential cause of the disease, and nevertheless, remarks: 
"the action of quinine is so doubtful that we do not know whether rational treat- 
ment is not deserving of consideration in its cure"-(p. 402). 
With regard to the intermittent fevers of the West Indies, Dutrouleau 
says: 
In the continued form, which is also the most serious, the bilious symptoms do 
not appear at the onset, but only after a period of thirty-six to forty-eight hours, 
characterized by an inflammatory period ; then the jaundice and bilious excretions 
become apparent, but less marked than in the intermittent form. The urine is 
always bloody, but in less degree than in the intermittent form; epistaxis some- 
times occur, and traces of blood are found in the stool and vomit. Some observers 
say they have met the real black vomit of yellow fever; 1 have never met it. The 
cerebral phenomena are always prominent in this form. Sometimes we have but 
excitement and slight delirium, complicated with anxiety and trouble of the respi- 
ration, but sometimes also there exists ataxic symptoms of an extremely violent 
nature. Such is the fever which the physicians of Point-a-Peitre, where it is more 
prevalent than elsewhere, have named ''bilious hcematuric fever," yellow fever of 
the acclimated and of the Creoles; when it is of some duration it assumes at times 
the mark of typhoid fever. It is subject to relapses, and ends by bringing the 
patient to a ehachexia, p. 904. From 1828 to 1838, a period of immunity from yellow 
fever, Dr. Therminier, whose name is authority at Guadaloupe, has frequently 
met with it in creoles, concurrently with the other forms of pernicious fever. He 
also classes it among the malarial fevers, rather than with yellow fever, notwith- 
standing its symptoms of affinity with this last disease, (p. 405). 
Dr. Faget thus expresses the results of his investigations in New 
Orleans, of what he denominates the hcematememc variety of haemorrhagic 
malarial fever: 
At New Orleans, things take quite an opposite direction. In our haemorrhagic- 
malarial fever, the haemorrhage which I have met the most often, is that of the- 528 
History of Haemorrhagic Malarial Fever. 
stomach, but in the most incontestible manner, recognizable to the naked eye. by 
every one, in all its shades, from the grumous of the color of chocolate to the clots 
of blood, sometimes yet red, sometimes already blackened by the acids of the 
stomach, to the grumous black coffee grounds, resembling perfectly genuine black 
vomit of yellow fever. * * It is by such facts, patiently collected without inter- 
ruption for the past seventeen years, in all seasons, even in winter, in the midst as 
well as outside of epidemics of yellow fever, facts of gastric haemorrhage being 
produced in the course of fevers of all malarial types, from the larvate to the 
exacerbating type, in passing by the intermittent, remittent, sub-inhant and 
pseudo continued, that I have been able to recognize the existence of the hazma- 
temesic variety of haemorrhagic malarial fever. New Orleans Journal of Medi- 
cine, vol. xxii, No. iv, October, 1869, pp. 768-784. 
L. J. B. Berenger-Feraud, who in virtue of his position as Medecin en 
Chef de la Marine, and in virtue of the advantages for extended and criti- 
cal observation, which he enjoyed for many years whilst in charge of a 
hospital at Goree, which received annually into its wards from eleven to 
thirteen hundred patients, is entitled to consideration with reference to 
the pathology and treatment of that form of malignant malarial fever, 
which he designates " Fievre Bilieuse Melanurique des pays chands," 
regards the disease as truly malarial in its character, distinct from yellow 
fever, and endemic to the most malarious regions of Africa. He describes 
this disease for which he proposes a new name [melanuric bilious fever}, as 
a malarial fever of variable type characterized by : 1. Persistent vomit- 
ing of bilious matter of a greenish color; 2. Jaundice of the skin and of 
all tissues; 3. A peculiar brownish color of the urine. The second and 
third of these characteristics he regards as the most pathognomonic, and as 
distinguishing this form of malarial fever from every other. 
With reference to its pathological anatomy, the color of the skin varies 
from a light to a dark yellow, according to the cases, and of a perfectly 
uniform tint everywhere. The stomach is perfectly sound, when the pati- 
ent has not formed any drunken habits; and the pungency of the mucous 
matter, which has been considered pathognomonic by some physicians, is 
positively nothing but the effect of alcoholic gastritis, entirely independ- 
ent of the disease. The gastric fluid is green, limpid, or contains lumps of 
green matter, exactly like chopped spinach-a differential sign between 
this disease and yellow fever. The liver is very generally increased in 
size, its normal weight being some 1796 grammes (571 ozs.), its weight in 
melanuric bilious fever, being about 2196 grammes (70i ozs.). The con- 
gested condition of this organ is special and entirely different from the 
anaemic condition of the liver of yellow fever. The bile is greatly increased 
in quantity, thicker than in its normal state, having a black color and a con- 
sistence which gives it the exact appearance of tar, or of raisine, too much 
colored. The spleen is decidedly hypertrophied, its normal weight being 
some 235 grammes (7? ozs.); and in this disease, its average weight was 
about 760 grammes (241 ozs.)-a positive proof of the malarial origin of 
this disease. In the early stages of the disease, the spleen is almost difflu- 
ent; later it is hard. The kidneys are congested and their weight increased, 
but M. Berenger-Feraud does not appear to have made any careful sections 
and microscopical examinations of the ultimate structures of the kidneys. 
There is reason to believe, however, that sometimes permanent injury is 
done to the kidneys by the fever. The blood contains bile in sufficiently 
large proportion to stain linen yellow, when dipped in it. 
Whilst Berenger-Feraud did not discover blood in the urine, but 
observed casts of albumen in some cases, and whilst he refers the peculiar 
dark color of the urine not to blood, but to the presence of bile; at the 
same time the great fatality of the severer forms, the mortality reaching History of Haemorrhagic Malarial Fever. 
529 
more than fifty per cent.; the presence of jaundice, distressing vomiting, 
and the supervention of the disease after repeated attacks of malarial fever, 
sustain the view that this form of malarial fever as it prevails upon the 
coast of Africa, is closely allied with the different forms of haemorrhagic 
malarial fever, and especially with the malarial haematuria of our South- 
ern States. 
With reference to the first appearance of melanuric bilious fever, on the 
Senegal river, Berenger-Feraud found that the records of St. Louis Hos- 
pital show that from 1841, the black urine was noted, and that similarity in 
this instance, and in others, justify the belief that in 1839, 1830, 1825 and 
1820, the disease was observed prior to the appearance of the yellow fever 
in Senegambia. The records of the ports along the Senegal furnish no 
additional information; but those of the hospital at Goree led him to think 
that what had been seen at St. Louis, was observed there also at the above 
mentioned dates. Lastly, the records of the ports of the Gold-Coast and 
the Gaboon, show very clearly that from 1845, three years after the estab- 
lishment, melanuric bilious fever was observed there. Moreover, neither 
Dr. Theze, nor Dr. Loupy, both of whom practiced in Senegambia about 
1856, seem to have regarded it as new, since they described it among the 
endemic diseases of the country.* 
The haemorrhages that took place from the cracked fissures of the 
tongue, from the lips, gums and bowels, the livid petechial blotches simi- 
lar to those of purpura, and the large discolorations or ecchymoses of vari- 
ous parts of the body, which characterized certain cases of the so-called 
typho-malarial or Chickahominy fever of the Federal army, were clearly 
referable to the action of the malarial and typhoid poisons on scorbutic 
subjects. This form of fever, which first attracted attention in 1862, as 
the Chickahominy fever of the Army of the Potomac, and received the 
name of typho-malarial fever from Dr. J. J. Woodward,! U. S. A., has 
since been common wherever the United States armies operated in malari- 
ous regions, amongst men saturated with paludal poison, exhausted by 
over-exertion and insufficient rest, imperfectly nourished, exposed to the 
action of animal effluvia from the decaying bodies of both men and brutes, 
and drinking water impregnated with the products of common putre- 
faction. These coincident causes, tending to lower the vital forces and cor- 
rupt the blood, produce a compound disorder, in which the combined 
action of paludal, pathogenic, and scorbutic influences are evident, and 
which varies in type, as one or other of the determining conditions is pre- 
dominant. 
As far as my experience extended, which was by no means limited, 
during the American Civil War, 1861-1865, whilst haemorrhages from the 
mucous surfaces, were not infrequent in typhoid fever and small-pox, they 
were comparatively rare in the various forms of malarial fever. I wit- 
nessed, however, in the military prisons at Richmond and Andersonville, 
a vast variety of diseases, in which the haemorrhagic tendency was promi- 
nent, from the scorbutic condition of the blood. In a number of cases of 
haemorrhage from the gums, stomach and bowels w'hich I have treated since 
the war, various causes appeared to have been in some of the cases, the 
origin of the haemorrhagic diathasis, as the abuse of alcohol, bad diet, 
exposure to wet and cold, scorbutus and the prolonged action of the mala- 
* De la Fievre Bilieuse Melanurique des pays chauds comparGe avec la Fievre Jaune. Etude 
Clinique faite au Senegal. Par L. J. B. Berenger-Feraud, Medecin-en-Chef de la Marine, etc., etc., 
p. 434. Paris: 1874. 
t Outlines of the Chief Camp Diseases of the United States Armies. Phila., 1863, pp. 77-149. 
The Science and Practice of Medicine, by William Aitkens, M. D.; 3d Am. Ed., Phila., 1872, 
vol. 1, p. 607. 530 
Hematuria. 
rial poison. Several of these cases, complicated with malarial fever in 
which large quantities of blood were vomited, and which were evidently 
thrown off from the mucous membrane of the stomach, recovered under a 
conservative and supporting plan of treatment. Both in the army and 
military prisons, and in civil and hospital practice, I have found that where 
the haemorrhages were clearly referable to the scorbutic state of the blood, 
certain well marked lesions and more especially fatty degeneration of the 
heart existed. 
In 1857, I investigated the changes of temperature, pulse, respiration 
and of the blood and urine in the various forms of malarial fever and 
described cases of the so-called melanuric bilious fever; and it was shown 
both by the record of the symptoms and by pathological anatomy of the 
various forms of intermittent, remittent, bilious and congestive or per- 
nicious fevers, that they were all mere varieties of the same disease, which 
was radically distinct from the continued typhus and typhoid fevers on the 
one hand, and yellow fever on the other. 
HAEMATURIA (BLOODY URINE) AND MALARIAL HJEMATURIA. 
{Recurrent Hw^naturia Miasmatica-, Epidemic Jaundice; Cachemia; Hcematuria 
or Yellow Remittent; Malignant Congestive Fever; Hcemorrhagic Malarial 
Fever; Purpurcemia; Splenic Fever; Cachemia Hoemorrhagica; Icteroid 
Pernicious Fever; Intermittent Icteroid Fever; Yellow Disease; Canebreak 
Yelloiv Fever; Country Yellow Fever; Swamp Yellow Fever). 
We have regarded that form of malarial fever in which haemorrhage 
from the kidneys is the most prominent and alarming symptom, as one of 
the forms of haemorrhagic malarial fever. And in the investigation of 
the natural history, symptoms and treatment of this fatal form of disease 
the following order will be observed in the subjects discussed : 
1. Blood in the urine; its importance as a symptom. 
2. The history of malarial haematuria in the Southern States, with an 
analysis of the writings relating to this disease. 
3. Cases illustrating the symptoms and chemistry and natural history 
of malarial haematuria. 
4. Cases illustrating the pathological anatomy of malarial haematuria. 
5. Treatment of malarial haematuria. 
BLOOD IN THE URINE; ITS IMPORTANCE AS A SYMPTOM. 
The importance of blood in the urine as a symptom must depend upon 
the part of the urinary apparatus from which it is derived; and its appear- 
ance is always a source of anxiety aud alarm to the patient, and if not 
rightly investigated and interpreted may become a source of serious error 
in treatment. The significance of haematuria, even when the blood comes 
from the kidneys, is momentous or otherwise, according to the character 
of the accompanying symptoms: it may indicate temporary conditions of 
disease to be easily removed by judicious measures; or it may afford 
unequivocal evidence of incurable organic mischief. Aside from the well 
known fact that blood may be derived from the bladder, prostate or 
urethra, independent of the kidneys, haematuria may occur in the course 
of many different diseases. 
Since the time of Sauvages the name of hematuria has generally been 
applied to haemorrhage from the urinary organs, but with somewhat differ- 
ent latitude of meaning by different authors; as for example, in the noso- 
logical system of Vogel h^maturia^ denotes hamorrhage from the kidneys Hosmaturia. 
531 
exclusively; that from the bladder being termed cystirrhagia; Sauvages, 
•on the contrary, included under hsematuria every discharge of blood from 
the urinary organs. Hsematuria, according to its entomological deriva- 
tion, should be restricted to cases in which blood is effused from the 
vessels of the kidneys, ureter and bladder, and discharged along with the 
urine, excluding from the definition urethral hoemorrhage, in which the 
blood flows by drops or in a continuous stream from the orifice of the 
urethra. 
Systematic writershave distinguished the following causes of hsematuria: 
external injuries on the loins; hypogastrium or perineum; falls or concus- 
sions of the trunk; prolonged or severe exercise on horseback; riding in 
carriages over a rough or broken pavement; violent muscular exertions; 
internal irritants, as calculi formed in the kidneys or bladder, and acrid 
substances taken into the stomach, absorbed into the blood, and carried to 
the kidneys, as turpentine, cantharides, savine, the poison of mushrooms, 
and various medicines; and whatever inflames or causes congestion of the 
urinary organs, as the application of cold, the suppression of customary 
discharges, etc.; hsematuria may also be produced by the concurrent influ- 
ence of plethora, venereal excesses, violent fits of passion, etc.; but the 
most common causes are organic changes, inflammatory or malignant, 
implicating the kidneys or bladder; general cachexia, as «curvy and pur- 
pura; and exanthematous, septic, malignant malarial fevers. 
It would be foreign to our present purpose to enter into an extended 
examination and description of hsematuria as caused by external injuries, 
calculi and malignant growths; but our endeavor shall be to bring forward 
such facts as relate to this symptom as it occurs in various diseases, and 
especially fevers, as will aid in the investigation of the hsematuria of 
malarial fever. 
As we have said, hsematuria may be symptomatic of various diseases 
of the kidney, as, 1st, simple inflammation, or nephritis ; 2d, the early 
stage of Bright's disease; 3d, scarlatinal dropsy; 4th, calculous pyelitis, 
including under this form gouty inflammation ; 5th, tubercular pyelitis ; 
6th, cancer or malignant disease of the kidney. Idiopathic hsematuria, or 
bleeding from the surface of the kidney, without any special cause beyond 
exposure to cold, or to the vicissitudes of climate in warm and damp local- 
ities, or to mental excitement, has been considered as rare by most writers; 
and many deny thathsematuria ever occurs except as an indication of decided 
disease of the kidney or other parts of the urinary apparatus; but even 
those who hold the view that hsematuria indicates structural disease of the 
renal organs, must admit that true idiopathic hmmaturia sometimes occurs, 
together with haemorrhage from other mucous surfaces in those who ascend 
to great heights, and who consequently suffer the loss of that amount of 
atmospheric pressure which preserves the conditions of equilibrium necessary 
to the proper circulation of the blood. The existence of idiopathic hcema- 
turia was doubted by Cullen, and the extensive clinical experience of Frank* 
shows it to be exceedingly rare in temperate and healthy localities unless 
when caused by cantharides or turpentine. Out of four thousand patients 
m the clinical wards of Paris, only six cases of spontaneous hsematuria 
were observed. In the clinical institution of Vienna, 1,913 patients 
afforded only a solitary case; and in the general hospital of that city, one 
only out of 13,647 deaths were recorded to have ensued from that disease. 
IDIOPATHIC AND VICARIOUS HEMATURIA. 
* Frank de Curandis Humori Morbis, tom. 1, pars, iii, p. 250. 532 
Hcematuria. 
Cullen has well observed, that from the frequent obscurity of the causes of 
haematuria, and especially of the symptoms denoting calculus or other dis- 
ease of the kidneys, it may often be supposed to be a primary affection, 
when in reality it depends on an undiscovered cause, and in particular on 
a calculus, or organic disease, the existence of which is only revealed on 
dissection. 
The correct diagnosis in all cases of haematuria, arising from the pre- 
ceding causes, is a matter of great importance. Dr. Prent considered that 
when blood tinctured the W'hole fluid, appearing equally dissolved through- 
out it, that the kidneys were generally involved, when {such an appearance 
is observed, however, it co-exists or alternates generally with blood as a 
deposit, and it may be concluded that there is calculus in the kidney, or 
that the organ is the subject of other diseased condition, attended either with 
great granular deposits, or malignant disease. Though in most cases if 
calculus be present, the history or severity of symptoms will assist the 
physician in forming a correct diagnosis, yet it sometimes happens that 
such evidence is not afforded, and this is especially the case when oxalate 
of lime calculi are contained in the kidneys. Under these conditions the 
urine may be bloody, and no other symptom observed beyond dull lum- 
bar pains. If oxalate of lime crystals exist in the urine, there is also pain 
in the penis, which does not affect the glans penis, as in stone in the blad- 
der, but on the contrary, is most painfully felt at the root of the organ. 
Though in these cases, the haemorrhage will generally follow upon some 
unwonted exertion, still it is not always so, and the case is thus obscured. 
If the haemorrhage is the result of any of those chronic states of disease to 
which the name " morbus Brightii" has been given, then the haemorrhage 
will give plaice to other conditions in which the colorless matters of the 
blood alone become effused. The continued presence of albumen, for a 
length of time, without the coloring matters of the blood, and especially the 
colored blood-corpuscles, w'ould indicate that the patient is suffering from 
some form of Bright's disease. If, however, the urine, on becoming of its 
natural color after an attack of haematuria, does not prove to contain albu- 
men, then the conclusion may be reached that the haemorrhage proceeded 
either from calculus in the kidney, or some malignant disease of the organ. 
In malignant disease the blood is generally passed in larger quantities 
than in calculus of the kidney; there is more frequent tendency to nausea 
on slight exertion; pus and mucus are generally absent; the appearance 
of the patient is nearly always indicative of anaemia, more or less advanced; 
careful examination of the abdomen will frequently lead to the detection of 
tumor; in calculus, on the other hand, haematuria generally follows upon 
some unwonted exertion; microscopical examination of the urine will 
frequently show mucus or pus in excess. Cases of intermittent or parox- 
ysmal haematuria, or more properly haematinuria, have been described by 
many observers, as Drs. Harley, Dickinson, Greenhow, Gull, Pavy and 
Druitt, the exciting cause of which seemed to be exposure to cold, as it 
was observed in individuals who had never visited malarial regions. 
Dr. Robert Willis* has described a remarkable case of intermittent 
haematuria, which continued for twelve years. The patient, a gentleman 
about forty years of age, of pale leucophlegmatic temperament, engaged 
in sedentary occupations. Dr. Willis referred the occurrence of the 
haematuria to irregularities of diet. Of the same nature as the case related 
by Willis, is the one mentioned by Abernethyf in the following words: "An 
elderly gentleman whom I had long known, and who was a very healthy man. 
* Urinary Diseases and their Treatment, by Robert Willis, M. D. London, 1838, p. 169. 
f Lectures on the Theory and Practice of Surgery. 8 vo. London, 1830. Haematuria. 
533 
told me that he was occasionally subject to haemorrhages (from the kidney). 
The first time he was seized he was very much alarmed. He had got up 
to make water as usual and voided about a quart; on looking at it, it was 
as red as blood; and after standing, about half of it formed into a coagu- 
lum." Sir E. Hune* appears also to have met with a case of the same 
kind, in which the bloody urine discharged not only coagulated in the pot 
de chambre, but in the bladder, and occasioned strangury. 
It is well known that haematuria may be caused by cold apoliedto the 
loins, or by prolonged immersion in cold water. Dr. Alfred Hudson, in 
his "Lectures on the Study of Fever'' (Am. Ed., 1S69, p. 116), states that 
some years ago he had attended two young gentlemen, in each of whom 
fever followed upon cold applied to the lumbar regions whilst perspiring. 
In both haematuria came on in an early stage of the lever, and was rapidly 
followed by complete suppression of the secretion, by strabismus, con- 
vulsions and coma, ending in death. 
Haematuria may even be unconnected with any preceding morbid 
condition, the only exciting cause which can be detected being mental 
agitation. Ray er, in his work on " Diseases of the Kidneys," in treating 
of renal haemorrhage, mentions a case of haematuria (tom. iii. p. 359) 
brought on apparently by no other cause than mental excitement. The 
accompanying symptoms were severe hypogastric pain, with heat and 
pain in the course of the ureter, and sensation of weight and aching iu 
the region of the kidneys. He was quickly relieved by rest, warm baths, 
diet and mucilaginous drinks. 
Dr. W. R. Barsham, physician to the Westminster Hospital, and Lec- 
turer on the Practice of Medicine, has recorded a similar case, in which, 
after a very careful observation of the sum of the symptoms exhibited by 
the patient over a period of more than eighteen months, and observing 
during this period the strictly temporary morbid condition of the urine, 
the constant relation of the state of haematuria to mental emotion, that 
Dr. Barsham came to the conclusion that the case might fairly be classed 
with those that Rayer has spoken of under the name of haemorrhages renales 
essentielles (sporadiques), and that he might attribute its exciting cause 
to the rare and exceptionable agency of mental excitement. 
It is thus by the absence of all the usual symptoms of irritation of the 
kidney, such as are ever present in gouty inflammation, whether excited 
by the presence of calculus or not; it is the absence of constitutional dis- 
turbance, whether febrile or dropsical; it is the temporary character of the 
attacks, the urine in a few days returning to a clear and natural state, with- 
out any trace of albumen, or any morbid morphological element therein 
that justify our excluding as the cause of luematuria all those organic dis- 
eases of the kidney in which haemorrhage occupies the position of a lead- 
ing symptom, and attributing the malady exclusively to the operation of 
mental excitement. Examples have been recorded in which haematuria 
appeared to be supplementary to some natural function or some diseased con- 
dition. In certain cases it has occurred in women as vicarious oi the menstrual 
flux ; and in one case of this kind which occurred in my private practice, 
the periodic discharge of blood from the kidneys continued for two years, 
and ceased only after the improvement of the general health and the com- 
plete re-establishment of catamenia. In this case microscopical examination 
revealed the presence of casts containing blood-corpuscles. 
Chopartf relates a case in which haematuria supplemented a haemor- 
rhoidal flux ; LatourJ adds another. Latour also mentions a singular case 
* Philos. Trans, 1796, p. -186. 
t Traite des Malades des Voies Urinaires, Sigales; edition, p. 263. 
j Cited by Rayer, t. ii; p. 25. 534 
Hoematuria. 
of spasmodic asthma, of such severity and persistence that the patient had 
not been able to lie in bed for eighteen months, which disappeared suddenly 
on the occurrence of haematuria. 
Chopart, P. Frank, Guthrie, Barsham and others have related examples 
in which the menstrual flux was deviated to the urinary passages, and 
appeared under the form of a periodical haematuria. Chopart cites one 
instance, and Bayer two instances, in which haematuria occurred at regular 
monthly periods in males. One of them was a butcher of Sedan. The 
circumstances became known, and such was the disgust caused thereby that 
no one would purchase meat from him. 
H JEM AT URI A RESULTING FROM THE ACTION OF FEBRILE POISONS AND 
IRRITATING AND POISONOUS SUBSTANCES INTRODUCED INTO THE CIR- 
CULATION. 
In contrast with the preceding states in which the urine may contain 
blood, it is well-known that the haemorrhage proceeding from the kidneys 
may not imply any organic disease of these organs, being symptomatic 
only of a general haemorrhagic condition in which the kidneys participate 
with other organs : as in the haematuria in purpura and scurvy. The 
haematuria of certain febrile disorders, as scarlet fever, small-pox. typhus 
fever, pyaemia and malarial haematuria and yellow fever, should be referred 
primal ily to both a general haemorrhagic condition and to structural or 
organic changes of the kidneys. 
In scarlet fever, the incipient stage of the renal disorder, the congestion 
and the haematuria are not accidental conditions, but arise undoubtedly 
from the secondary effects of the original febrile virus. That the morbid 
sequelae of scarlet fever are to be traced to the imperfect elimination of 
the original virus, might be shown in cases in which the morbid symptoms 
of this secondary stage are not limited to renal disturbance, but whose seri- 
ous complications both of the cerebral as well as the respiratory functions 
co-exist. On the other hand, when cerebral symptoms become developed 
during the presence of general dropsy, the urine being highly albuminous 
with abundant exudation of the renal epithelium, there can be no hesita- 
tion in attributing the convulsions, coma and death to uremic poisoning, 
the symptoms being strictly analogous to one form of cerebral disturbance 
frequently observed in cases of renal degeneration in adults, in whom the 
function of the kidneys is limited to the excretion of the water and albu- 
minous constituents of the blood, and fails to eleminate the urea, the reten- 
tion of which and of the extractive matters, acting as a poison in the blood, 
manifests its destructive power by fatal convulsions. It might, therefore, 
be assumed that these symptoms are referable rather to the renal incom- 
petency than to the febrile poison; doubtless they are so proximately: but the 
incipient stage, the congestion and the haematuria, are primary, and not 
accidental and secondary conditions, and arise directly from the secondary 
effects upon the blood and kidneys of the original febrile virus. 
In like manner we must regard the haematui ia. of the disease now under 
consideration, the so-called ''■malarial lurmaturia^ as due to the direct 
action of the malarial poison upon the blood and upon the nerves, blood- 
vessels, and excretory apparatus of the kidneys. The peculiar train of 
cm'ebro-spinal symptoms which follow* such structural alteration of the 
kidneys, are referable as much to the effects of the urea and bile in the 
blood, as to the direct action of the malarial poison upon the ganglionic 
cells. 
Haematuria may be an indication of the highly congestive type of 
fever, as noticed by Sir D. Corrigan : " The urine in such cases,'' says Sir Hcematuria. 
535 
D. Corrigan, "is dark colored, muddy, and without sediment, properly 
so-called, but occasionally showing a small quantity of a dark colored 
deposit, such as is seen in the dark colored urine of hsematuria after scarla- 
tina. It is of low specific gravity, is small in quantity, and coagulates 
when heated, from the serum which it contains." When luematuria occurs 
in malignant fevers, it indicates both congestion of the kidneys and a mor- 
bid condition of the blood ; and in such cases, the blood may escape from 
any part of the urinary organs, but it comes from the kidneys more fre- 
quently than from any other source. 
Dr. George Johnson* has figured a malpighian body and convoluted 
tube filled with blood which had been extravasated from the malpighian 
capillaries, and formed one of the red spots, as seen by the naked eye in the 
cortical substance of the kidney of a man who died of typhus fever. There 
was a large quantity of blood in the urine during life, and after death 
nearly all the tubes of the kidney were injected with blood which had 
escaped from the malpighian capillaries. The same kind of haemorrhage 
frequently occurs with purpura and scurvy, and the cause of the hsema- 
turia is sufficiently apparent from the associated symptoms. Dr. Johnson 
observed in a case of typhus fever which was complicated with haematuria, 
that the blood in all the casts was disintegrated, in consequence, perhaps, 
of the blood having remained for some time in the tubes before it escaped; 
but there were many scattered blood-corpuscles which had probably 
escaped from the tubes before coagulation took place. He regards the 
presence of scattered blood-corpuscles and the absence of epithelium as 
evidence that the granular casts are composed of disintegrated blood and 
not of disintegrated epithelium.f 
We will reserve the consideration of the history of hmmaturia as it 
occurs more especially in the Southern United States of America, as a 
special section of this inquiry, but will proceed to record some facts with 
reference to the occasional occurrence of bloody urine in yellow fever. 
The haemorrhage from the genito-urinary organs, which, in some epi- 
demics of yellow fever, is of a more or less frequent occurrence, is seldom 
observed in others; thus Louis did not observe it in any of the cases, fatal 
or otherwise, which he saw, or the histories of which he examined at 
Gibraltar in 1828- Benjamin Rush, Lining, Waring, O'Halleran, Bally, 
Stone, Gillespie, Savaresy, Berthe, Evans, Rouchoux, Desporters, Diet, 
Levacher, Michel, Dickson, Davey, Blair, Dickinson, Smith and others 
have alluded to the occasional presence of blood in the urine of yellow 
fever. Benjamin Rush notices its occurrence in 1793. 
Dr. Nodes Dickinson, in his work on yellow fever (London, 1819, p. 
151), not only alludes to urinary suppression in this disease, but states that 
in the second stage the urine is occasionally mixed with blood. Dr. John 
Davey, in a note to Dr. Daniel Blair's "Account of the Yellow Fever, Epi- 
demic of British Guiana," says: "In many instances, in the fatal cases of 
yellow fever in Barbadoes, the kidneys have exhibited a congested state, 
with ecchymosis of the investing membrane; and the urine during life has 
been found to be albuminous, coagulated when heated and on the addition 
of nitric acid; this I have learned from Staff-Surgeon Dr. Collings, who 
has made many observations and experiments on the subject. In a letter 
with which he has favored me, of the 28th of December, 1848, he says: 
In every ease of decided yellow fever I have found the urine highly albumin- 
ous, a condition which it assumes about the second or third day, and maintains 
throughout, increasing as the disease advances, and in cases of protracted conva- 
*Med. Chir. Trans., vol. xxix, pL 1. Diseases of the Kidney, pp. 94, 494. 
■EDiseases of the Kidney, p. 495. 536 
Hcematuria 
lescence, continuing long after all symptoms but debility have left the patient. 
Most of the albuminous precipitates, he mentions, were of a brownish color; in 
some cases, just before the fatal termination, the presence of blood in the urine 
was recognized by the microscope. In two instances he found the albumen in the 
urine replaced by a substance having the properties of casein. Third Ed. London, 
1852, p. 98. 
Dr. Daniel Blair, in his 11 Report of the First Eighteen Months of the 
Fourth Yellow Fever Epidemic of British Guiana." gives the additional 
observations relating to the occurrence of blood in the urine of yellow fever: 
On the 17th of May, 1852, the first sporadic case of bloody urine was noticed. 
A year afterwards it became a symptom of frequent occurrence, grouping and 
giving a character to the cases, and then disappearing. In a few cases it assumed 
the form of active hremorrhage. It appeared on the first day of fever in one case. 
In many of these cases of bloody urine there were no casts of tubes or of epithe- 
lium ; and in a few cases there was "smoky" urine, with a thin layer of blood- 
corpuscles as a sediment, when the supernatant fluid showed only a mere trace of 
albumen. In some few cases the blood intermitted. In one case the bloody 
urine of the morning was succeeded by pale urine, with cloudy sediment, which 
consisted of mucous corpuscles and organic globules in the evening. The bloody 
urine, in many cases, seemed a favorable sign ; and the interpretation of it. 
probably, was that the haemorrhage proceeding from the calyces or pelvis of the 
kidneys tended to relieve the congestion of the secreting apparatus. Brit, and 
For. Medico-Chir. Rev. April. 1856. Appendix. 
Hiematuria is one of the most frequent signs of the septic type of 
fever: of that condition in which the blood is decomposed by the action 
upon it of putrid substances received into it. either through the stomach 
or by respiration. Such cases are invariably fatal. 
Dr. Alfred Hudson, in his Lectures on the Study of Fever (Am. Ed.. 
1869. p. 116.) has recorded an interestiing case of hiematuria, apparently 
caused by the organic poison of mushrooms: In a patient, aged -35. pre- 
viously healthy, with the exception of a constipated condition of the 
bowels, fever came on after violent sickness, caused apparently bv eating 
mushrooms. He was profusely inoculated when I first saw him on the 
ninth day. His consciousness was perfect, but his manner listless and 
apethetic: his face and brow flushed; the eye injected, and the pupil con- 
tracted: distressing vomiting still continued, and during the ensuing 
thirty-six hours he had frequent returns of facial spasms, and constant 
tremor of the muscles generally. The attacks of spasms were accompanied 
by a peculiar tremulous moan, characteristic of uremic poisoning. The 
urine was a smoky-looking fluid, coagulating on the application of heat; 
and containing a large quantity of blood-corpuscles. The facial spasms 
gradually increased in frequency, and ended in a fatal attack of convul- 
sions on the eleventh day. 
Whilst hiematuria is in a large proportion of cases, only a symptom of 
disease or injury, in some part of the urinary organs: and whilst it may 
frequently occur in the early stages of all the forms of renal disease which 
have their origin in a morbid state of the blood, and especially when the 
attack is acute, and whilst it may more frequently be the result of acute 
desquamative nephritis: at the same time haemorrhage from the malpi- 
ghiau capillaries may be the consequence of the presence of some irritating 
material, as cantharidin or oil of turpentine or savin, or even bile in the 
blood. 
Dr. George Johnson* has recorded several interesting cases illustrating 
the production of hiematuria with blood casts of the renal tubes, after the 
administration of oil of turpentine, and after the absorption or develop- 
* On the Diseases of the Kidneys, their Pathology, Diagnosis and Treatment, etc. London, 
1852; pp. 4S7-683. Haematuria. 
537 
ment in the blood of some irritating material. Whilst at first sight such 
cases stand in marked contrast to those of haematuria recorded by Dr. 
Johnson and others, illustrating the occurrence of haematuria resulting 
from the combined influence of impoverished blood and exposure to the 
cold night air, inducing congestion of the kidneys and haemorrhage from 
the malpighian corpuscles; even in such cases, it might be conceived that 
some irritating material was engendered in the blood, which irritated the 
excretory structures of the kidneys. I have, both in private and in hospital, 
practice, observed cases of haematuria, arising fiom the introduction into 
the blood of various irritating substances as oil of turpentine, cantharidin, 
and certain organic poisons, as the venom of the water moccasin (trigono- 
cephalus picivorus), and of the copperhead (trigonocephalus contortrix). 
STATE IN WHICH THE BLOOD ESCAPES FROM THE KIDNEYS IN HAEMATU- 
RIA RESULTING FROM THE ACTION OF FEBRILE POISONS, AND IRRI- 
TATING SUBSTANCES. 
Vogel.* Oppolzer,f and Mettenheim er 4 have affirmed that the color- 
ing matter of the blood (haematin) may escape with the urine, unaccom- 
panied by rupture of the capillaries, and the presence of blood-corpuscles. 
It is said that the urine in such cases assumes a deep red or blackish red 
color, very much as if it contained blood; but no blood discs can be found 
under the microscope nor any fibrin. It is said that this condition is invari- 
ably accompanied by the presence of albumen in the urine; and farther, 
that it is caused by rapid destruction of the blood discs in the blood-vessels, 
such as occurs in that state {hypothetical) called by certain writers ua dis- 
solved state of the blood," in septic, pyaemic, and so-called putrid fevers, 
and in some extreme cases of scurvy and purpura. 
It is held by some pathologists that, in such cases, haematin is set free 
by the disintegration of the red blood discs, and appears in the urine. 
Vogel found that inhalation of arseniuretted hydrogen produced an intense 
(but temporary) degree of haematuria, and he is said to have produced the 
same condition artificially in animals by inhalation of the same gas, and of 
carbonic acid gas; and also by the injection of substances into the veins 
which are known to dissolve and break up the blood discs. With regard 
to the presence of haematoglobulin in the urine, Vogel says that in the body 
there is a constant disintegration of blood-corpusclestaking place, whereby 
haematoglobulin is set free, and subjected to further changes. Globulin 
probably serves for' the nutrition of the muscles and other albuminous tis- 
sues, and is at last removed from the economy in the form of urea and uric 
acid. Haematin is also further oxidized, and leaves the body in the 
form of biliary and urinary pigment, as cholo and uro-haematine. In 
health, therefore, haematoglobulin never passes through the kidneys with 
the urine. But when there are pathological processes going <>n in the 
blood, the result of which is a wholesale destruction of blood-corpuscles, 
then the quantity of pure haematoglobulin in the blood becomes so 
large that it cannot all be subjected to the normal changes, and it 
seems that a part may be secreted unchanged by the ordinary chan- 
nels of the urine, just as other substances, such as sugar, bile, and, 
perhaps, albumen, when contained in the blood in excess, may pass 
over into the urine. This explanation Vogel supports by the follow- 
ing observation : A professor of physics having performed an experi- 
* J. Vogel; Kranth. der Hainbercitendeu orgaiie, in Virchow's Handbuch der Speciallen 
Patho. u. Therop., Band, xi,2 ts. Abth., p. 539. 
t Weinir Med. Wochenseh, 1860, Nos. 25 and 26. 
j Wiirzburger, Med. Zeitsch, 1362, p. 1. 538 
Hwmaturia. 
ment with a balloon full of hydrogen, breathed some of this gas when 
emptying the balloon of its contents by pressure. He became suddenly 
very ill, but soon recovered, and after the lapse of some time passed a 
urine, which was black like ink, coagulated in boiling, bub contained no 
blood-corpuscles, when examined undei the microscope. This condition 
of the urine lasted for about twenty-four hours. It was found that the 
hydrogen used for the experiment contained arseniuretted hydrogen.* 
Dr. J. L. W. Thudichum,f without in the least doubting the correct- 
ness of Professor Vogel's observation, as far as it goes, expresses the opin- 
ion that the disintegration of blood-corpuscles in the circulation is by no 
means established by it. On the contrary, Dr. Thudichum bolds that 
other observations of similar cases tend to make it probable that the com- 
plaint caused by the breathing of arseniuretted hydrogen, as it exhibits 
itself in the urine, is really haemorrhage from the capillaries of the kid- 
neys. Thus, in the case which has been related by Dr. Schliuderj; of 
Greifensberg, deep reddish-brown urine, mixed with clots of blood, was dis- 
charged. In the case reported by Dr. O'Reilly,§ however, there was first 
bloody urine, succeeded by suppression of urine, after which the face 
became copper colored, and the rest of the body greenish ; symptoms prob- 
ably indicating the presence of free haematoglobulin in the blood. There 
may be both haemorrhage from the malpighian bodies, and subsequent 
disintegration of the effused corpuscles, ami also disintegration of the cor- 
puscles in the blood, and subsequent discharge of the solution. The explan- 
ation by way of haemorrhage is only more probable, and supported by 
collateral observations, and by the observations on the behavior of blood- 
casts, which do not appear to have been mentioned by Professor Vogel. 
This author also observed that a dog, after having breathed a quan- 
tity of arseniuretted hydrogen, discharged a blackish-brown urine, which 
contained a large amount of hiematoglobulin. In typhus, blood is not 
rarely discharged by the kidneys. Vogel, however, observed a case in 
which there was only hsematoglobulin present, no trace of blood-corpuscles 
being discoverable by the microscope. This happened during the acme of 
the disease, and disappeared after a few days, from which time the patient 
gradually rallied and made a perfect recovery. Dr. Thudichum,|| with 
reason, extends to this case the doubts just expressed. 
The observations of Mickel Heschl and Planer,quoted by Vogel in 
support of his opinion, undoubtedly prove that an excess of granular pig' 
ment may accumulate in the blood in either continuous or intermittent, 
with intense suffering, great anxiety of countenance, vomiting, and some- 
times general spasm of the muscles. 
In a fourth form the abdominal viscera, the peritoneum, the stomach, 
small and large intestines, the liver and the kidneys may one and all 
be involved, giving rise to the so-called peritonitic, gastric, choleraic, 
dysenteric, hepatic and nephritic forms of malignant intermittents. 
In a fifth form, known as algid fever, the cold stage is usually pro- 
tracted, there is great oppression at the chest and abdomen, restlessness, 
and prostration of nerves and muscular power. 
When from any cause, as bad diet, excessive exposure to cold and 
with the continuous use of salt meat, or the prolonged action of the mala- 
* Archiv. des Verins fur Gemeinschaftliche Arbeiten; Bd. i, Heft 2, p. 209. 
f A treatise on the pathology of the urine, including a complete guide to its analysis, Lon- 
don, 1858, p. 236. 
t Buchner's Repertorium fur die Pharmacie, Ixix 271; Christison on Poisons, 4th Ed., p. 326. 
g Lublin Joiirn. of the Med. Sc. xx, p. 422. 
|j Pathology of the Urine, p. 236. 
If Ueber das Vorkommen, von Pigment im Blute, Zeitschrift der Wiener Aerzte, 1854, pp. 127 
and 280. Hematuria. 
539 
rial poison, or by the introduction of certain parasites as the bilharzia, the 
constitution of the blood is altered, haemorrhage takes place during the 
congestive stage of malignant intermittent fever, or may have a sixth vari- 
ety, which has been indicated as hcemorrhagic malarial fever. Without 
doubt in this sixth form of malignantintermittent, haemorrhages from vari- 
ous organs, as the stomach, lungs, kidneys and bowels, are directly due to 
the prolonged and potent action of the malarial poisons upon the fibrin and 
colored corpuscles, consequence of a copious destruction of blood-corpus- 
cles; but the very fact of this (altered and insoluble) pigment accumulating in 
the blood and causing dangerous symptoms, particularly in the brain, by 
blocking up the capillary vessels, shows that the formation of an excess of 
free haematoglobulin in the blood stands in no necessary connection with 
its discharge by the kidneys : for haematoglobulin could not accumulate 
in the blood, if it were secreted, at the rate observed in Professor Vogel's, 
cases. 
As far as my observations extend in malarial haematuria, profound 
alterations of the colored blood-corpuscles take place chiefly in the liver 
and spleen, and the pigment particles, resulting from such changes, enter 
the circulation, and are to a certain extent, appropriated by the colorless 
or white corpuscles; they are also deposited in the walls of the capillaries, 
and in some cases they may by obstruction of the cerebral capillaries, give 
rise to grave nervous symptoms. The peculiar hue (greenish-yellow) which 
characterizes the prolonged action of the malarial poison in malarial haema- 
turia and other forms of paroxysmal disease, appears to be due to the 
altered haematin or pigment granules, and also to the imperfect elimina- 
tion of the coloring matter of the bile from the blood. In haemorrhage 
from the kidneys in malarial fever, both blood-corpuscles and blood casts 
appear in the urine; and even when the blood cells are not evident under 
the microscope, whilst haematoglobulin is present; a careful investigation 
of the cases during the different stages of the disease, followed by post- 
mortem examinations and microscopical observations of the structures of 
the kidneys, establishes the fact that in every case, blood is effused in the 
tubuli of the kidney, then coagulates and forms blood casts. These blood 
casts may give up their haematoglobulin, and thus, what really was a 
haemorrhage, may appear to be the secretion of fluid haematoglobulin; and 
the blood casts in their altered state, may finally be expelled from the kid- 
neys when all traces of haematoglobulin have disappeared from the urine. 
Under all circumstances the appearance of haematoglobulin in the urine, 
is a sign of severe lesion. It admits of a favorable prognosis, if in small 
amount and limited to a short time, after which it does not reappear; but 
when it occurs in severe scorbutic or septic disorders, or in grave forms of 
malarial fever, it is a sign of the greatest danger to the patient. Suppres- 
sion of the urine and discoloration of the skin, with vomiting restlessness 
and capillary congestion, when following the discharge of urine rich in 
haematoglobulin, are most unfavorable indications, and are almost inva- 
riably forerunners of a fatal termination. After a careful examination of 
the blood abstracted during life and after death, in various diseases, as 
hospital gangrene, pyaemia, erysipelas, yellow fever, intermittent, remit- 
tent and congestive malarial fever, small-pox and malarial haematuria and 
scorbutus, I may state the general results, that in no instance was there any 
proof that the blood-corpuscles by their dissolution in the blood-vessel 
system, furnish free haematoglobulin. If such was the case, in malarial 
haematuria, the entire surface should assume a bloody appearance. 540 
Haematuria. 
H2EMATURIA CAUSED BY LIVING ORGANISMS IN THE BLOOD. 
One of the most remarkable circumstances connected with haematuria. 
is that it occurs as an endemical disease in some countries. M. Chapotain* 
states that in-the Isle of France, children from their earliest infancy, are 
liable to this complaint, without suffering any pain from it, or its appear- 
ing to prejudice their general health. 
M. Salesse,t a native of the Isle of France, and a practitioner of Med- 
icine there, states that three-fourths of the children are affected with 
haematuria at one time or another. During the invasion of Upper Egypt 
by the French, many of the men suffered from an epidemic haematuria. J 
The endemic haematuria of Mauritius, Brazil. Cape of Good Hope. Egypt, 
and some other hot countries, which has hitherto puzzled pathologists, 
seems at length, through the researches of Griesinger, § Bilharz.|| and Dr. 
John Harley,to have found its explanation in the presence of a minute 
parasite which infests the mucous membrane of the pelvis of the kidney 
and the bladder. The parasite bilharzia haematobia was discovered by Bil- 
harz, while conducting, with Griesinger, an investigation into the diseases 
of the Egyptians. Bilharz named it distoma haematobium: but later writers 
have erected it into a separate genus, which Cobbold has named Bilharzia, 
in honor of its discoverer. It is an elongated, soft-skinned bi sexual 
entozoon, three or four lines in length, of the trematode or fluke kind. It 
inhabits the branches of the portal system and the minute veins of the 
pelvis of the kidneys, ureter and bladder. So common is it among the 
Egyptians, that Griesinger found it 117 times in 363 autopsies. The male 
is comparatively thick and short, and provided with a gymecopheric canal, 
in which the longer filiform female is lodged during the copulatory act. 
The eggs are oval bodies 1-170th of an inch long, with a spiny projection 
from the anterior end. The embryo, when newly escaped, is feather- 
shaped, and provided with cilia. The bilharzia haematobia does not pro- 
duce much mischief in the larger veins; but when lodged in the smaller 
vessels of the mucous and sub-mucous tissues, of the urinary and intesti- 
nal tracts, it engenders severe and often fatal disorganization. Griesinger 
found that, in the large intestines, it gave rise to a disease resembling 
dysentery, and that it was a frequent complication of that disease, but not 
the essential cause of it. 
The ravages of the Bilharzia produce much more serious results in 
the urinary channels than in the intestines. It chiefly affects the bladder, 
but frequently, also, the ureter and pelvis of the kblneys. In the bladder, 
it gives rise to injected and ecchymotic raised patches, varying from the 
size of a lentil to that of a shilling, covered with a tough mucus, or with 
grayish-yellow, bloody exudation, which contains masses of ova. In more 
advanced stages the patches are more elevated, discolored, mixed with 
pigment specks, smooth and leathery, or soft, pliable, and encrusted with 
gravelly matter composed of uric acid and other urinary deposits, mixed 
with ova and blood. In other cases, the patches resemble nodules or con- 
dylomata, over which the mucous membrane is sometimes preserved 
uninjured, sometimes thickened,injected, adherent and detached. When 
the parasite invades the ureter and pelvis of the kidney, its effects are 
still more destructive. The calibre of the ureter is narrowed at the 
* Topographic Med. de 1'Isle de France, Paris, 1812. 
f Diss, sur 1'H.ematurie, Theses de Paris, 1834. 
J Renoult, Notice sur 1'Hematurie, etc.,en Journ. Gen, de Med. tom. xvlii. 
g Beobachtungen uber die Krankheiten von Egypten. Archiv. d'Physiolog. Heilb. 1854, p. 561. 
|| Zeitscher fur Wissenschaftliche Zoologie, Bdw. 
f Endemic Haematuria of the Cape of Good Hope, Med. Chir. Trans., vol. xlviii, p. 55. Hcematuria. 
541 
affected spot. Above the constriction, the ureter is dilated from accumu- 
lation of urine; the pelvis is also distended, and a hydronephrotic condi- 
tion is produced. Or, inflammation and suppuration are set up, and severe- 
pyelitis ensues. In one instance, Griesinger found the kidney distended 
into an enormous sack filled with pus, the renal tissue being wholly 
destroyed. 
In addition to these direct results, urinary concretions are often formed 
on masses of ova, and grow into large calculi. This accounts for the fre- 
quency, and endemic prevalence, of calculous disorders in Egypt. Grie- 
singer remarks: " These various changes in the mechanical state and 
nutrition of the uro-poietic apparatus, fail not to react most deleteriously 
on the entire organism. A series of cases have fallen under our notice in 
which they produced general ill health, and at length death. Most of these 
individuals were finally cut off with shattered constitutions, by pneumonia, 
dysentery and the like. The direct signs of the disease are to be sought 
in the uro-poietic system, but especially in the urine. Repeated haematuria 
in sicklv individuals, from unknown causes, often came before us in Egypt. 
We no longer doubt that the symptoms were produced by distoma pro- 
cesses. The eggs of the distoma were found by Bilharz in the urine of a 
boy who, during convalescence from typhus, suffered from haematuria. 
Symptoms of pyelitis, or slight affection of the bladder, must be present in 
many cases * *. Cases also came before us which awoke a strong suspicion 
that the distoma disease sometimes ran its course as an acute, sure and 
fatal disorder. We found on two occasions, in the bodies of persons who 
had rapidly died from an unknown acute disease, abundant recent distoma 
changes in the bladder, recent pyelitis, and a uniform dark-red hyperaemia 
of the kidneys. In other cases of supposed rapid typhus, the same changes 
were found in the bladder and ureter. 
Griesinger throws out the conjecture that the endemic haematuria of 
hot countries may be due to the presence of this worm in the urinary pas- 
sages. The researches of Dr. John Harley have recently supplied a con- 
firmation of this conjecture. Dr. Harley had an opportunity of examining 
the urine of three gentlemen who had resided at the Cape of Good Hope, 
and who had been subjected to the endemic haematuria of that country; the 
other two considered themselves cured of the haematuria, but were subject 
to gravel. In the deposit, from the urine of all three, Dr. Harley detected 
numerous ova of the bilharzia. The condition of the urine in the first case 
is thus described by Dr. Harley: "Pale amber-colored, sp. gr. 1017.6, 
acid, deposits a deep layer of dirtyish white flocculent matter, amougst- 
which were two short opaque filaments about the l-35th of an inch in 
diameter, of a brownish color and soft consistence, two shorter and wider 
fragments of the same substance, a little reddish mass of the size of a hempen 
seed, like a little clot of blood, and numerous white specks. The clear, 
limpid urine when acidulated with nitric acid and heated, deposited a trace 
of albumen.'' The deposit examined microscopically, was found to con-, 
tain pus corpuscles; and the filamentous bodies and coagula contained 
imbedded in them great numbers-sometimes thirty, sometimes forty or 
more-of bright, highly refractive oval bodies, which were identified as the 
ova of bilharzia. These observations seem to indicate the possible parasitie 
origin of the endemic haematuria of Cape Colony, and establish the impor- 
tance of a thorough microscopic examination of the urine and urinary appar- 
atus, in this disease as it prevails in the Mauritius and other hot climates. 
Up to the present time I have failed in connecting the malarial haematuria of 
the Southern States with any specific parasite, and the manifest connection 
of the haemorrhage in many cases with the cold stage of paludal fever, and 542 
Bilharzia Hcematobia; Hcematuria. 
the existence of jaundice and great hepatic and gastric disturbance at the 
same time, as well as the great variety of calculus, cystic and nephritic dis- 
orders in the regions or country most affected by the fatal form of disease, 
would lead to the view that the disease was not of parasitic origin. This 
subject, however, demands the most careful and thorough investigation. 
The research should embrace the microscopy of the blood as well as of the 
kidneys, liver and alimentary canal. 
ENGRAVING NO. 74. 
Bilharzia Hcematobia. 
Engraving No. 74.- Bilharzia H.iaiatobia (Cobbold). Gynoecophorus hcematobus (Diesing). 
'Thecosoma hoematobium (Moquin-Tandon). Distoma hoematobium (Bilharz). Distoma Capense (J. 
Harley), Schistosoma hoematobium (Weinland), JStc. 
General and specific characters. A trematode helminth, in which the male and female 
reproductive organs occur in separate individuals; the male being a cylindrical vermiform 
worm, measuring only half an inch or rather more in length, whilst the female is filiform, longer 
and much narrower than the male, being about four-fifths of an inch from bead to tail. In both 
the oral and ventral suckers are placed near each other in the front of the body; in the male 
the suckers measuring l-100th inch; in the female l-312th inch in diameter; in either the repro- 
ductive orifice occurs immediately below the ventral acetablum. The comparatively short, thick 
and flattened body of the male is tuberculatedand furnished with a gyncecophoric canal, extending 
from a point a little below the ventral sucker to the extremity of the tail; this slit-like cavity 
being formed by the narrowing and bending in wards of the lateral borders of the animal, the 
right side being more or less completely overlapped by the left margin of the body; caudal 
extremity pointed; intestine in the form of two simple blind canals; female with a cylindrical 
,body measuring only l-312th of an inch in thickness in front of the oval sucker; lodged in the 
gyntecophoric canal of the male during the copulatory act; thickness of the body below the 
ventral acetabulum being about l-357th, at the lower part l-90th; surface almost smooth through- 
out; intestinal canals reunited after a short separation to form a broad, central, spirally-twisted 
tube, extending down the middle of the body: vitelligene and germigene canals combining to 
form a simple oviducal, which is continued into a simple uterine tube, finally opening near the 
lower margin of the ventral sucker; eggs pointed at the end, or by a projecting spine near the 
hinderpole. Engraving 74. The prominent figure represents Bilharzia hcematobia. Cobbold: male 
and female, the latter partly enclosed within the gyncecophoric canal. Considerably magnified. 
Kuchenmeister. Eggs and embryos of Bilharzia hcematobia. 
(A). Three ova (x 50 diam.) and a portion of mucus membrane with eggs attached (x 25 diam.) 
(B). Egg with segmented yolks. 
(C). Free embryo. 
<D). Ruptured egg, with embryo escaping (x 150 diam). John Harley. 
This genus is one of remarkable interest, not merely in a structural point of view, but also 
from its prevalence on the borders of the Nile, and also, according to Dr. John Harley, in South 
Africa and the Mauritius. The first specimens were discovered by Dr. Bilharz of Cairo, in the 
portal system of blood-vessels; and others were subsequently observed by him, Greisinger, Rein- 
hard, and Lautner in the veins of the mesentery, bladder, and other parts, giving rise to a for- 
midable and very common disease. This malady is likewise endemic at the Cape of Good Hope. 
On the 4th of December, 1857, Professor T. Spencer Cobbold, M. D., F. R. S., discovered a bi-sexual 
fluke of this kind in the portal vein of a Sooty monkey (cercopitheeus) which had died at the 
Zoological Society's Menagerie; and at the time, as well as for a considerable period since, Cob- 
bold believed it to be a species distinct from the worm described by Bilharz. It was accordingly 
named Bilharzia magno. However, whilst Cobbold still retains the generic title which was then 
adopted, he has abandoned the specific name, and agrees with Leuckart that the two forms are 
identical. The disparity of size which then appeared to be a bar to their identity, does not in 
reality exist since Leuckart has shown that some of the specimens derived from human sources 
were as large as the one which Cobbold found in the monkey. The occurrence of this curious 
genus in the blood-vessels of man and monkeys is highly suggestive, as indicating affinities of 
habits between bimana and quadrumana. Bilharzia Hcematobia; Hcematuria. 
543 
The cereapithecus fuligimosus is an African monkey, and no doubt in its native haunts procures 
the larvae of Bilharzia from the same or from similar sources, as those from whence the men of 
Egypt procure their larvae. 
According to Cobbold, animals lower in the scale do not appear to be liable to attacks from 
this strangely organized genus of flukes, and, as yet, we are uninformed as to the nests which 
contain it, in its larval condition. Up to the time of Bilharz's announcement of the existence of 
the distoma haematobium, so abundantly foundby him in thepeople of Egypt, almost all the flukes 
were considered to be hermaphroditic, etc., or, in other words, each individual was provided with 
male and female organs, the only exception being that of the distoma filicolle, regarded by Rudol- 
phi and Dujardin as a species of monostoma. 
So common and numerous is the distoma haematobium in Egypt, that Bilharz has expressed his 
belief that half the grown up people are infested with it; whilst in 363 examinations of the 
human body after death, Griesinger found this entozoon present no less than 117 times. 
The latter authority also conjectures that the young of Bilharzia exist in the waters of the 
Nile, in the Ashes which there abound, or even in bread, grain and fruit; but Cobbold thinks 
that it is more probable that the larvae in the form of cercariae. redise, and sporocysts, will 
be found in certain gasteropod moluscs proper to the localities from whence the adult forms 
have been obtained. The anatomy of Bilharzia has been described by Bilharz, Kuchenmeister, 
and especially by Leuckart and Cobbold. Without entering into minute anatomical details, there 
are several points whieh demand consideration. 
Taking the male first, one can not fail to notice the horseleech-like aspect of the animal, due to 
the position of the oral sucker, the disc of which is placed almost on the same level as that of the 
ventral acetabulum. The surface of the body is smooth in this region, but immediately below the 
ventral sucker the epidermis has a minutely tuberculated warty aspect, which is continued 
onwards to the point of the tail. The pharynx isapparently unprovided with any special pouch, 
and there is no oesophageal bulb; the tube bifucates immediately above the ventral sucker, and 
those divisions passing on towards the region of the tail, reunite in the central line. The same 
thing occurs in the female, the point of union taking place much higher up in the body, and pro- 
ducing a long, tortuous, broad, and twisted central canal which is continued to near the tip of the 
tail, where it terminates caecally. The testes appear to consist of several distinct lobes, or small 
oval organs, which are probably connected by a pair of vasa d~ferentia, opening externally by a 
single outlet below the ventral sucker. There is no evidence as to the existence either of a 
seminal pouch or intromittent organ. In the female the vitelligene glands are situated, one on 
each side of the central intestinal pouch, whilst the egg-shaped ovary occurs near the point of 
junction where the intestinal divisions unite. From the posterior margin a germ-duct is given off. 
which unites with the ducts coming from the vitelligene glands; and these together forming the 
oviduct are continued forward as a single uterine canal up to the vaginal outlet, which is directly 
below the tip of the ventral sucker. According to Bilharz the aquiferous system is represented 
by two thin canals, which unite to form a short, tubular expulsion-sac, anterior to the central 
point of the tail, where there is probably an open foramen caudate. 
The eggs of Bilharzia are somewhat variable in outline, being usually more or less oval, pyri- 
form, or sharply pointed at the hinder pole, but sometimes assuming a simple oblong figure, in 
which case they are furnished with a spine-like process placed at the side, and a little anterior to the 
hinder end. Between these two type-like forms, other slight differences ofoutline also exist, but in 
all eases, whilst the eggs are still within the uterine canal, the hinder pole (or, in other words, that 
end of the eggs which is opposed to the one ordinarily provided with an operculum), is directed 
towards the caudal extremity of the parent's body. Their size is likewise variable, presenting an 
average longitudinal measurement of about l-200th of an inch, and a breadth of l-550th. A true 
operculum does not appear to exist; but Bilharz saw the embryos escaping by a lateral slit 
near the anterior pole of the shell. Whilst the ova are still within the body of the parent, 
the embryos develop themselves into minute ciliated animalcules, and after their escape they 
exhibit lively movements. Many ciliated embryos were found by Griesinger free in the intes- 
tines of the human subject. According to Bilharz and Leuckart, the embryos measure l-227thof 
an inch in length, and l-676th transversely. They are extremely delicate in structure, being, for 
the most part, transparent, and containing in their interior a quantity of fine, highly refracting, 
sarcode globules. 
At the anterior end which is more or less pointed, Bilharz observed a double pyriform cor- 
puscular mass, which would probably represent the rudiments of a digestive pouch in the next 
stage of larval formation. Beyond this point, however, we know nothing as to the precise forms 
which the larvae of Bilharzia assume; but it is, of course, highly probable that their sporocystic 
and cercariau features correspond, in the main, with that displayed by the larvae of other trema- 
todes.* 
INJURIOUS EFFECTS OF THE BILHARZIA H.EMATOBIA UPON MAN. 
The peculiar and formidable helminthiasis produced by this parasite has been thoroughly 
investigated by Griesinger and Bilharz. and it is very fully described in the standard works of 
Kuchenmeister and Leuckart. The prevalence of the disease in Egypt has been noted by several 
authors. Its principal feature consists in a general disturbance of the uro-poietic functions. 
Diarrhoea and haematurla occur in advanced stages of the complaint, being also frequently asso- 
ciated with the so-called Egyptian chlorosis, colicky pains, anaemia and great prostration of the 
vital powers. The true source of the disorder, however, is easily overlooked unless a careful 
microscopic examination be made of the urine and other evacuations. If blood be mixed with 
them, and there also be a large discharge of mucus, a minute inspection of the excreta will scarcely 
fail to reveal the presence of the characteristic ova of Bilharzia. Beside the Increase of mucous 
secretion, there may even be an escape of purulent matter, showing that the disorder has far 
advanced. The whole constitution eventually becomes undermined; pneumonia often sets in, 
and death finally ensues. The following pathological facts have been revealed by post-mortem 
examination. Incases where the disease has not very far advanced minute patches of blood- 
extravasation present themselves at the mucus surface of the bladder, but in more stronglj' pro- 
nounced cases the patches areilarger or even confluent. In some instances they are villous or fun- 
gus-like thickenings, ulceration and separation of portions of the mucous membrane, with vary- 
ing d.egrees of coloration, according to the amount of the extravasation which becomes converted 
into grey, rusty-brown, or black pigment deposits. A gritty or sandy deposit is often superim- 
* Entozooa, an introduction to the Study of Helminthology, with reference more especially to 
the Internal Parasites of Man. By T. Spencer Cobbold, M. D., F. R. S., pp. 197, 204. 544 
Bilharzia Hcematobia; Hoematuria. 
posed, consisting of the ordinary lithic acid grains mixed with eggs and egg shells. Bilharz. 
detected eggs in the urine, these having probably escaped from the ruptured vesical vessels, 
producing the extravasation and hsematuria. 
The lining membranes of the ureters and renal cavities are also more or less affected: the kid- 
neys being frequently enlarged and congested. It must, however, be borne in mind that in all 
these organs the true seat of the disorder is the blood, which forms the proper habitat of the 
Bilharzia; and this being the case, the worms, as well as their escaped eggs, may be found in 
any of the vessels supplying the diseased organs. In oue instance quoted by heuckart, Griesin- 
ger found a number of empty eggs in the left ventricle of the heart, and from this circumstance 
it was supposed that they might be carried into the various important organs, or even plug up 
the larger vessels. The parasites, however, are more particularly prevalent in the vessels of the 
bladder, mesentery and portal system. The effects upon the intestinal mucous membrane are, in 
most respects, similar to those occurring in the urinary organs. Blood extravasation, with thick- 
ening, exudation, ulceration and fungoid projections, appear in and upon the intestinal mucous 
andsub-mucous tissues; these appearances of course being more or less strongly marked accord- 
ing to the degree of infection. 
In the larger vessels, such as those of the liver, this distoma gives rise to no derangements 
equal to those which result when it exists in the lining membrane of the urinary passages and 
the intestinal canal. There it induces haemorrhage and inflammation. In the intestines they are 
often associated with appearances resembling those of dysentery, with conjestion, extravasation 
of blood, deposit upon and beneath the mucous membrane, fungoid excrescences, and croupy 
exudations that occupy ulcerated patches of the bowels. In many of these cases the eggs of the 
creature may be found wedged in long rows within the intestinal vessels, or in and beneath exu- 
dations on the free surface of the mucous membrane. Hence it has been suspected whether the 
dysentery endemic in Egypt may not have to t hese diastoma the same relation as ''itch" has to 
Acarus. Such a conclusion receives a strong confirmation when we turn to the lesions produced 
in the urinary apparatus. Here the mucous membrane appears swollen in places which are 
covered with a soft sandy rotten mass firmly fixed to the subjacent tissue. Tne microscope 
shows this mass to consist of the full and empty shells of the parasitic ova, embedded in a mix- 
ture of blood, exudation, mortified epithelium and crystals of uric acid. The thickening of the 
sub-mucous tissue often produces stricture of the ureter, which is followed by retention of urine 
and all its dangerous consequences; degeneration of the kidneys, pyelitis, dilatation of the 
renal pelvis, or atrophy of the substance; or the masses themselves become the nuclei of calculous 
deposits, and thus aid in the chloritic exhaustion, these creatures produce in the person they 
inhabit by the consumption and loss of blood they imply. Lastly, it seems not unlikely that 
the dislodgment of clots into the general circulation sometimes brings about pneumonia in the 
way described by Virchow and illustrated by Kerkes. Brit.jand For. Med. Chir. Rev., L. C., p. 625- 
The disease is said to be more virulent in the summer months, which is probably owing to 
the prevalence of the eircarian larvae at the spring of the year. It makes very little difference,, 
however, as regards the prospect of cure, which, it need hardly be said, is extremely futile after 
the disorder has once set in. Here, indeed, remedies can be of little avail, the only treatment 
of any value, as regards the general loss of strength, being simply paliative and restorative. 
According to Cobbold, the great point to be aimed at is the discovery ot the precise source of thia 
higher larvae of the parasite; and should it eventually turn out that these circariae are limited to 
any one or two particular hosts, then, certainly, helminthologists would be in a position to show 
what precautions on the part of the people might secure them from the invasion of the fatal 
malady. At the same time they would be able more cogently to enforce a recognition of the 
truism that prevention is better than cure. Dr. Harley, (of King's College. London), in his paper 
on the haematuria of the Cape of Good Hope, has suggested the employment of diuretics, but 
these remedies could be of little avail since the seat of the disorder is in the blood. His distoma 
capense is certainly identical with Bilhirzia hcematobia, and the symptoms presented by it are, 
for the most part, similar to those above described.* 
* Entozoa, etc., Cobbold, p. 200, 204. J. Harley on a case of hydatid disease of the liver, and 
remarks on the treatment of similar tumors; rep. of Roy. Med. and Chir. Soc. in the''Lancet" 
for May 19, 1866, p. 538. Cysticucus in the brain; note respecting the case in the "Lancet" for May 
18, 1867, p. 612. 
Dr. John Harley has directed the attention of the medical profession to the remarkable pre- 
valence of hoematuria at the Cape of Good Hope, a condition which he found associated with 
the fertile ova of this entozoon passed in the urine. After micturition a little blood, never 
^exceeding a teaspoonful, or some dark coagula, like "veins," appear with the last half ounce of 
urine. The urine itself, according to Dr. Harley, is never bloody. Sometimes the blood-coagula 
will block up the urethra, and cause obstruction for a few minutes. These are al! the symptoms 
which appear in connection with the urinary apparatus, and numbers of people of both sexes 
are affected in precisely the same way in certain parts of the Cape, as endemic haematuria- 
especially at Utenhage and Port Elizabeth. In various samples of urine sent to Dr. Harley by a 
person suffering from this affection, he invariably detected the ova of the entozoon. The eggs 
measured l-200th of an inch long and l-550th of an inch broad. He was successful in observing 
the perfect ciliated embryo alter its escape from the shell. Dr. John Harley considers that the 
eggs often become after the total disappearance of the haematuria, the nuclei of renal calculi. 
IMPORTANCE OF THE MICROSCOPICAL EXAMINATION OF THE URINE IN THE 
H2EMORRHAGIC MALARIAL FEVERS OF NORTH AND SOUTH AMERICA. 
The preceding facts place in a clear light the great value of careful 
microscopical examinations of the urine in the miasmatic diseases of all 
countries, and especially in the southern portions of the United States of 
America, where malarial hsematuria of the most intractable and fatal 
character prevails at certain periods of the year and in certain localities. 
Whether the bilharzia hcematobia is indigenous to the swamps, marsh 
and rice fields of our Southern States, and whether this parasite distoma, 
or some related species, is active in the production of malarial haematuria. Distoma Ringeri. 
545 
has not yet been determined. It is well established that severe forms of 
malarial fever, attended with haemorrhages from the stomach, bowels and 
kidneys have been frequently traced to the use of well, river and swamp 
water, and to the exhalations of the rice fields in the months of August, 
September and October, when the waters have either evaporated spon- 
taneously, or been artificially drawn off or pumped out of the rice fields. 
How far these fatal forms of malignant malarial fevers, attended with 
haemorrhages and intense jaundice, may be due to the action of parasites 
introduced through the water, food and atmosphere, has not yet been fully 
determined. But the facts previously recorded establish the necessity of 
the most rigid examination of the fauna and flora of the waters and soil of 
malarious localities, in conjunction with similar examinations of the human 
secretions and excretions when acted upon by endemic morbific agents. 
Distoma Ringeri and Parasitical Hemoptysis. 
ENGRAVING NO. 75. 
Engraving No. 75 - Distoma Bingeri and Parasitical Haemoptysis. Figures 1-15. Figure 
18. After Patrick Manson, M. D. 546 
Distoma Ringeri and Parasitical Haemoptysis. 
The possible dependence of haemorrhagic fevers upon specific parasites 
is. still further illustrated by the parasitical haemoptysis of Japan and. 
certain portions of China caused by distoma ringeri. 
This subject is of such importance in its bearings upon epidemic haemor- 
rhagic diseases, that we quote at length the valuable investigations of 
Doctor Patrick Manson*, on 
DISTOMA RINGERI AND PARASITICAL HAEMOPTYSIS. 
In the Customs Medical Reports, Vol. xx, page 10, I called attention to a 
new parasite the mature form of which had recently been discovered by Dr. Rin- 
ger in Tamsui, Formosa. I therein succeeded in associating this animal with a 
peculiar form of recurring haemoptysis, common in one part, at least, of the Chi- 
nese Empire, which had hitherto not been understood ; and I gave some particu- 
lars of a case occurring in my own practice in which the association was apparent. 
At that time I was unaware that Professor Baelz, of Tokio, had been working at the 
same subject, and it was net until I read in the Lancet of 2d October, 1880, a sum- 
mary of a paper by this gentjeman that I learned that this disease had been 
described by him, and that it was not uncommon in Japan. Although Professor 
Baelz, in the paper I refer to, errs in calling the bodies which I have proved to be 
the ova of distoma rinyeri, gregarinae, yet, though I do not know the dates of his 
investigations, the merit of priority in the discovery probably rests with him. 
In my report I mention that in making a post mortem examination of a Portu- 
guese dead of aneurism of the aorta, Dr. Ringer found a parasite in the lungs; that 
in the sputum of a Chinaman suffering from a chronic intermitting haemoptysis I 
found certain bodies I had no difficulty in recognizing as the ova of a parasite; and 
that when these bodies and the ova emitted by distoma rinyeri were compared 
they were found to be identical in size, shape, color, and contents. 
Of the parasite discovered by Professor Baelz, the Lancet says that it is- 
" Met with in two forms : (i) as yellowish-brown ovoid bodies of .13 millime- 
tres long and .07 millimetres wide. They have a double contour, from a translu- 
cent wall, .02 millimetres thick, which in different positions appears greenish or 
reddish, and at the larger end is a kind of cover, at which the cyst opens. The 
contents consist of delicate jelly-like material, in which are embedded three or 
five aggregations of smaller bodies. The latter consist (a) of spherules about twice 
the size of a white blood-corpuscle, colorless, with sharp outlines. Around these 
spherules, and more or less inclosing them, is (6) a coarsely granular material scat- 
tered through the jelly, and in it molecular movements may often be seen. When 
the spherules have left the cyst they show fora time the same movements, andthen 
become invested with the granular substance, and become motionless." 
These bodies, he concluded, are a stage in the development of gregarinae, and 
he therefore proposes to call the disease they are connected with gregarinosis pul- 
monum, and the parasite yreyarina pulmonum or yreyarina fusca. 
As the above description applied pretty accurately to the ova of distoma rinyeri, 
and as they were associated with haemoptysis, I concluded they were identical, and. 
wrote to Professor Baelz, requesting him to send me a specimen of the characteris- 
tic sputum from Japan. He very kindly did so, and I had no difficulty in seeing 
that the bodies he described were identical with those I was familiar with and 
with the ova of distoma rinyeri. Indeed, in his letter to me the professor says that 
both he and Leuckhart had already suspected they might be the ova of a distom. 
That this view is the correct one will receive additional and corroborative evidence 
in the sequel. 
During the last eighteen months I have made many unsuccessful attempts to 
find the ova of the parasite in the sputa of natives of this district. I suppose I 
have examined altogether about one hundred and fifty individuals. Therefore, it 
is not at all likely that the disease is common in Amoy and its neighborhood. It 
is quite otherwise, however, in North Formosa, though only separated from us by 
some two-hundred miles of sea. Being anxious to attempt the development of the 
embryo, and despairing of finding supplies of ova in Amoy, I applied to my friend. 
Mr. John Graham, of Tamsui, to find me some sputa. He answered my letter by 
sending me two bottles full of ova-laden sputum, one of which was filled by his. 
house-boy, the other by his cooly. Dr. Johansen also recently sent me six speci- 
* From the Medical Reports No. 22, 1881, of the Inspector-General of Customs, China. By 
Patrick Manson, M D. Distoma Ringeri and Parasitical Hcematuria. 
547 
mens of sputum, three of which contained ova in abundance; of the ova-laden 
sputa one came from his hospital assistant, the other two from peasants living near 
Capsulan, a place about forty miles to the southwest of Tamsui. The facility with 
which these cases were found proves that the parasite must be very common about 
Tamsui; and Mr. Graham's servants, who sometime ago both visited Amoy, told 
me that hfemoptysis, such as they themselves suffered from, was extremely com- 
mon. Regarding their acquaintances, one of them said that twenty or thirty per 
cent., the other that fifteen per cent., spat blood. Possibly these are overstatements 
but at all events they show that the disease is extremely prevalent. With regard 
to Central and South Formosa, I recollect very distinctly my surprise at the large 
number of cases of hiemoptysis I used to meet with there, and have now little 
doubt that in distoma ringeri we have the explanation. . 
ENGRAVING NO. 76. 
ENGRAVING NO. 77. 
Distoma Bingeri of Parasitical 
Haemoptysis. 
Distoma Ringeri of Parasitical 
Haemoptysis. 
Engraving No. 76.-Distoma ringeri of parasitical haemoptysis.' Figures 16-20, and figure 26 
After Patrick Manson, M. D. 
Engraving No. 77.-Distoma ringeri of parasitical haemoptysis. Figures 21-25. After Patrick 
Manson, M. D. 
The geographical distribution of this parasite is peculiar, if it-is the case, as 
seems probable, that it is rare or entirely absent on rhe mainland of China. We 
have Professor Baelz's authority for its existence throughout Japan. I suspect, 
therefore, that there is something in the soil or geological structure common to 
Japan and Formosa, but not present on the neighboring continent, that determines 
this apparent caprice in the distoma area; and that this geological element, what- 
ever it may be, is one necessary to the existence of the intermediary host. The 
distribution of similar parasites depends principally on the distribution of their 
intermediary hosts; this fact can easily be understood. Both Japan and Formosa 
resemble each other in being volcanic, and are both members of that long string of 
volcanic islands that, stretching along the eastern coast of Asia, includes, besides 
these, the Loochoos, the Bashees, the Philippines, and a host of smaller islands. I 
believe that extended inquiry will show that distoma ringeri exists in all of these. 
Parasitical haemoptysis can readily be diagnosed. There is a history of irregu- 
lar intermitting haemoptysis associated with a slight cough, and, in the intervals 
of more active bleeding, the expectoration once or several times a day of small pel- 
lets of viscid, brownish mucus. Violent exercise is apt to produce profuse haemor- 548 
Distoma Ringeri and Parasitical Haemoptysis. 
rhage and irritation of the lung in any'way so as to induce coughing, causes the 
discharge either of quantities of blood or of the characteristic sputum. At the 
same time there are no objective symptoms of lung disease, and the patient probably 
enjoys good general health. Examination of a small portion of the sputum with 
the microscope at once settles the diagnosis. I many times examined sputa from 
the two cases I had under close observation for a considerable time, and never failed 
to find abundance of ova, sometimes counting as many as twenty in a single field. 
The following are short notes of the two cases I refer to; I am told they are 
typical examples of the disease as found in Formosa: 
" Heng, male, set. thirty-one; resides in Sinhang, Tamsui, where he works as a 
house cooly. His family, he says, is quite healthy; his mother, aged forty-four, 
and three brothers and four sisters, are alive and well. His father died at fifty- 
eight of dropsy, and a sister died in childhood of small-pox. He himself is liable 
to ague. He was born in the town of Banka, and lived there till his eighteenth 
year; then he lived in Kelung for two or three years; afterwards he removed to 
Hobe, Tamsui, where his home has been for the last ten years. He has traveled 
about the north part of the island a good deal; been in Tekchham two or three 
years ago; and eight years ago accompanied some Japanese to Khilai, on the east 
coast, where he resided for upwards of a month. His blood-spitting dates from 
eleven years ago; he was then working on the tea hills with his father, near Banka. 
At first he noticed when he breathed hard in carrying heavy burdens that he 
coughed a little and brought up mucus mixed with blood; from that time till now 
has spat blood more or less constantly; some days none, other days a considerable 
quantity. Once when pulling in a boat about two years ago he suddenly brought 
up over a bowlful of pure blood, but, as a rule, unless exerting himself violently, 
he only brings up a few drops mixed with the mucus. Sometimes he does not spit 
for a few days, perhaps a month on end, and t hen the hremoptysis recurs, to last for 
one or two months. He has a slight cough, but on auscultation nothing much 
amiss can be detected. His thorax is very finely developed. He says that he 
never exercised discretion about the water he drank, especially when young; used 
to take it from river, well, paddy-field, or ditch, whichever lay most convenient, 
and he says that nearly all North Formosans are similarly indiscreet." 
Heng lived in my house from the 14th to the 31st July, and during the whole 
of this time he could nearly always cough up blood or ova-laden mucus such as I 
have described. 
Heo, male, set. twenty-two; born and resident in Hobe, Tamsui; a house-boy. 
Father and mother are both dead, both of them of some dropsical affection. Until 
he was eighteen years of age enjoyed excellent health; then without any obvious 
cause, he began to spit blood, especially after making any very great exertion. 
During one year, many times each month, he continued to spit blood, about an 
ounce at a time. He then got lighter work and the bleeding ceased, and has not 
recurred; but he has a cough still, and almost every day expectorates pellets of 
tenacious, muddy, yellowish, brown mucus. Sometimes for several days, if the 
weather is fine his work is light, there is no cough or spit; but when the weather 
changes, or he has to exert himself, the cough and spit return. He complains of 
some pain about the left nipple, but the lungs appear healthy. His sputum is as 
described, and abundance of ova can be found in it." 
When examined with the microscope the ova of distoma ringeri are seen to be 
shaped very much after the fashion of a fowl's egg, with the exception that a cir- 
cular operculum about half the breadth of the egg closes the broad end. On an 
average they measure about X 5oo/z> but some specimens are slightly larger 
and others slightly smaller. There is considerable diversity likewise in shape, some 
being more globular than the majority, whilst others are more elongated and 
tapered towards the narrow end. Their color, which, when blood is entirely 
absent, as is sometimes the case, imparts the characteristic brownish tinge to the 
sputum, is a dirty reddish brown, and appears to reside both in the shell and in 
the granular portion of its contents. The shell is without markings, and shows in 
double outline, more especially when it has been fractured by pressure. When 
viewed with a high power the ovum is seen to contain one, two, or more well- 
defined, pale, sarcode globules embedded in a structureless matrix containing 
abundance of irregularly disposed dark granular matter. Usually one of these 
sarcode globules is brighter and better defined than the rest. By careful focusing 
they are seen to be made up of very minute granules in a state of active molecular 
movement. Pressure ruptures the shell at the opercular end, forcing out the con- 
tents, which resolve themselves into innumerable globules of all sizes, from fine 
microscopic granules to large bodies io diameter. The smaller particles Distoma Ringeri and Parasitical Haemoptysis. 
549 
exhibit very active molecular movements, and tend after a time to coalesce round 
larger. No trace of a differentiated embryo can be distinguished. Once or 
twice I have seen attempts at yelk cleavage, a dozen or more elongated cell-like 
bodies with a bright nucleus in each occupying the whole of the interior of the 
egg; but never anything more advanced than this. 
It is evident, therefore, that some time must elapse before an embryo can be 
sufficiently developed to start on the independent existence which has been found 
to be the first step in development in those distoms whose early life-history has 
been studied. Reflecting that the ova are deposited in the sputum, that this affords 
probably their only means of escape from the human lungs, and that they are 
placed in it with a purpose, I concluded that by following out the destinies of a 
sputum I should probably be set on the right track for working out the first stage 
at least of the history of distoma ringeri. 
When sputum is cast on the ground one of three things may happen : first, it 
may be eaten by earth-worms, mollusks, or other creatures; second, it may dry up 
and mix with the soil, the solid parts of it being perhaps afterwards blown about 
as dust; third, it may be washed and carried away by rain into well, ditch, pond, 
or river. I considered that if in any of these ways the ova are borne to suitable 
incubating media, the last is the most likely to favor the development of the dis- 
toma, and most in consonance with what happens in the case of better known 
species. Accordingly I determined to imitate nature as far as I could in this direc- 
tion, on the supposition that rain or water was the first agency that operated on 
the ova. I procured two supplies of sputum from the man Heng; one lot I placed, 
without admixture of any sort, in a wine-glass and covered»it up, keeping it for 
comparison and future experiment; the other lot, measuring about one ounce, and 
containing many thousands of ova, I shook up with about an equal quantity of 
filtered well-water until the mucous blood and ova were thoroughly diffused. This 
was divided into about equal portions between six wine-glasses, and water suffici- 
ent to fill the glass was added to each. These were numbered 1, 2, 3, 4, 5, 6, and 
placed under a glass shade, in a room where, during the subsequent steps of the 
experiment, the thermometer ranged between 80° and 94° F. Next day No. 1 was 
not disturbed, but all water, except the drachm or two at the bottom of each glass, 
containing the sediment and ova, was removed by means of a syringe from 2, 3, 4, 
5, and 6, and fresh water added. On the following day 1 and 2 were not disturbed, 
but 3, 4, 5, and 6 were again watered, and so on. Thus in No. 1 the ova was washed 
once, in No. 2 twice, in No. 3 thrice, in No. 4 four times, in No. 5 five times, in No. 
6 six times, the washing taking place at intervals of twenty-four hours. My notes 
of observations show that no development occurred in the unwashed ova; that 
it was delayed in No. 1, where only one washing had been performed; that it 
advanced steadily without much notable difference in 2, 3, 4, 5, 6, until at the end 
of from six weeks to two months the majority of the ova produced active ciliated 
embryos. A small quantity of sediment from one or more of the glasses was 
removed with a pipette daily, or every second day, and examined under the micro- 
scope. Ova were always easily found. For the most part they were entangled in 
little flakes of miscellaneous debris, but from this they could easily be separated. 
Notes were made of the various changes as far as they could be detected; but for 
the first few weeks, on account of the dark granular character of the contents, it is 
difficult to say precisely what the different steps were that led up to the formation 
of the mature embryo. Great molecular activity can be detected in the paler glob- 
ules for some time; then these lose their distinctness, large oil globules appear about 
the periphery of the yelk, and a paler mass shows in the centre (Figs. 1 to 11). In 
time the latter contracts, leaving the shell by a considerable space. Languid move- 
ments ensue in it; these become more active; a ciliated epithelium is developed on 
its surface, and an indentation at the opercular end indicates the presence of a 
mouth of some sort. 
On the twenty-sixth day of incubation I note: Examined some sediment from 
No. 3, and in it found an ovum of characteristic shape and color, with an embryo 
in it possessing considerable activity and plastic power. It moved vigorously in 
the shell, and altered from time to time the shape of its body, which for the most 
part was heart-shaped, a distinct depression existing at the opercular end. Con- 
tents of the body granular. No vessel visible. No cilia visible when in ova, but 
on crushing the egg the ruptured embryo escapes, and its collapsed integument 
is then seen to be covered by long cilia, which keep in active movement for about 
one minute. Examined No. 4, and found several ova with active embryos of the 
same character Also No. 1, but in it there appeared to be no advance in develop- 
ment. (Figs. 12-19) 550 
Distoma Ringeri and Parasitical Haemoptysis. 
On the twenty-eighth day I note: In all the glasses except No. 1 the ova con- 
tained ciliated embryos. If carefully expressed, the embryo retains its activity 
for eight or ten minutes after its escape. It rushes off from the egg a globular, 
ciliated, rotating ball. As movement subsides the body elongates, and a ciliated 
epidermis is seen to extend from the tail as far forward as the anterior third or 
shoulder of the animal. The anterior part is naked, and at its apex is provided 
with a papilla or beak. 
The body of the animal evidently lies free in tbe shell, the cilia motionless at 
this stage and directed backwards. If we watch the anterior part or bead, which 
is always directed to the operculum and for tbe most part closely applied to it, it 
is manifest that this is fixed in someway.- By careful examination of ova at a 
later stage of development I have satisfied myself that this is effected by an invo- 
lution of the delicate membrane lining the shell, which here becomes continu- 
ous with the ciliated epidermis of the body ; thus the neck is surrounded by a sort 
of collar, which keeps it a fixed point (Fig. 20). The movements of the animal 
during the last few days of its residence in the egg appear to be directed to ruptur- 
ing this connection, for the head is first turned forcibly to one side, then to 
another, expanded, contracted and jerked about, as if the little thing were annoyed 
and irritated by the collar restraining it. When this has been ruptured the embryo 
moves about in the shell, trying in an excited sort of way to escape, the cilia 
vibrating rapidly. Frequently, failing to force the operculum open, it turns com- 
pletely round and energetically butts the opposite pole of the ovum with its head. 
After a time it succeeds in opening the operculum, which is either carried com- 
pletely off, and may be found lying at some distance, or is thrown back, as if on a 
hinge. 
If we rupture an ovum very carefully a week or two after the appearance of 
the cilia, and are successful in extruding the little animal without crushing its 
delicate tissues, it will move away from the shell a short distance, its body elongat- 
ing and contracting, and the cilia playing rapidly for a few minutes. Gradually 
all movements will cease, the body passing from heart-shape to spade-shape, the 
handle of the spade being represented by a minute papilla with a very fine canal, 
apparently opening at its apex. Now, it may be distinctly seen that the ciliated 
epidermis does not cover the fore part of the body, only the posterior two-thirds 
extending as far forward as the rounding in of the shoulder; also that the epidermis 
is in plates, one covering the tapered posterior end, and two other indistinct lines 
in advance of this, indicating that altogether there are three or four such plates or 
bands. Soon after extrusion the homogeneous or finely granular contents present 
larger globules, containing actively moving granules, and as the feeble contractions 
of the body and ciliary motions cease these granular globules increase in number, 
until finally the entire mass is made up of minute dancing micrococcus-like parti- 
cles. Then the epidermic plates roll up, leaving the body quite naked, the cilia 
fade from view, and finally an amorphous mass is all that remains (Figs. 14-19). 
If, however, we rupture the ovum at a later stage of development, or if our 
observations are made just when the embryo has squeezed its plastic body through 
the natural opening, the behavior of the embryo is somewhat different. First, the 
cilia are seen to start into rapid motion, and then, after a preliminary pause, to 
rupture and separate itself from the lining membrance of the shell, which is 
sometimes forced out entire along with it, or, apparently to consider what has 
happened, the animal rushes off at great speed, gyrating about after the manner 
of certain infusoria. From time to time it pauses; contracting itself into a perfect 
disk or globe, rotating raoidly on its axis, first in one direction, then in another. 
Anon it dashes off to a distant part of the slide, exhibiting in its course many 
diversities of form. When going at high speed tbe body is much elongated ; at a 
less speed oval or fiddle-shaped, or square; but at no time is the beak or naked shoul- 
der protruded as long as the animal is aliveand active, a slight depression on the 
ciliated surface alone indicating where these are retracted. Beneath the epidermis 
is a thick contractile layer; the interior appears to be fluid or a soft jelly, holding 
minute granules in suspension, and sometimes a large bright point can be detected. 
No vessel of any sort can be traced. I do not know how long the animal preserves 
this active ciliated form. I have kept one alive in a glass cell for over twenty-four 
hours (Figs.21-25). 
Such, briefly, is the history of the first step in the development of distoma 
ringeri. The ova are laid into the bronchial mucus ; in the sputum they are cast 
on the ground; by rain or other means they are carried to stagnant water; they 
sink to the bottom; in the course of six weeks or two months ciliated embryos are 
developed; when mature these force their opercula and swim free in the water. Distoma Ringeri and Parasitical Rcemoptysis. 
551 
"What the next stage may be can only be conjectured. Doubtless they enter the 
body of some fresh water animal to undergo further metamorphoses. Perhaps 
this animal is eaten by man, or possibly the parasites once more obtain their free- 
dom. and, while still in the water, are swallowed, and thus obtain an opportunity 
of gaining access to the human lungs, their final destiny. 
I have not spoken yet of the fate of the unwashed ova. The glass containing 
them was not disturbed for about three weeks. At the end of this time the sputum 
had decomposed, stank abominably, and had settled into two layers, one upper, 
more or less clear, and a lower, turbid and dark brown. On sampling the lower 
layer, into which the ova might be supposed to have gravitated, but few speci- 
mens could be found. These, however, were, as far as I could judge, in no way 
different from perfectly fresh specimens. The sputum was then washed repeatedly 
with fresh water; but although in the sediment ova were numerous, no decided 
advance in development could be detected: on the contrary, in many, signs of 
decomposition were apparent at the end of two months, in others, again, the 
characteristic globules of sarcode could still be distinguished. Thus it would 
appear that unless the ova are freed from mucus and have access to fresh water 
within a short time of their birth they perish. If, however, water is supplied to 
them soon after they leave the lungs, though in limited amount, as was done in 
the case of glass No. 1, they do not rot, but retain their vitality, proceeding slowly 
in development. In the case of the ova in this glass the embryos were not differen- 
tiated till about the fortieth day. 
It is evident, therefore, that the ova must be brought into contact with water, 
and that that is the medium through which the parasite and the disease it pro- 
duces pass from one human lung to another, In the history of this parasite we 
have another argument, if such is needed at the present day, for a pure-water 
supply. Not many months ago there were few who would not have laughed at 
the idea that blood-spitting could be produced by a draught of dirty water. Now 
this connection can be demonstrated. How many more diseases acknowledge 
impure water as one of the most important factors in their etiology time and the 
advance of science will show. This matter of distoma ringeri and parasitical 
haemoptysis may have but little practical interest for any but some 40,000,000 or 
-50,000,000 of Asiatics and the few hundreds of Europeans who live among them, 
but is a valuable text for the advanced sanitarians of Europe to work on and 
preach from, to show that to-morrow some new fact may disclose unsuspected con- 
nections between disease and uncleanliness. 
By these observations the search for the intermediary host is limited to a com- 
paratively small group of animals. It must be an inhabitant of fresh water; it is 
common to Japan and Formosa; it does not inhabit or is rare on the mainland of 
China-at least that part of it near Amoy. The latter circumstance has precluded 
me from pursuing the investigation further, but I trust it will be taken up and 
successfully completed by some one residing in Formosa or Japan, who, being in 
the midst of the disease, must enjoy ample opportunity. The limitation of the 
field in which investigation need be made must simplify the search, but that it 
will be a short and easy one does not follow. The history of the river fluke, the 
cause ot so much disease in sheep, is not yet complete, notwithstanding the great 
inducements and facilities offered to its investigators in Europe and elsewhere. 
On discovering the cause of parasitical haemoptysis, the first thought that sug- 
gests itself is the possibility of curing it. Could the parasite be killed the dis- 
ease would be arrested. An important point bearing on this question has yet to 
be ascertained, and that is the exact site of the parasite in the lungs. Is it free in 
the bronchi, or is it jammed into the branches of the pulmonary artery? If the 
former, the parasite may be dislodged ; if the latter the prospect of cure must be 
very small indeed. An autopsy is necessary to settle this point, and I trust our 
confreres in Japan will bear this point in mind when they get the opportunity. 
The exact position of the mature parasite could easily be ascertained by micro- 
scopical examination of bronchial mucus; the appearance of ova in a particular 
tube would show that the animal is to be found by following up that lead. 
Proceeding on the assumption that the parasite had its habitat in the bronchi, 
I made several attempts in the two cases I have given to kill or dislodge it. I 
■caused the patients to inhale the spray of solutions of various drugs atomized by a 
Lister's steam apparatus. In this way the tincture and infusion of quassia, the 
infusion of kousso, solutions of turpentine and santonine in spirits of wine were 
introduced into the lungs. In addition to these the man Heng inhaled the vapor 
of burning sulphur. Inhalation was practiced twice daily fora week in one instance, 
and for a fortnight in the other. Certainly before these men passed from under 552 
Paroxysmal Haematuria. 
my personal observation they were improved so far as cough and expectoration 
were concerned, but in both instances a small amount of ova-ladened sputum 
could be still procured irritating the lungs and inducing cough. They returned 
to Jamaica before it could be seen that the cure was complete. In reply to my 
inquiries Mr. Graham wrote me lately that Heng still spits small quantities of 
blood at long intervals, but that Heo has now no cough and can no longer bring 
up distoma mucus He probably is cured. * * Our knowledge of the history 
of the ovum and the medium in which it is developed, indicates the direction 
which efforts at prevention should take. But our knowledge in this instance is a 
little in advance of any preventiou we may look for in a Formosean. Europeans 
who happen to be stationed in Formosa, or who may be travelling in the Island, 
will understand from these remarks the necessity for extra caution with regard to 
drinking water. They should never neglect to boil or filter it when the least sus- 
picion is entertained about its purity. A little neglect in this matter is paid for 
with a chronic haemoptysis. 
PAROXYSMAL HEMATURIA. 
In most cases of the so-called malarial haematuria or haemorrhagic 
malarial fever, distinct paroxysms, or intermissions or remissions of the 
phenomena may be noted; but there is a form of haematuria which may or 
may not be due to the action of malaria, which is characterized by the 
sudden appearance of blood in the urine, attended with symptoms which 
closely resemble those of a fit of ague, the urine quickly regaining its. 
former character until the next attack. Various observers have recorded 
cases of this comparative mild form of h®maturia, from which are absent 
the jaundice and violent and uncontrollable nausea and bilious vomiting 
of the malarial haematuria of our Southern States. Mr. Charles Stewart,* 
Surgeon at Archangel, published in 1794, the following case, under the 
title of "Account of a singular periodical discharge of blood from the urethra, 
terminating successf ully d ' 
Case 903.-J. Vernezobre, aged 51, complains of severe pain in the region of 
the kidneys, shooting downwards to the ossa pubis and groins. The skin exter- 
nally, is not discolored, nor is the pain increased on pressure, but it is much aggra- 
vated by motion of the body. He has had a periodical discharge of blood from the 
urethra for these eight months past; the hemorrhage usually lasts three days; is 
discharged with the urine, and the quantity which comes away at each period, is 
not less than eight ounces. During the interval, the urine is sometimes of a natural 
color, occasionally turbid, and deposits a whitish, branny sediment. Pulse of 
natural frequency, but very feeble. Eelly natural. Appetite is not much impaired. 
Sleep generally bad. Heis very much emaciated, and too feeble to support himself 
in an erect posture. About a year and a half ago, he says that his body, face and 
extremities, were covered with blotches, containing matter of a purulent nature, 
which gradually disappeared upon using some medicines, and he remained free 
from any complaint, except great debility, till the commencement of the present 
disease. The practitioners attending enjoined a strict adherence to the antiphlo- 
gistic plan of cure; this he has implicitly followed to its greatest extent; he has 
occasionally used the warm bath, with medicines calculated to promote the cuti- 
cular discharge. When Mr. Charles Stewart took charge of this case, the debility 
was so extreme that in the opinion of the attending practitioners, he could not 
survive more than a month. 
Mr. Stewart began by prescribing a nourishing diet, frequently 
repeated during the day, but in small quantity at a time, with a moderate- 
allowance of port wine. At the same time he ordered the following : R. 
Tincturae thebaic®; liquor, aether, vitriol: spt. sal. ammon. semp.; a a unc.. 
i, misco. Of this mixture he was directed to take a teaspoonful thrice a 
day, in a small glass of wine. Under this treatment, the patient began to 
* Medical Commentaries for the year 1794, collected by Andrew Duncanr M. D., etc., second, 
edition, vol. ix, Edinburgh, 1795, p. 332. History of Malarial Hcematuria. 
553 
improve and the amount of blood in the urine diminished and finally dis- 
appeared altogether. To accompany the medicine formerly prescribed, a 
small wineglassful of the following mixture was added: 11 Pulv. cortic. 
Peruvian unc. ii. Terantur bene fimul, dein adde durante trituratione 
aquae fontis unc. v. Aquae cinnam. fine, beno. unc. i. Misce. By perse- 
verance in this plan of treatment, the patient was at the end of five months, 
free of any complaint and able to attend his business in a counting house. 
Dr. John Elliotson* in a clinical lecture delivered at St. Thomas' Hos- 
pital, London, December 19th, 1831, describes the following interesting 
case of paroxysmal haematuria, under the head of diseases of the heart united 
icith ague. 
Case 904. "Among the men there was one case presented of a very interesting 
character, it was that of a man with a diseased heart and symptoms of ague, he was 
admitted on the 24th November. He was one of those unfortunate persons who was 
sent by a very wise government to Walcheren, where so many thousands of our 
countrymen lost their lives for no purpose whatever. A great many of the vic- 
tims of the expedition are dead and gone, but some are suffering still, and this was 
one of them. He had this violent fever of that place, and from that time was 
never perfectly well. He is forty years of age; he looked sallow and of a deadly 
pale hue, and on that account I asked him if he had had ague, to which he replied 
that he had had the fever of Flushing. Now, this man was laboring under fre- 
quent chills, but,had not regular paroxysms of ague. * * The singular circum- 
stance, however, in this man's disease was, that when his paroxysms came on he 
discharged bloody urine. In the cold fits of ague there are sometimes particular 
symptoms, such as cold sweating and tetanus, or something like it. I have had 
one or two such cases in the hospital; one man I recollect perfectly well, who in 
the cold ague had his hands clenched and his thumbs drawn in between his fin- 
gers. Sometimes there is epilepsy, and sometimes there are petechise observable in 
the paroxysms. The latter circumstance has been noticed in epidemic as well as 
sporadic cases. Now in this man the kidneys discharged blood ; at least there was 
blood in the urine, at first pure blood, and afterwards less and less, and this he 
said was invariably the case-haematuria every time the cold fit came on. This 
circumstance, however, made no difference in the treatment, and I gave him sul- 
phate of quinine. I mentioned, however, that he had had a disease of the heart. 
There was a great impulse of the left ventricle, but this was only a recent occur- 
rence, and the cause of it I do not know. There was also a strong, full, sharp 
pulse, and on that account I bled him to a pint, put him on low diet, and kept his 
bowels open every day. He was bled on the 25th to another pint, on account of 
the violent action. The aguish symptoms were now quite certain, for I had 
observed them myself, and I therefore gave him five grains of sulphate of quinine 
three times a day. He was bled again on the 6th of December to 16 ounces; he bore 
it well, and in fact was all the better for it. He then took ten grains of sulphate 
of quinine, three times a'day, till he became perfectly well, so far as his aguish 
symptoms were concerned. He lost the rigors, he lost the cold fits, and lost the 
bloody urine. The bloody urine was intermittent between the rigors; that is an 
interesting circumstance. I next met with an instance of a similar description. 
There can be no doubt of its truth, because the man showed his urine, and the blood 
was abundant in it. He was presently quite well, so faras this was concerned, and 
the symptoms arising from the hypertrophy of the heart were much diminished. 
* * The diseased heart and bloody urine appeared to have no connection with 
the other, but the bloody urine depended on the ague. Although the man consid- 
ered himself quite well, his ague and haematuria having been cured, and the 
impulse of the heart having been considerably diminished, yet he will of course, 
through the Walcheren expedition, be a shattered man as long as he lives." Lon- 
don Lancet, 1831-1832, vol. 1, p. 500. 
Dr. Gergeresf recorded a third case in 1838. which was relieved on the 
third day by twenty-five grains of quinine. 
This form of haematuria, however, has received careful consideration 
only during the past twenty-five years, and has been described by various. 
* London Lancet, Saturday, January 7th, 1832 (1831 -32, vol.. 1), p. 500. 
t Gaz. Med. de Paris, 1838, p. 151. 554 
History of Malarial Hcematuria. 
observers, as Beale,1 Begbie,2 Defer,3 Dickinson,4 Dressier,5 Druitt,6 Green- 
how,7 Gull,8 Habersham,9 Harley,10 Hassall,11 Kesterson,12 Laycock,13 Legg,14 
Matthew,15 Murchison,16 Pavy,17 Roberts,18 Secchi,19 Sacoloff,20 Southey,21 
Stevens,22 Tyson,28 Wiltshire.24 
This disease has received several names, as intermittent heematuria, by 
Dr. George Harley, paroxysmal haematuria Dy Dr. Pavy, intermittent 
hsematuria by Dr. Wm. Gull, from the fact that in most cases he found only 
luematin, and not blood-corpuscles, in the urine; and Secchi has denom- 
inated it htemaglobinuria, as the urine has been found to show the charac- 
teristic bands of luemagiobin in the spectrum. 
The view held by some writers, as Sir Wm. Gull, that in most cases, 
luematin, and not colored blood-corpuscles, are found in the urine, must 
be received with caution, for in many instances it is not stated how soon 
after the voiding of the urine the microscopical examination was made. It 
is especially unphilosophic and premature, to found any theory of the dis- 
ease upon the supposition that the luematin of the blood is liberated in the 
circulatory system and simply eliminated from the blood by the kidneys. 
It is of the utmost importance that the miscroscopical examinations of 
the urine in hrematuria, should be made immediately after its passage, and 
before any dissolution of the colored corpuscles has been effected by 
the urinary constituents, and the products of their decomposition. It is 
well known that when blood is mixed with urine, it is prone to undergo 
decomposition, and to promote the rapid conversion of the urea into the 
carbonate of ammonia, which is a rapid and powerful solvent of the colored 
blood-corpuscles. The application of nitric acid will neutralize the ammo- 
nia and precipitate the hrematin and thus record its presence when the 
microscope fails to detect the presence of the colored blood-corpuscles, 
although pre-existing in the urine immediately after its passage. It would 
also appear that when any considerable portion of the excretory tubes of 
the kidneys may become filled to a greater or less extent with coagulated 
blood, the luematin of the blood may continue to appear in the urine, after 
all active hjemorrhage has ceased, the colored blood-corpuscles being 
entangled in the fibrinous clots. 
Dr. Greenhow25 thus describes this form of hiematuria: 
The attacks have been excited by the same cause, have taken the same form, 
exhibited the same general group of symptoms, and run the same definite course. 
The immediate exciting cause of the attacks has been invariably some definite 
•exposure to cold or wet. The forms taken by the attacks has been invariably par- 
1 Practitioner, July, 1868, p. 73. Kidney Diseases, Urinary Deposits,etc. London, 1869, p. 372. 
2 Edinburgh Med. Jour., May, 1875. 
3 Comptes Rendus et Memoires de la Society de Biologie, 1848, Annee. 1, p. 143. 
4 Med. Chir. trans., 1865, vol. xlviii, p. 178; Trans. Path. Soc., vol. xvi, p. 174. 
5 Arch, and Path. Anat., 1854, bd. vi, p. 264. 
6 Med. Times and Gazette, 1873, vol. 1, p. 408. 
7 Trans. Clinical Society of London, 1868, vol. 1, p. 40: Edinburgh Med. Jour., 1868, vol. xlii.p. 
996. 
8 Guy's Hospital Reports, 1866, p. 381. 
9 Lancet, 1870, vol. 1, 158. 
10 Med. Chir. Trans., 1865, vol. xlviii, p. 161, Trans. Path. Soc. of London, 1865, vol. xvi, p. 168. 
11 Lancet, 1865, vol. ii, p. 368. 
12 Lancet, 1870, vol. ii, p. 920. 
13 Dublin Journal Med. Sci., 1874, July. p. I. 
14 St. Bartholomew's Hospital Reports, vol. x, 1874. 
15 Lancet, 1870, vol. 1, p. 900. 
16 Trans. Path. Soc.. London, 1865, vol. xvi. p. 183. 
17 Lancet, 1866, vol. ii, p. 33, Trans. Clinical Society, 1871, vol. iv, p. 74; Trans. Path. Soc. of Lon- 
Mon, 1867, vol, xviii, p. 158. 
18 Practical Treatise on Urinary and Renal Diseases, 2d Ed., London, 1862, p. 139. 
19 Berliner Klin. Wochenschrift, 1872, p. 237. 
20 Berliner Klin. Wochenschrift, 1874, p, 233. 
21 Lancet, 1870, vol. ii, p. 332. 
22 Stevens' Brit. Med' Jour., 1871, vol. ii, p. 323. 
23 Philadelphia Medical Times, September 1,1871. 
24 Trans. Path. Soc., 1867, vol. xviii. p, 180. 
15 Edinburgh Medical Journal, May, 1868. Am. Jour. Med. Sci. July, 1868, p. 263. Causes of Haematuria. 
555 
oxysmal, the paroxysms coming on suddenly, almost immediately after the chill, 
and passing off rapidly when the effects of the chill had been counteracted and the 
patient had become thoroughly warm. The general group of symptoms has been 
invariably the same, the additional ones occasionally exhibited being apparently 
due to an unequal degree of constitutional disturbance. In every instance the par- 
oxysms have begun with coldness of the extremities, followed by general chilliness, 
amounting in the severe attacks to rigors. In like manner, in every case, the 
chilliness or shivering has been attended by a feeling of weight or pain in the loins, 
and by pain < r a sense of weakness or stiffness in the lower limbs. The chilliness 
has been usually, though not always, followed by an imperfectly marked febrile 
hot stage. The patients have invariably passed during the paroxysm, urine look- 
ing as if it was mixed with blood, and identical in general character. And, lastly, 
the same definite course has been run by the paroxysms in every case. From half 
an hour to two hours after the chilliness or rigors, the patient has never failed to 
pass the first dark colored urine, which has always been highly albuminous, and 
has contained numerous crystals of the oxalate of lime, with more or less brown- 
ish-red amorphous granular matter and a few hyaline casts, but only occasionally 
some stray blood-corpuscles. At each succeeding micturition after the chilliness 
the urine has invariably shown more or less diminution of color, of albumen, of 
•oxalate of lime and of its other abnormal contents, resuming its natural character 
.and appearance by the second or third micturation after slight attacks, and usually 
by the fourth or fifth, after severe paroxysms. By the second day after an attack 
the patients, as a rule, have regained their ordinary degree of health and strength, 
and have continued well until some fresh exposure has brought on a new attack of 
their complaint. To this summary I may add that so far as my observation 
■extends, all the patients suffering from this disease have had the same pale, sallow, 
■cachectic aspect, two of them having been distinctly jaundiced, and others having 
all had at times an icterous tint of skin. It appears to me that this train of identical 
circumstances in so considerable a number of cases, places it beyond question that 
intermittent haematuria, or, as I think Dr. Pavy more accurately terms it, par- 
oxysmal haematuria, is a definite disease, due in all cases to remote constitutional 
causes. 
It will be seen from the preceding descriptions, by Stewart, Elliotson, 
Greenhow and others, that paroxysmal haematuria has some symptoms in 
common with the malarial haematuria, of tropical and sub-tropical regions, 
yet the two affections are evidently distinct ; the latter being evidently 
and universally of malarial origin, characterized by chill, fever, profuse 
perspiration, incessant nausea and vomiting, rapid jaundice and in many 
cases haemorrhage, not merely from the kidneys, but from the mucous sur- 
faces generally. As a general rule paroxysmal haematuria, is unattended by 
jaundice vomiting, and the great and lasting prostration which marks 
the malarial disease; it is also amenable to treatment and is never fatal, 
whilst malarial haematuria is one of the most fatal of all diseases. 
CAUSES OF HAEMATURIA. 
From the preceding observations we conclude that haematuria may be 
due to the following causes : 
CAUSES OF BLOODY URINE. 
1. Blows over the loins or region of the bladder, causing congestion, 
rupture and inflammation of the kidneys and bladder. 
2. Intense inflammation (gonorrhoeal and non-gonorrhoeal of the 
urethra, prostate, bladder and kidneys. 
3. Congestion of the kidneys by exposure to wet and cold. 
4. Acute cystitis, traumatic or otherwise. 
5. Congestion of the bladder in adynamic fevers. 
6. Stone in the bladder. 
7. Carcinomatous and billoid disease of the bladder. 556 
History of Malarial Hcematuria. 
8. Stone in the substance or pelvis of the kidney (calculous pyelitis./ 
9. Non-calculous pyelitis. 
10. Carcinomatous disease of the kidney. 
11. Tuberculous disease of the kidney. 
12. Hydatid of kidney. 
13. Congestion of the kidneys, desquamation of the excretory cells 
and rupture of the malpighian capillaries, induced by the inhalation of 
certain gases, as arseniuretted hydrogen, and by the internal administration 
of certain irritating substances and compounds, as oil of turpentine, can- 
tharides. etc. 
14. Congestion and inflammation of the kidneys, attended with desquam- 
ation of the excretory cells, and rupture of the capillaries in various acute 
disorders, as acute Bright's disease, small-pox. scarlatina, chicken-pox 
and malignant measles. 
15. The presence of the constituents of bile in large amount in the 
blood. 
16. Purpura, scorbutus and pyaemia 
17. Malignant, intermittent and remittent fevers imalarial hiematuria). 
18. Yellow fever. 
19. The destructive effects of certain parasites upon the bladder, 
uretus. pelvis and excretory structures of the kidneys, as in the haematui ia 
of Egypt. Mauritus and southern portions of Africa, bilharzia hamatobia. 
HISTORY OF MALARIAL HEMATURIA. 
In the preceding investigation, it has been shown that bloody and 
black urine was recognized by Hippocrates and other ancient writers, more 
than two thousand years ago. These investigations, however, related to 
all that class of malignant fevers which were attended with hiemorrhages. 
and did not relate directly or exclusively to malarial hiematuria Whilst 
we have adduced proof to show that this disease, which is only at the 
present time attracting the attention of American physicians, was not 
unknown to the Grecian. Roman and Arabian physicians: at the same time 
an extended examination of the medical literature of America, since the 
establishment of medical journals during the past century, will lead to one 
of two conclusions, namely: 
1st. Malarial haematuiia was unknown upon the North American 
Continent, and had no existence up to 1866. 
2d. Malarial hamaturia existed but was not recognized by the medi- 
cal profession as a distinct form of malarial fever. The second supposition 
is probably correct. The absence of descriptions of malarial haematuria 
from the writings of American physicians, appears to be due not so much 
to the rarity of the disease, or to the fact that it is really a new diseases 
but rather to the neglect of careful and systematic observations of the 
characters and changes of the urinary excretion. As a general rule, the 
writers upon American diseases have followed a well-beaten and familiar 
road: in the first place, the prominent features of the disease are described, 
the more important facts with reference to the changes of the pulse, respi- 
ration. temperature, blood and urine being carefully excluded or ignored^ 
then the writer gives certain lucubrations upon the nature of malaria and 
morbific agents: the pathology is dismissed briefly, and then the son of 
Esculapius, launches out uj«onpractice, treatment, and exhausts his powers 
upon this never-failing field for professional gl^rv and profit. Thus, these 
writers have been ever eminently practical. If the diligence of the ancient 
physicians had been exercised in the present age. the detection of blood in History of Malarial Hoematuria. 
557 
the urine of certain forms of malarial fever, and of albumen and casts in 
yellow fever urine, would have antidated, by more than a century, the 
discoveries of John Davy and Francis Blair. We have searched in vain, 
for accurate observations upon the urinary excretion in fevers, in the 
writings of Drs. Lyman Spalding,1 John Vaughan,2 Felix Pascalis,3 John 
W. Watkins,4 Jeremiah Barker,5 Samuel Brown,® William Harris,7 Isaac 
Cathrall,8 David Ramsay,9 Valentine Seaman,10 Chatard,11 Selden and White- 
head,12 Charles Caldwell,13 P. S. Physick,14 G. Pillson,15 Alexander Hosack, 
Jr.,1® Charles Coffin,17 B. W. Hall,18 Benjamin W. Dwight,19 Robert Dun- 
bar,20 Samuel Aguew,21 Maxwell W. McDowell,22 Charles Worthington,23 
Grafton Duvall,24 Joshua E. White,25 Dennis Smelt,2® James Speed,27 Peachy 
Harrison,28 John G. Scott,29 L. Wheaton,30 Joseph Pitt,31 Wm. Frost,32 
William Currie,33 E. Griffiths,34 Frederick Dalcho,35 Joseph Parish,36 John 
Stevens,37 John R. Lucas,38 Henry Staley,39 John Hill,40 Samuel Agnew,41 
Horatio G. Jameson,42 Nathaniel P. Causin,43 Thomas B. Merritt,44 John E. 
Cooke,45 Samuel A. Cartwright,4® Richard Dutton,47 Ezra Michener,48 Samuel 
Jackson, of Northumberland, Pa.,49 Thomas Miner,50 Thomas P. Rives.51 
Hunting Sherrill,52 B. Ticknor,53 F. A. L. Poken,54 Stephen Brown,55 Eliza 
Griffiths,5® Wm. R. Waring,57 Ayers P. Merrill,58 B. Ticknor,59 Samuel 
Emlen," John Bell,®1 Charles S. Lucas,®2 Samuel Jackson,®31. W. Heustis,64 
Samuel Henry Dickson,65 L. Callaghan,66 W. C. Daniel,®7 S. P. Hildreth,68 
A. Hopton,®9 Edwin B. Faust,70 Thomas H. Wright,72 A. C. Baldwin,73 Sam- 
uel Barrington,74 J. W. Monett,75 John B. Zabriskie,7® E. B. Harris,77 
Edward H. Barton,78 W. W. Gerhard,79 Thomas Stewardson,80 Samuel 
Ferry,81 Thomas Barbour,82 Austin Flint,83 C. C. Dupre,84 Richard D. 
Arnold,85 R. G. Wharton,86 Charles Pavey,87 John P. Mettauer,88 John A. 
Levett,89 F. Wendemanu," Josiah C. Nott,91 Edmonds Little,92 Wm. J. 
Tuck,93 John B. Porter,94 Wm. M. Boling,95 George Mendenhall,96 John M. 
B. Harden,97 R. S. Holmes,98 W. F. Anderson,99 E. H. Kelly,100 Charles E. 
Lavender,101 James F. Gayley,102 George R. Grant,103 Bedford Brown,104 J. 
D. Bryant,105 Wm. P. Buel,1" H. G. Jamesou,107 Lewis D. Ford,108 William 
J. Johnson,109 Edward Deloney,110 L. A. Dugas,111 J. B. Whitridge,112 Wm. 
M, Burt,113 G, R. Holloway,114 A. B. Arnold,115 John M. B. Harden,116 J. J. B. 
Wright,117 Austin Flint,118 Samuel B. Cunningham,119 H. R. Robards,120 
George Johnson,121 E. F. Bouchelle,122 Thomas Barbour,123 C. M. Hitch- 
cock,124 J. A. Mays,125 Tomlison Fort,126 Robert Newton,127 James C. Harris,128 
E. M. Pendleton,129 John Davis,130 Henry F. Campbell,131 Ashbee Smith,132 
P. M. Koiloch,133 W. L. Felder,134 Richard D. Arnold,135 Samuel B. Holt,136 
John F. Posey,137 W. F. Wragg,138 Isaac Branch,139 S. N. Harris,140 W. G. 
Ramsay,141 P. C. Gaillard,142 R. D. Arnold,143 Thomas G. Simons,144 J. C. 
Nott,145 A. P. Hayne,146 E. M. Boykin,147 C. Happoldt,148 J. T. Rusyh.149 
W. L. Felder,150 R La Roche, M. D.,151 E. S. Gaillard,152 S. H. Dickson,153 W. 
Hume,154 J. F. Beugnot,155 W. G. Williams and James Andrews,156 P. A. 
Lambert,157 W. R. Puckett,158 P. H. Lewis,159 John W. Monette,160 C. D. 
Valetti and Thomas M. Logan,161 Theodore Bland Dudley,162 J. Hampden 
Lewis,163 C. H. Stone,164 Edward Montgomery,165 Andrew R. Kilpatrick,166 
Bennett Dowler,167 John Harrison,168 Charles McCormick,169 W. F. Tuck,170 
Wm. P. Hort,171 Thomas D. Mitchell,172 F. A. Cooke,173 A. L. C. Magru- 
der,174 P. H. Lovelace,175 Wm. M. Carpenter,176 Samuel A. Cartwright,177 
Thomas C. Brown,178 E. D. Fenner,179 A. Hester,180 P. H. Lewis,181 Wm. M. 
Boling,182 Wm. P. Hort,183 Josiah C. Nott,184 A. L. C. Magruder,185 Thomas 
N. Love,186 Wm. A. Booth,187 J. Gilpin,188 W. G. Williams,189 B. J. Hicks,1" 
Wm. McCraven,191 N. Walldly,1" C. H. Stone,193 E. D. Fenner,194 J. B. Por- 
ter,195 W. McCraven,1" P. B. McKelvey,197 Wm. A. Booth,198 J. A. English,1" 
P. A. Bates,2" P. P. Pigne,201 A. G. Mabry,202 James C. Harris,203 E. Fowler,204 558 
History of Malarial Hematuria. 
Thomas E. Evans,205 Richard Lee Fearn,206 S. Ames,207 A- Duperier,206 A. P. 
Merrill,'209 E. H. Barton,210 J. C. Harris.211 J. C. Massie,21'2 S. L. Grier,2U- 
Thomas D. Mitchell,214 Wm. G. Williams,215 D. Nathaniel Jones,216 J. C. 
Nott,217 J. A. Cooke,215 Geo. A. Smith and W. F. Tuck,219 J. B. Hacker;220 
J. W. Lyman,221 E. McAllister,222 M. M. Dowler,2-23 Wm. H. Anderson,'224 J. 
C, Marks,225 N. Walkly,226 John Gorrie,227 A. Hester,228 Bennet Dowler,'229 
George A. Ketchum,230 J. J. Chisolm,231 E. D. Fenner,232 W. L. Gammage,233 
Chas. E. Johnson,234 J. J. Heard,235 W. H. Calvert,236 E. D. Fenner,237 James 
E. Smith,'238 Samuel A. Cartwright,239 James Jones,240 H. Barens,;41 Jesse 
Peebles,242 J. H. Castleton,243 Edward Jenner Coxe,244 Bennett Dowler,'245 
M. Morton Dowler,246. 
1 A Dissertation on the Bilious Malignant Fever which prevailed in the country adjacent to 
Dartmouth College, in the summer of 1798. Medical Repository, vol. iii, 1805, p. 5. 
2 A Sketch of the History of the diseases of the State of Delaware. Medical Repository, vol. 
iii, p. 336, p. 368, vol. iv, p. 130, vol. 238 ; 2 Hex., 2d vol. 11, p. 139. 
3 Observations on the Yellow Fever. Medical hep., iii, p. 344. Medical Rep., vol. iv, p. 5,. 
p. 121. 
4 On the Disease called the Lake Fever of the Western Counties of New York. Med. Rep., iii, 
p. 359. 
5 An Account of Febrile Diseases, as they have appeared in the County of Cumberland, Dis- 
trict of Maine, from July, 1798, to March, 1800. Med. Rep., iii, p. 364. July, 1800, July, 1801, v. p. 
144. 
6 A Treatise on the Nature, Origin and Progress of the Yellow Fever. Medical Repository, 
vol. iv, p. 61. 
7 Facts relative to the Black Vomit, Dysentery, etc., as they occurred in Mifflin County, 
Pennsylvania, during the hot weather of 1797,1798 and 1799. Medical Repository, vol. iv, p. 105. 
8 Memoir on the Analysis of the Black Vomit, ejected in the last stage of the Yellow Fever. 
Med. Rep., vol. iv, p. 163. 
9 History of South Carolina. Facts concerning the Yellow Fever, as it appears at Charleston, 
South Carolina, Med. Rep., vol. iv, No. iii, p. 217, 390. 
10 Au Account of the Epidemic Disease, which appeared in the City of New York, in the sum- 
mer and autumn of 1800. Med. Kep., iv, p. 248, vol. 1, p. 303. 
11 On the Yellow Fever, as it appeared at Baltimore, 1800. Med. Rep., iv, p. 253. 
12 On the Yellow Fever of Norfolk, 1800. Med. Rep., iv, p. 329. 
13 Analogies between Yellow Fever and Fever Plague, Philad., 1801. Medical and Physical 
Memoirs, Philad., 1801. 
14 Some observations on the Black Vomit. Medical Repository, vol. v, p. 129. 
15 On the Topography and Diseases of Greenville, on Tar River, North Carolina. Med. Rep., 
v, p. 137. 
16 Essay on the Yellow Fever in New York, 1795. 
17 An Account of the Pestilential Fever, which prevailed at Newburg Park, Massachusetts 
in 1796. Medical Repository, vol. 1, p. 493. 
18 An Account of the Yellow Fever at Alexandria, Virginia, 1803. Med. Rep., 2d Hex., vol. 
2d p. 18. 
19 Malignant Yellow Fever in Catskill, N. Y. Med. Rep., 2d Hex., vol. ii, pp. 105, 232. 
20 Malignant Fever, and Black Vomiting at Winchester, Va., 1804. Med. Rep., 2d Hex., ii, p. 
252. From the description, this disease resembled Malarial Heematuria, with Jaundice, and uri- 
nary suppression. ("Paucity of urine and strangury.' ) 
21 Epidemic Disease, Adams County, Pennsylvania, 1804. Med. Rep., 2d Hex., vol. ii, p. 345. 
22 Fever of Summer and Autumn, 1804, in Pennsylvania. Med. Rep., 2d Hex., ii, p. 367. 
23 Febrile Distempers at Georgetown, and Washington, Maryland, 1804. Med. Rep., 2d Hex., 
ii, p. 371. 
24 History of the Extraordinary Season of 1804. Med. Rep. 2d Hex., ii, p. 374; iii, p. 7, p. 165. 
25 Topography and Diseases of Waynesborough, Georgia. Med. Rep., 2d Hex., iii, p. 36, p. 
140, p. 241, p. 349, iv, p. 117. 
26 Account of the Epidemic Disease which prevailed at, and around Augusta, Georgia, 1804. 
Med. Rep., 2d Hex., iii, p. 125. 
27 Yellow rever. Written in New Orleans, Louisiana, 1803. Med. Rep., 2d Hex., iii, p. 259. 
28 Fatal Distemper, Epidemic in the Scioto Settlements, Ohio, in 1801. Med. Rep., 2d Hex.,iv, 
p. 6. Dr. Harrison, states that in this severe form of Malarial Fever, in some cases haemorrha- 
ges took place from the urinary passages, and in one or two cases which terminated fatally, there 
was a total suspension of the urinary excretion for a considerable time before death, which he 
supposed to be due to an engorgement of the kidneys themselves, as there was no distension or 
uneasiness in the region of the bladder. 
29 Examples of the Origin of Y'ellow (and non-contagious) Fevers, in various parts of the 
State of New York, 1806. Med. Rep., 2d Hex., vol. iv, p. 240. 
30 Y'ellow Fever in Providence, Rhode Island. Med. Rep., 1807,2d Hex., iv, p. 329. Topography 
of Savannah and its vicinity, by Dr. J. E. White. Weather and Diseases of 1805. Med. Rep., 2d 
Hex., iv, p. 252. Observations on the Soil, Climate, and Diseases of the State of Georgia, by J. E. 
White of Savannah. Med. Rep., 2d Hex., iv, p. 117. Remarks on the Weather and Maladies of 
1805, as they occurred in Georgia. Med. Rep., 2d Hex., iv. p. 12, v, p. 12. 
31 Observations on the Country and Diseases, near Roanoke River, North Carolina. Med. 
Rep., 2d Hex., v, p. 33t. 
32 Y'ellow Fever as it appeared at Stabruck, in 1803. Med. Rep., 2d Hex., vi, p. 209. 
33 View of the Diseases most prevalent in the United States. Philadelphia, 1811. Observa- 
tions on the causes and cure of Remitting Bilious Fevers. Philadelphia, 1798. 
34 On the Haemorrhagic State of Fevers. Philadelphia Medical Museum, vol. iii, 1807, p. 41. 
35 Oratiou delivered before the Medical Society of South Carolina, 1805. Philadelphia Medi- 
cal Museum, vol. iii, p. 125. History of Malarial Hoematuria. 
559 
36 Cases of Yellow Fever in City Hospital, 1805. Philadelphia Medical Museum, vol. hi. p. 
187. Dr. Parish states that three cases occurred wherein there was no secretion of urine, all of 
them sweated most profusely, and all died. One of them was examined after death, the bladder 
did not contain a teaspoonful of urine. This patient was affected with a paralysis of his lower 
extremities a few hours before his decease, his mind appeared to be perfectly collected at the time 
and he described his sensations with great clearness. Dr. Parish referred the deficient secretion 
of urine in yellow fever, to paralysis of the secretory vessels of the kidney. In this paper, Dr. 
Parish records the important observation that in yellow fever " the contents of the gall-bladder 
and the black vomit are specifically different; the latter fluid being blood discharged from the 
capillary vessels of the villous coat of the stomach. In support of this doctrine, Dr. Parish 
recorded several observations. 
37 Observations on Yellow Fever. Phila. Med. Museum, vi, pp. 1, 73,153. 
38 An Account of a Singular Fever that prevailed from 1818 to 1822 in Virginia. Am. Med. 
Recorder, vol. v, p. 417; vi, 117. 
39^Bilious Remitting and Intermitting Fever in Maryland, 1821. Am. Med. Recorder, vol. 
40 Yellow Fever in Wilmington, N. C., 1821. Am. Med. Recorder, vol. v, p. 86. 
41 Epidemic Bilious Fever, Harrisburg, Penn. Am. Med. Recorder, vol. vi, p. 126. 
42 observations on Yellow Fever. Am. Med. Recorder, vol. vi, p. 435. 
43 Autumnal Bilious Epidemic of the United States. Am. Med. Recorder, vol. vii, p. 55. 
44 Autumnal Fever of Brunswick, Virginia. /Im. Med. Recorder, vol. vii, p. 284. 
45 An Essay on Epidemic Fevers. Am. Med. Recorder, 1824, vol. vii, p. 449. 
46 Epidemic Fever of Monroe County, Miss., 1822. Am. Med. Recorder, 1824, vol. vii, p. 665. 
Essay on syphilis. Am. Med. Recorder, vol. viii, p. 441. Causes, Symptoms, Morbid Anatomy 
and Treatment of some of the Principal Diseases of the Southern States. Am. Med. Recorder, 
vol. ix, No.lp.l; Ao. 11.p. 225; vol.'x, pp. 41,153, 222. A dissertation on the question: "Whether the 
Veins Perform the Function of Absorption." Am. Med. Rep., vol. xiii, p. 73. Iodine and 
Hydriodate of Potash. Am. Med. Rep., vol. xv, p. 257. 
47 Autumnal Fevers, Delaware Co., Penn. Am. Med. Recorder, vol. viii, p. 217. 
48 Autumnal Fever of 1823, as it occuried in Chester County, Penn. Am. Med. Recorder, 
vol. xi, p. 335. 
49 Gangrtenopsis, or Gangrenous Erosion of the Cheek. Am. Med. Rep., vol. xii, p. 66. 
50 Typhus Syncopalis, or the Spotted Fever of New England. Am. Med. Repository, vol. 
xii, p. 209. 
51 Bilious Fever of Sussex and Prince George, Va. Am. Med. Repository, vol. xii, p. 302. 
52 Review of the Diseases of Dutchess County from 1809 to 1825. New York, 1826. 
53 North American Medical and Surgical Journal, April and July, 1827. 
54 Malignant Epidemic of 1826. Am. Med. Rep., 1828, vol. xiii, p. 49. 
55 Essay on Typhus Fever. Am. Med. Rep., vol. xv, p. 12. 
56 Observations on Fevers. Am. Med. Rep., vol. xv, p. 289. 
57 Description of a Febrile Disease which appeared among the negroes of the rice planta- 
tions, near Savannah, Ga. North Am. Med. and Surg. Jr., vol. i, p. 1. Yellow Fever of 1820, Savan- 
nah, Ga. Climate and Epidemics of Savannah, 1826, 18z9. N. A. M. and S. J., vol. ix, p. 374; 
vol. v, p. 136. 
58 Epidemic of 1825, in Natchez, Miss. N. A. Med. and Sur. J., vol. ii, p. 217. 
59 Medical Topography and Epidemic of 1825, Key West. Am. Med. and Surg. Jour., vol. iii, 
p. 213; vol. iv, p. 1. 
60 Yellow Fever. N. A. Med. and Surg. Jour., vol. v, p. 321. 
61 Pathology and Treatment of Intermittent Fever. N. A. M. and S. J., vol. viii, p. 256. 
62 Medical Topography and Endemic Fever of Montgomery Co., Ala. Am. Jour. Med. Sci., 
vol. 1, p. 78. 
63. Clinical Reports of Cases Treated in Philadelphia Alms House. Am. Jour. Med. Sci., vol. 
1 to 85, p. 267; vol. ill, p. 289. 
64 Topography and Diseases of Louisiana. Endemic Fever of Southern States. Endemic 
Diseases of Alabama. Am. J. Med. Sci. vol. ii, p. 26; vol. viii, p. 75; vol. ix, p. 279. The Fever in 
Mobile, 1835. Am. j. Med. sci., vol. xix, p. 65. 
65 Epidemic in Charleston, S. C. in 1827. Am. J. Med. Sci., vol. ii. p. 64. Dengue in Charles- 
ton, S. C. in. 1828. Am. J. Med. Sci., vol. iii, p. 3. Effects of Heat. Vol. iii, p. 262. Dengue. Vol. 
iii, p. 62. 
66 Topography and Diseases of Western Pennsylvania. Am. Jour. Med. Sci., vol. iii, p. 34. 
67 Epidemic in Savannah, Ga., 1826 and 18-28. A. J. M. S., iv, p. 291. 
68 Disease of Washington Co., Ohio. Am. J. Med. Sci., vol. v, p. 321. 
69 Endemic Fever of the Carolinas. Am. J. M. Sci., vol. v, p. 370. 
70 Malaria and Malarial severs. Am. Jour. Med. Sci., vol. vi, p. 38. 
72 Cases treated in Baltimore Alms House. Am. Jour. Med. Sci., vol. v, vi, vii. 
73 Bilious Remittent Fever in Burk Co., Ga., in 1831. Am. Jour. Med. Sci., vol. x, p. 347. Influ- 
enza of 1831-2. Am. Jour. Med. Sci., vol. xi, p. 33. Enlarged Spleen. S. M. and S. J., vol. ii, p. 131. 
74 Yellow Fever. Am. Jour. Med. Sei., vol. xii, p. 307. 
75 Sulphate of Quinine in Febrile Affections. Am. J. M. Sci., xiii, p. 33. 
76 Ataxic and Intermittent Fevers. Am. Jour. Med. Sci., xiii, p. 80. 
77 Cases of the Epidemic Yellow Fever, prevalent at New Orleans, 1833. Am. J. M. Sci., xiv, 
p. 41. 
78 Account of the Epidemic Yellow Fever which prevailed in New Orleans, during the 
autumn of 1833. Am. Jour. Med. Sci., xv, p. 30. 
79 Cases treated in Medical Wards of Penn. Hospital. Typhus and Remittent Fevers. Am. 
Jour. Med,Sci., xv, p. 320, xvi, p. 35, xvii, p. 13, p. 280. On Typhus Fever at Philad.,1836. Am. 
Jour. Med.'Sci., xix, p. 289, xx, p. 289. 
80 Observations on Remittent Fever, founded on cases observed in the Pennsylvania Hospi- 
tal. Am. Jour. Med. Sci., New Series, vol. 1, p. 289, vol. ii, p. 293. Yellow Fever, N. S., iii, p. 91. 
Remit. Fever, N. S., iii, p. 277. 
81 Statistical Researches elucidating the climate of the United States and its relations with 
diseases of Malarial origin. Am. Jour. Med. Sci., New aeries, vol. ii, p. 13. N. S., vol. iii, p. 307, iv,. 
p. 110. 
82 Congestive Fever. Am. Jour. Med. Sci., N. S., ii, p. 56. 
83 Intermitting Fever. Am. Jour. Med. Sci., N. S., vol. ii, p. 277. Epidemic Fever, vol. x, 
p. 21. 
84 Yellow Fever at Key West, Fla. Am. J. M. S., N. S., vol. ii, p. 380. 560 
Histoni of Malarial Hcematuria. 
85 Two Cases Black Vomit. Am. J. M. S., N. S., vol. iv; p. 316. 
86 Congestive Fever of Mississippi. Am. Jour. Med. Sci., N. S., vol. vii, p. 339. 
87 Congestive Fever. Am. J. M. S., N. S., vol. vi, p. 28. 
88 Continued Fever. Am. J. M. ri., N. S., vol. vi, p. 33. 
89 Remittent Fever. Am. Journ, M. S. N. S., vol. ix, p. 29. 
90 Yellow Fever. Am. Jour. M. S. N. S., Vol ix, p. 51. 
91 Yellow Fever. Am. Jour. M. S. N. S., Vol. ix, p. 277. 
92 Diseases of Middle Florida. Am. Jour. N. S., Vol. x, p. 65. 
93 Congestive Fever. Am. Jour. Med. Sci., N. S., Vol. x, p. 334. 
94 Quinine in diseases of South; diseases of Florida. Am. Jour. Med. Sci., N. S., Vol. x, p. 
296; Vol. xxiii, p. 13; xxiv, p. 291. 
95 Remittent Fever of Alabama. Am. J. Med. S., N. S., xi, p. 18. 
96 Quinine in Remittent and Intermittent Fever. Am. J. M. S., N. S., xi, p. 65. 
97 Isopathia. Am. J. M. S., N. S., Vol. x, and Vol. xi, p. 87, xiv 339. 
98 Malaria in Florida, etc. Am. J. M. S., N. S. x, p. 297. 
99 Cases of Remittent Fever in Baltimore Alms House. Am. Jour. M. S., N. S. xi, p. 312. 
100 Yellow Fever. Am. Jour. M. S., N. ri., Vol. xiv, p. 373. 
101 Congestive Fever. Am. Jour. M. S., K. S., xvi, p. 43. 
102 Etiology of Intermittent and Remittent Fever. Am. J. M. S., N. S., xviii, p. 53. 
103 Prevailing Diseases of Memphis, Tenn. Am. J. M. S., N.S., xxvi, p. 94. 
104 Adynamic Type of Remittent Fever. Am. J. M. S., N. S., xxxix, 93. 
105 Yellow Fever in Norfolk and Portsmouth, Va., in 1858. Am. J. M. S., N. S., Vol. xxxii. p. 
293. 
i06 Chagres Fever. Am. J. M. S., N. S., xxxii, p. 319. 
107 Yellow Fever in Baltimore in 1819-22. Am J. M. S., N. S., xxxii, p. 372. 
108 Pathology and Treatment of Intermittent and Remittent Fevers, with cases. Southern 
Medical and Surgical Journal, Nov. 1836. Vol. 1, p. 3*5. Pathology of Intermittent Fever. S. M. 
and Surg. Jour., N. S., Vol. 1, p. 1, p.481. Intermittent and Remittent Fever, S. M. and S. J., N. S., 
Vol. iii, p. 1. 
109 Congestive Fever of Chattahoochc. So, M. S. J., Vol. 1, p. 594. 
110 Diseases of Talbot Co., Ga. So. Med. S. J., Vol. 1, p. 601. 
Ill Pathology and Treatment of Bilious Fever. So. Med. and S. J., Vol. ii, p. 387. 
112 Remarks on Fever, more especially Yellow Fever. So. Med. and S. J., Vol. ii, p. 451. 
113 Congestive Fever. So. M. and S. J., Vol. iii,'p. 385. 
114 Congestive Fever. So. M. and S. J., Vol. iii, p. 595. 
115 Treatise on Congestive Fever. So. Med. and Surg. Jour., Vol. iii,p.705. 
116 Observations on the Soil. Climate and Diseases of Liberty Co., Georgia. So. Med. and Surg. 
Jour., N. S., Vol. 1, p. 545. Isopathia or the parallelism of diseases. So. M. and S. J., N. S., Vol. 
ii, p. 589, p. 652, p. 737. 
117 On the use of large doses of Sulphate of Quinine in the Diseases of the South. So. M. and 
S. J., N.S., Vol. l,p. 577. 
118 Remittent, Typhoid and Typhus Fever. Buffalo Medical Journal, January, 1846. 
119 Diseases of East Tennessee. S. M. and S. J., N. S., Vol. ii, p. 450, Vol. iii, p. 385. 
120 Diseases of the Army of Occupation, 1846. So. M. J., N. S., Vol. iii, p. 277. 
121 Medical Topography of Texas and Diseases of the Army of Invasion. S. M. J., N. S„ Vol. 
iii, p. 293. 
122 Congestive Fever. S. M. and S. J., N. S., Vol. iii, p. 355. 
123 Congestive Fever. So. M. and S. J., N. S., Vol. iii, p. 485. 
124 Sick and Wounded, Tampico, Mexico. S. M. and S. J., Vol. iii, p. 207. 
125 Malarial Fever. S. M. and S. J., N. S., Vol. iv, p. 257. 
126 Bilious Remitting Fever. S. M. and S. J., S., Vol. iv, p. 641. 
127 Diseases of Mexicans. So. M. and S. J., N. S. Vol. v, p. 86. 
128 Diseases of Wetumpka, Ala. S. M. andS. J., N. S., Vol. 5, p. 513. 
129 Diseases of Hancock Co., Ga. So. S. and M. J., N. S-, Vol. v, p. 461,p. 526, p. 647. 
130 Quinine in Malarial Fever. S. M. and S. J., N. S., Vol. vi, p. 129. 
131 Dengue Fever in Augusta in 1850. S. M. and S. 'J., N. S., Vol. vii, p. 20. Inquiry into the 
nature of Typhoidal Fever. Trans. Am. Med. Asso., 1853. Classification of Febrile Diseases by 
their relation to the nervous system. So. M. and S, J., N. S., Vol. xiv, p. 13. 
132 Diagnosis of Yellow and Bilious Fevers. So. M. andS. J., N. S., Vol. vii, p. 466. Dr. Ashbel 
Smith states that he had drawn off bloody urine from the bladder in yellow fever. He says: 'Tn 
seven cases of yellow fever the urine is generally of an intense saffron yellow, not unfrequently 
deposits blood on standing. In bilious fever the urine is more commonly of a reddish hue, and 
scanty, or copious and limpid." 
133 Epidemic Fever of 1854. So. M. and S. J., N. S., Vol. xi, p. 553. 
134 Vellow Fever of 1854, Augusta Ga. So. M. and S. J., N. S., Vol. xi, p. 598. 
135 Relations of Bilious and Yellow Fever. So. M. and S. J., N. S., Vol. xii, p. 515. 
136 General Pathology. So. M. and S. J., N. S., Vol. xii, p. 9, 67,136, 202, 239, 337, 451, 536, 593, 663; 
xiii, p. 195, p. 387. 
137 Topography of Epidemic Diseases of the State of Georgia. So. M. and S. J., N. S., Vol. xiv, 
p. 106, p. 191. 
138 Cases of Fever. So. Jour. Med. and Phar., vol. ii, p. 38. 
139 Type and its Application to Remittent Fever. So. J. Med. and Pharm., vol. ii, p. 383. 
140 Intermittent and Remittent Fever. So. J. Med. and Phar., vol. ii, p, 013; vol. iii, p. 121. 
141 Cases of Yellow Fever, 1834-38. So. S. Med. and Phar., vol. ii, p. 635. 
142 Yellow Fever, Charleston. M. J. and R., vol. iv, p. 280. 
143 Epidemics of Savannah, 1847-8. Chn. M. J. and Rev., vol. iv, p. 389. 
144 Country Fever, Charleston. Med. Jr. and Rev., vol. v, p. 543. 
145 Yellow Fever of 1847 in Mobile. C. M. J. and R., vol. iii, p. 1. 
146 Yellow Fever in Charleston, 1849. C. M. J. and R., vol. vi, p. 453. 
147 Medical Topography of Middle So. Ca. C. M. J. and R., vol. Vi, pp. 498, 627. 
148 Breakbone Fever, 1850. C. M. J. and R., vol. vi, p. 606. 
149 Malaria and Fever. C. M. J. and R., vol. vi, p. 669. 
150 Epidemic of Fever in Sumter, S. C. C. M. J. and R., vol. vii, p. 729. 
151 Connection between Pneumonia and Periodic Fever, Charleston. Med. Jr. and Rev., 1853. 
152 Ozone in its Relation to Intermittent and Remittent Fever. C. M. J. and R., vol. ix, 
p. 433. 
153 Epidemics. C. M. J. and R., vol. x, p. 609. 
154 Yellow Fever. C. M. J. and Rev., vol. xiii, p. 145. History of Malarial Hcematuna. 
561 
155 Yellow Fever, New Orleans. Med. Jour , vol. 1, p. 1. 
156 Yellow Fever, Rodney, Miss., 1843. N. O. M. J., vol. i, p. 35. 
157 Yellow Fever, New Orleans. (Dr. Lambert alludes to suppression of the urine.) Med. 
Jr., vol. i. p. 1. 
158 Erysipelatous Fever or Black Tongue. New Orleans Med. Jr., vol. i, p. 27. 
159 Yellow Fever. N. O. Med. Jour., vol. i, p. 31; vol. i, pp. 281, 413. Dr. Lewis states than 
blood is often passed from the bladder. 
160 Congestive Fever. N. O. Med. Jour., vol, i, p. 125; Yellow Fever, N. O. Med. Jour., vol. i, 
p. 178; Congestive Fever. N. O. Med. J6ur., vol. 1, p. 259. 
161 Yellow Fever of Woodville, Miss,, 1844. N. O. M. J., vol. 1, 237. 
162 Medical Topography of Diseases of Guines in the Island of Cuba. N. O. Med. Jour., 
vol. 1, p. 281. 
163 Yellow Fever. N. O. M. J., vol. i, p. 409. 
164 Yellow Fever in Woodville, Miss., 1844. N. O. M. J., vol. i, p. 520- vol. ii, p. 179. 
165 Topography and Diseases of Mississippi. N. O. M. J., vol. i, p. 536. 
166 Yellow Fever in Woodville, Miss,, 1844. N. O. M. J., vol. ii, p. 40. Dr. Kilpatrick states 
that the kidneys acted very variously in different persons, and even in the same case at differ- 
ent times. The urine was almost uniformly high colored, and in fatal cases became of a dark 
and muddy hue. Htematuria occurred in many cases; when it was discharged it produced 
burning of the urethra, especially in females. In many cases there was suppression of urine, 
requiring relief by cups, leeches and diuretics. N. O. M. J., vol. ii, p. 45. 
167 Febrile Caloricity, before and after death. Western Journal of Medicine and Surgery; 
New Orleans Medical Journal, vol. ii, p. 101. Yellow Fever. N. O. M. and S. J., vol. iii, p. 165. 
168 Remarks on Yellow Fever. N. O. Med. and Sur. Jour., vol. ii, pp, 139, 321. Speculations 
on the Cause of Yellow Fever. N. O. M. and S. J., vol. iii, p. 563. 
169 Treatment of Fevers. N. O. M. and S. J., vol. ii, pp. 172, 290, 472. 
170 Sulphate Quinine in large doses in Bilious Remittent Diseases. N. O. M. and S. J., 
vol. ii, p. 301. 
171 Causes of Disease. N. O. M. and S. J., vol. ii, p. 452. 
172 Remedial Powers of Quinine. N. O. M. andS. J., vol. iii, p. 16. 
173 Yellow Fever at Opelousas, 1837, '39 and '42. N. O. M. and S. J., vol. iii, pp. 27,173. 
174 Congestive Fever. N. O. M. and S. J., vol. iii, p. 147. 
175 Black Tongue. N. O. M. and S. J., vol. ii), p. 190. 
176 Periodicity in Disease. N. O. M. and S. J., vol. iii. p. 419. 
177 Camp Diseases in Southern Climates. N. O. M. and S. J., vol. iii, p. 436. Yellow Fever. 
N. O. M. and a. J., vol. V, pp. 192, 225. 
178 Congestion and Congestive. N. O. M. and S. J., vol. iii, p. 443. 
179 Yellow Fever in New Orleans, 1346- N. O. M, and S. J., vol. iii, p, 445, Fever Statistics. N. 
O. M. and S. J., vol. v, p. 48; vol. v, p. 192, 
180 Cases in Hospital Practice N. O- M. and S. J., vol. iii, p. 595. 
181 Medical History of Alabama. N, O. M. and S J., vol. iii, p. 691; vol. iv, pp.3, 151, 601; vol. 
v, p- 37. 
182 Remittent Fever, Complicated with Symptoms of Tetanus. N. O. M. and S. J , vol, iii, 
p. 732; vol. V, p. 189; vol. V, p. 275. 
183 Congestive Fever. N. O. M. and S. J., vol. iv, p. 36. 
184 Yellow Fever concentrated with Bilious Fever; insector animalcular origin. N. O. M. and 
S. J., vol. iv, p. 563. 
185 Epidemic in Vicksburg, 1847. N. O. M. and S. J., vol. iv, p. 689. 
186 Disease in 2d Reg't Miss. Rifles. N. O. M.-and S. J„ vol. v, p. 3. 
187 Sulphate of Quinine. N. O. M. and S. J., vol. v, p. 15. 
188 Yellow Fever in Covington, La., 1847. N. O. M. and S. J., vol. v, p. 216. 
189 Yellow Fever, Rodney, Miss., 1847. N. O. M. and S. J., vol. v, p. 217. 
190 Yellow Fever of Vicksburg, Miss., 1847. N. O. M. and S. J., vol. v, p. 220. 
191 Yellow Fever of Houston, Texas, 1847. N. O. M. and S. J., vol. v, p. 227. 
192 Yellow Fever. N. O. M. and S. J., vol. v, p. 481. 
193 Yellow Fever of Natchez, 1848. N. O. M. and S. J., vol. v, p. 549. Dr. Stone says that at 
the approach of death the urine became scanty and like porter. 
194 Yellow Fever in New Orleans, 1848. N. O. M. and S. J., vol. vi, p. 9. Abortive Treatment 
of Fevers, N. O. M. and S. J., vol. ix, p. 318. 
195 Yellow Fever. N. O. M. and S. J., vol. vi, p. 52. 
196 Yellow Fever, Houston, Texas. N. O. M. and S. J., vol vi, p. 6. 
197 Yellow Fever at St. Francisville, N. O. M. and S. J., vol. vi, p. 6. 
198 Yellow Fever at Thibodaux, La. N. O. M. and S. J., vol. vi, p. 6. 
199 Diseases of Cahawba, Ala. N. O. M. and S. J., vol. vi, p. 168. 
200 Diseases ol Dallas Co., Ala. N. O. M. and S. J., vol. vi, p. 178. 
201 Epidemic in Attakapas, 1849. N. O. M. and S. J„ vol. vi, p. 67. 
202 Diseases of Selma, Ala. N. O. M.and S. J., vol. vi, p. 628. 
203 Typhoid Fever in the South. N. O. M. and S. J., vol. vi, p. 712. 
204 Diseases of Cross Keys, Ala. N. O. M. andS. J., vol. vi, p. 728. 
205 Med. Hist. E. Ala. N. O. M. and S. J., vol. vi, p. 741. 
206 Diseases of Mobile, Ala., 1849. N. O. M. and S. J., vol. vi, p. 745. 
207 Congestive Fever. N. O. M. and S. J., vol. vii, p. 300; p. 419. 
208 Bilious Remittent Epidemic. N. O. M. and S. J., vol. vii, p. 574. 
209 Yellow 1 ever, Bay St. Louis, 1820. N. O. M. and S. J., vol. viii, p/1. Use of Quinine, vol. 
viii. p. 155. 
210 Report on the Met orology, Vital Statistics and Hygiene, State of Louisiana. 
211 Typhoid Variety of Remittent Fever. N. O. M. and S. J., vol. viii, p. 739. 
212 Observations on Yellow Fever. N. O. M. and S. J., vol. ix, p. 35. 
213 Typhoid or Epidemic Pneumonia identical with Periodic Fevers. N. O. M. and S. J., vol' 
ix, p. 427. 
214 Fevers of the Mississippi Valley. N. O. M. and S. J., vol. x, p. 281. 
215 Yellow Fever in Miss. N. O. M. and S. J., vol. x, p. 27. 
216 Yellow Fever at Grand Lake. N. O. M. and S. J., vol. x, p. 328. 
217 Yellow Fever of Mobile in 1853. N. O. .M. and S. J., vol. x., p. 571. 
218 Yellow Fever in Washington in 18513. N. O. M. and S. J., vol. x, p. 602. 
219 Yellow Fever at Memphis, Tenn., 1853. N. O. M. and S. J., vol. x. p. 662. 
220 Yellow Fever in Plaquemine,La. N. O. M. and S. J., vol. x,p. 668. 562 
History of Malarial Hoematuria. 
221 Yellow Fever at Franklin, La. N. O. M. and S. J., vol. x, p. 670. 
222 Yellow Fever at Grand Gulf, 1853. N. O. M. and S. J., vol. x, p. 676. 
223 Yellow Fever. N. O. M. and S. J., vol. xi, p. 43, vol. xi, pp. 364, 429, 493. Intermittent Fever, 
vol. xiii. p. 30. 
224 Yellow Fever, Mobile, 1853. N O. M. and S. J. vol. xi, p. 83. 
225 Yellow Fever, Selma, Ala., 1853. N. O. M. and S. J., vol. xi. p. 88 : vol. xi, p. 284. 
226 Yellow Fever, Mobile, 1853. N. O. M. and S. J., vol. xi, p. 287. 
227 Malaria. N. O. M. andS. J., vol. xi, 616, p. 730 
228 Yellow Fever. N. O. M. and S. J., vol. xii. p. 30, p. 149. 
229 Experimental Researches Animal Heat. N. O. M. and S. J., vol. xii, p.54: vol. xii, p. 205, 
p. 289, p. 437, p. 470, 603, 759. Yellow Fever, 1820. Vol. xii, p. 113; vol. xii, p. 321. Refrigeration in 
ArdentFevers. Vol. xiii, p. 149. Path. Anat. Vol. xiii. pp. 175,302,484,599,620. Types of Diseases. 
Vol. xv, p. 584. Nat. Hist, of Yellow Fever. Vol. xv, p. 717. 
230 Diseases of Mobile, 1854. N. O. M. and S. L, vol. xii. p. 224. 
231 Yellow Fever in Charleston, 1854. N. O. M. and S. J. vol. xii, p. 383. 
232 Yellow* Fever at Norfolk and Portsmouth. N. O. M. and S. J., vol. xii,p. 425. 
233 Diseases, etc., Cherokee Co., Tex. N. C. M. and S. J., vol. xii, p. 723. 
234 Malaria as the Cause of Periodic Fever. N. O. M, and S. J., Vol. xii, p. 785. 
235 Diseases of Washington Co., Texas. N, O. M. and S. J., vol. xiii, p. 1. 
236 Yellow Fever, 1855, at Pass Christian. N. O. M. and S. J., vol. xiii, p, 8. 
237 Yellow Fever and Quarantine. N. O. M. and S. J., vol. xiii, p. 339. 
238 Cases in Rusk and Panolo Co., Texas. N. O. M. and S. J., vol xiii, p. 443. 
239 Yellow Fever. N. O. M. and S. J., vol. xiii, p. 649, p. 755. 
240 Letter to the Hon. C. M. Waterman, Mayor of New Orleans. N. O. M. and S. J., vol. xiv, 
p. 320. Lectures on Yellow Fever. N. O. M. and S. J.,'vol. xv, p. 500. p. 697. 
241 Proximate Causes of Fever. N. O. M. and S. J., vol. xv, p. 20. 
242 Diseases of Crans Creek. N. O. M. and S. J. vol. xv, p. 33, p. 164, p. 331. 
243 Masked and Traumatic Yellow Fever. N. O. M. and S. J., vol. xv, p. 783. 
244 Yellow Fever. N. O. M. and S. J., vol., xvi, p. 60, p. 153. 
245 Illustrations of Fever. N. O. M. and S. J,, vol xvi, p. 207. Researches on Animal Heat. 
N. O. M. and S. J., vol. xvii, p, 199, p. 356. Pathol. Anat, and Nat. Hist, of Yellow Fever. N. O. 
M. and S. J., vol. xvii, p. 636; vol. xviii, p. 20,153; vol. xviii, p. 3n6. 
246 Yellow Fever. N. O. M. and S. J., vol. xvi, p. 220, p. 305, p. 457. 
Malarial hsematuria was observed by C. Glidden Young, M. D., of 
Greenwood, Louisiana, in the month of October, 1843, as will be shown by 
the following report of case of intermittent fever, attended xvith a periodic 
haemorrhage from the kidneys." New Orleans Medical and Surgical Journal, 
vol. ii; No. iii; November, 1845, pp. 306-309, case 905. 
" Vinkler Harper, aged 8 years, an exceedingly interesting little boy, of pre- 
cocious intellect, the son of a wealthy and respectable planter of this parish, in 
October last, had chills, attended with urgent symptoms of cerebral excitement, 
which disappeared after the operation of a cathartic, which removed from the first 
passages a large quantity of fruit seed. He then took quinine and recovered. After 
this attack the mucous membrane of the stomach and bowels was left in a tender 
and irritable state; and, notwithstanding the fever had left him and there was no 
return of chill, and the little boy was running about, and had a good appetite, the 
skin remained harsh and dry, the countenance sallow, the tongue too red, and the 
sclerotica presented that peculiar, bluish appearance which is so remarkably charac- 
teristic of affections of the spleen in miasmatic districts. Under these circum- 
stances, our further attention did not seem to be needed, and was not required. In 
the latter part of November, of the same year (1843), we were informed that our 
little patient had had a return of chills, that he had taken a dose of calomel, fol- 
lowed by a dose of castor oil and oil of turpentine, and that during the febrile 
excitement, and subsequent to taking the oil and turpentine, he had haemorrhage 
from the kidneys. We prescribed tinct. opii, iij gtt, to be repeated, if necessary ; 
warm fermentations to the lumbar regions, mucilaginous drinks, and quinine to 
arrest the chill. The next day he was up, and continued well until the 11th of 
December, when he had another chill with return of the haemorrhage, and on the 
13th we were called in to see him. We were informed that he had had no fever on 
the 12th, and that he had appeared quite well. The paroxysm came on this morn- 
ing, (13th) at 11 o'clock, A. M., and was declining on our arrival. We found him 
sitting up in bed fretting for something to eat, and had just been indulged 
with a few oysters. The tongue was a little furred; the bowels open; the skin 
harsh, dry and sallow; pulse 120, feeble; abdomen tympanitic; liver and spleen 
both enlarged. We were shown a vessel containing about three pints of bloody 
urine, which he had just voided, and were told that was not halfhe had passed 
during the present paroxysm. The urine and blood were so intimately 
combined that no estimate could be formed of their relative proportions. Nitric 
acid and heat both threw down copious precipitates of coagula. Both testicles 
retracted ; he complained of numbness down both thighs, and pain in the lumbar 
regions in both sides, which was not much, if at all, aggravated by pressure. He History of Malarial Hcematuria. 
563 
had passed only healthy urine during the intermission. We knew haemorrhage 
from the bowels was not generally a dangerous symptom in our fevers; that that 
from the kidneys in this case subsided when the fever was arrested, in November, 
and we hoped it would do so again, but the case was unique ; the quantity of blood 
discharged during each paroxysm alarming; and. the general state of the system was 
so vitiated that we doubted whether quinine would control the chills. We accord- 
ingly gave a guarded prognosis, and prescribed hyd. chloride, mit. grs v; pulv. 
ipecac comp. grs. iij, to be repeated in six hours. Sp. ether nitros, f^ss; tinct. opii 
xl gtt. m.; to take 20 drops every four hours. Cupping over the lumbar region, 
followed by a warm poultice. To be kept warm in bed, and drink freely of hot teas. 
December 14th. Found my little patient with but slight fever; quite restless 
and fretful. Medicine produced three small mucoid evacuations; no pain in the 
lumbar region ; urine natural; no numbness in the thighs ; testicles not retracted ; 
abdomen tender on pressure; slight eruption of urticaria on the breast and legs. 
Applied four cut cups to the abdomen ; gave hyd. chlorid, mit. grs. iij, creta prept. 
grs. iv., pulv. ipec. comp. grs. iij; to be repeated every five hours until he has 
taken four doses; continue spts. nit. without the laudanum. 15th. Saw our little 
patient early in the morning. Had some fever; slight pain in the head; tongue 
more coated and not so red; tenderness in the abdomen subsided ; evacuations bil- 
ious, urine natural; skin jaundiced; eruption disappeared. Gave one grain of 
quinine, after which fever rises without any marked chill. Fever was higher than 
had been during previous paroxysm, attended with slight delirium, and the most 
copious discharge of bloody urine. Pain in the lumbar region, retraction of the 
testicles, and numbness down the thighs, all returned. We made use of cold 
applications to the head, and gave J gr. tart. emet. The febrile excitement and 
heat of the skin partially declined, but the stomach became very irritable, and we 
had in consequence to discontinue its use. 
16th. He slept but little during the night, throwing up every half hour or hour 
large quantities of grass-green matter from the stomach. His bowels, too, became 
affected with watery discharges during the latter part of the night. At 8 o'clock A. 
M. we cupped over the region of the stomach and liver and gave him grs. x hyd. 
chlorid. mit., and grs. iv pulv. ipecac comp., and applied a blister to the sacrum. 
We visited our patient again in the evening, and spent the night with him. The 
general aspect of the case appeared somewhat improved, and he had voided healthy 
urine about four o'clock P. M. The other symptoms referable to the kidneys had 
not subsided as in the previous intermissions; indeed, to-day, there was only a 
remission. The bowels had been moved several times and the stomach was still 
irritable. We gave him hyd. sub. muriat. grs. iv, sulph. morph, gr. |, pulv. 
camphor grs. ij, and put him in a warm bath. In the latter part of the night we 
endeavored to keep the stomach quiet with opium and camphor, and the effervesc- 
ing draught, and at 5 o'clock A. M. commenced giving quinine in doses of two 
grains every two hours. Almost contrary to our expectations the quinine was 
borne remarkably well. Under its influence, combined with that of the opium, 
he rested and slept naturally: the pulse became slower and fuller, and the skin 
moist. At 9 o'clock, the dose was increased to three grains and another opiate com- 
bined with it. In a few minutes he fell into a quiet sleep, and so continued until 
half-past 10 o'clock, when we awoke him to administer another dose. He immedi- 
ately asked for water, and in the same hurried breath called for the chamber; the 
features of his face were contracted, his countenance anxious in the highest degree, 
the natural expression of his "soft black eye" which had been so beautiful in 
health, was changed to a painfully wild and vacant stare. We knew this paroxysm 
would be the last act in the scene, and the curtain of death would soon fall, and 
turning round to see who was in the room to witness with us the sad catastrophe, 
we caught his father's anxious countenance resting full upon us-" is there no 
hope?"-his looks inquired, and our answer sent a world of miseries to his heart- 
all is over! 
Just before his death he voided a large quantity of bloody urine, and this sin- 
gular feature of the case-the periodical haemorrhage from the kidneys, coming on 
with the paroxysm, subsided as it declined, disappearing entirely during the inter- 
missions; while the severity of the exascerbations indicated in every instance the 
quantity of blood discharged-is, so far as we know, unique. The haemorrhage 
undoubtedly resulted from extreme venous congestion of the kidneys; and the 
periodicity of the pathological condition of this organ was distinctly marked. To 
a greater or less extent a similar condition of the extreme veins, and even the 
larger trunks of other organs, or of the system generally, always obtains in that 
fatal form of fever, which has been denominated in some parts of our country, in 564 
History of Malarial Hcematuria. 
.the emphatic language of the South and West, " the battle-axe of Deaths And 
the particular organ upon which the congestion concentrates, is, for the most part, 
plainly marked by a rise of function, and other indications, which it is not our 
province at present to enumerate. This is a task we may undertake another time." 
It is evident that the preceding case reported by Dr. C. Glidden Young, 
about forty-two years ago, possessed all the marked symptoms of the 
malarial hmmaturia of the present day. It is evident also that the free 
use of opium exerted no appreciable effect upon the progress of the dis- 
ease. Dr. R. H. Day, of Baton Rouge, an experienced physician, who has 
practiced medicine for half a century in the Mississippi Valley, affirms 
that he encountered malarial fever as early as the year 1837 in the bottom 
lands of the Wabash and White rivers. Dr. R. H. Day has kindly placed 
his article at the disposal of the author; it is here reproduced for its his- 
torical and practical value. 
Malarial Hcematuria.*-The literature of haemorrhagic malarial fever is very 
meagre and dates back to only a few years in the past. Our old authors do not 
mention it, if I recollect rightly, and even our recent standard authors are nearly, 
if not quite, as silent; or if they speak of it at ail, it is so indirectly and cursorily 
as to convey but little information on the subject. Why this is so, it is difficult to 
give a good reason, unless, perhaps, it is that our standard medical writers, ancient 
and modern, were city practitioners of medicine and acquired their experience 
and information from those fields of labor only, where they had but few, if any, 
opportunities afforded for its personal observation; and hence, did not, and could 
not write of a disease they had not seen and knew nothing about. Nevertheless, 
whatever may have hindered, it is a fact,'that nothing is known of this disease, 
except w'hat has.been written about it of late years; for it is only in recent years 
that medical men have begun to observe it closely, to write up its symptoms, to dis- 
cuss its history and nature and its correct treatment. And especially is its inves- 
tigation upon a scientific basis of recent date. 
Those who first observed and wrote of this disease were men whose labors were 
confined to rural and insalubrious localities, where facilities for scientific investi- 
gations were entirely wanting, and were obliged to depend solely upon clinical 
observation and experience for the information or knowledge they collected; and 
hence, could merely describe its symptoms and the remedies used in its treatment; 
while those who have more recently observed and thought more deeply about it, 
have so differed as to its essential nature and plans of treatment, that the profes- 
sion up to this day are divided in opinion upon these points. 
I may not be more fortunate in my efforts to throw light upon this subject than 
others have been, but I may hope, from my long experience and attentive observa- 
tion, if I can express my thoughts clearly, to help to direct medical thought to cor- 
rect conclusions and dispel much of the ambiguity that now attaches to its litera- 
ture. Haemorrhagic malarial fever, or malarial haematuria, known by the laity as 
"swamp feverf and so-called by some of the faculty, to designate its prevalence in 
swampy localities, is a disease, according to my observation, more or less prevalent 
in all river deltas, low lying, swampy districts and contiguous neighborhoods in 
every part of the United States, between 42° north latitude and the Gulf of Mexico 
during the late summer and fall months. 
Notwithstanding it is thought by many to be a disease of recent development, 
having, it is said, first been observed in Georgia in 1846 (Dr. I. J. Newton, Jr., in a 
paper read before the Louisiana State Medical Society in New Orleans, in April, 
1885), I here emphatically state, repeating what I said on the occasion referred to, 
that in 1837 up to 1843, I encountered this disease every year in the bottom lands 
of the Wabash and White rivers in the States of Illinois and Indiana, and from 
1843 to 1846 in the White river bottom in the State of Arkansas, and that the oldest 
citiz ens of those places at that time, recognized this disease and spoke of it as their 
ancient and common enemy in those highly malarious localities. 
The idea then, that it is a disease of recent origin would seem to be erroneous, 
in the light of this experience, and clearly irrational, if we are correct in suppos- 
ing that the same causes and conditions which now engender it have existed in all 
past time, and must have exercised the same pathogenic efficiency then, as now. 
That it is a miasmatic disease, caused by malaria, whatever that undefined and as 
* By R. H. Day, M, D., Baton Rouge, La. Read before the La. State Medical Society, April, 
1886. History of Malarial Hosmaturia. 
565 
yet undiscovered fever poison may be, there can hardly be a reasonable doubt. Its 
occurrence in the same localities, at the same season of the year; its striking resem- 
blance and strongly marked physiognomy to the malarious bilious diseases endemic 
in those districts, and its general amenability to the same therapeutic agents, 
reveal its kinship, stamp it as allied to and of common origin and nature with 
them. We then, unhesitatingly class it, as an hepatic-renal affection of malarial 
origin, depending upon malarial toxsemia, for its existence and striking morbid 
manifestations. 
Luke all other diseases of which we have any knowledge, it is marked in its 
attacks and progress by various shades of intensity; some cases being comparatively 
mild and even intermittent in form, while others are deeply virulent, pernicious 
and rapidly fatal in character. In the milder cases, the systemic disturbances are 
less threatening and the local symptoms less aggravated ; the blood that is passed 
in the urine or from the bowels is not decomposed and disintegrated as in the 
violent and acute cases. In the former, the red blood-corpuscles are readily detected 
in the urine by the microscope; in the latter, the urine contains only the debris of 
decomposed and disintegrated red blood globules, tube casts, etc. The former is 
fairly illustrated in a case reported by the late Dr. 8. M. Bemiss, as "malarial 
hsematuria," in the "System of Medicine," by Pepper, in his article on "Malarial 
Fever." He says vol. 1st, page 611 : "U. E., aged 26 years, was admitted to ward 
19, Charity Hospital, November 18, 1872. He has been in America more than a 
year, and for several months had been working in an intensely malarial district, 
preparing the bed of a railroad. Has had malarial diseases for several months, and 
suffered a severe chill the day before admission. A few hours after admission, 
temperature 103°, pulse 120, respirations 29; effusions in both thoracic cavities and 
very marked in abdominal cavity; lower lobe of the right lung oedematous, legs 
anasarcous, pitting greatly on pressure, with several ulcers of long standing ; urine 
loaded with albumen, and showing under the microscope abundant blood-corpus- 
cles (italics mine); considerable jaundice present, which the patient states to have 
occurred suddenly. Ordered five grains each of calomel and bi-carb. sodium, to be 
followed with ten grains quinine every two hours. November 22d-Patient has 
taken and retained 108 grains of quinine. Secretion of urine abundant; no blood 
present and only a trace of albumen. Ordered twenty drops of tinct. chloride of 
iron three times daily. Discharged, cured, December 12." 
This case, reported by Dr. Bemiss as malarial hsematuria, although complicated 
with serous effusion in both thoracic and abdominal cavities, was obviously only a 
specimen of the milder form of the disease, demonstrated by the entire absence of 
nausea, the appearance of red blood-corpuscles in the urine, and the ready yielding 
to a dose of calomel and the liberal use of quinine. 
Dr. George Harley, in his great book on the "Diseases of the Liver" (and I add, 
the most practical and scientific work on the subject I have ever read), gives the 
history and symptoms of two cases of this disease under the title of "Paroxysmal 
Hepatic Hsematuria," less complicated than the one related by Dr. Bemiss, but 
possessing two remarkable peculiarities-that of a decided intermittence, with the 
urine normal or nearly so during the apyrexia, while during the paroxysm the 
urine was loaded with blood, decomposed and disintegrated, with scarcely a single 
entire red blood-corpuscle to be seen under the microscope. Dr. Harley says: 
"The most remarkable features of this affection consist in the strange fact that, 
although the abnormal urine passed by the patient during the attacks contains the 
whole of the ingredients of the red blood-corpuscles, scarcely a single entire blood- 
cell is to be detected in it by the microscope, their debris being at the same time 
visible in every direction." 
That these cases related by Dr. Harley, were also of the milder type, is very 
clearly shown by the comparatively mild constitutional symptoms and the readi- 
ness with which they yielded to calomel and quinine, the same as in the case of 
Dr. Bemiss. In the graver forms of this terrible disease, the symptoms are greatly 
aggravated, much more violent and of the gravest character. From the initial 
chill, there is distressing nausea and vomiting, small, frequent and feeble pulse, 
great prostration and emission of dark, bloody looking urine, presenting to the 
naked eye a broken down condition and decomposed aspect, loaded with small, 
black granular bodies and tube casts, and the debris of decomposed and disinte- 
grated red blood globules (with no entire blood-cell visible under the microscope) 
and pinched sunken features, all indicative of profound constitutional contamina- 
tion. I am sorry that I have not Dr. Joseph Jones' description at hand, but it gives 
me pleasure to be able to give what Dr. Jones says, through Dr. Harley, who 
writes: "Dr. Jones, of Louisiana, has called attention to the fact, that in his 566 
History of Malarial Hoematuria. 
district there is a very marked acute form of this hepato-renal malarial affection, 
which he says is characterized by well marked jaundice, as well as hsematuria. 
In some cases immense quantities of green biliary fluid, or liquid tinged with bile 
are vomited, and the patients die in a state of collapse, with blue mottled purplish 
extremities, and sunken, pinched features. As a general rule, suppresion of the 
function of the kidneys is a fatal sign, and as in yellow fever, sometimes attended 
with convulsions, coma and delirium. And while some of the symptoms as the 
nausea, incessant vomiting (in extreme cases black vomit), deep jaundice and the 
impeded capillary circulation, resemble those of yellow fever, yet there are marked 
differences between this disease and yellow fever; the pathological changes 
observed after death, are characteristic of paroxysmal malarial fever, and not 
yellow fever." Jt±is graphic and truthful description of this acute and violent 
type of malarial haematuria is significant of its typical character, clearly distin- 
guishing it from the milder forms spoken of, and accords with the experience of 
all careful medical observers who have become familiar with it by personal 
observation. 
It would be tedious to particularize cases, and would swell this paper to undue 
dimensions to do so, but I would refer my readers to an article on this disease by 
Dr. McHatton of Georgia, and published in the Atlanta Medical and Surgical 
Journal, October number, 1884, and to the valuable collection of cases by Dr. Coch- 
rane of Mobile, Ala., and reported in the Journal of the American Medical Associ- 
ation, verified by the analyses of the urines by Dr. Geo. Sternberg of the United 
States Army, and Prof. Tyson of Philadelphia. 
It will be observed by reference to these papers and cases, that the one invaria- 
ble and uniform symptom marking and distinguishing this type of the dis- 
ease was the bloody urine, destitute of red blood-corpuscles under the microscope 
and presenting a decomposed and disintegrated condition of the red blood globules. 
I deem it of very great clinical and therapeutic importance, that the differen- 
tial diagnoses between this malignant type and the milder forms of the disease 
should be clearly understood and recognized by the medical profession, in order to 
adopt the best and most rational treatment, suited to its varying conditions and 
manifestations, and to avoid that confusion and ambiguity of statement so con- 
spicuous in many of the contributions to the literature of this subject. 
Its etiology.-I suppose, as already stated, there can be no doubt of its malarial 
origin; and yet it is only proper that I should state, that the eminent medical 
scientist and practitioner, Dr. Harley, records a case, that would seem to indicate 
that the disease may be engendered by other causes than malaria. Dr. Harley in 
his work on the "Diseases of the Liver," pages 246-248, records in substance the 
following case : The subject, being by trade a blacksmith of a stout and robust 
constitution, had never been out of London, nor subject at any time, as far as 
could be known, to any miasma. When first seen by Dr. Harley, December 24th, 
1864, he had a dark, sallow, care-worn complexion, with evidence of hepatic trou- 
ble, and was paroxysmally passing bloody urine corresponding with his chilly or 
cold sensation. He was treated with calomel and quinine, and speedily made a 
perfect recovery. Notwithstanding this apparently exceptional case, I believe it is 
thought by all medical men who are conversant with the disease, to be the direct 
result of malarial poisoning; and so far as I am capable of judging, the evidences 
leading to this opinion are clear and beyond all question, and according to my 
observation, the type or violence of the disease bears a direct ratio to the intensity 
of the poison or the duration to its exposure. I have never seen a case of serious 
or grave import, but in connection wih indubitable proof of chronic and intense 
malarial toxaemia, not until such destructive changes had been wrought in the 
blood by this subtle poison, as to render it unfit and incapable of longer continuing 
the vital functions. 
How malaria operates on the human organism to effect this destructive change 
of the blood is a matter of conjecture: yet some experiments of Dr. Harley seem to 
be giving to physiological and pathological speculation the character of scientific 
certainty. After giving with great minuteness the chemical characteristics of the 
urine in malarial haematuria and its several constituents, he says : "I was particu- 
larly struck with the resemblance this urine bore, to the urine I have occasionally 
seen dogs pass afterl had injected either bile or bile acids in toxic doses under the 
skin of their backs. Their urine not only occasionally presented exactly the same 
color, but contained lots of granular tube casts, and still further resembled this 
human urine in being coagulable by heat and nitric acid. All this leads me to the 
conclusion that the condition of the urine in cases of paroxysmal hepatic albumi- 
nuria is in great part due to disorder of the biliary secretion brought about by the History of Malarial Hcematuria. 
567 
direct result of malaria acting upon the liver." Again he says: "As bile acids 
have a powerful disintegrating effect on the cell-walls of the red blood-corpuscles, 
it has once or twice crossed my mind, that this peculiar condition of the urine in 
paroxysmal hepatic hseinaturia may possibly be due to an abnormal quantity of 
bile acids in the circulation." If then the bile acids abnormally present in the 
blood, do have "a powerful disintegrating effect on the cell-walls of the red blood- 
corpuscles" as stated by Dr. Harley, we have furnished us a scientific and chemi- 
cal cause for the decomposition and disintegration of the blood, and the reason why 
no entire red blood-corpuscles are ever detected in the urine of malignant types of 
malarial hsematuria. "In the New Orleans Medical and Surgical Journal, for 
August, 1885, under the heading, 'A clinical study of the liver, as viewed through 
the urine,' is quite a well written article, commenting upon the researches and 
experiments of Dr. Oliver, an abstract of which is published in that number of the 
Journal. It will there be seen that Dr. Oliver ascribes to the bile acids or their 
salts in abnormal quantities in the blood a haemolytic property, corroborating the 
views advanced by Dr. Harley, and giving force to the statements herein made." 
And the writer very truly observed, "their (bile acids) enormous increase in mala- 
rial haematuria, also explains the presence of bloody urine, and suggests the point 
of attack in the treatment of the disease." 
That there is a destruction of the red blood-corpuscles under the action of mala- 
rial poison does not seem to be a matter of conjecture, but a pathological fact, 
demonstrated by rigid microscopical examination by our best and most experi- 
enced pathologists and microscopists-among them I may name with some degree 
of pride Dr. Joseph Jones, of New Orleans, whose skill and competency and inde- 
fatigable scientific researches are recognized everywhere among medical scientists, 
says in his Medical and Surgical Memoirs, vol. 1st, p. 485: "The colored blood- 
corpuscles are more uniformly and rapidly destroyed in severe cases of malarial 
fever than in any other disease, with the exception perhaps of pyaemia." But it 
is to be noted, that the destruction of the red blood-corpuscles is the direct result of 
the action of the bile acids upon the blood; and it is pertinent to inquire, whence 
the presence of the bile acids in abnormal quantities in the blood? They are not 
normally there, and must have been derived from some potent factor. 
It is unfortunate that up to this day, notwithstanding the claims of Drs. Salis- 
bury, Klebs, Crudelli and others to the discovery, no one has been able to establish 
the identity, the nature, physical or chemical, or bacteriological character of the 
poison, so that its properties could be analyzed, and its specific toxicological action 
upon the human organism scientifically tested and demonstrated ; but clinically, 
for ages upon ages, certain well-defined abnormal changes and diseased conditions 
in the human organism have been seen uniformly to be produced by a residence in 
or exposure for any lengthened period to marshy or what is by general consent 
of medical opinion regarded as malarious localities. Among these abnormal 
changes, besides the family of paludal fevers, dysentery, etc., which are so preva- 
lent in such districts, we have also the disease now under consideration, which 
appears to be the result of the chronic or protracted action of the miasma poison, 
and a careful clinical observation of the symptoms and abnormal changes in the 
human organism in their order of sequence, would seem to point to a congestion of 
the liver as the primary effect of this intangible poison, constituting the initial link 
in the chain of morbid processes afterwards developed. From this hepatic conges- 
tion, and the probable presence of the malarial poison in the circulation, still fur- 
ther paralyzing the nervous and vascular tone of the hepatic functions, its biliary 
secretion is arrested, more or less completely, and the elements that ought to have 
been eliminated, are retained in the blood, and among these, the bile acids-which 
at once begin their work of destruction upon the red blood-corpuscles. As a result 
of the passive congestion of the chylopoietic viscera, enlargement and induration of 
the liver and spleen ensue, while from the destructive changes in the hiemoglobin 
and the red-blood cell-walls, we have jaundice of all the tissues and well marked 
progressive anaemia. From the non-secretion and elimination of the bile and bile 
acids, and their consequent retention in the blood, daily and hourly in transit 
through the kidneys, there develops renal congestion, resulting in grave lesions in 
those important organs, and finally a break down, culminating in the discharge, 
through the kidneys, of the decomposed and disintegrated blood, epithelium tube 
casts, etc. This, it appears to me, is a rational and correct explanation of the patho- 
logical and anomalous conditions, and their order of sequence, which we witness 
in the clinical history of these cases, and fairly and logically deduced to arise from 
chronic malarial poisoning. 568 
History of Malarial Hematuria. 
It is very important that all of these abnormal processes should be clearly recog- 
nized and appreciated, in order to be able to institute a rational and scientific treat- 
ment; for it is obvious that the chief obstacle heretofore in the way of a correct 
treatment, was in the fact of a misconception or a misty apprehension of these 
lesions. 
Treatment.-In the milder forms of the disease, this is simple, easy and success- 
ful, as already illustrated in the cited cases of Doctors Bemiss and Harley, a few 
doses of calomel, followed with quinine, being all that was necessary. " When, 
however, the type is violent and malignant, we will have ample scope for the exer- 
cise of our deepest thought and grandest skill, in these malignant cases the patient 
will be troubled from the onset with distressing nausea, frequent retching and 
vomiting of a greenish fluid with mucous flocculi, the pulse will be small, frequent 
and feeble, the skin shriveled and surface cool or cold, with shrunken and pinched 
features, and the frequent emission of dark bloody urine, presenting the appear- 
ance of disintegrated and broken-down red-blood cells, loaded with the bile pig- 
ments in the form of small black granules. In all such cases the urine when care- 
fully examined with the microscope will be found almost, if not entirely, without 
a single red blood-corpuscle. These are the severer types of this disease, most 
malignant in character, that claim our attention. When called to a case of this 
type we should promptly apply dry cups to the epigastrium and right hypocon- 
drium, with a view to drive the blood from the congested vessels of the stomach 
and liver to the cutaneous surface, and follow the cups by a blistering plaster over 
the same regions to maintain the circulation in the skin and to aid in stimulating 
the liver to its secretory action. Give hypodermic injections of morphia to quiet 
nervous irritation and to compose the stomach to rest. Give to adults 5 grains of 
calomel with 3 grains of bi-carb. soda every 3 to 4 hours till the al vine discharges 
show the presence of bile, and the liver again resumes its work; after 3 or 4 doses 
have been given, if the bowels have not been moved, give enemas of plain warm 
water, or containing a dessert spoonful of camphorated oil, or a small teaspoonful 
of table salt. If the stomach should still be troubled with nausea or a tendency 
that way, give an emulsion, each dose consisting of 1 drop creosote, 1-12 to J sulph. 
morphia, 3 grs. bi-carb. sod., and a drachm aqua menthse. and repeat every 2 to 3 
hours as long as required. Frictions over the back with dry mustard and pulv. 
capsicum, as also to the arms and legs, should be assiduously applied, supplemented 
with dry heat to the body. As soon as the calomel has produced a well marked 
bilious fecal discharge, or reaction is manifest, no time should be lost in pushing 
quinine, but not in doses too large. It is all a mistake and highly mischievous to 
give very large doses of quinine, except in the congestive pernicious forms of inter- 
mittent fever, where it is an absolute necessity to prevent the recurrence of another 
paroxysm. But in this disease, with this type, 5 to 10 grs. every 3 to 5 hours, till 
there is slight manifestation of cinchonism, and then at longer intervals, so as to 
keep up a moderate impression, for the purpose of antagonizing the malarial poison 
and giving tone to the nervous centres. 
The quinine, if the stomach will not tolerate it, should be given hypodermati- 
cally, which is the preferable plan, on account of the danger of again setting up 
nausea and vomiting. As soon as the function of the liver is measurably or appre- 
ciably established and enough quinine has been introduced into the system to 
make its physiological effects manifest, commence to give the muriated tincture- of 
iron in full doses, twenty to thirty drops every four hours, with a view of toning 
up the debilitated blood-vessels, reconstructing and vitalizing the haemoglobin and 
the red blood-corpuscles, and thus restoring the normal and vital condition of the 
blood. If the kidneys should fail to excrete urine, use frequent frictions over the 
lumbar region with warm whisky, spirits of turpentine, and tincture digitalis, 
which will often be found efficient in stimulating the kidneys to activity. Some- 
times the administration of spirits turpentine in three to five drop doses every 
three to five hours either in an emulsion or upon loaf sugar may be needed to 
assist the frictions in hastening the actions of the kidneys; indeed it will always 
be found useful both in stimulating the kidneysand acting favorably upon the 
mucous membranes, both of the stomach and bowels and of the urinary passages. 
I have now given in detail my convictions of the etiology and essential nature 
of this disease, together with my plan of treatment and the medicines used, which 
I would recommend as being fairly successful-certainly as much so, if not more, 
than under other and diverse plans which I have seen others practice-and withal 
it is so rational and fulfills so completely every pathological condition and indica- 
tion of treatment, that even when not successful, for some must of necessity die, 
that the physician's mind is left with the composing reflection, that he could have History of Malarial Hcematuria. 
569 
done nothing more to turn away the shafts of death and bring his patient back to 
health again. 
I have concluded my paper without any reference to the dietary. Every phy- 
sician will know that with such a broken down state of the blood, and such a 
debilitated and impoverished condition of the digestive and assimilating organs, 
that the necessity for feeding is great, but that only the most nutritious and most 
easily digested and assimilable foods should be allowed, and they given in small 
portions, but often repeated, increasing the quantity, pari passu, with the improv- 
ing strength. 
As soon as the patient will bear moving, a dry bracing atmosphere and a 
healthy location should be sought, and the patient advised not to return to his 
malarious home, for we should never forget the pertinacity of this poison. Says 
Dr. Harley, " In fact, the poison of the worst forms of malaria, seems to saturate 
the tissues and adhere to the constitution with as much tenacity as the poison of 
syphilis; for there is no period of an individual's life, after he has once had a bad 
attack of malaria, at which he may be said to have completely gotten over it." 
We have shown that the opinion held by some that it was a new dis- 
ease is untenable, and in further support of this view I present the follow- 
ing highly practical article from Dr. T. W. Baird, of Point Jefferson, 
Morehouse Parish, Louisiana, in which he states distinctly that he treated 
cases of this disease before the Civil War. 
Prof. Joseph Jones, M. D., New Orleans, La.: 
Pt. Jefferson, Morehouse Parish, JLa., 
September, 1871. 
Dear Str-I received through the politeness of Mr. Lindsay, a message from 
you, requesting me to give you a history and treatment of the disease known here 
as "swamp fever," as seen and observed by me, to which I most cheerfully 
respond, hoping that the few suggestions that I may give will lead to good results. 
In this community the disease has been known and feared for many years-for 
when I came to this place, sixteen yearsago, it was very prevalent, notafew having 
succumbed to its dread blow during that same summer and fall-and from accounts 
that I obtained from all sources, I was constrained to look upon the prospects very 
gloomily, I assure you. At that time the prevailing opinion among our physicians 
in regard to the pathognomonic symptom (viz: that of passing urine identical in 
appearance to blood), was, that its color was due to a superabundance of bile in the 
urine, the liver becoming engorged or so inflamed and congested that it did not 
perform its functions, and the kidneys took upon themselves the vicarious office of 
secreting the bile as well as urine; hence our first duty was to direct our efforts 
towards correcting the functions of this important organ; and finding, as we usually 
did, excessive nausea and vomiting, tenderness of the epigastrium, and fever withal, 
of various intensity, we thought not safe unless the patient was put on mercury, 
and that, too, in very large and prompt doses, the result of which course was 
almost invariably ptyalism. We also used blisters to the epigastrium, and other 
agents to meet any indication that might arise. Some gave quinine during the 
remission and intermission; but quite a number, believing that the disease was 
superinduced by quinine, gave it very sparingly or rot at all; at any rate, most of 
the patients recovered but very slowiy, on account of the violence of the disease 
and the effects of heroic treatment. Some physicians believing it to bean idiopathic 
haemorrhage, directed their attention to checking haematuria by direct astringents 
with not very favorable results. Another class, believing it to be essentially mala- 
rial, considered quinine the sheet-anchor, the sine qua non, and in accordance with 
this belief, gave quinine in very large doses; very few recovering from this treat- 
ment. 
One gentleman observed to me that he was in the habit of using mercury too 
largely, although he would not treat a case without it, yet he believed some of his 
patients had recovered from the disease to die of the medicine. Such was the 
state of our knowledge and practice in 1860, the year I moved to the swamps. The 
course I adopted there was the mercurial, to get my patient salivated as quickly as 
possible, if the symptoms indicated; used blisters, and when a remission occurred 
gave quinine-giving no remedy directly to the relief of the apparent haemorrhage, 
and the result of my practice was that I lost no case until the 3d November, 1866, 
although up to that time I had treated not less than forty cases. This case 1 saw 570 
History of Malarial Hcematuria. 
in a few hoars after the first appearance of bloody urine; he had had chills and 
fevers all summer and fall; had very large spleen and an amemic look. I found 
him with high fever (having had a chill that morning), yellow skin, nausea and 
vomiting distressing, vomiting a bluish matter in large quantities, and passing 
large quantities of bloody urine. I gave calomel in large doses, used blisters to the 
stomach, and when a remission occurred gave quinine; the bloody urine continued 
until the third day, when the secretion of urine of any kind totally ceased, and 
that night he died of uremia. 
Quite a number of cases occurred that fall and winter in my practice, all of 
which recovered, but very slowly. There were also several treated by a physician 
who gave very large doses of quinine, nearly all of whom died. In the summer of 
1867 I treated a young lady who was seen by me within twenty-four hours after 
the first appearance of bloody urine. She had very great fever; quantity of urine 
not very large but bloody; complained of pain in head and stomach; very restless 
and semi-delirious; very soon the secretion of urine stopped, coma supervened, and 
death by uremia. No post-mortem. I treated her on the same plan as all others 
before her, whom I had treated. I was called in consultation with Dr. Harrison in 
a case of a young gentleman who had this disease. He had all the symptoms in a 
very grave form. We gave him small doses of calomel frequently repeated, 
induced actions from the bowels by enemata, put blisters to the epigastrium-no 
quinine. He recovered very well. 
I treated, in connection with another physician, a young man who had chills all 
fall, up to late in December, when he was taken with this disease, having taken a 
few hours before several large doses of quinine, had two or three rigors the first day 
and passed large quantities of bloody urine, with not much fever ; each day slight 
rigors, continuance of fever and bloody urine; on the third or fourth day he died, 
evidently from ancemia, having had no delirium or symptoms of coma. He had 
exceeding small doses of calomel frequently repeated, blisters, and little or no 
quinine. These are the deaths I have had in my practice upto this time, embrac- 
ing nearly or quite one hundred cases, and a term of eleven years, in one locality. 
I have had cases of this disease more or less, every year, and this year have had 
several. I will give you the history of the cases of two little patients, both of which 
recently occurred and are now recovering : I was called to see a little girl 8 years 
old, on the 2d August. 1S71; found her with high fever, very sick at stomach, 
vomiting a blue-colored matter; spleen very much enlarged and hard, pain in 
stomach and above spleen, was jaundiced and passing large quantities of bloody 
urine having had a chill that morning. I gave her calomel in decidedly large doses, 
oxalate of cerium to relieve the nausea and vomiting, and Battley's sedative and 
spts. nitre when restless and nervous, and the following B : Mucilage acacice ^iv, 
potassa nitratis ^ii, spts. terebinth giiss, in dose, teaspoonful every three hours. 
Next morning found patient with considerable fever, jaundiced, bowels having 
acted two or three times, and urine natural in quantity and clear; pain still in 
stomach and nausea and vomiting. Directed that the turpentine mixture be con- 
tinued, a blister over the region of stomach, and when a remission occurred to give 
quinine. On the next day found that she had had a short remission, when she had 
one dose of quinine, immediately after which she passed a large amount of bloody 
urine, during which time had a chill; fever rose and the quinine was discontinued. 
I found her more jaundiced, more restless and feeble; ordered the Battley and tur- 
pentine mixture to be continued, more calomel, and to stop the paroxysms, sulphur, 
4 or 5 grains every two hours during remission. Next morning found her with 
some fever, clear urine very icteric, with sore gums : directed continuance of the 
turpentine mixture, chlorate of potash for the salivation, and 3 grs. of ferrocyanate 
of iron, in connection with the sulphur as an anti-periodic. She had no more 
bloody urine, but fever in a slight form continued for more than a week, during 
which time she was caking the iron as an anti-periodic and the turpentine mixture 
to keep;the urine clear. She is now recovering, but very slowly. This patient had 
had chills and fevers all the summer. Was called to see another little girl about the 
same age, on Monday last, September 4th inst. She had been sick very little dur- 
ing the summer ; found her with fever and passing bloody urine frequently and in 
large quantities, having had a chill that morning, followed by the symptoms. Her 
mother had given her about 5 grs. of calomel, which had acted well, bringing dark 
looking actions, but urine continued bloody; she was very restless, with nausea 
and vomiting a blue matter; great pain in head and stomach ; spleen enlarged and 
icteric. Immediately put her on the turpentine mixture, gave oxalate cerium to 
quiet vomiting, Battley's sedative and spirits nitre to quiet restlessness, poultice 
to the stomach, and ordered 3 grs. ferrocyanate iron and same of sulphur, to be 
taken every two hours remission recurred. History of Malarial Hoematuria. 
571 
Next morning found that a remission had occurred; that the urine had 
remained clear until morning, when she passed her urine four times, twice of a 
natural color and twice quite bloody ; still sick at stomach and pain in head. I 
then ordered 5 grs. calomel to be given in four doses at intervals of three hours. 
The turpentine mixture to be given in more frequent doses, poultices epegastrium, 
oxalate cerium to relieve nausea, and Battley and spts. nitre for the restlessness, and 
when remission took place, to give ferrocyanate iron and sulphur as before. On 
my next visit found her doing well; but little fever, no pain in head or stomach, 
no nausea, wanted food and urine of natural appearance; ordered that the turpen- 
tine mixture be continued at longer intervals, the iron and sulphur next morning 
or before, and upon visiting found her still improving; put her upon the iron three 
times a day, with but little restriction in regard to diet, and on yesterday, Sun- 
day, the 10th, I saw her at church, looking very well. 
Directly after the close of the war I wrote an article on this subject and sent it 
to the New Orleans Medical and Surgical Journal for publication. The proprietor- 
ship of the Journal having changed hands before there was space for my paper, 
it was lost and could never be recovered. In that I gave a considerable amount of 
information from notes I had then; but supposing the printed document would 
be forthcoming, I destroyed or neglected to take care of these notes; hence I write 
from memory of what took place several years ago and many I leave entirely 
untouched. The prevailing opinion for many years was that the cause of these 
symptoms originated in the liver, as I said before-some held the idea that it 
resulted from duodenitis, extending to the liver and spleen, and then the kidneys 
in performing this double office threw out this colored urine. Whatever may be 
its cause, 1 know this, that the high-colored urine is sometimes due to blood, some- 
times to the presence of bile, and at other times it is first bile and afterwards 
blood; this I have demonstrated by tests. I also find many points of resemblance 
to "yellow fever," such as nausea, vomiting blue matter (sometimes regular "black 
vomit"), exceeding great yellowness of skin, and the tendencies to death being 
the same in both, viz: either by coma induced by the retention of urea in the 
blood, or by anaemia brought about by the excessive haemorrhage. Yet the disease 
of which we are writing is essentially of malarial origin. I find that every 
patient I have had, or seen, has had previous attacks of chills and fever, and in 
consequence the spleen is always very much enlarged, and so invariably is this 
the case that when my friends inquire of me how to avoid this disease, I tell 
them to break up their chills promptly and not to let their blood be poisoned by 
the long continuance of them. Keep the spleen acting right and you will have 
no "swamp fever," haemorrhagic malarial fever, or "splenic paludal." or by what 
other name you choose to designate. 
When I am called to see a patient with this disease I give calomel to produce 
a prompt action on the bowels, but avoid ptyalism if possible. I should deem it 
necessary to repeat it; the nitrate potash and turpentine mixture is to be given while 
the fever is on and the urine bloody, continuing the latter prescription for a day or 
two after the redness has disappeared; when remission or intermission takes place, 
order the prusciate of iron, sometimes with sulphur or salecine, and if a paroxysm 
recurs with bloody urine, I venture to give quinine very cautiously to prevent the 
next paroxysm; for the epigastric pain I use blisters; for nausea and vomiting 
oxalate cerium, and for restlessness Battley's sedative and spirits nitre. I prefer 
the Battley's sedative to any other preparation of opium, because of its not inter- 
fering with the action of the bowels, and it being the best agent known to me to 
quiet the pain and restlessness and to reduce fever. In cases where the fever runs 
high and nervousness is very great, I still am in the habit of giving large doses of 
mercury, even to speedy and excessive ptyalism, and where the paroxysms of 
chill and bloody urine continue to recur without it, I give quinine. Hoping that 
the above will be of some little benefit to you and others of the profession, 
I am, yours respectfully, T. W. BAIRD. 
A point of great practical importance in the history of malarial haema- 
turia is the belief held by many physicians, as stated by Dr. Baird, that 
the haemorrhages from the kidneys were caused by the sulphate of quinia. 
That this belief still exists amongst physicians practising in the malarial 
regions, swamps and ricefields of the delta of the Mississippi, is evident 
from the following interesting communication from my friend and former 
student, Dr. J. L. Deslattes, of St. James, Louisiana: 572 
History of Malarial Hematuria. 
St, James, August 14th, 1886. 
To Dr. Joseph Jones, New Orleans, La.: 
My Dear Doctor-I have endeavored to give you the clinical history of a few 
cases of malarial hsematuria. They are not complete, as you will yourself see; 
but what is there is true and correct. I have not said anything aboutthe chemical 
and microscopic examination of the urine, because I have not made any, or so 
little that it is better to omit them altogeiher, and leave you to get them from 
more competent hands. I have not lost any case by following strictly the rules 
put down i i the remarks. Hoping that you will not expect a scientific and elab- 
orate article from a poor country doctor's pen,-I remain, vours respectfullv, 
J. L. DESLATTES, M. D. 
MALARIAL HEMATURIA. 
In 1875, when I first began to practise medicine, the first thing that attracted 
my attention was that there existed at the Grand Point settlement, a peculiar form 
of malarial fever in which the patient was jaundiced and urinated blood. This 
fever had made its appearace there, during the latter part of the war or immedi- 
ately after. Nearly all, if not all the first cases, were fatal. It was the general 
belief that death in those cases, was due to the sulphate of quinine. At the Grand 
Point settlement, the fear of quinine was so great, that with most patients, it could 
only be given in pill form or disguised in some vehicle without either the knowl- 
edge of the patient or his friends. I had not been long in the parish, when I met 
Dr. G., who resides twelve miles from my house on the opposite bank of the river. 
The Doctor practises on both banks, and had seen many case^ of the disease. He 
was very kind, and related to me his experience. " I persistently used quinine 
for a long time," said he, "and lost my cases." Now that I have rejected it 
altogether the mortality is much less. 
The Doctor promised to let me see his next case. I did not have to wait long 
for this opportunity, as this fever was then much more prevalent than now ; 
although it was mostly confined to the Grand Point settlement, and to the lower 
portion of the parish, on the left bank of the river. The same year, I went to the 
Grand Point settlement, at the request of the attending physician, who did not 
feel well enough for a twelve mile ride, to see a case of fever; and the following will 
tell you all I remember of its history. 
Case No. 906.-Michel M., about 50 years old. tobacco planter, had had fever 
for two or three months at least. He worked hard and stopped only when com- 
pelled to. He had seen a good deal of fever, knew about its routine treatment and 
attended to his own case in order to save a doctor's bill. He would take his qui- 
nine along with him and take it while at work. He had in this way, taken a con- 
siderable quantity of quinine. The day that I saw him, he had remained at home 
and had taken twenty-five grains of quinine in three doses, and was fully cinchon- 
ized for 9 A. M., the expected hour of the return of the fever. Between 9 and 10 
A. M., he had a strong chill, with dull pain in the back. About two hours after, 
during the hot stage, he got up and urinated about half a chamberful of charac- 
teristic urine. It was then that I was sent for, and it must have been about 
4 o'clock, P. M., when I got to his house and found him in the following con- 
dition : the jaundice was intense and general; the urine had been kept and was 
characteristic. The vessel containing it was about half full. It had been done 
during one act of micturition. Pulse slow and full. Patient was perspiring freely. 
The feyer was not high and evidently declining. I do not remember the tempera- 
ture. There was a dull pain in the back and slight tenderness on pressure over the 
region of the stomach and liver. He had vomited at times yellow and green fluid 
matter. I ordered fifteen grains of calomel to be given immediately in one dose, 
and this to be followed by one fl. oz. of the cold infusion of cinchona every 
second hour until 9 o'clock the next morning. I then left with special request that 
his physician should be sent for early in the morning. The patient felt so well 
that he disregarded my advice and did not send for his physician. On the third 
day of the disease, the fever came back again with the same character of the urine, 
and his physician was sent for. I do not know what was ordered; but am sure 
that no quinine was given. On the fourth day, at the doctor's request, I went to 
seethe case with him, and found the patient with muttering delirium, stupor, 
hiccough, occasional vomiting or retching of green fluid matterand intense jaun- 
dice. He had passed in twenty-four hours about 1 fl. oz. of blue urine The tongue 
was covered with thick fur of a dirty yellowish color with red tip and edges. The History of Malarial Hosmaturia. 
573 
liquid from a blistered surface over the gastro-hepatie regions was yellow. The 
sheets were stained yellow both from this liquid and from the perspiration. Death 
preceded by coma, took place that night. Remarks. The points noted in this 
case are that the fever occurred notwithstanding the administration of quinia, and 
the peculiar color of the urine. 
Case 907.-In 1879, while I was practicing in St. John, Mrs. Widow B. sent for 
me to see her son, aged about 18. Mrs. B. resides in a small cabin on the Bonnet 
CarrS batture. She is very poor, remembers well what she sees physicians do, and 
treats with success ordinary cases of fever in her own family. Three or four years 
before, Mrs. B. had lost a boy with the same disease. The two physicians in 
attendance had given him quinine every morning and some drops. Nothing they 
did. however, stopped the blood in the urine, until he ceased urinating altogether 
and died. Upon my asking her why she had not sent for me earlier for this case, 
her answer was, that she had used the same treatment which had been done for 
the other; that is-a dose of blue mass and oil on the first day, and 25 to 30 grains 
of quinine in divided doses before the hour of the fever each morning. She had 
sent for me because she no longer knew what to do, as the fever, although slight, 
kept on returning, and the character of the urine had not changed. Patient was 
ordered nitrate of potassium, 10 grs. every two hours in the infusion of couch grass 
(triticum repens). The quinine was stopped; milk and beef tea were given at 
regular intervals. On the next day, the urine was becoming rapidly clear, but still 
presented a turbid, yellow appearance. There was no fever. Two days after this, 
the patient was in full convalescence and begged to be allowed to get up some ; the 
jaundice had nearly disappeared and the urine passed was copious, clear and 
natural in appearance. The patient was then put on the infusion of cinchona, 
three times daily, and afterwards was treated for an enlarged spleen, which he had 
for a long time. In this case, I believe that had the quinine been continued for 
two or three days later, the haematuria would not only have continued, but would 
have ended in suppression of urine and death. 
Case 908.-Not long after the Bonnet Carre case, I was called to see a boy of 
Mrs. R., aged about 12 years. Mrs. R. lived near the church of St. John the Bap- 
tist. She was very poor and very negligent. Her son had been having irregular 
fevers for months and was in bed with it several days, when I was called. The 
fever during the days preceding my visit was intermittent. The patient had taken 
a small quantity of quinine in the morning. 1st day.-At the time of my visit, 
between 11 and 12 o'clock, the fever was high with restlessness, tenderness on pres- 
sure over the region of the stomach and liver, furred tongue, vomiting of copious 
green fluid, jaundice, pains in the back and limbs. The chamber contained a great 
quantity of characteristic urine passed about an hour before my visit. As this case 
was not far from my house, I made two and three visits a day, and I took the tem- 
perature and pulse throughout the disease. I did not find it to differ from that of 
other forms of malarial fever. I ordered a foot bath followed by sweet spirits of 
nitre, every two hours, until the fever began to decline, and then calomel, 10 grs., 
sulphate of quinine, 25 grs.; mix and divide into three powders. Sig. One pow- 
der every three hours. 2d day.-Patient began his powders at midnight and had 
finished them when I saw him at about 7 A. M. He had not slept at all, was rest- 
less, had urinated twice; the urine was not as dark as that of yesterday. The 
vomiting had abated after midnight and the quinine and calomel were retained. 
There is only slight fever this morning. At about 12 M., I called again and found 
that the fever had begun to increase at about 9 A. M., with all thesymptoms of the 
preceding day. The urine passed was of a dark red color. The vomiting was 
more distressing than yesterday. The fever was somewhat less. The general con- 
dition of the patient was bad. I ordered pellets of ice to be taken as often as he 
desired, iced milk and lime water in small quantities repeated often, mustard to the 
pitof thestomach. At the evening visit, I found that upon the whole, the general 
condition of the patient was bad. The fever had continued with all its distressing 
symptoms. I ordered for the next day, 25 grs. of quinine in three doses. One at 
2 A. M., one at 5 A. M., one at 8 A. M. 3d day-morning visit.-Patient spent a 
bad night. He had hiccough once or twice during the night. He had urinated 
only once and the urine had not been kept. The fever had gone down during the 
night and there was like yesterday, a decided remission this morning. There is 
great weakness and prostration. I ordered iced milk punch and cold beef tea at 
regular intervals. At about 12 M., the fever had increased somewhat. No pain of 
any kind, great weakness and tendency to vomit at times. Patient wishes to be 
let alone. Intense jaundice ; perspiration stains the sheets yellow. No urine passed 574 
History of Malarial Hoematuria. 
during the forenoon. On manipulation, the bladder does not seem to contain much 
urine. 
I began to fear for my case. The milk punch and beef tea were continued. 
Sinapisms were applied to extremities. Evening visit.-Patient is not belter and 
does not wish to be bothered. The tongue is not dry, but covered with a thick, 
dirty grayish-yellow fur. I succeeded, after entreaties, in making him urinate, 
and he passed about 4 fl. oz. of urine as black as ink. I stopped the quinine and 
ordered 6 drops of turpentine in gum-water every second hour, milk punch, beef 
tea, and mustard to legs and arms occasionally. I went home, thinking that Iwas 
going to lose my ease. 4th day-Morning visit.-Patient has very little fever. He 
appeared to sleep every now and then last night; during that time he would occa- 
sionally mutter a few incomprehensible words. He had to be coaxed to take his 
food and medicine. He passed no urine during the night, and would not this 
morning make the attempt. Turpentine, milk punch and beef tea were continued. 
No quinine. Evening visit.-Only a slight increase of the fever during the day. 
Patient is weak; has not vomited any. and takes his food and medicine mechani- 
cally. He remains quiet in bed with bis eyes shut. He urinated about 6 fl. oz. of 
black urine once to-day. The turpentine, milk punch and beef tea were continued. 
A little ice-water was also given occasionally. No quinine. 5th day-Morning.- 
Patient remained quiet with his eyes shut during the night. He did not complain 
or say anything, unless spoken to. He took the food and medicine given him. 
The fur of tongue is getting loose, leaving a red, raw surface. He seems weak. He 
has very little fever. The skin is moist. The perspiration stains the sheets yellow. 
The latter have to be changed every day, and air is allowed to circulate freely 
through the room during the day. Evening.-Patient is neither better nor worse. 
There was a slight incease of fever during the day. He answers questions more 
readily perhaps. He passed about 6 fl. oz. of urine to-day and ic does not seem to 
be as dark. The same treatment was continued. 6th day-Morning.- Patient 
slept about three hours, during which time he was not disturbed. He took his 
food and medicine. He urinated this morning. The urine is evidently getting 
clear. The fever still continues and the jaundice also. The tongue is not dry, and 
its fur is dropping off. Patient seems better. The turpentine, beef tea and milk 
punch were continued. Iced apollinaris water, with or without whiskey, was also 
given. Evening.-Patient urinated twice during the day. The urine is getting 
clear. It is now a dirty yellow color. The quantity passed is increasing also. The 
fever is perhaps higher than yesterday. Patient does not complain of any pain. 
The tongue is not dry, and its raw surface is becoming covered with a white moist 
fur. The weakness is disappearing. He slept an hour or so during the day. The 
same treatment was continued. 7th day-Morning.-Patient is improving in every 
way, the fever continues, however, with exacerbations at about 11 or 12 o'clock. 
These last four or five hours, and are followed by profuse perspiration in the even- 
ing. Patient has to be fanned continually during the day and a portion of the 
night. The same treatment was continued for the day, and 20 grs. of quinine in 
three doses for the next. 8th day.-Patient takes his food and medicine readily 
and says he wants to get well. The turpentine was stopped, and 20 grs. of quinine 
were given for the next day. 9th day.-Patient evidently better. He begins to 
urinate freely. The urine is nearly natural. 20 grs. of quinine were ordered for 
the next day. 10th day.-Patient spent a good night; urinates freely of clear, 
limpid urine. No albumen. The quinine and food were continued. 11th day.- 
No fever this morning. Patient says he is cold at times. The skin is moist. The 
quinine and food are continued. 12th day.-No fever. The jaundice is disappear- 
ing fast. The urine is abundant and clear. The tongue is getting natural. Patient 
continues to improve. 20 grs. of quinine for next day. 13th day.-Patient is still 
improving. 15 grs. of quinine for next day. 14th day.-No fever at all since the 
11th day. 10 grs. of quinine for next day. 15th day.-Patient is convalescent. No 
more quinine is given. Patient is to take 1 fl. oz. of infusion of cinchona every 
three hours. After several days of improvement under the use of the infusion of 
cinchona, the patieut became anasarcous, with occasional attacks of fever. This 
yielded gradually to bark, iron and quinia in tonic doses, arsenic, good food, etc. 
20 grs. of quinine were given after each paroxysm of fever. Remarks.-This was 
certainly a bad case of malarial haematuria of the remittent tvpe. The chart of 
temperature and pulse I cannot find. They were kept in a large envelope with 
others. I must have lost them while moving to St. James. I saw nothing, how- 
ever, in the pulse and temperature to differ from other forms of malarial fever. 
The quinine was stopped for a few days, through fear of increasing the kidney 
trouble. I had forgotten to state that an occasional laxative enema was given. History of Malarial Hoematuria. 
575 
Case 909. -Some months after I was called in the same house for an older son 
of Mrs. R., about 20 years old. He worked in the swamp and had been having 
chills and fever for several weeks. I was there early in the morning, about three 
hours before the expected chill. Wishing to cut the fever at one blow I gave 20 
grains of quinine in one dose. At 12 M., I was called to see the patient who had 
had a chill at about 10 A. M., and had just passed a quantity of characteristic urine. 
The fever had returned apparently unaffected by the quinine. 1 immediately 
ordered 15 grs. of calomel to be followed in a few hours by small doses of sulphate 
of magnesia. The fever went down that night, and the urine passed in the morn- 
ing was only slightly turbid. I did not repeat the quinine, but gave nitrate of 
potassium, 10 grs. in 1 fl. oz. of infusion of couch grass (triticum repens) every two 
hours, requesting him to drink as much water as he could. At 10 A. M. the fever 
came back, the urine passed, although dark, was less so than the day before. On 
the 3d day the fever returned at its usual hour, but the urine is becoming less dark. 
On the 4th day the urine had a yellow turbid appearance, and the fever came back 
as on the preceding day. I then ordered 25 grs. of quinine for the next day. 5th 
day.-'So fever, urine still yellow and turbid. 20 grs. quinine for next day. 6th 
day.-No fever, patient is convalescent. I ordered for the six or seven following 
days the infusion of cinchona 1 fl. oz. three times daily. Remarks.-The fever 
came back notwithstanding 20 grs. of quinine. Did the quinine act as a cause in 
producing the haematuria? Would a mercurial purge given before have prevented 
thehsematuria? 
Case 910.-It was in 1880, I believe, I was called to the Dougan plantation, in 
St. Charles, to see Mr. F., who had been having intermittent fever for two or three 
weeks. Mr. F. was about 30 years old, cooper by trade, and lived in a small house 
in the field near the sugar house. Mr. Dougan has a large sugar plantation. The 
drainage in the immediate locality seemed good. No rice is in cultivation in that 
portion of the parish. Mr. F. had been treating his own case. As he had the mak- 
ing of all the cooperage of the plantation by contract, and was anxious not to lose 
any time, he would take quinine in the morning and go to his work. A small par- 
oxysm of fever would not prevent him from working. 1st day.-I saw Mr. F. in. 
the evening. He had had a chill that morning, followed by high fever, headache, 
pain in the back and limbs, and copious vomiting of yellow and greenish fluid, 
with pain at the pit of the stomach. During the height of the fever he had urin- 
ated a large quantity of characteristic urine. It was then that I was sent for. When 
I saw him the fever was going down and he was suffering less. He was perspiring 
freely. The perspiration stained the sheets. He was jaundiced. He did not know 
what to think of that urine. He had been having fever every summer, but had 
never seen anything of the kind before. Ordered 15 grs. calomel and 30 grs. qui- 
nine in three powders, to be given in three doses the next morning, bits of ice to 
be swallowed and mustard to the stomach when necessary. 2d day-evening.- 
Patient has had several stools. The fever came back, but was less than yesterday. 
There is less vomiting and less pain. The urine passed was copious and character- 
istic. The jaundice was more pronounced and of a darker hue than yesterday- 
Ordered nitrate of potassium in infusion of couch grass and 30 grs. of quinine for 
next morning. 3d day-evening.-Patient has had no fever. Less urine was 
passed during the day; it is darker. No vomiting, no pain. Patient says he is 
weak. Ordered infusion of cinchona 1 fl. oz. every three hours. The nitrate of 
potassium to be continued. No quinine for next day. 4th day-evening.-No fever. 
Urine less dark. Patient cannot retain the cinchona. The nitrate of potassium to 
be continued in as large quantity of diluent as can be taken without discomfort. 
5th and 6th days.-Patient improved steadily. No fever. The urine copious and 
nearly natural. Very little jaundice left. 7th day.-The fever has returned but 
the urine is clear. Ordered 20 grs. of quinine for next day, and 15 grs. daily for 
the two following. I then left with the request that I should be sent for if the fever 
returned. Three weeks after he came to my house in perfect health. I had for- 
gotten to state that an occasional small dose of sulphate of magnesia was given 
when necessary. In the fall of 1884,1 was called to see L. D., a clerk in a store three 
miles above my house. L. D. has fever almost every summer. He waits until he 
has several paroxysms before sending for a physician. He is not anaemic, and apart 
from a few paroxysms of fever in summer, he enjoys good health. On seeing him 
I ordered 30 grs. of quinine to be given during the intermission. As he was alone 
he took only a portion of it. I prescribed 30 grs. for the next day. As I made my 
visit early in the morning and saw him in the act of taking it, I feel certain that 
he took the whole amount ordered. 576 
History of Malarial Bosmaturia. 
Case No. 911.-In the evening, I was called in haste to him. He had felt 
worse during the day, and had been taken to his mother-in-law. 1st day-even- 
ing.-1 was shown on my arrival about 8 fl. oz. of characteristic urine. He was 
slightly jaundiced. The fever was abating and he was perspiring. Ordered fifteen 
grains of colomel and thirty grains of quinine to be taken in three doses the next 
morning. 2d day.-Fever has returned, jaundice has increased, and the urine 
passed less in quantity and darker. Ordered thirty grains of quinine in three doses 
for the next morning, and nitrate of potassium in the infusion of couch grass. 
3d day.-The fever came back again, but was much less. Patient threw up a quan- 
tity of greenish fluid. He had not urinated and felt no desire to do so. At my 
request, he passed about one tablespoonful of black urine. I withheld the quinine 
and gave him a second dose of fifteen grains of calomel, and continued the nitrate 
of potassium. 4th day.-Patient has not urinated since my last visit. The cham- 
ber was given him and he again passed about one tablespoonful of black urine. 
He had kept the calomel, but had not retained the nitrate of potassium, and had 
stopped taking it. Ordered ice water in as large quantity as the stomach will tol- 
erate. Evening visit.-Patient was again made to urinate and he passed about one 
teaspoonful of black urine. He suffered no pain save a dull feeling about the head. 
He seemed somewhat stupifled, but answered my questions readily, ordered a gen- 
eral bath to promote the action of the skin, and a poultice of digitalis leaves con- 
tinuously applied to lumbar region, and told him that I would apply cups to his 
back the next morning. Before leaving, he begged me to let him eat a piece of 
sugar cane as it was the only thing he really cared for. I told him to take as many 
as he wished, it would do him good. 5th day.-Patient ate six sugar canes dur- 
ing the night, and to my delight, he urinated before me 6 fl. oz. of dark urine (not 
black.) I was told that there were no digitalis leaves at the drug store, and that 
the patient had objected to the bath and had not taken it. He was then told to 
keep on with the sugar cane Evening visit.-Patient says he ate sugar cane all day 
and it is doing him good. He urinated twice during the day (about 6 to 7 fl. oz. 
each time.) The urine was kept and found to be less dark. 6th day.-Patient is 
better. The urine is more copious and becoming clearer although dark still. The 
jaundice continues. The sugar cane is continued. 7th day.-The urine is now 
yellow and turbid. The fever in the meantime had returned each day, neither 
increasing nor diminishing, and lasted only from three to four hours. I then 
ordered twenty grains of sulphate of cinchonidia daily for two days. The fever 
yielded readily and he was soon.well. In 1885, during the summer, he had a second 
attack of the same disease. The case was light and he was soon well. This year, 
although working in a rice field, he has had but one paroxysm of fever, and this 
without hfematuria. He however took quinine immediately and remained home 
several days. 
1. All the cases seen by me were preceded by several paroxysms of simple 
malarial fever. 
2. Of twelve cases, eleven were of the intermittent type and one of the 
remittent. 
3. Its three periods: Chill, pyrexia and sweating, and its periodic return, 
place it at once among the malarial fevers. 
4. Its biliary and haemorrhagic phenomena, that is, the jaundice, the copious 
vomiting of biliary fluid, the presence of bile and blood in the urine, and the 
yellow color of the serum of the blood and sweat would seem to point to great dis- 
order of the secretion of the liver. 
5. The renal complication is a secondary result, due to the presence in the 
blood of the biliary ingredients which the liver has failed to eliminate. 
6. It would seem that in this disease the malarial poison concentrates its 
action primarily and principally on the liver, causing hypersemia at first and 
increased secretion of bile. This hyperfemia state continuing becomes a true con- 
gestion or engorgement, with stasis of the circulation in the hepatic capillaries, 
and as a result diminished and perhaps complete cessation of the function of the 
liver. 
7. The system, in endeavoring to rid itself of this foreign element in the 
blood, calls upon the kidneys and the skin to do it. 
8. The excreting organs of both the skin and the kidneys being not adapted 
for such a purpose, perform it at their best imperfectly; and because of the deli- 
cate structure of the kidney's working apparatus, congestion and vascular stasis. 
This is followed by haemorrhage and even complete suppression of urine. With 
.REMARKS. History of Malarial Hematuria. 
577 
the skin a somewhat different process takes place: that portion of the foreign ele- 
ment of the blood which it fails to eliminate is deposited in the retimucosum, to 
be taken up by the circulation at some future time. 
9. Any means which will deplete the liver and lessen the hypersemia, is 
therefore indicated. For this purpose 1 have given at the onset of the disease a 
mercurial purge, followed, if necessary, by occasional small doses of sulphate of 
magnesia. 
10. Remedies were also directed to the relief of the condition of the kidneys. 
Of these, diluents were especially relied upon. The infusum tritici, sugar cane 
juice, apollinaris, pure water, were all given according to the patient's fancy, It 
is reasonable to suppose that the more concentrated the urine is the greater will be 
the injury it will inflict on the structure of the kidneys. I have given turpentine 
when adynamic symptoms presented themselves; firstly, because of its stimulant 
action; secondly, because of its special alterative influence on the lining mem- 
brane of the gastro-intestinal and urinary tracts. 
11. The type of the fever requires the anti-malarial specific. 
12. The sulphate of quinia is, however, not always well borne. This is 
especially so when used in such doses as are given in the other grave forms of 
malarial fevers. Thirty grains during the intermission or remission are amply 
enough. It should only be used as long as is necessary to remove the malarial ele- 
ment of the disease, or keep it under control for the time being; that is, for the 
first one, two or three days of the fever. If the fever and dark urine persisted 
after that time, or if the urine became scanty and darker, and the jaundice more 
intense, the quinine was at once withheld and attention was directed to the bilious 
and haemorrhagic conditions as related above. As soon as the functions of the 
liver and kidneys were restored to their normal state, the specific was resumed if 
necessary. Under no condition should I continue the administration of quinine, 
whether the fever persisted or not, if, after the third day, the hepatico-renal com- 
plication showed no sign of improvement. Still less, would I give it if the jaun- 
dice increased and the urine became more scanty and darker. If to the already 
overworked kidneys, we add that of eliminating the quinine, can we not hasten 
its breaking down and thus favor suppression of its function ? 
13. Remedies directed to the skin may also be indicated; for instance, dia- 
phoratics when the skin is dry. Stimulating frictions may also excite its excre- 
tory functionsand thus relieve the kidneys of some of its work. 
14. The cases seen presented no symptom calling for the use of opium. I 
should even hesitate to give it w'hen the urinary secretion is scanty and dark, 
15. The nausea and vomiting were relieved by ice, iced milk and lime water 
in small quantities. 
16. Beef tea, milk, milk punch, etc., were given pro re nata. 
Malarial htematuria was recognized in Alabama, by Dr. Terry H. 
Anderson, thirty-six years ago. In the report of the diseases of Sum- 
ter County, Alabama, made to the Alabama State Medical Association, at 
its session held in Mobile, December, 1850, Dr. Anderson* thus writes : 
"There were some cases of a character which had not been observed before, 
which was attributed to the deprivation of the fluids and derangement of the ner- 
vous system-that of organic life particularly-produced by protracted and half 
cured attacks of remittent fever. These cases were of a singular character. The 
patients were taken with chill followed by slight but obstinate fever, generally 
accompanied with delirium. There was some jaundice also, and the urine was 
extremely red, having the appearance of being mixed with a fourth or a third part 
of its quantity of venous blood. In one case that I attended very closely, the patient 
would sometimes void urine of nearly natural appearance, when he improved, but 
the reddish tinge soon returned, and the color deepened until it became of a dark 
bloody hue. The bowels answered well to laxatives, and general moisture could some- 
times be excited, but little amendment was observed from either evacuation. The 
case was treated with mild mercurialsand laxatives; quinine in sufficient doses, 
cups over the liver and spleen, followed by blistersand emollient cataplasms to the 
abdomen. Astringents of various kinds were prescribed for the alteration and 
excessive secretion of urine ; the iodides of potassium and of iron, and muriate of 
ammonia were given, but without benefit. The blisters that were drawn became 
filled with bloody serum, resembling the urine in appearance, and assumed an iron- 
* Trans. Alabama State Medical Association, Dec. 1850, pp. 97, 98. 578 
History of Malarial Hcematuria. 
burnt aspect when the cuticle was removed. The patient gradually got worse, 
and died on the fourteenth or fifteenth day after he was taken. In other cases 
there was a bloody diarrhoea throughout the attack, and some were much more 
deeply jaundiced than others." 
The late Dr. A. G. Mabry, of Alabama, in a report of a case of inter- 
mitting icteroid haematuric malarial fever, made to the Medical Association 
of Alabama, in 1870, says: 
" It is a mistake to suppose that this is a new form of disease. More than 
twenty-five years ago I treated in the vicinity of Selma, cases of intermitting fever, 
presenting in a marked degree all the symptoms characteristic of these cases at 
the present day." 
Dr. E. D. McDaniel, in his report on haemorrhagic malarial fever in 
Alabama, says : 
" In calling up my own reminescences, I am sure that I have occasionally, evee 
since my boyhood, seen isolated cases of what was considered intense bilious fevrr 
with the surfaces and under tissues stained deeply yellow and with the urine deep 
red. They were nearly all fatal, and were called in olden phrase 'bilious conges- 
tion,' and in more recent 'pernicious bilious.' I have also, but more rarely, known 
small groups of similar cases associated; say three or four cases occurring on the 
same premises, or in the same family, about the same time. All such cases, in 
addition to the deep, so-called, bilious color and the red urine, had jactitation, sus- 
pirious breathing, and inordinate thirst, and vomiting of variously shaded and 
tinted so-called bilious matters. By diligent inquiring, I have ascertained that 
very many old physicians, some of whom have now retired from practice, are satis- 
fied that they have observed similar cases, sometimes singly, and sometimes in 
groups." 
As far as my individual experience extends, on the coast of Georgia, 
in 1848, cases presenting all the marked characteristics of malarial hsema- 
turia, which proved rapidly fatal, occurred in the months of October and 
September. 
It appeared in Texas in 1853. Dr. F. M. Hall, of Bryan, Texas, in 
his reply to the inquiries of Professor T. J. Heard, of Galveston, Texas, 
says :* 
" The first case of malarial hsematuria that I ever saw, was in the person o^ 
Bat Hargrove, formerly of Chapel Hill. He lived eight miles above my residence, 
on a sandy prairie point, immediately on the east bank of the Little Brazos, which 
stream forms for sixty miles the eastern boundary of the great Brazos bottom. I 
was called to see him October 1853. When I reached,the house of Hargrove I was 
informed by his father-in-law, <'ol. Kauser, that the attack came on with a violent 
ague, and that a large quantity of blood had passed with the urine. I saw no 
bloody urine; in fact, I saw him pass no urine at all after I saw him, the suppres- 
sion continuing until death. Skin in color as I so often observed it to my sorrow 
nine years afterwards, and not until then did I know what to call the disease. Mr. 
H. had, as all other cases that I ever saw, been the i-ubjectof chronic intermittent, 
and resided immediately on and used water from the Little Brazos, which at that 
time was very low indeed; stood in stagnant pools. Ihavealways, since becoming 
acquainted with the disease, believed that Hargrove died of black jaundice. The 
years 1853-54 were noted in my section for an undue amount of rain during the 
spring and summer, but very dry autumn. 
In September, 1862, I was called to see Maggie, mv brother, J. M. Hall's 
daughter, and a grand-daughter of Jubal Marit. Her father lived at that time in 
the Brazos bottom, immediately on the east bank, and of course, Maggie had been 
the victim of chills all the summer and fall. I saw her in less than two hours after 
the ague made its appearance, and on reaching her bedside found her discharging 
every few minutes, bloody urine, and which continued, though in lessening quan- 
tities, both as to the amount of urine and blood. Well, the case passed on to a favor- 
* Trans. Texas State Medical Assoc., 1875, p. 102-106,112. History of Malarial Hoematuria. 
579 
able termination in health. Maggie had three attacks of it afterwards, in the two 
years following. She still lives. Her age, when first attacked, was nine years. 
Again, the latter part of the same month and year, 1862, my own daughter, ten 
years old, was struck down with the same disease and recovered. In December, 
the same year, W. B. Anderson's daughter, six years old, had it-bloody urine and 
yellow skin, as did Hargrove and the others mentioned. 
Dr. Hall mentions the disease as prevailing and proving fatal in Texas during 
the Civil War of 1861-1865. Dr. W. J. Burt of Austin, Texas, observed his first 
case in 1861, and Dr. H. C. Gray treated two cases in 1861. 
That malarial haematuria has been known to the physicians of the West 
Indies, is established by the fact that Dr. JuanC. Oxamendi, in the Revista 
Medica de la Isla de Cuba, April, 1858, reported a case of hsematuria 
occurring in a female, aged 30 years, living in an unhealthy and swampy, 
ill-drained malarious locality, in the district of San Anton de la Negada, 
which was successfully treated with the sulphate of quinia. Dr. Juan C. 
Oxamendi called in consultation Ldo. O. Jose Manuel Nunez, who had 
practiced twelve years with excellent success in that neighborhood, who 
stated that in his long practice which had brought him in contact particu- 
larly with diseases of an intermittent character, and their masked types, 
he had observed four cases of htematuria, similar to the one under the care 
of Dr. Oxamendi; and that he could not fail to recognize the miasmatic ele- 
ment, after he had observed that all the patients who presented them- 
selves with this affection, lived in swampy localities, and that consequently 
he had recourse to quinine, and always with satisfactory results. 
Dr. James Copland,* whose dictionary of Practical Medicine was 
republished in America in 1855, says that periodic hematuria is not uncom- 
mon in miasmatic climates; and it is, although rarely, even seen in this 
country (England) among those who have been exposed to malaria, or 
have resided long in warm climates, or suffered from periodic fevers. In 
a case of this kind, detailed by Dr. Elliotson, htematuria accompanied the 
cold fit of ague, and was cured along with the ague, by the sulphate of 
quinine. Hsematuria is also stated by M. Renoult, to have been very pre- 
valent among the French troops in Egypt. 
Dr. Charles A. Lee,f the American editor of Copland's Dictionary, in 
his addition to the article on haematuria, says: i: In the southern parts of 
our country, where the affection so often occurs in connection with derange- 
ments of the liver and spleen, it will often be found useful to apply leeches 
over these organs, which will enable us to administer tonic and astringent 
remedies with greater confidence and freedom." 
Edmund A. Parkes,J writing in 1860, says: 
Hsematin, or blood pigment, appears in the urine in two states, either in the 
blood-corpuscles or separated from them. In the first case, the blood forms a sedi- 
ment, and will be noticed hereafter. In the second, the pigment is completely dis- 
solved in the urine, to which it gives a more or less brown or black color. Dissolved 
haematin appears to indicate, not local disease and rupture of vessels, but a special 
affection of the blood, either general or local, produced by most septic or profound 
cachectic diseases. In bad typhus, malignant variola, pernicious remittents, etc., 
in scurvy and sometimes in morbus Brightii, the urine may be very dark from 
haematin ; and the very dark urine, if bile and vegetable pigments be absent, almost 
always indicates its presence. The rare cases of malaria would be the only excep- 
tions. Albu men is always present. 
The bile acids are said by Kuhne to have a powerful effect on the 
blood cells; and Parkes suggests that in febrile icterus, some of the cases of 
* Dictionary of Practical Medicine. Am. Ed., vol. ii, New York, 1855, p. 124. 
t Dictionary of Practical Medicine, etc., by James Copland, M. D., vol. ii, p. 126. 
I The Composition of the Urine in Health and Disease, etc. London, 1860, p. 183,184, 580 
Historu of Malarial Hoematuria. 
haematin in the urine, may be owing to an action of this kind. William 
Roberts,* writing in 1865, says that haemorrhage from the kidneys may 
arise from a great variety of causes and may be classified as follows: 
1. Local lesions.-External injury, violent exercise, calculous concre- 
tions, ulcers, abscesses, cancer, tubercle parasites, active or passive conges- 
tion, Bright's disease. 
2. Symptomatic.-In purpura, scurvy, eruptive and continued fevers, 
cholera, etc., mental emotion. 
3. Supplementary or vicarious.-To menstruation, haemorrhoids, asthma. 
The credit, however, of first carefully investigating malarial haema- 
turia, and correctly detailing its pathological lesions, must be awarded to 
Dr. Fried. Theod. Frerichs, and whilst the cases which he reports are 
few in numbers, they are typical in character, and establish the exist- 
ence of the disease at Breslau in 1854. The observations of Frerichs 
are found in the eighth chapter of the first volume of his " Clinical 
Treatise on Diseases of the Liverf which relates to " The Pigment Liver. 
Melanaemic Liver. Alterations in the Liver resulting from Intermittent Fever.11 
Frerichs thus classifies the cases of malarious fevers, accompanied 
with pigment liver, which he observed at Breslau : 
1. Cases with predominant brain symptoms. 
2. Cases in which the kidneys are pre-eminently implicated. 
3. Cases with predominant derangement of the gastro-intestinal tract, 
and of the appertaining glands, but particularly of the liver. 
4. In a fourth group may be included those forms in which the local 
derangements are not very conspicuous, and do not influence essentially 
the further progress of the disease, but where the anaemia and hydraemia, 
resulting from the affection of the spleen, constitute the most important 
marked condition. The pigment contained in the blood is here of subor- 
dinate importance, inasmuch as its quantity and characters do not give 
rise to extensive lesions of tne capillary circulation; it is productive of no 
injurious consequences, provided the physician succeeds in checking the 
anaemia. 
In order to give some idea of the frequency of the individual derange- 
ments, and of their fundamental anatomical lesions, Frerichs furnishes a 
short analysis of fifty-one cases observed in Breslau, of which thirty-eight 
terminated fatally and thirteen recovered. Severe brain-symptoms, such 
as delirium, convulsions, coma, etc., occurred twenty-eight times out of 
the fifty-one cases; in seven of these cases there was no deposit of pigment 
in the brain; in two cases there was haemorrhage in the cerebral membranes 
along with the pigment; and there was one case of cysticerus cerebri. Of 
the fifty-one cases, there were twenty-four acute and twenty-seven chronic. 
In the second class : " Cases with Predominant Affection of the Kidneys,''1 
the following observations are worthy of careful consideration, not merely 
in their historical relation, but also in their intrinsic value. 
Case -.-Observation No. XXXIX(Clinical Treatise on Diseases of the Liver). 
Quotidian intermittent of four weeks' duration; diarrhoea; albuminuria and 
hoematuria] sudden stupor; convulsions; death. Accumulation of pigment in the 
spleen, liver, kidneys, and brain. C Rienschke. aged 50 years, came to the clinique 
on the 3d of August, 1854. For four weeks he had suffered from a quotidian fever, 
which had latterly become complicated with diarrhoea. His complexion was of an 
extremely grayish-yellow hue; there was no oedema, however, anywhere. The 
spleen extended an inch beyond the margin of the false ribs; the abdomen was soft 
and painless, and there was no ascites; the liver was ot normal size; there was 
nothing abnormal in the respiratory organs or in the heart. 
* A Practical Treatise on Urinary and Renal Diseases. Philad., 1866, p. 110. History of Malarial Hoematuria. 
581 
The urine was deep reddish brown, and coagulated upon boiling, or the addi- 
tion of nitric acid. The pulse was 80; there was much complaint of headache. 
We ordered quinine with opium. On the 4th of August, the patient stated 
that he had an attack of rigors during the night; but the nurse had not observed it. 
The pulse was unchanged, 80, small and weak. The headache was considerably 
increased. One formed stool. Ordered quinine with elixiracidum halleri. In the 
night, sudden restlessness and loud groaning. Professor Ruble, who was sum- 
moned to the patient, found him in a state of deep coma, with irregular, interrupted 
respirations, and a small frequent pulse; the pupils were not enlarged; the temper- 
ature of the head was increased. At 7 o'clock in the morning he expired; death 
being preceded by slight convulsions. Autopsy fourteen hours after death. The 
pia mater congested; the dura mater thickened and adherent to the inner surface of 
the skull-cap. After removing the meninges, the gray substance of the brain 
appeared of a dark chocolate color, and was defined by a sharp line from the central 
white matter. This copious deposit of pigment was very marked in the corpus 
striatum and cerebellum, and also in the pons varolii. t he white substance was 
intersected by fine blackish lines; besides this, the brain presented nothing abnor- 
mal in consistence, or in any other respect. The air-passages pale; the lungs con- 
gested and oedematous. In the heart there was a moderate quantity of loosely 
coagulated dark blood, with much pigment in various forms. Spleen large, soft, 
and darkly speckled. The liver normal in size; surface smooth; margins sharp; 
its parenchyma loaded with grayish-brown pigment; the bile pale and copious. 
The mucous membrane of the stomach was of a slate-gray color; the lining mem- 
brane of the intestine was perfectly normal. The pancreas contained a larger quan- 
tity of pigment than is usual in such cases. The kidneys were lobulated, and, on 
section, presented a homogeneous brown, glistening surface. There were numer- 
ous pigment cells and scales in the glomeruli of the malpighian corpuscles. The 
bladder contained a large quantity of bloody urine, and its walls were hypertro- 
phied. There was a slight stricture of the urethra in front of the bulb. Frerichs 
also observed intestinal haemorrhages in three cases; "the bleedings were intermit- 
tent and came on each time with the paroxysm of the fever; they were not affected 
by any treatment directed against the haemorrhage, but yielded to large doses of 
quinine. The first case of this nature which I met with, terminated fatally; 
because, from the continued character of the fever, the disease was supposed to be 
typhus. The case was that of a young man, aged 20 years, in whom some intes- 
tinal haemorrhage took place, after he had been suffering for fourteen days, from 
what his medical attendants called a slight attack of typhus- The patient when I 
saw him, had passed several pounds of dark blood, and was much exhausted. His 
skin was greenish-yellow; pulse 110, scarcely perceptible. There was first, three 
attacks of haemorrhage, each relapse being preceded by an interval of two days; 
the attacks took place amidst great excitement of the vascular system, and were 
apparently arrested by styptics, such as alum, and the muriate of iron. The fourth 
attack, which also came on after an interval of two days, proved fatal. Soon after 
this, I saw another patient at the same place, in whose case, likewise the diagnosis 
of mild typhus had been made, from the fact that, after four attacks of quotidian 
fever, the intermission had become indistinct; in this case, also, there was profuse 
intestinal haemorrhage, which was subject to daily exacerbations, coming on always 
about the same hour. Styptics were tried in vain. Under the use of quinine, with 
elix. acid Hall., the haemorrhage ceased, and the patient became convalescent. In 
a third patient with quartan fever, the intestinal haemorrhage came on every three 
days, and was accompanied each time by hcematuria; here, also, quinine sufficed to 
effect its removal." Frerichs also reports a fatal case attended with haematuria, in 
which the albuminous and bloody urine contained clots loaded with black pigment, 
and the tubuli uriniferi occluded by pigment. The kidneys in this case were of 
normal size, the outer surface smooth; and the glomeruli of the malpighian cap- 
sules contained numerous brown and black pigment scales. The spleen was con- 
siderably enlarged, pultaceous and chocolate-colored; the blood of the splenic vein 
contained much pigment. The liver was dark brown, without any distinct indica- 
tion of lobules; the cells of the organ were very pale; the bile was dark, thick, and 
viscid. The elixer acidum Halleri, or mistura acida sulphurica, employed by Fre- 
richs in the treatment of these and similar cases, in conjunction with quinine, is 
composed of concentrated sulphuric acid (1 part), and rectified spirit of wine (3 
parts). Its specific gravity varies from 1005 to 1010. Dose 5 to 30 minims. 
These observations of Frerichs, which appear to have been first pub- 
lished in 1858, and reproduced by the New Sydenham Society of London, 582 
History of Malarial Haematuria. 
in 1859, establish the important fact that profound lesions of the blood 
liver and spleen precede and accompany the hfematuria of malarial fever. 
In 1857, I instituted an extended series of investigations upon the various 
forms of malarial fever, received into the Marine Hospital, and Poor House 
of Savannah, Georgia, and the reports of the cases embracing chemical 
and microscopical examinations of the blood and urine, were drawn from 
about 300 observations of the various types of malarial fever as it prevails 
in the Southern subtropical climate of the littoral zone of Georgia, and 
South Carolina. The reports of these cases, 53 in number were published 
in the Southern Medical and Surgical Journal, vol. xiv, May. 1858. p. 291 : 
June, p. 363 ; July, p. 435 ; August, p. 507; September, p. 579 ; October, 
p. 651 ; November, p. 723 ; vol. xv, February, 1859, p. 75 ; March, p. 
147 ; April, p. 219 ; and they formed the basis of the - Observations on 
some of the Physical. Chemical and Physiological Phenomena of Malarial 
Fever," published in the transactions of the American Medical Associa- 
tion, for 1859. 
Whilst these researches embraced a much wider scope than those of 
Frerichs, and were more elaborate and minute in the chemical examinations 
of the blood and urine, and the critical observations upon the changes of 
pulse, respiration and temperature than those of Frerichs. they corresponded 
in all respects as far as they were parallel with the results of the investi- 
gations conducted at Breslau. The correspondence of the pathological 
observations upon the changes of the liver and spleen, in the malarial 
fevers of Europe with those of America, was ascertained only after the 
close of the Civil War in 1870, when during a visit to London, I was 
enabled for the first time to purchase and study the valuable work of Fre- 
richs, on the Diseases of the Liver. 
My investigations of 1856, 1857. 1858, established the fact, that the 
pathological changes of all the various forms of malarial fever, intermit- 
tent, remittent and congestive, malignant and pernicious, are uniform. 
All the forms of malarial fever are characterized as illustrated by these 
cases, by a uniform diminution of the colored blood-corpuscles, by the 
deposit of pigment particles in the spleen and liver, and by an increased 
secretion of thick dark colored bile. The urine was found to vary with the 
stage and intensity and type of the disease, and as a general rule the height 
of its color, and its chemical constitution varied with the stage of the dis- 
ease, the variations of the pulse, respiration and temperature, and the 
prostration of the powers. Jaundice, bilious vomiting and dark brown and 
black urine were observed in the gravest cases. 
These researches also laid the foundation, for the accurate delineation 
of the natural history, and especially of the pathological chemistry of 
malarial fever, and established the absolute differences between this dis- 
ease and typhoid fever. The investigations were conducted during the 
war, upon an enlarged theatre in camps, armies and hospitals : and have 
been still further perfected and enlarged in the Mississippi Valley, and 
especially in the wards of the great Charity Hospital of New Orleans. The 
general results and circumstantial details of these labors of some thirty 
years will be found in the appropriate divisions of this the 2d volume of 
my Medical and Surgical Memoirs. 
Malarial hannaturia did not attract the earnest attention of Southern 
physicians until after the close of the recent Civil War. 1861-65; and received 
different names by the writers in Alabama. Louisiana and Texas, who 
brought its symptoms and treatment prominently before the American 
medical profession as "a singular and very fatal affection which has not History of Malarial Hcematuria. 
583 
received a name." Dr. Francis Barnes;1 "Recurrent Hamaturia Miasmatica" 
S. F. Starley, M. D.;2 ''Epidemic Jaundice," Dr. H. C. Ghent;3 " A New 
Variety of Malarial Fever, Cachemia," F. C. Osborn, M. D.;4 " Hwmaturia, 
or Yellow Remittent," Dr. Edward H. Scholl;5 "Malignant Congestive Fever," 
J. D. Osborn, M. D.;6 "Haemorrhagic Malarial Fever," R. D Michel, M. 
D.;7 " Purpuroemia" Dr. Benj. H. Riggs;8 "Malarial Hamaturia," S. D. 
Starley, M. D.;9 "Heematemesmic Paludal Fever" J. C. Faget, D, M. P;10 
"Splenic Fever." Obadiah Hendrick;11 "Cachemia Hwmorrhagica" Owens; 
"Icterode Pernicious Fever and Hemorrhagic Malarial Fever," E. D. 
McDaniel, M. D.;12 "Yellow Disease;" "Canebreak Yellow Fever;" "Country 
Yellow Fever;" "Swamp Yellow Fever;" "Icterode Intermittent Fever," 
Sharpe. 
Dr. Francis Barnes, in a paper on Nerve Force and Blood Changes, 
published in the New Orleans Medical and Surgical Journal, Vol. xix, 
No. 5, March, 1867, page 611, remarks with reference to the influence of 
the nerve force upon the blood : 
In the interior of Louisiana, in the most malarial regions of it, as the Tensas 
swamp, there is a singular and very fatal affection, which has not received a name, 
and which I shall describe and let another give it one: The affection is an assem- 
blage of symptoms, apparently the result of an impression on the nervous centres, 
and that impression a peculiar form of what occurs in a paroxysm of intermittent. 
It is always preceded by common chills, or paroxysms of intermittent, but finally 
the patient is seized with one, during which the chilly sensation experienced is 
much more protracted, and the following phenomena present themselves: From 
the moment the chill is ushered in, bloody urine is discharged from the bladder, 
and if a blister is applied bloody serum collects under the raised cuticle. A very 
small blood-letting causes syncope, and the blood appears broken down and dis- 
colored. These are the most remarkable phenomena, in connection with the sub- 
ject we are now considering, and the rest of the symptoms appear to be disorders 
of sensation, nutrition and assimilation, which follow and result from this primary 
impression. The patient rapidly becomes jaundiced; he vomitsand purges a great 
quantity of black, tarry-looking substance which, when smeared on a sheet, leaves 
a green stain. If he lives long enough the blistered surface, instead of discharg- 
ing blood serum will discharge green matter, which colei's a poultice like green 
paint The sufferings of the patient are terrible as long as he retains his reason, 
and finally delirium, coma and convulsions close the scene. 
Dr. S. F. Starley, in the August number of the Galveston Medical 
Journal for 1867, published an account of this disease under the head of 
"Recurrent Hcematuria Miasmatica." It first made its appearance in Fair- 
field, Texas, according to Dr. Starley, in the fall of 1866, since which time 
it has prevailed more or less every summer and autumn, until it has 
become a distinct and common disease of the country. Dr. Starley thus 
stated his views in the article above mentioned. 
Having had no opportunity of making a post-mortem examination, I have no 
knowledge of its anatomical peculiarities. But from its most prominent symp- 
toms and its evident dependence upon malarial causes, I regard it as a congestive 
form of intermittent fever, the stress of which is thrown upon the kidneys, But 
1 Nerve Force and Blood Changes. New Orleans Medical and Surgical Journal, vol. xix, 
March, 1867, No. 5, p. 611. 
2 Galveston Med. Jour., August, 1867. 
3 Richmond Med Jour., April, 1868. 
4 New Orleans Med. and Surg. J., vol. xxi. No. 4, October, 1868, p. 664. 
•5 Med. and Sarg. Reporter,Philadelphia, October24th, 1868 
6 New Orleans Med. andSurg. J., vol. xxii. No. 1, January, 1869. p. 61. 
7 New Orleans Med. and Surg J., vol. xxii, No. 3, July. 1869, p. 401. 
8 New Orleans Med. and Surg. J., vol. xxii. No. 2, April, 1869. p. 234. 
9 New Orleans Med. and Surg. J., vol. xxii. No. 4. October, 1MJ9. 
10 New Orleans Med. and Surg. J., vol. xxii, No. 4, October, 1869, p. 62; Memoires and Letters. 
New Orleaus, 1869; New Orleans Med. and Surg. J., vol. xxiii, p 440. 
11 New Orleans Med. and Surg. J„ vol. xxiii, 1870, p. 84. 
12 Trans. Medical Society, Alabama. 584 
History of Malarial Hematuria. 
what it is that causes the determination to these organs I cannot tell. Certain 
it is that they are excited to greatly increased functional activity, for coincidently 
with the haemorrhage the quantity of urine secreted is largely above what I have 
ever known in any other condition of the system, unless it is when the kidneys 
take upon themselves the task of removing some large dropsical effusion. 
In a highly practical article published by Dr. Starley in the October 
number of the Orleans Medical and Surgical Journal. 1869. vol. xxii, 
No. 4. page 623, he says : 
"Thai the disease differs somewhat in its mauifestations in different localities, 
is apparent from the descriptions given of it by different writers. One condition, 
however, seems to be essential to its development everywhere, viz: blood deterior- 
ation from exposure to malarial influences. This is admitted by all. and is at once 
the key to its etiology and the guide to a rational treatment. Nearly all the patients 
attacked with this disease are persons who have long suffered from the malarial 
cachexia, or who are having regular paroxysms of intermittent fever. In such 
persons the nerve force is lowered, nutrition is impaired, and the walls of the blood 
vessels are necessarily weakened. Hence the inability |of the malpighian vessels 
to resist pressure, and under the distension caused by congestive determination to 
the renal organs, they give way and haemorrhage follows." 
The following is the plan of treatment adopted by Dr. Starley : 
1st. When called to a person attacked with this disease, if it be in a person 
of an adult. I give from four to five grains of quinine by mean- of the hypodermic 
syringe, generally choosing a point near the insertion of the delloid for the injec- 
tion. through any other point where the skin can be raised easily, and where there 
are no large subcutaneous veins, will answer as well. I prefer this method of 
administering the quinine, partly because of its greater certainty- of action, its 
quicker diffusion through the system, but more especially because there is no dan- 
ger of the dose being lost, owing to the almost constant nausea and vomiting that 
attends the disease. It is my object to bring the patient at once under thelnflu- 
euce of quinine, and to maintain this influence until the disease is broken up. I 
give it hypodermically every five or six hours, in such doses as I think will secure 
its uninterrupted influence upon the system : and this I do regardless of the degree 
of fever that may be present, believing that the malarial poison must be neutral- 
ized in the system before we can bring safety to our pattern. To overcome the 
nausea and bilious vomiting, which is nearly always present, and is a most dis- 
tressing symptom. I give small and repeated doses of calomel, say half a grain 
every Half hour, or one grain every hour, and occasionally a littfe comp, spts., 
lavender, or soda water in a state of effervescence. 
After the stomach has been quieted by the calomel (which it seldom fails to 
be ), and some eight or ten grains have been taken, i commence giving teaspoonful 
doses of a saturated solution of epsom salts, flavored with a little comp, spts . lav- 
ender or ess. lemon. This I give every hour or two until the bowels are acted 
upon, when generally it will be found that the so-called bilious -tools will pass off 
freely, and this rarely fails to mark a decisive improvement in the patient's condi- 
tion. When there is cephalalgia, lumbar ;<ains and aching in the limbs-all of 
which are often present-Ido not hesitate to give small doses of morphine until 
relief is obtained, believing that the opiate, if not carried to the extent of produc- 
ing nervous depression, can do no harm, but is productive of immense good by 
quieting the system and procuring rest. Moreover, the excessive nausea and vom- 
iting is sometime- arrested by small doses of morphine when all other remedies 
have failed. * * 
The liver in these cases is always engorged and slow to act. and it is often use- 
ful to apply a blister over this organ to assist in relieving it of its turgescence. and 
to excite it to functional activity. * * 
The blood iu all these cases is profoundly altered in it< constituency and low- 
ered as a vital fluid : hence the propriety and necessity of administering the min- 
eral acids and iron tonics as blood restorers. These I usually commence with, as 
soon as the calomel has done its work and passed out of the system, and 
the fever has somewhat abated. If commenced with earlier they are apt to be 
rejected by the stomach, and thus prove annoying to the patient. + * 
I have said nothing of haemostatics in the treatment of this disease; as a gen- 
eral rule they are not needed, the haemorrhage ceasing as soon as the morbid pro- History of Malarial Hcematuria. 
585 
cess is interfered with by the anti-periodic. But there are cases, and I have seen 
numbers of them, in which the bleeding is so profuse as to exhaust the patient 
rapidly, and unless it can be checked a degree of anaemia is soon induced from 
which the patient cannot recover. In such cases we are to use a strong decoction 
of uva ursi, the astringent preparations of iron and the gallic acid. The latter I 
have found more reliable in such emergencies than any other remedy. I give it 
in doses of three to five grains every hour or two. until the haemorrhage is checked. 
In no disease is it of greater importance to watch an opportunity to administer 
suitable nourishment to the patient. The blood is impoverished and must be 
renewed, or the patient dies. N. O. M. and S. J., xxii, pp, 624, 626. 
Dr. Starley gives in his article no data by which an estimate may be 
made of the relative frequency of the disease, as compared with other 
fevers, or of its relations to climate, or of the value of his plan of treat- 
ment as determined by the ratio of deaths to cases treated. Dr. H. C. 
Ghent,* in his letter to Prof. L. 8. Joynes, of Richmond, Virginia, giving 
a, "brief account of an epidemic of jaundices called attention to the epi- 
demic prevalence of the disease ; to the occurrence of jaundice without any 
evidence either of a suppression of the secreting action of the liver, or of 
an obstruction of the biliary passages, but on the contrary, with the indica- 
tions of an excessive secretion, the system being, so to speak, deluged with 
bile; to the great fatality of the disease and the sanguineous character of 
the urine. 
Dr. Edward H. Sholl,f of Gainesville, Alabama, shortly afterwards 
published a concise view of this disease, under the name of "hcematuric or 
yellow remittents 
Dr. T. 0. Osborn, J of Greensboro, Alabama, in the same year published 
a valuable article illustrated by ten cases of what he calls cachemiaS 
The paper of Dr. J. C. Osborn was originally read before the Greens- 
boro Medical Society, May, 1868, as a " Report on a New Variety of Malarial 
Fever." 
Dr. T. C. Osborn was himself attacked with this disease, which he 
contracted upon the plantation of one of his patients, whose case demanded 
unremitting care and attention. Dr. Osborn thus describes his own 
Case 912.-On his plantation there were never less than one hundred persons, 
white and black, none of whom ever escaped a season without one or more spells of 
intermittent fever, which gradually undermining the constitution, left them, as we 
were in the habit of saying, in the touch and go condition; but the proportion of 
deaths to the whole number of cases occurring during twenty years, did not amount 
to one-half of one per cent. This locality is nine miles, a little south of west from 
Greensboro, and is upon the line of division between the prairie and sandy lands 
north and south, and at the junction of the hill and flat lands east and west. I 
mention these minute facts to show why I have persistently called it the head- 
quarters of malaria, and because it was there that I first began to observe and real- 
ize the importance of the peculiar appearance of the tongue, as a pathognomic objec- 
tive indication of malarial infection, and I will add, that time and thousands of 
repeated observations have continuously enlarged my estimate of its recurring 
fidelity. I hold it responsible for the administration of quinine, and whatever the 
disease may be or however difficult it may be to diagnose its true character, the 
margined and crimpled edges of the tongue gives unequivocal evidence that the 
cause is to be attributed to malarial poisoning. At the time I attended Mr. C. in his 
last illness, my health and energy were remarkably good, and I had not been 
troubled with fever since 1862; but, as I confidently predicted, in remaining every 
night with him as principal nurse, very soon afterwards labor became more and 
more irksome, without any decided feelings of distress, until the loth of October, 
nearly a month from the time of infection, when I fairly broke down and took to 
bed. My skin was deeply tinged, urine hsematuric, bowels costive, loss of appetite, 
* Richmond Medical Journal, April, 1868. 
t Medical and Surgical Reporter, October 24th, 1868. 
j New Orleans Medical Journal, vol. xxi, October, 1868, p. 664. 586 
History of Malarial Hcematuria. 
pain in the lumbar region, with uncontrollable disinclination to mental or physical 
exertion. Tongue coated, margined and crimpled ; spleen natural, and mind dis- 
turbed by dreams, but there was neither nausea nor fever. The attack was beyond 
•question exceedingly mild owing to my previous good health, but certainly should 
be classed with the new disease. I was deeply interested in the peculiarity of the 
urine, which seemed to be assuming an epidemic character, and occupied much of 
my time in examining it chemically and microscopically. This occupation served, 
also, to divert my mind from the atonic dejection, there beina at no time enough 
debility to prevent my sitting up or walking about the house. In quantity the 
secretion rarely varied from a healthy standard, but all its other features were 
continually changing. At one time it would be a truehaematuria with albuminous 
deposit, at another amber colored, and full of dumb-bell crystals, beautifully dis- 
tinct, and again limpid, with a splendid irridescent pellicle floating upon the sur- 
face ; all. too, under the same diet-boiled milk and light bread-from day to day, 
the case through. When it was ha?maturia, blood discs and tube casts were more 
or less abundant in the field of the microscope, and albumen and clots would fall to 
the bottom of the vessel. I mention these particulars because several intelligent 
physicians have expressed doubts as to the bloody character of the secretion * *. 
Only once did the urine fail to redden tissue paper, and that was during the pre- 
valence of the triple phosphates, it was then slightly alkaline, The specific grav- 
ity varied in the different specimens from 1010 to 1030, being highest in the haema- 
turic and lowest in the phosphatic. Sometimes the changes would follow each 
other in rapid succession during the same day. Under these ever-changing con- 
ditions, it was extremely difficult to decide upon any appropriate medication, and 
the consequence was I placed my trust in the regimen, and the conservative power 
of nature. For several alternate days I took twenty grains of quinine in broken 
doses, and distinctly felt its curative influence. From the following aperient mix- 
ture, I derived satisfactory actions from the bowels when necessary, viz: R 
Decoction of senna, f^ix; mannae, ^i; spts. ammon arom, f£ss; tinct. jalap; 
fluid ext. sennae, syr. buckthorn tr. hyosciami, syr. simp. tr. cardamom comp. a a 
f^i; mix, dose one to two ounces at bed time. This would give one free al bi ne 
dejection next morning, and leave the bowels feeling comfortable for the next 
twenty-four hours. The warm bath at night, constituted my greatest comfort, and 
after remaining in it for one or two hours my feelings would be delightful, sleep 
coming without an effort, whilst the skin continued soft and perspirable during all 
next day. Perhaps it would be well to add that the baths were made strongly 
alkaline by the addition of a gallon of lye water each time. No doubt can be 
entertained that if I had not rested so early from my professional duties, the vio- 
lence of the disease would have been greatly increased, and, on the other hand, if 
I had submitted to a more rigid discipline the duration might have been materially 
shortened. As it was, my health did not get re-established until late in January.1' 
The testimony of Dr. T. C. Osborn, as to the presence of blood-corpuscles 
and the constituents of blood in the urine is clear and was subsequently con- 
firmed by the examination of two samples of ^hamaturic urine." by Prof. X. 
F. Lupton, Professor of Chemistry, Southern University, Greensboro, Ala. 
Although the liquids were some five or six weeks old at the time of the 
qualitative examination, there was evidence of a considerable admixture of 
blood, and. indeed. Professor Lupton concludes his report with the simple 
and unequivocal statement that " the liquids are a mixture of blood and urine."1 
Of the ten cases reported by Dr. T. C. Osborn, five proved fatal, and 
in one case death was preceded by profound stupor, but no convulsions 
although the urine was suppressed and a blister filled with bloody serum, 
in another by stupor and delirium, and in a third by profound stupor and 
slight convulsion. With reference to the former existence of the disease, 
previous to this epidemic. Dr. T. C. Osborn says : 
" Here and there, in the several locations I have taken, during the twenty- 
eight years of my professional career, it has occcurred to me to see, now and then, 
after long intervals of time, isolated instances having the same general features 
and results, but classing them together under no congestive form. I fail to recog- 
nize the important position, in the family of malarial fevers, to which they were 
unquestionably entitled." History of Malarial Hcematuria 
587 
The following is the report of Professor Lupton. 
Two liquidssubmitted by Dr. James D. Osborn for examination, Decem- 
ber, 1867 : 
No. 1. 
1. Dark, or brownish-red liquid. 
2. Ash colored precipitate at bottom of 
bottle. 
3. Offensive smell of putrid urine. 
4. Blood-corpuscles detected by micro- 
scope. 
-5. Strongly alkaline, (ammonia evol- 
ved.) 
6. Hydrochloric acid caused evolution 
of carbonic acid showing presence of 
carbonates. 
7. Heat caused coagulation, the liquid 
assuming a muddy-brown color show- 
ing albuminoid substance. 
8. Nitric acid caused coagulation. 
9. Hydrochloric solution and chloride 
of barium, white precipitate showing 
presence of sulphates. 
10. NO5 Solution and nitrate of sil- 
ver, white precipitates showing pres- 
ence of chlorides. 
11. Acetic acid and ferrocy. of potas. 
precipitate showing albuminoid sub- 
stance. 
12. Acetic acid solution in addition to 
potas. and boiled does not coagulate 
showing fibrin, perhaps. 
No. 2. 
1. Light or cherry-red liquid. 
2. No precipitate at bottom of bottle. 
3. Offensive smell of putrid urine. 
4. No blood-corpuscles detected. 
5. Strongly alkaline, (ammonia evol- 
ved.) 
6. Hydrochloric acid caused evolution 
of carbonic acid, showing presence of 
carbonates. 
7. Heat caused coagulation, the liquid 
assuming a muddy-brown color show- 
ing albuminoid substance. 
8. Nitric acid caused coagulation. 
9. Hydrochloric solution and chloride 
of barium, white precipitate showing 
presence of sulphates. 
10. NO5 Solution and nitrate of sil- 
ver, white precipitate showing pres- 
ence of chlorides. 
11. Acetic acid and ferrocy. of potas. 
precipitate showing albuminoid sub- 
stance. 
12. Acetic acid solution in addition of 
potas. and boiled does not coagulate, 
showing fibrin, perhaps. 
The liquids are a mixture of blood and urine. 
N. F. Lupton, Prof. Chemistry, Southern University. 
Greensboro, Ala., January, 1868. 
Simultaneously with its appearance in the vicinity of Greensboro, it 
prevailed also in Tuscaloosa, Eutaw, Selma and Montgomery, with a mor- 
tality equal perhaps to that of the cases reported by Dr. Osborn. With, 
reference to treatment, Dr. T. C. Osborn says : 
" My hopes are based upon quinine, calomel, cayenne, and the alkaline baths, 
repeated freely and frequently, until the disease is brought to bay, and then the 
mineral acids, and the cold shower bath will naturally assist the recovery. For 
the nausea and vomiting, soda water in effervescence promises more than any other 
remedy. Blisters perhaps are harmless, but do not deserve especial confidence. The 
same may be said of diuretics. Opium is positively injurious, no one of my cases hav- 
ing recovered when a second dose had been administered. Indeed I believe that 
all narcotic and sedative medicines are decidedly inappropriate. If an alkaline 
remedy should become necessary, I would in future select it from one of the pre- 
parations of ammonia or potash, having seen the prompt returning hsematuria, 
under eight grains of bicarb, of soda, in hop tea, for the relief of urticaria durimi 
convalescence." New Orleans Medical Journal, xxi, No. 4, Oct. 1868, pp. 664, 679. 
Dr. J. D. Osborn, son of Dr. T. C. Osborn, describes this disease under 
the name of " Malignant Congestive Fever " in an essay, read at a meeting 
of the Greensboro Medical Society, 6th April, 1868, and published in New 
Orleans Journal of Medicine, vol. xxii, No. 1, January 1869, p. 61. Dr. 
J. D. Osborn's article is of interest, chiefly from his observations on the 
use of diuretics in the treatment of the disease; thus he says : 
"In one case in which I had not used astringents freely, and in the others I 
noticed a marked suppression of urine after the subsidence of the hsemorrhage ; in 
my next case after mature reflection, I determined to deviate from my former treat- 588 
History of Malarial Hcematuria. 
ment, and reject astringents entirely, and let the haemorrhage alone, fori had 
arrived at the conclusion that there was a morbid condition of the kidneys which 
tended to suppression, and by this suppression morbid matters were retained in 
the blood, which would prove to be of great damage to the nervous centres ; and 
now, in conjunction with other remedies, directed to the abdominal organs, I 
determined to direct a class of remedies to the renal organs which would oreak up 
that condition, and accordingly selected diuretics, which, in my opinion, would 
relieve the system of the dreadful poisoning by urea. My first patient, I am satis- 
fied, died from the effects of uremic intoxication. The convulsions were indeed 
fearful. With this view of the pathology of this disease, and the treatment, I 
think that in a measure I am right, for my subsequent practice confirms me in it. 
" With the administration of calomel and ipecac to break up the congestion, I com- 
bine a powerful diuretic draught, and have always found it to act well, and prepare 
the way for the free and rapid use of quinine. Since the introduction of diuretics 
into my practice, in the treatment of this fever, I have not lost a single patient." 
New Orleans Medical Journal, January, 1809, p. 69. 
Neither Dr. T. C. Osborn, nor his son, Dr. J. D. Osborn, performed any 
post mortem examinations, and it is therefore unnecessary to detail their 
speculations as to the nature and pathology of the disease. 
Dr. Benjamin H. Riggs of Selma, Alabama, treats of the disease under 
the name of purpuraemia, and whilst not deeming 11 it necessary to detail the 
symptoms of this disease," and whilst reporting in detail no cases and giv- 
ing no microscopical observations or chemical examinations, boldly pro- 
poses a theory and gives "what I know to be a successful treatments 
According to Dr. Riggs : 
" Theory.-I believe all the symptoms which are present in this disease, with 
its too frequent fatal ending, are due to systemic poisoning with purpurcemia. of 
Golding, Bird, or hsemophuein and uroerythrine, of Simon, or uroxanthin (sub- 
divided into uroglancin and uropodin) of Haller, or the red uremic coloring matter 
of Lehmann," * * "To sum up: Purpuraemia then is due to malarial poi- 
son acting upon the nervous system primarily, the sympathetic mainly-quenching 
the supply of nervous stimulus to the systemic emunctories, and attended with a 
torpid spleen and liver, and effete matters which should have been depurated by 
these organs are allowed to remain in the blood, poisoning it by its presence ; the 
result is yellow skin, red urine, haemorrhagic fluxes, fever, death or purpuraemia."' 
Dr. Riggs gives no satisfactory answer to the question which naturally 
suggests itself, "why, if this be the true explanation of the nature of this 
disease, have we not had it prevailing before, as we have certainly had 
abundant torpid spleens and livers heretofore, following malarial infection 
without it." Whilst giving no data by which the value of his mode of 
treatment may be measured, he says that, as it prevails around Selma, 
Alabama, " purpuraemia " is not a fatal disease. The following is the plan 
of treatment recommended by Dr. Riggs : 
" When there is an inflammatory condition of a high grade, attended by high 
fever, restlessness, pain in the back, quick and bounding pulse, and the frequent 
passage of quantities of bloody urine, try to relieve the congested and overburdened 
kidney; the irritation and engorgement of this organ is intense, and the delicate 
vessels of the malpighian bodies are bleeding freely. To do this excite the action 
of the skin by diaphoretics and the bowels by purgatives; use counter-irritants 
over the region of the kidneys; the pulv. jalap comp, answers as well as a watery 
purgative; if possible use the hotair bath to promote diaphoresis; blister the lum- 
bar region; let the patient drink warm lemonade, or flaxseed tea to dilute the acid 
urine. In most of the cases, however, you can resort at once to the following plan 
of treatment, and I believe when medicine can cure at all, success will invariably 
follow. Give half drachm acetate of potash every hour or two Ijoups in a teacupful 
of warm flaxseed tea, bruised watermelon seed tea, or buchu tea, if tiie stomach 
will take that quantity of fluid; if not, give it in a wineglassful of the same teas; 
let the patient drink chlorate of potash warm ad libitum; it is important to have 
as much fluid taken as the stomach will bear without vomiting, as diuretics are History of Malarial Hcematuria. 
589 
better when given by the teacup or tumblerful than when given in smaller quan- 
tities of water, or by the teaspoonful. Moreover, the water reduces the irritation 
of the kidney by diluting the acrid substances passing through it." * * ''The 
gist of the whole plan is this : Assist the kidneys to free the blood from the mor- 
bid poison; if it succeed in this the patient is saved. Eschew calomel, quinine and 
opium as agents that seem to act hurtfully in this disease." New Orleans Journal 
of Medicine, vol. xxii, No. 2, April, 1869, p. 234. 
Dr. E. S. Sharpe, of Natchez, Mississippi, in a short article on inter- 
mittent icteroid fever, thus describes his plan of treatment : 
" The nausea, vomiting, and restlessness of the patient, will first demand atten- 
tion; they are more certainly arrested by small portions (one grain) of dry calomel 
placed on the tongue, and followed by teaspoonful quantities of ice-water than any 
other remedy. Continue the calomel every half hour until tenor fifteen grains 
have been retained. If after six hours the liver is not acted on by the mercury 
thus administered, blister the surface over that organ. This is not easily doneiii 
this disease, but is very necessary. If indicated repeat the calomel. When the 
fever commences to subside give quinine, in the usual doses, not in large quanti- 
ties, for it seriously complicates the disease. As soon as the stomach will retain it, 
give potass, iodid. in large doses three times daily as a mercurial solvent, and a 
diuretic. To relieve pain use external applications. Opium and its preparations 
and remedies of this class are hurtful." New Orleans Medical Journal, vol. xxii, 
No. 2, April, 1869, p. 246. 
Dr, Sharpe affirms that "the above treatment has invariably been successf ul. 
Dr. R. F. Michel, of Montgomery, Alabama, read before the Medical 
Association of the State of Alabama, at its annual meeting in the city of 
Mobile, March 2d, 1869, an elaborate, learned and valuable article on 
"haemorrhagic malarial fever f which he thus defines : 
"A malignant malarial fever, following repeated attacks of intermittent, char- 
acterized by intense nausea and vomiting, very rapid and complete jaundiced con- 
dition of surface, as well as most of the external organs of the body, an impacted 
gall-bladder and haemorrhage from the kidneys. These phenomena present them- 
selves in an almost uninterrupted line, attended by remissions and exacerbations. 
It is a fever peculiar to the southern part of the United States." 
Dr. Michel begins the history of this disease with the year 1867. He 
regards malaria as the exclusive cause of this affection. In his accurate 
description of the symptoms, several points are worthy of record more 
especially in their relations to the historical development of the natural 
history and pathology of the disease : 
"The most prominent symptoms are the "yellow color," and the "hoematuriaV 
This yellow color tinging not only the skin, but many of the internal organs of 
the body, is not as a general rule gradually developed, as we are wont to see in 
jaundice and other hepatic affections ; but it is prompt, and as Dr. J. D. Osborn 
remarks, developed in the twinkling of an eye. Is this yellowness due to an 
obstruction in the gall passage? Have we evidence of gall-stone or of some for- 
eign substance engorged within these important channels? Not at all; nowant 
of bile; we find it freely secreted, lodged in almost every tissue except the brain, 
and as Dr. Joynes has justly remarked, deluging the body. * * The yellow of this 
disease is mingled with green, or, in other words, is of a bronzed character, and is 
justly described as a bronzed-yellow. Again, this color, no matter how deep it has 
invaded the tissues, is capable of rapid absorption. * * 
The next characteristic feature of importance is the haematuria, and we find 
this condiiion existing in every case. The urine is discharged in large quantity 
and without pain, but mixed with blood ; in fact, the discharge consists of more 
blood than urine. One remarkable fact in this connection is, that unlike other 
haemorrhages from the kidneys, a cessation is no guarantee for its non-reeurrence, 
for though the urine may become perfectly clear and limpid during a remission, 
if we are not successful in arresting the recurring chill, this excretion will quickly, 
nay almost instantaneously, give evidence of its bloody character. Very frequently 
our patient dies, not having passed a drop of bloody urine for twenty-four or forty- History of Malarial Hoematuria. 
590 
eight hours previous to his death, and the urine obtained from the bladder at the 
post-mortem is perfectly healthy. We think this last symptom on the peculiari- 
ties attending its manifestations perfectly characteristic of this, and only this dis- 
ease. We know of no malarial fever behaving in this way, and hence we have 
termed the disease hcemorrhagic malarial fever. 
The haemorrhagic tendency of the disease is demonstrated occasionally from 
other surfaces besides the urinary organs. Doctor Osborn mentions slight oozing 
of blood from the gums and fauces. Doctor Weatherly, of Montgomery, speaks 
ofsevereand protracted haemorrhage from the nose. We have all witnessed the bloody 
serum which exudes from the blistered surface. Not like the haemorrhage from 
the denuded surface of a yellow fever patient, which is truly alarming in its results 
from the fact that it is almost uncontrollable, but in this disease this haemorrhage 
is easily suppressed and readily recognized by the blood being freely mixed with 
bile, making a bloody green mass, almost pasty in character, as Dr. Barnes has 
very accurately described. Dr. Weatherly refers to this exudation as of a dark 
brown color. 
Only two forms of eruption have been noticed in this disease, purpura haemor- 
rhagica and vibices. This induces us to admit its low character, and has caused 
Dr. J. M. Owens of Hamburg, Arkansas, to speak of the disease as cachemia 
hcemorrhagica. 
The nausea and vomiting is remarkably severe and persistent. It begins with 
the chill, and ends when the patient has succumbed to the fell destroyer, or has 
passed far into convalescence. * * The matters ejected from the stomach have 
been carefully examined, not only chemically, but by the aid of the microscope; 
and no matter what shade of color they present, whether they be as Dr. Barnes 
has described, of "a black, tarry character," or as Dr. Ghent has recorded, ''of a 
red, sometimes green, and in one case blue color," or as Dr. T. C. Osborn has men- 
tioned, one of his patients vomiting a greenish fluid and having a greenish expec- 
toration, or as Dr. Weatherly says of M. E., on the fifth day, eructating and 
expectorating the greenest looking stuff he ever saw ; it is nothing m re than bile 
with the muriatic acid of the stomach. * We have no blood here, no trace of a 
haemorrhage from the stomach. The patient vomits dark grumous bile. * * 
The temperature of the body, as a general rule, does not vary much. Dr. 
Osborn, in case 4th says : ''The skin was not above a natural temperature." Dr. 
Weatherly in his case of Mr. E., found the temperature on the morning of 3d day, 
at eight o'clock, 96° on the axilla, and at eight o'clock in the evening of the same 
day 103°. On the 4th day at eight o'clock A. M., temperature 96°, and at one o'clock 
P. M., as well as at eight o'clock P. M., 96°. On the 5th and 6th days the thermo- 
meter made the same record as on the preceding day, although the skin was very 
cool, could almost be called cold. On the morning of the 7th day at eight o'clock, 
this valuable instrument registered 94°, and then varied from that time until the 
sufferer (breathed his last. Doctor Shollsays: "We have a temperature varying 
from 98° to 105°, the last the highest I have ever found it, falling rapidly 4° to 5°, 
the skin sometimes cool." 
"We find all forms of intermittent fever, quotidian, tertian and quartan, as 
well as remittent fever, terminating in this disease. It is epidemic in certain local- 
ities, particularly in the prairie country of Alabama, occurring in the fall or early 
winter, though we hear of cases in almost every month of the year. The progno- 
sis is very unfavorable * I have lost one-half my cases. Dr. T. C. Osborn reports 
ten cases of which five died. According to Dr. Barnes, in some districts the mor- 
tality has been as high as thirty-three and one-third per cent, of the cases, and in one 
neighborhood it was still higher. Doctor Shell says: 'This is eminently a grave 
disease; of twelve cases I have seen in consultation and my own practice, six or fifty 
per cent, have been fatal.' " 
Owing to the kindness of his friend, Dr. J. S. Weatherly, of Mont- 
gomery, Alabama, Dr. Michel was permitted to make a post-mortem exam- 
ination of one of his patients, M. E., who died of haemorrhagic malarial 
fever, on the 6th of December, 1868, and I condense the following from the 
report of Dr. Michel : 
Rigor mortis peculiarly great. Skin everywhere, as well as the cellu- 
lar tissue of a yellow color. Muscles very red. Dura mater yellow. Brain 
perfectly natural, without vascular congestion, of usual size and weight, 
and the nerves emanating from it in their normal condition. Upon open- 
ing the chest the yellow color pervaded every tissue, even the pericardium, History of Malarial Hcematuria. 
591 
and the fatty zone around the base of the heart, which was perfectly 
healthy. The usual quantity of serum in the pericardium, was of a deep 
bronzed color. Lungs normal. 
In the abdominal cavity the omentum was normal, but of a yellow 
color; stomach filled with dark grumous bile; mucous membrane thick- 
ened and vascular, especially in the vicinity of the pylorus; intestines 
normal; pancreas of usual length (six inches) and bright yellow; spleen 
enlarged and firm; weight nineteen and a half ounces (normal weight 
seven ounces); almost three times its normal size; liver larger than usual; 
weight sixty-four ounces, firm and of a dark chocolate color; the gall- 
bladder protruded beyond the anterior or upper border of the liver, was 
conical or pear-shaped, and upon being cut into contained a very thick 
granular, biliary mass, impacted and pasty, of a dark green color, resem- 
bling meconium, the smallest particle of which could tinge a basin of 
water the color of saffron; clinical and microscopical examination proved 
it to be bile. There was in this gall-bladder, as in another case examined 
previously, no blood to be detected in the mass under the field of the micro- 
scope. Biliverdine, cholesterine and the biliary salts (in fact the true 
elements of bile) were present. Dr. Michel says, that although thirteen 
years of his life had been spent in anatomical investigations, he had never 
found the gall-bladder in such a condition-hard and containing so con- 
sistent a mass. 
Dr. Michel says that the kidneys were much larger than usual. The 
normal weight of a healthy kidney being four and a half to six ounces, 
while this kidney weighed ten and a half ounces, which is almost double 
the normal weight. The dense areolar tissue surrounding the kidney 
could be easily peeled off, leaving the organ smooth and of a pale, reddish 
color, demonstrating the fact that the organ had passed through no severe 
inflammatory action. A transverse section revealed the cortical and 
medullary substance of a dark green color. 11 This organ appeared to have 
been soaked in alcohol until it had become hardened, and then painted a 
bottle green color." The super-renal capsules were of their usual yellow 
color, and these appendages to the kidneys were perfectly normal. 
Some time before this examination, through the kindness of Drs. 
Douglas and Seelye. of Montgomery, Dr. Michel was enabled to examine 
the kidneys of Dr. Dellard, who died of haemorrhagic malarial fever, and in 
this instance, although he saw no evidence of change in the organ, it had 
appeared to these gentlemen, upon removing the kidney from the body, 
that it had been somewhat congested. It was reddish, but normal in size 
and weight. In the case of Dr. Weatherly, the bladder was distended with 
urine, which was of a clear color and ammoniacal odor. 
Dr. Michel observed no pathological change in the sympathetic nerve,, 
or the nerves emanating from the spinal cord. 
Dr. Edward H. Sholl. in his valuable paper already alluded to,, 
remarks, under the head of anatomical characters, that upon making a post- 
mortem examination of a man aged forty years, twenty-four hours after 
death by haemorrhagic malarial fever, the following condition of the body 
was apparent: 
Cadavre unusually rigid; emaciation slight, patient having been sick but four 
days; liver less firm than usual, slightly enlarged, much engorged with blood; bile 
in unusual quantity; gall-bladder containing a small quantity of the dark green 
biliary matter, its inner coat slightly softened; kidneys right, small and firmer 
than normal; left, one-third larger than normal in size, its tissues much softened 
and easily broken down; spleen enlarged one-half, softened, its mass giving way 
readily under pressure of the finger, deeply engorged with a dark grumous blood. 
Intestines and bladder presented no lesion. Blood almost entirely deprived of History of Malarial Hoematuria. 
592 
fibrin. The urine tested by heat and nitric acid was very heavily charged with 
albumen. In response to various tests, employing f^ss. of urine, one-half 
to two-thirds of its bulk became firmly coagulated. Under the microscope the urine 
presented ragged, disintegrated and broken-down blood-corpuscles. In a recent 
post-mortem made by Dr. Pearson of this county, the same characteristics pre- 
sented themselves, the subject having been a regular drunkard, the liver was 
found very much enlarged, its upper half being nothing but a pultaceous mass." 
With reference to the treatment, Dr. Michel justly remarks that- 
" It is necessary for us to consider solemnly and carefully what course of treat- 
ment has been, or might be beneficial for the relief of a disease, which we have 
described as of malignant character, and whose prognosis we have regarded as posi- 
tively unfavorable. W e must rely for success upon the administration of calomel and 
quinine: The former is used for its peculiar impression upon the liver and portal 
circulation in addition to its purgative quality, and the latter not only for its tonic, 
but mainly for its antiperiodic property. 
First of all, therefore, we administered twenty grains of calomel, and in six 
or eight hours a dose of oil; so soon as successful purgation has been secured and 
bile appears to flow rapidly through the primse vise, we begin with the sulphate of 
quinine and capsicum, twenty-one grains of the former and three grains of the 
latter, divided into seven pills; one every hour until all are taken, being careful to 
secure the administration of the entire amount at least two hours before the 
expected paroxysm. * * Should, however, the chill with all its serious conse- 
quences recur notwithstanding the amount of quinine already taken, we return 
with confidence to the same remedy. * * W bile the skin is cold, we apply warm 
bricks to the feet and even around the body, and at the same time the use of warm 
drinks, as pepper or sage tea, to promote the action of the skin is desirable. 
Dr. Michel coincides with Dr. T. C. Osborn, as to the unfavorable 
effects of the vegetable astringents for the arrest of the haematuria, and 
has found most benefit from spirits of nitre in half ounce doses every three 
hours; pulverized nitrate of potash, ten grains in a gill of watermelon 
seed tea, or in buchu tea, or rhe fluid extract of buchu three or four times 
a day, also the acetate of potash. 
Dr. McOliver, of Montgomery, uses the hyposulphite of soda in large 
doses to control the haemorrhage from the kidneys, and expresses the 
utmost confidence in its administration. Dr. C. F. Fahs, of Selma, regards 
the hyposulphite of soda as the sheet-anchor in this disease. In Florida, 
where this malady took root, November, 1868, the physicians, in addition 
to the mercurial treatment, rely upon wood-ashes to. control the bleeding. 
Drs. Smith and Edwards, of Prattsville, Alabama, mentioned to Dr. Michel 
their success in controlling the haemorrhage from the bladder by adminis- 
tering large doses of lime-juice-say one ounce every hour or two until the 
bleeding ceases. Dr. Michel employed this remedy successfully in one of 
his cases. 
Dr. Michel says that the nausea and vomiting baffled all his attempts 
at treatment; the administration of one-quarter of a grain of sulphate of 
morphia by the stomach, rectum or hypodermically, was used without 
effect, and even the application of a blister to the epigastrium seemed not 
to produce the desired effect. In addition to these remedies for the relief 
of the nausea and vomiting, he used powdered ice, ice, soda water with a 
little wine to prolong effervescence, iced sangaree, hoc and soda water, 
iced lemonade, magnesia or lime water and milk, with a little tincture of 
ginger, but without effect. 
Dr. Michel affirms that the blister never controls the nausea and vom- 
iting in this disease, and if it produces strangury, it must be decidedly 
hurtful, for the kidneys and urine play no insignificant part in the history 
of this formidable affection; and as any risk of uremic intoxication should 
be strenuously avoided, he condemns in toto the use of this agent. He 
says: History of Malarial Hcematuna. 
593 
" With regard to the use of narcotics, various opinions have been expressed. 
For the jactation, restlessness, hiccup, and many other nervous manifestations I 
should recommend the bromide of potash or ammonium, and, should these fail, 
would resort to the opiates. Many physicians in correspondence with me, have 
expressed themselves warmly upon this subject, advocating even large doses of 
morphine. One of our very successful practitioners tells me he would not treat a 
case of haemorrhagic malarial fever if he was deprived of the use of the sulphate 
of morphia. On the other hand, Dr. Osborn remarks: ' Opium is positively 
injurious, no one of my cases having recovered where a second dose had been 
administered.' Dr. Sholl says: ' Avoid opiates unless there is diarrhoea.' With 
this evidence before us we must be cautious in the use of these agents, and we hope 
that time and experience will positively settle this important question." New 
Orleans Journal of Medicine, vol. xxii, No. 3, July, 1869, pp. 401-424. Transac- 
tions of the Medical Association of the State of Alabama, 1869, pp. 35-53. 
The testimony of Dr. Michel as to the presence of both blood and 
bile in the urine of malarial htematuria, was unequivocal: thus he says: 
"The bloody discharge from the bladder was repeatedly examined by the 
microscope, and found to be excess of blood and urine, with the addition 
of the coloring matter of bile, which was well marked in every specimen." 
Dr. F. O. Summers, Professor of Chemistry in the Southern Uni- 
versity, Greensboro, observed in the urine of a typical case of haemor- 
rhagic fever, occurring in the practice of Dr. Young of that place, but 
few well-defined blood-corpuscles, though the coloring matters of the blood 
appeared to be generally different, and leucocytes or pus-corpuscles were 
very numerous. 
The following is the analysis of this specimen of urine, which was of 
a deep red color, perfectly opaque, of an alkaline reaction, and a specific 
gravity of 1.025. 1000 parts contained: Water, 924.50; urea, 31.00; crea- 
tine, 2.50; createnine, 1.50; urates of soda potassa and ammonia, 1.60; 
glyko-cholate of soda, 1.45; tauro-cholate of soda, 1.00; coloring matter 
and mucus, 2.50; pus, 1.50 ; alkaline phosphates, 3.45; hsematine and 
haematosine, 3.50; chloride of sodium and potassium, 7.30; sulphates of 
soda and potassa, 7.00; albumen, 11.20; 1000.00. This specimen when 
evaporated left a coagulum, which could with difficulty be distinguished 
from blood itself. 
Dr. Summers observes: 
"That blood did not exist in the urine in an organized condition, as only one or 
two well-defined corpuscles could be detected in an inch of surface, though the 
coloring matters of both blood and bile are present in large quantities, which, 
being superinduced upon the uro-sacine itself, produce the deep red color now 
considered pathognomonic of the disease." Transactions of the Medical Association 
of the State of Alabama, Huntsville, March 26th, 27th, 28th, 1872, p. 117. 
Dr. Summers gives no details of the case and no dates, neither does 
he state the length of time which elapsed after the passage of the urine 
and the microscopical and chemical examination; and as the urine was 
alkaline it is probable that many of the red blood-corpuscles had been dis- 
solved by the free ammonia. 
Dr. M. H. Taylor, Assistant Surgeon United States Army, stationed 
at Thomas' Barracks, Huntsville, Alabama, in a letter dated April 10th, 
1872, says, with reference to malarial ha?maturia : 
"In all the specimens of urine examined I found blood-corpuscles. * * In the 
examination of the urine the following microscopic elements were observed: 1. 
The usual epethelical cells of the urinary passage. 2. A very few hyaline urinifer- 
ous tubes. 3. Vibriones, consisting apparently of a row of cells 1-10,000th in diame- 
ter. * * 4. Active molecular elements of cellular structure, ranging from about 
1-10,000th to 1-15,000th of an inch in diameter. * * 5. Bacteria-some of them were 
attached to the red blood-corpuscles." Trans, of the Medical Association of the 
State of Alabama, Huntsville, 1872, p. 125. 594 
Inestigations by Joseph Jones, M. D. on Malarial Hcematuria. 
Dr. Taylor failed to detect bile in the urine of his patients. 
Contributions from J. S. Weatherly,1 M. D, Montgomery, Alabama: 
T. C. Osborn.2 M. D.. of Greensboro. Ala.: SamT H. Coffman,3 M. D.. 
of Enterprise, Miss.; J. W. Anderson,4 M. D.. of Bridgeville. Ala.; D. C. 
Hewson,5 of Orange, Texas; W. A. Cochran.® M. D.. of Cambridge, Ala.; 
R. T. Abernethy,7 M. D., of Tuscumbia. Ala.; P. B. Minor,8 M. D., of 
Green Comity. Ala.; A. G. Mabry.9 M. D., of Alabama; E. D. McDaniel,10 
M. D., of Camden. Ala.: T. G. Howard,nM. D.. of Autauquaville, Ala.; H. 
B. Robinson.12 M. D.. of Birmingham. Ala.; George Whitfield,13 M. D., of 
Marengo County, Ala.; Wm. A. Greene,14 M. D., of Americus, Georgia; 
Peter Bui ford,15 M. D., of Morgan County, Ala.; R. D. Webb.16M. D., of 
Sumter Co., Ala.; D. R. Wallace,17 M. D., of Waco. Texas; J. M. Morrison.18 
M. D., of Hearne, Texas; Wm. A. B. Norcom.19 M. D.. of Edenton. N. C.; 
B. F. Hart.20 M. D., of Dallas. Texas: William A. Caveness.21 M. D., of 
New Salem, Texas; E. D. McDaniel," M. D., of Camden. Ala.; T. J. 
Heard,23 M. D.. Galveston. Texas; E. P. M. Johnson.24 M. D., of Texas; 
R. A. Gardner,25 M. D., of Centreville. Florida: R. D. Webb,26 M. D., of 
Livingston, Ala.; L. S. Joynes,27 M. D.. of Richmond. Va. 
Several other Southern physicians have appeared at various times in 
different journals and State medical transactions. After a careful exami- 
nation and analysis of many of these articles relating to malarial htema- 
turia. we have failed to discover any systematic quantitative analysis of the 
blood and urine, or post-mortem examinations, or any important additions to 
the natural history of the disease. Whilst it appears to be unnecessary to 
repeat the endless speculations, as to the nature of malaria. and with reference 
to unsettled points in physiology and pathology, especially when unsupported 
by personal observation and investigation; on the other hand the practical 
expeiience of cultivated and intelligent Southern physicians, who are 
brought in frequent contact with this most dangerous and fatal form of 
malarious disease, is worthy of study and comparison; for by this means 
the profession may hope at some future day to arrive at useful results, by 
which the largest possible success in mitigating human suffering and in 
saving human life may be attained. 
1 Report of a Case of Hsemorrhagie Malarial Fever. New Orleans Med. J., vol. xxiii, Janu- 
ary, 1870, No. 1, p. 129. 
This is the interesting and important case alluded to by Dr. Michel, in his paper on 
Haemorrhagic Malarial Fever, which we have already analyzed. 
2 Cachaemia Hasmorrhagica. A reply to Dr. J. H. Hammond. N. O. M. J., vol, xxiii, Octo- 
ber, 1870, No. 4, p. 780; Trans. Med. Ass., Alabama, 1871. p. 213. 
3 N. O. M. J., vol. xxiii, October, 1870. No. 4, p. 795. 
4 N. O. Med. J., vol. xxiii, October, 1870. No. 4, p. 797. 
5 N. O. M. J., vol. xxiii, October, 1870, No. 4. p.798, 
6 Transactions Med. Ass., Ala., 1871, p. 15S. 
7 Trans. Med. Ass., Ala., 1871, p. 180: 1872, p. 85. 
8 Trans. Med. Ass., Ala., 1871, p. 201. 
9 Prans. Med. Ass., Ala., 1870; Trans. Med. Ass.. Ala.. 1872. p. 89. 
10 Trans. Med. Ass.. Ala., 1871, p. 346. 
11 Trans. Med. Ass., Ala., 1872, p. 81. 
12 Trans. Med. Ass., Ala., 1872, p. 102. 
13 Trans. Med. Ass., Ala., 1872, p. 153. 
14 Miasmatic Hamaturia. Richmond and Louisville Med. Journ., vol. xiii, February, 1872. 
p. 149. 
15 Trans, Med. Ass., Ala., 1873, p. 61. 
16 Trans. Med. Ass., Ala., 1873, p. 92. 
17 Report on Hamogastric Malarial Fever. Richmond and Louisville Med. J., 1873, p. 917; 
Trans. Texas State Med. Ass.. 1875, p. 66. 
'8 Jaundice with Hasmaturia. 
19 Haemorrhagic Malarial Fever. Raleigh. N. C.. 1874. 
20 Richmond and Louisville Med. J., January, 1874, vol. xvii, No. 1, p. It. 
21 Treatment of Haemorrhagic Malarial Fever, by William A. Caveness. Richmond and 
Louisville Med. Journ., vol. xviii, January. 1874, p. 32. 
22 Haemorrhagic Malarial Fever. Trans. Med. Ass. of Alabama. 1874, p, 292. 
23 Malarial Haematuria. Trans. Texas State Med. Ass., 1875, p. 95. 
24 Malarial Haematuria. Trans. Texas State Med. Ass.. 1875, p. 120. 
25 Richmond and Louisville Med. Journ.. vol. xxi, May. 1876. p. 430. 
26 Haemorrhagic Malarial Fever. Trans. Med. Ass. of Alabama, 1876, p. 163. 
27 Haemorrhagic Malarial Fever. Richmond and Louisville, Med. J., March, 1877, p. 209 Investigations by Joseph Jones, M. D.. on Malarial Bcematuria. 
595 
The general results of the preceding observations confirmed those of 
my own investigations on the changes of the urine in malarial fever insti- 
tuted in 1857. From the first appearance of malarial hematuria after the 
close of the Civil War, I not only investigated cases in private and hospital 
practice, but also examined a number of specimens of urine sent from 
Texas, Louisiana and Alabama, and conducted an extended correspondence 
with physicians, in which the results of the examinations as well as my 
views as to the pathology of the disease were freely unfolded. 
In proof of this statement I submit the following extract from a valu- 
able article entitled " Report of a Case of Acute Malarial Toxemia; together 
unth remarks on the Pathology of the Disease of Malarial Origin" (Read 
before the Selma Medical Society, October 14th, 1869, and ordered for pub- 
lication in the Richmond and Louisville Medical Journal.) By H. S. Hud- 
son, M. D., Selma, Alabama. Richmond and Louisville Medical Journal, 
vol. x. No. 1, July, 1870, p. 16. Dr. H. S. Hudson thus reports the case : 
" What I have to say of its clinical features, will be confined to the report of 
the following case, which occurred in the practice of Dr. R. D. Jackson, under 
whose medical care the girl was during the attack. Dr. B. H. Riggs and myself 
saw the case on Sunday morning, but suggested nothing likely to be beneficial to 
the patient, which Dr. Jackson had not already administered. Clinical history.- 
Sarah, mulatto, aged 13 years, had had two attacks of intermittent fever during the 
summer, otherwise had been in good health. Thursday, August 26th.-Had a chill 
about noon, followed by fever, which passed off during the evening; took that 
night by direction of her mistress, a dose of blue mass, and next morning quinine 
and a dose of castor oil and turpentine. Friday, August 27th.-Had another chill 
about 12 o'clock M.; soon after passed some dark colored urine. Dr. Jackson was 
then sent for, and saw her about 4 o'clock P. M., at which time there was some 
febrile heat; had pain in her head and back; vomited bile occasionally; complained 
of thirst, tongue dry, pulse 115, respiration 22. 
Saturday, August 28th.-Passed urine of the same appearance as yesterday 
(reserved specimen No. 1 this morning, voided about eighteen hours after the first 
dark colored urine); pain in head and back more severe; vomited more frequently, 
thirst urgent; was restless, skin dry, but no sensible heat; adnata lemon-colored, 
pulse 123, respiration 25. Sunday, August 29th, 9 A. M.-Had not slept during the 
night; restlessness has increased; complained of being tired, but was not suffering 
pain; countenance anxious; vomited frequently a dark-blue grumous fluid, with 
green particles floating in it, later looking like'chopped spinach; bowels had been 
opened during the night, evacuations of a black color and tarry consistence; skin 
of normal temperature; passed urine of a dark color about the same* as before, but 
of a dark inky hue. Pulse 140, deficient in volume, respiration 38. (Preserved 
specimen of urine No. 2 this morning.) 5 P.M. Patient worse; respiration and 
pulse were more rapid; vomiting was measurably abated: passed viscid urine of a 
greenish hue and almost black color. Thirst very urgent. During the night fol- 
lowing the patient had attacks of occasional delirium lasting a few minutes; these 
attacks ceased towards morning. No other symptoms supervened until about 7 
A. M. Monday, when, with a few slight twitchiugs of the hands, the patient died, 
Specimen of urine No. 3 was collected Sunday night, and next morning forwarded 
to Professor Jones, University of Louisiana, for examination. 
Autopsy.-Dr. B. H. Riggs and myself present, Dr. Jackson seven hours after 
death; body not much emaciated; still warm about the thorax; skin bronzed; 
adnata lemon-colored; lips, gums and tongue white and bloodless; rigor mortis 
unusually great; tissues very firm; opened thoracic and abdominal cavities; 
muscles rather redder than usual; cellular tissue yellow; no blood followed the 
knife, and the visceral organs presented a blanched and colorless appearance; a 
remarkable absence of fluidity in every tissue, almost amounting to dryness; liver, 
color, size and consistence natural; gall-bladder distended, with a dark greenish 
mass, about the consistence of blackberry jam; stomach full of fluid, similar in 
appearance to that previously voided; kidneys, size, two inches across the pelvis, 
four inches in length, weight three ounces six drachms, firm and a little dark-col- 
ored; cortical substance also darker than usual; lower part of the ileum contained 
faecal matter, which stained linen yellow; colon empty; bladder contained about 
ten ounces of fluid, having the same appearance as that previously voided; lungs 596 
?; X. D.. Xalarial Hematuria. 
very pale idnlly marbled. crepitate -?c pressure and very light, much more so 
thar usual: heart of natural appearaa^ and size, firm and contracted: about an 
ocnee of stnw-e* lored fluid in the pericardiaesac; remove! the left kidney, spleen, 
pan x' the dver. gah-bladder; pressed ^ad collected some bfaxi from theiiver and 
apleea; tlx nr zrn i rimiard if my oflRi r by Dr. U. J. Clark, Dr. B. H. Riggs and 
myse-lf. Ii._ arec nieMed &? Drs. Clark and Riggs for assistance in the examina- 
tion of she urine an i blood. which are here recorded. These examinations were of 
the urine specimens 1. _ and me bLoi fc en the Ever and spleen. Specimen of 
urine N: » was sent to Professor Joseph Jones, oy whom a very complete exami- 
natica of this find was made, the results of which are inserted in this report. 
JVgfrieaf and ebenucof eamnumfian of arioc aod Mood.- 
Urine specimen N x 1 Examination made about six hours after its dischanre. 
«o&r reddish-brown. mx quite as dark as porter; sp. gr. Jits, faint acid reaction, 
has a urinoss odor, de . sirs a copious brown precipitate about one-sixth of 
thedepcaof the Equid ; the clear liquid gives a brown deposit on boiling, redis- 
sc-lved .u x'dltt . u . ' nitric acid, and changed toastraw color: about one ounce 
l dryness and residuum water with coiling alcohol, and found 
insofar le: residuum : la: t-uei an : charted under the blow-pipe, emitting theodor 
of bunt bom; PCftenkofer** test gave no indications of bile, and no play of colors 
was ooaerred on the addition of nitric- acid: results, no bile, no albumen. * * 
Urine specimen No. ± ~p. gr Idla. color nearly black, has a dead inky hue. on 
landing does not became bright and dear, as did specimen No. 1, has a dense 1 
deposit perhaps acout one-tenth the depth of the liquid, an alkaline reaction 
and becomes turbid on boifing, precipitate. not entirely dissolved on addition 
of nitric a .id: result, albumen present in small quantities; did not test for bile. 
Dr. Michel fijuud :«tle present in it. Jf*ero*cepfcaf Eramraufioa. Urine speci- 
men. N x 1. Eze very ex . us sediment in this specimen wa- composed of epithe- 
lium and numerate granular particles em.edied in the gehitenous fluid, together 
with a few race casts >f she tubuli uriniferi. Urine specimen No. 2. Deposit con- 
sists ulnxst entirely of the cf: ris of the .ood cell-, and appeared to consist of the 
shrivelled membrane only : caese were not aggregated. but fl acing freely in the 
surrounding "red. 
ey speewwen of vrioc No. f. mode fry JVqfemor Joseph Jone*. 
1 - . . • 5 ■ c •- • - i„ t r :-'t . x - 1^ k .- 1 : 
az. i resembled the dark viscid bile of some caees of congestive malarial fever. The 
ixii peered like diluted bile, and the neavy sediment presented a ropy, viscid 
az cearanee and aerie n ±:ke in all respects to thick bile The odor was very pecu- 
litr. .rad was rail.ke that of patnc urine and resenibiei that of decomposing bile 
and bimd. 
.: .c". - . . ■ • •: - 7 . x ' ~ - ; > 
the arise wjs fetra i to eoe.Liin nnmerous casts of the tUL-ali uriniferi; these casts 
txo d * esLAi.2 . A few altered bl.»i-cocpascles were ~een in the fluid, but if 
thev had ever teen tireseat in Imre amcen taev ^ad been destrovei by the mix- 
ture of urine and t he. remre cotorless corpuscles and epithelium :rem the genito- 
uri nary apcoraras were also diaeBnoed. 
hi • .; - . - _ : 1 .. -.xl.-?. .. . 1 .: ■ 1. -1 ' .: 
sEght eoagilaticu.. and the eoagu xtioc. appehrei t< save ceen caused by the pres- 
ecre :f the eiemertte of edwt When, evaporated the residuum, resembled, in all 
respects, dark inspessataf bile. Under the microee pe the concentrated and dried 
arise presented the eristic ri< .Its and crystals of concentratei -fie. When 
the ?:r.Tertrated and dried urine was treated with nitric acid but very few crystals 
of the retrate of urea were round- This i rtaut constituent of the urine was 
almost absent. As the nfeah f this evamtuati u therefore, we have a urine of 
low ipeeiflg gravity leaded witb caste of the tobali winifieri, filled with bae.na- 
"t :ed:.TCt _ urea, ij.ut i t g with biLiaryaei<l--.Audevkringinatter,andc©n- 
taisirg a smaZL amomit'>f allxwien. E was asc. uisu.ed at the amtrann of oile coti- 
raiaed tn the specimen of urln.-. and the lid matter of the urine appeared to oe 
ehisfy tnose of the tile. In many eases of congestive fever I Lave observed, after 
daath l<:<.-al congvstica of p»xtt->as of the kidneys, presenting a deej. slate color 
op»xi rae exterior and a I: re axe within, in whi.-a the bk»i aad evidently stagnated 
± : . ' . < : • • ' ;es re t : - . .re - re . . •■ ..•- : 
Dr. H S Hudson gives the following iadicacioDS for the treatment of 
a zisease: Investigations by Joseph Jones, M. D., on Malarial Hoemat uria. 
597 
1st. As cinchona and quinia are recognized as antidotal to malaria, the 
early and free use of these remedies wouid seem to be positively indicated. 
2d. That the danger of disorganization of the kidneys should be early 
combatted by measures calculated to relieve the congestion or inflamma 
tion of these organs. Free purgation and the prolonged and frequent use 
of the hot bath would, perhaps, best attain this object. 
3d. Thar the frequent discharge of the contents of the gall-bladder 
should be induced: perhaps purgation, especially if produced by mercu- 
rial preparations, and the exhibition of liquid food would best accomplish 
this. Bidder and Schmidt state that this viscus is emptied about two hours 
after a meal. 
4th. That the absence of fluids and urgent thirst, point to the neces- 
sity of an abundant supply of whatever fluid can be administered, either 
by the mouth, rectum or the peripheral absorbing system, calculated to 
supply this want. Of other remedial measures, stimulation, general and 
local, would seem to be the one most needed. 
The excellent paper of Dr. Hudson was received by the editor of the 
Richmond and Louisville Medical Journal, in October, 1869, but was not 
published in this journal until July. 1870. pp. 16-30. 
Whilst the investigations of the various physicians were progressing, 
an analysis of which I have recorded. I made analysis of the blood and 
uriue and post-mortems in the Charity Hospital, responded to vari- 
ous inquiries and examined specimens of urine forwarded from vari- 
ous sections of the southern country, and unfolded my views as to the 
natural history, pathology and treatment of malarial haematuria in the 
clinical lectures in the wards and amphitheatre of the Charity Hos- 
pital. to the students of the medical department of the University of 
Louisiana, and also addressed extended replies to the inquiries of vari- 
ous physicians. A portion of these laborshave been published by Dr. 
R. B. Porter.* of Courtland. Alabama, and Dr. Wm. A. B. Norcom,t 
of Edenton, X. C. In replying to the various inquiries, as will be seen 
from an examination of the articles just referred to, it will be seen that I 
-udeavoted to sustain and illustrate the following propositions, by careful 
observation of the various symptoms, by analysis of the blood, secretions 
and excretions and by careful examination of the pathological lesions after 
death, performed during the past twenty-nine years : 
1st. The malarial poison induces profound alterations in the consti- 
tuents of rhe blood. Under its action, the colored blood-corpuscles are 
more rapidly and to a greater extent destroyed than in any other disease ; 
the fibrin is diminished and altered in quantity and quality : the albumen 
- in like manner diminished : the extractive and coloring matters of the 
blood are frequently increased. The unhealthy hue in malarial fever 
appears to l»e due to both the destruction of the colored blood-corpuscles, 
aud the presence of coloring matter in the blood, thedeposit of pigmentary 
matter, and rhe failure of the liver to separate fully the coloring matter of 
the bile. Malaria by its effects in inducing sudden congestions, and by its 
depressing effects upon the heart, and upon the general and capillary cir- 
culation a nd'by its potent action on both the sympathetic and cerebro-spi- 
rA system of nerves. tends to promote the formation of heart-clots, although 
there is an actual diminution of the fibrin of the blood during malarial 
te^er. It is worthv of observation, that in pyaemia and in malarial fever, 
* UeSfEkos of Yellow Fever an-d MaJarial Hematuria, by Joseph Jones, M. D., etc. Ameri- 
eats PfhKatL >»r. Jasanary. >~s pp.1-3-22. 
v Hfr'&jniiMM'Malarial Fever. An address delivered before the Medical society of North 
<;>-■ ■ iHu'at its aaannal meeti-ns. held in Charlotte. May, 1874, by Wm. A. B. Norcom. M. D., of 
1^3 : r«ca, President of lie Society. 598 
Investigations by Joseph Jones, M. D., on Malarial Hematuria. 
in both of which diseases, there is a more rapid destruction of the colored 
blood-corpuscles than in any other class of diseases, chills should charac- 
terize both affections, and form prominent symptoms. If such facts do not 
point out the nature of the cause of malarial fever, they at least sustain the 
belief that this disease like pyaemia and yellow fever, is due to the action 
of a special poison, and not to mere variations of climate and changes of 
moisture and temperature. 
2d. The rapid destruction of the colored blood-corpuscles in malarial 
fever, is evident not merely by the results of actual chemical analysis, but 
also by the presence of a large amount of coloring matter in the urine. 
While the presence of the coloring matter in large amount in the urine of 
malarial fever may be dependent in part upon some imperfection in the 
excretion of carbon by these organs, whose special function is to eliminate 
this element from the blood, as the liver and lungs, and may as has been 
observed by Golding Bird, be connected with some functional or organic 
mischief in the liver and spleen, or some other organ connected with the 
portal circulation, at the same time. From a careful consideration of the 
accompanying symptoms and subsequent post-mortem revelations, we have 
been led to the belief that in malarial fever, the pigment is derived chiefly 
from the coloring matter of the blood cells, and that its amount may be 
taken as an index or measure of their destruction. This would be true 
whether it comes at once from the blood-corpuscles by changes taking- 
place in the mass of the circulating fluid, or by the destruction of the 
blood-corpuscles in the liver and spleen. Certain it is that this pigment is 
not found in the kidneys, and does not accompany diseases of the kidneys; 
nor is it thrown off under the action of organic medicines and compounds, 
drastic and purgative salts, which irritate and even cause diseases of the 
intestines and kidneys. Even tincture of cantharides, when given in such 
large doses as to cause albuminuria and even blood to appear in the urine, 
does not cause such pigments as purpurine (Bird) uroerythrin (Heller), or 
urohsematin, urophsein to appear in the urine. In those cases of yellow 
fever in which we have the greatest irritation of the kidneys, or rather in 
which there is the greatest structural alteration of these organs, will be 
found as a general rule, the lightest colored urine. On the other hand, 
poisonous metallic salts, which derange the constitution of Vee, colored blood- 
corpuscles, and interfere with the blood making or blood regulating f unctions 
of the liver and spleen, as the compounds of lead, copper, mercury, arsenic, 
and antimony, cause even in small doses the appearance of this substance 
in the urine ; and when taken in doses sufficiently large to produce poison- 
ous effects, the quantity is greatly increased. 
3d. The peculiar action of the malarial poison upon the colored blood- 
corpuscles induces a distinct train of symptoms, and establishes distinct 
recognizable lesions, characterized chiefly by the deposit of pigment mat- 
ter in certain organs. During the active stages of malarial fever, the 
increased temperature and the accelerated respiration and circulation, is 
attended by increase of the products of chemical change, and especially of 
urea, the mineral acids and the extraction and coloring matter of the renal 
secretion. During the active stages of malarial fever, phosphorus and the 
components of phosphorus, in the nervous structures, as well as sulphur 
and the components of sulphur in the muscular structures and blood, 
undergo more rapid changes than in the normal state ; and phosphoric 
acid and the phosphates, and sulphuric acid and the sulphates; as well as 
urea and the coloring matters resulting from the changes of the red blood- 
corpuscles and bile, appear in increased quantities in the urine when the 
kidneys are unimpaired and perform their offices. In that form of parox- Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
599 
ysmal fever called malarial hoematuria, the function of the kidneys is 
impaired, chiefly by rupture of the malpighian corpuscles and the impac- 
tion of the tubuli uriniferi, with coagulated blood, and the urea, mineral 
acids and coloring matters accumulated in the blood. The peculiar intoxi- 
cations, nervous depression, delirium and convulsions which characterize 
certain cases are referable to the conjoined effects of jaundice aud urinary 
suppression ; or in other words, to the effects upon the blood and nervous 
system, and heart, of the constituents of the bile and urine. 
4th. During the slow action of the malarial poison, as well as during 
the active stage of the paroxysms, important changes take place in the 
liver and spleen ; in both organs the colored blood-corpuscles are destroyed 
in large numbers, and the coloring matter resulting from the disintegration 
of the colored corpuscles accumulated in them, and in conjunction with 
other changes in the nutritive processes of these organs, produce these 
characteristic alterations of the normal color. Not only do these changes 
induce the dark slate spleen ami bronze color of the liver hi malarial fever, 
but the particles of pigment may be deposited in other organs, not only 
giving vigor to the peculiar bronzed hue of malarial fever, but they may 
even obstruct the cerebral and renal capillaries, and thus give rise to a 
peculiar train of symptoms. 
5th. In malarial fever as a general rule the bile is greatly increased 
in quantity and altered in chemical constitution and physical properties. 
These changes of the bile are without doubt due to the chemical changes 
in the constituents of the blood, and especially of the coloring matter of 
the l ed globules. In addition, therefore, to lesions of the spleen and liver 
and hepatic and portal congestion, there is increased secretion of bile. The 
jaundice, therefore, in malarial luematuria may be referred to several 
causes, as hepatic congestion, increase of biliary secretion, destruction of 
colored corpuscles and impairment of the function of the kidneys. The 
incessant nausea and vomiting may be due not merely to the effects of the 
bile which has regurgitated into the stomach, but it is also referable to the 
vicarious action of the gastric mucus membrane, in the elimination of the 
excrementitious matter retained in the blood, and especially the urea. The 
vomiting may also be due in a measure to the action of the biliary consti- 
tuents upon the ganglionic centres involved in the act of vomiting. 
6th. Whilst thesudden variations in the physical and nervous phenom- 
ena of malarial fever are accompanied by equally sudden and marked ana- 
tomical lesions in certain organs as the liver and spleen, and changes in the 
blood and excretions ; at the same time I have shown by careful observa- 
tions upon over three thousand cases of the various forms of paroxysmal 
fever, that in the vast majority of cases neither albumen nor blood appear 
in the urine. 
Albumen, however, may be present in the urine of malarial fever, 
under certain circumstances, as : 
a. Its presence in the urine of malarial fever may be due to preced- 
ing disease of the kidneys, of the liver or heart. 
b. To the prolonged action of the malarial poison, and the structural 
alterations induced by it in the spleen, liver and kidneys. 
c. To the congestion of the kidneys from cold, or from the impaction 
in the capillaries of pigment matter, or from the irritant action of the 
malarial poison upon the excretory structures in cases which have suffered 
with repeated attacks of intermittents. 
d. From alterations in the blood caused by the malarial poison induc- 
ing diminution of fibrin and colored blood corpuscles, and impairing the 
proper nutrition of all the organs. It is, however, the exception to the 600 
Investigations by Joseph Jones, M. D.. on Malarial Hcematuria. 
rule, to find albumen or blood iu the urine iu malarial fever. Even in 
those cases where the prolonged action of malaria has produced profound 
structural alterations of the liver, consisting in the extensive deposit of 
black pigment granules within and around the capillaries of the liver, 
obliteration of many of the branches of the portal system, within the lob- 
ules, and in the hardening and contraction of the entire organ, albumen, 
according to my experience, is rarely present in the urine. I have 
examined the urine carefully, without detecting albumen in a number of 
cases of ascites, and extreme dropsical infiltration of the lower extremities, 
produced by the hardening and contraction of the liver, and watery (ana*- 
mic) condition of the blood, in chronic malarial poisoning. 
I have observed cases, however, in which the kidneys were structurally 
altered by the malarial poison in a manner somewhat similar to the changes 
in the liver, in which albumen was a constituent of the urine. A certain 
proportion of such cases may be referred to the causes which ordinarily 
lead to structural alterations of the kidneys, as the excessive use or abuse 
of ardent spirits, and the effects of exposure to wet and cold and extremes 
of temperature in moist, warm climates; but these are cases of albumi- 
nuria, which can be explained only upon the supposition that they are due 
to structural alterations of the kidneys, induced by the prolonged action of 
the malarial poison. And this condition of the urine is not to be referred 
to the watery condition of the blood induced by the destruction of the 
colored blood-corpuscles and diminution of the albumen and fibrin : for the 
state of extreme anaemia frequently induced by the action of the malarial 
poison is seldom, if ever, attended by albuminuria, unless there be some 
structural alteration of the kidneys. 
7th. In that fatal form of malarial fever which is characterized by 
complete jaundice, a general yellow hue of skin, intense and uncontrol- 
able vomiting and haemorrhage from the kidney: this last symptom is 
preceded by congestion of these organs, and is attended by rupture of the 
malpighian vessels, and desquamation of the excretory cells, and fibrinous and 
blood casts o f the tubuli uriniferi. 
It is worthy of note that malarial hematuria haemorrhagic malarial 
fever), as a general rule, occurs only in those who have suffered irom 
repeated attacks of intermittent fever, or who have been exhausted by a 
prolonged attack of remittent fever, and while some of the symptoms, as 
the nausea and vomiting, deep jaundice and impaired capillary circula- 
tion. resemble those of yellow fever, yet there are material differences 
which we have previously and upon various occasions established. 
Sth. Without doubt the peculiar manifestations of this fatal form of 
disease are based upon preceding alterations of the blood and organs, 
which establish a predisposition to congestion, structural alterations and 
inflammations of certain organs, as the brain, lungs, bowels and kidneys. 
Owing to the defibrinated state of the watery blood, the tendency during 
congestions of the paroxysms (especially when aggravated by the agency 
of cold and tho effects of bad diet, and exposure to rhe vicissitudes of a 
moist, damp, malarious atmosphere), is either to serious effusions or 
htemorrhages. No matter in what organ the haemorrhage occurs, the 
subsequent progress of the disease is changed and the pyrexia becomes 
complicated by true inflammatory action. 
9th. In those cases of malarial hamaturia which have come under my 
observation, a careful examination of the blood revealed great diminution 
of the colored blood-corpuscles, with pigment granules and colored blood- 
corpuscles. filled with pigment granules. This condition of the blood 
continued throughout the disease, with a progressive diminution of the Investigations by Joseph Jones. M. D. on Malarial Hcematuria. 
601 
colored corpuscles. The fibrin, which was below the normal standard, 
progressively increased during the active stages of the haematuria, as in 
the case of inflammations generally. There was evident congestion of the 
kidneys, followed by desquamation of the excretory cells of the tubuli 
uriniferi, rupture of the malpighian corpuscles, active haemorrhage and 
the discharge of blood-corpuscles and blood casts of the tubuli uriniferi 
in the urine; during the stage of active congestion and actual haemor- 
rhage the urinary constituents were diminished in amount, and when the 
cases took a favorable change, greatly increased quantities of the urinary 
constituents were eliminated, and when, on the contrary, the functions of 
the kidneys were permanently impaired by structural alterations, and 
especially by the coagulation of the blood and the accumulation of granu- 
lar and cellular elements in the tubuli uriniferi, the urinary excretion 
gradually ceased, or was suddenly suppressed, and death resulted from 
uremic poisoning as well as from exhaustion. In some of these cases 
immense quantities of green biliary fluid was vomited, and it was impos- 
sible to introduce either medicines or nourishment by way of the stomach; 
in other cases the vomiting was also accompanied by profuse biliary dis 
charges of dark matters from tlie intestines, and the rectum could not be 
used either for medication or nutrition. 
10th. In some cases death appeared to result from the exhaustion 
caused by the incessant vomiting and purging, and the patients died in a 
state of collapse, with cold clammy skin and small thready pulse. As a 
general rule, suppression of the functions of the kidneys is a fatal sign, 
and. as in yellow fever, was attended with convulsions, coma and delirium. 
As the skin and tissues as well as the serum of the blood was of a golden 
color, which numerous chemical examinations showed to be due to the 
pressure of bile, and as the urine was in most cases loaded with bile, it is 
but reasonable to refer certain phenomena and even a fatal issue to the con- 
joint action of the bile and urinary constituents dpon the cerebro spinal 
system. Death in some cases appeared to be the result of the great loss of 
blood through the urinary organs. Finally, in every case, the malarial 
poison, without doubt, was active in virtue of its peculiar relations to the 
blood and cerebro-spinal and sympathetic nervous systems, and in conjunc- 
tion with the causes just enumerated caused death. 
11th. The pathological changes observed after death are character- 
istic of malarial fever; enlarged slate and bronzed liver, with pigment 
granules deposited in the capillary net work of the hepatic lobuli and 
around the liver cells, which were pale and with diminished oil globules; 
enlarged spleen, filled with disorganized colored corpuscles and pigment 
granules; gall-bladder distended with thick ropy bile presenting when seen 
en masse, a greenish black color, and in thin layers a deep yellow. From 
one thousand to sixteen hundred grains of thick and in some cases semi- 
solid bile, the fluid portion reaching a specific gravity of 1036 to 1042, and 
occasionally exceeding the specific gravity of the blood of the patient, have 
been obtained from the gall-bladder; while in yellow fever not more than 
one hundred and twenty grains of bile are, as a general rule, contained in 
the relaxed gall bladder.. The serum of the blood as well as the cellular 
tissue generally, presented a golden color and contained bile. The, kidneys 
presented a deep purplish red and congested appearance, and sections with 
Valentine's knife were examined under the microscope; the tubuli urini- 
feri were found filled with coagulated blood and blood-corpuscles, granular 
matter, pigment matter and detached excretory cells. In many specimens 
I have been able to ascertain that the rupture of the capillaries occurred 
chiefly in the malpighian corpuscles: and have been able to trace the tubuli 602 
Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
uriniferi through their whole extent, as brilliant opique cylinders filled 
with coagulated blood. It is evident, therefore, that the issue in any case of 
malarial haematuria will largely depend upon the number of urinary tubes thus 
blocked up with coagulated blood. 
In some cases of yellow fever, I have found the gall-bladder to contain 
only an albuminoid liquid, coagulable by heat and nitric acid; and in other 
cases I have found the gall-bladder distended with dark liquid blood: but 
I have never witnessed this remarkable transudation and haemorrhage from 
the mucus membrane of the gall-bladder in malarial haematuria. 
The bile of malarial haematuria is highly concentrated, and as far as 
my experience extends, never contains blood; neither is the dark green (black) 
vomit of this, disease blood or altered blood, but it is an acid secretion 
from the stomach highly charged with bile. Bile is universally present in 
the vomited matters of malarial haematuria, bile is universally absent from the 
black vomit of yellow fever; in the former disease the whole system, blood, 
stomach, intestinal canal, and organs generally, are deluged with bile: in 
yellow fever, the coloring matters and acids of the bile are found in the 
blood, but in the third stage of the disease, namely that of calm and 
depression and black vomit, bile is absent throughout the gastro-intestinal 
canal. 
I have thus clearly demonstrated that malarial hannaturia is related to 
the various forms of true malarial fever (intermittent, remittent and con- 
gestive). and in fact is only one of the phases of this fever, which may at 
any time be assumed, after the alterations of the blood, liver and spleen, 
induced by the prolonged action of malaria, have been established in pati- 
ents badly nourished and exposed to such vicissitudes of heat, moisture 
and cold as tend to produce sudden congestions of the internal organs. I 
have also shown that this disease is entirely distinct from yellow fever, 
although it may have some symptoms in common, as jaundice, "black 
vomit" and albuminuria. 
It is unnecessary to consider the views which I expressed in these 
various communications with reference to the principles of treatment of 
malarial haematuria, as this subject will be more fully considered hereafter; 
but we may briefly condense the measures which had been employed in 
my practice, as follows : 
1st. Prompt purgation, with such agents as calomel, extract of 
rhubarb and aloes. 
2d. Counter irritation over the region of the kidneys. 
3d. Cut cups-the local abstraction of blood over the region of the 
kidneys by cut-cups. 
4th. Quinine in full and sufficient doses to prevent the recurrence of 
the paroxysms. 
If rejected by the mouth, the quinine must be administered by the 
rectum, and if both avenues are closed in virtue of incessant purgation 
and vomiting, then it may be introduced by subcutaneous injection, or 
through the blistered surfaces. 
5th. Nutritious diet, in small quantities and at regular intervals, 
when retained by the stomach. 
6th. The persistent use of calomel, rhubarb, aloes and colocynth in 
small doses, combined with quinine, at regular intervals, three or four 
times a day, during the continuance of the jaundice, if the bowels are 
torpid. 
7th. After the establishment of convalescence, the continuous use of 
such tonics as the nitro-muriatic acid and tincture of sesqui chloride of 
iron, in combination with quinine; nutritious diet; generous wine, and Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
603 
change of climate to an elevated, non-malarious region, if within the 
power of the patient. * 
MALARIAL HEMATURIA; SYMPTOMS, CHANGES OF TEMPERATURE, PULSE 
AND RESPIRATION; COMPOSITION OF BLOOD AND URINE; TREATMENT; 
INVESTIGATIONS OF JOSEPH JONES, M. D. 
In that form of malarial fever characterized by complete jaundice, 
nausea, incessant vomiting of green biliary matters, and haemorrhage from 
the kidneys, which has received different names, at different times, and in 
several countries, and which is no new disease even in these Southern 
States, the haemorrhage from the kidneys is preceded by congestion of 
these organs, and is attended with desquamation of the excretory cells and 
casts of the tubuli uriniferi of these organs. 
Malarial haematuria (haemorrhagic malarial fever), as a general rule, 
occurs only in those who have suffered from repeated attacks of intermit- 
tent fever, or who have been exhausted by prolonged attacks of remittent 
fever; and whilst some of the symptoms, as the nausea, incessant vomit- 
ing (and in some cases black vomit) and deep jaundice and impeded capil- 
lary circulation, resemble those of yellow fever, yet there are marked 
differences between the two diseases. The presence of the albumen in the 
urine of "'malarial haematuria" is attended also with the presence of col- 
ored blood-corpuscles, excretory cells of the kidneys, and casts of the 
tubuli uriniferi, impacted oftentimes with altered corpuscles. I have even 
detected portions of the lining membrane of the malpighian capsule con- 
taining colored corpuscles, and deeply stained by the coloring matters of 
the blood. As a general rule, in severe cases of yellow fever, the tubuli 
uriniferi, both in the kidneys themselves after death, and the casts in the 
urine excreted during the second stage of the disease, are loaded with 
yellow granular, albuminoid and fibroid matters. 
We select the following cases, from a number which we have observed 
at various times, and the effort has been made by chemical and microscopi- 
cal examinations of the blood and urine to establish the true nature and 
relations of this dangerous form of disease. 
Case No. 914.-J. C. Easterland, age 21; fair complexion, light hair, 
blue eyes, 5 feet, 10 inches in height, weight 143 lbs., native of Carrollton, 
on Tombigby River, Alabama, entered Charity Hospital (Ward 31, Bed 
466), November 27th, 1876. The patient describes his native place near 
Carrollton, as a low marshy swampy tract of land, where chills and fever 
prevailed, and he was informed by his parents, that at the early age of two 
weeks, he suffered with attacks of chills and fever. ' He states, that he was 
subject to chills and fever, during his residence at this locality, and his 
spleen remained enlarged. Between the ages of ten and nineteen, he lived 
in Jasper County, Mississippi, near Garlansville, one of the most healthy 
regions in that State ; during this period, labored on a corn and cotton 
farm, and always enjoyed excellent health, nevertheless the spleen contin- 
ued hard and enlarged. From his nineteenth year, until a short time ago 
(21st year of age) he was employed as a carpenter in Washington County, 
MALARIA H2EMATURIA. 
* Relations of Yellow Fever, Malarial Fever and Malarial Heematuria, by Joseph Jones, M. 
D. The American Practitioner. Vol. vii, No. 37. 1873, p. 13. Haemorrhagic Malarial Fever, by 
Wm. A. B. Norcom. M. D., Baleigh, N. C., 1875. Malarial Heematuria; Natural History and 
Treatment, illustrated by ca«es by Joseph Jones, M. D. New Orleans Medical and Surgical Jour- 
nal, New Series, vol. v, Februa>y,1878, No. 7, 575, 591. 604 
Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
Mississippi, near Greenville, a section of country very unhealthy on account 
of its marshes and swamps. 
In August, 1875, after working three months in a swamp, after a sud- 
den change in the weather, was seized with nausea, and a severe chill which 
lasted two and a. half hours, and was followed by a u burning fever." His 
physician administered calomel and quinine, and he was vomited and- 
purged freely. Three weeks before this attack, the patient observed that 
his urine was dark colored ; and during the paroxysm of fever, it assumed 
a very dark brown color, and was diminished in quantity. His recovery 
was tedious, aud he remained weak and anaemic, during the fall and win- 
ter, and was not fully restored to health until May, 1876. 
On the 1st of June, 1876, he felt drowsy, dull, and stupid, and could 
not perspire, even whilst laboring in the hot sun. On the 5th of June, was 
prostrated by a burning fever, and on the 8th of June, had a chill which 
lasted one hour and was followed by high fever. During this attack his 
m ine was of a deep brown color. Continued weak and was placed on iron 
to improve the condition of his blood. On the 19th of June, he took a 
ride of fifteen miles on horseback, which greatly exhausted his strength, 
aud was followed at night by a "burning fever." On the 24th of June, 
suffered with violent cramp colic. 
On the 1st of July, had a congestive chill, followed by jaundice and 
high fever. Was confined to his bed. until the 7th of August. On the 21st 
of August, again seized with a high fever, which continued unabated until 
the 25th, when he had a slight chill, after which the fever resumed its 
course. Was treated with quinine and squills ; the chills were arrested, 
but a " slow fever11 continued. In September, he again became slightly 
jaundiced. On the 16th of November, chill followed by fever sof eighteen 
hours. Feeling stronger, he determined to immigrate to Texas, and arrived 
in New Orleans, on the 27th of November; but was compelled by sick- 
ness to discontinue his journey. On the 28th, was seized with a "conges- 
tive chill,'1 which lasted for two hours, and was followed by intense jaun- 
dice and high fever. The entire surface assumed a deep yellow color dur- 
ing the night of the 28th. 
Admitted to the Charity Hospital of New Orleans, November 29th, 
1876, 4 o'clock, P. M. (ward 31, bed 466). At the time of his admission 
the patient presented the following symptoms: Intense jaundice, the 
entire surface of the face and body as yellow as gold; pulse rapid, 144 
beats per minute; respiration, 30; temperature of axilla, 102.°5; nausea, 
vomiting, restless. 30th, 9 A. M.; pulse, 132 ; respiration, 16; temperature 
of axilla, 98° F.; vomits large quantities of dark green biliary matter. 
Has passed no urine since entering the hospital. Jaundice intense, even 
the saliva is of a golden color ; appearance of great antemia; lips, tongue, 
gums and the hands pale and bloodless ; dullness upon percussion on the 
right side from the sixth rib downwards, for two inches below the border 
of the false ribs; great tenderness upon pressure in the epigastric and 
hypochondriac regions ; pressure over the region of the stomach and liver 
causes the patient to shrink and cry out; flatness upon percussion over the 
region of the spleen and the area ofdulluess due to the enlargement and indu- 
ration of this organ, extends in the left hypochondiac region, downwards 
from the border of the false ribs, six inches, and laterally four inches and a 
half. The enlarged and indurated spleen may be readily grasped with the 
hands pressed firmly against the abdominal walls. Palpation and percus- 
sion also reveal the outlinesof thecongested, enlarged and tender liver. The 
enlarged spleen encroaches about one and a half inches upon the umbilical, 
and about three and a half inches on the left lumbar region. Administered Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
605 
eight grains of calomel and ten grains of quinine by the mouth, also threw 
up the rectum ten grains of quinine in two ounces of water ; applied sina- 
pisms over epigastrium, and also over region of kidneys ; ordered ten 
grains of quinine every three hours until thirty grains were administered 
to the first dose. As a drink, iced water charged with carbolic acid gas;, 
diet beef tea and milk and lime water. 7th October. Pulse, 134; respira- 
tion, 22; temperature, 99.°5. The kidneys have resumed their functions,, 
and the urine presents a deep brownish-red color and contains blood. The 
vomiting has ceased and the patient is quiet, although the pulse is very 
rapid and feeble. 
December 1st, 8 A. M. Pulse 122, respiration 22, temperature 100° F. 
Jaundice continues; bowels have been moved. The quinine was ordered 
to be continued, in the proportion of five grains every three hours. The 
tenderness in the hypochondriac and epigrastic regions continuing, and, 
the patient also complaining of great pain in the lumbar region, I deter- 
mined to abstract blood by means of cut-cups. The blood flowed slowly 
and with difficulty, and rapidly coagulated from the lumbar regions, over 
the location of the kidneys; but the flow of blood was sufficiently free from, 
the epigastric and hypochondriac regions. The cupping appeared to be 
productive of good, and the patient experienced great relief. 
CHEMICAL AND MICROSCOPICAL EXAMINATION OF BLOOD. 
Serum of the blood of a deep golden yellow color. When the blood was 
dropped on white bibulous paper, the central carmine spot, containing the 
red corpuscles, was surrounded by a deep orange colored border. See plate 
13, figure 51. Careful tests revealed the presence in the serum of,the blood,, 
of the coloring matters and acids of the bile The deep golden hue of the 
serum was caused by the bile pigment, and imparted the golden hue to the 
skin and conjunctiva; coagulum firm: separation between clot and serum, 
perfect. The clot floated in golden colored serum. Under a magnifying 
power of 420 diameters, numerous dark granular masses, dark spherical 
bodies resembling spores, and pigment cells from two to four times the size 
of the colorless corpuscles were observed in the blood. Many of the col- 
orless corpuscles contained numerous pigment particles. See plate 13,. 
figure 52. 
ANALYSIS OF BLOOD, MALARIAL HAEMATURIA. 
1000 parts of blood contained- 
Water 820.50 
Solid matters, including fixed saline 179.50 
Fixed saline matters 7.18 
1000 parts of serum contained- 
Water 902.66 
Solid matters, including saline 97.34 
Fixed saline matters 5.77 
1000 parts of blood contained-• 
Water 820.50 
Dried colored blood-corpuscles 86.47 
Fibrin 4.50 
Albumen and extractive matters 88.53 
Saline matters* 7.18 
* It is evident that In the preceding analysis the saline matters of the blood-corpuscles and> 
albumen and extractive matters, are all included in the figures 7.18 representing the fixed saline- 
matters, and hence the sum total of the analysis exceeds li)03. 606 
Investigations by Joseph Jones. M. D.. on Malarial Hoematuria. 
The extractive matters of the serum were not determined directly by 
quantitative analysis: but by various experiments it was shown that they 
contained urea, and the coloring matter and acids of the bile, and were 
far more abundant than in normal blood. 
The colored blood-corpuscles were diminished: but not to the extent 
which I have often observed in the various forms of chronic intermit 
tent of long standing, attended with greenish-yellow and dark bronzed 
liver, and bloodless lips and tongue. The moist blood-corpuscles in 
this case were about 345.88 in the 1000 parts of blood: and the liquor 
sanguinis 654.12. In healthy blood the dried globules may vary in the 
1000 parts from 120.00 to 150.00; and the moist globules from 480.00 to 
600.00; and the liquor sanguinis from 520 00 to 400.00. It is evident, there- 
fore. that in this case of malarial ha-maturia the blood contained relatively 
a much greater proportion of liquor sanguinis and a less number of glob- 
ules than in health. 
It is also worthy of note that the fibrin was increased and reached 4.50 
parts per 1000 of blood. The blood also coagulated firmly and there was 
no appearance of the dissolution of the colored blood-corpuscles in the 
serum. The formation of the dark pigmentary particles in the blood is not 
peculiar to malarial hiematuria. and it is probable that a large proportion 
of these were derived from the changes of the blood in the spleen and liver. 
The increment of the fibrin in the blood in this case is of the greatest 
interest, as indicating that an inflammatory condition of this fluid as well 
as of the organs most deeply involved, namely, the kidneys, exists. Such 
results overthrow entirely the view that malarial hiematuria is the result 
of the action of some sudden and potent agent upon the blood-corpuscles 
which causes their dissolution in the bl c od vessels and the escape of the 
hiematiu through the excretory structures of the kidneys. 
The establishment of the fact that malarial hiematuria is often if not 
invariably attended by an inflammatory condition or hyperfibrinated state 
of the liquor sanguinis and structural alteiaiion and inflammation of 
certain portions of the kidneys, will lead to new views as to the pioper 
method of treatment and will go far to sustain the practice of those phy- 
"Sicians who employ local depletion and mercury in small and continuous 
doses in this disease. 
CHEMICAL AND MICROSCOPICAL EXAMINATION OF URINE OF MALARIAL 
ILEMATURIA. 
Amount of urine passed during twenty-four hours. November 30th. 9 
A. M. to December 1. 1876. cubic centimetres. 1560 up to this observation, 
commencing November 30th. the urinary excretion had been almost entirely 
suspended and the patient state> that during the preceding chills and fever 
he had passed little or no urine. 
Heavy deposit of casts of urinary tubes, excretory cells, blood corpus- 
cles. and urate of ammonia, giving to the urine a muddy, brownish-red 
color. This deposit settled very slowly and the clear ur ine then presented 
a deep brown and greenish-black color. The deposit contained blood, and 
stained bibulous paper of a red and yellow color, and small coagula of 
blood were also visible. Chemical analysis revealed the presence of both 
biliary coloring matter and biliary acids in the urine : also blood and albu- 
men. 
Under the microscope the casts of the tubuli uriniteri were stained 
of a deep orange yellow and reddish-brown color, from the presence of the 
coloring matters of the blood and bile. Masses of altered hiematin, of Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
607 
dark brown and black color, were also observed in the urine. The appear- 
ance presented by the urinary deposit is represented in plate 13, figures 53 
and 54. Reaction of urine, acid, sp. gr. 1014. 
1560 cubic centimetres of urine contained: 
Grains. 
Urea 528.52 
Uric acid 18.72 
Phosphoric acid 120.12 
Sulphuric acid 51.38 
Chloride of sodium 24.02 
Blood casts and albumen and bile Undetermined. 
As the patient was in a state of starvation, taking little or no nourish- 
ment, we observe a great increase of the urea, uric acid, and especially of 
the phosphoric acid; 7 P. M., P. 110, R. 21. Temp. 100°. December 2d, 8 
A. M,, intense jaundice, surface of a bright golden color; conjunctiva of 
eyes of a deep golden color. Saliva and mucus from nose of a deep golden 
color. Pulse rapid. Temperature of trunk but slightly elevated. Pulse 
80, respiration 20, temperature of axilla 99° F. Urine abundant, reddish 
orange, with heavy deposit of urates and casts. Amount of blood in urine 
diminished. Urinary deposit similar to that in preceding sample, but casts 
and urinary tubes less abundant. The urine contained bile pigment and 
biliary acids. Upon standing the deposit fell, and left a brownish greenish- 
black colored urine. Amount of urine passed during 24 hours 1520 C. C. 
(Dec. 1st, 9 A. M., to Dec. 2d, 9 A. M.) Specific gravity 1015. reaction acid. 
1520 cubic centimetres of urine passed during 24 hours, (Dec. 1st, 9 
A. M., to Dec. 2d, 9 A. M.), contained : 
Grains. 
Urea 585.20 
Uric acid 18.24 
Phosphoric acid 87.78 
Sulphuric acid 25.93 
Chloride of sodium 23.24 
Blood and albumen greatly diminished, but exact amount not determined. 
For appearance of urinary deposit, see plate 13. 7 o'clock P. M., pulse 
74, respiration 19, temperature 100° F. Dec. 3d, 8 A. M., pulse 71, respi- 
ration 18, temperature of axilla 99. °5 F. Continues to improve slowly, 
although deeply jaundiced and very weak. Amount of urine passed dur- 
ing 24 hours, Dec. 2d, 9 A. M., to Dec. 3d, 9 A. M., 1150 c.c., sp. gr. 
1017; Reaction acid, orange red color. Heavy deposit of urates, casts 
and desquamated cells. Deposit in urine of this day, as well as in that of 
yesterday, dissolved to a large extent by heat. After standing the deposit 
subsided and the urine presented a a deep brownish-green color. Urine 
contained a mere trace of albumen, and the casts had almost entirely dis- 
appeared. 
1150 c.c. of urine passed during twenty-four hours, December 2d, 9 
A. M. to December 3d, 9 A. M., contained: 
Grains. 
Urea 566.72 
Uric acid 17.25 
Phosphoric acid 44.57 
Sulphuric acid 22.81 
Chloride of sodium 26.56 
Albumen Trace. 
After the fall of the urates, the urine assumed a greenish, almost black 
appearance ; coloring matters and acids of bile present. Eight o'clock, P. 
M.-Pulse 72; respiration 18; temperature of axilla 98. °5. December 
4th, 8 A. M.-Pulse 69; respiration 19; temperature of axilla 100.°5. 608 
Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
Patient continues to improve. The treatment has consisted chiefly of 
quinine (twenty grains in five grain doses every three hours, at 6 A. 
AI., 9 A. and 12 AI.) and nutritious diet. One or two evacuations of 
the bowels have been secured each day by means of small doses of extract 
of rhubarb and aloes. Amount of urine passed during tweny-four hours, 
December 3d, 9 AM, to December 4th, 9 A. AI., 825 c.c. Sp. gr. 1018, 
reaction acid, heavy deposit of urates, soluble by heat. Alere trace of 
albumen. Under the microscope the deposit of urates, as heretofore, 
consist of granules, colored of a deep yellow by bile pigment. The casts of 
the urinary tubeshave almost entirely disappeared. 825 c. c. of urine passed 
during twenty-four hours, December 3d, 9 A. AI. to December 4th. 9 A. AI., 
contained: 
Grains. 
Urea 444.67 
Uric acid 6.60 
Phosphoric acid 26.93 
Sulphuric acid 17.54 
Chloride of sodium 31.41 
Albumen., Trace. 
7 o'clock P. AI.-Pulse 75 ; respiration 18 ; temperature of axilla 
100.°5. F. December 5th, 8 A. AI.-Pulse 67 ; respiration 19; temperature 
of axilla 100° F. Jaundice diminishing; red color of lips more appar- 
rent. Patient much better; has some appetite. Amount of urine passed 
during twenty-four hours, December 4th, 9 A. AI., to December 5th, 
9 A. AI., 1220 c.c. Sp. gr. 1018. Acid reaction. Heavy deposit of urates 
on standing. Biliary coloring matters and acids present. Albumen and 
blood entirely disappeared and only a few light colored casts present. 
1220 c.c. of urine passed during twenty four hours. December 4th, 9 A. AI., 
to December 5th, 9 A. AI., contaiued: 
Grains. 
Urea 563.64 
Uric acid 6.10 
Phosphoric acid 32.97 
Sulphuric acid 26.34 
Chloride of sodium , 27.18 
7 o'clock P. M.-Pulse 72; respiration 22; temperature 100.°5F. Decem- 
ber 6th. 8 A. AI.-Pulse 67 ; respiration 19; temperature of axilla 99.°25. 
Patient continues to improve; complexion much clearer. Yellow jaundiced 
hue gradually fading ; no albumen nor blood in the urine ; no deposit of 
urates. Urine of dark, blackish, green color; coloring matters and acids 
of bile present. Patient sat up this morning and was carried down in a 
chair to my clinical lecture in the amphitheatre. 
1140 cubic centimetres of urine passed during twenty-four hours, 
December 5th, 9 A. M., to December 6th, 9 A. M., contained: 
Grains. 
Urea 474.10 
Uric acidl 3.32 
Phosphoric acid 19.76 
Chloride of sodium 96.55 
Sulphuric acid 29.81 
7 o'clock P. AI.-Pulse, 72; respiration, 22: temperature of axilla, 
100. °25. December 7th. 8 A. M.-Pulse. 66: respiration. 19; temperature 
of axilla. 100° F. December 8th. 8 A. AI.-Pulse, 108; respiration, 20; tem- 
perature of axilla. 100° F. 7 P. AI.-Pulse, 65; respiration, 20; tempera- 
ture. 100° F. December 9th. 8 A. M.-Pulse. 70; respiration, 19; temper- 
ature, 100s F. 7 P. M.-Pulse, 79; respiration, 19; temperature, 100° F. Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
609 
December 10th, 8 A. M.-Pulse, 127; respiration, 23; temperature, 100® F. 
7 P. M.-Pulse. 115; respiration. 20; temperature, 100° F. 
We observe in the preceding case that the pulse, which was 144 per 
minute; the respiration 34 per minute, and the temperature 102. °5 F., were 
iu like manner reduced after the evacuation of the bowels and the free 
administration of the sulphate of quinia. From the 27th of November up 
to the Sth of December, the pulse and respiration gradually descended to 
the normal standard; and the temperature of the trunk oscillated between 
98.° and 100. °5 F. In the determination of the temperature I was assisted 
by my student. Mr. C. A. Bourgeois. On the 8th of December, and on 
the 9th, the patient suffered from indigestion, attended with vertigo and 
acceleration of the pulse: and this derangement was consequent upon 
overloading the stomach. Under the continuous action of quinine and 
iron and gentle occasional purgation, the patient continued to improve, 
the jaundice disappeared, and at the time of his discharge from the 
hospital appeared to be fully restored to his usual health and strength. 
Table Illustrating the Relations of the Pulse, Respiration. Temperature and 
Urinary Excretion in the Case of Easterland-Malarial Hematuria. 
X © 
X 
X X 
□ 
Pulse. 
Resp. 
Temperature. 
25 J x 
o 
C O 
Ur 
21 J 
LVlt 
)f I 
fou 
- 
3s I- 
DATE. 
c- 5 - 
.22 
br 
be 
be 
bi 
- 
- 
- s - 
< 
2 - 
© 
© 
£ 
C 
S 
© 
< X 5 
Uric 
2 ' - 
Cen Grns Grns 
Gr'ns Gr'ns 
Gr'ns 
November 29 
144 
34 
102.°5 
" 30 
132 
134 
16 
22 
98.° 
99. °5 
December 1 
122 
110 
22 
21 
100.° 
100.° 
1560 1014 528.5 
18.7 
120.2 51.3 
24.0 
" 2.... 
80 
74 
20 
19 
99.° 
100.° 
1520 1015 585.2 
18.2 
87.7 25.9 
23.2 
" 3 
71 
72 
18 
18 
99. c5 
98.c5 
1150 1017 566.7 
17.2 
44.5 22.8 
26.5 
" 4 
69 
78 
18 
18 
100.°5 
100c5 
825 1018 444.6 
6.6 
26.3 17.5 
31.4 
o 
67 
1*' 
19 
100.e 
100.c5 
1220 1018 563.6 
6.1 
32.9 26.3 
27.1 
" 6 
67 
1'2 
19 
22 
99.°25 
100.c25 
1140 474.0 
3.3 
19.7 29.8 
96.55 
" 7 
66 
1'2 
19 
22 
100.° 
100.° 
100.° 
100.°25 
100.° 
" 8 
108 
70 
20 
20 
9 
99 
19 
19 
100.° 
| ■ 
10 
127 
115 
23 
20 
100.° 
100.° 
1013 
I 1 
MALARIAL HEMATURIA COMPLICATED WITH PLEURITIS. 
Case 915. Mr. H , light hair, fair complexion, well-built, active 
man. Has been much exposed to the malaria of the Mississippi Valley 
during the building of levees. Was seized on the night of the 26th of May, 
1877. at the residence of Judge M., 267 Josephine street, with a severe 
chill, which lasted about four hour's. In the morning. May 27th. I found 
the patient of a deep golden color-, and suffering with intense pain in the 
right lung, which upon careful auscultation and percussion was determined 
to l>e due to inflammation of the pleura. I immediately ordered a large blis- 
ter. eight by eight inches to be applied over the region of pain on the left 
side, also the following: B. Quiniae sulph., grs. xxx: hydrargyri subchloride, 
grs. xr extract aloes, extract rhei, a a grs. x; mix. divide into ten pills, two 
pills every two hours. Believing the case to be one of malarial hrematuria, 610 
Investigations by Joseph Jones, M. D.. on Malarial Hoematuria 
complicated with pleuritis, I requested that the urinary secretion should 
be carefully preserved. The partner of this gentleman, Mr. G. P, had 
been seized with double pneumonia, on the 18th of March, 1877, and 
died on the 25th, after an illness of about eight days. Both lungs in this 
case were involved ; almost the whole of the middle and lower lobes of the 
right, and the lower lobe of the left. The pleura of the left lung as well as 
the pericardium was also involved, and the sufferings of the patient from 
this complication were of the severest character. A remarkable feature of 
this case, was that the expectoration from the lungs which was quite abun- 
dant, consisted of little less than pure blood, and death took place finally, 
apparently from the tilling up of the bronchial tubes with coagulated 
blood. The efforts of the patient to breathe and to dislodge the clots by 
coughing during the last twenty-four hours of life, were of the most dis- 
tressing character. I treated this case by means of quinine, Dover's pow- 
ders, blisters, and nutritious diet, (milk punch and beef tea), at regular 
intervals, and also applied a blister over the left lung. The haemorrhage 
of blood from the lungs continued unabated up to the hour of death. This 
patient was also jaundiced. 
It is, therefore, a matter worthy of careful consideration, that two 
active young men, both in the same business, and upon the same locality, 
namely, the construction of levees on the Mississippi river, should have 
been seized with chill followed by jaundice; and the one with pleuro- 
pneumonia and haemorrhage from the lungs, and the other with pleuritis 
and haemorrhage from the kidneys. This observation in like manner sus- 
tains the view that we must regard malarial haematuria, as the supervention 
of an inflammatory disease upon a fever. 
Upon my return at the end of ten hours, I found that Mr. H. had 
passed a quantity of dark, bloody urine, in which the clots of blood were 
clearly visible. The blister had drawn well and the serum which flowed 
from the surface in great abundance, was of a golden color. The serum from 
the blister had discolored the bed and pillow, which looked as if deep, yel- 
low paint had been spread over them. The blister appeared to have exei ted 
the most beneficial effects, in relieving the congestion of the left lung and 
pleura, and the complete dissipation of the pleuritic pain. The bowels 
were freely moved, and the quinine was continued, and the strength sup- 
ported with beef tea. 
On the 28th the discharge of bloody urine presenting the same micro- 
scopical and chemical characters, as in the preceding case of Easterland, 
but there was a marked improvement in the pulse, which was reduced 
from about 140 beats to about 100, and the patient expressed him- 
self stronger and better. The blister continued to discharge large quanti- 
ties of golden colored serum. On the 29th the urine was much clearer and 
lighter colored and contained much less blood, and only a comparative small 
number of high-colored casts. During the past forty-eight hours, I had 
administered to the patient 100 grains of quinine in the form of pill and in 
combination with small quantities of calomel, aloes and rhubarb. The 
results of this treatment were of the most satisfactory character, and on the 
31st the patient was able to sit up. By attention to the diet', and by the 
daily use of one or more doses of quinine combined with iron and rhubarb, 
this gentleman was entirely restored, and at this moment, enjoys excellent 
health. 
Case 916.-Win. M., age 21. light complexion, red hair, native of New 
York ; has been working in a low malarious situation on the Mississippi 
MALARIAL H^EMATUKIA. Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
611 
river. Entered Charity Hospital November 1st. 1871, suffering with mala- 
rial intermittent, which appeared to yield readily to quinine, and the 
patient was discharged, and again went to work on the banks of the Mis- 
sissippi. The chills and fever again returned, and the patient re entered 
the Charity Hospital on the 26th of December. Had a chill at the time of 
entrance, and presented a pale, anaemic sallow hue. December 27th- 
morning-clear of fever. 7 o'clock P. M., patient seized with a severe 
chill, which lasted two hours, and was followed by fever of great intensity, 
which declined towards morning, and at 9 A. M. (Dec. 28th) pulse 110, 
temperature of axilla 101°. During the cold stage last night, commenced 
passing bloody urine, in considerable amount, (it was not possible to ascer- 
tain the exact amount, but the secretion was not apparently diminished). 
The urine was of a deep blood color, and bloody odor, and resembled to 
the eye liquid blood. Heat and nitric acid produced a heavy coagulum, 
which was very high colored, from the presence of the coloring matter of 
the blood. After the removal of the coagulum by filtration, and the con- 
centration of the filtrate, the addition of nitric acid, caused the formation 
of a heavy crop of the lozenge-shaped and tabular crystals of the nitrate of 
urea. The presence of urea in consider able amount was still farther' deter- 
mined by the addition of the solution of the per-nitrate of mercury to the 
filtrate. When the filtrate was allowed slowly to evaporate upon a glass 
slide, numerous octohedral and dagger-shaped crystals of chloride of sodium, 
made their appearance. The presence of chlorine and of phosphoric acid 
and sulphuric acid, was also demonstrated by the appropr iate tests. 
Under the microscope the urine contained numerous granular parti- 
cles, apparently composed of fibrin and altered fragments of blood-corpus- 
cles ; also blood-corpuscles, some of which were swollen, and others rup- 
tured, and others distorted and shriveled. The number of colored blood- 
corpuscles appeared to be much less numerous than in an ordinary uncom- 
plicated case of hsematuria, dependent upon active haemorrhage from the 
kidneys, or bladder ; and it was supposed that some of the colored glo- 
bules had been ruptured in the capillary net work and in the excretory 
structures of the kidney, and the coloring matter had exuded through the 
capillaries and excretory tubes, along with the serum of the blood. This 
specimen of urine, which had stood for some hours in an open vessel, dur- 
ing the night and morning of its passage, contained some sporules and 
delicate branching filamentous cells, of a fungous growth. The presence of 
these plants appeared to be due to the exposure of the urine in the ward, 
as they were not observed in specimens of urine collected subsequently in 
stoppered vessels. The following was ordered : E. Quinise sulph., 5!; 
acidi sulphurici aromatic, m. x.; aqute f^vi; administer one-half at once, 
and the remainder in one hour and a half. Diet, beef tea and alcoholic 
stimulants. 
29th-morning. Quinine retained; patient restless ; says that he passed 
a very restless night, and suffered with ringing in the earsand head, vom- 
ited during the night a greenish fluid, and complains of nausea at the pres- 
ent time. Sweated profusely during the greater portion of the night. 
Features palid and sombre; fingers wrinkled and shriveled; pulse 140, 
temperature of axilla 104° F., skin moist and relaxed ; thirst exrteme. E. 
Chloral hydrate ^iij, syrupi cort. aurantii fgii, aquse f^iv ; mix: f^ss, every 
half hour, until the patient is quiet. Continue nutritious food and alco- 
holi cstimulants. Apply sinapisms over epigastric region ; continue acid 
drink. 
Patient still passing bloody urine; passed at one time, apparently 
without pain or inconvenience, f^xii of bloody urine. The color, however, Investigations by Joseph Jones. M. D.. on Malarial Hcematuria. 
612 
does not appear so deep as on yesterday. There appears to be no diminu- 
tion of the quantity of blood. Specific gravity of mine 1026 : reaction 
acid: when passed turbid: upon standing, let fail a heavy brownish-yellow 
flocculent deposit. Under the microscope, the deposit was found to consist 
of numerous cells from the urinary tubes, highly colored by the coloring 
matter of the blood, and filled with highly colored granular matter : also 
numerous casts of the urinary tubes, filled with colored blood corpuscles, 
and highly colored fibroid matter. 
4 o'clock P. M.. symptoms unchanged, except an inclination to sleep. 
Stomach still very irritable : temperature of axilla 104° : pulse 140: skin 
hot but moist: urine which has just been passed very red: great thirst. 
30th. 9 o'clock A. M. Patient passed a very restless night: nausea con- 
tinuous : skin hot but moist: thirst very great: pulse 150; respiration 30; 
temperature of axilla 140° F: continues to pass bloody urine: complains of 
great pain in the region of the kidneys. Urine of a much lighter color, 
and of a deep orange red. with heavy yellow deposit of excretory cells and 
casts of the tubuli uriniferi. Urine also contains blood-corpuscles. 
Chemical analysis, showed the presence of urea, and the chlorides, phos- 
phates and sulphates. Specific gravity 1022. of urine passed during the 
night, and 1019. during this morning. The color of the morning urine, is 
lighter than that passed during the night, contains less blood-corpuscles, 
less albumen, and much fewer excretory cells and urinary casts. 
Forty-seven fluid ouncesof urine have been passed during the last twenty 
four hours; heat and nitric acid produced, only a slight coagulation in the 
last sample of urine passed this morning. R. Magnesite snip, si : aqua* 
fy^vi. make a solution, and administer a wineglassful every hour until the 
bowels are moved. R. Autimouii et pot. tart, grains ii; morphia sulph. 
grains ii: aqme fsviii: mix: tablespoonful every four hours, until nausea is 
induced. R. Quinia? sulph. grains xx. acidi aromat. sulph. Q. S; divide 
into 10 pills, and administer ar once. Continue nutritious diet and alcho- 
holic stimulants 4 o'clock P. M. Skin warm but moist: complains of dis- 
tressing nausea: thirst very great: pulse 130; temperature of axilla 103°; has 
had two small evacuations. 
31st. 10 o'clock A. M. Patient appears to be much improved: rested 
welt during the night: still complains of nausea, but not to the extent of 
yesterday. The nausea prevented the administration of the tartar emetic 
solution. Bowels moved seven times during the past twenty-four hours- 
The nausea seemed to be increased immediately after the administration 
of the solution of sulphate of magnesia. Skin moist and relaxed, com- 
plains of great pains in the lumbar regions. Pulse 110: respiration 20: 
temperature of axilla 100. 5 F: has some appetite: urine abundant: sp. gr. 
1019: reaction acid; bright orange yellow, nearly normal in color. Blood- 
corpuscles. and casts and cells of urinary tubes, still present but greatly 
diminished in numbers. Albumen greatly diminished. Urea, chlorides, 
sulphates and phosphates present in normal quantities. R. Quinia* sulph. 
grains xx. administer at once. 
January 1st 1872. 9 o'clock A. M. Patient greatly improved; pulse 
97: temperature of axilla 99-; respiration 20: skin moist and relaxed: 
patient in gentle perspiration, urine normal in color, no deposit: under the 
microscope, only a few cells and casts could be discerned. Albumen in 
very small quantity. The patient was placed upon the following mixture. 
R. Ferri sesquichloridi. tinct. quinia* <ulph. 3SS; aqme f^xvi; wine- 
glassful three times a day. 
The patient continued to improve and was discharged from the hos- 
pital. A eareful examination of the blood was made in rhe preceding case. Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
613 
and the colored globules were found to be greatly diminished: and this 
change in the blood was characteristic of all such cases, which have come 
under our observation. 
I have observed other cases of malarial haematuria. in which the 
changes of the urine were similar, and in which there was in like manner 
evident congestion of the kidneys, attended with desquamation of the 
excretory cells of the tubuli uriniferi. and active haemorrhage. 
In some of these cases, immense quantities of green biliary fluid were 
vomited, and the patients died in a state of hopeless collapse, with depres- 
sion of temperature and cold extremities covered with a cold clammy sweat. 
As a general rule, suppression of the functions of the kidneys is a fatal 
sign: and. as in yellow fever, may be attended with convulsions, delirium 
and coma. 
The pathological changes observed after death, are characteristic of 
malarial fever: enlarged slate and bronzed-colored liver, with pigment 
granules: enlarged and softened spleen with altered globules and pigment 
granules: gall-bladder distended with thick ropy bile, presenting when 
seen en masse. a greenish-black color, and in thin layers, a deep yellow. As 
much as 1600 grains of bile of high specific gravity has been obtained from 
the gall bladder, in malarial Inematuria; whilst in yellow fever, not more 
than 120 grains of bile are, as a general rule, contained in the relaxed gall- 
bladder: and in some cases of this disease I have found the gall-bladder 
containing only an albuminoid liquid coagulable by heat and nitric acid: 
and in other cases I have found the gall-bladder distended with dark liquid 
blood. The kidneys in this malarial haematuria present after death a red 
congested hue; and their sections examined under the microscope exhibit 
the tubuli uriniferi filled with coagulated blood. The following cases will 
illustrate the 
PATHOLOGICAL ANATOMY OF MALARIAL HEMATURIA. 
Case 917.-Malarial Hamaturia; Intense Jaundice; Urinary Suppression; 
Stoic. Irregular action of Heart: Death; Urine in Bladder contained Blood; 
Pathological Anatomy of Malarial Hamaturia. 
Samuel Linman. aged 25 years: native of Germany; laborer: entered 
ward 13,' bed 159, November 24th. 1874. at 1 o'clock P. M. At time of 
entrance skin hot and dry; intense jaundice: hiccough: irregular and 
laborious action of heart: muttering delirium: restless: can give no account 
of himself: his friends, however, state that he had been sick for two weeks, 
and from the account which they gave, the fever was remittent in its 
character. 
I saw this patient, for the first time. November 25th. 1874. at 8 o'clock 
A. M.. and was informed that the ward student. Sisters of Charity and 
attending priest, and hospital clerk regarded this as a case of undoubted 
yellow fever. The jaundice was intense-skin of the entire body of a deep 
golden yellow color: conjunctiva of eyes of a deep yellow: no marked 
capillary congestion of extremities: tongue dry: furred, and feels to the 
touch like sand paper. Low muttering delirium: the patient cannot be 
aroused. Suppression of urine: patient has passed no water since entering 
the ward, and careful examination revealed the fact that there was no 
accumulation of urine in the bladder. Sordes about the teeth of a thick 
and black character. Body emits a disagreeable typhoid odor. Hiccough. 
Irregular laborious action of heart: the heart's action intermits every third 
or fourth beat. Patient very restless, tosses about the bed. Pulse slow, as 
in the stage of calm in yellow fever. Temperature of axilla 99.°4 F. 614 
Investigations by Joseph Jones. M. D.. on Malarial Heematuria. 
Extremities feel cool. Patient lies with his eyes wide open, muttering 
incoherent words. Respiration rapid, about 40 per minute. Great tender- 
ness upon pressure of the epigastrium. When this region is pressed, the 
patient groans, and exhibits signs of great distress. Whilst I was care 
fully observing this case, and endeavoring to make and announce the 
" diagnosis " to the medical students, the patient vomited a large amount 
of thick green bile, which was ejected over the breast and abdomen. The 
surface of the body presented the appearance as if thick green paint had 
been smeared over it. Notwithstanding the intense jaundice, slow pulse, 
depressed tor rather normal) temperature, urinary suppression and deli- 
rium, I was couvinced by the characters of the matter's vomited that the 
patient was suffering with the so-called malarial hematuria, and not with 
yellow fever. Quinine and tincture of bark were freely administered by 
the mouth, and quinine in twenty grain doses by the rectum, but without 
any appreciable effects, and the patient died in a comatose state at 7 
o'clock P. M. 
AUTOPSY IN CASE OF MALARIAL HEMATURIA, TWELVE HOURS AITER 
DEATH. 
Exterior: Golden colored; dependent'portions of neck, trunk and 
extremities, mottled with capillary congestions, as in yellow fever. Teeth 
thickly coated with dark, almost black sordes; muscles full and not wasted. 
Muscular tissues of a deep purplish color, which did not change to the 
brilliant red of yellow fever. Much less blood escaped from the several 
muscles than in yellow fever. . The muscular fibres were more contracted 
than in yellow fever. 
Thorax.-Lungs normal. Heart firmly contracted, and of a dark, pur- 
plish red color. Under the microscope, the muscular fibrillie of the heart 
were firmly contracted and normal in appearance, with distinct transverse 
striie, as in healthy hearts. There was no deposit of oil globules or granular 
matter within and around the muscular fibrillie of the heart, as in yellow 
fever. The microscopic characters of the heart were carefully compared 
with those of the heart of yellow fever, and the differences were carefully 
demonstrated under the microscope to the medical students and several 
physicians. 
Abdominal cavity.-Liver enlarged, slate-colored in the exterior and of 
a deep, bronze color within. Sections with Valentine''s knife. placed under 
the microscope, showed the presence of a vast number of dark, brownish, 
red and black pigmentary particles, similar in all respects to those 
characteristic of malarial fever. No deposit of yellow granular matter was 
observed in any portion of the liver. The dark pigmentary particles, 
resulting from the changes of the colored corpuscles were most abundant 
in the peripheral or portal capillaries of the hepatic lobuli. Under the 
microscope the liver cells were pale and without the numerous yellow oil 
globules and granules, characteristic of the yellow fevei liver. Sections of 
this liver were carefully compared with those of the yellow fever liver and 
the differences pointed out to the medical students of the Charity Hospital 
and medical department of the University of Louisiana and several 
medical practitioners. 
The gall bladder was distended with 900 grains of deep green, almost 
black, tenacious bile. Specific gravity of bile 1042. Bile thick, ropy and 
pouring like tar. Numerous soft, deep green biliary concretions were 
found in the gall bladder. A single drop of the bile was sufficient to color 
a gallon of water of a rich, golden color. Under the microscope rhe bile Investigations by Joseph Jones. M. D., on Malarial Hematuria. 
615 
was found to contain numerous cells from the mucous membrane of the gall 
bladder and cells and casts from the biliary tubes. Also numerous dark' 
red acicular and dagger shaped crystals, many of which were agglomerated 
together, forming crystalline tufts. The magnifying power was 450 dia- 
meters. The bile was much more abundant than in fatal cases of yellow 
fever. 
Spleen.-Enlarged and filled with black pigmentary particles, similar to 
those observed in the liver. This organ presented all the marked charac- 
teristics of the malarial spleen. The blood from both the spleen and the 
liver presented a dark, purplish appearance. 
Stomach.-Filled with one and a half pints of green liquid, resembling 
that contained in the gall bladder. No blood corpuscles were observed 
under the microscope, in this liquid, and its color was due to the presence 
of bile, and it resembled in all respects the liquid which had been vomited 
during life, in large quantities. 
Kidneys.-Several slate colored spots on the surface of these organs, 
which were greatly congested, and presented a dark, purplish bloody 
appearance, both upon the exterior and within when their sections were 
made. The blood-vessels to the minutest capillaries were distended with 
blood, and many of the tubuli uriniferi were filled with coagulated blood. 
The textures of the kidneys were softer than normal. The appearance pre- 
sented by the kidneys was wholly different from the yellow, fatty kidney 
of yellow fever. There was no increase of fatty matters in the kidneys; 
neither was there any development of the yellow granular matter which 
characterizes the yellow fever kidney and liver. 
Urinary Bladder.-The urinary bladder contained 180 cubic centimetres 
of deep red urine. This was the whole amount of urine excreted during 
the period (thirty hours) which this patient remained in the Charity Hos- 
pital. I directed the nurse to observe carefully and preserve all discharges 
from the stomach and bladder. 
Specific gravity of urine, 1014; reaction strongly acid. Chemical 
examination established that the urine contained coloring matters of the 
bile, as well as biliary acids. Under' the microscope the urine contained 
both colored and colorless corpuscles, and numerous casts of the tubuli 
uriniferi, of a deep reddish-brown (mahogany) color, loaded with pigment 
particles, and altered colored blood-corpuscles; also " desquamated " epithe- 
lial cells of the tubuli uriniferi. These constituents imparted to the 
urine a turbid appearance. The whole amount of albumen, or matter 
coagulated by heat, in the urine (180 c.c.), was 4.95 grains. The albumen 
in the urine appeared to be derived from the blood effused, and did not 
present the golden color of the albumen of the yellow fever urine; but on 
the contrary, presented a brownish-red color, as if discolored by the hsema- 
tin of the blood. 
In yellow fever, as a general rule, the albumen is more abundant in 
the urine, and is associated not with the colored corpuscles, and presents 
when coagulated, a golden-yellow color. As far as my observation extends, 
the urine of malarial haematuria, is of a much deeper color than that of 
yellow fever. 
The urine from the bladder of this case of malarial haematuria con- 
tained both urea and uric acid ; thus the whole amount of urea, in the 
180 c.c. of urine, wasfound on analysis to equal 55.584 grains. Therefore, 
only about fifty-five and a half grains of urea wereexcreted by the kidneys 
during thirty hours. This amount was less than one-twelfth of the normal 
excretion of urea, in a healthy adult during thirty hours. More than eleven- 
twelfths, or at least six hundred grains, were in this patient uneliminated, 616 
Investigations by Joseph Jones. M. D., on Malarial Htematuria. 
and contaminated the blood, and deranged the cerebro-spinal and sympa- 
thetic systems. Upon standing, a delicate cryptogamous plant formed in 
the urine, the thallus of which was about l-4000rh of an inch in diameter, 
and resembled the torula of diabetic urine, but was more delicate and of 
slow growth and development. 
Commentary. Upon a careful comparison of the main features of this 
case of undoubted malarial ha-maturia. with those of yellow fever, the fol- 
lowing points may be noted : 
1st. In the last stages, after the supervention of jaundice and urinary 
suppression, many cases of malarial ha-maturia bear a striking resemblance 
to yellow fever in the state of calm depression of circulation and black 
vomit. The vomited matters, however, in malarial hitmaturia. contain 
bite. and the dark color is due to bile, rather than to blood. 
2d. Important differences are revealed by rhe microscope, between 
the organic elements in the urine of these diseases: in yellow fever, rhe 
casts of the tubuli uriniferi are filled with yellow granular matter and oil 
globules: in malarial hmmaturia. the tubuli uriniferi. in many cases present 
a dark brownish red color, and contain dark pigmentary matter, and 
altered colored corpuscles, in addition to the yellow granular matter. 
3d. After death from malarial ha-maturia, the fibres "f the heart 
present under the microscope a normal appearance, rhe transverse stria* 
being distinct, and the oil globules and yellow granular matter charac- 
teristic of yellow fever, being in most eases absent. Where no preceding 
lesions have existed, the heart of malarial tever and of malarial hama 
turia presents a firm structure, wholly different from the softened, altered 
and flabby yellow heart of yellow fever. 
4th. There is less congestion of the mucous membrane of the stomach, 
and it is almost uniformly discolored by bile in malarial ha-maturia. Bile 
is absent from the contents of the stomach in yellow fever. Bile is univer- 
sally present in the stomach of malarial ha-maturia. 
5th. The heart, liver and spleen in malarial hematuria present the 
same structural and the same microscopical and chemical characteristics 
as in the various forms of paroxysmal malarial fever. In malarial fever, 
the spleen and liver are loaded with dark pigmentary particles: in yellow 
fever the former organ is without any special increment of pigment ary par- 
ticles. and the latter is of a yellow color, and loaded with oil globules, and 
yellow granular matter. When yellow fever supervenes in malarial fever, 
both the dark pigment particles and the oil globules and yellow granular 
matter are found in the liver, and this organ presents a deeper color and 
more mottled appearance than in uncomplicated yellow fever. The gall- 
bladder contains much more bile in malarial fever than in yellow fever: 
and this liquid is absent from the stomach and alimentary canal in yellow 
fever, but is universally present in malarial fever in all its forms. 
6th. Malarial ba-maturia is only one of the forms or varieties of par- 
oxysmal paludal malarial fever, and should not be regarded as a distinct 
disease. dependent for its origin upon the action of distinct causes. Any 
case of malarial fever, especially when of long continuance, and without 
proper nourishment and treatment, may present the phenomena : f mala- 
rial hiematuria. in which congestion and haemorrhage of the kidneys super 
vene. When the congestion of the kidneys is so great as to cause urinary 
suppression, then another distinct train <»f phenomena is sec up. which 
has much in common with those cases of yellow fever in which the func- 
tion of rhe kidney is suspended. Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
617 
Case No. 918.-Malarial Hematuria; Diminution of Urinary Excretion; Ure- 
mic Convulsions and Death' Kidneys congested; Tubuli Uriniferi filled with 
coagulated Blood. 
A. N. Fike; native of Selma, Alabama; age 21: height 6 feet, 1 inch; 
weight in health 137 lbs; dark hair and eyes; entered Charity Hospital 
(Ward 13, Bed 185), October 15th. 1877. Patient states that he had 
chills and fever, about one year ago. Was taken sick October 1st, 1877, 
whilst walking from Pensacola to Mobile. Has been in Louisiana about 
one week. October 15th. Patient entered in a state of great prostration, 
with rapid feeble pulse; skin of face and body of a deep greenish yellow 
color; sclerotic coat of eyes yellow; headache, great thirst, nausea and 
vomiting of dark green biliary fluid; tongue swollen, dry rough and coated 
with brownish yellow fur; gums and lips pale; teeth coated with sordes: 
anorexia; pain and tenderness upon pressure over the abdomen, and especi- 
ally in the epigastrium and right hypochondrium; bowels lose: great rest- 
lessness. Patient lies prone upon his back with ey^s partially closed. 
Pressure in the epigastric and right hypochondriac region causes the 
patient to cry out. Auscultation and percussion revealed no lesion of the 
heart or lungs. Palpation and percussion revealed enlargement of spleen 
and liver. Surface of the head and trunk feel cold to the touch. 6 o'clock 
P. M. Vomiting of green fluid and intense thirst continue; bowels loose, 
moved several times during the day; stools of a dark green color, and of 
the consistency of thick soup. Ordered the urine to be saved with care as 
I regarded this as an undoubted case of malarial hmmaturia- 
October 16th. 9 o'clock A. M. Vomiting of green matteis continues. 
Patient suffers with intense thirst and great prostration. The intensity of 
the greenish yellow color of the skin has increased. Pulse 112; tempera- 
ture of axilla 98° F. R Quinue sulph. grains xxx; divide into three pow- 
ders; one powder every three hours; apply sinapisms over epigastrium. 
6 o'clock P. M. Wild delerium; patient confined to bed by mechanical 
means; vomiting of green matter continues; jaundice increasing in intensity. 
Pulse 104; respiration 30; temperature of axilla 100.°5; Continue quiniae. 
Urine high colored resembling blood and scanty. Amount excreted dur- 
ing twenty-four hours, October 16th, 6 A. M. to October 16th, 6 P. M. 475 
c.c., specific gravity 1011°; reaction strongly acid; color blood red. Heavy 
deposit of a deep brownish red color. 
Under the microscope I found the deposit to consist of blood-corpus- 
cles variously altered iu shape, some being swollen, and others crenated. 
Yellow granular matter; masses of haematin; and numerous casts of the 
tubuli uriniferi. Many of the casts of the urinary tubes presented a deep 
red color and contained colored blood-corpuscles and fibrinous or coagu- 
lated matter deeply stained by the hmmatin of the blood. Some of the 
casts presented a lighter orange yellow color and were filled with orange 
colored granular matter. Haemorrhage had evidently taken place into 
the excretory tubes of the kidneys, as many of the casts contained coagu- 
lated blood. The casts resemble in their general outline those character- 
istic of the urine of grave cases of yellow fever; with this difference how- 
ever that they are of a deeper color, many of them resembling cylinders of 
coagulated blood. The urine also contained numerous detached excretory 
cells of the tubuli uriniferi. Many of these cells presented a deep yellow, 
orange and red color, as if stained by bile, and by the coloring matter of 
the blood. Heat causes the precipitation from the urine of a deep reddish 
brown precipitate; and the addition of nitric acid to the urine causes a 
similar result. The precipitate produced by heat and nitric acid was 
much darker in color, than that characteristic of yellow fever, which 618 
Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
generally presents a yellow color. Chemical analysis revealed in addi- 
tion to albumen, and the coloring matter of the blood, the coloring matter 
and acids of the bile. 
475 cubic centimetres of urine excreted during twelve hours (October 
16th, 6 A. M., to October 16th, 6 P. M.), contained: 
Grains. 
Urea 174.02 
Chloride of sodium 17.55 
Albumen (coagulable matters by heat) 10.04 
October 17th, 9 o'clock A. M. Patient somewhat more quiet; vomit- 
ing somewhat diminished in intensity and frequency. Patient lies with 
eyes half open. Delirium not so wild. Pulse 104; respiration 20; temper- 
ature of axilla 98° F. B. Quiniae sulph. grains xxx; divide into three 
powders; one powder every two hours. B. Quiniae sulph. grains xxx, 
tincture opii f^ii; aquae f^iii; mix: one fluidounce by euema, every two hours, 
apply at once sinapisms to back of neck, abdomen and calves of legs. Sur- 
face of trunk and limbs to be sponged with the following. B. Tincture 
camphorae; olei teribinth; alcoholis, a a f^i; olei olivae f^iii; mix. Diet beef 
tea, and milk punch. As a drink, iced water charged with carbonic acid 
gas. The bowels have been more quiet during the night. 
Urine still scant and of a yellowish red. Amount of urine excreted 
during 12 hours, October 16th, 6 P. M., to October 17th, 6 A. M., 450 cc. 
Specific gravity 1011.°5. The urine is not so high colored and the deposit 
is less. Under the microscope the deposit was found to consist of numer- 
ous deep red lozenge-shaped crystals of uric acid, yellow granular matter, 
and orange colored and red casts of the tubuli uriniferi, and cells of the 
excretory tubes of the renal organs. Heat and nitric acid produced a 
brownish red precipitate, but the amount of coagulable matter has dimin- 
ished, as it amounts to only 6 grains in the whole amount of urine. 
450 cubic centimetres of urine excreted during 12 hours (Oct. 16th, 6 
P. M , to Oct. 17th, 6 A. M., contained- 
Grains. 
Urea 152.40 
Chloride of sodium 16.63 
Albumen (matter coagulated by heat) 6.00 
Total amount of urine excreted during 24 hours, 925 cubic centime- 
tres. 
925 cubic centimetres of urine excreted during 24 hours, Oct. 16th, 6 
A. M., to Oct. 17th, 6 A. M., contained- 
Grains. 
Urea 326.42 
Chloride of sodium 34.18 
Albumen (matter coagulated by heat) 16.04 
6 o'clock P. M. Patient not so restless. Vomiting not so frequent. 
Bowels have not been moved since the first enema. The pulse has under- 
gone a great change, having lost 3G beats per minute during the past twelve 
hours. This slowing of the pulse may be due in a measure to the action 
of the bile in the blood; Pulse 68, respiration 20, temperature of axilla 
99. °5 F. October 18th, 9 A. M. The patient appears to be calmer and 
more rational, although there has been an almost total suppression of the 
urinary excretion, only a small quantity having beeen passed involunta- 
rily in bed. Pulse 96, respiration 16, temperature of axilla 98.°75 F. B. 
Hydrargyri sub-chloridi, grains vi; quinise sulph. gss; mix: divide into six 
powders, one powder every 4 hours. Diet, beef tea and milk punch. 
Patient says that he feels better, although the prostration of the muscular 
and nervous forces is extreme. Investigations by Joseph Jones, M. D., on Malarial Hoematuria'. 
619 
In order that the students of the medical department of the Univer- 
sity of Louisiana might observe carefully the appearance and symptoms of 
a case of malarial haematuria, I caused this patient to be carried on a litter 
to the amphitheatre, where he remained about twenty minutes. He was 
well wrapped up in blankets. No bad results appeared 10 result from this 
change, and the patient fell into a quiet sleep after his removal to the 
ward. 6 o'clock P. M. Vomiting and purging have ceased. Patient 
drowsy and has slept much of the day. Urinary excretion suppressed. 
Pulse i02, respiration 10, temperature of axilla 101° F. Continue treat- 
ment. 
October 19th, 9 A. M. Patient drowsy and aroused with difficulty. 
Bowels quiet and vomiting arrested. No urine passed during the night 
and morning. Pulse 104, respiration 11, temperature of axilla 97° F. The 
slow respiration, as well as the urinary suppression and the deep sleep- for- 
bode evil, and are, perhaps, the precursors to convulsions and death. 
Appetite good, the patient takes beef tea and milk punch readily. 
1 o'clock P. M. Mr. P. B. McCutcheon, Jr., my ward student, and 
resident of the Charity Hospital, who assisted me in the clinical record, 
was summoned by the nurse of ward 13, and found the patient in a dying 
condition. A few minutes before 1 o'clock P. M., the patient had had a 
convulsion. Whiskey and water were administered and seemed to rouse 
the patient somewhat, but five minutes after taking the stimulant he had 
another convulsion, and his heart stopped beating ; the pulse could not be 
felt, and the sounds of the heart were inaudible to the ear placed upon the 
chest; the patient gasped several times, for five minutes after his heart 
ceased to beat. 
AUTOPSY TWENTY HOURS AFTER DEATH. 
Exterior.-Surface of a greenish-yellow color. Mucous membrane of 
mouth and tongue pale and bloodless, both coated with sordes. Trunk and 
limbs present an emaciated appearance. Abdomen shrunken. 
Head.-Brain presented no abnormal appearance, and the blood ves- 
sels of the dura mater, arachnoid and pia mater were not congested with 
blood. Neither the membranes of the brain nor the cortical or medullary 
substance, showed any marks of congestion or irritation or inflammation 
or structural alteration. The ventricles of the brain were carefully exam- 
ined and found to contain only the usual amount of ventricular fluid. My 
colleague, Dr. Samuel Logan, Professor of Anatomy and Clinical Surgery, 
was present at the dissection of this brain, and agreed with me that it 
was normal in appearance and structure ; and so far from presenting any 
marks of congestion was on the contrary rather ansemic in appearance. It 
is evident from this observation that the uremic convulsions which closed 
the life of this patient, were not dependent upon any recognizable lesion 
of the cerebro-spinal nervous system, nor upon any effusion into the ventri- 
cles. The spinal cord was in like manner free from congestion or struc- 
tural alteration, and was normal in appearance. 
Thorax, heart.-Normal in color and appearance. No deposit of oil or 
granular matter, as in yellow fever, was observed in the muscular struc- 
tures of the heart. Transverse striae of muscular fibrillae of heart distinct. 
Lungs pale, anaemic ami normal in all respects. 
Abdomen.-Abdominal walls retracted and belly not prominent. There 
were no marks of decomposition about the abdominal walls or viscera, as 
are invariably present after a similar lapse of time after death from yellow 
fever. Exterior of stomach not congested, and mucous membrane free 
from marks of inflammation or congestion. Mucous membrane of stomach, 620 
Investigations by Joseph Jones. M. D.. on Malarial Hematuria. 
especially the dependent portion, deeply stained with bile Large and 
small intestines not congested, and without marks of irritation or inflam- 
mation. 
Liver of a Spanish brown color, and not of the deep slate upon the 
exterior and bronze within, characteristic of malarial fever. The micro- 
scope revealed the presence of oil globules in larger numbers than in the 
normal or malarial liver. The pigment particles were present, but in fewer 
numbers than in malarial fever uncomplicated by fatty degeneration of 
this organ. After careful microscopical examination. I was led to regard 
the increase of oil in this liver as being due to one of two causes : 1st- 
preceding structural change induced by the abuse of alcoholic stimu- 
lants; suppression of the function of the kidney, and the retention of the 
biliary matters in the blood and textures of the liver. 
Gall-bladder, distended with about 1000 (one thousand) grains of 
thick, ropy, semi-solid, greenish-black bile. Specific gravity of the most 
fluid portion of the bile 1031; the specific gravity of the more solid por- 
tions was about 1050. The bile under the microscope, both the fluid and 
semi-solid portions, contained mucous corpuscles, cells from the mucous 
coat of the gall-bladder, biliary cells from the biliary ducts, and yellow 
granular matter. No crystalline matters were observed in the bile. 
Spleen.-Somewhat enlarged; eight inches in the long and five inches 
in the short diameter. Enlargement of the spleen of long standing, as the 
texture of the organ was firm. The splenic blood contained fewer pig- 
ment particles than in cases of bilious remittent fever. 
Kidneys.-These organs presented upon the exterior a deep purplish- 
red congested appearance. When these organs were divided by the knife 
they presented a highly congested and bloody appearance. The cortical 
portion was more congested than the medullary. Many deep purplish, 
almost black, spots of ecchymosis were observed in various portions of 
these organs. When sections of the kidneys were examined under the 
microscope many of the tubuli uriniferi were filled with coagulated blood, 
altered blood-corpuscles and granular fibroid matters deeply colored by 
the haematin of the blood. Many of the capsules of the malpighian cor- 
puscles were filled with coagulated blood and blood-corpuscles, and highly 
colored deep-red fibroid matter. The haemorrhage had occurred chiefly 
in the malpighian corpuscles, as many of the urinary tubes were filled 
with coagulated blood through their entire extent. A few dark pigment 
corpuscles were observed in the textures of the kidneys. The sections of 
the kidneys presented a striking and beautiful appearance under the 
microscope, as no known process could have produced a more perfect 
injection of many of the urinary tubes. 
The urinary bladder contained a small quantity of urine of a brown- 
ish-yellow color; in which the microscope revealed casts of the tubuli urini- 
feri, excretory cells of the kidney, epithelium from the pelvis, ureter and 
mucous membrane of the bladder, and yellow granular matter. This speci- 
men of urine appeared to contain less blood and albumen than during life. 
Commentary.-It is worthy of note that, although the amount of the 
blood diminished in the urine, the kidneys ceased to act during the last 
forty-eight hours of life, and the patient died of uremic poisoning and in 
convulsions. The examination of the brain and spinal cord after death 
revealed the fact that the uremic convulsions were in no manner dependent 
on or connected with any structural alterations, congestions or effusions 
in the cerebro spinal system. Effusions into the ventricles of the brain, and 
within and around th« hemispheres may often accompany uremic con- 
vulsions, especially in Bright's disease, but such effusions are not essential Investigations by Joseph Jones. M. D. on Malarial Haematuria. 
621 
to the production of uremic convulsions. The essential cause of uremic 
convulsions appears to be the toxic action of the retained elements of the 
urine upon the ganglionic cells of the cerebro spinal system, and more 
especially upon the ganglia at the base of the brain and within the medulla 
•oblongata. In the present case the involvement of the medulla oblongata 
was clearly shown by the reduction in the frequency of the respirations, 
which, in a case of malarial fever of equal severity but uncomplicated by 
structural alterations of the kidney and uremic poisoning, would have 
ranged from 20 to 50 per minute. This effect, however, upon the respira- 
tion is not uniform in malarial haematuria. The retention of the bile also 
in the blood, or rather its accumulation in the circulatory fluid, from its 
excessive production and reabsorption from the alimentary canal, con- 
stitute an efficient cause of certain nervous phenomena and the incessant 
vomiting which characterize malarial haematuria. 
In this disease the distressing vomiting of large quantities of liquid 
heavily charged with bile, appears to be mainly due to three causes: 1st. 
To disturbances of the cerebro-spinal and sympathetic nervous systems by 
the malarial poison, and the retained constituents of the urine and bile in 
the blood. 2d. The excessive secretion of bile and its regurgitation into 
the stomach. 3d. The suppression or impairment of the function of the 
kidneys, the retention of the urinary elements, and more especially of the 
urea, uric acid and extractive matters in the blood, and the vicarious 
action of the gastro-intestinal mucous membrane in the elimination of 
these excrementitious compounds. 
Thepiofound lesions of the kidneys, consisting essentially in the 
obstruction of the tubuli uriniferi by coagulated blood and fibrin, consti- 
tute malarial haematuria, one of the most dangerous of all diseases. 
Upon inquiry I ascertained that the druggist of the Charity Hospital 
in filling the prescriptions in the preceding case, substituted for the sul- 
phate of quinia the sulphate of cinchonidia. 
During the past six months, owing to the high price of quinine, the 
sulphate of cinchonidia has been substituted for the sulphate of quinia in 
the Charity Hospital. Thus far my clinical experience has led me to regard 
the sulphate of cinchonidia as far inferior to the sulphate of quinia in the 
treatment of the graver forms of malarial fever. I could not discern that 
the sulphate of cinchonidia produced any beneficial effects in the preced- 
ing case. The value of this remedy in malarial haematuria is unknown, 
whilst that of sulphate of quinia is well established. 
Case 919.-Malarial Harmaturia; Intense Jaundice; Bloody Urine; Progress- 
ive Diminution of Blood in Urine; Uremic Convulsions; Death; Excretory 
Tubes of Kidneys Blocked up with Coagulated Blood. 
George Price, native of Louisville, Kentucky; aged 26 years; dark 
hair and eyes; height 6 feet i inch; weight in health 170 lbs.; occupation 
laborer. During the months of August, September and October visited 
my office several times, and appeared to be suffering from the prolonged 
effects of the malarial poison. Pale, sallow, greenish-yellow hue. As he 
was sick and destitute I furnished him with medicines, and such small 
assistance as lay in my power. Ou the 31st of October, I was called to see 
this man, and found him sick at the house of a kind lady who had given 
him food and shelter and purchased him a set of carpenters tools. At the 
time of my visit, October 31st, I found the patient of a deep golden color; 
incessant vomiting; urine resembles blood in appearance and odor. Pulse 
rapid. Patient restless. I informed the lady of the house that this was a 
case of malarial haematuria, and that it would in all probability terminate 622 
Investigations by Joseph Jones, M. D., on Malarial Hematuria. 
fatally; and hence I advised that the patient be sent to one of my wards in 
the Charity Hospital. 
The patient entered the Charity Hospital of New Orleans, November 
1st, 1877, 11 o'clock A. M. (ward 13, bed 184). 
The patient states that he had always been in good health, until Janu- 
ary, 1876, at which time he moved to Claiborne parish, Louisiana; and in 
about a week after he was attacked with chills and fever. He remained 
in Northern Louisiana, where he continued to have chills and fever, at 
intervals of two or three weeks, until the 1st of August, 1877, when he 
arrived in New Orleans. After remaining a few days in this city he went 
to work on a rice plantation, about seven miles below the city. After 
remaining on the, plantation for several weeks, he was sent to the Charity 
Hospital, where he remained only one day. He remained in the city, but 
continued to have chills and fever about once every two or three weeks. 
The present attack commenced with a chill, about 1 o'clock P. M. on the 
night of October 27th, 1877; had another chill on the night of the 28th. 
October 29th felt quite well all day, and was up late at night, talking with 
a friend. October 30th felt sick and feeble all day, and at night noticed 
that his urine was of a yellow color. In the morning observed blood on 
his clothing, which appeared to have been passed from the kidneys. Had 
a chill during the night of the 30th, and on the following morning found 
his skin of a yellow color. October 31st, jaundice and frequent vomiting 
of a grass green color; urine abundant, and of a dark brown bloody color. 
I saw the patient at 8 o'clock P. M. October 31st, and found him with 
intense jaundice, and incessant vomiting, and passing bloody urine. At 
my request the utine passed during the day was preserved. 
November 1st, 11 o'clock A. M. The patient has just entered the 
Charity Hospital, having been tranferred thither at my request. Patient 
suffering with headache, intense thirst, nausea, and vomiting of " grass- 
green " liquid. Tongue swollen; coated, dry and very rough. Gums pale. 
Great pain and tenderness over the entire abdomen; respiration labored, 
and the patient groans during respiration. Bowels moved twice this morn- 
ing. Entire surface of a golden yellow color. Pulse weak and rapid, 102 
per minute. November 1st, 11:30 o'clock A. M. Pulse 102; respiration 
24; temperature of axilla 192. °4 F. Urine of a deep blood red color, with 
the odor of blood. R. Quinise sulph. 5SS.; acidi citrici $ij; aquse menth; 
pip: fgvi; mix: sig: tablespoonful every 3 hours. Sinapisms to abdomen, 
back and calves of the legs. Diet, milk punch and beef tea. 
Examination of urine of malarial hcematuria.-Amount of urine excreted 
during 12 hours, October 31st, 6 o'clock P. M., to November 1st, 6 o'clock 
A. M., 500 cubic centimetres. Reaction strongly acid; specific gravity 
1020; deep blood-red color; odor of blood. Upon standing the urine let 
fall a heavy brownish red deposit. Under the microscope the deposit con- 
tained colored blood-corpuscles variously altered in shape, yellow granular 
matter, and casts of the tubuli uriniferi, some of which were of a deep 
orange color, others of a deep red-blood color, and containing colored 
blood-corpuscles. Specific gravity of the urine, after the removal of the 
albumen by coagulation and filtration, 1016. 500 cubic centimetres of 
urine passed in 12 hours (October 31st, 6 o'clock A. M. to October* 31st, 6 
o'clock P. M.), contained- 
Grains. 
Urea 205.60 
Chloride of sodium 38.50 
Albumen and matters coagulated by heat 119.75 Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
623 
November 1st, 6 o'clock P. M. Pulse 102; respiration 24; temperature 
of axilla 102. °4 F. Patient says that he feels better; has vomited four 
times since his admission; vomited matters of a deep grass green color. 
Has had too stools of a green color, streaked with yellow. Urine of a dark 
brownish, bloody-red color. November 2d, 8 o'clock A. M. Pulse 98; res- 
piration 20; temperatureof axilla99° F. Patient slept some duringthe night. 
Vomited eight times during the night and morning. Vomited matters of 
a dark green color and much thicker than before. Bowels not moved. 
Micturated four times; urine of a deep blood color. Whilst the bed clothes 
were being changed, the patient was seated upon a. stool, and he had a con- 
vulsion. He lies very quiet and seems disposed to sleep. B. Tinct. opii. 
f^i; quinise sulph. $ss; aquae f§iij; mix: sig., one fluid ounce by enema, every 
two hours. Diet, one tablespoonful of lime-water, with two tablespoonfuls 
of fresh milk every two homs. Milk punch and beef tea in small quanti- 
ties at regular intervals, judiciously administered according to the condi- 
tion of the patient, and the tolerance of the stomach. Turpentine stupes 
to abdomen and small of the back. Blood was abstracted to the amount 
of about three fluid ounces by cut cups from the loins, over the region of 
the kidneys. 
Chemical and microscopical examination of blood, malarial hcematuria.- 
Coagulum small, but very firm, Serum golden colored. Serum of blood 
upon analysis contained, coloring matter of bile and biliary acids, urea, 
and extractive matters in greatly increased amounts. The deep golden 
yellow color of the serum was due to the presence of the coloring matter 
of the bile. Under the microscope (420 diameters), some of the colored 
corpuscles presented a swollen and crenated appearance; the majority, 
however, presented the normal appearance. A few pigment particles were 
observed in the blood, and some of the colorless corpuscles contained the 
pigment granules characteristic of malarial fever. The blood also con- 
tained minute vibriosand vibrating filaments, about 1-20,000thof an inch 
in diameter. 
1000 parts of blood contained- 
Water 844.29 
Solid residue 155.71 
Saline (fixed) matters in solid residue 12.85 
1000 parts of serum contained- 
Water 911.00 
Solid residue 89.00 
Extractive matters soluble in water and alcohol 20.24 
Fixed saline matters 9.27 
1000 parts of blood contained- 
Water 844.29 
Dried blood-corpuscles 47.55 
Moist blood-corpuscles 190.20 
Fibrin 14.51 
Albumen 57.27 
Extractive matters, and salts, urea, coloring matters of bile, biliary 
acids and soluble salts' 23.80 
Fixed saline constituents, iron salts, phosphates of lime, soda and 
potassa, chlorides of sodium and potassa 12.85 
It will be observed in the preceding analysis that a portion of the con- 
stituents included under the head of extractive matters, soluble in alcohol 
and water, is included also under the fixed saline constituents obtained by 
incineration. 
1000 parts of blood, after complete coagulation, contained- 
Clot 348.17 
Serum 651.83 624 
Investigations by Joseph Jones, M. D.. on Malarial Hoematuria. 
The following changes in the blood when referred to the normal stand- 
ard, are worthy of consideration, in the preceding analysis of the blood in 
malarial haematuria. 
1st. Marked diminution of the solid constituents aud corresponding 
increase of the watery elements. 
2d. Great diminution of the red globules; the dried corpuscles being 
only 47.55, and the moist globules 190.20 in the 1000 parts of blood. The 
relationship of the colored moist globules to the liquor sanguinis, was as 
190.20 to 809'.80 in the 1000 paits of blood. 
3d. Marked increase in the fibrin, which was 14 51 parts in 1000 parts 
of blood. The fibrin had actually risen to the high figure which we 
regard as characteristic of the phlegmasiie, and more especially of acute 
pneumonitis and pleuritis. Notwithstanding this increase in the fibrin, 
the body of this patient during the last two days of his illness was covered 
with small petechiae of a deep purplish and red color. 
4th. Marked increase in the extractive and fixed saline constituents. 
The extractive matter's soluble in alcohol aud water were 23.80 parts in 
the 1000 of blood. Careful analysis revealed the fact that the soluble 
extractive matters of the blood contained a large amount of urea, as well 
as the coloring matter and acids of the bile. The urea existed in about 5 
parts in 1000 of blood, and was. therefore, greatly increased above the 
standard of health. The analysis, therefore, revealed alterations of the 
most profound and important character in the blood; and many of the 
grave symptoms and even the death of the patient may be referred to such 
radical changes in the constitution of the blood. 
Examination of Urine.-Amount of urine excreted during twenty- 
four hours. November 1st, 11 A. M., to November 2d, 11 A. M., 880 cubic 
centimetres. Reaction strongly acid; specific gravity, 1016; color, deep 
blood red; oder like that of blood; heavy brownish red color. The micro- 
scope revealed the presence of casts of the tubuli uriniferi, some of which 
were composed of coagulated blood and others of orange yellow granular 
matter. Vibrios and micrococci were observed in this urine. Upon stand- 
ing a heavy crop of deep-red lozenge shaped crystals of uric acid was pre- 
cipitated. 
880 cubic centimetres of urine passed during twenty-four hours, 
November 1st, 11 A. M., to November 2d, 11 A. M., contained: 
Grains. 
Urea 271.04 
Chloride of Sodium 13.55 
Albumen (coagulated by heat) 142.24 
The relative amount of blood in the urine has somewhat diminished, 
as during the past twenty-four hours 142.24 of coagulated matter was 
excreted by the kidneys, whilst during the twelve hours preceding this 
observation, 119.75 grains were excreted; or in the proportion of 239.50 
grains during the twenty-four hours. There has also been a marked 
diminution of the urea, only 271.04 grains having been eliminated during 
the past twenty-four hours, whilst during the preceding twelve hours 
205.60 grains were excreted, or in the proportion of 410.20 grains in 
twenty-four hours. 
November 2d. 6 o'clock P. M.-Vomiting ceased, bowels not moved; 
urine greatly diminished; passed water only once during the day, and 
then in small quantity and apparently unconsciously in the bed. It was 
impossible to determine the exact amount of urine passed, but it was about 
three fluid ounces, and of a less high color than during the night. Pulse, 
112; respiration. 15: temperature of axilla, 98.°8. Lies quiet in a stupor, Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
625 
and cannot be aroused so as to speak or return any answer to inquiries. 
November 3d, A. M-Passed a quiet night; no vomiting; bowelsnot 
moved; suppression of urine; did not urinate during the night. At 5:30 
o'oclock, A. M., had a slight convulsion, gasped three or four times, with 
an interval of a minute between each gasp, and then ceased to breathe. 
AUTOPSY FOUK AND A HALF HOUKS AFTER DEATH. 
Exterior.-Large head, good countenance, well formed body and 
extremities. Surface of a greenish yellow color. 
Head.-When the skull cap was removed the dura mater, arachnoid, 
pia mater and surface of the brain presented no marks of inflammation or 
structural alteration. No unusual amount of cerebro-spinal effusion was 
observed. When careful sections of the brain were made, so as to expose 
the ventricles, no effusion was found in the ventricles; and the grey and 
white textures of the brain, as well as its membranes, presented a pale, 
anaemic and firm appearance. This observation, as well as others of a 
similar character, made by myself in cases of death resulting from urinary 
suppression, stand in direct opposition to the theory which refers uremic 
convulsions chiefly to a hydraemic condition of the brain and its cavities. 
This brain, as well as the kidneys and spleen and liver, were pre- 
sented to the Medical and Surgical Association of New Orleans; and the 
members of this learned body will vouch for the accuracy of the preced- 
ing and following observations. The micr oscopical examination of the 
brain reveals no structural alterations. The medulla oblongata and spinal 
cor'd presented a pale, anaemic appearance Urea in large amount in brain. 
Weight of brain fifty ounces, troy. 
Thorax.-Lungs normal in structure and appearance, but pale and 
anaemic. Heart pale and of a more decided yellow color than usual in 
malarial fever; it was also softer' than usual in this disease, and resembled 
in its yellow color and soft textures more nearly the heart of yellow fever. 
How far this change was due to urinary suppression and the retention of 
the biliary and urinary constituents in the blood, we are not prepared to 
say. Right side of heart distended, with a fibrinous clot attached to the 
carneae columnse and chordae teudinae and edges of the tricuspid valve. 
Branches of the clot also extended into the pulmonary artery and its 
branches. Under the microscope the muscular textures of the heart pre- 
sented a large number of oil globules and more granular matter than is 
usual in the normal heart, or in that of malarial fever uncomplicated by 
lesion of the kidneys, urinary suppression and jaundice. That there was an 
actual increase of oil in this heart is shown by the results of chemical anal- 
ysis, thus: Weight of heart, 91 troy ounces; oil and fat in heart, 216.60 troy 
grains; oil and fat in 1000 parts of the muscular textures of the heart, 
47.50 The textures of the heart contained urea in abnormal amounts; 
but the amount of this constituent of the urine in this organ was less than 
in the brain, or in the serum of the blood. By the established chemical 
processes of analysis for the separation of urea from blood and animal 
textures, large crops of crystals of urea and of nitrate of urea were 
obtained from the blood, brain and liver. This constituent, however, was 
most abundant in the textures of the brain. 
Abdomen.-External surface of stomach pale and ansemic. Internal 
mucous membrane deeply stained by green biliary matter; corrugated, 
but without marks of inflammation. The stomach contained eight fluid 
ounces of dark green fluid, which presented almost a black color. Specific 
gravity of fluid from the stomach, 1012. 626 
Investigations by Joseph Jones, M. D., on Malarial Hoematuria 
1000 parts of green liquid from the stomach contained : 
Water 952.00 
Solid residuum 48.00 
Green fluid from the stomach not coagulated by heat. This was true 
also of the thick bile from the gall-bladder, when rendered fluid by 
admixture with water; it did not coagulate. 
The chemical analysis of the green liquid from the stomach revealed 
the following: 
Albumen Absent. 
Blood Absent. 
Oil Present. 
Urea Present. 
Biliverdin Abundant. 
Glycocholate of soda Abundant. 
Taurocholate of soda Abundant. 
Cholesterin In small quantities. 
Mucus Abundant. 
When the liquid contents (black vomit) of the stomach were sub- 
jected to microscopical examination, no vegetable or animal ferment and 
no blood-corpuscles were observed; mucous corpuscles and desquamated 
cells from the mucous membrane of the stomach and biliary ducts were 
the only morphological elements observed. Comparative chemical exam- 
inations were made with the golden colored serum of the blood, the green 
liquid of the stomach and the bile from the gall bladder, and the presence 
of the coloring matter and biliary acids in the serum of the blood, and in 
the dark fluid of the stomach was fully and absolutely established. Whilst 
conducting these chemical researches in this case of malarial luematuria, 
I enjoyed the opportunity of making a careful comparative examination 
of the black vomit and urine, of the only recognized fatal case of yellow 
fever which escaped the quarantine and died in New Orleans during the sum- 
mer and fall of 1877. This case had been contracted in Havana. The 
black vomit from this undoubted case of yellow fever contained not a trace 
of bile-contained not ft trace of the coloring matters or acids of the bile. 
The comparative tests with the green vomit (black vomit') of malarial 
luematuria and the black vomit of yellow fever were not only performed 
in my laboratory in the presence of several medical practitioners and 
students of medicine, but the demonstrations were repeated publicly in 
the amphitheatre of theCharity Hospital of New Orleans, in the presence of 
the resident students of this institution, and of the medical department of 
the University of Louisiana. I was thus enabled to demonstrate conclu- 
sively, even to medical students, the grand differences between the vomited 
matters of yellow fever and malarial fever. In the former disease the 
black vomit contains blood and no bile; in the latter disease the dark green 
(black vomit) contains no blood, but biliary coloring matters and acids. 
Liver enlarged; transverse diameter 101 inches; longitudinal diame- 
ter 81 inches. Color of the liver lighter than in malarial fever, and of a 
brown color (deep Spanish brown or bronze color). Under the microscope 
the liver, and especially the liver cells, contained more oil globules than 
usual in malarial fever, but less than in yellow fever. 
1000 parts of the liver, upon analysis, yielded 40.10 parts of oil. It is 
evident that equal amounts of the liver yielded less oil than the heart, 
which gave47.50 parts of oil in 1000 parts. 
. Gall-bladder distended with 1600 grains, of dark, tar like bile, which 
contained numerous semi-solid concretions. The bile poured like thick Investigations by Joseph Jones, M. D. on Malarial Hoeniaturia. 
627 
tenacious tar. In mass it presented a dark greenish-black appearance ; in 
thin layers a deep orange yellow color. A single drop of bile was capa- 
ble of tinging a gallon of water of a decided yellow color. Specific gravity 
of the more fluid portions of the bile 1035 ; of the entire mass about 1042. 
1000 parts of bile contained- 
Water 868,88 
bolid residue 131.12 
Fixed saline constituents 17.35 
It is evident from the preceding analysis that the bile contained very 
nearly the same amount of solid matter as the blood ; the ratio in 1000 
parts being blood 155.71, bile 131.12. It must be observed that in malarial 
hjematuiia, the incessant and distressing vomiting, precludes the absorp- 
tion of liquids from the gastro-intestinal membrane, and this condition 
may account, in part, for the great concentration of the biliary secretion. 
The saline matters of the blood were 12.85, whilst those of the bile 
were 17.35 in 1000 parts. The saline matters of the bile consisted chiefly 
of the soda salts, whilst those of the blood included the sodic, potassic, 
calcic, magnesic and ferric salts. 
The bile contained oil, cholesterin, biliverdin, and the glycocholate and 
taurocholate of soda and mucus. Under the microscope the bile contained 
numerous deep red mucous corpuscles, and cells from the mucous mem- 
brane of the gall-bladder and yellow granular matter. No crystals were 
observed in the biliary fluid. Upon standing the bile became more fluid 
and emitted a foul putrid odor, and numerous fungoid and algoid bodies 
were developed, having a rapid rotatory and vibratory motion. Many of 
the fungi were branched and possessed a diameter of about 1-10,000th of 
an inch. They resembled bacteria, and sirula. 
Intestinal canal.-Empty and contracted throughout. The entire intes- 
tinal mucous membrane was carefully examined ; surface discolored by the 
green biliary fluid and dark green almost black foeces. No congestion of 
mucous membrane; no enlargement or abnormal alteration of Peyers and 
solitary glands. 
Spleen.-Enlarged, longitudinal diameter 7a inches; transverse diam- 
eter 5 inches. Under the microscope numerous pigment particles observed 
in the splenic pulp. The microscopical examination of the liver also 
revealed the presence of dark pigment particles, and congestion of the 
portal capillaries in the periphery of the lobules. But both in the spleen 
and liver the pigment particles were less abundant than in many fatal 
cases of malarial fever. The liver cells were distinct, and contained less 
oil than in yellow fever, and presented a greenish color, quite distinct from 
the yellow color of the liver cells of yellow fever. 
Kidneys.-External capsule adherent. External surface of a deep pur- 
plish red congested appearance. Weight of kidneys nine ounces and one 
drachm troy. When sections were made of the kidneys the cortical and 
medullary portion presented a deep purplish-red and bloody appearance. 
The color was deeper in some portions than others, resembling circum- 
scribed effusions of dark blood. All portions of the kidneys, however, 
were altered in appearance, and the tubuli uriniferi, especially at the ter- 
mination of the pyramids, could be seen like dark red lines of coagulated 
blood. The appearance of the section of the kidneys is represented in 
plate 13, figure 55. 
Microscopical examination revealed the fact that many of the tubuli 
uriniferi throughout their entire extent, were filled with coagulated blood. 
The haemorrhage appears to have taken place through the malpighian cor- 628 
Investigations by Joseph Jones, M. D., on Malarial Hematuria. 
puscles chiefly. Little or no blood was effused around the tubuli uriniferi. 
It would appear from this observation that during the prolonged cold stage 
the kidneys become, in this form of malarial fever, congested in a manner 
similar to what occurs in the spleen. During this congestion rupture of 
the bloodvessels and the capsular membrane of the malpighian corpuscles 
occurs : such rupture being mainly due to their anatomical structure and 
greater tension of the blood When from any cause the blood coagulates 
in the tubuli uriuiferi, their function as excretory tubes is destroyed, and 
the extent of the impairment of the excretory function of the kidneys will 
depend upon the number of excretory tubes blocked up by coagulated 
blood. 
The appearance presented by the tubuli uriniferi is represented in the 
p^ate 13, figure 56. In this figure a view is given of the cortical termina- 
tion of one of the pyramids of the kidney. 
We have here in these structural alterations of the kidneys the grand 
cause of the severe, dangerous and often fatal character of malarial 
haematuria. 
Urinary bladder.-When the bladder was examined it appeared to be 
distended, and when pressed, the feeling of liquid and air was experienced. 
Percussion of the superior walls gave forth a distinct tympanitic sound, 
and upon pressure about four cubic inches of gas, and 170 cubic centi- 
metres of urine were forced out. The four cubic inches of gas and the 170 
cubic centimetres of urine constituted the entire contents of the urinary 
bladder. Urine of a dark brownish red color, with a heavy flocculent 
deposit. The amount of blood has greatly diminished. Under the micro- 
scope the sediment was found to consist of casts of the tubuli uriniferi, 
many of which were deeply colored by the coloring matter of the blood 
and by the corpuscles enclosed in the fibrous matrix; also cells from the 
excretory tube, pelvis of kidney and ureters, and yellow granular matter. 
No crystalline bodies were observed in the urine. 
170 cubic centimetres of urine from the urinary bladder after death 
(representing the urinary excretion of about 20 hours), contained- 
Grains. 
Urea 52.56 
Chloride of sodium 3.92 
Albumen coagulated by heat 6.63 
Reaction of urine acid 
Specific gravity of urine 10.16 
With the exception of a small portion of nrine passed in bed, the pre- 
ceding constituents represent the excretion of the urine during the last 
twenty hours. We observe, therefore, a progressive diminution of the 
urea and chloride of sodium, and an almost complete disappearance of the 
blood. 
It appeared as if the haemorrhage had so completely impaired the 
greater portion of the tubuli uriniferi by the coagulated blood, that these 
organs were unable to perform their offices except to a limited extent, and 
only a comparatively small number of tubes were capable of excreting the 
urine. The important fact is also established that mere arrest of the loss 
of blood through the kidneys is not necessarily indicative of a salutary 
change. I ascertained after the death of the patient that, as in the pre- 
ceding case, the sulphate of quinia had not been administered as ordered, 
but the sulphate of cinchonidia had been substituted. Investigations by Joseph Jones. M. D.. on Malarial Ilcematuria. 
629 
Case 920. Malarial Httmaturia; Enlarged Spleen; Ascites; Death from 
Haemorrhage of the Bowels. 
Peter Morse, aged 21 years; native of New Orleans. Admitted to 
Charity Hospital, ward 31. bed 466, November 2d. 1876. Painter by occu- 
pation. Patient states that five years ago he suffered severely with chills 
and fever; about twelve months ago, whilst painting the side of a hcuse, 
fell from the ladder to the ground, a distance of about thirty feet; lay for 
some time unconscious; recovered, however, from the effects of the fall; 
nine months ago worked in a swamp, up to his neck in water, gathering 
willow trees for the jetties, daily for about ten weeks; entered Charity 
Hospital, ward 18, October 31st, 1876, with malarial fever, and after remain- 
ing a few days, left the hospital, but returned again on the 2d of November. 
1876; has had chills and fever for two weeks before entering the hospital. 
At the time of his admission, the condition of this patient was as follows : 
Pale, jaundiced, greenish-yellow hue of surface; tongue, lips pale and 
amemic; tongue patulous, with edges deeply indented by the teeth; features 
of face pinched and wasted; upper extremities thin, poor and wasted; all 
parts of the body above the diaphragm thin and wasted; all parts of the 
body below the diaphragm distended with dropsical effusion; abdomen 
swollen, this condition being due to the enlarged liver and spleen, and the 
presence of dropsical liquid (ascites) in the abdominal cavity; lower extremi- 
ties oedematous; veins of abdominal surface enlarged, filled with dark 
blood and with an arborescent appearance. Liver enlarged and tender on 
pressure; spleen enlarged and tender on pressure; in the left side the line 
■of dullness caused by the enlarged spleen, commences at the lower border 
of the seventh rib, and extends through the left hypochondriac region into 
the left lumbar, and also encroaches in front upon the umbilical region, for 
about one inch; pulse weak and intermittent; distinct anaemic murmur 
heard over area of heart; both spleen and liver enlarged and painful upon 
pressure; a crackling sensation and sound are perceived when the walls of 
the abdomen are pressed down upon the enlarged spleen, and the sensation 
is that of pressing upon effused lymph; bowels loose, frequent bilious dis- 
charges, incessant vomiting of large quantities of green bilious fluid; no 
appetite; skin warm; urine scant, high colored, of a deep red and brown, 
inclining to black when viewed in large quantity. November 3d, 9 o'clock 
A. M. Pulse 78; respiration 25; temperature of axilla 100° F.; 7 o'clock 
P. M., pulse 80; respiration 25; temperature 100. °5 F. The patient has 
been freely treated with quinine, 5 grains combined with 10 drops of tincture 
•of opium every three hours. Vomiting not so frequent. 
Amount of urine collected during twenty-four hours, November 2d. 
10 A. M., to November 3d, 10 A. M., 280 cubic centimetres; sp. gr. 1021, 
Reaction acid: deep brownish-red, almost black color. Urine contains 
blood, both albumen and colored corpuscles being present. Upon stand- 
ing the urine let fall a deposit of urate of soda and urate of ammonia, in 
amorphous particles, and globular masses with acicular crystals attached 
to the periphery, also prismatic crystals of triple phosphate. A small, 
delicate fungus, resembling in its general appearance the yeast plant, but 
far more delicate, was developed. 
280 c.c. of urine, collected during twenty-four hours, November 2d, 10 
A. M.. to November 3d 10 A. M., contained : 
Grains. 
Urea 205.97 
Uric acid.... 5.32 
Sulphuric acid 13.34 
Phosphoric acid 4.78 630 
Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
Chloride of sodium 2.15 
Colored blood-corpuscles Undetermined. 
Albumen Und eterm i ned. 
November 4th, 9 A. M.-Continues in much the same state; eats 
little or nothing; bowels loose; pulse very feeble; pulse, 81; respiration, 
16: temperature, 101°. 
Amount ot urine collected during twenty-four hours. November 3d, 10 
A. 31., to November 4th. 10 A. 31., 150 c.c. A small portion of urine was 
lost during the action of the bowels. The patient takes so little nourish- 
ment that he may be regarded as in a state of partial starvation. Urine 
of a deep reddish-brown, almost black color, and contains some blood. 
Upon standing the urine threw down a heavy deposit of urates of yellow 
color. Sp. gr. 1023; reaction acid. 
150 c.c. ot urine collected during twenty four hours, November 3d, 10 
A. 31., to November 4th. 10 A. 31.. contained : 
Grains. 
Urea 113.19 
Uric acid 1.95 
Phosphoric acid ' 3.78 
Sulphuric acid 6.69 
Chloride of sodium 0.67 
Colored blood-corpuscles Uodetermined. 
Albumen Undetermined. 
7 o'clock P. 31.-Pulse. 81; respiration, 18; temperature, 100°. 
November 5th. 9 A. 31.-Patient still very feeble; in same condition; 
pulse. 71; respiration, 16: temperature, 100. °5. 
Amount of urine collected during twenty-four hours, November 4th, 
10 A. 31., to November 5th. 10 A. 31., 330 c.c.; sp. gr. 1021; acid reaction. 
Heavy deposit of the urates of soda and ammonia, in granulesand in globu- 
lar masses, with acicular crystals attached. Urine deep reddish-brown; 
blood present but in much smaller quantities. Patient takes but little 
nourishment. 
330 c c. of urine collected during twenty-four hours, November 4th, 10 
A- 31., to November 5th, 10 A. 31., contained: 
Grains. 
Urea 239.69 
Uric acid 9.90 
Phosphoric acid 9.94 
Sulphuric acid 14.15 
Chloride of sodium 1.01 
Colored blood-corpuscles Undetermined. 
Albumen Undetermined. 
The urine is that of almost complete starvation, and the extent of tho 
deprivation of food is shown in the small amount of chloride of sodium- 
only a little more than one grain of this salt being excreted in twenty-four 
hours. 
November 6th. 9 A. 31.-Pulse. 77; respiration. 15; temperature, 
100. °75. 7 o'clock P. 31-Pulse, 77; respiration, 18; temperature, 100.° 
November 7th. 9 A. M-Pulse. 82; respiration, 17; temperature, 99.°25. 
This being the day for the election of President of the United States, 
Governor and other officers of Louisiana, at the instigation of his "politi- 
cal friends'' this patient left the Charity Hospital without my consent, in 
order to cast his vote. 
Ou the 16th of November he returned to the Charity Hospital, and 
re-eutered the same ward. The patient states that he was taken very ill 
after leaving the hospital; was unable to vote, although he was placed in Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
631 
a comfortable carriage, and remained in his bed at home up to the moment 
of his return, November 16th, 1876. Belly greatly distended with drop- 
sical effusion; ascites increased; lower extremeties oedematons. All above 
the diaphragm, as before, wasted. Liver and spleen, especially the latter 
organ, greatly enlarged. Spleen very painful on pressure. A peculiar 
creaking and crackling sensation is felt upon pressing the walls of the 
abdomen over the spleen. When the hand is placed over the region of the 
enlarged spleen and pressed gently but firmly, in such a manner as to dis- 
place the intervening layer of dropsical liquid, a peculiar crepitation is 
felt, as if the pressure broke down recent adhesions of the plastic lymph, 
between the surface of the indurated organ and the abdominal walls. 
Urine high-colored and scant. Pulse very feeble. Anaemic murmur of 
heart distinct; complexion greenish-yellow and bronzed; no appetite; skin 
warm. 
November 17th, 9 A. M.-Pulse, 97; respiration, 2S; temperature, 
104. °4. Patient has high fever, with dry surface, and yet the pulse is 
under 100 per minute. Patient very weak; suffers much discomfort from 
the distention of the abdomen; distention of abdomen somewhat relieved 
by purgatives, as the looseness of the bowels had ceased. Quinine has had 
no marked effects, although used liberally . 
November 18th, 8 A. M.-Pulse, 91; respiration, 21; temperature of 
axilla, 100. °2. There has been a marked fall in the temperature. Novem- 
ber 20th, 8 A. M.-Temperature of axilla 103.°6. The distinct period- 
icity of the disease. 
November 21st, whilst I was standing by the bedside of this patient, 
he was suddenly seized with profuse haemorrhage from the bowels, the 
blood being in sufficient quantities to deluge the bed. In consequence of 
the great loss of blood this patient died in three hours. It is but just to 
consider the haemorrhage from the bowels in this case as resulting from 
the same causes which induced the haemorrhage from the kidneys in this and 
in the preceding cases. I have treated cases of malarial fever in which the 
haemorrhage took place from the mucous membrane of the stomach, and 
was a true haemorrhage, differing from the ordinary black vomit of yellow 
fever, and in some cases rendered the patient so anaemic that the loss of 
blood was followed by general anasarca. 
It is worthy of note, that notwithstanding the great reduction of the 
colored corpuscles which characterizes the action of the malarial poison, 
and especially in those cases, subjected to its action for weeks, months and 
even years, the system is still capable of manifesting the phenomena of 
fever, the most prominent characteristic of which is elevation of tempera- 
ture. From numerous examples, we select the followiug: 
Case No. 921.-Chronic Malarial Poisoning. M. McGrath; age 40; 
native of Ireland; has been in America twenty five years, and has resided 
the greater portion of this time in the Southern States; laborer; entered 
Charity Hospital, ward 30. bed 448, October 23d, 1876. Pale anaemic, 
with dark greenish yellow and bronze hue of surface; lips and tongue pale 
anaemic; bloodless; tongue large flabby, with indented edges. Has been 
working in the swamps of the Mississippi River, ditching, during the past 
two months, and often stood knee-deep in water during his labors. Belly 
swollen. Spleen greatly enlarged, forming a firm tumor iii the left hypo- 
chondriac lumbar and iliac regions, and encroaching upon the umbilical 
region. Longitudinal diameter of spleen ten inches; transverse diameter 
eight inches, as determined by palpation, percussion and mensuration. 
Liver enlarged and extending two inches below bolder of right false ribs. 
Lower extremities cedematous; oedema due to diminution of blood-cor 632 
Investigations by Joseph Jones, M. D., on Malarial Hcematuria. 
puscles, and obstruction of portal and splenic circulation. Distinct anae- 
mic murmur in the heart. Urine scant, high colored, deep red. clear, and 
without blood or albumen. Notwithstanding the extreme amemia, the 
temperature was often above the normal standard. Thus October 28th, 
A. M., pulse 88: respiration 17; temperature 101.°75; 30th, A. M., pulse 83; 
respiration 17; temperature 102.°!. 31st, A. 31., pulse 82; respiration 18; 
temperature 101.°8. Recovery gradual, but complete under the continu- 
ous use of quinine and iron. Discharged cured. The comparatively slow 
pulse in many cases of malarial htematuria, is evidently due to the action 
of the constituents of the bile retained in the blood. That retention of the 
constituents ofthebilein the blood is capable of rendering the action of 
the heart slow, might be illustrated by numerous examples, but we select 
for the purpose of actual demonstration the following case. 
Case No. 922.-Jaundice following fever. Andrew Gracia; native of 
Spain, age 23; entered Charity Hospital, ward 30; bed 435, November 3d, 
1876. States that he had fever in Havana. Intense jaundice. Sur- 
face of entire body, and of mucous membrane of eyes of a golden deep 
yellow hue. Suffered with fever during passage from Havana to New 
Orleans. Urine reddish yellow and loaded with bile; no albumen nor bile 
present: chemical examination revealed the presence of biliverdin and bil- 
iary acids in bile. Serum of blood of deep yellow golden color. The 
effects of the constituents of the bile in the blood were evident in the slow 
pulse and great prostration of the nervous and musculai forces. Novem- 
ber 6th, 9 o'clock A. 31., pulse 50; respiration 20; temperature 98°; 7 o'clock 
P. 31., pulse 50; respiration 22; temperature 98°; November 7th, 9 o'clock 
A. 31.. pulse 50: respiration 24; temperature 99°; 7 o'clock P. 31., pulse 44; 
respiration 20; temperature 98°. November 8th, 9 o'clock A. 31., pulse 44; 
respiration 22; temperature 99°; 7 o'clock A. 31., pulse 50; respiration 22; 
temperature 98°. Amount of urine excreted during twenty-four hours, 
November 7th, 10 o'clock A. 31., to November Sth. L0 o'clock A. 31.. 1620 
cubic centimetres contained: 
Grains. 
Urea 498.96 
Uric acid 12.86 
Phosphoric acid 28.06 
Sulphuric acid 27.49 
Chloride of sodium Undetermined. 
Coloring matter of bile Present. 
Biliary acids Present. 
Blood and albumen Absent. 
Specific gravity of urine 1010: acid reaction; deep orange red color. 
November 9th. 9 o'clock A. 31.. Pulse 60; respiration 25; temperature 
99.°25; 7 o'clock P. 31., pulse 54: respiration 25: temperature 98°. Novem- 
ber 10th, pulse 60; respiration 24; temperature 101. °2. 7 o'clock P. M., 
pulse82; respiration 20: temperature 98°. November 11th, 9 o'clock A. M., 
pulse 60; respiration 22; temperature 100°; 7 o'clock P. 31., pulse 54; respi- 
ration 22; temperature 98°. November 12th, 9 o'clock A. 31., pulse 100; res- 
piration 16; temperature 99c. On the 12th of November, the deep colora- 
tion of the skin had almost entirely disappeared, and the patient was 
dressed and sitting by his bed. With the disappearance of the jaundice 
the pulse increased in frequency. Under the use of quinine and mercu- 
rial and vegetable purgatives (rhubarb and aloes), the jaundice entirely 
disappeared: the skin assumed its normal white hue; the depression of the 
nervous and muscular systems disappeared, and the patient was discharged, 
in good condition, a few days after the last observation. Investigations by Joseph Jones, M. D., on Malarial Hoematuria. 
633 
Having thus presented details of our investigations, and furnished 
data which illustrate the prominent symptoms and post-mortem lesions 
of malarial haematuria, we will close this portion of our investigations with 
the record of facts bearing upon the nature and causes of jaundice. 
JAUNDICE, ITS PHENOMENA AND SYMPTOMS IN MALARIAL HEMATURIA AND 
OTHER FORMS OF MALIGNANT FEVER. 
The most prominent symptoms in malarial haematuria, which not only 
arrest the attention, but are so characteristic as to have led to the applica- 
tion of various names to the disease, are jaundice, obstinate vomiting of 
biliary matters, and haemorrhage from the kidneys. The yellowness of the 
integuments and conjunctiva, and of the tissues and secretions generally, 
and of the entire liquor sanguinis of the blood from impregnation with 
bile pigment, is not, however, peculiar to malarial haematuria, but may be 
present in all the various forms of malarial and continued fevers, consti- 
tuting one of the most prominent and fatal symptoms of yellow fever and 
acute atrophy of the liver, and in some cases complicating such acute dis- 
eases as rheumatism, pleuritisand pneumonia. 
I have shown by chemical analysis that the serum of the blood in cases 
of malarial haematuria, contains the coloring matters of the bile, and when 
the function of the kidneys has been arrested before death, the acids of 
the bile, and that the coloration of the liquor sanguinis, as well as of the 
integuments and tissues, depends upon the presence of the coloring mat- 
ters of the bile, and that in this respect the jaundice of this disease does 
not differ from that observed in other forms of malarial and in yellow fever, 
acute atrophy of the liver and in other diseases. It is true that pigment 
matter, derived from the coloring matter of the red globules, is found in 
the liquor sanguinis, and in certain organs as the liver and spleen, and in 
the walls of the capillaries of the brain, medulla of the bones and integu- 
ments; but these pigment particles and cells are not peculiar to malarial 
haematuria, but are common to all the forms of malarial fever, whether or 
not they be attended with jaundice. To the presence of these pigment par- 
ticles without doubt is due a certain modification of the icteric hue whereby 
it assumes a more bronzed or greenish color than in what might be called 
uncomplicated jaundice, that is, in jaundice occurring in those not under 
the action of the malarial poison ; but as far as my observation extends, 
neither the peculiar and sudden coloration of the skin, nor the haematuria, 
are directly the result of the liberation of unchanged haematin in the 
blood. The latter proposition, however, demands careful consideration, 
as not only theories or hypotheses as to the true nature and pathology of 
this disease, but also plans of treatment have been proposed, resting mainly 
upon the view that by some sudden impression upon the nervous system 
the blood was decomposed, and hence the sudden occurrence of jaundice. 
HISTORICAL ACCOUNT OF JAUNDICE (ICTERUS AURIGO, MORBUS REGIUS, 
MORBUS ARQUATUS). 
From the infancy of medicine through all ages, down to the present 
day, the yellow tinging of the skin, and of several of the secretions by 
bile pigment has, under various names, as icterus, morbus regius, jaun- 
dice and bilious fever, engaged the attention of physicians; and whilst 
many facts have been recorded, various theories as to the nature of the 
diseased process and its relations to the prevailing constitution of disease, 
and local influences have been advanced without solving satisfactorily the 
most important and fundamental questions. 634 
Historical Account of Jaundice. 
Hippocrates, in his sixty-second aphorism, affirms that "when jaun- 
dice supervenes in fevers before the seventh day, it is a bad symptom, 
unless there be watery discharges from the bowels. All the Greek author- 
ities confirmed the truth of this prognostic, but the Arabians called it in 
question. Hippocrates, in his sixty-fourth aphorism, modifies the preced- 
ing statement in this wise: "When in cases of fever, jaundice occurs on 
the seventh, the ninth, the eleventh, or the fourteenth day, it is a good 
symptom, provided the hypochondrial region be not hard. Otherwise it is 
not a good symptom. Galen, with justice, thinks that the sixty-fourth 
aphorism should have been joined with the sixty-second. A Cornelius 
Celsus, in the 3d book and 24th chapter of his work on medicine, which 
treats of "The Jaundice and its Cause," alludes to the foregoing aphorisms 
of Hippocrates in the following terms : "This distemper is equally known, 
which is called sometimes arquatus, sometimes regius. If this comes on 
after the seventh day of a fever Hippocrates pronounces the patient to be 
safe, provided only the prmcordia be soft." Diodes declares, without reserve, 
"that ii it comes after fever, it even does good ; if a fever follows it, it is 
mortal." Hippocrates, in the third constitution of his First Book on Epi- 
demics, states that when the autumn and the rains had set in, the ardent 
fevers were of a fatal character, and "some were attacked with jaundice on 
the sixth day, but these were ben efitted either by an urinary purgation, or 
a disorder of the bowels, or a copious haemorrhage." The complication of 
the autumnal remittent fever with jaundice, which attracted the attention 
of Hippocrates, Celsus, Aret sens, Paulus, JEgineta, Galen, and other ancient 
physicians, who practised along the malarious shores of the Mediterranean 
Sea, has ken observed and recorded by Sir John Pringle and a host of 
medical writers in Asia, Africa, Europe and America. 
Hippocrates, in the first section of the Third Book of the Epidemics, 
records the following interesting case of fever accompanied by jaundice 
and coma: "Hemocrates, who lived by the new wall, was seized with 
fever. He began to have pain in the head and loins; an empty distension 
of the hypochondrium; the tongue at first was parched; deafness at the 
commencement; there was no sleep; not very thirsty; urine thick and reel, 
when allowed to stand, it did not subside; alvine discharges very dry and 
not scanty. On the fifth, urine thin, hard substances floating in it which 
did not fall to the bottom; at night he was delirious. On the sixth had 
jaundice; all the symptoms were exacerbated; had no recollection. On 
the seventh, in an uncomfortable state; urine thin as formerly; on the fol 
lowing days the same. About the eleventh day. all the symptoms appeared 
to be lightened. Coma set in; urine thicker, reddish thin substances 
below, had no sediment; by degrees he became collected. On the fourteenth, 
fever gone; had no sweat; sleep quite collected; urine of the same charac- 
ter. About the seventeenth, had a relapse, became hot. On the follow- 
ing day, acute fever; urine thin; W'as delirious. Again, on the twentieth 
had a crisis; free of fever; had no sweat; no appetite through the whole 
time; was perfectly collected; could not speak; tongue dry, without thirst; 
deep sleep. About the twenty-fourth day he became heated; bowels loose, 
with a thin, watery discharge; on the following day acute fever, tongue 
parched. On the twenty-seventh he died. In this patient deafness con- 
tinued throughout; the urine either thick and red, without sediment, or 
thin, devoid of color, and having substances floating in it; he could taste 
nothing." " Explanation of the characters.-It is piobable that it was the 
suppression of the discharges from the bowels which occasioned death on 
the twenty-seventh day." Historical Account of Jaundice. 
635 
Galen, in his commentary on this disease, says, that there being three 
distinct classes of fever, namely, the ephemeral, the hectic, and those con- 
nected with putrid humors, the preceding case belongs to the last of them. 
Galen justly thinks it somewhat singular, that no further mention of the 
jaundice is made by Hippocrates, in the course of his report of the case of 
Hemocrates; but he inclines from this to draw the conclusion, that it 
remained in the same state throughout. As there was no crisis by the 
stomach, the bowels, the urine, or sweat, he concludes that the jaundice 
could not have been carried off. From all that has been said, he adds, that 
the organ primarily affected was the liver; and, in opposition to Hippo- 
crates, Galen contends that the death of this man was not connected 
with any suppression of the alvine discharges, but with the affection of 
the liver. 
Dr. Francis Adams, the learned translator of the "genuine works of 
Hippocrates," has called attention to the complication of this case with 
jaundice and its resemblance to the epidemic of relapsing fever which pre- 
vailed in Scotland in the year 1843. In this epidemic, as in the case recorded 
by Hippocrates, the fever was very subject to relapses, and to jaundice at 
an early stage. Hippocrates was not only acquainted with abscess of the 
liver, but he has left in the forty-five aphorisms the following observation, 
which indicates that both the knife and the cautery were used at this early 
day for the evacuation of pus from this organ. " When abscess of the liver 
is treated by the cautery or incision, if the pus which is discharged be pure 
and white, the patients recover (for in this case it is situated in the coats 
of the liver); but if it resemble the lees of oil as it flows, they die." In 
his Prognostics, Hippocrates evidently alludes to hepatitis ending in 
abscess; and this would seem to have been a very common termination of 
inflammation of the liver in Greece and in the malarious region on the bor- 
ders of the Mediterranean, as it is often described in the ancient medical 
works. Thus A. Cornelius Celsus, in the eighth chapter of his fourth book 
which treats "of the disease of the liver and its cure," says that the dis- 
temper of this organ is sometimes long and sometimes acute. " Greeks 
call it hepaticus. There is a violent pain to the right, below the prsecordia; 
and the same reaches to the right side, and to the clavicle, and the shoulder 
of the same side; sometimes, also, the right hand is benumbed, and there 
is a strong shuddering. When it is severe, bile is vomited; sometimes the 
hiccough almost suffocates. And these are the symptoms when it is acute. 
But it is chronical when there is a suppuration in the liver; and the pain 
sometimes ceases, at other times increases; on the right side t he prfecordia 
are hard and swollen; after eating, the difficulty of breathing is increased. 
There is also a sort of paralytic relaxation of the jaws. When the disorder 
has continued long, the belly, and legs, and feet swell; the breast, and arms, 
and the parts about both clavicles, are emaciated. * * If the liver is 
oppressed with a vomica, the same method must be followed as in other 
internal suppurations. Some even make an incision over it, and cauterize 
the vomica itself." 
According to the views of the ancient physicians and physiologists, 
the liver is the seat of the natural powers, being the grand organ of san- 
guinification, and the blood being the pabulum which nourishes the whole 
body. That the liver performs an important part in the fabrication of the 
blood, seems probable, from all the veins of the stomach and upper por- 
tion of the intestines passing to the liver, whereby, it is to be supposed, 
that a considerable proportion of the nutritive juices will be conveyed to 
it; and from this viscus being proportionately large in the foetus when 
it is much required to form blood, and cannot be supposed necessary for 636 
Historical Account of Jaundice. 
any other purpose. The ancients taught that the liver, by its attractive 
power, attracts the chyle from the stomach; that by its retention it retains 
the same until the alteration converts it into blood; and that then the 
expulsion separates the superfluities of the blood, namely, the bile, and 
conveys them to the gall-bladder. 
Aristotle held that the spleen is part of the hepatic system, and his 
commentator. Averrhoes, in like manner, considers the spleen as a second 
liver. 
The following extract from Actuarius contains a clear exposition of 
ancient opinions on the functions of the liver and other abdominal vis- 
cera: 
When the food in the stomach is changed and digested, the mesenteric veins, 
which derive their origin from the liver by their vein called the ramalis, suck the 
stomach and intestines; and having emulged, as it were, the purer part, (namely, 
the food converted into chyle) and having drawn it as if through a strainer, they 
convey ii to the concave part of the liver, and deliver it over to the sanguiticatory 
power. Here, then, if nothing impede it, when it is changed into blood, whatever 
is subtle and acrid is received by the gall-bladder, which is placed at the con- 
vex part of the liver, and attracts the bile; but whatever the blood possesses of a 
terrene and melancholic humor is attracted to the spleen by some natural faculty, 
whereby every part attracts whatever suits its nature. Thirdly, the serous humor 
remains. It is attracted by the kidneys. 
Aretaeus, the Cappadocian, in the seventh chapter of his second book 
on Acute Diseases, savs that. 'Tn the affections of theliver the patients do 
not die, indeed, more quickly than in those of the heart; but yet they 
suffer more pain, for the liver is, in a great measure, a concretion of blood. 
But if the cause of death happen to be situated in its porta. they die not 
less speedily than from the heart; for these parts are tissues formed of mem- 
branes, of important and slender nerves, and of large veins. Hence cer- 
tain of the philosophers have held that the desires of the soul are seated 
there. In haemorrhage it greatly surpasses all the others, for 'the liver is 
made up of the roots of veins.' Wherefore a great inflammation does form 
in it, but not very frequently, nor in its vital parts, for the patient would 
die previously. But a smaller inflammation often takes place, when it 
happens that they escape death, indeed, but experience a more protracted 
state of disease. For of its office, as regards sanguinificatiou, there is no 
stop nor procrastination, as from it a supply of blood is sent to the heart, 
and to the parts below the diaphragm." Aretfeus held icterus to be a dan- 
gerous complaint in acute diseases, for not only when it appears before the 
seventh day does it prove fatal, but even after the .seventh day it has 
proved fatal in innumerable instances. Rarely the affection has proved a 
crisis to a fever towards the end, but itself is not readily discussed. 
Aretaeus regarded jaundice as arising not only from a cause connected 
with the liver, as certain physicians had supposed, but also from the 
stomach, the spleen, the kidneys and the colon. From the liver in this 
manner: "If theliver becomes inflamed or contracts scirrhus, but remain 
unchanged with regard to its functional office, it produces bile, indeed, in 
the liver, and the bladder, which is in the liver, secretes it; but if the 
passages which convey the bile to the intestine be obstructed from inflam- 
mation or scirrhus, the bladder gets over distended, and the bile regurgi- 
tates; it, therefore, becomes mixed with the blood, and the blood passing 
over the whole system carries the bile to every part of the body, which 
acquires the appearance of bile. But the hardened faeces are white and 
clayey, as not being tinged with bile, because the bowels are deprived of 
this secretion. Hence, also, the belly is very much dried up; for it is Historical Account of Jaundice. 
637 
neither moistened nor stimulated by the bile. The color in this speciesis- 
whitish green." 
Aretaeus maintained that jaundice may arise from affections of the 
spleen, stomach and colon, as digestion is partly performed in the latter 
viscus ; in a word, he held that "icterus may be lormed in any viscus, not 
only of those which send nutriment to the liver, but also of those which, 
receive it from the liver. For nature sends nutriment to all parts, not 
only by ducts perceptible to tne senses, but much more so by vapors, which 
are readily carried from all parts to all, nature conducting them even 
through the solid and dense parts. Therefore these vapors become tinged 
with bile, and discolor any part of the body in which they get lodged. 
Aretaeus also had a theory which has found able advocates for near sixteen 
centuries, even up to the present day, namely, that c the general system 
likewise, is most powerful in producing icterus, for the cause is seated in 
the whole body. It is of this nature; in every part there is heat for con- 
cretion ; in every pait for the creation and secretion of humors, different 
in different places, but in each that which is peculiar to it, in flesh, indeed, 
sweat; in the eyes, tears; in the joints- and nose, mucus; in the ears, wax. 
If the heat, then, fails in the performance of each of its operations, it is, 
itself, converted into that which is acrid and fiery; but all the fluids become 
bile, for the products of heat are bitter, and stained with bile. But if indi- 
gestion happens in the blood, the blood assumes the appearance of bile,, 
but is distributed as nourishment to all parts, wherefore bileappears every- 
where.'' Aretaeus thus clearly announces the theory that under morbid 
conditions of the system, substances are formed in the blood, and from its 
constituents, without the co-operation of the liver, which in color and 
properties are identical with the ingredients of bile. The views of Aetius 
and Avicenna were similar to those of Aretaeus, and they maintained that 
there were other causes of jaundice besides obstruction of the duct of the 
gall-bladder; and in like manner Leo held that jaundice arises either from 
obstruction or from the conversion of the blood into bile by the heat of 
the system. This view as to the formation of bile in the blood, was 
revived at a latter day by Bianchi, and was fully discussed by Grant, who 
assumed that the yellow material of the serum consisted of bile, and attri- 
buted the causes of bilious diseases to an excessive quantity, or to altera- 
tions in the quality of this fluid, quite independent of the liver. This 
theory was at one time maintained by Beil ; the ideas of Grant were sus- 
tained by J. P. Schotte, in his account of the Malignant Fever on the Coast 
of Senegal, and A. Diel attributed the cause of bilious diseases not to the 
bile already formed, but to an increase of the elementary constituents of 
this substance in the unhealthy juices of the blood. 
Senac, in his work on the hidden nature offerers, advanced the hypothe- 
sis that the red portion of the blood was the peculiar material from whence 
the bile was formed, and that it assumed a yellow color when it became 
putrid or otherwise decomposed; and since pigments have been more care- 
fully studied, and the doctrine advocated that the luematin of the blood 
forms the basis of all pigments, there has been no lack of observers who, 
adopting the ideas of Senac, have referred the jaundiced tint of the skin, 
which is present in pyaemia, in putrid infection, and other allied conditions, 
without any mechanical obstruction to the flow of bile into the alimentary 
canal, to a direct metamorphosis of the luematin with a yellow substance 
similar to, if not identical, with the bile pigment. 
Breschet supported the derivation of the pigment of the bile from the 
blood by direct proofs; his views were sustained by Dubreuil, and this 
theory acquired fresh support from the investigations of Virchow upon 638 
Historical Account of Jaundice. 
pathological pigments, which proved that under certain circumstances a 
yellow7 substance is formed from the hrematin. which in its relation to sol- 
vents and reagents, bears a close resemblance to chloropyrrhin. Zenker 
and Funk have brought forward fresh arguments in favor of the intimate 
relation subsisting between the bile pigment and the red matter of the 
blood, by showing that a modification of the coloring matter of the bile, 
namely bilifulvine, can be transformed into hoematoidine, a derivative of 
hoematine, thus indicating the possibility of a direct transformation of 
hoematine into chloropyrrhin, Dr. Fred. Theod. Frerichs, has shown in 
his great work on the the diseases of the liver, that the observations on the 
formation of pigment, how ever numerous these may be, are not yet suffi- 
ciently mature for arriving at any conclusion, but that there exists still 
other sources of coloring matter hitherto neglected, which may assign 
to the brown matter of the bile another place in the series of pigment 
changes. 
Important changes on the intimate relation subsisting between the bile 
pigment and the coloring matter of the blood, were further confirmed by 
observations made in the laboratory of Dr. Frerichs, by Dr. Valentin, 
according to whom a portion of the coloring matters of the bile dissolves 
in ckloroform, and from this solution a crystalline substance may be 
obtained presenting all the characters of haematoidiue. From this it 
appeals possible, nay, probable, that as in extravasations, haematoidine 
may be developed from blood pigments, so in like manner, in the vascular- 
system, and in the liver, the coloring matter of the bile may originate from 
the same source. Hitherto, however, no one has succeeded in obtaining 
bile pigment directly from the red matter of the blood. Investigations 
upon the origin of the coloring matters of the bile and urine, have also 
been instituted more recently by Kiihne, Neukomm, Hoppe, Stredeler, 
Thudichum and others. 
Ou the other haud. many ancient and modern writers have held that 
the seat of jaundice and of bilious diseases generally, is to be looked for in 
a disturbance of the functions of the liver; that they arise from abnormal- 
ities in the secretion, or in the excretion of bile ; and that thus they 
exhibit symptoms indicative of derangement of the liver. Thus Paulus 
2Egineta held that jaundice is a diffusion of bile over the whole body, 
sometimes of black, and sometimes of yellow: 
There are many varieties of this complaint, the causes and diagnosis of which 
areas follows: If jaundice occurring suddenly in a febrile complaint diminishes the 
fever, it is critical, being occasioned by a metastasis of the matter from the deep- 
seated parts, and therefore stands in no need of medicines, but is soon removed by 
baths and friction. But if it is attended with fever and bilious evacuations from 
the bowels, and if there be a sense of weight in the right hypochondrium, a hot 
inflammation of the liver is indicated, by which the blood is conveyed over.the whole 
body. When there is heat in the part without a sense of weight, the affection is 
occasioned by a hot intemperament alone of the liver. If it is without fever, and 
the alvine discharges are white, an affection of the gall-bladder, or of its ducts, is 
indicated. When there is a sense of heaviness in the right hypochondrium, it 
indicates that the ducts are obstructed ; and when without heaviness, weakness of 
some of its powers is indicated, either of the attractive, by which it attracts the 
bile from the liver, or of the expulsive by which it propels the bile to the intes- 
tines. For when the blood is not purged of bile it is diffused over the whole body 
(as we stated respecting the black jaundice); in which case the urine is voided very 
much mixed with bile. But jaundice is also occasioned by a hot intemperament of 
the solid parts, which convert into bile whatever is brought to them in place of 
food, in like manner as in anasarcous complaints a conversion to a pituitous fluid 
takes place. This variety of jaundice is recognized by it not occurring at once but 
by degrees, none of the aforementioned symptoms being present. Moreover, jaun- 
dice is occasioned also by drinking certain deleterious medicines, and by the exter- 
nal application of poison from some venomous animal. Historical Account of Jaundice. 
639 
It is evident from the preceding quotation that Paulus Asgineta refer- 
red jaundice to several distinct causes, as the following : 
1. Jaundice occurring suddenly in a febrile complaint occasioned by 
a metastasis of the matter from the deep-seated parts. 
2. Inflammation of the liver, attended with fever and bilious evacua- 
tions from the bowels, and a sense of weight in the right hypochondrium. 
3. Obstruction of the biliary ducts and affection of the gall bladder, 
attended withwhite alvine discharges. 
4. Weakness of the powers of the liver, either of the attractive, by 
which it attracts the bile from the liver, or of the expulsive, by which it 
propels the bile to the intestines. 
5. A hot intemperament of the solid parts which convert into bile 
whatever is brought to them in place of food. 
6. By drinking certain deleterious medicines. 
7. By the action of the poison of venomous animals. 
Paulus JEgineta followed closely the views of Galen and remarks that 
when in fever the bile is suddenly determined to the skin, it proves criti- 
cal, and is easily removed by baths of sweet water and friction with a dis- 
cutient or rarefying oil. The ancients maintained that the primary action 
of certain poisons is exerted upon the liver ; and Galen remarks that the 
poisons of certain reptiles occasion jaundice, a fact confirmed by modern 
observers, as Van Sweeten, Simson, Rogerius and others. 
Caelius Aurelianus says that jaundice is brought on by indigestion, or 
by cathartic medicines, which have been taken, and which have not oper- 
ated. Sometimes, he says, it is attended with enlargement or scirrhus of 
the liver, and sometimes, though rarely, the spleen and stomach are affected 
sympathetically. According to Actuarius, the color of the urine which is 
characteristic of jaundice, is the coerulian, that is to say, the color of a ripe 
cherry, or of a dark colored wine. Theophilus in like manner states that 
the cxrulian-colored urine indicates jaundice. Rufus, the Ephesian, describes 
accurately the situation and use of the gall-bladder, and remarks that 
when its duct is obstructed jaundice is produced, in which case the stools 
are white and clayey. Alexander Aphrodisiensis states that the constipa- 
tion of the bowels in jaundice is occasioned by the want of the natural 
bile, which serves as a stimulant to the intestines. For the same reason, 
he adds, the stools are of a whitish color. 
The poet Lucretius, and the philosopher Aristippus, take it for granted 
that persons in jaundice see every object tinged with yellow. 
According to Serapion, a redundance of yellow bile in the body is 
occasioned either by the system not being properly purged of it, or by 
an over-secretion of it, or by a combination of the^e causes; and obstruc- 
tion, he says, may take place either in the liver itself or in the gall-bladder. 
Sometimes, he remarks, the liver having been inflamed, becomes as hard 
as a stone, or its ducts are obstructed, so that the blood becomes mixed 
with bile, and this is carried over the whole body. He adds, that perhaps 
the whole gall-bladder is affected, or only one of its ducts, namely, either 
the superior one, by which it receives bile from the liver, or the inferior, 
by which the bile passes down to the intestines. In like manner, he after- 
wards states, that sometimes the superior duct losing its tone and becom- 
ing obstructed, the bile becomes mixed with the blood ; or the inferior 
being obstructed, the bile regurgitates to the superior, and becomes inter- 
mixed with the blood. And sometimes, he says, the affection arises from 
the gall-bladder being over-distended in like manner as the urinary blad- 
der sometimes is. 640 
Historical Account of Jaundice. 
A similar account is given by Avicenna, who describes the species of 
jaundice connected with disorder of the general system, described by 
Aretseus. 
A passage by Haly Abbas puts it beyond a doubt that the ancients 
were acquainted with hepatic calculi or gall-stones. 
From the time of Hippocrates to the decline of the doctrines of Galen, 
bile secreted in excessive quantity, or of bad quality, was regarded as a 
fruitful source of diseases ; and its passage into the blood and its abnor- 
mal color, were looked upon as so many etiological impulses, from which 
numerous disturbances took their origin ; but in the sixteenth century, 
when Parcelsus and Van Holmont rejected almost all the pathogenic 
properties of the bile, the functional importance of the liver assumed 
another fo^m, and the theories with reference to the offices and effects of 
bile in disease underwent a temporary change. Parcelsus regarded the 
bile as nothing more than a useless refuse; and Van Holmont thought it 
impossible that such an excellent fluid, the very balsam of life, could give 
rise to disease. This change of opinion was but of short duration, and 
even Sylvius regarded in a manner similar to the ancients the bile as an 
important source of disease, bat he transferred the theory of its mode of 
action to a chemical basis. 
As the zeal for anatomical studies increased, the opinions concerning 
jaundice and the allied affections, so far assumed a definite shape that a 
disturbance in the evacuation of the secretion formed in the liver was dis- 
tinctly recognized as the cause of an excess of bile in the blood. The 
question as to whether there could be a suppression of the secretion, was 
sometimes affirmed and sometimes denied, according as the liver or the 
blood was regarded as the seat of the secretion of the bile; and the sup- 
porters of the latter view who, with Glisson, looked upon the liver as only 
a peculiar organ for filtering the bile from the blood, who maintained that 
interruption of the functions of the organ was the cause of bilious con- 
ditions of the system, and who included among them Morgagni, Boerhaave, 
and Van Sweeten, gradually lost ground in opposition to those who. like 
many of the older writers, to whom we have referred, and Monro, Eller, 
Werlhof Selle and Beil, believed that jaundice arose only from an obstruc- 
tion. The experimental demonstration by Saunders, of the passage of the 
bile into the blood after the ligation of the common duct; and the investi- 
gations of Berzelius, Thenard, Gmelin, Tiedemann, Demar^ay, Strecker, 
and others, revealing the physical and chemical properties of the bile, and 
showing that with the exception of cholesterin, the elements of this secre- 
tion are absent from the blood of the portal vein and other vessels; as well 
as the experiments of extirpating the liver, have placed upon a still firmer 
foundation the theory that the bile is formed in and by the liver, and that 
jaundice arises from an obstruction to the excretion of bile after its forma- 
tion in the liver. In most cases of jaundice it has been possible to discover 
the causes which obstruct the evacuation of the biliary ducts; but in certain 
cases as in the jaundice resulting from the action of animal poisons, putrid 
animal matters and febrile poisons, no material proof of such obstructions 
could be furnished; and consequently a large number of eminent physicians, 
such as Andral, Darwin, Mayo, Watson and Budd, have maintained the 
view held byAreheus, Aetius, Avicenna, Leo, Bianchi, Grant, Beil, Schotte, 
and Senac, that the bile does not originate in the liver, but is previously 
generated in the blood, and thus jaundice may be caused by anything 
which interferes with its elimination. Many pathologists reject both theo- 
ries; and at no time have they received a universal application; and others 
have been brought forward from time to time, as the view entertained by Composition of Bile. 
641 
the ancient physicians, that the infiltration of the bile in the tissues in 
jaundice was owing to its becoming fluid from the operation of poisons, 
marsh miasmata, and putrid substances; or the view which made jaundice 
dependent upon a spasmodic condition of the skin, and an obstruction to 
the circulation of blood through it; and lastly, the absurd hypothesis of 
Deyeux, that the yellow coloring matter was secreted by the skin, without 
any necessary participation of the liver. 
PHYSICAL AND CHEMICAL PROPERTIES OF HUMAN BILE IN HEALTH 
AND DISEASE. 
In the consideration of this branch of our subject, the historical method 
will to a certain extent be followed. Of all organic fluids, human bile is 
that of which least is known of its chemical and physical changes in health 
and disease. We cannot in human beings, abstract the bile for analysis at 
pleasure, at any stage of their diseases, as we may do in the case of the 
blood; neither is it poured out as the urine, nor is there any means by 
which we may determine with any approach to accuracy the rate of its 
increase or decrease in any disease. Even when the patient vomits liquid 
discolored with bile from the stomach, or purges it from the bowels, or 
appears to be deluged with its elements in the blood and organs and tis- 
sues, we have no known means of investigation, by which to determine 
with accuracy whether there is either an actual increase or diminution of 
the bile, in given periods of time, as compared with similar periods in 
health. We are still wanting in accurate and comprehensive knowledge, 
as to the physiological and chemical constitution of healthy human bile, 
and its changes during various states of nutrition, or starvation, exercise 
and rest. And yet such information manifestly underlies all our knowl- 
edge of its changes in disease. With the exception of a few observations 
made in some cases of biliary fistula, and upon the cystic bile of those who 
have been executed or who have been suddenly killed in circumstances 
permitting of the prompt labors of the physiologist and chemist, we know 
nothing of the physiological characteristics of healthy human bile. The 
question as to whether the bile found in the dead body, has a similar con- 
stitution to that which exists during life has not been fully and satisfacto- 
rily answered. It would appear from a case communicated by M. Aron, 
to the Society of Hospital Physicians, that the bile undergoes a great mod- 
ification when brought into contact with the air after death. By a mis- 
take, from which, however, no evil consequences arise, a small trochar, 
instead of being plunged into an hydatid tumor of the liver, was pushed 
into the gall-bladder. There immediately issued a clear, transparent, 
nearly colorless liquid, containing merely a few cloudy flakes. Such a fluid 
as this is certainly far from resembling the bile in the dead body; and it has 
even been questioned whether the liquid obtained in certain rare cases of 
biliary fistula, be really healthy bile. 
On examining the older analyses of bile, it is impossible not to be struck 
with their discrepancies; and more recent researches have confirmed the sur- 
mise, that the great majority of substances pointed out by authorities, and 
more especially by Tiedemann and Gmelin, are the products of decomposi- 
tion of the principal constituents of the bile, under the influence of the 
reagents and chemical operations, to which the liquid is subjected, during 
the process of analysis. This will be evident from a comparison of the fol- 
lowing analysis of human bile. 642 
Composition of Bile. 
Thenard published* an elaborate dissertation on the chemical consti- 
tution of the bile in 1805, in which he announced the existence of a pecu- 
liar proximate principle which gives the bile many of its special proper- 
ties, and composes a large proportion of its solid constituents; to this he 
gave the name of picromel. Th6nardf gives the following as the composi 
tion of ox bile. 
Water 700.0 
Picromel and resin 84.3 
Yellow matter 4.5 
Soda 4.0 
Phosphate of soda 2.0 
Muriate of soda 3.2 
Sulphate of soda . 0.8 
Phosphate of lime 1.2 
Oxide of iron Trace. 
800.00 
According to Th6nard, the composition of human bile is considerably 
different, the picromel not being found in it, but its place partly supplied 
by what is termed resin. 
Analysis of human bile by M. Thenard: 
Water ..905.0 
Albumen ?. 42.0 
Resin (yellow and very bitter) 41.0 
Yellow coloring matter 'and mucus 2 to 10 
Soda 5.6 
Salts of potash and soda 4.5 
Oxide of iron A trace. 
Berzelius,^ however, calls in question theaccuracy of Thenard's anal- 
ysis; he does not admit of the evidence of the resin as described by Th6- 
nard, but attributes the peculiar character of bile to a substance which he 
simply denominates biliary matter. Analysis of human bile by Berzelius: 
Water 904.4 
Biliary and fatty matter (bilin fellinic acid, etc.) 80.0 
Mucus of the gall-bladder, dissolved in a free alkali 3.0 
Osmazene, chloride of sodium and lactate of soda 7.4 
Soda 4.1 
Phosphates of soda and lime 1.1 
From the researches of Berzelius, it appears that the bilin is so 
unstable a compound that it is hardly possible to obtain bile in the condi- 
tion in which it is secreted by the liver, or as it exists in the gall-bladder; 
for when bile is left to itself, and much more when it is acted on by heat 
and other more or less energetic agents, the bilin undergoes a series of 
metamorphoses by which fellinic, choliuic, and very probably also cholanic 
and fellanic acids are produced. According to Berzelius, the biliary secre- 
tion, as it exists in the liver, may be regarded as pure bilin, mixed with 
biliverdin and fats; the bilin, probably, commences its metamorphoses in 
the gall-bladder, and continues them in its passage towards the alimentary 
canal. Dr. Davy's analysis of human bile, in Monro's Elements, vi, p. 
.579, is as follows: Water 86.0; resin of bile 12.5; albumen 1.5 
* Mem. d'Arcueil, t. i, p. 23; also Traite, t. iii, pp. 517, 518. 
t Mem. d'Arcueil, 1.1. 1, p. 38. 
J Ann. Chim. t. Ixxi, p. 220. Ann. Phil. vol. ii, pp. 377 379. Med. Chir. Jr. vol. iii, p. 241. Composition of Bile. 
643 
The chemical investigations of Thenard* and Berzeliusf were followed 
by those of Tiedemann and Gmelin, J Frommherz and Gagert.§ 
Analysis of human bile by Tiedemann and Gmelin: Water 915.1; 
solid matters 84.9: these are as follows: a volatile substance having the 
odor of musk; cholesterine; oleic and margaric acids; cholic acid; biliary 
resin; taurin; biliary sugar; coloring matter; osmazone; a substance having 
the odor of urine when heated; a substance analogous to albumen and 
gluten; mucus; cheesy matter; bicarbonate of soda; carbonate of ammonia; 
acetate of soda; acetate; margarate and cholate of soda; sulphates and 
phosphates of soda and potash; phosphate of lime; chloride of sodium. 
A comparison of the results of the preceding analysis illustrate the 
difficulties and impediments in prosecuting such zoo-chemical processes, 
and the different and opposite views which were for a long time held by 
the most eminent chemists as to the real composition of the bile, and the 
disputes amongst the first chemists of the day regarding the constitution 
of the bile, were calculated at first glance to cause the faith of the physi- 
cian, in the extreme certainty of chemical investigation, to stagger, and to 
blight his hopes of ever attaining to an exact humoral pathology. But 
the subsequent investigations of Liebig, Lehmann, Demargay, Scherer, 
Frerichs, Bernard, Blendot, Schwann, C. Schmidt and others have thrown 
important light on the function of the liver and its secretion. 
In the year 1837, M. Demargay endeavored to unveil the mystery which 
surrounded the subject of the chemical composition of the bile, by reviving 
the notion that the bile is a soda soap; in a word that it consisted essenti- 
ally of an organic acid combined with soda. According to M. Demargay, 
the bile is a choliate of soda; but it would appear from the researches of 
M. Strecker, that two acids enter into its composition, and that it must be 
regarded as a choleate and cholate of soda. Demargay obtained choleic 
acid in the following manner : Bile from which the mucus had been pre- 
cipitated by alcohol, was evaporated in the water bath, and ten parts of 
the dried residue were dissolved in 100 of water, to which ten of hydro- 
chloric acid had been added. Allowing evaporation at a moderate temper- 
ature to proceed, it was observed that a dark green oil collected on the 
surface, while at the same time the fluid became turbid. On removing this 
oil and allowing the fluid to rest for some time, it gradually became clear, 
with the precipitation of a green deposit. This dark green deposit is 
Demargay's choleic acid, and is regarded by him as constituting nine-tenths 
of the solid constituents of the bile. It is still mixed with margaric acid, 
cholesterin, pigment, etc. After the removal of these impurities, it is 
described by Demargay as a yellow, spongy, pulverulent matter, which 
rapidly absorbs oxygen from the atmosphere; very bitter, slightly soluble 
in ether, soluble in water, and very soluble in alcohol. Its solutions have 
an acid reaction, decompose carbonates, and form a peculiar class of salts 
with bases from which the choleic acid may be removed by acetic acid. 
Its composition is represented by the formula C42H36NO12. The choleate 
of soda obtained by adding an alcoholic solution of soda, to an alcoholic 
solution of choleic acid, till there is an alkaline reaction, and then passing 
a current of carbonic acid through it to remove the excess of soda, pos- 
* Memoirs d'Arcueil, i. 
t Lehrbuch du Thierchemig, Dresden, 1831, and Medico-Chirurgical Transactions, iii. 
j Uber die Verdanung (Essay on Digestion). 
? Schweiggers' Journal, v. 1. 
For opinions entertained before and during the investigations of Th6nard, Berzelius and 
Tiedemann and Gmelin, respecting the chemical constitution of the bile, consult Baglivi, disi. 
3, circa Bilem; Haller, Ed. Phys., xxlii. 3, 2, 20; Fourcrey System, vol. x, p. 17 et seq.; Thompson, 
Chern., v. iv. p. 518 etseq.; Thenard, Chem., t. iii, p. 698 et seq.; Henry, Elem., v. ii, p. 412 et seq.; 
Pleu.. Hydro!., p. 110 et seq.: Blumengaeb, Inst. Physiol., sec. 25. 644 
Composition of Bile. 
sesses all the characters of bile; it yields on evaporation a brown resinous 
mass, and is soluble in water and in alcohol. When choleic acid Is boiled 
with hydrochloric acid, it yields ammonia, taurin and choloidic acid; the 
latter being insoluble is deposited. As Redtenbacher has shown that 
taurin contains 26 per cent, of sulphur, and as choleic acid yields taurin 
on decomposition, the formula assigned to it by Demargay is evidently 
erroneous. 
Berzelius, in the edition of his A.uimal Chemistry, published in 1840, 
states that he concurs that cholic acid is produced by biliu alone, and that 
any fellinic or cholinic acids that may be simultaneously present, take no 
part in the metamorphosis. In his article "Bile," in Wagner's Haud- 
wortenbuch. published two years later, he stated that bilin in a state of 
purity undergoes only a very slight change by boiling with hydrated potash, 
and that he could not convert it into cholic acid in that manner. Accord- 
ing to this view cholic acid does not pre-exist in the bile. Bilin is the 
name given by Berzelius to the substance which he considers as the most 
important constituent of the bile. On digesting bilin with dilute hydro- 
chloric acid, five distinct substances are ultimately obtained, three of which 
are insoluble iu water, and have received from Berzelius the names of fel- 
linic, cholinic acid, and dyslysin; the remaining two being soluble in water, 
namely, taurin and hydrochlorate of ammonia. Fellinic and cholinic acids 
possess the property of combining and forming acid compounds with unde- 
composed bilin, to which Berzelius has given the names of bilifellinic and 
bilicholiuic acids. Bilifellinic acid apparently exists as such in fresh bile; 
it may be obtained either from bile, after the removal of mucous, coloring 
matters and other acids, by neutral acetate of lead, or from pure bilin. 
According to Berzelius, a mixture of these two bilin containing acids, con- 
stitutes Demargay's choleric acid, and forms the principal part of Thenard's 
biliary resin. 
Dr. Kemp has communicated some experiments relative to the bile, 
tending to show that it is principally composed of a mere simple solution 
of a salt of soda, the acid which differs from the choleic acid of Demargay 
in several respects, he terms bilic acid. Liebig published a memoir based 
on Kemp's experiments, in which he arrived at similar conclusions, but 
regarded bilic acid as identical with the choleic acid of Demargay and the 
bilifellinic acid of Berzelius. 
Theyer and Schlosser subsequently published an account of researches 
on the bile which were made in the Gressin laboratory, and which confirm 
the accuracy of Liebig's previous conclusions. 
Platner* iu his essay on the bile, showed that bilic acid and acid bilate 
of soda may be procured in a crystalline state. In a subsequent communi- 
cation by the same chemist, he proceeds to show that two distinct sub- 
stances are met with in perfectly fresh bile: 
"I have been able," he observes, "to cause bile, which was evaporated in a 
water bath, and freed from mucus and the greater part of its salts by repeated solu- 
tion in alcohol, to crystallize immediately. For this purpose, nothing further is 
necessary than to add ether repeatedly to as strong an alcoholic solution of the bile 
as possible, and then to set it aside in a cool place. The principal and most impor- 
tant constituent of the bile then crystallizes, in the same manner as in my former 
experiments ; but one-sixth to one-fourth of the bile used does not crystallize, but 
remains as a yellowish-brown syrup. I have not been able to succeed in separat- 
ing this in any manner from the crystals; consequently, I can say nothing more 
concerning its nature. It is, however, evidently a different substance from the 
principal constituent of the bile, possibly a product of its decomposition. The 
* Muller's Archiv., No. 2,1844. Chemistry and Physiology of Bile. 
645 
decomposition of the bile begins even in the organism, and it is impossible to 
examine fresh bile which is not partially decomposed. The brown liquid appears 
to consist principally of biliary coloring matter. I must, however, remark that the 
crystals have also a slight yellow tint. The principal constituent of bile is a com- 
pound of soda with a peculiar organic body, and this compound may be imme- 
diately procured from the bile, without its undergoing any important alteration. 
Liebig called this compound bilate of soda ; I have denominated it choleric soda. 
It does not appear to me sufficiently proved that the principal organic constituent 
of bile is positively an acid. It is possible that like albumen, it may combine with 
acids as well as bases. The most recent examinations of bile by Berzelius, would 
then be partly true. Further experiments must decide this. These, however, are 
peculiarly difficult, because in separating the bile from soda, an acid body may 
undoubtedly be formed. From the above observation, it is further evident that 
the formula advanced by Liebig for bilicacid must be incorrect; for Kemp, Theyer, 
and .Schlosser have not analyzed the essential biliary ingredient in a perfectly pure 
state, but have always at the same time included the brown syrup." 
Professor C. G. Lehmann, bases his description of the constitu- 
tion of the bile chiefly upon the most recent investigations conducted 
under Liebig's auspices. Lehmann regards every kind of bile as con- 
taining two essential constituents, namely, a resinous and a coloring consti- 
tuent. The resinous consti'uent is, as a general rule, the soda salt of one 
of the conjugated acids (glycocholie acid. C52H4NOn.HO. hyocholic acid, 
C^H^NOwHO: and taurocholic acid, Cj-H^NSjOj* or CiHgNSjOsC^HgOa), 
whose adjunct is glycerine or taurine. As far as investigations have 
hitherto extended, glycocholic acid has been found in the bile of all ani- 
mals with the exception of the pig. It is probable that cholic acid obtains 
its essential elements from the fats, and that in short, it is oleic acid conju- 
gated with a non-nitrogenous body. But in glycocholic we meet with the 
same nitrogenous adjunct, as in hippuric acid, and which consequently 
seems to be an ordinary product of decomposition of nitrogenous bodies. 
Important as it would be in a physiological point of view, to ascertain 
whether cholic acid or the conjugated biliary acids occur in the blood, and 
whether these or choloidic acid occur in the intestine, Lehmann leaves 
these questions undecided. Kunde, one of his pupils, very distinctly 
recognized the presence of biliary matters by means of Pettenkofer's test, 
in the fluid from the hydrocele of an otherwise healthy man. By the same 
tests. Lehmann affirms that he was able to demonstrate the presence of 
biliary matters in the blood of frogs, whose livers he had extirpated. Of 
six frogs upon which he operated, only two survived. Hyocholic acid has 
hitherto only been found in the bile of the pig. From the determination of 
the amount of sulphur instituted by Bensch and others, we may conclude 
that taurocholic acid exists in the bile of the ox, fox, bear, sheep, dog, 
wolf. goat. frog, and certain fresh water fish; and Gorup-Besanez has 
shown that it exists in human bile. 
The coloring principle of the bile occurs in combination with an alkali 
in the bile. 
A third never failing constituent is the cholesttrin. Besides these 
essential constituents, the bile also contains fats, and combinations of the 
alkalies with fatty acids. Moreover, the bile contains the same mineral salts 
which occur in most animal fluids, namely, chloride of sodium (the princi- 
pal salt), and extremely minute quantities of iron and manganese, but no 
alkaline sulphates. No salts of ammonia are found in fresh healthy bile. 
The relations of the potash and soda in the bile of different animals-a fact 
noticed by Bensch. but more prominently evolved by Strecker-is deserv- 
ing of careful attention ; the bile of salt-water fishes contains almost exclu- 
sively potash salts, while that of the herbivorous mammalia contains almost 
exclusively soda salts: whereas from the nature of the food of the animals, 646 
Chemistry and Physiology of Bile. 
we should have expected to have met with the opposite result. Finally, a 
greater or less quantity of mucus always occurs in bile. This, like other 
varieties of mucus, is mixed with numbers of epithelial cells; here, how- 
ever, the mucous juice very much preponderates over the epithelium. 
Fresh normal bile contains no morphological elements, except the 
cells of cylindrical epithelium thrown off from the mucous membrane of the 
biliary ducts, and the gall-bladder; these cells often remain grouped 
together in their natural arrangement.* 
Frerichst gives thefollowing as the physical and chemical characters of 
healthy human bile. In color it is always deep brown, but when seen in 
thin layers, it has a brownish yellow tint. It is very fluid, being viscid 
only in new-born infants. The specific gravity varies from 1032 to 1040. 
On examining with the microscope, bile from the gall-bladder, with which, 
of course, a certain amount of mucus is mixed, there are observed : 1. 
Transparent or grayish round vesicles about l-700th of a line in diameter. 
They disappear on the addition of alcohol or ether, and are removed by 
filtration. 2. Conical yellow bodies, about l-140th of a line in length, 
and about l-300th or l-400th of a line in breadth, apparently devoid of 
nuclei; these are epithelial cells from the gall-bladder. 3. Here and there 
irregular dark granules, which disappear on the addition of a solution of 
potash, apparently pigment cells. 4. Occasionally minute crystals of 
cholesterin, occurring as colorless rhombic tablets. The chemical charac- 
ters are shown in the following analysis. The bile in these cases was 
obtained from healthy men killed by severe accidents. 
■ (1) 
(2) 
Water 
86.00 
85.92 
Solid constituents 
14.0<> 
14.08 
Bilate of soda 
10.22 
9.14 
Cholesterin 
0.16 
0.26 
Margarine and olein 
0.32 
0.92 
Mucus 
2.66 
2.98 
Chloride of sodium 
0.20 
Tribasic phosphate of soda 
0.20 
025 
Basic phosphate of lime and magnesia 
0.18 
0.2S 
Sulphate of lime 
0.02 
0.04 
Peroxide of iron 
Traces 
Traces 
Human bile, according to Gorup-Besanez, contains the following con- 
stituents in 1000 parts: 
Water from 822.7 to 908.1 
Solid matter from 177.3 to 91.3 
Biliary acids with alkalies from 107.9 to 56.5 
Fat and cholesterine from 47.3 to 30.9 
Mucus and coloring matters from 23.9 to 14.5 
Ash from 10.8 to 6.3 
Composition of human bile according to Robin, f 
Water 1 915.00 to 819.00 
Taurocholate or cholate of soda (N aO,C52H95NOi 4S2) 56.50 to 106.00 
Glycholate or cholate of soda (NaO,C52,H42,NO1 J Traces. 
Cholesterine (C25H22O) 1.60 to 2.66 
Biliverdine 14.00 to 30.00 
* Physiological Chemistry, by C. G. Lehmann, trans, by G. E. Day, M. D., Am. ed., vol. 1, pp. 
201-204; pp. 273-283; pp. 246-248; pp. 457-502. 
t Hannov, Anna!. 1 and 2, 1845. 
f Robin, Lemons sur les humeurs, Paris. 1867, p. 512. In making up the table, the difference- 
between the sum of the constituents and 1000 has been put down as less. Leucine, tyrosine, and 
urea, have been omitted, as their existence as proximate principles of normal bile is doubtful. 
Physiology of Man, by Austin Flint, Jr., M. D., Secretion Excreted, etc., p. 261. Chemistry and Physiology of Bile. 
647 
Lecithene, 
Margarine, olein and traces of soaps. 
3.20 to 31.00 
Choline (Ci0H1sNO2) Traces 
Chloride of sodium 2.77 to 3.50 
Phosphate of soda 1.60 to 2.50 
Phosphate of potassa 0.75 to 1.50 
Phosphate of lime 0.59 to 1.35 
Phosphate of magnesia 0.45 to 0.80 
Salts of iron 0.15 to 0.30 
Salts of manganese Traces to 0.12 
Silicic acid 0.03 to 0.06 
Mucosine Traces 
Loss 3.45 to 1.21 
1000.00 1000.00 
PHYSICAL AND CHEMICAL PROPERTIES OF THE INDIVIDUAL CONSTITUENTS 
OF BILE IN MAN AND ANIMALS. 
Human bile is a ropy liquid of a yellowish green color, when concen' 
trated, but of a bright yellow when diluted. It has a peculiar musky odor 
and bitter taste. When poured into water it sinks to the bottom, and does 
not mingle readily with it, but it may be mixed with it by agitation, and 
it then forms a liquid which froths strongly, like a solution of soap. The 
viscidity of the bile is owing to the presence of a quantity of mucus from 
the gall-bladder, which it holds in solution. Owing to this mucus the bile 
is very prone to putrefaction, but if the mucus be got rid of by coagula- 
tion with acetic acid and filtration, or otherwise, the bile may be preserved 
without decomposition for some time. When freed from mucus the bile is 
soluble readily in water and alcohol, but insoluble in ether. The vegeta- 
ble acids do not coagulate it ; but hydrochloric, sulphuric and nitric acids 
occasion precipitates immediately, if concentrated, or more slowly if 
diluted. Aqueous solutions of bile are precipitated copiously by solutions 
of basic plumbic acetate; the solution is soluble in excess of lead acetate 
to some extent, and is freely soluble in an excess of acetic acid. 
No albumen is present in normal bile, but its organic constituents con- 
tain a small percentage of nitrogen. It also contains sulphur in notable 
quantity. Owing to the facility with which bile undergoes decomposition, 
the statements of the earlier chemists who examined this liquid, were con- 
tradictory, but the masterly researches of Strecker have at length removed 
all doubt respecting the true nature of the biliary secretion. The result 
of these investigations has been to show that ox bile may be regarded as 
a species of soap, formed by the combination of two peculiar resinoid 
acids with sodium. Both of these resinous acids (the glycocholic and the 
taurocholic) contain nitrogen. The taurocholic acid also contains sulphur, 
but the glycocholic acid is free from this element. Ox bile likewise con- 
tains, in addition to the mucus of the gall-bladder, minute quantities of 
cholesterin, and a small amount of stearic, oleic and lactic acids, united 
with potassium and ammonium. Besides these substances, a peculiar color- 
ing matter is found in combination with an alkaline base.* 
Fresh human bile can only be obtained from the bodies of criminals 
who have been executed, and has been very rarely examined. Most of our 
knowledge regarding the biliary secretion, and the influence of bile on the 
digestive system has been derived from observations on animals, in which 
the bile ducts were tied and biliary fistulie have been established. We are 
indebted to the researches of Bidder and Schmidt for almost all the knowl- 
♦ Lieb Ann. , Ixv, Ixvii and Ixx. 648 
Chemistry and Physiology of Bile. 
edge we possess regarding the differences between fresh hepatic and cystic 
bile. The fresh bile of carnivorous animals (dogs, cats, crows), is yellow 
or yellowish-brown, while that of herbivorous animals (rabbits, sheep, 
geese) is green. The color of cystic bile in the former class of animals is 
for about three hours after a meal, as yellow as the hepatic bile; but it then 
becomes greenish, and if no food has been taken for twenty hours, it 
assumes a deep green tint. As hepatic bile gradually becomes green on 
exposure to the atmosphere, and as further, the yellow tint re appears on 
the application of deoxidizing agents, we cannot entertain a doubt that 
this change of color is dependent on an oxidation effected by the arterial 
blood in the capillaries of the inner coat of the gall-bladder. 
Prolonged retention of the bile in the gall-bladder gives rise to a very 
decided concentration of this fluid. Thus while the fresh hepatic bile of 
dogs and cats contains, on an average 5 per cent, of solid constituents, the 
cystic bile may contain from 10 to 20 per cent., according to the length of 
its retention; and while the fresh bile of the rabbit contains only 2 per 
cent, the cystic bile may yield as much as 5 per cent. The bile of the 
goose and the crow yield similar results. It is evident, therefore, that the 
specific gravity of human bile obtained from the gall-bladder after death 
may vary within wide limits even when there has been no disease of the 
liver and no obstruction to the flow' of bile. Professor John C. Dalton* 
found the specific gravity of human bile to be 1018, that of ox bile 1024, 
that of pig bile 1030 to 1036. 
As we shall see more fully hereafter, the most important abnormal con- 
stituents of the bile, are albumen, urea, blood, haematin, leucine and tyro 
sine. Albumen has been observed in cases of fatty liver and Bright's dis- 
ease, whilst urea has been found in cases of uraemia in Bright's disease, 
malarial haematuria, yellow fever and cholera; and leucine and tyrosine in 
acute atrophy of the liver and in yellow fever; and blood and haematin in 
yellow fever. Bile, which in consequence of disease, has been retained for 
a long time in the gall-bladder, occasionally presents a sediment, w7hich, 
when examined under the microscope, is found to consist of greenish or 
brownish rod-like molecules, or of crystals, ranged in rows. The term 
bilifulvin has been applied by Virchow to the substance forming these 
sediments, and we occasionally find intermingled with these molecules, 
those crystals of haematoidin which are also found in old extravasated blood. 
COMPOSITION OF BILE OF MAN AND ANIMALS, COMPARED. 
Human bile consists mainly of taurocholate of sodium, with very little 
glycocholate (Gorup-Besanez); ox bile, on the contrary, contains chiefly 
glycochoiate (Strecker); pig bile consists mainly of the sodium salt, of an 
acid analogous to glycocholic acid, viz: glycohyocholic acid (Gunderlach 
and Strecker), together with a small quantity of a sulphuretted acid, yield- 
ing taurine, by decomposition tauro-hyocholic acid; it likewise contains a 
very strong base containing sulphur. The bile of most other animals con- 
sists mainly of taurocholate of sodium or potassium. That of the dog con- 
tains only taurocholate of sodium; that of the shepp and that of the kan- 
garoo contains taurocholate, with very little glycocholate. In the bile of 
several kinds of fish, viz: turbot, cod, pike and perch, Strecker found tauro- 
cholate, with mere traces of glycochoiate. a similar result was obtained by 
Schlossbergerf with the bile of the shad fish. According to Bensch^: and 
* Human Physiology, 4th ed., p. 159. 
t Ann. Ch. Pharm., cvii, 166. 
j Ann. Ch. Pharm., Ixv. 
Die. Chem., Watts', vol. i, p. 5S6. Chemistry and Physiology of Bile. 
649 
Strecker, the bile of sea ^contains potassium salts; that of fresh water fish 
chiefly sodium salts. The body of the boa anaconda, according to Schlie- 
pej*, and that of the python tigres, according to Binderf, consists mainly 
of taurocholate. Goose-bile appears likewise to consist essentially of tau- 
rocholate of sodium though MausenJ, and more recently Heintz, and Wis- 
liscenus§ state that the sulphuretted acid of goose bile differs in composi- 
tion from taurocholic acid; Heintz and Wisliscenus assign to it the compo- 
sition C^H^NSOs; but the analyses are regarded by chemists as not quite 
satisfactory. Taurocholate of sodium contains about 6 per cent, of sulphur; 
in the dried bile of the dog, Bensch found 6.2 per cent, of sulphur; in that 
of the fox 5.96 per cent.; of the wolf 5.03; of the bear 5.75; of the pig 0.32; 
of the calf 5.62; of the sheep 6.46; of the goat 5.99; of the domestic fowl 
5.57; and of several fishes 6.46 per cent.|| 
In normal human bile Frerichs found 14 per cent., or rather more of 
solid constituents; Gorup-Besanez, in the bile of two recently executed 
criminals, found 10.19 and 17.79 per cent, solid matter; in that of an old 
man 9.13 per cent.; and in that of a boy twelve years old 17.19 per cent, 
solid matter. Ox bile contains 10.12 per cent, solid constituents; pig's 
bile 10.6 to 11.08 per cent. (Gunderlach and Strecker); dog's bile 5.1 per 
cent.; cat's bile 5.6 per cent. (Bidder and Schmidt), sheep's bile 5.3; rab- 
bit's bile 1.8; goose bile 6.9; kangaroo's bile 14.13, and crow's bile 7.3 
per cent, solid constituents. The concentration of the bile appears to 
increase with the time it remains in the gall-bladder. The proportion of 
ash in the dried residue amounts, in normal human bile, to 6.14 per cent. 
(Gorup-Besanez); in ox bile to 12.7. (Berzelius); in calf's bile to 13.16 
(Bensch); in sheep's bile to 11.86; in goat's bile to 13.21; in pig's bile to 
13.6; in fox's bile to 12.71; in that of the domestic fowl to 10.99; in that 
of freshwater fish to 14.11 per cent.; in that of the fresh water turtle 
(Emfs Geographical to 5.5, and in that of the salt water turtle (Emy's 
Insculpta) to 6.3 per cent. (Wetherell, Jr. Pr. Chern., Ixxvi, p. 61). The 
fresh bile of Python tigris yields 1.21 per cent. ash. Ox bile extracted 
from the gall-bladder, without pressure, contains 0.134 per cent, mucus; 
human bile 0.158 per cent. (Lehmann); Gorup-Besanez found in human 
bile 1.45 and 2.21 per cent, of mucus and bile pigment. The bile of the 
kangaroo contains 4.34 per cent, mucus and coloring matter, and 1.09 
chloresterin and fat; that of the shark fish contains 1.26 per cent, mucus 
and coloring matter, and 0.23 per cent, fat; that of Python tigris contains 
0.89 per cent, mucus and 0.03 fat; goose bile contains 2.56 per cent, mucus 
and 0.36 fat and cholesterin (Manson). 
CHEMICAL COMPOSITION OF THE CHIEF CONSTITUENTS OF HUMAN BILE. 
Glycocholic Acid (Cholic acid of Strecker, HC26H42NOB).-This 
acid constitutes the principal portion of the resinous matter of the 
ox bile; it forms white, voluminous, silky, acicular crystals, which shrink 
much in drying; it is sparingly soluble in cold water, more freely so in 
hot water; the solution on cooling deposits crystals which have a bitterish 
sweet taste. Alcohol dissolves it freely, but leaves it as a resinous mass 
on evaporation; it is very sparingly soluble in ether. The salts which it 
forms with the metals of the alkalies and of the earths may be crystalized; 
* Ann. Ch. Pharm., ix, 109. 
t Ann. Ch. Pharm., eii,91. 
j Arch. Pharm. [2], Iviii, 138. 
£ Pogg. Ann., cviii, 547. 
!' Die. Chemistry, Henry Watts, vol. i, p. 586. 
If Dictionary of Chemistry. Henry Watts, vol. 1, p. 586. 650 
Chemistry and Physiology of Bile. 
they are soluble in alcohol. Lehmann held that hardly a doubt can remain 
that this is a conjugated acid, when we consider, on the one hand, that we 
are acquainted with another acid (hippuric acid), from the same nitro- 
genous body, glycine, may be separated by acids, and that, on the other 
hand, there is another acid from which the same non nitrogenous acid, 
cholic acid, is liberated by acids, another body, taurine, being simultane- 
ously produced (this taurine in the taurocholic acid taking the place of 
the glycine in the glycocholic acid). In glycocholic acid we cannot, how- 
ever, consider glycine, as we know it in its isolated state, to be the adjunct 
of cholic acid, but must rather assume that the true adjunct of cholic 
acid, as in the case of hippuric acid, undergoes a change during its sepa- 
ration, by which it forms the body known as glycine. Whilst cholic acid 
obtains its essential elements from the fats, and may be regarded as oleic 
acid, conjugated with a non-nitrogenous adjunct; in glycocholic acid, on 
the other hand, there is the same nitrogenous adjunct which is encoun- 
tered in hippuric acid, and consequently seems to be an ordinary product 
of decomposition of nitrogenous bodies. According to this view glyco- 
cholic acid is derived from the animal albuminous substances, and prob- 
ably from effete tissue or products resulting from the retrograde metamor- 
phosis of the animal tissues. Whilst the albuminous elements from which 
glycocholic acid is formed undoubtedly exists in the blood, experiments 
upon the extirpation of the livers of various animals would indicate that 
this acid does not pre-exist in the blood, but is formed in and by the excre- 
tory cells of the liver. 
Cholic acid of Demargay, cholaic acid of Strecker, (HC^HmCsHjO, 
and 2s HZO). Fusing point 385°F. (195° C.). By adding hydrochloric 
acid, drop by drop to the solution of baric cholate obtained by boiling 
glycocholic acid with baryta, the cholic acid is separated as a resinous mass; 
and this on adding a small quantity of ether is converted into colorless 
tetrahedra, or octahedra which are brittle and efflorescent. Cholic acid, 
is very slightly soluble in water, forming with it a solution which distinctly 
reddens litmus. It is however freely soluble in alcohol, but less soluble in 
ether. The ethereal solution deposits the acid in rhombic tabular crystals 
which contain FLO; this water of crystallization, may be expelled by a gen- 
tle heat, after which the acid fuses at 383° F, and a little beyond this it loses 
its basic water, and becomes converted into choloidic acid, and by a still 
further heat into dyslysin. The cholates of the alkali-metals and of barium 
are soluble in water and alcohol; most of them may be crystallized from 
the alcoholic solution. The most characteristic test for cholic acid, is fur- 
nished by treating it with sugar and sulphuric acid; an intense red color, 
passing into violet, is thus developed. Pettenkofer. to whom this observa- 
tion is due, has founded upon it an excellent test for the presence of bile in 
organic fluids. Cholic acid is formed by the action of sulphuric acid upon 
the resinoid acid of the bile, and then furnishes the reaction in question. 
In order to apply this test, an alcoholic extract of the substance for exami- 
nation is prepared, and dissolved in water; a drop of syrup consisting of 
one part of sugar to four of water, is then added, and pure sulphuric acid 
free from sulphurous acid is cautiously poured in; the liquid at first becomes 
turbid, but it clears as more acid is added, and passes in succession through 
cherry red, carmine and purple into violet. The temperature must not be 
allowed to rise beyond 122° or 131°F, and care must be taken not to use too 
much sugar, as it would be liable to become charred. Acetic acid may be 
substituted for the syrup in applying this test. Cholic acid approaches the 
fatty acids in character, and its salts are somewhat anolagous to ordinary 
soaps. Chemistry and Physiology of Bile. 
651 
Choloidic acid (C^H^Os). Glycocholic acid is soluble in cold con- 
centrated acetic, sulphuric, and hydrochloric acids without alteration, but 
it is decomposed when heated with them. If glycocholic acid be boiled 
with hydrochloric acid, glycocine is separated, and a new resinous acid, the 
choloidic of Demarcay, is produced. 
Glycocholic acid. Choloidic acid. Glycoci ne. 
2HC26H42NO6-rH2O=C48H78O9-|-2G2H5NO> 
Two molecules of cholic acid, by the abstraction of the elements of one 
molecule of water furnish one of choloidic acid. Choloidic acid is a resi- 
nous, white, friable substance, freely soluble in alcohol, scarcely soluble in 
ether and insoluble in water. It reddens litmus, and when treated with 
sulphuric acid and sugar, produces the same reaction as cholic acid. The 
alkaline choloidates are soluble iu alcohol and in water, but they do not 
crystallize; baric choloidate is insoluble in water. These salts are isome- 
ric with the cholates, but do not at all resemble them. Choloidic acid is 
stated to contain no basylous hydrogen, but this is not probable. 
Both cholic and choloidic acids, like oleic acid, when distilled with 
nitric acid, yield by oxidation, the volatile fatty acids of the group CuII2n 
O2, acetic, butyric, caproic, oenanthylic, caprylic, pelargonic and capric 
acids having been discovered in theresultsof distillation by Redtenbacher. 
Various other oxidized products remain in the retort, among which are 
oxalic and cholesteric acids aud a crystallized body termed chloidanic acid, 
Ci6H24O7. By long boiling with hydrochloric acid, the choloidic acid in 
turn is decomposed: each molecule loses three molecules of water, and 
becomes converted into neutral resin (C48H72O6) fusible 284° F. (140° C.). 
and which from the difficulty of bringing it into solution by ordinary 
solvents, Berzelius called dy sly sin. When fused with hydrate of potash or 
boiled with an alcoholic solution of potash, dysiysin is reconverted into 
choloidic acid. 
From the choloidic acid of Demar^ay, Berzelius separated two acids 
which he named fellic and cholinic acids; and like Mulder, he regards 
choloidic acid as a mixture of these two acids. In the bile, we neither 
find cholic nor choloidic acid isolated from its respective adjunct; hence 
either within the animal body, in the gall-bladder or after removal from the 
organism, it seems to have already passed into a state of decomposition or 
else one of these acids must have been produced by the chemical treatment 
to which the bile has been subjected. In examining the blood and urine of 
patients suffering from diseases iu which the liver is not directly implicated, 
we not unfrequently meet with substances yielding the above described 
reaction for bile; but Lehmann and other chemists have never satisfied 
themselves in such cases by any method that the one or the other of the 
biliary acids could be recognized with certainty. 
In healthy solid excrements, Pettenkofer found no substance yielding 
this biliary reaction; the dejections in cases of diarrhoea on the other hand, 
always contained a substance yielding this reaction. Lehmann has always 
been able to detect a little cholic acid in perfectly normal excrements. 
According to Lehmann, the alcoholic extract of previously dried solid 
excrements presented no reaction with sulphuric acid and sugar; but on 
further treating this extract with ether and purifying the residue of the 
ethereal solution by means of water from the fatty acids which are always 
mixed with it, the somewhat concentrated aqueous solution of the ethereal 
extract presented the biliary reaction most beautifully. On using a larger 
quantity of material the acid was obtained iu a crystalline state; as it 
yielded no ammonia when treated with potash, and as its baryta salt was 652 
Chemistry and Physiology of Bile. 
soluble, it could hardly have been any other than cholic acid. In the 
■intestinal canal we can detect the presence of bile in the contents of the 
small intestines, by the addition of sulphuric acid to the alcoholic extract, 
in the manner above described. Lehmann affirms that substances contain- 
ing or yielding cholic acid sometimes occur in exudations and the blood is 
sometimes overloaded with such matters. In the dropsical exudations 
occurring in a case of granular liver and in another case of the insufficiency 
of the mitral valves, with stoppage of the biliary ducts, Lehmann found 
a considerable quantity of biliary matter. The presence of biliary matter 
in morbid saliva and expectoration has been asserted by Wright and other 
observers. Cholic and choloidic acid proceed from conjugated biliary 
acids, but it is probable that cholic acid exists preformed in these biliary 
acids, just as in every conjugated acid, the chemist regards the. true 
acidifying group of atoms as already formed. Without discussing the 
question at this time, whether the bile is primarily formed in the blood or 
in the cells of the liver; even if many physiological and pathological 
facts did not support the view that the fats yield the principal material for 
the formation of the bile, the experiments regarding the products of oxida- 
tion of cholic and choloidic acids would lead to the belief that these bodies 
are closely allied to the fats, and especially to oleic acid. As we have 
seen, Redtenbacher has obtained from choloidic acid when treated with 
nitric acid precisely the same volatile acids as were yielded by oleic acid 
under similar treatment, independently of other specific substances. These 
latter may appropriately be regarded as arising from a group of atoms still 
hidden in the choleic acid, which group must be assumed to be an adjunct 
in the cholic acid. According to Lehmann, if it be not improbable that 
such simple acids as acetic acid, butyric acid, etc., are to be regarded as 
conjugated acids, we are almost compelled to regard an acid like cholic acid 
and with so high an atomic weight and so considerable an amount of 
oxygen (that is to say, with so small a saturating capacity) as a conjugated 
acid. From the circumstance of cholic acid yielding those products of 
decomposition, Lehmann conjectures that it is a conjugated oleic acid. 
Taurocholic acid; choleic acid of Strecker (HC26H41NO7S). The sul- 
phuretted acid of ox bile, is the less abundant of its two compounds; though 
it is the principal ingredient in the bile of serpents, of fishes, and of some 
other animals; it does not appear to have been isolated in a pure state. It 
has, however, been ascertained that it gives rise by the treatment with 
acids to cholic or to choloidic acid and to dyslysin, but instead of glyco- 
cine, it furnishes a remarkable crystallizable body, which contains all the 
sulphur of the acid; this substance has been named taurin (C2H7NO3S). 
Taurocholic acid is the chief acid in human bile, and the only one in that 
of dogs. Gorup-Besanez wai the first to prove that taurine may be obtained 
from human bile. As this acid, like glycocholic acid, becomes resolved 
when acted on by mineral acids and by alkalies, into choloidic or cholic 
acid, which in place of glycine it yields taurine, Strecker; to whom we are 
especially indebted for our knowledge of this acid, and of its properties, 
correctly argues that its composition is perfectly analogous with that of 
glycocholic acid, the only difference being that the adjunct in this case is 
taurine. We must, therefore, regard taurocholic acid as containing an 
adjunct rich in sulphur, which on its separation from the cholic acid, 
becomes converted into taurine. By elementary analysis of a mixture of 
pure alkaline glycocholates and taurocholates, obtained directly from fresh 
bile, Strecker has further confirmed his view regarding the composition of 
this acid (Anu. d. ch. u. Pharm. Bd. 66, S. 43-61). Pure taurocholic acid, 
contains 6 223ds of sulphur. Unchanged taurocholic acid has not yet been Chemistry and Physiology of Bile. 
653 
found in any other animal fluid than bile; but from the experiments of 
Kunde, one of Lehmann's pupils, who very distinctly recognized the pres- 
ence of biliary matters by means of Pettenk offer's test, in the fluid from the 
hydrocele of an otherwise healthy man, and by the same test was able to 
demonstrate the presence of biliary matters in the blood of frogs whose 
livers he had extirpated, it is not improbable in the opinion of Lehmann 
that it also occurs in the blood. What has been already stated respecting 
cholic and glycholic acid, is equally applicable to taurocholic acid. As it 
has not yet been found in the blood, it is impossible to decide chemically 
whether it be primarily formed in the liver from its proximate constituents 
or whether it proceeds from the general metamorphosis of the non-nitroge- 
nous and nitrogenous animal matters. Since physiologists are as ignorant 
of the chemical changes which taurocholic acid undergoes in the intestinal 
canal, as they are regarding those of glycocholic acid, they are unable to 
express by a chemical equation, the part which it takes in the process of 
digestion; and until this can be done, it will be impossible to give a satis- 
factory explanation of the chemical action of the bile. 
The taurocholates of the alkali metals are very soluble in alcohol and 
in water. They give no precipitate with normal salts of lead, but with 
basic salts of this metal, slowly deposit a paste-like compound, which is 
soluble in boiling water. They yield with sulphuric acid and sugar, a 
violet color, similar to that produced by the cholates. 
Taurine (C2H7NO3S), contains more than twenty-five per cent, of 
sulphur, but is a compound of remarkable stability. As we have stated, 
it may be obtained from taurocholic acid, when treated with acids.. 
Taurocholic Acid. Taurin. Cholic Acid. 
H. C26H«NO7S+H2O=C2H7NO3S4-H. C24H39O5., 
Taurine formerly termed biliary asparagin, was first discovered by 
Gmelin in the bile, and was soon afterwards analyzed with very similar 
results, by Demargay, Pelouze and Dumas; these chemists, however, 
entirely overlooked the existence of sulphur in this body, the discovery of 
which was made by Redtenbacher (Ann. d. ch. u. Pharm. Bd. 57, S. 170- 
174), from whose analyses it was found to consist of: 
Carbon, 4 atoms 19.20 
Hydrogen, 7 atoms 5.60 
Nitrogen, 1 atom 11.20 
Sulphur, 2 atoms 25.60 
Oxygen, 6 atoms 38.40 
100.00 
It may be prepared by freeing fresh bile from mucus by the addition 
of an acid, and filtering it; the clarified bile is then boiled for some hours 
with hydrochloric acid; the liquid decanted from the resinous acids is 
evaporated in the water baths nearly to dryness, and decanted from the 
crystals of sodic chloride which have separated : the mother-liquor is then 
mixed with five or six times its bulk of alcohol, and the liquid on cooling 
yields crystals of taurin, which must be purified by recrystallization from 
water. 
The crystals of taurin assume the form of a six-sided prism terminated 
by four and six-sided pyramids resembling those of quartz. Taurin has 
a cooling taste; it is soluble in about 16 parts of cold water, but it is not 
soluble in absolute alcohol or in ether. The mineral acids dissolve taurin 
without alteration, but do not combine with it, and even when heated with 
it, they do not decompose it. When burned in the open air it emits 
abundance of sulphurous anhydride. A solution of caustic potash dis- 654 
Chemistry and Physiology of Bile. 
solves it, and if boiled down with it nearly to dryness, decomposes it, 
ammonia being evolved abundantly, while potassic sulphate and acetate 
are formed. Hence it appears that the sulphur is already in an oxidized 
condition. Taurin is isomeric with sulphite of aldehyd-ammonia, a com- 
pound which may be prepared artificially, but which differs in properties 
from taurin; C2H4O, H3N, SO2=C2H7NO3S. Strecker (Chern. Gaz., 1854, p. 
388) has, however, succeeded in procuring taurin artificially from ammonic 
isethionate. Isethionic acid is prepared by absorbing olefiant gas by means 
of sulphuric anhydride, and the product thus obtained is dissolved in 
water; in neutralizing the liquid with ammonia and evaporating it until 
crystals are formed, on cooling the ammonic isethionate is obtained. Now, 
this salt contains the elements of 1 molecule of taurin and 1 of water: 
Ammonic isethionate Taurin 
h4n. c2h5so4-h2o=c2h7no3s. 
On heating the isethionate gradually to 446° F. (230° C.), it loses 11 
per cent, of its weight, and the residue when dissolved in water yields by 
spontaneous evaporation, crystals which have the form and properties of 
taurin from bile. By the action of nitrous acid, taurin may be reconverted 
into isethionic acid. 
Taurin Isethionic 
c2h7no3s+hno2=h, C2H5SO,+H2O+N2. 
Cloetta has found taurin in small quantities ready formed in the lungs 
of the ox; previous to this observation it had never been found isolated in 
the healthy organism; it appears to be contained preformed in normal bile, 
and to occur there as an adjunct to cholic acid; at all events, it only occurs 
in an isolated state in decomposed or morbid bile. After the removal of 
the mucus, the only sulphur-compound in these animals in which the bile 
contains sulphur, is taurin conjugated into cholic acid. Doubts have been 
expressed whether sulphur, and consequently taurocholic acid exists in 
humanbile, butGorup-Besanez (Untersub Galle, Erlangen, 1846,S. 31-37),has 
completely set this point at rest, and Lehmann* has confirmed the accuracy 
of his statements. In diseased bile taken from the dead body, taurine is 
especially found, when, as is sometimes the case, the bile has an acid reac- 
tion; thus Gorup-Besanez found taurin in the bile of a person who had died 
from arachnitis. Although some of the products of this decomposition of 
bile, occur in the excrements, especially in cases of diarrhoea, taurin has 
never yet been found there; neither has it been detected in bilious urine. 
With reference to the origin of taurin, ProfessorC. G. Lehmann, held 
that if we consider that the excreted products of the animal organism are 
usually highly oxidized organic matters, and that most of the matters 
separated from the blood and even deposited in the tissues, differ from the 
food in containing a larger amount of oxygen, it must, at first sight, strike 
us as singular that a substance so rich in sulphur as taurin, either alone or 
in combination, should be produced, even in the normal state of the body, 
from the animal fluids, which are almost universally saturated with free 
oxygen. Although Redtenbacher failed in obtaining taurin artificially, 
his admirable researches render it highly probable that sulphur in taurin 
exists in an oxidized state, as indeed may be inferred from the fact that it 
-cannot be recognized in this substance by means of the ordinary fluid oxi- 
dizing agents. As we have seen Strecker (Compt. Rend., t. 39, p. 63), 
subsequently succeeded in forming taurin artificially from the isethionate 
*'Physiological Chemistry, vol. i, p. 168. Chemistry and Physiology of Bile. 
655 
of ammonia, which only differs from taurin by two equivalents of water. 
The method of preparing isethionic acid, from olefiant gas, sulphuric anyh- 
dride and ammonia, in like manner indicates that the genesis of taurine 
should not be sought in a deoxidising process in the blood (a very improb- 
able process), but rather in a process of oxidation. It has been surmised 
that if taurin be the product of an oxidation, the source of its formation 
should hardly be sought in the liver, since the blood that is poorest in 
oxygen is supplied to this organ; and this indication leads to the reference 
of the seat of the formation of taurine, or at least its proximate constituents 
to the blood, where, however, it cannot be detected. Chemical physiology 
needs accurate information and extended research to determine the steps 
that occur in the formation of taurine; it is, however not improbable that 
the sulphur of the albuminous food in its conversion into the elements of 
tissues, which are either free from or poor in sulphur, yield in part the 
materials for the formation of taurin. Physiologists have not yet deter- 
mined the function which the taurin excreted with the bile in the intes- 
tine exerts on the animal organism. As there are some animals, as for 
instance the pig, which, although they secrete bile copiously, separate no 
taurin by the hepatic organs, it appears at all events, it is unimportant to 
the process of digestion. 
Cholesterin. (C26H44O, H2O), fusing point 204° F. (145° C.) This crys- 
tallizable fatty body formerly known as biliary fat, constitutes a never fail- 
ing ingredient of healthy bile, though according to Berzelius, it does not 
exceed in quantity one part in 10,000 of the bile. It is probably held in 
solution by the agency of taurocholic acid, which possesses a certain sol- 
vent power over cholesterin. It acquires its chief interest and importance 
from the circumstance that, owing to its extreme insolubility, it cannot be 
reabsorbed when once deposited, and hence it frequently accumulates in 
the gall-bladder, and forms the principal ingredient in the most common 
variety of gall stone, or biliary calculus. We will notice the occurrence of 
cholesterin in the human system more fully hereafter, but will content our- 
selves at this moment with the statement that it is found as a normal con- 
siituent of blood, and is present in the brain in considerable quantity; it 
is, moreover, a constituent of the yolk of the egg, and in small proportion 
is a very frequent component of serous and fibrous exudations. It appears 
likewise to be always present in pus, and is commonly met with in the resi- 
due of the putrefaction of muscular tissue. It also occurs in the vegetable 
kingdom, having been found in small quantity in almond oil, olive oil as 
well as in wheat, peas, and other seeds. Cholesterin is nearly insoluble in 
water, but is readily soluble in ether. When the ethereal solution is 
mixed with half its volume of alcohol, and left to spontaneous evaporation, 
regular crystals are deposited, they contain about 5 per cent of water, 
when heated to 212° the crystals become opaque, and the water is expelled. 
Cholesterin fuses at 293°, and becomes crystalline on cooling; it may be 
distilled at a temperature of 662° (350° C.), without decomposition; but at 
a somewhat higher temperature it is partially decomposed, In the open 
air it burns with a smoky flame. The alkalies do not act upon it. 
Bertholet finds that by heating cholesterin for some hours in a sealed 
tube with various acids in excess, compounds may be obtained correspond- 
ing to the ethers of cholesterin, thus veryfying the suggestion of Gerhardt, 
that cholesterin is a monobasic alcohol fC26H43HO ). In this manner the 
following compounds have been formed : Butyrocholesterin (C26H43C4H7 
O2)=Cholesterin (C26H44O),+butyric acid (C4H8O2)-water (H2O); stearo- 656 
Chemistry and Physiology of Bile. 
cholesterin (C26H43C18H35O2)=cholesterin (C2gH44O)+stearic acid (Ci8H36O2) 
-water (H2O); benzocholesterin (C26 H43C7Il5O2)=cholesterin (C26 H^O) 
benzoic acid (C7HBO2)-water (H2O). Concentrated sulphuric acid 
decomposes cholesterin, by removing water and forming a mixture of 
three isomeric resinoid hydro-carbons (C26H42), termed cholesteribin, which 
are distinguished by the letters a, b and c. These hydro-carbons bear the 
same relation to cholesterin that olefiant gas does to hydrocarbons and bear 
the same relation to cholesterin that olefiant gas does to ethyl alcohol. 
Long boiling of cholesterin with nitric acid convertsit first into a resinous 
mass and then decomposes it, producing, amongst other bodies, cholesteric 
acid (H2C8H8O5), which assumes the form of a light yellow deliquescent 
substance, of an acid and bitter taste ; it is readily soluble in alcohol. 
According to Redtenbacher, the production of acetic butyric, caproic, and 
oxalic acids, also accompanies the formation of cholesteric acid. 
The following table will assist in indicating the relations which sub- 
sist between the most important of the numerous compounds obtainable 
from the bile : 
Glycoholic acid, C26H43NO6 
Cholonic acid, C26H41NO5. 
Cholic acid, C24H40O5H2O. 
Uholoidic acid, C48H78O9. 
Dyslysin, C48H72O6. 
Taurocholic acid, C26H45NO7S. 
cholesterin, C26H44O,H2O. 
Taurin, C2H7NO3tS. 
Hyocholic acid, C2TH43NOS. 
Hyocholaic acid, C26H40O4. 
Hyoclyslysin, C60H76O6. 
Hyocholeic acid, C27H45N'OfiS. 
Lithofellic acid, C20H36O4. 
Glycocine, C2H5NO2. 
PHYSIOLOGICAL ORIGIN AND PATHOLOGICAL RELATIONS OF CHOLESTERIN. 
This substance was first obtained by Conradi in 1775, from human 
gall-stones, of which it sometimes constitutes nearly the entire substance. 
It was found in human bile by Chevreul,* who made the first exact analy- 
sis of this substance, and assigned to it a formula similar to that which we 
have given above. In the normal condition cholesterin is dissolved in the 
bile, and hence cannot be recognized under the microscope; and according 
to Gorup-Besanez, even in bile removed from the dead body, we rarely 
find tablets of cholesterin ; and in those cases in which it is present in the 
crystalline form it is difficnlt to tell whether it depends on the augmenta- 
tion of the cholesterin, or on its separation in consequence of the decom- 
position of the taurocholic acid. Frerichst found no cholesterin in several 
examinations which he made of the bile in cases of fatty liver. Choles- 
terin was first distinctly recognized as a constituent of the blood by Lecanu.J 
Denis,§ Boudet,|| and Marchand; while Becquerel and Rodier^T have 
especially directed attention to its augmentation and diminution in dis- 
eased conditions of the blood. According to these authors, the amount of 
cholesterin in 1000 parts of normal blood ranges from 0.025 to 0.200, the 
mean being 0.088. There is an augmentation of the cholesterin in the blood, 
in old age, and in most acute diseases soon after the occurrence of febrile 
symptoms, especially in inflammation and in icterus. They have not dis- 
covered any physiological or pathological condition in which there is a 
constant diminution of this substance. 
* Ann. Chern, xcv. 5; xcv, 166. 
t Hannov. Ann., Bd- 5, H. J. 
t Ann' Ch. Phys., Ixvii, 54. 
g J. Chem. Med., [2], iv, 161. 
|| Ann. Ch. Phys., Hi, 336. 
IF Gaz. Med., 1844, No. xlvii. Chemistry and Physiology of Cholesterin. 
657 
According to Becquerel and Rodier the blood contains several species 
of fatty matter, which are as follows: Seroline, cholesterine, margaric, 
stearic and oleic acids, in the form of margarate, stearate or oleate of soda 
or soap. A phosphureted fatty substance. Seroline, discovered by M. F. 
Boudet, is a specific fatty matter, the existence of which cannot be 
doubted. Becquerel and Rodier were the first and only experimenters that 
have sought to determine its proportions. Becquerel and Rodier found, as 
the result of analysis, that the amount of seroline existing in healthy 
blood may be estimated at from 0.020 to 0.025 in every thousand parts of 
that fluid. They have seen it rise as high as 0.060. and fall to an almost 
inappreciable quantity. They present no definite facts as to the varia- 
tions, of which it may be susceptible through the instrumentality of 
disease. According to Becquerel and Rodier,the cholesterin exists in the 
blood in much larger quantity than the seroline. Thus, for instance, they 
found as the result of numerous analyses, that the mean quantity of this 
principle in healthy blood varies from 0.090 to 0.100; they have seen it, 
moreover, rise as high as 0.175 and fall to 0.075. As the cholesterin may 
be obtained pure and isolated, the accuracy of these results cannot be 
doubted. The increase of cholesterin in disease may be referred to the 
following circumstances: 
1st. In every acute febrile affection the cholesterin increases on an 
average about one-third. The cholesterin is generally increased in the 
phlegmasiae, as shown in the following table: 
In 1000 parts of blood cholesterin : 
The amount of cholesterin in healthy blood from 0.075 to 0.150 
Mean amount of cholesterin in the phlegmasise generally 0.153 
" " in acute bronchitis 0.166 
" " in pleurisy 0.182 
" " in pneumonia, first bleedings 0.191 
" " in pneumonia, second bleedings 0.124 
" " in articular rheumatism 0.147 
In 1000 parts of blood animal soap : 
Animal soap in 1000 parts of healthy blood from 1.00 to 2.00 
Mean amount of animal soap in the phlegmasise generally 1.563 
" " in acute bronchitis 1.530 
" " in pleurisy 1.723 
" " in pneumonia, first bleedings 1.566 
" " in pneumonia, second bleedings 1.479 
It appears, then, from the above tables that the fatty matters are 
increased in the phlegmasise. Becquerel and Rodier admit that the 
increase of the fatty matters in phlegmasise is somewhat difficult to explain; 
but they are, nevertheless, disposed to ask, whether it may not be the 
result of low diet, and of the consequent absorption of the adipose tissues and 
their entrance into the blood. Becquerel and Rodier conclude that in all 
acute inflammations, as in those just specified, the cholesterin may be esti- 
mated at nearly double its healthy standard. 
In typhoid fever, cholesterin, first bleeding, 0.055; second bleeding, 
0.156. Animal soap, first bleeding, 1.428; second bleeding, 1.232 in 1000 
parts of blood. 
In cholera, the fatty matters as well as the extractive matters and salts 
and solid matters generally are increased. Thus in a man twenty-nine 
years of age, bled at the commencement of the typhoid stage of cholera, 
the fatty matters amounted to 4.70; and in a man twenty-six years of age, 
bled during the stage of reaction, the fatty matters were 4.23 in 1000 parts 
of blood. 658 
Chemistry and Physiology of Cholesterin. 
In sixteen cases of phthisis, cholesterin, 1st bleeding, 0.134; 2d bleed- 
ing, 0.171; 3d bleeding, 0.100; animal soap, 1st bleeding, 1.4; 2d, 1.271; 
3d, 0.95 in 1000 parts of blood. In phthisis the saponified fatty matters of 
the blood decrease, perhaps, more than in any other, whether as the result 
of disease, or of the previous bleedings. In the yiajority of somewhat 
advanced cases of phthisis, there exists a true anaemic condition, i. e., a 
diminution of the total mass of blood contained in the vascular system. 
2d. In cases of jaundice, accompanied with retention of bile and 
paleness of the faeces, the cholesterin increases to a great degree, and its 
weight is sometimes found to be five or six times greater than in health. 
In answer to the questions, can the bile pass into the blood ? or can the 
bile be developed in the blood? Becquerel and Rodier reply, by asking, 
" What is bile ?" If we admit the exact analysis made of this substance 
by M. Demargay-and we are inclined to do so-we should say that the 
bile is a fluid, holding in solution choleate of soda, margarate, oleate and 
stearate of soda, ch oles ferine, and one, if not two, biliary pigments. When, 
therefore, we ask, if bile can exist in the blood, and understand, by such a 
question, the bile in its perfect state, we answer no; it is not fully formed 
bile that exists in the blood. If, however, by bile in the blood we mean 
the principal constituents of this fluid, then, without doubt, such an occur- 
rence may take place, and we frequently even find a serum which might in 
some sort be termed bilious. The following component parts of the bile 
are found in the blood, under certain circumstances, accumulate in the 
serum, where they are consequently met with in much larger proportion 
than in health: 1. Cholesterin. 2. Animal soap; or the compound formed 
by the oleates, margarates and stearates of soda. These principles accu 
mulate in the blood: 1. When there is an obstacle to the free flow of bile, 
with jaundice and pale evacuations; 2. When from some general predispo- 
sition, the nature of which is often latent, but which is itself the result of 
a warm moist temperature, there has been developed what is commonly 
called a bilious state of the system. The bile appears in such cases to be 
more abundantly secreted by the liver; it flows into the intestines, and at 
the same time the skin becomes jaundiced. In both these cases, while the 
cholesterin, and soda in combination with the fatty are accumulating in 
the blood, there is almost always an appearance of bile pigments in the 
serum. * *, To sum up, then, we may state, that the component parts 
of the bile, with the exception of the choleate of soda, may accumulate in 
the serum of the blood, when the flow of bile is arrested, or its secretion 
greatly increased*. 
In jaundice, with hypersecretion of bile, and an escape of that fluid by 
the intestines, in the first case the fatty matters were rather less than usual, 
their proportion being represented by 1.406, the seroline was scanty 0.005; 
the cholesterin had rather increased as is generally the case in acute dis- 
eases, especially in the phlegmasise, 0.234; the proportion of saponified 
matters was natural. In the second case, then, there was in the blood a 
fair amount of fatty matters; a very small quantity of seroline; a great 
abundance of cholesterin (0.798); animal soap (2.032). Becquerel and 
Rodier ask, "towhat cause are we to attribute the large proportion of 
cholesterin? How and wherefore did it accumulate in the blood in spite 
of the bilious diarrhoea? This question does not admit of a ready answer." 
Jaundice with diminution or suppression of the biliary secretion and 
pale clay-colored evacuations. In the case of a young man, twenty-three 
years of age, affected with simple non-febrile jaundice, which had com 
* Pathological Chemistry as applied to the Practice of Medicine. London, 1857, pp. 66-68. Chemistry and Physiology of Cholesterin. 
659 
menced three days before admission, as the result of an attack of indiges- 
tion accompanied with slow pulse (sixty per minute), constipation with 
clay-colored faeces, the fatty matters were very abundant (3.646 in 1000 
parts of blood), being more than doubled. Thus the seroline gave 0.070; 
the cholesterin 0.897; and the animal soap 2.679. We know that the fatty 
acids of which the latter is composed, are likewise found in the bile in 
combination with soda. In the case of a, young man, twenty-four years of 
age, a baker by trade, and of a tolerably strong constitution, attacked by 
jaundice, without heat of skin, and with a slow pulse (56), (as in the for- 
mer instance, the disease set in after a fit of indigestion), an analysis of 
the blood showed that the fatty matters were still more abundant than in 
the preceding case (4.176), and were thus distributed. Seroline very abun- 
dant (0.128); cholesterin likewise (0.942); animal soap (3.105.) 
From the analysis of these cases, Becquerel and Rodier established, 
that in simple or complicated jaundice, accompanied by biliary flux, the 
fatty matters are either found unaltered, or concentrated in the blood; there 
is however, no increase of the saponified fatty acid. In simple or compli- 
cated jaundice with diminution or suppression of the biliary secretion 
(retention), there is concentration of the fatty matters, more especially of 
the cholesterin and saponified fatty acids, ail of which are essential con- 
stituents of the bile. The serum presents a strong tinge of bile, equally 
indicative of the presence of the biliary coloring matter.* 
It is worthy of note, that in these cases recorded by Becquerel and 
Rodier, as well as those observed by others, the accumulation of the con- 
stituents of the bile in the blood was not attended by any serious or fatal 
symptoms. As we shall see at another stage of this inquiry that it has 
been sought more recently by some physiologists to connect cholesterin with 
certain important physiological and pathological conditions. Becquerel 
and Rodier have shown conclusively that cholesterin is an invariable con- 
stituent of the blood in health and disease, and that its great accumulation 
in the blood is not necessarily attended with any marked evil effect. 
In health, the mean amount of the saponaceous matters (oleate, mar- 
garate, and stearate of soda), is about 1.00 for every 1000 parts of blood, 
the maximum and minimum of variation, ranging from 0.7 to 2.0. The 
changes which it undergoes in disease are, in general, similar to those of the 
cholesterin. Thus it is increased. 1. In acute febrile affections. 2. In 
acute inflammations 3. In jaundice with retention of bile. 
According to Simon, meconium contains a large proportion of choles- 
terin, as will be seen from the following analysis of meconium: 
100 parts of meconium when dried afforded cholesterin 16.0 
Extractive matterand bilifellinic acid 14.0 
Casein 34.0 
Bilifellinic acid and bilin 6.0 
Biliverdin and bilifellinic acid 4.0 
Cells, mucus and albumen 26.0 
Becquerel and Rodier have recorded the following analysis of the 
meconium of a healthy child immediately after birth : 
Water 72.7 
Mucus and epithelial scales 23.6 
Cholesterin and margarin 0 7 
Biliary matter and olein 3.0 
The alvine evacuations produced by calomel, are for the most part, of 
a green color, they have an acid reaction, and are inodorous. When 
* Pathological Chemistry in its application to the Practice of Medicine. London, 1857, pp. 
iyy zuo. 660 
Chemistry and Physiology of Cholesterin. 
examined under the microscope, they are seen to contain a large number 
of mucous globules and ejiithelial cells; crystals of cholesterin, covered 
with biliverdin, may likewise be detected. The following analysis of 
these evacuations has been given by Simon : 
100 parts of the al vine evacuations produced by calomel contained- 
Green fat, containing cholesterin 10.0 
Salivary matter, soluble in water and slightly precipitable by tanic acid 
and acetate of lead 24.3 
Bilin, bilifellinic acid and biliverdin 21.4 
Extractive matter, soluble in alcohol 11.0 
Albumen, mucus and epithelial scales 17.1 
Salts . 12.9 
No trace of mercury was found in the evacuations. 
Analysis of the green evacuations of infants. (Golding Bird.) 
Water 900.00 
Biliverdin alcoholic extract, fat and cholesterin 24.50 
Pty aline, watery extract, colored with biliverdin 11.25 
Mucus, coagulated albumen and heematin 56.00 
Chloride of sodium, with traces of tri basic phosphate of soda 5.50 
Tribasic phosphate of soda 1.75 
Peroxide of iron 1.00 
1000.00 
Dr. J. Franz Simon detected cholesterin in the fluid extracted by para- 
centesis, in the dropsical fluid of Bright's disease, and in the fluid of hydro 
cele, as will be shown by the following analyses: 
Analysis of the fluid extracted by paracentesis from the abdomen of a man in 
whom suppuration of the kidneys was discerned after death. (Simon.) 
Specific gravity 1010.0 
Water 978.0 
Solid matters 12.0 
Far containing cholesterin 1.0 
Albumen 5.4 
Alcoholic extract 0.3 
Aqueous extract . 1.7 
Carbonate of soda and phosphate of lime 1.2 
Urea 1.2 
Chloride of sodium and lactate of soda 1.2 
Analysis of the fluid found in the inferior extremities of an individual affected 
with Bright's disease of the kidneys. (Simon.) 
(This fluid contained urea, together with a large quantity of albumen 
and chloride of sodium.) 
Specific gravity 1012.0 
Water 976.0 
Solid matters 24.0 
Fat containing cholesterin 0.5 
Albumen 7.0 
Alcoholic extract, with urea 2.0 
Alcoholic extract 1.9 
Watery extract 3.0 
Carbonates of soda and phosphale of lime 1.0 
Chloride of sodium and lactate of soda 8.1 
Analysis of fluid of hydrocele. {Simon.} 
Water _ , 860.00 
Solid matters 140.00 Chemistry and Physiology of Chloresterin. 
661 
Cholesterin, with a little margarine and oleic acid 8.40 
Albumen 48.30 
Albuminate of soda and extractive matters 6.88 
Extractive matters soluble in alcohol 2.30 
Chloride of sodium and calcium, a little sulphate with traces of phos- 
phate of lime 72.52 
Phosphate of Ijme, with traces of peroxide of iron 0.70 
Heller also observed cholesterin in the fluid of hydrocele. 
Fluid of hydrocele (an alkaline liquid), a man fifty years of age : 
Specific gravity 1020.00 
Water 906.36 
Solid matters 93.64 
Albumen 60.00 
Fat containing cholesterin 0.23 
Extractive matters, biliphsein and soda soap 24.04 
Fixed salts, especially chloride of sodium 9.37 
Gmelin found cholesterin in the urine of a case of jaundice, in which 
the flow of bile was impeded, and Lionel S. Beale has detected it in the 
urine. 
Dr. Lionel S. Beale, in 1850, when examining the fatty matters which 
accumulate in the epithelial cells passed in the urine in considerable num- 
ber, in cases of fatty degeneration of the kidneys, was surprised to find that 
it contained a considerable quantity of cholesterine. Dr. Beale stated 
this fact in an introductory lecture which he gave in November, 1852. The 
only cases in which previous to the investigations of Dr. Beale, cholesterine 
seems to have been detected in the urine, are those which are referred to 
in Simons' Chemistry, viz., the case of icterus observed by Gmelin; and the 
two cases of pregnancy in which Miller detected this substance on the kies- 
tein, upon the surface of the urine. 
The fatty matters deposited in the kidneys in the cases observed by 
Beale, contained a large proportion of cholesterin; and he detected the 
presence of this substance in the fatty matter of so many organs in a state 
of fatty degeneration as to justify the conclusion that the formation of this 
substance is intimately connected with the change which takes place in this 
morbid process. When cholesterin occurs in the urine, it is always dis- 
solved in other fatty matters, so that its presence cannot be detected except 
by extraction with alcohol and subsequent crystallization. It forms part 
of the constituents of the minute fat globules contained in the epithelial 
cells and casts of the uriniferous tubes, which Dr. Johnson has proved to 
be so characteristic of this form of kidney disease. Dr. Beale has detected 
cholesterin in the large cells ^granular corpuscles') containing oil globules, 
which are abundant in the fluid of ovarian dropsy, and sometimes in hydro- 
cele, and that found in cysts generally in similar cells which are common in 
sputum, and are derived from the surface of the mucous membrane of the 
bronchial tubes, in the cells which are frequently very numerous about the 
small arteries of the brains, in cases of white softening in those found in 
cases of the so-called fatty degenerations of the placenta and in other situ- 
ations. (Archives of Medicine, vol. 1, p. 8-10. 
Simon made an analysis of a thick chocolate-colored alkaline fluid, 
obtained by puncture in a case of ovarian dropsy. Under the microscope 
there was a considerable number of pus-corpuscles, and a few colored blood- 
corpuscles visible. It contained so much albumen, on heating it coagulated, 
forming thick, brown flocculi. The coloring matter was doubtless due to 
the presence of hmmato-globulin ; the fat abounded in cholesterin*. It 
contained: 
* Animal Chemistry, with reference to the Physiolosy and Pathology of Man, by Dr. J. Franz 
Simon. Philad., 1846, p. 662. 662 
Chemistry and Physiology of Cholesterin. 
Specific gravity 1030.00 
Water 925.00 
Solid constituents 75.00 
Fat containing cholesterin 1.10 
Albumen , 56.77 
Alcohol extract, spirit extract, water extract 4,50 
Carbonate of soda, phosphate of lime, chloride of sodium and lactate 
of soda . 8.89 
Albuminate of soda - 7.50 
Girardin detected 6.475 parts of cholesterin in thefluid in certain vesi- 
cles in the abdomen. 
In 1000 parts there were contained- 
Water 939.600 
Solid constituents 60.500 
Albumen 49.200 
Cholesterin 6.475 
Alcohol extract 1.075 
Phosphate of soda and lime and chloride of sodium 3.750 
Cholesterin has been observed in pus by Valentin,* Wood,f Wright,J 
and others. 
Analysis of pus by Valentin- 
Water 883.78 
Solid constituents 116.22 
Cholesterin 11.86 
Oleate of soda, olein and chloride of potassium 10.02 
Stearin 6.85 
Coagulated albumen and fibrin 79.78 
Fluid albumen and chloride of sodium 19.34 
Analysis of pus by Wood- 
Water 857.15 
Solid constituents 142.85 
Cholesterin 1.57 
Oleate of soda 10.91 
Extractive matter, with chloride of sodium and other salts 8.34 
Albumen 19.09 
Animal matter, with the properties of ptyalin and glutin 16.57 
Fibrous matter, with phosphate of lime, peroxide of iron and sulphur, 86.37 
Analysis of pus by Dr. Wright (from a vomica)- 
Water r 894,4 
Fatty matter 17.5 
Cholesterin 5.4 
Mucus 11.2 
Albumen 68.5 
Lactates, carbonates, sulphates and phosphates of soda, potash and 
lime 9.7 
Iron. a trace. 
Loss 3.3 
Cholesterin appears, therefore, to be an integral constituent of pus, 
and of certain morbid products^ of the animal economy, such as cerebral 
concretions, scirrhous matter, hydropic liquid of the abdomen, ovaries, 
testicles, etc. 
Lehmann states that whenever he has allowed pus to become sour, he 
has found tablets of cholesterin in the decomposed mass; and he confirms 
* Valentin's Repertorium, 1838, p. 307. 
t De purls natura atque formatione, desq. phys. Berlin, 1827, p. 10. 
I Medical Memoirs, p. 117,1845. 
? Lassaigne, Ann. Ch. Phys., ix, 324. 6 Henry, J. Chem. Med. Lebrts. d. Physiol. Chern., 2d 
Auft. i, 286. Chemistry and Physiology of Cholesterin. 
663 
the accuracy of the results of Caventou, Giilleboch, Valentin and many 
others. 
Cholesterin has been found by Fromherz and Guggert in the vernix 
caseosa, by Breschet, Wohler and Marchand in hydrocele; by Stromeyer in 
an encisted tumor in the abdomen of a woman; by Breschet and Barruel in 
the ovary and testicle in a diseased state; by Caventou in an abscess of the 
tooth; by Lassaigne in a scirrhous structure in the mesocolon; by Guggert 
in fungus medullaris; by Marchand in medullary sarcoma; and by Druntz 
in a vesical calculus extracted from a dog. It sometimes exists in a state 
of solution, while in other cases it floats on the surface, either in the form 
of brilliant scales, or of solid masses. 
In pulmonary expectoration, Lehmann has only found cholesterin in 
the cheesy concretions ejected in advanced phthisis, and when vomicae are 
already present. Cholesterin has also been found in exudations, especially 
in obsolete tubercle, and in old echinococcus cysts, such as are sometimes 
found in the liver; and it has likewise been observed in the inner coat of 
arteries that have undergone atheromatous degeneration, in various kinds 
of tumors, and in the crystalline lens in cases of cataract. The cholesterin 
which is often found in the solid excrements, takes its origin in the bile 
Traces of it have been found in the urine. 
Cholesterin always occurs in the brain, where it was first discovered by 
Couerbe (Ann. Ch. Phys. vol. vi, 281). Many subsequent observers, as 
Fr6my (Ann. Ch. Phys. [3] ii, 486),^Lehmann (Physiological Chemistry, 
vol. 1, p. 247), and Von Bibra. It is also found in the spinal cord and 
nerves. Lehmann once found the choroid plexus completely encrusted 
with crystals of cholesterin. 
Von Bibra maintains that the brain-fats consist of cerebric acid and 
cholesterin, and of a series of fatty acids possessing different properties 
and different fusing points ; these fatty acids not even being the same in 
different brains of one and the same species, and as he conceives, undergo- 
ing perpetual decomposition in the living organism, passing into one 
another, and taking share in the cerebral functions. To obtain cholesterin 
from the brain, that substance is treated with ether, the* ethereal extract 
boiled with alcoholic potash, and the liquid left to cool, it then deposits 
cholesterin mixed with cerebrate and phosphate of potassium. The follow- 
ing are the steps in the process : 
To obtain cholesterin from the brain that organ must first be deprived 
of all its water, by being finely triturated, and then placed upon the water- 
bath. This being fully accomplished, it must be treated with ether, and 
afterwards with boiling alcohol, until these fluids cease to abstract any- 
thing more. As the alcoholic solution cools, a white powder is precipi- 
tated. By gently distilling the ethereal solution a residue remains, from 
which cholesterin may be taken up by boiling alcohol; on mixing the two 
alcoholic solutions, evaporating to one-fourth, and allowing the mixture to 
cool, a portion of the fat separates in the form of a white powder, which 
consists not merely of cholesterin, but also of a substance which is insoluble 
in cold ether, the cerebrat of Couerbe. If, therefore, we treat this fat with 
ether, the cholesterin dissolves, while the cerebrat remains unacted on. By 
evaporation we obtain the cholesterin in a crystalline state, and by dis- 
solving it in boiling alcohol and allowing it to re-crystallize on cooling we 
obtain it in a state of purity. 
Cholesterin is white, tasteless, inodorous, insoluble in water, sparingly 
soluble in cold alcohol, but dissolves very easily in boiling alcohol, from 
which it separates on cooling, in beautiful crystalline nacreous laminae, 
soft to the touch, and melting at 137° C. It dissolves also in ether, wood 664 
Chemistry and Physiology of Chi or ester in. 
Spirit, oil of turpentine, soap water, and neutral fats. A solution of chol- 
esterin, in a mixture of two volumes alcohol, and one volume ether, deposits 
by spontaneous evaporation, laminated transparent crystals of hydrate of 
cholesterin C2GH44O4-H2O, which give off then water at 101° C. It is evi- 
dent from the preceding observations that- 
1st. Cholesterin is a normal constituent of the blood. This fact was 
established by the investigations of Lecanu, Dennis, Boudet, Marchand, 
Simon and Becquerel and Rodier. 
2d. The extended and accurate and elaborate investigations of Bec- 
querel and Rodier have established the important facts, that the mean 
quantity of this principle in healthy blood varies from 0.090 to 0.100, it 
may rise as high as 0.175 and fall to 0.075 in 1000 parts of blood ; in every 
acute febrile affection the cholesterin increases on an average about one- 
third ; in all acute inflammations the augmentation is still greater, being 
nearly double its healthy standard ; in cases of jaundice, accompanied with 
retention of bile and paleness of the faeces, the cholesterin increases to a 
great degree, and its weight is found to be five or six times greater than in 
health. 
3d. Becquerel and Rodier clearly established the important fact that 
not only are cholesterin and the oleates, margarates and stearates of soda 
component parts of the bile, but that these principles accumulated in the 
blood: 1st, when there is an obstacle to the free flow of bile, with jaundice 
and pale evacuations. 2d, when from some general predisposition the 
nature of which is often latent, but which is itself frequently the result of 
a moist warm temperature, there has been developed what is commonly 
called a bilious state of the system. The bile appears in such cases to be 
more abundantly secreted by the liver ; it flows into the intestines, and at 
the same time the skin becomes jaundice. 
4th. Cholesterin is a normal constituent of the brain and nerves, as 
shown by the labors of Frdmy, Lehmann, Von Bibra and others ; and Dr. 
W. Marcet* has found it to exist in considerable abundance in the tissue 
of the spleen. 
5th. Cholesterin exists also in the yolk of the egg, in certain plants, 
and in various diseased structures and products of disease. 
6th. Cholesterin forms one of the constituents of human bile; the 
proportion in 1000 parts of human bile, varying according to Frerichs, 
from 1.6 to 2.6, and according to Robin, from 1.60 to 2.66. Becquerel and 
Rodier, as well as other physiologists, held that cholesterin was not formed 
by the liver, but that it was separated from the blood by this organ. The 
inference was drawn by Daltonf that cholesterin originates in the substance 
of the brain and nerves and of the spleen, and perhaps of other organs, and 
that from all these tissues it is absorbed by the blood, then conveyed to the 
liver and discharged with the bile. The very small quantity of choles- 
terine in the bile is probably held in solution by the taurocholate of soda, 
since it very rarely occurs in the bile in a crystalline form. 
7th. No light has as yet been thrown upon the increment or decre- 
ment of cholesterin in the tyle during various conditions of rest and exer- 
cise, variations of food and of different diseases. We are ignorant of the 
conditions of the general system, of the blood, of the liver and of the bile 
which lead to the deposit of cholesterin in the form of biliary calculi. 
Lehmann^ concluded that, judging from its mode of occurrence, we 
must regard cholesterin as a product of decomposition ; but from what 
* Philosophical Translations. London, 1857, p. 413. 
t Human Physiology, p. 161. 
j Physiological Chemistry, vol. 1, p. 248. Chemistry and Physiology of Cholesterin. 
665 
substances and by what processes it is formed, it is impossible even to 
guess. Notwithstanding the similarity which many of its physical proper- 
ties present to those of the fats, we can hardly suppose that it takes its 
origin from them, since the fats, for the most part, become oxidized in the 
animal body, whereas in order to form cholesterin, they must undergo a 
process of deoxidation. 
Dr. George E. Day* regarded it as a product of excretion. 
8th. Cholesterin is comparatively an insoluble, inert, substance with 
but few chemical affinities, and not a single fact has been recorded to show 
that it imparts any injurious properties to the blood, or exudations in which 
it is found. It is well known that in uncomplicated jaundice in which 
cholesterin increases to a great extent, no ill effects arise from its accumu- 
lation in the blood. The cerebral disturbances and fever attending certain 
diseases as acute atrophy of the liver, yellow fever and malarial fever, 
accompanied by jaundice, can, with no show of reason, be referred to the 
accumulation of cholesterin in the blood. This inert substance is not only 
abundant in healthy pus, which acts as a bland and soothing coating to- 
raw inflamed surfaces, when there is a free outlet and no pressure caused 
by the accumulation of the pus; but it also appears to exert no irritant 
and excitant effects when deposited in the coats of the cerebral vessels, and 
even in the. very textures of the brain. In its composition it appears to be 
wholly unlike the unstable albuminous animal and vegetable poisons. 
The more recent experiments of Dr. Austin Flint, Jr.,f of New York, 
have to a certain extent corresponded with those of Becquerel and Rodier, 
with this notable difference, that the amount of cholesterin in normal 
blood is far greater, according to the former physiologist, than that 
assigned by the latter accomplished physiological chemists. Thus Dr. 
Austin Flint, Jr., found in his experiments upon dogs, instituted with a 
view to determine whether cholesterin is deposited in the nervous matter 
from the blood, or is formed in the brain and taken up by the blood; in 
1000 parts of blood from the carotid 0.774; internal jugular 0.801; femeral 
vein 0.806. In another experiment, carotid 0-967; internal jugular 1.545; 
femeral vein 1.026. In a third experiment carotid 0.768; internal jugular 
0.947. From these three experiments upon dogs, Dr. Austin Flint, Jr., feels 
himself justified in arriving at the conclusion, '■ that cholesterin is produced 
in the brain, and is taken up by the blood as it passes through this organ." Dr. 
Flint, however, does not limit the production of cholesterin to the brain, 
for he says: " But the brain is not the only part where cholesterin is pro- 
duced. It will be seen that in experiment two there is 4.134 per cent., 
and in experiment three 6.308 per cent, of increase in the cholesterine in 
the passage of the blood through the inferior extremities, and probably 
about the same in other parts of the muscular system. In examining 
these tissues chemically we find that the muscles contain no cholesterine, 
but that it is abundant in the nerves; and as we have found that the pro- 
portion of cholesterine is immensely increased in the passage of the blood 
through the great centre of the nervous system, taken, as the specimens 
were, from the internal jugular, which collects the blood mainly from the 
brain and very little from the muscular system, it is rendered very prob- 
able that, in the general nervous system, the cholesterine, which the blood 
contains, is produced in the substance of the nerves."^ 
Dr. Flint endeavored to sustain the view that cholesterin is one of the 
products of the disassimilation of the nervous tissue, by examining the 
• Chemistry in its Relations to Physiology and Medicine. London, 1860. p. 83. 
t Experimental Researches into a New Function of the Liver. Am. Jour. Med. Sci., 1862, NK 
S., vol, xliv, p. 305. 
I The Physiology of Man. Secretion, Excretion, etc. New York, 1870, pp. 277-283. 666 
Chemistry and Physiology of Cholesterin. 
blood from both arms in three cases of haemaplegia. In the first case he 
•operated upon about fifty-five and a half grains (55.458) of blood from the 
paralyzed side with the following result: "The watch glass contained 0.031 
of a grain of granular substance, but the most careful examination failed 
to show a single crystal of cholesterin." The only conclusion deduceable 
from this statement, shown in tabular form upon page 285 of the volume 
of "The Physiology of Man," relating to secretion, excretion, etc., is that 
55.458 grains of blood from the paralyzed side yielded 0.031 of a grain of 
-a granular substance, which was not cholesterin; that is, 1000 parts of the 
blood from the paralyzed side yielded 0.55 parts of a granular substance 
which contained not a single grain of cholesterin. The sound side yielded 
0.062 grains of cholesterin in 128.407 grains of blood, or 0.481 grains of 
^cholesterin in 1000 parts of blood. It is evident, therefore, that the pro- 
•cess of Dr. Flint in one case yielded 0.55 grains of a granular substance, 
which yielded "not a single crystal of cholesterin," and in the blood of 
the same patient 0.481 of so-called cholesterin. In describing his process 
of obtaining the cholesterin from the blood, Dr. Flint proceeds in the fol- 
lowing manner: "The blood, bile or brain, as the case maybe, is first care- 
fully weighed, then evaporated to dryness over a water bath, and pulver- 
ized in an agate mortar. The powder is then heated with ether, in the 
proportion of about a fluid ounce for every hundred grains of the original 
weight, for from twelve to twenty-four hours, agitating the mixture occa- 
sionally. The ether is then separated by filtration, throwing a little fresh 
•ether on the filter so as to wash through every trace of the fat, and the 
solution is set aside to evaporate. If the fluids, especially the blood, have 
been carefully dried and pulverized, when the ether is added, it divides it 
into a very fine powder and penetrates every part. After the ether has 
evaporated, the residue is treated with boiling alcohol, in the proportion 
of about a fluid drachm for every hundred grains of the original weight 
of the specimen, filtered while hot into a watch-glass, and allowed to eva- 
porate spontaneously. To keep the fluid hot while filtering, the whole 
apparatus may be placed in the chamber of a large water bath, or, as the 
filtration is generally rapid, the funnel may be warmed by plunging it 
into hot water or steaming it, taking care that it be carefully wiped. We 
now have the cholesterine mixed, with a certain quantity of saponifiable 
fat. After the fluid has evaporated, we can see the cholesterin crystals in 
the watch glass, mingled with masses of fat. This we remove by saponifi- 
cation with an alkali; and for this purpose we add a moderately strong 
solution of caustic potash, which we allow to remain in contact with the 
residue for from one to two hours. If much fat be present it is best to 
heat the mixture to a temperature a little below the boiling point, but 
in analysis of the blood this is not necessary. 
Dr. Flint concludes thus: "The mixture is then to be largely diluted 
with distilled water, thrown upon a small filter, and thoroughly washed 
till the fluid which passes through is neutral. We then dry the filter, and 
fill it up with ether, which in passing through dissolves out the choles- 
terin. The ether is then evaporated, the residue extracted with boiling 
alcohol, as before, the alcohol collected on a watch-glass, previously 
weighed, and allowed to evaporate. The residue consists of pure cholesterin, 
the quantity of which may be estimated by weight. The accuracy of this pro- 
cess may be tested by means of the microscope; for the crystals have so 
•distinctive a form that it is easy to determine, by examining the watch- 
glass, whether the cholesterin be perfectly pure. * * With these precau- 
tions, the quantity of cholesterin in any fluid or solid may be determined with 
perfect accuracy; and the estimate may be made in so small a quantity as from Chemistry and Physiology of Cholesterin. 
667 
fifteen to twenty grains of blood."* In the preceding quotation the italics 
are our own. It may well be asked if a process which in one case yields a 
definite weight of granular substance, which by " the most careful exami- 
nation failed to show a single crystal of cholesterin," is capable of deter- 
mining with perfect accuracy the quantity of cholesterin in any fluid or solid ? 
And it may still farther be asked for the sake of truth, whether in any one 
of the experiments detailed by Dr. Flint, the residue consisted of abso- 
lutely chemically pure cholesterin, free from all granular substance, and 
especially from seroline and other modifications of fat. 
But the process of Dr. Flint yielded this granular substance, not only 
in one case, but in three cases of hsemiplegia, as will be seen from the fol- 
lowing table extracted from the work of Dr. Flint: 
Table of Quantity of Cholesterin in Blood of Paralyzed and Sound Sides in 
Three Cases of Hcwniplegia. 
Blood 
Grains 
•55.458 
128.407 
18.381 
66.396 
21.842 
52.261 
Cholesterin 
Cholesterin per .'000 
Case I. Paralyzed side- 
Case I. Sound side 
Case II. Paralyzed side- 
Case II. Sound side 
Case III. Paralyzed side.. 
Case III. Sound side 
Grains 
0.062 
0.062 
0.031 
The watch-glass contained 0.031 of a 
grain of granular substance, but 
the most careful examination 
failed to show a single crystal of 
cholesterin. 
0.481. 
Same as Case I. 
0.808. 
Same as Case I. 
0.579. 
In order to determine the elimination of cholesterin by the liver, Dr. 
Flint abstracted blood from the carotid, portal vein and hepatic vein of " a 
good-sized bitch (pregnant)," and subjected the blood to analysis for cho- 
lesterin, with the following results: 
Blood, 
Cholesterin, 
C'holesterin per 
Grains 
Grains 
1000 parts 
Arterial blood 
159.537 
0.200 
1.257 
Portal vein 
168.257 
0.170 
1.009 
Hepatic vein 
78.848 
0.077 
0.964 
Percentage of loss of arterial blood in its passage through the liver... 
23.309 
Percentage of loss of the blood of the portal vein 
4.660 
In comparing this experiment with that performed upon the blood 
passing through the brain of a dog, Dr. Flint says: "The gainin the arte- 
rial blood in cholesterin in passing through the brain was23.307 per cent., 
and the loss of this substance in passing through the liver is 23.309 
per cent." 
In a case of simple jaundice from duodenitis, in which there was no 
great disturbance of the system, a specimen of blood from the arm, exam- 
ined by Dr. Flint, "presentediundoubted evidence'of the coloring matter of 
the bile, but the proportion of cholesterin was not increased, being only 
0.508 of a part per thousand;" in a case of cirrhosis of the liver, which 
had been tapped about that time for ascites, ''the proportion of choles- 
terin in the blood was only 0.246 of a part per thousand, considerably 
below the quantity that we had found in health;" in a patient with cirr- 
hosis, confined to the bed and very feeble, " the proportion of cholesterin 
* The Physiology of Man, etc.. Secretion, Excretion, etc. New York, 1870, p. 272. 668 
Chemistry and Physiology of Cholesterin. 
in the blood in this case was 1.922 of a part per thousand, a little above the 
proportion we have found in health." 
The results obtained by Dr. Flint by his method of examination of the 
blood in diseases of the liver were, therefore, not uniform and not in accord- 
ance with the more elaborate researches of Becquerel and Rodier. 
The differences between the results obtained by Becquerel and Rodier 
and those recorded by Dr. Flint, appear to be referable to three causes: 
1st. Differences in the amounts of blood and serum employed in 
analysis. 
2d. The employment of serum by Becquerel and Rodier, and of both 
blood-corpuscles, fibrin and serum (blood) by Dr. Flint. 
3d. Differences in chemical processes. Becquerel and Rodier* in 
their investigations upon the constitution of the blood in health and 
disease, abstracted in each case blood to the amount of about 375 grammes 
(gxi^v). The blood designed for the determination of the constituents of 
the serum, amongst which were included the extractive matters, urea, 
fatty matters and cholesterin, was received into a vessel capable of contain- 
ing from 250 to 300 cubic centimetres (from about 100 to 120 cubic inches); 
that is, the serum of about eight fluid ounces of blood were subjected to 
analysis for the determination of the cholesterin, serolin, phosphorized 
fats, etc. In these series of operations which had for their object the 
determination of the weight of the extractive and fatty matters, the fol- 
lowing process was employed by Becquerel and Rodier: "The serum 
having been dried in a stove and finely pulverized, is repeatedly washed 
with boiling water, in order to remove all soluble materials. These con- 
sist on the one hand, of extractive matters, such as osmazome, the coloring 
matter of the serum, ere., and on the other, of free salts which exist in a 
state of solution in the serum. The serum thus treated with water, is 
again dried and weighed. * * The product of the second desiccation is- 
now treated with boiling alcohol until thoroughly exhausted. The insolu- 
ble residuum consists of pure albumen, the weight of which may be ascer- 
tained when dry. As for the boiling alcohol, it holds in solution all the 
fatty matters, which may be separated by the process of M. Boudet, and 
consist of seroline, cholesterine and saponified fat." Boudet described as a 
fat peculiar to the serum, a substance extracted from the residue by hot 
alcohol (serolin) which Gobley considers as a mixture of olein, margarin, 
cholesterin and cerebrin. 
Dr. Austin Flint, Jr., in his examinations, employed very small quan- 
tities of blood, ranging from 18.381 grains (less than nineteen grains) to 
179.463 grains (less than one hundred and eighty grains); and at the same 
time the fibrin and the colored blood-corpuscles were subjected to the 
action of the reagents; and the important preliminary step of extracting 
the saline matters and urea, by water, was not performed. We are also 
not informed whether any seroline was mixed with the cholesterine, or 
whether any of the varied constituents of the colored blood-corpuscles were 
finally contained in the matters precipitated by water, and then dissolved 
by ether and alcohol. 
That ether and alcohol dissolve certain constituents of the colored 
blood-corpuscles which are insoluble in water, is well known to chemists; 
thus Professor C. G. Lehmann,f in his remarks upon the various methods 
of analysis of the blood, says : Simon j struck upon a method of finding 
the quantity of the blood-corpuscles directly, which however, is altogether 
* Pathological Chemistry, pp. 19-23. 
t Physiological Chemistry, vol. 1, p. 593. 
j Med. Chern. Bd. 2 S., 83, or English Trans., vol. 1, p. 178. Chemistry and Physiology of Cholesterin. 
669 
wanting in accuracy. He coagulated whipped blood by the application of 
heat, stirring or shaking it the whole time, and then extracting the coagu- 
lum with ether and boiling alcohol; he thought that boiling alcohol left the 
albumen of the serum in a state of purity, and dissolved the constituents of 
the blood-corpuscles, together with the salts and extractive matters of the 
serum; after the evaporation of the alcoholic solutions, the residuum was 
extracted with cold aqueous spirit, which Simon appeared to believe, left 
undissolved all the constituents of the blood-corpuscles, while it dissolved 
the non-coagulable matters of the serum. This method presents so many 
imperfections, that one only wonders how Simon's blood analyses should 
coincide so tolerably well with those of other experimenters. In illustra- 
tion of the utter unfitness of this method, it may suffice to mention that 
two analyses of one and the same blood, made according to Simon's direc- 
tions, would never by any chance coincide." 
Dr. W. Marcet,* in his elaborate "account of the organic chemical con- 
stituents or immediate principles of the excrements of man and animals in the 
healthy stated arrived at the following conclusions:-Human evacuations in 
the healthy condition contain: 
1st. A new organic principle, containing a crystalline structure and 
an alkaline reaction, which Dr. Marcet calls excretine. 
2d. A substance possessing the characters of margaric acid, which 
though not constantly present in human evacuations, is generally found as 
one of its constituents. 
3d. A coloring matter analogous to that of blood. 
4th. A pure olive-colored acid, which Dr. Marcet proposed to call 
excretoleic acid. 
5th. Volatile fatty acids, free, however, from butyric acid. 
Dr. Marcet concluded from his investigations upon the chemical con- 
stituents of the castings of animals: 
1st. That they contain no excretine, thus differing very materially 
from human evacuations. 
2d. That the castings of carnivorous mammalia contain. (1) a peculiar 
crystalline organic substance obtained by the same process as excretine, 
(2) butyric acid, existing probably in the form of a salt, as one of their 
constituents. 
3d. That the castings of the crocodile yield cholesterine. 
4th. That the castings of herbivorous animals contain no excretine, 
and no butyric acid, and do not yield the crystalline substance obtained 
from those of carnivorous animals, except perhaps in the case of the 
monkey. 
The following is the method employed by Marcet for the extraction of 
excretine f The evacuation if possessed of the usual healthy consistence, is 
at once introduced into a long necked glass flask, to be exhausted with boil- 
ing alcohol; if fluid, it is first to be concentrated in the water bath to the 
degree of the consistence of solid faeces. It will be found very convenient 
to prepare the alcoholic extract in a vessel similar to a coffee strainer, 
when the fluid solution is separated from the insoluble residue by means of 
atmospheric pressure; this method has the advantage of saving a great 
deal of trouble and time, of requiring less alcohol, and of yielding a much 
purer alcoholic extract. The mass is to be extracted with small successive 
quantities of alcohol, sp. gr. 850, until it has quite lost its pasty nature. 
The clear alcoholic fluid being allowed to remain undisturbed for twelve 
hours, or longer, is decanted from the deposit which has occurred, con- 
* Philosophical Transactions of the Royal Society of London, 1854, vol. 144, pp. 265, 283. 
t The Archives of Medicine, edited hy Lionel S. Beale, vol. 1, p. 99-101. 670 
Chemistry and Physiology of Cholesterin. 
tsisting of lime and magnesian soaps, and earthy phosphates, and the deposit 
is thrown in a filter in order to lose none of the alcoholic extract. The 
fluid is now to be mixed with a small quantity of thick milk of lime just 
prepared from the pure caustic substance, and is next diluted with a bulk 
of water equal to that of the extract, the whole being subsequently agi- 
tated with a glass rod. After the lapse of a few hours, it will be noticed 
that a light precipitate has subsided to the lower part of the vessel. The 
whole mixture is now filtered, in order to separate the lime precipitate, 
which is washed several times and dried in the water bath. The dry resi- 
due being removed from the filter, is introduced into a dry glass flask, and 
alcohol added to it; finally, a little ether is poured into the flask, which 
greatly increases the property possessed by the alcohol of dissolving the 
excretine contained in the lime precipitate. After shaking the contents of 
the flask, from time to time for several hours, the fluid part is thrown in a 
filter, and more alcohol and ether are mixed with the residue in the flask, 
the solution being again filtered after some hours. In order to separate the 
whole, or at all events the greatest portion of excretine from the lime pre- 
cipitate, it will be necessary to repeat three or four times the above men- 
tioned operation. The clear filtrate, or alcoholic extract, of the lime pre- 
cipitate, is now to be exposed to the air in an open capsule, and placed in 
as cold a spot as possible. If the fluid contains a very large proportion of 
excretine, the substance will begin crystallizing after a few hours, but 
usually twenty-four hours or two days elapse before the crystals appear. 
Two or three days after the crystals have begun forming they are to be 
collected on a filter, the clear filtrate being again left undisturbed. Another 
crop of crystals will now occur in the mother liquor, which is again to be 
separated by filtration ; finally a third crop of crystals may be obtained 
in the fluid. In order to submit this impure excretine to a process of puri- 
fication, it is now dissolved in hot alcohol and the solution mixed and agi- 
tated with animal charcoal, to be subsequently filtered through a filter con- 
taining another quantity of charcoal, when it will be found to have become 
considerably discolored. The filter washed with hot alcohol and then 
with ether, yields most of the excretine remaining in the charcoal, and the 
solution is again to be left undisturbed for some days, in order to allow the 
substance to crystallize ; if not yet colorless, it must be made to go through 
a second similar process of purification. From the very delicate nature of 
the crystals, their microscopical examination is attended with some diffi- 
culty ; they consist of acicular four-sided prisms, varying greatly in size, 
the largest being distinctly visible with a low magnifying power. 
Excretine is insoluble in water, hot or cold, and when suspended in 
boiling water is converted into a yellowish resinous mass floating on the 
fluid. It is sparingly soluble in cold alcohol, but dissolves readily in hot 
alcohol. It is very soluble in cold or hot ether. The reaction of its alco- 
holic and ethereal solution is slightly alkaline. Heated on a platina 
spatula, excretive fuses, evolving a peculiar aromatic smell, and leaving a 
brown stain, which on the further application of heat, is completely 
removed, showing its entirely organic nature. The crystals fuse at between 
92°and 96° Cent.; unbecoming cold the substance may be noticed to have 
acquired a resinous consistence, and exhibits no crystals. It is not acted 
upon when boiled in a solution of potash or soda, or when treated with 
dilute sulphuric or hydrochloric acid. With boiling nitric acid, however, 
it is decomposed, giving out fumes of nitrous acid. Excretine is not at all 
hygroscopic or subject to decomposition, and can be preserved for years in 
a glass-stoppered bottle. Dr. W. Marcet* did not establish the chemical 
composition of excretine until the year 1857. 
♦ Philosophical Transactions for 1857. Chemistry and Physiology of Cholesterin. 
671 
No substance having been found as yet to combine with excretine, its 
atomic composition was calculated from the assumption that one equivalent 
contained one equivalent of sulphur, and the following formula was 
obtained : 
78. equivalents of carbon 468? 
78. equivalents of hydrogen 78. 
1. equivalent of sulphur 16. 
2. equivalents of oxygen 16. 
Atomic weight of excretine <.578; 
The following is the composition in 100 parts: 
Found. Calculated. 
Carbon 80.427 80.969 
Hydrogen 13.515 13.495 
Sulphur 2.780 2.768 
Oxygen 3.278 2.768 
100.000 100.000 
Dr. Marcet has given, therefore, the following formula for excretine: 
C78H78O2S. Excretine is, therefore, a new animal substance, for although 
resembling the crystallizable fats stearine and margarine, it differs from 
them as to its fusing point, which is much higher, by its not assuming the 
crystallized form as soon as it becomes cold, by its not being acted upon 
by caustic potash or soda, and finally from its having a different chemical 
composition. It appears to be closely allied to cholesterin; but its fusing 
point is much lower than that of cholesterine, which fuses at 140° C.; 
moreover, it does not crystallize in tabular crystals like cholesterine, and 
contains sulphur. 
The physiological relations of this interesting substance; its forma- 
tion in the body, functions and elimination, were investigated, but the 
results were very incomplete, as it occurs only in human evacuations, and 
as it is extremely difficult to procure for examination the intestines of a 
perfectly healthy individual. The blood, spleen, liver, muscular tissue, 
bile and urine were submitted to analysis, but in none of these instances 
did Dr. Marcet succeed in extracting excretine. The investigations on the 
blood and spleen led to the detection of cholesterine in these parts; it 
was found in comparatively large quantities in the spleen, a fact interest- 
ing in a physiological point of view. In one instance cholesterine was 
obtained from the bile by the same process. Excretine is probably a pro- 
duct of the hepatic and intestinal secretions, and a form under which free 
sulphur is eliminated from the body without undergoing any process of 
direct oxidation. It is possible that it is derived in part, at least, from 
taurocholic acid of the bile. 
Stercorine, discovered in the faeces in 1862, by Dr. Austin Flint, Jr.,* 
was described by Boudet, in 1833, as existing in small quantities in the 
serum of the blood, and was called by him seroline. Subsequently to the 
labors of Boudet, seroline was found in the blood, and described by 
Lecanu and Sanson. In order to exhibit it, blood must be first evap- 
orated to dryness in the water bath, and the residue treated with water as 
long as anything continues to be taken up. It must then be dried, pul- 
verized, treated with boiling alcohol, and filtered while hot. On cooling 
the alcohol deposits this fat in flocculi. It must be collected on a filter 
and washed with cold alcohol. Boudet assigns the following character- 
istics to seroline. It forms flocks of a fatty nacreous, appearance, is per- 
* American Journal of the Medical Sciences, October, 18(>2. 672 
Chemistry and Physiology of Cholesterin. 
•fectly heated, and melts at 97°. On exposing it to a higher temperature, a 
portion is distilled unchanged, while another part is decomposed into 
ammoniacal vapor. In water it is perfectly insoluble; in hot alcohol of 
•833 it is only slightly soluble, and separates on cooling into its original 
flocculent appearance, since cold alcohol exerts no solvent influence over 
it. It dissolves readily in ether. It does not form a soap with caustic 
potash. Lecanu describes the seroline obtained from human serum as a 
white, but not nacreous substance, which melts at 95.°; is soluble in ether, 
but not'in watery alcohol. It may be distinguished from other fats by its 
insolubility in cold alcohol; from cholesterin by its lower point of fusion. 
We have^already recorded the results of the labors of Becquerel and 
Rodier with reference to cholesterin and the fatty matters of the blood, 
and they have shown that the amount of seroline existing in healthy blood 
may be estimated at from 0.029 to 0.025 in every thousand parts of that 
fluid; they have'£seen it rise as high as 0.060, and fall to an almost inap- 
preciable quantity. Becquerel and Rodier assign the physiological limits 
of the variations of the serolin as between 0.010 and 0.030 in 1000 parts of 
blood. In the ?blood of nine pregnant women, viz., one at the fourth 
month, five at the fifth month, one at five months and a half, one at six 
months, and one at seven months, the seroline ranged from 0.108 to 0.018; 
the phosphorised fat 0.863 to 0.381; the cholesterine 0.225 to 0.030; the 
saponified fat 0.328 to 0.737. With regard to the variations, of which 
serolin may be susceptible through the instrumentality of disease, patho- 
logical and physiological chemists have contributed nothing. 
According to Dr. Austin Flint, Jr., seroline, which he calls stercoline, 
may be extracted from faeces in the following manner : " The fieces are 
first evaporated to dryness, pulverized and treated with ether. The ether 
extract is then passed through animal charcoal, fresh ether being added 
until the original quantity of the ether extract has passed through. It is 
impossible to deodorize the solution entirely by this process; but it should 
pass through ciear, and of a pale amber color. The ether is then evapor- 
ated, and the residuum extracted with boiling alcohol. This alcoholic solu- 
tion is evaporated, and the residue treated with a solution of caustic pot- 
ash for one or two hours, at a temperature a little below the boiling point, 
by which all the saponifiable fats are dissolved. The mixture is then 
largely diluted with water, thrown upon a filter, and washed until the 
fluid which passes through is neutral and perfectly clear. The filter is 
then carefully dried, and the residue washed out with ether. The ether 
solution is then evaporated, extracted with boiling alcohol, and the alco- 
holic solution evaporated. The residue of this last evaporation is com- 
posed of pure stercorine. 
When first obtained, the stercorine is a clear, slightly amber, oily substance, 
about the consistence of Canada balsam used in microscopic preparations In four 
or five days it begins to show the characteristic crystals. These are few in number 
at first; but soon the entire mass assumes a crystalline form. * * In many 
regards, stercorine bears a close resemblance to cholesterine. It is neutral, inodor- 
ous, and insoluble in water and in a solution of potash. It is soluble in ether and 
hot alcohol, but is almost insoluble in cold alcohol. A red color is produced when 
it is treated with strong sulphuric acid. It may be easily distinguished from chol- 
lesterine, however, by the form of its crystals. It fuses at a low temperature, 
'98.°8 Fahr., while cholesterine fuses at 293° Fahr. Stercorine crystallizes in the 
form of thin delicate needles, frequently mixed with clear rounded globules, which 
are probably composed of the same substance in a non-crystalline form. When 
the crystals are of considerable size, the borders near their extremities are split 
longitudinally for a short distance. * * These crystals cannot be confounded with 
■excretine, which crystallizes in the form of regular, four-sided prisms, nor with Coloring Matters of the Bile. 
673 
the thin rhomboidal or rectangular tablets of cholesterine. They are identical 
with the crystals of seroline figured by Robin and Verdeil.* 
Dr. Flint concludes that- 
There can be no doubt with regard to the origin of stercorine, which exists 
in the faeces. We have found that whenever the bile is not discharged into the 
duodenum, as is probably the case, for a time, in icterus, accompanied with clay- 
colored evacuations, stercorine is not to be discovered in the dejections. * * * 
Taking the estimates, which have been made of the entire quantity of bile dis- 
charged into the intestine in twenty-four hours, by'Bidder and Schmidt, and Dal- 
ton, a comparison of the total quantity of cholesterine, contained in the bile with 
the quantity of stercorine actually discharged (about 10.4 grains in twenty-four 
hours), shows a correspondence which serves as an additional argument in favor of 
the view that stercorine is formed from a modification of cholesterine in its passage 
along the intestinal canal. 
We cannot, however, agree with Dr. Austin Flint, Jr., that ."these 
facts show conclusively that the cholesterine of the bile, in its passage 
through the intestine, is changed into stercorine," for the following 
reasons : 
1st. The true chemical composition of stercorine has not been deter- 
mined. It has not been shown in what respect its chemical elements differ, 
on the one hand from the excretive of Marcet, and on the other from 
cholesterine. 
2d. According to the statement of Dr. Flint, stercorine is identical 
with seroline. 
3d. Seroline, as shown by the observations, by Boudet, Lecanu, San- 
son, Becquerel and Rodier, is a normal constituent^of the blood. 
It is evident from the preceding facts that a careful quantitative deter- 
mination of the proximate constituents, and ultimate chemical constitution 
of human faeces in health and disease, and under different forms of alimen- 
tation, rest and exercise, is still a great desideratum to the physiologist, 
pathologist and physician. 
COLORING MATTERS OF THE BILE. 
If an alcoholic solution of bile be filtered through a column of animal 
charcoal, it runs off nearly deprived of color. The coloring matter of the 
bile appears to exist in three modifications: one of them is brown, a second 
red, and the third green; the latter is abundant in the herbivora; it forms 
the biliverdin of Berzelius, who considered this green pigment to be iden- 
tical with chlorophyll, or the green coloring matters of vegetables, anopin- 
ion since found to be erroneous. The exact composition of all the color- 
ing bodies, is yet a matter of dispute. They have lately been elaborately 
examined by Thudichum, but his numerous analyses still leave the sub- 
ject undecided. Staedler's analysis of biliverdin (Liebig's Annal., cxxxii, 
p. 323), leads to the formula C16H20N2O5. It is insoluble in water, but is 
taken up by alcohol and by ether. The cholepyrrhin or biliphsein, 
obtained by Briicke, crystallized from its solution in chloroform, according 
to Maly, is au amide of biliverdin. In human bile, the brown pigment 
predominates; it has been termed bilifuscin. The bilijuscin is soluble in abso- 
lute alcohol, but insoluble in chloroform, and in absolute ether, and nearly 
insoluble in water. Staedler gives its formula as C16H20N2O4, or as contain- 
ing H2O more than bilirubin, and an atom of oxygen less than bili- 
verdin. The.red coloring matter is of an acid character; it is insoluble in 
* Robin et Verdeil, Chimie Anatomique, Paris, 1853, Altar, Pl. xxxvi, Diag. p. 2. 
The Physiology of Man. Alimentation, etc., pp. 399-403. 674 
Coloring Matters of the Bile. 
water, sparingly soluble in alcohol, and in ether, but soluble in chloroform, 
from which it may be obtained in crystals of a dark red color (G16H18N2O3 
Staedler), and is by this chemist called bilirubin. It combines with the 
alkalies, forming solutions, which are of a deep orange yellow, and when 
largely diluted, of a yellow color, like that of a jaundiced person; with 
the earths it forms compounds which are insoluble in alcohol and water. 
This brownish red coloring matter of the bile is very rapidly altered by 
reagents, the changes of color produced in it by nitric acid, have been 
proposed as one means of detecting the presence of bile in certain cases, as 
for instance, when it occuis in urine. When a solution containing this 
coloring matter is mixed with nitric acid, the color becomes at first green, 
then blue, passing rapidly into violet; it then changes to red, and finally 
the red passes slowly into yellow. Many biliary calculi contain a large 
quantity of the coloring material in combination with lime, with which it 
forms a brown compound insoluble in water. Calculi are also frequently 
found in the ox, composed of a pure intense yellow coloring substance, 
much prized by artists for its durability and for the brilliancy of its tint. 
The greater portion of the coloring matter of the bile, with a small 
portion of the bile itself, passes off with the faeces, but by far the larger 
portion of the secretion is reabsorbed into the system, where it has been 
conjectured to supply a portion of the material consumed by the oxygen 
in respiration, for the maintenance of animal heat. This theory has been 
questioned, on the ground, that, the constituents of the bile have not been 
satisfactorily discovered in normal blood, whilst the cholesterin and the 
serolin, preexist in the blood and in certain organs; the resinous acids of 
the bile, which constitute the characteristic components of the secretion 
appear to be truly formed by the liver itself. The mode of action of the 
liver differs therefore in an important manner from that of the kidneys, 
since these organs do not produce the compounds excreted by them. Sugar 
is not an ingredient in normal bile, but it is remarkable that this sub- 
stance is formed rapidly from glycogen, one of the constituents of the 
liver itself in which organ, Bernard and others have found sugar in con- 
siderable quantity after death. Whilst the bile seeks a definite route 
through the biliary tubes, to the alimentary canal, the sugar passes in an 
opposite direction to the blood vessels and mingles with the general mass 
of the circulation. 
Cholochrome has been applied as a general name for the coloring mat- 
ters of the bile; and includes the ordinary known bile pigment (cholophaein 
or biliphaein); a green substance (cholochloin or biliverdin), produced by 
oxidation of cholophaein; and a yellow substance found in the ox bile 
choldfulvin or bilifulvin).* 
-RELATIONS OF BILE PIGMENT TO COLORING MATTER OF COLORED BLOOD 
CORPUSCLES. 
Constituents of the Colored Blood Corpuscles. 
Berzelius has shown that the colored blood-corpuscles contain an albu- 
minous substance (globulin), differing from albumen. Schmidt separated 
* These substances were first examined by Berzelius (Lehr. A. Chern., ix, 281); afterwards by 
Simon, Platner, Schmidt, Scherer and Heintz (Gerb. Traits, iv, 532) ,and Thudlchum. Brit. 
Med. Jour., July 14, 1860. The brown pigment cholopheein is contained in bile and in the intes- 
tinal canal, and is the substance to which excrements owe their color. In certain states of the 
disease it occurs in the blood, the serous fluids, the urine, and other liquids of the organism, and 
is the cause of the yellow skin and cornea in jaundice, t holophaein contains, according to 
Heintz's analysis, 60.9 per cent, carbon, 6.05 hydrogen, and 9.1 oxygen, whence may be deduced 
the lemperical formula C16H18N2O4. Caustic alkalies and alkaline carbonates dissolve cholo- 
phsein into a brownish-yellow color. The green pigment, cholochloin, or biliverdin, is produced 
in the oxidation of the cholophfein. According to Heintz cholochloin contains 60.04 per cent, 
carbon, 5.84 hydrogen, 8.53 nitrogen, and 25.59 per cent, oxygen, whence is deduced the formula 
C8H9NO2. The formula of cholophaein and cholochloin, as deduced from these analyses, are 
very uncertain. Coloring Matters of the Bile and Blood. 
675 
the corpuscles by means of sulphate of sodium, and found them to contain 
87.59 globulin, and 12.31 per cent, hsematiu. Mulder considers the outer 
membrane of the corpuscles to be binoxide of protein, a hypothetical sub- 
stance, whilst others have taken it for fibrin. Its composition does not 
appear to be fixed, since the membrane of different corpuscles is variously 
affected by the same reagents. 
Blood Crystals.-Hsematocrystalin. O. Funke first completely investi- 
gated the nature of the crystalline substance of the red corpuscles. Funke 
and Kunde obtained the crystals by adding to a drop of blood, water, ether, 
alcohol, or chloroform, allowing the mixture to dry slightly on a glass plate, 
and then covering the whole with a glass cover. Lehmann passes a slow 
stream of oxygen or nitrous oxide for about fifteen minutes into a. mixture 
of blood and water, and afterwards carbonic acid, till the liquid turns 
bright red, and becomes turbid, whereupon it crystallizes. The form of 
the crystals varies in the blood of different animals ; those obtained from 
the blood of men, most mammalia, and fish, form prisms; from the mouse, 
rat and guinea pig tetrahedrons ; from the squirrel hexagonal tablets; and 
from the German marmot, rhombohedrons (of about 120°), or very thin 
hexagonal plates. The tetrahedral crystals dissolve with peach-blossom 
color, in 600 parts of water, the prismatic, with dark red color in ninety- 
four parts of water. Nitric acid turns the crystals almost black, but dis- 
solves them on warming, and acquiring a yellow color. Their solution is 
decolorized by chlorine, which precipitates white flakes; it is turned dark 
brownish-red by carbonic oxide, and rendered turbid and brownish-red by 
nitrogen. The same sized crystals, from the same blood, often differ in 
intensity of color, and have possibly not always the same composition. 
They seem to be an albuminous substance. The solution of the tetrahedral 
crystals coagulates at about 63°C., that of the prismatic crystals .between 
64° and 65°. It cannot be doubted that both oxygen and carbonic acid 
by their chemical action on the contents of the corpuscles are instrumental 
in the formation of the crystals. The crystals exhibit, according to Leh- 
mann's analysis, the percentage composition of the albuminoids- 
Carbon 55.41 55.24 55.18 
Hydrogen 7.08 7.12 7.24 
Nitrogen 17.27 17.31 16.40 
Sulphur 0.25 0.21 0.25 
Oxygen . 19.19 25.12 20.03 
100.00 100.00 100.00 
Hsematin is peculiar to the blood of the vertebrata, and is in some way- 
combined with the remaining albuminous contents of the corpuscles. It 
is obtained as an amorphous blackish-brown substance by treating the 
corpuscles with sulphate of sodium, extracting the residuum with alcohol 
containing sulphuric acid, and treating with ammonia, water, alcohol and 
ether. It is insoluble in water, alcohol, ether, acetic ether, and oils, both 
fat and volatile, but readily soluble in alcohol containing sulphuric or 
hydrochloric acid. It is not dissolved by concentrated mineral acids. 
Aqueous or alcoholic solutions of alkalies or their carbonates dissolve 
hsematin in all proportions. A sulphuric acid solution of hsematin, which, 
has been turned red by addition of alkali, exhibits dichroesin, appearing 
green by transmitted, and red by reflected light. If heematin be allowed 
to stand in contact with pure concentrated sulphuric acid, it may be 
obtained perfectly free from iron without suffering any perceptible change 
in its properties. Berzelius found in the dry blood-corpuscles of men, 
oxygen 0.38 per cent, metallic iron, and since Mulder has found 6.64 per 676 
Coloring Matters of the Bile and Blood. 
cent, iron in haematin, the corpuscles would contain 5.72 per cent, haema- 
tin, and the blood 0 732 per cent, iron, and 14.11 per cent, corpuscles, 
which would give 6.02 parts baematin, in every 100 parts corpuscles. Ini 
disease the proportion of haematin to the whole blood probably varies with 
the corpuscles. It is not known whether there is a fixed relation between 
the haematin and the albuminoid of the corpuscles. Mulder assigns to it 
the formula CUH22N3O6. The arterial blood of the horse contains rather 
less haematin than that of the outer jugular vein; the corpuscles of the 
liver blood contain far less than those of the vence portce. The proportion 
of iron,, to dry blood-corpuscles in arterial blood 1.394; in that of the 
jugular vein 1.300; of the venae portae 1.312; of the liver 1.500 (Lehmann). 
Poggale found 0.126 per cent, ferric oxide in the human blood; in that of 
the ox 0.125; calf 0.111; dog 0.145; sheep 0.106; chicken 0.75. A sub- 
stance called haematoidin has been found in blood extravasated in the 
tissues of living animals. It is sometimes amorphous, in grains and little 
globules; sometimes in crystals, belonging to the monoclinic system. It is 
transparent, strongly refracting, yellowish red, or ruby red, insoluble in 
water, alcohol, ether, acetic acid, and dilute mineral acids. It generally 
turns ardent red on addition of potash; gradually disintegrates and splits 
up into red globules, which gradually dissolve. The haematoidin is not. 
re precipitated by neutralizing the alkali. By the action of concentrated 
sulphuric acid the sharp contour of the crystals vanishes, and the color of 
the round concretions first turns brownish red, then green, blue and rose, 
and finally dirty yellow. In the liquid, iron may sometimes be detected, 
but not always. According to Robin the formula is CUH18N2O3. The sepa- 
ration of haematin from globulin cannot be effected; but, if the quantity of 
iron in the dry coagulum be determined, the amount of blood pigment 
may be calculated, on the supposition that this pigment contains 6.64 per 
cent, of iron.* 
1000 parts of blood-corpuscles contain: Water 688.00; solid constituents 
312.00; density 1.0885; haematin 16.75; globulin and membrane of corpus- 
cles 282.22; fat 2.31; extractive matters 2.60; mineral matters (without 
iron) 8.12; chlorine 1.686; sulphuric acid 0.066; phosphoric acid 1.134; 
potassium 3.828; sodium 1.052; oxygen 0.667; phosphate of calcium 0.114; 
phosphate of magnesium 0.073. According to Vierordt one cubic milli- 
metre contains 5,055,000 blood-corpuscles. Haematoidin appears to be 
produced by the decomposition of haematin, but the nature of the trans- 
formation has not been exactly made out. Robin (Compt. rend., xli, 506) 
found a considerable quantity or haematoidin in a hepatic cyst, forming 
hard, brittle prisms, 118° and 62°, and of a bright orange color. Accord- 
ing to Valentin (Jahresb, d. Chem., 1859, p. 656,) gall-stones, bile and the. 
livers of persons affected with jaundice, when treated with chloroform, 
yield a crystalline substance differing from all previously known ingre- 
dients of bile, and agreeing in all respects with haematoidin. 
RELATIONS OF BILE PIGMENT TO HAEMOGLOBIN. 
Bilirubin (bilifulvin, biliphcein, cholopyrrhin, hcematoidin), C16H18N2O3, is 
generally believed to be formed from, haemoglobin, which becomes altered 
during the passage of blood through the liver. The grounds for this belief 
are the apparent identity of bilirubin and the pigment called haematoidin, 
found in old extravasations of blood, and the observation that the bile pig- 
ment appears in the urine after the injection into the veins of solutions of 
haemoglobin, or of any substance which will dissolve the blood-corpuscles,. 
* Stricker, Handen d. Chem., 11 [2], p. J15. Coloring Matters of the Bile and Blood' 
677 
and liberate h®moglobiu, such as water (Hermann), bile acids, (Frerichs, 
Kuhne), or ether (Fiegel). They also appear after prolonged inhalation 
of ether (Nothnagel), or chloroform (Bernstein). Further support is also 
lent to this view by tne destruction of h®moglobin, which appears to take 
place in the blood during its passage through the liver (Grehaut). Though 
a positive result has been obtained by so many observers, Naunyn failed to 
detect bile pigments in the urine of rabbits after the injection of h®moglo- 
bin, either subcutaneously or into the jugular vein, and attributed the 
success of others to their experiments having been made on dogs, in whose 
urine, bile pigment is normally of frequent occurrence. He noticed them, 
however, in rabbits' urine, when blood in which the corpuscles had been 
destroyed by freezing or ether, was injected into the intestines, so that the 
h®moglobin absorbed from it, or set free by the action of the ether on the 
blood of the portal vein, passed through the liver before reaching the 
general circulation. Naunyn's experiments also have been repeated by 
Wolff and Wickham Legg with a negative result. 
RELATIONS BETWEEN THE COLORING MATTER OF THE BILE BILIRUBIN 
(C16H18N2O3) BILIVERDIN (C16H2oN205 OR C16H18N2O4), AND THAT OF THE 
URINE. 
The urinary pigment is supposed to be derived from that of bile, as a 
substance which presents similar spectroscopic characters, can be extracted 
from bile, or produced by deoxidation from bilirubin. In the organism, 
bile pigments are probably reduced by hydrogen, or other reducing agents 
present in the intestine. When dogs' bile is extracted with dilute hydro- 
chloric acid, and filtered, the filtrate has a reddish or reddish-yellow color, 
and on spectroscopic examination, presents a band close to F, between it 
and B, which disappears on the addition of liquor sod®, and is replaced by 
a narrower band, also between B and F, but nearer B, this filtrate at the 
same time assuming a yellowish color. If the solution is only very slightly 
alkaline, both bands may be seen at once. Ammonia produces similar 
changes in the color of the fluid, but the second band is very faint when it 
is employed. On acidulation, the alkaline liquid retains its red color and 
the first band reappears. By treating it with chloroform, a solution is 
obtained in which the first band is visible,, but is somewhat nearer B. 
Urine, especially when high colored, exhibits the band at F, though not 
very distinctly; but it may be clearly seen by precipitating the urine with 
lead acetate, decomposing the precipitate by an acid, and examining the 
filtrate spectroscopically. The addition of sodium hydrate causes the other 
band faintly to appear, and when treated with chloroform, in the same way 
as bile, the solution and the position of the band seen in the chloroform 
solution, is altered in a similar manner. A substance presenting a similar 
band is obtained by acting on a solution of bilirubin in liquor potass®, or 
liquor sod®, with sodium amalgam, for several days with exclusion of air 
(Maly). 
H®matine, or h®matoglobuline, may be regarded as dissolved blood- 
corpuscles; for it is in fact a mixture of the albuminous fluid filling the 
■corpuscles-globuline, and of the coloring matter which may be obtained in 
crystals, under certain conditions-h®matocrystalline. The membranes of 
the corpuscles are either dissolved or invisible in urine where h®mato- 
globuline occurs, as no corpuscles can be detected by the microscope. It 
is best distinguished from albumen by its point of coagulation, being 
199. °4 or 204. °4 F., while that of albumen is 54° F. lower. It is not entirely 
coagulated by heat alone, but the presence of any neutral salt of the alka- 678 
Coloring Matters of the Bile and Blood. 
lies will affect complete coagulation. It is so intimately mixed with the 
red coloring matter proper, or haematin, that it includes the entire amount 
of this substance in its coagula. On boiling, the latter containing some 
sulphuric acid, haematin is dissolved, and forms a reddish-brown solution 
with the alcohol. For though urine may contain albumen and luemato- 
globuline at the same time, yet they must be present in the same propor- 
tions as in the blood, before we can say that they are due to haemorrhage, 
and consequent solution of the blood. Thudichum observes that no atten- 
tion has hitherto been paid to this distinction, and in cases where the urine 
has been blood-colored and gave a coagulum on boiling, the presence of 
haematoglobulin has been assumed, without a question, as to the probable 
amount of albumen; these cases are, therefore, not quite satisfactory as 
regards the distinction between dissolved blood and haematoglobuline; a 
distinction the more important, as blood may be effused into the tubuli of 
the kidneys, then coagulated, and form blood casts, which may give up 
their haematoglobuline; and thus what really was a haemorrhage may appear 
to be the secretion of fluid haematoglobuline. The blood casts, in their 
altered state, are then frequently only expelled from the kidneys when all 
traces of haematoglobuline have long disappeared from the urine. Accord- 
ing to Vogel, the presence of haematoglobuline in the urine may thus be 
explained. In the body, a constant disintegration of blood-corpuscles 
takes place, whereby haematoglobuline is set free and subjected to further 
changes. Globuline probably serves for the nutrition of the muscles, and 
other albuminous tissues, and is at last removed from the economy in the 
form of urea and uric acid. Haematin is also further oxydized and leaves 
the body in the form of biliary and urinary pigments, as cholo and uro- 
haematine. In health, therefore, haematoglobuline never passes through 
the kidneys with the urine. But when there are pathological processes 
going' on in the blood, the result of which is a wholesale destruction of 
blood-corpuscles, then the quantity of pure haematoglobuline in the blood 
becomes so large that it cannot all be subjected to normal changes, and it 
seems that a part may be secreted unchanged by the ordinary channels of 
the urine, just as other substances, such as sugar, bile, and, perhaps, albu- 
men, when contained in the blood in excess, may pass over into the urine. 
This explanation Vogel supports by the following observation. A profes- 
sor of physics having performed an experiment with a balloon full of hydro- 
gen, breathed some of its gas, when emptying the balloon of its contents by 
pressure. He became suddenly very ill, but soon recovered, and after the 
lapse of some time passed a urine, which was black like ink, coagulating 
on boiling, but contained no blood-corpuscles when examined under the 
microscope^. This condition of the urine lasted for about twenty-four 
hours. It was found that the hydrogen used for the experiment contained 
arseniuretted hydrogen. Dr. Thudichum* expresses the opinion that the 
disintegration of blood-corpuscles in the circulation, is by no means estab- 
lished by this case of Professor Vogelf, for, on the contrary, other observa- 
tions of similar cases tend to make it probable that the complaint caused 
by the breathing of arseniuretted hydrogen, as it exhibits itself in the 
urine, is really haemorrhage from the capiliaries of the kidneys. Thus, in 
the case which has been related by Dr. SchlinderJ, of Greifensberg, deep 
reddish-brown urine, mixed with clots of blood, was discharged. In the case 
reported by Dr. O'Reilly^, however, there was first bloody urine, succeeded 
* Pathology of the Urine, pp. 234-235. 
t Archiv. des Vereins fiir gemeinschaftliche Arbeiten, Bd. i, Heft, 2, p. 209. 
j Buchner's Repertorium fiir diePharmacie, Ixix, Christosin on Poisons, 4th ed., p. 326. 
§ Dublin Jour, of the Med. Sci., xx, p. 422. Nature of Jaundice. 
679 
by suppression of urine, after which the face became copper-colored, and 
the rest of the body greenish; symptoms probably indicating the presence 
of free hsematoglobuline in the blood. 
In the present state of our knowledge, two views are held ; there may 
be both haemorrhage from the malpighian bodies and subsequent disintegra- 
tion of the effused corpuscles ; or on the other hand, there may be also dis- 
integration of the corpuscles in the blood and subsequent discharge of the 
solution. The observations of Mickel, Hirsche and Planer, quoted by 
Vogel in support of his opinion, undoubtedly prove that an excess of a 
grannlar pigment may accumulate in the blood in consequence of a copious 
destruction of blood-corpuscles ; but the very fact of this (altered and 
insoluble) pigment accumulating in the blood and causing dangerous symp- 
toms, particularly in the brain, by blocking up the capillary vessels, shows 
that the formation of an excess of free hrematoglobulin in the blood stands 
in no necessary connection with the discharge by the kidneys. It seems 
impossible that heematoglobulin could accumulate in the blood, if it were 
secreted at the rate observed in Vogel's cases. Whether the destruction of 
the blood-corpuscles takes place in the blood or elsewhere, the destruction 
itself is certainly indicated by the appearance of hmmatoglobulin in the 
urine; and under all circumstances, this is a sign of severe lesion. It 
admits of a favorable prognosis, if it is limited to a certain short time, after 
which it does not reappear, but when it is a symptom of severe scorbutic or 
septic disorders, it is a sign of great danger to the life of the patient. Sup- 
pression of the urine, and discoloration of the skin, when following the 
discharge of urine rich in htemoglobulin, are also very unfavorable, and 
are forerunners of a fatal termination of the case. 
The occurrence of the coloring matter of bile in the urine, indicates 
that the flow of bile from the liver into the intestinal canal is impeded or 
entirely suspended. By absorption the coloring matter of bile enters the 
blood, and hence passes into all the secretions and tissues. . There is, how- 
ever, a certain dissolution of the blood consequent upon or part of the 
pathological process of pyaemia, which produces the green or yellow icteric 
color of the skin and tissues, without being accompanied by retention of 
bile, as the frequent fluid evacuations contain abundance of green coloring 
matter, and the dark red or brown urine does not show the color test with 
nitric acid. 
Dr. George Johnson* says: "We have another illustration of the effect 
upon the secreting cells of an effort to eliminate new materials in cases of 
jaundice. When from any cause, the functions of the liver are so imper- 
fectly performed as to allow of the bile accumulating in the blood, the urine 
is found to be deeply tinged with some, at least, of the constituents of the 
biliary secretion, and on a microscopical examination of the urine, we find 
the renal secreting cells in variable numbers, some being scattered, whilst 
others are entangled in moulds of the kidney tubes, and all of them colored 
by the bile contained within them. When we have an opportunity of 
examining the kidney after death in these cases, we find the tubes deeply 
tinged by the bile contained in their secreting cells, and some tubes are 
nearly or quite filled with cells, which have been thrown off, whilst others 
have been formed upon the basement membrane beneath them. Thus it 
appears, that when the blood circulating through the kidney contains an 
excess of bile, the renal cells, in striving to eliminate those materials, 
become deeply tinged by it, and many of them are so far modified as to be 
shed by a process of desquamation." It is possible that the desquamation 
* Diseases of the Kidney, p. 108. 680 
Tyrosine and Leucine. 
of the cells of the tubuli uriniferi in certain fevers, accompanied by jaun- 
dice, may, in like manner, be referred to the action of the constituents of 
the bile. 
TYEOSINE AND LEUCINE. 
Tyrosine and leucine, which have been observed by Frerichs in the 
blood, liver and urine in acute atrophy of the liver, may be obtained as 
artificial products of the decomposition of albumen and fibrin, when either 
of these substances, but particularly the latter, is heated with dry caustic 
potash, or boiled with a strong solution of potash. They are also obtained 
in the decomposition of casein and horn, by the action of alkalies and of 
acids, and by putrefaction. These substances are regarded as some of the 
intermediate products of the destruction of the animal tissues, between the 
sanguinous bodies at one extreme, and the still less complex excreted com- 
pounds, such as uric acid, hippuric acid, urea, kreatene, etc., at the other. 
The composition of leucine is C6NH2O13, and that of tyrosine is C9NHUOS. 
Frerichs, vi, p. 205. 
Tyrosine, C9HnNO3. A crystalline, nitrogenous body, produced by the 
decomposition of albuminoidal substances, under the influence of acids, 
alkalies and putrefaction. It was discovered by Liebig, who obtained it by 
decomposing casein with melting potash. A. Muller found it amongst 
the products of the putrefaction of yeast. Leyer and Koller obtained it by 
the action of fused potash on globulin, feathers, hairs and hedgehogs' 
prickles, or by treating these bodies with sulphuric acid. Hinterberger 
prepared it by boiling ox-horn with sulphuric acid. Stadeler obtained it 
in like manner from muscle fibrin, vegetable fibrin, fibroin and animal 
mucus. Stadeler has further pointed out that the white bodies resembling 
poppy seeds, sometimes observed in badly preserved alcoholic anatomical 
preparations, also consist of tyrosine; and that the so-called cystinoid 
tubercles, or xanthocystin, found by Chevallier and Lassaigne, in a corpse 
two months old, likewise agreed in character with this substance. 
Tyrosine occurs ready-formed and always accompanied by leucine, in 
the animal organism; it has been found in the spleen and the pancreas; in 
the liver and in the blood of the hepatic veins, in certain states of liver 
disease; in the bile of typhous patients and in acute atrophy of the liver, 
and in the urine, sometimes, in yellow fever, typhus fever and acute atro- 
phy of the liver (Frerichs, Stadeler and Joseph Jones); in the cutaneous 
scales in pellagra (Schmetzer). It occurs also in cochineal (De la Rue), 
probably as a product of decomposition, and in most of the forms of animal 
life. According to Wittstein, it is found in American extract of rhatany. 
Tyrosine crystallizes from aqueous solution, in stellate groups of long 
slender needles, having a silky lustre, and becoming interlaced and con- 
fused in drying. From ammoniacal solutions, it crystallizes in permanent 
tufts of larger needles, also having a silky lustre. Tyrosine dissolves in 
150 parts of boiling water, in 1900 parts of cold water (at about 10°), or 
about 13,500 parts of cold 90 per cent, alcohol, not more freely in boiling 
alcohol, and is quite insoluble in ether. 
Leucine, CfiH13NO2, formerly called aposepedine and caseous oxide. This 
substance was first observed by Proust in 1818, as a product of the putre- 
faction of cheese; and Braconnot in 1820, found it among the products of 
decomposition of animal substances by sulphuric acid; Mulder, in 1838, 
showed that the two substances thus obtained, were identical. It is homo- 
logous with glycocine (C2H5NO2) and alanine (C3H7NO2), and may be 
regarded as lactanic acid, being related to leucic acid in the same manner 
as glycocine to glycoIlic acid, and alanine to lactic acid. Ligature of the Bile Ducts. 
681 
Leucine occurs in old cheese (Proust); in fresh calf's liver (Liebig 
Chern. Briefe, 3 Aufl. 453); also together with tyrosine, in the human liver, 
in certain cases of disease, but not in the healthy liver (Frerichs and Sta- 
deler, Jahresber, 1854, p. 675). According to later researches of these 
chemists, (Jahresber, 1856, 702, 1858, 550), leucine and tyrosine are very 
widely diffused in the animal organism. Leucine also exists, together with 
taurine, inosite, and uric acid in the tissue of the lungs (A. Clbetta 
Ann. Ch. Pharm. xcii, 289). According to Gorup-Besanez. (Ann. Ch. 
Pharm. xciii, 7), it occurs in many parts of the glandular system, viz., in 
the thymoid and thyroid glands, in the liver and especially in the pan- 
creas. It has been found also in the brain of oxen (W. Muller, Ann. Ch. 
Pharm. ciii, 131); in the pancreas of oxen (Scherer, Jahresber, 1859, p. 
610); in the stomach and intestines of the pupae of butterflies (Schwarzen- 
bach, Jahresber, 1857, p. 538), and in the fly-agaric, agaricus muscarius 
(Ludwig, Jahresber, 1862, p. 516). Leucine crystallizes from alcohol in 
soft nacreous scales, lighter than water, and resembling cholesterin. It 
sublimes completely at 170°, in cotton-like flocks, without fusion or 
decomposition, (Mulder); according to Schwan er t, on the contrary, it melts 
at 170°. It is sparingly soluble in cold but dissolves easily in hot 
water, sparingly in alcohol of ordinary strength, (in 6.58 pts. of cold alco- 
hol, of sp. gr. 0.828, according to Mulder) very sparingly in absolute alco- 
hol. It is insoluble in ether. According to Zollikoffer, it dissolves in about 
27 parts of cold water, in 1040 parts of cold alcohol of 96 per cent., and in 
800 parts of hot alcohol of 98 per cent. 
EFFECTS OF LIGATURE OF THE BILE DUCT. 
Effects of ligature of the bile duct.-Sir B. Brodie (Quarterly Jour, of 
Science and Arts, 1828), has endeavored to ascertain the degree in which 
the bile contributes to the process of chylification, by applying a ligature 
to the ductus choiedocus. Jaundice was a consequence of the operation, 
but this sometimes disappeared after a time, and then it was found that an 
effusion of lymph had taken place at the seat of the ligature, and had 
reunited the divided portions of the duct. As to the effect of the opera- 
tion on digestion, Sir. B. Brodie states that the process in the stomach 
was unaffected, but that chyle was no longer formed from the chyme; that 
neither the lacteals nor the thoracic duct contained any white chyle. 
Tiedemann and Gmelin have rendered valuable service to physiology 
by the experiments (ten in number), which they have performed to ascer- 
tainthe correctness of Brodie's statement. The results which they obtained 
are the following : Jaundice ensued on the second or third day after the 
operation, but disappeared again in some instances after the lapse often or 
fifteen days, the canal of the ducts in such cases being restored by a spon- 
taneous process, either the ligature had cut through the coats and had 
fallen away before the divided ends of the duct united, or lymph having 
been effused around the ligature, this had separated and fallen into the 
cavity of the duct, thus restored on the exterior, and was subsequently 
carried out through it. After an interval varying from thirteen to twenty- 
six days, the canal was found to be restored. In other cases (experiments 
1, 4 and 8), death ensued at the end of from three to seven days. One 
dog, in which the jaundice continued, although the duct was afterwards 
found pervious, and had survived the operation twenty-six days, whenhewas 
killed. In one case (experiment 1), in which the dog died seven days after 
the duct had been tied, the animal had become so emaciated and feeble 
that it could scarcely stand. After death either inflammation of the peri- 682 
Constitution of the Blood in Jaundice. 
toneum, or some of its effects were found. The coloring matter of the bile 
was detected in the blood and urine, and the lymphatics of the liver were- 
yellow. In the experiments of Tiedemann and Gmelin, as in those of 
Brodie, digestion went on in the stomach uninterruptedly. The contents 
of the small intestines also did not essentially differ from what they are 
under ordinary circumstances, they contained albumen in large quantity; 
the matter which acquires a red color when acted on by chlorine, was also 
present. 
In all Tiedemann and Gmelin's experiments, the contents of the large 
intestine had a much more fcetid and disagreeable odor than ordinary (while 
Leuret and Lassaigne stated that they had a strong odor and insipid savor, 
not the usual disagreeable odor and savor), and the excrements were white. 
(Dr. J. Muller* has observed that of two similar portions of spleen, the 
one macerated in the bile of the ox, and the other in the same quantity of 
water, the latter became putrid somewhat sooner than the former). In 
dogs which were killed while fasting, the thoracic duct contained a clear, 
transparent, yellow fluid, which sometimes coagulated but little, sometimes 
perfectly. In dogs which had been fed after the operation, the lacteals of 
the small intestines contained a clear, transparent fluid, just as in dogs 
which had not taken food; while in dogs in which the ductus choledochus 
has not been tied, the contents of the lacteals are milky. The flnid of the 
thoracic duct was generally redder than ordinary, and yielded a larger and 
redder coagulum in dogs in which the ductus choledochus had been tied, 
than in dogs in which the operation had not been performed; the serum in 
the former was yellow and turbid; in the latter milky. Tiedemann and 
Gmelin do not attribute much weight to this circumstance, and regard it 
as certain that chyle is still formed without the aid of bile; for they say 
the white milky color of the chyle is known to be owing to the presence of 
particles of fat. " Dogs will live about thirty-six days, although wholly deprived 
of food." Leuret and Lassaigne, who, with Tiedemann and Gmelin, main- 
tain that digestion and chymification aie not arrested by ligature of the 
ductus choledochus, attributed to the bile the property of dissolving fat, of 
decomposing it, and forming with it a kind of soap, thus effecting its diges- 
tion. But experiments of Tiedemann and Gmelin show that bile is not 
capable of dissolving the smallest quantity of fatty matter, and can, there- 
fore, contribute to its division and absorption only in a mechanical manner 
by effecting its suspension in minute particles. The bile seems to be a 
necessary stimulus for the peristaltic motions of the intestines; for, wheni 
its flow is arrested, constipation is the result." Vol. i, pp. 603-G04. 
CONSTITUTION OF THE BLOOD IN JAUNDICE. 
The constitution of the blood in jaundice will depend in great meas- 
ure upon the state of the system, whether of health or disease at the time 
of the supervention of the jaundice. Thus when the symptom of hepatic 
derangement appears during the existence of malarial fever, the blood will 
manifest the peculiar characters of this disease as diminution of the red 
globules, fibrin and albumen, and increase of the extractive matters. 
In specific yellow fever, on the other hand, when it attacks a healthy 
subject free from all preceding action of the malarial poison, there will be 
no marked diminution of the red globules and albumen, but on the other 
hand a greater diminution of the fibrin than in the various forms of mala- 
rial fever. We have presented in the second chapter of this work, numer- 
* Elements of Physiology, vol. i, p. 603. Congenital Cirrhosis of the Liver. 
683 
ous cases illustrating the diminution of the colored corpuscles, albumen 
and fibrin in malarial fever; and we will present cases and analyses repre- 
senting the composition of the blood, and the diminution of the fibrin, and 
the increment of oil and urea, in the blood of yellow fever, in that por- 
tion of this work devoted to the consideration of the disease. 
The question arises whether the presence of bile in the blood tends to 
induce haemorrhages and whether such haemorrhages are due to the direct 
dissolvent effect of the bile upon the colored blood-corpuscles. That bile 
has a direct effect as a solvent of the colored blood-corpuscles, may be 
demonstrated by direct experiments. 
In 1854 I commenced a series of experiments upon the functions of the 
liver, and found that the amputation of this organ in those animals who 
were capable of surviving the operation the longest, as the ophidia, sauria, 
did not manifest any discoloration of the serum of the blood or of the dif- 
ferent tissues after ablation of the liver. Experiments with the blood of 
various animals, including those which possess largest red blood-corpus- 
cles, as the amphiuma, as well as those which possess the smallest as the 
mammalia, including man, it was shown that bile rapidly dissolves the 
colored blood-corpuscles. 
That jaundice induces, when long continued, a tendency to haemor- 
rhage from the mucous membranes, and even intramuscular haemorrhages 
may be demonstrated by the following cases : 
Case 923.-Congenital Cirrhosis of the Liver, Intense and Prolonged Jaundice; 
Haemorrhages into the Cellular and Muscular Tissues. 
The subject of the following sketch was born January 6th, 1874. The labor was 
natural. The child presented all the appearances of being in perfect health. It 
nursed well and slept well. During the course of the second week it was observed 
to be very much jaundiced. This must have existed from birth, but was not noticed 
because the room was darkened. A few small doses of calomel were administered 
but no apprehension was felt, because the child seemed to be so perfectly well in 
every other respect. This state of things continued till some time during the course 
of the second month, when a thorough examination revealed the fact that the liver 
was very much enlarged, and also very much indurated. It extended across in 
front nearly to the left hypochondrium : and on the right side it projected about 21 
inches below the bordei- of the ribs. To the touch it seemed as hard as wood. 
Notwithstanding this condition of things the child ate well, slept well and devel- 
oped about as rapidly as any child of its age. About the end of the third month 
it began to suffer with fever-more marked at night-and paroxysms of acute pain. 
These continued during the last six months of its life. The fever seldom ever 
ceased entirely, and at times it was very high. The pain sometimes amounted to 
an agony. The little patient would pull its hair, bite its fingers and try to tear off 
its clothes. Opium, bromide of potash, hydrate chloral, or some other narcotic, 
had to be resorted to almost daily to secure any rest. Sometimes large doses had 
to be used before rest could be obtained. About the 1st of the eighth month ascites 
made its appearance. But by the persistent and free use of bitartrate of potash the 
effusion was so controlled as to obviate the necessity of tapping. 
At the beginning of the ninth month, from a slight abrasion or ulcer on the 
frenum of the tongue, there occurred a hsemorrhage. This continued at intervals 
for a week. It was kept in check by the use of tinct. ferri mur. and Monsel's solu- 
tion. Then came on a general haemorrhagic condition. Haemorrhages took place 
underneath the skin on the legs, the arms, the body and the head. A large one 
occurred in the left cheek. Blood was poured out in the tissues until the whole 
side of the face was distorted. The clot formed must have been larger than a hen's 
egg. The whole cheek, both within and without, turned almost perfectly black. 
This existed one week before death. Eighteen hours before the final termination 
a violent fever supervened, attended with cough and great oppression of breath- 
ing ; and finally with stupor. At the very last there was vomiting of blood and 
large quantities of bloody mucus issued from the mouth and nostrils. 
In the case No. 924, of a native of China, suffering with cancer of the liver, 
which came under my treatment in the Charity Hospital of New Orleans, intense 684 
Cirrhosis of Liver. 
jaundice was induced by the obstruction of the hepatic and cystic ducts by cancer- 
ous masses. Before death haemorrhage took place into the cellular and muscular 
tissues of various portions of the body. There circumscribed haemorrhages formed 
dark purplish tumors, of various sizes, from that of a walnut to an orange. This 
case may be regarded cas a counterpart of the preceding ease No. 923, in which 
jaundice existed from birth. 
In malarial haematuria we have both hepatic and renal congestion 
combined with intense jaundice, and without doubt the haemorrhages 
which sometimes occur from the stomach and bowels in this disease are 
referrable to the congestion and structural alterations of the liver. Haemor- 
rhage from the stomach and bowels occur in many forms of liver disease, 
as in chronic and acute hepatitis, and in the interstitial parenchymatous 
hepatitis resulting from the repeated congestions of this organ induced by 
the action of the malarial poison. In cirrhosis, however induced, either by 
the excessive use of alcoholic stimulants or by the prolonged action of the 
malarial poison, and in all forms of hepatic disease which impede the por- 
tal circulation, we have repeatedly observed haemorrhages, profuse and 
fatal from the bowels, as will be illustrated by the following case No. 925. 
Case No. 925.-Cirrhosis of Liver; Great Distention of Abdomen; Death 
caused by profuse Haemorrhage from Stomach and Bowels. 
Thomas Dillon, age 48; native of Georgia; laborer; entered ward No. 13, bed 
173, Charity Hospital, January 22d, 1886. Patient states that he served through 
the Civil War in the Confederate Army; has used alcoholic stimulants to excess; 
enjoyed good health until one year ago, when abdomen began to swell. Condition 
on entrance: Sallow unhealthy hue; emaciated pinched features; emaciated upper 
extremities and dry harsh skin. Abdomen greatly distended with liquid. Abdo- 
minal veins large, prominent, filled with dark blood. Liquid effusion in abdo- 
men bounded above by the diaphragm, Great oppression of breathing and great 
muscular prostration. Intellect clear. I advised the patient to consent at once to 
tapping and drew out my trochar to perform the operation. He requested me ear- 
nestly to delay the operation for a few days and try the effects of internal remedies. 
In accordance with his request I placed him upon purgatives and diuretics. The 
relief was not perceptible, although the patient expressed himself as feeling better. 
On the 3d day of February, 8 o'clock A. M., the patient was seized with violent 
vomiting and purging of blood. Asi entered the ward I found him vomiting 
blood by the mouth and passing blood by the anus. The bed, and floor around the 
bed, were covered with blood of a dark hue. The pulse was pulseless, with pale 
bloodless lips, shriveled hands, but still conscious. I gathered the students around 
his bed to witness the fatal effects of profuse haemorrhage. A few more mouthfuls 
of blood were vomited, slight spasms convulsed the muscles of the face and 
■extremities, and the patient became pale, the respiration ceased, the eyes became 
glassy and fixed, and death was so gradual and gentle that the watchers supposed 
that he had fallen asleep. Post-mortem examination revealed the stomach dis- 
tended with dark blood; the intestines also contained considerable quantities. 
Liver contracted and cirrhosed. Kidneys healthy. 
In my opinion, if the patient had consented to the operation of tap- 
ping, his life would have been prolonged, but his disease would not thereby 
have been cured. 
Obstruction to the portal circulation also frequently induces the for- 
mation of internal piles, the bleeding from which is often profuse in 
advanced cases of cirrhosis. 
Dr. George Harley states in his valuable work on the diseases of the 
liver, p. 99, that haemorrhage of the bowels is also frequently met with in 
cases where a gall-stone ulcerates its way into the intestines, from its open- 
ing one or more of the intestinal blood vessels. 
In private practice we have observed a number of cases, at various 
seasons of the year in New Orleans, during the past seventeen years, in Cirrhosis of Liver. 
685 
which, cases of malarial fever terminated fatally from haemorrhage from the 
stomach and bowels; also cases in which death resulted from the same 
cause, which were due to alterations of the liver induced by the abuse of 
alcoholic stimulants. I have seen the altered blood ejected from the 
stomachs of patients in the months of December and January, at periods 
when yellow fever was entirely absent from Louisiana, which presented 
identically the same appearance and physical properties with the black 
vomit of yellow fever. 
The late eminent and learned Dr. Charles Faget, once called me iu 
consultation to see a young man, a native of New Orleans, who had had, 
undoubtedly, yellow fever, some years before; but who, at the time of our 
visit, was suffering from paroxysmal fever, and who vomited large quan- 
tities of "black vomitnot dark bilious matter, but dark altered blood. 
Dr. Faget also informed me that all the members of this family were liable 
to throw up black vomit, whenever they were attacked with malarial 
(paludal paroxysmal; fever. 
But the question of greatest moment with us in this investigation, in 
its bearing on the natural history and progress of malarial haematuria, is, 
whether the haemorrhage from the kidneys be due to the solvent action of 
the bile upon the colored blood-corpuscles, within the blood vessel system, 
the haemorrhage from the kidneys being nothing more than the elimination 
by these organs of the altered haematin, or whether it is a true haemorrhage, 
remotely connected with the action of the biliary constituents upon the 
fibrin and colored blood-corpuscles? The solution of this question may be 
sought in an examination of the blood itself in malarial haematuria, as we 
have already seen, and also by the examination of the excretion of the kid- 
neys, which we have shown to be in many cases nothing more nor less than 
blood, with the colored blood-corpuscles in urine. We have also laid great 
stress on this examination, upon the immediate examination of the urine 
after its passage, by the microscope, for not only the water but the salts of 
the urine and especially the constituents of the bile when present, rapidly 
dissolve the colored blood-corpuscles. But the investigation should include 
a consideration of the chemical constitutions of the blood in jaundice. 
Our knowledge of the composition of the blood in jaundice is chiefly 
due to the labors of Becquerel, Rodier, Simon and Andral. Icterus offers 
such marked phenomena that physicians have not been able to ignore 
altogether the opinion of the vulgar, that the bile has passed into the blood. 
Some chemists* as Orfila (Elem. de Chern, t. ii, p. 313) and Clarion (Thesis 
of the Faculty. 1811) assert that the blood of icteric patients always con- 
tains bile; others, as M. Th^nard (Chern., t. v, p. 3,) and Lassaigne (Jour, 
de Chern., t. i, p. 266), on the contrary, affirm that the blood does not con- 
tain bile, but owes its color to the presence of a peculiar coloring matter; 
others, as M. Chevreul (Diet, des Scien. Nat. Art. Saug.,) F. Boudet 
(Thesis of the School of Pharm., 1833), Collard de Martiguy (Jour, de 
Chern. Med.,) and Lecanu (Jour, de Pharm., t. xvii, 1831, and Thesis 
est.) adopting a middle opinion, hold that, without containing bile, the 
blood of the icteric contains its coloring principles. M. Lecanu makes 
mention of an experiment recorded in vol. i, p. 439, of the physiology of 
M. Richerand, iu which M. Thenard, having analyzed the blood of an 
animal, into the veins of which a great quantity of bile had been injected, 
could not discover the presence of this fluid, which seemed to indicate 
either that the means of analysis could not detect the bile in the normal 
blood, or else that bile when, by any cause, introduced into the current of 
the circulation, almost immediately takes on the decomposition suspected 
by Legallois. M. Lecanu, in the blood of two icteric patients analyzed by 686 
Composition of Blood in Jaundice. 
him, found the proportion of globules (including the fibrin) remarkably 
diminished. M. Martin-Solon discovered the coloring principles of the 
bile in the blood of individuals laboring under bilious pleuro-pneumonia. 
(See vol. xii of the Bullet, de Therap). 
Becquerel and Rodier have shown that jaundice, considered simply with 
reference to the composition of the blood, may present itself under two very 
different conditions; in a certain number of cases there is an overflow of 
bile, consequent upon increased secretion, and this occurs simultaneously 
with the jaundice; in others, on the contrary, there is a retention of the 
bile, due to some obstacle situated in the course of the biliary ducts, such 
as calculi, etc., or to some peculiar condition, perhaps spasmodic, which 
.affords no indication of morbid change after death, and which constitutes 
what is termed simple jaundice. In this last case the pale color of the 
fieces indicates suppressed, or at least considerable diminution of the 
biliary secretion. 
In the first class of cases in which a bilious flux co-exists with jaundice, 
the fatty matters of the blood, and more especially those which are found 
in the bile, undergo no modification. MM. Becquerel and Rodier had an 
opportunity of ascertaining the truth of this proposition in two cases. 
In the second category, where there is either a diminution or a sup- 
pression of the biliary secretion with clay-colored fieces, the most important 
constituents of the bile previously existing in the blood are not eliminated 
by the liver, but becoming concentrated in that fluid are there found in 
large quantity. 
1st.-Jaundice with Hypersecretion of Bile and an Escape of that Fluid by 
the Intestines. 
Becquerel and Rodier have given brief notes of two such cases. 
The first relates to a man suffering from congestion of the liver, and 
possibly hepatitis in its early stage, complicated with slight enteritis and 
bilious diarrhoea; there was fever, moreover, and very marked jaundice. 
The blood presented all the characters of the phlegmasim. The fatty mat- 
ters, however, were rather less abundant than usual, their proportion 
being represented by 1.406; the seroline was scarcely 0.005; the choles- 
terine had rather increased, as is generally the case in the acute diseases, 
especially in the phlegmasife, 0.234; the proportion of saponified matter 
was natural. 
The second case is very similar to the last, with the exception of there 
being no inflammatory complication. It is that of a lad, aged nineteen 
years, laboring for some time under bilious diarrhoea, with feverish symp- 
toms, with well marked but recently developed jaundice. An analysis of 
the blood of this patient showed a slight decrease of the globules (136); a 
healthy proportion of albumen (71.4), and fibrin (2.3); a fair amount of 
fatty matters, and a very small quantity of seroline; a great abundance 
of cholesterine (0.798); animal soap (2.032). Becquerel and Rodier ask, 
to what cause are we to attribute the large proportion of cholesterine? 
How and wherefore did it accumulate in the blood in spite of the bilious 
diarrhoea? 
2d.-Jaundice with Diminution or Suppression of the Biliary Secretion, and 
Pale Colored Evacuations. 
In the form of simple jaundice there is not merely an accumulation 
of cholesterin in the blood, but of the other fatty matters likewise. 
Analysis of eight cases of simple jaundice, analysis of 1000 grammes, 
of blood : Composition of Blood in Jaundice. 
687 
Specific gravity of the blood 
Water 
Mean. 
1056.82 
774 90 
Maximum. Minimum. 
1061.05 
1052. 
Globules 
138.37 
154.21 
117.51 
Solid matters of the serum 
81.21 
88.65 
74.63 
Fibrin 
4.45 
7.00 
2.42 
Analysis of 1000 grammes of serum- 
Mean. 
Maximum. 
Minimum. 
Specific gravity of the serum 
1026.70 
1030.05 
1023.86 
Water 
906.46 
Albumen 
76.83 
86.25 
70.15 
Extractive matters and salts 
16.71 
23.11 
11.12 
A detailed analysis of each case affords the following results : 
The Globules.-In two cases the proportion of globules was above 150 
per 1000 ; in three others it varied from 140 to 150 ; and in the last three 
cases from 120 to 140. It follows, therefore, that in simple jaundice the 
globules either remain within the limits of health, or tend to increase, 
since in five cases out of eight they exceeded the physiological standard. 
The Fibrin.-In three cases it oscillated between 5 and 7 ; in three 
between 3 and 5; and in two between 2 and 3. We have here a similar 
change to that which takes place in the case of the globules, viz: that in 
the majority of cases of jaundice without inflammatory complication the 
fibrin invariably tends to increase, and to exceed its physiological limits. 
The Albumen of the Serum.-In two cases the proportions were above 
£0 parts per 1000; in three cases it varied from 75 to 80 ; and in three 
others from 70 to 75; in other words, the quantity of albumen did not 
exceed the standard of health. 
UOMPOSITION OF THE BLOOD IN THE JAUNDICE OF MALARIAL HAEMATURIA. 
The blood in the jaundice of malarial hsematuria presents material 
differences from that of simple jaundice, uncomplicated by the preceding 
or concurrent action of a specific micro-organism or morbific ferment. 
Thus the blood in the jaundice of malarial haematuria presents the follow- 
ing characteristics: 
(a.) Great diminution of the colored blood-corpuscles. In uncom- 
plicated jaundice the colored blood-corpuscles are either increased or remain 
within the physiological limits. 
(b.) The marked diminution of the colored blood-corpuscles in mala- 
rial haematuria is not due to suppression of the function of the liver and 
the retention in the blood of the constituents of the bile, but to the direct 
destructive action of the morbific ferment or micro-organism of malaria on 
the colored blood-corpuscles. 
(c.) In common with the blood of simple jaundice the blood of mala- 
rial haematuria manifests an increment of the coloring matters and other 
constituents of the bile, and also an increment of the fibrin. 
(d.) In uncomplicated jaundice (jaundice uncomplicated by the 
action of any febrile poison; the increment of the fibrin is due to conges- 
tion of the liver and hepatitis. 
(e.) In malarial haematuria the increment of the fibrin is due to con- 
gestion of the liver with hepatitis, and in addition to these conditions, that 
of renal congestion and renal irritation and inflammation. 
(f.) Haemorrhage from the kidneys rarely occurs in uncomplicated 
jaundice. 
Haemorrhage from the kidneys is by no means rare in the jaundice of the 
severe forms of malarial fever. We conclude, therefore, that the renal hcemor- 688 
Classification of the Causes of Jaundice. 
rhages which characterize certain severe forms of malarial fever are not the result 
of the action of the biliary constituents retained in the blood, upon the colored 
blood-corpuscles, but are due rather to hepatic and renal congestions, the 
irritant action of the malarial poison and its products and of the constituents 
of the bile in the blood upon the capillaries and excretory structures of the 
kidneys. In many cases of malarial haematuria, we have not merely 
jaundice, but a profuse discharge of biliary matters from the stomach and 
bowels. To use a common expression, "the entire system appears to be 
surcharged with bile." The haemorrhages from the kidneys in malarial 
haematuria are therefore due neither to the direct action of the biliary con- 
stituents upon the colored blood-corpuscles, nor to a diminution of the 
fibrinous constituents of the blood. 
All cases of jaundice have been referred by systematic writers to two 
classes : 
I. Cases in which there is a mechanical impediment to the flow of bile 
into the duodenum, and when the bile is in consequence retained in the 
biliary passages, and thence absorbed into the blood. 
II. Cases in which there is no impediment to the escape of bile from 
the liver. 
Dr. Charles Murchison has given the following comprehensive classifi- 
cation of jaundice: 
CLASSIFICATION OF THE CAUSES OF JAUNDICE. 
TABULAR VIEW OF THE CAUSES OF JAUNDICE. 
A. JAUNDICE FROM MECHANICAL OBSTRUCTION OF THE BILE DUCT. 
1. Obstruction by Foreign Bodies within the Duct. 
1. Gall-stones and inspissated bile. 
2. Hydatids and distomata. 
3. Foreign bodies from the intestines. 
II. Obstruction by Inflammatory Tumefaction of the Duodenum, or of the 
Lining Membrane of the Duct with Exudation into its Interior. 
III. Obstruction by Stricture or Obliteration of the Duct. 
1. Congenital deficiency of the duct. 
2. Stricture from perihepatitis. 
3. Closure of orifice of duct in consequence of an ulcer in the duo- 
denum. 
4. Stricture from cicatrization of ulcers in the bile ducts. 
5. Spasmodic stricture. 
IV. Obstruction by Tumors closing the Orifice of the Duct, or growing in 
its Interior. 
1. Tumors projecting from the liver itself. 
2. Enlarged glands in the fissure of the liver. 
3. Tumor of the stomach. 
4. Tumor of the pancreas. 
5. Tumor of the kidneys. 
6. Postperitoneal or omental tumor. 
7. An abdominal aneurism. 
8. Accumulation of faeces in bowels. 
9. A pregnant uterus. 
10. Ovarian and uterine tumors. 
K Obstruction by Pressure on the Duct from without by- Classification of the Causes of Jaundice. 
689 
B. JAUNDICE INDEPENDENT OF MECHANICAL OBSTRUCTION OF THE 
BILE DUCT. 
I. Poisons in the Blood Interfering with the Normal Metamorphosis of Bile. 
1. The Poisons of the Various Specific Fevers. 
(a.) Yellow fever. 
(b.) Remittent and intermittent fevers. 
(c.j Relapsing fever. 
(d.) Typhus. 
(e.) Enteric or pythogenic fever. 
(f.) Scarlatina. 
(g.) Epidemic jaundice. 
2. Animal Poisons. 
(a.) Pyiemia. 
(b.) Snake poison. 
3. Mineral Poisons. 
(a.) Phosphorus. 
(b.) Mercury. 
(c.) Copper. 
(d.) Antimony, etc. 
4- Chloroform and Ether. 
5. Acute Atrophy of the Liver. 
II. Impaired or Deranged Innervation Interfering with the Normal Metamor- 
phosis of Bile. 
1. Severe mental emotions, fright, anxiety, etc. 
2. Concussion of the brain. 
III. Deficient Oxygenation of the Blood Interfering with the Normal Meta- 
morphosis of Bile. 
IV. Excessive Secretion of Bile, more of which is Absorbed than can undergo 
the Normal Metamorphosis. 
Congestion of the liver. 
(a.) Mechanical. 
(b.) Active. 
(c.) Passive. 
V. Undue Absorption of Bile into the Blood from Habitual or Protracted 
Constipation. * 
It is evident that the jaundice of malarial hsematuria should be referred 
to several divisions, namely, jaundice independent of obstruction of the bile 
duct, and to the first subdivision, poisons in the blood interfering with the 
normal metamorphosis of the bile, and probably also to the fourth sub- 
division, excessive secretion of bile, more of which is absorbed than can 
undergo the normal metamorphosis. It is well known that jaundice fre- 
quently occurs in the various specific fevers, and under the action of vari- 
ous animal poisons, as those of certain reptiles and the products of gan- 
grenous and unhealthy wounds; and whilst in such cases it is probable that 
the mechanism of the jaundice is not always precisely the same, in the 
more serious cases, the disturbance of the nervous system as well as the 
* Clinical Lectures on Diseases of the Liver, Jaundice and Abdominal Dropsy. By Charles 
Murchison. M. D., F. R. S., etc., New York, 1868, pp.^316-317. 690 
Effects of Bile in the Blood. 
passive haemorrhages and the alterations in the amount and chemical con- 
stitution of the urine, the jaundice appears to be only the visible sign 
of the changes of the blood and the imperfect elimination of the normal 
products of metamorphosis in the blood and tissues. 
Both in yellow fever and in certain forms of malarial fever, and espe- 
cially in malarial haematuria, the jaundice is accompanied, and is often 
preceded by profound lesions of the kidneys, attended with congestion of 
these organs, desquamation of the excretory cells and casts of the tubuli 
uriniferi. In some cases of malarial fever, and probably in every grave 
case of yellow fever and malarial haematuria, there is considerable enlarge- 
ment and congestion of the liver, and this congestion may be one cause of 
the jaundice. The cerebral symptoms in the jaundice of acute atrophy of 
the liver, and in yellow fever and malarial haematuria, certainly resemble 
those produced by many known blood poisons, but the poison is more 
probably generated in the blood and throughout the body generally than 
in the liver in particular, and when the function of the kidneys is impaired 
the constituents of the urine retained in the blood, are important factors in 
the production of the disturbances in the cerebro spinal and sympathetic 
nervous system. 
Whilst the general proposition has been accepted by pathologists that 
the liver is not merely an excretory organ, but exercises an important 
influence on the matamorphosis of matter constantly taking place in the 
blood and tissues, the precise nature of the changes which it effects is but 
little known and demands further investigation. The sudden arrest of the 
functions of the liver as in acute atrophy, checks or modifies the metamor- 
phosis of the blood and tissues ; urea is not elaborated, but such substan- 
ces as leucine and tyrosine of a intermediate composition between urea and 
the albuminoid compounds are developed, and the materials which ought 
to be eliminated from the body, as urea and uric acid, accumulate in the 
blood. Sir Charles Murchison* has endeavored to show that the pathology of 
the cerebral symptoms in jaundice is probably identical with the pathology 
of the typhoid state in all diseases. 
Thus the cerebral symptoms of the typhoid state constitute one of the 
most frequent and striking peculiarities of acute atrophy of the liver. As 
a rule they appear simultaneously with the jaundice, but occasionally not 
for two or three weeks subsequently. At first there is headache, with 
despondency, irritability and great restlessness; and this condition is suc- 
ceeded by low muttering delirium, tremors, subsultus, muscular rigidity, 
and carphology, retention or incontinence of urine, involuntary passage 
of feces, stupor, coma and convulsions. These symptoms are independent 
of any lesion of the brain or of its membrane; but like the analogous 
symptoms in typhus fever and in the typhoid state generally, they result from 
the circulation through the brain of blood poisoned by the accumulation in 
it of urea and other products of metamorphosis which ought to be elim- 
inated by the kidneys. The disease is not accompanied by much febrile 
excitement. The pulse varies. In cases ushered in with gastroenteric 
catarrh, the pulse is usually accelerated at first, but falls to the normal 
standard or below this, on the appearance of jaundice, but again rises on 
the supervention of cerebral symptoms. The urine undergoes important 
changes; its quantity is not materially altered; it is of acid reaction, and 
its specific gravity varies from 1012 to 1024; its color is usually dark, but 
the ordinary reaction of bile pigment may be faint or indistinct. It often 
* Abstract of a Clinical Lecture on the Pathology and Treatment of the Typhoid state in 
different Diseases. Brit. Med. Jou. July 4, 1868. 
Diseases of the Liver, 1865, p. 299, p. 577. Condition of the Blood in Malarial and Yellow Fever. 
691 
contains a small quantity of albumen or even blood; but after the removal 
of the urinary pigment, it yields no reaction of bile acids to Pettenkofer's 
test. The most remarkable alterations, however, consist in the great 
diminution or even total disappearance of the urea and uric acid, and also 
of the chlorides, sulphates and earthy phosphates, and the substitution of 
two new substances of a peculiar nature, leucine and tyrosine, which are 
regarded as products of the metamorphosis of matter intermediate between 
albumen and fibrin, at one extreme, and the less complex bodies, urea, uric 
acid, kreatine, etc., at the other. Leucine and tyrosine are found in the tis- 
sues of the liver, spleen and kidneys, and they are usually also secreted in 
large quantity in the urine, from which they separate as a distinct deposit 
on standing, or they may be obtained by evaporating a few drops of the 
urine in a glass slide. Haemorrhages are very common, and particularly 
haemorrhage from the stomach or bowels. Blood is often vomited in large 
quantity. Petechiae and vibices may appear on the skin, or in rarer 
cases there is uterine haemorrhage or epistaxis. Pregnant females, who 
constitute a large proportion of the cases, almost invariably abort or mis- 
carry before dying. Such facts as these, which have been established by 
the labors of Frerichs, Murchison and other observers are of the highest 
importance in their connection with the jaundice, cerebral symptoms and 
haemorrhages of yellow fever and malarial haematuria; and establish the 
important conclusion that many of these symptoms in the two latter dis- 
eases may have a common origin in the liver and blood with those of the 
former. 
I have repeatedly demonstrated that in specific yellow fever, the yel- 
low suffusion of the skin and conjunctiva is occasioned by the presence of 
bile in the liquor sanguinis, from whence it transudes into the various 
organs and tissues. In many cases also I have demonstrated the presence 
of the constituents of the bile, not merely in the urine, but also in the tex- 
tures of the brain. Post-mortem examinations have shown that in the 
early stages of this disease, the liver is congested with blood, and if we 
might judge from the bilious vomitings which occur in some cases during 
the early stages, the secretion of the bile is increased. The fact however 
that in fatal cases the gall-bladder is as a general rule found collapsed and 
devoid of bile, and an entire absence of bile from the black vomit of the 
stomach and from the contents of the intestinal canal throughout its whole 
length; the assertion therefore, by Murchison and others, that in the 
yellow fever of the tropics, the jaundice is independent of any impediment 
to the escape of bile from the liver, cannot be wholly sustained by the 
results of clinical and post-mortem examinations. Aside from the fact that 
in the early stage of the disease, there may be considerable enlargement 
and congestion of the liver, tending to cause jaundice, and in some rare cases 
of this disease, the duodenal orifice of the biliary duct may be plugged 
by catarrhal inflammation; careful microscopical and chemical examina- 
tions reveal the fact that as the disease progresses profound alterations 
take place in the liver, and these alterations are chiefly marked by a change 
in the color and appearance of the organ, which assumes a paler and more 
bloodless color than in malarial fevers, and than in good health, and by a 
marked increase of oil within and around the liver cells, as in phospho- 
rous poisoning and acute atrophy of the liver. We have in the acute and 
fatty degeneration of the liver in yellow fever, and the deposit of granular 
albuminoid matters, as well as oil, in the texture of the heart and kidneys, 
as well as in those of the liver, proof of the profound alteration of the con- 
stitution and metamorphosis of the blood. In severe cases of yellow fever, 
the urine is albuminous and contains tube casts, and is frequently sup- 692 
Condition of the Blood in Malarial and Yellow Fever. 
pressed, and in some cases I have found leucine and tyrosine in this excre- 
tion. The del ciency of urea in the urine of vellow fever, I have shown 
not to be due to the failure of the formation of the constituents in the blood 
and tissues, but to those peculiar structural alterations of the kidneys, 
characterized by desquamation of the excretory cells, and the plugging up 
of the uriniferous tubes by detached cells and granular albuminoid matter 
and oil globules. The formation of urea is as great in yellow fever as in 
any other febrile disease; and appears to be far greater than in the various 
forms of malarial fever; but when the function of the kidney is arrested by 
structural alterations the urea accumulates in the blood, and is also elimi- 
nated by the gastro-intestinal membrane; in some cases carbonate of ammo- 
nium as well as urea accumulates in the blood, and carbonate of ammonium 
in the expired air, and carbonate of ammonium in the black vomit. The 
sweat also has a penetrating urinous odor. The liver which in the early sta- 
ges is enlarged from hypenemia, becomes pale, and assumes a distinct yel- 
low color, and the secreting cells are loaded with oil. The kidneys in the 
early stage are found to be large and congested, but as the disease progres- 
ses the cortex becomes hypertrofied and the secretory tubes gorged with 
granular epithelium. 
In yellow fever it is probable that in fatal cases, attended with jaun- 
dice, there is not merely a reabsorption of the bile from the biliary ducts 
and especially from the interlobular network, but it is also probable that 
the excretory and secretory function of this organ is much impaired. 
There is every probability that the constituents of the bile exist in a con- 
dition not very dissimilar to that in which they are found in the products 
secreted from it. Thus cholesterine exists in the cerebral textures as well 
as in the blood, and it is occasionally deposited in various parts of the 
body, especially in the fluids of local dropsies as a result of diseased action. 
The coloring matter appears to be derived directly or indirectly, from the 
hsematine of the blood. It would seem probable that biliary matter does 
not exist as such in the blood, previously to the formation of the secretion; 
but that its elements, derived from the disintegration of the tissues, are 
present in the circulating fluid under some more pernicious form, and are 
transformed by the agency of the liver, in order that they may be reab- 
sorbed in a less noxious condition, to be finally eliminated by the respira- 
tory process. It is certain that the effects of the reabsorption of bile into 
the blood, as seen in ordinary cases of jaundice, dependent upon obstruc- 
tion of the biliary ducts, are not nearly so injurious as are those of the 
retention of the elements of the secretion, consequent upon deficiency of the 
secreting power of the liver, as in acute atrophy of this organ, in acute 
phosphorous poisoning, and in specific yellow fever; for whilst in the latter 
diseases, death speedily supervenes, if no other outlet be found for the 
excrementitious matters; no severe injury necessarily arises from the accu- 
mulation of biliary matter in the former, to even such an extent that the 
tissues in general are tinged by it. And it appears to be established that 
the reabsorption of certain constituents of the bile into the circulating cur- 
rent, is the means by which they are finally carried out of the system. 
From what has been stated, it seems but fair to conclude that the jaundice 
of yellow fever is only one of the results of that impairment or derange- 
ment of the metamorphosis taking place in the blood and tissues, of the 
existence of which there is such striking and abundant proof in the liver, 
kidneys and heart. 
I have observed the occurrence of jaundice in all the various forms of 
the malarious, remittent, intermittent and pernicious or congestive fevers 
of the Southern States, and have myself suffered, in three distinct attacks Jaundice in Various Fevers. 
693 
•of severe malarial fevers, in the autumns of 1860,1869 and 1877. In the last 
attack the jaundice was preceded by congestion of the left lung, liver and 
kidney and intense fever; and was accompanied with incessant vomiting 
of acrid, bilious matter, during six days, and with blood, urinary casts and 
albumen and bile in the urine. I attributed the most distressing of the 
symptoms to urinary suppression, which continued during thirty-six hours 
and commenced at the height of the fever. Intense pain in the back and 
abdominal viscera, accompanied this suppression. The entire cerebro- 
spinal nervous system was in a state of agitation, and owing to the tremb- 
ling of the muscles, I could, with difficulty, lift a cup of cold water to my 
lips. Such was the violent irritation of the stomach, that medicines were 
rejected immediately and appeared to be inert if administered by the 
stomach, and I contented myself with cracked ice in the mouth and iced 
milk as nourishment. A strong ammoniacal taste remained in my mouth 
for eight days after the commencement of the attack. 
In some cases of congestive fever, I have observed the jaundice to 
appear a few hours before death. The occurrence of jaundice in malarial, 
remittent and intermittent fevers, has been observed in all countries sub- 
ject to these diseases, as the West Indies, tropical, sub-tropical and tem- 
perate America, Africa, India, Algeria and China. The occurrence of 
jaundice in these fevers, has been as seen, repeatedly noted in those coun- 
tries, as India and Algeria, where true yellow fever is believed to be 
unknown. Sir Charles Murchison* met with it thirty-three years ago in the 
malarious fevers of Burmah; Morehead,f in India, observed jaundice in 
twenty-eight out of one hundred and fourteen cases of remittent fever, and 
Bonding records the fact that in Algeria, jaundice has been sometimes 
noted in as many as seven-tenths of the cases of intermittent fever. 
The jaundice of the various forms of malarial fever may arise from 
different causes, in some cases being associated with congestive enlargement 
of the liver, or with gastro-duodenal catarrh, more or less obstructing the 
flow of bile and causing deficiency of bile in the motions; in both these 
eases the general symptoms are often mild; but in other cases which are 
usually fatal, jaundice is found associated with a dry, brown tongue, drow- 
siness, delirium, tremors, subsultus and other symptoms of the typhoid 
state, with petechia* and haemorrhages from the stomach and bowels, and 
with albumen and bloody urine, which, as in malarial hematuria, is some- 
times completely suppressed.§ Dr. Murchison, in 1853, found no albumen 
in the urine of persons suffering from remitting fever in Burmah. His 
observations, which, for the most part, were made early in the disease, 
before the supervention of typhoid symptoms, have been quoted as estab- 
lishing a distinction between malarious intermttent and true malarious 
remittent and true yellow fever. Murchison suggests that the comparative 
frequency of albuminuria in yellow fever is probably due to the fact that 
the typhoid state is much more common in this disease than in malarious 
remittents; and affirms that when the typhoid state is developed in remit- 
tent fever, it would indeed be extraordinary, if it differed from the typhoid 
state of all other diseases in the absence of albuminuria. My investiga- 
tions on the symptoms, pathology and treatment of yellow and malarial 
fevers were commenced in 1856, and established the fact that albumen and 
blood are, as an almost universal rale, absent from the urine in the various 
forms of malarious disease, with the exception of malarial haematuria, in 
* Diseases of the Liver, p. 379. Notes on the climate and diseases of Burmah, Ed. Med. and 
SurglcalMournal, April, 1855, p. 229. 
t Clinical Researches on Disease in India, 2d Ed., 1860, p. 73. 
i Bondin, Traite des FiOvres Intermits., Paris, 1842. 
J Frerichs, Op. Cit., vol. 1, p. 180. 694 
Causes of Death in Malarial Hcematuria. 
which there occurs actual rupture of the malpighian corpuscles; on the 
other hand, in yellow fever albumen and casts of the urinary tubes are 
almost invariably present in the grave cases. This difference is clearly due 
not to the establishment of what Murchison calls the typhoid state, but to 
the peculiar lesions of malarious fever and yellow fever. In the former 
there is no structural alteration of the kidneys, except in malarial hsema- 
turia, in which actual rupture of the blood-vessels and a true haemorrhage 
occurs; but in yellow fever there is, as in certain cases of scarlet fever, an 
active disintegration of the excretory cells of the tubuli uriniferi, and an 
exudation of albumen, with structural alteration of the organs and a great 
increase of oil. 
CAUSES OF DEATH IN MALARIAL HaEMATURIA. 
From the preceding observations and investigations thecauses of death 
from malarial haematuria may be thus classified : 
1st. The direct action of the malarial poison upon the colored blood- 
corpuscles, inducing secondary derangement of nutrition, innervation, cir- 
culation and respiration. 
2d. Action of the malarial poison and its products upon the cerebro- 
spinal and sympathetic nervous system, and upon the heart. 
3d. Congestion of the internal organs, and more especially of the 
liver, kidneys and gastro-intestinal mucous membrane. 
4th. The poisonous effects of the products of the action of the mala- 
rial poison, and also of the constituents of the bile retained in the blood. 
In profound jaundice induced by the excessive use of alcoholic stimulants 
occurring in hot weather and attended by high fever, 1 have seen death 
preceded and apparently directly caused by convulsions, which appeared 
to be induced by the action of the biliary constituents in the blood upon 
the cerebro-spinal nervous system. The cases of jaundice to which I have 
alluded as occurring in my private practice had no blood or albumen in 
the urine, and manifested a free flow of urine highly charged with the 
constituents of the bile. 
5th. Haemorrhage from the kidneys, inducing: 
(a.) Obstruction of the excretory structure, suppression of the urin- 
ary excretion, convulsions and death; or- 
(b.) Fatal exhaustion from the prolonged continuance of the haemor- 
rhage and the great and fatal loss of blood resulting therefrom. As I 
write (September 14th, 1886,) the following interesting case illustrating 
this important practical point in the history of malarial fever has just 
come to hand from Dr. Deslattes, of St. James parish, of Louisiana : 
St. James, Sept. 9th, 1886. 
To Prof. Joseph Jones, New Orleans, La.: 
My Dear Doctor.-I am thankful indeed for your favorable opinion on my 
meagre remarks and observations on malarial hsematuria. The whole article is 
really too poor to be putin print. It would need too much pruning to be put in 
shape for the public. If, however, you should think that any special fact or my 
method of administering quinia may be of special service, I shall be flattered and 
honored to have you to give it a small space in such a valuable and beautiful mon- 
ument of thought and learning as your work will be. Enclosed you will please 
find the clinical history of another case, which was very interesting to me. I am 
your most obedient servant and pupil, J. L. DESLATTES. 
Case No. 926-Malarial Haematuria-Death Caused by Haemorrhage.-On the 
24th of last month I was called to see Mrs. J. R.. aged 59. I reached her house at 
about sunset. Mrs. J. R. had a chill at 3 P. M., followed by fever, with pain in the 
back and limbs, vomiting of biliary liquid, uneasy sensation at the epigastrium Causes of Death in Malarial Hcematuria. 
695 
and urination of dark colored urine. This fever had been preceded by two other 
paroxysms of a simple quotidian intermittent fever. These had occurred, although 
she had been taking for several days previously ten grains of quinia night and 
morning. On the day on which the hsematuria took place (August 24th) she had 
taken, besides the ten grains of the morning, eight more grains two or three hours 
later. Mrs. J. R. had been an invalid for over ten years. For the three years she 
had been my client she had suffered from fevers every summer. Quinine, bark, 
arsenic, iron and bitter tonics had been used in treating her case. 
August 24th, Evening.-Temperature 1O4.°5; nausea and vomiting of biliary 
liquid; pain in the back and limbs, uneasy sensation of weight, and tenderness on 
pressure over the region of tiie stomach; urine dark colored; ordered fifteen grains 
of calomel in two powders; one immediately, the other two hours after. 
August 25th, Morning.-Temperature 102.°2; spent a bad night; no sleep; nausea 
and vomiting of yellow, yellowish-green and green liquid; jaundice general; had 
urinated several times during the night. The urine was of a dark red color. On test- 
ing it with heat and nitric acid it was found to contain a large quantity of albu- 
men; reaction acid; specific gravity 1039. Ordered small pellets of ice occasion- 
ally, mustard to the pit of the stomach, and gave hypodermically twenty-four 
grains of bisulphate of quinia in three doses; the first at 9 A. M., the second at 11 
A. M. and the third at 1 P. M. At 1 P. M-The fever was abating (100°); the 
nausea and vomiting continued; the purgation had begun after the morning visit; 
the urine passed was of a dark red color. Evening Visit.-Temperature 98°; the 
vomiting was unrelieved; the urine last passed was red, but more liquid, and 
looked very much like blood diluted with water; four or five stools during the day. 
Ordered iced milk and lime water in small quantities, frequently repeated; mus- 
tard applied occasionally to the pit of the stomach; pellets of ice ad libitum, and 
ten grains of calomel to be given in one dose. 
August 26th, Morning.-Patient spent a bad night, although there was no fever. 
The milk and limewater was thrown up. The vomiting of bile and muco-serous 
liquid had been so continuous that the patient had not been able to sleep. The 
urine, however, was no longer dark nor red, but of a turbid yellow appearance. 
It still contained albumen, but in much lesser quantity. Twenty-four grains of 
bisulphate of quinia were given hypodermically as on the preceding day. Iced 
champagne in small quantities. Evening Visit.-The fever began at 3 P. M., but 
was not high (101.°5), nor was it preceded by a chill. The urine was getting clear. 
The vomiting continued and interfered with all rest. Several stools were passed 
during the day. Ordered creosote gtti; sulphate of morphine gr. J; bicarbonate of 
soda, grs. iii; peppermint water ^i; to be repeated every second hour. (Vide R. 
H. Day's article on Malarial Hsematuria, in the July number of the N. O. Med. 
and Surg. Journal. 
August 27th.-The fever went down completely at about midnight. The vom- 
iting remained unchecked; no sleep. The patient had not probably retained any 
of her medicine. The urine, however, was clear, of natural color and contained 
no albumen. The jaundice was disappearing. The patient complained of weak- 
ness and pain in her stomach. The creosote and morphia were continued. A 
small blister was applied to the epigastrium; iced champagne in small quantities, 
and the bisulphate of quinia as before. Evening Visit.-No fever at all during the 
day. Temperature 98.°4. The vomiting was as bad as in the morning; weakness; 
jaundice disappearing; the urine is perfectly clear and natural; ordered efferves- 
cent drinks (Potion de Riviere); ice in small pieces ad libitum. 
August No fever (98.°2). No sleep at all during the night; the urine 
natural; the stomach retained nothing; jaundice disappearing; flatulence; stomach 
tender on pressure; ordered small doses of calomel placed dry on the tongue every 
half hour. My hypodermic syringe having got out of order, I gave forty grains 
of bisulphate of quinia per rectum in three doses. Evening-No fever; vomiting 
stopped; patient very weak. Ordered iced toddies in teaspoonful doses every half 
hour. Patient to be let alone if sleeping. 
August 29th. Morning.-Patient slept a little; no vomiting; no fever; urine 
normal; weakness very great. The iced toddies were continued, and milk and 
lime water were given in small quantities. At 12 M.-No vomiting, no fever. 
Patient not rallying, however. The iced toddies and milk were continued. 
Evening Visit-\ atient evidently losing ground. 
August 30th.-Death last night at 11 P. M 
Remarks.-The direct cause of death could not have been either the urinary 
trouble or the fever, but more probably the exhaustion from the continued vomit- 
ing and want of sleep and food. It is a common belief here that nearly all the 
cases of malarial hsematuria occurring in persons over fifty terminate fatally. 696 
General Conclusions as to Malarial Hcematuria. 
It is evident from the preceding case (No. 924), that death may result 
in this disease from the continuous loss of large quantities of blood from 
the kidneys. In such cases the fatal issue may be preceded by convulsions 
even when there has been no suppression of the urine, and no uremic 
poisoning. Such convulsions are caused in the same manner as those 
resulting from traumatic haemorrhages, and are due to aberrated, nervous 
and muscular actions consequent upon the withdrawal of the necessary sup- 
plies of blood from the capillaries of the cerebro-spinal, sympathetic and 
muscular systems. 
GENERAL CONCLUSIONS WITH REFERENCE TO THE NATURE OF MALARIAL 
H2EMATURIA. 
By direct microscopical and chemical examinations of the blood 
abstracted from patients during the different stages of the various forms of 
malarial fever, I have arrived at the following conclusions : 
1st. In all the various forms of malarial fever, the colored corpuscles 
are destroyed; and such destruction and diminution of the colored blood 
globules takes place irrespective of the existence or absence of jaundice or 
other discoloration of the skin, and irrespective of the characters of the 
urine, whether containing bile or blood or albumen, or none of these 
constituents. 
2d. The destruction of the colored blood globules takes place chiefly 
in the liver, spleen and medulla of the bones. The destruction of the col- 
ored blood-corpuscles is usual in all the forms of true malarial fever, and 
is the grand characteristic of this disease in all countries, at all times and 
under all circumstances. We have demonstrated by careful chemical 
analysis and microscopical investigation that the destruction of the colored 
blood-corpuscles takes place within the living blood-vessels in virtue of 
the action of the malarial ferment or micro-organisms. This action of the 
morbific ferment upon the colored blood corpuscles is characteristic of 
malarial haematuria, as well as of all the various forms of malarial fever, 
and the presence ofjaundiceand haematuria are not specific, and do not form 
a basis of classification of the various forms of malarial fever into distinct 
species. 
3d. Black pigment particles, and colorless or white corpuscles, loaded 
with these pigment particles are frequently observed in all the forms of 
malarial fever, floating in the blood. These pigment particles are, as is 
well known, frequently deposited in the capillaries of various organs. The 
formation of this pigment results chiefly from the blood effused into 
the splenic tissue, and is not the result in any sense of the action of the 
organic nervous system directly, upon the blood-corpuscles in the circula- 
tory system. 
4th. In malarial haematuria, as well as all the various forms of mala- 
rial fever attended with jaundice, the yellow color of the skin is due to the 
golden color of the serum, and such golden color has been produced by the 
coloring matter of the bile. When the pigmentary particles exist to any 
extent in the capillaries of the skin, the yellow color may incline to a 
deeper or more bronzed hue. 
5th. In no case, either during life or during the post-mortem 
examinations, have I ever witnessed a single instance of the decomposition 
of the blood in the vessels, the liberation of the haematin and its transuda- 
tion into the surrounding tissues. 
6th. In malarial haematuria we have a true haemorrhage from the 
renal organs, preceded by congestion and attended with rupture of the 
malpighian capillaries, and the escape of true unaltered blood. General Conclusions as to Malarial Hcematuria. 
697 
7th. Whatever alterations are observed in the blood effused from the 
kidneys into the bladder, are due to several causes, as- 
(a.) Action of urinary constituents, both fresh and stale, (e.g. car- 
bonates of ammonium) upon the colored blood-corpuscles, causing dissolu- 
tion of their envelopes and escape of hrematin. 
(b.) Solvent action of the bile often excreted in large quantities along 
with the urine, upon the colored blood-corpuscles. 
(c.) Escape of the coloring matters of the blood from the clots in the 
tubuli uriniferi, dissolved outby the urine. 
We cannot refer the phenomena of malarial fuematuria to mere dis- 
turbances of the nervous system. In reply to those who urge the nervous 
theory of its origin and causation, we would say that it is certainly 
remarkable that a condition dependent upon no structural lesion, but 
simply upon perversion of nervous supply in the kidney, should be incapa- 
ble of treatment and almost universally fatal. The truth is, that in fatal 
cases of malarial hsematuria, preceded by urinary suppression, the kidneys 
present profound structural alterations, such alterations consisting in rup- 
ture of the malpighian capillaries, desquamation of the excretory cells of 
the tubuli uriniferi, and obliteration of the interior cavities of the excre- 
tory tubes of the kidneys by coagulated blood. CHAPTER V. 
CIRCULATION, RESPIRATION, TEMPERATURE, STATE OF THE SKIN. TONGUE, AND 
CHANGES OF THE URINE IN INTERMITTENT, REMITTENT AND CONGESTIVE 
FEVER. PRINCIPLES OF TREATMENT BASED UPON THESE OBSERVATIONS. 
Fever-its phenomena. History of investigations in animal temperature. Investigations of 
the author relative to animal temperature and the changes of the body heat in diseases. Deter- 
mination of the variations of the human temperature at stated intervals in health and disease, 
and in the various stages of different diseases. Determination of the variations of the pulse and 
respiration in health and disease. Physical and chemical changes of the urine in the various 
stages of disease. General results of the labors of the author, published in the Southern Medical 
and Surgical Journal, in 1858, and in the Transactions of the American Medical Association, 1859. 
Importance of these results in the investigation and differential diagnosis of malarial and con- 
tinued fevers, during the Civil War, 1*61-1865, and in the differential diagnosis of yellow and 
malarial fevers, during the term of service of the author as President of the Board of Health of 
the State of Louisiana, 1880-1883. Circulation, respiration, temperature, state of the skin, tongue, 
and changes of the urine in intermittent, remittent and congestive fever. Principles of treat- 
ment based upon these observations. Reports of cases of malarial fever by the author, 1857-1886, 
Effects of the Civil War upon the labors of the author. 
Intermittent Fever: Duringthe cold stage (chill), there is a rapid, feeble pulse, full, rapid 
respiration, and a hot trunk and cold extremities. The chemical changes and elevation of tem- 
perature due to the action of the morbific ferment of malarial fever, precede the cold stage. 
Analysis of the phenomena of the various stages of intermittent fever. During the cold stage the 
temperature of the extremities is reduced far below that of the trunk, even below the standard of 
health, whilst that of the trunk may rise to 107° F. Cases illustrating the conditions of the pulse 
and respiration, and the changes of temperature in intermittent fever. The higher the tempera- 
ture of the trunk i n the cold and hot stages in intermittent, fever, the milder will be the subse- 
quent attacks and the elimination of the malarial poison will be more rapid and complete. Illus- 
trative cases. Comparison of the thermic phenomenaof yellow and malarial fevers. Appearance 
of the tongue in intermittent fever. Characters of the urine in intermittent fever. Illustrative 
cases. 
Remittent Fever.-The phenomena of the cold stage of remittent fever are similar to those 
of intermittent fever. In remittent as well as intermttent fever, the increase of the action of 
the pulse and respiration is attended by elevation of temperature, which corresponds with the 
increased actions of the circulatory and respiratory systems. The elevation of temperature is 
more persistent in remittent than intermittent fever. Condition of the tongue and secretions 
of the mouth in remittent fever. The coma delirium and nervous disturbances in remittent 
fever not indicative of inflammation of the brain. The changes of the urine are the same in 
kind, but different in degree from those of intermittent fever. Cases illustrating the changes 
of pulse, respiration and temperature and of the urine in remittent fever. Cases illustrating 
the treatment of and pathological anatomy of remittent fever. 
Congestive Fever.-Pernicious malarial fever. Malignant mala, ial fever. Profound impres- 
sions of the malarial poison on the blood, and upon the capillary and general circulations, on 
the ganglia of the heart, and on the ganglionic cells of the sympathetic and cerebro-spinal 
nervous systems in congestive fever. Conditions of the tongue, skin, pulse, respiration and 
bodily temperature in pernicious malarial fever. Changes of the urine in congestive malarial 
fever. Illustrative cases. Changes of the urine, pulse and respiration in malarial hiematuria. 
Comparison of the phenomena of malarial hsematuria with those of yellow fever. Tabular view 
of the pulse, respiration, temperature and urine in intermittent, remittent, congestive and 
hsematurial malarial fever. 
FEVER. 
As heat is the most universal and powerful of all physical agents in 
the economy of nature, we have in the changes of the bodily temperature 
in disease an illustration, that not merely physical and chemical pheno- 
mena are subject to the action of definite laws, but also that both physiolo- 
gical and pathological states are controlled by laws similar to those which 
regulate the visible universe. The most important phenomena of fever 
are : 1st. Elevation of bodily temperature. 2d. Nervous disturbances. 
3d. Acceleration in the action of the heart, and increment in the rate of 
the general and capillary circulation. 4th. Acceleration of respiration. Investigations of Joseph Jones, M. D., on Malarial fever. 
699 
5th. Increased chemical change. 6th. Disturbance of nutrition, secretion 
and excretion. 
The elevation of the bodily temperature is the most prominent symp- 
tom of the process of fever, which has been defined to be "an acute derange- 
ment of all the functions." Changes of temperature in the human body 
have in all ages been regarded as worthy of careful observation by the- 
physician, as affording at once data for the diagnosis and treatment of dis- 
ease. In a future portion of these Medical and Surgical Memoirs we will 
discuss the subject of animal heat, its source, variations and relations to 
the phenomena of muscular and nervous force, nutrition and secretion, and 
to the various essential acts of health and disease. And whilst deferring 
to this discussion, the analysis of the labors of philosophers and physi- 
cians with reference to the subject of animal temperature, and the varia- 
tions of bodily heat of man under the various conditions of climate, alti- 
tude, diet, rest and exercise, and of health and disease, we will briefly 
remark that it was not until about 1840, or a little before the middle of the 
nineteenth century, that the temperature of the body in health and dis- 
ease was viewed with any great interest by the medical profession. The 
year 1840, is justly regarded as the date of the commencement of the most 
important and continuous clinical observations, instituted for the purpose 
of evolving practical laws relating to the natural history and treatment of 
diseases. 
The investigations of the author relative to animal heat in general 
commenced in 1854, and his labors upon the variations of body tempera- 
ture in disease commenced in 1856, and found their widest expansion, and 
brought forth their richest fruits in 1857. We sought to determine in the 
various diseases investigated : 
1st. The variations of body temperature at stated intervals of the 
twenty-four hours. 
2d. The variations of body temperature in the various stages of each 
disease. 
3d. The variations of the pulse and respiration in each case at 
stated intervals, and in each stage of the special disease. 
4th. The changes of the physical and chemical characters of the blood 
in each case, and in various stages of disease, and in various diseases. 
5th. The physical and chemical changes of the urine, in each case, at 
stated intervals in various stages of disease, and in various diseases. 
6th. The physical, microscopical, chemical and pathological changes' 
of the organs in fatal cases, in the various stages of disease, and in various 
diseases. 
7th. The consolidation of these results in each case, and in various 
diseases, and the establishment of fixed principles in pathology, and in the 
natural history and treatment of various diseases. In the tabulated results 
we endeavored to express, in the most compact form, the data obtained by 
actual observations and chemical analysis of all the essential phenomena 
presented by each case and by each disease. This method we regarded as 
more accurate and comprehensive than the graphic representation of the 
phenomena by means of curved lines or charts, although this method of 
presenting results has been freely used, especially in clinical instruction. 
The results of these labors upon the changes of the temperature, pulse, 
respiration, blood, urine and organs in disease, and more especially in mala- 
rial fever, 1856, 1857, 1858 and 1859, were published in the Southern Medi- 
cal and Sugical Journal, published in Augusta, Georgia, and in the Trans- 
actions of the American Medical Association for the year 1859. As far as 
our knowledge extends these were the first and most elaborate, and 700 
Investigations of Joseph Jones, D., on Malarial Fever. 
thorough investigations upon the phenomena of fevers. The general results 
were of practical importance. 
Thus we demonstrated: (a.) The necessity in every pathological 
investigation of determining the amount of matter chemically altered and 
thrown off by the human subject, and the character of the matters thus 
eliminated. This can only be accomplished by the determination of the 
amounts and characters of the matters thrown off from the lungs, skin and 
kidneys, and bowels. 
(b.) We demonstrated by numerous careful observations, that the 
determination of the relations of the circulation, respiration and tempera 
ture in diseases, is of the greatest importance in enabling the practitioner 
of medicine to understand the nature and treatment of diseases, and pre 
diet with a great degree of certainity their course and termination. Thus 
when as in congestive fever, there is a want of correspondence between the 
circulation, respiration, temperature and chemical changes, the patient is 
in great danger. A patient with a rapid feeble pulse, and rapid thoracic 
respiration, and low temperature (sluggish chemical changes), is always in 
great danger. A full moderately rapid pulse, and moderately rapid and 
full respiration, and correspondingly high temperature, are favorable symp- 
toms, provided there be no complications, as congestion of the brain. 
(c.) The severity of malarial fever is by no means proportional to 
the height of the fever (animal temper ature.) As a general rule, the higher 
the fever (temperature), the more readily does the attack yield to treat- 
ment, and the less serious the effects. In many cases of malarial fever, 
high temperature may signify active chemical changes and an effort on the 
part of nature to break up, alter and consume the poison. In the malig- 
nant forms of malarial fever, the want of body heat, the absence of fever 
heat, is the most dangerous symptom. 
(d.) In like manner we have demonstrated by numerous cases and 
clinical observations in Hospital and private practice, that whilst the pulse 
at the commencement of an attack of yellow fever, is rapid and full, with 
a corresponding elevation of temperature, the frequency of the pulse does 
not as a general rule, continue to correspond with the elevations and oscil- 
lations of temperature, as in many other febrile diseases; and in many 
eases of yellow fever, the remarkable phenomenon is witnessed of the pulse 
progressively decreasing in frequency, and even descending below the nor- 
mal standard, while the temperature is maintained at an elevated degree 
If in yellow fever, the temperature rises in the first stage above 105° the 
patient is in imminent danger; and if it reaches from 107° to 110°, death is 
inevitable, whatever may be the treatment adopted. In cases attended 
with the rapid rising of the temperature to 106° and beyond, in the first 
stage, death sometimes occurs suddenly, and apparently solely from rhe 
effects upon the blood and nervous system of the great elevation of tem- 
perature, as in sun stroke. 
(e.) Whilst malarial fever on the one hand is characterized by rapid 
elevations and depressions of the temperature, and corresponding oscilla- 
tions of the pulse and respiration, yellow fever on the other hand, is char- 
acterized by the uniformity of the ther mometric indications, and the pro 
gressive decleusion of the beats of the pulse, after the complete establish- 
ment of the febrile stage. 
(f.) We regard our demonstration in 1857 of the two facts, of the rise 
of temperature during the cold stage, and the existence of paroxysms of fever 
after the apparent cure by quinine, attacks which often escape the observa 
tion of both physician and patient, unless the thermometer is constantly 
used, as of great importance in illustrating the nature of malarial fever. Investigations of Joseph Jones, M. D., on Malarial Fever. 
701 
Previous to the investigations of the author in 1857, the chill was usually 
regarded as the first manifestation, and the first beginning of the ague, and 
the preceding rise of the temperature, and the continuance of the rise 
during the cold stage was unknown. 
Whilst the separate paroxysms of intermittent fever are each charac- 
terized by a sudden rise of temperature, attended generally wilh rigors, and 
cold shivers to the height of extreme fever, and an equally rapid return 
to the normal degree of heat, or a little below it, on the other hand we 
noted the important fact that the temperature begins to rise before any other 
symptom of the incipient attack announces itself. 
We have in these facts conclusive proof of the continuous action of 
the malarial ferment, before, during and subsequent to the cold stage. The 
cold stage of peripheral contraction of the blood-vessels and conges- 
tion with elevation of temperature in the internal organs, is not the begin- 
ning of malarial fever, neither is this stage its essential phenomenon; the 
phenomena of the cold stage are only partial manifestations of the action 
of the malarial poison. The order of the morbific phenomena are as fol- 
lows: 
1st. Introduction of the morbific ferment of malarial fever into the 
blood. 
2d. Increment of the micro-organisms of malarial fever in the living- 
blood. 
3d. Destruction of the colored blood-corpuscles by the micro organ- 
isms of malarial fever. 
4th. Elevation of the temperature of the blood and of the body gen- 
erally by the action of the malarial poison, and in virtue of the chemical 
changes which it has excited. This rise of temperature in virtue of the 
action of the malarial ferment, begins before any other symptom of the 
incipient attack announces itself; the rise of temperature is, however,, 
comparatively slow at first, that is, it may continue from one to three 
hours, without reaching more than 101.°2 to 102. °4 F. 
5th: As soon as the rigor of the cold stage occurs the rise of temper- 
ature becomes more rapid, and in the course of one hour may reach from 
105° to 107° F. in the central portions of the body. At the same time the 
temperature of the extremities remains depressed throughout the cold 
stage. The nervous sensations of cold are referrable to the contraction of 
the peripheral blood vessels, and not to any actual reduction of the tem- 
perature of the great mass of the blood. On the contrary, the blood in: 
the large blood vessels manifests the elevated temperature of fever, and 
probably reaches in the liver in some cases 108° to 112° F. The so-called 
cold stage is a delusion. It is the stage of congestion of the internal organs 
and of rapid destruction of the colored corpuscles, of rapid chemical 
changes of the red blood-corpuscles and proteids of the blood, and of 
rapid rise of temperature, during this "cold stage," indicates progressive 
aud increasing chemical changes excited by the malarial ferment. The 
aberrated nervous phenomena, the contracted peripheral vessels, the shriv- 
eled. mottled skin, and the shivering muscles and chattering teeth are 
clearly referable to the action of the malarial poison and its products upon 
the central ganglia of the sympathetic and cerebro spinal nervous systems. 
The results of these labors, commenced in 1857, have been of great 
value in enabling the author to correctly distinguish the various forms of 
tever during the Civil War, and during his term of service as President of 
the Board of Health of the State of Louisiana, 1880-1883, in the critical 
differential diagnosis of yellow and malarial fevers- The questions 
involved in the distinction of the various forms of malarial fever from 702 
Cold Stage of Malarial Fever. 
specific yellow fever, were of momentous importance to the welfare of the 
inhabitants of Louisiana and of the Mississippi Valley. During a period 
of four years, 1880-1883, no question was ever raised with reference 
to any case diagnosed as yellow fever by the author; and no case 
diagnosed as malarial fever ever gave rise to specific yellow fever, not- 
withstanding the attempts of interested parties to create panic and alarm, 
and for the erection of quarantines against New Orleans by organizations 
hostile to the best interests of the people of the Mississippi Valley. 
CIRCULATION, RESPIRATION, TEMPERATURE, STATE OF THE SKIN, TONGUE, 
AND CHANGES OF THE URINE IN INTERMITTENT, REMITTENT, AND 
CONGESTIVE FEVER. 
Reports of Cases of Malarial Fever 1857-1886, by the Author, illustrating 
the Phenomena, and Treatment of the various forms of this Disease. 
The supervention of the American Civil War, 1861-1865, caused the 
destruction of the greater portion of the copies of the Southern Medical 
and Surgical Journal, and of the Transactions of the American Medical 
Association in the Southern* (Confederate) States, which were rent by the 
storms of battle and desolated by sword, rapine and fire. Whilst a few 
copies of my work during the year and a half of their existence before the 
Southern States were environed by hostile fleets and armies, found their 
way across the Atlantic and received a generous reception and friendly 
notice at the hands of Richard Owen, Benjamin Ward Richardson, Edmund 
A. Parkes and William Aitken of England, it is our belief that our labors 
never reached the laborious investigators of Germany. Thus we find no 
allusion to our labors, and thermometric, observations in disease, in the 
important work of Dr. C. A. Wunderlich 11 On the Temperature in Diseases-, 
a Manual of Medical Thermometry f published in Leipsig in 1868, nine years 
after the reception and publication of our labors by the American Medical 
Association. We shall, therefore, reproduce the original cases and ther- 
mometric observations in the present chapter. 
PRINCIPLES OF TREATMENT BASED UPON THESE OBSERVATIONS. 
1. CHANGES OE THE PULSE, RESPIRATION, TEMPERATURE AND URINE 
IN INTERMITTENT FEVER. 
COLD STAGE. 
Proposition I. During the cold stage (chiU) there is a rapid, feeble pulse, 
full, rapid respiration, and a hot trunk and cold extremities. 
During the rapid thoracic respiration oxygen is supplied in abundance, 
and enters into the blood, which is confined during the cold stage almost 
entirely to the trunk and large organs. The amount of oxygen received, 
and the elevation of the temperature of the trunk, will depend upon the capil- 
lary circulation of the lungs and large organs of the trunk, andupon the action 
of the heart. The cold stage of ague may be sudden in its attack, and without 
previous illness; or it may bejireceded by general indisposition, headache, 
weariness, pain in the limbs, thirst, loss of appetite, white tongue, frequent 
pulse, high colored urine, and dark colored discharges from the bowels. 
These prodromes in some cases are accompanied with exacerbations and 
remissions of fever, displaying a periodic tendency, and after the first 
state has lasted from four days to a fortnight, a severe rigor occurs, com- 
monly causing a fit of the ague. The most violent symptoms are frequently Cold Stage of Malarial Fever. 
703 
manifested by strong sthenic subjects who come from elevated and cold non- 
malarial regions, into the low swampy malarious districts of our Southern 
States, and who suffer with the first attack of ague. Repeated attacks of 
ague are attended with progressive destruction of the colored blood-cor- 
puscles, repeated congestions of the liver and spleen, irritability of the 
cardiac ganglia, and of the cerebro-spinal nervous system; and in the cold 
stage, the temperature of the trunk does not rise to so high a point as in 
sthenic cases. 
Proposition LI. During the cold stage the temperature of the extremities is 
reduced far below that of the trunk, and evenbelow the standard of health, because 
the circulation of the blood in the blood-vessels and capillaries is feeble. 
The surface of the trunk and extremities presents a mottled purplish 
color during the cold stage, because the supply of oxygen being greatly 
diminished, the change from the venous to the arterial hue does not take 
place. 
The shivering and twitching of the muscles during the chill are excited 
in a manner analogous to the shivering produced by exposure to cold. 
When the temperature of the extremities is rapidly reduced by rapid 
radiation, the capillary circulation becomes feeble, the surface presents a 
wrinkled and often bluish appearance, the blood is not furnished in suffi- 
cient quantities to supply the elements of nutrition and chemical change 
in the muscles and nerves, the chemical actions of both the muscles and 
nerves are diminished and perverted, and, as a necessary consequence, this 
diminution and perversion of chemical change is attended by aberrated 
muscular and nervous action. 
The phenomena of diminished • capillary circulation, and correspond- 
ing diminution in the supply of nutritive materials, and elements of chem- 
ical change, and reduction of temperature, may be also produced by 
derangement of the general circulation and derangements of the sympa- 
thetic nervous system. In both cases the cause of the diminished tempera- 
ture in the extremities would be due to feeble capillary circulation. In 
both cases the cause of the aberrated muscular and nervous phenomena 
would be due to diminished and perverted chemical changes. 
That the chemical changes are perverted during this state of reduction 
of animal temperature and diminution of capillary circulation, is conclu- 
sively demonstrated by the fact that in congestive fever, where we have, as 
it were, a permanent reduction of temperature, and arrest of capillary cir- 
culation, and diminution of chemical change, both in the trunk and in the 
extremities, the products resulting from these perverted chemical changes 
are far different both from those of health and those of fever, when the 
system reacts. The derangement of the sympathetic and cerebro-spinal 
nervous system, in the cold stage of ague, is clearly indicated by the fol- 
lowing symptoms : A sensation of coldness of the extremities, then of the 
back, aud, lastly, of the whole body, blueness of the nails; shrunken, pale 
and sharp features; shrivelled and purple mottled hue of the surface of 
the body, the skin assuming that rough condition popularly named goose- 
skinned. The contraction of the capillaries of the extremities must be 
referred to the profound impression of the malarial poison upon the vaso- 
motor centres. The chattering of the teeth must be referred to the affec- 
tion of the motor nerves of the fifth pair. 
The tremor which extends to every muscle until the whole body shakes 
with the rigors, is evidently an involuntary reflex action evidencing 
deranged action in the motor and sensitive ganglionic cells of the spinal 
axis. The cough, dyspnoea, and oppression of the circulation, and the pain- 704 
Hot Stage in Malarial Fever. 
ful sensations down the back, must be referred to congestion of the central, 
ganglia of the sympathetic and cerebro-spinal nervous system, induced by 
the toxic action of the malarial ferment in the blood. The nausea and 
vomiting characteristic of the cold stage, are referable not merely to 
derangement of nervous action in the central ganglia of the medulla 
oblongata and solar plexus, but also to the reversion of the peristaltic 
action of the ilium and duodenum, and the irritant action of the altered 
bile of the congested liver upon the gastric mucus membrane. 
Proposition III. The diminution of the capillary circulation and reduction 
of the temperature of the extremities precede the aberrated nervous and muscular 
phenomena denominated chill. 
This fact corresponds to the changes in the blood, and demonstrates 
conclusively that the first phenomena of the cold staae are connected with the 
sympathetic nervous system. 
The impression of the morbific ferment and the products of its action 
in the blood on the vaso-motor centres, must therefore be regarded as the 
initiation of the sensation of cold, the congestion of the peripheral blood 
vessels, the constriction of the smaller eccentric arteries, and the conges- 
tion of the cerebro-spinal centres, and the hypersemic condition of the liver 
and spleen. We speak of the cold stage in its existence, as a special phe- 
nomena; but it must be carefully noted that it is not the true initial act 
or manifestation of malarial fever, but in the order of time is a consequence 
of the preceding action of the malarial poison ; the temperature begins to 
rise before any other symptom of the incipient attack announces itself. 
An elevated temperature has in itself an influence on rhe functions of the 
body, on the nutrition of the tissues, upon the secretions, and on the 
development and supply of the nervous and muscular forces. The pulse 
and respiration are accelerated before the manifestation of the peculiar 
and striking condition of the human system, known as the cold stage or 
chill. The chill of malarious disease is, therefore, the manifestation of 
Ihe cumulative action of the poison and its products, and of the increased 
temperature upon the central ganglia of the sympathetic and cerebro- 
spinal nervous systems. 
Proposition IV. The higher the temperature of the trunk during the cold 
stage, the more rapid, will be the equalization of the circulation and temperature. 
This proposition needs explanation and amplification. As far as my 
observations extend the most marked phenomena of the cold and hot 
stages, and the highest degrees of temperature, both in the cold and hot 
stages, are witnessed in strong healthy individuals, who are attacked for 
the first time by ague. The recurrence of the paroxysms with the progres- 
sive enlargement of the spleen and derangement of the liver, and destruc- 
tion of colored blood corpuscles, in many cases is attended with enfeeble- 
ment of the nervous and muscular powers, and the degree of heat mani- 
fested during the febrile stage is not so elevated, but the fever is more per- 
sistent. In many cases of pernicious malarial fever we have observed even 
during profound coma, accompanied with capillary congestions, almost a 
continuous elevation of temperature with but slight diurnal oscillations. 
In such cases, which are most generally fatal, the temperature in the axilla 
and under the tongue rarely reaches 104° F., and usually ranges between 
102° and 103° F. In yellow fever a temperature above 105° indicates great 
danger. In intermittent fever on the contrary a temperature of 107° of 
the trunk during the close of the cold and the commencement of the hot Cases illustrating the Changes of the Pulse and Temperature. 
705 
stage does not necessarily indicate an unfavorable progress or termination 
of the disease. 
These propositions are sustained by the following cases: 
Case 927. Savannah, 1S57.-Seaman, aged 55; height 5 feet 4 inches; small, 
spare man; has been in the hospital several months, suffering with an affection 
of the eyes. This case of intermittent fever originated in the hospital. Chill 
came on one hour ago; he is still shaking violently, and his lips and hands look 
blue. Pulse 100, feeble, small. .Respiration 36 to 50, varies with each quarter of a 
minute; irregular, thoracic, labored. Temperature of atmosphere 71.°5 F.; tempe- 
rature of hand 92°; temperature under tongue 104°. 
Case 928. Savannah, 1857.-Seaman, aged 38; height 5 feet 8 inches; light hair, 
blue eyes, sallow complexion; looks as if his liver was out of order. Says that he 
has had chills off and on from the 16th of July to the present time, October 12th. 
His first attack of intermittent fever was contracted in the swamps of the Peedee 
River, South Carolina. Tongue clean and pale; lips pale, anaemic. This patient 
presents the true malarial hue, and his blood is deficient in colored corpuscles. In 
the present attack of intermittent fever he has a chill every day. October 12th. This 
morning had a chill, followed by hot fever. During the febrile excitement his 
pulse was 108 and his respiration 32 to the minute. As soon as the fever remitted 
twenty grains of sulphate of quinia were administered. The sulphate of quinia 
delayed the chill. It did not appear at the regular hour on the 13th inst., but 
came on at 4 o'clock P. M., on the 14th inst. At this time I commenced the exam- 
ination about fifteen minutes after the commencement of the chill. Lips and 
fingers pale and of a bluish color; extremities cold, whilst the trunk is hot to the 
touch. Patient is shaking all over. Pulse 92, feeble; respiration 32, full and 
labored. Temperature of atmosphere 77.°5 F.; temperature of hand 91°; tempera- 
ture under tongue 103°. A small amount of urine was excreted at the close of the 
cold stage and commencement of the general elevation of temperature (equaliza- 
tion of the actions of the general and capillary circulation,), which had a normal 
color. Specific gravity 1023. Reaction decidedly acid. One thousand parts con- 
tained-urea 21.825; uric acid 1.467; fixed saline constituents 7.436. During the 
sweating stage the reaction of the skin was neutral; as a general rule I have found 
it to be acid in the various forms of malarial fever. Reaction of saliva, as usual, 
acid. October 15th, 1857. Complete intermission of fever. Pulse 80, fuller; respi- 
ration 20, regular. Temperature of atmosphere 71.°5 F.; temperature of hand 96°; 
temperature under tongue 98°. 
Case 929. Savannah, 1857.-Frenchman, aged 45; brown hair and eyes; height 
5 feet 7 inches; weight 130 pounds. Thin, spare man. Had an attack of intermittent 
fever, commencing September 15th. This case was treated in the Savannah Poor- 
house, and yielded to the ordinary remedies, and the patient was discharged in the 
course of ten days. He returned to a miasmatic situation, and was again attacked 
with intermittent fever. Entered the hospital and poor-house October 7th, and 
stated that for the last four days he had "dumb ague," which came on at the same 
hour (11 o'clock A. M.), and lasted two hours. A purgative, followed by twenty-five 
grains of sulphate of quinia, was administered. This delayed the "dumb ague" 
until October 9th, 3:30 o'clock P. M. (twenty-eight hours.) Examination com- 
menced half an hour after the commencement of the "dumb ague." Lips and 
fingers purplish; extremities cold; head and trunk warm; complains greatly of the 
sensation of cold, but shakes far less than in the former cases recorded. Pulse 92, 
so feeble that it is with difficulty felt, and with still greater difficulty counted. 
The vibrations of the pulse resemble those of a fine thread. Respiration accel- 
erated and irregular. Temperature of atmosphere 75° F.; temperature of hand 
83°; temperature under tongue 101.°5. 6:30 o'clock, P. M. Reaction has taken 
place, and he now has fever. Pulse 96, much fuller than during the chill, but 
weaker than in a frank open case. Temperature of atmosphere 70° F.; tempera- 
ture of hand 101.°75; temperature under tongue 1O2.°75. In this case, which was 
far more serious than the preceding cases, we observe that the temperature of the 
trunk was not so much elevated duiing the chill, nor during the subsequent reaction. 
The urine indicated serious disturbances; it was of a high color gnd specific gravity, 
and correspondingly rich in urea and extractive matters. The uric acid was 
slightly increased. October 10th. Intermission of fever. Temperature of atmos- 
phere 70° F.; temperature of hand 97.°5; temperature under tongue 98.°5. 
Case 930, 1857.-Irishman ; black hair; black eyes; height 5 feet 10 inches; 
weight 130 pounds. In health florid complexion. Has been suffering with inter- 706 
Cases illustrating the Changes of the Pulse and Temperature. 
mittent fever for four days; chills have been slight. The present chill (September 
23d, 1857) is slight. Temperature of atmosphere 79° F.; temperature of hand 90°; 
temperature under tongue 102. 
Case 931. 1857.-Seaman; Englishman; brown hair; brown eyes; florid com- 
plexion in health; now his complexion is anaemic; weight 146 pounds; age 25; 
height 5 feet 6 inches. September 10th. Entered the Savannah Marine Hospital 
with bilious remittent fever, and from this date until the 19th inst. was extremely 
ill. This patient recovered so as to be able to walk about the hospital yard. Not- 
withstanding the administration of tonics and iron his complexion was pale, 
anaemic, and he complained of a severe and continued pain in his head. On the 
4th of October he was taken with severe chill, followed by high fever. This 
returned every day. October 6th. The chill has been on him one hour, and the 
hot stage is just coming on. Pulse 110, feebler than after the complete reaction, 
but stronger than during the lowest depression of the cold stage. Respiration 
irregular, thoracic, panting, from 40 to 50. Muscles trembling violently. Tem- 
perature of atmosphere, 70° F.; temperature of hand 97°; temperature under 
tongue 104°. 
Case 932,1857.-Irish laborer; stout, well-formed man; sanguine temperament; 
light hair, blue eyes, florid complexion; height, 5 feet 9 inches; weight 190 lbs. 
This is his second attack of chill and fever this season. Sept. 18th, 11 A. M. Chill 
is now just going off. Pulse 112; respiration 28. Temperature of atmosphere 
9O.°5 F.; temperature of hand 100° ; temperature under tongue 104°. 19th, 2 P. M. 
Apyrexia complete. Pulse 68; respiration 24. Temperature of atmosphere, 91° F.; 
temperature of hand 97.°5; temperature under tongue 99°. Recovered from this 
attack. Commenced work upon a steam-tug, and slept on board in the Savannah 
river, at night. Returned to the hospital with a third attack of intermittent fever. 
Oct. 2d, 2 P. M. Has a chill and is shaking violently. Pulse 120, in sitting pos- 
ture. Respiration 22, in sitting posture. Temperature of atmosphere 79° F.; tem- 
perature of hand 89°; temperature under tongue 102. °25. Oct. 3d. 2P. M. Has high 
fever. Pulse 100 ; respiration 26, full. Temperature of atmosphere 77.°5 F.; tem- 
perature of hand 105°; temperature under tongue 106°. Oct. 4th, 2 P. M. Apyrexia 
complete. Pulse 58; respiration 20. Temperature of atmosphere 76° F. ; tempera- 
ture of hand 96.°5 ; temperature under tongue 98.°5, 
Case 933. 1857.-Seaman; age 22; heights feet 4 inches; weight 140 lbs.; black 
hair and florid complexion ; sanguine, nervous temperament; native of New York. 
Sept. 29th. 1857. Entered the Savannah Marine Hospital, with intermittent fever. 
Has never been sick before in his life. Has been in Savannah two weeks, and this 
is his first visit. Says that he was taken sick four days ago, with chill, vomiting, 
and pains in all his bones, and has had a chill every day since, commencing regu- 
larly at 12 o'clock, M. Had a chill this day, commencing a few minutes after 12 
o'clock, M. Says that he took three blue pills and castor oil, night before last. 
This medicine operated twice. 7 o'clock, P. M. Has fever, and complains of pains 
in his joints. Slight tenderness upon pressure of epigastrium. Tongue clean, 
moist, red at tip and edges ; papillae enlarged and of a bright red color. Reaction 
of saliva decidedly acid. Pulse 120 ; respiration 32, full, thoracic. Temperature of 
atmosphere 79° F.; temperature of band 103.°33; temperature under tongue 106°. 
R.-Calomel gr. xij ; sulphate of quinia gr. vij.. Mix and administer immediately 
and follow with castor oil in four hours. As soon as fever remits, give sulphate of 
quinia gr. v, every three hours, up to gr. xxv. During fever, give soda powders 
(pulveres effervescentes tartarizati). Diet, gruel and flaxseed tea. Oct. 30th, 1 
o'clock, P. M. Medicine operated freely, and says that he is much better, but 
complains of weakness. Tongue presents the same appearance; skin cool and 
relaxed; face not so much flushed. Pulse 70, regular ; respiration 22, regular and 
gentle. Temperature of atmosphere 68° F.; temperature of hand 92°; temperature 
under tongue 99.°5. Here we see, that although the pulse and respiration are more 
rapid than in health, the temperature of the trunk is normal, whilst the tempera- 
ture of the extremities is 6° below the normal standard, and there is no shaking of 
the muscles. Color of the urine, light orange, sp. gr. 1009. Reaction decidedly 
acid. Uric acid in grs. 23,220 of urine passed during the last eighteen hours, gr. 
1.0035; uric acid in grs. 30,952 of urine, calculated for 24 hours, gr. 1.3376. Up to 
this time, 1 o'clock, P. M., has taken 20 grs. of the sulphate of quinia, and the 
marked diminution of the uric acid may be connected with the action of this 
medicine. 5 o'clock, P. M. Half an hour ago was taken with chill and vomiting. 
Now the chill appears to be subsiding, the shaking and contraction of the muscles 
are diminishing. Extremities cool, whilst the head and trunk are pungent to the Cases illustrating the Changes of the Pulse and Temperature. 
707 
hand. Pulse 108, feeble; respiration 30, full, labored, panting. Temperature of 
atmosphere 74° F.; temperature of hand 91°; temperature under tongue 105.°5. In 
three hours and a half the pulse has increased 38 beats in the minute ; the respira- 
tions have increased 8 in the minute; the temperature of the extremities has 
diminished, whilst that of the trunk has increased 6°. The comparison of this 
observation with the preceding one three hours ago, demonstrates the truth of the 3d 
proposition, viz: the diminution of the capillary circulation, and reduction of the 
temperature of the extremities, precedes the aberrated nervous and muscular phe- 
nomena, denominated chill. 8$ o'clock, P. M. Three hours and a half after the 
observation upon the chill, the relations between the temperature of the trunk and 
extremities have been restored, and the shaking and shivering of the muscles, and 
the sensation of cold, have vanished. Pulse 108°, fuller and stronger; respiration 
32, not so full and labored as during the chill, but still much fuller and more 
labored than during health. Temperature of atmosphere 73° F.; temperature of 
hand 103.°5; temperature under theitongue 105°. Specific gravity of urine excreted 
during the cold stage and commencement of the hot stage, 1020. Color normal. 
Reaction decidedly acid. Uric acid in 5100 grs. of urine excreted during 8 hours, 
grs. 2. Uric acid in 15,300 grs. of urine calculated for 24 hours, grs. 6. The uric 
acid has increased in amount during the chill and commencement of the fever, 
when compared with the former specimens of urine ; it is, however, still below the 
standard of health. If the diminution of the amount of uric acid be due to the 
action of the sulphate of quinia, it shows that this action of this remedy pointed out 
by Ranke,*is not necessarily attended by a disappearance of the chill. Oct. 1st, 
it o'clock, A. M. Apyrexia; says he is better and has no pain except a slight 
headache, and was in a perspiration all night. Fever intermittent at 12 P. M. 
Skin cool. Pulse 76 ; respiration 23. Temperature of atmosphere 70° F.; tempera- 
ture of hand 95°; temperature under tongue 98.°5. Has taken 15 grs. of sulphate of 
quinia since the intermission of the fever. 
Case 934.-Englishman, entered the Savannah Marine Hospital, October 9th, 
1857; age 27. Has been in America thirteen years. Height 5 feet 10 inches ; weight 
145 lbs.; muscular system well developed; sanguine temperament; occupation, 
steward on ship; has been in Savannah three weeks. Says that he was taken 
yesterday at 12 o'clock, M., with cold feelings and headache. The chilly feelings 
lasted four hours, and were succeeded by fever, which continued until 4 o'clock 
this morning. Two and a half hours after the subsidence of the fever (8J o'clock, 
A. M.) he shook violently. This chill was followed by fever. Now, 8 o'clock, P. 
M., fever is subsiding. Pulse 98, full but soft. Temperature of atmosphere 72° F.; 
temperature of hand 102. °5; temperature under the tongue 103°. Tongue moist; 
skin in a profuse perspiration ; says that he took last evening a dose of salts and 
cream of tartar, which operated twice this morning. R.-When fever goes off, 
give sulphate of quinia, grs. v, every three hours upto grs. xx. Oct. 10th, 12o'clock. 
M. There was a complete intermission of the fever about 2 o'clock this morning. 
At this time the sulphate of quinia was commenced, and he has taken gr. xv. 
Amount of urine passed during the last 16 hours 6144 grs. 
*• " hourly " u 321.5 " 
Calculated amount of urine for 24 hours 9216 " 
In 6144 grains of 
urine (16 ho urs.) 
In 9216 grains of 
urine 4calculated 
for 24 hours. 
In 1000 parts 
of urine. 
Urea 
226,980 grs. 
0.600 " 
40.200 " 
340,470 grs. 
0.900 " 
60.100 " 
36.943 
0.097 
6.542 
Uric tacid 
Fixed saline constituents 
Sp. gr. of urine 1024-clear ; no deposit; light red color. Reaction decidedly 
acid. After standing twelve hours no deposit; after standing thirty-six hours, a 
very slight light-yellow deposit; after standing sixty hours the surface was covered 
with a pellicle, which, under a magnifying power of 210 diameters, was found to 
consist of small oval cells, about the size of human blood-corpuscles. There were 
also other elongated elliptical cells, the short diameters of which did not differ from 
those of the globular cells. Many of the elongated cells had a vibratory motion. 
The deposit at the bottom consisted of these globular elliptical acicular cells, and a 
* Medical Times and Gazette, May 30,1857, p. 540. 708 
Pulse, Temperature, Respiration and Urine. 
few crystals of triple phosphate. That these cells were organized bodies was demon- 
strated by the action of chemical reagents under the microscope. Not a trace of 
uric acid was found in the pellicle and deposit. 
12:30 o'clock P. M. A chill is just coming on. The thermometer placed in his 
hand indicated 91.°5 F. Simultaneously with the increase in the sensations of 
cold, it commenced to descend, and in fifteen minutes stood at 87.°5, 10^ degrees 
below the normal standard. In fifteen minutes his hand lost4°, and simultaneous 
with this loss of temperature in the extremities, the sensation of cold increased. 
He feels very cold, but does not shake. The extremities feel cold, whilst the sur- 
face of the head and trunk feels hot and pungent. When the bulb of the thermo- 
meter was simply placed between the skin and flannel shirt, and gently pressed 
against the surface of the chest, it commenced to rise rapidly, and in a few 
moments indicated 103° F.. and when placed in the armpit, it rose rapidly to 107° 
F. Pulse 100, not so full as during fever, butsmall, feebleaud threaded. Respira- 
tions 26, full and labored. Temperature of atmosphere 68.°5 F.; temperature of 
hand 87.°5; temperature of axilla 107°. Tongue pointed, but moist, and not much 
redder than usual. Skin dry, with a purplish mottled appearance as if the circula- 
tion in the capillaries was retarded. iSays that he has dull " wandering pains 
around his loins up to his chest." Complains of great thirst. His stomach is so 
irritable that I could not ascertain the temperature under his tongue. I made 
seven unsuccessful attempts. At every trial the contact of the bulb of the ther- 
mometer with the base of the tongue excited violent retching and vomiting. I 
applied a sinapism over the region of the spinal column, eighteen inches in length, 
and three inches in breadth, also one over the epigastrium, and administered 
stimulants. In half an hour after their application, the mustard and stimulents 
assisted in arousing the capillary circulation in the extremities. His surface does 
not present the mottled appearance ; the heat has, in a great measure, returned to 
his extremities; the cold sensations have disappeared, and he ' feels warm all 
over." The temperature of his hand is now 99°, whilst the temperature in the 
axilla is still 107°. In half an hour the temperature of the extremities has risen 
11.°5. The temperature of the hand does not correspond fully with that of the 
trunk, and reaction is not yet fully established. 
Has just passed clear limpid straiv-colored urine. Sp. gr. 1003. Amount of 
urine voided, 7021 grs. 
7021 grains of urine 
contained. 
1000 parts of urine 
contained. 
Urea 
39.551 grs. 
5.650 
Uric acid 
0.420 " 
0 059 
Fixed saline constituents 
9.800 " 
1.395 
Nitrate of urea remarkably silky and white. 
Microscopical Examination.-The urine was placed in a closely stoppered bottle, 
and set aside for sixty hours. At the end of this time there was a pellicle over the 
surface, and a small light-yellow deposit. The pellicle consisted entirely of the 
globular, elliptical, and vibrating cell.® observed in the former specimen. The 
deposit also consisted of these cells, and a few beautifully formed, prismatic crys- 
tals of triple phosphate. This specimen of urine was interesting, because it was 
passed at the close of a chill, and was probably excreted by the kidneys during the 
existence of the cold stage. It was much lighter in color than that passed during 
fever ; in fact it resembled the urine of hysterical women, in its light color and low 
specific gravity. 
PHENOMENA DURING THE HOT STAGE AND PERIOD OF INTERMISSION. 
Proposition F. The higher the temperature of the trunk during the cold 
stage, and of the extremities and trunk during the subsequent hot stage (stage of 
equalization of the circulation and chemical action), the milder and shorter will 
be the attack, as a general rule, provided there be no complication, as congestion 
of the brain. 
Whenever, as in congestive fever, there is a want of correspondence 
between the circulation, respiration and chemical changes, the patient is Phenomena of Malarial Fever. 
709 
always in danger. A patient with a rapid feeble pulse, and rapid thoracic 
respiration and low temperature (sluggish chemical changes), is always in 
great danger. In cases of malignant (congestive) malarial fever there is, 
as far as my observations extend, a want of co ordination between the 
actions of the circulatory and respiratory systems, and the rapidity and 
character of the chemical changes. The heart attempts to propel the blood; 
it beats rapidly (flutters 140 to 160 times in the minute), but the blood does 
not flow readily through the capillaries, because the chemical changes are 
in a great measure arrested, and in many cases perverted. On the other 
hand, the bounding, full, accelerated pulse; the full, heaving, accelerated 
respiration, and correspondingly high temperature, are always favorable 
symptoms, provided there be no complication, as obstinate vomiting, or 
cerebral symptoms. The severity of the fever is by no means proportional to 
the height of the fever (animal temperature}, for, as a general rule, the higher 
the fever (temperature), the more readily does the attack yield to treatment, and 
the less serious the effects. 
A high temperature, then, in intermittent fever, is a favorable 
symptom. 
Whether the high temperature signifies an effort ou the part of nature 
to break up, chemically alter, destroy and throw off, the malarial poison; 
or whether the high temperature be significant of nothing more than vig- 
orous, vital, nervous, physical and chemical forces; nevertheless the deter- 
mination of the correlation of the respiration, circulation, and temperature, 
affords the most valuable information to the medical practitioner. 
Proposition VI. In malarial fever there is a close relation between the 
state of the skin, pulse, respiration, and temperature of the extremities and trunk. 
A rapid, full pulse, hurried, full respiration, and dry skin, were 
attended with a corresponding elevation of temperature. If the functions 
of the organs and apparatus be properly performed, a full, and rapid, vig- 
orous circulation and respiration, must be attended by the rapid absorption 
of oxygen, and exhalation of carbonic acid gas, and correspondingly rapid 
chemical changes, and development of heat. 
A slow pulse, and respiration, and moist skin, was always accompan- 
ied with a reduction of temperature. 
During the intermission of the fever, the slow pulse, and respiration, 
and moist, relaxed skin, were attended withareduction of the temperature, 
in mauy cases, below the standard of health. 
The questions immediately arise: Is the intermission of the fever due 
to the restoration of the functions of the sudoriparous glands, which col- 
lectively expose a surface of tubing 1,570,000 inches, or nearly twenty- 
eight miles in length ? Is the morbific agent or agents, which have dis- 
turbed the chemical actions and correlation of the forces, eliminated by 
these glands ? If the intermission is due to the restoration of the functions 
of the sudoriparous glands, what excited them to action? Is the phenomena 
connected with the nervous system alone, or with chemical and physical 
changes of the morbific agents, and of the blood, and secretions and excre- 
tions? If the reduction of temperature be not dependent upon the restora- 
tion of the functions of the sudoriparous glands, what retarded the chemi- 
cal actions by which the physical forces are generated ? If the chemical 
actions developing an unusual amount of heat were excited by the intro- 
duction of foreign elements, may not the foreign elements themselves have 
entered into these chemical actions, and been so altered that they have 
been for a time rendered inert ? That a special end is accomplished in 
malarial fever by an elevation of temperature, is proved by the fact that 
the cases which manifest the highest temperatures, are, as a general rule, 710 
Tongue in Intermittent Fever. 
attended with little or no danger; whilst in those cases, as congestive fever, 
where there is a depression of temperature, the danger is always imminent. 
It is true that the sudoriparous glands have much to do with the regu- 
lation of the temperature, for the water which they eliminate from the 
blood during its evaporation, abstracts one thousand degrees of heat from 
the surface of the body and the surrounding atmosphere. The heat is 
expended in the mechanical action of keeping asunder the particles of 
water, and is hence insensible to the themometer. The experiments of Dr. 
Southwood Smith,* at the Phoenix Gas Works, and of MM. Berger, Dela- 
roche, f Fordyce, Blagden4 and others,§ have shown that when animalsand 
riian were subjected to great external degrees of heat, the temperature of 
the body was regulated by the evaporation from the surface of the skin 
and lungs. When the air was dry, individuals were able to endure, for a 
considerable length of time, a temperature of from 250 to 350 degrees, with- 
out injurious effects, and without any great elevation of temperature. The 
loss of water from the surface of the body was correspondingly great, and 
by its evaporation maintained the temperature of the interior at the nor- 
mal standard. If, however, this evaporation be interfered with, by satura- 
ting the air with aqueous vapor, the temperature rose rapidly, and the 
individuals died in a short time. The determination of the fact that the 
sudoriparous glands can, to a certain extent, regulate the temperature of 
the surface, does not by any means prove that the remission or intermission 
of malarial fever is due to the restoration of the function of these glands. 
In congestive fever, when these glands are active, and the whole surface is 
bathed in perspiration, the malarial poison is far more active than in remit- 
tent and intermittent fevers, attended with a rapid, bounding pulse, and 
rapid, full respiration, and high temperature, and hot, dry skin. 
APPEARANCES OF THE TONGUE IN INTERMITTENT FEVER. 
In almost every case the papillae of the tongue were enlarged, and of 
a bright, red color. In the mildest cases the tongue was only slightly 
coated with white and light yellow fur, and the tip and edges were redder 
than normal. In the severest cases the tip and edges of the tongue 
assumed a bright-red color, and the tongue was much dryer than in the 
milder cases, and the reaction of the saliva more intensely acid. The fur 
of the tongue in many cases was thick, and of a brownish-yellow color. 
The reaction of the saliva was always acid during the active stages, and the 
intensity of the acid seemed to correspond, in a measure, to the severity of 
the disease. After repeated attacks of malarial fever, the tongue pre- 
sents a pale, flabby, purplish and bluish anaemic appearance. In marked 
and protracted anaemia resulting from the prolonged action of the mala- 
rial poison, the tongue presents a pale color, which does not differ much 
* Philosophy of Health, vol. ii, pp. 391-396. 
t Experiences sur les Effets qu'une forte Chaleur produit sur 1'Economie, Paris, 1805; and 
Journal de Physique, tomes Ixxi. etlxxiii. 
t Philosophical Transactions, 1775. 
g " Magendie's Experiments upon the Influence of Hot Air on Animal Life;" Am. Jour. Med. 
Sciences, Jan., 1845, p. 183. M. Constantine James, " On the Effects of the Hot Moist Air of the 
Baths or Stoves of Nero, at Pozzuoli;" Gazette MOdicale, 27th Avril, 1844. W. F. Edwards, "On 
Animal Heat;" Cyclcpsedia of Anatomy and Physiology, vol. ii, pp. 649-884. John Davy, " On 
Animal Temperature," Phil. Trans., 1814; Edinburgh Philosophical Journal, Jan., 1826; see also 
Researches, Physiological and Anatomical, by John Davy, Dondon, 1839, vol. i. pp. 141-248. Experi- 
ments of Tillet and Duhamel, "Experiments on the Servants of a Baker, at Rochefoucault, in 
Angoumois;" M6m. Acad. Scien., pour 1764, p. 186 et seq. Experiments of Dobson at Liverpool; 
Phil. Trans, for 1775, p. 463 et. seq. " Observations on the Effects of High Temperatures," by Bell,, 
of Manchester; Manchester Memoirs, vol. i, p. 1 et. seq- Currie " On the Application of Water at 
Different Temperatures;" Phil. Trans, for 1792, p. 199 et seq. Experiments of Delaroche, Journ. 
Phys., t. Ixiii. p. 207. Nicholson's Journ , vol. xvii, pp. 142,215. Journ. Phys. t. Ixxi, p. 289, and t. 
Ixxvii, p. 1. Lavoisier on Transpiration, M6m. Acad, pour 1790. John Reid on Respiration, Cyclo- 
peed, of Anatomy and Physiology, vol. iv, pp. 325-368. Constitution of Urine in Intermittent Malarial Fever. 
711 
in depth from the pale lips ; and the lips in turn present but little deeper 
hue than the surrounding greenish-yellow and bronzed hue of the skin of 
the face and body generally. In these cases of protracted intermittent 
fever and confirmed amemia, the swollen flabby tongue presents serrated 
or indented edges, from the pressure of the teeth. The position of each 
tooth is indicated on the borders of the tongue. The tongue of chronic 
malarial poisoning is clearly distinguishable from that of other constitu- 
tional diseases, as phthisis, scrofula, syphilis, rheumatism, scurvy and 
cancer. This condition of the tongue in malarial fever indicates the 
necessity for the employment of iron. 
GENERAL CONCLUSIONS AS TO THE CHARACTERS OF THE URINE, DRAWN 
FROM THE OBSERVATIONS OF 1856, 1857, AND ANNOUNCED IN 1858 AND 
1859.* 
Tn the mildest cases the characters of the urine did not differ very 
essentially from those of health. As a general rule the amount of urine excre- 
ted during the active stages, and during the earliest period of intermission, 
when the temperature of the trunk and extremities sinks below the nor- 
mal standard, was less than that of health. During convalescene, especially 
under the action of depurants, the amount of urine excreted was greatly 
increased. These statements cannot be applied rigidly to all cases, for the 
urine is affected by so many varied external and internal conditions, that 
the amount excreted exhibits great fluctuations, even in health. No two 
observers agree with reference to the amount excreted in definite periods. 
Thus, Lecanu, from the examinations of the urine of sixteen individuals, 
living upon mixed food, estimated that the amount of urine discharged in 
twenty-four hours ranged from 8085 grains to 34,973 grains. Becquerel 
found that the mean daily quantity passed by four men was 19,511 grains, 
and that by four women was 21,130 grains. Lehmann, from experiments 
instituted upon himself, estimated the quantity discharged daily at from 
13,829 grains to 22,299 grains. According to the valuable experiments of 
Dr. William A. Hammond, instituted upon himself, the amount of urine 
excreted under a mixed diet ranged from 19,684 grains to 22,756 grains with a 
mean of 20,898 grains; under a diet of albumen, from 12,325 to 21,592, with a 
mean ofl7,738; under a diet of starch, from 14,339 to 23,352, with a mean of 
18,427 grains; and under a diet of gum, from 20,516 to 23,721 grains, with 
a mean of 21,538 grains. The only accurate method of determining whether 
or not the urine be increased or diminished is to refer it to the standard of 
health in the individual examined. In hospital practice this is in the 
majority of cases impossible, and we are compelled to be content with 
approximate results. The density of the urine was slightly increased in the 
majority of cases during the active stages, and in others it remained at the 
standard of health, aud in others, again, it varied within wide limits. The 
color of the urine varied from deep yellow and the normal yellow color to 
light red. During the active stages deep orange was the most common 
color. The intensity of the color was greatest daring the active stages, 
and diminished during convalescence. During the active stages of inter- 
mittent fever the urine always contains more free acid than in health. It 
will retain the acid reaction for several days, even in the heat of summer. 
When the fever intermits, and the skin is soft and relaxed, and the 
patient is convalescent, the urine then excreted rapidly undergoes decom- 
position, and in a few hours the reaction changes from acid to alkaline. I 
* Southern Medical and Surgical Journal, Augusta, Ga., 1858-1859. Transactions of the Amer- 
ican Medical Association, 1859. 712 
Pulse, Respiration, Temperature and Urine in Malarial Fever. 
believe this to be one of the most certain signs of convalescence in mala- 
rial fever. The acidity of the urine in malarial fever is in proportion to 
the severity of the attack; it is more intense in remittent than in intermit- 
tent fever, and still more intense in congestive fever than in intermittent 
and remittent fever. The urea was increased during the active stages above 
the standard of starvation. During the active stages the patients took 
little or no nourishment, and the urine excreted during these periods 
shonld be compared with that excreted during starvation and repose, and 
not with that of health. Unfortunately the standard of the urine during 
starvation varies with each individual, and as it is impossible to establish 
a standard previous to the attack in the great majority of hospital patients, 
we can only establish approximate results. In the majority of the cases 
the uric acid was diminished, both with and without the action of the 
sulphate of quinia, during the active stages, when the pulse was full and 
rapid, and the respiration full and accelerated, and the temperature ele- 
vated. In almost every case, as the fever declined, the uric acid increased 
above the standard of health, both with and without the action of the 
sulphate of quinia. From the microscopical examination of several hun- 
dred specimens of urine excreted during the different forms of malarial 
fever, I found it, as a general rule, to be true that, in the mode of treat- 
ment which I adopted, the uric acid appears in much larger quantities in 
the urine of convalescence than in that excreted during fever, even when 
the sulphate of quinia had been withheld, or sparingly administered. The 
majority of specimens of urine excreted during fever, which were set aside 
and examined under the microscope, at successive intervals, gave no 
deposits of the crystals or salts of uric acid, whilst specimens of the urine 
of convalescence very soon gave evidence of the presence of uric acid by 
letting fall deposits of urate of soda and ammonia. As far as my observa- 
tions extend, it may be stated, as a general rule that the phosphates are 
'more abundant in the stage of convalescence than during the active stages. 
The deposits so common during convalescence consist chiefly of urates of 
soda and ammonia, and the phosphates most generally in the form of the 
triple phosphate. The chief reason why the deposit of the phosphate is 
more frequent in the intermission than in the active stages is because the 
urine in the active stage of convalescence is far less acid, and far more 
readily decomposed and rendered alkaline by the ammonia resulting from 
the decomposition of urea than the urine of the fever. 
These facts explain the nature of the so called critical discharges of 
malarial fever. The urine excreted during fever is generally deficient in 
uric acid and the earthy salts, whilst its acidity and power of resisting 
decomposition is greatly increased, and it will remain for a great length of 
time without undergoing decomposition. The urine of convalescence, on 
the other hand, is rich in uric acid and the earthy and alkaline salts, and 
readily undergoes decomposition. The deposit of the urates of soda and 
ammonia, and the precipitation of the triple phosphate by the ammonia 
generated during decomposition of the urea, form the so-called critical 
discharges. As a general rule, the urine excreted during the hot stage of 
intermittent fever is poorer in uric acid than the urine of remittent fever; 
and I have known cases in which, during fever, the uric acid disappeared 
almost entirely. In several cases of congestive fever the urine contained 
only traces of uric acid, and in one case, which terminated fatally, the 
disappearance of the uric acid was attended with the disappearance of the 
urea. Dr. Ranke* states, in his article upon the physiological action of 
* Medical Times and Gazette, May 30,1858, p. 537. Pulse, Respiration, Temperature and Urine in Malarial Fever. 
713 
ENGRAVING 78. URINARY DEPOSITS IN MALARIAL FEVER. 
Engraving No. 7S.-Urinary deposits in intermittent malarial fever. Urate of soda in 
granules, globules and acicular deposits. Triple phosphates of lime, magnesia and ammonia in 
prysmatic crystals, magnified 400 diameters. From nature by Joseph Jones, M. D. 
sulphate of quinia, that, according to all observers, there is in ague an 
increase of uric acid. My observations do not correspond with this asser- 
tion, if it is intended to apply to the active stages of intermittent, remit- 
tent and congestive fevers. The fact that uric acid increases during con- 
valescence from malarial fever demonstrates conclusively that the diminu- 
tion of the amount of uric acid by sulphate of quinia is an attending cir- 
cumstance, and not necessarily one of the beneficial remedial modes of the 
action of this medicine. As a general rule, extractive and coloring 
matters are less abundant during thp active stage of intermittent fever 
than during the first period of the intermission. They are either not 
formed in such abundance, or if formed are partially consumed during the 
active chemical changes of fever. The nitrate of urea formed from the 
urine excreted during the active stages of intermittent fever is silvery 
white, whilst the nitrate of urea formed from the urine excreted during 
the intermission is dark, discolored, and the crystals are not so well formed. 
The former kind of urine, when evaporated and concentrated, generally 
has a yellowish or brownish color, whilst the concentrated urine of the 
intermission assumes the color of a very strong decoction of over-parched 
coffee. The depressed state of the forces consequent upon the continued 
action of the malarial poison is, as far as my observations extend, attended 
by a marked diminution of the solid constituents of the urine. 
These propositions and statements will be illustrated by the following 
cases: 714 
Pulse, Respiration, Temperature and Urine in Malarial Fever. 
Case 935.-Seaman ; native of New York ; age 22 ; height 5 feet 4 inches ; weight 140 lbs. ; black hair, florid complexion ; hand- 
some, intelligent countenance; sanguine nervous temperament. Has never been sick before; has been in Savannah two weeks, and 
this is his first visit; has slept on board the ship lying in the Savannah River. Was taken sick four days ago, and has had a chill 
every day since at 12 o'clock, M. ; had a chill this day commencing a few minutes after 12 o'clock, M. Says that he took three blue 
pills and castor oil night before last; this medicine operated twice. 
Date. 
■ 
Hour 
OF DAY. 
Medicine. 
State of 
Skin. 
| Pulse. 
Respiration. 
Temperature of 
atmosphere. 
I Temperature of 
hand. 
Temperature under 
tongue. 
Urine excreted in 
24 hours. 
Uric acid excreted 
| in 24 hours. 
Urine excreted 
hourly. 
| Urine excreted in 
| Hours. 
Specific gravity. 
Uric acid. 
Calculated amount 
of urine excreted 
in 24 hours. 
Calculated amount 
of uric acid excreted 
in 24 hours. 
No. of hrs. in which 
urine changed from 
acid to alkaline. 
Color and 
Microscopical 
Examination 
of Urine. 
Sept. 29 
7 P. M. 
Calomel gr. xij, snip. 
Hot, dry 
120 
32 
79.0° 
103.33° 
106.0° 
Grs. 
Grs. 
Grs. 
Grs. ' 
Grs. 
Grs. 
Grs. 
" 30 
1 P. M. 
qui. gr. vij, castor oil 
in 4 hrs., sulph. qui. 
gr. xxv. 
Cool, relaxed 
70 
22 
68.0 
92.00 
99.5 
1290 
23220 48 
... ... 
1009.5 
1.003-5 
30952 
1.3376 
60 
Light orange; af- 
" 30 
5 P. M. 
Spirit of Mindererus. 
Chill 
108 
30 
74.0 
91.00 
105.5 
ter 50 hours, no 
deposit of urates 
or phosphates. 
" 30 
8P. M. 
Sulph. quinia gr. xx. 
Hot, dry 
108 
32 
73.0 
103.50 
105.0 
28320 
3.0035 
1180 
5100 8 
1020.0 
2.0000 
15300 6.0000 
60 
Normal color; no 
Oct. 1 
11 A. M. 
Sulph. quinia gr. v. 
Cool, moist 
76' 
23 
70.0 
95.00 
98.5 
24309 
1014 
19200 15 
1011.0 
... 
30734 
60 
deposit. 
A shade higher 
" 2 
11 A. M. 
Calomel gr. vj, sulph. 
Warm and 
84 
32 
74.0 
100.51 
102.0 
15810 
9.3000 
658 
15810 24 
1 
1020.0 9.3000 
20 
than normal. 
Deposit of urates 
" 3 
11 A. M. 
qui. gr. vj, castor oil 
in 4 hrs., sulph. qui. 
gr. xv. 
Snakeroot tea and 
moist 
Cool and 
| 
62 
20 
74.0 
96.00 
98.5 
18180 
8.1000 
757 
18180 24 
1010.0 8.1000 
20 
and phosphates. 
Light yellow; 
" 4 
11 A. M. 
sulphate of quinia. 
Quassia and soda. 
moist 
Normal 
60 
20 
72.5 
96.00 
99.5 
20520 
855 
20520 24 
1018.0 
phosphates and 
urates precipita- 
ted. 
Color normal; de- 
" 5 
11 A. M. 
Quassia and soda. 
Normal 
I 
62 
21 
70.0 
96.00 
99.3 
30450 
15.000 
1268 
30450 24 
1015.0 15.000 
posit. 
Color normal; de- 
J 
posit. Case 936.-American seaman; age 16; weight 125lbs.; light hair, blue eyes, florid complexion; sanguine temperament. From U. S. cutter, which has been 
lying at the ship-yard in the low lands east of the city. Four nights ago, he slept on the Savannah River in an open boat; has not felt well since, and thinks 
that this was the cause of his sickness. The next morning felt badly; had pains in his bones and back, but no chill. These uncomfortable feelings were followed 
by fever, which intermitted yesterday. This morning had a slight chill, followed by fever. 
Pate. 
Hour 
ofDay. 
Medicine. 
State of Skin. 
State of 
Tongue. 
Pulse. 
Respiration 
Tern, of 
atmosphere 
Tern, of 
hand. 
1 
Tern, under 
tongne. 
1 . 
Urine excre- 
ted in 24 
hours. 
Urine excre- 
ted hourly 
1 , 
Specific 
gravity of 
urine. 
Color and Reac- 
tion of Urine. 
Oct. 5 
11 A. M 
Cal. gr. vlij, castor oil 
Hot, dry. 
Red, dry,rough 
120 
40 
72° 
105.75° 
106.00° 
Grs. 
Grs. 
Light orange color. 
- 6 
l^P.M. 
in 4 hours, cit. potas- 
sa mixture, sulph. 
of quinia, gr. xv. 
Sulphate of quinia, 
Moist, soft, and 
Moist, soft, and 
64 
20 
- 
73 
94.50 
99.00 
1022 
Reaction strongly 
... 7 
1% P. M. 
gr. v. 
Snakeroot tea, quas- 
relaxed. 
Normal 
clean 
Normal 
62 
20 
72 
94.75 
99.20 
8240 
343.3 
1030 
acid in 70 hours. 
Reaction alkaline 
- 8 
2 P. M. 
sia, and soda. 
Quassia and soda. 
Nornal 
Normal 
52 
24 
73 
98.20 
99.50 
8721 
363.3 
1026 
pn 16 hours; heavy 
deposit. 
< 
12 M. 
Quassia and soda. 
Normal 
Normal 
52 
24 
73 
98.20 
99 50 
15912 
663.8 
1024 . 
Case 937.-American seaman, native of Maine; weight 140 lbs.; height 5 feet 8 inches; age 19; light hair and blue eyes; fair complexion. Has been in 
Savannah three weeks. Was taken with chill, followed by fever, yesterday at 12 [o'clock M.; had another chill this morning at 4 o'clock. Oct. 10th, 11 o'clock A. 
M. Has a high fever now, and complains of pains in his head and bones. Skin very hot, but moist; pulse ' 12; respiration thoracic, labored; tongue slightly 
coated with fur. R - Calomel, gr. x; sulph. of quinia, gr. vj. Mix, and administer immediately, and follow with castor oil in four hours. R.--Soda powders. 
Date. 
Hour 
of Day. 
Medicine. 
State oe Skin and Tongue. 
Pulse. 
Respirati'n 
Specific 
gravity of 
urine. 
Amount of 
urine excre- 
ted in 
Hours. 
Urea. 
Uric acid. 
Fixed saline 
constitu- 
ents. 
1 Calculated 
a't of urine 
for 24 hrs. 
Calculated 
am't of urea 
for 24 hrs. 
Calcu'd amt 
uric acid for 
24 hrs. 
Calcu'd amt 
fixed saline 
constitu'nts 
for 24 hours. 
Reaction, Codor, Etc., 
of Urine. 
Oct. 10 
" 11 
" 12 
" 12 
" 13 
7 P. M. 
1 P. M. 
11 A M 
8 P. M. 
HAM 
Sulph. of quinia, 
gr- x. 
Sulph. of quinia, 
gr. x. 
Quassia and soda 
Quassia & soda 
Quassia & soda 
Skin hot, but moist; fever con- 
tinues unabated. 
Skin cool and moist; papillae of 
tongue red and enlarged, 
tongue soft, moist, and slight- 
ly coated with white fur.; 
Skin cool and moist; tongue 
clean. 
Skin soft and normal. 
Normal. 
1 
"T" 
74 26 
72 20 
64 16 
1022 
1027 
1023 
1020 
Grs. 
9198 
3580 
5100 
5120 
10 
7 
2b 
Grs. 
222.5 
132.0 
Grs. 
3.96 
1.75 
2.75 
Grs. 
87.30 
21.70 
46.00 
Grs. 
22075 
12177 
8192 
Grs. 
534.0 
452.7 
Grs. 
9.50 
5.99 
4.40 
Grs. 
209.5 
74.3 
73.6 
Clear orange color; still acid, 
with no deposit after 70 hrs. 
Reaction changed from acid to 
alkaline in 36 hours, and de- 
posit of triple phosphate and 
urate of soda thrown down. 
Reddish-orange color; reac- 
tion acid at end of 50 hours, 
and no deposit. 
Straw-colored. 
Normal. Case 938.-Englishman, aged 27 years; height 6 feet 10 inches; weight 145 lbs.; muscular system 
well developed; sanguine temperament; occupation, steward on ship. Has been in Savannah 
three weeks. Says that he was taken yesterday, at 12 o'clock M., with cold feelings and head- 
ache. The chilly feelings lasted four hours, and were succeeded by fever which continued 
until 4 o clock this morning. Four and a half hours after the subsidence of th e fever (8^ 
o'clock A. M.), he shook violently. This chill was followed by fever which is now subsiding^ 
Case 939.-Irish laborer, aged 40 years; height 5 feet 8 inches;^ weight 145 lbs.; brown hair, gray 
eyes, and sallow complexion. Was in the hospital ten days ago with intermittent fever. 
Was discharged, but has returned, August 17th, at 12 o'clock M. 
Oct. 9 8 P. M. 
" 10 12 M. 
" 10 i P. M. 
" 10 I P. M. 
" 10 7 P. M. 
" 11 10 P. M. 
" 12 11 A. M. 
" 13 10 A.M. 
" 141 
Ava jo vrvrr 
aaoH 
jsulph. of qui. 
gr. xx. 
'Spiritof minde- 
[ rerus and sin- 
apisms 
Sulph. of qui. 
gr. xx. 
Snakeroot tea 
Quassia & soda 
i ::: ::: . 
Medicine 1 St^kinOF 
2®§§ S g si 
-""SB • to 
2.2. 8 
98 
ibo 
100 
88 
1 84 
68 
1 04 
Pulse 
tc to • tc be • 1 iRcspiration 
aaioho o o> J 
72.0° 
68.5 
69.0 
67.0 
78.0 
Temperature of 
atmosphere 
102.5° 
87.5 
99.0 
102.0 
98.0 
Temperature of 
hand 
103° 
107 
107 
99 
Temperature under 
tongue 
Grs. 
18290 
28782 
16320 
Amount of urine 
excreted in 24 
hours 
Grs. Grs 
365.9 1.27 
488.8 9?60 
Urea excreted in 24 
hours 
Uric acid excreted 
in 24 hours 
. QjFixed salineconsti- 
5: : : S: : ; : 2 tuents in 24hrs. 
to Ci ' 
Grs. 
6144 
7021 
5075 
9144 
15120 
13662 
16320 
Urine excretedin 
Hours 
13 
6 
% 
91 
1024 
1003 
1615 
1016 
1008 
1012 
1020 
Specific gravity 
Grs. 
226.0 
39.0 
99.4 
157.0 
101.8 
488.0 
Urea 
Grs. 
0.600 
0.420 
0.250 
3.150 
2.025 
9.600 
Uric acid 
Grs. 
40.2 
9.8 
28.5 
40.5 
29.7 
115.2 
Fixed saline consti- 
tuents 
oocSd : C'Urine excreted 
cTooo o' hourly 
Grs. 
9216 
20300 
14630 
40219 
2i859 
Calculated amount 
of urine excreted 
in 24 hours 
Grs. 
340.0 
397.7 
251.4 
162.9 
Urea calculated for 
24 hours 
Grs.' 
0.90 
i"oo 
5.04 
3^24 
Uric acid calcula- 
ted for 24 hours 
Grs. 
60.10 
... 
114.00 
64.80 
47'52 
... 
Fixed saline con- 
stituents calcula- 
ted for 24 hours 
-- -• -- ■ ■ ■ ■■ _ : 
Days 
Houk 
OF DAY 
■ 
Pulse, Tongue, Skin, etc. 
Pulse 
Respiration 
Temperature of 
atmosphere 
Temperature of 
hand 
[Temperature un- 
der tongue 
Specific gravity of 
urine 
Amount of urine 
excreted during 
24 hours 
Uric acid 
Character of Urine 
Aug. 17 
" 18 
" 18 
" 19 
" 20 
" 21 
12 M, 
12 M. 
8 P. M. 
12 M. 
Intermission. Skin cool and moist; 
tongue slightly furred. 
Fever has returned; complains of 
great thirst and pain in head; 
tongue coated in middle with yel- 
low fur, red at tip & sides; skin dry. 
Skin softer, but still very hot; fever 
continues. 
Skin cool: tongue covered with yel- 
lowish fur. 
Slight febrile excitement. 
60 
100 
104 
70 
86 
72 
20 
36 
22 
27 
- 17* 
90° 
90 
87 
80 
106° 
100 
96 
106° 
98 
101 
98 
1005 
1014 
1017 
1009 
Grs. 
3000 
2000 
14120 
14126 
Grs. 
a trace 
1.20 
5.60 
Amount of urineexcreted during fever 
in six hours, 7035 grains. 
Urine excreted during fever, clear and 
light colored. 
Amount of urine passed in seven 
hours of the intermission, 6089 grains; 
uric acid 0.48grains. 
High color. 
Heavy deposit of prismatic crystals of 
triple phosphate. Investigations by Joseph Jones, M. D., on Malarial Fever. 
717 
Case 940.-Irishman ; age 18; brown hair and brown eyes; height 5 feet 6 inches ; weight 125 pounds; well developed chest. 
Occupation, barkeeper in a sailors' boarding-house on the bay. Five days ago attended a boat-race at Thunderbolt, and slept for 
two nights in an open boat. The second morning, after waking, felt badly and vomited. 
Sept. 11 
" 12 
" 12 
" 13 
" 13 
" 14 
" 15 
Date. 
8 
P. M. 
12 
M. 
8:30 
P. M. 
11 
A.M. 
' 5:30 
P. M. 
1 
P. M. 
10 
A.M. 
Hour of Day. 
P CO UMS B* M_ 
Medicine 
iuassit 
id sod 
lip. qt 
?r. xx. 
Dal. gr 
j. cast 
oil in 4 
•s. sul 
li. gr. 
lip. qi 
gr. x. 
P F F * ? 2 
Tongue slightly 
coated with 
white fur; skin 
moist and cool. 
Pulse, skin and 
respiration nor- 
mal ; up and 
walking about 
the Hospital 
grounds. 
Tongue slightly 
furred; skin 
warm. 
Skin cool; tongue 
slightly coated 
with white fur. 
Skin hot; tongue 
slightly furred. 
Tongue moist; 
skin hot. 
State of Skin 
and Tongue. 
- 
116 30 
84 24 
100 24 
98,26 
90 28 
65 24 
Pulse. 
Resp i ration. 
Tern, of atmosphere. 
00 00 QO CO 00 QO 
Cn Cn to to Co O 
o o o o o o 
102.5° 
98.5° 
102.5° 
102.2° 
101.0° 
96.0° 
I 
Temperature of 
Hand. 
103.0° 
99.0° 
103.9° 
103.0° 
102.9° 
98.0° 
Temperature under 
Tongue. 
1018.0 
1022.0 
1020.0 
1022.0 
1021.0 
1019.7 
Specific Gravity of 
Urine. 
1021020 
11726 20 
7126 
6138 
7154 
4002 
1 Grs. 
Amount of Urine 
passed in 
| Hours. 
M S QO Ci 
11291.3 
6766.0 
Grs. 
Water. 
1 
WlO! 
203.70 
1 
1 Grs. 
r 
Urea. 
8.624 
t'ce. 
Grs 
Uric Acid. 
204 2 
110.3 
Grs. 
Extractive and color- 
ing matters. 
§ 
45.8 
Grs 
Fixed saline 
constituents. 
10689 
18414 
11446 
14029 
12252 
14071 
Grs. 
Calculated amount of 
urine for 24 hours. 
g 
o 
10149 
Grs 
Calculated amount of 
water for 24 hours. 
re 
o 
o 
305 5 
Grs. 
Calculated amount of 
urea for 24 hours. 
Ci 
8 
g 
- 
t'ce. 
..... 
Calculated amount of 
uric acid for 24 hrs. 
165.5 
Grs. 
Calculated amount of 
extr've and coloring 
matters for24 hours. 
72.77 
68.70 
Grs. 
Calculated amount of 
fixed saline constit- 
uents for 24 hours. 
Sr $r Su hp®h 
gw gw®»®®g®rfwag® Oga? 
3 y S S- P-F Q P 3 r* £ . p- 3 (t> CL 3 a 
on? p- cr? F ^*3 
o a> a> o । o cd 
Color of Urine. 
bcW % 2g®®» 
p. p. as-Sa 
"5 S.g. ® p-rrfS oo® o o ©"--.^b 
S>°g5' S- 
roooo-. jit to © p- S> u... " r' r r^Sa? 
Deposits in 
Ukine. 718 
Pulse, Respiration, Temperature and Uaine in Malarial Fever. 
No. of case. | 
Age. 
Weight. 
Height. 
Date. 
Houk 
of Day. 
Medicine. 
State of Skin and 
Tongue. 
Pulse. 
Respiration 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Specific gravity 
of urine. 
Am't of uriue 
excreted in 24 
hours. 
Uric acid. 
Color of 
Urine. 
Deposits in Urine. 
Yrs 
Lbs 
Ftln 
Grs. 
Grs. 
r 
Sept. 18 
11 A. M. 
Sulph.qui.gr. xx. 
Chill is just going off. 
112 
28 
90.5° 
100.0° 
104,0° 
Reaction strongly acid. 
" 19 
2 P. M. 
Skin cool and moist. 
68 
24 
91.0 
97.5 
99.0 
1008 
18144 
2.88 
A shade 
No deposit. 
higher than 
normal. 
l 
Oct. 2 
2 P. M. 
Cal. gr. xij,sulph. 
Lips and hands pur- 
120 
22 
79.0 
89.0 
102.25 
Do. 
qui.gr. vij. 
pie; violent chill. 
3 
2J P. M. 
Snip. qui. gr. xxv. 
Skin hot and dry; ton- 
100 
2G 
77.6 
105.0 
106.0 
Do. 
p 
25 
192 
5 8J-) 
gue red at tip, but 
moist and soft. 
" 4 
2 P. M. 
Skin cool; pulse full 
58 
20 
76.0 
96.5 
98.5 
1008 
14112 
Deep orange 
Do. 
and soft. 
color. 
" 5 
Skin cool and normal. 
1016 
15290 
Reddish 
Do. 
orange. 
" 15 
2 P. M. 
Skin hot; high fever. 
... 
... 
1002 
35070 
trace 
Do. 
I 
12 hrs. 
f 
Aug. 12 
2 P. M. 
Comp, blue pill 
Face red; skin hot. 
112 
40 
Reaction strongly acid; no 
and castor oil. 
deposit after 60 hours. 
" 14 
... 
Sulph.qui.gr. xv. 
Tongue red at tip,furr- 
112 
88.0 
104.0 
106.0 
Do. do. 
ed and pointed. 
" 15 
Sulph.qui.gr. xv. 
Skin cool, moist and 
92 
26 
88.0 
98.0 
99.7 
Do. do. 
relaxed. 
" 16 
Skin hot and moist. 
112 
1020 
Do. do. 
q 
18 
150 
5 9 
" 17 
Skin cool and moist. 
82 
24 
86.0 
99.0 
100.0 
Do. do. 
" 18 
Skin warm and soft. 
96 
36 
86.0 
99.0 
102.75 
1020 
High color- 
Do. do. 
ed. 
" IS 
8 P. M. 
In profuse perspiration 
90 
Shade of Ma- 
Do. do. 
deira wine. 
" 19 
76 
23 
89.0 
99.0 
1021 
Do. 
Heavy deposit of urate of 
soda and triple phosphate. 
I 
" 20 
72 
26 
85.0 
... 
98.0 
1020 
Do. 
Do. do. 
Case 941.-Pulse, respiration, temperature and character of urine in intermittent fever. Investigations of Joseph Jones, M. D., ou Malarial Fever. 
719 
No. of case. 
Age. 
Weight. 
Height. 
Date. 
Hour 
of Day. 
Medicine. 
State of Skin and 
Tongue. 
Pulse. 
: Respiration. 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Specific gravity 
of urine. 
Amount of urine 
excreted in 24 
hours. 
Uric acid. 
C olor of 
Urine. 
Deposits in Urine. 
Yrs 
Lbs 
Ft In 
Sept. 
18 
8 P. M. 
Cal. gr. xii. 
Tongue red at tip & ed- 
96 
22 
84.0° 
103.0° 
104.0° 
Grs. 
Grs. 
Deep orange 
Reaction strongly acid. 
1 
ges; papillae enlarged, 
coated with white fur. 
1 
u 
19 
11 A. M. 
Snip, qui.gr. xxx. 
Skin warm and moist; 
100 
36 
86.0 
103.0 
104.0 
1020.0 
9840 
8.160 
Do. Do. 
r 
17 
150 
5 8 < 
It 
20 
11 A. M. 
tongue the same. 
Skin moist. 
76 
21 
84.0 
96.0 
100.0 
1023.0 
23460 
Deep orange 
Do. Do. 
red. 
it 
21 
12JM. 
Profuse perspiration. 
82 
24 
83.0 
102.0 
104.5 
1021.9 
7161 
9.800 
Do. 
Do. Do. 
it 
22 
11 A. M. 
Sulp. qui. gr. xx. 
72 
21 
81.0 
98.0 
99.2 
1011.0 
22 
7 P. M. 
78 
28 
80.5 
99.0 
102.0 
1018.0 
Deposit of triple phos- 
Sept. 
18 
8 P. M. 
Sulp. qui. gr. xx. 
Skin moist; tongue 
90 
28 
84.0 
103.0 
104.0 
High color- 
phate. 
pointed, red at tip, and 
ed; deep or- 
furred. 
ange. 
19 
11 A. M. 
Do. do. 
80 
21 
86.0 
98.0 
100.5 
1020.2 
9792 
4.600 
Do. 
147 
• • 
20 
11 A. M. 
Sulp. qui. gr. xv. 
Tongue red at tip & ed- 
80 
26 
84.0 
100.0 
101.5 
1023.0 
19437 
Do. 
s 
24 
... X 
It 
21 
12JM. . 
ges,poiuted, and coat- 
ed with white fur. 
80 
24 
83.0 
96.8 
100.5 
36.000 
Do. 
Do. 
Heavy deposit of urate of 
soda and triple phosphate 
1021.0 
9180 
22 
74 
17 
... 
1017.0 
22374 
Do. Do. 
r 
July 
8 
2 P. M. 
Skin hot and dry; 
88 
8 2.0 
105.0 
106.0 
Deep orange 
After standing several 
tongue dry; papillae 
red. 
days, a slight deposit of 
enlarged, covered 
mucus and vegetable 
with thick yellow fur. 
cells. 
11 
9 
4 P. M. 
Sulp. qui. gr. xv. 
Skin moist and cool. 
58 
30 
81.0 
95.9 
101.0 
1012.0 
4.480 
Reddish 
Reaction decidedly acid; 
154 
5 7- 
orange. 
no deposit of urates or 
t 
26 
it 
9 
6 P. M. 
Do. do. 
58 
30 
1015.0 
7.400 
Do. 
phosphates. 
No deposit. 
10 
11 A. M. 
Skin hot and dry. 
66 
29 
80.5 
102.0 
104.6 
1012.3 
2.723 
Do. 
13 
8 P. M. 
Sulp. qui. gr. xv. 
48 
20 
81.0 
99.0 
100.0 
1020.0 
9180 
Orange. 
14 
11 A. M. 
44 
21 
79.0 
99.0 
1021.0 
10212 
13J)00 
Light 
Heavy deposit of urate of 
I 
orange. 
soda& triple phosphate. 
CASE 941-CONTINUED; 720 
Pulse, Respiration, Temperature and Urine of Malarial Fever. 
Case 942.-Frenchman ; age 45; weight 120 pounds ; thin and spare; nervous temperament; complexion pale. Has been in 
Savannah three weeks ; has been acting as nurse in the hospital two weeks. September 15th, 12 o'clock M. Was taken with a chill 
at 8 o'clock A. M., attended with vomiting, and followed with high fever. Urine passed during the height and decline of the fever, 
orange colored, and diminished in amount. 
Date. 
Hour 
of Day. 
Skin, Medicine, Color of 
Urine, Etc. 
|Pulse. 
Respiration. 
Temperature of 
atmosphere. 
Temperature of 
Hand. 
Temperature under 
Tongue. 
Specific Gravity of 
Urine. 
Amount of Urine 
Excreted in 
Hours. 
Urea. 
Urie Acid. 
Fixed Saline 
Constituents. 
Calculated amount of 
Urine for 24 hours. 
Urea calculated for 
24 Hours. 
Uric Acid calculated 
for 24 Hours. 
Fixed Saline Con- 
stituents calculated 
for 24 Hours. 
Grs. 
Grs. 
Grs. 
Grs. 
Grs. 
Grs. 
Grs. 
Grs 
Sept. 
16 
12 M. 
Apyrexia; skin cool. 
1021.5 
4086 
24 
0.400 
4086 
0.400 
17... . 
12 M. 
Apyrexia; skin cool. 
1021.7 
6641 
24 
252.2 
2.275 
6641 
252.2 
2.275 
u 
18 
12 M. 
Apyrexia; skin cool. 
88.0° 
93.5° 
99.9° 
1023.0 
6640 
24 
136.1 
13.480 
6640 
136.1 
13.840 
19 
12 M. 
Convalescent. 
Continued to improve and was dis- 
charged September 23d. 
89.5 
96.5 
98.0 
7530 
24 
7530 
Oct. 
7 
3:30 P. M. 
Has returned; has had chill every 
day since the 5th inst., at 11 
o'clock A. M.; calomel, gr. xij. 
sulphate of quinia, gr. xxv. 
75.0 
it 
9 
3:30 P. M. 
The chill has returned; pulse very 
feeble, with difficulty counted; 
respiration irregular; lips and 
fingers blue. 
92 
83.0 
101.5 
... 
9 
6:30 P. M. 
Hot stage; pulse much fuller, 
96 
70.0 
101.8 
102.5 
It 
10 
11 A. M. 
Febrile excitement has almost en- 
tirely subsided; sulp. of quinia, 
gr. xxv ; urine high colored, like 
new Madeira wine. 
70.0 
97.5 
98.5 
1022.0 
8687 
15 
342.1 
5.950 
28.0 
813899 
547.3 
^9.520 
44~8 
tl 
12 
11 A. M. 
Pulse, skin and tongue normal 
convalescent. 
1022.0 
15330 
24 
349.2 
11.250 
76.5 
15330 
349.2 
11.250 
76.5 Investigations of Joseph Jones, M. D., on Malarial Fever. 
Case 943.-Irish seaman; black hair, black eyes and florid complexion ; height 5 feet 11 inches; weight 175 lbs. Has been slaying on beard the light-ship 
and running up and down the Savannah River at all hours of the day and night. Says that he resided six years at Panama, but was never sick. Wa > 
taken with chill and fever two days ago, and the captain of the light ship gave him several doses of drastic medicine. 
721 
Sept. 6 
" 7 
" 7 
" 8 
" 8 
" 9 
•- 9 
" 10 
" 10 
" 11 
• 11 
"• 12 
" 13 
" 14 
Date. 
Sept. 6 
" 7 
" 7 
" 8 
" 8 
" ib 
" 10 
" u 
" n 
" 12 
" 13 
" 14 
Date. 
7J > T > 7: > 7! > 7! > 75 > 75 71 
o 
0° 
4*.HSoSH-qoa5®®-<OffiH 
71 > g r" > 75 > 75 > 71 > 7!75 
Hour 
OF DAY. 
Si i : i 
o • : : ooo**4»«o:: : 
: Q 
i ? 
Urea. 
Pulse. 
I IMM 
: 
Grs. 
Uric acid. 
Respiration. 
690.0 
Grs. 
54.4 
272.3 
126.4 
215.9 
Extractive and 
coloring mat- 
ters. 
■: : 8S88888888gi 8 
Temderature of 
atmosphere. 
007'88 
oeru 
12.235 
56.200 
42.600 
32.400 
Grs. 
Fixed saline 
constituents. 
: : ggggggSSgagj 8 
Temperature of 
hand. 
i! 
: 
Grs. 
Calculated am't 
of urine for 24 
hours. 
: i § 
- • oooMcpooocnCncnoo: wj 
Temperature 
under tongue. 
6405 
19856 
15570 
13015 
: 
: Q 
Calculated am't 
of water for 24 
hours. 
in? 
Am't of urine 
excreted dur- 
ing 24 hours. 
hhhhSI! 
Grs. 
Calculated am't 
of solid mat- 
ters for 24 hrs. 
Grs. 
Am't of urine 
excreted 
hourly. 
H H 
• 
Grs. 
Calculated am't 
of urea for 24 
hours. 
14015 
17453 
14517 
23971 
Grs. 
Water excreted 
during 24 hours. 
1 i isKKHii 
:• 
Grs. 
Calculated am't 
of uric acid for 
24 hours- 
ilH H H 
| Grs. 
Solid matters 
excreted dur- 
ing 24 hours- 
:::::: 
:::::: 
144,9 
466.0 
837.0 
324.0 
Grs. 
Calculated ain't 
of extractive 
and col'ng mat- 
ters for 24 hrs. 
gi * i issim! 
Q 
Urea excreted 
during24 hours. 
61.792 
= 
: 8883 
i : Q 
Calculated am't 
of fixed saline 
constituents 
for 21 hours- 
. . 3z,®wc.cncn?l^. 
11 SBSMsSSSi 
i 
' Grs. 
1 Uric acid ex- 
creted during 
24 hours. 
H 
1 i sSKSi 
: 
Water in 1000 
parts of urine. 
§H i H H £Sgl I 
C 
a 
Extractive and 
coloring mat- 
ters excreted 
during 24 hrs. 
; S'K 
1 RtiE 
: 
Solid matters 
in 1000 parts 
of urine. 
8 Hi 
i j M 
; : o oo o: : : : jo 
Fixed saline 
c >nstituents 
excreted dur. 
ing2 hours. | 
& : : 
8: : : $gg£ggg$8: 
: 
Urea in 1000 
1 parts of urine. 
gsssgsgsuigg; 
•SJD 
I Am't of urine 
excreted in 
Hours. 
i । gggm 
: 
: 
Uric acid in 1000 
| parts of urine. 
08 
II 
91 
6 
91 
8 
91 
6 
II 
6 
: 
P: : : : 
r - = 
21.270 
21.350 
22.283 
20.6(10 
23.500 
Extractive and 
colorins mat- 
ters in 1000 
parts of urine. 
si BHWOpi 
8 5888888838 
: 
Specific gra- 
vity. 
to. . . 01. 
gH ; §; 
i SIB 
i 
Fixed saline 
constituents 
in 1000 parts 
of urine. 
29667 
11'18 
0880 
t:i9ii 
7087 
Grs. 
j Water. 
Grs. 
Am't of urine 
excreted 
hourly. 
!hh 
1 
Grs. 
149.3 
616.2 
2S0.9 
486.5 
। Solid matters. 722 
Urine in Intermittent Fever. 
Case 944.-Illustrating the diminution of the constituents of the urine, when the 
forces have been reduced by the continued action of the malarial poison.-Irish 
laborer; light-brown hair, brown eyes; has been in America seven years, and in 
Savannah three years; age 22, medium height. Has been living and making 
bricks in a low, miasmatic situation. Says that he has suffered with chill and 
fever for six weeks. Complexion sallow and ansemic; lips, gums and tongue pale. 
He is exhausted by slight exertions, and complains of great weakness. Sept. 16th, 
12J o'clock P. M. Pulse 88; respirations 24. Temperature of atmosphere 87° F.; 
temperature of hand 100°.5; temperature under longue 101°.25. 17th, 1U o'clock 
P. M. Pulse 72; respirations 20. Temperature of atmosphere 86° F.; tempera- 
ture of hand 90°; temperature under tongue 98°. Has just awoke from sleep, and 
is in a profuse perspiration. 
16,027 grains of urine, 
excreted in 21 hours 
(sp. gr. 1001.7), clear 
and limpid, contained 
1000 parts of urine 
contained 
Water 
Grains. 
15,958.568 
995.730 
Solid matters 
68.432 
4.270 
Urea 
42.680 
2.664 
Uric acid 
1.280 
0.074 
Extractive and coloring matters 
18.776 
1.171 
Fixed saline constituents 
5.696 
0.356 
The reduction of the nervous and physical forces was attended by a reduction 
in the amounts of the solid constituents of the urine. B .-Infusion of Virginia 
snakeroot f^xvj ; brandy f^ vj ; sulph. of quinia gr. xv ; mix. Take a wineglass- 
ful five Limes a day. B.-Citrate of iron gr, iv, three times a day, 17th, 12 M. 
Pulse, 72; respirations, 20. Temperature of atmosphere 88° F.; temperature of 
hand, 98.5°; temperature under tongue 99.5°. Amount of urine excreted during 
the last twenty-four hours under the action of the diuretic and tonics, 11,645 grs.; 
sp. gr., 1010. Urea in 14,645 grs. of urine, 196.910 ; uric acid in 14,645 grs. of urine, 
7.975; urea in 1000 parts of urine, 12.445; uric acid in 1000 parts of urine, 0.544. 
The infusion of snakeroot, and sulphate of quinia and citrate of iron, have pro- 
duced an increase of the solid constituents of the urine. 
Case 945.-Illustrating the diminution of the constituents of the urine, when the 
forces have been reduced by the continued action of the malarial poison. Germaa 
laborer, age 30 , heights feet 5 inches; weight, in health, 112 pounds ; light hair, 
blue eyes ; small, delicate man. Has been in the United States three years, and in 
Savannah three months. Has been 'keeping store" on the river, near the rice 
mill. Was taken sick with chill and fever two months ago. Complexion amemic. 
Complains of great weakness. Lips, gums, and tongue pale ; tongue coated with 
white fur. 10th, 11 o'clock A. M. Says that he had a chill yesterday. B.-Sulph. 
of quinia gr. v, every three hours, up to gr. xv. 11th, 12 o'clock M. Skin cool; 
in a profuse perspiration. Pulse 76, respirations, 19. Temperature of atmosphere 
85° F.; temperature of hand 94°; temperature under tongue 98°. Color of urine a 
shade higher than normal. Sp. gr. 1014.5. 
5072 grains of urine 
excreted in 17 
hours, con- 
tained 
7157 grains of 
urine, calculated 
for 21 hours, 
contained 
1000 parts of urine 
contained 
Grains. 
Grains. 
Water 
4886.160 
6895.783 
963.462 
Solid matters . 
185.340 
261.514 
36.538 
Urea 
65,475 
92.385 
12.907 
Uric acid 
2.750 
3.880 
0.552 
Extractive and coloring matters... 
102.485 
144.607 
20.225 
Fixed saline constituents 
14.631 
20.642 
2.884 
In this case, as in tlie preceding, we see that the depressed state of the forces 
consequent upon the action of the malarial poison, was attended by a marked 
diminution of the solid constituents of the urine. 12th, 121 o'clock P. M. Pulse, 
72; respirations, 19. Temperature of atmosphere, 84° F.; temperature of hand, 
97.25°; temperature under tongue, 99.9°. Sp. gr. of urine, 1011.3. After sixteen 
hours a copious deposit of urate of soda and triple phosphate. Intermittent Fever: Investigations by Joseph Jones, M. D. 
723 
13,652 grains of urine' 
excreted in 24 hours 
contained 
1000 parts of urine 
contained 
Water 
Grains. 
13,242.437 
970.000 
Solid matters 
409.563 
30.000 
Urea 
209.520 
15.316 
Uric acid 
19.710 
1.443 
Extractive and coloring matters 
158.485 
11.676 
Fixed saline constituents 
20.265 
1.567 
Under the action of the sulphate of quinia, the urea, uric acid, extractive and 
coloring matters have been increased in amount. The following cases of inter 
mittent fever were observed during and subsequent to the American Civil War, 
1861-1865, and .-till further enlarged our knowledge of the relations of the changes 
of the urine tb the general symptoms of this disease. The results of this and the 
preceding series will be summed up in the form of general conclusions. 
Case. 916.-Mild attack ; Disease treated without Quinine. Chill disappeared 
spontaneously. Changes of the Urine during the Chill and Fever. Effects 
of Quinine after the subsidence of the Fever. 
, General Hospital, Augusta, Ga., July 27, 1862.-Confederate soldier, E. Brazier; 
age 31 ; heights feet 9 inches; black hair, florid complexion ; dark brown eyes; 
weight 150 lbs.; native of Pickens County, Alabama ; has lived in Fayette County, 
Ala., and moved thence to Calhoun County, Miss. Had chills and fever in Ala- 
bama, when about 12 years of age ; had chills and fever last fall-at the time, was 
ditching in low grounds ; entered the Confederate Army three months ago ; served 
one month at Oxford, Miss., situated in Lafayette County, on Central Railroad ; 
surrounding country hilly and sandy; water good; considered a healthy place. 
During his stay at Oxford, slept in open air, without tents. Soldiers were very 
healthy at Oxford. From Oxford was transferred to Grenada; this place proved 
sickly to the men, many of whom were sick during their stay of four weeks, and 
after "they left, they continued to be sick with climate fever; eleven of the regiment 
were left in the hospital (several very bad cases of fever and one death from pneu- 
monia) ; water very bad at Grenada. From Grenada, went by Jackson to Meri- 
dian ; stopped in this low place one day ; from thence went to Mobile and remained 
in this city four hours, and came on from thence, through Montgomery, Alabama, 
to Augusta. Entered the General Hospital in Augusta, Georgia, four weeks ago, 
with measles; recovered entirely from this disease, ahd was fit for duty, when the 
patient was last night (July 26th, 1862), seized with a chill followed by fever. 
The chill returned this morning at 9 A. M., and is still on him. Pulse 124, 
very small and threaded ; extremities cool; head and trunk very hot. at least 107° F., 
whilst the extremities cannot be more than 88° F. This is evidently a true mala- 
rial chill. The urine was carefully collected at the close of the chill, when the 
equilibrium of the temperature had been restored between the trunk and the 
extremities. 
Amount of urine passed during two and one-half hours of chill, grains 5425.44. 
Specific gravity 1016. Light yellow normal color. Acid reaction. The urine was 
carefully tested for grape sugar ; no traces whatever were found. 
Analysis of urine passed during two and one-half hours of chill: 
Constituents of Urine 
during 2}^ hours of Chill, 
drains. 
Amount of urine 5425.44 
Urea 118.11 
Uric acid 1.07 
Free acid 7.39 
Phosphoric acid 0.61 
Sulphuric acid (determined quantitatively by chloride of 
barium) 3.57 
Chlorine (determined by nitrate of silver) 48.41 
Equivalent of chloride of sodium 76.99 
Grape sugar no trace. 
Ammonia added to the urine produced but slight turbidness from the small 
amount of phosphoric acid and phosphates existing in the urine. With reference 724 
Urine in Intermittent Malarial Fever. 
to the phosphates, the results corresponded with those of other cases ; they were 
greatly diminished during the fever, but increased during the intermission ; and 
finally, together with the urates, at this stage of the disease, were thrown down as 
a heavy deposit, after the urine had stood several hours, and commenced to undergo 
change. 5 o'clock, P. M. High fever; skin hot and dry. Amount of urine passed 
during the height of the fever, commencing from the close of the chill, 12 M., and 
ending at 5 o'clock, P. M. (5 hours), 7297.92 grains. Color of the urine, a shade 
deeper than that formed during the chill, and inclining more to an orange color ; 
the urine passed during the chill being very nearly normal in color. Specific 
gravity 1008. 
Analysis of urine during five hours of the height of the fever, 12 M. to 5 P. M. : 
Urine passed during 
5 hours, 12 M. to 5 P. M. 
Grains. 
Amount of urine 7297.92 
Urea 99.42 
Uric acid 0.65 
Free acid 6.37 
Phosphoric acid (a mere trace) 0.56 
Sulphuric acid 5.04 
Chlorine 34.07 
Equivalent of chloride of sodium 53.03 ' . 
Grape sugar no trace. 
10 o'clock, P. M.-Fever going off; patient feels better, with the exception of 
headache. Urine passed since 5 P. M., very clear, like spring water. July 28th, 
5 A.M. Fever continued to decline and went off with little or no sweat, about 
midnight; headache continued through the night. 
Amount of urine passed during the decline of the fever, from July 27th, 5 P. 
M. to July 28th, 5 A. M., 12 hours, grains 15193.59. Specific gravity 1005; very 
light colored ; light straw color, several shades lighter than the urine passed just 
after the chill. The salt of iron indicated a mere trace of phosphoric acid and the 
phosphates were precipitated in exceedingly small quantities by ammonia. 
Analysis of urine passed during twelve hours, July 27th, 5 P. M. to July 28th, 
5 A. M., during the decline of the fever : 
Urine of 12 hours, July 27th, 
5 P. M. to July 2Sth, 5 A. M. 
Grains. 
Amount of urine 15193.59 
Urea 163.04 
Uric acid 1.47 
Free acid 3.96 
Phosphoric acid a mere trace. 
Sulphuric acid 17.01 
f Chlorine (determined by nitrate of silver) 26.08 
1 Equivalent of chloride of sodium 40.20 
Chloride of sodium (determined by nitrate of mercury) 40.01 
Grape sugar no trace. 
10 o'clock, A. M.-Continues free of fever. Amount of urine excreted during 
the last five hours (from 5 A. M. to 10 A. M ), 4076 grains. Orange color, inclining 
to red, much deeper in color than that passed at any previous time. Specific 
gravity 1019. 
Analysis of urine passed during five hours, 5 A. M. to 10 A. M. : 
Urine passed during 5 hours, 
5 o'clock A. M. to 10 o'clock, A. M. 
Grains. 
Amount of urine 4076.00 
Urea 138.96 
Uric acid 2.04 
Free acid 5.79 
Phosphoric acid 5.75 
Sulphuric acid 6.20 
Chlorine 20.26 
Equivalent of chloride of sodium 33.40 
Grape sugar no trace. Intermittent Malarial Fever : Investigations by Joseph Jones, M. D. 
725 
11 o'clock, A. M.-Pulse 92, respiration 28. Temperature of hand 38.°7 C. 
(101.°7 F.) Temperature of axilla 40° C. (104° F.) Skin warm and dry, tongue 
very slightly coated with fur. 9 P. M. Temperature of hand 40° C. (104° F.) 
Temperature of axilla 4O.°4 C. (104,°8 F.) Says that he felt cold about one o'clock, 
P. M. ; his fingers and toes were a little cold, but he did not shake. This was fol- 
lowed by an increase of the temperature and pulse. Pulse 96, respiration 26. R. 
Cold water ad libitum. July 29th, 8 o'clock, A. M. Says that he rested tolerably 
well during the night; has had no other chill ; towards the latter part of the night 
commenced to sweat. Temperature of hand 38.°2 C. (100.°8 F.) Temperature of 
axilla 38.°4 C. (1O1.°2 F.) Pulse 80. Amount of urine passed from July 28th, 10 
A. M. to July 29th, 8 A. M. (22 hours), grains 35607.15. Specific gravity 1005. Light 
yellow color, like the urine of health. Acid reaction. 
Analysis of urine collected during twenty-two hours, July 28th, 10 A. M., to 
July 29th, 8 A.M.: 
Urine of 22 hours, July 
28th, 10 A. M., to July 29th, 8 A. M. 
Amount of urine 35607.15 
Urea 363.83 
Uric acid 5.31 
Free acid, alkaline a few hours after passing from rapid change- 
acid wdien first passed. 
Phosphoric acid 10.80 
Sulphuric acid...., 21.35 
Chlorine 53.72 
Equivalent chloride of sodium 88.56 
11 o'clock A. M.-Amount of urine passed from 8 A. M. to 11 A. M. (three 
hours), grains, 3187.80. Sp. gr. 1012. Deep orange color, in striking contrast with 
preceding specimens; after standing a short time, let fall quite a heavy deposit of 
urates and phosphates, and gave an alkaline reaction. 
Analysis of urine collected during three hours, 8 A. M.-ll A. M. 
Urine, 3 hours, 
Calculated for 
8 A. M.-ll A. M. 
24 hours, grs. 
Amount of urine 
3187.80 
25502.40 
Urea 
80.63 
645.04 
Uric acid 
1.26 
10.08 
Free acid (immediately after passage) 
6.74 
53.92 
Phosphoric acid 
3.87 
31.16 
Sulphuric acid 
6.40 
51.20 
Chlorine 
42.88 
Equivalent chloride of sodium 
8.83 
70.64 
9 o'clock P. M.-Pulse 80; respiration 20; temperature of hand, 38.°1 C. (100.°6 
F.); temperature of axilla 38.°2 C. (100.°8 F.). Has had no fever this day; com- 
plains of some sore throat; now in good perspiration. Has passed but little urine 
this day, and that has been high colored. As his body needed washing, the follow- 
ing disinfecting, cleansing and stimulating lotion was ordered: R. Labarraque's 
solution of chlorinated soda, f^ij; whisky, f^iij; spirits of camphor, f^ij; com- 
mon salt, f^vi; water, f5 vi; dissolve the common salt (chloride of sodium) in the 
water when hot; after allowing the solution of salt to cool, add the whisky, then 
the spirits of camphor, and finally the solution of chlorinated soda. Sponge the 
entire body and limbs off with* this preparation. 10 o'clock P. M.-Amount of 
urine passed from. 11 A. M. to 10 P. M. (11 hours), grains, 5461.08. Orange colored, 
much higher colored than the urine passed during the night. Sp. gr. 1020. Reac- 
tion alkaline in a few hours after its passage, and a heavy deposit was thrown 
down. The free acid disappeared so rapidly that no determination was made. The 
determinations of the free acid of urine in many cases, and especially during the 
period of convalescence of malarial fever, affords data for approximate determina- 
tions, rather than for absolute quantitative results, for the free acid is constantly 
liable to be neutralized by the changes of the urine, after being voided, so that a 
sample of urine, which actually contains a large proportion of free acid will give 
no indication of its presence, by our modes of determining it, because all its dis- 
tinctive properties are neutralized by the ammonia generated during the various 
changes of decomposition of the urine exposed to the atmosphere. The rapidity 
of these changes also varying with the temperature, estimates of the free acid 
would also vary greatly with the temperature. 726 
Urine in Intermittent Fever. 
Analysis of urine passed during eleven hours (11 A. M. to 10 P. M.), July 29th: 
Urine passed during 11 hours, 
July 29th. Grs. 
Amount of urine (11 hours) 5461.08 
Urea 220.48 
Uric acid 6.10 
Free acid, not determined, alkaline in a few hours. 
Phosphoric acid 12.87 
Sulphuric acid 14.76 
Chlorine... , 7.77 
Equivalent chloride of sodium 12.80 
July 30th, 10 A. M.-Pulse 70; respiration 16; temperature of hand 37.°3 C. 
(99.°1 F.); temperature of axilla 37,°8 C. (100.°1 F.). Skin cool and moist. Amount 
of urine passed from 10 P. M., July 29th, to 10 A. M , July 30th (10 hours), grains, 
8568.00. Sp.gr. 1008. Reaction alkaline in a few hours-light colored-the color 
of health. 
Analysis of urine passed during 12 hours, 10 o'clock P. M., July 29th, to 10 
o'clock A. M., July 30th, grains, 8568.00. 
Urine passed during Calculated for 
12 hours, July 29, 10 
P. M., to July ;>0, Lu A. J 
24 hours. 
J. 
Amount of urine (12 hours) 
8568.00 
17136.00 
Urea 
166.75 
333.50 
Uric acid 
1.02 
2.04 
Free acid, not determined, alkaline 
in a few 
hours. 
Phosphoric acid 
8.50 
17.00 
Sulphuric acid 
11.11 
22.22 
Chlorine 
11.55 
23.10 
Equivalent chloride of sodium 
19.04 
38.08 
9 o'clock P. M. Pulse 76; skin cool; temperature of hand 37.°4 C. (99 .°3 F. 
temperature of axilla 37.°9 C. (100°2 F.) July 31st. Pulse 76 ; respiration 16 ; tem- 
perature of hand 37.°5 C. (99.°5 F.); temperature of axilla 37.°6 C. (99.°7 F.) Appetite 
good ; has been up and walking about the yard this morning. Amount of urine 
passed from July 30th, 10 o'clock A. M., to July 31st, 10 o'clock A. M., (24 hours), 
grains 15,986.25. Sp. gr. 1015. Light orange color. Deposit of phosphates quite 
abundant, and coating the sides of the glass vessel. 
Analysis of urine passed during 24 hours, July 30th, 10 o'clock A. M., to July 
31st, 10 o'clock A. M 
Analysis of urine passed during 24 
hours (July 30th, 10 o'clock A.M., 
to July 31st, 10 o'clock A. M. 
Amount of urine 15,986.25 
Urea 586 72 
Uric acid 5.35 
Free acid alkaline in a few hours. 
Phosphoric acid 40.39 
Su 1 ph uric acid undetermi ned 
Chlorine : 36.22 
Equivalent chloride of sodium 59.71 
August 1st, 10 o'clock A. M. Temperature of hand 36° C. (96.°8 F.); tempera- 
ture of axilla 37.°8 C. (101.°1 F.) Pulse 72; respiration 16. B.-Quinine grs. v, 
every two hours up to grains xv. Amount of urinepassed during the first 24 hours, 
from July 31st, 10 o'clock A. M., up to August 1st, 10 o'clock A- M., 28,453.80. Sp. 
gr. 1009. Urine abundant and of a natural color. Hydrochloric acid produced no 
deepening of the color, and the uric acid precipitated was of a remarkable light 
color. 
Analysis of urine passed during 24 hours- 
Grains 24 hours. 
Amount urine, 24 hours 28,453:80 
Urea , 466 42 
Uric acid 2.82 
Free acid alkaline in a few hours. 
Phosphoric acid 36.94 
Sulphuric acid 37.85 
Chlorine 43.49 
Equivalent chloride of sodium 71.65 Intermittent Fever: Investigations by Joseph Jones, M. D. 
727 
9| o'clock P. M. Pulse 68; respiration 16; skin moist and relaxed. Temper- 
ature of hand 36.°7 C. (98.°1 F.); temperature of axilla 37.°6 C. (99.°7 F.); pulse soft, 
full and regular; tongue clean and moist. Urine normal in color, and not specially 
abundant. Has taken 15 grains of quinine. Patient says that the quinine has 
produced no unpleasant sensations in his head. Bowels have been moved once 
during the day. R.-Quinine grs. v, now, and at 5 A. M. and 7 A. M. in the 
morning. 
August 2d, 10 o'clock A. M. Temperature of hand 36 °8 C. (98.°3 F.); tempera- 
ture of axilla 37.°6 C. (99.°7 F.) Skin feels moist, cool and relaxed. Has taken 20 
grains of quinine yesterd ly at the hours prescribed, and 10 grains this morning. 
Says that the quinine has had no unpleasant effect upon his head. Says that 
quinine does not affect his head unless he takes cold, and then his head will 
ring for even one month after. Tongue clean and pale; pulse 66; respiration 
16. The skin of the extremities looks pale and shriveled. Amount of urine passed 
during,the past24 hours, grs. 28,280.00. Sp. gr. 1010. Took the quinine at 6 A. M. 
and 9 A. M. This urine has, therefore, been passed under the action of 25 grains 
of quinine. Urine inclining to a a bright yellow, presenting the color of health. 
Free acid evidently diminished; urine passed contained free acid just sufficient to 
redden litmus. 
Analysis of urine passed during twenty-four hours, under quinine : 
Urine during 24 hours, under 
action of 25 Grains Quinine. 
Amount of urine, 24 hours, under quinine 28,280.00 
Urea 547.02 
Uric acid 2.80 
Free acid alkaline in a few hours. 
Phosphoric acid 30.10 
Sulphuric acid 31.48 
Chlorine 100.89 
Equivalent chloride of sodium 166.32 
August 2d, P. M.-Temperature of hand 37° C. (98.°6 F.) Temperature of 
axilla 37.°4 C. (99.°3 F.) Pulse 60, respiration 18. Skin cool, moist and relaxed. 
Tongue clear. Urine light colored. August 3d, 11 A. M. Temperature of hand 
36.°8 C. (98.°3 F.) Temperature of axilla 38.°2 C. (100. °8 F.) Pulse 86, respiration 
22. Has been walking about an hour or two before this observation ; however, 
caused the patient to lie down on his back for half an hour before counting the 
pulse. Tongue normal. Urine passed this morning higher colored than that 
passed yesterday. August 4th, 1J A. M. Has had no return of fever. Pulse 66, 
respiration natural. Temperature of trunk and hands normal. Amount of urine 
passed during the last forty-eight hours, grains 55,605.99. Light normal color. 
Specific gravity 1009. 
Analysis of urine passed during forty-eight hours: 
Analysis of Urine 
Computed average 
during 18 hours. 
of Urine each 24 hours. 
Grains. 
Grains. 
Amount of urine . 
.55.605.99 
27,802.99 
Urea 
. 891.66 
445.83 
Uric acid 
6.99 
3.49 
Free acid 
.alkaline in a few hours. 
Phosphoric acid - 
52.99 
26.49 
Sulphuric acid 
. 114.04 
57.02 
Chlorine 
89.31 
44.65 
Equivalent of chloride of sodium 
147.36 
73.68 
Phosphates of lime and magnesia, precipi- 
tated by ammonia 
20.94 
10.47 
Case 947. Intermittent Fever.-Shuman ; private, C. S. A.; age J8 ; height 5 
feet 7 inches; weight 127 lbs. Has been stationed at Causton's Bluff'(Cedar Hill 
Battery), near Savannah. In the latter part of June, 1862, had chills in camp at 
the Cedar Hill Battery, which were broken up by quinine. On the 10th of July, 
was seized with chills again, and has had a chill every other day, up to the time of 
his entrance into the Augusta General Hospital, July 20th, 1862. The patient says 
that during this last attack, has had no quinine and in fact no special medication, 
as the regiment has been on the move for Virginia. General Hospital, C. S., 
Augusta, Georgia, July 20th, 1862, 1 o'clock, P. M. The patient shows the effects 
of the malaria of the low grounds around Savannah, in his pale cadaveric counte- 
nance. Is now free of fever; pulse 71. Skin cool and moist. Tongue moist. 728 
Urine in Intermittent Fever. 
July 21st, 1 o'clock, P. M.-Had a chill this morning about sunrise, which con- 
tinued two hours ; I saw him at 10 o'clock, A. M., the fever had then set in, Com- 
menced collecting his urine at this time. At the present moment (1 o'clock, P. M.) 
skin hot. Patient complains of pain in his head. Pulse 130, respiration 36. Tem- 
perature of hand 40.°95 C. (105.°7 F.) Temperature of axilla 41.°6 C. (106.°9 F.) 
Tongue moist and soft, slightly coated with yellow fur. Urine passed during the 
fever, light yellow color. The odor of this urine was something like sweet briar, 
and this sample of urine when set aside, maintained this odor for weeks. After 
keeping the urine for days, there was little or no deposit and it did not undergo 
rapid change like the urine of the intermission. Specific gravity 1019. Amount of 
urine collected during twelve hours of high febrile action, grain's 4076.00. 
Analysis of urine passed during twelve hours fever : 
Urine during 1'2 
hours fever. 
Calculated ior 
24 hours. 
Amount of urine (12 hours) 
4,076.00 
8,152.00 
Urea 
86.85 
173.70 
Uric acid 
Undetermined. 
Free acid 
Phosphoric acid 
0.90 
1.80 
Sulphuric acid 
4.50 
9.00 
Chlorine 
26.55 
53.10 
Equivalent of chloride of sodium 
43.77 
87.54 
Phosphates of lime and magnesia 
1.15 
2.30 
Phosphatesand sulphates of potassaand sodium 1.73 
3.46 
We observe here, as in the preceding cases, a marked diminution of the phos- 
phoric acid and phosphates of potassium and sodium. 10 o'clock, P. M. Fever is 
nearly entirely subsided, and it may be said to be off. Pulse 96. Tongue moist, 
red at edges and slightly coated with fur. Skin feels cool and moist; the analysis 
of the urine just given, includes the urine collected up to this point. 
July 22d. Pulse 76. Skin cool, tongue clear. Fever has not returned. Urine 
of the intermission presents a much deeper color than that of the fever. This 
morning the patient took a purgative of ten grains of calomel, followed by a table- 
spoonful of oil; also quinine, ten grains were directed after the action of the purga- 
tive ; and in the evening it was ordered that five grains of quinine be administered 
at 5 A. M., 7 A. M. and 9 A. M. July 23d, 2 o'clock, P. AL Patient free of fever. 
Has taken fifteen grains of quinine this morning, as directed. Urine passed dur- 
ing the last twenty-four hours up to 2 P. M., July 23d, under the action of quinine 
and during the intermission of the fever, more highly colored than the urine of 
fever. Amount of urine collected during this period, grains 10,496.98. Specific 
gravity 1026. 
Analysis of urine passed during twenty-four hours of the intermission and 
under the action of 15 grains of quinine: 
Urine, 24 hours. 
Grains. 
Amount of urine 10,495.98 
Urea 557.56 
Uric acid 
Free acid 
Phosphoric acid 43.74 
Sulphuric acid..., 61.89 
Chlorine 8.38 
Equivalent chloride of sodium 14.10 
Phosphates of lime and magnesia 9.70 
Phosphates, sulphates, and carbonatesof potassa and soda (a 
portion of tbefixed saline constituents consisted of the 
carbonates of the alkalies) 76.90 
R. Saturated tincture of dogwood, f^xii; nitric acid, f^i; common salt, 
^viii; mix: administer f 3 ii of this mixture in half cup of water every four hours. 
Suck through a quill. 10o'clock P. Al. Free of fever, skin cool and moist. July 
24th, 2o'clock, P. M., pulse 70; respiration 20; temperature of hand 37.°6 C (99.°7 F . 
Temperature of axilla, 37.°8C (100°F.) Skin feels cool and moist. Commenced 
acid mixture this morning, and has taken only two doses. Urine of a deep orange 
red color, much deeper than the urine of fever. Amount of urine passed during 
the last twenty-four hours, grains 6,748.81. Specific gravity, 1021. Intermittent Fever: Investigations by Joseph Jones, M. D. 
729 
Analysis of urine passed during twenty-four hours of intermission of fever: 
Urine, 24 hours. 
Grains. 
Amount of urine 6,748 81 
Urea 327.48 
Uricacid 
Free acid 12.96 
Phosphoric acid 20.69 
Sulphuric acid 17.28 
Chlorine 7.95 
Equivalent chloride of sodium 13.10 
Phosphates of lime and magnesia 10.32 
Phosphates, sulphates and carbonates of soda and potassa... 15.46 
July 26th. Has had no return of fever. Pulse 72. Skin moist and cool. 
Tongue clean. Has been taking acid mixture of dogwood, (Cornus Fiorido) three 
times a day, half an hour before eating. Urine passed yesterday of a reddish color. 
Urine of this morning light yellow. Amount of urine passed during the past 
forty-eight hours, grains 23,218.11, sp. gr. 1017. 
Analysis of urine passed during forty-eight hours up to 2 o'clock, P. M., 
July 26th. 
Urine of 48 hours. 
Average Composites of 
Urine during 24 hours. 
Grains. 
Grains. 
Amount of urine 
23,218.11 
11,609.05 
Urea 
.................... 828.35 
414.17 
Uric acid 
Undetermined. 
Free acid 
32.46 
16.23 
Phosphoric acid 
54.44 
27.22 
Sulphuric actd 
29.10 
14.55 
Chlorine 
80.57 
40.28 
Equivalent chloride of 
sodium 132.82 
66.41 
Phosphates of lime and magnesia 27.50 13.75 
July 27th. Free of fever; tongue natural. Urine already abundant and of 
natural color; has had no return of fever. 
July 28th. Appears to be entirely well, in fact has been confined to his bed 
only a portion of the two first days, and his appetite has been very good. Tongue 
pale, moist and clear. Tongue' feels normal. Pulse 84 in the sitting posture. 
Urine light colored. Amount of urine passed during the past twenty-four hours, 
grains 31,221.90. Sp. gr. 1017. Moderately heavy deposit of phosphates and 
urates. 
Analysis of urine passed during forty-eight hours, upto 2 o'clock P. M., July 
28th: 
Urea of 48 hours. 
Grains. 
Average Capacity of 
Urine 24 hours. 
£ Grains. 
Amount of urine 
31221.90 
15610.95 
Urea 
Uric acid 
873.13 
Undetermined. 
436.56 
Free acid 
Phosphoric acid 
63.77 
31.88 
Sulphuric acid 
25.63 
12.81 
Chlorine 
161.35 
80.67 
Equivalent chloride of sodium 
265.72 
132.86 
Phosphates of lime and 
magnesia. 
28.83 
14.41 
This case in like manner illustrates the increase of phosphoric acid 
after the fever, and its diminution during the active stages of the fever 
following immediately after the chill. The changes in the chloride of 
sodium are also similar. In addition to the observations of a general 
character upon the case of Sharpe, as applicable to these changes in the 
urine, we may also surmise that the absence of the phosphates in the 
urine of fever may be due in part, at least, to the more rapid destruction 
of the non-nitrogenous elements, as fat and glycogen, during the fever 
than in the intermission, and hence the comparatively small amount of the 
phosphates. The less amount of urea in the urine of fever may in, like 730 
Urine in Intermittent lever. 
manner be referred in a measure to the more complete combustion of the 
elements. Still another fact which I think is brought out by these investi- 
gations, is that it requires time for the elimination of the products of the 
changes in fever They are gradually eliminated, as in the case of the 
products resulting from the altered blood-corpuscles. 
Case 948. Intermittent Fever.-Case of Troop; private C. S. A ; age 28; height 
5 feet 8 inches; black hair, black eyes; well built; moderately stout man; weight 
150 pounds; entered the General Hospital, Augusta, Ga., August 4th, 1862, with 
chill and fever. The fever yielded apparently to the use of quinine, and as he 
appeared to be much affwcted by the malarial poison (sallow complexion, pale, 
bloodless lips, etc.), the patient was placed upon a mixture of nitro-muriatic acid, 
sesquichloride of iron and quinine. The patient appeared to improve under this 
treatment for a time, but at the end of two weeks the chills returned again, notwith- 
standing that the tonicof iron had greatly increased the tone of the digestion and 
given the patient a'clear florid complexion. August 20th, 1862. Had a chill this 
morning, which was followed by some fever. The paroxysm, however, has been 
slight. 9 o'clock P. M. Fever declining and almost subsided. Pulse 88; respira- 
tion 24; pulse full and strong; skin warm. August 21st, 10 A. M. Free of fever, 
Pulse 74; respiration 20; tongue moist and but slightly furred. The preceding 
paroxysm was very slight. Urine passed during twenty hours of the height, 
decline and complete intermission of the fever, commencing from 1 o'clock P. M., 
July 20th, and ending at 10 o'clock A. M., July 21st, high colored. Sp. gr. 1014. 
Amount passed during this period, grains 16761.42. Have prescribed twenty 
grains of quinine this day. 
Analysis of urine passed during twenty hours, August 20th, 1 o'clock P. M., 
to August 21st, 10 o'clock A. M.: 
Urine of 20 Hours. 
Grains. 
Amount of urine 16761.42 
Urea Undetermined 
Uric acid.... Undetermined 
Free acid Undetermined . 
Phosphoric acid 34.64 
Sulphuric acid 25.21 
Chlorine 56.19 
Equivalent chloride of sodium 92.74 
Phosphates of lime and magnesia 0.48 
Phosphates, sulphates and carbonates of potassa and sodium 36.76 
B. Quinia, grs. v, at 7 A. M., 10 A. M., 12 M., 2 P. M. 
August 22d.-The quinine yesterday prevented the recurrence of a decided 
chill, but did not prevent the rise of the fever, and the fever continued quite warm 
during the night. This morning, about 10 o'clock, administered fifteen grains of 
quinine. This, together with the twenty grains taken on the preceding day, are 
now exerting their effects. Pulse 64, full and strong, but compressible; skin 
relaxed; in a great perspiration Amount of urine passed during the last twenty- 
four hours, grains, 23614.15. Sp. gr. 1007. Patient has a troublesome cough. 
Analysis of urine passed during twenty-four hours : 
Urine, 24 hours, August 
21st-22d. 
Grains. 
Amount of urine 23614.15 
Urea Undetermined. 
Uric acid Undetermined. 
Free acid Undetermined. 
Phosphoric acid 33.38 
Sulphuric acid 24.69 
Chlorine 52.74 
Equivalent chloride sodium 86.94 
Phosphates 10.08 
Phosphates of potassium and sodium and carbonates 2.45 
August 23d, 12 M.-Patient free of fever. Tongue clean ; skin pale and 
shrivelled. I have observed that after the profuse sweating produced by quinine, 
skin frequently presents this pale, shrivelled appearance. Pulse 76; respiration 
normal. Had some fever last night; it was not preceded by a chill, and did not Intermittent Fever: Investigations by Joseph Jones, M. D. 
731 
last long. Urine high colored. Sp- gr. 1020. Very heavy deposit of phosphates 
and urates in the urine after standing a short time. 
Analysis of urine passed during twenty-four hours, up to August 23d, 12 M.: 
I l ine passed during24 
hours. 
Grains. 
Amount of urine 10200.00 
Urea Uimvtermined. 
Uric acid Undetermined. 
Free acid Umh rermined. 
Phosphoric acid 43.41 
Sulphuric acid 23.41 
Chlorine 12.11 
Equivalent chloride of sodium 19.86 
Phosphates of lime and magnesia 9.46 
Phosphates, sulphates and carbonates of alkalies - 33.47 
Commentary.-The first analysis includes the urine of the height, 
decline and intermission of the fever, and hence we do not note the marked 
changes of this excretion, which were manifested in the preceding analyses. 
And we have in this observation a striking illustration of the value of 
examining the urine at different periods of the disease. The changes of 
the urine in even the apparently mildest caees of intermittent fever, are 
interesting, and, perhaps, as characteristic as those of continued fever; for 
the malarial poison, surely but slowly, undermines the constitution, destroy- 
ing the blood-corpuscles and deranging the liver and spleen, when the 
patient remains in the malarious region. Even apparently mild cases of 
the disease, if unchecked, and if the patient remains in the malarious 
atmosphere, may finally destroy the health and life. Whilst the quinine 
and tonics in this case did not entirely prevent the action of malaria or 
eradicate it from the system, at the same time they exerted important 
effects, and moderated the character of the fever and chill. 
Case 949.-Intermittent Fever.-Rodney, private C. S. A.; age 23; height 
5 feet 8 inches ; weight 130 lbs. Has been stationed during the summer near Caus- 
ton's Bluff, at the Cedar Hill battery. The Cedar Hill battery was located near 
the junction of St. Augustine Creek, with the Savannah river-fresh water river 
on one side, wiih its extensive fresh water marshes, and on the other a brackish 
creek, with brackish marshes. During the fab and winter of 1861, and during the 
entire year of 1862. the mortality amongst the Confederate soldiers stationed below 
Savannah and on the outskirts of the city was considerable, and especially in those 
regiments in which typhoid fever prevailed. As many as sixty died in a single 
regiment in the course of a few months. Typhoid fever, especially when engrafted 
upon the malarial constitution, was the most fatal form of disease. Measles also 
destroyed a number of the troops. So prevalent were climate fevers (bilious fever, 
intermittent and congestive fevers) during the fall months, that in some companies 
not two men were fit for duty, all prostrated by fever or the more slow action of 
the malarial poison. And towards the close of the season, the men who were 
retained in the most sickly stations, looked as if all the red blood-corpuscles had 
been washed out of their veins. This patient suffered with chills and fever during 
seven months of last year. During the latter part of June of this year, 1862, was 
taken again with chills, which lasted one week and were broken by quinine in 
the camps. Three days ago the chills returned in rhe quotidian form.. 
Entered the general hospital, Augusta, Ga., July 19th, 1862. The patient shows 
the effects of the malarious exhalations of the swamps in his sallow, cadaverous 
complexion and pale lips. July 20th, 1862, 11 o'clock A. M. Pulse 76; skin of 
hands and trunk feels cool ; respiration very nearly natural. Shortly after this 
observation the fever rose. The cold hands and feet and the cool trunk indicated 
the cold stage of intermittent fever. It is important to note that during the depres- 
sion of temperature in the trunk and in the extremities, there was no trembling, 
shivering of the muscles, and chattering of the teeth, as in a real chill, when the 
trunk is warm and the extremities cold. Such observations correspond with the 
phenomena of congestive fever, and show that the shaking in chills is due mainly 732 
Urine in Intermittent Fever. 
to the difference of temperature between the extremities and trunk. At 10 o'clock 
P. M., his pulse was 110, and the skin hot and dry. 
Commenced to preserve his urine at 12 M. just after the rise of the fever. B.- 
Cold water ad libitum. July 21st, 1 o'clock P. M. Pulse 100; respiration 24; tem- 
perature of hand 36.°8 C. (98.°3 F.); temperature of axilla 40.°8 C. (105.°5 F.) Trunk 
feels hot, whilst the extremities feel merely warm. The skin of the extremities 
shows the appearance called goose-flesh. The phenomena resemble those of chill, 
but there is no regular shivering, the appearance of goose-flesh upon the surface is, 
however, very interesting. Amount of urine passed during 24 hours, from July 
20th, 1 o'clock P. M., to July 21st, 1 P. M., during chill, feverand intermission 
of quotidian, grains 10.705.64. 
Analysis of urine during 24 hours: 
Urine during 24 hours chill, fever 
and intermission quotidian. 
Grains. 
Amount of urine 10,70 s.64 
Urea 510.67 
Uric acid 6.59 
Free acid . 13.02 
Phosphoric acid 32.94 
Sulphuric acid '. 34.12 
Chlorine 10.67 
Equivalent chloride of sodium 17.49 
Phosphates of lime and magnesia 1.70 
Phosphates and sulphates of sodium and potassium 47.56 
B.-As soon as the fever declines give 5 grains of quinine every three hours up 
to grs. xv. 
9 o'clock P. M. Pulse 96; feyer declining; patient sweating all over. Has 
taken one dose of quinine (5 grs.) one hour ago. Has passed but little urine. B. 
Continue quinine grs. v, every three hours, up to grains xv. July 22d, 9 o'clock P. M. 
Chill came on about 6 o'clock P. M., three hours ago. At the present time has 
fever. Pulse 108. This morning and during the latter part of last night there was 
a clear intermission of the fever, and during this time the patient took 15 grains 
of quinine. Amount of urine passed during 12 hours of the intermission of the 
fever, grains 4080. Sp. gr. 1022. Orange colored. Heavy deposit after standing a 
few hours. 
Analysis of urine during 12 hours of the intermission of quotidian malarial 
fever: 
Urine during 12 hours. 
Urine during 24 hours. 
Grains. 
Grains. 
Amount of urine 
4080. 
8160. 
Urea 
196.86 
393.72 
Uric acid 
undetermined 
Free acid 
undetermined 
Phosphoric acid 
9.08 
18.16 
Sulphuric acid 
12.42 
24.84 
Chlorine 
4.27 
8.54 
Equivalent chloride sodium 
6.99 
13.98 
Phosphates 
9.32 
Phosphates and sulphates of alkalies 8.01 
16.02 
July 23d, 2 P. M.-Free of fever. Pulse 80 ; skin cool ; has taken 15 grains of 
quinine this morning, in three doses of five grains each. Temperature of hand 
137°C. (98.°6 F.); temperature of axilla 37. °5 C. (99.°5 F.) Amount of urine col- 
lected during the past twenty-four hours, includingchill, feverand completed inter- 
mission up to 2 o'clock P. M.-Grains 8763.40. Sp. gr. 1019; deep reddish color. 
This represents also the urine passed during the action of quinine. 
Analysis of urine collected during twenty-four hours' 
Urine during 2-1 hours. 
Grains. 
Amount of urine 8763.40 
Urea 407.66 
Uric acid not determined. 
Free acid " 
Phosphoric acid 9.99 
Sul ph uric aci d 28.16 
Chlorine 8.14 
Chloride of sodium 13.36 
Phosphates lime and magnesia 6.29 
Saline constituents (ohosphates, sulphates of soda and potassa 6.44 Intermittent Fever : Investigations by Joseph Jones, M. D. 
733 
P. M.-Free of fever. Pulse 80; skin cool and moist. R. Tincture of dog- 
wood, f5 xii; nitric acid, f^i; common salt, 5 viii; mix: tablespoonful in cup of 
water every four hours sucked through a quill. July 24th, 1 P. M.-Clear of fever. 
Has taken three doses of his acid mixture. Pulse 84, respiration 20, temperature of 
hand 36.°2C., (97.°2 F.); temperature of axilla 37. °8 C., (100.°l F.) Patient says that 
he had a very light chill yesterday morning; rested well during the night and had 
no fever. Appetite very good and improving daily. Amount of urine collected 
during the last twenty-four hours, up to July 24th, 2 P. M.: Grains 9430.2 ; sp. 
gr. 1044. The reaction of the urine at the end of twenty-four hours was alkaline, 
up to this time it has been acid. 
Analysis of urine during intermission of quotidian fever and under the action 
of acid mixture. 
. Urine of 24 hours. 
Grains. 
Amount of urine 9430. 
Urea 335.23 
Uric acid not determined 
Free acid " " 
Phosphoric acid 8.46 
Sulphuric acid 23.60 
Chlorine 8.70 
Equivalent chloride of sodium 12.80 
Phosphates of lime and magnesia 8.53 
Phosphates, sulphates and carbonates sodium and potassium 
July 26th. No return of fever. Pulse 76, skin cool, urine orange color and not 
abundant. Amount of urine collected during the last thirty-six hours: Grains 
13,486.20. 
Analysis of urine during thirty-six hours : 
Urine of 36 hours, 
ur 11 1 i. 
Amount of urine 18,486.20 
Urea 400.02 
Uric acid not determined. 
Free acid not determined. 
Phosphoric acid 12.35 
Sulphuric acid 14.60 
Chlorine 9.79 
Equivalent chloride sodium ? 16.06 
Phosphates of lime and magnesia 6.94 
Phosphates and sulphates of potassium and sodium 9.43 
July 27th. Still free of fever. Tongue clear and moist and of natural color; urine 
more abundant and approaches more nearly the normal color. July 28th. Con- 
tinues to improve ; has had no return of fever, and is still taking the acid mixture 
of dogwood. Amount of urine passed during the last forty-eight, hours: grains 
31720.5; sp. gr. 1007, normal in color. After standing twelve or more hours let free 
a heavy deposit of urates and phosphates which coated the sides of the bottle with 
a heavy crust. 
Analysis of urine during forty-eight hours : 
Urine of 48 hours. 
Grains. 
Amount of urine 31720.50 
Urea 408.80 
Uric acid 
Free acid 
Phosphoric acid 52.29 
Sulphuric acid 21.72 
Chlorine 54.66 
Equivalent chloride of sodium 89.55 
Phosphates of lime and magnesia 9.71 
Sulphates and phosphates of potassium and sodium 50.45 
Case 950. Intermittent Fever-I.evert, private C. S. A.; age 43; height 5 feet 
8 inches; weight 145 pounds; dark complexion; black hair and dark eyes; native 
of Cuba. Entered General Hospital, Augusta, Ga., July 19th, 1862. This morn- 
ing at 10 o'clock, had a chill which was followed by a hot fever. 
" July 20th, 11 A. M.-Pulse 82; skin of hands and trunk cool; urine passed dur- 
ing the last twelve hours deep red. 9 o'clock P. M. Pulse 82; skin hot and dry; 
tongue coated with dry brown fur. 734 
Urine in Intermittent Fever. 
July 21st, 11 A. M.-Pulse 88; respiration 35; temperature of hand (41° C.) 
105.°8 F.; temperature of axilla 41.°2 C (106.°2 F.); tongue slightly coated with fur. 
R. Calomel, grains x; quinine, grains vi; mix: administer at once, and follow 
with castor oil in four hours; as soon as the calomel and oil have acted three 
times, or freely, give quinine, grains v, every three hours up to grains xx. 
Amount of urine passed during forty-eight hours, from July 19th, 12 M., up to 
July 21st, 12 M., grains 18629.40; sp. gr. 1018. 
Analysis of urine collected during forty-eight hours July 19th, 12 M., to July 
21st, 12 M.: 
Urine 48 hours. 
Urine 21 hours. 
Grains. 
Grains. 
Amount of urine 
18629.04 
9314.07 
Urea 
703.32 
351.66 
Uric acid 
511 
2.55 
Free acid 
35.82 
17.91 
Phosphoric acid 
38.63 
19.31 
Sulphuric acid 
43.21 
21.60 
Chlorine 
10.02 
5.01 
Equivalent chloride of sodium 
16.44 
8.22 
Phosphates of lime and magnesia... 
5.11 
2.55 
Phosphates of potassium and sodium and 
sulphates 
101.74 
50.87 
9 o'clock, P. M. L'he medicine has acted several times. The free action of the 
medicine has been attended with almost complete remission of the fever. Skin is 
now cool and in a profuse perspiration. During the action of the medicine the 
patient has been unable to preserve his urine. Pulse 84. The conjunction of the 
quinine with the purgative appears to be highly beneficial, because the quinine is 
absorbed in the stomach entirely, whilst the calomel exerts its effects in unloading 
the portal system and relieving the liver, which is engorged with blood, and not 
only engorged, but the blood is altered and disintegrating. 
July 22d, 9 o'clock P. M.-Has been free of fever during the night and day. 
Pulse 80; tongue red at edges and slightly coated with fur. Has taken thirty 
grains of quinine since the free action of the medicine, fifteen grains during the 
night, and fifteen grains this morning. The action of the medicine during the 
night prevented the saving of the urine; commenced collecting his urine again at 
8o'clockA.M. July23d,2o'clock, P. M.; pulse 76; surface feels cool. Temperatureof 
hand 38° C. (100.°4 F.); temperature of axilla 38.°8 C. (101. °9 F.) Tongue coated 
slightly, but much les# red. Amount of urine passed during the last thirty hours, 
under the action of thirty grains of quinine, grains 19903.60. Urine of a much 
lighter color. (Dogwood mixture as prescribed in the preceding cases). 
Analysis of urine passed during thirty hours : 
Urine passed during 30 hours. 
Grains. 
Amount of urine 19903.60 
Urea 965.00 
Uric acid 
Free acid 
Phosphoric acid 43.15 
Sulphuric acid 131.46 
Chlorine 5.14 
Chloride of sodium 8.43 
Phosphates of lime and magnesia 3.24 
Phosphates and sulphates of sodium and potassium, con- 
sisting chiefly of pofassa, salts-carbonates potassa 76.57 
July 24th, 1 P. M.-Has taken three doses of the acid dogwood mixture. 
Patient says that he feels very well and has a good appetite. Pulse 66; respiration 16; 
temperatureof hand 36.°8 C.'(98.°3 F.); temperature of axilla 38.°25 C. (100.°9 F.) 
Tongue clean and moist. Urine much lighter color; sp. gr 1012. Amount of urine 
passed during the last twenty-four hours, up to 1 o'clock P. M., grains 15918.76. 
Analysis of urine passed during twenty-four hours, up to July 24th, 1 P. M.: 
Urine 24 hours. 
Grains. 
Amount of urine 15918.76 
Urea 617.60 
Uric acid 
Free acid .' 7.72 Intermittent Fever: Investigations by Joseph Jones, M. D. 
735 
Phosphoric acid 24.90 
Sulphuric acid 50.30 
Chlorine 6.99 
Equivalent chloride of sodium 11.47 
Phosphates of lime and magnesia 9.11 
Phosphates, sulphates and carbonates of potassium and 
sodium 34.53 
July 25th.-Continues to improve; continues to take the dogwood mixture. 
Amount of urine passed during the past twenty-four hours, grains, 15950.22. Urine 
orange colored. Sp. gr. 1014. 
Analysis of urine passed during twenty-four hours : 
Urine, 24 hours. 
Grains. 
Amount of urine 15950 21 
Urea 617.60 
Uric acid 
Free acid 
Phosphoric acid 29.67 
Sulphuric acid 17.66 
» Chlorine 10.37 
Equivalent chloride of sodium 17.00 
Phosphates of lime and magnesia 12.99 
Phosphates, sulphates and carbonates of potassium and 
sodium , 7.50 
July 26th.-Continues to improve. Has been up and dressed since the second 
day. Has had but little appetite until the two last days. Has been taking, and 
continues to take, the acid-dogwood mixture. Pulse 60; respiration 12. Tongue 
much paler, and but slightly coated. Urine orange colored. Sp.gr. 1019. Rapidly 
becomes alkaline after being voided, and lets fall a heavy deposit. Amount of 
urine passed during the last twenty-four hours, grains, 11209.00. 
Analysis of urine passed during twenty-fours, in grains (troy): 
Urine, 24 hours. 
Grains. 
Amount of urine 11209.00 
Urea 518,78 
Uric acid 
Free acid 
Phosphoric acid 34.76 
Sulphuric acid 26.41 
Chlorine 23.77 
Equivalent chloride sodium 38.98 
Phosphates 13.64 
Phosphates, sulphates and carbonates of sodium and potassa, 
chiefly potassa salts 
July 28th.-Patientsays that he feels restored to his usual health. Temperature 
of extremities and trunk normal. Pulse 68. Urine of yesterday lightstraw color; of 
this day of a deeper shade. Sp. gr. 1010. Amount of urine passed during the last 
forty-eight hours, grains, 46056.00. 
Analysis of urine passed during forty-eight hours : 
Urine, of 48 hours. 
24 hours. 
Grains. 
Grains. 
Amount of urine 
46056.00 
23028. 
Urea 
1224.73 
612.36 
Uric acid 
Free acid 
Phosphoric acid 
63.59 
31.79' 
Sulphuric acid 
47.07 
23.53 
Chlorine 
134.89 
67.44 
Equivalent chloride of soda 
221.58 
110.79 
Phosphates of lime and magnesia 
18.92 
9.04 
Phosphates, sulphates and carbonates 
of 
sodium and potassium 
20.08 
10-04 
In this comparatively severe attack of malarial fever the urine was 
greatly increased. This case, in like manner, illustrates the importance of 
studying the urine of different periods. 736 
Urine in Intermittent Fever. 
Case 951. Intermittent Fever -Case of intermittent fever, running into remit- 
tent, and the patient falls into the state sometimes denominated "typhoid." Gen- 
eral Hospital, C. 8. A., Augusta, Georgia. E. Lenard, private; native of Laurens 
County, Ga.; has been living in Leon County, Florida, for four years. Has been 
in the provisional Army of the Confederate States, since May 15th, 1862. Has had 
repeated attacks of chill and fever fora number of years. About six years ago, had 
pneumonia. Age 28 ; height 5 feet 8 inches ; weight 134 lbs. Brown hair, bluish- 
gray eyes ; fair complexion. Entered the Confederate General Hospital, Augusta, 
Ga., August 4th, 1862, with high fever, which had been preceded by a chill. Had 
a chill for three days, following each other at regular intervals, the chills coming 
on chiefly in the evening ; the fever then assumed the remittent type, without any 
special recurring periods which could be characterized by the term chill. At the 
same time, however, there was a depression of the temperature and diminution of 
the frequency of the pulse at stated periods. 
The free administration of cold water during the height of the fever, and of 
quinine during the remissions, diminished the force of the fever, but the effects of 
the disease were so lasting, that notwithstanding the moderation of the febrile 
excitement, the patient remained in an exceedingly debilitated and feeble condi- 
tion. Bowels occasionally very loose; pulse exceedingly feeble, and at times it 
could scarcely be felt; tongue very dry and red at the edges, and coated with brown 
fur in the centre. Spleen greatly enlarged. Muscular and nervous forces greatly 
reduced; unable to sit up. Patient greatly depressed in spirits; countenance 
anxious and distressed. 
This case resembles in many respects one of typhoid fever, but differs from this 
disease in several respects : 
1st. The countenance is pale and more sallow, and there is not so much con- 
gestion about the skin, as is usual in typhoid fever. 
2d. The rose-colored spots (eruption'), characteristic of typhoid fever, are 
absent. 
3d. The intellect is clear. 
4th. There is no twitching of the muscles, as in typhoid fever. 
5th. The eruption and sudamina so often, if not universally present in typhoid 
fever, have never appeared in this patient. 
6th. The urine does not present the uniform characters of typhoid fever, but 
has during the course of this disease varied with the changing state of the disease. 
7th. The history of this case, in its origin and progress, was clearly malarial. 
8th. Quinine exerted a most beneficial effect. 
9th. The spleen is enlarged, and the liver torpid, as is manifested more espe- 
cially in the sallow complexion. 
Another case of climate fever was treated and carefully examined in this hos- 
pital about the same time, which presented very much the same symptoms. A 
strong athletic Mississippian (Dollaheit), had been exposed to great changes of 
climate, in coming from the northern portion of Mississippi to Mobile, on the Gulf 
coast of Alabama, and from thence to Augusta, during the summer of 1862. This 
exposure to the malaria of the rich low lands and swamps of Mississippi and Ala- 
bama, caused an attack of congestive fever, with a comatose tendency. This patient 
was brought into the general hospital in Augusta, from his regiment then on its 
way to Virginia, in an almost insensible'condition. Large doses of quinine, car- 
bonate of ammonia and alcoholic stimulants, rescued the patient from the insensi- 
ble and dangerous congestive stage, and prevented the recurrence of the paroxysm, 
but he continued feeble, unable to walk, with feeble thready pulse, cold extremi- 
ties, and complete nervous and muscular prostration for near two weeks. The 
patient lay in a listless state, incapable of mental or bodily exertion. Quinine, 
quassia, stimulants, mineral acids and iron, with frictions of turpentine, salt, cam- 
phor and brandy, were finally successful in restoring this patient to his usual 
health, but the improvement was so slow at first that during the first two or three 
weeks, we could scarcely note the changes from dav to day. In such cases as this 
and the one now under consideration, the malarial poison has produced such pro- 
found changes in the blood, spleen and liver, that the nervous and muscular 
powers are prostrated, and time is needed for the complete regeneration of the 
organsand tissues. August 20th, 12 o'clock M. Pulse 98; respiration 24; tem- 
perature of hand 39° C. (102. °2 F.); temperature of axilla 40°.4 C. (1O4.°8 F.); tongue 
which has been heavily coated with yellow fur, is now cleaning off, his pulse is 
also much fuller and stronger. August 21st. Pulse 84; skin cool, both on the 
extremities and trunk. Fever went off with a profuse sweat. Urine highly colored. 
Quinine is still freely administered daily. August 22d. Temperature of hand Intermittent Fever: Investigations by Joseph Jones, M. D. 
737 
37°.1 C. (98.°8 F.): temperature of axilla 38.°5 C. (101.°4 F.) Amount of urine 
passed during the last 48 hours, grains 27,100.5 (c.c. 1710). Sp. gr. 1015. Patient 
says that he has carefully preserved the w'hole amount during this time. 
Analysis of urine passed during forty-eight hours: 
Urine passed 
during 48 hours. 
Grains. 
Urine passed 
during 24 hours. 
Grains. 
Amount of urine 
27,100.05 
13,550.25 
Urea 
Urie acid 
k I 
* I 
Free acid 
I 4 
Phosphoric acid 
78.34 
39.17 
Equivalent of phosphorus 
34.38 
17.19 
Sulphuric acid 
71.36 
33.78 
Equivalent of sulphur in sulph. acid... 
28.55 
14.27 
Chlorine 
13.37 
6.68 
Equivalent of chloride of sodium 
21.93 
10.96 
Phosphates lime and magnesia 
9.93 
4.96 
Phosphates, sulphates and carbonates potassa 
and soda 
45.60 
22.80 
August 23d.-Continues without fever; bowels somewhat troublesome during 
the night. Temperature of the trunk and extremities, and the pulse and respira- 
tion the same as yesterday. Tongue quite clean. Took ten grains of quinine this 
morning. Patient exceedingly weak. Urine high colored. Specific gravity 1017. 
Amount of urine passed during the last twenty-four hours, grains 10,485.37. 
Analysis of urine passed during twenty-four hours : 
■ Urine passed during 
J 24 hours. 
Grains. 
Amount of urine 10,485.37 
Urea not determined. 
Uric acid " " 
Free acid " " 
Phosphoric acid 28.37 
Equivalent of phosphorus 12.45 
Sulphuric acid 22.33 
Equivalent of sulphur 8.93 
Chlorine 4.87 
Chloride of sodium 8.01 
Phosphates of lime and magnesia 5.71 
Phosphates, sulphates and carbonates soda and potassa 30.80 
Case 952. Intermittent Fever, illustrating the effects of the long-continued, 
action of the Malarial Poison- Warren Byrum; Confederate soldier; age 17; 
native of Pierce County, Ga. Slight frame; pale cadaverous complexion. Light 
hair, blue eyes, sallow freckled face; pale bloodless lips and tongue. Has been 
stationed during the winter and summer, near Savannah, at the Spring Hill Bat- 
tery. Has had chills and fever for one month. In his case, as in many others, no 
medicine, except an occasional purgative, has been administered in camp. Many 
of the soldiers around Savannah, did not intermit their duties, except just at the 
time of the paroxysm of chill and fever. Towards the fall of the year, these men, 
as in the present case, showed the effects of these repeated chills, in their pale, 
cadaverous countenances, bloodless lips and sallow countenances. Since entering 
the Augusta General Hospital on the 19th of July, 1862, although this young 
soldier has taken no quinine, has, nevertheless, missed his chill. 
General Hospital, Augusta, Ga., July 24th, 1 o'clock, P. M.-Pulse 96, respira- 
tion 24. Temperature of hand 38.°6 C. (101.°5 F.) Temperature of axilla 38.°8 C. 
(101.°9 F.) This patient presents the true malarial hue-sallow, cadaverous coun- 
tenance, bloodless lips and tongue. The pulse gives a sharp, quick impulse, as if 
some fluid like water was circulating in the blood-vessels. The red blood-corpus- 
cles cannot in this patient, be more than one-fourth the normal numbers. During 
the passage of the blood through the heart and large arteries, a loud rushing sound 
is heard, in auscultation. This sound is also distinguished in the jugular veins. 
Urine light greenish-yellow'color. Specific gravity 1010. Amount passed during 
last twenty-four hours, 620 c.c. Free acid in 20 c.c.-27 milligrammes. PO5 in 25 
c,c.=0.151417+2.8. Urine in 10 c.c.-210 milligrammes. Chloride of silver precipi- 
tated for 30 c.c.-grains 3.1. Sulp. bar. precipitated 30 c.c.-grains 1.55. 738 
Urine in Intermittent Fever. 
Analysis of urine passed during twenty-four hours: 
Grains. 
Amount of urine 9,776.80 
Urea 197.12 
Uric acid not determined. 
Free acid 12.52 
Phosphoric acid 10.59 
Phosphorus in phosphoric acid 4.61 
Sulphuric acid 11.16 
Equivalent sulphur in sulphuric acid 4.46 
Chlorine 15.96 
Equivalent chloride of sodium 27.25 
July 25th. Amount of urine passed during last twenty-four hours, 1150 c.c. 
Specilic gravity 1010. 
Analysis of urine collected during 24 hours : 
Grains. 
Amount of urine (1150 c.c.) 18,1^0 
Urea 318.78 
Uric acid 
Free acid 7.02 
Phosphoric acid 10.59 
Sulphuric acid 8.14 
Chlorine 28.38 
Equivalent chloride of sodium 46.53 
July 26th. Yesterday administered 15 grains of quinine in three doses, after 
the collection of the urine in the preceding analysis. The following sample of 
urine, therefore, was excreted under the action of 15 grains of quinine. Amount 
of urine passed during 24 hours under the action of 15 grains of quinine, 1140 c.c. 
Sp. gr. 1008=grains 17,942.46. 
Analysis of urine: 
Grains. 
Amount of urine pissed during 24 hours , 17,942.46 
Urea 228.22 
Uric acid 
Free acid 
Phosphoric acid 3.87 
Sulphuric acid 10.42 
Chlorine 24.87 
Equivalent chloride of sodium 40.78 
July 27th. Amount of urine passed during the last 28 hours, 2300 c.c. Sp.gr. 
1008. Yellow color. Let fall a deposit of phosphates and urates in 12 hours. 
Analysis (urine 28 hours) collected in 24 hours : 
Grains. 
Amount of urine in 24 hours=2000 c.c 34,479 
Urea 492.80 
Uric acid 
Free acid 
Phosphoric acid 10.47 
Sulphuric acid 13.94 
Chlorine 
Equivalent chloride of sodium 92.40 
R.-Citrate of iron 3 ij; quinine £i, water fgxij; mix: tablespoonful three times 
a day. July 28th. Amount of urine passed during last 22 hours, since commencing 
the citrate of iron and potassa, 1250 c.c. Light yellow color. Sp. gr. 1005. 
Analysis of urine 22 hours and 24 hours : 
Grains. 
Amount (24 hours, 2145.18) 22 hours 19,597.50 
Urea 229.36 
Uric acid 
Free acid 
Phosphoric acid 9.24 
Sulphuric acid... 
Chlorine 
Chloride of sodium 133.99 Intermittent Fever; Investigations by Joseph Jones, M. D. 
739 
Measles were prevailing amongst the Confederate troops, and we 
record the following analysis of the urine in a case of well marked measles 
for purposes of comparison: 
Case 953.-Illustrating the Composition of the Urine in Measles.-General Hos- 
pital C. S., Augusta, Ga. Confederate soldier, native of South Carolina; stout 
athletic man ; height 5 feet 9 inches ; stout, well developed chest; florid complex- 
ion. July 26th, 1862. Entered the Augusta hospital with a fully developed crop 
of measles; eruption well developed; eyes watery; voice hoarse; pulse 102; hot 
fever. The cough as is usual, after the appearance of the measles has subsided 
almost entirely. July 27th. Pulse 96; tongue soft and but slightly coated. July 
28th, 12 o'clock M. Pulse 84; respiration 24; temperature of hand 39,°2 C. (102,°5 
F.); temperature of axilla 39.°7 C. (1O3.°5 F.) Amount of urine passed during 48 
hours, from July 26th, 12 o'clock M., to July 28th. 12 o'clock M., grains 23,369.92. 
Sp. gr. 1024. Urine red colored ; strong acid reaction. 
Analysis of urine passed in case of measles just after the appearance of a most 
full and perfect eruption during forty-eight hours: 
48 hours. 
24 hours. 
Grains. 
Grains. 
Amount of urine 
23,369.92 
11,684.91 
U rea 
1,622.40 
811.20 
Phosphoric acid 
79.17 
39.58 
Sulphuric acid 
51.70 
25.85 
Chlorine 
56.72 
28.36 
Equivalent chloride sodium 
90.66 
45.33 
We observe a marked increase in the amount of urea, during the 
febrile stage of measles. There is also an increase of the phosphoric and 
sulphuric acids, and a diminution of the chloride of sodium. The dimi- 
nution of the latter constituents is however, not so great as in pneumonia, 
notwithstanding the great irritation of the bronchial tubes which charac- 
terizes measles. In measles the diminution of the chloride of sodium must 
be referred chiefly to the loss of appetite, and the diminished amount of 
food injested. Observations on the urine in small-pox, Pymmia Hospi- 
tal gangrene and typhoid fever will be recorded in the appropriate sec- 
tions of this work. The field of observation was enlarged, so as to 
embrace the sick of the Confederate Army, in Virginia, South Carolina and 
Georgia. The following communication from the author to Dr. S. P. 
Moore, Surgeon General of the Confederate Army, written in Charleston, 
South Carolina, on the 16th of October, 1863, will give a general idea of 
the objects sought to be accomplished by a careful and extended investiga- 
tion of the nature and relations of various fevers. 
INVESTIGATIONS ON THE NATURAL HISTORY AND RELATIONS OF MALARIAL, 
PAROXYSMAL AND CONTINUED FEVERS, AS THEY MANIFESTED THEM- 
SELVES IN THE ARMY OF THE CONFEDERATE STATES OF AMERICA, BY 
JOSEPH JONES, M. D., DURING THE AMERICAN CIVIL WAR, 1861-1865. 
Letter of Surgeon Joseph Jones, M. D., P. A. C. 8. to Surgeon General 
8. P. Moore, M. D., C. 8. A., relative to Fevers. 
(Copy) Charleston, South Carolina, October 16th, 1863. 
Surgeon General S. P. Moore, C. S. A., Richmond, Virginia. 
Sir:-T have the honor to offer to the Surgeon General the following 
report of my labors from September 3d to the present time. Immediately 
after the presentation to the Surgeon General of the report of my labors in 
the General Hospitals in Richmond, I visited the Hospitals at Gordons- 
ville, Charlottesville and Lynchburg, with the design of subjecting the 740 
Natural History and Relations of Malarial Paroxysmal Fevers. 
results contained in my First Report on Tetanus and Typhoid Fever, to a 
rigid examination, and test, by extending the investigation to the largest 
possible number of cases in non-malarious regions. 
At Charlottesville, in the elevated region of Piedmont, Virginia, I 
enjoyed good advantages for the investigation, and was enabled to select 
typical cases of uncomplicated typhoid fever, suitable in all respects for 
the critical study of the characteristic phenomena of the disease. In the 
investigations I was most ably supported by Surgeon Davis of the Univer- 
sity of Virginia, and the intelligent Surgeons of the General Hospital at 
Charlottesville. It gave me satisfaction that I was able to demonstrate in 
the presence of these surgeons the results embodied in my First Report on 
Typhoid Fever. Other subjects, as the character, relations and existence 
of the fevers set down upon the Hospital and Field Reports as Typhus and 
Common Continued Fevers, engaged my attention. The results of these 
labors will be presented to the Surgeon General, as soon as they can be 
placed in the proper form. After closing these investigations, I was pre- 
vented by the occupation by the enemy of the railroad, from fulfilling my 
original plan of visiting the Army of Tennessee, and returned through 
Richmond, to the Department of South Carolina and Georgia, and com- 
menced my labors around and in Charleston. It was considered impor- 
tant that I should be present in this low malarious region during the last 
and most unhealthy months of the fall, that the attempt might be made 
to establish the relations of typhoid fever to remittent fever, and especially 
to the typhoid stage of remittent fever. If the view held by many surgeons 
be taken, that remittent fever of malarious origin can be converted by an 
actual change into typhoid fever, the whole theory and classification of 
fevers must be changed. The establishment of the transmutation of a dis- 
ease due to malarious poison, into another excited by a different poison, 
would produce the same derangement in the classification of disease that 
would follow the establishment of the proposition that measles may be con- 
verted into small-pox. 
The results of these, as well as of many other inquiries connected with 
the diseases of the army, in this malarious region, will be presented to 
the Surgeon General at the earliest practicable moment. I have to regret 
that the continuous exertions, together with the sudden change from the 
elevated regions of Piedmont, Virginia, to this low malarious plain, have 
seriously impaired my strength, and subjected me to the effects of mala- 
ria, and thus rendered my labors in this department less extensive and 
energetic than I desired. By the early aud energetic use of quinine, how- 
ever, my fever was arrested, aud by keeping the system under its influence 
I haye been able to prosecute my labors continuously up to the limits of 
my strength, even in positions where I was still subjected to the cause of 
the original attack. 
If from a want of sufficient health and strength, or from any other 
cause, not under my control, the important questions now under investi- 
gation should not be settled in accordance with the judgment of the Sur- 
geon General, I will beg the privilege of again resuming them next fall in 
Charleston, Savannah or Mobile. 
* * Immediately upon my return to Augusta, Georgia, I will for- 
ward the " Inquiries to the Medical Officers of the Confederate Army," 
according to directions of the Surgeon General. 
Very respectfully, your obedient servant, 
JOSEPH JONES, M. D., 
Surgeon P. A. C. S. The Last Days of Battery Wagner. 
741 
The nature of the service performed by the Confederate troops serving 
in and around Charleston, South Carolina, during the memorable defense 
of this place by General G. T. Beauregard, of the Confederate Army, is 
well and graphically illustrated by the following account of the Last days 
of Battery Wagner-an earthwork which played an important part during 
a portion of the siege of this historic city. The writer, Rev. A. F. Dick- 
son, Chaplain of the Eutaw Regiment, Twenty-fifth South Carolina Volun- 
teers, was personally known to the author as a gentleman of learning and 
high character. 
Ever since my departure from that famous place, a few hours previous to its 
evacuation, it has been my purpose to gratify the anxious desire of the country for 
some more minute and full details of the closing scenes, than have yet been fur- 
nished; but itisvery difficult to overcome the reluctance one feels to recall the 
horrors of such a period, and to live over again the most terrible moments of his 
life. This must account for the tardiness with which these imperfect sketches 
make their appearance. 
Battery Wagner is a high crescent-shaped work, with the bulge of the crescent 
facing south; towards the enemy, and the interior of the curve filled with still 
higher mounds of sand and sand bags, covering the cluster of the bomb-proofsand 
covered ways which were used as barracks, magazines, and hospital, the enclosure 
being completed by a work in the rear. The distinction between covered ways 
and bomb-proofs, is merely that between passages and rooms. These caverns were 
built thus: stout, short pine logs, about two feet in thickness, were setupright, 
side by side, touching each other. Across from top to top of these, other similar 
logs, roughly hewn, were laid, and the whole covered by eight or ten feet of sand. 
This makes a covered way about seven feet high within, and from six to ten feet 
wide. The walls of the bomb-proof began with a height of only four or five feet, 
and the covering timbers slope up from them. If the room were a large one, as in 
the case of the hospital, at right angles to these standing roof-timbers, and just 
under them'ran a huge square log, supported against the roof by pairs of pillars, 
planted several feet apart on the ground, and butting their heavy heads together 
above. Each pair of pillars was about four feet from the next pair under the same 
square log, and the foot of each standing pillar under one log was planted against 
the standing pillar under the next log. But right down the centre ran a sort of 
aisle, uninterrupted by any supports, about twelve feet wide. 
This room, the hospital, was by far the best ventilated part of the fort. The 
bomb-proofs, as a rule, were foul places to breathe in, dark, close, crowded, hot. 
But to have opened them freely to the air, would have been to open them freely to 
theshells also. The best praise of the construction is, that nobody was killed in a 
bomb-proof, from first to last, and but few wounded, even in the covered ways. 
The last garrison of Battery Wagner (and that is destined, doubtless, to be a 
famous phrase) was composed of two Georgia regiments (named first, because they 
went there first, the Twenty seventh and Twenty-eighth, commanded by Major 
Gardner and Captain Crawford, respectively the Eutaw regiment (Twenty-fifth 
S. C. V.), Lieutenant Colonel Bressley-a company of the First Infantry, regulars, 
acting asartillery, CaptainHugueniu, and two companies of the Palmetto Battalion, 
S. C. Artillery, Captains Johnson and Kanapaux. Colonel Keitt was in com- 
mand, Major Bryan, of General Beauregard's staff, acting adjutant, and Captain 
T. Lee, engineer, and Lieutenant Mazyek, ordnance officer. Major Warley, 
Second South Carolina Artillery, commanded the artillery till he was wounded; 
after him. Captain Huguenin. The Eutaw regiment, to which the writer is 
attached, was ordered to Battery Wagner on Tuesday night, September 1st, but 
was prevented from arriving there in full numbers that night, by the appearance 
of the monitors in Charleston harbor, attacking Fort Sumter. Ninety men and 
several officers had made the passage from Fort Johnson before that difficulty arose. 
The rest were, per force, delayed until Wednesday night. Being absent from the 
regiment on leave, and not receiving news of their movement until Wednesday 
noon, I did not succeed in overtaking them until Thursday night, 10 o'clock. 
And this seems to be the place cursorily to notice a silly accusation, not worthy of 
a formal and separate contradiction-that no clergyman performed duty in Battery 
Wagner. I myself can enumerate four (and there were doubtless others unknown 
THE LAST DAYS OF BATTERY WAGNER. 742 
The Last Days of Battery Wagner. 
to me), Rev. S. E. Axson, Chaplain Eighth Georgia; Rev. Mr. Green, Chaplain 
Thirty-second Georgia; Rev. Mr. McDaniel, acting Chaplain Nineteenth Georgia; 
and Rev. A. F. Dickson, Eutaw regiment, Twenty-fifth S. C. V. So much for that 
story. 
Well! we are there. Sharpshooters at their posts, guns manned, guards out. 
Firing at first quite moderate on all hands, and nobody hurt until Friday about 
noon. The principal complaints are of insufficient food and bad water. Many 
supplies sent by private kindness, and by the association, were stolen on the way. 
I carried down a keg of cold coffee, it was both pleasant and pitiful to see the men 
crowd up for a mere mouthful of that refreshing drink. The lack of sleep, too, 
became a serious matter. Guard duty over, the men were often, and necessarily, 
summoned to labor on repairs of the works cut down by the shells of the enemy. 
And many of the most signal instances of courage appeared, not in the fighting, as 
might be imagined, but while thus engaged in what is called (not unjustly) "fatigue 
duty." But this is anticipating. 
Saturday morning early I was awakened from a refreshing nap, taken on a 
box, with my head on a bench, by a thundering overhead and a trembling of the 
earth, which told that the great bombardment had begun. Parrot shells; shriek- 
ing up with viewless speed, ami exploding by percussion, eleven-inch mortar shells 
dropping like aerolites out of the sky-fifteen-inch shells from the monitors, howl- 
ing along the water, rolling up the parapet and bursting inside-sharpshooters' 
balls whizzing in and striking the cannon with a fierce snap-all combined, 
shrieked, dropped, burst, tore, without intermission all that day and night-all Sun- 
day and Sunday night. No! I am wrong; there was a very'marked remission on 
Sunday at half-past ten, that our pious assailants might worship God. But lest 
we should avail ourselves of the same privilege, some gun or mortar opened on us 
every five or ten minutes, it is to be supposed, without disturbing their tender 
consciences. 
Sunday's fire was not as destructive as Saturday's chiefly because it was 
divided between Batteries Wagner and Gregg, and Fort Johnson, instead of being 
monopolized by us. That Saturday ! no man, on our side at least, who was con- 
cerned in it, will ever forget if-least of all those whose places were, as mine was, 
in the hospital. Men brought in killed instantly-men who ought to have died 
instantly, but could not die for long hours of ghastly anguish. Men mutilated, 
defaced, stunned, sickened; men broken-hearted for brothers killed by their side. 
Fortitude and patience gloriously illustrated on every hand; only here and there a 
poor fellow, frenzied by unendurable agony, or unnerved by previous exhaustion, 
broke the eloquent silence with his groans' One thing that seemed trivial enough 
in the telling, added not a little to their suffering-the endless drip, drip, drip, from 
the cavernous roof. Some of the men tried to drink it. but it had percolated 
through salt sand, and rather enhanced their thirst. The wounded were abun- 
dantly supplied with cistern water from Charleston. By dark, or a little later, of 
Saturday night, the hospital was full; the dead decently disposed at one end of the 
room, and the wounded occupying t he rest, as we thought. Ah, we little realized 
what was before us ! The enemy's tire had become so accurate that they dropped 
their shells into every open place, and struck the very sills over the doors of the 
covered ways. By the combinat ion of their batteries with their monitors and gun- 
boats, they obtained such a cross-tire that there was literally no place, out of the 
bomb-proofs, that afforded any shelter. And now, out of a garrison, numbering 
say eight hundred men, and subjected to this cluster of crucial tests, how many 
heroes were there? How many to stand up, faint but undismayed for their bleed- 
ing country, while hungering, thirsting, sleepless, begirt with this infernal fire? I 
will tell you the literal truth : out of the whole mass, I heard of but three or four 
that shrank even for a moment from obeying any command. 
In one case, a squad of six men was ordered co repair a parapet which the enemy 
had cut down, and were still at work upon. They started out, and almost imme- 
diately a shell burst among them, killing one and wounding four ; the remaining 
man picked up his sand bag and walked up to the breach without a moment's hesita- 
tion. The next squad was called, and went up to the work in just the same manner. 
A ten inch columbiad, loaded, was dismounted by the enemy's shot, fell over, and 
pointed directly at a magazine; its carriage took fire, and the officers who ran up 
to it, tried in vain to extinguish the fire by shoveling sand upon it. They called 
for volunteers, but the cannonade was too furious. Many shrank : it was not a 
command, but an invitation. At last one gallant fellow rushed up,joined the offi- 
cers in their work, got the fire under, and came down, thank God, in perfect safety. Last Days of Battery Wagner. 
743 
That Saturday night, a body of Georgians, so many privates from each com- 
pany of the Twenty-eighth Georgia, the only officer with them a Captain, were col- 
lected, and had just marched out of the battery on some expedition to Battery 
Gregg, when they were halted to receive final orders. The Captain and our 
lamented Lieutenant Blum who was passing by, entered into conversation, when 
a shell burst just there and killed them both. An officer who went out shortly 
after to see how things were going on, found these fellows sitting quietly in the 
sand, conversing as calmly as though there were no such things as shot and shell, 
and as though that were not notoriously one of the most dangerous spots about the 
fort. On being asked what they were doing there, they answered that they had 
no officer to command them, that they had sent for one, and were waiting till he 
came. There were those who thought this the finest exhibition of courage in the 
whole period ; for the usual support of soldiers, the command of one whom they 
must obey, was wanting. If they had taken refuge in some safer place until their 
officer arrived, they could hardly have been blamed ; but at the very point where 
their leader fell, they sat down and waited orders. 
To illustrate the dangers of that fearful night, I may mention that a comis- 
sioned and non-commissioned officer with six privates were sent to a certain point 
as a guard. They had but just reached it when a shell fell among them, killing one 
and wounding all the rest ofthe soldiers-only the officers escaping uninjured. 
But the strength of the garrison was no longer adequate to the maintenance of 
the post; the enemy's works turned the extreme point of one of our outer works ; 
the more important guns were either dismounted or seriously injured. And, in 
truth, the object of this long and obstinate defence was now at last gained. It had been 
held until the interior line of defences had become too formidable to fear an assault. 
This being secured, such an outlay of precious blood became too costly for any 
benefit it could purchase, and the evacuation was decided upon after a careful sur- 
vey of the battery, by a leading engineer sent down for the purpose. Of course it was 
indispensible that the enemy should be blinded as long as possible. Certain troops, 
therefore, from the sand hills were marched into the fort just at dark, Sunday 
night. Picked men were detailed to fire such cannon occasionally as were capable 
of it, and a party of thirty sharpshooters fired each once in ten minutes, so as 
neither to provoke too severe a fire from the enemy, nor to lead them to suppose 
that the lines were being weakened. It was decided that South Carolina and 
Georgia should divide the honors between them-the first holdingthe fort last, and 
the others holding the island last. As it turned out, South Carolina got both the 
honors. 
The sick and wounded had been removed by successive wagon loadsail through 
the latter part of Saturday night, and all day Sunday. Even the box of blankets 
was not overlooked, but the blankets entrusted one by one to the litter bearers and 
safely brought away. A leading officer remarked to me afterwards (for I had been 
sent away in the afternoon of Sunday) that he never supposed, until that night, 
that he could be thankful for being shelled; but whenever the enemy's fire 
slackened, the greater fear arose that their retreat had been discovered, and it was 
a real relief when they began again. The successive detachments marched away, 
suffering somewhat from the shells, but bringing away their wounded. The 
leisurely fire of the sharpshooters kept up the deception admirably ; the cannon 
proved unmanageable, were loaded, but could not be fired, probably because the 
breech was filled with sand. The magazine, with some two or three hundred 
pounds of powder was put in proper order, and the fuse lighted, and watched until 
the explosion seemed certain. Then the last men were withdrawn and marched 
away to Cumming's Point. The enemy say they discovered and extinguished the 
fire, and saved the battery; but it is not possible. They shelled the abandoned 
works too long. It is much more likely that the drip from the sand extinguished 
it. But, as has been truly said, abandoned forts never do blow up, whatever the 
(reason may be. It only remains to be said that General Beauregard, at the close of 
the detailed order for the evacuation, remarks that if it succeeded, it will be one of 
the most brilliant achievements of the war. It did succeed. God be praised that 
so many of those gallant fellows were saved the agony of wounds and death, and 
the humiliation of capture, and live still for their country, and many for their God I 
May He grant them all to know and love Him, which is life eternal! Eutaw. 
P. 8. I find I have forgotten one act of justice, hitherto overlooked on all 
hands, a tribute to the courage and faithfulness of the cavalry employed as couriers 
on Morris' Island. When I was there, members of the Charleston Light Dragoons 
performed that duty, and I never saw a moment's hesitation, though the peril was 
often terrific, and had to be encountered alone. 744 
Intermittent Fever, Charleston, 1863. 
During the prosecution of my investigations on the diseases of the 
Confederate Army, assembled for the defence of Charleston, South Caro- 
lina, 1 enjoyed many opportunities of conversation with the officers com- 
manding the lines and earthworks (amongst whom may be mentioned 
General Talliaferro, commanding the Confederate forces and my brother, 
Colonel Charles C. Jones, Jr., commanding the Field Artillery on James 
Island, S. C.,) with reference to the effects of the service when in the trenches 
and in the forts, including Fort Sumter, upon the health of the Confederate 
troops. Careful inspections were also made by the author of the troops 
in the field and in the forts, and of the sick in the field and general hos-- 
pitals, and conferences held with the medical officers. Much of this mate- 
rial which I prepared for the medical department of the Confederate States, 
during the siege of Charleston, and subsequently in various portions of 
the Confederate States was destroyed by fire in the Confederate Capital 
hear the close of the War. 
We reproduce the following observations from those original notes 
which we were able to preserve amongst our private papers: 
CASES OBSERVED IN THE GENERAL HOSPITAL AT SUMMERVILLE, SOUTH 
CAROLINA, TWENTY-TWO MILES BY RAILROAD FROM CHARLESTON, 
south Carolina. 
The village and Confederate Hospital of Summerville is situated in a 
Hat pine-barren region intersected with small streams called branches. 
The growth is similar to that of Walthourville, Liberty County. Ga., with 
this exception, that the short-leaved pine is more abundant. Upon the 
whole the vegetation resembles more nearly that of Flemmington, in 
Liberty County, Ga. The forests consist of the long and short-leaved 
pines, and the undergrowth of the barren scrub oak, upland willow oak. 
The most common shrub in the lower portions of the pine barren region 
appears to be the gall-berry and a dwarf magnolia and myrtle. In the 
branches the red maple, black gum, sweet gum, button root, and romelus. 
The branches appeared favorable to the growth of the pinckneya pubeus 
and it is probably found here. My examination was not sufficiently 
extended to determine in what quantities. The soil is sandy, in fact almost 
pure silex, with a slight admixture of vegetable matter. The character 
of its growth indicates its general poverty. 
Medical officers: Surgeon, W. S. Meirre, General Hospital; Assistant 
Surgeon, Henry Jervey; Acting Assistant Surgeon, Dr. Smith; Surgeon, 
E. E. Jenkins, Hospital Encampment. 
This place is considered healthy, without local cause of disease, and is 
one of the summer retreats to which the inhabitants of Charleston resort 
for health during the summer and fall months. Seven miles from this 
village is the original settlement of Dorchester. The settlers of this place 
came originally from Dorchester; England, then settled Dorchester, New 
England, and then Dorchester, South Carolina, and finally Midway, Ga., 
between the Ogeechee and Altamaha rivers. The tower of the old church 
now stands as the sole relic of the former inhabitants. The General Hos- 
pital contained 280 patients, from which I selected the following cases for 
investigation: 
Case 954. Slight Case of Intermittent Fever and Inflammation of the Eye.- 
James Clarpe, private, Company H., C. 6th 8. C. Reg. Cav'ly. Entered General 
Hospital, Summerville, October 7th; recorded intermittent fever. Says that he 
served eighteen months in the army in Virginia; during this time had one attack 
of sickness, which lasted four weeks. He describes it as fever and headache. At Intermittent lever, 1863. 
745 
the time of this attack he was stationed near Manassas. This was twelve months 
ago. During the past seven months has been serving at Adams Run. During the 
month of July was taken with fever and pain in his head, accompanied with 
inflammation of his left eye. Hays that he suffered severely with the erysipelas 
in his eye and head. The eye is greatly disfigured; the cornea is opaque, and the 
patient affirms that he is entirely blind in this eye. During this attack of sick- 
ness he was sent to Charleston, where he remained four days, and was then trans- 
ferred to Summerville, and from thence to Columbia. Was discharged from 
Columbia and returned to Adams Run nineteen daysago. 
On the 8th I examined him and found him with some fever. His attendant 
physician, Dr. Smith, prescribed 10 grains of quinine in the morning early, and 
placed him upon tea diet and soup. 9th. Free of fever; tea diet and soup. Octo- 
ber 10th, 12 o'clock M. Temperature of hand 92° F.; temperature under tongue 
102° F.; pulse 102; irregular and intermittent to an appreciable degree. The irregu- 
larity in the different beats is quite marked and the intermission less marked. 
When the ear is placed upon the chest the action of the heart appears to be rather 
weak, and to a certain degree irregular, corresponding in a measure to the irregu- 
lar beat of the pulse. This patient has just been walking about previous to my 
entrance into the ward, and this may account for the irregularity in the circula- 
tion and the increased action in the respiration, which is now 32 per minute. The 
lungs are clear' and normal upon percussion and auscultation. No appreciable 
enlargement of spleen. Bowels bound. No spots upon abdomen. Says that he 
has never had typhoid fever. This patient presents a florid appearance. His com- 
plexion is much clearer than usual in malarial disease. His urine is but slightly 
higher colored than in health and does not present the high color of a serious case 
of malarial fever. His physician prescribed infusion of bone-set fg i every three 
hours. Tea diet and soup. 
October 11th. Continues free of fever. This case is evidently a slight one, and 
with the exception of the right eye, which is now much inflamed, the patient pre- 
sents the appearance of health. 
Examination of urine passed during the last 24 hours, from October 10th, 12 
o'clock M., to October 11th, 12 o'clock M. Amount of urine passed during 24 
hours, 610 c.c.=grains 9730.13. Sp. gr. 1021. Reaction October 12th, acid. Deep 
orange colored. Slight light deposit, consisting of triple phosphate and octohedral 
crystals of lime and urate of ammonia. The deposit, even after standing several 
days, was quite slight. This day Dr. Smith prescribed infusion of bone-set, con- 
tinued quinine grs. v, in morning early. 
Analysis of urine c.c. 610 : 
Grains. 
Amount passed during 24 hours 9730.13 
Specific gravity ..1021. 
Urea 273.86 
Free acid 2.81 
Phosphoric acid... 12.37 
Sulphuric acid ,, 13.62 
Chloride of sodium 118.03 
Tne inflammation of the eye in this case continued to increase in intensity, 
and upon the 16th there was every appearance of its entire destruction. The febrile 
excitement appeared to be chiefly due to the inflammation of the eye. There was 
no return of chill, and the febrile excitement was not intense. 
Case 955 ■-Intermittent Fever.-General Hospital, Summerville. D. F. Terry, 
private Lucas Batallion, Company A.; age 2S; height 5 feet 5 inches; remark- 
ably well developed chest and long body and short legs ; brown hair ; brown eyes; 
weight 148 lbs. Has been in service since February 28th, 1862. Native of Cobb 
county, Georgia. Says that he has never had typhoid fever, and has always been 
healthy previous to entering the service. During the past seventeen months he 
has been serving at Fort Pemberton on Stone river, James Island. This is a mala- 
rious situation. (See previous investigations upon Fort Pemberton). Says that he 
had chills during last September, 1862. The chills continued at irregular intervals, 
during the early part of the winter. During the latter portion of the winter and 
the early portion of spring, the chills disappeared, until May, 1863, when they 
returned. At first the chills came on every other day ; after they were arrested by 
quinine they became irregular, coming on every three, four, five or seven days. 
The chills disappeared in the latter part of June. 
On the 10th of August, served in Battery Wagner, on Morris Island, and after 
remaining in this fort during the severe bombardment, the exposure at night, 746 
Cases of Intermittent Fever, Charleston, 1863. 
together with the constant labor and excitement, and the effects of the foul air, bad 
■water and food, induced a return of the chills, together with diarrhoea. He was 
transferred from Battery Wagner to Charleston, where his chills were arrested by 
the use of quinine for several days. This patient was then transferred to the Gen- 
eral Hospital at Summerville. On the 4th of September, entered the General Hos- 
pital at Summerville. Was marked by the attending physician as diarrhoea and 
intermittent fever. No record of his case was kept. The following is the record of 
his treatment: Sept. 5th. Sulphur (flowers), grains xxx. Dover's powder, grains 
xx. Mix : divide into two powders, one powder night and morning. Tea diet, milk 
and rice. 6th. Continue treatment. 7th. Blackberry root infusion. 9th. Rhu- 
barb, grains xij ; hippo, grains ij ; opium, grains ij. Mix and divide into two pow- 
ders, one morning and night. lOtb. Repeat powders. 11th. Repeat powders. 
12ih. The diarrhoea continuing, he was placed upon pills composed of sugar of 
lead, grains 2; opium, grains 1. Mix. One pill every six hours. At same time, 
the disease had assumed a dysenteric form. 13th. The pills of acetate of lead and 
opium, appeared to arrest the bowel affection. 16th. The intermittent fever reap- 
peared without the dysentery. This was the first chill since his entrance into the 
hospital. He was then put upon Fowler's solution, 10 drops, three times a day. 
Continued Fowler's solution until Sept. 23d. On 24th, infusion of bonesett was 
given and continued to 27th. Full diet. 30th (Wednesday). Hada recurrence of 
chills. Quinine, 10 grains in the morning. 
.On Sunday, 4th, Monday, 5th and Tuesday, 6th, had a chill. 5 grains of qui- 
nine were administered each morning and afternoon, up to Sept. 6th, and from the 
6th to the present time, Oct. 12th, has had no return of chill. 7th. Infusion of 
bonesett. The infusion of bonesett, with tea diet and soup, was continued up to 
Oct. 11th. 11th. Quinine, grains v, in the morning. 12th. Quinine, grains v, in 
the morning. Free of fever. Has had no return ofchills for one week. Says that 
he feels quite well, walks about; complexion clear, and in fact, resembles the com- 
plexion of health, rather than of one suffering with malarial fever. Tongue soft, 
moist and clean. Pulse soft, full and regular. Appetite good ; spirits good. Amount 
of urine passed during the last twenty-four hours, 600 c.c. Specific gravity 1017.8 
-grains 9567.32. Heavy light yellow deposit after standing a few hours. This 
deposit consisted chiefly of the urates of ammonia and soda and the triple phos- 
phates. Urine passed this morning, very light colored. Reaction only slightly 
acid a few hours after its passage. 
Analysis: 
Grains. 
Amount of urine passed during twenty-four hours 9,567.32 
Specific gravity 1,017.8 
Urea 240.24 
Uric acid (in great abundance but not determined) 
Free acid 4.52 
Phosphoric acid 21.06 
Sulphuric acid 9.24 
Chloride of sodium 92.40 
Treatment Oct. 12th. Quinine, grains v, in the morning. Oct. 13th, 2 P. M. 
Tongue clean, soft and moist. Pulse 64, respiration 22. Presents the appearance of 
health. Says that he feels quite well, but is not as strong as in health. Spleen 
slightly enlarged. Temperature of hand 36° C. (96.°8 F.) Temperature of axilla 
38° C. (100.°4 F.) Has taken 5 grains of quinine this morning. Amount of urine 
passed during the last twenty-four hours, 450 c.c. Deep orange color. Affirms 
that this is all. After standing, a heavy light yellow deposit falls. Urine in 
twenty-four hours, grains 7140. 
Analysis of urine passed during twenty-four hours : 
Grains. 
Amount of urine, 450 c.c 7,140.00 
Urea 180.18 
Free acid 12.16 
Phosphoric acid 21.48 
Sulphuric acid 40.37 
Chloride of sodium 62.37 
The increase in the amount of sulphuric acid was due to the sulphate of qui- 
nine taken internally. Chemical and Microscopical Examination of Urine. 
747 
MICROSCOPICAL EXAMINATION OF URINE. 
After standing a heavy light yellow deposit fell, which consisted of urates and 
phosphates, with a few octohedral crystals of the oxalate of lime. The low 
diet determined by the diet tables, with the large amount of farinaceous food, is 
perhaps favorable to the formation of the oxalates. The sides of the glass ves- 
sel were, as is ususal in the urine of intermittent fever, encrusted with the yellow 
deposit of the urates and phosphates. The appearance of the deposit in the urine 
in this case was similar to that delineated in the preceding figure. No. 78, and also 
to figure 46, plate No. It. Asi haveshown such deposits are quite characteristic 
of malarial fever during the sweating and anti-febrile stage, constituting the 
so-called critical discharges. During the active stages of the fever in this case, as 
in many others of intermittent fever, the brick-dust deposit in the urine consisted 
in a large measure of red and reddish-brown, lozenge-shaped crystals of uric 
acid. 
Case 956. Chill and Fever.- General Hospital, Summerville, October 15th, 
1P.M. Carmack, private 61st N. C. Reg. Vols. Has been in the hospital for 
several weeks. His disease is marked chronic rheumatism. There is no swelling 
about his limbs and no sign of former rheumatic inflammation, but still he com- 
plains of pain in his joints and in the muscles of his back. Has had no chills 
since entering the hospital, and in fact has had no chills this season. Several years 
ago suffered with chills in North Carolina. At 1 o'clock P. M. his chill came on. 
The trunk was hot, whilst the extremities were cold; the pulse was small and 
rapid and feeble, whilst the respiration was full, rapid and labored. The chill 
remained on about two hours; that is, the patient felt chilly and trembled for this 
length of time, although the warmth commenced to be diffused from the trunk 
into the extremities before this time. The patient was made to void his urine just 
as the cold stage was coming on. This was not collected. As soon as the tempera- 
ture was restored in the extremities the urine was voided again. 
Analysis of urine passed during two hours of chill (cold stage) of the case of 
Intermittent fever, No. 953: 
Grains. 
Amount of urine , 1591.20. 
Specific gravity 1020. 
Urine orange colored, clear and bright. 
Urea 53.90 
Free acid 2.31 
Phosphoric acid... 0.369 
Chloride of sodium 18.48 
If the preceding data be made the basis of calculation for twenty-four hours, 
so that a comparison may be readily instituted with a definite period of time, and 
with the urinary excretion of twenty-four hours in different stages of intermittent 
fever, we obtain the following results : 
Analysis of urine calculated for twenty-four hours: 
Grains. 
Amount of urine 18994.40 
Urea 646.80 
Free acid 27.72 
Phosphoric acid 4.428 
Chloride of sodium 221.76 
We observe that we have in the chill a marked increase of urea and chloride of 
sodium, and a marked decrease of phosphoric acid. 
The urine was collected again at the commencement of the hot stage, when the 
febrile excitement was intense. Pulse 120; skin hot and dry; patient restless. 
Amount of urine passed from 3 o'clock P. M. to 6 o'clock P. M. (three hours), dur- 
ing the first stage of fever, 140 c.c. Sp. gr. 1018.5. The color is higher than in the 
chills, and is reddish-orange. The urine was collected during the three hours of 
the hot stage, and yielded upon analysis the following: 
Grains. 
Amount of urine collected in three hours, hot stage 2240.70 
Urea 58.17 
Free acid 3.88 
Phosphoric acid 0.258 
Chloride of sodium 30.08 748 
Malarial Fever in the Confederate Army. 
Calculated constitution of the urine passed during 24 hours, based upon the 
urine of three hours of the commencement of the hot stage : 
Grains. 
Amount of urine calculated for 24 hours 17,925.60 
Urea 464 88 
Free acid 31.04 
Phosphoric acid 2.064 
Chloride of sodium 120.72 
We note a comparative diminution in the urea and chloride of sodium, although 
both are far above thestandard of rest and starvation. The phosphoric acid still con- 
tinues far below the standard. During the night the febrile excitement declined, 
and before morning the temperature had fallen in the extremities a little below the 
normal standard, and in the trunk nearly to that of health, and the skin was moist 
and soft. 
Analysis of urine passed during the height and decline of the fever (15 hours): 
Grains. 
Amount of urine in 15 hours 11,222.10 
Urea 189.70 
Free acid 20.77 
Phosphoric acid . 1.749 
Chloride of sodium 20.86 
Sulphuric acid 19.68 
The urea and chloride of sodium continue to diminish. The sulphuric acid 
was most probably derived from the sulphate of quinine. Urine passed during 
the height and decline of the fever; calculated for 24 hours : 
Grains. 
Amount of urine calculated for 24 hours 17,855.36 
Urea 293.52 
Free acid 33.24 
Phosphoric acid 2.798 
Sulphuric acid 31.48 
Chloride of sodium 38.97 
Actual amount and composition of the urine passed during 24 hours, including 
chill, hot stage and intermission : 
Grains. 
Amount of urine 15,043.00 
Urea 301.74 
Flee acid 26.96 
Phosphoric acid 2.374 
Sulphuric acid 
Chloride of sodium 79.42 
Case No. 957.-Illustrating the effects of malaria.-Intermittent fever fol- 
lowing remittent fever-cachectic state of the patient.-Private J. J. W. Brown, 
Sixth S. C. Cavalry, Company H. The following history of this case (the following 
facts in the history of this case) were furnished me by the attendant physician, 
Assistant Surgeon Henry Jervey, General Hospital, Summerville, S. C.: Admitted 
October 2d, 1863. Had been suffering for some days with tertian intermittent 
fever, which assumed a remittent type, on the day after admission. The patient 
was also suffering from severe accompanying diarrhoea, and was much prostrated. 
The following prescription was adopted: Quinine gss; calomel and opium a f 
grs. iij.; mix and divide into vi pills. Sig. one every four hours. Spoon diet and 
chicken soup were given; also milk punch to sustain his strength. This treatment 
was continued until the third day, with very satisfactory results. The diarrhoea 
being then entirely controlled, the calomel and opium were discontinued, and qui- 
nine, grs. iij, ter die administered. This has been kept up until the present time, 
with the same diet. The patient has had no return of fever or diarrhoea; has 
regained his appetite and spirits; is improving rapidly in strength and doing well 
generally 
October 15th, 1863. Henry Jervey, 
Assistant Surgeon, Summerville General Hospital. 
General Hospital, Summerville, S. C., October 13th, 11 A. M. Description of 
case.-This should precede the account of Dr. Jervey. Age, 26 years; weight, 
about 125 lbs. in health. Now weighs less than 109. Native of Chesterfield Dis- 
trict, S. C. Pale, cadaverous-looking patient. All the red blood appears to have Malarial Fever in the Confederate Army. 
749 
been washed out of hissystem. Complexion sallow and bloodless. Lips bloodless. 
Pulse feeble. Entered service more than one year ago. Previous to entering ser- 
vice had never been subject to chills and fever, having had only one attack about 
eight years ago. During the months of May and June, 1862, served in Fort Moul- 
trie, and during this time suffered with rheumatism. Was discharged from service 
on account of the rheumatism, and then entered Aiken's Rangers of Cavalry 6th 
October, 1862. Has been serving in this company at Adams run. Has performed 
but little duty from that time to the present. Has during this period suffered with 
chills and tever and pains in his limbs. The chill comes on sometimes every day, 
and often an entire week will be passed without its return. Pale, sallow com- 
plexion and unhealthy yellow tinge. Says that he has never had the jaundice. 
Whites of his eyes present a light greenish-yellow tinge. Spleen appears to be 
only moderately enlarged, as it requires careful examination to discover it and 
define its boundaries. Appetite now quite good. Bowels regular. Has little or 
no strength-too weak to walk about. Has not had a chill for two weeks. Imme- 
diately after this attack of fever commenced taking quinine as previously recorded, 
and has been taking it up to the present time. Since this attack has not walked 
about. Diet during this period, as at the present time, has been light, corn hominy 
and gruel, wheat loaf-bread, coffee, and chicken soup. Has had no salt meat. 
This appears to be a fair case for the determination of the characters of the urine 
in which the system has been greatly reduced (the blood-corpuscles diminished, the 
liver and spleen deranged, the muscles and nervous forces reduced) by the pro- 
longed action of the malarial poison. 
Temperature, pulse and respiration. 
Examination of urine-Amount of urine passed during twenty-four hours, 
October l()th, 11 A M., to October 11th, 11 A. M., 980 c.c. Sp. gr. 1013. Grains, 
15498.90. The urine passed at the close of the day and during the night was higher 
colored than that passed during the morning. Color of urine light orange. 
Analysis of urine : 
Grains. 
Amount of urine passed during 24 hours 15498.90 
Urea 241.47 
Free acid 18.86 
Phosphoric acid 14.48 
Sulphuric acid 15.09 
Chloride of sodium 135.82 
After standing, a very slight deposit (light yellow of phosphates and urates fell. 
October 13th, II A. M.-Temperature of hand 36.°6 C. (97.°9 F.) Temperature 
of axilla 37.°3 C. (99.°2 F.). Pulse 60, slow and regular, but feeble, with small 
volume. Respiration 21. Tongue pale, tremulous and cleaner than usual. It is 
evident that the temperature does not differ materially from that of health. 
Amount of urine passed during twenty-four hours, up to October 13th, 2 P. M., 
1340 c.c. Sp. gr. 1011.5. Light yellow color. Grains, 21133.5. After standing, 
slight deposit of phosphates and urates. 
Analysis of urine. Amount, grains, 21133.5 : 
Grains. 
Urea 309.54 
Free acid... 15.16 
Phosphoric acid 18.96 
Sulphuric acid 18.57 
Chloride of sodium 145.06 
At 2 P. M. this patient was placed upon $j of common salt in giij of coffee 
every three hours. 
October 14th.-Amount of urine passed during the last twenty-four hours, 
from October 13th, 2 P. M., to October 14th, 2 P. M. (During this time the patient 
is said to have taken between six and eight powders of salt 3 vj or 3 viij.) c.c. 1150. 
Sp. gr. 1015. The entire amount of urine was not collected, as a small portion was 
lost. Deep yellow color, inclining to orange. This observation shows that the 
diminution of the chloride of sodium in the urine was caused by its absence from 
the food. Sp.gr. 1015. 
Analysis of urine, 24 hours, 1150 c.c.: 
Grains. 
. Amount of urine in 24 hours 18270. 
Urea 265.65 
Phosphoric acid 20.25 
Chloride of sodium 265.65 750 
Malarial Fever in the Confederate Army. 
Slight light yellow deposit-phosphates and urates. After standing, the urine 
contained trematones (bacilli), similar to the urine of typhoid fever. 
Case 958.-Illustrating the effects of malarial fever {intermittent variety.)- 
Daniel Hall, Private. Twenty-first S. C. Regiment Volunteers, Co. G. General Hos- 
pital, Summerville, S. C., Oct. 13th, 1863, 1 P. M. Age 28; entered service over one 
year ago. Has never had typhoid fever. Weight in health 159 pounds, now his 
weight can scarcely reach 120 pounds. Emered service July, 1862; served first at 
Georgetown, and then in Charleston, and finally upon Morris' island, where he 
remained nearly one year. Was on Morris' Island during the bombardment of Fort 
Wagner. His bowels were much affected by the foul air of the bomb-proof, by the 
bad water and by the spoilt food. After the evacuation of Morris' Island, was 
stationed on James' Island, at Kort Johnston. On James' Island five weeks ago, 
was taken with quotidian fever. Suffered with chills regularly every day (the 
chills came on about the same hour of the evening every day) for two weeks on 
James' Island. He was then sent to Charleston and entered the Third N. C. Hos- 
pital and was sent to the Summerville Hospital at the end of five days. Was admitted 
into the Summerville General Hospital Sept. 25th, 1863. The assistant surgeon, 
Dr. Jervey, who attended him, furnished the following short history of his case: 
"Had been suffering from malarial fever for two or three weeks, which assumed a 
remittent character a few days previous to his admission. Quinine grs. v, ter die. 
was administered until the sixth day, when the fever not having returned, this 
medicine was discontinued, and the infusion eupatorium, perfol fgi. every four 
hours was given. This is still continued, and the patient is doing moderately well, 
though quite weak and anaemic. No very noticeable feature has occurred in the 
progress of the case, except the quantity of urine voided daily, which was much 
larger than usual. Diet has been entirely farinaceous." 
October 13th, 1 P. M.-Pulse 58, respiration 20. Pulse regular and rather 
feeble. Temperature of hand 29.°8 C. (85.°8 F.); temperature of axilla 37.°6 C. 
(99.°7 F.) Surface of extremities feel cool; says that they are generally in this 
state. From the preceding observation it is evident that they are 13.°9 F. below 
the temperature of the trunk. Has been suffering for three days with a boil under 
the left arm, which deprived him of sleep last night. Although this patient has 
not had a chill for two weeks, still he is pale, cadaverous and bloodless, and has an 
unhealthy sallow hue, as if the malarial poison had destroyed the colored blood- 
corpuscles-deranged the functions of the liver. This case, like the preceding one, 
affords an admirable example of theeffects of malaria after longstanding. Exami- 
nation of urine passed during twenty-four hours up to October 13th, 2 P. M.: 
Urine unusually abundant; pale, limpid after standing forty-eight hours; slight 
deposit (light yellow) of urates and phosphates. Amount of urine passed during 
twenty-four hours, 3300 c.c. (three thousand and three hundred c.c.) 
The color of the urine as well as the great abundance, at first sight led one to 
suspect the existence of diabetes mellitus, but this suspicion was almost immedi- 
ately dispelled when the urinometer was dropped into the fluid and immediately 
sank to a low specific gravity. Sp. gr. of urine 1004.2. Other tests confirmed the 
absence of grape sugar. Analysis of urine: 
Amount of urine passed during twenty-four hours 3330 c.c.; grains 51615.88. 
Grains. 
Urea 307.69 
Free acid 20.51 
Phosphoric acid 10.25 
Sulphuric acid 15.38 
Chloride of sodium 123.07 
Case 959.-Case of convalescence from remittent fever.-General Hospital, 
Summerville, S. C.-W. C. Corbett, Private, Third Regiment S. C. Cavalry; age 30, 
native of Clarendon Co., 8. C., wife and four children. Red hair, blue eyes, florid 
complexion; has a florid complexion in health. There is a tinge of yellow about 
his complexion, although florid. Red hair and beard; heights feet 8 inches; 
weight in health 155 pounds; not much reduced in health; stout, athletic man. 
Has been in service near two years, during this period served at Pocatalligo, 
Charleston Neck, Mount Pleasant and Fort Moultrie. Has never had typhoid 
fever. Had an attack of chill and fever some eight or ten years ago. One month 
ago had a little fever which lasted him five or six days. About six weeks ago 
acted as courier on Morris' Island during the severe bombardment. He did not 
enter the bomb-proof and says that he experienced no ill effects in his health. The Malarial Fever in the Confederate Army. 
751 
present attack came on nine (9) days ago, whilst he was guarding the fortifications 
upon Charleston Neck. Was taken with vomiting, headache, pain in all his limbs 
and bones, followed by fever. Before the rise of the fever he felt cold but had no 
distinct chill; has had no chill at all in this attack. Says that he was 
jaundiced in the entire stages of the attack and also threw up much bile. 
He was transferred to the Third N. C. Hospital where he remained four days; 
here he took medicine, and his fever declined. Entered the General Hospital at 
Summerville October 9th, 1863; was free of fever at the time of his entrance, but 
very weak. Since his entrance into the Summerville Hospital has taken but 
little treatment. The following treatment was directed by nis attending phy- 
sician, Dr. Smith: October 10th. Quinine grs. x in the morning. 11th. Quinine 
grs. xxx, water fgviij, mixf^i every four hours; tea diet and soup. 12th. Comp, 
cathartic pill at bed time; tea diet and soup. On the 12th I made a careful 
examination of the case and analysed his urine, which I had ordered to be saved. 
Pulse full and rather slow ; spleen enlarged; tongue clear at edges and tip but 
heavily coated with fur which is white towards the tip, but assumes first a yellow 
and then a decided brown color over the root of the tongue where it is very thick, 
and at the base of the tongue the color of the thick fur assumes almost a black color; 
want of power in the capillary circulation of the extremities; the surface pits 
slightly and becomes white when pressed. Says that he feels very poorly; appetite 
bad; depressed in spirits, and very weak; confined to bed. Amount of urine passed 
during twenty-four hours, October 11th, 11 A. M , to October 12th 11 A. M., 800 c.c.; 
sp. gr. 1018.5; grains 12,731.25. 
Analysis of urine: 
Grains. 
Amount of urine passed during twenty-four hours 12,731.25 
Urea 394.24 
Uric acid (in great abundance) 
Free acid 24.64 
Phosphoric acid 36.96 
Sulphuric acid 19.71 
Chloride of sodium 6.16 
Microscopical Examination of Urine.-After its passage, as soon as the urine 
cooled, a heavy deposit of the urates of ammonia and soda commenced to fall, and 
in a short time the urine presented an opaque cream color, throughout one-half its 
bulk in the lower portion, from the abundant deposit of these yellow urates. Under 
the microscope the deposit was found to consist of granules and globules, with 
aciCular crystals, oftimes shooting from the globules of the urates; also prismatic 
crystals of the triple phosphates, together with minute vegetable organisms. When 
the deposit was spread upon a glass slide and treated with nitric, hydrochloric or 
acetic acid, a heavy crop of crystals formed, of uric acid. When heated, this 
deposit dissolved. The deposit formed a thick, hard crust against the sides of the 
glass vessel. This deposit commenced to form whilst the urine was acid. The 
Figure 78 represents the appearance of the deposit in the urine, when viewed, 
under a magnifying glass. 
October 13th, 2 P. M.-Pulse 68. Temperature of hand 35.°3 C. (95.°6 F.) 
Temperature of axilla 38.°5 C. (101.°3 F.) Skin cool and moist upon the extremi- 
ties. Says that he feels better than yesterday. Tongue continues much the same 
showing however, a disposition to clear from the tip. The fur is softer, more moist 
and appears to be disappearing. I endeavored to measure the size of the spleen, 
more accurately. It is enlarged and indurated; about five inches in the largest 
diameter from the ribs downwards, and four inches in its transverse diameter. 
The liver does not appear to be specially enlarged. Spirits somewhat better; still 
feels very weak. 
Amount of urine passed during twenty-four hours, up to Oct. 18th, 2 P. M., 
760 c.c. Specific gravity 1016. Deep reddish-orange color, with heavy yellow 
deposit after standing a short time. 
Analysis of urine: 
Grains. 
Amount of urine passed during the last 24 hours 12,090.50 
Urea 327.71 
Uric acid 
Free acid 29.26 
Phosphoric acid 36.04 
Sulphuric acid 18.25 
Chloride of sodium 11.70 752 
Malarial Fever in the Confederate Army. 
Microscopical Examination of Urine.-Very heavy deposits of the urates of 
§oda and ammonia, with some prismatic crystals of triple phosphates. When this 
deposit was treated with acetic, hydrochloric or nitric acid, a heavy deposit of well 
formed prismatic and lozenge-shaped, almost colorless crystals of' uric acid, were 
thrown down. The uric acid, as in the previous specimen of urine, and as in my 
previous examinations of bilious fever, during the remission, was very abundant. 
But during the active stages, as I have before shown, the uric acid is diminished. 
We have here, a striking contrast to typhoid fever, in which the uric acid is abun- 
dant at ail stages. In this case, the deposit resembled yellow cream and tilled one- 
half the vessel. 
We selected the following brief notes of cases when by the bedside, in 
the First Georgia hospital, in the city of Charleston, in the month of Octo- 
ber, 1863, during the siege of that city. We have in the second chapter 
of these memoirs, page 153,156, recorded an interesting case of fever 
observed in this general hospital, and detailed the post-mortem examina- 
tion, and figured the micro organisms observed in the bile and intestinal 
canal, which resembled those subsequently observed by Klebs and others 
in typhoid fever. The facts presented in the following case, although few 
in number, are sufficient to illustrate the nature of the fevers then pre- 
vailing amongst the Confederate troops engaged in the defence of Charles- 
ton. The occurrence of diarrhoea and dysentery caused serious complica- 
tions in many of the cases. 
■CASES OF MALARIAL FEVER OBSERVED IN THE FIRST GEORGIA HOSPITAL, 
CHARLESTON, SOUTH CAROLINA, 1863. 
Case 960.-John Willoughby, private Twenty-seventh Regiment, Georgia 
Volunteers, Company B, age 21. October 29th. Complexion dark and sallow; 
hair dark. Has been on James Island during the last two months. Taken with 
chills three weeks ago. Quotidian, quinine and pill hydrarg. Chills stopped, but 
has fever every day at 1 o'clock P. M., going off in night. Fever slight; patient 
anaemic and icteric. Pulse 115; respiration 26; temperature of hand 100.°; tem- 
perature under tongue 103°. 
Case 961.-J. J. Heape, private Company K, Eleventh Regiment South Caro- 
lina volunteers. Has been staying on James Island six weeks. Taken with siight 
chill October 10th ; constant fever since. Violent headache and loose bowels. 
Admitted October 19th. Tongue red and dry; Countenance dusky ; pulse 120 and 
firm. Stools not very frequent. Respiration 33 ; temperature of hand 103°; under 
tongue 1O5.°5. October 20th. Pulse 100; respiration 26; temperature of hand 
•92.°5; under tongue not determined. Tongue coated and dry, and intellect slug- 
gish. Considerable mucus in discharges of bowels, which were loose. Skin moist 
and extremities cool. Urine reddish-orange ; very slight cloud after standing sev- 
eral hours, composed of mucus, mucous cells and uriniferous casts. 
Case 962.-B. Horton, private Company F, Eleventh Regiment, S. C. volun- 
teers; atre 30 ; complexion dark and sallow. Has been on James Island four weeks. 
Chill Sept. 18th, fever, diarrhoea and violent headache. Took large doses of quinine 
and opium for several days, but not improving, was sent here. Admitted October 
13th. Ordered 5 gr. doses quinine every three hours. Pulse 120 and full; tongue 
dry, with heavy, dirty-white coating. 15th. Pulse 125, small and feeble; skin 
moist; countenance dusky ; eyes brilliant; urine scanty, reddish. Deposits yellow- 
ish-red and heavy. Stopped quinine. Bowels loose. Enema of zinci sulph. and 
laudanum, and mustard poultice to abdomen; stimulants. 17th. Quinine grs. iii, 
and opium grs. J every two hours; oil terebinth gtts. xv three times a day. Tongue 
dry; pulse frequent and feeble; urine more copious. 18th. Tongue dry; pulse 
frequent, but fuller and stronger; continued treatment. Bowels loose, very offen- 
sive. R.-Enema of starch and laudanum. 19th. Tongue slightly moist and 
cleaner; pulse 125; respiration 38; temperature of hand 103°; under tongue 104.°|; 
skin cool and slightly moist. Bowels loose; headache; restlessness; slight hebi- 
tude. Continued quinine, opium and turpentine, enema and mush poultices. 
20th. Pulse 120 ; respiration 38; temperature of hand 1O2.°|; under tongue 105.° 
October 21st. Urine reddish-orange, slightly turbid when passed, turbidity due to 
mucus corpuscles and casts of tubuli uriniferi. After standing changed to a yellow Pulse, Temperature and Urine in Pneumonia. 
753 
cream-like appearance, and no longer appeared light, but looked opaque. This 
deposit appeared to be a urate, most probably urate of ammonia, arranging itself in 
the form of flattened scales, composed of numerous granules. When this was treated 
with acetic and hydrochloric numerous crystals of uric acid formed. 
Case 963.-C. Cook, Sergeant Company D, Eleventh Regiment, S. C. volun- 
teers ; age 27; complexion dark and sallow; hair black. Has been on James 
Island six weeks. Taken with chill October 10th ; fever recurred for three con- 
secutive days; stopped by quinine. Admitted October 19th. Bowels have been 
very loose for several days. Fever remits in afternoon ; tongue rather dry, anaemic; 
skin cool, slightly jaundiced ; pulse 120, soft. Urine scanty for three days and red- 
dish. Micturition difficult. Respiration 3S; temperature of hand 102.°5 ; tem- 
perature under tongue 106°. 
Case 964.-J. Mears, private, Company F, 1 I th S. C.: age 31; complexion 
fair, ruddy; hair reddish; has been on James Island six weeks. Taken with fever 
(no chill, but violent pains in the back and head preceding) September 28th. Took 
quinine, but fever continued. Admitted October 19th. Pulse 100 and firm. 
Tongue dry, glazed and fissured; nervous tremor; bowels loose; urine deep yellow; 
spleen enlarged and tender; skin moist and pleasant. Temperature of hand 
1O2.°25; temperature under tongue 105°; respiration 40; urine deep orange red 
and slightly turbid; the turbidity is due to numerous mucus corpuscles and casts 
of tubuli uriniferri. 
Case 965.-M. Carlisle, private, Company B, 27th Ga.; age 18; complexion 
fair; hair reddish. On James Island three months. Taken with fever October 
10th. Took quinine and opium for six days without checking fever. Admitted 
October 16th. Skin and tongue dry; pulse 115 and strong; bowels loose; urine 
tolerably copious. Ordered quinine, grains v, every three hours; enema and 
Dover's powders to check diarrhoea. 19th. Tongue dry; bowels checked by enema 
of zinci sulph. and morphine; continued treatment. Pulse 88; respiration 26; 
temperature of hand 88°; under tongue 101.°5; urine yellow, without deposit. 
Case 966.-Private B. Durham, Company F. 1st S. C. Artillery; age 36; com- 
plexion dark; hair dark; has been sick three weeks with diarrhoea, nausea and 
general debility. Noticed an increase of urine four weeks ago; makes about six 
pints a day; light amber color; tongue pale, slightly coated; anaemic; complains 
of inability to use his arms and hands in raising or grasping objects; locomotion 
difficult; appetite poor; thirst considerable; pulse 74; respiration 18; temperature 
of hand 82°; under tongue 102,°25. 
CHANGES OF THE PULSE, RESPIRATION, TEMPERATURE AND URINE IN 
PNEUMONIA, AND IN THE DIFFERENT STAGES OF INTERMITTENT 
MALARIAL FEVER COMPARED. 
As pneumonia not only frequently supervenes upon malarial fever, 
and also itself manifests decided paroxysmal characters, it is important 
that a comparison should be instituted with reference to the changes of the 
most important constituents of the urine. This appears to be especially 
necessary in these two diseases, not merely from their frequent co-exist- 
ence, but also from the remarkable variations in the amounts of chlorine 
excreted during the successive stages of pneumonia. In presenting the 
comparison we also give a summary of the general results of our investi- 
gations in the changes of the urine during the various stages of malarial 
fever. 
In the following case of pneumonia, which I treated during the recent 
war, the remedies employed were of the mildest character. 
Case No. 967.-Circumscribed Pneumonia, attended with high fever, arrested 
or resolved in second stage.-Andrew Jackson Sharpe, Confederate soldier; private; 
age 25; height 5 feet, 7 inches; weight 150 lbs.; black hair, dark eyes. Had mea- 
sles in the month of June, 1862, in this hospital, and regained his usual health. 
General Confederate Hospital, Augusta, Georgia, July 17th, 1862. Patient seized 
with rigor, followed by pain in right side, high fever and troublesome cough. July 
18th. Pain in side severe, cough painful and troublesome; skin hot and dry; pulse 
and respiration accelerated; dullness upon percussion over right lung. I ordered 
nothing but the internal use of cold water, in such quantities as the thirst of the 754 
Pulse, Temperature and Urine in Pneumonia. 
patient might dictate. Evening, skin hot and dry, pulse 112; cough painful and 
troublesome; patient very restless. July 19th, 12 M. Pulse 100; respiration 24; 
temperature of hand 41° C (105°. 8F); of axilla 41°.85 C. (107°. 4 F). Right lung 
dull on percussion; auscultation revealed minute crackling crepitation, with some 
increase of vocal fremitus. The natural resonance of the lung was more dimin- 
ished, and the sense of resistance increased, more especially over the lower lobe of 
the right lung. At first the expectoration consisted only of glairy mucus, but it 
now presents the rusty color, and viscid tenacious characters of the characteristic 
pneumonic sputa. Patient restless and depressed, and the hot " burning " fever 
causes him to toss incessantly from side to side in the bed. Breathing oppressed, 
and painful and hurried. Tongue dry and red. Severe pain in head. R. Tinct. 
Opii, two fluid drachms; pulv. ipecac, ten grains; sodse, proto carb., two drachms; 
flaxseed tea, ten fluidounces. Wineglassful every two hours, or at shorter inter- 
vals, if the cough is troublesome. Apply flannel, saturated with oil of turpentine, 
over the region of the lower and middle lobes of the right lung. Cold water as a 
drink, ad libitum. 
Examination of Urine.-Amount of urine passed during the preceding twenty- 
four hours, July 18th, 12 M., to July 19th, 12 M., grains, 15,996.56. Specific grav- 
ity 1016.3. Golden-yellow color. Reaction acid. 
Analysis of urine passed during twenty-four hours: 
Amount of urine 
Urine passed during 24 hours. 
Grains. 
15,996.56 
Urine passed each hour 
Grains. 
666.52 
Urea 
432.32 
18.00 
Uric acid 
5.00 
0.20 
Free acid...., 
69.48 
2.89 
Phosphoric acid 
60.56 
2.52 
Sulphuric acid 
37.73 
1.57 
Chlorine 
13.11 
0.54 
Equivalent chloride of sodium 21.58 
0.89 
Phosphates of lime and magnesia... 17.00 
0.70 
Evening.-The mixture caused the patient to vomit freely, and "much bile was 
thrown off." The ipecac and soda mixture also excited free perspiration. The 
Satient is now (9 P. M.) in a gentle sleep, and the skin is bathed in perspiration. 
;. Continue ipecac and soda mixture. July 20th, 12 M. Pulse 70. After the 
relief of the stomach by the emetic, the severe headache disappeared and has not 
returned, and the patient appears to be better. Skin moist, and the temperature is 
not so elevated. Respiration more regular and less painful. Expectoration still 
rusty-colored, tenacious and gelatinous. Continue turpentine stupes to the chest, 
and'also the ipecac and soda mixture. July 21st, 2 P. M. Patient continues to 
improve; temperature of hand 36.C1 C. (97° F.); of axilla 38° C. (1OO.°4F.); pulse 
52; respiration 20 ; skin feels cool and moist-in a profuse perspiration ; pulmonary 
symptoms improved ; the rusty colored sputa has disappeared and been superseded 
by clear, viscid sputa. The right lung is less dull on percussion, although the cre- 
pitant rales continue. 
Examination of Urine.-Amount of urine passed during forty-eight hours, 
July 19th, 12 M., to July 21st, 12 M., grains 28,980.48 ; specific gravity 1022.6 ; orange 
colored. Upon standing, the urine emits a putrid smell, and throws down a heavy 
deposit of urates and phosphates. 
Analysis of urine passed during forty-eight hours : 
Amount of urine 
Urea 
Urine, 48 
hours. 
Grains. 
28,980.48 
1,181.16 
Urine, 24 
hours. 
Grains. 
14,490.24 
590.58 
Urine each 
hour. 
Grains. 
603.76 
24.61 
Uric acid 
34.00 
17.00 
0.70 
Free acid 
166.75 
83.37 
3.47 
Phosphoric acid 
109.01 
54.50 
2.26 
Sulphuric acid 
58.32 
29.16 
1.21 
Chlorine 
6.22 
3.11 
0.12 
Equivalent chloride of sodium 
10.26 
5.13 
0.21 
Phosphates 
14.45 
7.22 
0,30 
Phosphates and sulphates and carbonates 
of soda, potassium 
134.27 
67.13 
2.79 Pulse, Temperature and Urine in Pneumonia. 
755 
July 22d, 9 P. M.-The left lung appears to be involved to a certain extent. 
The cough is more troublesome than yesterday, and the rusty colored pneumonic 
sputa has returned. In addition to the crepitant and sub-crepitant rales, mucous 
rales are heard distinctly in lower and middle tubes of right lung. The pulse is 
regular and compressible, and the skin is moist. Tongue clean. Notwithstanding 
some apparent increase in the pneumonic symptoms, the patient says that he feels 
much better. The patient was placed upon a mixture composed of camphorated 
tincture of opium, one fluidounce ; syrup of ipecac, three fluidounces ; honey, four 
fluidounces. Teaspoonful every two hours. July 23d. Continues to improve. 
July 24th, 12 M. Pulse 76 ; respiration 16 ; temperature of hand 38.°4 C, (101.°1 F.); 
of axilla 38.°5 C. (1O1.°3 F.); tongue clean ; patient much better. 
Examination of Urine.-Amount of urine passed during the last seventy-two 
hours, grains 45,004 07; specific gravity 1023. Upon standing, the urine changed 
rapidly to the alkaline condition and emitted a putrid odor. 
Analysis of urine passed during seventy-two hours-July 21st, 12 M., to July 
24th, 12 M.: 
Urine, 72 
Urine, 24 
Urine each 
hours. 
hours. 
li our. 
Grains. 
Grains. 
Grains. 
Amount 
45,004.07 
15,001.35 
625.05 
Urea 
2,134.52 
711.50 
29.64 
Phosphoric acid 
105.02 
35.00 
1.45 
Sulphuric acid 
180.86 
60.28 
2.51 
Chlorine 
54.90 
18.30 
0.76 
Equivalent chloride of sodium 
93.32 
31.10 
1.21 
The patient continued to improve rapidly, and in fact, on this day (July 24th), 
was dressed and walking about the ward, although the temperature was about three 
and a half degrees above the normal standard. 
In the preceding Case 966, although, but little medicine was employed, 
and that of the mildest character, the pneumonic inflammation resolved 
spontaneously, and did not pass into the stage of hepatization and suppu- 
ration. There was no subsequent purulent expectoration, and the recovery 
of the patient was rapid and complete. The favorable result in this case 
could scarcely have been predicted or hoped for, on the 19th of July, third 
day of disease, when the temperature of the axilla was 107. °4 F., and of 
the palm of the hand, grasping the thermometer, 105. °8 F. The tempera- 
ture of the internal organs was, without doubt, at least from two to three 
degrees higher, and probably reached 110° F. That high degrees of febrile 
heat are not necessarily fatal in pneumonia, will be clearly shown by an 
examination of the outlines of the histories of the two following cases, 
which I treated successfully in the Charity Hospital of New Orleans: 
Case 968. Double Pneumonia ; Great Elevation of Temperature ; Recovery.- 
John Venwick, age 23; laborer; stout, muscular, well-built man. Admitted into 
Charity Hospital, ward 13, bed 195, December 9th, 1873, in the evening. I saw this 
patient for the first time, December 10th, 8 A. M. Skin hot; cheeks flushed ; pulse 
104 ; respiration 20 ; tongue furred, and red at tip and edges ; temperature of axilla 
104° F.; no appetite; pain in left side ; bowels constipated ; restless ; considerable 
thirst; dullness over lower lobe of left lung, which is most marked posteriorly. 
Breathing weak in the lower lobe and lower portion of the middle lobe of right 
lung, but exaggerated in the superior portions. Vocal fremitus increased; bron- 
chial breathing and bronchophony, with feeble crepitation heard over those por- 
tions of the right lung which were especially dull upon percussion. Expectoration 
scanty ; the sputa consisting of thick, gelatinous, rusty colored, fibroid exudation. 
Urine devoid of chlorides; no albumen ; urea and uric acid, phosphoric and sul- 
phuric acids increased ; coloring matter of bile and bile acids present. I ordered 
the following : R. Emplastri cantharidis, 6 by 8 inches, over lower portions of 
right chest. R. Quinise sulph., half drachm; pulv. doveri, half drachm. Mix: 
divide into ten powders ; one powder every three hours. R. Liq.: Ammonias 
acetatis (spts. mindereri), half a fluidounce every two or three hours. Diet, milk 
punch and beef tea. Eight o'clock, P. M. Patient suffering much pain, with great 
oppression of respiration. Skin hot and dry. Temperature of axilla 1O6.°2 F. 
Continue treatment. The blister has not had the usual effect. December 11th, 8 756 
Pulse, Temperature and Urine in Pneumonia. 
A. M. The patient was delirious during the night. This morning the skin is hot, 
but bathed in perspiration. Features haggard and pinched. Cheeks much flushed. 
Pulse 116, full and bounding. Respiration 54, panting, oppressed and painful. 
Temperature of axilla 1O4.C8 F. Pneumonic inflammation progressing in lower 
and middle lobes of right lung, and it has also invaded the lower lobe of the left 
lung, which is dull upon percussion, and emits crepitant rales. Expectoration has 
ceased. R. Tinct. veratri viridi, 5 drops every three hours. Continue solution of 
acetate of ammonia, and quinine and Dover's powders. Dress blister with simple 
cerate. Milk punch and beef tea in small quantities, at regular intervals of two 
hours. Eight o'clock, P. M. Respiration rapid and panting, about 60 per min- 
ute ; pulse full and rapid. With the invasion of the left lung by the pneumonic 
inflammation, there has been a progressive rise of temperature, and the thermom- 
eter in the axilla indicates 109° F. It is probable that the temperature of the blood 
in the internal organs is between 111° and 113° F. No trace of chlorides in the 
urine, which is of a brownish red color, and entirely free from albumen. No 
expectoration from lungs. December 12th. 8 A. M. Pulse 108; respiration 26. 
The fever subsided gradually during the progress of the night, and the patient 
breathed easier and obtained some refreshing rest. The temperature has fallen 
5.°5 F., and the thermometer now indicates in the axilla, 1O3.°5 F. Careful exami- 
nation of both lungs, by auscultation and percussion, reveals the fact that (here 
has been no fresh portion of lung invaded, and that crepitation is now heard in 
portions of the lungs which were devoid of all respiratory sounds, except bronchial 
breathing. The expectoration has reappeared, and the sputa presents the appear- 
ance of thick, semi-transparent jelly, which adheres firmly to the bottom of the 
vessels in which it is received. Chlorides still absent from urine. No albumen in 
urine. I regarded the arrest of the pneumonic inflammation in both lungs, and 
the reappearance of the expectoration, and the marked diminution of the tempera- 
ture, and the absence of delirium, as most favorable signs in this apparently hope- 
less case. Eight o'clock, P. M. Patient continues in much the same state, 
although, as was to have been expected, under any circumstances, there has been 
a slight rise of temperature, the thermometer indicating 104° in the axilla. There 
has been no increase of the pneumonic inflammation during this day, and there is 
just grounds for a favorable prognosis. I attributed the arrest of the pneumonic 
inflammation to the combined effects of the veratria, quinine and Dover's powders. 
The blister also, as well as the administration of nourishment and alcoholic stimu- 
lants at regular intervals, may also have contributed to the favorable result. With 
the arrest of the progress of the pneumonic inflammation, that is, as far as the 
invasion of fresh portions of the lungs is concerned, there has been a progressive 
decrease in the frequency of the pulse and respiration. December 13th, 8 o'clock, 
A. M. Continues to improve; expectoration more abundant; air penetrating 
gradually the solidified portions of lungs, crepitant and sub-crepitant rales being 
heard in the solidified portions of both lungs. Chlorides have reappeared in small 
quantities in urine. Pulse 100; respiration 24; temperature of axilta 1O4.°4 F, 
Eight o'clock, P. M. The patient has continued to improve, and the temperature 
to descend, and now stands at 102° F., haven fallen during the past twelve hours, 
2.°4 F., and the past three days, 7° F. December 14th, 8 o'clock, A. M. Continues 
to improve. Pulse 84; respiration 28 ; temperature of axilla 101.°4 F. 8 o'clock, P. 
M. Temperature of axilla 99.°8 F. On the following day, the temperature rose to 
101.°5 F., and for several days oscillated between 99.°5 F. and 101° F. The recovery 
of this patient was complete, without any abscess of lung, or purulent expectora- 
tion, and he was discharged from my service in good health. 
Case 969. Double Pneumonia; Temperature of Axilla reached 109° F.; abcess 
of Lung; Tedious Convalescence; Recovery.-August Raville; native of Italy; age 
21; black hair and black eyes; florid complexion. Entered Charity Hospital, ward 
25, bed 377, November 19tb, 1873. Hays that he was taken sick two days before 
entering the hospital, and that he had suffered with chills and fever occasionally 
during the autumal months. Complained of pain in right lung, difficulty in 
breathing, loss of appetite, thirst, and pain in the head, back and lower extremi- 
ties. Five grains of quinine and twenty drops of tincture of opium (laudanum) 
were administered, and sinapisms applied to the chest. November 20th. The 
pain continues to increase upon the right side, the cheeks are flushed, and auscul- 
tation and percussion reveal the presence of pneumonic inflammation in the middle 
and lower lobes of the right lung. Pulse 100; respiration 52. 
November 21st, 8 A. M.-Pulse 116; respiration 56; temperature of axilla 104° 
F. Great dyspnoea; rapid respiration. Cheeks of a purplish red color. Sputa 
consists of blood, mixed with tenacious, jelly-like matter. Cough troublesome and Pulse, Temperature and Urine in Pneumonia. 
757 
painful. Pain in the right side, greatest about three inches below the nipple, 
and extends towards the back. Patient was restless and delirious during the 
preceding night. Tongue rough and covered with a yellowish fur in the 
centre. Pulse rapid, full, strong and compressible. Upon percussion right 
lung dull over region of middle and lower lobe. Auscultation reveals crepitation 
in inspiration, with bronchial respiration and increased vocal fremitus over the 
lower and middle lobes of right lung. R. Quinise sulph., pulv. Doveri (ipecac et 
Opii), of each, one scruple; mix; divide into four powders. Sig: One powder 
every four hours. Apply turpentine stupes over right side. Milk punch and beef 
tea at regular intervals. 8 o'clock P. M. Temperature of axilla 105°. 
November 22d, 8 A. M.-The patient passed a disturbed, restless night, but 
appeared to be more comfortable this morning, the pulse being 106 and the respira- 
tion 24. Auscultation and percussion revealed no increase in the pulmonary dis- 
ease. The treatment and diet were continued. The temperature, also, of the 
axilla has fallen one and a half degrees, and is 1O3.°5 F. Shortly after this observa- 
tion the patient expressed a desire to receive "extreme unction" from the Catholic 
priest. He was, accordingly (without my knowledgeor consent), taken out of bed 
and placed in a chair, with his feet resting upon the bare floor. This exposure 
brought on severe pain in the left lung also, with a rapid rise of the temperature, 
and at 8 P. M. the thermometer in the axilla stood at 109° F. The temperature of 
the blood in the internal organs was most probably as high as 112° or 113° F. 
November 23d.-Patient delirious during the night, it being necessary to con- 
fine him to the bed. The burning fever appeared to abate towards morning. 8 
o'clock A. M. Restless, anxious, and at times delirious. Cheeks flushed, and of 
a purplish blue color; lips and hands congested. Respiration rapid and panting. 
Expectoration almost entirely suppressed. Respiration rapid, embarrassed and 
painful. Lower lobe of left lung dull upon percussion, with crepitant rales and 
tubular breathing. Pneumonic symptoms of right lung aggravated. Pulse 130; 
respiration 56; temperature of axilla 102.°5. The exposure of yesterday has evi- 
dently excited fresh inflammatory actions in the lungs, both of which are now 
involved, and the remarkable rise of temperature to 109® F. during the evening, 
was evidently due to the sudden spread of the pneumonic inflammation. I ordered 
quinine and Dover's powders and turpentine stupes and beef tea and milk punch 
to be continued as before, and ordered, in addition, the following: R. Liq: Ammo- 
nise acetatis, half afluidonce every two hours. R. Tinct. jelseminum semper- 
virens (yellow jassamine) ten drops every four hours. Under these measures the 
fever slowly declined; a large portion of the right lung, however, passed into the 
stage of solidification and gray hepatization. A large cavity formed in the middle 
lobe of the right lung. 
In this case, during the changes of the pulmonary textures resulting 
from the pneumonic inflammation, the temperature for one hundred days 
oscillated between 100° and 104° F., the mean ranging between 100° and 
102° F., as in some cases of phthisis pulmonalis. Under the continuous 
employment of quinine, iron, bitter tonics, gentle expectorants and cod 
liver oil and nutritious diet, I had the satisfaction of seeing this patient 
restored to health after an illness extending over four months. Daily 
observations were taken of the pulse, respiration and temperature, with 
observations upon the physical changes of the lungs and the characters of 
the urine, but it would extend this report to too great a length to present 
the details. The Confederate soldier, Andrew Jackson Sharpe, whose 
case has been detailed, No. 968, had in the month of August following, an 
attack of intermittent fever, and I was thus enabled to institute a com- 
parison between the phenomena of this disease and those of pneumonia, 
occurring in the same individual. 
Case 970. Intermittent Fever following Pneumonia in the same Individual.- 
Andrew Jackson Sharpe, Confederate soldier; had an attack of pneumonia, which 
we have recorded (Case 968). August 21st. Had a chill this morning about 8 
o'clock, and at the present time, 11 o'clock A. M., has fever. Pulse 94; respiration 
28; temperature of hand 41.°4 C , 106.°6 F.; temperature of axilla, 41.°6 C., 1O6.°9 
F. Face flushed. Urine light colored; urine passed, after the chill, during the 
onset and height of the fever, normal in color, limpid, without deposit, even after 758 
Pulse, Temperature and Urine in Intermittent Fever. 
standing several days: reaction strongly acid; specific gravity 1011. Amount of 
urine passed during ten hours of the commencement and height of the fever, 7794 
grains. 
Analysis of urine passed during ten hours of the commencement and height 
of a paroxysm of paludal ferver: 
Urine passed during 10 hours. 
Grains. 
Amount of urine 7794.81 
Phosphoric acid 2.93 
Sulphuric acid 10.08 
Chlorine 42.75 
Fixed saline] 
Constituents, } 
74.22, 
Equivalent chloride of sodium 70.56 
Phosphates of lime and magnesia 0.23 
Phosphates, sulphates and carbonates of soda 
and potassa 3.34 
The saline constituents consisted almost entirely of chloride of sodium, whilst 
the potassa salts appeared to be, in a great measure, absent. The presence of 
chloride of sodium, and the absence of the phosphates and potassa salts in the urine 
during the active stages of malarial fever, correspond with the pathological changes 
which we have demonstrated by the analysis of the blood and urine and organs in 
a large number of cases. During the chill of paludal fever, the spleen and liver, 
and, in fact, all the central organs, but more especially the spleen and liver, are 
congested with blood. The changes of the blood in the liver and spleen are of a 
peculiar nature; there is not a mere congestion and stagnation of the blood; 
important changes take place in the blood of these engorged organs. [ have deter- 
mined by numerous microscopical observations, as well as by chemical analysis, 
that the mud of the enlarged and softened malarial spleen consists almost entirely 
of dead and altered colored blood-corpuscles. So also the liver contains vast num- 
bers of pigmentary fragrants deposited chiefly in the periphery of the lobuli, and 
which have resulted from the destruction and alteration of the colored blood-cor- 
puscles. The denial of the existence and the pathological significance of the pig- 
ment particles of the liver and spleen in malarial fever, can be referred only to 
absolute ignorance of the natural history and pathology of this disease, ami to 
gross incompetency in the use of the microscope. It is impossible that the pig- 
ment particles of the liver and the spleen of malarial fever, which consist chiefly 
of altered hsematin, should escape the attention of any competent microscopist. 
After the active congestion of the liver and spleen during the cold stage, the blood- 
corpuscles, which have been withdrawn from the circulatory fluid, undergo pro- 
found alterations. Therefore, after the chill, an impoverished blood circulates and 
undergoes chemical change. This blood is characterized by a deficiency of col- 
ored blood-corpuscles, ami a preponderance of the liquor sanguinis; and, hence, it 
appears that the urine excreted during the first stages of the paludal paroxysm 
presents corresponding characters:-as chloride of sodium is the salt which more 
especially characterizes the liquor sanguinis, it will appear in the greatest abun- 
dance in the urine; and as the colored blood-corpuscles have been withdrawn in a 
great measure from the general circulation, we have during such withdrawal a 
clear, limpid, colorless urine. As a large portion of the colored blood-corpuscles 
have been temporarily withdrawn from the general mass of the circulation, the 
salts peculiar to them, and resulting from the chemical changes of their compo- 
nentelements, viz: the phosphates of potassa, lime, magnesia and iron, will, in a 
great measure, disappear from the urine. August 22, 11 A. M. Pulse 66; respira- 
tion 22; temperature of hand 38° C. (100.°4 F.); of axilla 38.°3 C.; (101° F.) Patient 
in a good perspiration; fever appears to be declining, which change commenced 
about 7 A. M., when sweating commenced. 
Examination of urine.-The urine passed during the gradual subsidence of the 
fever, was much more deeply colored than the urine of fever, and presented a red- 
dish color. Amount of urine passed during fourteen hours after the decline of the 
fever, from August21st, 10 P. M., to August22d, 12 M.: Grains 9601.20; specific gravity 
1016. The phosphoric acid appeared to be combined chiefly with the alkalies, for 
ammonia failed to precipitate but a very small quantity of phosphates of lime 
and magnesia, and, in fact, so small a quantity, that it was found impracticable to 
filter them from the urine. The crystals also appeared to be unusually small, and 
to pass readily through the filter. The saline constituents consisted in considerable 
measure of common salt, but not to so large an extent as during the fever. Pulse, Temperature and Urine in Intermittent Fever. 
759 
Analysis of urine passed during fourteen hours, August 21st, 10 P. M., to 
August 22d, 12 M.: 
Urine passed during 
14 hours. 
Grains. 
Amount of urine 9601.20 
Phosphoric acid 29.07 
Sulphuric acid 19.20 
Chlorine 36.30 
Fixed saline 
constituents 
76.50 
Equivalent chloride of sodium 
Phosphates and sulphates of lime, soda and 
potassa 
59.84 
16.66 
We observe a dccmen luvreuHe ui puvspuonu uuiu. auu puusphates. Some of 
the characteristic changes of the urine in malarial fever are shown in the two pre- 
ceding analyses. These changes correspond with the phenomena. As paroxysms 
characterize the phenomena of malarial fever, so do marked changes, at different 
periods of the disease, characterize the urine. August 23d, 12 M.-Pulse 80; respi- 
ration 24; temperature of axilla 38.°5 C. (101.°3 F.). 
Examination of urine.-Heavy crystalline deposit in urine, of phosphates of 
lime, magnesia and ammonia, and of urates and uric acid. Amount of urine 
passed during the last twenty-four hours, grains, 12.927.60. Sp. gr. 1026. 
Analysis of urine passed during twenty-four hours, August 22d, 12 M., to 
Urine passed during 
24 hours. 
Grains. 
Amount of urine 12927.60 
Phosphoric acid 52.93 
Sulphuric acid 43,54 
Chlorine 64.90 
Entire^aline 
constituents 
146.43 
Equivalent chloride of sodium 106.99 
Phosphates of lime and magnesia 15.81 
Phosphates and sulphates of potassaand soda 23.63 
By a comparison of the various analyses of the urine in this case, we observe a 
progressive increase in the saline constituents, and especially of the phosphates of 
lime and magnesia, Absolutely no medication was employed in the preceding 
case, so that it furnishes data for the comparison of the phenomena of pneumonia 
and paroxysmal fever, occurring at different times in the same individual. 
That cases of fevershould arise inahospital, or in camp at any time, inde- 
pendently of the effects of exposure or fatigue, or the supervention of any recog- 
nizable inflammatory lesion, may be accounted for in a measure by the fact, 
that tents and hospitals are often loaded with deleterious exhalations, 
which may be capable of inducing febrile excitement in the animal 
economy. Sudden check of perspiration may also induce general febrile 
excitement, not so much as Dr. Hall and others would have us believe, 
from an impression upon the sensitive nerves of the surface transmitted 
through the central spinal ganglia, and reflected upon the sympathetic and 
vaso-motor nerves, as from the sudden suppression and perversion of the 
functions of the extensive glandular system of the skin, and the consequent 
retention of deleterious matters in the blood, which are capable of affect- 
ing the nervous system and inducing febrile action. In the problem of the 
action of the emunctories of the skin, and of the amount and chemical 
composition of the matters eliminated, cold or temperature enters as a 
material element. It is possible that the phenomena may be explained 
without resort to the theory of the transmission of nervous influence to 
internal organs. Disturbances in the electric phenomena of the nerves 
and muscles, and of the secretions, should also be considered in the dis- 
cussion of the origin of irritative fever and inflammations. I select the 
following case of irritative fever, arising spontaneously in my hospital 
practice during the Civil War. as affording materials for comparison with 
the case of pneumonia (969) previously recorded, in that it was treated 
strictly upon the so-called expectant plan, without drugs. 760 
Pulse, Temperature and Urine in Intermittent Fever. 
Case No. 971.-Fever originating in military hospital, without any assignable 
cause, and without any discernible local inflammation; treated upon the expectant 
plan, without drugs. - Powers, Confederate soldier, age 18 years; height 5 feet 7 
inches; weight 115 pounds; light hair, fair complexion. Has been in the General 
Hospital, C. S. A., Augusta, Georgia, for four weeks. Entered with bronchitis, 
and in an anaemic condition. Native of Marion District, South Carolina. Says 
that he had chillsand fever last year; and has had pneumonia three times in his 
life. During his stay in this hospital, has been treated with quinine, iron and bit- 
ter tonics, and supplied with nutritious diet. Under this treatment the patient 
has improved rapidly, gaining both in flesh and strength, and presenting a clear, 
healthy complexion. The patient was in apparent good health, and fit for active 
service in the field, when on the night of July 18th, 1862, he was seized with severe 
pair, in his head, followed by high fever, the pulse beating 120 per minute and the 
temperature of the axilla reaching 106° F. July 19th, 12 M.-Pulse 120; skin hot 
and dry; tongue moist, but red. Ordered his urine saved from this moment. I 
prescribed nothing, but directed that the patient should be supplied with cold 
water, ad libitum. July 20th, 11 A. M.-Much better; skin cooler; pulse 112; skin 
warm, but moist; tongue red, but moist. Bowels have been moved four times, and 
are inclined to diarrhoea. Urine orange colored. Nothing ordered beyond cold 
water and simple nutritious diet. July 21st, 2 o'clock P. M.-Pulse 92; respiration 
22; temperature of hand 36° C. (98° FJ; of axilla 38.°4 C. (101.°1 F.). 
Examination of urine.-Amount of urine passed during the last forty-eight 
hours, grains, 31890.6; specific gravity 1012.4. Urine rapidly underwent putrefac- 
tion, and emitted an offensive smell, as in that of the case of pneumonia, 969; 
while on the other hand the urine excreted during the active stages of malarial 
fever, as in case 971, did not undergo a similar change and emit an offensive odor, 
until the febrile excitement had subsided. 
Analysis of urine passed during forty-eight hours 
Amount of urine 
Forty-eight 
hours. 
Grains. 
31890.60 
Twenty-four 
hours. 
Grains. 
15945.30 
Each hour. 
Grains. 
664.38 
Urea . 
741.12 
370 56 
15.44 
Uric acid 
22.68 
11.34 
0.47 
Free acid 
46.32 
23.16 
0.96 
Phosphoric acid 
96.90 
48.45 
2.01 
Sulphuric acid 
47.53 
23.76 
0.99 
Chlorine 
15.82 
7.91 
0.32 
Equivalent chloride of sodium. 
26.05 
13.02 
3.13 
Phosphates and sulphates of 
lime, 
75.17 
0.54 
magnesia, and of potassa and soda 150.35 
July 22d, P. M. Free of fever; pulse 84; skin cool. July 23d, 2J o'clock P- 
M. Pulse 96 ; respiration 22 ; temperature of hand 36.°8 C. (98.°2 F.); of axilla 38° 
C. (100.°4 F.); skin moist; tongue red. 
Examination of urine.-Amount of urine passed during the last forty-eight 
hours, grains 19,857.12; specific gravity 1009; normal color, slight deposit. 
Analysis of urine passed during forty-eight hours: 
Forty-Eight 
Twenty-four 
Each hour. 
hours. 
hours. 
Grains. 
Grains. 
Grains. 
Amount of urine 
19,857.12 
9,928.56 
413.69 
Urea 
636.90 
318.45 
13.26 
Phosphoric acid 
22.71 
11.35 
0.47 
Sulphuric acid 
44.10 
22.50 
0,93 
Chlorine 
3.57 
1.78 
0.07 
Equivalent chloride of sodium... 
5.48 
2.94 
0.12 
P. M. Free of fever; pulse 80; surface of body feels cool and natural. July 
24th, 1 P. M.; pulse 96; respiration 16; temperature of hand 36.°4 (97.°5 F.); of 
axilla 38.°2 C. (100.°7 F.) 
Examination of urine.-Amount of urine passed durins; twenty-four hours, 
grains 9,515.52; specific gravity 1008 ; straw colored; heavy deposit of phosphates 
and urates. Alkaline reaction and putrid odor. Pulse, Temperature and Urine in Intermittent Fever. 
761 
Analysis oi urine passed during twenty-four hours : 
Urine twenty- 
Urine each 
four hours. 
hour. 
Grains. 
Grains. 
Amount of urine 
9.515.52 
396.48 
Urea 
236.23 
9.84 
Phosphoric acid 
7.62 
0.30 
Sulphuric acid 
11.31 
0.47 
Chlorine 
1.48 
0.06 
Equivalent chloride of sodium 
2.43 
0.10 
During this day, all traces of the fever subsided, and the only perceptible effects 
were those of debility-the complexion being rendered paler, the skin more relaxed 
and the patient more languid and feeble than in health. As far as could be deter- 
mined by physical exploration and chemical research, no organ was implicated in 
this fever. With the exception of several discharges from the bowels, on the 20th, 
no derangement of any of the viscera was manifested, and this slight disturbance 
of the alimentary canal, might have been produced by the copious draughts of cold 
water. 
The consideration of the spontaneous resolution of such cases of fever, 
which in their onset, forbode serious consequences, is important in the 
warning which it gives against the unconditional acceptance of the state- 
ments of those who assert that certain fevers, and especially typhoid fever, 
can be aborted or strangled in the earliest stages by ceitain remedies and 
measures. If in this case (972) quinine or opium, or any other remedy, 
had been used, the physician might have attributed the gradual subsidence 
of the fever to the so-called abortive effects of his drugs ; whilst in reality, 
nature needed no assistance; either the poison producing the fever being 
so limited in amount, as to be readily destroyed during the changes of 
fever,-or else the disturbances in the nervous system and blood, and 
organs, were so slight as to be readily re-adjusted by the working of the 
natural and fixed laws of the economy. It would also be a subject of 
inquiry to determine how far the free use of cold water internally may 
have promoted the favorable result; as well as the probable effects of the 
withdrawal of this agent, and free supplies of fresh air upon the progress 
and lesultsof such a case of fever. An examination of the changes of the 
urine in the preceding case reveals the fact that the chlorine was dimin- 
ished to a marked degree. The diminution of this element is character- 
istic not alone of pneumonia, but all those diseases, as typhoid fever, small 
pox and remittent fever, which continue for a considerable length of time, 
and in which little or no nutriment is taken. We have shown that the 
chlorides may be diminished to a marked extent even in traumatic tetanus. 
It would expand the present volume to too great an extent to detail the 
observations which we have made upon the urine in pneumonia and vari- 
ous other diseases in order to illustrate the chemistry, pathology, and 
treatment ; and I will content myself with an expression of such general 
conclusions as will illustrate certain questions relating more especially to 
the method of treatment. 
1st. During the active stages of pneumonia, the urea, uric acid, free 
acid, phosphoric acid and sulphuric acid are present'in increased quanti- 
ties in the urine ; and such increase is evidently due to the metamorphosis 
of tissue during the increased chemical changes of the forces. 
2d. During the active progress of the pneumonic inflammation, the 
chlorine rapidly diminishes in amount and may entirely disappear; and 
its re appearance in the urine and progressive increase indicates an arrest 
of the farther progress of the pneumonic inflammation. The re-appear- 
ance of the chlorides in the urine may indicate the commencement of con- 
valescence, before auscultation and percussion afford any information as to 762 
Pulse, Temperature and Urine m Intermittent Fever. 
the progress or arrest of the pneumonic inflammation in the sound por- 
tions of the lungs. A similar observation is also true with reference to 
the indications afforded by the thermometer. The retention of the chlo- 
rides is connected with the morphological changes of the pneumonic exu- 
dation, and their excretion is increased during the absorption and disap- 
pearance of the exudation. 
3d. In malarial fever, on the other hand, during the chill and early 
stage of the febrile excitement, chloride of sodium appears in increased 
amounts, whilst there is a marked diminution of uric acid and phosphoric 
acid. During the cold stage the colored blood-corpuscles are accumulated 
and altered in the liver and spleen ; and during the hot stage an impover- 
ished blood circulates and undergoes chemical change ; as this blood is. 
characterized by a preponderance of the liquor sanguinis, and as the chlo- 
ride of sodium is the most abundant and characteristic saltaf the liquor 
sanguinis, it will appear most abundantly in the urine. As a large portion 
of the colored blood-corpuscles have been temporarily withdrawn from the 
general mass of the circulation, the salts peculiar to them and their chemi- 
cal changes, viz : the phosphates of iron, lime and potassa, will in a great 
measure disappear from the urine. Owing to the congestion of the liver, 
the bile also is altered in its properties, and appears to be excreted in 
larger quantities than in health. 
4th. During the continuance of the fever, however, the urine becomes 
of a deeper color, the phosphoric acids and potash salts, and uric acid 
gradually increase. The increase of those constituents in the urine during 
the progress of the fever is readily explained by the fact that the altered 
blood-corpuscles, during the active changes of the fever, are themselves 
drawn into the round of chemical change, undergo decomposition, and 
yield up the coloring matters and salts to the eliminating action of the 
kidneys. 
5th. The remarkable changes of temperature, as well as the internal 
congestions characteristic of the chill, are probably due to the action of 
the malarial poison, or of the blood altered by the paludal poison, upon 
the internal ganglionic centres. This appears to be indicated by the remark- 
able fact that during the chill, there is an actual elevation of the tempera- 
ture of the trunk sometimes as high as 107° F., whilst there may be a 
reduction of the temperature of the extremities as low as 87° F., or ten 
degrees below the standard of health, and 20 degrees below the tempera- 
ture of the trunk. This phenomenon resembles in some respects that of the 
division of the sympathetic in the neck. There is then during the chill a 
paralysis of the sympathetic system, a dilatation of the largest blood ves- 
sels, and especially of the veins and sinuses and capillaries of the brain, 
spinal cord, liver and spleen, and an accumulation of blood in the central 
organs ; and attending this stagnation of the blood in the central organs, 
and contraction of the capillaries of the periphery of the body, there is 
an actual rise in the temperature of the mass of blood, as if by some agent 
or ferment, rapid chemical change was excited in the vital fluid. It is a 
question whether the paralysis of the vessels of the surface be due to direct 
action of the vaso motor nerves, or to the accumlation of the blood in the 
large central organs, consequent upon the paralysis of the ganglia of the 
sympathetic cerebro spinal system, which preside over circulation and 
animal heat. When the chills recur frequently these phenomena will be 
frequently repeated, becoming less distinct as they approach each other ; 
and in the remittent form of fever they are less marked, and the changes 
of the urine present greater uniformity. Pulse, Temperature and Urine in Intermittent Fever. 
763 
6th. The disappearance of the phosphoric acid from the urine in the 
early stages of the paroxysm, also indicate perversion or arrest of the 
normal and nutritive and chemical actions of the nervous system. 
7th. In typhoid (enteric, continued, camp) fever, uniformity charac- 
izes the phenomena; whilst paroxysmal changes characterize those of 
malarial fever. In typhoid fever the colored blood-corpuscles are not 
specially altered, either in character or amount; neither are the spleen and 
liver specially affected. 
8th. Typhoid fever is characterized by an elevated temperature with 
slight morning and evening variations; great mental, nervous and muscu- 
lar depression; rapid chemical change of the elements of the nerves, mus- 
cles and blood; great and continuous increase in the amounts of urea, 
phosphoric and sulphuric acid excreted in the urine. 
9th. Pneumonia is characterized by structural alterations of certain 
defined anatomical elements of the lungs; malarial fever is characterized 
by certain definite lesions of the blood, liver and spleen; yellow fever, by 
certain lesions of the blood, heart, liver and kidneys; typhoid fever, by 
certain lesions of the intestinal canal; in each case, the important question 
arises, what is the exact connection between the local lesions or manifes- 
tations of diseased action, and the genera! pyrexiae? If in pneumonia, the 
exudation into the lungs coincides with the end of the pyrexiae, it would 
appear that the exudation into the air cells, relieved or cured the fever; 
and the conclusion might be justified, that the lung disease is not a pri- 
mary but secondary affection, and that by purifying the blood, it brings to 
an end, a condition of general pyrexiae, arising from preceding- blood dis- 
ease. On the other hand, it may be held that the local inflammation of the 
lung is the primary lesion, and the fever is the result of the disturbances 
in the blood circulation and nervous system caused by the inflammation of 
certain anatomical elements of the pulmonary tissue. I do not propose to 
enter into an exhaustive discussion of these theories, and will dismiss the 
subject with the practical observation that, as a general rule, the fever is 
coincident with the supervention of the local inflammation, and presents 
characters in accordance with its extent and severity, and continues as 
long as active inflammation is present, and is renewed in intensity when- 
ever fresh portions of the pulmonary tissue are involved. According to 
this view the fever of pneumonia resembles the traumatic or so-called sur- 
gical fever attending wounds. 
II. CHANGES OF THE PULSE, RESPIRATION AND TEMPERATURE IN 
MALARIAL REMITTENT FEVER. 
Proposition VII. The phenomena of the cold stage, preceding the hot stage 
of remittent fever, are similar to those of the cold stage of intermittent fever. 
During the cold stage of remittent fever, there is a rapid, feeble pulse, 
full, rapid respiration, and hot trunk, and cold extremities. The temper- 
ature of the extremities is reduced far below that of the trunk, and even 
below the standard of health. The diminution of the capillary circulation 
and reduction of temperature of the extremities precede the aberrated nervous 
and muscular phenomena, denominated chill. The higher the temperature of 
the trunk, during the cold stage, the more rapid will be the equalization of 
the circulation and temperature; the higher the temperature of the trunk 
during the cold stage, and of the extremities and trunk during the subse- 
quent hot stage (stage of equalization of the circulation and chemical 
action), the milder and shorter will be the attack, if judiciously treated, 
provided there be no complication, as congestion of the brain, or obstinate 764 
Pulse, Respiration and Temperature in Malarial Intermittent Fever. 
vomiting; whenever there is a want of correspondence between the circu- 
lation, respiration, and chemical changes, the patient is in danger. 
Remittent fever is usually ushered in by a chill, the characteristic 
features of which are headache, pain in the back and lower extremities; 
nausea and vomiting of bile, tenderness of the epigastrium; thick white or 
yellow coating on the tongue; slight jaundice; loss of appetite, constipa- 
tion; scanty high colored urine; great nervous and muscular disturbance 
and inability to perform any protracted effort. In many cases the head- 
ache is intense, the pain darting with a sense of tension across the fore- 
head. The varieties, forms or types of malarial fever, known as ague, 
intermittent, quotidian, tertian, quartan, remittent fever, continuous mala- 
rial fever, remittent malarial yellow fever, masked, pernicious, algid, 
comatose and cachexia paludiana, have many features in common, and 
appear to be produced by the same morbific cause, micro-organisms or fer- 
ment. The specific contagious form of yelloiv fever, is a different fever 
from remittent fever, and its cause is different from that which induces 
the various forms of malarial fever. 
Proposition VIII. As far as my observation extends, the most impor- 
tant difference betiveen the cold stage of remittent, and that of intermittent fever, 
is a difference of degree and not of hind; the phenomena of the cold stage of 
remittent fever are more protracted than those of intermittent fever; the sympa- 
thetic system is not so rapidly aroused, and the circulation in the capillaries of 
the extremities is not so rapidly restored in remittent, as in intermittent fever. 
We have before shown that the alterations of the blood are more pro- 
found in remittent than in intermittent fever, and that in both diseases the 
alterations in the blood precede the disturbances of the circulation and respira- 
tion and action of the sympathetic nervous system; it follows then, as a neces- 
sary consequence, that the phenomena of the cold stage should be more 
prolonged in remittent than in intermittent fever. 
The fever is often accompanied with jaundice at an early stage, and 
hence some authors speak of a malarious form of yellow fever. The early 
appearance of jaundice in remittent fever however only indicates the 
degree of severity, and does not indicate the existence of a cause similar to 
that which induces specific yellow fever. Jaundice may occur in any of 
the forms of malarial fever, and at any stage of the disease; but in remit- 
tent fever it occurs at an earlier stage, as a general rule, and in the sever- 
est and most dangerous forms (the so-called malarious yellow fever) the 
hepatic derangement is a prominent symptom from the very commence- 
ment, and the intense jaundice may constitute the most prominent and 
startling symptom to the casual observer. The origin and pathology of the 
" malarious yellow fever " is the same in kind with that of the other forms 
of intermittent and remittent fevers. 
Proposition. IX. In remittent as in intermittent fever the increase of 
the action of the pulse and respiration is attended by an elevation of temperature, 
and the elevation of temperature corresponds more accurately with the increased 
actions of the circulatory and respiratory systems in intermittent than in remit- 
tent fever-that is, the pulse and respiration are more accelerated in remittent 
fever, whilst the temperature does not rise higher than that of intermittent fever. 
The explanation of this phenomenon lies in the fact that the blood is most 
altered in remittent fever, and that the chemical changes of the capillaries 
are most disturbed, and probably the power of the blood to absorb oxygen, 
or the force of the circulation in the capillaries of the lungs, more dimin- 
ished in remittent than in intermittent fever. Remittent Fever: Investigations by Joseph Jones, M. D. 
765 
The hot stage or period of exacerbation of remittent fever generally 
commences at noon or early in the afternoon, subsiding towards evening, 
or in the early part of the night, the remissions being generally most com- 
plete early in the morning; sometimes however, the exacerbations come on 
towards evening, and continue all night, the remissions being then most 
complete in the forenoon; while in a few cases there may be two exacerba- 
tions in the twenty-four hours, and these cases are generally the most 
severe. 
Proposition X. The elevation of the temperature is more persistent in 
remittent than in intermittent fever. The alterations of the blood induced 
by the malarial poison are greater, and the effects upon the liver, spleen, 
sympathetic and cerebro spinal nervous systems, and upon the heart, are 
greater than in intermittent fever, and hence more vigorous chemical 
changes are needed for the alteration and elimination of these altered 
offending products. 
The exacerbation in remittent fever is usually marked by some cere- 
bral derangement, as severe headache, a painfully acute state of every 
sense, an injected state of the conjunctiva, a red flushed countenance, and 
violent action of the carotid arteries. The pulse varies from 90 to 130 beats 
per minute; and is generally full, but in some cases it is rapid and small 
from the beginning of the disease. The tongue is dry, red at the tip and 
edges, and coated with white, yellow or brown fur at the root, and in the 
centre. In many cases when the patient has been breathing, in the height 
of the fever, with his mouth open the tongue feels harsh and rough like 
sand paper to the touch. The lips are parched and the thirst is unquen- 
chable, more or less tenderness of the epigastrium exists in every case; and 
pain with increased dullness on percussion in the region of the liver is a 
common symptom. These symptoms are frequently accompanied by deli- 
rium, sometimes of a violent character; when giddiness is distressing and 
proceeds to high delirium, at an early period, a severe form of fever may 
be expected. In some cases the patient is oppressed with great drowsiness, 
lethargy or coma. 
Proposition XL The pain upon pressure of the epigastrium is more 
acute, and the vomiting more obstinate, and the cerebral symptoms more common 
and dangerous, in remittent than in intermittent fever. 
In remittent fever the stomach is often the seat of great pain and 
uneasiness, followed by vomiting, and the matters vomited are often bilious; 
in comparively rare instances the vomited matters may contain blood 
mixed with mucus and bile, or they may consist almost entirely of blood. 
When the attack is mild the first paroxysm of fever may terminate in six 
or seven hours, but if severe it may last fifteen, twenty-four, thirty-six or 
even forty-eight hours, and cases have been observed in which there was 
no remission for seventy-two hours; the first exacerbation is generally the 
longest. The fever, however, at length remits, sometimes with sweating, 
but at other times without any sensible increase of perspiration. The dura 
tion of the remission which follows is as various as that of the hot stage; 
sometimes it does not last more than two or three hours, more commonly 
it extends to six, eight, ten, fifteen, thirty, or even thirty-six hours. The 
fever then returns, and in some cases assumes a quotidian type, and has 
an exacerbation every day, and, perhaps, nearly at the same time; yet 
more frequently there is no regularity in their time, either of the accession 
or remission. 766 
Remittent Fever: Investigations by Joseph Jones, M. D. 
Proposition XII. The secretions of the mouth are more completely checked, 
and the tongue is drier, redder, and rougher to the feeling, in remittent than in 
intermittent fever. 
In the active stages of remittent fever, the tongue, in many cases, 
especially if it be the first attack of fever, presents, upon those portions 
which are clean, a brilliant scarlet color, and dry, glazed surface; the 
papillm are enlarged; the fur which frequently coats the tongue is of a yel- 
lowish and brownish-yellow, and sometimes black color, and almost always 
dry; the tongue, in many cases, feels, when the finger is passed over it, as 
dry and as rough and harsh as the surface of a rough board. 
The appearance of the tongue should be carefully regarded by the 
physician as furnishing a valuable guide for prognosis and the administra- 
tion of remedies and nourishment. As long as the tongue presents a 
bright red tip and red edges, with a heavy coating of fur in the centre, 
there is no assurance that the fever will not return. No agent is so certain 
in its effects in changing the character of the tongue in remittent fever as 
the sulphate of quinia, especially when its use has been preceded by a pur- 
gative dose of calomel. As long as the tongue presents the red tip and 
edges, and furred centre, the free use of full doses of quinine must be con- 
tinued at regular intervals. When the stomach is so irritable that quinine 
cannot be borne by the mouth, it should be administered by the rectum, or 
by the skin by inunction. If possible quinine should not be administered 
hypodermatically in remittent fever, on account of the severe local inflam- 
mation which its sometimes causes. Several cases of traumatic tetanus 
have been caused by the subcutaneous injection of the sulphate of quinia. 
When administered by the rectum, ten grains of sulphate of quinia may 
be administered with five minims of laudanum in two fluid ounces of water 
every two or three hours. 
Proposition XIII. The glowing tongue of remittent fever is not an index of 
inflammation. 
It indicates arrest or disturbance of circulation in the capillaries of the 
superficial parts of the tongue. The secretions of the mucous membrane 
have been checked; the moisture is evaporated by the elevated tempera- 
ture; the circulation in the superficial capillaries is thus retarded, and they 
become filled w'ith colored blood-corpuscles, which give the bright color to 
the tongue. 
It is manifest that digestion is greatly impaired, in this condition of 
the mucous membrane of the alimentary canal, and that the physician 
should pay the utmost attention to the nourishment of his patient. As 
this disease in its active stages is characterized by a rapid destruction of 
the colored blood-corpuscles, and by repeated congestions of the internal 
organs, and more especially of the liver, and by high temperature and 
increased chemical changes and increased formation of urea, uric acid, 
phosphoric acid, sulphuric acid, and the extractive matters, it is evident 
that the free use of water is indicated, both internally and externally. 
The patient suffering with remittent fever should not be denied cool water, 
and his fevered and frenzied brow should be refreshed and calmed by 
cloths wet with cool water. The fever heat will also be reduced, and per- 
spiration promoted by sponging the body with water, either pure or mixed 
with a portion of alcohol, bay rum or tincture of camphor. Even when 
the stomach rejects the water, its judicious and continuous use, will tend 
to reduce and relieve the congested and irritable gastro-mucous membrahe, 
to dilute the acid secretions, to promote free diuresis and the elimination Remittent Fever : Investigations by Joseph Jones, M. D. 
767 
of the increased products of the chemical changes of the blood, bile and 
tissues. 
Fragments of ice in the mouth, and cool water charged with carbonic 
acid, will often allay thirst and diminish the congestion of the gastric 
mucous membrane, dilute the acrid secretions of the stomach, and arrest 
obstinate vomiting. When the pulse is weak, iced champagne has often 
proved of great benefit. There can be no greater mistake than to deny the 
frenzied fever patient regular and liberal supplies of cool water. In many 
cases, the whole progress of the disease may be changed for the better by 
the proper employment of cold water internally and externally. The diet 
should be simple, but nutritious; for it is manifest that the hot, congested 
stomach of the patient in remittent fever is incapable of digesting solid 
food. Beef tea (four pounds of rare, tender beef, cut up into fine particles, 
treated with from ten to thirty drops of hydrochloric acid, and boiled in a 
porcelain vessel for from one to two hours, and the juices pressed out in a 
coarse cloth), in small quantities at short intervals, is the best nutri- 
ment; but we may also employ barley water, rice or corn gruel, and milk 
and lime water (three parts of milk to one of lime water). 
Proposition XIV. The secretions of the salivary glands and mucous mem- 
brane of the mouth are not only more diminished, but they are also more perverted 
in remittent than in intermittent fever. The acidity of the saliva is greatest in 
remittent fever. 
The solution of the question-What checked the secretions of the 
salivary glands and mucous membrane of the mouth?-involves the con- 
sideration of the relations of the malarial poison to the salivary glands and 
mucous membrane of the mouth; involves the consideration of the relations 
of the altered products of the blood, resulting from the action of the mala- 
rial poison, to the salivary glands and mucous membrane of the mouth; 
involves the consideration of the relations of the malarial poison and altered 
elements of the blood to that portion of the nervous system which presides 
over the circulation and secretion of the salivary glands and mucous mem- 
brane of the mouth. The proposition will be readily comprehended, if the 
material particulate and living nature of the malarial poison be admitted. 
The more numerous and the more active the micro-organisms of malarial 
fever, the more profound will be the impression of the poison which they 
generate, upon the nervous centres which preside over the circulation, calor- 
ification and secretion of the individual organs. Whilst the salivary glands 
are directly affected by the action of the malarial poison, the nervous 
centres of the sympathetic and cerebro spinal nervous systems, which pre- 
side over their circulation, nutrition and secretion, are also profoundly 
impressed, and the character of such impression must be definitely related 
to the amount and character of the morbific ferment. As long as the 
tongue presents a red, dry appearance, and as long as the salivary secre- 
tions are altered in quantity and quality, the disease must be regarded as 
still progressing, even if the thermometer indicates no elevation of temper- 
ature. 
Proposition XV. The coma, delirium and severe pain in the head so often 
present in the severe cases of remittent fever, are, as a general rule, not indica- 
tive of inflammation of the brain, but of the stagnation of the blood and perver- 
sion of the chemical changes in the capillaries of the brain, and of the action of 
the altered blood upon the nervous elements, and of the direct action of the 
malarial poison upon the nervous structures. 768 
Remittent Malarial Fever. 
The truth of this proposition is established by the effects of stimu- 
lants and sulphates of quinia in the severest forms of remittent fever. In 
numerous cases I have seen, under the free administration of stimulants 
and sulphate of quinia, the dry, red, glowing, parched, hard, rough tongue, 
become moist, clean and pale; the tenderness upon pressure of the epi- 
gastrium disappear; the circulation and respiration abate in force and 
frequency; the dry, harsh, hot skin become soft, relaxed, cool and cov- 
ered with perspiration; the severest headache relieved, and the dullness, 
and even profound coma and wild delirium, of the intellectual faculties 
vanish, and the brain restored to the exercise of its normal functions. 
There are certain points to be observed in the administration of stim- 
ulants under the conditions just described. Thus the alcoholic stimulants 
must be pure, and they must be properly diluted. Impure whisky, brandy 
or wine may accomplish more harm than good. Strong undiluted whisky 
or brandy will still farther irritate and derange the stomach. When pure 
brandy or whisky is diluted with from three to six parts of water, and 
administered in moderate quantities, the restlessness of the patient is often 
relieved, sleep is promoted, and the skin becomes soft and moist. The 
great tendency of the action of the malarial ferment is to derange the con- 
stitution of the blood, to obstruct the functions of the blood-making organs 
and to reduce the nervous and muscular forces. The physician must, as far 
as possible, sustain the strength of the patient by the judicious use of nutri- 
ment, and when indicated diluted alcoholic stimulants. 
PERIODS OF AND DURATION OF REMITTENT MALARIAL FEVER. 
The duration of remittent fever will depend upon the following con- 
ditions: 
(A.) The condition of the patient at the time of the onset of the dis- 
ease and the geographical and climatic surroundings. A strong, healthy 
individual attacked for the first time by remittent fever, will manifest 
different symptoms from an inhabitant of malarious regions who had- 
suffered with preceding attacks of malarial fever. The black race in our 
Southern States and in Africa is not subject to so severe or so pro- 
longed attacks of remittent fever as the white race. The medical writers 
of North America, and more especially of the United States, noting 
at an early date that whilst remittent or bilious fever occurs more or less 
in almost all parts of the United States lying between the Northern lakes 
and the Gulf of Mexico, the situations in which the disease is most preva- 
lent are the valleys of streams, the borders of lakes, ponds, marshes and 
swamps, and the rich prairies of the Western States; and in the United 
States it manifests its severest symptoms in the low malarious regions and 
warm moist climates of the Southern and Southwestern States. It is 
endemic in hot climates, extending its periodic ravages in the East 
Indies, Africa, and South America and in the countries of Southern 
Europe bordering on the Mediterranean. At various times it has depopu- 
lated the Campagna of Rome, and rendered intertropical Africa uninhab- 
itable by whites. European writers have long noted the fact that there 
are great varieties in the degree of severity and type of remittent fever as 
it occurs in England, France, Holland and Germany, as compared with its 
occurrence in Spain, Italy, the Mediterranean Islands, Africa and the East 
and West Indies. Accordingly, three varieties have been distinguished by 
some authors. (1) The autumnal remittents of temperate countries, as Eng- 
land, France, Germany, Holland, Hungary. (2) The summer and autumn 
remittent of warm countries, as Spain, Italy, Greece and the Mediter- Remittent Fever: Investigations by Joseph Jones, M. D. 
769 
ranean coasts and islands generally, the Levant, the North of Africa and 
Asia and the United States. (3) The endemic remittents of hot and tropical 
climates, as in the South of Asia, Central and Western Africa, Equinoc- 
tial America and the West India Islands. 
With reference to one of the several grades of malarial remittent 
fever, Professor William Aitken* says : ''Malarious yellow fever seems to 
prevail, for the most part, in towns situated, on the sea or river 
coasts, of alluvial countries, in warm climates; and, that while the 
banks of these rivers or seas are liable to occasional alternate periods 
of inundations and drying up, the fluctuations of the tides, co-operating 
with them, contribute powerfully, under intense solar heat, and a windless 
atmosphere, to render the towns along the shores of such districts the seat 
of malarious yellow fever." Craige saysjhat the malarious yellow fever 
"appears to be the product of that state of the atmosphere which takes 
place after a long continuance of solar heat, with little or no wind, in those 
points chiefly where the atmosphere of the sea and that of the land are in 
constant communication and interchange. It is indeed a remarkable fact 
that the intense form of remittent fever which has been distinguished as 
malarious yellow fever, and sometimes as bilious remittent of malignant 
type, is rather rare in the interior of countries, and is seldom found in 
towns situated on rivers higher than the influx of the tide. The fevers 
which appear in these situations are more of the usual remittent character, 
and in the interior of the American continent there is little doubt that the 
lake fever represents the malarious yellow fever of the coasts. Even in 
Europe, while the towns on the sea coast, and on rivers, were laboring 
under the malarious yellow fever, the sickness in the interior approached 
more to that of the remittent, or remittent continuous type." 
According to Aitken, the endemic conditions under which malaria 
gives rise to this form, of yelloxv fever, may be referred (1) To thermometric 
temperature of the air ; (2) to the state of the atmosphere as to currents of 
winds and electricity ; (3) local peculiarities of surface; (4) constitutional 
susceptibility and crowding together of masses of people. 
(B.) The type of the disease.-The type of the disease depends upon 
(a.) The intensity of the poison and the amount introduced into the sys- 
tem. (b.) The nature and rapidity of the pathological lesions and changes 
induced by the action of the poison, (c.) The natural powers of the sys- 
tem to sustain the cycle of changes excited by the malarious poison. 
(C.) The extent of the primary congestions, and lesions of the internal 
organs, and more especially of the liver. 
(D.) The nature, rapidity and extent of the lesions of the blood. 
(E.) The supervention of secondary lesions, inflammations and com- 
plications, as: (a.) Parenchymatous, interstitial inflammation of the 
liver (hepatitis), (b.) Acute inflammation and abscess of the liver, (c.) 
Severe and persistent jaundice with destructive changes in the blood, 
(d.) Secondary inflammation of the stomach, small intestine and large 
intestine, gastritis, enteritis, colitis, (e.) The supervention of diarrhoea 
or dysentery, (f.) Supervening diseases, as meningitis, cerebritis, pleuritis, 
pneumonitis, carditis or peritonitis. 
(F.) The plan of treatment : If the case be abandoned to the powers 
of nature, the duration of many cases of remittent fever will be limited 
only by the period at which death occurs. On the other hand, I have 
found, by extensive experience, that the disease may be in many cases 
promptly arrested by administering at once in the first stage or paroxysm 
* Science and Practice of Medicine, 7th Ed. London, 1880, vol. i, pp. 673-674. 770 
Varieties of Remittent lever. 
ten grains of calomel and ten grains of quinine, followed in four hours 
with two fluidounces of castor oil and ten grains of quinine; and after 
the action of the calomel and oil, the continuance ol five or ten grains of 
quinine every three or four hours, until the temperature is reduced to the 
normal standard. When the quinine cannot be borne by the mouth, it 
must be administered by the rectum (ten grains of quinine with five min- 
ims of tincture of opium, in two fluid ounces of water by the rectum), and 
also at the same time by inunction. I have found the following formula 
of great value in the treatment of the various forms of remittent fever: B. 
Sulphate of quinia, $j; soap liniment, olive oil,"aa fgiii; mix: use as a 
liniment to the surface of the body every two or three hours. The effect 
of this liniment is to open the pores of the skin, promote perspiration, 
and also to reduce the temperature by the antipyretic action of the quinine 
absorbed. In the experience of the author, the so-called long continued 
fevers are due to insufficient doses of quinine. The so-called typho-mala- 
rial fever of Woodward, and the Federal surgeons, may be referred to 
three classes: 
1st. Remittent fever of the continuous variety unchecked by suffici- 
ent doses of quinine. 
2d. Remittent fever, with secondary lesions of the stomach, bowels 
and liver. 
3d. True typhoid fever with lesions of the glands of Peyer, either 
uncomplicated, or supervening on pre-existing malarial fever. 
Left entirely to itself, remittent fever, if it did not prove speedily fatal, 
would assume a continued form in many cases, the secretions becoming 
greatly disordered, and the internal organs, and more especially the liver, 
congested, inflamed and structurally altered. In this respect malarial 
remittent fever differs essentially from enteric fever on the one hand, and 
specific yellow fever on the other. I have never felt justified, either in 
civil, military or hospital practice, to allow a case of malarial remittent 
fever to run its course unchecked by drugs, and especially by the sulphate 
of quinia. 1 have, however, enjoyed numerous opportunities of examining 
cases suffering from the many forms of intermittent and remittent fever, 
which from the force of circumstances had been almost entirely abandoned 
to the powers of nature. Such cases presented the following conditions : 
1st. Obstinate, continuous fever, with but slight remissions, and very 
refractory to the action of the sulphate of quinia; twitching of the tendons, 
low muttering delirium; dry, furred tongue; loss of appetite, prostration 
of the nervous and muscular forces; sallow or jaundiced surface, harsh 
dry skin; and most generally bowels not tympanitic and constipated; no 
rose spots on the abdomen. The temperature frequently ranged with 
but slight oscillations, between 102° and 104° F. Fullness and tenderness 
in right hypochondriac region. Scantjorange-colored acid urine, which'let 
fall little or no deposits in the height of the fever, and retained its acid reac- 
tion for a considerable length of time after its passage. Such cases resisted 
the action of quinine, and a complete remission did not take place, and 
convalescence was not established until the lapse of from ten to thirty days. 
2d. Cases similar to the above, but complicated with hepatitis, and 
obstinate jaundice. 
3d. Cases similar to the above, but complicated with obstinate diar- 
rhoea. 
4th. Remittent fever, which had changed its type into a distinct 
quotidian, tertian or quartan intermittent. The miserable victims of the 
prolonged and unrestrained action of the malarial poison presented a sal- 
low, amemic, light yellow hue, with enlarged spleen and liver. Chronic Changes of the Urine in Remittent Fever. 
771 
hepatitis, anaemia and general anasarca were generally present. Whilst dis- 
tinct remissions sometimes ending in recovery have been noted by various 
observers, and more especially upon the fifth, ninth, fifteenth, twenty-first 
and thirtieth days, and whilst recovery has been dated from such distinct 
remissions and crises; at the same time the results of our investigations 
have established that malarious remittent fever is not a, self-limited disease. 
Whilst we have shown that each paroxysm with its elevated temperature 
tends to the destruction of the malarial micro-organisms, in virtue of the 
antiseptic products developed in the blood and organs; on the other hand, 
it is true, that many of the morbific germs survive these cycles, and again 
multiply in the blood and organs; and it is also well established that the 
lesions caused by the action of the malarial poison on the liver, spleen and 
kidneys may set up a special train of pathological phenomena which may be 
prolonged indefinitely. 
Proposition XVI. The changes of the urine in remittent fever are the 
same in kind, but different in degree from those of intermittent fever. 
As a general rule, the amount of urine excreted during the active 
stages, and during the earliest period of intermission, when the tempera- 
ture of the trunk and extremities sinks below the normal standard, is less 
than that of health; and during convalescence (especially under the action 
of depurants) the amount of urine excreted is greatly increased. The color 
of the urine is much deeper in remittent than in intermittent fever, and 
varies from deep orange to deep red and reddish-brown, and in some cases 
almost black. The intensity of the color is greatest during the active 
stages, and diminishes during convalescence. The acidity of the urine is 
greater in remittent than in intermittent fever. The urine excreted during 
the active stages is far more acid than that of convalescence or of health, 
and retains its acidity and resists decomposition much longer. When the 
fever intermits and the cause of the disease is removed, and the patient is 
convalescent, the urine then excreted rapidly undergoes decomposition, 
and in a few hours the reaction changes from acid to alkaline, and the 
phosphates, which, as in intermittent fever, are most abundant in the urine 
of convalescence, are thrown down in the form of beautiful silvery, shin- 
ing crystals, which resemble, when held in the sunlight, particles of shin- 
ing silver. The increased temperature and correspondingly increased 
chemical changes of the active stages of remittent fever were attended by 
an increase of the urea, not only above the normal standard, during rest 
and a deprivation of food, but also above the standard of active health 
and far above the standard of intermittent fever. When the temperature 
falls below the normal standard in the earliest stages of convalescence of 
remittent fever, the urea, as in the similar changes in intermittent fever, 
decreases in amount. In the majority of the cases, the uric acid was 
diminished both with and without the action of the sulphate of quinia, dur- 
ing the active[stages of remittent fever, when the pulse was full and rapid, 
and the respiration full and accelerated, and the temperature elevated. In 
almost every case of remittent fever, as the fever declined, the uric acid 
increased above the standard of health both with and without the action 
of the sulphate of quinia. Phosphoric acid is greatly diminished in the 
chill or cold stage of remittent fever, as in the cold stage of intermittent 
fever. In some cases it may even appear in almost inappreciable quanti- 
ties during the chill and first stage of the febrile excitement. This fact 
indicates that the disturbances of the cerebro-spinal and sympathetic sys- 
tems are similar in both intermittent and remittent fever. After the estab- 
lishment of the fever, both the phosphoric and sulphuric acids are excre- 772 
Changes of the Urine in Malarial Fever. 
ted in increased amounts, and correspond to the increased changes of the 
nervous and muscular elements, excited by the morbific ferment of mala- 
rial fever. The chloride of sodium exhibits similar oscillations in the chill 
of remittent fever as in that of intermittent fever. The formation of 
DEPOSITS OF THE URATES OF SODA AND AMMONIA AND OF THE TRIPLE 
phosphates (critical discharges')} in the urine of remittent fever is similar 
in all respects, takes place at analogous periods of the disease, and is due 
to the same causes as that of intermittent fever. The coloring and 
extractive matters were diminished during the activestages and increased 
during the subsidence of the fever. In several hundred examinations of 
the urine of the different forms of malarial fever in the Marine Hospital of 
Savannah, Georgia, albumen was found in only one case, which was com- 
plicated with typhoid fever. This fact is important in its bearing upon 
typhoid and yellow fever. 
The disease called malarious yellow fever by certain English writers, 
is not usually accompanied by albuminuria, although we have in private 
practice and in the Charity Hospital of New Orleans, during the past 
seventeen years, observed cases of severe remittent fever in which albu- 
men appeared in the urine, accompanied with granuler casts of the tubuli 
uriniferi and detached cells of the excretory structures. Albumen, of course, 
occurs in the urine of malarial haematuria, but in this form of the disease 
blood-corpuscles, and the coloring matters of the blood are also present. 
The repeated congestions of the internal viscera, are not merely confined 
to the liver and spleen in malarial fever, but may also involve the kidneys, 
causing diffused interstitial parenchymatous inflammation of these organs, 
with transudation of albuminous and fibrinous protoplasm into the mal- 
pighian corpuscles, exfoliation of the epithelium of the excretory struc- 
tures, and the formation and expulsion of the fibrinous casts of the tubuli 
uriniferi. As far as my experience extends the albuminuria of intermit- 
tent and remittent fever is more persistent than that of yellow fever and 
more frequently leads to the permanent structural alteration of the renal 
organs. These propositions will now be supported and illustrated by the 
following cases : 
URINARY DEPOSITS CHARACTERISTIC OF REMITTENT MALARIAL FEVER.. 
The changes of the urine in remittent fever, are the same in kind, but 
different in degree from those of intermittent fever. The urine is higher 
colored, more concentrated, and richer in urea, phosphoric acid and sul- 
phuric acid. If the case be protracted, the chloride of sodium diminishes 
as in typhoid fever. When the temperature falls below the normal stand- 
ard in the early stage of convalescence, the urea, as in the similar stage of 
intermittent fever, decreases in amount. During the period of remission 
and convalescence, the uric acid, which had suffered decrease in the active 
stages, increases above the normal standard. The formation of deposits of 
the urates of soda, and of ammonia, and of the triple phosphates (critical 
discharges), in the urine of remittent fever, is similar in all respects, takes 
place at analogous periods, and is due to the same causes as in the urine 
of remittent fever. 
The appearances presented by the deposits in the urine of intermittent, 
remittent and of typhoid fever, engrafted on remittent fever, are repre- 
sented in Engravings No. 78 and 79. 
Plate 11, Figure 46, represents the appearance under the miscroscope, 
of the deposits of urate of soda and triple phosphate often observed in the 
urine during the remission of malarial fever, and granular urates and Changes of the Urine in Malarial Fever. 
773 
lozenge-shaped crystals of uric acid are also represented in this figure. 
The deposit of uric acid in many cases of malarial fever is abundant; the 
lozenge-shaped crystals of uric acid being large, well-formed and highly 
colored. 
The color of the crystals of uric acid in malarial fever varies from a 
light red to deep red and from light brown to deep brown. As a general 
rule albumen and urinary casts are absent in the ordinary varieties of 
malarial fever; but in the severe grades they are frequently present. 
Albumen and casts have been observed in cases of malarial fever, both in 
the acute stage and in the chronic form in the urine of laborers brought 
directly from the swamps of the Atchafalaya and other parts of the delta 
of the Mississippi river. I have also observed the occurrence of albumen 
and casts in the urine of inhabitants and natives of New Orleans, who in 
previous epidemics suffered with yellow fever, when they were subse- 
quently attacked with malarial fever. This symptom is most likely to 
occur in the lowest and undrained portions of the city, bordering on the 
swamp, and extending back to Lake Pontchartrain. Whilst yellow fever 
has almost invariably made its first appearance on the river front and 
around the new and old basins, these severe cases of malarial fever attended 
with renal congestion and albuminuria occur in the opposite direction. 
In Plate 13, figures 53 and 54, we have the microscopical appearance of 
the urine in malarial hematuria, showing the highly colored casts of the 
tubuli uriniferi and the presence of pigmentary matter and pigment cells. CASES ILLUSTRATING THE CHANGES OF THE PULSE, RESPIRATION, TEM- 
PERATURE AND URINE IN REMITTENT MALARIAL FEVER. 
The preceding observations will be illustrated by the following cases: 
Case 972.-English seaman ; age 25; weight 140; height 5 feet 6 inches; black hair, florid complexion. Sailed from N. Y. to 
Darien ; remained in Darien five days, during which time he slept on board the vessel lying in the Altamaha River; sailed from 
Darien, and arrived in Savannah twelve days ago. During the day, has been running on a steam tug up and down the Savannah 
River, from its mouth to the city, and has slept during the night on the bay. Was taken with chill September 6th, at 10 o'clock, A. 
M. This was a severe attack ; the cerebral symptoms were well marked. The stupor and the dry, red tongue, and harsh, dry skin, 
and the disturbances of the sympathetic system and of the respiration and circulation, were relieved by the free administration of 
stimulants and sulphate of quinia. 
Date. 
Houk 
of Day. 
Medicines. 
State of Tongue. 
State of 
Skin. 
ration 
o 
® ? 
3 S 
Temperature of 
hand. 
erature 
r tongue. 
of urine 
jted dur- 
of uriue 
ted hourly. 
ic gravity 
ine. 
matters. 
Pulse. 
Respi 
£03 
Temp 
unde 
Am't 
excrc 
ing 
Hours 
Am't 
ex ere 
*3 2 
ft© 
CC 
Q 
£ 
Solid 
Grs. 
Grs. 
Grs. 
Grs. 
Sept. 
ci 
4* 
10 
11 
11 
7 P. M. 
11 A. M. 
7 P. M. 
Sulphate of quinia gr. xx, 
soda powders. 
Soda powders, sulphate of 
quinia gr. x. 
Calomel.gr. xij, castor oil in 
4 hrs., sulph. qui. gr. xl. 
Dry, red; superior portion 
coated with black fur. 
Dry, red and glazed; feels 
rough. 
Tip clean and red; supe- 
Dry, hot. 
Dry, harsh, 
hot. 
Moist, hot. 
90 
38 
90 
48 
34-40 
40-44 
80.0° 
82.0 
81.0 
103.00° 
103.25 
104,00 
105.00° 
105.00 
104.80 
8160 
5098 
16 
8 
510 
637 
1020.0 
1019.6 
7618 
4764 
541 
333 
12 
12 M. 
rior portion coated with 
dark fur. 
Cleaner and moist; still 
red at tip and edges. 
Moist. 
70 
70 
26-36 
83.0 
100.75 
102.50 
13258 
15285 
20383 
24 
17 
24 
552 
899 
849 
1019.8 
1019.0 
1019.3 
12382 
14475 
19210 
874 
899 
1142 
12 
9 P. M. 
Sulphate of quinia gr. xv, 
snakeroot tea fl. ozs. xvj, 
Moist; stfll redder than 
normal. 
...... 
53 
83.0 
99.16 
101.50 
1020,0 
ll 
13 
13 
11 A. M. 
6 P. M. 
tablespoonful ev. 4 hours. 
Brandy, sulphate of quinia, 
and snakeroot tea. 
Do. do. 
Do. do. 
Slightly coated with yel- 
52 
60 
48 
26-32 
85.0 
97.00 
100.00 
1021.0 
1022.0 
u 
Cl 
Cl 
Cl 
14 
15 
15 
16 
16 
1 P. M. 
10 A. M. 
7 P. M. 
12 M. 
12 M. 
Do. do. 
Quas. & soda, snakeroot tea. 
Do. do. 
Do. do. 
low fur. 
Normal. 
Do. 
Do. 
Do. 
Normal. 
Do. 
Do. 
Do. 
58 
50 
47 
46 
28 
24 
27 
20-26 
87.0 
84.0 
87.0 
87.0 
99,00 
94.50 
96.00 
97.00 
102.00 
99.00 
99.00 
99.00 
1 - 
15375 
6607 
5121 
4599 
9720 
19 
20 
9 
17 
24 
809 
330 
569 
270 
405 
1025.0 
1016.5 
1018.2 
1022.2 
1020.0 
... 
6230 
4946 
4292 
9238 
"376 
174 
306 
481 
CC 
ll 
16 
17 
13 
8 P. M. 
11 A. M. 
12 M. 
Quas. & soda, snakeroot tea. 
Do. do. 
Normal. 
Do. 
Normal. 
Do. 
47 
44 
44 
i 28 
24 
24 
87.0 
84.5 
86.0 
95.90 
96.00 
96.25 
: 99.00 
! 99.00 
99.00 
4080 
8712 
15903 
8 
15 
24 
510 
514 
662 
ioi's.0 
8139 
572 
Cl 
19 
12 M. 
44 
24 
88.5 
97.00 
99.00 
24240 
24 
1010 
io;o.o 
1018.0 
ll 
20 
22 
12 M. 
12 M. 
14 
22 
84.0 
97-80 
99.12 
32320 
23300 
24 
1 24 
1316 
929 
... 
: 
- Remittent Fever: Investigations by Joseph Jones, M. D. 
775 
QD 
~ -*d_ 
d 
► 
*-1 
-l k_ t-. *-1 k-I 
p p 50 po h a o a cn p 4^ co 
co to to •- ►- p 
o 
gggs^dggd^.^^ 
>d g d >d 
gg • g gg 
d2 
M. 
M. 
M. 
M. 
M. 
M. 
538 
222 
52 
150 
203 
1 123 
Grs 
349 
223 
572 
567 
790 
Urea. 
8.55 
4.22 
1 6.25 
2.70 
8.95 
5.69 
35.65 
Grs, 
3.20 
1.45 
4.65 
6.00 
7.45 
Uric Acid. 
: • • • bO; to*-1 »-*: r 
si s 
Extractive and color- 
: : : : qc • - ic c to • . 
: : : : : 4^ G 4*- co: : 
ing matters. 
• $ 
Fixed saline 
• • • : cs: ch co to to co: 
::::>-: octoeGen: 
rs. 
20 
18 
;w 
40 
58 
consti tuents. 
: : : : cc to: cscooo: : 
Calculated amount of 
16 
13 
61 
S9 
SO 
• g- s !2i ® 
urine for 24 hours. 
GO O LO 00 
• : : : co • • a w *1 • ; 
. g. E d. ® 
Calculated amount of 
584 
186 
057 
023 
rs. 
428 
294 
435 
water for 24 hours. 
Calculated amount of 
452 
465 
432 
916 
1ST 
666 
118 
•SJf 
solid matters for 24 
hours. 
ton-tcco: 
: 00: o Cn: O 
Calculated amount of 
: : : : : : to o -4 co: 
: o: g to; 
. o. G co• co 
urea for 24 hours. 
: : : : g : : co a ci o: 
. co: ax *.: ® 
Calculated amount of 
79 
07 
66 
79 
ii 
... 
::: 
9^; 
CO* 
o«; 
*SJ 
uric acid for 24 hrs. 
Calculated amount of 
• • • . kt.. . 1 ■ p- 1,.. . 
, Ml KO a 
extractive and col- 
• : : : : o cn 4^ • • 
. . . . c©: . g to M. 
rs. 
53 
70 
34 
oring matters for 24 
hours. 
Calculated amount of 
45 
31 
55 
46 
258 
>- Q 
fixed saline constit- 
uents for 24 hours. 
i^CU 
o 
w a-K 
o 
dddd® gaTSgOd 
as 
6 d 2. K'w 
o 
o 0 O O H : = 
r* 
• £ : p o p: 
o 
•n ' 
- ' S3 
£ o ® ® 
CD 
2. 
2 E ® 
O 
2 • 
3O1O1 
3W 
one 
do. 
11 re 
'Uri 
g ® 
CD 
Ko 
F 
¥5^ 
CD 
Length of time re- 
■ 
: M M <i -I: 
quired forthe ch'ge 
CH*' 
: o o o o: 
from the acid to 
alkaline. 
W p 
Mo 
of 
ddd£s S 
5dE 
dddddddddd^P® 
o o o w *2 
■■■oS£ 
d 
w 
hi 
ppppppppop^ 
O Q- 
2 5 
) hours 
it of pri 
' triple 
and u 
OSITS 0 
GO go 
c.sr3 < 
$0 
a3 
O O ® O p ® 
d 
hrl 
?3 
o 
S5 O 
3 GO 
p^' 
y sms 
ic erj 
ph at 
if sod 
SINE. 
as 
sc • ao 
CASE 972-Continued. 776 
Remittent Fever: Investigations by Joseph Jones, M. D. 
Case No. 973.-Irish seaman; age 21; height 5 feet 4 inches; weight 125 pounds; 
brown hair, brown eyes, sallow complexion. Has been in Savannah three weeks, 
and has been sick three days. This is his first trip to Savannah during the sum- 
mer season. 
October 12th, 1857, 12 M. Complains of great weakness and pain in his back 
and bones; says that he had no chill and no fever during the three days of indispo- 
sition previous to his entrance into the hospital. Pulse 80, full. R. Sulph. of 
quinia gr. v every three hours up to gr. xv. 13th, 12 M. Did not rest well last 
night. Complains of pain in his head and bones. Hada chill two hours ago. 
Tongue clean, red, dry, and rough; papillae enlarged. Some tenderness of epigas- 
trium. bkin hot and dry. Pulse, 118; respiration 24 to 26, irregular, thoracic. R. 
Calomel gr. x. Follow with castor oil in four hours. R. After fever remits give 
sulphate of quinia gr. v every three hours up to gr. xx. 
14th, 12 M. Medicine acted twice. Tongue clean and very red. Patient is 
not so restless; complains of great weakness; has taken gr. xx of sulphate of quinia. 
Temperature of skin normal. R. Brandy fgviij; sulph. of quinia gr. xv: infusion 
of Virginia snakeroot f^ viij. Mix: Tablespoonful every four hours. 
15th, 12 M. Had an increase of fever yesterday afternoon, which was accom- 
panied with severe pain in his head and bones. Now he is restless and nervous; 
countenance uneasy, anxious. All his motions are indicative of restless, uneasy, 
anxious feeling; complains of great thirst; tongue as red as scarlet; at 9 o'clock this 
morning it was dry and glazed; at the present time (three hours afterwards) it is a 
little moister and softer; lips dry, red, and rough. Epigastrium tender upon pres- 
sure; trunk and head very hot; extremities only moderately warm. Complains of 
pain in the small of the back, and in the knees and bones of his legs. Pulse 106, 
feeble; respirations 30 to 34, irregular, labored, thoracic, panting. Temperature of 
atmosphere, 74° F.; temperature of hand, 101°; temperature of axilla, 105°. The 
temperature under the tongue could not be taken on account of his restlessness. 
There is a great want of co-ordination between the circulation, respiration, and 
temperature of the extremities. The capillary circulation and chemical changes 
are impeded. Reaction of saliva, acid. R. Four cut cups to epigastrium. Four 
cut cups over the lumbar regions and spine. 
R. Sinapisms to the extremities. Urine high-colored, of a deep brownish-red 
color. Sp. gr. 1028: reaction decidedly acid. 
Grains. 
Amount of urine passed during the last 30 hours 15430 
Amount of urine passed during the last 24 hours 12344 
Amount of urine passed hourly during the last24 hours 515 
15,430 grains of 
urine, passed 
during 30 hours, 
contained 
12,344 grains of 
urine, passed 
during 24 hours, 
contained 
1000 parts of urine 
contained 
Urea 
Grains 
727.500 
9.300 
75.000 
Grains 
582.000 
7.440 
60.000 
47.178 
0.603 
4.863 
Uric acid 
Fixed saline constituents 
7| o'clock P. M.-Lies in a stupor, muttering to himself, and is with great 
difficulty aroused. When aroused, answers incoherently and says that he feels 
very well. Temperature of extremities below the normal standard, cool; temper- 
ature of head and trunk normal; tongue of a bright red color; great tenderness of 
epigastrium; pressure here arouses him more quickly than violent shaking. Pulse 
100, feeble; respirations, 32. R. Two cut cups to each temple. R. Blister over 
the epigastrium, 6 inches by 4 inches, and another to the back of the neck, 4 inches 
by 5. R. Apply sinapisms to extremities. R. Brandy and infusion of Virginia 
snakeroot, and spirit of mindererus, f^ss; of each alternately every half-hour, 
until reaction is established. R. Sulph. of quinia, gr. v, every three hours up 
to gr. xlv. 
Grains. 
Amount of urine passed during the last 7| hours 4,072 
Amount of urine passed hourly during the last hours 543 
Calculated amount of urine for 24 hours 13,030 
Sp. gr, of urine 1018; high colored and strongly acid. After standing seventy 
hours there was no deposit, and the reaction was still decidedly acid. Remittent Fever: Investigations of Joseph Jones, M. D. 
777 
4072 grains of 
urine passed 
during 7}^ hours, 
contained 
13,030 grains of 
urine, calculated 
for 24 hours, 
contained 
1000 parts of urine 
contained 
Grains 
Grains 
Urea 
151.320 
483.224 
37.161 
Uric acid 
1.888 
6.036 
0.461 
October 16th, 9 o'clock A. M.-Much better; intellect clear. The cups, blisters 
and stimulants, and sulphate of quinia, have restored the capillary circulation to 
its normal state. 12^ o'clock P. M.-Continues to improve; urine high-colored, of 
a deep orange-red; reaction strongly acid; after standing fifteen hours, a slight 
deposit of mucus-corpuscles; and alter one hundred hours, a small light yellow 
deposit of mucus-corpuscles, urate of ammonia and vegetable cells. The presence 
of the mucus-corpuscles in the urine is due to the absorption and action of the can- 
tharidin upon the mucous membrane of the genito-urinary apparatus. In several 
cases of severe remittent fever, I have discovered, after the action of blisters, numer- 
ous spermatozoa in the urine. Sp. gr. of urine, 1021. 
Urea 
11,231 grains of 
urine, passed 
during the last 
16 hours, 
contained 
16,746 grains of 
urine, calculat'd 
for 24 hours, 
contained 
15,303 grains of 
urine, excreted 
during 24 hours, 
contained 
J00O parts of 
urine contain'd 
Grains 
357.445 
5.500 
53.900 
Grains 
535.667 
8.250 
80.850 
Grains 
508.760 
7.380 
64.680 
31.820 
0.489 
4.799 
Uric acid 
Fixed saline constituents 
Grains 
Amount of urine passed during the last 16 hours 11231 
Amount of urine passed hourly during last 16 hours 702 
Calculated amount of urine for 24 hours 16746 
Actual amount of urine excreted during the last 24 hours 15303 
Amount of urine excreted hourly during the last 24 hours 637 
3 o'clock P. M.-Skin dry but soft. Has taken xlv grs. of sulphate of quinia. 
This has not yet exerted its characteristic effects upon the skin. Tongue red but 
moist and soft; blisters have drawn well. Serum from blistered surfaces of a 
golden color; patient complains of difficulty in passing his urine. This is due to 
the absorption and action upon the mucous membrane of the bladder and urethra, 
of the cantharidin absorbed from the blistered surfaces. Pulse 84, respiration 16. 
Temperature of atmosphere, 69.°5 F.; temp, of hand, 99°; temp, under tongue, 
99.°5. R. Sulphate of quinia, gr. v, every three hours, up to gr. xv. R. Con- 
tinue spirit of mindererus, and brandy, and snakeroot tea, f^ss of each alternately 
every two hours. Diet, mutton soup and arrowroot. 
17th, 12 M.-Continues to improve; tongue red, but clean and soft. Pulse, 70; 
respiration, 16. Temperature of atmosphere, 67c F.; temp, of hand, 97.°33; temp, 
under tongue, 98.°5. Color of urine deep red, reaction decidedly acid. Sp. gr. 
1022. Reaction of saliva strongly acid. 
Amount of urine passed during the last twenty-four hours 8176 grs. 
" " hourly " " " 383 " 
8176 grains of urine 
excreted during24 hrs 
contained. 
1000 parts of urine 
contained 
Urea 
Grains. 
185.240 
4.400 
40.000 
22.578 
0.538 
4.892 
Uric acid 
Fixed saline constituents 
The reduction of the tempeaature, and of the action of the respiratory and cir- 
culatory system, has been attended by a corresponding diminution of the consti- 
tuents of the urine. 
18th. Continues to improve; "feels quite well, with the exception of great 
weakness.'' His appetite has returned : tongue clean, moist, and soft, and not so 
red. Pulse 72; respiration 18. R.-Continue brandy and infusion of Virginia 
snakeroot. Color of urine orange, much lighter; reaction in twenty-four hours, 778 
Remittent Fever: Investigations by Joseph Jones, M. D. 
decidedly alkaline. Sp. gr. 1020. Heavy light yellow deposit, after standing twenty 
hours, of urate of soda and triple phosphate. 
Amount of urine passed during the last twenty-four hours 20,400 grs. 
" " hourly " " " 850 " 
Diet, soft boiled eggs, milk punch, arrowroot, and mutton soup. 
18th, 12 M. Skin, pulse and respiration normal. Urine orange colored. Sp. 
gr. 1020. Reaction alkaline in twelve hours ; heavy light yellow deposit in twelve 
hours. 
Amount of urine excreted during the last twenty-four hours 15,300 grs. 
" " hourly " " " 637 " 
20th. Amount of urine pissed during the last 24 hours 17,374 grs. 
" " hourly " " 724 " 
17,374 grains of 
urine passed during 
24 hours contained 
1000 parts of urine 
contained 
Uric acid 
Grains. 
11.730 
93.500 
0.675 
5.381 
Fixed saline constituents 
Sp. gr. of urine 1022. Reaction alkaline in twelve hours; orange color. After 
standing twenty-four hours, a light yellow deposit of triple phosphate and urate of 
soda were thrown down. 
21st, 9 A. M. The patient is dressed, and has been walking about the hospital 
grounds. His pale sallow complexion and feeble gait show the effects of the mala- 
rial fever. Urine of a light orange color, only a shade darker than normal. Sp. 
gr. 1024. Reaction, just after its deposition, acid; in ten hours afterwards, alka- 
line. This change gave evidence of the formation of ammonia, and was attended 
by the formation of crystals, presenting, when the urine was held in the sun, a 
sparkling appearance, like particles of silver. Under the microscope these crys- 
tals were found to be well formed, prismatic crystals of triple phosphate. The 
microscope also revealed a few crystals and globular masses of the urates of soda 
and ammonia. 
9234 grains of 
urine excreted 
during 12 hours, 
contained 
18.468 grains of 
urine, calculated 
for 24 hours, con- 
tained 
1000 parts of 
urine contained. 
Urea 
Grains. 
229.599 
7.740 
91.800 
Grains. 
458.198 
15.480 
183.600 
25.128 
0.935 
9.941 
Uric acid 
Fixed saline constituents 
Amount of urine passed during twelve hours 9,234 grs. 
" " hourly " 769 " 
Calculated amount for twenty-four hours 18,468 " 
The following table will present the relations of the pulse, respiration, and 
urine: Remittent Malarial Fever. 
779 
to 
" 19 
" 20 
" 17 
" 18 
" 15 
" 16 
" 16 
Oct. 13 
" 15 
" 15 
Date. 
9 A. 
K tO 
12 M. 
12 M. 
tOtO<I 
to tO to 
Hoi 
of D 
Normal 
i Normal 
Normal 
to o 
100 
84 
118 
106 
Pulse. 
Normal 
Normal 
Normal 
Ci 05 
: >-co 
• oto 
24-26 
30-40 
... 
Respiration. 
67.0 
bi* 
o' 
o 
Temperature of 
atmosphere. 
Normal 
Normal 
Normal 
97.33 
99.0 
oO'JOT 
Temperature of 
hand. 
IBCUIO^ 
'Normal 
|Normal 
98.5 
99.5 
Temperature 
under tongue. 
1024 
1020 
1022 
! 1022 
I 1020 
1018 
. 1021 
I 1021 
8201 
Specific gravity 
of urine. 
9231 
i 15300 
1 17374 
8176 
20400 
4072 
11231 
15313 
- 
' 15430 
12 544 
I Grs. 
Amount of urine 
excreted in 
to 
to to 
tG JO 
7J 
16 
24 
Hours. 
229.50 
185.20 
151.32 
,357.44 
508.70 
727.50 
582.00 
! Grs. 
Urea. 
7.74C 
- 
11.730 
4.400 
00000 
O ■" ce 
9.300 
: 7.440 
' Grs. 
Uric acid. 
- 
il 91.80j 18468 
i 93.50: ... 
- 
। 40.00 ... 
; ... : 13030 
i| 53.90! 16746 
। 64.65 ... 
- : 00-09 
00'92. 
1 i 
: Grs. Grs. 
Fixed Saline 
Constituents. 
Calculated ain't 
of urine for 24 
hours. 
458.10 
483.22 
535.60 
[ Grs. 
Calculated ain't 
of urea for 24 
hours. 
' 15.480 
6.036 
8.250 
S1° 
Calculated am't 
of uric acid for 
24 hours. 
183.600 
: S: 
' § 
Grs. 
Calculated am't 
of fixed saline 
constituents for 
24 hours. 
normal 
color. 
Do. 
Light 
orange. 
Very light 
orange, 
almost 
Deep red. 
Orange. 
Deep 
brownish 
red color. 
Do. 
Deep 
orange. 
Color of 
Urine. 
of urate of soda, and 
ammonia, and triple 
phosphate. 
1 
Do. do. 
! Reaction alkaline in 12 
hours; heavy deposit. 
Reaction changed from 
acid to alkaline in 10 
hours; heavy deposit 
Do. do. 
Afier 15 hours, a small 
deposit of mucus-cor- 
puscles ; after 100 hrs., 
small deposit of vege- 
tative cells and urate 
of soda. 
Heavy deposit of urate 
of soda and triple phos- 
phate, and alka'ine re- 
action after 20 hours. 
No deposit after 110 
hours. 
Reaction, Deposits 
in Urine, &c. 780 
Remittent Malarial Fever; Investigations by Joseph Jones, M. D. 
Case No. 974.-Irish seaman, aged 38; weight 160 lbs; heights feet 6 inches; 
stout, muscular man; first trip to Savannah. Has been in Savannah ten days, 
during which time he lias worked on a ship lying along the shore of the river, and 
has slept on Bay Street at night. October 14th. 1857, 2 o'clock, P. M. Was taken 
sick four days ago, with pain in his head and in all his bones, accompanied with 
fever, which has continued unabated up to the present time. Has had no chill. 
Took a dose of calomel three days ago, which acted freely. Now his face is much 
flushed; skin hot and dry; head very hot; complains greatly of pain in his head; 
eyes look heavy and stupid; tongue bright red and dry; voice hoarse and guttural; 
says that he has been vomiting, and can retain nothing upon his stomach. R. 
Cut cups to each temple, and two to back of neck, and four over the region of the 
stomach. 
If the cut cups do not relieve the vomiting, administer a tablespoonful of equal 
parts of milk, lime water, and the aqueous solution of the acetate of morphia. 
15th, 11 o'clock, A. M. Says that he feels better; the cut cups over the temples and 
back of neck relieved the pain in his head, and the cut cups over the region of the 
stomach checked the vomiting. Face is not so much flushed; tongue still very red, 
dry, and rough; no tenderness upon pressure of epigastrium, although the state of 
his tongue would lead us to look for it; skin soft and not so hot. This morning at 
3 o'clock A. M., the fever remitted with perspiration. Pulse 76; respiration 20. 
Has taken xxvj grains of sulphate of quinia. R. Neutral mixture; drink ad 
libitum. 
8 o'clock P. M. Has been vomiting this evening. This was arrested by milk 
and lime water, and acetate of morphia. Tip of tongue for three-fourths of an inch 
clean, dry, glazed, and of a brilliant red color-the remainder of the tongue is 
coated with brownish-yellow fur, which is dry and harsh to the feeling; face flushed 
and hot; skin, upon all parts of the body, hot, pungent, and dry; no tenderness upon 
pressure of epigastrium. The calomel has acted several times, and is still acting. 
Pulse 94; respiration 26. R. Soda powders. Urine high colored, like new 
Madeira wine. 
16th, 1 o'clock P. M. Did not rest during the night; was tossing about, and 
getting up out of the bed every few moments, and was and is now tormented by 
unquenchable thirst; appears to be completely exhausted. Tip of tongue clean, dry, 
scarlet-colored, glazed, shining-posterior portion (base) of tongue coated with 
brown and black fur, dry, harsh, and as rough as sand-paper. The under surface 
of the tongue is dry, glazed, and shining. There is no more moisture in his tongue, 
and in the walls of the mouth, than if they were made of glass. Skin hot, dry, and 
harsh to the feeling. The temperature under the tongue cannot be taken, on 
account of the dry condition of the lips and tongue. Bowels are loose-stools 
watery and yellow; no pain upon pressure of epigastrium. Complains of no pain 
anywhere. There is a great tendency to stupor. Although his tongue is glowing 
red, and his face is flushed, amf there is an inclination to stupor, still I will admin- 
ister sulphate of quinia and stimulants, because he is exhausted, and the appear- 
ance of the mucous membrane of his mouth and tongue is indicative, not of inflam- 
mation, but of derangement of the capillary circulation, and of alterations in the 
nervous system and blood. R. Brandy f$viij; infusion of Virginia snakeroot 
f^ viij; sulphate of quinia gr. xv. Mix: f$ j every hour. R. Spirit of mindererus 
f§j every hour. R. Mustards to extremities. R. Sulphate of quinia gr. v; cam- 
phor gr. ij; Mix: Every three hours. R. Soda powders. 
Grains. 
Amount of urine passed during the last 17 hours 10,210 
Amount of urine passed hourly during the last 17 hours 600 
Calculated amount of urine for 24 hours 14,406 
Sp. gr. 1020. Reaction decidedly acid; urine high colored, like new Madeira 
wine. No deposit after thirty hours; after sixty hours, a slight deposit of mucous 
■corpuscles and triple phosphate. Crystals of nitrate of urea, silvery and well- 
formed. Hydrochloric acid showed the presence of coloring matters in large 
amount. 
10,210 grains of 
urine, excreted 
during 17 hours, 
contained 
14,406 grains of 
urine, calculated 
for 24 hours, 
contained 
1000 parts of urine 
contained 
Urea 
Grains 
320.980 
0.200 
30.000 
Grains 
452.581 
0.382 
40.330 
32.305 
0.019 
2.938 
Uric acid , 
Fixed saline constituents. Remittent Malarial Fever: Investigations by Joseph Jones, M. D. 
781 
17th, 11 o'clock A. M.-Much better. Tip of tongue clean-superior portion 
coated with fur; tongue moister, softer, and not so red as on yesterday; face much 
less flushed; the burning thirst has almost entirely disappeared; has no pain any- 
where, and says that he has an appetite; no tenderness of epigatrium. Has taken 
grs. xxx of the sulphate of quinia since 1 o'clock P. M., October 16th. Pulse 68; 
respiration 18. Pulse much fuller; respiration more regular and soft. Temper- 
ature of atmosphere, 68° F.; temperature of hand 98°; temp, under tongue 98.°5. 
Here we see, that under the action of the sulphate of quinia and stimulants, his 
respiration has become regular; his pulse slower and fuller; his burning thirst 
diminished; his glowing tongue and flushed face paler; his parched mouth moister; 
his intellect brighter; his exhausted forces more active; and all the secretions and 
functions more regular. Urine high colored. Decided acid reaction. Sp. gr. 1022. 
No deposit after standing thirty hours. After eighty hours a small light yellow 
deposit of triple phosphate and urate of soda. 
Grains 
Amount of urine excreted during the last 24 hours 12264 
Amount of urine excreted hourly during the last 24 hours 511 
12,264 grains of urine 
passed during 24 
hours, contained 
1000 parts of urine 
contained 
Urea 
Grains 
315.250 
5.200 
34.800 
30.846 
0.440 
2.846 
Uric acid 
Fixed saline constituents 
R. Continue camphor and sulphate of quinia, and brandy and snakeroot tea. 
Diet: milk punch, wine-whey, arrowroot, and mutton soup. 18th, 12 o'clock M.- 
Rested well during the night; had no fever, and his skin was in good perspiration. 
The great thirst has entirely disappeared. Tongue still redder than normal, but 
moist and soft, and the yellow fur coating of the posterior portion is breaking up 
and cleaning off; skin moist, and normal in temperature and feeling. Pulse and 
respiration normal. Dressed himself, and has been walking in the ward. Urine 
of a deep orange color, several shades lighter than that voided yesterday. Sp. gr.. 
1019. Reaction slightly acid. 
Grains 
Amount of urine passed during the last 24 hours 12737 
Amount of urine passed hourly during the last 24 hours 614 
R. Continue brandy and snakeroot tea, tablespoonful every three hours.. 
Diet: soft boiled eggs, milk punch, mutton soup, arrowroot, and rice. 
19th.-Dressed and walked about the ward. 20th.-Walked about one mile 
into town; says that he feels well; urine orange color. Sp. gr. 1020. After stand- 
ing twelve hours, a heavy light yellow deposit of triple phosphate and urate of 
soda. 1000 parts of urine contained uric acid 0.607. Fixed saline constituents 
3.529. 21st.-Says that he took a slight cold yesterday, during the walk into the 
city; urine orange color. Sp. gr. 1019. 
Grains 
Amount of urine passed during the last 17 hours 13247 
Amount of urine passed hourly during the last 17 hours 770 
Calculated amount of urine for 24 hours 19495 
13,247 grains of 
urine, excreted 
during 17 hours, 
contained 
19,495 grains of 
urine, calculated 
for 24 hours, 
contained 
1000 parts of urine 
contained 
Urea 
Grains 
181.568 
6.110 
96.900 
Grains 
290.508 
9.770 
154.040 
12.992 
0.461 
7.199 
Uric acid 
Fixed saline constituents 
This patient had no return of fever, and was discharged a few days subse- 
quently. This case sustains not only the conclusions, but also the treatment of the 
two preceding cases of remittent fever. 782 
Remittent Malarial fever. 
SIX CASES FROM THE SAME SMALE VESSEL, ILLUSTRATING THE INJURIOUS 
EFFECTS OF THE USE OF CALOMEL, AND THE NEGLECT OF STIMULANTS 
AND SULPHATE OF QUINIA IN REMITTENT FEVER; THE RELATIONS OF 
THE PULSE AND RESPIRATION AND TEMPERATURE IN MALARIAL 
FEVER; THE EFFECTS OF STIMULANTS AND SULPHATE OF QUINIA 
UPON THE SEVERE CEREBRAL SYMPTOMS; THE DEPRESSING INFLU- 
ENCES OF THE MALARIAL POISON; AND THE DIVERSITY OF THE MANI- 
FESTATION OF ITS EFFECTS IN MEN LIVING IN THE SAME SMALL VES- 
SELS, AND EXPOSED, IN AN EQUAL MANNER, TO THE MALARIAL 
INFLUENCE. 
Case No. 975.-American seaman from U. S. cutter, aged 24 years; height 
5 feet 10 inches; weight 150 pounds; brown hair, brown eyes. This is his first 
summer in Savannah. Has been employed as a sailor on the United States revenue 
cutter, which has been cruising during the summer, up and down the Savannah 
river. Ten days ago, the cutter was struck by lightning and was placed in the 
dry dock, at the ship yard, on the river, east of the city. This ship yard is located 
on the Savannah river, about five hundred yards from the eastern boundary of the 
city in a malarious district which was formerly under the rice (wet) culture; now 
the surrounding lowlands are protected from overflows by dams, and are under dry 
culture. The banks of the river, at this locality, are coated with mud composed 
in large measure of animal and vegetable matters; the banks and bottom of the 
canal, in which the ships are floated at high water, also contain large quantities of 
similar mud. The crew of the cutter slept on board one night after she was placed 
in dry dock. The crew consisted of ten healthy seamen, and out of this number 
six were taken sick in the course of ten days. Whilst the cutter continued in 
the stream the men were healthy, but as soon as they were exposed to the 
exhalations of the mud, and low grounds, they were taken sick. September 24th, 
1857.-Has just entered the hospital, and says that he had a slight chill yesterday, 
followed by fever. Tongue coated with brownish yellow dry fur. Pnlse rapid; 
intellect dull. Says that his bowels have not been moved for several days. R.- 
Calomel gr. xv; castor oil in four hours. 25th.-Medicine acted freely. Has fever. 
Tongue still coated with fur, but a little more moist. The fur shows a disposition 
to come off in patches. Pulse accelerated; intellect continues dull. R.-Sulph. of 
quinia gr. v, every three hours, up to gr. xv. Soda powders. 26th.-Has been 
passing his faeces in bed, and lies in a comatose condition. R.-Cut-cups to 
back of head. R.-Sinapisms to extremities; blisters to back of neck and epi- 
gastric region. R .-Infusion of snakeroot, and sulphate of quinia. R .-Calomel 
gr. xxiv; opium gr. ij.-Mix: Divide into twelve pills, and administer one every 
two hours. 27th.-Continues comatose. Pulse 106, small and feeble. The blisters 
drew finely. The blisters and sinapisms jailed to arouse this patient, and. he died 
this afternoon at 1 o'clock. 
AUTOPSY TWENTY HOURS AFTER DEATH. 
/ . . 
Exterior.- Full; limbs round; subject apparently not at all emaciated; skin of 
the superior (uppermost) portions of the body presented the usual appearance, 
whilst the skin of the inferior (dependent) parts presented a mottled, purplish 
appearance. This was due to the settling of the blood under the action of gravity. 
Head.-Dura mater presented the usual appearance. Arachnoid membrane not 
opalescent, but presented the usual transparency. Bloody serum was effused 
between the arachnoid membrane and pia mater. Blood-vessels of pia mater con- 
gested with blood. 
Ventricles of brain almost completely filled with reddish serum. Bloodves- 
sels of the superior portions of the brain, more congested with blood than those of 
the inferior portions. Substance of the brain presented the usual appearance and 
consistency, considering the length of time since death. Chest.-Heart and lungs 
normal. Abdomen-Liver.-Color of the exterior appeared to be normal (perhaps 
a shade darker than usual), with the exception of two slate-colored spots. The 
largest of these slate-colored spots was four inches in diameter, and situated upon 
the anterior surface of the right lobe, whilst the smallest was situated upon the 
posterior surface of the left lobe. When an incision was made into the surface of 
the liver, through these spots, the structures presented a bronze color for the depth 
of a quarter of an inch. In all other parts of the liver, the cut surface presented Remittent Malarial Fever. 
783 
a color only a shade deeper than normal. Spleen enlarged, softened, and of a dark 
slate color.' When the mud of the spleen was exposed to the atmosphere, a part 
retained the dark-purplish and reddish-brown color, whilst another smaller portion 
changed to an arterial hue. The difference between these two portions of the 
splenic mud was clearly seen when a section of the organ was exposed for several 
hours to the action of the atmosphere. The other portion of the mud of the spleen 
did not change its color. It is probable that this phenomenon was due to the fact 
that the blood had been but recently effused into the spleen. The portions first 
effused had lost the power of changing to the arterial hue, whilst those last effused 
had not lost this power. Kidneys normal. Alimentary Canal.-The mucous 
membrane of the alimentary canal, from the oesophagus to the anus, presented the 
normal color, and showed no signs whatever of congestion or inflammation. 
CONCLUSIONS. 
(1.) This case illustrates the rapid and powerful action of the mala- 
rial poison. (2.) The brain and its membranes appeared to be normal, 
with the exception of the serous effusion which was entirely inadequate to 
account for the cerebral disturbance during life ; the liver, with the excep- 
tion of the small spots, appeared to be normal in structure ; the affection 
of the spleen was recent; and the alimentary canal, from the mouth to the 
anus, bore no marks of inflammation, and yet this strong, hearty young 
man fell a victim to the malarial poison. The malarial poison appeared to 
act in this case directly upon the nervous centres of the cerebro-spinal and 
sympathetic nervous systems. (3.) The treatment in this case was radi- 
cally defective-it was wanting in energy. The effects of the disease were 
those of exhaustion, and not of inflammation and excitement. The chemical 
changes of the elements were interfered with, and the relations of the forces, as 
a necessary consequence, disturbed. The manifest indication was to stimulats 
the exhausted nervous system, and excite those chemical changes by which the 
forces are generated, which work the animal machinery. The blisters and sina- 
pisms, and cut-cups, and small doses of sulphate of quiuia, were right, as 
far as they went. The last doses of calomel were decidedly wrong, and 
worse than useless ; they simply worked in conjunction with the malarial 
poison. Large doses of brandy, carbonate of ammonia and sulphate of 
quinia, should have been administered promptly and energetically, in 
conjunction with the blisters and sinapisms. The following case, which 
resembled this one in all respects, will illustrate, in a forcible manner, 
these conclusions : 
Case 976.-Seaman from the United States revenue cutter, and a shipmate of 
the previous case; and the remarks which were made with reference to the history 
of that case, apply also to the present one. Age 26; light hair, blue eyes, florid 
complexion; height 5 feet 11 inches; weight 160 lbs. This is his first summer in 
these regions. September 25th, 1S57. Has been sick two days ; says that he was 
suffering with a thick eruption of prickly-heat. This disappeared suddenly and 
then the fever appeared. Has fever now. R .-Calomel gr. xv ; castor oil in four- 
hours. 26th. Medicine acted freely; heat of skin much less; tongue heavily 
coated with yellow fur, tip and edges very red ; intellect dull; appears to articulate 
with difficulty. R.-Sulph. of quinia gr. v every three hours, up to gr. xv. Infu- 
sion of Virginia snakeroot. 27th. Intellect still dull; tongue presented the same 
coated appearance. Pulse 83. R.-Calomel gr.x; sulph. of quinia gr. v. Mix and 
administer immediately. 
28th, 10 o'clock A. M. Was delirious during the night, audit was necessary to 
use much force to keep him in bed. Appears to be much worse this morning, and 
continues delirious; tongue heavily coated and very red at tip and edges. Pulse 86. 
No pain upon pressure of epigastrium. R.-Blister to epigastrium and back of 
neck. R.-Calomel gr. xxiv; opium gr.ij. Mix; divide into twelve powders, and 
administer one every two hours. 7 o'clock P. M. Appears to be very weak and 
stupid. When aroused by shaking, whines and mutters incoherently. Pulse 82 ; 
respiration 20; skin dry ; tongue presented the same appearance. It is evident that 784 
Remittent Malarial Fever: Investigations by Joseph Jones, M. D. 
unless the calomel be abandoned, and a more vigorous method, of treatment adopted,, 
this patient will die just as the previous case- R .-Two cut-cups to each temple ;. 
sinapisms to extremities. R.-Brandy f^viij; infusion of Virginia snakeroot 
f^ viij ; sulphate of quinia gr. xv. Mix and administer a tablespoonful every half 
hour' R.-Sulph. of quinia gr. v every three hours up to gr. xx. 
29th, 11 o'clock A. M. The stimulants and sulphate of quinia have been pro- 
ductive of much good. Tongue, although very red, and dryer and rougher than 
normal, is moister and softer than it was yesterday. During the night slept soundly, 
and this morning his skin relaxed and was bathed in a copious perspiration. Intel- 
lect clearer. Pulse 78; respiration 15. Temperature of atmosphere 80° F.; tem- 
perature of hand 99°. Has taken during the last eighteen hours, forty grains of 
sulphate of quinia. R.-Give 20 more grains of sulphate of quinia during the next 
twenty hours, and continue the brandy and infusion of Virginia snakeroot, table- 
spoonful every hour. Diet, beef-soup and tea. 7 o'clock P. M. Continues to 
improve, and says that he is much better. The blisters have drawn and discharged 
golden colored serum. Intellect more active, but still much duller than usual. 
Tongue red, dry and harsh, feels like sand paper-superior portion coated with yel- 
low fur; face much flushed; reaction of saliva decidedly acid ; urine high colored. 
Pulse 80; respirations 16; temperature of atmosphere 78.°5 F.; temperature of hand 
1OO.°33. R.-Mustard to extremities. Stop sulphate of quinia. Continue brandy 
and infusion of Virginia snakeroot. Diet, milk punch, and brandy and arrowroot. 
30th. Says that he is much better. Pulse 79: respiration 16; temperature of atmos 
phere, 70° F.; temperature of hand 97.°5; temperature under tongue 100°. Tongue 
still very red, but more moist. Skin dry; reaction of saliva acid. Urine of a bright 
red color, and decided acid reaction-sp. gr. 1022. Uric acid in 1000 parts 0.538. R . 
Continue stimulants and nutritious diet. 
October 1st, 11 o'clock A. M. Rested well during the night, and continues to 
improve. Complains of great weakness. Tongue much softer. Pulse 70; respi- 
rations 14. Temperature of atmosphere 71°F.j temperature of hand 98°.; tempera- 
ture under tongue 99.°5. Urine only a shade higher colored than normal, reaction 
acid-sp. gr. 1010. Uric acid in 1000 parts, 0.0099. R . Continue brandy and infu- 
sion of snakeroot tea. Administer 15 grs. of the sulphate of quinia during the next 
fifteen hours. 2d, 11 oclock A. M. Surface of blister red and raw; tongue cleaning 
off; papillae enlarged and distinct; bowels torpid. Pulse 60; respirations 13, slow 
and full. It is probable that the frequency of the respiration is diminished by the 
blistered surface. Temperature of atmosphere 76°F.; temperature of hand 97 °75; 
temperature under tongue 99.°5. R. Continue stimulants and nutritious diet, 
milk punch and mutton soup. Urine, of a bright red color, sp. gr. 1020-turbid 
after standing several hours. Amount passed during the last twenty-four hours, 
13,260 grs. 
3d, 11 o'clock A. M. Pulse 62; respiration 14. Temperature of atmosphere 
76° F.; temperature of hand 98°.; temperature under tongue 99.°25. Reaction of 
saliva acid; urine of a deep orange color-heavy, light-yellow depositafter standing 
a few hours. The acid has greatly diminished-reaction alkaline after standing a 
few hours. Amount passed during the last twenty-four hours, 15,330 grs.; sp. gr. 
1022. Uric acid in 15,330 grs. of urine, 10.5 grs. Uric acid in 1000 parts of urine, 
0.684. Bowels have not been moved for four days. R. Calomel gr. viij; sulph. of 
quinia gr. v. Castor oil in four hours. Continue stimulants and infusion of 
snakeroot. 
4th. Dressed and walking about the ward. Tongue moist and soft, and oniy 
a little redder at the tip than usual. Pulse 60; respiration 12. Blister raw, an d 
slow in healing. Urine orange colored, reaction slightly acid, when first voided, 
but rapidly changes to the alkaline, and lets fall a heavy deposit after standing a 
few hours.' R. Quassia and soda. Full diet. 5th. Urine, orange colored; sp. gr. 
1024. Heavy deposit-reaction of saliva very slightly acid. 8th. Entirely restored 
to health. Pulse 48; respiration 14. Temperature of atmosphere 73° F.; tempera- 
ture of hand 97°.; temperature under tongue 99.°5. 
(1.) Although the pulse of this patient, at first sight, did not appear 
to have been much accelerated, when compared with the pulse in other 
cases of malarial fever, still it was greatly accelerated. The pulse was 
unusually slow in health, only 48 to the minute. The respiration was also 
very slow in health. 14 to the minute. The temperature of the surface was 
not greatly elevated. 
CONCLUSIONS. Remittent Malarial Fever: Investigations by Joseph Jones, M. D. 
785 
(2.) Aside from the cerebral symptoms, there was nothing to alarm 
the practitioner, except the state of the tongue. The prominent symptoms, 
as in the previous fatal case, from the same vessel, were connected with the 
brain. 
(3.) Active purgation and alternative doses of calomel, so far from 
benefiting, were, as was conclusively demonstrated, by careful examina- 
tions and analyses of all his symptoms, working in conjunction with the 
malarial poison, and rapidly bringing on a fatal termination. Stimulants, 
blisters, sinapisms, and large doses of sulphate of quinia, administered 
without any regard to the state of the tongue and brain, so far from increas- 
ing the cerebral disturbance, diminished it rapidly. Under the vigorous 
use of these active remedies, the dry, red tongue became moist, soft, and 
pale-the pulse was diminished in frequency, and became fuller-the dry 
skin became moist, and the delirium entirely disappeared. These facts 
demonstrate conclusively that the action of the malarial poison in this case was 
that of depression and not of inflammation. 
Case No. 977.-American seaman from United States revenue cutter; compan 
ion of the two former cases. Taken sick at the same time. Age 23; brown hair, 
dark eyes, florid complexion; height 5 feet 7 inches; weight 155 lbs; large chest and 
stout muscular limbs. September 25th, 1857. Was taken sick two days ago. His 
attack commenced with a prolonged chilly feeling, followed in the course of six 
hours with fever. Has fever now. R . Calomel gr. x; sulphate of quinia gr. v. 
26th. Medicine operated freely. Complains of pain in his head. Tongue coated 
with fur; pain upon pressure of epigastrium. Pulse 88. R. Apply sinapism over 
•epigastric region; and administer infusion of red pepper. 
27th. Much better; febrile excitement much less. Complains of slight pains 
in his bones and bowels. R .-Sulph. of quinia gr. v, every three hours, up to gr. 
xv; infusion of Virginia snakeroot. 28th. Has no fever. Gave fifteen more grains 
of sulph. of quinia. 29th, 11 o'clock A. M. Much better. 7 o'clock P. M. Within 
the last two hours has taken a change for the worse. Intellect wandering. Com- 
plains of great pain in his head. Pulse 92, feeble; respiration 32. Reaction of 
saliva intensely acid. The secretions of the mucous membrane of the mouth are 
almost entirely dried up, and it is with difficulty that sufficient saliva is obtained 
to moisten the litmus paper. Tongue, where the fur is absent, very red-it is dry, 
harsh, and r6ugb to the touch. Pain upon pressure of the epigastrium. Head and 
trunk hot, and extremities cool. R.-Sinapisms to extremities and epigastric 
region; cut-cups to temples and back of head. R.-Sulphate of quinia gr. vij. 
every three hours, up togr. xl. Administer brandy and infusion of Virginia snake- 
root, freely. Diet, brandy and arrowroot. 
30th, 11 o'clock A. M. The mustards and stimulants have aroused the intel- 
lect, and rendered the dry, parched longue moist and diminished the frequency 
•of the pulse and respiration. Pulse 68, rather feeble; respiration 22; temperature 
of atmosphere 80° F.; temperature of hand 95.°5; temperature under tongue 97°; 
skin slightly moist, and cool to the touch; face much flushed; surface of head cool, 
although from its congested, florid, red appearance, we would judge it to be hot. 
The temperature of the trunk and extremities is below the normal standard, not- 
withstanding that the pulse and respiration are much more rapid than in health. 
During the night he was delirious, and it was difficult to keep him in bed. The 
blood from the cut cups appeared to be normal under the microscope, and showed 
no signs of inflammation. R.-Continue stimulants and sulph. of quinia. Diet, 
milk punch, brandy and arrowroot. October 1st, 11 o'clock A. M. Continues to 
improve under the action of the stimulants and sulphate of quinia. Tongue 
moister and softer; pulse 66, rather feeble; respiration 20; temperature of atmos- 
phere 71.°5 F.; temperature of hand 95°; temperature under tongue 97.°15. Com- 
plains of weakness. Rested well during the night, and has had no pain in his head 
since the application of the cut cups. Urine orange-colored; sp. gr. 1013. R.- 
Continue stimulants and nutritious diet. 
2d, 12 o'clock M.-Tongue moist and clean, redder than normal. Pulse 62, 
regular, full and soft; respiration 20. Temperature of atmosphere 76.°5 F.; temp, 
of hand 98°; temp, under tongue 99°. Reaction of saliva decidedly acid. Urine 
orange-colored and clear, reaction decidedly acid. Sp. gr. 1014. Amount excreted 
during the last twenty-four hours, grs. 21210. R.-Continue. Full diet. 3d.- 786 
Remittent Malarial Fever. 
Face not so much flushed. Tongue clean, moist, soft, and approaching the usual 
color. Respiration 19. Temperature of atmosphere 76.°5 F.; temp, of hand 
96.°5; temp, under tongue 98.°8. Reaction of saliva decidedly acid. Color of urine 
reddish-orange; after standing several hours, let fall a light yellow deposit. Sp. 
gr. 1017. R.-Continue stimulants and infusion of Virginia snakeroot tea. 4th, 
12 o'clock M.-Up, and walking aboutthe ward. Urine orange-colored; the change 
from the acid to the alkaline reaction took place in the course of a few hours, and 
a heavy deposit was thrown down. Amount of urine passed during the last 
twenty-four hours, 15270 grs. Sp.gr. 1018. Pulse 54, slow and full; respiration 
14. R,-Quassia and soda. 5th, 11 o'clock A. M.-Tongue, pulse, respiration and 
skin normal. Color of urine light orange. Sp. gr. 1020; reaction of saliva acid. 
9th.-Entirely restored to health. Pulse 43; respiration 15. Temperature of 
atmosphere 72° F.; temp, of hand 96.°5; temp, under tongue 99.°75. 
Case No. 978.-Irish seaman from United States revenue cutter, aged 19 years;, 
height 5 feet 7} inches; weight 145 pounds; light-brown hair, gray eyes, fair com- 
plexion. October 4th, 1859.-Was taken sick four daysago; his attack was two 
days later than that of his companions Has had no chill, but has suffered with 
pain and dizziness in the head; face flushed. Pulse 100; respiration 20. Tongue 
coated with yellow fur, tip and edges red; papillae enlarged. No tenderness of 
epigastrium. Skin hot. R.-Calomel gr. xij; sulph. of quinia gr. vj. Mix. and 
administer immediately, and follow with castor oil in four hours. As soon as the 
medicine has commenced to act, give sulph. of quinia gr. v every three hours up 
to gr. xx. 5th.-Much better. Head relieved. Skin in a profuse perspiration. 
Reaction of sweat and saliva decidedly acid. Pulse 104. Skin hot, but moist and 
relaxed. Respiration 24, full, thoracic. No tenderness upon pressure of epigas- 
trium. Tongue redder and dryer than normal. Medicine operated four times. 
Has taken thirty grains of sulphate of quinia. R.. - As soon as fever remits, give 
brandy and infusion of Virginia snakeroot. 6th.-Continues to improve. Pulse 
96. Skin warm, but moist. Continue stimulants. The febrile excitement sub- 
sided, and there was no return, and this patient was discharged a few days 
afterwards. 
Cases 978 and 979-1857.-Two stout, athletic young seamen, from the United 
States revenue cutter, who contracted their sickness simultaneously with the four 
seamen just mentioned. One suffered with a slight attack of intermittent fever, 
and remained in the hospital only a few days. The other suffered also with inter- 
mittent fever, but of a severer type. In this case, the chill was well marked, by a 
hot trunk and cold extremities, and great disturbance of the sympathetic and cere- 
bro-spinal nervous systems; and in the succeeding stage of febrile excitement, the 
pulse was full and strong, the respiration accelerated and the animal temperature 
correspondingly elevated; and in the intermission there was a marked subsidence 
of the febrile excitement. At first sight, the severe chill-the full, bounding pulse 
-the thoracic respiration, and the hot and parched skin, would excite the belief 
that the patient was in danger. Such an opinion would have been erroneous, for 
these phenomena signified powers of resistance. This case yielded far more 
readily to the action of the sulph. of quinia than the former cases from the cutter. 
CONCLUSIONS DRAWN FROM AN EXAMINATION, ANALYSIS, AND COMPARI- 
SON OF THESE SIX CASES OF MALARIAL FEVER, OCCURRING IN THE 
CREW OF THE UNITED STATES REVENUE CUTTER. 
(1.) Whilst the revenue cutter was cruising about the mouth of the 
Savannah river, the crew remained healthy; but as soon as they were 
exposed to the exhalations of the low grounds and marshes, they were 
attacked by malarial fever. This fact demonstrates that a special cause 
resided in a special locality, capable of producing a special disease. 
(2.) There was a remarkable uniformity in the symptoms of four out 
of the six young men from the cutter who were attacked with fever. In 
these cases, the malarial poison appeared to act either directly or second- 
arily, powerfully upon the nervous centres of the sympathetic and cerebro- 
spinal systems. The action of the malarial poison was depressing, rather than 
inflammatory. Whatever diminished the forces, acted in conjunction with the 
malarial poison. Whatever stimulated the nervuos system, excited the action of Typhoid Fever. 
787 
the heart, excited the capillary circulation, excited and increased the chemical 
changes of the nutritive fluids and organs and tissues, acted directly antagonistic 
to the action and effects of the malarial poison. 
(3.) A rapid feeble pulse, rapid respiration and low temperature, and 
wandering intellect, are always dangerous symptoms, which signify a per- 
version of the functions, an interference with the normal chemical actions, 
which generate the forces, and an unconditional surrender to the fatal 
poison. 
(4.) A rapid, full pulse, accelerated respiration, and a corresponding 
development of heat, are favorable symptoms, and signify an effort on the 
part of nature to get rid of the poison. The fever is not the disease-it is 
an effect of the action of the malarial poison upon the living organism, and sig- 
nifies a power of resistance. 
(5.) The differences in the symptoms of these cases show that men 
living on the same small vessel, and exposed in an equal manner, will not 
suffer alike. The effects of the poison will depend, in great measure, upon 
the nature of their vital and physical endowments. 
Case No. 980.-Remittent Fever followed by Typhoid Fever. Illustrations of 
the Chemical and Microscopical Characters of the Urine in Typhoid Fever 
Supervening on Malarial Remittent Fever. 
The relations of remittent malarial fever to specific typhoid fever is a 
subject of importance, not merely in its relations to treatment, but also to 
the classification of diseases. The opportunity of examining the relations 
of the various forms of malarial fever to the various forms of so-called con- 
tinued fever, were extensive and of the most important character, and the 
author embraced every opportunity within the area of his observation to 
arrive at definite results. We will present the details of thi^ investigation 
in that section of this work devoted to the investigation of typhoid fever. 
The case now under consideration is presented on account of the important 
facts which it contributes to our knowledge of the microscopical and 
chemical characters of the urine, in typhoid fever supervening on malarial 
remittent fever: 
A. J. Wolf, private, Company F, Second Regiment South Carolina Artillery. 
Admitted into Summerville Hospital, South Carolina, Sept. 4th, 1863. Had been 
sick (with, malarial fever of a remittent type), for one week previously. For two days 
subsequent to admission, fever presented marked remissions and the attempt was 
made to control it by the free administration of quinine, five grains every four hours, 
but typhoid symptoms only slightly apparent on first day, gradually increased, 
inducing a corresponding change in treatment. On the fourth day, the patient's 
tongue became harsh, dry and red ; considerable tympanites and tenderness on 
pressure was observed with accompanying diarrhoea. He was put upon the use of 
the turpentine mixture, and the diarrhoea easily controlled by pills of nitrate of 
silver and opium, a £ gr. J. The diet at this period of the disease was chiefly milk 
(for which a preference amounting almost to mania, was exhibited), and farina- 
ceous food. Same treatment was continued, until the fourteenth day, with no 
decided change in the patient's condition. From the seventh day, a small 
quantity of stimulants was given, the pulse indicating the necessity. Ou the 
twelfth night, much restlessness and nervous twitching ensued, but was readily 
controlled by the administration of a mixture of camphor and Hoffman's anodyne 
(Hoffman's anodyne 3 ij, aqua camphor 5 i v. Mix: Sig. f § ss every two hours when 
necessary). On the fourteenth day, symptoms of pneumonia appeared. Breath- 
ing much oppressed ; great dullness on percussion ; slight cough with little or no 
sputa. Counter irritants were applied and pills of calomel gr. ij and opium gr. ss, 
every two hours were administered. 
This treatment was continued until the twenty-second day and then stopped, 
the symptoms having abated. The calomel appeared to produce profuse discharges 
from the bowels, with slight haemorrhage from the bowels and great reduction of 788 
Typhoid Fever. 
strength. The same diet (spoon) was given. All regular medicine was now 
stopped, except an occasional pill of silver and opium, to regulate the bowels, or a 
dose of the camphor and anodyne to procure sleep. Stimulants were given ad 
libitum, and the same diet, with the addition of animal broths. On the thirtieth 
day some improvement was visible; but the day after the patient complained 
greatly of his throat, and the tongue became so much swelled that it could not be 
protruded from the mouth. His fever at the same time increased. The applica- 
tion of a blister to the throat and the administration of a solution of chlorate of 
potash ($i to fgviij of water) caused relief. Since that time the convalescence has 
been slow. On the thirty-sixth day a mixture was given to relieve his cough, 
which still annoyed him (infus. cherry giv, morphine, grs. ij. tartar emetic, gr. j. 
M. Sig. ^ss every three liours), and produced the desired effect (with apparent 
benefit). At the present time, forty-one days after admission, the patient is con- 
valescent, but the final issue still doubtful. He is taking from eight to twelve 
ounces of brandy daily and the same diet." 
The preceding notes on the history of this case were furnished by Dr. Henry 
Jervey, Assistant Surgeon P. A. C. S., stationed at the Confederate General Hos- 
pital, located at Summerville, South Carolina. 
I examined private A. J. Wolf during my inspection of the Confederate sick 
and wounded in the Summerville Hospital, and made the following record of the 
observations of his case: October 13th, 2 P. M.-Aged 23 years; height 5 feet 8 
inches; weight in health 140 pounds; now not more than 100 pounds, and scarcely 
that. Was stationed at James' Island, eastern part, facing the city, below Fort 
Johnston, three miles below, nearly opposite the city. Was taken with quotidian 
fever, 28th of August, 1863, and had a chill every day for five consecutive days. 
The typhoid fever followed immediately upon this. Says that he took no quinine 
during the first five days. Entered the hospital at Summerville September 4th. 
Has been extremely ill with typhoid fever, and now, October 13th, 3 P.M.. is 
extremely weak and reduced, but slowly convalescing. His complexion does not 
present the clear, florid hue of the cases of typhoid fever examined in Piedmont, 
Virginia-it is much paler and more sallow-it is bloodless, and it is highly 
probable that the malarial fever is still active. Slight enlargement of spleen. 
Bowels torpid now, although they have been much deranged during the early 
stages of the disease, Has not had an action for three days. Actions on bowels 
hard. He is too weak to sit up, although the patient has been sick about six weeks. 
Pulse 102; respiration 22. Temperature of hand 38° C. (100.°4 F.); temperature of 
axilla 38° C. (100.°4 F.) 
Examination of Urine.-Amount of urine passed during preceding twenty-four 
hours, October 12th, 2 P. M., to October 13th, 2 P. M., 580 cubic centimetres. Spe- 
cific gravity 1020. The urine presented a striking appearance. At the time of its 
passage, it was turbid, and of a dirty, brownish-red color. After standing, a heavy 
deposit of large, deep-colored, reddish-brown crystals of uric acid fell, together with 
a heavy dark brown deposit. The crystals of uric acid occupied the lowest station, 
and the dark brown, almost black deposits rested upon the upper portion, and the 
color of this portion of the deposit gradually shaded away into a greyish, reddish- 
brown color. The superior portions of the deposit presented a flocculent appearance. 
Each layer of the urine was subjected to careful examination. The lowest layer 
contained numerous red and reddish-brown lozenge-shaped crystals of uric acid, 
visible to the naked eye. The largest crystals of uric acid adhering to the bottom, 
and sides of the glass vessel, were about one-thirtieth of an inch in diameter. The 
middle layer in addition to the uric acid crystals, contained also black masses of 
altered blood pigment, casts of the tubuli uriniferiand rod-shaped vegetable organ- 
isms (bacilli), also granular and globular particles of urate of soda. The more light 
and flocculent superior deposits, consisted chiefly of the casts of the tubuli uriniferi, 
mucous corpuscles, small crystals of uric acid and small particles of black altered 
blood pigment, and the vegetable organisms previously described; and granules 
and granular and globular concretions of urate of ammonia, with a few crystals of 
oxalate of lime and triple phosphate. The following is an accurate reproduction of 
the microscopical appearance of this deposit, magnified 420 diameters, from a 
drawing which I carefully executed in the wards of the Confederate Hospital at 
Summerville, South Carolina, October 13th, 1863: Typhoid Fever in the Confederate Army. 
789 
ENGRAVING NO. 79. 
Urinary Deposits in Remittent and Continued Fever. 
Engraving No. 79.- Urinary deposits in urine of remv tent malarial fever, followed by typhoid 
fever.-Altered haematin. Crystals of uric acid and casts of the tubuli uriniferi, magnified 420 
diameters. From nature, by Joseph Jones, M. D., Confederate General Hospital, Summerville, 
South Carolina, October 13th, 1863. Case No. 980, A. J. Wolf, private Company F, Second Regi- 
ment South Carolina Artillery. Numerous micrococci and rod-like bodies were developed in the 
urine shortly after its evacuation. 
This case had suffered with malarial fever before the attack of typhoid 
fever, and was evidently suffering under the action of malaria at the time 
of this observation. We regard the presence of the casts of thetubuli 
uriniferi as evidently due to the effects of the action of the poison of 
typhoid fever on the excretory structures of the kidneys; the dark masses, 
represented the action of the malarial poison upon the red corpuscles of 
the blood. In numerous examinations of the urine of uncomplicated 
typhoid fever, I have never discovered these dark pigment masses. By 
uncomplicated typhoid fever, I mean specific typhoid fever, occurring in a 
healthy subject, who had never suffered with malarial fever, and who was 
not under the influence of the action of malaria during the progress of the 
fever induced by the typhoid poison. The pale sallow anaemic hue of this 
patient was quite different from the clear complexion and flushed cheeks 
and red lips of uncomplicated typhoid fever. 
The Civil War afforded many opportunities for the verification of the 
preceding statements. The strong vigorous men of rhe mountains, brought 
with them the seeds of typhoid fever, into the low malarious plains along 
the Atlantic Coast of Virginia, North Carolina, South Carolina and 
Georgia. 
In this arena, we had the manifestation of the action of two poisons, 
namely, of typhoid and malarial fever. The malarial poison frequently 
manifested its symptoms first; when the typhoid poison excited its pecu- 
liar train of symptoms it appeared to preoccupy the ground, to the exclu- 
sion of the malarial poison; after the disappearance of the typhoidal symp- 
toms, the malarial were frequently again manifested. 790 
Investigations by Joseph Jones, M. D. 
Amount of urine passed during twenty-four hours, October 12th, 2 o'clock, 
P-M-, to October 13th, 2 o'clock, P. M., 580 cubic centimetres. Specific .gravity, 
Analysis of urine passed during twenty-four hours: 
Grains. 
Amount of urine 9180. 
Urea 267.96 
Free acid 44.66 
Phosphoric acid 31.44 
Sulphuric acid 15.18 
Chloride of sodium 19.65 
The black pigment matter observed in the urine, resembled that so often seen 
in the spleen in malarial fever, and without doubt resulted from the action of the 
malarial poison in breaking down the colored blood-corpuscles. The increased 
deposit of uric acid in this case, was in like manner observed in the cases of 
typhoid fever investigated amongst the Confederate troops serving in Virginia. 
October 14th, 1863, 2 o'clock, P. M. Amount of urine passed during the last 
twenty-four hours, 1150 c.c. Specific gravity, 1012. 
Analysis of urine passed during twenty-four hours, October 13th, 2 o'clock, 
P. M., to October 14th, 2 o'clock, P. M. Grains, IS,216. 
Grains. 
Urea 309.92 
Free acid 24.79 
Phosphoric acid 22.66 
Sulphuric acid 15.93 
Chloride of sodium 113.34 
At 2 o'clock, P. M., immediately after the collection of the entire amount of 
urine for the twenty-four hours, I prescribed 6) grains (ji) of common salt in two 
fluidounces of coffee (infusion of coffee without milk, but with sugar,) every three 
hours in order to determine its effects upon the amount and chemical character of 
the urine. Amount of urine passed during twenty-four hours, October 15th, 2 
o'clock, P. M., to October 15th, 1863,-1540 c.c. Specific gravity, 1017. 
Analysis of urine passed during twenty-four hours: 
Grains. 
Amount of urine 24,40S. 
Urea 474.19 
Phosphoric acid 19.12 
Chloride of sodium 403.142 
The urine is of lighter color and with but small deposit of phosphates, and 
urates of ammonia. 
We observe that the chloride of sodium has caused the following 
effects : 
1st. Increase in the amount of urine. 
2d. Increase of the specific gravity. 
3d. Diminution of the deposit of uric acid, urates, phosphates and 
black pigment matter. 
4th. Increase of urea. 
5th. Diminution of the phosphoric acid. 
6th. The chloride of sodium was rapidly eliminated by the kidneys, 
nearly one ounce or about three times the normal quantity having been 
eliminated in 24 hours. 
Many other cases of malarial and typhoid fever were subjected to 
investigation in the department of South Carolina, during the month of 
October, 1863, but we will close this record with the report of the follow- 
ing case, illustrating the composition of the urine during the period of 
convalescence in typhoid fever. 
Case 981.-- Illustrating the composition of the urine during the period of con- 
valescence from typhoid fever.-Robert Alley, private Charleston Batallion, Com- 
pany G.; admitted into Summerville Hospital, September 30th, 1863. Has had 
severe fever after entering the hospital, but has had but little medicine. Diet, 
farinaceous with animal broths. Convalescence from typhoid fever has been slow Remittent Fever: Investigations by Joseph Jones, M. D. 
791 
<but steady. I made the following clinical observations on this patient in the C. S. 
Hospital October 13th, 18G3, 12 o'clock M.: Native of Spartensburg, 8. C.; age 22. 
Has had chills and fever in his childhood. Never before had typhoid fever. Weight 
an health 133 pounds; now it is much less, probably not more than 100. Was in Fort 
•Sumpter during the attack, which resulted in the capture of the storming party, 
with the original flag of Major Anderson. Had been doing duty up to this time. 
During the bombardment and attack was quite unwell, had pain in his limbs, 
■especially in the legs; he fought through the action, however, but was very tired. 
The next day was too weak to walk, and entered the hospital in the Fort. Lost his 
recollection and was out of his head al most immediately, and scarcely knew when 
he was carried in an open boat to the city. Entered a Confederate hospital in 
Charleston September 30th, having remained in the Fort about one week after 
being taken sick. Has been walking about for several days. Diet has been chicken 
soup, coflee, bread and hominy; has had no salt meat or beef. Now, October 13th, 
pulse 78; respiration 14; temperature of hand 34° C. (94.°3 F.); temperature of axilla 
39° C. (102.°2 F.) The morning is cool and this will account for the depression of 
the temperature in the hands. 
Examination of urine passed October 10th, 11th, (24 hours): 
Amount of urine passed during 24 hours, 1205 c.c.; sp. gr. 1014.5. 
Analysis of urine passed during twenty-four hours, October 10th to October 
11th: 
Grains 
Amount of urine passed during 24 hours 18174.05 
Urea 445.36 
Free acid 29.66 
Phosphoric acid 29.09 
Shlphuric abid 21.34 
Chloride of sodium 112.62 
The urine was clear without deposit. 
The experiment was made of placing a portion of the urine in a carefully 
stoppered bottle, and the other placed in an open vessel. At the end of two days no 
deposit had taken place in the urine closed with the stopper, whilst in that exposed 
to the atmosphere a heavy deposit had fallen. The reaction, however, remained 
acid. The formation of this deposit was attributable to the introduction of fermen- 
tative germs from the atmosphere, as well as the supplies of atmospheric air with 
its oxygen. 
We observe, that, notwithstanding the great reduction in flesh and 
strength of this patient, and his low diet, the temperature still remains at 
a high degree, and the urea is excreted in large amount. After a careful 
investigation of the history of fevers in and around Charleston, and after 
conferences with the various medical officers, the following general con- 
clusions were reached: 
1st. The sandy islands of the coast of South Carolina, as Edistow, 
James and Morris Island, etc., were regarded as health resorts in those 
portions which bordered upon the Atlantic Ocean, and were free from 
paroxysmal and continued fevers. The settlements in the neighborhood 
of the extensive salt and brackish marshes, and in the neighborhood of the 
rice fields, both on the islands and main land, and on the borders of the 
streams, were subject to the severest forms of malarial fever. The cases 
of congestive fever were often of rapid progress, terminating fatally upon 
the third paroxysm if quinine was not properly administered. These con- 
gestive cases were most generally quotidian, and death was often preceded 
by coma. They prevailed most commonly in the fall months. Quinine 
was the sheet-anchor in these cases-and the best results were obtained by 
the use of large doses. Some of the physicians of the littoral zone of South 
Carolina had found it beneficial to combine opium with quinine in the 
treatment of congestive malarial fever. 
Surgeon E. E. Jenkins, P. A. C. S., of the General Hospital of Sum- 
merville, who had practiced medicine on Edistow Island, from 1856 to 
1861, stated to the author on the 14th of October, 1863, that large doses of 792 
Remittent Fever: Investigations by Joseph Jones, M. D. 
quinine were absolutely essential in the treatment of the various forms of 
malarial fever, and that in severe cases its neglect was almost uniformly 
followed by death. 
The cases of congestive fever which had occurred in his practice were 
most generally intermittent quotidian; he had, however, seen one case of 
the algid variety, with cold skin, feeble, rapid pulse, and expression of 
indescribable agony, although the patient complained of no pain whatever. 
The following was given by Surgeon Jenkins, as a brief history of this 
case : 
Negro woman, age about 28 years. On inquiry, Dr. Jenkins found 
that she had had two paroxysms-the first slight, the second commencing 
with two convulsions. Dr. Jenkins saw the patient about one hour before 
the regular time for the paroxysm. Her skin was relaxed and loose and 
shrivelled, as the skin of a cholera patient, and when pinched up it 
remained so. Pulse 160, feeble and delicate. Expression of agony in the 
face ; skin cold; the patient, however, in answer to inquiries said, that she 
was perfectly well. Dr. Jenkins gave her 60 drops of laudanum and 20 
grains of quinine; in fifteen minutes the pulse had lost fifteen beats. At 
the end of one hour, repeated the dose of quinine with 20 drops of lauda- 
num. At the end of this time, there was further diminution of the pulse, 
and the second dose still further diminished its frequency. At the end of 
the second hour, gave 20 grains of quinine; at the end of third, gave 20 
grains more; in all, 80 grains of quinine and 80 drops of laudanum. At 
the end of this time, the skin had recovered its warmth, the face had lost 
its unnatural expression, the pulse was below one hundred beats to the 
minute, and the patient apparently doing well in every respect. Dr. 
Jenkins considered her now safe, but to make sure, doubly sure, left her 
70 grains of quinine to be taken by the next morning by sunrise, 10 grains 
each hour. The amount of quinine given, was 150 grains, from 4 o'clock, 
P. M., to sunrise next morning, say 6 o'clock, A. M. (in 14 hours). 
Dr. Jenkins saw this patient next morning. She appeared well in all 
respects, with the exception of weakness. Pulse and respiration seemed to 
be natural; face cheerful, expression good. What appeared singular was 
that there were no evidences of the action of the quinine. No ringing in 
the ears, no deafness nor any sign of quinism. The quinine appeared to 
be expended, simply in neutralizing the poison, just as if it had combined 
with it chemically. Dr. Jenkins considers the country fever of the regions 
around Charleston, as nothing more than a high grade of bilious fever and 
congestive fever, and he found large doses of quinine, often as much as 120 
grains in a day, the great means of arresting the disease. In bilious remit- 
tent fever, he found that by this energetic use of quinine, the disease was 
most generally arrested in three days. 
2d. Typhoid fever was of comparatively recent appearance upon the 
coast of South Carolina, and had prevailed chiefly amongst the negroes up 
to rhe commencement of the Civil War in 1861. The assemblage of large 
bodies of troops in and around Savannah, Georgia, and Charleston, South 
Carolina, had been attended by the appearance of typhoid fever, and there 
were many instances observed showing the infectious nature of the disease. 
Some outbreaks of malignant and fatal typhoid fever, had occurred, as 
that at Georgetown, South Carolina, in the month of February, 1862. The 
malignant form of typhoid fever at Georgetown, first appeared in a com- 
pany of the 21st Regiment of South Carolina Volunteers. This company 
arrived some time after the others were encamped. In consequence of 
defective police, the open space which was left for their encampment, 
became the receptacle of offal and filth. When this company arrived, the Congestive, Pernicious Malarial Fever. 
793 
filth which had been accumulating for six weeks, was cleared off. This 
appeared to be the origin of the disease, the fatality of which was shown 
by the fact that nine deaths in ten cases occurred in this company. 
Typhoid fever was said to have prevailed amongst the negroes of the 
coast of South Carolina for the first time in 1856. When introduced upon 
a plantation it generally attacked a large portion of the inhabitants and 
caused many deaths. On one plantation 50 cases occurred amongst 200 
negroes. 
3d. Typhus fever has occasionally made its appearance in Charleston 
and upon the surrounding plantations. The disease could, in most instances, 
be traced to infection from ships. In one instance it was introduced upon 
a large plantation by blankets brought from an infected ship. 
4th. The so-called country fever of the plantations in the vicinity of 
Charleston, which in past times was famed for its fatality, was nothing 
more nor less than severe remittent malarial fever, and was best controlled 
by the free use of sulphate of quinia. 'The cases of country fever, and 
that form of typhoid fever designated by Woodward as typho-malarial 
fever, were distinct diseases. There were marked differences between the 
malarial remittent fever and the specific typhoid fever. 
(a.) The malarial fever presented distinct intermissions and remis- 
sions, and was in most cases arrested by the proper and judicious admin- 
istration of quinine. 
(h.) The typhoid and so-called typho-malarial fever, manifested con- 
tinuous febrile phenomena with slight daily oscillations, and were neither 
arrested nor cured by sulphate of quinia. The thermic symptoms of the 
two diseases were radically different. 
(c.) The chemistry of the blood and urine was different in malarial 
fever, and in typhoid and the so-called typho-malarial fever. The former 
was characterized by profound and rapid changes; the latter by the uni- 
formity in the amounts and character of the urinary constituents, and the 
absence of any marked lesions of the colored and colorless blood-cor- 
puscles. 
(d.) Typhus malarial fever is not a distinct disease; as far as my 
observations extended the cases thus named could be referred to one of four 
classes, namely: Remittent fever complicated with the inflammation of one 
or more organs; second, remittent fever accompanied with diarrhoea; third, 
typhoid fever engrafted on malarial fever; fourth, uncomplicated typhoid 
fever. 
(e.) In the various forms of malarial fever the blood, liver and spleen 
were chiefly involved; in typhoid fever, as it occurred in the armies of the 
Confederacy, the characteristic lesion was found in the intestinal canal, 
namely: lesions and ulcerations of the glands of Peyer, and enlargement 
and softening of the mesenteric glands. I demonstrated the persistence 
and uniformity of the lesions of typhoid fever amongst the Confederate 
troops serving in Virginia, North Carolina, South Carolina, Georgia, 
Alabama, Florida, Mississippi and Tennessee. 
III. CHANGES OF THE PULSE, RESPIRATION, TEMPERATURE AND URINE 
IN MALARIAL CONGESTIVE FEVER. 
Pernicious Fever-Malignant Fever. 
These terms do not designate distinct diseases, but peculiar manifesta- 
tions of one disease, malarial fever. The complete prostration of the vital 
and physical forces; the reduction of animal temperature, both in the 
trunk and in the extremities; the cold, clammy sweat; the rapid, feeble 794 
Investigations by Joseph Jones, M. D. 
pulse; the rapid thumping action of the heart, and the sudden interven- 
tion of the most alarming cerebral symptoms, may occur gradually or sud- 
denly in either intermittent or remittent fever, and may be induced by 
several distinct causes acting singly or in combination. In the first chap- 
ter of this volume of the Medical and Surgical Memoirs, the author has 
presented a classification of the most pr ominent forms of congestive or 
pernicious malarial fever-. We have established the important fact that, 
whilst the forms of malignant malarial fever are numerous, they are all 
attended by profound alterations of the blood, and with congestion of one 
or more vital organs which may endanger the life of the patient, and which 
may pass into actual inflammation, attended with effusion of plastic lymph 
and serum or blood. 
In many cases in which no structural alterations have ensued during 
the congestive stage, there comes on at the conclusion of the paroxysm a 
perfect intermission of all the violent symptoms. The sudden disappear- 
ance of the most alarming symptoms may lead to a false prognosis, and 
prevent the institution of energetic measures. It is well known that in 
the malarious regions of the Southern and Western States, one of these 
violent paroxysms, whenever occurring either at the onset of the disease 
or during the progress of an ordinary mild intermittent, is the harbinger 
of others still more violent. If unheeded, the disease may prove fatal at 
the third, fourth or fifth paroxysm. The nature and effect of the malig- 
nant paroxysm will depend upon various causes, as the state of the con- 
stitution of the patient, peculiar idiosyncracies, pre-existing diseases, the 
effects of diet and occupation, the composition of the blood, and the organ 
or organs chiefly involved. 
We distinguished six varieties of malignant congestive or pernicious 
fever, namely : 1st. The comatose or cerebro spinal; 2d. The pulmonic; 
3d. The cardiac; 4th. The gastro-intestinal, hepatic and choleraic; 5th. The 
algid; 6th. The haemorrhagic. The symptoms of each of these varieties 
were carefully delineated in the first chapter, pp. 55-59. 
The action of the malarial poison is made apparent in its effects upon 
the blood and organs; after a period of latency of variable duration, 
changes of the blood, and functional disorders of the great nervous centres 
are brought about, terminating in the phenomena of intermittent, remit- 
tent or pernicious malarial fever. If the individual attacked, dies in the 
earliest stages of one or the other of these forms of the malarious disease, 
comparatively slight alterations in the structure of the organs may be 
observed, beyond hyperaemia and alteration of the secretions and blood. 
When the patient dies in the severest form of this disease, the scalpel often 
discovers scarcely a trace of disease beyond marked congestion of the 
brain, liver and spleen. When, however, the disease has continued for a 
length of time, in the masked and milder forms, a greater number of 
organs and tissues are morbidly altered than in any other febrile disease, 
as the liver, spleen, brain, and serous and mucous membranes of the body 
generally. Unlike other fevers, the specific action of the malarial poison 
within certain limits may be said to be in the inverse ratio of the fever 
which attends its action. The affections of the internal organs, and more 
especially of the liver, spleen and brain, as well as the alterations of the 
blood, vary greatly in different countries, and in different seasons. Certain 
types of the disease prevail in certain countries, and in different years. In 
most cases and in all countries when the disease prevails, if it is neglected 
the liver and spleen suffer. The inflammation of the liver may be indica- 
ted by jaundice and acute chronic, diffuse or limited hepatic inflammation. Congestive, Pernicious Malarial Fever. 
795 
When the liver becomes the seat of diffuse malarious inflammation, it 
may be of the deepest hepatic tint and loaded with blood, or it may be 
greatly hypertrophied, filling the abdominal and pelvic cavities, and as the 
inflammation is acute or chronic, greatly indurated or softened. In some 
•cases, this inflammation terminates in abscess most generally of the phleg- 
monous variety; the abscess may rupture into the duodenum or into the 
cavity of the abdomen, or it may point externally. It is also well known 
that the paludal poison produces structural alterations of the spleen, which 
in some cases may weigh from ten to thirty pounds, and exceed the liver 
in size. In some cases of protracted malarial poison, the organ has been 
found contracted hard and of less weight than in health. In some fatal 
cases, the organ is softened and filled with altered blood. Rupture of the 
spleen has occasionally caused death in malarious disease. Dropsy, ascites 
and general anasarca, frequently result from the visceral obstructions and 
changes caused by the prolonged action of the malarial poison. The super- 
vention of diarrhoea, acute dysentery, pleuritis and pneumonitis, may be 
attended with inflammatory symptoms and sudden prostration and rapidly 
fatal results. 
All the different types of malarious fever-quotidian, tertian, quar- 
tan, remittent, continued, bilious, and haemorrhagic, may suddenly mani- 
fest pernicious symptoms. The so-called congestive and pernicious fevers of 
tropical and sub-tropical regions, are only malarial fever accompanied by 
some rapid or formidable change, as the congestion of some important 
organ, failure in the action of the heart, the formation of heart clot, depres- 
sion of the central ganglionic centres which preside over circulation, secre- 
tion, nutrition and calorification, sudden attacks of diarrhoea or dysen- 
tery, profuse sweats, congestion of the brain and coma. The poison of 
malarial fever induces different results in different individuals; in some it 
causes well defined phenomena of the intermittent, remittent or continu- 
ous type; in others it slowly induces anaemia, hepatic derangement, hepe- 
tilis, splenitis, and malarious cachexia. But the pernicious tendencies are 
always ready to start up and to aggravate the malarious condition. 
The poison of malarial fever may lie in a dormant or masked form in 
the human system for indefinite periods, and may complicate any super- 
vening disease, or impart an intermittent character to the fever excited by 
wounds and mechanical injuries; or it may suddenly manifest its deadly 
-effects in the congestive comatose, and algid forms of this disease. No 
known poison has ever produced such diverse results, or has worn so many 
masks, ^r has ever produced such a train of symptoms, neuralgia, hys- 
teria, convulsions, internal congestions, paralysis, cardalgia, gastralgia, 
hepatitis, splenitis and coma, as the malarial poison; and. it may generate a 
fever which from its tendency to cause a, dissolution of the blood and to paralyze 
all nervous power, has been correctly denominated pernicious fever. 
Proposition XVII. The malarial poison may produce such profound alter- 
ations in the blood, and such profound impressions upon the sympathetic and 
cerebro-spinal systems, and upon the fibres of the heart, that both the capillary 
circulation and the general circulation ivill be greatly deranged, the chemical 
changes in the capillaries and organs from which the nervous and muscular 
forces are developed, arrested, and the temperature of the trunk diminished. 
If the cerebro-spinal system is chiefly affected, the paroxysm may be 
characterized by delirium, coma, convulsion and tetanic spasms, hence 
some writers have distinguished the comatose, the delirious, the convulsive 
and the tetanic varieties of the malignant intermittent. In many cases, in 
which the whole force of the disease appears to fall upon the cerebro- 796 
Investigations by Joseph Jones, M. D. 
spinal system, these symptoms indicating serious disturbances of the func- 
tions of animal life, as disorder of the mind, coma, apoplexy and paraly- 
sis, catalepsy, and various involuntary spasmodic movements, may disap- 
pear entirely as the paroxysm abates, not even a trace of headache being 
left during the intermission; in some cases, however, effusion may take 
place into the ventricles, or within and around the cerebiospinal system, 
and lead to the establishment of permanent coma, with dilatation of the 
pupils, general paralysis and death. In some cases the effusion consists 
chiefly of serum, and in others of blood, with all the symptoms of Inema- 
plegia, paraplegia, apoplexy and paralysis. A true inflammation of some 
portion of the cerebro-spinal substance may result from the congestion 
induced during the malignant paroxysm. Recovery is possible from such 
states, but convalescence is often tedious, and accompanied with paralysis 
of one or more sets of voluntary muscles. In many cases of malarial coma, 
I have observed the temperature to be elevated to a degree varying from 
102° to 106° F., and such elevation may be attended either with a hot, dry 
skin, or with a surface bathed in a hot, profuse perspiration. The action of 
the malarial poison is without doubt one of the causes of fatal and sudden 
apoplexy. It is probable that the result during the paroxysm is largely 
determined by preceding alterations of the arteries of the brain, and spinal 
cord such as fatty and calcarious degeneration. 
Exposure to the direct rays of the sun, conjoined with fatigue in those 
already under the influence of the malarial poison often induce that form of 
pernicious fever known as the comatose variety. In the first chapter we have 
recorded observations upon sun stroke, and the remarkable rapidity and 
extent of the rise of the temperature of the unfortunate patient; we have 
also shown that in many cases of congested pernicious fever of the coma- 
tosed variety, the temperature of the body is not depressed, but on the con- 
trary is elevated, ranging from 102. °5 F.; to 105° F.; the most sudden and 
unexpected attacks of the comatose variety of pernicious malarial fever, 
are generally witnessed in those suffering from the malarial poison,who have 
neglected the use of the proper remedies, and who have continued to per- 
form their active daily labors. These attacks are most common in the hot- 
test months of the summer and autumn, and their suddenness and severity 
are without doubt promoted by the debilitating and depressing effects of 
prolonged atmospheric heat upon white laboring men. As far as the 
experience of the author extends, the black negroes of the Southern States 
are much less liable to sun-stroke, and to the comatose and algid forms of 
pernicious malarial fever than the white race. The natives of Europe and 
of the Northern States who labor in the swamps, and marshes, cutting tim- 
ber, building railroads, or cultivating rice, are especially liable to perni- 
cious fever, and especially to the comatose, algid and haemorrhagic varie- 
ties. As a general rule these men have been suffering with derangement 
of health, when suddenly stricken down. It is also true that many are 
attacked by the pernicious fever, who after a long residence in a marshy 
district remove to one comparatively free from the malarial poison. In 
all such cases, it is evident that the morbific agent has already entered the 
blood before the sudden advent of profound coma, marked by the vio- 
lence of its invasion, the severity and intensity of its stages, and the rapid- 
ity of its progress to a fatal issue. The cold stage with shivering and 
depression of the temperature of the extremities, as a general rule does not 
precede the attack of coma. The hot stage is rapidly developed; and 
like the skin in algid fever it is covered with a hot perspiration. The 
length of time occupied by a comatose fit is variable, ranging from four to 
six hours, or even to six days; of course the length of the comatose state Congestive, Pernicious Malarial Fever. 
797 
will vary with, the treatment, and also with the time at which the fatal ter- 
mination ensues. Loss of motion, of sensation and of intelligence with 
impaired circulation and respiration, insensibility of the pupils to light, 
muttering delirium, muscular contractions, trismus, strabismus, violent 
tonic and clonic contractions, and complete loss of motion and sensation 
are the most prominent symptoms. 
We must distinguish between the comatose or apoplectic form of per- 
nicious malarial fever, and true apoplexy. The pernicious attacks of inter- 
mittent or remittent fever, the malarious location, the anaemia and the 
absence of plethora, the sallow and jaundiced hue, the rapid feeble pulse, 
the fullness of the belly, especially in the right and left hypochondria, and 
the marked signs of discomfort and distress when the epigastrium is 
pressed, will enable the physician to form a correct diagnosis. This sub- 
ject is of great practical importance; Whilst bleeding may be indicated 
in many cases of true apoplexy, as well also as free purgation; in the apo- 
plectic form of pernicious fever, bleeding ami excessive purgation would 
inevitably hasten the fatal termination. The remedial measures are : 
1st. The free use of mustard, in the form of the sinapism or hot 
foot bath. The application of blisters to the back of the neck and 
epigastrium. 
2d. The free administration of quinine. In many cases owing to the 
profound coma, and spasm of the muscles of the throat, this drug cannot 
be introduced into the stomach. Under this condition, the physician must 
introduce the quinine by inunction, by enema, or by subcutaneous injec- 
tion. If the bowels are loose, we are shut up to inunction and subcutane- 
ous injection. If the bowels are obstinately constipated, calomel should 
be administered. When heart clot has not formed, and when no serious 
lesions of the brain exist from serous effusions into the ventricle or from 
derangement of the capillary circulation by the detachment of fibrinous 
clots, or the impaction of pigment matter and large pigment cells, we may 
hope for favorable results from the preceding measures. 
Quinine in all cases and in all circumstances, freely and fully adminis- 
tered, must be the main reliance, the sheet anchor " of the physician. 
Proposition XVIII. The malarial poison may produce such derangements 
in the blood and its containing vessels, that fibrinous coagula will be formedin 
the heart and large blood-vessels, and produce suddenly and without previous warn- 
ing the phenomena denominated congestive. 
We have before illustrated this proposition by several striking cases of 
fibrinous concretions in the heart and large blood-vessels during life, in 
the second chapter of this (2d) volume of the Medical and Surgical 
Memoirs, and it will not be necessary to repeat the facts then stated, and 
the principles then established. 
Proposition XIX. The action of drastic purgatives or of an emetic or 
profuse bloodletting, may act in conjunction with the malarial poison and induce 
the phenomena denominated congestive, pernicious or malignant. 
Proposition XX. As far as my observations extend, there is in many cases 
a want of co-ordination between the actions of the circulation and respiration and 
animal temperature in congestive fever. 
The respirations are accelerated, full, and often panting and heaving, 
varying from 30 to 50 in the minute; the pulse beats from 120 to 160, and 
feels like a delicate thread, or is so small that it cannot be counted; the 798 
Algid Malarial Fever. 
heart thumps irregularly and spasmodically against the walls of the chest,, 
as in some cases of narcotic poisoning; the circulation in the capillaries is 
arrested; the temperature of the trunk, notwithstanding the full and rapid 
respiration, sinks below the normal standard; the temperature of the 
extremities sinks far below the normal standard, and the surface is covered 
with a cold clammy sweat. 
In that form of malarial fever, known as algid fever, the cold stage is- 
usually protracted; there is great oppression at the chest and abdomen, 
restlessness, and prostration of nervous and muscular power. The attempt 
at the formation of the hot stage proves abortive, the skin becomes cold, 
pale and shrunken on the extremities, and covered with a cold clammy 
perspiration, while, on the contrary, the central portion of the body and 
the internal organs are hot. In some cases of algid fever, I have observed 
the temperature of the extremities to be 80°, whilst that of the trunk has 
reached 104°, and higher. The patient complains of intense thirst, and 
when water is drunk it is frequently rejected by vomiting; the pulse is 
small, frequent, and almost imperceptible at the wrist; the heart beats in 
a tumultuous, irregular manner, giving a thumping sound to the ear, the 
number of beats sometimes reaching 180; the respiration is irregular, often 
panting, and numbering 40 and over to the minute; there is great restless- 
ness, jactitation, impatience of bed covering, with continuous complaints 
of oppressive heat, not only at the chest and abdomen, but even on the cold 
extremities, so that the patient refuses to have them covered. The intel- 
lect is generally undisturbed and the expression of the countenance may 
be quiet, even when the pulse cannot be felt, and when the disorder of the 
circulation and temperature becomes so extreme that the heat of the trunk 
is reduced, and even the tongue and mouth become cold. This irregularity 
continues through the whole period of the paroxysm, and it is only at the 
end of it, in favorable cases, that the temperature and circulation are par- 
tially restored. 
In algid fever we have congestion of the internal organs, prostration 
of the nervous and muscular forces, and marked disturbances of the circu- 
lation and calorification. As the circulation and calorification depend 
mostly upon the cerebro-spinal and sympathetic nervous systems, as well 
as upon the physical and chemical changes of the blood and organs, the 
algid state must be referred at least to lesions of certain ganglionic cells or 
tracts of the cerebro-spinal and sympathetic nervous systems; and whilst 
similar phenomena, but less in degree and duration, are manifested in every 
true malarial chill, it is not entirely correct to regard the algid state as 
simply a prolonged chill, for in the algid state the chill is followed by 
imperfect reaction, and the elevated temperature of true chill is rarely 
reached in the central organs, whilst there may be an actual diminution of 
heat. 
Proposition XXI. The phenomena of the algid form of congestive fever 
differ from those of the cold stage of intermittent a,nd remittent fever in the 
want of elevation of the temperature of the trunk. 
This distinction is most important as a diagnostic and prognostic sign. 
Proposition XXII. The phenomena of congestive fever are due to depres- 
sion of the forces, and not to excitation, and should be treated accordingly. 
The characters of the urine are not so readily determined in congestive fever 
on account of the restlessness, and often delirium of the patients. In some 
cases it is increased and of a light color. The color of the urine does not, 
as in remittent and congestive fever, correspond with the severity of the Investigations by Joseph Jones, M. D. 
799 
disease. The changes in the urine during congestive fever point to pro- 
found disturbances in the chemical changes of the capillaries. In a case 
which we shall relate, the characters of the urine were completely altered. 
The following cases will illustrate some of the phenomena and some of the 
principles of treatment of congestive fever: 
Case 982.-Illustrating the Changes of the Blood in Malarial Fever, and the 
Disturbances of the Pulse a,nd Pesinration in Congestive Fever, and the Effects of 
Stimulants and Sulphate of Quinia.-American seaman, native of Boston; age 21; 
weight 150; height 5 feet 16 inches; dark brown hair, brown eyes; muscular system, 
moderately well developed. This is his first trip to Savannah. Has been in Savan- 
nah ten days. During this time has been sleeping at night on the deck of the ship 
in the open air. The captain compelled all his men to sleep on board the ship, 
which was lying at the saw-mill, opposite the low marshy shore. Was taken sick 
four days ago. The crew consisted of eight; four of the crew slept on deck, and 
the same number in the cabin. The former are now sick, whilst the latter are 
well. 
September 26th, 1857. Tongue dryer than normal, and coated with yellow fur; 
complexion sallow. Pain upon pressure of epigastrium. Has some fever, and 
appears to be very weak. R. Sinapism over epigastric region. R. Sulphate of 
quinia gr. v, every three hours, upto gr. xv. 27th. Has taken a change for 
the worse. Has been passing his water in bed, and is in a comatose state. When 
the epigastrium is pressed exhibits signs of pain. Pulse and respiration accelerated. 
R. Blister over epigastric region, and sinapisms to extremities. R. James pow- 
der (Pulvis Antimonii Compositus) gr. xxij; calomel gr. xij; opium gr. ij;--Mix. 
Divide into twelve powders and administer one every two hours. 28th, 11 o'clock 
A. M The blister has aroused the nervous system, and the patient is restored to 
the use of his reason. R. Continue calomel and opium. R. Neutral mixture. 
7 o'clock P. M. The action of the blister has been only temporary, and the patient 
is now stupid, almost comatose. Pulse 120. Respiration 22. Pulse is so feeble that 
it is with difficulty counted. Tongue coated with yellow fur, dry and rough. The 
surface feels harsh, like the surface of a board. It is evident that the stimulant 
effect of the blister has vanished, and that the calomel is exerting no beneficial 
effect. R. Sinapisms to extremities. R. Brandy f^viij; infusion of Virginia 
snakeroot f 3 viij; sulphate of quinia gr. xv.-Mix. Administer every half hour. 
R. Sulph. of quinia gr. v every three hours, up to gr. xx. 29th, 11 o'clock A. M. 
Lies in a stupor, with mouth and eyes partially open. When aroused by shaking, 
answers sluggishly and in a few moments relapses into a stupor. Teeth coated with 
sordes. Tongue coated with black and light fur, with swollen edges, indented by 
the teeth; perfectly dry and rough. The surface of the tongue is transversed by 
several deep cracks. Surface of blister red, raw ana dry. The serum which issued 
from the blister was of a golden color. This patient emits a disagreeable nauseous 
smell. Has taken 40 grs. of sulph. of quinia. R. Continue brandy, infusion of 
Virginia snakeroot, and sulphate of quinia. 
2 o'clock P. M. Examination of blood.-Blood coagulated slowly. Serum of 
a deep golden color. Nitric acid showed that this color was due to the presence of 
bile. Reaction of serum, alkaline. 
Specific gravity of blood 104o 
Specific gravity of serum 1022 
WATER. 
In 1000 parts of blood 833.449 
In 1000 parts of serum 912.386 
(1) In 1000 parts of liquor sanguinis 910.79s 
(2) In 1000 parts of liquor sanguinis 875.813 
In 1000 parts of blood 166.551 
In 1000 parts of serum 87.614 
(1) In 1000 parts of liquor sanguinis 89.203 
(2) In 1000 parts of liquor sanguinis 124.187 
In serum of 1000 parts of blood 80.033 
SOLID MATTERS. 800 
Pernicious Malarial Fever. 
In 1000 parts of blood 6.314 
In 1000 parts of serum 6.620 
(2) In 1000 parts of liquor sanguinis 8.759 
In 1000 parts of dried blood-corpuscles 6.595 
In 1000 parts of moist blood-corpuscles 1.648 
In 1000 parts of dried residue of blood 37.909 
In 1000 parts of dried residue of serum 75.558 
In serum of 1000 parts of blood 5.747 
1000 parts of Blood contained-- 
Water 833.449 
FIXED SALINE CONSTITUENTS. 
Dried blood-corpuscles 85.968 
Dried organic residue 84.400 
. Fixed saline constituents 0.567 
Albumen, extractive and color- 
ing matters 80.033 
Fibrin 1.450 
Dried organic residue 74.186 
Fixed saline constituents 5.747 
1000 parts of Blood contained- 
Water 258.804 
Dried organic residue 84.400 
Fixed saline constituents 0.567 
Moist blood-corpuscles 343.872 
Water 574.646 
Albumen, extractive and color- 
ing matters 74.185 
Fixed saline constituents 5.747 
Fibrin 1.450 
Liquor sanguinis 656.128 
1000 parts of Moist Blood-Corpuscles contained- 
Water 752.646 
Dried organic residue 245.239 
Fixed saline constituents 1.648 
(1) 1000 parts of liquor sanguinis contained- 
Water 910.797 
Albumen, extractive and coloring matters 80.996 
Fixed saline constituents 1.587 
Fibrin . 6.620 
(2) 1000 parts of liquor sanguinis contained- 
Water 875.813 
Albumen, extractive and coloring matters 113.064 
Fixed saline constituents 8.758 
Fibrin 2.209 
7i o'clock P. M. The stimulants and sulphate of quinia have excited the 
•chemical changes and aroused the nervous system, and the patient is now restored 
to the exercise of his intellect. He is still, however, very weak, and has a great 
tendency to sleep. Pulse 98; respiration 18, full. Temperature of atmosphere 
80° F.; temperature of hand 98°. Skin of head and trunk feels a little warmer 
than normal, and is slightly moist. Tongue presents the same dry, coated, rough 
appearance. Reaction of saliva decidedly acid. R. Mustard to extremities. 
Continue brandy, infusion of Virginia snakeroot, and sulphate of quinia. Diet: 
milk punch, brandy, and arrowroot. 
30th, 2 o'clock P. M.-His intellect is clear, and there is less tendency to sleep, 
and he appears to be decidedly better. Pulse 80, much fuller; respiration 14. Tem- 
perature of atmosphere 71° F.; temperature of hand 97°. Tongue is still very dry, 
rough and black in the centre; it appears, however, when pressed with the Anger, 
to be somewhat softer. Urine passed this morning high colored. Urine passed 
during the night several shades lighter, and of the usual color, Reaction decidedly 
acid. Specific gravity of urine passed this morning 1016. Owing to the weakness 
of the patient, the whole amount was not collected. Amount of uric acid in 1000 
parts of urine 0.59. Reaction of saliva acid. R.-Continue stimulants, sulphate 
of quinia, and nutritious diet. October 1st, 1 o'clock P. M.-Says that he feels bet- 
ter, and is hungry. Pulse 90; respiration 20. Temperature of atmosphere 73° F.; 
temperature of hand 98.°75 ;temperature under tongue 101°. Complexion very sal- 
low. Tongue slightly moister, cleaner and softer. Urine of a deep orange color, 
clear and limpid; reaction acid; sp. gr. 1016. Uric acid in 1000 parts of urine, 
'0.659. 2d, 1 o'clock P. M.-The expression of the countenance is better, and the 
surface of the blister looks much better. Tongue still coated with dark-brown fur, 
but moister and softer. The sordes around his teeth, and the disagreeable smell, Investigations by Joseph Jones, M. D. 
801 
are rapidly disappearing. Abdomen tumid. Pulse 88; respiration 18. Tempera- 
ture of atmosphere 77° F.; temperature of hand 102°. Was able to get up and walk 
across the ward this morning. R.-Continue brandy and snakeroot tea, and sul- 
phate of quinia; tablespoonful every three hours. Urine orange colored; sp.gr. 
1016. Uric acid in 1000 parts of urine 0.511. Reaction of saliva decidedly acid. 
As in the former examinations, there was scarcely sufficient saliva to moisten the 
test paper. 
3d, 1 o'clock P. M.-Has apparently taken a change for the worse. Inclined to 
stupor; goes to sleep whilst conversing; countenance anxious and distressed. This 
inclination to stupor may be the effect of the brandy and sulphate of quinia. 
During the last four days has taken about one hundred grains of the sulphate of 
quinia. R.-Stop stimulants and sulphate of quinia. Pulse 94; respiration 18. 
Temperature of atmosphere 77° F.; temperature of hand 1O2.°5. Bowels are costive. 
R.-Citrate of magnesia and soda powders. Urine of yesterday deposited a heavy 
light yellow deposit. Urine just passed light orange colored, limpid, reaction acid; 
sp. gr. 1006. Uric acid in 1000 parts of urine 0.238. 4th, 2 o'clock P. M.-Medi- 
cine operated slightly. Pulse 94. R.-Infusion of Virginia snakeroot. R.-Tinc- 
ture of muriate of iron, mix, three times a day. 5th. 2 o'clock P. M.-Anxious 
expression of countenance; bowels costive; abdomen tumid. Tongue a little 
softer and cleaner, but still much drier, harder, and rougher than normal. Not- 
withstanding the slight improvement of his strength, there is still an almost 
complete absence of the secretions of the mucous membrane of the mouth. 
Pulse 90; respiration 15. Temperature of atmosphere 74° F.; temperature of 
hand 96°; temperature under tongue 103°. The temperature of the extremities is 
two degrees below, whilst the temperature of the trunk is four degrees above that 
of health. Accompanying this loss of animal heat in the extremities, and 
exaltation in the trunk, there is a rapid, feeble pulse, normal respiration, 
dry, harsh skin, dry mouth, feeble digestion, torpid bowels, sluggish intel- 
lect, and feeble forces. These facts, taken in connection with the analysis 
of the blood, show that the malarial poison has produced profound altera- 
tions in the constituents of the blood, interfered with the formation of the secre- 
tions, interfered with the chemical changes of the blood and nutritive fluids, inter- 
fered with the development and correlation of the physical, vital, and nervous 
forces. The dry, harsh tongue; the scanty, acid secretions of the mucous mem- 
brane of the mouth; the torpor of the bowels; the high-colored, acid urine; the dry, 
harsh skin; the feeble circulation in the capillaries of the extremities; the elevation 
of the temperature of the trunk; the loss of harmony between the actions of the 
circulatory and respiratory systems-all point to profound disturbances in the 
domain over which the sympathetic system presides. The sluggish intellect indicates 
derangement of the cerebro-spinal system. The feeble forces point to derangements 
in both the sympathetic and cerebro-spinal systems. The fact that the temperature 
of the extremities is but two degrees below the normal standard, whilst that of the 
trunk is several degrees above the normal standard, affords evidence that the chem- 
ical changes of theorgans, tissues, and blood are sufficient in quantity to work the 
machinery with the accustomed vigor. But the machinery is not worked with the 
accustomed vigor; the patient is weak, and unable to accomplish any mechanical 
effort at all corresponding to the chemical changes of the elements and solids. The 
forces are generated, but they are not properly applied, or they are not properly 
related to each other, or they are not generated in the right position or in the proper 
apparatus. If muscular force is generated by the chemical changes of the ele- 
ments composing the muscular tissue, and if the nervous force is generated by the 
chemical changes of the elements composing the nervous and muscular systems, 
if the transmission of the nervous excitement is dependent upon chemical changes 
in the elements of the nerves along which the excitement passes, it is evident that 
whatever interferes with those chemical changes must be attended by either an 
exaltation or depression or aberration of muscular and nervous force. If the col- 
ored blood-corpuscles, taken collectively, be an immense gland which elaborates 
the materials for the nutrition and development of the forces of the muscular and 
nervous systems, then their destruction by the malarial poison would in great 
measure account for the disturbances in the muscular and nervous systems. Impor- 
tant questions present themselves: Do the disturbances in the sympathetic and 
cerebro-spinal systems arise from a direct action of the malarial poison upon one or 
the other of these systems? Do the alterations in the secretionsand excretions, 
and in the amount and character of the chemical changes and physical forces, 
depend upon the direct action of the malarial poison upon the organs, elaborating 
the secretions and separating the excretions, and preparing the materials destined 802 
Congestive Malarial Fever. 
to form the elements of the tissues and undergo those chemical changes, by which 
all the forces are generated? Or, do the alterations of thesecretions and excretions, 
depend upon alterations of the blood, which is the great reservoir of materials for 
chemical change and nutrition? Or, do they depend upon a deficiency, or excess, 
or perversion, of nervous influence, which is supposed to influence secretion? A 
correct solution of these problems is impossible, in the present state of medical 
science, because the ultimate facts are wanting. Specific gravity of urine 1006: 
reaction alkaline after standing twenty-four hours. Amount of uric acid in 1000 
parts of urine, 0.078. R.-Stop tincture of muriate of iron immediately. At 10 
o'clock P. M. this night (twelve hours afterwards) administer calomel gr. x, fol- 
lowed by castor oil in four hours. If he is weakened by the action of the medi- 
cine, administer stimulants freely. 
6th, 1 o'clock P. M. Medicine operated four times, and has produced great 
exhaustion. Tongue clean and much moister and softer; the moisture of the tongue 
however, varies greatly. This morning at 10 o'clock A. M. it was moist and soft; 
at 12 o'clock M. it was almost entirely dry, and now it is moist. Pulse 100, very 
weak; feels like the vibrations of a spider's thread. It requires time and care to 
find the pulse, and much more time and care to ascertain correctly its number of 
vibrations. It appears that I have made a mistake in giving the calomel and oil. 
His system is so much exhausted that it is doubtful whether it will rally. R.- 
Brandy and infusion of Virginia snakeroot; milk punch. R.-Compound tincture 
of gentian f^j; compound tincture of bark f^j. Mix, and administer three times 
a day in a wineglassful of infusion of snakeroot. R.-Chlorate of potassa jj; 
water f^viij. Dissolve, and administer during the twenty-four hours. Diet, mutton 
soup, boiled rice, brandy, arrowroot, and milk punch 7th, 3 o'clock P. M. Looks 
better The anxious expression of his countenance is removed, his intellect is 
brighter, and his spirits better. Tongue softer and moister than it has been during 
the sickness. Pulse 92, watery and feeble, but stronger than yesterday; respira- 
tion 13; temperature of atmosphere 7O.°5 F.; temperature of hand 97°: temperature 
under tongue 103°. .R-Continue medicine and diet. R.-Spirits of turpentine. 
10 drops, four times a day. 8th, o'clock P. M. Says that he feels very weak. 
Tongue moister and softer. Pulse 96, feeble and watery; respiration 16; tempera- 
ture of atmosphere 72.°5 F.; temperature of hand 97.°25; temperature under tongue 
102.°o. Has not had a movement of the bowels since the action of the calomel. 
R.-Phosphate of soda $iij, water f^v. Dissolve, and administer in two doses. 
Continue tonics, stimulants and nutritious diet. 
9th, 2 o'clock P. M.-Complains of great weakness. His sallow complexion, 
anaemic lips and gums, feeble pulse, and feeble forces, demonstrate that his feelings 
are founded in the effects of the malarial poison. Pulse 92; respiration 16. Tem- 
perature of atmosphere 73° F.; temperature of hand 86°; temperature under tongue 
103°. The hand in which the thermometer was placed was carefully surrounded 
with the non-conducting blanket. Notwithstanding this favorable arrangement 
for the accumulation and manifestation of animal heat, the thermometer during the 
period of one hour indicated a temperature of 86°, which is twelve degrees below 
the normal standard. The temperature of his trunk, on the other hand, is four 
degrees above the normal standard and seventeen degrees above that of the extremi- 
ties. Here we have a disturbance of the temperature analogous to that of the well- 
marked chill of malarial fever, and yet the patient does not complain of the sensa- 
tion of cold, and there is no shivering of the muscles, and the respiration is normal 
in frequency, and the violent action of the respiratory muscles characteristic of a 
well-marked chill is absent. The feeble pulse, on the other hand, attended with ele- 
vation of the temperature of the trunk and depression of the extremities, corre- 
sponds with the phenomena of a well-marked chill, and indicates deficientcircula- 
tion of blood and arrest of chemical action in the capillaries of the extremities, 
and, at the same time, accumulation of blood and increase of chemical change in 
the capillaries and blood-vessels of the largo organs of the trunk. The increased 
heat of the trunk during the cold stage may arise, in part, from the chemical 
changes in the blood-corpuscles, resulting in their destruction, and in the liver, 
resultingin the alterations of its secretions and nutritive fluids. The heat thus 
generated by the destruction of the blood-corpuscles, by the alterations of the other 
elements of the blood, and by the alterations of the secretions and nutritive fluids 
of the liver, induced by the presence of an extraneous poisonous body, would be 
generated in the wrong position, and by a wrong collocation, action, and reaction 
of elements; and would, so far from adding to the forces, produce derangement and 
interfere with the carefully adjusted balance of the forces. It is a well-established 
truth in physiology that vital phenomena are manifested by matter having a. Congestive Malarial Fever: Investigations by Joseph Jones, M. D. 
803 
definite chemical and physical constitution, and whatever alters the arrangement 
of the matter destroys the essential conditions of the manifestation of the vital 
phenomena. The study and investigation of man should be, not what are the 
essences of the physical, chemical, and vital forces, but what are the essential con- 
ditions and laws of their existence and manifestation. 
Whilst the low temperature of the extremities, accompanied by a feeble, rapid 
pulse, is a very dangerous symptom, still the condition of the patient would be 
much worse if the temperature of the trunk corresponded with that of the extremi- 
ties. A definite temperature of the trunk is absolutely essential to the mainten- 
ance of life in man. An elevation or depression of the temperature of the great 
organs of the trunk, of only a few degrees, is attended with death; because this 
fixed temperature is one of the essential conditions for the conduction of those 
chemical processes, by which the forces are generated; and by which, under the 
guidance of the vital principle, poisonous compounds are removed and new matter 
elevated into a state of force, and rendered suitable for the habitation of the vital 
principle, by the action of the forces of the sun through the apparatus of the vege- 
table kingdom, are introduced into the position of that chemically altered and 
removed; and by which that constitution of matter is preserved, which is indis- 
pensable for the existence of the vital principle, and the manifestation of vital 
phenomena, by the correlation of the chemical and physical forces, acting under 
the guidance of the vital principle, upon and through special apparatus. Whilst 
even a moderate elevation or depression of the temperature of the great organs of 
the trunk is necessarily attended by the generation of abnormal compounds, or by 
a complete arrest of the chemical and physical and nervous actions; the elevation 
or depression, even to a great extent, of the temperature of the extremities is not, 
on the other hand, attended by such serious consequences, because these parts of 
the body are destined to act as mere servants to the spiritual nature, as mere organs 
of locomotion and mechanical action, and not as chemical laboratories for the pre- 
paration of the nutritive elements, and of the matters destined for the develop- 
ment of the forces. Nevertheless, as the forces which work the muscular system 
are developed by the chemical changes of the structures of the muscles, and of the 
compounds and elements of the surrounding blood; and as the excitement and 
transmission of the nervous force to the muscular system is the result of the chem- 
ical changes of the elements of the nerves (and probably of the muscles'), it is evi- 
dent that a reduction or elevation to any great extent, of the temperature of the 
extremities, must also, but in a much smaller degree, interfere with the chemical 
changes going on in those muscles and with the correlation of the chemical, phys- 
ical, and nervous forces. 
The development of the muscular and nervous forces depends upon the constitu- 
tion of the muscular and nervous apparatus, and a free supply of oxygen (the great 
agent of chemical change), and of the nutritive and force-generating elements of the 
blood. In the case before us, the muscular and nervous systems appear to be nor- 
mal in constitution, whilst the blood and oxysren are wanting. To restore the 
action of the muscular and nervous systems, and prevent the generation of noxious 
compounds by the reduction of temperature, we must restore the circulation of 
blood, and the distribution of oxygen. Acting upon these principles, I endeavored 
to arouse the circulatory, respiratory, and nervous systems, by sinapisms. Applied 
large mustard plasters to the extremities. In ten minutes after the application of 
the mustard, the temperature of his extremities had risen six degrees (from 86° to 
92°), and his pulse had become fuller, and increased eight beats (from 92 to 100 
beats). In half an hour after the application of the mustards, the temperature of 
the extremities had risen sixteen degrees, from 86° to 102°, and the pulse had 
increased 12 beats to the minute. During these changes the respiration and the 
temperature of the trunk have remained uniform. The elevation of the tempera- 
ture from 86° to 92°, during the first ten minutes, was more rapid than the subse- 
quent elevation during the succeeding twenty minutes, from 92° to 102°. After 
reaching this temperature, the thermometer indicated a stationary temperature 
both in the hand and under the tongue, and at 8 o'clock P. M., five hours after 
these observations, the pulse was 94; respiration 16. Temperature of atmosphere 
70° F.; temperature of hand 102°; temperature under tongue 103°. 
Here we see that although the frequency of the pulse has been reduced, and it 
has returned back to within two beats of what it was when the temperature of the 
hand was only 86°, still the temperature of the hand is 102°. The pulse has 
increased in volume, and hence the increased elevation of temperature is due to 
the increased circulation of blood. It is evident that the action of the mustard has 804 
Congestive Malarial Fever: Investigations by Joseph Jones, M. D. 
not been evanescent. The following table will exhibit in a clear light the changes 
induced by the revulsives. 
Before the ap- 
plication of the 
sinapisms. 
10 minutes after 
the application 
of the 
sinapisms. 
30 minutes after 
the application 
of the 
sinapisms. 
5 hours after 
the application 
of the 
sinapisms. 
Pulse 
92 
100 
104 
94 
Respiration 
16 
16 
16 
16 
Temp, of atmosphere 
73° 
73° 
72° 
71° 
Temp, of hand 
86 
92 
102 
102 
Temp under tongue 
103 
103 
103.2 
103 
The restoration of the circulation and chemical changes in the capillaries of 
the extremities, was attended by a subsidence of the twitching of the tendons, by 
a disappearance, in a great measure, of the feelings of exhaustion, by an increase 
of the secretions of the mucous membrane of the mouth, tongue, and fauces, and 
by an increase of muscular and nervous force. The patient says that the mustards 
have made him feel much stronger. In this experiment the volatile, stimulant oil 
of mustard, has not simply called forth the nervous force existing in the system, 
but has produced a permanent exaltation of the nervous and physical forces. This 
was accomplished by the stimulant principle of the mustard, and its distribution, 
by the blood vessels, to all parts of the sympathetic and cerebro-spinal nervous 
systems. The action of the heart was thus increased, and the absorption and dis- 
tribution of oxygen, promoted by an acceleration of the general and capillary cir- 
culation. Before the action of the stimulant, the chemical changes in the capil- 
laries of the extremities were slow and small, because the circulation in the capil- 
laries of the extremities was sluggish, and the amount of oxygen and blood sup- 
plied to the muscles and nerves of the extremities, insufficient to sustain vigorous 
chemical changes. When the circulation was aroused, the chemical actions in the 
extremities were correspondingly increased, because the elements of these changes 
were presented in abundance, and with rapidity. As the muscular and nervous 
forces depend upon chemical change, the excitation of the chemical changes were 
necessarily attended by an increase of muscular and nervous force. 
Thus, the increased supply and distribution of the elements of chemical change 
led to an increase of nervous and physical force, and !this nervous and physical 
force, in turn, led to a still farther excitement of the machinery devoted to the 
absorption and distribution of the oxygen, the great element of chemical change. 
Hence, the excitement was permanent. B.-Carbonate of ammonia gr. x, every 
four hours. B .-Oil of turpentine mix, every three hours. Continue stimulants, 
tonics, and nutritious diet. 10th. Much better. Temperature of the extremities 
corresponds with thatof the trunk. Urine has a strong smell of turpentine. Amount 
passed during the last eighteen hours, 12,168 grains; sp. gr. 1014. Deep orange 
color, inclining to red; reaction decidedly acid. Slight turbidity, but no deposit. 
12,168 grs. of urine passed during twenty-four hours contained urea 209,520 grs.; 
uric acid 12.60 grs. 1000 parts of urine contained urea 17,212; uric acid 1,035. 4 
o'clock P. M. Appetite good; tongue moist. Pulse 100; much stronger than yes- 
terday, before the application of the mustards. Respiration 16; temperature of 
atmosphere. 69.°5 F.; temperature of hand 101.°; temperature under tongue 102.°5. 
Urine high colored, reddish-brown; sp. gr. 1016; reaction decidedly acid, clear lim- 
pid. Amount passed during the last five hours 4,562 grs. B .-Continue. 
11th. Continues to improve. Is able to walk about the ward. B.-Citrate of 
iron gr. ij; sulph. of quinia gr. iij. Mix. Administer three times a day. B.-Con- 
tinue stimulants, tonics, and nutritious diet, oysters, soft boiled eggs, milk punch, 
etc. 17th. Has continued to improve, and is now able to walk in the hospital 
grounds. He is still, however, pale, sallow, and very weak. Pulse 76, full and 
strong; perspiration 14; temperature of atmosphere 67° F.; temperature of hand 
97.°25; temperature under tongue 100°; reaction of saliva very slightly acid. Dur- 
ing his sickness it has been decidedly acid. 
I have been informed, upon reliable authority, that one week after the admis- 
sion of this patient into the hospital, his captain weighed anchor and sailed for New 
York. The crew consisted of the men whom he had compelled to sleep on board 
the vessel, lying along the low, marshy shore. Several of the crew were unwell at 
the time of sailing. Before getting well out to sea, the captain and the whole crew 
were taken sick. In a few days there was not a man with strength to navigate the 
ship. Fortunately, a small vessel perceived their signals of distress, and towed Pernicious Malarial Fever. 
805 
them into Darien. Before reaching this port, the captain and five out of seven of 
the crew had died. There were but two remaining of eight, and these were extreme- 
ly ill. The severity of the disease, in this case, resembles the accounts of African 
fever. From the report of this case, which came under our own observation, it is 
evident that any carelessness or neglect would have been attended by a fatal ter- 
mination. Notwithstanding the administration of the most active tonics, and of 
the most nutritious diet, this patient exhibited tor a great length of time the effects 
of the bilious remittent fever, in his pale, sallow, anemic countenance, pale lips 
and gums, and tottering gait. 
Case 9S3.-Illustrating the. Change of Pulse, Respiration, and Animal Tem- 
perature, and the Effects of Purgatives, in Congestive Fever.-American seaman; 
height 5 feet 9 inches; weight 160 pounds; stout, well built; large chest, brown hair, 
bronzed complexion, bilious temperament; age 45. Has been in Savannah three 
weeks. Was taken with a chill October 8th, at 12 o'clock M., which lasted one 
hour, and was followed by fever, which continued, without remission, for eight 
hours. On the 9th inst. (the next day) had no chill. October 10th, 1857, II o'clock 
P. M. Entered the hospital this morning at 10 o'clock. At 12 o'clock M. the chill 
came on. The chill was well marked; rapid, small pulse; rapid thoracic respira- 
tion; shivering, quivering muscles; high temperature of the trunk, and low tem- 
perature of the extremities. The chill lasted one hourand twenty minutes. Now 
(1J o'clock P. M.) the shivering has ceased, and the circulation in the capillaries is 
more vigorous, and the difference between the temperature of the trunk and 
extremities less. Pulse 130, full; respiration 46, thoracic. Temperature of atmos- 
phere 6S.°5 F.; temperature of hand 100°; temperature under tongue 106°. The 
difference of temperature between the trunk and extremities shows that the rela- 
tion between the general and capillary circulations has not as yet been completely 
established. Tongue perfectly dry, and feels rough under the finger, like sand- 
paper. Those portions which are not coated by yellow furare of a bright red color. 
Pressure over epigastric region causes some pain. Has pain in his chest, and a 
very bad cough. Says that he has suffered with a cough for one month, and three 
weeks ago ''spit blood." Complains of ''pain in his bones." Has taken no medi- 
cine. R.-Calomel gr. xij; sulphate of quinia gr. yj. Mix, and administer imme- 
diately, and follow with castor oil in four hours. R.-Neutral mixture. As soon 
as fever remits, give gr. v of the sulphate of quinia every three hours, up to gr. 
xxv. 8 o'clock P. M. Febrile excitement is declining. Skin in a good perspira- 
tion. Has no pain anywhere, and is very comfortable. R.-Commence with sul- 
phate of quinia immediately. 
11th, 11 o'clock A. M.-Severe vomiting commenced last night at 11 o'clock P. 
M., and has continued unchecked up to 4 o'clock A. M., when the nurse adminis- 
tered a mixture of milk, lime-water, and acetate of morphia, which has in a great 
measure cheeked the vomiting. Twenty-six grains of the sulphate of quinia have 
been administered since 8 o'clock P. M.; only eleven grains have been retained. 
Says that the calomel and oil operated powerfully, and he was upon the night- 
chair almost the whole night. The discharges appear to have been serous fluid 
colored with bile. Says that he has always been greatly affected by cathartics; 
even the smallest doses have produced violent purgation, followed by great exhau- 
tion. I was not aware of this idiosyncrasy when the medicine was administered. 
Now his extremities are covered with a cold, clammy sweat, and he is completely 
exhausted. During the action of the medicine he was almost senseless from the 
great prostration consequent upon the violent purgation and vomiting. Pulse 94! 
respiration 22. Temperature of atmosphere 71° F.; temperature of hand 79°; tem- 
perature under tongue 97°. The temperature of the extremities is nineteen degrees 
below the normal standard, whilst the temperatureof the trunk is only two degrees 
below that of health. The pulse is accelerated thirty-four beats to the minute; the 
respiration is but slightly accelerated. The temperature of the extremities and 
trunk does not correspond to the increased action of the circulation and respira- 
tion. This remarkable reduction of the temperature of the extremities and trunk 
is attended by a complete prostration of the forces. The respiration is sufficiently 
rapid and full to introduce large quantities of the great element of change-oxygen; 
and the action of the heart is sufficiently rapid, but not sufficiently powerful, to 
distribute the elements of nutrition and chemical change in the capillaries of the 
extremities. The pulse is feeble, and the circulation in the capillaries of the 
extremities exceedingly sluggish. Here we have a condition of the extremities 
resembling that of a well-marked chill. The elevation of the temperatureof the 
trunk, and the shivering and quivering of the muscles, characteristic of a well- 806 
Pernicious Malarial Fever. 
marked chill, however, are absent. The temperature of the trunk is absolutely 
lower than that of health, notwithstanding the acceleration of the respiration and 
circulation. This disturbance of chemical action, this disturbance of the physi- 
cal forces, this prostration of the nervous and muscular systems, are, without doubt, 
due to the simultaneous actions of the purgative and malarial poison. Here we 
have an instance of vomiting and purgation producing such a disturbance of cir- 
culation, respiration, and chemical action, and such a prostration of the muscular 
and nervous systems, that a simple case of intermittent fever is con verted into 
what is ordinarily called congestive fever. The phenomenaof this patient, during 
the febrile excitement, were such as warranted the administration of calomel. 
Administered stimulants and sulphate of quinia. His stomach is so irritable 
that it will not retain these medicines. Sinapisms have been applied to the extremi- 
ties; hoi ties of hot water applied to feet and legs. The mustards have been very 
slow in their action, producing but little or no coloration of the skin after the lapse 
of half an hour. They remained on for three-quarters of an hour before the skin 
was decidedly reddened. After the action of the mustards for three-quarters of an 
hour, the temperature of his hand is 88°, and that under the tongue 97.°75. The 
temperature of the extremities has risen nine degrees, whilst that of the trunk has 
risen only three-fourths of a degree. The action of the stimulant principle of the 
mustard has been to excite the general and capillary circulation, through the sym- 
pathetic nervous system. This excitement has been attended by a more rapid dis- 
tribution of the elements of nutrition and chemical change. These increased 
chemical changes have been attended by an increased generation of the physical, 
muscular, and nervous forces. The increase of chemical change, and the increase 
of physical force, are attended by a rectification of the aberrated phenomena of the 
sympathetic and cerebro-spinal nervous systems. The restlessness, the feeling of 
complete exhaustion and prostration, and the vomiting have in a great measure 
disappeared. The stomach is now able to retain stimulants andsulphateof quinia. 
B.-Continue sulphate of quinia gr. v, every three hours, up to gr. xl. If the 
stomach rejects the sulphate of quinia, administer ten grains by the rectum, com- 
bined with starch and tincture of opium, every three hours. Continue stimu- 
lants and infusion of Virginia snakeroot. Urine of a brownish-red color; sp.gr. 
1014; reaction decidedly acid, even after standing forty-eight hours. When treated 
with hydrochloric acid, the urine was changed to an almost black color. After 
standing forty-eight hours there was no deposit. Uric acid in 1000 parts of urine, 
0.0197. It was impossible, on account of the severe purgation, to determine the 
whole amount of urine excreted. 
12th, 12 o'clock M.-Says that he rested well during the night, and feels better, 
but is still very weak. Has vomired three times this morning. The cold, clammy 
feeling of his skin has disappeared, and the patient appears to be decidedly better. 
Tongue red at tip, and pointed; papillae enlarged and distinct. Pulse 100, much 
fuller and stronger than during the state of prostration. Respiration 30, quick, but 
gentle; does not resemble the full, labored, thoracic respiration of many eases of 
congestive fever. Temperature of atmosphere 74° F.; temperature of hand 100.°75; 
temperature under tongue 101.°20. This observation demonstrates that the increased 
distribution of blood and oxygen has been attended by a decided elevation of tem- 
perature. Whenever there is an imperfect capillary circulation, whenever there is 
a deficiency of the elements of nutrition and chemical change, then will we have 
feeble forces and aberration of muscular and nervous action. The temperature, 
the muscular force and the nervous force, depend absolutely upon the chemical 
changes of the elements of the living organism, which have been elevated into a 
state of force, by the action of the forces of the sun upon special apparatus, or 
rather upon a great laboratory, the vegetable kingdom. 
The rapidity of the chemical changes, which develop the forces of the machin- 
ery, depends first, upon the supply and distribution of materials capable of enter- 
ing into the constitution of the organs, tissues, and apparatus; secondly, upon the 
supply and distribution of materials capable of undergoing chemical change, 
within and around the machinery, and thus generate the forces in positions advan- 
tageous for their application; thirdly, upon the replacement of the chemically 
altered matter which once formed part of the apparatus (machinery), by new mat- 
ter; fourthly, upon the removal of the products of chemical change, which derange 
chemical action, first, by occupying positions in the apparatus which should be 
occupied by matter in a state of force, and not by matter which has lost the amount 
of force originally received from the sun; secondly, by inducing chemical changes 
in the wrong position in parts of the organism, where the forces resulting from 
these chemical changes cannot be applied; and, thirdly, by a direct poisonous Pernicious Malarial Fever. 
807 
■effect upon the organs, tissues, and apparatus, especially upon the nervous system, 
which keeps up a communication between all parts of the system, and controls, in 
a great measure, the distribution of the elements of nutrition and chemical change, 
by controlling the action of the respiratory and circulatory apparatus. The supply 
and distribution of the materials of nutrition and chemical change depend, first, 
upon the perfection and action of the vegetable apparatus, and secondly, upon the 
perfection and action of the animal digestive, circulatory, and respiratory appara- 
tus, related and co-ordinated by the nervous system. 
The study of the animal kingdom, as a whole, demonstrates that the perfection 
and action of the respiratory and circulatory systems may be taken as an index of, 
not only the physical and chemical changes of the organized fluids and solids, but 
also of the development and perfection of the organs, and tissues, and apparatus, 
and of the activity and intelligence of animals. The action of the respiratory and 
circulatory apparatus, and the co-ordination of this action with the action and 
wants of the muscular and nervous systems, and of all these organs, and tissues, 
and apparatus, are guided by the nervous system in which a special force is gen- 
erated : excited and guided by nervous force, but not carried on by nervous force, 
independent of chemical change. Chemical change in the organs and apparatus, 
and chemical change in the nervous system, is the source not only of heat, but of 
muscular and nervous force, and of all the forces generated in the animal economy. 
The generation of any force-vital, nervous, chemical, or physical-in the animal 
economy, independent of antecedent force, would destroy the great law upon which 
the stability of the universe rests, that force is indestructible-would destroy the great 
law that action and reaction, are equal. All the forces in the animal economy are 
generated by chemical action. The various organs and apparatus are simply 
arrangements for the preparation of materials suitable for chemical change, and for 
the application of the forces generated by chemical change. According to this 
view, the action of the vital force, like that of the intelligence, is limited to a 
guidance and direction of the forces with which the Creator has endowed all matter. 
The action of the vital principle upon matter, like that of the intelligence, does not 
consist, either in a creation of matter or in a direct movement of matter, independ- 
ent of the forces of matter, but in the mere guidance and application, of the forces 
of matter, so that definite forms are developed from formless matter, and definite 
results accomplished. According to this view, the vital principle and the intelli- 
gence, cannot create force, any more than they can create matter. Their influence 
is limited to an excitement and application of the forces of matter. 
We judge of the influence of one just as we judge of the influence of the other. 
The complicated machine points to the existence of an intelligence distinct from 
matter, which has so applied the forces of one portion of matter, that another por- 
tion has been moulded into definite shapes and formed into definite apparatus, 
capable of accomplishing definite results when acted upon by forces generated and 
applied in the right manner. We infer the existence of the intellect by the results 
of its application of the forces of matter. In precisely the same manner do we infer 
the existence of the vital principle. The vital principle directs the forces, resulting 
from the chemical changes of one part of matter, in such a manner that surround- 
ing matter is fashioned, moulded into definite forms and apparatus, destined to 
accomplish definite results. This apparatus cannot be worked by the vital prin- 
ciple, independent of chemical change, any more than a watch will run, or any 
machine will accomplish various mechanical effects, without a supply of exterior 
force, or a steam engine accomplish mechanical effects, without the development 
of force by the chemical changes of matter, which has been elevated into a state 
of force (placed in a state capable of undergoing chemical change) by the forces of 
the sun. 
The development and structure of the vegetable kingdom, the development 
.and structure and actions of the most simply constructed animals, the appearance 
of the nervous system in the animal kingdom, and in the foetus of the higher 
animals subsequently to the grouping of the atoms of formless matter into definite 
forms and apparatus, before the formation of nerve-cells and nervous systems, 
demonstrate unequivocally, conclusively, and absolutely, that development, nutri- 
tion and the direction of tiie forces of one part of matter, to the fashioning of another 
part, are under the guidance of the vital principle ; demonstrate unequivocally, 
conclusively, and absolutely, that the nervous system itself is developed and its 
perfection maintained under the guidance of the vital principle. The nervous 
system is the last and best work of the forces of matter directed by the vital force, 
and is destined to connect together and influence the various organs and apparatus, 
and is destined to regulate secretion and excretion, and the consequent develop- 808 
Pernieions Malarial Fever: Investigations by Joseph Jones, M. D. 
ment of force; and is destined to excite and control the actions of the dynamic 
muscular apparatus, not by the possession and emission of a peculiar force generated 
de novo, but rather by a modification of physical force generated by the mutual 
chemical reactions of the elements of the blood and nervous system. The truth of 
this proposition is conclusively demonstrated by the fact that an arrest of chemical 
action is immediately attended by an arrest of nervous and muscular force. 
During the last twenty-four hours, has taken and retained 25 grs. of the sulphate 
of quinia. R.-Continue stimulants. Diet, wine whey and arrowroot. Urine 
orange-colored ; sp. gr. 1020; reaction decidedly acid, and remained so longer than 
sixty hours. After standing fifty hours there was a slight deposit of epitheliel 
cells, mucous corpuscles and cylindrical casts of the tubuli uriniferi. Amount of 
urine collected during the last twenty-four hours 6120 grs. The patient affirms 
that this was the whole amount passed during the last twenty-four hours. When 
the urine was evaporated to the consistence of a syrup and treated with nitric acid, 
there was a powerful effervescence, and the urine assumed a dirty-brownish yellow 
color, and the nitrate of urea presented a brownish-black color, and imperfect crys- 
tallization. When the urine was concentrated by evaporation it assumed a 
brownish-black color. When the unconcentrated urine was treated with hydro- 
chloric acid, it assumed a dark-mahogany, almost black color. The solid matters 
of the urine appeared to consist principally of the coloring matters. 
Urea 
Uric acid 
G120grains of urine, 
collected during 24 
hours, contained 
1000 parts of urine 
contained 
Grains. 
41.960 
0.060 
43.800 
6.822 
0.009 
7.156 
Fixed saline constituents 
This examination of the urine shows that during the reduction of the tempera- 
ture of the body and exhaustion of the forces, the urine was excreted in less amount, 
and altered in quality Here we have a demonstration of the previous propositions, 
that animal temperature and muscular and nervous force are the results of chemi- 
cal change, and that the reduction of temperature is attended by the generation of 
chemical compounds different from those of health, and that the malarial poison 
acts by inducing chemical changes in the elements, of the blood and organs, differ- 
ent from the chemical changes of health. The fact that the chemical changes or the 
nutritive and force elements in the capillaries of the muscles and nerves and bones 
of the extremities and surface of the trunk and head were very small, and the fact 
that the blood was congested in the blood-vessels of the trunk, render it probable 
that the peculiar coloring matter of the urine was derived from the disintegrated 
blood-corpuscles. 
8 o'clock P. M. Says that he feels very weak. Has been vomiting bile. 
Three hours ago six cut cups were applied over the epigastric region, without any 
arrest of the vomiting. Tongue very red at tip, and the surface is dry and rough, 
like sand-paper. The patient appears to be completely prostrated. Pulse 104. R . 
Apply a blister, six inches by six inches, immediately over the epigastric region, 
and as soon as it blisters, if the vomiting is not arrested, remove the cuticle, and 
sprinkle over the raw surface one grain of the acetate of morphia. Stop all stimu- 
lants and administer internally small fragments of ice and milk and lime-water 
and acetate of morphia. Urine, orange colored; sp. gr. 1016. Amount passed dur- 
ing the last eight hours, 10,160 grs.; calculated amount of urine for twenty-four 
hours, 30,480 grs.; reaction decidedly acid. Here we have a decided increase of the 
urine. 
13th, I o'clock P. M. Says that he feels much better. Pulse 86, fuller and 
stronger; respiration 28. Temperature of atmosphere 76° F.; temperature of hand 
91°; temperature under tongue 98.°5. Surface of the body in a profuse perspiration, 
which feels cold to the hand. The temperature of the extremities does not corres- 
pond with the increased circulation and respiration. The blister has drawn well, 
and the serum is of a light-yellow color, and not the golden color of many cases of 
remittent and congestive fever. The blister and the acetate of morphia and ice 
have completely arrested the obstinate and violent vomiting. R. Sulphate of 
quiniagr. xv; tincture of opium wxx; starch f§iv. Mix and administer imme- 
diately as an enema, and repeat in the course of four hours. Diet, arrowroot and 
chicken soup. Amount of urine passed during the last fifteen hours, 8,112 grs. 
Color only a shade darker than normal; sp. gr. 1014; reaction decidedly acid after 
standing thirty hours. No deposit after standing thirty hours. Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
809 
8112 grainsofurine 
excreted in 15 
hours, con- 
tained 
12,979 grains of 
urine, calculated 
for 21 hours, 
contained 
1000 parts of urine 
contained 
U rea 
Uric acid 
Fixed saline constituents 
Grains. 
159.080 
2.000 
16.800 
Grains. 
254.528 
3.200 
26.880 
19.594 
0.256 
2.071 
During the last three days the patient has been able to retain little or no nour- 
ishment, so that this is the urine of starvation. 14th, 11 o'clock A. M. Much bet- 
ter; dressed and walking about the ward. Pulse 72, full and strong; respiration 22; 
temperature of atmosphere 78.°5 F.; temperature of hand96.°75; temperature under 
tongue 98°. Skin feels normal. The cold, clammy sweat has disappeared. Tongue 
clean, but redder than normal. Although the vomiting has almost entirely disap- 
peared, still the stomach is unable to retain the sulphate of quinia. B.-Repeat 
the enema of sulph. of quinia. Diet, wine whey, soft boiled eggs and arrowroot. 
15th. Continues to improve. Pulse 64; respiration 24; temperature of atmosphere 
74° F.; temperature of hand 97.°75; temperature under tongue 98.°33. Tongue still 
quite red, but moist and soft. The amount of urine has greatly increased. During 
the last twenty hours has passed 30,360 grains of light-yellow urine, which rapidly 
changes from the acid to the alkaline reaction, and lets fall a yellow deposit. 
Sp. gr. of the urine passed during the night 1010 grs. 
" " this morning 1014 " 
Amount of uric acid passed during the last 10 hours 28 " 
This is at the rate of sixty-seven grains of uric acid during the twenty-four 
hours. This examination confirms the statement previously made and substantiated 
in former eases, that, as a general rule, the uric acid is either normal in amount or 
diminished in the active stages of malarial fever, and increases during convalescence. 
Asin the present case, this increase of the uric acid may take place even whilst the 
patient is under the influence of sulphate of quinia. 
R.-Infusion of Virginia snakeroot and sulph. of quinia. Diet, oyster soup, 
wine whey, and arrowroot. 16th, 1 o'clock P. M. Still very weak, but continues 
to improve. Tongue not so red, moister and softer. Reaction of saliva alkaline; 
up to this time it has been decidedly acid. Pulse 56; respiration 22; temperature of 
atmosphere 71.c5 F.; temperature of hand 96°; temperature under tongue 98.°75. 
Urine light straw colored; becomes al kali ne and throwsdown a light-yellow deposit 
after standing a few hours. Amount passed during the last twenty-four hours, 
29,000 grains; sp. gr. of the urine passed during the evening and night 1010; sp. gr. 
of the urine passed this morning 1005; 1000 parts of the urine passed this morning 
contained urea 8,686; uric acid, a trace, a few small crystals; fixed saline constitu- 
ents 1.990. This examination shows that the elimination of uric acid has ceased in 
the course of a few hours. 
17th. Has been walking about the hospital grounds. Pulse 60; respiration 26; 
temperature of atmosphere 64° F.; temperature of hand 94.°75; temperature under 
tongue 99°. The exercise will account for the acceleration of the pulse and respir- 
ation, and the free exposure of the hands to the cool morning air will account for 
the slight diminution of temperature. Reaction of saliva acid. The acidity, how- 
ever, was not so intense as in the paroxysms. Yesterday the reaction of the saliva 
was alkaline. During the active stages of malarial fever the saliva, according to 
my observations, is always decidedly acid, whilst during convalescence it is gen- 
erally alkaline, but may vary from alkaline to slightly acid. This change in the 
intensity of the acidity of the saliva corresponds, in a general way, with the dimin- 
ution of acid in the urine. B .-Quassia and soda. Full, nutritious diet. Amount 
of urine passed during the last twenty-four hours, 21,000 grains; urine passed dur- 
ing the last afternoon, evening, and night, orange-colored; sp. gr. 1014. After 
standing a few hours the reaction changed from the acid to the alkaline, and a 
heavy, light-yellow deposit was thrown down. Urine passed this morning of a 
light straw color; sp.gr. 1004. 19th. Says that he feels as well as he ever did in 
his life. Has been walking about the hospital grounds. Pulse60; respiration 24. 
Tongue, skin, and temperature normal. Blister almost entirely healed. This 
patient had no recurn of fever, and was discharged from the hospital a few days 
after this observation. 
Case 984.-Illustrating the Effects of Purgatives in Malarial Fever-the dela- 
tions of the Pulse, Respiration and Temperature of Trunk and Extremities in Con- 
gestive Fever-the Formation of Heart Clots in the Latter Stages of Congestive 810 
Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
Pever. The Chemical Constitution of the Urine. The Chemical and Physical and 
Pathological Changes of the organs. Irishman, age 28, height 5 feet 7 inches, 
weight 140 lbs.; dark brown hair, brown eyes, dark complexion. Has been in 
Savannah nine months. Engineer on steam-tug running upand down the Savan- 
nah River. One month ago was discharged from the steam-tug, and commenced 
"day labor," along the wharves, and at the saw-mill. Habits temperate. Has 
been sick one week. Says that " three days ago he took a large dose of castor oil, 
which operated ten times. On the following day took three blue pills, and yester- 
day took another dose of castor oil, which has been operating up to the present 
time." August 24th, 1857, 1 o'clock P. M. Has just entered the hospital. Skin 
cool. Tongue coated with yellow fur. Pulse 120. Complains of great weakness. 
R. Sulphate of quinia gr. xv; infusion of Virginia snakeroot f^xvj. Mix. 
f^ij every two hours. Diet, gruel. 25th, 12 o'clock M. Complains of great pain 
in his back. Surface of trunk and extremities cool. Tongue dry at tip and centre, 
and coated with yellow fur. No tenderness upon pressure of epigastrium. Bow- 
els loose. R. Stop sulph. of quinia and infusion of Virginia snakeroot. R. 
Calomel gr. xij; James powder (pulvis antimonyl compositus) gr. xxij; mix and 
divide into six powders. Administer one powder every three hours. If the 
extremities continue cool, apply mustards. 26th, 12 o'clock M. During the after- 
noon of yesterday was very feeble, and at one time was almost pulseless. The 
nurse administered brandy. This induced reaction. Now skin of trunk and 
extremities cool and moist. Complexion pale, sallow; lips and gums very pale. 
Tongue coated with yellow fur, and dry at tip. Pulse small and weak-so feeble 
that it is with difficulty that it can be felt at all. Pulse 120; respiration 22. Tem- 
perature of hand 95.°5 F. R. Burnt brandy and infusion of Virginia snakeroot. 
Apply sinapisms to extremities. Diet, arrowroot and brandy. 8 o'clock P. M. 
Pulse a little stronger, but still very weak, 112. Surface of trunk and extremities 
warmer. Tongue cleaning oft towards the tip; the clean portion is very red, dry, 
and glazed. Has no pain, and rests quietly. Appears to be very weak. R. Con- 
tinue brandy and infusion of Virginia snakeroot. 
27th, 12 o'clock M. Pulse 120, larger in volume, but still very feeble, and with 
■difficuly counted; respiration 24. Skin a little warmer. Temperature of atmos- 
phere 87.°5 F.; temperature of hand 98°; temperature under tongue 98.°5. There is 
a great want of co-ordination between the actions of the circulatory and respira- 
tory systems. Says that he is very weak. His appearance is that of complete 
exhaustion. Superior portion of tongue coated with dry yellow fur. A lozenge- 
shaped space of the surface of the tongue, extending for one inch from the tip to 
the centre, is clean and of a brilliant red color. Teeth coated with sordes. Hands 
and tongue tremulous. Says that he feels very weak. Has no pain anywhere, 
and lies quiet. R. Stop the calomel and James powder. R. Sulph. of quinia 
gr. ij, every two hours, up to gr. xv. Continue brandy and infusion of snakeioot. 
Urine orange-colored, several shades higher than in health, but much less highly 
colored than usual in severe cases of malarial fever. Reaction slightly acid, sp. gr. 
1009, contained as usual in uncomplicated cases of malarial fever, no albumen, and 
no grape sugar. Amount of urine collected during the last twenty-four hours, 
grs. 16,144. The nurse states that this is the whole amount that has been passed. 
16,144 grains of urine, 
excreted in 24 hours, 
contained 
1000 parts of urine 
contained 
Water 
Grains. 
15,745.336 
398.664 
975.306 
Solid matters 
24.674 
Urea 
170.610 
10.499 
Uric acid . 
a trace, scarcely 
visible. 
203.683 
24.161 
a trace 
Extractive and coloring matters 
Fixed saline constituents 
12.560 
1.496 
1 o'clock P. M.-Much worse. Pulse 140, feeble; respiration 40, labored, pant- 
ing. Extremities feel cold. Temperature of hand 90°. Restless, groans and sighs 
frequently. Inclined to stupor. Intellect sluggish; when aroused appears to be 
sensible, but articulates with great difficulty. The heart appears merely to flutter; 
the sounds are so rapid and feeble that they are counted with difficulty. The eir- 
•culation in the capillaries is sluggish and feeble. The temperature, the index of 
the chemical changes of the elements of the solids and fluids, is below the normal Pernicious Malarial lever: Investigations by Joseph Jones, M. D. 
811 
.standard, and does not correspond with the frequency of the circulation and respi- 
ration. No pain upon pressure of epigastrium. Asks for water continually, and 
complains of much thirst. The nurse has just raised him up to administer brandy; 
he groans and tosses about the bed, and makes several ineffeciual efforts to rise; in 
a few moments he is quiet and apparently asleep. This patient died thirty minutes 
after this observation. 
AUTOPSY TWELVE HOUKS AFTER DEATH. 
Exterior-Body muscular, with well-developed limbs and prominent chest; 
trunk and limbs round, and not emaciated. Adipose matter not wasted. Color of 
muscles when the integument was removed, red and normal. Color of the skin of 
the superior parts of the corpse pale, bloodless; color of the skin of the inferior 
parts of the corpse of a dark purple. This dark purple color gradually diminished 
towards the superior parts of the body, and appeared to have been due to the 
gradual settling of the blood in the capillaries of the most dependent parts towards 
the close of life, when the general and capillary circulations were feeble. .Lips and 
gums very pale, almost white. Teeth loaded with sordes. 
Head.-Dura mater unusually thick and firm, and adherent in several places 
to the arachnoid membrane. The thickening of the dura materand the adhesions 
were of long standing, and were not connected with this attack of malarial fever. 
Blood-vessels of the dura mater filled wilh blood. Arachnoid membrane opales- 
cent, pearl colored, and in many places adherent to the pia mater. These adhe- 
sions, like those between the dura, mater and arachnoid membrane, were appar- 
ently of long standing. Between the arachnoid membrane and pia mater, bloody 
serum was effused, thus imparting to these membranes (especially the inferior por- 
tions from the gravitation of the blood) a red appearance. Blood-vessels of pia 
mater were filled with blood. The blood-vessels of those portions of the pia mater 
•which extended into the ventricles of the brain, were also engorged with blood. 
The ventricles of the brain contained a small quantity of clear serum. Structure 
of cerebrum appeared to be softer than normal. This softening may have been the 
result of partial decomposition. Blood-vessels in the substance of the brain, dis- 
tinct, and more engorged with blood than usual. Structure of cerebellum, medulla 
oblongata and superior portion of spinal cord appeared to be normal. Blood-ves- 
sels of spinaTcord appeared to be more congested with blood than usual. 
Chest.-Heart normal in structure; contained several clots of blood, which 
from their ragged appearance, light yellow color, and freedom from colored blood- 
corpuscles, must have been formed before death. Long, fibrous coagula were found 
in the aorta and vena cava. Lungs.-Old adhesions in several places, numerous 
small tubercles were scattered throughout the tissues of the lungs. The tubercles 
did not appear to have suppurated. During his sickness this patient showed no 
feigns either in appearance or in action, of the existence of these tubercles. Supe- 
rior portions of the lungs (leaving out of view the tubercles) were normal in color 
and density. The inferior portions were engorged with blood, and the most 
•dependent portions were almost black from the great engorgement of the blood- 
vessels and capillaries, and when cut resembled in appearance and density por- 
tions of liver. The accumulation of blood in the lower portions of the lungs was 
due to the action of gravity, during the feeble state of the circulation previous to 
•death. The chemical changes of the elements of the blood and organs and tissues 
had been greatly diminished, previous to death; the physical forces resulting 
from these chemical changes which propelled the circulatory apparatus, and 
worked all the machinery, were correspondingly diminished, and the blood gradu- 
ally obeyed the physical law of gravity, which although constantly acting during 
health, was counterbalanced by the physical forces developed by the chemical 
changes of the elements of the organism. 
Abdomen.-Liver normal in size, and of a slate color externally, and of a dark 
bronze color internally. Substance firm. When pressed, the dark yellow, green- 
ish bile flowed out in small quantities from the cut ends of the hepatic ducts- 
Blood-vessels of the liver appeared to contain more than the normal quantity of 
blood. Blood of liver dark purplish-brown, and did not change to the arterial hue 
when exposed to the action of the oxygen of the atmosphere. 
The liver contained animal starch, but no hepatic sugar. Under the microscope 
the cells of the liver appeared normal with the exception that many of them con- 
tained more oil-globules than usual. The gall-bladder was filled with bile, which 
was of a dark-brownish green when seen in mass, and of a gamboge color when 
viewed in thin layers. The surface of the gall-bladder was of this gamboge color, 
from the endosmosis of the bile, probably after death. 812 
Pernicious Malarial Fever .• Investigations by Joseph Jones, M. D. 
Spleen enlarged; color dark slate, two shades darker than the liver. Tissues of 
spleen softened; partially disorganized. When the organ was pressed gently 
between the fingers it was evident that the tissues gave way. Mud of spleen of a 
dark purplish-brown color. This dark color was not altered, notwithstanding that 
it was exposed to the action of the atmosphere for twenty-four hours. When first 
removed, the mud of the spleen coagulated slightly. The coagulum, however, 
possessed no consistency, and was readily dissolved. When the mud of the spleen 
(pulp and extravasated blood) was examined under the microscope. It was found to 
consist of colored and colorless blood-corpuscles and numerous granules of a black 
color. These black granules were frequently conglomerated together, forming dark 
flakes like the coffee-ground sediment of the black vomit of yellow fever. Many of 
the colored corpuscles appeared to be swollen ; the colorless corpuscles appeared to 
be more numerous than normal. 
Alimentary Canal.-Stomach contained no fluid or gas : bloodvessels upon the 
exterior filled with blood. Mucous membrane of stomach of a dark purplish color. 
The color of the mucous membrane was not uniform ; it was much deeper in some 
spots than in others, thus presenting a mottled appearance. The compound muci- 
parous follicles (Brunner's glands) of the stoinacn and duodenum were prominent 
and enlarged. Blood-vessels of the superior and inferior portions of the intestinal 
canal appeared to be more engorged with blood than those of the middle portions. 
The mucous membraneof the small intestine was covered by a layer of mucous and 
fecal matter, colored yellow by the bile. The solitary glands in the inferior portion 
of the ileum, and especially in the region of the ileo-csecal valve, were enlarged and 
distinct. The glands of Peyer were distinct, but not enlarged or inflamed. The 
serous membrane of the intestines bore the marks of anoldinflammation. The 
serous membrane was thickened, and organized bands of coagulable lymph in 
many places bound the large and small intestines together and to the walls of the 
abdominal cavity. This inflammation had nothing whatever to do with the 
present attack. 
Kidneys normal in size and structure. Blood had settled in the vessels and 
capillaries of the inferior dependent portions. Color of superior portions of kidneys 
normal; color of inferior dependent portions almost as dark as the slate-colored 
liver. The blood-vessels and capillaries of the cellular tissue of the posterior 
dependent walls of the abdominal cavity were engorged with blood, whilst those 
of the upper anterior and lateral walls were almost devoid of blood. This was due 
to the action of gravity upon the enfeebled circulation. The facts which we have 
presented show that the capillary circulation had been greatly enfeebled in every 
organ and tissue previous to death, and the blood necessarily accumulated in the 
most dependent blood-vessels and capillaries. This view is farther confirmed by 
the fact that the vena cava contained but little blood. 
The bladder contained 5000 grains of light-colored urine. Reaction acid ; sp. gr:, 
1008.7. After standing forty-eight hours no deposit was thrown down. This was 
also true of the former specimen of urine. 
6000 grains of urine 
con tai ned 
1000 parts of urine 
contained 
Water . 
Grains. 
4863.140 
972.628 
Solid matters 
136.860 
27.372 
Urea 
38.945 
7.789 
Uric acid 
0.240 
0.048 
Extractive and coloring matters 
88.005 
17.601 
Fixed saline constituents 
9.120 
1.824 
CONCLUSIONS. 
(1.) The slate-colored liver, the dark greenish brown bile, the absence 
of grape sugar and the presence of animal starch in the liver-the slate- 
colored, enlarged, engorged, softened spleen-demonstrated that this was a 
case of malarial fever. 
(2. The rapid and feeble action of the heart; the rapid and feeble 
pulse ; the depressed temperature of the trunk and extremities ; the dry, 
red tongue ; the complete exhaustion of the muscular and nervous force ; Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
813 
the acid, light-colored urine ; the feeble, general and capillary circulation, 
gradually overcome by the action of gravity; the gradual settling of the 
blood previous to death in the blood-vessels of the most dependent parts of 
all the organs and tissues; the alterations of the blood-corpuscles of the liver 
and spleen ; the alterations in the color and constitution of the bile ; the 
destruction of the special ferment in the blood which converted the animal 
starch into grape sugar-demonstrated that the malarial poison had not 
only interfered with the action of the cerebro spinal system, but had also 
affected the sympathetic system, and produced profound alterations in the 
structure of the nutritive fluids, and correspondingly interfered with the 
chemical changes, the development of the forces, and the formation of the 
secretions and excretions. 
(3.) The rapid exhaustion of the forces was, without doubt, due, in a 
great measure, to the severe purgation to which this patient had been sub- 
jected previous to his entrance into the hospital, and to his previous intem- 
perate habits, and to the presence of tubercles in the lungs. The adminis- 
tration of large doses of purgative medicines (castor oil and blue pill), 
without any sulphate of quinia, and without any stimulants, converted an 
ordinary case of malarial fever into a congestive malarial fever. The term 
congestive, as applied to this case, means nothing more than a state of 
exhaustion, inability to resist the action of the malarial poison, inability 
to react. 
(4.) The plan of treatment in this case was correct in principle, but 
deficient in energy. Stimulants were administered, but not in sufficient 
quantities. Sinapisms were used, but not often enough, nor large enough, 
nor long enough. Sulphate of quinia was administered, but too infre- 
quently and in too small doses to be efficient, and much valuable time was 
wasted. This case demanded prompt and vigorous action. Large doses of 
the sulphate of quinia and the most diffusible and powerful stimulants 
should have been promptly and frequently administered, and the extremities 
should have been repeatedly covered with sinapisms. 
Case 985.-Illustrating the Action of Purgatives in Malarial Fever. Principles, 
which should govern the Administration of Purgatives in Malarial Fever.-Eng- 
lish seaman; height 5 feet 7J inches; weight 145 pounds; black hair, brown eyes, 
dark complexion; age 46; well built, muscular man. First trip to Savannah. Has 
been in this port three weeks, and during this time hasslept on board ship. Octo- 
ber 13th, 1857, 11 o'clock A. M. Says that he was taken sick two days ago, with 
pain in his head and bones, and loss of appetite. Last night, between 8 and 9 
o'clock P. M., had a chill, which lasted for one hour, and was succeeded by fever, 
which remitted this morning with a profuse perspiration. Tongue pale and clean. 
Bowels have not been moved for three days. R.-Calomel gr. xij; sulphate of 
quinia gr. vj. Mix. Administer immediately, and follow with castor oil in four 
hours. As soon as the medicine has operated once, give gr. v of the sulphate of 
quinia every three hours, up to gr. xx. 
13th, 11 o'clock A. M. The medicine operated freely. Has taken twenty-six 
grains of the sulphate of quinia. The patient is weak and stupid. Pays no atten- 
tion to inquiries, even when the voice is greatly elevated. When aroused by vio- 
lent shaking, answers incoherently, and in a few moments relapses into a stupor. 
Great tenderness upon pressure of epigastric region; pressure here arouses him, and 
he cries out. Pulse 120, very feeble; so feeble that it is with difficulty that it can be 
felt, and with still greater difficulty that its number of beats to the minute can be 
ascertained; respiration 40, thoracic, labored. Tongue coated with yellow fur, 
moist and soft. Skin warm and moist; in a perspiration. Administered f^ij of a 
mixture of equal parts of brandy and infusion of Virginia snakeroot. As soon as 
the fluids entered the stomach they were ejected again, with great violence, over 
the table and the neighboring bed. The brandy and infusion of snakeroot had 
mingled with the contents of the stomach, and were of a green color. The act of 
vomiting was performed, apparently, without any effort. There was no retching 814 
Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
previous to the ejection of the fluids. They came up in a stream. R.-Mustards 
to extremities and interior surface of thighs, and a blister Six inches by five over 
the epigastric region. R.-Lime-water f^ij; milk f^ij: solution of acetate of mor- 
phia f^j. Mix. Administer immediately, and repeat every half hour until bis 
stomach is settled. As soon as the stomach will retain this mixture, administer 
sulphate of quinia, brandy and infusion of Virginia snakeroot, freely. 8 o'clock 
P. M. More sensible than this morning, but weak and restless. Breathing not so 
accelerated and labored. Pulse 120, still very feeble. Blister is drawing. R.- 
Sulphate of quinia gr. v every three hours, up to gr. xxx. If his stomach rejects 
this, give the following injection : R.-Sulphate of quinia gr. x; starch f^ i j; tinc- 
ture of opium mxv. Mix. Repeat every three hours untill forty grains of the 
sulphate of quinia have been administered. Administer brandy, infusion of Vir- 
ginia snakeroot, and spirit of mindererus, freely. 
14th, 11 o'clock A. M. Says that he is much better. Intellect clear; answers 
coherently. He is much more quiet. Blister has drawn well; serum golden colored. 
Pulse 96, much stronger and more regular, but still feeble; respiration 24. Tongue 
soft and moist; superior portion coated with white fur. Under the action of sul- 
phate of quinia and stimulants the pulse has diminished in frequency and increased 
in volume, and the respiration has diminished in frequency, and the spasmodic 
actions of the respiratory muscles have ceased, and the nervous system has been 
aroused, and the dull intellect has resumed its normal actions. If stimulants had 
been withheld it is highly probable that this patient would have died from complete 
exhaustion of the nervous and vital powers, consequent upon the action of the 
malarial poison, either directly upon the nervous ganglia of the sympathetic sys- 
tem presiding over the respiration and circulation; or by such changes in the ele- 
ments of the blood (especially of the blood-corpuscles) as resulted in the perversion 
of the nutritive elements of the nervous ganglia, or in the generation of compounds 
in the blood and in the secretions of the liver, spleen, and alimentary canal, which 
acted as poisons upon the sympathetic and cerebro-spinal nervous systems, or by 
the simultaneous action of the poison in all these different ways. R.-Continue 
brandy and infusion of Virginia snakeroot. Stop sulphate of quinia. Diet, milk 
punch and arrowroot. 
15th, 11 o'clock A. M. Continues to improve. Has no pain anywhere. Tip 
of tongue clean and redder than normal; posterior portion coated with patches of 
black fur. Pulse 88; respiration 16; temperature of trunk normal; reaction of saliva 
neutral. R .-Continue stimulants and nutritious diet. 8 o'clock P. M. Continues 
to improve. Up to the present time, owing to the action of the medicine, the con- 
gestive chill, delirium and weakness, it has been impossible to obtain any urine for 
analysis. Urine passed this afternoon orange-colored. Amount passed during the 
last twenty-four hours, 5050 grs.; calculated amount for twenty-four hours, 15,510; 
sp. gr. 1010; reaction acid. 
5050 grains of 
urine, excreted 
during 8 hours, 
contained 
15,150 grains of 
urine, calculated 
for 24 hours, 
contained 
1000 parts of urine 
contained 
Urea 
Grains 
129.495 
3.250 
8.500 
Grains 
338.395 
9.750 
25.500 
25.642 
0.643 
1.683 
Uric acid , 
Fixed saline constituents 
16th, Il o'clock A. M. Continues to improve. Tongue soft, moist and normal 
in appearance. Reaction of saliva decidedly acid. His appetite is good. Pulse 
84; respiration 15. Urine passed during the night of a deep orange color; sp. gr. 
1014. Reaction when first voided acid, after the lapse of fifteen hours slightly 
alkaline. Simultaneously with the change from acid to alkaline, there was the 
formation of numerous well formed prismatic crystals of triple phosphate. When 
the urine was held in the sunlight these crystals sparkled like particles of silver. 
1000 parts of urine contained- 
Urea 24.761 
Uric acid 0.029 
Fixed saline constituents 1.773 
R.-Continue brandy and infusion of Virginia snakeroot and nutritious diet. 
R. -Quassia and soda. 
17th. Greatly improved; dressed and walking about the hospital yard. Pulse 
72. Tongue, skin, respiration and temperaturej normal. Complains of nothing Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
815 
but weakness. The captain of the vessel to which this seaman belonged has just 
informed me that his crew consisted of eight men and a woman (the cook). Four 
of the men and the cook slept aboard the ship lying in the Savannah river. Every 
one was taken sick with malarial fever, and entered the hospital. Of the four sea- 
men who slept ashore, two were taken sick; their attacks, however, were much 
lighter than those who slept on board the ship. 
CONCLUSIONS. 
PRINCIPLES WHICH SHOULD GOVERN THE ADMINISTRATION OF PURGA- 
TIVES IN MALARIAL FEVER. 
(1.) This case illustrates the necessity of watching the action of pur- 
gatives in malarial fever. I have treated numerous cases of malarial fever, 
both with and without purgatives, and from a careful comparison of the 
results of the different modes of treatment, have found that the disease 
yields much sooner to the action of sulphate of quinia, after the action of 
a purgative. The purgative which I have almost invariably employed at 
the commencement of the disease, is calomel. It was administered in 
doses from vij to xij grains, conjoined with from v to vij grains of the sul- 
phate of quinia. The liver and portal circulation, and perhaps the spleen 
to a certain extent, are relieved by the action of the purgative, and the 
sulphate of quinia is absorbed much more readily and rapidly. The sul- 
phate of quinia appears to affect the head much less after the action of a 
purgative. I have frequently observed, that in both intermittent and 
remittent fever, the action of calomel on the alimentary canal, and liver, 
especially when accompanied by, and followed with, large doses of sulphate 
of quinia, was attended with relaxation of the hard dry skin, increase of 
the secretions of the dry red mucous membrane of the tongue and mouth, 
and relief of the cerebral symptoms. The purgative by no means cures the 
disease. The purgative simply excites the alimentary canal to eliminate 
and throw off offending matters, and relieves the congestion of important 
organs, and thus equalizes the circulation, promotes secretion, and second- 
arily relieves some of the nerveus phenomena. If the patient was left 
thus without further treatment, the malarial poison would still continue its 
work unchecked. The purgative "prepares the system " for the action of 
sulphate of quinia and stimulants. In the administration of purgatives in 
malarial fever, however, the practitioner should always bear in mind the 
important fact, that there are certain cases, as the present one, and others 
already recorded, in which purgatives will produce in conjunction with 
the malarial poison, sudden and dangerous depression of the system. It 
is important that the practitioner should study carefully the indications 
for and against the employment of purgatives. I will state my experience 
in the following propositions. 
(a.) Whenever there is a full, rapid, bounding pulse, rapid respiration 
and corresponding chemical change and development of heat; whether the tongue 
be red or pale, dry or moist; whether the shin be dry or moist; whether the intel- 
lect be clear or clouded, a moderate dose of calomel, especially if it be mixed 
with sulphate of quinia, will prove highly beneficial, and expedite the subsequent- 
action of the sulphate of quinia, and hasten the termination of the disease. 
(b.) Whenever there is a feeble, rapid pulse, and rapid, thoracic respira- 
tion, and no corresponding elevation of temperature (im many cases a greed 
depression), wi h or without a dry, red tongue, with a dry, harsh skin, or with a 
cold clammy siveat, with or without cerebral disturbance, with or ivithout restless- 
ness, purgatives should be rigidly avoided. 
(c.) Whenever there is a marked want of co-ordination between the actions 
of the circulatory and respiratory systems, and the chemical changes and conse- 816 
Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
quent development of the physical and nervous forces, purgatives should be 
avoided. 
(d.) If purgatives be administered, without being followed with sul- 
phate of quinia, they act in conjunction with the malarial poison, by dimin- 
ishing the amount of the blood and depressing the forces. 
(e.) If purgatives be administered repeatedly with or without sul- 
phate of quinia, they may convert a case of simple intermittent or remit- 
tent fever into one of congestive fever. 
(/.) The best purgative is calomel. 
(g.) The proper time for the administration of the purgative, is at the 
commencement of the disease. 
(h,) After the free evacuation of the intestinal canal, the purgative 
should not be repeated. 
{if The action of the purgative in all cases of malarial fever should 
be carefully watched, and if there is any depression of the forces, stimu- 
lants and sulphate of quinia should be immediately and liberally adminis- 
tered, and sinapisms or blisters applied. Carbonate of ammonia is one of 
the most valuable stimulants in these cases; sulphate of quinia should 
always be combined with the purgative. 
(2.) The tongue did not present the dry, harsh, red appearance, so com- 
mon in these severe cases. I have observed that the dry, red tongue is more 
common in the first than in the second or succeeding attacks of malarial 
fever. This patient stated that he had a severe attack, of fever, several 
years ago, on the coast of Africa, at the mouth of the river Sierra Leone. 
Says that this attack was similar to the present one. He was out of his 
head, and no hopes were entertained of his recovery. The fever was of a 
malignant type. The crew of the ship was composed of eight strong, active 
men, and out of this number six died. It is highly probable that the dis- 
ease was malarial fever. It is reasonable to suppose that this severe attack 
of malignant malarial fever left a permanent impress upon his constitution, 
and influenced the symptoms of the present attack. In attempting to 
account for the different manifestations of disease, we have not, in the 
present state of science, access to all the data, such as original constitution, 
previous habits and previous diseases. It is probable that the course of 
severe diseases is always modified by the constitution, diet, occupation, and 
previous habits, whether virtuous or vicious, temperate or intemperate, and 
by previous diseases, and by the relations of the individual and his ances- 
tors to the climate and soil. We know that in a body of strong, healthy 
men, exposed to precisely the same sources of malarial disease, we may 
have manifestations of disease, from a slight febrile excitement, scarcely 
deviating from the condition of health, down to the most malignant type, 
commonly called congestive fever. If all have been alike exposed upon the 
same small ship to the same poison, whence this difference? The difficulty 
and complexity of this problem may be comprehended when we state that, 
amongst other things, its solution would demand a knowledge of the 
previous history of the physical, chemical, physiological and moral influ- 
ences of soil and climate, and disease upon the ancestors, and even upon 
the races; would demand a knowledge of all hereditary tendencies, peculi- 
arities of temperament and idiosyncrasy; would demand a knowledge of 
the relative activity and perfection of the individual organsand apparatus, 
and of the relations of these to each other; would demand a knowledge of 
the relations of the vital force to the matter of each organ, and tissue, and 
apparatus, and to the morbific agent or agents; would demand a knowledge 
of the action and reaction of the morbific matter upon the different forms 
of organized structure, and the consequent derangement of the physical, Pernicious Malarial Fever: Investigations by Joseph Jones, M. D. 
817 
nervous, intellectual and moral phenomena; would demand a knowledge 
of the relations of chemical action to the development of the physical and 
nervous forces, and the action of the intellectual and moral faculties; would 
demand a knowledge of the correlations of the physical, vital, nervous, 
intellectual aud moral phenomena; would demand a knowledge of the 
relations between physiological phenomena and the phenomena of the 
exterior universe. Every candid man will admit that the solution of such 
a problem is impossible at the present time, because the facts are wanting. 
And they will be long wanting, owing to the extreme complexity of the 
phenomena. A thorough knowledge of pathological phenomena necessarily 
includes a knowledge of the relations of all the phenomena of the universe. The 
dignity and glory of a science should certainly depend upon the multitude 
and complexity of its phenomena. We hope, however, that the day will 
come when the science of medicine shall be founded upon the immovable 
basis of inductive philosophy, and the world be compelled to recognize the 
truth, that the solution of the problems of medicine requires a higher exer- 
cise of the reasoning faculties than the solution of the most complicated 
and difficult problems in physical and chemical science; a higher exercise 
of the reasoning faculties than the solution of even the grandest problems 
of astronomy. 
Case 986.-Congestive Fever, illustrating the Effects of the Malarial Poison 
upon the Nervous System, Muscular System and Organs; the Physical and 
Chemical Changes of the Urine; and also the Formation of Heart-Clots. 
Treatment of Congestive Fever. 
Observation.-German ; age, 40 ; height, 5 feet 9 inches; weight, 150 lbs,; black 
hair, black eyes, sallow complexion ; occupation bar-keeper. October 16, 1857, 
8 o'clock P. M. Has just entered the hospital. Is unable to give coherent answers, 
and is either stupid or unable to speak the English language. His companion 
states that this patient has been in Savannah for two months, and has been sick 
with chill and fever for two weeks. He is exceedingly weak, and his intellect 
wanders. Pulse 112, rather feeble. B .-Calomel gr. xij ; sulphate of quinia gr. vj. 
-Mix. Administer and follow with castor oil in four hours. B.-As soon as the 
calomel has acted once, commence with sulph. of quinia, gr. v every three hours 
up to gr. xx. 17th, 11 A. M. When I saw this patient last night, I supposed that 
this stupidity and difficulty of speech were due, in a great measure, to the fact that 
he was a foreigner, imperfectly acquainted with our language. A careful exam- 
ination this morning, however, shows that the difficulty of speech and torpor of 
intellect are dependent upon the effects of the malarial poison (either directly or 
indirectly) upon the brain. When questioned, endeavors to converse; commences 
sentences, but is unable to finish them. Pulse 124, very feeble; respiration 28 ; 
tongue dry, hard, and rough, and coated with dry, brownish-yellow fur. The 
tongue feels very hard and rough. There is not moisture enough in his mouth to 
produce any sensible effect upon a bit of paper pressed against the tongue. Skin 
warm and dry. The temperature of the skin corresponds with the feebleness of 
the pulse, but not to its frequency, and not to the frequency of respiration. Says 
that he feels well. B--Mustards to extremities. Cut-cups to temples and back of 
neck. B.-Administer freely, brandy, infusion of Virginia snakeroot, spirit of 
mindererus and sulphate of quinia. 8 o'clock P. M. The cut-cups and mustards 
aroused him for a short time, but he has relapsed into a state of partial stupor, in 
spite of the action of the sulphate of quinia and stimulants., B.-Continue stimu- 
lants, infusion of Virginia snakeroot, and sulphate of quinia. 
18th, 11 o'clock A. M. No improvement. Tongue very red at edges and tip, 
which are free from fur. Surface of tongue coated with dry, yellow fur, and presents 
the same dry, rough feeling and appearance. Teeth coated with sordes. The pulse 
is so rapid and feeble that it is almost impossible to ascertain accurately its number 
of beats. It feels like the delicate pulsations of a minute capillary filled with 
water. The pulsations cease as soon as the slightest pressure is made*. Pulse 155 
to minute. The heart merely thumps (flutters). The two sounds are merged into 
-one, and cannot be distinguished. The sounds of the heart correspond in number Pernicious Malarial Fever: Investigations by Joseph Jones, M. D: 
818 
to the beating of the pulse, 155 to minute. The correspondence of the two was- 
examined not only by separate calculation, but also by applying the ear over the 
region of the chest, and the hand over the pulse at the wrist. Respiration 34, 
spasmodic. Skin covered with cold, clammy sweat. Extremities are at least 20- 
degrees below the normal standard. Trunk and head feel cold ; their temperature 
several degrees below the normal standard. The action of the heart is feeble ; the 
capillary circulation is exceedingly feeble and sluggish. The distribution of the 
nutritive and force elements is correspondingly retarded, and, as a necessary con- 
sequence, the chemical changes are diminished and altered both in quantity and 
kind. The patient is very restless, tosses about the bed, and is with the greatest 
difficulty retained in bed. Passes his water and faeces in bed. Intellect wander- 
ing ; talks incoherently. Says that he is perfectly well, and wishes nothing but 
water. When aroused, his eye looks bright, and there is no expression of pain or 
uneasiness upon his countenance. During the last thirty-six hours has taken fifty 
grains of the sulphate of quinia, together with large quantities of stimulants. 
Mustards have been frequently applied. The effect of these remedies appears to be 
only palliative. They have produced no permanent beneficial effect. Whenever 
the mustards and stimulants were withheld, the forces decreased rapidly, and the 
patient would relapse almost into a profound stupor. The action of the mustards, 
was very slow on account of the sluggish capillary circulation. R.-Continue 
stimulants. Apply bottles of hot water to the extremities. Administer 10 grains 
of the sulphate of quinia immediately, and repeat every three hours. R.-Blister 
to back of neck. 
9:30 o'clock P. M. The mustards and stimulants aroused him, and at 6 P. M*. 
this evening his pulse was fuller, bis tongue was moister, his intellect clearer, and 
the restlessness had, in a great measure, disappeared. The patient, during the 
momentary absence of the nurse, got out of bed and attempted to walk across the 
floor, to the bucket of water at the other end of the ward. He had not proceeded 
more than five steps, before he fell upon the floor completely exhausted. Almost 
immediately his pulse became more frequent and feeble, in fact, almost entirely 
disappeared, and his extremities became much colder. Mustards were again 
applied, and stimulants administered. [Inder the action of these, his circulation, 
both general and capillary, was increased somewhat in force, and his exhausted 
forces revived. Now his pulse is 135, and his respiration 32. The sordes on the 
teeth, which were this morning perfectly dry, are moister; the tongue is moister; 
the pulse is fuller (although still exceedingly feeble and flickering), than it was 
this morning. There is an unnatural brilliancy about his eye, and excitement 
about his intellect. He converses freely for the first time ; says that he feels per- 
fectly well, and wishes to go immediately home to the hotel and take the place of 
the bar-keeper, who he says is sick. Complains bitterly of being confined to bed, 
when nothing is the matter with him, and he feels as strong and as well as he ever 
did in his life. Has been quarrelling with the nurse, and threatens vengeance, 
because he confines him to bed and will not allow him to dress himself and go and 
drink freely of water. Complains greatly of thirst; keeps his eye fixed on the 
vessel containing water, notwithstanding that he is liberally supplied. Hits 
vomitted several times. The blister is acting, and the serum is of a golden color. 
Has taken 30grs. of the sulphate of quinia since 11 o'clock this morning. 
Has just passed urine. It is perfectly clear and amber-colored. The color of 
the urine is in striking contrast to that of patients who are able to resist the effects, 
of the malarial poison to the extent of the production of the febrile excitement. 
When the constitution is able to cope with the malarial poison, we have a rapid 
pulse, rapid respiration, high temperature, rapid chemical change, and high-col- 
ored concentrated urine. Specific gravity of urine 1015.3. Reaction strongly acid. 
The urine changed the litmus blue paper to as bright a red as a strong mineral, 
acid. The rapidity of the change also corresponded to the action of a powerful 
acid. After standing 70 hours the reaction was still decidedly acid, and there was 
no deposit of any kind. When the urine was evaporated, the residue was a dark 
reddish-brown viscous mass, resembling tar. After prolonged, tedious, and careful 
evaporation, it was found to be impossible to reduce it to a solid state. When the 
urine, concentrated to the consistence of a syrup, was treated with nitricacid, there 
was a slight effervescence, and a few crystals appeared. These crystals were trans- 
parent, and resembled rather crystals of saltpetre than the silvery crystals of nitrate 
of urea. After standing fora short time these crystals disappeared, and did not 
again appear even when the fluid was concentrated by evaporation. If these crys- 
tals were nitrate of urea, the whole amount existing in 1000 grs. of urine must 
have been less than 2 grs. In a fluidounce of urine not more than a trace of uric Congestive Malarial Fever. 
819 
acid could be detected after careful examination. Under the microscope a few 
small crystals could be detected which were invisible to the naked eye. 
1000 parts of urine contained- 
Solid matters 34.482 
Water 965.518 
Urea a trace 
Uric acid a trace 
Extractive, coloring and organic matters 24.805 
Fixed saline constituents, principally phosphates 9.655 
The fixed saline constituents were principally the phosphates. A short time 
after this observation the excitement and restlessness of this patient disappeared, 
and he went into a profound sleep and died at 1 o'clock A. M, 
AUTOPSY TWELVE HOUKS AFTER DEATH. 
Exterior.-Limbs and trunks round and full, and apparently in full flesh. The 
skin over the whole surface except the face presented a fair white color. There 
was no settling of the blood in the capillaries of the most dependent portions of the 
skin producing the mottled appearance previously noticed. This may be due to the 
fact that the patient was under the action of stimulants at the time of death. 
Head.-Dura mater, normal. Arachnoid membrane opalescent (pearl colored) 
in many spots. Serum was effused between the arachnoid membrane and pia 
mater. Blood-vessels of pia mater filled with blood. Substance of brain was firm, 
and was altered neither in consistency nor in appearance. Blood-vessels of the 
substance of the brain not more distinct than normal. Ventricles of the brain were 
almost entirely filled with light-yellow serum. Light-yellow serum was effused 
around the medulla oblongata, and superior portion of spinal cord. The effused 
serum appeared to fill completely the spaces between the spinal cord and its mem- 
branes and the surrounding vertebral cavity. When the medulla oblongata and 
superior portion of the spinal cord were removed, the serum flowed in (the shoul- 
ders being slightly depressed) and filled the vertebral canal. 
Chest.-Lungs normal. Blood-vessels of the dependent portions engorged with 
blood. Heart normal in size and structure. The ventricles and auricles contained 
clots. Portions of these clots were free from colored corpuscles and presented the 
yellow color of whipped fibrin. Surrounding, and attached to these, were ordi- 
nary coagula of blood. The vena cava, and all the large venous trunks in the 
abdominal cavity, were filled with dark, almost black coagulated blood. 
Abdominal Cavity.-Liver somewhat enlarged, and presented a singular mot- 
tled appearance. At a distance it presented a light bronzed color. Upon nearer 
inspection, the lobules were found to be distinct, elevated, and of alight-bronze 
color, whilst the spaces between the lobules inclined to a slate color. There were 
several spots varying from two inches to half an inch in diameter of a uniform 
slate color. The structure of the liver was unusually firm; it required considera- 
ble force to tear it asunder; it cut toughly under the knife, and the lobules started 
out from the cut surface as if they had been bound down. The fibrous capsule sur- 
rounding the exterior of the liver and forming a sheath for the large vessels lying 
in the portal canals was thickened, and the individual lobules of the liver were 
surrounded with fibrous tissue. These facts, which were demonstrated not only by 
the touch and naked eye, but also by the microscope, show that this liver was in a 
cirrhosed condition. Cirrhosis of the liver in this case was not caused by the action 
of the malarial poison, but in all probability by the habitual use of ardent spirits. 
This patient was a barkeeper. Men in this occupation are, as a general rule, addicted 
to the free use of ardent spirits. The liquors drunk in this country at the hotels 
and bar-rooms contain much alcohol, which acts upon the secreting structures of 
the liver and upon the blood-vessels, and excites adhesive inflammation in the 
areolar tissue of the small twigs of the portal vein, and in the areolar tissue of the 
portal canals, by which serous fluid and coagulable lymph are thrown out. Under 
the microscope, the substance of the liver contained many dark looking masses, 
resembling the altered blood-corpuscles of the spleen, and the black granules and 
flakes of black vomit. These dark masses were not sufficiently numerous to have 
any marked effect upon the organ. When the fibrous capsule was torn off it pre- 
sented a light slate color, and yet when magnified and carefully examined, but 
few of these dark masses were seen in the meshes. The structures of the liver, and 
the liver-cells, contained numerous oil-globules. These oil-globules existed in suf- 
ficient numbers to induce the belief that the liver was in a state, not only of cirr- 
hosis, but also of fatty degeneration. The blood-vessels of the liver were filled with 820 
Congestive Malarial Fever. 
dark blood, which did not change to the arterial hue upon exposure to the atmos- 
phere. The mottled appearance of the liver, and the want of that decided slate 
and bronze color characteristic of malarial fever, were due not to any peculiarity 
of the effects of the malarial poison, but rather to the pathological conditions of 
cirrhosis and fatty degeneration. Allowing due weight to these pathological 
changes, it is evident that the change in the color of the liver was similar in all 
respects to the slate or bronze color of livers, which were normal before the onset 
of the malarial fever. The change in the color of the liver during malarial fever 
is due to changes in the amount and physical and chemical constitution of the 
blood in the capillaries of the liver, and to the physical and chemical changes in 
the bile and the contents of the secretory apparatus, and not to the deposition of 
black granules in the structures of the liver. I have seen the slate and bronze color 
as well marked in the liver when these dark masses were absent, as in the liver 
where they were most abundant. The peculiar color of the liver is due, in a great 
measure, to changes in the coloring matter (hsematin) of the blood. The blood will 
not change to the arterial hue when exposed to the atmosphere. This altered 
coloring, matter resulting from the destroyed disintegrated blood-corpuscles, or 
from the blood-corpuscles acted on by the malarial poison, without actual disinte- 
gration, escapes and permeates the surrounding tissues and imparts the peculiar 
color to the liver. The color is also due to the altered color of the bile. 
In all the cases of malarial fever which I have thus far examined, I have found 
the bile to be of high specific gravity, thick, concentrated, and of a greenish-black 
color, when seen in mass, and of a gamboge yellow when spread in thin layers. 
The altered bile also infiltrates the surrounding tissues and gives this peculiar color 
to the liver. This peculiar color can be to a certain extent abstracted from the 
liver by boiling with water. I have always found the filtered decoction of mala- 
rial fever livers to be of a brownish-yellow color, whilst the decoction of yellow 
fever livers is of a bright golden color, whilst that of normal livers is of a light 
yellow. After the altered coloring matters of the blood and bile have infiltrated 
the structures of the liver, they will sometimes remain for a considerable length of 
time without being absorbed, and communicate the peculiar bronzed color to the 
liver long after the restoration of its normal functions, and the disappearance of 
the malarial fever. I have observed, however, that the intensity of the color of 
the liver bears a marked relation to the time of convalescence; as convalescence 
advanced the color diminished in depth. 
The liver contained animal starch. Several of the hepatic ducts were isolated 
and treated with tincture of iodine and carefully observed under the microscope. 
Their color, with the exception of a few small spots, was simply changed to that 
of the tincture of iodine. In these spots, the color was changed to a bright blue. 
In other cases of malarial fever, I have seen long portions of the hepatic ducts 
changed to a bright blue color under the action of the tincture of iodine. These 
facts would show that they do sometimes contain animal starch. The gall-bladder 
was filled with concentrated bile of the consistency of molasses, and of the color 
(when seen in mass) of a saturated solution of iodine. When spread in thin layers 
the bile presented a gamboge color. 
Spleen enlarged. It was at least three times the normal size. The structures of 
the spleen were so much disorganized, that in attempting to remove it from the 
abdominal cavity, the capsule and trabeculae gave way under a slight pressure, and 
the fingers plunged into its soft substance. Dark brownish purple, almost black 
mud flowed from the rupture. After thirty-six hours' exposure to the atmosphere, 
the color of the mud of the spleen remained unchanged. Under the microscope, 
the mud of the spleen contained a great number of dark, reddish-brown and red- 
dish-black granules, and conglomerations of granules. These granules and black 
masses, composed of conglomerated granules, resembled the bodies found in the 
liver; and also the black sediment of the black vomit of yellow fever. Similar 
granules and masses have been observed in normal spleens. They appear, how- 
ever, to be most abundant in the malarial fever spleens of long standing. In cases 
which have terminated fatally after only a short illness of only two or three days, I 
have observed that these granules were not so numerous as in cases of longer dura- 
tion, and in some very recent cases they were not more numerous than in the 
spleen of health. These masses appear to be derived from the disintegrating blood- 
corpuscles. 
Alimentary and intestinal canal. Stomach.-Blood-vessels upon its exterior 
filled with blood. Mucous membrane bore no marks of inflammation, and was not 
more congested with blood than usual. The exterior and mucous membrane of 
the jejunum presented the usual appearance. There was no unusual appearance Congestive Malarial Fever. 
821 
either of congestion, irritation or inflammation. The mucous membrane of the 
ileum, especially at the lower portion, was more congested, and of a darker color 
than usual. The intestinal canal throughout its entire length was empty. The 
mucous membrane presented a yellowish appearance, probably due to the presence 
of bile. The solitary glands of the ileum especially in the neighborhood of the 
ileo-csecal valve, were numerous, enlarged, elevated, distinct, and of a brown color. 
When the intestines were held up to the light, the blood-vessels filled with blood 
could be distinctly seen sending off branches to each gland. TTie glands of Peyer 
were large, distinct and elevated. Several of these glands in the lower portion of 
the ileum were three inches in length. These glands, however, were not inflamed, 
as in typhoid fever, but presented the usual pale appearance. 
Kidneys.- Each kidney had upon its inferior surface a spot about one inch in 
diameter, of a slate color, resembling, in all respects, the color of the exterior of the 
malarial fever liver and spleen. When these portions of the kidney were cut, they 
presented a bronzed color for the depth of one-eighth of an inch. Microscopical 
examination showed the absence from these portions of the liver of those granules, 
and brownish-red and reddish-black masses, so abundant in the spleen and liver. 
Microscopical examination showed that the excretory structures of the kidnev were 
not altered in these discolored portions. These facts sustain the assertion that! 
have previously made that the color of the liver in malarial fever does depend upon 
the diffusion through its substance of dark granules and granular masses. The 
bladder was empty. The scrotum was reddened, and appeared to be blistered and 
excoriated. This was due to the action of the intensely acid urine. 
CONCLUSFOXS. 
1. This case corresponds to the congestive fever of American writers. 
The prominent symptoms of this case were rapid, (nil pulse; rapid, tho- 
racic respiration; relaxed skin, with cold clammy sweat; sluggish capillary 
circulation; deficient and perverted chemical action; reduced temperature; 
deranged physical, muscular, and nervous forces, and aberrated intellec- 
tual action. 
2. The rapid, feeble action of the heart; the rapid, feeble pulse; the 
almost entire arrest of the circulation and chemical changes in the capil- 
laries, were attended by a reduction of temperature, and loss of muscular 
and nervous force, and aberration of the actions of the sympathetic and 
cerebro spinal nervous systems. These disturbances of the chemical 
changes, and physical, muscular, and nervous forces were reflected in the 
urine. The appearance and chemical constitution of the urine were strikingly 
different from the urine of those cases of intermittent and remittent fevers where 
the action of the poison is attended by an excitement of the general and, capillary 
circulation and of the respiration, and corresponding rapid chemical changes, 
and high temperature. In those cases of malarial fever where there is a 
rapid, full pulse; moderately accelerated respiration; rapid introduction 
and distribution of oxygen and corresponding high temperature, the urine 
is invariably high-colored, concentrated, and rich in solid matters. If we 
examine the analyses of the urine of those cases of intermittent and remit- 
tent fever, which have been previously recorded; and, at the same time, 
bear in mind the fact that the urine was excreted during the summer sea- 
son, and during starvation, it is evident that during the febrile excitement 
the urea is greatly increased. When the febrile excitement (rapid distri- 
bution of oxygen, and rapid chemical change, and high temperature) sub- 
sides, the urea and other solid constituents of the urine decrease. 
After the establishment of convalescence, when the patient is able to 
take food freely, the solid constituents of the urine again rise, notwith- 
standing that the temperature is the same, or a few degrees above that of 
the intermission. The urea during convalescence is probably derived 
partly from the food, and partly from the metamorphoses of the tissues. 
In this case, on the other hand, the arrest of the circulation and chemical 822 
Congestive Malarial Fever. 
changes of the capillaries, and the reduction of temperature, was attended 
by a complete alteration of the physical and chemical constitution of the 
products resulting from the metamorphoses of the blood, organs and tis- 
sues. The urea and uric acid were absent, the acid of the urine was 
greatly increased, and the physical properties of the urine altered. 
Whether the disappearance of the urea and uric acid resulted from 
the arrest of the metamorphoses of the muscular tissue, or of the blood- 
corpuscles and nitrogenized elements of the blood; or from the disturbance 
of the normal chemical changes, by the introduction of the malarial poison, 
amongst the substances undergoing chemical change; or from the primary 
action of the malarial poison upon the sympathetic and cerebro spinal 
nervous systems, aud the perversion of the chemical changes of the organ- 
ized elements, by the consequent aberrated nervous action, cannot be defi- 
nitely answered in the present state of chemical, physical, physiological 
and pathological science, because the fundamental facts are wanting. 
Whilst it is known that urea and uric acid are products of the chemical 
changes of the nitrogenized elements, still it has not as yet been definitely 
settled whether urea and uric acid* result from the metamorphoses of the 
blood-corpuscles, or of some one special nitrogenized constituent of the 
blood, or of the muscular tissue, or from all these sources. The chemical, 
physical, physiological and pathological properties and relations of the 
malarial poison are unknown. What relations, chemical, physical, physio- 
logical and pathological, do the metamorphoses of the organized bodies 
which result in the formation of urea and uric acid, and of the extractive 
and coloring matters, bear to the metamorphoses induced by the malarial 
poison ? It is impossible to give any answer to this important question, 
which lies at the foundation of the solution of the problem. Neither 
would the answer of this important fundamental question clear up the 
difficulty, for we have here complicated phenomena and numerous com- 
plicated actions and reactions. So complicated and involved are the phe- 
nomena that the solution of one necessarily demands the solution of all. 
Such questions as these demand an answer : What are the chemical, 
physical, physiological and pathological relations of the malarial poison 
to the sympathetic and cerebro-spinal nervous systems'? What is the effect 
of derangement of the sympathetic nervous system upon secretion and excre- 
tion, in fact upon all chemical changes of the elements of the human 
* The following observations are interesting in their bearings upon the origin of uric acid. I 
kept a large Indigo snake (coluber couperi) in a cold, dry room, during the winter season, with 
out food and drink. This serpent remained in a partially torpid state for three months. He was 
never entirely without the power of motion, and would, when aroused, show considerable power. 
At the end of this time the serpent died. When the heart was exposed after death, its surface was 
covered with a chalky granular substance, which was demonstrated both :by microscopical and 
chemical analysis, to be the urate of ammonia. The external surface of the aorta and its largest 
branches were in like manner covered with the urate of ammonia. When the substance of the 
heart was cut, numerous particles of the urate of ammonia were found along the course of the 
blood-vessels and amongst the muscular fibres. Numerous particles of the urate of ammonia 
were also discovered amongst the fibres of the muscular coat of theaortaanditslargestbranches. 
When a portion of the muscle of t he heart, or of the muscular coat of the aorta was treated with 
acetic or hydrochloricacid under the microscope, thousands of small lozenge-shaped crystals of 
uric acid were discovered lying around the muscular fibrillae. Theurateof ammonia was depos- 
ited in no other organ or tissue except the heart and the aorta, and its largest branches. The fol- 
lowing appears to be the explanation of this singular phenomenon : The heart was the only por- 
tion of the muscular system in continual action during the season of hibernation. Muscular 
force is developed by chemical change. The heart, therefore, was the only portion of the muscu- 
lar system undergoing chemical change. The blood was concentrated, deficient in water. There 
was not sufficient water to dissolve the urate of ammonia, resulting from the chemical changes 
of the blood and muscles of the heart, by which the muscular force was developed. The urate of 
ammonia consequently remained just where it was formed. This observation not only points to 
the origin of uric acid and ammonia in the animal economy, but also demonstrates that the mus- 
cular force is developed during the chemical changes of the elements, of the blood and muscles. 
If these conclusions be legitimate, true and universal, it follows as a necessary consequence, that 
any alteration in amount or kind of the chemical changes of the blood and muscular tissue must 
be attended by corresponding alterations in the amount and kind of the products resulting from 
those chemical changes. Congestive Malarial Fever. 
823 
■organism? Will the derangement of the secretions and excretions differ 
with different poisons, when the actions of those poisons are limited sim- 
ply to the sympathetic nervous system1? What is the effect of derangement 
■of the sympathetic nervous system upon the cerebro-spinal nervous system? Can 
the sympathetic nervous system induce alterations in the actions of the organs 
and tissues, in the secretions and excretions, independent entirely of any 
direct action, but by communicating or reflecting its aberrated action to 
the cerebro spinal nervous system? What is the effect of derangement of 
the cerebro spinal nervous system, upon secretion and excretion, in fact upon 
all the chemical changes of the elements of the human organism? Will 
the derangements of the secretions and excretions differ with different 
poisons, when the actions of those poisons are limited simply to the cere- 
bro-spinal nervous system? What is the effect of derangement of the 
'Cerebrospinal nervous system upon the sympathetic nervous system? Can the 
cerebro-spinal nervous system induce alterations in the actions of the 
organs and tissues, in the secretions and excretions, independent entirely 
of any directaction, but by communicating or reflecting its aberrated action 
•to the cerebrospinal nervous system? Would the phenomena of nervous and 
muscular action and of secretion and excretion vary if the action of the 
poison or poisons were primarily upon the blood, rendering it unsuited to 
the healthy action of the cerebro-spinal and sympathetic nervous systems 
and of the muscular system, rendering it unsuitable for the formation of 
the secretions and excretions? Notwithstanding the absence of the facts 
necessary for the absolute solution of these complicated phenomena, and 
problems, still the present observations, that arrest of capillary circula- 
tion and chemical change, due to the action of the malarial poison, was 
attended by a reduction of the temperature, aberrated muscular and nerv- 
ous action, and a marked alteration of the properties of the urine are of 
.great interest in their bearing upon the treatment of congestive fever. 
3. In the treatment of that form of malarial fever called congestive 
fever, those remedies should be employed, which excite the general and 
capillary circulation, promote the introduction and distribution of oxygen, 
increase the chemical changes, and excite the development of the muscu- 
lar and nervous forces. Sulphate ol quinia and diffusible stimulants, 
brandy, and carbonate of ammonia should be freely and promptly admin- 
istered, and sinapisms freely applied. Bottles of hot water, or, better still, 
the hot water bath should be used to impart heat and stimulate the capil- 
lary circulation, and relieve the engorgement of the large organs. Brandy 
and red pepper may be applied to the surface with advantage. The sul- 
phate of quinia may be administered in doses of 15 to 30 grains every one, 
two or three hours, according to the urgency of the symptoms, up to from 
30 to 100 grains during the twenty-four hours. The best method of admin- 
istering the sulphate of quinia is dissolved in a weak solution of citric 
acid or in lemon juice. It is perfectly soluble in this, and is much more 
readily absorbed when in this soluble form. If the stomach rejects the 
sulphate of quinia, it should be administered in solution with starch, by 
the rectum. These stimulants will in many cases be the means of pro- 
longinglife until the sulphate of quinia can be absorbed and act. Whilst 
therefore the stimulants do not cure the disease, they often preserve life by 
supporting the patient until the sulphate of quinia can act. The carbonate 
of ammonia is peculiarly valuable in that form of malarial fever where 
there is a rapid feeble pulse and corresponding rapid feeble action of the 
heart. The observations which I have recorded prove that heart-clots are 
almost always formed previously to death from malarial fever. It is 
probable that cases often occur where the sudden and distressing symptoms 824 
Congestive Malarial Fever. 
are due in a great measure to the formation of these heart-clots during 
life. The feeble action of the heart, and the sluggish circulation of the 
blood, are very favorable to the formation of these heart-clots. The free 
administration of the carbonate of ammonia, in congestive fever, will 
fulfill two indications: 1st, stimulation: 2d, prevention of the formation 
of fibrinous clots in the heart and large blood-vessels. 
4. The failure of this mode of treatment to prevent a fatal termina- 
tion in this case was due to several causes. The disease had been 
allowed to progress without any opposition for at least ten days before this 
plan of treatment was instituted. During this time such profound altera- 
tions of the blood, spleen, and liver had taken place, and the chemical 
changes so perverted and the correlation of the physical, vital, nervous, 
and muscular forces, so disturbed, that no plan of treatment, however 
vigorous, however appropriate, could arrest the progress of the disease. 
The symptoms were without doubt aggravated by the cirrhosed condition 
of the liver. The alterations of the color of the blood and of the secretions 
of the liver in malarial fever, point to profound alterations. The cirrhosed 
condition of the liver would necessarily increase these morbid effects. The 
cirrhosed condition of the liver also points to the former intemperate habits 
of the patient, and the effects of these upon the constitution no doubt 
influenced materially the course of the disease. As far as my observations 
upon malarial fever extend, I can assert that this disease most frequently proves 
fatal in those who have been addicted to the intemperate use of ardent spirits, 
and especially in those in whom a cirrhosed condition of the liver has been induced 
by the free use of ardent, spirits. This statement is worthy of the attentive 
examination and consideration of the profession. It is probable that the 
fibrinous clots found in the heart were formed some time before death, and 
if they did not determine, they at least hastened the fatal termination. 
5. In this case the marked reduction of the temperature of the trunk 
and extremities was unattended by the shivering and sensations of cold 
characteristic of the chill of intermittent and remittent fever. 
The observations which I have recorded have established that in the 
chill of intermittent and remittent fever the temperature of the trunk is 
actually elevated several degrees above the normal standard, whilst the 
temperature of the extremities is depressed many degrees below the normal 
standard. In this state of things we find a feeble pulse, feeble circulation 
of the blood in the capillaries of the extremities, diminished chemical 
action in the capillaries of the extremities, accumulation of blood in the 
large organs of the trunk, and increased chemical change in the blood and 
large organs of the trunk. This state of things is attended by shivering of 
the muscles and a sensation of cold, just as a similar reduction of the tem- 
perature of the extremities in cold weather would be attended by shivering 
of the muscles and a sensation of cold. On the other hand, in that form of 
malarial fever called congestive fever, where the temperature of both the 
trunk and extremities is depressed, the patient often complains of no sensa- 
tion of cold, and, in some instances, even says that he feels perfectly well, 
and there is no shivering of the muscles. Here we find a feeble general and 
capillary circulation and an arrest and perversion of chemical action, both 
in the trunk and in the extremities. 
Whence this difference? Without attempting to decide dogmatically 
upon the solution of these complicated phenomena, we would simply state 
that in congestive fever the chemical changes in all parts of the body are- 
so diminished and perverted, and the correlation of the forces so disturbed, 
that the muscular system ceases to indicate by shivering and aberrated 
action, and the nervous system ceases to indicate by the sensation of cold,. Congestive Malarial Fever. 
825 
the depression of temperature consequent upon the arrest of capillary cir- 
culation and chemical change. As muscular and nervous force, and even 
sensation, depend upon chemical change, it is font reasonable to suppose 
that a marked perversion and diminution of chemical change should be 
attended by an arrest of muscular and nervous action, and even of sensa- 
tion. In congestive fever, whether from peculiarities of constitution or 
from the overwhelming amount of the poison introduced, those chemical 
changes are not excited, which result in the breaking up and removal of 
the malarial poison. The febrile excitement following the chill of inter- 
mittent and remittent fever, appears to be due to the equalization of the 
general and capillary circulations ; and to the distribution through the 
blood-vessels and capillaries of all parts of the body, of the substances 
undergoing active chemical changes, developing high temperature, which 
during the chill were confined to the trunk. The equalization of the 
capillary and general circulations is, without doubt, dependent in great 
measure, primarily, upon the action of the sympathetic nervous system ; 
aud, perhaps, may be secondarily and remotely affected by the action of 
the cerebro-spinal nervous system. We say dependent in great measure, but 
not absolutely, and entirely, upon the sympathetic nervous system; 
because the malarial poison may act, in addition to the modes already 
pointed out, direct ly upon the fibres of the heart, and thus influence circu- 
lation, and through it respiration, and chemical change, and temperature, 
and muscular and nervous force, and the manifestation of intellectual 
phenomena, independently altogether, of any direct and primary action 
upon either the sympathetic or cerebro-spinal nervous systems. It is 
highly probable that, during the febrile excitement, the malarial poison is 
drawn into the round of chemical changes, and so altered, that its action 
is for a time suspended. Hence the intermission, or remission. 
The fever, then, is a favorable symptom, and the want of fever, a most unfa- 
vorable symptom; and if these views be true, the paroxysms of malarial fever 
are due to the alterations and paitial destruction of the poison during the 
active chemical changes of the febrile excitement. The manifest duty of 
the physician in congestive fever (if these views, which have been sug- 
gested by the results of actual observation and experiment, be correct), is 
to administer those remedies which will excite the general and capillary 
circulations-excite chemical change-excite fever, and arouse into vigor- 
ous action the sympathetic nervous system, and destroy, or counteract, or 
paralyze the action, or eliminate the malarial poison. 
Case 987.-Illustrating the Power and Rapidity of the Action of the Malarial 
Poison in Congestive Fever, and Changes of Blood in the Liver and Spleen.-Amer- 
ican seaman; age 25; height 5 feet 9 inches; weight 150 pounds; dark complexion, 
dark-brown hair, brown eyes. October 19th, 1857, 8 o'clock P. M. This patient 
entered the hospital three hours ago, at 5 o'clock P. M., in an almost insensible 
condition. Now he is aroused with great difficulty and answers incoherently. 
Extremities cold. ' Pulse 80, feeble. Head and trunk cooler than normal. Tongue 
by the gas light appears clean, soft, and normal in color. R.-Cut-cups to each 
temple and back and neck. R.-Mustards to extremities and over epigastric region. 
R .-Sulphate of quinia gr. v; camphor gr. ij. Mix, and administer every three 
hours until fifty grains of the sulphate of quinia have been taken. R.-Spirit of 
mindererus, brandy, and infusion of snakeroot fgssof each, alternately every half 
hour. 
20th, 9 o'clock A. M. Lies in a profound coma. This came on a short time 
after the first observation yesterday evening. The cut-cups aroused him partially 
for a few moments, but he soon relapsed. Mustards have been applied to the 
extremities and epigastric region three times during the night; they failed to rouse 
the brain; they excited the capillary circulation and induced an elevation of tem- 
perature, but did not restore reason. The stimulants also failed to arouse the intel- 826 
Congestive Malarial Fever. 
lect. Whenever the mustards were removed and the stimulants withheld his sur- 
face became cool and the pulse diminished in volume. It is evident, then, that the 
mustards and stimulants excite the general and capillary circulation, and induce 
an elevation of temperature, but they do not arrest the disease. During the night 
has passed his urine and faeces in bed. Pulse 140, full. The sounds of the heart 
are not distinct; they cannot be distinguished, but sound to the ear like one sound. 
The beating of the heart sounds stronger even than in health. The sounds of the 
heart correspond in frequency to the beat of the pulse, 140 to the minute, Respira- 
tion 40, spasmodic; temperature of atmosphere 70° F.; temperature of hand 104°; 
temperature of axilla 104.°5. Great tenderness of epigastrium. Whilst neither 
shaking nor loud talking will arouse him, pressure upon the epigastrium causes 
him t<> emit a short cry. The epigastrium and region of the liver feel to the hand 
warmer than the head or any other part of the body. Complexion very sallow. I 
administered gr. xxx of sulphate of quinia in f^ij of brandy. It was with great 
•difficulty that the spoon was forced between his clenched teeth. The dose had 
not been swallowed more than a few moments before it was ejected violently, appa- 
rently without any effort or consciousness on the part of the patient. This dose 
was again repeated, and his trunk and extremities covered with mustards, and 
bottles of hot water applied to the feet, without producing the slightest good effects. 
This patient died one hour and a half after these observations. 
AUTOPSY TWENTY-FOUR HOURS AFTER DEATH. 
Body not emaciated; apparently in full flesh. Has the marks of a large ulcer 
over the superior portion of the sternum. Skin of the dependent parts of the body 
of a purplish hue- The discoloration of the skin commences about the middle of 
the body and gradually increases downwards, until the most dependent portions 
are of a deep purple color. 
Head.-When the skullcap was removed, much blood flowed out. Arachnoid 
membrane opalescent, in a few spots. Blood-vessels of pia mater filled with blood. 
Bloody serum was effused between the arachnoid and pia mater. Blood-vessels at 
the base of the brain and surrounding the medulla oblongata and superior portion 
of the spinal cord, congested with blood. Blood was effused upon the base of the 
brain. This blood was fluid, and contained no coagula. The substance of the 
brain was normal in consistence and appearance. 
Chest.-Heart, normal; right auricle and ventricle contained a small clot, left 
heart empty. Lungs, normal; dependent portions congested with blood. Blood- 
vessels of superior portions almost entirely free of blood. 
Abdomen- Liver.-A large portion of the surface of the liver presented the 
healthy Spanish brown color, and, when cut, the substance presented the usual 
healthy color. Other portions, however, presented a mottled appearance of Span- 
ish brown and dark purple, and the blood-vessels of these parts appeared to be 
engorged with blood. The right lobe of the liver had upon its undersurface a spot 
iibout two inches in diameter, of a dark slate (malarial) color. When an incision 
was made through this portion of the liver, it presented for the depth of about one- 
fourth of an inch, the true bronze color. Numerous incisions were made into the 
liver in all directions, so as to expose its substance fully to view; portions were 
found approaching in color the bronze hue of the malarial fever liver; the great 
mass of the liver, however, resembled more nearly that of a healthy liver, engorged 
with blood. Portions from different parts of the liver were examined under the 
microscope, rhe liver cells from the slate-colored and bronzed portions did not 
differ in appearance, under the microscope, from those of the normal colored, or 
from those of the mottled portions. The colored corpuscles appeared to be more 
altered in form in the bronzed portions than in the normal colored portions. The 
alterations, however, even in the bronze portions, were small and by no means 
universal, but confined comparatively to a few, and, after all, the difference may 
have been imaginary. The determination of comparative alterations of this kind 
is not so easy as at first sightappears. Did not discover any of those dark granules 
in the bronze portion, which have been said to impart the peculiar color to the 
liver. From the cut surface of the liver much black blood issued, which assumed, 
upon exnosure to the atmosphere, the arterial hue. The liver-cells did notappear 
to be altered in any manner. 
Gall-bladder, tilled with bile. Specific gravity of bile, 1043.5. Viewed in mass, 
-the bile was of a brownish-black color, with greenish reflections, and resembled, 
upon a general view, a saturated tincture of iodine. It resembled, and poured like 
molasses, being thick and ropy. Upon close inspection, the bile was found to Congestive Malarial Fever. 
827 
contain numerous flakes of a green color, which, under the microscope, were found 
to consist of the conglomerated cells of the mucous membrane of the gall-bladder. 
When spread out in thin layers, the bile presented a gamboge yellow color. 
Pancreas, normal. 
Spleen, slate colored, softened and enlarged; not as much softened and altered, 
however, as in cases of malarial fever of longer standing. The mud of the spleen 
was of a dark purplish hue, and appeared to be in transition to the color and state 
of the mud of the spleens of malarial fever of longer duration. After exposure for 
a few hours to the oxygen of the atmosphere, a large portion of the mud of the 
spleen assumed a color approaching the arterial hue, much brighter than the mud 
of the spleens upon which malarial fever had exerted its full effects, and somewhat 
darker than the bright arterial hue assumed by the splenic mud of healthy, nor- 
mal spleens. When the splenic mud was spread in thin layers upon a glass slide, 
the change of color was much more rapid. Under the microscope, the splenic mud 
appeared to consist almost entirely of colored corpuscles, many of which appeared 
swollen and altered in appearance. After careful examination, I was unable to 
find those conglomerations of black granules, resembling the black sediment of 
black vomit, which were discovered in other malarial spleens. 
Kidneys, normal. Bladder contracted; contained no urine. Scrotum red, and 
apparently scalded. This was due most probably to the acid urine. I have 
■observed this effect of the urine upon the scrotum in many cases of malarial fever of 
the severest types. 
Alimentary and intestinal canal.-The mucous membrane of the stomach pre1* 
sented two well-defined portions: the mucous membrane of the lesser curvature of 
tne stomach was pale and normal in appearance; the mucous membrane of the 
greater curvature and pyloric extremity, and of the pylorus was of a purplish color, 
and ecchymosed in crimson spots. The blood-vesseis of the greater curvature and 
of the pylorus were congested with blood. Mucous membrane of the superior por- 
tion of the jejunum congested with blood. Valvulae conniventes, especially at the 
edges, ecchymosed in spots of a purple and scarlet color. Mucous membrane of 
the lower portion of the ileum greatly congested with blood. Peyer's glands some- 
what enlarged, more distinct and elevated than usual, but pale, and not congested 
and inflamed as in typhoid fever. Solitary glands enlarged and distinct. Mucous 
membrane of colon greatly congested with blood. 
CONCLUSIONS. 
1. The slight alteration of the color of the liver; the change of the 
blood of the liver to the arterial hue upon exposure to the atmosphere; the 
change of the splenic mud to the arterial hue, all prove that this patient 
had died very soon after the commencement of the malarial fever. As we 
have seen, the patient was unable to answer any inquiries with reference 
to the history of his case. So convinced was I that this was a case of only 
one or two days' standing, that I sought out the captain of the vessel to 
which this patient belonged and made minute inquiries. The captain 
stated that this man was the cook on the vessel. One month ago, whilst 
the vessel was lying in the Santee river of South Carolina, this patient was 
taken with a fit. This was relieved in a few hours, and was not followed by 
fever, and the patient appeared to suffer no ill effects and resumed his 
duties. Two weeks ago the captain brought his vessel to Savannah. This 
patient has been sleeping on board the ship at night up to the time of his 
entrance into the hospital. He was well, active, and attentive to his 
duties up to 5 o'clock P. M., October 18, when he was suddenly seized with 
vomiting, cold extremities, complete prostration and delirium. He had 
cooked dinner this day, and was attending to his duties at the time of this 
sudden attack. He had, however, "a singular look out of his eyes," 
which attracted the attention of the captain, and led him to inquire if he 
was well. The patient answered yes, and complained of nothing. Whilst 
sick on board the ship, he complained of no pain; and, before the com- 
plete loss of reason, said that he felt well. The next day, the 19th inst., 828 
Congestive Malarial Fever. 
he was sent to the hospital at 5 o'clock P. M. I saw him for the first time 
at 8 o'clock P. M. He died at 12 o'clock M. the next day. This patient, 
then, died after forty-three hours' sickness. 
2. The general and capillary circulations were easily aroused by 
stimulants; the temperature of the body, under the action of stimulants, 
was elevated above the normal standard; there was a correlation between 
the temperature of the trunk and extremities; the chemical changes 
appeared to be amply sufficient for the development of the muscular and ner- 
vous forces; and the liver and spleen had undergone comparatively but slight 
alterations. The most prominent apparent cause of death was the effu- 
sion of blood upon the base of the brain. The fit which occurred one 
month ago points to a previous derangement of the cerebro-spinal system. 
Was the effusion of blood upon the brain the result of the action of 
the malarial poison alone, or the result of the action of the malarial poi- 
son upon the delicate structures of the brain, already altered by previous, 
disease ? It is impossible to decide these questions positively, but all our 
observations upon malarial fever would lead us to accept the latter suppo- 
sition. We regard the action of the malarial poison as depressing, and 
not inflammatory. Cerebral disturbances in malarial fever appear to be 
due-first, to the direct action of the malarial poison and of the altered 
blood upon the nervous structures; and secondly, to the stagnation and 
accumulation of blood in the capillaries, and blood-vessels of the brain, 
due to the diminished action of the heart, arrest and perversion of chem- 
ical change in the blood of the capillaries or loss of power in the 
capillaries themselves. If by previous disease, arising of itself, or 
induced by the intemperate use of ardent spirits, the capillaries and blood- 
vessels of the brain and its membranes lose their tonicity, elasticity and 
coherency, the simple stagnation and accumulation of blood may be 
attended by a rupture of the altered vessels, without any inflammatory 
action. A strong confirmation of these views is the fact that the vigo- 
rous administration of the most active stimulants, conjoined with sulphate 
of quinia, is the most efficient mode of preventing, arresting and relieving 
the coma and delirium of malarial fever. If the action of the poison was 
inflammatory, this would not be the case. The preceding case shows that 
we may have symptoms of inflammation of the brain in malarial fever, 
without a single pathological alteration after death, cognizable to the 
unaided senses. We say cognizable to the unaided senses, because the thor- 
ough knowledge of the nature of malarial fever demands, amongst many 
other things, a thorough knowledge, not only of the appearance and 
chemical constitution of the structures of the cerebro-spinal and sympa- 
thetic nervous systems, but also a thorough knowledge of the physical, 
chemical and pathological alterations of these structures when acted upon 
by morbific agents. We are actuated by no disparaging spirit, when we 
assert that in the present state of chemical, physiological and pathological 
science, we are wholly ignorant of the chemical, physiological and patho- 
logical relations of the malarial poison to the nervous elements. In 
those cases in which the cause of death was not found in the pathological 
alterations of the organs and tissues, the question immediately arises, 
what destroyed life? In the present state of medical science we can offer 
suppositions, but we can give no decided answer. How difficult would it 
be to prove or disprove that the malarial poison produced death by its 
direct action upon the nervous system, in a manner analogous to the action 
of some of the violent alkaloid and metallic poisons? We know that 
some substances, as chloroform, will produce sudden death in some cases, 
when there is no assignable cause either in the structures and forces of the Congestive Malarial Fever. 
829 
patient, or in the pathological alterations produced. This peculiar action 
is said to be due to the idiosyncrasy of the patient. May not the fatal 
action of the malarial poison be due in some cases to the idiosyncrasy of 
the patient? Has any one ever determined upon what an idiosyncrasy 
depends? 
3. A comparison of the autopsy of this case with that of previous cases 
shows that in the first stages of malarial fever the liver is first engorged 
with blood, and the slate and bronze coloris not at first universal, but con- 
fined to definite portions. It is an interesting fact that in the present case 
the solitary glands were found enlarged even at this early stage of the dis- 
ease. The mucous membrane of the stomach and intestines presented 
marks of congestion, if not of inflammation. This condition of the mucous 
membrane is by no means characteristic of malarial fever, even when there 
is great tenderness upon pressure of the epigastrium. Tenderness here may 
be due rather to the state of the spleen and liver. The observation which 
we made upon previous cases is also true with regard to this, that the slate 
and bronze color of the liver is not due to the formation and distribution 
through the liver of peculiar dark-colored granules. 
1. Although the stimulants and sulphate of quiuia did not cure the 
disease, still they aroused the capillary and general circulation, and 
induced the chemical changes. 
The following tables, drawn up after the careful examination of several 
hundred cases of malarial fever, will present a comparative view of some of 
the most striking phenomena of the different forms of malarial fever: 830 
Composition of Urine in Malarial Fever. 
o 
o 
PHYSICAL AND CHEMICAL CONSTITUTION OF URINE. 
No. of Case 
Date, Year 
and 
Month. 
Disease and Stage of Disease 
Hous 
OF 
Day. 
Pulse 
Respiration. 
Temperature 
Hand. 
Temperature 
Axilla. 
Length of peri- 
od in which 
urine was col'd 
Amount of 
urine collected 
Grs. 
Color of urine. 
Specific gravi- 
ty of urine. 
Urea-Grains. 
Uric Acid, 
Grains. 
Free Acid, 
Grains. 
Phosphoric 
Acid-Grs. 
Sulphuric 
Acid-Grs. 
Chloride of 
Sodium-Grs. 
1863. 
988 Oct. 13 
1 
989 Oct. 13 
Intermittent fever, (fever) 
" intermission. 
Intermittent fever, 
12 M. 
64 
22 
Fah. 
96.°8 
Fah. 
100. °4 
H'rs. 
24 
24 
9,567 
7,140 
Orange 
Orange 
1017. 
1017. 
240. 
186. 
4.5 
12.1 
21. 
21. 
9.2 
10.3 
92. 
63. 
990 
991 
992 
Oct. 11 
October 
October 
Two hours co Id stage 
Three hours hot stage 
Fifteen hrs. hot& sweat'g stage 
Intermittent fever, hot stage 
Intermittent fever,intermission 
Intermittent fever, intermission 
Quotidian 
Remittent fever, convalescence.. 
3 P. M. 
6 P. M. 
A. M. 
11 A. M. 
11 A. M. 
2 P. M. 
1 P. M. 
11 A. M. 
6'1 
58 
21 
20 
97.9 
85.8 
99.2 
99.7 
2 
3 
15 
24 
21 
24 
24 
•24 
1,591 
2,240 
11,222 
15,498 
21,153 
is,270 
51,115 
12,731 
Orange 
Orange 
Orange 
orange 
Orange 
Orange 
Yellow 
Red 
1020. 
1018. 
1011- 
1013. 
1011. 
1015. 
1004. 
1018. 
53.9 
58.1 
189. 
241. 
309. 
265. 
307. 
394. 
2.1 
3.8 
20.7 
18.8 
15.1 
20.5 
21.66 
0.3 
0.2 
1.7 
14.4 
18.9 
20.3 
10.2 
36.9 
19.6 
15. 
18.5 
26. 
15.3 
19.7 
18.4 
30 1 
21.8 
135. 
145. 
265. 
123. 
6.1 
Remittent fever, convalescence.. 
2 P. M. 
68 
20 
95.6 
101.3 
24 
12,090 
Red 
1016. 
327. 
29.26 
36. 
18. 
993 
991 
October 
October 
Remittent fever, 
remission 
Remittent fever, remission 
3 P. M. 
2 P. M. 
102 
78 
U 
100.4 
94.3 
100.8 
102.2 
24 
24 
9,180 
18,174 
Brown 
Orange 
1020. 
1014. 
267. 
445. 
44.6 
29.6 
31.4 
29. 
15.1 
21.3 
11.7 
19.6 
110.6 
Remittent fever, remission 
Remittent fever, remission 
2 P. M. 
2 P. M. 
24 
24 
18,216 
24,408 
Orange 
Orange 
1012. 
1017. 
309. 
414. 
24.7 
19.1 
22. 
16. 
113. 
403. 
995 
1862. 
July 27... 
27... 
Intermittent fever, (chill) 
Intermittent fever, (fever) 
Intermittent fever, (fever) 
12 M. 
5 P. M. 
5 A. M. 
124 
88. 
107. 
2/2 
5 
12 
5,425 
7,297 
15,193 
Yellow 
Yellow 
Yellow 
1016. 
1008. 
1005. 
118. 
99.4 
163, 
138. 
519. 
363. 
1.0 
0.65 
1.4 
7.3 
6.3 
3.9 
0.6 
0.5 
trace. 
3.5 
5.0 
17. 
76.9 
53.0 
40. 
28... 
28"; 
28... 
29... 
Intermittent fever, (fever) 
Chill and fever 
Chill and fever 
Chill and fever 
intermission 
10 A. M. 
11 A. M. 
9 P. M. 
8 A.M. 
92 
96 
80 
28 
26 
101.7 
104. 
100.8 
104. 
104.8 
101.2 
5 
21% 
22 
4,076 
31,991 
35,607 
Orange 
Orange 
Orang6 
1019. 
1019. 
1005. 
2.0 
5.2 
5.3 
5.7 
2.3 
5.7 
6.9 
10.8 
6.2 
31.8 
21.3 
33. 
203. 
88.5 
29... 
29... 
30... 
31... 
intermission 
intermission 
intermission 
intermission 
11 A. M. 
10 P. M. 
9 P. M. 
11 A. M. 
"so" 
76 
76 
"20 " 
16 
16 
"166.6 
99.3 
99.5 
"166.8 '" 
100.2 
99.7 
3 
11 
24 
3,187 
5,461 
15,986 
Orange 
Orange 
Orange 
1012. 
1020. 
1015. 
80. 
220. 
586. 
1.2 
6.1 
5.3 
6.7 
3.8 
12-8 
10,3 
6.4 
14.7 
8.8 
12.8 
59.71 
Aug. 
1... 
intermission 
10 A.M. 
72 
16 
96.8 
101.1 
24 
28,453 
Orange 
1009. 
466. 
2.8 
36.9 
37.8 
110.5 
2... 
intermission 
10 A. M. 
66 
16 
98.3 
99.7 
24 
28,280 
Orange 
1010. 
547. 
2.8 
30.1 
31.4 
166.3 
996 
Aug. 
3... 
21... 
22... 
23... 
intermission 
Intermittent fever, (fever) 
intermission! 
intermission^ 
10 A. M. 
11 A. M. 
12 M. 
12 M. 
86 
94 
66 
80 
22 
28 ' 
22 ■ 
24 । 
98.3 
106.6 
100.4 
100.8 
106.9 
101. 
101.3 
24 
10 
14 
24 
27,802 
7,791 
9,601 
12,927 
Orange 
Orange 
Orange 
Orange 
1009. 
1011. 
1016. 
1026. 
445. 
3.4 
1 
26.4 
2.9 
29.0 
52.93 
57.0 
10.0 
19.2 
43.51 
112.4 
70.5 
59.8 
106.8 
CASES ILLUSTRATING THE COMPOSITION OF THE URINE IN MALARIAL FEVER. Composition of Urine in Malarial lever. 
831 
No. of Case. 
Date, Year 
and 
Month. 
Disease and Stage of Disease. 
Hour 
of 
Day, 
P ulse. 
Respiration. 
I 
Temperature of 
Hand. 
1 
| Temperature of 
Axilla. 
1 
PHYSICAL AND CHEMICAL CONSTITUTION OF URINE. 
Length of peri- 
od in which 
urine was col'd 
Amount of 
urine collected 
Grs. 
Color of urine. 
Specific gravi- 
ty of urine. 
Urea-Grains. 
Uric acid. 
Grains. 
Free acid. 
Grains. 
Phosphoric 
acid.-Grains 
Sulphuric acid 
Grains 
Chloride of 
sodium. 
Grains. 
997 
July 21... 
22... 
24... 
25... 
27... 
Intermittent fever (fever) 
12 M. 
2 P. M. 
2 P. M. 
2 P. M. 
2 P. M. 
9 P. M. 
9 P. M. 
9 P. M. 
i P. M. 
130 
76 
70 
88 
64 
76 
100 
80 
84 
88 
76 
66 
60 
68 
98 
81 
96 
92 
115 
120 
125 
120 
100 
36 
20 
24 
20 
24 
20 
35 
16 
i'2 
24 
24 
82 
26 
33 
38 
38 
40 
105.7° 
106.7° 
12 
24 
24 
24 
24 
20 
24 
24 
24 
12 
24 
24 
36 
24 
24 
30 
24 
24 
24 
24 
24 
24 
24 
24 
24 
24 
24 
24 
4,076 
10,496 
6,748 
11,609 
15,610 
16.761 
23,614 
10,210 
10,705 
4,080 
8,763 
9,430 
13,486 
15,860 
9,347 
19,903 
15,918 
15,950 
11,-09 
23,028 
13,550 
10,485 
9,776 
18,180 
17,942 
34,449 
24.451 
1010 
86 8 
i'2.9" 
16.23 
13.'6" 
i'7'9" 
W 
0.9 
43.7 
20.6 
27,2 
31.8 
34.6 
33.3 
43.41 
32.9 
9.0 
9.9 
8.4 
12.3 
26.14 
19.3 
43.1 
24.9 
29.6 
34.7 
31.7 
39.17 
28.3 
19 5 
10.5 
3.8 
10.4 
9.24 
4.5 
61.8 
17.2 
14.5 
12.8 
25.2 
24.6 
23.4 
34.1 
12.4 
28.1 
23.6 
17.6 
10.8 
21.6 
131.4 
50.3 
17,6 
26,4 
98 S 
43.7 
14.1 
13.1 
66.4 
132.0 
92.7 
86.9 
19.8 
17.4 
5.9 
13.3 
12.8 
16.0 
44.7 
8.2 
8.4 
11.4 
17.0 
38.9 
im 7 
Fever and intermission 
Orange 1026. 
Ora Iura 10°l _ 
intermission 
99.7 
100. 
327. 
414. 
436. 
510." 
196. 
107. 
335. 
402. 
204. 
351. 
965. 
617. 
617.6 
SI 8 
intermission 
1017. 
intermission 
6.5 
"2.5" 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever (fever) 
Red 
1014. 
1007. 
1020. 
1022. 
1022. 
1019. 
1014. 
1015. 
1007. 
1018. 
1018. 
1012. 
1014. 
1019. 
1010. 
1015. 
1017. 
1110. 
1010. 
1008. 
1008. 
1005. 
999 
1000 
22... 
23... 
July 21... 
22... 
23... 
24... 
26... 
27... 
July 21... 
23... 
24... 
25... 
26... 
27... 
Red 
Red 
98.3 
"98.6" 
97.2 
105.5 
"99.5" 
100.1 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent lever, intermission 
Intermittent fever, intermission 
Intermittent fever (fever) 
Red. . 
2 P. M. 
2 P. M. 
Red 
Red 
Red.. 
Red.. 
11 A. M. 
2 P. M. 
2 P. M. 
2 P. M. 
2 P. M. 
2 P. M. 
12 M. 
12 M. 
1 P. M. 
1 P. M. 
1 P. M. 
1 P. M. 
1 P. M. 
105.8 
100.4 
98.3 
106.2 
10..9 
100.9 
Orange 
Orange 
Orange 
Orange 
Yellow 
Yellow 
Red 
Intermittent lever, intermission 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever, intermission 
Intermittent fever (fever) 
612. 
102.2 
98.8 
101.5 
104.8 
101.4 
101.9 
23 .. 
Intermittent fever, intermission 
। ihronic malarial poisoning 
Red 
22.3 
11.1 
8.1 
10.4 
13.9 
8.0 
27.1 
46.5 
40.7 
92.4 
133.19 
1002 Tillv 20 
Yellow 
Yellow 
Yellow 
Yellow 
Yellow 
Orange 
197. 
318. 
228. 
492. 
229. 
273. 
12.5 
"7.O2 
"2.81 
1003 
1004 
1005 
1006 
1007 
1008 
25... 
26... 
27... 
28... 
Chronic malarial poisoning 
Chronic malarial poisoning 
Chronic malarial poisoning 
1863. 
Oct. 10... 
10... 
II... 
Oct. 19... 
Intermittent fever 
... 
102."" 
fever... 
intermission 
12 M. 
12 M. 
11 A. M. 
P. M. 
A. M. 
A. M. 
P. M. 
1 
9,730 
1021. 
12.37 
13.6 
118.6 
Remittent fever 
Remittent fever 
Remittent fever 
Remittent fever 
Remittent fever 
100. 
103 
103. 
102.5 
102.5 
103. 
105.5 
105. 
106. 
105. 
Cases Illustrating the Composition of the Urine in Malarial Fever-Continued. 832 
Intermittent Fever: Cold Stage. 
Hour 
of 
Day. 
State of Inteleect, Skin, Tongue, Puese, 
Respiration, Etc. 
Pulse. 
Respiration. 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Characters of VrinE; 
§ Date. 
o 
o 
6 
1009... iSept. 30 
1pm 
Intellect clear; tongue clean, moist, red at tip and 
edges; papillae enlarged, and of a bright red color; 
skin cool and relaxed; pulse feeble; saliva acid. 
Extremites cold; head and trunk hot; pulse feeble. 
70 
22 
68.0° 
92.0° 
99.5° 
Light orange color; sp. gr. 1010; reaction strong- 
1 1856. 
Sept. 30 
1010.. Oct. 10 
5pm 
108 
30 
74.0 
91.0 
105.5 
ly acid; no deposit after standing 70 hours. 
Do. do. 
12J P M 
Tongue pointed but moist, and not much redder 
100 
26 
68.0 
91.5 
107.0 
Urine excreted during the chill clear and lim- 
iOct. 10 
1PM 
than usual; skin of extremities cold, of head and 
trunk hot, andpresents a purplish mottled appear- 
ance; pulse small and feeble; saliva acid. 
Do. do do. 
100 
20 
68.0 
87.5 
107.0 
pid, of a light straw color; sp.gr. 1003; reac- 
tion strongly acid; slight deposit of triple 
phosphate after 60 hours. 
Do. do. 
1011...'Oct. 14 
Lips and fingers pale, and of a bluish color; extremi- 
92 
32 
77.5 
91.0 
103.0 
Urine excreted during the chill normal color; 
i 
1012...j 
1013... । 
1014...1 
ties cold, whilst the trunk is hot; pulse small and 
and feeble. 
Shaking violently; lips and hands look blue; pulse 
small, feeble and rapid; respiration lull, panting 
and irregular. 
Do. do. do. 
Do. do. do. 
100 
"120 
36-50 
""22" 
71.5 
79.0 
79.0 
92.0 
90.0 
89.0 
104.0 
102.0 
102.25 
sp. gr. 1023. 
1015... 
Pain in bones of legs; slight tenderness of epigas- 
trium; tongue clean, moist, red at tip and edges; 
papillae red and enlarged; skin hot and dry; saliva 
acid; pulse full. 
Do. do. do. 
Fever subsiding; pulse full, but soft; tongue moist; 
skin in a profuse perspiration. 
Skin hot and dry. 
Skin hot, dry and pungent to the hand; lips parched 
and dry; tongue dry and red; no tenderness of epi- 
gastrium; pulse full, strong and bounding. 
Chill just going off. 
Tongue red at tip, but moist and soft; skin hot and 
dry; saliva acid; pulse full and bounding; com- 
plains of pain in head. 
Great thirst, and pain in head and back; tongue 
coated in the middle with yellowish fur, pointed 
and red at the sides and tip; skin hot and dry; 
pulse full and strong. 
120 
108 
98 
100 
120 
112 
100 
100 
32 
32 
79.0° 
73.0 
72.0 
67.0 
72.0 
90.0 
77.0 
90.0 
103.3° 
103.5 
102.5 
102.0 
105.75 
100.0 
105.0 
106.0 
106.0° 
105.0 
103.0 
107.0 
106.0 
104.0 
106.0 
106.0 
Color of urine light orange; sp. gr. 1011; reac- 
tion strongly acid; no deposit after 60 hours. 
Color of urine normal; sp. gr. 1020; strongly acid 
Orange colored; sp. gr. 1025; reaction strongly 
acid; no deposit after 60 hours. 
Specific gravity 1015. 
Light orange color; sp.gr. 1022; reaction strong- 
ly acid; no deposit. 
Urine of a deep orange color, and decided 
acid reaction; sp.gr. 1008. 
1016... 
1017... 
26 
40 
28 
26 
36 
1018... 
1019... 
Oct. 5 
Sept. 17 
Oct. 3 
Aug. 18 
INTERMITTENT FEVER. 
COLD STAGE (CHILL). 
HOT STAGE (FEVER). Intermittent Fever: Hot Stage. 
833 
No. of Case. 
Date. 
Hour 
of 
Day. 
State of Intellect, Skin, Tongue, Pulse, 
Respiration, Etc. 
Pulse 
1 
Respiration 
Temperature of 
atmosphere 
Temperature of 
hand 
Temperature un- 
der tongue 
Characters of Urine. 
1020... 
Sept. 11 
1856. 
Sept. 12 
Sept. 7 
Tongue slightly furred, not redder than normal; no 
tenderness of epigastrium; pulse full. 
Tongue moist and slightly furred; reaction of saliva 
acid; skin hot. 
Skin warm and moist; tongue slightly coated; no 
pain upon pressure of epigastrium. 
Skin hot, and dry; pulse full; saliva acid. 
Skin hot and dry; tongue red at tip, but moist and 
soft; pulse full and strong. 
skin hot and dry; tongue dry; papillae enlarged; 
tongue covered with thick yellow fur. 
116 
30 
80.0° 
102.5° 
103.0° 
Deep orange; sp. gr. 1818; reaction strongly acid; 
no deposit after 70 hours. 
Orange colored: sp.gr. 1022. 
Deep orange colored; sp. gr. 1020.8; after stand- 
ing 39 hours, small deposit of urate of soda. 
100 
24 
82.0 
102.1 
103.9 
1021... 
108 
24 
82.0 
103.7 
105.0 
1022... 
108 
28 
85.0 
101.0 
105.0 
J 021 
Oct. 3 
100 
26 
77.6 
106. 
Reaction strongly acid; no deposit after stand- 
ing several days. 
Deep orange color; after standing several days, 
slight deposit of mucus and vegetable cells. 
1021... 
July 8 
80 
82.0 
105.0 
106 0 
1025... 
Sept. 30 
1856. 
Ooi. 3 
1PM 
Skin cool and relaxed; pulse soft; tongue clean and 
moist; red at tip and edges; papillae enlarged, and 
of a bright red color; reaction of saliva decidedly 
acid. This intermission was followed by high 
fever. 
Tongue clean and moist, only a shade redder than 
normal; papillae still enlarged and distinct; saliva 
acid. 
Tongue clean, moist and soft; papillae only a shade 
redder than normal; saliva acid. 
Tongue and skin normal; saliva slightly acid; dur- 
ing the height Of the fever, it was intensely acid. 
High fever three days ago. 
Tongue clean and normal. Two days ago had high 
fever. 
Do. do. do. 
70 
62 
22 
20 
68.0° 
74.0 
92.0° 
96.0 
99.5° 
98.5 
Reaction of urine strongly acid; sp, gr. 1008; 
after standing 48 hours, a light deposit of 
vegetable cells, but no salts; orange colored. 
Urine normal in color; sp. er. 1010; reaction 
slightly acid; in 20 hours changed toalkaline, 
and threw down a heavy deposit; of phos- 
phates and urate of soda. 
Color normal; sp.gr. 1018; changed from acid to 
alkaline in 8 hours, and let fall a heavy pre- 
cipitate of urates and phosphates. 
Sp. gr. 1012; color normal; alkaline reaction, 
and heavy deposit of phosphates and urates 
in 12 hours. • 
Normal color; sp. gr. 1030; reaction alkaline in 
J6 hours, and heavy light-yellow deposit of 
urates and phosphates 
Alkaline reaction, and heavy deposit in 14 
hours. 
Sp. gr. 1009; alkaline, and heavy deposit In 16 
hours. 
Sp. gr. 1021; alkaline,2 and heavy deposit in 20 
hours. 
Oct. 
4 
60 
20 
72.0 
96.0 
99.5 
1026... 
Oct. 
13 
68 
16 
78.0 
98.0 
99.0 
1027... 
Oct. 
7 
64 
20 
73.0 
94.5 
99.0 
99.5 
Oct. 
8 
52 
24 
17.5 
24 
73.0 
98.2 
1028... 
Auer 
21 
Two days before had high fever. Tongue and skin 
moist. 
Had fever on the preceding day, Tongue and skin 
moist. 
72 
80.0 
96.0 
98.0 
1029... 
Sent. 14 
65 
85.0 
96.0 
98.0 
INTERMITTENT FEVER-Continued. 
HOT STAGG (FEVER)-Continued. 
INTERMISSION. 834 
Remittent Fever: Cold Stage. 
No. of Case. 
Date. 
Hour 
of 
Day. 
State of Intellect, Skin, Tongue, Pulse, 
Respiration, Etc. 
Pulse. 
Respiration. 
1 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature un- 
der tongue. 
Characters of Urine. 
1030... 
Oct. 9 
Pulse very feeble, resembles the vibrations of a fine 
thread, with difficulty counted; respiration accel- 
erated and irregular; lips and fingers blue, reac- 
tion of saliva intensely acid; extremities cold; 
tongue dry and red. 
?2 
75.0° 
83.0° 
101.5° 
High colored, like new Madeira'wine; sp. gr. 
1022; strongly acid; amount of iron increased; 
no deposit after 60 hours. 
1031... 
Oct. 6 
Respiration rapid, thoracic, panting; extremities 
cold; tongue dry, red and rough; saliva strongly 
acid. 
no 
45 
70.0 
97.0 
104.0 
High colored, dark brownish red; strongly 
acid; sp. gr. 1020; iron increased; no deposit 
after 70 hours. 
1032... 
Sept. 10 
7pm 
Tongue pointed and red at tip and edges, superior 
90 
48 
80.0° 
103.0° 
105.0° 
High colored, like new Madeira Wine; sp.gr. 
1856, 
portion coated with black fur, dry and rough; skin 
hot, dry and rough; great thirst, and pain in head; 
1020; iron increased. 
Sept. 11 
reaction of saliva strongly acid; pulse full. 
11AM 
Tongue red, dry and glazed; skin dry, hot and harsh; 
88 
34-40 
82.0 
103.2 
105.0 
Reaction strongly acid; after standing 48 hours 
no pain of epigastrium; intellect dull; face as red 
threw down a small deposit of regularly 
1033... 
Oct. 15 
7PM 
cis scai let. 
Do. do. do. 
90 
40-44 
81.0 
104.0 
104.8 
formed crystals of triple phosphates. 
Do. do. do. 
Oct. 15 
12 M 
Lips and tongue dry, red and rough; epigastrium 
very tender upon pressure; skin dry and hot; pulse 
rather feeble; respiration full and irregular; intel- 
106 
30-40 
74.0 
101.0 
105.0 
Urine high colored, of a deep brownish red 
color; sp. gr. 1028; strongly acid. 
1034... 
lect dull; saliva strongly acid. 
Intellect torpid; aroused with difficulty; apex of 
90 
30 
74.0 
105.0 
106.0 
Deep orange color; strongly acid; sp. gr. 1020; 
1035... 
Sept. 16 
tongue, for about half an inch, clean, red and dry; 
the remainder of the tongue is coated with rough, 
dry, brownish'-black and yellow fur; no tenderness 
of epigastrium; skin hot, dry and rough. 
* 
no deposit after 60 hours; still acid.* 
7 PM 
Face as red as scarlet; lies in a stupor; skin in a pro- 
too 
24 
88.0 
102.0 
103.2 
Unusual secretion of urine; the amount much 
fuse perspiration; tip and middle of tongue clean, 
larger than usual in remittent fever; specific 
Sept. 18 
and of a bright red color; root of tongue coated 
with yellow fur; tongue rough and perfectly dry; 
when the finger is passed over the longue, it, feels 
as dry and as rough as a board; great tenderness 
upon pressure of epigastrium. 
gravity correspondingly diminished; orange 
colored: sp. gr. 1008; strongly acid; no de- 
posit. 
12 M 
Tongue presents the same appearance; continues in 
a stupor; pulse feeble. 
98 
32 
87.0 
103.0 
104.0 
Light straw colored; sp. gr. 1010; reaction 
strongly acid. 
REMITTENT ' FEVER. 
COLD STAGE (CHILL). 
HOT STAGE (FEVER). Remittent Fever: Hot Stage. 
835 
No. of Case. 
Date 
Houk 
of 
Day. 
State of Intellect, Skin, Tongue, Pulse, 
Respiration, Etc. 
■ 
> Pulse. 
i Respiration. 
Temperature of 
atmosphere. 
' Temperature of 
1 hand. 
Temperature un- 
der tongue. 
CHARAbTEKS OF UkINE. 
AUg. 7 
11 AM 
Skin hot, but in a profuse perspiration; tongue coat- 
ed with yellow fur, dry and rough; lies in a stupor. 
112 
38 
81.0° 
3.0° 
104.0° 
Reddish-brangb colored ; Sp. gr. 10? 3; reaction 
strongly acid. 
1036... 
Aug. 11 
10 A M 
Continues stupid, and almost insensible; passes 
urine and feeces in bed; body has a peculiar, dis- 
agreeable smell; tongue coated and dry. 
132 
47 
80.0 
101.0 
105.0 
Urine normal in color; sp. gr. 1011.3 
1037... 
Sept. 12 
12 
M 
Tongue very red, but softer and moister than during 
70 
26-36 
83.0 
100.7 
102.5 
Urine high colored, brownish-red; sp. gr. 1019; 
Sept. 12 
9 
P M 
the fever; the dry, yellow and brown fur has com- 
menced to clean off; slight tenderness of epigas- 
trium. 
Skin moist and relaxed; tongue softer and not so 
70 
53 
83.0 
99 1 
101.5 
reaction decidedly acid; after 48 hours, small 
deposit of vegetable cells, urate of soda, and 
triple phosphate. 
Brownish-red: sp. gr. 1020; strongly acid. 
Sept. 13 
11 
A M 
red; pulse regular and soft. 
Tongue continues to improve. 
52 
48 
85.0 
97.0 
100.0 
Orange colored, sp. gr. 1024; reaction alkaline; 
heavy deposit of the urates and phosphates 
in 15 hours. 
Orange colored; sp. gr. 1025; reaction alkaline; 
Sept. 14 
1 
P M 
Tongue and skin normal. 
58 
28 
87.0 
99.0 
102.0 
1038... 
Oct. 16 
Intellect restored; tongue red, but soft and moist; 
skin dry, but soft; saliva strongly acid. 
Tongue moister and softer, not so red as in fever; 
84 
16 
69.5 
99.0 
99.5 
heavy deposit of urates and phosphates in )5 
hours. 
Deep orange red; strongly acid; after standing 
1039... 
Oct. 16 
12 
M 
75 
20 
70.0 
101.3 
101.5 
15 hours, slight deposit of mucus corpuscles; 
after 100 hours, small light yellow deposit of 
mucus corpuscles, urate of ammonia and 
vegetable cells. 
Bright red color; sp. gr. 1020; after standing 
posterior portion still coated with brownish- 
yellow fur. 
15 hours, slight deposit of urates and phos- 
phates 
1040... 
Sept. 16 
8 
P M 
Skin cool, moist and relaxed; tongue soft and moist, 
but slightly redder than normal. 
47 
28 
24 
87.0 ' 
95.9 
99.0 
Shade higher colored than normal; after 12 
hours, heavy deposit of urates and phos- 
phates; sp. gr. 1019. 
Sept. 17 
11 
AM 
Do. do. do. 
44 
84.0 
96.0 
99.0 
Reaction alkaline in 16 hours, with heavy de- 
86.0 
posit of urates and phosphates; sp.gr. 1018. 
Sept. 18 
12 
M 
Pulse, skin and tongue normal. 
44 
: 24 
96.2 
99.0 
Color normal; great increase of uric acid; in 8 
hours, heavy deposit of urates and phos- 
phates ; sp. gr. 1020. 
Remittent fever-Continued. 
HOT STAGE (FEVER)-Continued. 
REMISSION. 
INTERMISSION. 836 
Congestive Fever. 
No. of Case. 
Date. 
Hour 
of 
Day. 
State of Intellect, Skin. Tongue, Pulse, 
Respiration, Etc. 
Pulse. 
Respiration. 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Characters of Urine. 
Sept. 19 
12 M 
12 M 
Pulse, skin and tongue normal. 
44 
24 
88.0° 
97.0° 
99.0° 
Color normal; great increase of uric acid; in 8 
hours, heavy deposit of urates and phos- 
phates ; sp. gr. 10-0. 
Do. do. do. 
Sept. 2-2 
Do. do. do. 
44 
24 
84.0 
97.8 
89.1 
1041... 
Oct. 17 
12 M 
Tongue red, but clean and soft; saliva acid. 
70 
16 
67.0 
97.3 
98.5 
Deep red color; sp. gr. 1022. 
1012... 
Oct. 17 
11 PM 
1 ip of tongue clean, sup. portion coated with fur. 
68 
18 
6S.0 
97.0 
99.5 
Deep O'anse color; sp. gr. 10'2. 
1013... 
< >ct. 8 
12 M 
Tongue soft and moist; s diva acid. 
54 
18 
68.0 
96.0 
99 0 
Only a shade higher than normal; s. g, 1020. 
1044... 
Sept. 30 
11AM 
Tongue red, but soft; intellect restored. 
68 
22 
80.0 
95.5 
97.0 
Oct. 1 
11 AM 
Do. do. do. 
66 
20 
71.0 
95.0 
99.1 
Orange colored; sp.gr, 1013. 
1045... 
Oct. 17 
1856 
11 
A 
M 
1 
Intellect wandering; tongue dry, hard and rough, 
and coated with dry, brownish-yellow fur; 
124 
28 
Clear amber colored; sp. gr. 1015; reaction 
strongly acid; after standing 60 hours, the 
Oct. 18 
11 
M 
pulse very feeble; skin cool upon trunk and 
extremities. 
Intellect wandering; tongue continues still as $ry 
and as rough as a board; pulse exceedingly feeble; 
trunk and head cool; skin covered with cold, 
clammy sweat; saliva strongly acid ; respiration 
spasmodic; teeth coated with sordes. 
Do. do. do. 
155 
34 
reaction was still decidedly acid. 
The urine contained no urea, and no uric acid. 
Oct. 18 
9i 
1 
p 
M 
135 
32 
After 90 hours, no deposit. 
Urine light col'd, sp. gr. 1020; urea and uricacid 
greatly diminished: reaction strongly acid. 
Urine;'orange colored, several shades .higher 
than in health, but much less highly colored 
than usual in severe cases of Malarial Fever; 
sp gr. 1009; contained no uric a gid. 
Do. do. do. 
Do, do. do- 
1016... 
Oct. 10 
p 
M 
Tongue perfectly dry and rough, feels like sand- 
paper; bright red color. 
Severe vomiting and purgation; skin of head and 
extremities bathed in cold clammy sweat. 
Severe pain in head ; tongue thickly coated with 
yellow and black fur, tip and edges clean, and of a 
scarlet color; dry and rough. 
Do. do. do. 
Do. do. do. 
Pulse very feeble; skin of trunk and head cool; 
tongue dry, rough and coated. 
Do. do. do. 
Do. do. do. 
130 
94 
46 
22 
68.5° 
71.0 
80.0. 
81.0 
78.0 
71.0 
87.0 
100.0° 
79.0 
89.0 
99.0 
89.0 
95.5 
98.0 
90.0 
106.0° 
97.0 
97-0 
104.0 
96.0 
98.0 
98.5 
1Q47... 
1048... 
Aug. 21 
Aug. 22 
A ug. 29 
Aug. 26 
Aug. 27 
1 
12 
12 
12 
12 
7 
p 11 
M 
M 
M 
M 
P M 
92 
112 
72 
120 
120 
39 
52 
34 
22 
24 
40 
REMITTENT FEVER-Continue*. 
INTERMISSION-Continued. 
CONGESTIVE FEVER. Congestive Fever. 
837 
No. of Case. 
Date. 
Hour 
of 
Day. 
State of Intellect, Skin, Tongue, Pulse, 
Respiration, Etc. 
Pulse. 
Respiration 
Temperature of 
atmosphere. 
Temperature of 
hand. 
Temperature 
under tongue. 
Characters of Urine. 
1049... 
1050... 
1051... 
Sept. 29 
1856. 
11 A M 
7pm 
2i p m 
2pm 
2pm 
2pm 
4PM 
12 M 
3i p m 
12 M 
10 A M 
10 A M 
Tongue slightly coated ■with yellow fur, dry and 
harsh to the feeling; intellect stupid; pulse very 
feeble, with difficulty counted. 
Do. do. do. 
Do. do. do. 
Restless and stupid; tongue the same. 
Do. do. do. 
Restless and stupid; skin hot, dry and rough. 
Do. do. do. 
Tongue red, dry and rough; skin of extremities and 
trunk cold. 
Lies with mouth and eyes open, and is insensible; 
skin in a profuseperspiration. 
Skin covered with a clammy sweat, resembling 
bloody serum ; passes urine and fteces in bed. 
Lies in a stupor, and emits a barking sound; muscles 
of body twitching violently. 
Do. do. do. 
Lies in profound stupor; great tenderness of epigas- 
trium ; skin dry aud rough. 
Intellect wandeiing; pulse feeble; tip of tongue 
clean and of a bright red color, the remaining por- 
tion coated with yellow fur, dry, rough and harsh 
as sand-paper. 
Do. do. do. • 
Intellect wandering; delirious aud violent; tougue 
coated and dry; pulse feeble; respiration thoracic; 
skin dry. 
Do. skin in a profuse perspiration. 
Do. do. do. 
112 
140 
112 
100 
120 
118 
130 
140 
128 
106 
144 
140 
140 
137 
144 
140 
130 
120 
18 
34 
17 
16 
24 
24 
28 
28 
33 
26 
42 
38 
40 
82 
30 
36 
36 
32 
■ 
80.0° 
95.1° 
7.0° 
Bright red color; sp.gr. 1016; strongly acid. 
Do. do. do. 
Do. do. do. 
Do. do. do. 
Do. do. do. 
Do. do. do. 
• 
)• Could not be determined on account of rest- 
lessness aud stupor of the patient. 
Sept. 30 
Oct. 1 
Oct. 4 
Oct. 5 
Oct. 10 
Sept. 3 
73.0 
79.0 
76.0 
73.0 
70.0 
75.0 
78.0 
81.0 
79.0 
80.0 
70.0 
91.0 
88.5 
100.5 
100.0 
103.7 
94.5 
101.0 
100.0 
103.0 
105.0 
104.0 
96 
94.5 
104.0 
104.5 
99.0 
102.0 
10! .0 
104.0 
106.0 
104.5 
Sept. 4 
Sept. 5 
Sept. 6 
1052... 
1053... 
Oct. 12 
Oct. 13 
Sept. 3 
Sept. 3 
Sept. 3 
12 M 
11 A M 
12 M 
3pm 
7pm 
77.0 
75.0 
80.0 
76.0 
103 5 
102.0 
98.0 
94.0 
104.5 
104.0 
99.0 
98.0 
CONGESTIVE EEVEE-Cont^Ved. 838 
General Conclusions concerning Malarial Fever. 
GENERAL CONCLUSIONS FROM PRECEDING INVESTIGATIONS IN RELATION TO- 
THE CHANGES OF THE CIRCULATION, RESPIRATION AND TEMPERATURE 
IN MALARIAL FEVER. 
Intermittent fever.-During the cold stage (chill), there is a rapid, fee* 
ble pulse, rapid respiration, and hot trunk and cold extremities-the tem- 
perature of the extremities is reduced far below that of the trunk, and 
even below the standard of health, because the circulation of the blood in 
the peripheral capillaries is to a great extent arrested, apparently by the 
contraction of the unstriped muscular tissue of the walls of the ultimate 
arterioles. The diminution of the capillary circulation and the reduction 
of the temperature of the extremities precede the aberrated nervous and 
muscular phenomena denominated chill. This fact corresponds with the 
changes in the constituents of the blood, and indicates that the first phe- 
nomena of the cold stage are connected with derangements of the vaso- 
motor system of nerves. As a general rule, the higher the temperature of 
the trunk during the cold stage, the more rapid will be the equalization of 
the circulation and temperature. The severity of the fever (animal tem- 
perature), which often reaches in the hot stage 107° F., is by no means an 
index of the character and seventy of the subsequent effects. As a gen- 
eral rule, the higher the temperature (within, of course, certain defined 
limits, not exceeding 102° and 107. °5 F.,) the more readily does the attack 
yield to treatment. The changes of the temperature in intermittent fever 
are characterized by abrupt elevations and depressions, so that when the 
cases are projected upon a chart, they differ in the rapidity of the eleva- 
tions and depressions from those furnished by yellow fever, typhus and 
typhoid fever and other diseases, the phlegmasia, phthisis, hospital gan- 
grene and pyaemia. 
Remittent Fever.-The phenomena of the cold stage preceding the hot 
stage of remittent fever, are similar to those of intermittent fever; the 
difference is one of degree, and not of kind; the phenomena of the cold 
stage of remittent fever are more protracted than those of intermittent- 
fever; the sympathetic system does not so rapidly regain its normal action^ 
and the circulation in the capillaries of the extremities is not so rapidly 
restored in remittent as in intermittent fever. The alterations of the blood 
are more profound in remittent than in intermittent fever, and therefore it 
results that the cold stage is more prolonged in remittent than in intermit- 
tent fever. The elevation of temperature corresponds more accurately 
with the increased action of the circulatory and respiratory system in 
intermittent than remittent fever. Remittent fever may be distinguished 
from typhoid fever by the greater and more sudden elevations and depres- 
sions of temperature. 
Congestive or Pernicious Fever.-The complete prostration of the mus- 
cular and nervous forces, the reduction of animal temperature, both in the 
trunk and extremities, the cold, clammy sweat, the rapid feeble pulse, the 
rapid, thumping action of the heart, and the sudden intervention of the 
most alarming cerebral symptoms, may occur gradually or suddenly, in 
either intermittent or remittent fever, and may be induced by several dis- 
tinct causes, acting singly or in conjunction. There is a want of co-ordi- 
nation between the circulation, respiration and animal temperature in con- 
gestive fever. The respirations are full, accelerated, and often panting 
and heaving, varying from thirty to fifty per minute, the pulse beats from 
120 to 160, and feels like a delicate thread, and is often so small that it can- 
not be counted; the heart thumps irregularly and spasmodically and 
rapidly, against the walls of the chest as in some cases of narcotic poison- 
ing; the circulation in the capillaries is feeble; the temperature of the trunk,. Symphographic Tracings of the Pulse in Malarial Fever. 
839 
notwithstanding the full, rapid respiration, sinks below the normal stand- 
ard, and the surface is covered with cold, clammy sweat. 
SYMPHOGRAPHIC TRACING OF THE PULSE IN MALARIAL FEVER. 
The pulse in malarial fever is subject to greater variations than in any 
other febrile disease. Thus in a single paroxysm of not more than twenty- 
four hours, the pulse may vary from the rapid thread-like beat of the cold 
stage to the full and bounding, rapid pulse of the hot stage; the pulse of 
remittent fever approaches in its frequency and in its diurnal variations 
the rapid pulse of typhus and typhoid fevers; and the pulse in the pro- 
tracted and neglected remittents (typhoid stage of remittent fever) may 
present all the feeble and irregular undulations of abdominal typhus. 
These peculiarities of the pulse in febrile diseases have been well illus- 
trated by the tracings of the symphograph, as shown in the following 
engraving, No. 80: 
ENGRAVING NO. 80. 
Symphographic Tracings of the Pulse. 
FIG. 4- FIRMIAND LONG PULSE OF VIGOROUS HEALTH 
FIG.5 NORMAL SOFT PULSE 
FIG. G SOFT AND FREQUENT PULSE OF MILD 'PYREX A 
OFTEN PRESENT INEARLV STAGE OF TYPHUS 
FIG. 7 IRREGULAR PULSE OF IRRATATIVE FEVER 
FIG. 8 IRREGULAR UNDULATORY PULSE OF 
TYPHUS FEVER 
Engraving No. 80.-Symphographic Tracings of the Pulse in Health and Disease, after San 
Person. 
In most fevers the temperature is more readily and rapidly affected 
than either the pulse or respiration, and the increase or variations are per- 
sistent as long as the fever lasts. But in malarial fever, on the other hand, 
we have the most sudden and the greatest variations of the pulse in the 
shortest periods of time; and whilst the temperature also in many cases 
exhibits the corresponding changes, in other cases, however, as those of 
algid fever, there is no rise of temperature corresponding to the increment 
in the rate of the pulse. The poison of malarial fever appears in such 
cases to depress the liberation of animal heat. This want of co-ordination 
between the pulse and temperature must be referred to several causes, as: 
(a.) derangement in the normal chemical changes of the blood and organs; 840 
Comparison between Malarial Hcematuria and Yellow Fever. 
(b.) diminution of the calibre of the arteries from an impression upon 
the vaso-motor system; (c.) congestion of certain organs; (d.) embarrassed 
action of the heart; (e.) toxic effects of the malarial poison upon those 
centres of the nervous system which preside over the development of ani- 
mal heat. 
i he general rule expressing the correlation of pulse and temperature, 
namely: An increase of temperature of one degree above 98° corresponds 
with an increase of about eight beats of the pulse per minute, does not hold 
good with reference to certain forms of pernicious malarial fever. In some 
Cases of malaiial fever a high temperature is found with a comparatively 
low pulse, and a low temperature with a high or rising pulse in other cases. 
Upon a careful comparison of the main features of malarial biematu 
ria, with those of yellow fever, the following points may be noted : 
(a.) In the last stages, after the supervention of jaundice and urinary 
suppression, many cases of malarial haematuria bear a striking resemblance 
to yellow fever in the period of calm, depression of circulation and black 
vomit. The vomited matters, however, in malarial haematuria contain 
bile, and the dark color is due to bile, rather than to blood. 
(b.) Important differences are revealed by the microscope between 
the organic and organized elements in the urine of these diseases; in yel- 
lowfever, the casts of the tubuli uriniferi are filled with yellow granular 
matter and oil globules; in malarial haematuria, the tubuli uriniferi in many 
cases present a dark brownish-red color, and contain dark pigmentary 
matter, and altered colored corpuscles, in addition to the yellow granular 
matter. 
(c.) After death from malarial haematuria, the fibres of the heart pre- 
sent under the microscope a normal appearance, the transverse striae being 
distinct, and the oil globules and yellow granular matter characteristic of 
yellow fever, being in most cases absent. When no preceding lesions have 
existed, the heart of malarial fever, and of malarial haematuria, presents 
a firm structure, wholly different from the softened, altered and flabby 
yellow heart of yellow fever. 
(d.) There is less congestion of the mucous membrane of the stomach 
and it is almost uniformly discolored by bile in malarial haematuria. Bile 
is absent from the contents of the stomach in yellow fever. Bile is univer- 
sally present in the stomach of malarial haematuria. 
(e.) The heart, liver and spleen in malarial haematuria present the 
same structure, and the same microscopical and chemical characteristics as 
in the various forms of paroxysmal malarial fever. In malar ial fever, the 
spleen and liver are loaded with dark pigmentary particles; in yellow fever 
the former organ is without any special increment of pigmentary particles, 
and the latter is of a yellow color, and loaded with oil globules and yellow 
granular matter. When yellow fever supervenes in malarial fever, both 
the dark pigment particles, and the oil globules and yellow granular mat- 
ter are found in the liver, and this organ presents a deeper color and more 
mottled appearance than in uncomplicated yellow fever. The gall-blad- 
der contains much more bile in malarial fever than in yellow fever, and 
this liquid is absent from the stomach and alimentary canal in yellowfever, 
but is universally present in malarial fever in all its forms. 
(f.) When in malarial haematuria the congestion of the kidneys, is so 
great, and the structural alterations so profound as to cause urinary sup- 
pression, then another distinct train of phenomena is set up, which has 
much in common with the analogous condition in yellow fever when th® 
function of the kidney is suspended. 
COMPARISON BETWEEN MALARIAL HAEMATURIA AND YELLOW FEVER. CHAPTER VI. 
PATHOLOGICAL ANATOMY OF MALARIAL FEVER. 
changes of the organs and tissues, and apparatus oe the bodies of 
THOSE WHO HAVE DIED WITH THE DIFFERENT TYPES OF MALARIAL FEVE R, 
INTERMITTENT, remutent, and congestive-comparison OF THESE 
CHANGES vviTh THE PHENOMENA OF MALARIAL FEVER, AND WITH SIMILAR 
CHANGES IN OTHER DISEASES, AND UI1H THE ORGANS, TISSUES, AND APPA- 
RATUS OF MEN AND ANIMALS IN THE NORMAL CONDITION. 
Exterior skin-Muscular system. Head-dura-mater, arachnoid membrane, pia-mater, cerebrum, 
cerebellum, medulla oblongata, ventricles of brain, etc. Nervous phenomena of fever, compared 
with post-mortem examinations. Chest-Lungs, heart. A limentary and intes inal canal--Mouth, 
tongue, oesophagus, stomach, duodenum, jejunum, ileum, colon, rectum, glands of Peyer, solitary 
glands. Liver-Slate and bronze color of liver; changes of blood of liver; malarial liver conains 
! animal starch, but no hepa'ic sugar; bile. Spleen-Slate color of spleen; pulp of spleen; alterations 
' of structure. Kidneys-Suprarenal capsules. Bladder. 
Pathological anatomy ofthe various forms of endemic, paroxysmal, non-contagious malarial 
fever, and of specific contagious yellow fever. Importance of investigating the pathological 
Anatomy of the endemic, epidemic and contagious fevers, of tropical and subtropical countries. 
Data upon which the author baseshis conclusions. Appearance of the exterior of the body in 
fatal cases of malarial fever, and of yellow fever. Pathological anatomy of the cerebro-spinal 
And sympathetic nervous systems in malarial andyellow fever. Difficulties of th-e investigation. 
Value of microscopical and chemical observations. Necessity ot delineating accurately anato- 
mical details by micro-photography. Appearance ot the membranes of the brain after death 
from malarial fever. The opalescent pearl color of the arachnoid membrane in malarial fever, 
■Of little diagnostic value. Observations on t he pathological changes and lesions of the brain and 
spinal cord in acute sthenic cases of malarial fever. Theory of the action of the malarial poison, 
morbific ferment or micro-organism in the cerebro-spinal and sympathetic nervous system. 
Analysis ot the phenomena of malarial chill. Cases illustrating the appearances presented by 
the brain and its membranes in fatal cases of malarial fever. General results of the changes of 
the nervous structures in malarial fever. Deposit of pigment in the brain in certain cases of 
chronic malarial fever. Historical account: Observations ofBailly, Ballard,Bright, Meckel, Fre- 
richsand others, on the pigmentation ofthe brain in chronic malarial disease. Engravings illus- 
trating the deposit of pigment matter and pigment cells in the brain of malarial fever. 
Comparative changes of ihe cerebro-spinal and sympathetic nervous systems in specific yel- 
low fever. Pathological anatomy of the lungs in malarial and yellow fever. Pathological anat- 
omy and microscopical and chemical changes of the heart in malarial and yellow fever. Fatty 
degeneration of the heart in yellow fever. Comparative pathological anatomy of the alimentary 
canal in malarial and yellow fever. Lesions of the stomach and intestinal canal in malarial 
fever. Cases illustrating the condition and appearance of tire stomach and intestines afterdeath 
from malarial fever. Comparative view ofthe pathological changes of the stomach and intes- 
tines in malarial fever, yellow fever and typhoid fever. Engravings illustrating the lesions of 
the .stomach in yellow fever. Engravings illustrai ing. the lesions of the intestines in typhoid 
fever and acute dysentery. Uniformity of the intestinal lesions of typhoid fever, as it prevailed 
in the Confederate army in different portions ofthe Southern States.. Lesions of acute and 
chronic dysenteiy amongst the Confederate troops, 1861-1865. Pathological anatomy of the liver 
in malarial and yellow fever. Anatomy and functions of the human liver. Relative weights of 
the liver in different animals. Weight of the human liver in health and in malarial fever. Gly- 
cogenic function of the liver. Effects of disease upon the glycogenic function ofthe liver. Effects 
of previous diseases, as cirrhosis and fatty degeneration, in modifying the appearance of the liver 
After death from malarial fever. Color of the liver in malarial fever. Deposit of pigment in the 
malarial liver. Acute and chronic parenchymatous hepatitis caused by paroxysmal paludal 
fever. Researches of Professors A. Kelsch and Keiraer of Vai de Grace, upon acute parenchyma- 
tous and chronic nodular parenchymatous malarial hepatitis. Engravings Illustrating the 
pathological anatomy of the liver in malarialand yellow fever. Cases illustrating the patholo- 
gical changes ol the liver in malarial fever. Sources of the changes of color in the liver. Charao- 
ters ot the bile in malarial fever. The liver ot those cases which died in the active stages of mala- 
rial fever, contained animal starch whilst hepatic sugar was absent. Points of difference between 
the malarial fever liver and the yellow fever liver. Comparative pathological anatomy of the 
liver in malarial fever, and in yellow fever. Pigment liver of malarial fever. Hepatitis and 
abscess of the liver due to the action of the malarial poison. Fatty degeneration of the liver in 
specific yellow fever. Pathological anatomy of the spleen in malarial fever. Functions.of the 
spleen. Weight of the spleen in different animals. Relative size of the spleen in health and dis- 
ease. The enlarged spleen of malarial fever. Cases illustrating the pathological changes of the 
spleen in malarial fever. Comparative paihological anatomy of the spleen in malarial, and yel- 
low fever. Deposit of pigment and pigment cells in the malarial spleen. Engravings illustrat- 
ing the pathological changes of the spleen. 842 
Pathological Anatomy of Malarial Fever. 
Comparative pathological anatomy of the kidneys in malarial and yellow fever. Effects of 
the repeated congestions of malarial fever on the structures of the kidneys. Relat ions of malaria 
to the causation of Bright's disease of the kidneys. Interstitial parenchymatous inflammation 
of the renal structures caused by the action of malaria. Researches of Professors Kelseh and 
Kelrner, of Vai de Grace, on the alterations of the renal structures in malarial fever. Pathological, 
anatomy of the kidneys in malarial hsematuria. Presence of blood-corpuscles and blood casts of 
the tubuli uriniferi. Cases illustrating the effects of the malarial poison in inducing albumin- 
uria. Pathological anatom;, of the kidneys in yellow fever. Engravings and plates illustrating 
the comparative pathological anatomy of the kidneys in malarial and yellow fever. 
PATHOLOGICAL ANATOMY OF THE VARIOUS FORMS OF ENDEMIC PAROX- 
YSMAL. NON-CONTAGIOUS MALARIAL FEVER, AND OF SPECIFIC CONTA- 
GIOUS YELLOW FEVER. PULMONARY ABERRATIONS. 
There is no subject of greater importance to the general welfare than 
the accurate determination of the characteristic symptoms and pathological anat- 
omy of the various forms of continued, intermittent, remittent, pernicious and 
yellow fevers. Aside from the inestimable value of such knowledge to the 
physician in furnishing the basis of rational and scientific diagnosis and 
treatment, it enables the experienced pathologist and conscientious guar- 
dian of the public health to distinguish the various forms of paroxysmal, 
non-contagious malarial fever, from specific contagious yellow fever. By 
scientific and thorough attainment in those branches of knowledge which 
relate to the natural history, symptoms and treatment of the various forms 
of fever which prevail in the tropical and temperate regions of the. earth, 
and more especially of North and* South America, the health officers of 
cities exposed to the ravages of specific yellow fever, will be able, upon 
every alarm, to investigate intelligently, and decide accurately as to the 
nature of the disease. It is of the utmost importance that the first case of 
yellow fever, occurring in any city, town, village or habitation, or on 
board any vessel along the Atlantic and Gulf coasts of North, Central, 
South and Insular America, be carefully investigated, accurately diag- 
nosed, and promptly isolated. By vigilance, by scientific investigation 
and firm action on the part of health officials in all cases of suspected con- 
tagion, and of contagious diseases, the public will have timely notice of 
danger; panic, alarm, and the brutal shot-gun quarantine will be avoided.* 
The following observations are based upon a careful examination and 
comparison of the symptoms of more than three thousand cases of mala- 
rial fever; and over 100 post-mortem examinations of the bodies of those 
who had died from the different types of malarial fever, intermittent, 
remittent and congestive; numerous examinations of the bodies of those 
who had died from various diseases, as phthisis pulmonalis, pneumonia, 
* Until the medical profession attains to accurate knowledge concerning the path' dogicai 
and comparative anatomy of the contagious and non-contagious fevers of the Atlantic and Gulf 
Coasts of America, the inhabitants of the shores of Texas, Louisiana, Mississippi, Alabama, 
Florida, Georgia and South Carolina, will be ,'iable at any time, during the months of June, July, 
August, September and October, to a repetition of the alarm of August 31st and September 1st, 
1886, in the town of Biloxi, Mississippi, with reference to cases of fever occurring at Point Cadet. 
(See the Biloxi fever,. New Orleans Medical and Surgical Journal, October, 1886, V. S., vol. Ie, pp. 
273-298.) - That controversies should arise amongst the physicians of the United States of America 
concerning the nature of the so-called 'suspicious crises' of yellmv fever- National Board of Wealth," 
is not singular, when the professional teachers and systematic standard writers and authors, fail 
to make post-mortem examinations, and fail to place in a clear and precise form the comparative 
pathological anatomy of malarial lever and contagious yellow fever. Thus Dr. Austin Flint 
i.n his celebrated "treatise on rhe principles and practice of medicine." teaches his pupils with 
reference to the anatomical characters of intermittent fever-. 'There are no known lesions which 
are characteristic of intermittent fever. In the case in which it proves fatal, irrespective of 
pre-existing diseases or of complications, the spleen is enlarged and softened, but these changes 
occur in other pathological connections. Aside from.more or less congestion of internal organs, 
the lesions which may be found after death, are due to concomitant affections. (Principlesand 
Practice of Medicine, 2d edition, p. 821.) The reader will search in vain for the detailsof original 
pathological investigations relative to the characteristic lesions of malarial and yellow fever by. the 
author of the articles on malarial fever and yellow lever, in A System of Practical Medicine by. 
American authors, edited by William Pepper, M.D., LL. D„ Phila.. 1885, vol. 1, p. 589-640. A sim- 
ilar remark applies to malaria and malarial diseases. Wood's Library of Standard Medical' 
Authors, New York, 1884. Pathological Anatomy of Malarial Fever.. 
843 
pleurisy, dysentery, diarrhoea, cirrhosis of the liver, fatty degeneration of 
the liver, dropsy, haemorrhage, apoplexy, cancer, intemperance, scarlet 
fever, diabetes, Bright's disease, enlargement of the lymphatic glands,, 
typhoid fever, and yellow fever, and upon the careful dissection and micro- 
scopical examination of the organs, tissues, and apparatus of several hun- 
dred fishes, reptiles, birds, and mammalia. 
APPEARANCE OF THE EXTERIOR OF THE BODY-IN FATAL CASES OF MALA- 
RIAL FEVER. 
Exterior.-In the severe cases of malarial fever, which terminate in a 
short time, the muscular system, and the fat surrounding the muscles, did 
notappear reduced to any great extent. In cases of long standing, espe- 
cially those which had been neglected, there was great loss of flesh and 
fat, and the body and limbs presented an emaciated appearance, unless the 
tissues were intiltrated with serum. As a general rule the cadaverous 
rigidity was well marked. In many cases the surface presented a sallow 
hue ; and in one violent case of congestive fever, several hours before 
death, as the patient lay in a profound stupor, the whole surface assumed 
a golden yellow color, similar to that of the serum which issued from a 
blistered surface over his epigastrium. In the majority of cases, the color 
of the skin of the superior parts, after death, presented a pale, bloodless 
appearance; whilst the skin of the inferior (dependent) portions presented 
a mottled purplish color. This dark purplish color of the dependent parts, 
gradually diminished towards the superior uppermost parts of the body in 
the recumbent posture, and appeared in every instance to have been due 
to the gradual settling of the blood in the capillaries of the most depend- 
ent parts towards the close of life, when the general and capillary circula- 
tions were feeble. For this reason the lips and gums were almost always 
pale, and almost white. The lungs, and liver, and kidneys, and intes- 
tines, and stomach, and brain in many, if not in every case, presented sim- 
ilar evidences of the gradual settling of the blood in the vessels and capil- 
laries of the most dependent parts towards the close of life, when the 
feeble circulation was readily overcome by the force of gravitation. If 
stimulants and sinapisms had been freely used in the last hours., the set- 
tling of the blood in the most dependent parts was not so marked. 
The general appearance of those who die from the effects of malarial 
fever, will depend upon the nature and length of time and the effects of 
the disease. When stout, healthy men are suddenly destroyed by perni- 
cious malarial fever, the body may present the fullness of health; and in 
such cases the superior portions of the body may, as in yellow fever, pre- 
sent a golden yellow color, whilst the dependent portions present a pur- 
plish and mottled appearance. The jaundice and mottling of the skin, 
however, as a general rule, present to a less degree than in yellow 
fever. In cases of protracted bilious fever, the body is frequently greatly 
emaciated. In chronic malarial poisoning, attended with enlargement of 
the spleen and cirrhosis of the liver, the belly and body and limbs gener- 
ally are distended with dropsical effusion. The cut surface of the muscles 
presents a purplish hue, and the change to the arterial hue, upon exposure 
to the atmotphere, is much slower and less perfect than in yellow fever. 
The following facts should be noted with reference to 844 
Pathological Anatomy of Malarial Fever. 
APPEARANCE OF THE EXTERIOR OF THE BODY IN FATAL CASES OF YELLOW 
FEVER. 
Exterior.-Generally full and not reduced in flesh; features may even 
present a swollen, bloated aspect. Skin of face and upper portions of 
trunk of a golden yellow color. Dependent portions of body of a mottled, 
purplish and yellow ecchymosed appearance. Black vomit frequently 
•oozes from the corners of the mouth, and trickles down the face and neck. 
When the muscles are cut, a large quantity of dark blood escapes, which, 
upon exposure to the atmosphere, changes to a bright scarlet hue. Putre- 
factive changes take place rapidly after death. In some cases of yellow 
fever, especially when the functions of the kidneys have been arrested for 
some time before death, the putrefactive changes take place with great 
rapidity and energy, and sometimes even appear to commence before death, 
the body exhaling a disagreeable odor. 
pathological anatomy of the cerebrospinal and sympathetic 
NERVOUS SYSTEMS IN MALARIAL FEVER AND IN YELLOW FEVER. 
The relations of disease to the nervous system is a subject of the great- 
est importance and interest to the physician; and the study of the nervous 
centres has strongly attracted the anatomist. It is natural that the physio- 
logist, pathologist and physician should desire to penetrate the inmost 
secrets of the organization. There is an unconscious attraction which 
draws the human mind towards the unexplored regions of the unknown. 
In all ages philosophers have sought to tread those mysterious realms, 
where the living forces of all our mental activities are silently elaborated, 
and where the solution of those eternal prob'ems regarding the relations of 
the physical organization of the living being to the acts of the psychic and 
intellectual life, evade the scalpel of the anatomist, the alembic of the 
chemist, the microscope of the physiologist, and the highest and noblest 
efforts of the physician. The great anatomists and physicians, Galen, 
Varolius, Willis, Malpighi, Vieussens, Vic d'Azyc, Sommoring, Beil, 
Hoffman, Boerhaave, Cullen, Stoll, Frank, Clutterbuck, Bayer, and others 
have successively, from century to century, described the structure of the 
nervous system and dwelt upon its relations to disease. In dealing with 
the vast subject of the relations of the nervous system to the phenomena 
•of febrile diseases, and more especially of yellow and malarial fevers; the 
substance of the brain and spinal cord is so fragile and easily alterable, 
that the physician and pathologist is forced to perform his post-mortems 
nt the earliest practicable moment after death, and also to depend upon 
the different methods placed at his disposal by the arts and sciences of his 
own epoch. Hence the smallest technical discoveries, (as for example the 
preservative powers of chromic acid,} frequently become of inestimable 
value: while on the other hand the perfecting of the magnifying power of 
the microscope has been of immense service. The discoveries of the pres- 
ent century have permitted the intellect of man to advance into unexplored 
regions, where it stands face to face with those ultimate anatomical units, 
the nerve cells, of which our predecessors scarcely caught a glimpse: and it 
is now possible to give exact descriptions of their configuration, whether 
we study their connections, their minute structures or the different patho- 
logical deviations they may undergo. By means of the microscope and the 
reagentsand methods furnished by modern science such investigators aa 
J. Luys, physician to the hospital Salpetriere of Paris, have been able to 
penetrate farther into the still unexplored regions of the nervous centres, Pathological Anatomy of Malarial Fever. 
845 
and like travellers returned, from distant lands, to bring back correct views and 
faithful representations of certain territories of which our predecessors caught 
scarcely a glimpse. 
The thorough investigation of the changes induced by febrile poisons 
upon the nervous structures invites the careful dissection and microscopi- 
cal and chemical examination of the blood, blood-vessels and structures of 
the encephalo-spino-neural system, and the organic or sympathetic system. 
As pathology advances, the physiologist and physician will no longer 
be content with a general description of the appearance of the membranes 
of the brain, of the gray matter ami white substance of the cerebrum, cere- 
bellum and medulla spinalis and spinal cord. The highest powers of the 
microscope must be used to reveal if possible the earliest changes in the 
molecular grouping of the component elements of the gray and white mat- 
ter. Thin slices of the nervous tissue must be made and subjected 
to the necessary process for their proper coloration and preservation. 
The employment of suitable re agents which testing in some degree, the 
special sensibility of each histological element, colors it in a particular 
manner, and thus sets in relief the peculiarities of its structure. The 
demands of science go farther; it is not sufficient that the observer sees for 
himself the new facts observed in his researches; it is necessary to make 
others see the details of nature, and thus place the newly registered facts 
beyond dispute. Even the most skillful artist who portrays by means of 
his pencil the complicated structures of the brain under the microscope, 
may fail to express accurately and intelligently the nature and relations of 
( minute details. The sensitive plate of the photographer has, within our 
day, ; ,eded the artist's brush and pencil, and has become the imper- 
sonal and automatic register and portrayer of the most minute details of 
anatomical structures. By the use of these means of investigations which 
the scientific methods of the nineteenth century have placed within the 
reach of this generation, may the pathologist of the present day and of 
the future hope to connect many of the phenomena of fever with recog- 
nizable lesions of the ultimate elements of the nervous structures. 
This investigation is beset with difficulties, and we must look to the 
future labors of pathologists, microscopists and chemists working together, 
as a band of brothers, amicably sharing the labors and portioning out the 
different subjects; and thus by comprehensive and united effort extending 
our knowledge to the utmost bounds. It must, however, be borne in mind 
that as fast as new discoveries are registered new problems incessantly 
start up. Thus by means of high power's the histological elements of the 
nerve cell, hitherto considered as the primoidal and irreducible units of 
the system, become themselves divisible into secondary elements. Photo- 
chemical histology has demonstrated that the protoplasm of the cell, 
formerly described as a homogeneous substance, is arranged in a fibrillary 
trellis-work; that its nucleus presents an arrangement of radiated fibres; 
and that which was thought to be the nucleus is itself a complex element. 
The nerve cell thus becomes in its turn a little nervous organ sui generis. 
The same analytic process has shown that the net work, so dense and com- 
pact, which unites all the nerve cells of the cerebral cortex, one; with 
another, is so delicate that when enlarged to 286 diameters, the fibres of 
which it is composed, become visible like single hairs in magnitude and 
appearance. 846 
Pathological Anatomy of Malarial Fever. 
•OBSERVATIONS ON THE PATHOLOGICAL CHANGES AND LESIONS OF THE 
BRAIN AND SPINAL CORD IN ACUTE STHENIC CASES OF MALARIAL 
FEVER. 
By acute sthenic cases of malarial fever we mean to indicate the dis- 
'ease as it manifests itself, either for the first time in healthy individuals, 
or in its severest and most violent forms. We will show in subsequent 
portions of this chapter that the prolonged action of the malarial poison 
may be attended with lesions of the brain and spinal cord, recognizable to 
the naked eye. We shall also show that the microscope has thrown light 
upon these changes. If death takes place in the active stages of malarial 
fever, occurring in those who have been attacked for the first time by the 
disease the nervous structures present marks of great congestion, but the 
sight and touch reveal no characteristic alterations which would distin- 
guish malarial fever from other fevers. We must hope, however, that the 
•employment of the highest powers of the microscope in the hands of skilled 
anatomists and pathologists will reveal the true nature of the changes in 
the molecular arrangement of the gray substance of the cerebrum and 
•cerebellum, and of the conducting paths which connect these gray masses 
with one another, and with the central gray tube of the encephalo-spinal 
system. 
MEMBRANES OF THE BRAIN. 
As far as my observations have extended in malarial fever, the dura 
mater was always normal; the arachnoid membrane pearl-colored, opales- 
cent in some cases, in others perfectly transparent and normal in appear- 
;ance; the blood-vessels of the pia mater congested with blood, but most 
generally without marks of inflammation. Subarachnoid fluid in almost 
nil cases clear, transparent, and in some cases of a golden color; the amount 
varied in different cases, sometimes exceeding, but most generally falling 
short of the usual amount. Blood-vessels of the brain generally filled with 
blood. The structures of the brain appeared in acute cases, as a general 
rule, to be unaltered either in structure or appearance; in chronic cases the 
nervous structures sometimes presented a deeper and more grayish color, 
from the presence of pigment granules. 
The opalescent pearl, color of the arachnoid membrane in malarial fever of 
little diagnostic value.-The opalescent pearl-color of the arachnoid mem- 
brane in spots, was of little diagnostic value, because it was by no means 
uniform. In like manner, the variations in the amount of the subarach- 
noid fluid and cerebro-spinal fluid was of little diagnostic value, because 
its chief use is mechanical, and Magendie has shown that it can be rapidly 
secreted and rapidly absorbed without any disturbance of the functions of 
the brain; and further, that even in the normal condition it varies greatly 
in amount, from two drachms to two ounces; and Cotunnius, the original 
discoverer of this fluid, states that in experiments upon the bodies of 
twenty adults, the amount of this fluid varied from four to five ounces. 
In sthenic acute cases of malarial fever the structures of the brain were, 
as a general rule, altered neither in consistence nor in color. 
In asserting that the structures of the brain in acute malarial fever 
were, as a general rule, altered neither in consistence nor in appearance; 
we do so upon the evidence afforded by sight and touch; we do therefore 
by no means affirm this to be a fact established upon an immutable basis. 
How difficult is it to prove the mode of action of the malarial poison upon 
the nervous system, especially when it may act in a manner analogous to 
that of certain violent poisons, which will occasion almost instantaneous Pathological Anatomy of Malarial Fever. 
847 
death, without producing a single pathological alteration recognizable by 
the most delicate chemical tests, or the most rigid microscopical examina- 
tion. We know that some substances, as chloroform, will produce sudden 
death, in some cases, where there is no assignable cause, either in the 
structures or forces of the patient, or in the pathological alterations pro- 
duced, or in its accustomed action. This peculiar action is said to be due 
to the idiosyncrasy of the patient. May not the fatal action of the mala- 
rial poison be due, in some cases, to the idiosyncrasy of the patient? The 
question is, what is an idiosyncrasy? No one has ever demonstrated 
whether these peculiarities of constitution depend upon the physical and 
chemical structures and relations of the solids and fluids, or upon the rela- 
tions of the physical, chemical, vital, nervous, and muscular forces, or 
upon both sets of relations combined. We must admit that to determine 
accurately the alterations of the nervous apparatus, under the action of 
various morbific and remedial agents, it is absolutely necessary that the 
structures of the different parts of the nervous apparatus should be sub- 
mitted to a rigid chemical and microscopical analysis. Numberless insu- 
perable difficulties lie in the way of complete microscopical and chemical 
analysis. It is impossible to obtain the substances for analysis until sev- 
eral hours after death, and, in substances so liable to change, important 
alterations may take place, even in this short time. It is impossible to 
separate the blood entirely from the nervous elements; and the presence of 
a varying amount of blood, of varying constitution, would of itself be 
sufficient to vitiate the results of every analysis which had for its object 
the determination of the chemical changes induced by a most subtle 
poison. Notwithstanding this imperfect state of pathological science; not- 
withstanding that we have no facts to warrant the assertion that the mala- 
rial poison acts primarily or exclusively upon one system of nerves or the 
other; we should, nevertheless, analyze the phenomena as far as our means 
of analysis extend, and use all the well established facts to the extent of 
their bearing and significance. We will proceed to do this. 
As far as my observations extend, the pathological alterations of the 
structures of the brain and spinal marrow in sthenic acute cases of mala- 
rial fever do not correspond to the symptoms during life. The most uni- 
versal phenomena appears to be the stagnation and accumulation of the 
blood in the blood-vessels and capillaries of the brain and pia-mater. This 
accumulation of the blood in the vessels of the brain and pia-mater appears 
to be due neither to inflammation nor to irritation, but simply to a stag- 
nation of the blood, similar to the stagnation and accumulation of the 
blood in the vessels of the large organs. This view is conclusively sus- 
tained by the results of treatment. In numerous cases of acute malarial fever 
I have seen the wildest delirium calmed; the intellect aroused into full vigor 
from the most profound coma, and the most alarming cerebral symptoms van- 
ish under the free use of stimulants and sinapisms, with or without the sulphate 
of quinia. When the sulphate of quinia was withheld, the effects of the stim- 
ulants and sinapisms would be but temporary; whilst, when it was admin- 
istered in sufficient quantities, the restoration of the intellectual functions 
and the removal of the cerebral symptoms were permanent. Now, is this 
the action of stimulants or of sulphate of quinia upon an irritated or 
inflamed brain? These facts alone demonstrate conclusively that the cere- 
bro-spinal system is not the seat of irritation or inflammation in malarial 
fever, if we limit irritation and inflammation to the meaning universally 
adopted; and that if irritation and inflammation of the cerebro spinal sys- 
tem do arise in the progress of malarial fever, they are by no means uni- 848 
Pathological Anatomy of Malarial Fever. 
versa! phenomena dependent upon the definite and universal action of the 
malarial poison. • 
To what, then, must we refer the aberrated nervous phenomena of 
malarial fever ? Whilst we cannot answer this question fully and abso- 
lutely in the present imperfect state of physiology and pathology, we can 
point out and demonstrate three distinct causes : 1st, the alterations of the 
blood; 2d, the disturbances of the general and capillary circulations; and 
3d, the direct depressing effects of the malarial poison upon the nervous 
apparatus. 
1st. The altered blood.-We have shown in the preceding chapter that 
the colored blood-corpuscles are not only greatly and rapidly diminished 
in malarial fever, but that they often lose the saline constituents. We have 
every reason to believe that the blood corpuscles, taken collectively, per- 
form the offices of an immense gland for the elaboration of the materials 
for the nutrition of the muscular and nervous systems. We have further 
shown that the coloring matters of the serum are increased, and the color- 
ing matters of the bile retained in the blood of malarial fever. And I 
have shown that the constitution of the urine is greatly altered in the 
severest forms of malarial fever, and that in certain cases some of its most 
important constituents are either not formed at all, or, if formed, are not 
eliminated. We have also shown that the fibrin is altered both in quantity 
and in quality. 
Here, then, we have profound alterations of the blood which must 
nduce corresponding disturbances in the muscular and nervous systems, 
and in all the oigans and tissues which derive their nutrition from the 
blood. Here, then, we have profound alterations in the constituents of the 
blood which must produce corresponding disturbances in the general and 
capillary circulations, and in the chemical changes in the capillaries and 
surrounding tissues upon which depend the capillary circulation, and, in 
fact, the development and maintenance of all the forces-physical, muscu- 
lar and nervous. 
As a general rule, the general and capillary circulations are greatly 
disturbed in congestive fever. These disturbances are manifested in the 
quick, thumping action of the heart, the small, feeble, rapid pulse, the 
panting, full respiration, the want of correspondence between the temper- 
atures of the trunk and extremities, the aberration of the physical, chemi- 
cal, muscular, and nervous phenomena, and in the stagnation of the blood 
in the different organs and tissues. The stagnation of the blood in the 
organs, tissues, and apparatus, is due to disturbances in the sympathetic 
and cerebro spinal system, disturbances in the general circulation, disturb 
ances in the quantities and qualities of the constituents of the blood, and 
arrestor perversion of the chemical changes of the capillaries. It is well 
established that the circulation of the blood through the capillaries depends 
upon the relations, quantitative and qualitative, physical and chemical, of 
the individual constituents of the blood to each other, and to the capil- 
laries and the surrounding tissues, and that disturbances of their relations 
will be attended by arrest of the capillary circulation, and stagnation and 
congestion of the blood, notwithstanding that the general circulatory 
apparatus may receive a sufficient supply of nervous force, and perform its 
offices with sufficient vigor. 
When the general circulation is impeded, either by the directaction 
of the malarial poison, or of the altered blood upon the fibres of the heart, 
or by the withdrawal or perversion of the nervous force supplied by the 
sympathetic nervous system, or by the cerebro-spiuaL nervous system, 
through the sympathetic, consequent upon the action of the altered bloody Pathological Anatomy of Malarial Fever. 
849 
or of the malarial poison, or of both, it follows, as a necessary consequence, 
that the introduction and distribution of oxygen will be retarded, and the 
chemical changes in the capillaries will be impeded, and the blood will 
stagnate and accumulate in the capillaries. 
We have demonstrated that chemical change is necessary for the 
development of muscular and nervous force, and for the manifestation of 
intellectual phenomena. Whenever, therefore, the normal chemical actions 
of the blood are disturbed, aberrated nervous action, both in the cerebro- 
spinal and sympathetic nervous systems, must result. 
We have a striking confirmation of these views in the mode of origin 
and progress of the phenomena called chill in malarial fever. 
The poison, as we have before demonstrated in the chapter on the 
blood, first alters the constitution of the blood, and interferes with the 
actions and secretions of those organs which elaborate the blood, before 
producing any perceptible changes in the phenomena of either the sym- 
pathetic or cerebro spinal nervous systems; this alteration of the blood 
progresses umil a point is reached, where either such compounds are gen- 
erated in the cycle of chemical changes, induced by the malarial poison, or 
the constituents of the blood, especially the colored blood-corpuscles and 
fibrin, become so altered that disturbances are produced in the chemical 
changes by which the capillary circulation is maintained, and as a neces- 
sary consequence the action of the heart, which depends, as all other mus- 
cular actions do, upon the chemical changes in the capillaries, is impeded, 
and the blood gradually stagnates in the capillaries, and accumulates in 
the large blood-vessels of the trunk and internal organs and ganglionic 
centres, and the temperature of the extremities, due to the chemical changes 
of the blood in the capillaries and the surrounding tissues, sinks far below 
the normal standard; this arrest of the capillary circulation in the extrem- 
ities, and probably also in the lungs, is attended by the retention of the 
products of excretion, as carbonic acid, and the matters thrown off from 
the skin and kidneys; these excrementitious offending matters, together 
with the products resulting from the perverted chemical changes, due in 
part to the reduction of the temperature of the extremities many degrees 
below the normal standard, stimulate the sympathetic and cerebro spinal 
nervous system ; the sensation of cold is felt, attended by twitching and 
jumping of the muscles, entirely beyond the control of the will, because 
they are due to aberrated muscular and nervous action, arising from dis- 
turbances in the capillary circulation, and from the action of the perverted 
elements of the blood; the respiration is aroused, more oxygen is intro- 
duced, and the temperature of the trunk elevated, provided the alterations 
in the constitution of the blood have not proceeded too far, or the nervous 
system been so overwhelmed, either by the action of the altered products, 
or of the malarial poison, that they cannot respond to the excitation pro- 
duced by the altered and retained productions ; the elevation of the tem- 
perature of the trunk is attended by a more rapid circulation of the blood 
in the capillaries of the heart and of the nervous centres, and consequently 
by a more rapid and powerful action of the heart and generation of nervous 
force ; the oxygen is introduced and distributed with greater rapidity, the 
chemical changes in the capillaries are again excited, the capillary circula- 
tion is first restored in the trunk and then in the extremities, the elevation 
of temperature becomes general, and we have the phenomena called fever. 
During the active chemical changes of fever, the malarial poison and 
the altered products of the blood are drawn into the round of chemical 
change, physically and chemically altered, and are finally thrown off from 
the lungs, skin, kidneys, and intestinal canal. After the removal of these 850 
Pathological Anatomy of Malarial Fever. 
offending products, the excitants of the sympathetic and cerebro-spinal 
nervous system, after the system has been purified, as if by fire, then the 
nervous system returns back to the normal exercise of its functions; the 
force and frequency of the heart diminish; the panting, full respiration 
subsides into the calm regularity of health ; the temperature, both in the 
trunk and in the extremities, returns to the normal standard, and we have 
what is called the remission of fever. 
If remedies have been applied which effect the permanent alteration, 
and destruction, and removal of the malarial poison, there is no return of 
the chill, succeeded by fever. 
If, on the other hand, the poison, morbific ferment or micro-organism 
has not thus been removed, the same round of phenomena is repeated, the 
blood is again altered, the capillary circulation is again retarded ; the 
cerebro-spinal and sympathetic ganglionic masses are again congested, and 
the whole round of phenomena is repeated. 
If these vie ws be correct, it is evident that malarial fever is paroxysmal, 
not because the action of the cerebro-spinal or of the sympathetic system is 
paroxysmal, but because the relations of the malarial poison to the con- 
stituents of the blood and organs and apparatuses are such, and the rela- 
tions to the chemical changes necessary to the development of the physical, 
muscular, and nervous forces are such, that a definite series of actions and 
of chemical changes are established, which result in the removal of the 
offending products ; but not always of the primary, disturbing element, 
the poison, which will again excite another round of the same class of 
actions-a paroxysm. 
The theory here advocated is based upon thousands of observations 
upon the pulse, respiration, temperature, physical and chemical changes 
of the solids and fluids during all the stages of fever and after death, 
and is consistent with every fact and observation recorded in this work. 
It is important, because it does not call in the aid of occult qualities of the 
nervous system, or the assistance of the unknown vis-medicatrix naturae; 
because it expresses an analysis of the phenomena, at the same time that it 
indicates the true principles of the treatment of malarial fever; and it is 
especially important, because it points out the relative position and 
importance of the phenomena, and the true direction of scientific 
investigation. 
Without multiplying at this time facts, we would simply adduce the 
phenomena of congestive algid fever, as conclusive demonstration of the 
truth of this theory, or, rather, expression of the relations of the phenom- 
ena of fever. In congestive algid fever, where the nervous system is over- 
whelmed, and does not respond to the action of the altered compounds, no 
elevation of temperature is produced, the chemical changes are perverted 
and retarded, and the temperature sinks both in the trunk and in the 
extremities, the altered products remain, and death is inevitably the result, 
unless those remedies can be applied which will arouse the sympathetic 
and cerebro-spinal systems ; arouse the action of the heart; arouse the 
chemical changes in the capillaries, and lead to a vigorous development of 
the physical, chemical, muscular, and nervous forces, and result in the 
elimination of the altered products and the poison. 
The following pathological observations will substantiate the assertions, 
with reference to the alterations of the nervous structures during the active 
stages of sthenic malarial fever: 
Case No. 1054.-Intermittent fever occurring in the latter stages of j>hthisis 
pulmonalis.-When the skullcap was removed, about f§ij of subarachnoid and 
cerebro-spinal fluid, colored red by the blood which escaped from the vessels divi- Pathological Anatomy of Malarial Fever. 
851 
ded during rhe removal of the skullcap, flowed from the base of the brain. Dura- 
mater normal. Arachnoid membrane slightly opalescent in several spots, especi- 
ally in the neighborhood of the large blood-vessels; the greater part of this mem- 
brane, however, was transparent and normal in appearance. Subarachnoid fluid 
moderately abundant. Blood-vessels of pia-mater filled with blood. There were 
no marks of inflammation either in the pia-mater or in the arachnoid membrane. 
The ventricles of the brain contained small quantities of serum. The cortical and 
medullary substances, the cerebellum, pons Varolii, the medulla oblongata, and 
the spinal marrow, appeared natural to the naked eye. The structures did not 
appear to be softened or materially altered. 
Case No. 1055.-Remittent and typhoid fevers combined.-Several days before 
the fatal termination, the cerebral symptoms were well marked. The patient lay 
in a stupor, with mouth and eyes open, and passed his urine and faeces in bed; and 
it was impossible to arouse him, even by the most violent shaking. The examina- 
tion of the blood, on the day previous to death, showed that it had undergone pro- 
found alterations. Dura-mater perfectly natural; arachnoid membrane opalescent 
(pearl-colored) in most parts. There were different degrees of this opalescency, 
from almost perfect transparency to .semi-translucency. This change was especi- 
ally evident in the neighborhood of the large blood-vessels, and in those portions 
of the arachnoid which covered the depressions between the convolutions. Blood- 
vessels of pia-mater somewhat more distended with blood than usual; but not so 
much, however, as to account for the cerebral symptoms during life. Substance of 
brain firm, and not more congested with blood than normal. The appearance of 
the structure and condition of the brain, and its blood-vessels and membranes, did 
not correspond to the condition of congestion, effusion, or softening, which the 
cerebral symptoms led us to expect. The brain was not examined microscopically 
or chemically, and there may have been minute chemical and physical changes 
in its delicate structures, which escaped the observation of the naked eye. This is 
possible, but not probable; for we can hardly suppose that profound alterations in 
the structure of sodelicate an organ as thebrain, without some changes in the color 
or consistence palpable to the naked eye. 'rhe cerebro-spinal phenomena during 
life appear to have been the result of disturbances in the circulation and constitu- 
tion of the blood, and of the action of the poison or its products in the blood upon 
the ganglionic cells and commissures. 
Case No. 1056.-An Irish baker, attacked during convalescence from 
Remittent Rever with Influenza, and drowned by the effusion of Serum into the 
bronchial tubes and air-cells.-Dura-mater presented the usual appearance; arach- 
noid membrane transparent; blood-vessels of pia-mater filled with blood. When 
the dura-mater was removed, an ulcer in the substance of the brain was discovered, 
occupying a position near the centre of the superior surface of the left hemisphere 
of the cerebrum. This ulcer was three-fourths of an inch in length and half an 
inch in breadth, and about one-eighth of an inch in depth. The walls were thick- 
ened and much harder than the surrounding brain. The blood-vessels of the sur- 
rounding pia-mater and brain were congested with blood, and there was an effu- 
sion of a small quantity of bloody serum between the arachnoid and pia-mater, in 
the immediate neighborhood of the ulcer, but nowhere else. The appearance of 
the ulcer, and the congestion of the blood-vessels around, by no means accounted 
for the death of the patient. The ulcer appeared to be of long standing, and was 
in the process of healing. During the attack of malarial fever, and during conval- 
escence, the patient was dull, lethargic, and indisposed to exert his mind or body. 
The existence of this ulcer will account for these phenomena, but not for the death 
of the patient, which was due to the rapid pouringout of the altered liquor sangui- 
nis of the blood into the air-cellsand bronchial tubes. The cerebral symptoms 
after this calamity were not different from those which would occur in impeded 
respiration and circulation, when the distribution of the oxygen and the removal 
of the carbonic acid were retarded. The ventricles of the brain contained the 
usual amount of clear fluid, and the structures of the brain presented the usual 
consistence and appearance. 
Case No. 1057.-Irish laborer, attacked with pleuro-pneumonia, during conva- 
lescence from Remittent Fever.-During the attack of remittent fever, which was 
severe, the cerebral symptoms were absent. During the attack of pleuro-pneumo- 
nia which supervened immediately upon the remittent fever, the cerebral symp- 
toms were well marked; great excitement and frequent aberrations of the intellec- 
tual faculties. Dura-mater healthy; arachnoid membrane transparent throughout 
its extent over the hemispheres of the brain. At the base of the brain it was 
slightly opalescent. Blood-vessels of pia-mater not more filled with blood than Lesions of the Cerebro-Spinal System in Malarial Fever. 
852 
usual. The cortical and medullary substances of the cerebrum and cerebellum, 
the pons Varolii, the medulla oblongata, and superior portion of the spinal mar- 
row, appeared natural in consistence and color; ventricles of the brain contained 
f 3 iv of golden-colored serum. The superior longitudinal sinus of the dura-mater 
contained a golden-yellow elongated clot, the diameter of which was about one- 
half that of the longitudinal sinus. 
Case No. 1058.-Irish laborer, who was attacked in the early stages of con- 
valescence from Intermittent Fever, with an eruptive disease resembling the severest 
form of lichen agrius.-This patient had been exposed to the malarial influence in 
a low, damp, marshy situation. The eruption was very thick upon the face, neck 
and chest; in these regions, and especially upon the face, the papula were very 
numerous, prominent, of a vivid red color, and in many places closely aggregated 
into large clusters, of irregular form and size. Numerous vesicles and pustules, 
containing sero-purulent fluid, were mingled with the papulae. From the clusters 
of papulae, vesicles and pustules, an ichorous or sero-purulent fluid issued, and des- 
iccated into yellow crusts. In some places, from the thickening of the skin, the 
density of the crust, and the depth of the fissures, the disease might have been 
mistaken for psoriasis. On the legs the eruption was much thinner, and resembled 
lichen tropicus (prickly heat). The vesicles and pustules were so large and numer- 
ous, that across the ward the eruption resembled small-pox. Under treatment, the 
discharge of sero-purulent fluid ceased, the pustules and vesicles dried up, and the 
symptoms gradually disappeared, but the patient continued weak and feeble and 
lethargic. Twelve days after his entrance into the hospital with the eruption, he 
was seized with a strong convulsion, which lasted about ten minutes, and was .suc- 
ceeded by stupor. Four hours after the convulsion, could not be aroused by the 
loudest interrogations and the most violent shaking. The left arm was drawn 
across the breast, and appeared paralyzed. It required considerable force to 
straighten it, and when released it would fly back to its former position, like asteel 
spring. The left leg was also paralyzed, and in like manner returned when 
removed from its position. The patient remained in this state for forty- 
eight hours, and then died. When the skullcap was removed, about f^vj of blood 
flowed from the base of the brain. Dura-mater normal in appearance; arachnoid 
membrane slightly pearl-colored, opalescent in several places; blood-vessels of pia- 
mater, especially at the base of the brain, filled with blood. Much blood and bloody 
serum were effused between the dura-mater and arachnoid membrane. Cerebellum 
and pons Varolii of a blood-red color upon the exterior. The ventricles of the brain 
were almost entirely filled with serum. The structure of the brain appeared to be 
somewhat softer than usual, and the blood-vessels were filled with blood, and dis- 
tinct. Blood-vessels of medulla oblongata and superior portion of spinal cord 
filled and distended with blood. Much bloody serum was effused around the spi- 
nal cord. No clots were found in the blood and serum effused around the brain. 
The liver and spleen bore the marks of the effects of malarial fever; they were, how- 
ever, recovering. ^It is impossible to determine positively the cause of this sudden 
effusion of blood and 'serum upon the brain. Were the softening of the nervous 
structures and alterations of the capillaries the results of the malarial poison? or 
were they the results of the action of the cause, whatever it was, which produced 
the eruption? 
Case 1059.-Remittent Fever, occuring in an Irish baker, of feeble consti- 
tution, during exposure and dissipation.-This patient died without any treat- 
ment, except the administration of a purgative. Dura materand arachnoid mem- 
brane normal; blood-vessels of pia mater contained more blood than usual, but 
there were no marks ef inflammation; f^j of clear serous fluid escaped from the 
spaces between the dura mater and arachnoid membrane, and between the arach- 
noid membrane and pia mater. 
Case 1060.-Remittent Fever converted into Congestive Fever, by excessive pur- 
gation, and neglect of stimulation and the sulphate of quinia. Towards the close 
of life the intellect was sluggish, but perfectly clear when aroused. Throughout 
the attack there were no well-marked cerebral symptoms. Brain examined twelve 
hours after death. Dura mater unusually thick and firm, and adherent in several 
places to the arachnoid membrane. The thickening of the dura mater and the 
adhesions were of longstanding, and were not connected with this attack of mala- 
rial fever. Blood-vessels of the dura mater filled with blood; arachnoid membrane 
opalescent, pearl-colored, and in many places adherent to the pia mater. These 
adhesions, like those between the dura mater and arachnoid membrane, were 
apparently of long standing. Between the arachnoid membrane and pia mater Lesions of the Cerebro-Spinal System in Malarial Fever. 
853 
bloody serum was effused, thus imparting to these membranes (especially the infe- 
rior portions from the gravitation of the blood) a red appearance. Blood-vessels of 
pia mater were filled with blood. The blood-vessels of those portions of the pia 
mater which extended into the ventricles of the brain were also engorged with 
blood. The ventricles of the brain contained a small quantity of clear serum. 
Structure of cerebrum appeared to be somewhat softer than normal. This 
softening may have been the result of post-mortem decomposition. Blood- 
vessels in the substance of the brain distinct and more engorged with blood than 
usual. Structure of cerebellum, medulla oblongata, and superior portion of spinal 
cord presented the usual appearance and tenacity. The blood-vessels of the spinal 
cord appeared to be more congested with blood than usual. 
Case 1061.-Congestive Fever, aggravated and shortened by Bleeding and Pur- 
gatives, and allowed to run its course unchecked, by the neglect of stimulants and 
sulphate of quinta. Before the abstraction of blood the cerebral symptoms were 
urgent. The patient appeared to suffer intense agony in his head; both hands 
were clasped around his head; he tossed violently about his bed; every breath was 
accompanied with a deep groan, and an exclamation about the pain in his head; 
and he was unable to give a coherent answer. Cut-cups to the templesand back of 
the neck, general bloodletting, and sinapisms, relieved the cerebral symptoms. 
Stimulants and sulphate of quinia were not administered, and the cerebral symp- 
toms returned with much less violence, and at the end of fifty hours the patient 
died. When the skullcap was removed, four hours after death, f^ijof blood 
flowed from the base of the brain, and appeared to have come, in great measure, 
from a rupture in one of the sinues of the dura mater. Arachnoid membrane opa- 
lescent, pearl-colored. A small quantity of yellow serum was effused between the 
arachnoid membrane and pia mater. Blood-vessels of pia mater engorged with 
blood. Substance of brain appeared to be softer than usual. Upon the cut surface 
were seen the cut extremities of numerous blood-vessels filled with blood. The lateral 
ventricles of the brain were nearly filled with golden serum. Blood-vessels of that 
portion of the pia mater which enters the ventricles engorged with blood. Blood- 
vessels at the base of the brain and superior portion of the medulla oblongata 
greatly distended with blood. The blood vessels at the base and dependent por- 
tions of the brain were more distended with blood than those of the superior por- 
tions of the brain. There were no marks of inflammation anywhere, and the 
congestion of the blood in the blood-vessels appeared to be due to its stagnation 
from disturbances of the general and capillary circulations, produced by thealtered 
blood and the formation of heart clotsand fibrinous concretions in the pulmonary 
arteries and veins. 
Case 1062. - Congestive Fever; Death resulting, in great measure, from, the for- 
mation Gffibrinous concretions in the Heart and Blood-vessels. The cerebral symp- 
toms appeared suddenly, and were of the most marked and decided character. The 
patient was taken suddenly with coma, and lay with his mouth and eyes open, 
perfectly insensible, and emitting at every breath a sharp, quick groan, like the 
barking of a dog. When the skullcap was removed, three hours after death, f^iij 
of bloody serum flowed from the base of the brain. The admixture of blood with 
the cerebro-spinal fluid appeared to have been due entirely to the wounding of 
blood-vessels during the removal of the skullcap. The arachnoid membrane was 
but slightly opalescent; in most places it was perfectly transparent. The fluid 
effused between the arachnoid membrane and pia mater, and into the ventricles of 
the brain, presented the golden color of the serum of the blood. Blood-vessels of 
piamater filled with blood. Blood-vessels at the base of the brain, and upon the 
medulla oblongata and spinal cord, more engorged with blood than those upon the 
superior portions of the brain. This was, without doubt, due solely to the effect 
of gravity. The substance of the brain possessed the usual consistency, and 
appeared to the naked eye to be normal in structure. 
Case No. 1063.-Congestive fever. Stoutseaman, sick only four days. On the 
second day became comatose, and continued insensible, passing his urine and faeces 
in bed until death. The treatment was defective in energy. Stimulants and sul- 
phate of quinia were not used with sufficient freedom and frequency. Brain 
examined, twenty hours after death. Dura mater and arachnoid membrane pre- 
sented a healthy appearance. The subarachnoid fluid was of a reddish color. The 
ventricles of the brain were almost completely filled with a reddish fluid. Blood- 
vessels of pia mater congested with blood. Blood-vessels of the superior portions 
of the brain Jess congested with blood than those of the inferior portions. The 854 
Lesions of the Cerebro-Spinal System in Malarial Fever. 
substance of the brain presented nothing abnormal to the naked eye, or to the 
touch. 
Case No. 1064.-Remittent fever, neglected for ten days, terminating in conges<- 
tive fever. Four days before death cerebral symptoms well marked ; great torpor 
of the intellect when stimulants were withheld, and when freely administered 
unusual excitement, attended with aberration and incoherency. Brain examined 
twelve hours after death. Dura mater normal; arachnoid membrane opalescent, 
pearl-colored in many spots: subarachnoid fluid in normal quantity; blood-vessels 
of pia mater filled with blood ; substance of brain firm, and altered neither in con- 
sistency nor in appearance. Blood-vessels of the substance of the brain not more 
distinct than normal; ventricles of brain, and the space around the medulla oblon- 
gata and spinal cord, filled with light yellow fluid. When the medulla oblongata 
and superior portion of the spinal cord were removed, the serum flowed in (The 
shoulders being slightly depressed), and filled the vertebral canal. 
Case No. 1065.-Congestive fever; fibrinous concretion in the heart and blood- 
vessels, cerebral symptoms severe, coma, and complete insensibility. Brain exam- 
ined twelve hours after death. The longitudinal sinus of the dura mater contained an 
elongated, flattened, ribbon-like, fibrinous clot, which was free from colored blood- 
corpuscles, and of a light yellow color. This was, without doubt, formed before 
death. Arachnoid membrane opalescent, pearl-colored in many places. Blood- 
vessels of pia mater filled with blood. Substance of brain appeared to be normal 
in color and texture, as far as an examination with the naked eye extended; it was, 
perhaps, a little softer than usual; but this may have been due to post-mortem 
changes, and at any rate would not account for the symptoms during life. Blood- 
vessels of medulla oblongata and superior portion of spinal cord not congested with 
blood. 
Case No. 1066.-Congestive fever. Death occurred forty-three hours after the 
commencement of the attack, which commenced suddenly, with vomiting, cold 
extremities, complete prostration, and delirium. When the skullcap was removed, 
twenty-four hours after death, f^iij blood flowed from the base of the brain, which 
contained no coagula, and appeared to have been effused before death. Arachnoid 
membrane opalescent in a few spots. Blood-vessels of pia mater filled with blood. 
The subarachnoid fluid was of a bloody red color. Blood-vessels at the base of the 
brain, and surrounding the medulla oblongata and superior portion of the spinal 
cord, were filled with blood. The substance of the brain was normal in consistence 
and appearance. 
We observe in the preceding examinations of the brain after death, 
caused by malarial fever in its active stages, that the following results are 
worthy of careful consideration: 
1st. The brain presents no marks of inflammation or softening. The mem- 
branes of the brain, as a general rule, are without marks of inflammatory 
action, such as thickening, softening, and deposits of plastic lymph. The 
symptoms of remittent and pernicious malarial fever, as far as they relate 
to the cerebro-spinal nervous system, are different from those of cerebro- 
spinal meningitis. It is unnecessary to detail the symptoms and post- 
mortem lesions in this latter disease, which occupied a distinct memoir 
in the first volume of these Medical and Surgical Memoirs, pages 409- 
553 ; and we will present only the general conclusions as to those relations 
of the symptoms or pathological anatomy of these diseases. 
After the careful study and record of the phenomena and pathological 
anatomy of a large number of cases of the various forms of malarial fever, 
I have reached the following general results: 
GENERAL CONCLUSIONS CONCERNING THE RELATIONS OF THE MALIGNANT 
FORMS OF MALARIAL FEVER TO CEREBRO SPINAL MENINGITIS. 
1. In many cases of malarial fever, various disturbances of the cere- 
bro-spinal nervous system occur, as active delirium and coma, which some- 
times disappear, without leaving any manifest alterations of function or Relations of the Malignant Forms of Malarial Fever. 
855 
structure; and which are quickly and entirely relieved by the free and 
energetic administration of stimulants and sulphate of quinia. It is evi- 
dent that in such cases there is neither structural alteration, nor inflam- 
mation of the cerebro-spinal nervous system. The term irritation, even 
cannot with any propriety be applied to such phenomena, if the term be 
used in its ordinary sense, as related to inflammation. 
2. In many cases of malarial fever, which prove fatal, no lesions are 
discovered in the cerebro-spinal structures, which will account for the 
symptoms during life, or for the fatal termination. The truth of this asser- 
tion has been established by the post-mortem examinations, which I have 
at various times published in the Southern Medical and Surgical Journal, 
and in the Transactions of the American Medical Association. The action 
of the malarial poison upon the cerebro-spinal nervous system, in such 
cases, may be compared to that of a violent alkaloid, or even mineral 
poison. It is well established that in death from various violent poisons, 
which produce great disturbances in the functions of the nervous system 
we are in many cases unable to discover any lesions in the structures of 
the ce rebro spinal nervous system, which could at all account for the ner- 
vous manifestations during the action of the poison. Other causes and 
agents are also active in producing the nervous disturbances in malarial 
fever, as: 
(a.) Alterations in the physical, chemical and physiological proper- 
ties of the blood, iuduced by the direct action of the malarial poison upon the 
blood. This action is characterized by alteration and diminution of the fibrin, 
by destruction of the colored blood-corpuscles, by profound changes in the 
relations of the blood to the absorption of oxygen and elimination of car- 
bonic acid. The altered blood itself, independent of any direct action of the 
malarial poison upon the nervous ganglia, may induce such alterations in the 
nutrition of the nerve structures, as to induce the most aggravated nervous 
disturbances. It is probable, also, that under certain circumstances the 
altered products and constituents of the blood in malarial fever and other 
diseases, may act as poisons to the nervous system. 
(b.) Arrest of the functions of certain organs, as the spleen and liver. 
(c.) Retention of certain excretions, which should be separated by 
the liver, colon and skin, in the general mass of the circulation. 
(d.) Re-absorption of the altered secretions and products of certain 
organs, and the toxemic action of these agents. Thus the re-absorption of 
the altered bile of malarial fever is attended with intense headache, vom- 
iting and even delirium. The re-absorption of the large mass of altered 
blood, in the enlarged, softened spleen of malarial fever must be attended 
with injurious results. 
3. In some cases of malarial fever the severe nervous symptoms 
remain; stimulants and revulsives, and sulphate of quinia exert no effect 
in arresting the disease, or in arousing the patient from the state of coma, 
or in relieving the convulsions and wild delirium. Such cases may occur 
at any period of the year, in those who have been subjected to the action 
of malaria, but as far as my experience extends, they occur most frequently 
in the autumn and winter. Cold appears to have much to do with the 
production and termination(of such cases, as we shall endeavor to show. 
Individuals who have the 'Seeds" of malaria in them, may even remove 
to healthy regions, and pass months with only an occasional slight chill or 
headache, and then suddenly be seized with fatal symptoms, which appear 
to be referable chiefly to the cerebro-spinal nervous system. In such cases 
in which the cerebro-spinal symptoms were persistent, and terminated 
fatally, the true causes are found in the lesions of the blood, as well as of 856 
Relations of the Malignant Forms of Malarial Fever. 
the nervous structures. Even in those cases of pernicious malarial fever, 
which manifested during life symptoms similar to those of cerebro spinal 
meningitis, T have failed to detect after death fibrinous effusions, coating 
the membranes of the brain and spinal cord; but on the other hand, the 
ventricles of the brain and the subarachnoid space, were in some cases 
distended with fluid. It is but reasonable to suppose that this effused 
fluid may, in some cases of malarial fever, cause death; and at the same 
time it is not necessary to suppose that this effusion or fluid, in and around 
the cerebral structures is due to the presence of inflammation. After the 
colored blood-coipuscles have been destroyed, and the fibrin and albumen 
altered, and the blood thus rendered watery and thus altered in its most 
essential, physical and chemical and physiological properties, by the rapid 
or more slow action of the malarial poison, it is evident that an effusion of 
the watery elements of the blood is liable to occur from the blood-vessels 
of any organ and tissue in which there is an active determination or con- 
gestion of blood. A prolonged chill, in itself, or in conjunction with the 
action of cold, which still farther increases the internal congestion, may 
be attended with such effusions of the liquor-sanguinis of the blood as 
permanently to impede the functions of important organs. In like man- 
ner, (as will be fully shown in the investigations on pneumonia) in the case 
of the lungs, the irritation or inflammation of a comparatively small por- 
tion of an organ, in the body, upon which the malarial poison has exerted 
its characteristic effects, may be attended with large serous effusions, not 
only from the parts immediately involved, by the inflammation, but from 
surrounding parts. We may thus explain in certain cases at least, the 
sudden supervention of symptoms of compression of the brain, without 
any apparent inflammation of that organ, in those laboring under the 
action of the malarial poison. 
4. The functional and structural derangements of the cerebro-spinal 
nervous system in malarial fever, and under the action of the malarial 
poison, without those symptoms characterized as fever, are referable to 
several causes : 
(a.) The direct action of the poison upon the nervous structures. 
We have regarded the action of the malarial poison in most cases, as 
depressing and not inflammatory, and analogous in its action and relations 
to certain alkaloid vegetable poisons. We must admit, however, that to 
determine accurately the alterations of the nervous apparatus, under the 
action of various morbific and remedial agents, it is absolutely necessary that 
the structures of the different parts of the nervous apparatus should be sub- 
mitted to rigid chemical and microscopical analysis. Numberless and almost 
insuperable difficulties lie in the way of complete microscopical and chemical 
analysis of the cerebrospinal system. It is impossible to obtain the sub- 
stances for analysis, until several hours after death, and in substances so 
liable to change, important alterations may take place, even in this short 
time. It is impossible to separate the blood from the nervous elements; 
and the presence of a varying amount of blood, of varying constitution, 
would of itself be sufficient to vitiate the results of every analysis which 
had for its object the determination of the chemical changes, induced by 
a subtile poison. Notwithstanding this imperfect state of pathological 
science, we may by an analysis of those phenomena, which can be investi- 
gated, form at least a reasonable system of belief. We will endeavor to 
do this. As far as my observations extend, in most cases of malarial fever 
the pathological alterations of the brain and spinal marrow do not corres- 
pond with the severity of the symptoms during life. The most universal 
phenomenon appears to be the stagnation and accumulation of blood in Relations of the Malignant Forms of Malarial Fever. 
857 
the blood-vessels and capillaries of the brain, and its meninges, and espe- 
cially the pia-mater. This accumulation of the blood in the vessels of the 
cerebro-spinal system, appears to be due neither to inflammation nor irri- 
tation, but simply to a stagnation of the blood, similar to the stagnation 
and accumulation of the blood in the vessels of the large organs. Such 
stagnation of the blood signifies clearly a depression, rat her than an exal- 
tation or irritation of the cerebro-spinal and. sympathetic nervous system. 
These views are sustained by the results of treatment. In numerous cases, 
I have seen the wildest delirium calmed, the intellect aroused into full vigor 
from the most profound coma and the most alarming cerebral symptoms van- 
ish under the free use of the sulphate of quinia. When quin ia was withheld, 
the effects ofthe stimulants and sinapisms would be temporary; whilst when 
it was administered in sufficient quantities the restoration of the intellectual 
functions, and the removal of cerebral symptoms were permanent. Now 
is this the action of stimulants or of sulphate of quinia, upon an irritated 
or inflamed brain? These facts alone demonstrate conclusively that the 
cerebro spinal system is not usually the seat of irritation, or of inflamma- 
tion in malarial fever, if we limit irritation and inflammation to the mean- 
ing universally adopted; and that if irritation and inflammation of the 
cerebro-spinal system do arise in the progress of malarial fever, they are 
by no means universal phenomena, dependent upon the definite and uni- 
versal action of the malarial poison. Nevertheless, the malarial poison 
does appear to exert a direct influence upon the structures, and especially 
upon the sympathetic system. This influence is manifested, not merely in 
the disturbed cerebro-spinal functions, and in the disturbances of the cir- 
culation and respiration, and in the disturbances of the muscular force 
generally, but also in the derangement of the nutritive processes of the 
nervous structures. Thus during the chill and earliest period of the hot 
fit, the oxydation of phosphorus in the nervous structures, is either 
arrested or is so modified that the products of this important change do 
not appear in the urine; as the hot stage, however, progresses, and during 
the active stages and changes of fever, the elements of the nervous system 
are rapidly oxydized and phosphoric acid increases largely in the urine. 
Although the increase of phosphoric aeid necessarily attends all active 
changes in the constitution and structure of the blood, muscles and nerves, 
and is characteristic of most fevers during the hot stage, still the preced- 
ing facts, compel us to admit one or the other of two suppositions;- the cessa- 
tion of the excretion of phosphoric acid and its compounds, and its sub- 
sequent increase during the different stages of malarial fever, is either due 
to the direct action of the malarial poison upon the cerebro-spinal and 
sympathetic nervous system; or to the effects of the changes excited by 
the poison, in bringing about that condition which we call fever, the results 
of the increased chemical changes of fever, being manifested in the excre. 
tion of increased amounts of phosphoric acid, and of all other compounds 
necessarily resulting from those changes in the structures. 
(b ) The direct action of the malarial poison upon the blood. The 
colored blood-corpuscles are not only greatly and rapidly diminished in 
malarial fever, but they also often lose a portion of their mineral constitu- 
ents. It is probable that the colored corpuscles, taken collectively, per- 
form the offices of an immense gland, for the elaboration of the materials 
for the nutrition of the muscular and nervous systems. The coloring mat- 
ters of the serum are increased, and the coloring matters of the bile 
retained in the blood of malarial fever. The retention of the coloring 
matters of the bile in the blood, as well as the absorption of the altered 
bile, must, as we have before remarked, produce disturbing and injurious 858 
Relations of the Malignant forms of Malarial Fever. 
effects upon the nervous system. The constitution of the urine is greatly 
altered in the severest forms of malarial fever, and some of its most 
important constituents are either not formed, or, if formed, are not elimi- 
nated. The retention of such constituents as urea and uric acid, as well as 
of the excrementitious matters in a partially oxydized form, inlike manner, 
must disturb the normal action of the nervous system. The fibrin of the 
blood is altered, both in quantity and quality. I have frequently found 
fibi inous heart clots, free from colored blood corpuscles, in fatal cases of 
malarial fever; and these clots often extended long branches into the pul- 
monary arteries. The coagulation of the fibrin during life, signifies loss 
of vitality in the blood, and change of its physical properties and relations 
to the containing vessels. The presence of these bodies especially in the 
pulmonary arteries, deranges the action of the heart, and of the general 
circulation, and in like manner deranges the respiration, and the absorp- 
tion and distribution of oxygen. These disturbances must necessarily be 
attended by similar disturbances in the actions of the nervous and muscu- 
lar systems. These profound alterations of the blood must induce corre- 
sponding disturbances in the muscular and nervous systems, and in all the 
organs and tissues which derive their nutrition from the blood. The pro- 
found alterations in the constituents of the blood, must produce corre- 
sponding disturbances in the general and capillary circulation, and in the 
chemical changes in the capillaries and surrounding tissues, upon which 
depend the development and maintenance of the physical, muscular and 
nervous forces. 
5. As a general rule, the general and capillary circulations are greatly 
disturbed in congestive fever. These disturbances are manifested in the 
quick, thumping action of the heart, the small, feeble, rapid pulse, the 
panting, full respiration, the want of correspondence between the tempera- 
tures of the trunk and extremities, the aberration of the physical, chemi- 
cal, muscular and nervous phenomena, and in the stagnation of the blood 
in the different organs and tissues, dhe stagnation of the blood in the 
organs, tissues and apparatus, is due to disturbances in the sympathetic 
and cerebro spinal system, disturbances in the general circulation, disturb- 
ances in the quantities and qualities of the constituents of the blood, and 
arrest or perversion of the chemical changes of the capillaries. It is well 
established, that the circulation of the blood through the capillaries, 
depends upon the quantitative and qualitative physical and chemical rela- 
tions of the individual constituents of the blood to each other, and to the 
capillaries, and the surrounding tissues; and that disturbances of these 
relations will be attended by arrest of the capillary circulation, stagnation 
and congestion of the blood, notwithstanding that the general circulatory 
apparatus may receive sufficient supplies of nervous force, and perform its 
offices with sufficient vigor. When the general circulation is impeded, 
either by the direct action of the malarial poison, or by the altered blood 
upon the fibres of the heart, or by the withdrawal or perversion of the 
nervous force, supplied by the sympathetic nervous system, or by the 
cerebro spinal nervous system, through the sympathetic, consequent upon 
the action of the altered blood, or of the malarial poison, or of both, it 
follows, as a necessary consequence, that the introduction and distribution 
of oxygen will be retarded, and the chemical changes in the capillaries, 
impeded, and the blood will stagnate and accumulate in the capillaries. 
As chemical change is necessary for the development of muscular and 
nervous force, and for the manifestation of intellectual phenomena, when- 
ever the normal chemical actions of the blood are disturbed, aberrated 
nervous action, both in the cerebro-spinal and sympathetic nervous systems, 
may result. Relations of the Malignant Forms of Malarial Fever. 
859 
6. The treatment of the sudden and fatal form of malarial fever, the 
pathology of which we have endeavored to unfold in connection with that 
of cerebro-spinal meningitis, should be conducted upon the same general 
plan, regardless of the period of the year, and the length of time which 
has elapsed since the exposure of the patient to the malarious poison. 
Quinine, stimulants, and revulsives, are the main and essential remedies 
in the malignant form of malarial fever, as has been well established by 
the experience of numerous practitioners. These remedies should be used 
immediately and freely, regardless of the cerebral symptoms, and of the 
presence or absence of delirium and fever. The greatest portion of these 
cases will be arrested, and the patient rescued from the jaws of death 
by the energetic use of quinine, in doses varying from 5 to 15 grains every 
two or three hours, and by the free use of diffusible stimulants, as alcohol, 
sulphuric ether, chloroform and ammonia. If the sudden and severe 
symptoms are not arrested by the free use of quinine and stimulants, and 
the patient does not die, but remains in a feeble, semi conscious state, anti- 
periodics and stimulants should not be abandoned, even though we may be 
convinced that serous effusion has taken place around the brain and spinal 
cord, and in the ventricles of the brain. The anti-periodics should be 
continued to ward off if possible the recurrence of the congestive stage, 
and stimulants and nutritious diet should be given to support the strength, 
with the hope that the effusion may be absorbed, and the impaired cerebro- 
spinal structures restored. Iodide of potassium and iodide of quinia, 
together with blisters to the back of the neck and head have proved bene- 
ficial in cases which would have terminated fatally without the use of these 
remedies. It is well established that quinine, with the various prepara- 
tions of iron, with nutritious diet, and attention to the state of the liver 
and kidneys, and the use of such depurants as the ascetates and citrates of 
potassa and soda, constitute the best remedies in the treatment of those 
who are thought to be liable, from previous attacks of malarial fever, to 
these sudden congestive attacks. Arsenic is, without doubt, a remedy of 
great value in obstinate cases of malarial fever, but its administration will 
not always pi event the sudden supervention of fatal symptoms. Arsenic 
should never supercede entirely quinine and iron, and during its use, due 
attention should be paid to the functions of the kidneys and liver; and it 
should be remembered that whenever it exerts its local effects upon the 
stomach, in producing nausea and vomiting, its constitutional effect in 
relieving the paroxysmal fever, is greatly impaired, if not wholly lost. 
7. In cerebro-spinal meningitis, on the other hand, although many of 
the symptoms resemble those of certain forms of malignant malarial fever, 
the nature of the lesions and the entire pathology of the disease is differ- 
ent. The changes of the blood, and of the liver and spleen, described as 
characteristic of malarial fever, form no necessary part of the history of 
uncomplicated cerebro-spinal meningitis. The pathological phenomena are 
more complicated in malarial fever than in cerebro-spinal meningitis; whilst 
the former disease is induced by a poison which alters the chemical 
and physical properties, and physiological offices of the blood, and 
which acts also upon the muscular and nervous structures, the latter 
consists essentially in a violent inflammation of the meninges, and 
especially of the pia mater of the entire cerebro-spinal system. Not- 
withstanding the essential differences in the characters of these two dis- 
eases, yet in many cases, and especially in the first cases of an 
epidemic of cerebro-spinal meningitis, the physician is liable to con- 
found the disease with malignant malarial fever. This similarity of 
symptoms is due, rather to the fact that the manifestations of depressed 860 
Investigations of Joseph Jones, M. D., on the 
and aberrated nervous actions are similar in many sudden and fatal forms 
of disease, involving profound lesions of the blood and cerebro-spinal and 
sympathetic systems. As far as our knowledge extends, the main differ- 
ences between cerebro-spinal meningitis and malignant malarial fever, 
appear to be as follows : 
DIFFERENCES BETWEEN THE SYMPTOMS AND PATHOLOGICAL LESIONS OF 
CEREBRO-SPINAL MENINGITIS AND MALIGNANT (CONGESTIVE PERNI- 
CIOUS) MALARIAL FEVER. 
(a.) Cerebro-spinal meningitis more frequently commences with con- 
vulsions, and less frequently with a well marked chill, in which there is an 
elevation of the temperatur e of the tr unk, and a depression of the temper- 
ature of the extremities. 
(b.) The temperature is not subject to the periodical elevations and 
depressions which characterize malarial fever. 
(c.) Contractions of the muscles, and persistent dilatation or contrac- 
tion of the pupils of the eyes, are less frequent in malarial fever. 
(d.) The pulse is more rapid, feeble, and irregular1, and subject to 
gr eater hourly variations, and the respiration is more rapid, irregular and 
panting in malignant malarial fever, than in cerebro-spinal meningitis, and 
at the same time the temperature is liable to greater variations, and the 
difference between the temperature of the trunk and extremities is greater, 
as well as the range of variations during the progress of the disease. 
(e.) The tongue is dryer, redder and more coated in malarial fever. 
(f.) The bowels are not so obstinately constipated in malarial fever. 
(g.) The complexion is more generally sallow and anaemic in malarial 
fever. Jaundice is much less frequent in cerebro-spinal meningitis. 
(h ) The alterations of the blood are more profound in malarial fever. 
In cerebro-spinal meningitis the fibrin is increased, and there is no destruc- 
tion of the blood-corpuscles, nor of the ferment, by which glucogene is 
transformed into glucose, as in malarial fever; and the tendency to passive 
haemorrhages is much less in the former disease. 
(i.) The liver and spleen are universally involved in malarial fever, 
whilst they are frequently not at all affected in cerebro-spinal meningitis. 
The bronzed liver and large, softened, disorganized spleen of malarial fever 
will serve to indicate to the pathological observer whether or not the epi- 
demic of cerebro-spinal meningitis be complicated with the action of 
malaria. 
(j.) Even in the most sudden, and malignant, and rapidly fatal forms 
of malarial fever, with the greatest marks of cerebro-spinal disturbance, 
no organized or organizable fibrous lymph is thrown out from the mem- 
branes of the brain, and if effusions occur, the fluid thrown out is serous, 
or serum colored with bile, and mo^ rarely with the coloring matter of the 
blood. On the other hand, the effusion of coagulable plastic lymph is the 
characteristic lesion of cerebro-spinal meningitis. 
(k.) The nervous disturbances are more uniform and persistent in 
cerebro-spinal meningitis, and do not yield, as they do in malarial fever, 
to the free use of alcoholic stimulants and quinine. It is not to be denied, 
that inflammation of one or more organs may arise in the progress of an 
essential fever. Pneumonia is frequently excited during the progress of 
malarial fever, just as peritonitis may arise in typhoid fever from perfora- 
tion of the bowels; but we contend that when these inflammations arise 
during the progress of these fevers, they do not stand in the relation of an 
effect to a cause; they are in no manner essentially and uniformly the Pathological Anatomy of Malarial Fever. 
861 
results of the action of the malarial and typhoid poisons. We have also 
dwelt upon the important fact that the delirium, coma, and irregular nerv- 
ous actions which chaiacterize the severer forms of malarial fever, typhoid 
and typhus fevers, are not due to an inflamed condition of the cerebro- 
spinal nervous system, but rather to impairment of the nutrition and action 
of the ganglionic cells, and of the nerves generally, in consequence of the 
disorganization of the blood and nutritive fluids, and in consequence of the 
retention of noxious products resulting from ihe chemical changes excited 
by the febrile poison, and probably also in consequence of the direct action 
of the peculiar poisons upon the nervous elements. The delirium of fevers 
is frequently removed by the most active stimulation, and by the adminis- 
tration of alkaloids, as quinia, which excite the nerve centres, and pro- 
mote also the removal of the products ot the metamorphosis of the blood 
and tissues. The delirium and coma of cerebro-spinal meningitis cannot 
thus be relieved by free stimulation, and such alkaloids as quinia and 
morphia. In a word, cerebro spinal meningitis like other acute inflamma- 
tory diseases, is characterized by an increase of fibrin in the blood,and by 
the formation of deposits of inflammatory lymph, capable of organization 
into flbro-elastic tissue. 
2. HYPER2EMIA OF THE BRAIN AND SPINAL CORD IS THE MOST COMMON 
AND CHARACTERISTIC CONDITION AFTER DEATH FROM THE VARIOUS 
FORMS OF MALARIAL FEVER. 
The congestion of the brain and spinal cord daring the active stages 
of malarial fever may be both active and passive; and while various symp- 
toms, as intense pain in the head, vertigo, delirium, stupor and coma, and 
even convulsions and paralysis, may, in some case«, be referred to the con- 
gestion of the nerve centres, as well as to the toxic action of the malarial 
poison; at the same time true inflammation of the cerebral structures, fol- 
lowed by softening and abscess, has been rarely observed by the author. 
The congestion induced by the malarial poison affects all parts of the 
brain. In the active stages of malarial fever there is not an exclusive 
congestion of one or the other constituents of the nervous system; the con- 
gestion is not confined to the neurologia, the white substance of the brain, 
with its series of conducting tubules or commissural fibres, or to the gan- 
glionic masses, with their numerous nerve cells. We do not find the 
cortical periphery congested to a greater or less extent than the other 
ganglionic centres, as the optic thalamus, the corpus striatum, the medulla 
oblongata and the gray matter of the spinal cord. 
The repeated congestions of the cerebro-spinal centres during the par- 
oxysms of malarial fever, without doubt, induce more or less permanent 
lesions in the nervous structures, as we shall endeavor to show in the 
section which relates to the deposit of pigment in the brain in certain cases 
of chronic malarial fever. Loss of muscular and nervous power, neuralgia, 
vertigo, sudden loss of consciousness, local paralyses, obstruction of the 
blood-vessels and capillaries by pigment or pigment cells, great debility of 
the mental powers, and even insanity, may be referred to the effects of 
the repeated congestion of the cerebro-spinal axis; but there are always 
concurrent changes in the blood, liver and spleen, and, hence, the primary 
origin of malarial fever cannot be located in the cerebro-spinal or in the 
sympathetic nervous system. 862 
Lesions of the Nervous Structures in Malarial Fever. 
GENERAL RESULTS OF INVESTIGATIONS IN THE CHANGES OF THE NERVOUS 
STRUCTURES IN MALARIAL FEVER. 
Cerebro-Spinal Nervous System-Sympathetic Nervous System.-As far as 
my observations have extended in malarial fever, the dura mater was 
always normal; the arachnoid membrane pearl-colored, opalescent in some 
cases, in others perfectly transparent and normal in appearance; the blood- 
vessels of the pia mater congested with blood, but most generally without 
marks of inflammation. Subarachnoid fluid in almost all cases clear, 
transparent, and in some cases of a golden color; the amount varied in 
different cases, sometimes exceeding, but most generally falling short of 
the usual amount. Blood-vessels of the brain generally filled with blood. 
The structures of the brain appeared in acute cases, as a general rule, to 
be unaltered either in structure or appearance; in chronic cases the 
nervous structures sometimes presented a deeper and more grayish color, 
from the presence of pigment granules. 
The structures of the brain and spinal cord, in malarial fever, were, 
therefore, as a general rule, altered neither in consistence nor appearance, 
and the same is true also with reference to the sympathetic nervous system. 
The rapidity with which the symptoms of cerebral disturbances, such as 
coma and delirium, vanish under appropriate treatment, in many cases, 
render it evident that the congestion of the cerebro-spinal system is 
temporary and unattended with structural alterations. When death occurs 
in coma, the blood-vessels of the brain, even to their minutest ramifications, 
are distended with blood, such congestion being not merely evident to the 
naked eye but also more fully shown under the microscope, when thin 
sections are made of the brain structures. The ventricles of the brain are 
also filled with serum, often of a golden color. The paralysis which some 
times results from a paroxysm of malarial fever, may be due to several 
causes, as the actual rupture of blood-vessels and the effusion of blood, the 
detachment of a fibrinous clot, and the obstruction of some one of the arte- 
ries of the brain, and the impaction of some of the minute capillaries by 
pigment granules. Occasionally in cases of chronic malarial poisoning, 
attended with a watery condition of the blood, coma, with dilated pupils, 
sometimes supervenes suddenly, and in such cases I have found the ven- 
tricles to be greatly distended with serous fluid, which, by its pressure, 
had caused the cerebral symptoms. 
DEPOSIT OF PIGMENT IN THE BRAIN IN CERTAIN CASES OF CHRONIC 
MALARIAL FEVER. 
The old tradition that black substances are formed in the spleen and 
in the blood of the portal vein (the so-called black bile), and may give rise 
to disease, constituted an important element in the earliest theories of 
humoral pathology. The theory of Galen, that this substance accumulated 
in the spleen, as a product of the formation of bile, and that from that 
locality it gave rise to obstructions of the vessels, enlargements of the 
abdominal viscera and dangerous nervous symptoms, continued with a few 
intermissions, and some slight modifications to be resorted to for the 
explanation of abdominal affections generally, and of diseases of the portal 
system in particular, until the establishment of medicine upon a scientific 
basis, by chemical analysis, microscopic investigation, anatomical and 
pathological researches, and physiological experiments. 
It was not until the end of the eighteenth century that Reil showed 
how the doctrine of black bile was opposed to physiological observations ; Deposit of Pigment in the Brain of Malarial Fever. 
863 
but the majority of physicians continued to believe in the dreaded patho- 
genic potency of the black bile : the marsh fevers of the tropics, and the 
diseases which, in 1826, devastated the littoral districts of the northwest of 
Germany and the Netherlands, were regarded as atra-biliary fevers; and 
even as late as the year 1829, Vogel described the atrabilis after the fashion 
of the ancients in the Berlin encyclopaedia. Scientific investigation had 
scarcely removed this tradition of Hippocratic humoral pathology, when 
diseases became known in which black matters, produced by decomposition 
of the blood, became developed in the spleen, passed into the portal vein, 
atone time obstructing the hepatic vessels, at another passing through 
them, entered the general circulation, filled up the capillaries of the brain 
and the other organs, and induced morbid processes with symptoms similar 
to those which had been described by the ancients. 
It is only in the more recent times that accurate observations have 
been made of this lesion, although isolated instances are found recorded 
by the older physicians. Thus Lancisi found the liver of an individual, 
who had died of bilious fever, of a blackish tinge, and Stoll described a 
dark pigmentary deposit in the brain and liver of a female who had 
succumbed after several attacks of fever. 
Bailly, in his Pathological Anatomy of Intermittent Fever, published 
in 1825, makes the important observation that ''Le foie tout entier etait 
noirA,tre, sembiait compost de sang noir," * * * " la couleur du cer- 
veau beaucoup plus foncee." 
Ballard simul taneously described the same changes in the brains of three 
patients who died of acute cerebral disease ; and observations of a similar 
nature are found in Montfaucon's "Histoire Medicale des Marais." 
Black pigmentarj^ deposits were repeatedly observed in the spleen, 
liver and brain, during the fever epidemic which, in 1826, ranged along 
the coast of the North Sea. 
Richard Bright, in his "Reports of Medical Cases," published in 
London in 1831, gives a graphic representation of a brain, the cortical 
substance of which was of a dark color, like black-lead. This was taken 
from a man who died of cerebral paralysis after an attack of fever. 
Annesley, Haspel. Stewardson, and other physicians who have had oppor- 
tunities of observing intermittent and remittent fevers in hot climates, 
have frequently described a black tinging and pigmentation of the spleen 
and liver. These observations remained without further results because 
the mode of origin and the distribution of the pigment were not accurately 
traced. 
In 1847, Meckel ascertained that the dark color of the organs depended 
upon an accumulation of pigment in the blood; two years later Virchow 
found numerous pigment cells in the blood and in the enlarged spleen of a 
man who became dropsical after a persistent intermittent fever; and 
Heschl and Planer have recorded numerous observations of a similar 
nature. 
Our knowledge of the alterations of the liver resulting from intermit- 
tent fever, and of the mode in which the pigment is deposited in the various 
organs and especially in the brain, in malarial fever, has been materially 
advanced, by the investigations of Dr. Fried. Theod. Frerichs, embodied in 
his valuable "Clinical Treatise on Diseases of the Liver," published at 
Breslau, in March. 1858, and reproduced by the New Sydenham Society of 
London in 1860. 
In some fatal cases of intermittent, remittent and continued fevers, the 
deposit of pigment is not confined to the liver, spleen or portal system, 
but is recognized in the brain. Considerable collections of pigment are 864 
Deposit of Pigment in the Brain of Malarial Feuer. 
sometimes recognized by the dark coloring of the cortical substance, which 
assumes a chocolate or black lead-like hue, whilst the white matter remains 
unchanged. It is only where the pigmentary deposit is excessive that.the 
white matter presents a grey appearance, and the vessels in it resemble 
brown streaks. In such cases, microscopic examination;has shown the 
capillaries to be filled with black granules and scales,'which at one time 
are uniformly distributed, but at another are aggregatedin groups. Along 
with the pigment particles may be observed a rpale hyaline coagulum or 
plotoplasm which, when viewed with a light of a strongly refracting'power, 
may be seen to fill up the calibre of individual capillaries. 
In the typical forms of the melanaemic malarial fever we find, as a 
general rule, pigment deposited everywhere where the blood penetrates, 
and independently of the abdominal glandular organs, we find it in greater 
abundance in those parts of the body where the capillaries are most nar- 
row, and consequently when the pigment particles and cells are most easily 
arrested. The pigment found in the cerebral capillaries is brought to them 
by the blood; it exists in abundance in this fluid, and particularly in that 
portion of it contained in the portal vein, where its .'pioperties, color and 
chemical relations may be readily studied. Numerous particles of pig- 
ment, which have passed unarrested through the vessels of the liver and of 
the lungs, accumulate in the narrow capillaries of the brain, andjparticu- 
larly in those of the cortical substance ; and even by simple inspection of 
the shade of color, we can form an approximate estimate^of the quantity of 
coloring matter which has been deposited, and of the extent of the vascular 
obstruction. We must not, however, rely entirely upon inspection,; for 
slight accumulations of pigment in the capillaries easily escape notice, 
particularly when viewed by an unpracticed eye, and can only be, distin- 
guished with the assistance of a microscope, which will also in some cases 
reveal the obstruction of the vessels by a colorless fibrous-like coagulum. 
The mechanical interruption to the circulation, which is produced in this 
way, not unfrequently gives rise kto rupture of the small vessels, and the 
formation of numerous capillary apoplexies. Meckel made observations 
of this nature; Planer described eight cases in which small extravasations 
were scattered through the grey and white substance of the brain, and 
Frei ichs observed in two cases extravasations into the meninges. 
In the following figures we have important illustrations of the deposit 
of pigment matter in the brain in certain cases of melamemic malarial 
fever: 
Pigment Brain in Malarial Fever. 
ENGRAVING NO. 81. 
Engraving No. 81.-Illustrating the effects^of Melanaeinia upon the Brain. 865 
Deposit of Pigment in the Brain of Malarial lever. 
Section of the cerebellum, from a case of melaneemia. The deposit of pigment is most marked 
in the cortical substance; but vessels of a blackish tinge may be observed in the white substance 
also.* The pigment characteristic of the prolonged action of the malarial poison is easily detected 
in the brain, in which considerable collections are sometimes recognized by the dark-coloring of 
the cortical substance. This assumes a chocolate or black-lead-like hue, while the white matter 
remains unchanged; it is only when the pigmentary deposit is excessive, that we see the white 
matter present a gray appearance, and the fine vessels in it resembling brown streaks. Under 
such circumstances, microscopic examination has shown the capillaries to be filled with black 
f;ranules and scales, which at one time are uniformly distributed, but at another are aggregated 
n groups. Some observers have frequently observed along with the pigment granules and scales, 
a pale hyaline protoplasm, which when viewed with a light of a strongly refracting power, may 
be seen to fill up the calibre of individual capillaries. The brain undergoes important altera- 
tions during the prolonged action of the malarial poison. Numerous particles of pigment, which 
have passed unarrested through the vessels of the liver and of the lungs, accumulate in the nar- 
row capillaries of this organ, and particularly in those of the cortical substance. By simple 
inspection of the shade of color, an approximate idea can be found of the quantity of coloring 
matter that has been deposited, and of the extent of the vascular obstruction. 
* Diseases of the Liver-Frerich-Eng. Trans, vol. 1, p. 319. Atlas, plate x, figure 1. 
ENGRAVING NO. 82. 
Deposit of Pigment in Cerebral Capillary in Malarial Fever 
Engraving No. 82.-Illustrating Malarial Melansemia. Capillary Vessel of the Brain of a 
case of Malarial Fever of some standing, magnified 280 diameters. 
In the subject the particles of pigment appeared surrounded by a brown ring.* Along with 
the structural changes of the brain just depicted, remarkable aberrations of the functions of 
the organ have been observed during the progress of malarial fever. These derangements as is 
well known to any practitioner, intermit, and vary greatly in their nature. Sometimes they 
intermit, and cease with each paroxysm of fever, but more frequently they are protracted into 
the period of the intermission, or are continuous. Even in the last case, however, there are 
usually unmistakable indications of more or less distinct remissions. The cerebral disturbances 
manifest themselves in various ways; in the slighter cases they assume the form of headache and 
giddiness; in the more severe, that of delirium, but more usually of coma, and not unfrequently, 
there are disturbances of mobility, convulsions or paralysis. The most constant symptom is 
dull pain in the head, extending over the entire vertex, and almost always associated with 
attacks of giddiness. The headache is frequently accompanied by derangements of the senses, 
noises in the air, deafness, black vision, and dimness of sight, nausea and vomiting. The deposits 
of pigment in thesubstance of thebrain in malarial fever, are intimately connected and in some 
cases at least appear to be related as cause and effect. 
* Diseases of the Liver-Frerichs--vol. 1, p. 328. Atlas, plate x, figure 3. 866 
Deposit of Pigment in the Brain of Malarial Fever 
Deposit of Pigment in Capillaries of Brain in Malarial Fever. 
ENGRAVING NO. 83. 
EngravingNo. 83.-Capillaries of the brain of the same case of melaneemic (malarial fever) as 
in the preceding figure. Capillaries contain pigment. 150 diameters*. In malarial fever the 
mechanical interruption to the circulation which is produced by the deposit of pigment in the 
capillaries of the brain not unfrequently gives rise to the rupture of the small vessels and the 
formation of numerous capillary apoplexies. Meckel long ago made observations of this nature: 
Planer described eight cases in which small extravasations were scattered through the gray ana 
white substance of the brain, and Dr. Fried. Theod. Frerichs observed extravasations into the 
meninges in two cases. It has not been proved by direct examination whether, besides haemor- 
rhages, other organic lesions of the brain, such as atrophy from interrupted supply of plasma, 
result from occlusion of the capillaries. Frerichs and myself have seen pigment brains of old date 
without any remarkable diminution of the cortical substance. I have observed loss of memory, 
great mental weakness, hallucinations, and even paralysis, as the result of the action of the 
malarial poison. In the case of a stout German, brought in an unconscious state from the swamps 
of Louisiana, with high fever, it was found that after the fever had been relieved by purgatives, 
quinine, and a large blister to the back of the neck, the entire right arm and leg were paralyzed. 
Partial use of the right leg was regained under the use of strychnia, but the right arm remained 
contracted, with diminished heat and sensation, gradually, during the seven years that this 
patient was under my treatment, wasting considerably in size. 
* Diseases of the Liver. Frerichs, vol. i, p.326; Atlas, plate x.flg. 1. , 
ENGRAVING NO. 84. 
Section of Brain in Malarial Fever. 
Engraving No. 84.-Section of brain cortex from a case of death by malarial coma 
(chronic malarial poisoning), rhe capillaries are seen filled with pigment. X 125. Patient 
aged 67; male; died October 9, 1884. The first symptom of his lastattack was the flighty condition 
of his mind; this gradually grew worse, and, at the end of seven days, terminated in profound 
coma and death. The brain cortex was of a dark choco'ate color; ventricles of brain slightly 
distended with clear serum, meninges ofcord slightly hypereemic; corditself darkerthan normal, 
especially thegray columns of the same, which stood out in bold contrast to the white. Mucous Theories with reference to Malarial Feuer. 
867 
membrane of the pharynx, larynx and oesophagus pale; a slight quantity of mucus in the trachea; 
thyroid small; both lungs free from adhesions; posterior portion of lungs very ansemic; mucous 
membrane of bronchi red and congested. Heart, flesh firm; valves normal. Liver enlarged; 
weighed three pounds fourteen ounces, and was of a dark grayish color. Spleen enlarged; weight 
one pound nine ounces.and so soft, that when taken in the hands it felt like a bladder full of 
fluid. It was intensely congested and of a dark almost black color. The following figures, Aand 
B, represent capillaries of the brain and spleen filled with pigmented hyaline bodies.*. 
Capillary Vessel of Brain in Malarial Fever. 
ENGRAVING NO. 85. 
Engraving No. 85.-A. Capillary vessel of brain filled with pigmented hyaline bodies. B. 
Section of a small vein in the spleen. The hyaline bodies are seen generally inclosed in a red 
blood-corpuscle. The ordinary black pigment in round masses is seen both free in the 
vessel and enclosed in the leucocytes. In both the brain apd spleen some of the hyaline 
bodies are seen without pigment x800 by 1-20 oil immersion and slightly reduced. In the 
bone marrow a slight amount of pigment was found, both free and enclosed in cells. The blood 
taken from the right heart was of a lakey color, and contained here and (here pigment granules 
enclosed in white corpuscles. After placing the textures in absolute alcohol a microscopical exam- 
ination of the brain showed the capillaries of the gray and white matter, but especially the 
former, to be filled with small masses of pigment. Examination with high powers, 1-20 oil 
immersion and Abbey illuminator, showed the pigment to be contained in the small hyaline 
masses. It was distinctly seen that these bodies stained with Bismarck brown. In sections 
mounted in water they were easily seen and appeared to be composed either of homogenous or 
very fine granular protoplasm. In size they varied from one-fourth to one-half of that of a 
red blood-corpuscle. The pigment contained in them assumed various forms. Councilman and 
Abbott.f 
THEORETICAL OPINIONS AS TO THE RELATION OF MALARIAL FEVER IN ITS 
ORIGIN, CAUSATION, SYMPTOMS AND LESIONS TO THE CEREBRO-SPINAL 
AND SYMPATHETIC NERVOUS SYSTEMS. 
We have presented facts which establish the important principle that 
the primary action of the malarial poison is upon the blood, and that the 
nervous ganglionic centres and the alimentary canal, liver and spleen, are 
secondarily involved; and that the subsequent phenomena are complex, in 
which deranged nervous actions in both the cerebro-spinal and sympa- 
thetic systems play an important and prominent part. These views are at 
variance with those of the older theoretical writers, who, as a general 
rule, extended their inquiries no farther than the most prominent and 
manifest symptoms of fevers, without chemical and microscopical exami- 
nations of the blood secretions and excretions, and the minute anatomy of 
the diseased organs. Professor John Fred Lobstein, whose valuable work 
was published in the United States as early as the year 1831, advocated 
the theory that the cause of intermittent fever was to be found in the dis- 
order and perverted action of the abdominal (sympathetic) nervous sys- 
tem. Thus Lobstein says: 
»A Contribution to the Pathology of Malarial Fever, by Councilman and Abbott, Am. Jour. 
Med. Sci., April, 1885, pp.416-429. 
t Loe. cit., p. 421. 868 
Theories with reference to the Nervous Origin of Malarial Fever. 
"In reflecting upon the nature of intermittent fevers, I have thought that it 
might, perhaps, be found in the disorder and perverted action of the abdominal 
nervous system, and there appear, indeed, to be sufficient grounds to render thia 
opinion probable: 1st. The cases of this disease are very rare in which the func- 
tions of the abdominal organs continue vigorous and entirely unaffected. 2dl The 
commencement of the paroxysms is often marked with vomiting. 3d. We expe- 
rience daily that this disease is mitigated, and very often entirely removed, by the 
use of cathartics. 4th. A single emetic, when given previously, sometimes sup- 
presses the paroxysm, and not unusually removes the whole disease; from which 
it appears that this remedy makes an impression upon the solar plexus of an oppo- 
site nature to that which had produced the fever. 5th. When the disease is either 
left to itself or maltreated, congestions are produced in the abdominal viscera, 
induration of the liver, intumescence of the spleen, etc., and the general morbid 
state is changed into a topical affection. This metamorphosis appears to me toprove 
that the morbid action prevails at first in all the plexuses, and afterwards migrates 
from one to another; for it is first apparently disseminated in the whole territory of 
the ganglionic system before it runs with impetus into a single plexus, which is 
commonly the splenic; and as the vessels are under the influence of the nerves, it 
cannot be otherwise than that congestions should thus be produced in the vessels. 
6th. The paroxysms of intermittent fever are tied down to a regular rhythmus, in 
consequence of their being radicated in the nervous system, upon which nature 
has impressed a law according to which they must perform their functions period- 
ically. "Each nervous system, therefore, is obnoxious to its own diseases. But the 
mode in which the cerebral and spinal nerves of the abdominal plexuses and gan- 
glia are affected by disease is the same. Asin the various kinds of convulsions, 
epilepsy, tetanus, etc., there is disorder in the voluntary nerves, even when no 
organic lesion can be discovered in them; so the nerves of the thoracic and abdom- 
inal viscera may be affected without any alteration perceptible to the senses. As 
the perverted action of the cephalic brain is reflected with great force upon the 
abdominal brain, so, in turn, does the latter react upon and overwhelm the former. 
And, finally, as the cerebral system, when it is stupefied, as it were, by the violence 
of disease, destroys life, in like manner, I believe, an analogous effect takes place 
in certain diseases in the solar plexus."* 
Lobstein, more than half a century ago, announced that "Each nervous 
system is obnoxious to its own diseases," and laid the foundation for the 
hypothetical classification of diseases into: 1. Cerebro-spinal; 2. Sym- 
pathetic. 
The opinion of Hoffmann, Boerhaave, Cullen, Selle, Tode, Thorer, 
Stoll, J. C. Frank, Fodere, Clutterbuck, Alibert, Bayer, Nepple, and 
others, which referred fevers to a lesion of the nervous system, was adopted 
and extensively applied by Maillot,! in his original, elaborate work on 
malarial fever. M. Maillot looked upon the cerebro-spinal axis as the point 
of departure of the series of morbid actions constituting periodical fever, 
and affirmed that an acute irritation or hyperiemia of the great nervous 
centres existed during the active stages of malarial fever. 
In this country my former colleagues. Professor Lewis D. FordJ and 
Professor L. A. Dugas,§ of the Medical College of Georgia, shortly after the 
appearance of the work of M. Mail lot, in Paris, maintained that the phe- 
nomena of intermittent and remittent fever depend primarily upou lesions 
of the cerebro-spinal nervous system. 
Dr. Lewis D. Ford thus expresses the results of his clinical study of 
forty cases of intermitting and remitting fevers: 
* A Treatise on the Structure, Functions, and Disease of the Human Sympathetic Nerve, by 
John Fred. Lobstein. Translated by Joseph Pancoast, M. D. Philadelphia, 1831, pp. 121,122. 
t Traitd des Fievres ou Irritations Cerebrc-Spimdes Intermitt.entes d'aprSs des Observations 
Recueillies en France, en Corse, et en Afrique. Par F. C. Maillot. Paris, 1836. 
I Remarks on the Pathology and Treatment, of Intermittent and Remittent Fevers, with 
Cases. By Lewis D. Ford, M. D., Professor of Chemistry in the Medical College of Georgia; 
Southe'.n Medical and Surgical Journal, vol. i. No. 6, November, 1836, pp. 335-360. 
2 Remarks on the Pathology and Treatment of Bilious Fever. Head before the Medical Society 
of Augusta. By L. A. Dugas, M. D., Professor of Anatomy in the Medical College of Georgia. 
Southern Medical and Surgical Journal, vol. ii, No. 7, February, 1838. pp. 387-397. Theories with reference to the Nervous Origin of Malarial Fever. 
869 
"It thus appears that of these forty cases of intermitting and remitting fever, 
this tenderness on pressure of some portion of the spinal column was present in all 
but four cases of remitting fever, and in two cases of intermittent; of these, how- 
ever, one was arrested by a blister to the spine, without other means used but diet- 
ing, and the other was modified materially in its character in like manner." 
* * *-p. 354. "Another question naturally presents itself: What is the force 
and value of this symptom? whence this uneasiness? what does its existence indi- 
cate? Certainly not that the skin at these particular points is sore and tender. 
I have examined carefully, to verify this fact, by taking it up between the thumb 
and finger, and compressing it with more force than was applied by the direct 
pressure; uniformly receiving the assurance of the patient that the uneasiness was 
of a different character from that produced by pressure upon the bone. But if this 
might be the cause of pain in the method by pressure, it cannot be in that by per- 
cussion; for it is well known to those who make use of mediate percussion that it 
may be employed freely even upon a blistered surface, without producing pain. It 
as certainly does not indicate that the bone itself is tender and diseased; for we can- 
not conceive why pressure upon a diseased bone should be followed by sighing, 
coughing, increased oppression of the prsecordia, nausea, and faintness. It is as 
unsatisfactory, for the same reasons, to attribute this symptom directly to a dis- 
eased state of the ligaments of the vertebrae. Having thus excluded these three 
parts from any participation in the production of this phenomenon, we next inquire: 
Can it proceed from a diseased state of the dura mater lining the bony channel? We 
answer unhesitatingly that the symptoms above referred to, developed in distant 
organs by the examination, cannot arise directly from an inflammation or any 
degree of irritation of the dura mater, for reasons assigned already; but we can con- 
ceive very readily how the dura mater, being in a swollen state, might produce 
such symptoms by compressing the origin of nerves supplying these distant organs 
when an unusual degree of motion is communicated to the vertebrae by percussion. 
But we perceive that this unusual motion of the vertebrae would produce the same 
degree of pressure if the dura mater were in its normal state, and the substance of 
the cord itself enlarged. We therefore must necessarily adopt the conclusion that 
this phenomenon indicates a diseased stale either of the medullary substance of the 
spinal cord, or of its investing membranes. I am not prepared to infer from these 
few cases that this local affection of the spine always exists, nor that it is the pri- 
mary irritation upon which these fevers depend ; but if subsequent observations 
shall establish the uniform existence of this spinal irritation at the commencement 
of intermitting and remitting fevers, it will confirm the opinion, now almost uni- 
versally held by the profession, of the local origin of all fevers, and the equally 
universal persuasion that this location is in some part of the nervous system." 
-pp. 357-359. 
Dr. L. A. Dugas thus defined his view that malarial fever was an origi- 
nal. affection of the nervous centres, subsequently complicated by phlogosis of 
some other organ or organs: 
When, fresh from the benches of the school of organic medicine, I was called 
■on to examine and to treat cases of " bilious fever," I instinctively interrogated in 
succession every organ of the body, in search of the seat of the disease, or, in 
other words, of thecause of so much constitutional disturbance. In some cases, 
despite all my investigations, no trace of disordered function (the best evidence of 
a diseased organ) could be detected elsewhere than in the stomach; in others the 
bowels were alone distempered; other sets evinced the disturbance to be located in 
the liver, in the brain, or in more than one of the principal viscera. The bilious 
modification implied by the name of the affection, though very frequently mani- 
fest, was often entirely wanting. Yet each of these cases presented certain char- 
acters peculiar to all. Their onset was always marked by loss of muscular power, 
by pains in various parts of the muscular system of animal life, etc.; their early 
stage by intermittency, or decided remissions; their duration and termination pre- 
sented a strong analogy; in short, it was evident that although modified by the 
affection of some special organ, all these cases were under the predominance of an 
original and common affection. The seat of this original and common affection 
cannot be mistaken if we adhere to the principle already alluded to, that of regard- 
ing vitiated function as the best indication of diseased organs. If an organ be 
healthy, its function must necessarily be normal; consequently, if a function be 
abnormal, the organ presiding over it cannot be in a physiological condition. I 870 
Theories with reference to the Nervous Origin of Malarial Fever. 
am aware that it will be urged that certain secretions may be vitiated by an altered 
condition of the fluid whence they are derived, without disease of the secerning 
organs. For example, the urine may present various aspects, according to the sub- 
stances taken into ciiculation, or the composition of the bile may depend on that 
of the blood. But this cannot affect our position, for the condition of the blood 
itself depends entirely on that of the organs which form it, and of those whose 
office it is to eliminate its impurities. If it remains impure, the cause must be 
found in the vitiated action of the emunctories. But whether these principles of 
diagnosis be admitted or not, it is presumed that no one would, on reflection, refer 
the morbid condition of the contractility and sensibility of the muscular system to 
any other locality than the nervous centres. We have already stated that the 
earliest symptoms of our fevers to be lassitude, loss of muscular power, and pains 
in the muscles of animal life; also, that intermittency, more or less complete, 
always marks their early stage. We are, therefore, led to the conclusion that the 
nervous system is the original and common seat of this class of affections. I trust 
that I will not be misunderstood; the term original being here used expressly to 
indicate that these fevers subsequently undergo serious modifications, from the 
supervention of other derangements. It is to these complications we must look for 
the explanation of the various forms assumed by the fevers misnamed bilious, so 
that the proper definition of them should be an original affection of the nervous 
centres, subsequently complicated by phlogosis of some other organ or organs, which 
secondary disorder may either gain the ascendancy of the primary, or merely mask 
and modify it. * * *-pp. 388, 389. We have already stated that neither of the 
above complicating phlegmasise, alone or unattended with spinal disease, could pro- 
duce the phenomena common to all the forms of our " bilious fevers," and we 
have furthermore stated the primary lesion to be that of the nervous centre, or, 
in other words, of the spinal cord. If the primary affection remain uncompli- 
cated, then we have a disease of the mildest form known, one which retains its 
peculiar characteristics, its paroxysmal form, and its periodicity. In short, we 
have a plain case of ague and fever, such as we daily see. * * ' *-p. 393. The 
action of quinine will always be most happily seconded by revulsive applications 
to the spine, which is frequently found painful on pressure or percussion. Indeed 
these will alone, in many instances, be found sufficient to arrest the disease. For 
evidence of this very decided effect I would refer to the interesting and able paper 
published by Professor Ford in the sixth number of the Southern Medical and 
Surgical Journal.-p. 394. 
The late Dr. Milton Antony,* of Augusta, Georgia, Professor of Obstet- 
rics in the Medical College of Georgia, published in 1837 an interesting 
article on spinal irritation, from which we extract the following : 
We find an intermitting fever attended with some degree of irritation about 
the spinal marrow. As spinal irritation seldom, if ever, exists idiopathiCally, shall 
we not rather look to it as an index pointing to other disorder? In this case an 
inquiry is necessary into the pathological condition of the general system, or the 
various organs, under the existence of an intermitting fever. And here we find 
that the liver and the spleen sometimes are laboring under an obstructing torpor, 
which prevents that free transmission of blood through them which the great 
portal system demands. This is a fact that we know to exist; and if we did not, it 
is susceptible of plain proof. Now, suppose a given quantity of blood in the system 
at the moment of consideration as twenty-four pounds, and that one-twelfth, or two 
pounds, passes the portal system, whilst the other twenty-two do the other circula- 
tion. The abdominal fullness evinces the obstruction. If, now, we allow any 
obstructing cause in the route of the portal circulation, the liver is the only organ 
where we may suppose it located. Let us suppose that this obstruction is such as 
to transmit only half the quantity of blood in a given time. The unavoidable con- 
sequence and proximate effect of this must be an increased fulness of the portal 
vessels. This accomplished to its utmost, and the next consequent must be their 
refusal to imbibe or receive more than half their natural quantity in a given time, 
or one instead of two pounds, and consequently, if the health were perfect in the 
former state, there is, to say nothing about the quantity of blood, a redundance of 
* Ilemarks on Spinal Irritation, by M. Antony, M. D., Professor of Obstetrics in the Merllcal 
College of Georgia. Southern Medical and Surgical Journal, vol. i, Nos. 9 and 10, March, 1837, pp 
680-587. Classification of Feuers into Cerebro-Spinal and Sympathetic. 
871 
about four per cent. Following this inquiry, we perceive, therefore, local phe- 
nomena, and especially in non-resisting parts, and consequently a cause of irrita- 
tion or of oppression. ' * * *-p. 585. In all these cases, therefore, we are bound 
to direct attention to the first seat of the obstruction and irritation. Let the parti- 
san in medical doctrines have his choice of the horns of the dilemma, still he is 
bound to look to it as a cause, whether it be the local irritation alone acting through 
the medium of the nerves, or merely the effect of the sanguine plethora, already 
prescribed. And in case of the combination of both, he must look to the removal 
of the obstruction to circulation, as well as the subduction of irritation in the pri- 
marily obstructed and irritated part.-p. 586. 
Dr. James Copland, in his great work "Medical Dictionary/'* the first 
American edition of which was published in 1855, advocated, in his accus- 
tomed learned and philosophical style, a view similar to that advanced by 
Lobstein; namely, that the malarial poison affects primarily and especially 
the sympathetic nervous system. The following is an outline of the views 
of Dr. Copland: 
" The doctrine that the causes of fever first affect the cerebro-spinal nervous 
system is invalidated by the following considerations: a. This system either does 
not send nerves or it supplies but few nerves, and those often indirectly, to the 
organs especially or essentially affected in idiopathic fevers; as the heart, blood- 
vessels, secreting viscera, lungs, etc. b. 1'hat the chief avenues to this system open 
to the invasion of the exciting causes are the organs of sense and the cutaneous 
surface. Of these, the sense of smell is the principal. Although this sense is evi- 
dently impressed by several of these causes when acting intensely, and admitting 
that the brain is somewhat affected in consequence, still the effect produced in this 
quarter seems inadequate to explain the chief, and far less the whole, of the early 
phenomena, c. In some instances the intense operation of the effluvia generating 
fever has produced its effects almost instantly, and even caused death itself with 
equal rapidity, a result which the total annihilation of the cerebral functions could 
not produce, but which would necessarily followthe interruption or suppression of 
the influence transmitted to the heart and lungs by the nervous system of organic 
life. d. The generation of fever within the body itself cannot be explained upon 
the supposition that the cerebro-spinal nervous system is primarily and solely, or 
even chiefly, concerned in the production of the disease, but may be readily solved 
by means of the nervous system of organic life, if we take into consideration its 
functions and structural relations, especially with the vascular system, the circu- 
lating fluids, and the excreting viscera, e. The early lesions, whether of function 
or of organization, characterizing the first as well as the advanced periods of fever, 
cannot be accounted for by assigning the cerebro-spinal nervous system as the 
primary seat of the disease; for, 1st. As this system cannot influence the action of 
the heart and the state of the vessels, excepting through the medium of the organic 
nervous system, and this only to a very limited extent, changes in it do not explain 
the alterations of vascular action, and still less the vitiation of the blood. 2d. As 
it does not control animal heat, so it cannot induce those remarkable extremes and 
morbid states of temperature distinguishing the malady. 3d. As it does not supply 
nor materially influence secreting surfaces and glands, so it cannot give rise to 
those early changes of function which they present, nor to those lesions of struc- 
ture which they often subsequently experience. 4th. As it does not materially 
affect the actions of assimilation and nutrition, so it cannot occasion the remark- 
able changes they present in fevers. And, 5th. As it does not present aberrations 
of function, in the slighter and simpler states of fever, equal in degree to those 
manifested by the viscera, chiefly supplied by the nerves of organic life; and as, 
when such aberrations supervene in a remarkable manner, they are generally 
consequent upon those of the organic nerves and vascular systems, and of the 
blood itself, so that the primary impression made upon it must be much less 
energetic than is supposed by those who support the present doctrine, although I 
«A Dictionary of Practical Medicine, comprising General Pathology, the Nature and Treat- 
ment of Diseases, Morbid Structures, and the Disorders specially incident to Climates, to the Sex, 
and to the different Epochs of Life, etc,, by James Copland, M.D., F. R. S., etc. Edited, with 
additions, by Charles A. Lee, A. M., M. D„ etc., in three volumes. New York, Harper & Brothers, 
1855. Vol. I., article Fever, pp. 1(1(14. 1065; also pp. 1038-1084. Intermittent fever, pp. 10s5-1100. 
Remittent Fever, pp. 1100-1122. Hectic, Continued, Inflammatory. Bilo-gastric, Synchoid, 
Typhoid, and Typhus fevers, pp. 1123-1230. Article Disease, pp. 641-689. 872 
Classification of Fevers into Cerebro-Spinal and Sympathetic. 
may grant that it partakes, in some measure, or in some forms of fever, of the 
morbid impression especially and principally made upon the nervous system of 
organic life, and extended to the organs which it actuates. That the efficient 
agents of fever act primarily and chiefly upon the organic or ganglionic nervous 
system is evident from what has been now adduced, and is farther proved by the 
following facts and inferences: a. The intimate connection of this system with 
the organs of circulation, respiration, assimilation, and secretion, on the one hand, 
and with the cerebro-spinal nervous system on the other, and the influence exerted 
by it over their functions in health, are sufficient to show that morbid impressions 
made upon it must necessarily affect all the organs and parts with which it is 
related, b. The functions primarily disordered in fever, and chiefly affected in its 
course, are precisely those which are especially subjected to the influence of this 
system. As we cannot, consistently with our knowledge of the animal actions in 
health and in disease, infer that a grave and permanent disorder of any one 
function can exist, unless either the influence that actuates it is impaired, excited, 
or otherwise altered, or the structure of the organ, which is the instrument of the 
function, is more or less affected; we are necessarily led to inquire as to which of 
these sources the disorder is to be imputed. Having inferred from the nature and 
extent of the disorder, from the causes in which it arose, and the suddenness and 
manner of its occurrence, as well as from various other circumstances, that it does 
not consist of lesion of structure, we are, therefore, compelled to adopt the former 
alternative, and, from the kind of disorder, to infer the manner in which the 
influence actuating the organ is affected. Thus, observing that respiration, circu- 
lation, secretion, and animal heat are primarily and especially disordered at the 
commencement of fever, and that various other morbid phenomena are conse- 
quently produced, and finding no structural or local change to account for the 
affection, we refer it to the state of the influence which actuates these functions. 
Anatomical and physiological evidence concur in showing that the nervous system 
of organic life is chiefly concerned in the production of those functions; and, 
therefore, it may be inferred that this system is first impressed by the causes of the 
disease." 
My former colleague Professor Henry F. Campbell, M. D., of the 
Medical College of Georgia, in 1858, published a classification of febrile 
diseases in which he expressed views with reference to the nature of mala- 
rial fever similar to those previously announced by Maillot, of Paris, and 
Ford, Antony and Dugas, of the Medical College of Georgia. Dr. Camp- 
bell, on the other hand, in opposition to Lobstein and Copland, referred the 
continued fevers to the sympathetic or organic system of nerves, as will be 
seen from the following outline of his hypothetical classification of fevers : 
"As in the nervous system we recognize two grand departments-viz, 1st, the 
cerebro-spinal system, all the normal actions of which are subject to cessations and 
interruptions; and, 2d, the ganglionic system, all the normal actions of which are 
of a continuous and uninterrupted character-so in the manifestations of febrile 
diseases do we distinctly recognize two grand distinguishing characteristics respect- 
ively typifying the normal actions of the-ie two systems of nerves; thus a character 
of paroxysm obtains in certain cases, while a character of continuousness as plainly 
marks the others. Again, as in the cerebro-spinal system we find that its normal 
action pertains almost exclusively to sensation and to motion, with only a secondary 
and comparatively somewhat remote influence (which we have termed excito- 
secretory) upon nutrition and secretion, while in the normal action of the ganglionic 
system the entire function is known to be to preside over nutrition and the secre- 
tions, so in paroxysmal fevers do we find intense pain, modified sensation, and 
symptoms allying them to neuralgic and convulsive diseases very prominent, while 
in continued fevers modified nutrition and altered secretion are the marked and 
most prominent characteristics. We would therefore announce, as our classifica- 
tion of febrile diseases, two grand divisions of fevers corresponding with the two 
grand divisions of the nervous system, thus: I. Cerebro-spinal fevers. AH 
paroxysmal. The secretions and nutrition secondarily affected. 2. Ganglionic 
fevers. All continued. The secretions and nutrition primarily affected. Under 
the head of cerebro-spinal fevers we would place the whole family of paroxysmal 
fevers, whatever type they may assume, and also the various forms of neuralgia, Lesions of the Nervous System in Yellow Fever. 
873 
which are nearly always intermittent, as well as the sthenic forms of traumatic 
fever, together with the fever accompanying simple pharyngitis, pneumonitis, 
dysentery, and many other diseases of malarious districts.''* 
The classification of fevers, in accordance with the most prominent 
nervous symptoms, into two great classes, cerebro spinal and sympathetic, 
us proposed by Lobstein, and others before him, and advocated by various 
writers, as Maillot, Ford, Dugas, Antony, Copland and Campbell, cannot 
be accepted for the following reasons: 
1. In all fevers, whether idiopathic or symptomatic, both the cerebro- 
spinal and sympathetic systems are involved. Pain in the head and back, 
■disturbance of vision, delirium, muscular prostration, twitching of tendons, 
chilly sensations, elevation of temperature, increase of circulation and 
respiration, increase of chemical changes, and derangements of secretion, 
nutrition and excretion, are common to all levers. 
2. The cerebro spinal and sympathetic nervous systems are so inti- 
mately connected in their anatomical arrangements that it is impossible 
to affect the one without affecting the other. I have discussed the rela- 
tions of the cerebro-spinal and sympathetic nervous systems to each other, 
and to circulation, respiration, nutrition and secretion, animal heat and 
muscular force, in the first volume of these Medical and Surgical Memoirs. 
See Introduction to the Study of the Nervous System, pp. 79-137. These 
relations must be carefully considered in every theory of fever. 
3. In no class of fevers are the signs of cerebro-spinal derangement 
more marked than in the so-called continued fevers, typhus and typhoid 
fevers, which Dr. Campbell includes under the head of ganglionic fevers. 
In typhoid fever we have the most marked symptoms of cerebral derange- 
ment from the very onset of the disease, before the advent of any signs of 
■derangement in the sympathetic system, namely: Pain in the head and 
back, hebitude, nervous and muscular prostration, loss of intellectual 
power, persistent delirium. The deposit in the glands of Peyer and their 
subsequent ulceration, gives no more proof that the primoidal and essen- 
tial action of the poison of typhoid fever is upon the sympathetic ganglia, 
than that the eruption of small pox indicates a similar origin. 
4. The progress of modern science has gradually established the 
important fact that specific fevers are produced by specific poisons, germs, 
ferments or micro organisms. No classification of fever has any claim as 
a philosophical and comprehensive expression of the ti ue nature and dis- 
tinctive characteristics of different fevers, which is not based upon a cor- 
rect knowledge of the nature and origin and specific effects of the specific 
causes. Thus the author has shown by experiment to be recorded in the 
appropriate sections of this work : 
(a.) It is possible to excite fever and dysentery by the subcutaneous 
injection of the waters of swamps and marshes of malarious regions 1 
demonstrated this fact by actual experiment in I860. 
(b.) The poison of Hospital gangrene when inoculated iuto healthy 
men and animals will reproduce this disease. This fact in military sur- 
gery the author demonstrated in the Confederate army in 1863 and 1864. 
(c.) The blood and black, vomit of yellow fever injected subcutane- 
ously will induce a fatal form of fever, in some cases attended with violent 
convulsions. I demonstrated this proposition on animals in 1870, 1873, 
1876, 1878, 1880 and 1882. When we have fully determined the nature of 
♦Glassification of Febrile Diseases by their Relation to the Nervous System. By Henry F. 
Gampbell. M. D., Professor of Anatomy in the Medical College of Georgia. Southern Medical and 
Surgical Journal, vol. xiv. No. 1, January, 1858, pp. 13-18. See also Translations of the American 
(Medical Association, 1858. 874 
Lesions of the Nervous System in Yellow Fever. 
the poison, as well as its effects in specific fevers, we will not only be able 
to establish a rational classification, but we will most probably be able to 
base our therapeutics upon philosophical and truly scientific principles. 
COMPARATIVE CHANGES OF THE CEREBRO-SPINAL AND SYMPATHETIC NER- 
VOUS SYSTEMS IN YELLOW FEVER. 
Cer ebro-Spinal Nervous System-Sympathetic Nervous System.-The post- 
mortem examinations of the brain, spinal cord and sympathetic systems 
have thus far revealed no characteristic lesions to which the aberrated 
nervous symptoms of yellow lever can be referred. Beyond congestion of 
the capillaries of the cerebro-spinal and sympathetic systems, which con- 
gestion appeared to be referable to the same cause as that producing capil- 
lary congestion in the internal organs, I have observed no structural haem- 
orrhagic lesion, as fibrinous effusion, or softening of the cerebro-spinal and 
sympathetic nervous structures. Chemical analysis revealed the presence 
of urea, bile, and leucine in the brain, and to the effects of these sub- 
stances, as well as to the direct action of the yellow fever poison, must be 
referred the aberration of intellect, the restlessness, convulsions and coma. 
The amount of the congestion of the blood-vessels of the brain will to 
a certain extent vary with the stage and with the conditions under which 
death takes place. Thus, when the functions of the kidneys are greatly 
impaired or wholly suppressed, owing to the retention of the watery ele- 
ment of the blood, the vessels throughout the entire system are filled with 
blood to repletion, and the brain is especially, from its soft structure and 
the character of its circulation, the organ most affected. In such cases, 
the blood is seen issuing from numberless vessels when sections of the 
brain are made. Under the microscope, the thin sections of the brain reveal 
a state of great hyperaemia, the minute capillaries bmng filled with colored 
blood-corpuscles. 
The golden hue of the brain substance and membranes, as well as that 
of the tissues generally, is due to the presence of the coloring matter of the 
bile, and not to the escape of haematin from the blood-vessels. When death 
occurs after profuse haemorrhages from the stomach and bowels, the cere- 
bral structures present less evidences of congestion than when these symp- 
toms have been absent or present to a small degree. 
It is probable that the cerebral ganglia and commissures, as well as 
those of the spinal cord and sympathetic nervous system are affected with 
the same chain of chemical reactions which result in the formation and 
accumulation of oil in the blood and in the heart, liver and kidneys. In 
this connection, the recent observation of Dr. H. D. Schmidt, during the 
yellow fever of 1878, in the Charity Hospital of New Orleans are of inter- 
est, in that they sustain the view that the accumulation of oil is not con- 
fined exclusively to the liver, heart and kidneys. 
Dr. Schmidt affirms that he has observed fatty degeneration of the 
nuclei in the walls of the minute vessels of the pia mater venures, as well 
as arterioles. In many vessels the nuclei have disappeared, leaving a num- 
ber of fat globules in their places; others are met with in which an increase 
of the mere trace of protoplasm, surrounding the nucleus in the normal 
condition has taken place, causing a thickening of the wall of the vessels. 
"With reference to the brain, the most prominent observation thus far 
made is the existence of fatty degeneration of the blood-vessels of the 
cortex-cerebri, similar to that observed in the vessels of the pia mater, 
together with degeneration of the ganglionic bodies of the cortex." 
If these observations should be confirmed by farther research and 
especially by chemical analysis, determining the exact proportion of oil in Lesions of the Heart in Yellow and Malarial Fever. 
875 
the brain in health and various diseased states, it will thus be shown that 
the nervous system both cerebro-spinal and sympathetic, is involved in a 
similar series of changes as the other organs. The universality of these 
changes point to the blood as the great medium and source of the chemical 
actions, and we have a confirmation of this view in the fact which I have 
determined by chemical analysis, that the oleaginous constituents are 
greatly increased in the blood of yellow fever. That the mere presence of 
oil in increased amounts in certain organs, during yellow fever, is not the 
cause of the gravest symptoms, is evident from the rapidity of the conval- 
escence in many cases; and also from the well known fact that in many 
cases the general health is greatly improved by an attack of yellow fever. 
The grave symptoms of this disease must be sought not merely in the struc- 
tural alterations of certain organs, but in the initial chemical changes 
induced by the poison, which precede the final lesions discoverable alter 
death. 
MALARIAL FEVER. 
Chest.-The lungs, in uncomplicated malarial fever, presented no abnor- 
mal appearance, except the accumulation of the blood in the most depend- 
ent parts, which resembled in all respects and were due to the same causes 
as the accumulation of the blood in the vessels of the most dependent parts 
of all the organs and tissues. 
Lungs.-Dependent portions congested without blood ; otherwise 
healthy. Owing to the effects of the malarial poison in decreasing the 
fibrinous element of the blood and the colored corpuscles, pneumonia 
engrafted upon an individual suffering with malarial fever, tends to spread 
by diffusive inflammation, and in the case of pleuritis as a supervening 
disease, the effusion int o the pleural cavity is rapid and destructive in its 
effects. If pneumonia be complicated with malarial fever, the periods of 
congestion of the lungs, attended with oppressed breathing and increase 
of pulmonic inflammation are periodic and may be to a certain extent 
controlled by quinine. 
YELLOW FEVER. 
Lungs.-Dependent portions greatly congested; otherwise normal. In 
some cases circumscribed effusions of blood in textures of blood. I have 
in a few instances observed pneumonia as a supervening disease in yellow 
fever; in such cases the sputa consisted of almost pure blood. The super- 
vention of pneumonia causes a continuation of the febrile phenomena 
beyond the usual period of the uncomplicated disease. 
PATHOLOGICAL ANATOMY OF THE HEART IN MALARIAL AND YELLOW 
FEVER. 
The heart presented no uniform pathological alterations which could 
be referred to malarial fever. In the hearts of drunkards, fatty degenera- 
tion was frequently observed; but this was an effect of the alcohol, and not 
of the malarial poison. In some eases the heart was paler and softer than 
usual; these did not appear to be uniform alterations, in any manner refer- 
able to the action of the malarial poison. The general results of our inves- 
tigations on the condition of the heart in undoubted and uncomplicated 
cases of malarial fever (uncomplicated by scurvy, typhoid fever, typhus 
fever, yellow fever, and fatty degeneration of the heart), may thus bo 
formulated : 876 
Lesions of the Heart in Yellow and Malarial Fever. 
MALARIAL FEVER. 
Heart.-Normal in color, presents the deep purplish red muscular 
appearance of the healthy heart. Muscular fibres of the heart firm and of 
normal appearance under the microscope. No deposits of oil in the 
muscular structures. Cavities of the heart frequently distended with dark 
blood. Firm laminated fibrinous concretions very common; and in some 
cases of pernicious fever, the formation of these heart-clots during the cold 
stage without doubt causes death, and renders unavailing the action of 
remedial agents. The fibrinous concretions are not only attached to the 
carna) column® and chordae tendinae and auriculo-ventricular valves, but 
they also frequently send forth long branches into the pulmonary arteries. 
The formation of these concretions is rare in yellow fever, and when formed 
they are much smaller and softer than in malarial fever. The blood of 
malarial fever contains more fibrin, fewer colored corpuscles, and changes 
more slowly to the arterial hue, upon exposure to the atmosphere, than the 
blood of yellow fever. 
In malarial fever the heart does not, as in yellow fever, undergo fatty 
degeneration. We do not by any means wish to be understood as affirming 
that fatty degeneration of the heart is characteristic of yellow fever in 
contradistinction to all other diseases ; but only as distinguishing this dis- 
ease from the various forms of malarial, paroxysmal or paludal fever. By 
quantitative analysis of microscopical examination, I have demonstrated : 
1. Yellow fever is characterized by acute fatty degeneration of the 
muscular fibres of the heart. 
2. The fat or oil is far more abundant in the yellow fever heart than 
in the healthy heart. 
3. Fatty degeneration of the heart is not the sole state of this organ in 
yellow fever; a molecular change has taken place in the substance of the 
muscular fibres, and this change affects the albuminous or nitrogenous con- 
stituentsand most probably represents one of the stages in the acute fatty 
degeneration. We do not by any means wish to be understood as affirming 
that fatty degeneration of the heart is characteristic of yellow fever, in con- 
tradistinction to all other diseases ; but only as distinguishing this disease 
from the various forms of malarial paroxysmal or paludal fever. In the 
first cases of fever which occur in those seasons, and in those towns and 
cities in which yellow fever prevails, it is all important that the heart 
should be subjected to careful microscopical and chemical examination, in 
order that a correct diagnosis should be formed and malarial fever clearly 
distinguished from specific yellow fever. Of course, all other phenomena 
and lesions upon which a correct diagnosis may be based should be care- 
fully observed, and recorded in those cases by which it is sought to deter- 
mine the true characters of an epidemic in its earliest manifestation. 
Softening of the substance of the heart has been observed to occur in certain 
asthenic states of the system, in which there is loss of power or tone in the 
entire muscular system; this atony originating from a diffluent or otherwise 
depraved condition of the blood, itself one of the most important varieties 
of this morbid lesion, is that which so often occurs in typhus and other low 
fevers. I have shown by a number of observations recorded in the Medi- 
cal Memoirs of the United States Sanitary Commission, that fatty degene- 
ration of the heart charterized the scorbutic state of the prisoners at Ander- 
sonville, Georgia, manifested by petechia), intermuscular haemorrhages, 
swollen ulcerated gums, uncontrolable diarrh<ea, and dysentery and foul 
gangrenous ulcers. Comparative Changes of the Heart in Yellow Fever. 
877 
As far as my experience extends, it corresponds with that of the learned 
P. M. Latham, M. D., contained in his valuable " Lectures on subjects con- 
nected with Clinical Medicine, comprising Diseases of the Heart;" and I 
have been convinced by numerous facts, that the softened heart of .yellow' 
fever, as well as of scurvy and typhoid fever, is gradually but fully restored 
to its normal condition, in the vast majority of cases which recover. 
It is true, however, t hat the softening (acute fatty degeneration) of the- 
heart in yellow fever, is fraught with danger, and may be the cause of sud- 
den death, both during the period of calm and during that of convales- 
cence. Hence, we have deduced the important indication of treatment to 
preserve the yellow fever patient at rest and in the recumbent position'. 
Imprudence in rising out of bed, and in attempting to move about, both 
during the active stages of the disease, and during convalescence, has been' 
attended with rapid failure of the enfeebled heart, and sudden death. 
Whilst holding that this softening or acute fatly degeneration of the 
heart to be one of the most marked and special effects of yellow fever, and 
while admitting with Dr. Stokes, that its diagnostic signs are the impulse 
of the ventricles becoming almost or altogether imperceptible, and the" 
systolic sound at the same time almost or altogether inaudible; at the same- 
time such are the lesions of the stomach, kidneys and liver in yellow fever, 
that in many cases it is difficult, if not impossible, to apply the precise and 
plain indications for the use of stimulants in fever, as deduced by Dr. 
Stokes from these ausculatory signs. 
Aftercareful microscopical and chemical examination of the heart, in 
the various forms of intermittent, remittent, congestive or pernicious mala- 
rial fever, and malarial heematuria, I have never observed any increase 
in the normal amount of fat or any condition which could be designated as 
molecular change, or acute fatty degeneration. If the heart be compared 
in malarial and yellow fever, it will be possible to distinguish by the naked 
eye, the flabby, softened, yellowish and brownish-yellow hue of the latter, 
from the dense, firm, dark colored heart of the former disease. All doubts 
are immediately removed by the chemical and microscopical examination, 
the malarial heart presenting no accumulation of oil, and revealing a firm, 
normal, distinctly striated structure of the muscular fibrillae. If acute 
fatty degeneration of the heart was characteristic of malarial fever, from 
the almost universal prevalence of this disease in the Mississippi valley, 
and other portions of the Southern and Western States, and from the oft 
recurrence of the disease in the same individual, fatty degeneration of the 
heart would become one of the common diseases in malarial regions. Peri- 
cardium not specially congested. In some cases pericardial fluid of clear 
straw color, in others, especially when jaundice has existed, the pericar- 
dial fluid is of a golden color. 
COMPARATIVE CHANGES OF THE HEART IN YELLOW FEVER. 
Heart.-Pale yellow and brownish yellow as if undergoing fatty degen- 
eration; structures of heart flabby and somewhat softened; numerous oil 
globules deposited within and around the muscular fibrillae of the heart. 
The appearance of the heart in a case of yellow fever (Edward Griffin, who 
died in the Charity Hospital, of yellow fever, November 9th, 1876, on the 
sixth day of the disease, after the ejection of large quantities of black 
vomit), is represented in plate 7. figure 20. The following is the record of 
temperature, pulse and respiration in this case : November 5th, tempera- 
ture 104°; November 6th, temperature, morning, 105°; evening, 104.°5J 
pulse, morning, 108; evening, 104; respiration, morning, 27, evening, 24'. 878 
Comparative Changes of the Heart in Yellow Fever. 
November 7th, temperature, morning, 103°; evening, 103°; pulse, morning, 
86; evening 100; respiration, morning, 28; evening, 20. November Sth, 
temperature, morning, 102°; evening, 100. °5; pulse, morning, 100; evening, 
108; respiration, morning, 29; evening, 24; profuse black vomit. Novem- 
ber 9th, morning, temperature, 97.°5; pulse, 120; respiration, 40; death. 
Heart yellow and softened. Under the microscope, transverse markings of 
muscular fibres indistinct, and much oil and granular matter deposited 
within and around the muscular fibres. The appearance of the muscular 
fibres of this heart are represented in plate 7, figure 21; 1000 parts of the 
muscular structure of the heart contained water, 786.44; solid matter, mus- 
cular fibres, etc., exclusive of oil, 267.06; oil, 46.50. 
In this case the left ventricle was dilated and hypertrophied, but this 
condition appeared not to have affected the health of the patient before the 
advent of the fever. In the case of Samuel Kinsley, aged 23 years, who 
entered the Charity Hospital November 14th, 1873, on the fourth day of 
yellow fever, the temperature, pulse and respiration were as follows : 
November 14th, temperature, 104. °8; pulse, 104; respiration, 40. Novem- 
ber 15th, temperature, 1O5.°6; pulse, 100; respiration, 32; P. M., tempera- 
ture, 106°; pulse 112; respiration, 32. November 16th, temperature axilla, 
105. °6; pulse, 96; respiration 36; P. M., temperature, 105.c9; pulse, 102; 
respiration, 30. November 17th, A. M., temperature, 102°, and pulse, 104; 
respiration, 32; threw up black vomit on sixteenth and seventeenth. Died 
1 o'clock P. M., November 17th, on eighth day of disease. 
The autopsy was made eight hours after death. Weight of heart, 9 
troy ounces. Great congestion of blood-vessels of pericardium, resembling 
the appearance of the pericardium of a case of yellow fever, which died on 
the sixth day of the disease, August 5th, 1871, represented in plate 7, 
figure 18. Blood-vessels of the heart distended with dark-colored blood. 
Cavities of the heart contained almost three fluid ounces of blood, and 
golden yellow clots. Vena-cava and pulmonary veins filled with fluid 
blood. When washed, the muscular structures of the heart presented a 
distinct yellow color, similar to that of the heart delineated in plate 7, 
figure 20, and was readily mashed between the fingers; under the micro- 
scope the muscular fibrillae presented indistinct transverse striae, and con- 
tained numerous oil globules ami much yellow granular matter, resembling 
the fibres of the heart of a case of yellow fever depicted in plate 7, figure 
21. One thousand parts of the muscular structure of the heart contained, 
water, 736.65; solid matter, exclusive of oleaginous matters, 186.8; oil (fat), 
76.59. In the preceding case, oil or fat in abnormal quantities was pres- 
ent in the muscular structures of the heart, the fat being deposited within 
and around the musular fibrillse in the form of minute globules of various 
sizes. There is also an obliteration or degeneration of the muscular fibril- 
lae of the heart leading to a disappearance of the muscular striae. The 
removal of the particles of oil from the muscular structures of the heart 
by sulphuric ether, did not restore the obliterated striae, neither did this 
agent remove all the molecular particles, a portion at least being insoluble 
in ether, alcohol and chloroform, and having an analogous constitution to 
albumen and fibrin. 
It would without doubt be a matter of great interest to medical science 
to establish clearly the exact physical and chemical changes which result 
in the final transformation of the muscular structure of the heart, and the 
secretory and excretory structures of the liver and kidney into fat. The 
difficulties of such an investigation are very great, especially as the chem- 
ical research can be commenced only in fatal cases and after death. The 
complete investigation of this subject should embrace the following inqui- 
ries: Comparative Changes of the Heart in Yellow Fever. 
879 
1. Is there an actual increase of the entire amount of fat in the blood, 
organs and textures in yellow fever? 
2. Is there any movement of the fatty matters from the positions in 
which they are chiefly accumulated in health, as in the adipose tissue, the 
marrow of the bones, the brain, spinal cord, and nerves generally during 
the febrile stage of yellow fever? < 
3. Are the heart, liver and kidneys simply infiltrated with fat con- 
veyed by the blood during the fever? 
4. Is there an actual conversion of the fibrin and albumen of the 
blood, and the albuminous elements of the heart? 
5. Does the accumulation of fat in certain, organs in this disease result 
from chemical changes directly excited by a specific poison, or from imper- 
fect oxidization and perverted nutrition? 
6. Has the perversion and arrest of the function of the liver, and the 
retention in the blood of the constituents of the bile any relationship to the 
deposit of fat in the various organs? 
As the acute fatty degeneration of yellow .fever is in no wise depend- 
ent upon the food of the patient during the fd^er, the change occurring 
with rapidity during absolute starvatiou^it is evident that the only possi- 
ble sources of the oil or fat are those indicated jn the preceding inquiries; 
namely the pre-existing sources of fat or its.iransformation of the nitro- 
genous and albuminous constituents of the blood'and organs. Cavities of 
the heart in many cases filled with dark fluid blood; yellow fibrinous clots 
sometimes present. Blood contains-abnormal amounts of urea and extrac- 
tive matters and ammonia. Fibrihbf' blood greatly diminished in amount. 
I have determined, both by comical analysis and microscopical exami- 
nation, that the heart undergoes fiitty degeneration in yellow fever. As 
far as my observations have extended, the heart undergoes more rapid and 
extensive degeneration in yellow fever than in any other acute disease. The 
acute latty degeneration of the heart in. yellow fever should not be con- 
founded with similar changes observed in spirit drinkers and in certain 
chronic diseases, but is most probably dependent upon the same or similar 
chemical actions, as those leading to a profound alteration of the liver. In 
yellow fever the fat is deposited within and around the muscular fibrillae 
of the heart, in the form of minute globules of various sizes. There is also 
an alteration or degeneration of the muscular fibrillae of the heart, leading 
to a disappearance of the striation. The removal of the particles of oil 
from the muscular structures .of the heart by sulphuric ether does not 
restore the obliterated striaaj rieither does this agent remove all the molecu- 
lar particles, a portion at least being insoluble in ether, alcohol and chloro- 
form, and having an analogous constitution to albumen and fibrin. 
Fatty degeneration of the heart, therefore, is not the sole state of this 
organ in yellow fever; a molecular change has taken place in the substance 
of the muscular fibres, and this change affects the albuminoid or nitrogene- 
ous constituents, and most probably represents one of the stages of acute 
fatty degeneration. 
The pericardium in yellow fever presents a congested appearance. 
Under the microscope the minute blood-vessels appear to be injected with 
colored blood-corpuscles. Pericardial fluid of deep yellow color. The 
appearance presented by the pericardium of the heart of a case of yellow 
fever which terminated fatally in New Orleans, August 5th, 1871, is repre- 
sented in plate 7, figure 18. The pericardium was put on glass slide and 
preserved in Canada balsam. The drawing represents the natural appear- 
ance as injected with blood. 880 
Pathological Anatomy of the Alimentary Canal in Malarial Fever. 
PATHOLOGICAL ANATOMY OF THE ALIMENTARY CANAL IN MALARIAL ANI> 
YELLOW FEVER. 
Malarial Fever-Alimentary Canal. 
During the severe forms of malarial fever, the secretions of the mouth 
were, as an almost universal rule, suppressed ; and the tongue, when not 
coated with fur, presented a bright red, dry, rough surface, with enlarged 
papillae. The bright red color of the tongue was due to the stagnation of 
the blood and the accumulation of the blood corpuscles in the capillaries. 
In numerous instances f have observed t he dry, harsh, hard tongue become 
soft and moist under the action of stimulants and sulphate of quinia. This 
suppression of secretion and congestion of the blood-vessels of the tongue 
and mucous membrane of the mouth, was the result of derangements in the 
capillary circulation, induced by altered blood, by the disturbed circula- 
tion, and by aberrated nervous force supplied by the sympathetic system, 
and not of inflammation or irritation. We consider the glowing, red, dry 
tongue of remittent and congestive fever as a valuable index of the condition of 
the capillary circulation in other ports of the body. It does not by any means 
indicate an inflamed or even irritated state of the stomach. In several cases, 
which presented throughout their course dry, red tongues, as hard and as 
rough as boards, attended with great tenderness of the epigastrium, the 
stomach presented after death a normal appearance, without any marks of 
inflammation, or even of irritation. 
The pathological alterations of the stomach, observed after death, did 
not correspond to the severity of the symptoms, the vomiting, and pain 
upon pressure, during the progress of the fever. The injection of the 
blood-vessels, and the mottled, purplish, brownish-red color after death, 
appeared to be indicative, not of inflammation, but rather of stagnation 
and accumulation of the blood in the capillaries, consequent upon the dis- 
turbance of the relations of the blood to the capillaries. The distressing 
vomiting, so often a troublesome symptom in malarial fever, appeared to 
depend upon the contact of the altered bile (the stomach was frequently 
found discolored with bile), and the irritation of the nervous centres which 
supply the stomach with nervous force by the altered blood and by the 
malarial poison. In cases where there had been chronic, inflammation of 
the stomach before the appearance of the fever, and in cases of long stand- 
ing, where the solids and fluids were permanently altered, decided altera- 
tions of structure were found in the stomach. It maybe asserted, how- 
ever, that there is no constant and characteristic lesion of the stomach in 
malarial fever, which would distinguish it from other fevers. These 
remar ks apply also to the small intestines. The mucous membrane fre- 
quently presented a purplish, irregularly injected, mottled appearance, 
especially after- the administration of purgatives; and it was frequently 
observed that the injection of the blood-vessels was greatest in the depend- 
ent portions of the intestines. In several cases, Brunner's glands in the 
duodenum were enlarged and distinct. The solitary glands of the small 
intestines appeared in many cases enlarged and distinct. Peyer's glands, 
in all the cases except one which was characterized by true typhoid symp1 
toms, were uniformly free from any well-marked morbid alteration. In 
some cases they were distinct and well defined in their outline, and pre- 
sented a honey-comb surface dotted with dark points; but they were always 
free from marks of inflammation, and even of irritation, and in their pale 
Malarial Fever-Stomach and Intestinal Canal. Pathological Anatomy of the Alimentary Canal in Yellow Fever. 
881 
white color contrasted strongly with the surrounding mucous membranes, 
discolored with bile, and often irregularly injected with blood. These 
statements will now be illustrated by the following post-mortem examina- 
tions : 
Case No. 1067.-Intermittent fever occurring in the latter stages of phthisis 
pulmonalis. Atdoi^sy twelve hours after death, Stomach small, contracted; small 
intestines and colon inflated with air. Mucous membrane of stomach of a pur- 
plish-red color in spots, presenting a mottled appearance. Blood-vessels upon the 
exterior filled with blood. The small intestines contained fecal matters colored 
by bile. Mucous membrane of the small intestines of a dark-purplish and reddish- 
yellow hue. Blood-vessels upon the exterior and through the structures of the 
intestines were filled with dark blood. Glands of Peyer normal, not enlarged nor 
congested. Brunner's glands did not attract attention. 
Case No. 1068.-Remittent and typhoid fevers combined. Autopsy four hours 
after death. Internal surface of the stomach, colored yellow with bile. As far as 
the unaided eye could ascertain, the mucous membrane was continuous and unal- 
tered in structure. The blood-vessels of the mucous membrane were filled with 
blood, and several spots were more engorged with blood than the rest of the sur- 
face. presenting in ecchymosed appearance. The mere stagnation of the blood in 
the vessels and capillaries of the mucous membrane is not significant of altera- 
tions in the structures, or of inflammation, or even of irritation. To the naked eye 
there were no pathological alterations in the structures of the stomach. The color 
of the intestines, externally and internally, was darker than usual; the small 
intestines contained fecal matters, epithelial cells, mucus-corpuscles, and mucus 
colored yellow with bile. Blood-vessels of the mucous membrane of the small and 
large intestines injected with blood. Themucousmembrane was most injected with 
blood, and presented a purplish color, in the last eight feet of the inferior portion 
of the ileum. This engorgement of the blood-vessels was greatest in the imme- 
diate region of the ileo-csecal valve. The solitary glands were numerous, enlarged, 
elevated and distinct, and of a brown color. When the intestines were held up to 
the light, blood-vessels engorged with blood were seen passing to each gland. The 
blood-vessels supplying the solitary and Peyer's glands were more engorged with 
blood than those supplying the mucous membrane generally. These solitary 
glands were most numerous in the neighborhood of the ileo-caecal valve, and were 
found scattered over the superior portion of the colon ; and over the caecum, and 
over eight feet of the inferior portion of the ileum. 
Peyer's glands were enlarged and elevated. These glands were of various 
sizes, from one-quarter of an inch to half an inch in breadth. They occurred at 
intervals of from one to two inches from each other, and extended from the ileo- 
caecal valve, along the mucous membrane of the ileum, for about nine feet. Tht 
blood-vessels around these glands were engorged with blood. This part of the 
mucous membrane of the ileum, studded with the solitary and Peyer's glands, was 
far more injected with blood than the stomach, jejunum, or superior portion of the 
ileum. Although these glands were enlarged, elevated, and injected with blood, 
still they could not by any means be compared to the condition of these glands, in 
an advanced stage of typhoid fever. That this case was one of typhoid fever was 
demonstrated by the great susceptibility of the intestinal canal to the action of 
small doses of purgatives, the continued elevation of the temperature, the rapid 
action of the pulse without any remission, the appearance of albumen in the urine, 
and the low muttering delirium ; that it was also a case of remittent fever was 
demonstrated by the slate or bronzed liver, the alteration in the blood, and the 
disorganized enlarged spleen. 
Case No. 1069.-An Irish baker, attacked during convalescence from remittent 
fever, with influenza, and drowned by the effusion of serum into the bronchial tubes 
and air-cells. Autopsy eight hours after death. Stomach pale and perfectly 
healthy in appearance. Intestinal canal, from the stomach to the anus, pale and 
healthy in appearance. 
Case No. 1070. - Irish laborer, attacked withpleuro-pncumonia during conval- 
escence from Remittent Fever. Autopsy nine hours after Death-Stomach enor- 
mously distended with gas. Mucous membrane pale and healthy in appearance. 
Small intestines and colon healthy in appearance to the naked eye. 
Case No. 1071.-An Irish laborer who was attacked in the early stages of con- 
valescence from Intermittent lever, with an eruptive disease resembling the severest 
form of lichen agriv#, and who died suddenly from effusion of blood upon the base 882 
Pathological Anatomy of the Alimentary Canal in Malarial Fever. 
of the brain. Autopsy five hours after Death.-Blood-vessels upon the exterior of 
the stomach filled with black blood. Internal mucous membrane generally of a 
reddish and pinkish color, and in many spots where the congestion was greater, 
the color was much deeper. Brunner's glands in the duodenum, and Lieber- 
kuhn's follicles, in the pyloric extremity of the stomach, and in the pylorus and 
duodenum, appeared to be enlarged, and gave to the mucous membrane a mam- 
millated appearance. Mucous membrane of the small intestines of a reddish color, 
with blood-vessels filled with blood, especially at the superior portion. The glands 
of Peyer, in the inferior portion of the ileum, especially in the region of the ileo- 
ceeeal valve, were enlarged. Solitary glands in the superior portion of the colon 
also enlarged. Mucous membrane of the stomach and intestines was colored yel- 
low by the bile. The small intestines contained much offensive gas, tenacious 
mucus, and fecal matters colored yellow by the bile. The colon was distended 
with offensive gas. 
Case No. 1072.-A house painter, who during convalescence from a severe 
attack of malarial fever was seized with convulsions, and died comatose Autopsy 
five hours after Death.-IStomach and small and large intestines presented a healthy 
appearance. 
Case No. 1073.-German butcher, who, after suffering with Chill and Fever for 
two months without any medical attendance, was seized with Congestive Fever. 
Autopsy four hours after Death.-He was relieved from congestive fever, but the 
alterations of the organs and tissuesand blood had been so profound, that notwith- 
standing the use of alteratives, sulphate of quinia, stimulants, and nutritious diet, 
he died twenty-three days after the attack of congestive fever. Previous to death 
the digestion was imperfect and the bowels loose. The stomach and small and 
large intestines were greatly contracted. Blood-vessels of mesentery, omentum, 
and exterior surface of stomach, and small and large intestines, engorged with 
black blood. The mucous membrane of the stomach presented an appearance 
resembling that of chronic inflammation. The exterior of the large and small 
intestines was of a purplish color. The mucous membrane of the small intestines 
did not appear to be altered in structure. Glands of Peyer enlarged and distinct; 
some of them were several inches in length. The glands of Peyer, however, did 
not present the apearance of active inflammation, as in typhoid fever. They were 
even paler than usual. The solitary glands did not attract attention. The lym- 
phatics of the mesentery were much enlarged. It is worthy of note that in this 
case, which assumed a low typhoid type, the glands of Peyer were not inflamed. 
Case No. 1074.-Remittent Fever, occurring in an Irish laborer of feeble con- 
stitution, during exposure and dissipation. This patient died without any treat- 
ment except the administration of a gentle purgative. Autopsy four hours after 
Death.-The mucous membrane of the stomach presented the usual healthy 
appearance. The mucous membrane of the small intestines appeared to be healthy. 
Glands of Peyer large and distinct, but pale, and without any marks of congestion 
or inflammation. Several of these glands were three inches in length. The soli- 
tary glands, especially in the region of the ileo-csecal valve, were enlarged and 
prominent. They were about the size of millet-seed, and of a reddish-brown color. 
Case No. 1075.-Remittent Fever, converted into Congestive Fever by excessive 
purgation and neglect of stimulation and the sulphate of quinia. Autopsy twelve 
hours after Death.-The stomach contained no fluid or gas; blood-vessels upon the 
exterior filled with blood; mucous membrane of stomach of a dark purplish color. 
The color of the mucous membrane was not uniform; it was much deeper in some 
spots than in others, thus presenting a mottled appearance. The compound muci- 
parous follicles (Brunner's glands) of the stomach and duodenum were prominent 
and enlarged. Blood-vessels of the superior and inferior portions of the intestinal 
canal appeared to be more engorged with blood than those of the middle portions. 
The mucous membrane of the small intestines was covered by a layer of mucus 
and fecal matter, colored yellow by the bile. The solitary glands in the inferior 
portion of the ileum, and especially in the region of the ileo-csecal valve, were 
enlarged and distinct. The glands of Peyer were distinct, but not enlarged or 
inflamed. 
Case 1076.-Congestive Fever, aggravated and shortened by Bleeding and Pur- 
gatives, and allowed to run its course unchecked by the neglect of stimulants and 
Sulphate of Quinia. Autopsy four hours after death. Mucous membrane of 
stomach corrugated and of a purplish color, varying in intensity in different spots. 
The stomach contained eight fluidounces of a dark greenish-black fluid, which 
resembled, upon a general view, the black vomit of yellow fever. Under the 
microscope this fluid Mas found to contain numerous mucus corpuscles, epithelial Pathological Anatomy of the Alimentary Canal in Malarial Fever. 
883 
cells of the mucous membrane, and gastric glands, peptic cells, and dark granules. 
These various bodies were of a greenish and yellow color under the microscope. 
The action of nitric acid demonstrated that the color was due to the presence of 
bile. The color of a mass of this fluid from the stomach, like that of the bile from 
the gall-bladder, was of a dark blackish-green color, whilst the thin layers, like 
those of the bile, were of a yellow color. I was unable to distinguish any colored 
corpuscles, notwithstanding the close resemblance to black vomit. The granules 
did not resemble altered blood-corpuscles. The color of the mucous membrane of 
the small intestines was darker than usual, and the surface was covered with 
mucus-corpuscles and epithelium, colored yellow by bile. Blood-vessels of the 
ileum, especially in the region of the ileo-cseeal valve, engorged with blood. 
Neither the glands of Peyer nor the solitary glands were enlarged. Blood-vessels 
of colon filled with blood. Exterior surface of rectum diversified by numerous 
ecchymosed spots of a bright arterial hue. 
Case 1077.-Congestive Fever. Death resulting in great measure from the 
formation of Fibrinous Coagula in the Heart and Blood-vessels. Great tenderness 
upon pressure of Epigastrium. Autopsy three hours after Death Stomach dis- 
tended with gas. Mucous membrane discolored by yellow bile, and diversified 
with punctated spots of a brilliant red color. Small intestines contained bile and 
faeces, which were extraordinarily offensive. The calomel and oil administered 
previous to death had commenced to operate. When the faeces and epithelial cells, 
colored yellow by bile, were scraped off, the mucous membrane presented the nor- 
mal appearance.' The glands of Peyer were remarkably large and distinct; several 
of them were three inches in length; their surfaces were pale, and exhibited no 
marks of inflammation. 
Case 1078.-Congestive Fever. Stout Seaman, sick only four days. On the 
second day became comatose, and continued insensible, passing his urine and fceces 
in bed until Dea^h. Autopsy twenty hours after Death. The mucous membrane of 
the alimentary canal, from the oesophagus to the anus, presented the normal color, 
and showed no signs whatever of congestion or inflammation. 
Case 1079.-Bemittent Fever, neglected for ten days, terminating in Congestive 
Fever. Tongue red, dry, and hard. Autopsy twelve hours after Death. Blood- 
vessels upon the exterior of the stomach filled with blood. The mucous membrane 
bore no marks of inflammation, and was not more congested with blood than usual. 
The exterior and mucous membrane of the jejunum presented the usual appear- 
ance. There was no unusual appearance, either of congestion, irritation, or 
inflammation. The mucous membrane of the ileum, especially at the lower 
portion, was more congested with blood, and of a darker color than usual. 
The intestinal canal, through its entire length, was empty. The mucous mem- 
brane presented a yellow appearance, probably due to the presence of bile. 
The solitary glands of the ileum, especially in the neighborhood of the ileo- 
csecal valve, were numerous, enlarged, elevated, distinct, and of a brown 
color. When the intestines were held up to the light, the blood-vessels 
filled with blood could be distinctly seen sending off branches to each gland. The 
glands of Peyer were large, distinct, and elevated. Several of these glands in the 
lower portion of the ileum were three inches in length. These glands, however, 
were not inflamed, as in typhoid fever, and presented the usual pale appearance. 
Case 1080.-Congestive Fever. Fibrinous concretions in the Heart and Blood- 
vessels; Cerebral symptoms severe; Coma and complete Insensibility; Tongue red, 
dry, rough, and hard. Autopsy twelve hours after Death. Exterior surface of 
stomach and intestines pale. Blood-vessels of omentum and mesentery were filled 
with black blood. The stomach contained a yellow mucus-like fluid. Themucous 
membrane of the stomach was dyed yellow by the bile. With 1 he exception of this 
discoloration, the mucous membrane of the stomach appeared to be normal. There 
were no marks of inflammation. The small intestines contained large quantities 
of yellow ;mucoid matter, mixed with soft faecal matters. When carefully and 
completely washed under a gentle stream of water, the free edges of the valvulse 
conniventes presented a bright red and bistre color, which diminished in intensity 
towards the attached portion. The whole surface of the mucous membrane of the 
small and large intestines was of a darker color, and indicated much more con- 
gestion than usual. I do not consider the congestion of the blood-vessels of the 
mucous membrane as a pathological alteration, due either to the primary or second- 
ary effects of the malarial poison, because at the time of his death the patient was 
under the action of a cathartic. Cathartics, as far as my experiments upon animals 
have extended, produce engorgement of the vessels of the mucous membrane of 
the intestines. Glands of Peyer and solitary glands not enlarged or inflamed. 884 
Pathology of the Alimentary Canal in Malarial and Yellow Fever. 
Case 1081.-Congestive Fever. Death occurring forty-three hours after the 
commencement of the disease, which was ushered in suddenly with Vomiting, Cold 
Extremities, complete Prostration, and Delirium. Autopsy twenty-four hours after 
Death. The mucous membrane of the stomach presented two well-defined por- 
tions; the mucous membrane of the lesser curvature of the stomach was pale and 
normal in appearance; the mucous membrane of the greater curvature and pyloric 
extremity, and of the pylorus, was of a purplish color, and ecchymosed in crimson 
spots, rhe blood-vessels of the greater curvature and of the pylorus were con- 
gested with blood. Mucous membrane of the superior portion of the jejunum con- 
gested with blood; valvulte conniventes, especially at the edges, ecchymosed in 
spots, of a purple and scarlet color. Mucous membrane of the lower portion of the 
ileum greatly congested with blood Peyer's glands somewhat enlarged, more dis- 
tinct and elevated than usual, but pale and not congested and inflamed as in 
typhoid fever. Solitary glands enlarged and distinct. Mucous membraneof colon 
greatly congested with blood. 
COMPARATIVE VIEW OF THE PATHOLOGICAL CHANGES OF THE STOMACH 
AND INTESTINES IN MALARIAL AND YELLOW FEVERS AND TYPHOID 
FEVER. 
MALARIAL FEVER. 
Stomach.-Mucous membrane often presents a normal appearance; 
sometimes ecchymosed; rarely inflamed or softened; sometimes discolored 
with bile; rarely contains black vomit (altered blood). Reaction of mucous 
membrane of stomach and intestines acid. The pathological alterations 
of the stomach, observed after death, do not correspond, as a general rule, 
with the severity of the symptoms, the vomiting and pain on pressure dur- 
ing the progress of the fever. The injection of the blood-vessels, and the 
mottled, purplish-brownish red color, after death, appear to be indicative, 
not of inflammation, but rather of stagnation and accumulation of the 
blood in the capillaries, consequent upon the disturbance of the relations 
of the blood to the capillaries. The distressing vomiting, so often a trouble- 
some symptom in malarial fever, appears to depend upon the contact of 
the altered bile and the irritation of the nervous centres which supply the 
stomach with nervous force, by the altered blood, and by the malarial 
poison. 
In cases where there has been chronic inflammation of the stomach 
before the appearance of the fever, and in cases of long standing, where 
the solids and fluids were permanently altered, decided lesions of struc- 
ture were found in the stomach. It may be asserted, however, that there 
is no constant or characteristic lesion of the stomach in malarial fever. 
The vomited matters in the various forms of malarial fever, unlike 
those of yellow fever, contain bile. Even in that form of malarial fever 
which most nearly resembles yellow fever, namely: in malarial hsematuria, 
the dark, almost black vomit, owes its color chiefly to altered bile. It is 
true that in some cases of malignant malarial fever we may have the vom- 
iting of dark blood and bloody matter, resembling the vomito nigra of yel- 
low fever, but as a general rule bile is present, even in these rare instances, 
whilst it is almost always absent from the black vomit of yellow fever. The 
presence of blood and its constituents, occasionally, in the vomit of mala- 
rial fever is due to the same causes, namely: desquamation, rupture of 
capillaries, and the transudation of tne haemoglobin of the colored corpus- 
cles. 
Intestines.-These remarks relating to the stomach apply also to the 
small intestines. The mucous membrane frequently presented a purplish, 
irregularly injected, mottled appearance, especially after the administra- 
tion of purgatives, and it was frequently observed that the injection of the 
blood-vessels was greatest in the dependent portion of the intestines. In 
several cases, Brunner's glands in the duodenum were enlarged and dis- Pathology of the Alimentary Canal in Malarial and Yellow Fever. 
885 
tinct. Peyer's glands were uniformly free from any well marked morbid 
alteration. In some cases they were distinct and well defined in their out- 
line, and presented a honey-comb surface, dotted with dark points; but 
they were always free from marks of inflammation and even of irritation, 
and in their pale, white color, contrasted strongly with the surrounding 
mucous membrane, discolored with bile and often irregularly injected with 
blood. 
As a general rule, bile is found in the intestinal canal of malarial 
fever, and in some cases in large quantities, whilst it is absent from the 
entire alimentary tract in fatal cases of yellow fever. 
YELLOW FEVER. 
Stomach.-Mucous membrane of stomach in many cases intensely con- 
gested, softened and eroded. Stomach often contains large quantities of 
black vomit. Reaction of black vomit often alkaline from the presence of 
ammonia, resulting from the decomposition of urea, eliminated by the gas- 
tro-intestinal mucous membrane. Ammonia and urea present in the black 
vomit ejected during life and also when examined almost immediately 
after death. The presence of ammonia in the stomach and black vomit 
was not the result of post-mortem putrefactive changes. In many cases 
ammonia was present in such large amount, that when a rod, dipped in 
hydrochloric acid, was held over the mucous membrane of the stomach, or 
over the black vomit, dense fumes of chloride of ammonium were formed, 
as if the rod had been held over a bottle containing liquor ammonia?. 
Chemical analysis revealed the presence of ammonia and also of urea in 
the black vomit. Under the microscope the black vomit was seen to con- 
tain coloied blood corpuscles, aud cells of the mucous membrane of the 
stomach, and broken capillaries. In some cases vibrios and fungi were 
numerous in the black vomit; in others they were absent. 
That the stomach suffers, and suffers severely, in yellow fever, is 
evident from the fact that, in a great majority of cases, the stomach is 
finely injected with blood, and exhibits, even when examined immediately 
after death, abrasions of the tissue in pit-like holes and furrows. In some 
cases the whole surface of the stomach is affected; in others the effusion 
and injection is confined to the cardiac or pyloric portion; but, in some 
rare instances, the stomach, duodenum aud intestines have been said to 
present an almost entire absence of appreciable lesions. I have not myself, 
in post-mortem examinations, observed the absence of lesions in the gastro- 
intestinal mucous membrane. The congestion of the stomach is to a certain 
extent due to the disturbance of the circulation in the liver, but not wholly 
to this cause. We must, from careful chemical and microscopical exam- 
inations, admit the existence of irritation, desquamation and haemorrhage. 
The congested appearance of the mucous membrane of the stomach 
after death from yellow fever is represented in plate No. 8, figure 22, 
mucous membrane of stomach in vellow fever, Charity Hospital, October, 
1871. 
Figure 23, mucous membrane of stomach in yellow fever, Griffin, 
Charity Hospital, November, 1876. 
These illustrations must be regarded as exhibiting the extreme condi- 
tions of congestion in the mucous membrane of the stomach in yellow 
fever. In many cases the stomach, after death, presents less congestion, 
and in some portions of the mucous membrane shows different degrees of 
congestion; the congestion being greater in some portions of the stomach 
than in others. i • 886 
Lesions of the Intestinal Canal in Typhoid Fever. 
Intestines-As a general rule, dark colored and distended with gas. 
In some cases the reaction of the intestinal contents was strongly alkaline, 
from the presence of ammonia. 
Haemorrhage from the intestinal mucous membrane has been observed 
during life, and in such cases, as well as in others in which no blood had 
been discharged previous to death, the intestines have been found, upon 
post-mortem examination, distended with blood. A remarkable feature in 
yellow fever is the frequent occurrence of intussusception of the small 
intestines. The late Professor John Harrison, M. D., states that intussus- 
ception of the small intestines was exceedingly common in autopsies made 
in 1839, in New Orleans. The quantity of intestines invaginated sometimes 
exceeded a yard. The large intestines and the lower portion of the small 
are not so often found congested as the stomach and duodenum, yet such a 
condition is by no means rare. The congestion of the veins, venules and 
mucous membranes generally of the intestines in yellow fever have been 
referred to the anatomical distribution of the veins, which, like those of 
the stomach, are tributaries to the portal vein. But we have been inclined 
in many cases to regard the congestion as active and not passive. During 
life, the rectum in yellow fever presents an intensely red and congested 
appearance, and some cases of yellow fever in 1878 were follow'ed by irri- 
tation and fissure of the rectum. 
LESIONS OF THE INTESTINAL CANAL AND MESENTERIC GLANDS IN TYPHOID 
FEVER. 
The first opportunities which the author enjoyed of studying the 
characteristic lesions of typhoid (enteric fever) were in the Pennsylvania 
Hospital of Philadelphia, during the years 1854 and 1855, under the 
instruction of Samuel Jackson, M. D., Prof. George B. Wood, M. D., of 
the Medical Department of the University of Pennsylvania, and Dr. Ger- 
hard, the distinguished pathologist of Philadelphia. Cases were subse- 
quently observed in Savannah and Augusta, Georgia, preceding the Ameri- 
can Civil War, 1861-1865; but it was during this memorable era, when 
almost the entire available fighting population of the States of Virginia, 
North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, 
Tennessee, Louisiana, Arkansas and Texas, were gathered in vast armies, 
that the author enjoyed the fullest opportunities for the investigation of the 
symptoms and pathological lesions of typhoid fever. A vast field was 
opened during this memoi able struggle for the study of the comparative 
symptoms and pathological anatomy of the various forms of paroxysmal 
and continued levers. The full record of our labors with reference to 
typhoid fever, were destroyed at the burning of Richmond, Virginia, in 
1865; but we hope to present those portions which were preserved as 
original notes amongst our private papers, in a future monograph of these 
Medical and Surgical Memoirs. At the present time we shall present such 
views of the drawings which we made in the Confederate armies and hos- 
pitals as will illustrate in the clearest and most forcible manner the true 
nature of the lesions of the typhoid fever as it prevailed amongst the Con- 
federate troops during the American Civil War, 1861-1865. 
The structural lesions of the typhoid fever of the Confederate troops 
were closely associated with the symptoms, and were accountable for many 
of the complications which occurred. The primary change was in the 
blood, the characteristic lesions were observed in the intestinal canal. In 
fatal cases, local congestions and inflammations were met with in the lungs Lesions of the Intestinal Canal in Typhoid Fever. 
887 
and other organs; but the characteristic lesions were those which took 
place in the intestines and mesenteric glands. The intestinal mucous 
membrane of the ileum generally presented the appearance of acute 
catarrh; but the chief seat of the morbid changes was in Peyer's patches. 
The changes consisted in hypermmia and gradual infiltration and enlarge- 
ment of the glands here crowded together, followed by ulceration. This 
process was divisible into four stages : 
1st. Hyper®mia and inflammation. 
2d. Infiltration and enlargement. 
3d. Softening, fatty degeneration and ulceration. 
4th. Separation of the diseased structures and resolution. In the 
stage of infiltration tin*, glands of Peyer were swollen and distended by a 
corpuscular exudation; the entire patch was thickened and raised above 
the level of the surrounding mucous membrane, and assumed a reddish or 
fawn color, according to the intensity and stage of the inflammation. As 
Peyer's patches were largest and most numerous at the lower end of the 
ileum, near the ileo-csecal valve, it is here that post-mortem examinations 
revealed the most extensive and advanced lesions. 
As the typhoid fever progresses, in from seven to ten days from the 
commencement of the infiltration of Peyer's patches, ulceration com- 
mences. In the earlier part of the stage the elevated patches frequently 
presented a number of distinct ulcerations which were appropriately 
described as "a worm eaten appearance;" and later the entire Peyer's 
patches became one large ulcer. In some cases the patches sloughed and 
fell off. and these deep erosions in the mucous membrane were in some 
cases stained with bile, and in others they were gangrenous and of a dark 
slate and black color. In mild cases, when resolution occurred, about the 
third week, the infiltrated material was broken down and absorbed. In 
some cases the ulcerative destruction continued, and was most extensive in 
the lower portion of the ileum, near the ileo-csecal valve. The sloughing 
and separation of the Peyer's patches left ulcers of corresponding sizes 
and shapes; and as the patches mu longitudinally along the portion of the 
bowel opposite the mesenteric attachment, the ulcers also had their long 
diameter in the same direction. In some cases the superficial layer of the 
mucous membrane alone was ulcerated, whilst in others the entire thick- 
ness was destroyed, and even the muscular and peritoneal coats exposed. 
Large vessels were thus frequently opened, giving rise to profuse and fatal 
haemorrhages. Perforation of the intestines, followed by sudden and fatal 
peritonitis, was also the result of these deep ulcerations which involved all 
the coats of the intestines. Besides the large ulcers of Peyer's patches, 
small circular ulcerations were also frequently found scattered over the 
mucous membrane. 
The mesenteric glands were enlarged, firm, deep red, pink or fawn- 
colored, and presented on section a corpuscular and oily infiltration similar 
to that of the agminated glands. 
The spleen was enlarged but to a less extent than in malarial fever. 
The liver presented a normal reddish brown color, wholly differing from 
the slate-colored and bronze liver of malarial fever. In some cases glandular 
degeneration of the gland cells of the liver and kidneys and fatty degenera- 
tion of the muscular fib»es of the heart, and of the voluntary muscles 
generally, was observed and referred to the effects of the prolonged heat 
and of the perverted chemical changes induced by the typhoid poison, 888 
Lesions of the Intestinal Canal in Typhoid Fever. 
ENGRAVING NO. 86. 
Small Intestine ^lleum) in Typhoid Fever, Confederate Army, 186%. 
Engraving! No. 86.-Portion of small intestine (ileum, near ileo-csecal valve); case oftyphold 
lever, showing congestion of the mucous coat; enlarged and ulcerated Peyer's glands, with 
elevated fibrous bodies within the area of the ulcerations of Peyer's glands. The original drawing 
made by the author was carefully colored so as to represent the exact appearance of the highly 
congested mucous membrane of the small intestine and the purplish mottling; also the green 
color of the enlarged solitary and Peyer's glands. One of the green fibrous bodies had been cleft 
with the knife and revealed a yellow fibrous structure. Case: A. Noblip, Confederate soldier, aged 
26; sent up from James Island, South Carolina, sick with continued fever; symptoms of typhoid 
fever well marked; nervous prostration, high fever; tympanitic bowels, diarrhoea; persistent 
high fever, entered General Hospital, Augusta, Georgia. August 3d 1862, on the twentieth day 
of illness. Died August 6th, 1862, 10 A. M. Autopsy four hours after death. Drawn from nature 
by Joseph Jones, M.D., Surgeon P. A. C. S. Lesions of the Intestinal Canal in Typhoid Fever. 
889 
Small Intestine {Ileum) in Typhoid lever; Enlarged Glands of Peyer and 
Mesenteric Glands, Confederate Army, 1862. 
ENGRAVING NO. 87. 
Engraving No. 87.-Portion of small intestine and mesentery from lower portion of ileum 
of Confederate soldier, October 6ih, 1862; autopsy four hours after death. Enlarged solitary 
glands. Enlarged purplish-colored mesenteric glands. The original drawing by the author was 
carefully colored according to nature, illustrating the intense congestion of the mucous membrane, 
the deep purplish mottlings; also the green color of the enlarged fibrous solitary glands. Case: 
A. Noblio, Confederate soldier; contracted the fever in the Confederate Army, on James Island, 
South Carolina. Entered the General Hospital, Augusta, Georgia, August 3d, 1862. Died August 
6th, 10 A. M., 1862. Drawn irom nature by Joseph Jones, M. D., Surgeon P. A. C. S., August 6th, 
1862. 
Appearance of Portion {Exterior Portion') of Fibrinous Bodies in Small Intes- 
tine of Case of Typhoid Fever, Confederate Soldier. August 6, 1862. 
ENGRAVING NO. 88. 
Engraving No. 8s.-Appearance of exterior portion of enlarge ! solitary gland in case of 
typhoid fever occurring in Confederate soldier, who contracted the disease on James Island,. 
South Carolina, in the month of July, 1862, and who died August 6th. 1862, in the General Hospital, 
Augusta, Georgia. 890 
Lesions of the Intestinal Canal in Typhoid Fever. 
ENGRAVING NO. 89. 
Microscopic Appearance of the Mesenteric Glands of Typhoid Fever, as it pre- 
t vaded amongst the Confederate Troops, 1862-186f 
Engraving No. 89, illustrating the microscopical characters of the mesenteric glands in the 
typhoid fever, as it prevailed in the Confederate Army, 1862-1864. The enlarged and softened mes- 
enteric glands contained oil globules, granular matter, particles of htematin, and microcci. From 
nature, by Joseph Jones, M. D., Surgeon P. A. C. S. Magnified 420 diameters. 
ENGRAVING NO. 90. 
Enlarged Feger's Patches and Mesenteric Glands in Typhoid Fever. 
Engraving No. SO.- Enlarged Feyer's patches and mesenteric glands of typhoid fever, as it 
prevailed amongst the troops of the Army of Noitfiern Virginia and of the Valley of Virginia, 
under Generals Lee and Jackson, 1863. * . ' Leswns of the Intestinal Canal in Typhoid Fever. 
891 
ENGRAVING NO. 91. 
Ulcerations of Peyer's Pitches anil of Intestinal Mucous Membrane and Enlarged 
Mesenteric Glands in Typhoid Fever. 1861-1865. 
Engraving No. 91.-Ulcerated Peyer's patches and enlarged Inesenteric glands in typhoid fever 
as it prevailed in theCohfederate Army, 1861-1865. 892 
Lesions of the Intestinal Canal in Typloid Fever. 
ENGRAVING NO. 92. 
Ulcerations of Intestinal Mucous Membrane in Typhoi I Feoer. 1862-1865. 
Engraving No. 92.-Ulcerations of the intestinal mucous membrane in typhoid fever, aa 
prevailed amongst the troops of the Confederate Army, 1862-1865. Lesions of the Intestinal Canal in Typhoid Fever. 
893 
LESIONS OF ACUTE AND CHRONIC DYSENTERY AMONGST THE CONFEDER- 
ATE TROOPS, 1861-1865. 
The symptoms and pathological anatomy of dysentery as it prevailed 
in the Confederate Armies, and amongst the Federal prisoners, will receive 
careful consideration in a separate memoir, in the fourth volume of these 
Medical and Surgical Memoirs, and we shall simply direct attention to the 
important fact, that post mortem examinations revealed intense conges- 
tion of the mucous membrane of the colon in cases which terminated fatally 
in the early stages, and extensive ulc'rations, and exudations of fibrinous 
lymph in the mucous'membrane of the colon and rectum in the chronic 
stage of dysentery. This statement will be clearly illustrated by the fol- 
lowing figures. 
ENGRAVING NO. 93. 
Ulceration and Fibrinous Exudation in Chronic Dysentery. 
Federal Prisoner confined at Camp Sumpter, Andersonville, Ga., 186A 
Fia. 102 
FiaJ 03. 
Engraving No. 93.-Figure 102. Mucous membrane of colon, illustrating the thickening and 
ulceration caused by dysentery. Federal prisoner, (lamp Sumpter, Andersonville, Georgia, 1864, 
from nature b, Joseph Jones, M. 1)., Surgeon P. A. C. S. Figure 103. Portion of rectum; mucous 
membrane, thickened, ulcerated and coated with fibrinous exudation. Federal prisoner, Camp 
Sumpter, Andersonville. Georgia, 1*64. From nature by Joseph Jones, M. D., Surgeon P. A. C. S. 
The lesions of the intestines in the fatal dysentery of the armies, hospitals and prisoners of the 
Confederate States, during the Civil War. 1861-1865, differed, both in its symptoms and patholog- 
ical anatomy, from those of typhoid fever. 894 
Lesions of Liver and Spleen in Malarial Fever. 
Perforation of the Intestine in Typhoid Fever. 
ENGRAVING No. 94. 
Engraving No. 94.-Perforation of the Intestine in typhoid fever, as it prevailed in the Con- 
federate Army, 1861-1865. 
DISEASES OF THE LIVER AND SPLEEN' RESULTING FROM THE ACTION OF THE 
MALARIAL PoTSON. 
In every form of malarial paroxysmal fever, the liver and spleen are 
involved; it is, therefore, difficult in many cases to determine the exact 
role which lesions of these organs play in the mortality occasioned by this 
disease. It is well established, however, that in warm, moist malarious 
climates diseases of the liver are more common and occasion a greater mor- 
tality than in temperate and cold regions. Such affections of the liver as 
cirrhosis, hepatitis and abscess, when induced by the malarial poison or 
other causes, are painful, tedious and very fatal in their effects. It is 
without doubt true that hepatic affections cause a considerable portion 
of the mortality occasioned by the various forms of malarial fever. 
In 6311 cases of disease treated in the Charity Hospital of New Or- 
leans, up to April 1st, 1886, the clinical record shows the following num- 
bers of cases and deaths from the vaiious forms of diseases of the liver and 
spleen: 
Cases. 
Deaths. 
Hepatitis 
24 
6 
Hepatitis and abscess of liver 
Cirrhosis of liver, with ascites and anasarca of lower 
12 
7 
extremities 
31 
21 
Adenoma and cirrhosis of liver 
1 
1 
Jaundice 
10 
Fatty degeneration of liver 
3 
Amyloid degeneration of liver 
1 
Hydatids of liver 
1 
i 
Tuberculosis of liver 
1 
i 
Obstruction of common bile duct and jaundice 
1 
i 
Total diseases of liver 
85 
38 
DISEASES OF THE LIVER. 
Cases 
Deaths. 
Splenitis 
2 
Hypertrophy of spleen 
1 
Leucocythsemia 
1 
1 
Total diseases of spleen 
4 
1 
DISEASES OF THE SPLEEN. Pathological Anatomy of the Liver in Malarial Fever. 
895 
The following facts should be noted with reference to the preceding 
classification of the diseases of the liver and spleen. The cases recorded 
as jaundice did not express the number of cases presenting this symptom, 
for almost every case of yellow fever, and a large number of the various 
forms of malarial fever, as well as some cases of hepatitis, cirrhosis and 
pneumonia were jaundiced. Every ca^e of prolonged malarial fever pre- 
sented more or less hepatic derangement and enlargement of the spleen, 
but the secondary derangements were included under the head of the orig- 
inal malarious diseases. 
We observe that nearly one-half the cases of liver disease proved 
fatal, or thirty-eight deaths in eighty-five cases; per cent, of deaths 44.7 
pei cent. Cirrhosis of the liver occasioned the largest number of deaths, 
and exhibited the highest rate of mortality of any of the other forms of 
hepatic disease. Thus there were twenty-one deaths in thirty-one cases of 
cirrhosis of the liver, or 68.7 per cent mortality. Of 2885 cases of mala- 
rial, endemic, non-contagious fevers treated by the author in the Charity 
Hospital during the same period, January 1st, 1869-April 1st, 1886, only 
eighty-eight terminated fatally. Per cent, of deaths in the various forms 
of malarial fever, 3.05. The preceding facts, as well as many others relat- 
ing to hepatic derangements in the various forms of malarial fever, recorded 
in the preceding chapters of this work, illustrate the great importance of 
the careful study of the causes, prevention and treatment of diseases of the 
liver. In the present chapter we design to confine our remarks chiefly 
to the pathological anatomy of the liver in malarial and yellow fever. 
PATHOLOGICAL ANATOMY OF THE LIVER IN MALARIAL FEVER AND 
YELLOW FEVER. 
Liver.-The size of this organ, the complexity and delicacy of its 
structures, and the extent and variety and importance of its offices, all 
demonstrate the value and necessity of careful microscopical and chemical 
examinations of its structures, blood and products, in pathological condi- 
tions. The necessity of these careful examinations is placed in a stronger 
and clearer light every time that the bounds of pathological and physio- 
logical science are enlarged. 
Modern research has confirmed the ancient idea that the liver is the 
fabricator of the blood. M. Cl. Bernard* has demonstrated that the liver 
is a starch and sugar manufactory, that it possesses the power of convert- 
ing cane sugar into hepatic sugar, and of changing the albuminose received 
from the alimentary canal through the portal circulation, into the albumen 
of the blood. 
Weberf has shown that there is an extensive generation of colored 
blood-corpuscles in the liver of the embryo, and in the liver of the frog in 
the spring of the year, when the sexual organs are highly developed, and 
when the lymphatic system is in a highly active state. 
Kolliker^ and Bernardg have confirmed these observations, and it is 
now known that there are both a destruction and a regeneration and for- 
mation of the colored and colorless corpuscles in the liver. 
Thackrah, Simon, Lehman and Bernard have shown that the fibrin 
is altered both in quantity and quality, during its passage through the 
liver. 
* " Lectures on the Function of the Liver," L'Unlon M<5dicale, 1850. 
+ HenlS and Pfeufer's Zeitschrift, 1816. 
j Kblliker uber die Blutkbrperchen der Menschlichen Embryo und die Entwickelung der 
Blutkbrperchen der Saggethieren. 
§ Bernard and Robin on the Blood; translated by W. T. Atlee, M. D., Philada., 1854, p. 106. 896 
Pathological Anatomy of the Liver in Malarial Fever. 
According to Simon and Lehmann, the fats are diminished in the blood 
passing through the liver. 
The extractive matters, according to several observers, are increased 
in hepatic blood, whilst the albumen, salts, and iron are diminished. 
These facts, and many others as well established, indicate that the 
complete examination of the liver in physiological and pathological con- 
ditions, requires a careful analysis and comparison of the blood in the 
portal system before its entrance into the liver, and of that in hepatic 
veins, which has traversed the liver-requires a careful analysis of the 
venous blood in other parts of the system, and a comparison of the venous, 
portal, and hepatic blood-requires a careful chemical analysis, quantita- 
tive and qualitative, of the starch and sugar and bile and other matters 
separat ed or elaborated from the blood by the liver-requires a complete 
chemical analysis of the contents of the capillaries, and of the biliary 
tubes and cells, and of the walls of these capillaries, tubes and cells- 
requires a complete microscopical examination of all the structures of the 
liver. Not even one single division of these separate subjects of inquiry 
can, in the present state of physiological and pathological science, be exe- 
cuted with absolute accuracy, and the majority are so complex and difficult 
of investigation, that even the attempt has never been made. 
Besides the difficulties necessarily attending the procuring of the blood 
from the portal and nepatic veins; the value of the analyses must be in a 
great measure vitiated, and the conclusions based upon them rendered 
doubtful in the extreme, by the changes in the circulation and in the chemi- 
cal constitution of the blood during the last moments, independent entirely 
of the original changes resulting from the action of the poison. 
The difficulty of correct microscopical examination of the liver, is 
strikingly shown by the differences of opinion amongst the most distin- 
guished anatomists, with reference to the connection of the liver-cells with 
the hepatic ducts. Kiernan,1 Schroder Van der Kolk,2 Krukenberg,3 Weber,4 
Retzius,5 Theile,6 Backer,7 Leidy,8 and Beale,9 have advocated the existence 
of a tubular basement membrane, continuous with the ducts, within which 
lie the liver-cells. 
Kolliker10 describes the hepatic cells as so arranged in the lobules as to 
form a network, by the simple apposition of the flat surfaces, without the 
assistance of any foreign connecting, intermediate, or investing coat. Not 
a trace of biliary ducts is to be observed in this network, and it is impos- 
sible to make out any connection between the biliary ductsand hepatic-cell 
network, which is undoubtedly the secreting portion of the liver. 
Dr. Handheld Jones11 asserts that the ducts terminate in blind extremi- 
ties on reaching the lobule, instead of forming a plexus within it, and that 
1 " The Anatomy and Physiology of the Liver," by Francis Kiernan, Philosophical Transac- 
tions, 1833. 
2 In Backer's Essay, "De Structure Subtilori Hepatis Sani et Morbosi." 
3 Gerlach's Gewebelhre, ii. Auflage, p. 329. Untersuehungen ueber den feineren Bau der Men- 
schichen Leber, in Mull. Archiv., st. 318. 
I Anuot. Anat, et Physiolog., prol. vi, vii, viii, Lips. Zusatzezu selnen Untersuehungen uber 
den Bau der Leber in Berichte derK. Sachs. Ger. d. Wissench zu Leipzig, st. 151. Programmatar 
Collecta, Fasc. ii. Lips. 
5 Uber den Bau der Leber, Miill. Archiv. ii, p. 141. 
6 Art. Leber, in R. Wagner's Handw. der Phys, ii, st. 308. 
7 De Structura Subtilori Hepatis sani et Morbosi, Dis Inaug. Trajecti ad Rhenum. 
8 " Kesearches into the Comparative Structure of the Liver," by Joseph Leidy, American 
Journal of the Medical Sciences, January, 1848, p. 18. 
9 On Some Points in t he Anatomy of the Liver of Man and Vertebrate Animals, by Lionel 
S. Beale. M. D. London, 1850. 
10 Manual of Human Microscopical Anatomy, by A. Kolliker. Translated by G. Busk and T. 
Huxley. Philadelphia, 1854, p. 532 et seq. 
11 C. Hanfleld Jones, " On the Secretory Apparatus of the Liver;" Philosophical Transactions, 
1846, p. 473. "On the structure and Development of the Liver;" Phil. Trans., 1849, 1. p. 10 
" Further Inquiries on the Structure, Development, and Functions of the Liver;" Phil. Tran, 
1853, part i, pp. 1-29. Pathological Anatomy of the Liver in Malarial Fever. 
897 
the chief agents in the secretion of the bile are the cells lining these ducts, 
and not the cells lining the lobular substance. 
Dr. H. D. Schmidt* states as the results of his observations upon fresh 
and injected livers, that "two capillary networks, each independent of the 
other, exist in the lobule of the liver; the one, commencing at the peri- 
phery of the lobule, from the smallest branches of the portal vein and 
hepatic artery, and ending in the centre in those of the hepatic vein, is 
destined for the circulation of the blood brought there by the portal vein 
and hepatic artery; the other, commencing independently in the centre of 
the lobule, near the intralobular vein (branch of the hepatic vein), and 
ending in the smallest branches of the hepatic duct, is most probably des- 
tined to carry off the secretion of the cells. The cells lie within the meshes 
of these two networks; but seem to be especially held in their position by 
their adhesion to the network destined to secretion." These facts show the 
necessity for careful and laborious research, and the importance of having 
a large number of careful, conscientious investigators engaged in this 
field. The accuracy and value of pathological investigation depend upon 
the state of anatomy and physiology. If anatomists and physiologists are 
not agreed with reference to the minute anatomy of the liver, and the mode 
of formation and offices of its secretions, how can the pathologist arrive at 
accurate and definite conclusions when he has to investigate not only the 
complex anatomical structures and secretions, but also examine the morbid, 
physical, and chemical alterations, and if possible discover the character 
and mode of action of the morbific agent or agents ? 
It will serve a useful purpose to those engaged in the investigation of 
the pathology and treatment of the fevers of tropical and temperate regions 
to review the accepted facts with reference to the minute anatomy of the 
human liver. During the years 1853, 1854 and 1855, the author made an 
extended series of investigations in the departments of comparative 
anatomy and physiology, one of the objects of which was to determine the 
size and function of the liver. We abstract from those labors the follow- 
ing general results, which have a direct bearing upon the subsequent 
investigations upon malarial and yellow fever in 1856 and 1857: 
SIZE OF THE LIVEK. 
It was reasonable to suppose that the relative size of an organ might 
throw some light upon its functions in the different classes of animals, espe- 
cially when examined in connection with the chemical and morphological 
elements of the blood. It was necessary to select a definite and uniform 
standard of comparison, and the weight of the animal from which the liver 
was taken was selected as the object of comparison. It was found that the 
size of the liver varied within wide limits in the various classes of animals 
subjected to examination. The truth of this assertion will be readily veri- 
fied by a reference to the following table of the relative weights of the 
livers of different animals, which were carefully ascertained upon delicate 
balances: 
* American Journal of the Medical Sciences, January, 1859, vol. xxxvii, N. S., p. 22. In this 
article Dr. Schmidt describes valuable apparatus for microscopical investigation, invented and 
constructed by himself. The use of such delicate and accurate apparatus will, without doubt, 
greatly facilitate and add much accuracy to the microscopical examinations of the liver. 898 
Comparative Weights of the Liver. 
Comparative Weights of the Liver of Animals. 
COMPARATIVE WEIGHTS OF THE LIVER. 
Number of times the 
weight of its liver. 
FISHES. 
Weight of the body of Trygon sabina (Stingray) female 
18 
16 
25 
41 
75 
62 
55 
26 
71 
64 
57 
55 
73 
47 
42 
53 
18 
36 
25 
48 
50 
45 
77 
70 
67 
33 
22 
68 
64 
56 
47 
26 
61 
43 
48 
35 
42 
39 
36 
20 
25 
19 
23 
24 
32 
36 
Trygon sabina (Stingray foetus) 
Zygsena malleus (Hammerhead Shark)... 
Zygama malleus (Hammerhead Shark)... 
Lepisosteus osseus (Garfish) 
Lepisosteus osseus (Garfish) 
REPTILES. 
Rana catesbiana (Bullfrog) 
" Heterodon niger (Black Viper) 
Psammophis flagelliformis (Coachwhip 
Snake) 
Coluber guttatus (Corn Snake) 
" Coluber constrictor (Black Snake) 
Crotalus adamanteus (Rattlesnake) 
Alligator Mississippiensis (Alligator) 
male 
Chelouia caretta (Loggerhead Turtle) 
Chelonura serpentina (Snapping Turtle).. 
Emys terrapin (Saltwater Terrapin) 
Emys reticulata (Chicken Terrapin) 
Emys serrata (Yellow-bellied Terrapin)... 
Emys serrata (Yellow-bellied Terrapin)... 
Emys serrata (Yellow-bellied Terrapin)... 
Testudo polyphemus (Gopher) 
Testudo polyphemus (Goober) 
BIRDS. 
Turtle Dove, male 
Meleagris gallopavo (Wild Turkey) 
Meleagris gallopavo (Wild Turkey) 
Pious erythrocephalus (Redheaded 
Woodpecker) 
Night Heron... 
Tantalus loculator (Wood Ibis) 
Tantalus loculator (Wood Ibis) 
Syrnium nebulosum (Barred Owl) 
Cathartes atratus (Black Buzzard) 
MAMMALS. 
Didelphis Virginianus (Opossum) 
" " Common Sheep ' 
Sciurus Caroliuensis (Gray Squirrel) 
Sciurus capistratus (Fox Squirrel) 
Cervus Virginianus (Foetus^of Deer) 
Cervus Virginianus (Foetus of Deer) 
Mus rattus (Rat just born) 
Mus rattus (Rat just born) 
Mus rattus (Rat half grown) 
Procvon lotor (Raccoon), female. 
Procyon lotor (Raccoon), female 
Procyon lotor (Raccoon), female 
Procyon lotor (Raccoon, just born).. 
Pointer Dog, female 
Common Cat, female 
-■ ■ - - ■ Functions of the Liver. 
899 
FUNCTIONS OF THE LIVER. 
M. Cl. Bernard and other physiologists consider one essential function 
of the liver to be the elaboration of the blood. Chemical analyses have 
shown that the blood-corpuscles are more numerous in the blood after 
passing out of this organ than when entering into it. It is, therefore, rea- 
sonable to believe that the blood-corpuscles have their origin in the liver. 
If the main offices of the liver be the elaboration of the albumen, and the 
formation of the blood-corpuscles, we might infer that it should be larger 
in warm than in cold-blooded animals, because in the former the blood is 
more abundant and much more rapidly formed and consumed in supplying 
the wastes of the tissues than in the latter. Another function of the liver 
is the production of grape sugar. Physiologists of high reputation suppose 
that this is used in the production of animal temperature. If the supply 
of grape sugar corresponds to the temperature, the liver should be largest 
in warm-blooded animals. 
These are the considerations which led me to investigate the relative 
size of this organ in different animals. But it must be stated, decidedly, 
that these views have not been sustained by my researches. A reference 
to the table shows us that the liver is smaller in birds than in many fishes, 
reptile®, and mammals, while the former have the highest temperature 
and the greatest number of blood-corpuscles. Notwithstanding these 
results we need not abandon the preceding physiological doctrines, as no 
organ in the bodies of animals is so liable to alterations in its weight, 
unconnected with its secretory or excretory apparatus, as the liver. 
Fishes especially contain an extraordinary amount of oil. I have detected 
the presence of oil under the microscope, in the form of innumerable small 
globules in the livers of all animals, and even in the livers of cold-blooded 
animals which had been starved for sixty days, and warm-blooded animals 
which had been starved to death. In the cold-blooded animals, although 
every particle of fat had disappeared from their tissues, and the animals 
had died from starvation, still oil globules were found in considerable 
numbers in their livers. Again, the structure of the liver in the cold- 
blooded animals, and fishes especially, is much softer and less compact than 
in the warm-blooded ones. These facts show that the weight of the liver 
is not a true exponent of that portion of the gland which is devoted to 
the elaboration and formation of the constituents of the blood. 
The livers of all animals, cold or warm-blooded, always, as far as my 
observation has extended, yield grape sugar. I have detected its presence 
by various tests in the livers of numerous fishes, batrachians, ophidians, 
chelonians, birds, and mammals. I have found it in the livers of cold- 
blooded animals at all periods of starvation, and even after death from a 
deprivation of food and drink. In the liver, however, of a dog which was 
starved to death, I failed to discover hepaticsugar. These facts show that, 
during starvation, grape sugar must be formed in the animal economy in 
part, from the nitrogenized elements. 
One of the most prominent effects of starvation in all animals is the 
consumption of the fatty matters. Fat is found in considerable quantities 
in the livers of all animals, whether supplied with, or deprived of food and 
drink; and a universal accompaniment of this fact is grape sugar, a sub- 
stance closely allied to it in chemical constitution. A relation, therefore, 
appears to exist between the consumption of fat in the animal economy 
and the production of grape sugar; but what this relation is, and whether 
grape sugar is formed from fat, has never been determined. 900 
Weight of the Liver in Malarial Fever. 
The liver, unlike other glands, elaborates its secretion, not out of 
arterial blood, but from the venous blood of the vena porta. The extensive 
capillary network into which the vena porta pours its contents not only 
constitutes the starting point of the hepatic vein, but also receives the 
blood from the hepatic artery after it has flowed through a peculiar system 
of capillaries destined for the nutrition of vessels, gall-ducts and nerves. 
The secreting cells of the liver are arranged in such a manner as to bring 
them into a much more intimate and extensive contact with the capillaries 
than is the case with other glands. Moreover the number ot canals into 
which these cells pour their secretions is much greater than in any other 
gland in proportion to the number of the cells. From its large size and 
from the extensive system of blood-vessels connected with it, the liver has, 
from the earliest periods of medicine, been regarded as the seat of many 
important functions connected with animal heat, sanguinification and 
vegetable life, and with the origin and progress of various diseases. 
WEIGHT OF THE LIVER IN MALARIAL FEVER. 
Weight of healthy liver; mean of 82 observa- 
Avoirdupois 
pounds. 
} 3 to 4 
3 to 4 
3 lbs. 44 ozs. 
3 " 11| " 
5 " 3 " 
4 " 3 " 
5 " 0 " 
5 u ° u 
4 u u 
Avoirdupois 
ounces. 
48-58 
40-50 
52J 
59 J 
83 
67 
80 
83 
67i 
Troy 
grains. 
13,000 
to 
25,375 
17,500 
to 
21,875 
22.968 
Weight of healthy liver, mean of 36 observa- 
Weight of liver in remittent and typhoid fever 
Weight of liver in lichen agrius during conva- 
25,642 
36,312 
29,312 
35,000 
36,312 
29,416 
Weight of liver in remittent fever 
Weight of liver in congestive fever 
Weight of liver in congestive fever 
Weight of liver in congestive fever 
According to the researches of Dr. John Reid, the liver weighed, in 43 
cases out of 82, between 48and 58 ounces in the adult male; and in 17 cases 
out of 36 its weight in the adult female ranged between 40 and 50 ounces. 
It may, then, in general terms, be stated that the weight of the liver in health 
varies from three to four pounds, according to the quantity of blood which 
it may contain at the time it is examined. The comparison of these results 
with the weight of the liver in the different forms of malarial fever, shows 
that the weight of the liver is increased in malarial fever. We would 
naturally expect this increase of weight from the stagnation and accumu- 
lation of blood in the capillaries and blood-vessels of the liver in malarial 
fever. In all such examinations it should ever be remembered that the 
weight of the liver varies considerably in health, according to the amount 
of blood which it contains. 
The lobes of the liver in its several grades of natural subdivision in the 
mammalian class are united by a delicate fibrous coat which is continuous with 
the similar loose in vestment of the vessels in the portal fissure called Glisson's 
capsule. The serous accompanies and closely adheres to the fibrous coat seen at 
the portal fissure and along the suspensory and other folds, called ligaments where 
the serous coat is reflected from the gland. 
The ultimate subdivisions into which the lobes and lobules of the liver are 
resolved have been called acini; but as the anatomist to whom we are indebted 
ANATOMY OF THE HUMAN LIVER. Anatomy of the Human Liver. 
901 
for a knowledge of their structure has applied to these acini, the term usually given 
to such secondary divisions as the lobus spigelii, and has founded his nomencla- 
ture thereon, it has been retained by many anatomical writers. Kiernan's lobules 
{Acini) range in size from one-twentieth to one-tenth of an inch in diameter, pre- 
sent a foliated contour in longitudinal section; and a polygonal one in transverse, 
a venule issuing from their centre connects them with the initiator sublobular 
branches of the hepatic vein; the rest of their surface is attached by similar 
beginnings of hepatic ducts and absorbants, by terminal branches of the hepatic 
artery and portal vein, and by nerves to the thin stratum of areolar tissue con- 
necting one lobule acinus) with others. 
Each lobule {acinus} is composed of ramifications of the suspensory " intra- 
lobular " venule, of arterial capillaries, of a plexus of portal capillaries, a plexus of 
biliary passages, of nerves, lymphatics and intermediate cell substance-the essen- 
tial part of the gland which the other structures subserve. The section magnified, 
of a "sublobular" venule shows the commonly hexagonal outline of the flattened 
bases of the lobules, the termination of the intra lobular venules; the interlob- 
ular fissures, and the interlobular spaces at their angles; these are continued into 
the intervals between the more or less rounded lateral surfaces of the closely 
packed lobuies. 
The portal vein in man and mammals generally is formed by the superior and 
inferior mesenteric veins, by the splenic vein, by the gastro-epiploic, and pancreatic 
veins; the trunk entering the portal fissure divides into a right and left branch; 
these penetrate their respective divisions of the liver, ramify and subdivide therein, 
along tracts termed portal canals, but which likewise lodge branches of the hepatic 
artery and duct. 
As all these are connected together by a prolongation of the areolar tissue of 
Glisson's capsule, branches continued from the portal vein, and forming a plexus 
in that tissue, are termed " vaginal," from which as well as directly from the por- 
tal vein, venules enter the interlobular spaces, called interlobular venules, 
penetrate the lobule and form a capillary plexus therein, most richly at the peri- 
phery. but from which the " interlobular" vein begins. The hepatic artery has a 
similar distribution through the portal canal, where the minute branches form 
vaginal plexuses, sendingoff interlobular branches which terminate in the lobule 
by a capillary plexus communicating and localised with the portal ones. 
The meshes of the radially arranged plexuses are occupied by organites, which 
subsist by endosmotic intussusception and assimilation of the blood elements, modi- 
fying them by interchange of other elementary combinations, then perish by rup- 
ture or solution of their walls. These bodies called hepatic cells, much exceed in 
size the monads of infusoria, (as the monas atomus l-2000th line in diameter), being 
about l-2000th of an inch in diameter; but like them they have a hyaline granular 
nucleus, which contrasts by refractory brightness with the tawny yellow of the 
minute granules of the main contents of the cell, in which also float oil globules. 
These contents exuded or set free, fill the intervals of the nucleated cells and form 
the bile, or brief equivalent of bile vesicles, without proper walls. When an epi- 
thelium is discernable separating them from the capillaries, the bile ducts may be 
said to commence, when or where such epithelial walls are gained, forming a begin- 
ning of proper conduits for carrying off the bile from the interspaces of the forma- 
tive cells, has long been debateable ground with micrographists, as has been well 
shown by the discussions of Beale, Budge, Herring and Tothers. The inductive 
figure given by Kiernan of the intra-lobular or bile conducts receives support from 
the careful researches of Herring, in the liver of the rabbit. He describes them as 
forming a plexus with polygonal meshes, from which the canals are continued to 
form the inter-lobular ducts; from these are continued the vaginal branches which 
progressively unite to form the hepatic ducts. These in man emerge, two in num- 
ber, at the portal fissure. In more divided livers the liberated livers are more num- 
erous, but all unite, as a rule; in mammals, into one trunk, which, in those having 
a gall-bladder, joins the cystic duct to form the ductus communis choledochus. 
This duct penetrates the duodenum distinctly from the pancreatic duct; both run 
obliquely between the several tunics of the gut in man, before uniting to form the 
common receptacle within the terminal prominence. 
The human cytsic duct shows a series of crescentric folds of the lining mem- 
brane, directed obliquely round the canal, and so arranged as to give the appear- 
ance of a spiral valve. Numerous minute follicles, either branched or clustered, 
open upon the mucous tract of the bile-ducts; in the smaller branches these orifices 
are in two opposite longitudinal rows. 902 
Lobules of the Liver. 
From the arrangement and localization in the lobules of the capillaries of the 
two systems of veins, determined together with most that is of importance in 
hepatic structure, by the research and skill of Kiernan, an explanation has been 
afforded of appearances otherwise unintelligible or misleading. When the capil- 
laries of the hepatic vein are gorged, as is usual in an early stage of congestion, the 
flattened surfaces .of the lobules on the superficies of the liver present a central 
area of congestion. When the portal capillaries are congested the peripheral parts 
of the lobules present the deeper color.* 
LOBULES OF THE LIVER. 
Professor Edward Hering, of Vienna, thus describes the structure of the lobules 
of the liver: The lobules of the human liver are irregularly polyhedral and usu- 
ally oblong bodies, measuring one millimetre in their transverse, and 1-2 millime- 
tres in their long diameter. We distinguish in them a base, side surfaces and sum- 
mit. The base rests upon the wall of the small hepatic vein (venus sublobulosis}, 
from which the lobule receives its vein direct. Those lobules whose central veins 
are not the lateral, but the terminal branches of the hepatic vein, coalesce com- 
pletely with each other in the neighborhood of their bases, so as to form a com- 
pound lobule (Theile.) It also frequently happens that the central vein subdivides 
within the lobule, and that in harmony with this subdivision the latter, while 
retaining its single bases, will have several distinct summits separated by shal- 
lower or deeper furrows. 
The substance of the lobule of a liver consists essentially of two elements, the 
livf-r cells and the capillaries. In the same manner as the short trunk of a tree 
sends off branches on all sides at nearly a right angle to the axis, and at the top 
breaks up into radiating branches like a pencil, so the central vein gives offnumer- 
ous capillaries from its entire surface. These latter seek the periphery of the lobule 
by the shortest route, and therefore follow in the main a radial course, and on the 
way they repeatedly make forked subdivisions. This accounts for the fact that 
these radial capillaries are placed as close to one another at the peripheral portion 
of the lobule as at the central. The diameter of these capillaries when they are 
moderately distended is about 0.01 millim., and they are separated from their near- 
est neighbors by a distance of about 0.015 millimetre. From the frequent inter- 
communication between these radial capillaries, through short transverse anasto- 
moses, there is formed a very close capillary net-work with long meshes, whose 
long axis lies in the radial direction (within the lobule) while the short transverse 
axis corresponds to the distance between two radial capillaries. It is only at the 
periphery of the lobule, where the latter communicates uninterruptedly with its 
neighbor, that shorter and rounder meshes are found in the place of the oblong. 
All the space which this omnipresent capillary net-work does not occupy is 
filled with liver cells. These Dr. Hering regards as balls which with a little force 
can be made to find room for themselves, between the adjacent capillaries, so that 
when all the spaces between the capillaries are completely filled with these balls, 
the latter will not only become somewhat flattened by pressure upon each other, 
butthey will also receive groove-like impressions on their surfaces from the capillary 
tubes with which they come in contact. The totality of the closely packed poly- 
hedral liver cells may be represented as one connected mass whose continuity is 
broken up by the many meshed capillary net-work. 
The description given by Hering of the structure of the lobules of the liver 
differs materially from the descriptions hitherto given. All the more recent inves- 
tigators, from E. H. Weber to Eberth, accept the existence of the so-called hepatic 
cords. These cords are composed of one or more rows of cells, and form a sort of 
network that intertwines with the capillary network or plexus. 
It is the belief of some investigators that the cells of the human liver are sur- 
rounded in rows by a structureless membrana propria, and that the tubules which 
are thus formed-the so-called liver tubules-are connected together in the form of 
a network. In the walls of these tubules, according to E. Wagner, round nuclei 
are found which measure 1-lOOth mm. in diameter. In children, according to 
Beale, the tubules can easily be separated from the wall of the capillary, while in 
adults it is either not practicable or else can only be done with great difficulty. 
* Kiernan, Frances. F. R. S„ the Anatomy and Physiology of the I.iver: Philosophical 
Trans., 4th vol., 1833. Wilson, Erasmus, W. J. F. R. S., Art. Liver, Cyclopaedia of Anatomy, 
vol. iii, 1848. Herring, E. Ueber den Bau der Wirbelthierleben in Litzungsberichte Sitzung 
der Wissenschafter in Wien, 6th December, .'866. Owen, Richard, F. R. S., on the Anatomy of 
Vertebrates, vol. iii, Mammalia, p. 4S7. Herring, Edward, Professor of Physiology in the Impe- 
rial Academy of Vienna. A Manual of Histology, by Prof. L. Stricker, New York, 1872, p. 407. Hepatic Cells. 
903 
From the description given by Hering of the structures of the lobules, it will 
be evident that such a membrana propria of the liver-cells could only exist as a 
covering of the capillaries, so that what Hering has interpreted, partly from his 
own observations, and partly from the views of other observers, to be simply the 
wall of the capillary would, in fact, consist of the latter together with the mem- 
brane of the tubule. Frey believes that this membrane encloses the perivascular 
lymph spaces; in other words, that the lymph is contained between it and the wall 
of the capillary.* 
According to Lionel S. Beale, M. D., F. R. S., the cells of the liver are some- 
what irregularly arranged in the interior of delicate tubes, so as to constitute a cell- 
-containing network, the walls of which are so thin that in some instances only 
can they be demonstrated. In the frog, toad, and many of the lower vertebrata, 
the continuity of the tubes of the network with the ducts can be proved beyond a 
doubt. In man and the higher vertebrates, the arrangement is sometimes to be 
very distinctly determined in health, but in certain forms of disease, in which con- 
traction of the liver and thickening and condensation of the anatomical elements 
have been proceeding for some time, the appearances are such as render any 
other anatomical explanation of them inadmissible. Portions of the cell-contain- 
ing network can be demonstrated clearly enough insections of liver that have been 
hardened by being kept for a long time in syrup or glycerine, or other medium 
containing a little chromic acid. Philosophical Transactions for 1855, Archives 
of Medicine. The Microscope in Medicine, 4th ed., p. 407. The hepatic cells, in a 
state of health, generally contain a few oil globules, which vary a good deal in size, 
but which for the most part are very minute. The oil globules lie amongst a gran- 
ular-formed material in which biie pigment can often be seen, and not unfre- 
quently crystals of yellow biliary matter. The bioplasm, usually nearly spherical 
in form, with its new centre (nucleus), is embedded in the formed material. 
In disease the cells may become wasted and shrunk; they may be filled with 
granular matter, or gorged with fat, or the fatty matter may have increased so 
enormously in quantity as to cause the obliteration of the cell form altogether, in 
which case another section of the liver will be found to present, under the micro- 
scope, an appearance not to be distinguished from ordinary fatty tissue. Not unfre- 
quently the cells of the liver, especially those in the central part of the lobule, will 
be found to contain minute crystals or granules of red, reddish-brown and yellow 
coloring matter. 
In malarial fever the hsematin is found abundant within and around the liver 
cells. 
When the diffused hepatitis, excited by the malarial poison, has resulted in 
cirrhosis, we find that the great abundance of the dark pigment and melanotic 
matter, gives to the organ a dark greenish black color with spots of yellow. These 
yellow portions often contain liver cells loaded with oil globules in a process of 
degeneration, as well as cells containing much pigment matter. 
The cells of those portions of the malarial liver which are undergoing fatty 
degeneration, contrast in a marked manner with the stained state of the cells of a 
scrofulous liver, or with the pale granular cells which are often met with in the 
livers of patients who have died of diabetes. The cells of cirrhosis and fatty degen- 
eration of the liver, caused by the action of the malarial poison, are characterized 
from those of other diseases, as for example, yellow fever, by the great abundance 
of dark blood pigment. 
It is of the first importance to determine positively the precise locality of the 
pathological changes of an organ having so complex and delicate a structure as the 
liver; and although it would appear at first sight a simple matter to determine 
whether any given alteration was situated in the centre or at the circumference of 
the lobule, it is often difficult to do so, for although the position of the artery and 
duct enable us to decide at once the intervals between the lobules, it is very difficult 
to distinguish these tubes truly unless they have been injected previously, and this 
proceeding cannot always be carried out in specimens removed at a post-mortem. 
The object is more easily gained by injecting a branch of the portal vein in one 
part of the liver and one of the hepatic vein in another. In some cases of disease 
the tissues in the centre of the lobules waste, and when the wasting process has 
affected several adjacent lobules, an appearance as of inter-lobular fissures is pro- 
duced in the central part of the lobule. The capillaries also are prone to degener- 
HEPATIC CELLS. 
* A Manual of Histology, by Prof. S. Stricker, of Vienna, Austria. New York, 1872, pp. 407-427 904 
Color of the Liver in Malarial Fever. 
ate in some diseases, and their canals to be obliterated. This degeneration com- 
mences sometimes in the capillaries connected with the portal, and sometimes in 
those opening into the hepatic vein-a point that cannot be easily determined until 
it is decided which is the centre and circumference of the lobule. 
COLOR OF THE LIVER IN MALARIAL FEVER. 
My observations upon the color of the liver, agree in the main with 
those of Dr. Thomas Stewardson,* of Philadelphia. This distinguished 
pathologist first pointed out the fact that the color of the liver in malarial 
fever is changed from the normal reddish-brown to a slaty or bronze, or 
mixture of bronze and olive. The knowledge of this peculiar change of 
the color of the liver during malarial fever is exceedingly valuable as a 
means of distinguishing malarial fever from yellow, typhoid, typhus, and 
all other fevers. The observations of Dr. Thomas Stewardson, have been 
confirmed by those of Dr. Wm. T. Howard,f in the Baltimore Almshouse, 
of Dr. Swett,J in the New York Hospital, of Drs. Andersong and Frick, in 
the Baltimore Almshouse and Infirmary, and of Dy. Bichard Arnold.|| in 
the Savannah Marine Hospital and Poor House. 
In all the different forms of malarial fever, intermittent, remittent, 
and congestive, which had continued longer than five days, and in which 
there had been no previous structural alterations of the liver, as cirrhosis 
or fatty degeneration, I found the exterior to be of a slate color, and the 
interior of a bronze color. Tn a case of remittent and typhoid fever, the 
liver presented the true malarial slate color upon the exterior, and the 
bronze color in the interior. 
In cases of death from other causes, during convalescence from mala- 
rial fever, the color of the liver, both upon the exterior and within was not 
so deep, and presented various shades, from the slate, to dark Spanish 
brown. The change in the color appears to be very persistent. I have, in 
several cases, observed that the liver retained shades of light slate and 
light bronze, several weeks after the relief of the attack of malarial fever. 
The liver of a stout American seaman, who had died from a severe 
attack of congestive fever, of only three and a half days' duration, pre- 
sented upon the exterior, a color onl} a shade darker than usual, with the 
exception of two slate colored spots. The largest of these slate colored 
spots, was four inches in diameter, and was situated upon the anterior sur- 
face of the right lobe, whilst the smallest was situated upon the posterior 
surface, of the left lobe When an incision was made into the structures 
of the liver, through these spots, the substance presented a bronze color 
for the depth of a quarter of an inch. In all other parts of the liver, the 
cut surface presented a color only a shade deeper than normal. 
In a case of congestive fever of the most sudden onset and rapid pro- 
gress, which was ushered in by vomiting, complete exhaustion of the mus- 
cular and nervous forces, and profound coma, a large portion of the sur- 
face of the liver presented the healthy Spanish-brown color, and when cut, 
the substance presented the usual healthy color, whilst the other portions 
presented a mottled appearance of Spanish-brown and dark purpie, and 
the blood-vessels of these parts appeared to be engorged with blood. The 
right lobe of the liver had upon its under surface a spot about two inches 
* Stewardson, "On Remittent Fever,'' American Journal Med. Sciences, April, 1841, New 
Series, vol. 1, p. 289. Tillotson's and Stewardson's Practice of Medicine, p. 338. 
f Communicated by Dr. Stewardson, Am. Journ. Med. Sciences, 1845. 
t Swett " On Pathol, of Remittent Fever," Am. Journ. Med. sciences. 1845. 
g Published by Dr. Alfred Still6, Am. Journ. Med. Sciences, April, 1846. 
I) " An Essay upon the Relation of Bilious and Yellow Fever, prepared at the request of, and 
read before the Medical Society of Georgia. April, 1856," by Richard D. Arnold, M. D. Southern 
Medical and Surgical Journal, vol. xii, p. 515. Effect of Preceding Diseases on the Color of the Liver. 
905 
in diameter, of a dark slate (malarial) color. When an incision was made 
through this portion of t he liver, it presented for the depth of about one- 
fourth of an inch, the true bronze color. 
Numerous incisions were made into the liver in all directions, so as to 
expose its substance fully to view; portions were found, approaching in 
color the bronze hue of the malarial fever liver; the gr eat mass of the liver, 
however resembled more nearly that of a healthy liver engorged with 
blood. Portions from different parts of the liver were examined under 
the microscope. The liver cells, from the slate-colored and bronzed por- 
tions, did not differ in appearance under the microscope, from those of the 
normal colored, or from those of the mottled portions. The colored cor- 
puscles appeared to be more altered in form in the bronzed portions, than 
in the normal colored portions. The alterations, however, even in the 
bronzed portions, were small and by no means universal, but confined to 
a few, and after all, the difference may have been imaginary. The deter- 
mination of comparative alterations of this kind is not so easy as at first 
sight appears. Did not discover any of those dark granules in the bronze 
portion, which have been said to impart the peculiar color to the malarial 
liver. The liver cells did not appear under the microscope to have been 
altered in any manner. 
EFFECTS OF PREVIOUS PATHOLOGICAL ALTERATIONS UPON THE COLOR OF 
THE LIVER, IN MALARIAL iEVER. 
In making examinations of the different organs after death, and in attempt- 
ing to determine definitely the changes of color, toe should always determine, if 
possible, the condition of the liver previous to the disease. There are two affec- 
tions of the liver which are attended with profound alterations of the 
structures, and always modify the color characteristic of malarial fever. 
The liver of an Irisman, who died in the latter stages of phthisis pul- 
momdis, from intermittent fever, presented a purplish-red color, notwith- 
standing the presence of the disease long enough to have produced 
the decided slate and bronzed color. The structure was unusually firm; it 
required considerable force to tear it asunder. It cut toughly under the 
knife, and the lobules started out from the cut surface, as if they had been 
bound down. The fibrous capsule surrounding the exterior of the liver, 
forming a sheath for the larger vessels lying in the portal canals, was 
thickened. The individual lobules of the liver were surrounded with 
fibrous tissue. Here, then, we have, the explanation of the variation of 
the color of the liver from that characteristic of malarial fever. 
The lobules of the liver have been described by Malpighi,* Kiernan, f 
Miiller, t Leidy.§ and others, as isolated from each other, and each invested 
with a layer of areolar or fibrous tissue. In the pig, in which these lobules 
were first noticed, and in the polar bear, according to Muller, and in the 
octodon cummingii, according to Hy itl, 11 the lobules are invested by fibrous 
tissue, but in the liver of the human subject, and in that of vertebrate 
animals generally, the lobules are not separated from each other by a 
fibrous partition, and there is no areolar or fibrous tissue or prolongation of 
Glisson's capsule between them or in their interior. 
* Malpighi, De Viscerum, Structura, Bologna. London, 1699. 
+ "The Anatomy and Physiology of the Liver," by Francis Kiernan, Philosophical Transac- 
tions of the Royal Society of London, 1833. p. 714. 
I Muller, De Glandularum Secernent Struct. Penit, Berlin; 1830. Elements of Physiology, by 
J. Muller, M. D., translated by Wm. Baly, M. D. London, 1840; vol. i, p. 49.;. 
2 " Researches into the Comparative Structure of the Li ver," by Joseph Leidy, M. D. Ameri- 
can Journal of the Medical Sciences. Aew Series, vol. xv, 1848, p. 18. 
I Hyrtl, Lehrbuch der Anatomie des Menchen, 1850. 906 
Effect of Preceding Diseases on the Color of the Liver. 
Vogel, Henle,* Bowman, f and Beale, J have failed to detect any fibrous 
tissue in the interlobular fissures of the normal human liver. 
In cirrhosis of the liver, on the other hand, there is a remarkable 
development of fibrous tissue in the parenchyma of the liver; and the 
individual secreting segments become prominent or even firm isolated 
lobules. 
The increase of fibrous tissue in the liver of this subject was manifest 
to the eye, and especially when the liver was subjected to the action of a 
stream of water, and gently mashed between the fingers. The softer parts 
were washed out, and the fibrous tissue remained. The character of this 
was determined by microscopical examination. The portions of the liver 
surrounded by the indurated fibrous tissue appeared to be but little altered, 
and could be readily scraped away. The cirrhosed condition of the liver 
was not the result of malarial fever, for the microscopical examination 
showed that the fibrous tissue was abundant and well-formed. The whole 
structure of the liver could not have been pervaded with fibrous tissue in 
a few days. It is reasonable to conclude with Dr. Budd, § that the remark- 
able changes in cirrhosis, are mainly the consequences of adhesive inflam- 
mation in the areolar tissue about the small twigs of the portal vein, and 
in the areolar tissue of the portal canals, by which serous fluid and coagu- 
lable lymph are poured out. In this stage the liver may be enlarged. The 
serous part of the effusion is next absorbed, the lymph contracts, becomes 
converted into dense fibrous tissue, which divides the lobular substance of 
the liver into well-defined masses, and gives great density and toughness 
to the organ. Finally, this fibrous tissue compresses the small twigs of the 
portal vein and the small gall-ducts, and thus impeding the escape of the 
bile and the flow of blood induces great atrophy of the original hepatic 
tissue, and causes by a deprivation of blood and the admixture of this 
dirty white fibrous tissue, marked changes in the color of the liver. If 
these views of Dr. Budd be correct, it is evident that this conditiion of the 
liver could not have resulted from an attack of malarial fever, which had 
commenced only twelve days before death. This patient was an Irish 
laborer. This class is addicted to the free use of ardent spirits, and the 
true cause of this cirrhosed condition of the liver was the action of the 
alcohol in the portal blood, absorbed directly from the stomach and intes- 
tines upon the blood-vessels and secreting apparatus of the liver. We 
know that this form of disease is most frequent in large manufacturing 
towns, among the poorer classes, who drink large quantities of ardent 
spirits. All the cirrhosed livers which I have had an opportunity of 
examining, have been taken from the bodies of those who have been 
accustomed to the free use of spirits. So common and well known is this 
cause, that cirrhosis is familiary termed by the English practitioners, gin- 
drinker's liver. 
The color of the liver of this patient was very different from that 
generally presented in cirrhosis. Upon the inferior surface of the liver 
there was a small portion of a dark slate, inclining to bronze color, 
resembling the color of the malarial fever liver, and forming a striking 
contrast with the surrounding purplish red color. In cirrhosis, owing to 
the admixture of fibrous tissue and the impediment to the circulation of 
* Hufeland's Journal, 1838, p, 8, 
+ Article "Mucous Membrane," in Todd's Cyclopaedia of Anatomy and Physiology, by W. 
Bowman, vol. iii,p. 497. The Physiological Anatomy and Physiology of Man, by Todd and Bow- 
man. Philadelphia, 1857, p. 773. 
t On Some Points in the Anatomy of the Liver of Man and Vertebrated Animals, by Lionel 
S. Beale, M.D. London, 1856, pp. 13, 16, 19,72. 
g On Diseases of the Liver, by George Budd, M. D. London, 1857, p. 143. Effect of Preceding Diseases on the Color of the Liver. 
907 
the blood, and the passage of the bile, and the compression of the capilla- 
ries and secreting apparatus, the normal, dull reddish brown, color of the 
liver is altered sometimes to a bright canary yellow, sometimes to a 
brownish or greenish, and occasionally to a reddish color. A section of 
the liver upon a general view presents the grayish and yellow color of 
impure beeswax. In this case, owing to the pathological conditions of 
cirrhosis, the admixture of fibrous tissue, impediment of the circulation of 
the blood, and flow of bile, and the compression of the capillaries and 
secretory apparatus, the color of the liver was not so marked as in those 
cases of malarial fever in which the liver was normal before the introduc- 
tion of the malarial poison. Allowing due weight to the pathological 
changes of cirrhosis, it is evident that the change in the color of the liver 
was similar, in all respects, to the slate and bronze color of livers which 
were normal before the onset of the malarial fever. 
The liver of a house painter, who died suddenly during convalescence from 
a severe attach of malarial fever, presented, upon a general view, a light 
slate color, with purplish and brownish reflections. Upon nearer inspec- 
tion, it presented a mottled appearance, many of the lobules presented the 
yellow color of cirrhosis. The cut surface presented upon a general view 
a light bronze and purplish yellow color. Upon close inspection, the 
yellow lobules were distinctly visible. Structure of the liver unusually 
firm, it required great force to tear it. The yellow color of many of the 
lobules and the large admixture of dense fibrous tissue prove that the liver 
was in a cirrhosed condition previous to the attack of malarial fever. The 
yellow color of the cirrhosis was masked very much by the characteristic 
effects of the malarial poison. In the case of a German barkeeper, who died 
with congestive fever after seven days' sickness, the liver presented a singular 
mottled appearance; at a distance, it presented a light bronzed color; upon 
nearer inspection the lobules were found to be distinct, elevated, and of a 
light bronze color, whilst the spaces between the lobules inclined to a slate 
color. There were several spots, varying from two inches to half an inch 
in diameter, of a uniform slate color. The structure of the liver was 
unusually firm, it required considerable force to tear it asunder, it cut 
toughlv under the knife, and the lobules started out from the cut surface 
as if they had been bound down. The fibrous capsule surrounding the 
exterior of the liver, and forming a thick sheath for the large vessels lying 
in the portal canals, was thickened, and the individual lobules of the liver 
were surrounded with fibrous tissue. These facts, which were demon- 
strated, not only by the touch and naked eye, but also by the microscope, 
showed that this liver was in a cirrhosed condition. Cirrhosis of the liver 
in this case was not caused by the action of the malarial poison, but in all 
probability by the habitual use of ardent spirits. This patient was a 
barkeeper. Men in this occupation, as a general rule, are addicted 
to the free use of ardent spirits. The liquors drunk in this country, 
at the hotels and bar-rooms, contain much alcohol, which acts upon 
the secreting structures of the liver, and upon the blood-vessels, and 
excites adhesive inflammation in the areolar tissue, about the small 
twigs of the portal vein, and in the areolar tissue of the portal canals, by 
which serous fluid and coagulable lymph are thrown out. Under the 
microscope, the substance of the liver contained many dark-looking masses 
resembling the altered blood-corpuscles of the spleen, and the black 
granules and flakes of black vomit. These dark masses were not sufficiently 
numerous to produce any marked effect upon the color of the organ. 
When the fibrous capsule was torn off it presented a light slate color, and 
yet when magnified and carefully examined but few of these dark masses 908 
Effect of Preceding Diseases on the Color of the Liver. 
were seen in the meshes. The structures of the liver and the liver-cells 
contained numerous oil-globules. These oil-globules existed in sufficient 
numbers to induce the belief that the liver was in a state not only of 
cirrhosis, but also of fatty degeneration. The mottled appearance of the 
liver, and the want of that decided slate and bronze color characteristic of 
malarial fever, were due not to any peculiar effects of the malarial poison, 
but rather to the pathological conditions of cirrhosis and fatty degeneration. 
Allowing due weight to these pathological changes, it is evident that the 
change in the color of the liver was similar in all respects to the slate or 
bronze color of livers which were normal before the onset of the malarial 
fever. 
These facts show the importance, in all pathological investigations of 
the physical and chemical changes of the organs after death, of determining 
definitely the previous diseases and habits of the patients. Without such 
examinations the most erroneous conclusions might be drawn with reference 
to the nature of the structural alterations of the different organs, especially 
of the liver, during disease. The length of the disease should always be 
accurately ascertained. We know that the malarial poison is, in many 
cases, either from peculiarities of constitution, or changes in the forces 
induced by bad habits and previous diseases; or from the amount and 
concentration of the dose; or from the extent and importance of the offices 
of the organ upon which its force appears to be mainly expended; exceed- 
ingly rapid and violent in its action-death in some cases occurring in 
forty hours after the appearance of the first symptoms. If the patients 
thus suddenly attacked have never been exposed previously to the malarial 
poison we should not expect to find the characteristic alterations in the 
color and structures of the liver and spleen as well marked as in cases of 
longer standing, for all morbific changes attended with physical changes 
of structure and color are attended by definite chemical changes, and, in 
most cases, are absolutely dependent upon such changes, either in the 
blood or in the nervous systems or in the structures of the organs; and as 
every chemical change requires time for its production and completion, so 
must every pathological change have time for its production and completion. 
The pathological alterations of the organs would be most decidedly mani- 
fested, even after apparent sudden attacks in those who have iesided for 
some time previous in the malarious district, for, in two instances on 
record, the bronzed liver was found a year and more after the patient had 
suffered from remittent fever, and, in the interval, these persons had 
enjoyed good health. 
In localities like Savannah, Charleston, New Orleans and Mobile, 
where the yellow fever has prevailed as an epidemic, it would be exceed- 
ingly important and interesting to determine the effects of previous attacks 
of yellow fever upon the structures and color of the liver, and the charac- 
ters of the alterations presented in a subsequent attack of malar ial fever. 
Judging by the extent and character of the alterations of the liver in yellow 
fever, we would say that they were as persistent as those of malarial fever, 
and that they would,, like the alterations of cirrhosis and fatty degenera- 
tion, mask the characteristic color- of the malarial liver. These facts 
demonstrate the extent and complexity of pathological phenomena and 
the number of the sources of uncertainty and error in pathological investi- 
gations. Sources of the Color of the Liver in Malarial Fever. 
909 
CHANGES OF THE COLOR OF THE BLOOD IN LIVER OF MALARIAL FEVER. 
The blood of the liver in malarial fever presents a dark brownish red 
and dark purplish-red color, often inclining to black, and does not change 
to the arterial hue when exposed to the atmosphere. If the patient dies 
within two days of the commencement of the disease, there may be a 
change in portions of the blood issuing from the cut su'face, to the arte- 
rial hue. This change takes place also in the blood of the liver taken 
from patients who have died from other diseases, during convalescence 
from malarial fever. 
SOURCES OF THE CHANGE OF COLOR IN THE LIVER DURING MALARIAL 
FEVER. 
The change in the color of the liver during malarial fever is due to 
changes in the amount, and physical and chemical constitution of the blood 
in the capillaries of the liver, and to the physical and chemical changes in 
the bile, and the contents of the secretory apparatus. 
Dr. A. Clarke* has announced that the hue peculiar to the malarial 
liver ' is produced by an infinite number of colored microscopical particles 
of irregular shape and size, totally different from anything that enters into 
the constitution of the healthy liver; that these colored particles are scat- 
tered irregularly through the hepatic tissue, are seen to occupy the secret- 
ing cells of the organ, and even the nuclei of these cells; that they vary in 
hue from red or orange to an opaque, jet black, though much the greater 
number are of a semi-transparent dark brown color; and that, in shape, the 
red and dark brown particles are, some beautifully crystallized, some in 
globular dotsand grains; while the black, often in globular grains, are also 
seen in friable, semi-crystalline scales, some of them almost large enough 
to be seen by the naked eye. The nature of this coloring matter must be 
sought among the chemical transformations of htematin, or coloring prin- 
ciple of the blood. The belief is expressed that in the remittent fever, as 
in many other diseased states, the haematin is readily yielded by the blood, 
and passing into the liver substance, there meets with some unknown agent 
which changes its chemical constitution, and converts it into the formsand 
colors here described." 
With reference to the extent and character of his investigations, Dr. 
Clarke states in a note appended to the first volume of Dr. La Roche's 
learned work on yellow fever: "The hospital with which I am connected, 
though a very large one, does not receive many cases of this disease, and 
within the paved and sewered districts of this island it is virtually extinct. 
In the last seven years, I may have witnessed seven post mortem examina- 
tions, and though I have not kept notes of them, I can trust my recollec- 
tion to assert that I have seen no instance in which one of the recognized 
hues did not exist. Portions of the liver in each one of these cases have 
been studied with the aid of the microscope; and in all the coloring matter 
here called hcematoidin has been found abundant, and in each case, as far 
as could be judged, the quantity was nicely proportioned to the intensity of 
the abnormal color."-p. 614. 
The careful microscopical examination of the livers of many cases of 
intermittent, remittent and congestive fever, has convinced me that whilst 
* The History, Diagnosis and Treatment of the Fevers of the United States, by Elisha Bart- 
lett, M. D , edited by A. Clarke, M. D„ Philada., 1856, pp. 370, 371. Yellow Fever considered in its 
Historical, Pathological, Etiological and Therapeutical Relations, by R. Da Roche, M. D. Phila- 
delphia, 1855, Vol. i, pp. 610-615. 910 
Bile in Malarial Fever. 
the red and dark brown and black granules do occur in most cases of mala- 
rial fever, they are absent in the livers of acute cases of short duration, 
which do not differ in color from those in which they are present. I have 
seen the slate and bronze color of the liver well marked in the liver when 
these dark masses were absent, as in the liver when they were most abun- 
dant. Careful microscopic examinations of the slate and bronze colored 
spots in the livers of those who had died suddenly with malarial fever, and 
of the slate and bronzed colored spots sometimes found upon the kidneys 
in malarial fever, demonstrated that this hue was decidedly marked when 
there was a paucity of the peculiar dark masses. That the peculiar color 
of the liver in acute cases is due in a great measure to changes in the col- 
oring matter (haematinj of the blood, is indicated by the fact that the blood 
from the capillaries of the liver will not change from the dark reddish- 
brown and purplish color to the arterial hue. It is probable that the 
altered coloring matter, resulting from the destroyed disintegrated blood 
corpuscles, or from the blood corpuscles acted on by the malarial poison 
without actual disintegration, escapes and permeates the surrounding tis- 
sues, and imparts the peculiar color of the liver. The color of the liver 
remains the same, whether the coloring matter be retained in solution, or 
is precipitated, forming the dark granules. 
The peculiar hue appears to be also due to thealtered color of the bile. 
In all the cases of malarial fever which I have thus far examined, I have 
found the bile to be of high specific gravity, thick, concentrated, and of a 
greenish-black color when seen in mass, and of a gamboge yellow when 
spread in thin layers. The liver cells under the microscope presented a 
light greenish-yellow color, as if they also were infiltrated with the altered 
coloring matters. In some cases the liver cells contained fewer oil glo- 
bules, and the cell-walls looked thinner than usual; in other cases they 
resembled closely the healthy cells. 
The peculiar color of the malarial liver can, to a certain extent, be 
extracted by boiling water. In almost every case I found the filtered 
decoction of malarial fever livers, to be of a brownish-yellow color, whilst 
the decoction of yellow fever livers is of a bright golden color, whilst that 
of normal livers is of a light yellow. These observations, however, should 
be repeated upon an extensive scale before we can decide upon the charac- 
teristic color of the decoctions of the liver in different diseases. After the 
altered coloring matters of the blood and bile have infiltrated the struc- 
tures of the liver, they will sometimes remain for a considerable length of 
time without being absorbed, audit may communicate the peculiar bronzed 
color to the liver, long after the restoration of its normal functions, and 
the disappearance of the malarial fever. I have observed, however, that 
the intensity of the color of the liver bears a marked relation to the time 
of convalescence; as convalescence advances, the color diminishes. 
The gall-bladder, in many cases of the different forms of malarial fever, 
was filled with bile, which had, in the majority of cases, the consistency of 
molasses, and presented a greenish-black, with yellowish and reddish 
reflections when seen in mass, and of a gamboge-yellow when spread in 
thin layers. In every case the mucous membrane of the small intestines 
were colored yellow by the bile throughout almost the entire extent, and 
in many cases the mucous membrane of the stomach was in like manner 
discolored with bile. The characters of the bile vomited during life corre- 
sponded to that found in the gall-bladder after death. 
CHARACTERS OF THE BILE IN MALARIAL FEVER. Bile in Malarial Fever. 
911 
In a case of congestive fever of only forty-three hours'1 duration, the specific 
gravity of the bile was 1042.5, and viewed in mass it presented a brownish- 
black color with greenish reflections, and resembled, upon a general view, 
a saturated tincture of iodine. It poured like molasses, being thick and 
ropy. Upon close inspection, the bile was found to contain numerous 
flakes of a green color, which, under the microscope, were found to consist 
of the conglomerated cells of the mucous membrane of the gall-bladder. 
When spread out in thin layers the bile presented a gamboge-yellow color. 
In a case of malarial fever of eleven weeks, which had been entirely 
without treatment during the first eight weeks, and which ended in exten- 
sive disorganization of the blood, muscular system, and spleen, the gall- 
bladder was filled with bile of a brownish-yellow opaque color, when seen 
in mass, and of a gamboge-yellow in thin layers. The bile contained 
numerous, irregularly-shaped, yellow masses of various sizes, from an 
English pea to a grain of sand. These yellow masses formed about two- 
fifths of the contents of the gall-bladder. These masses were soft, and 
readily crushed between the fingers. Under the microscope they were 
found to consist of numerous cells from the mucous membrane of the gall- 
bladder, and a yellow amorphous matter. The bile-duct appeared to be 
completely stopped up with these cells, and this yellow amorphous matter. 
The specific gravity of this specimen of bile was 1036. 
In the case of the house painter who died suddenly during convales- 
cence from a severe attack of remittent fever, the bile presented a brown- 
ish-yellow color in mass, and a gamboge-yellow color in thin layers. It 
was tenacious like mucus; in fact, it resembled closely-colored mucus, 
suecific gravity 1022.5. 
PHYSIOLOGICAL RELATIONS OF THE LIVER TO DIGESTION, ABSORPTION AND 
ASSIMILATION, AND MORE ESPECIALLY TO GLYCOGENE (AMYLOID SUB- 
STANCE; HEPATINE, ZOAMYLINE) AND GLUCOSE. 
In 1820 it was shown by Magendie and Tiedeman that the absorption 
of nutritive matter from the bowel was not limited to the lacteals, but 
that part was taken up into the blood through the portal vein. 
The subsequent researches of physiologists have established that the 
liver exercises important functions in assimilation and nutrition. Claude 
Bernard and other observers have shown that the liver has the power of 
making and storing up within its cells for a time glycogen (C6H10O5), a 
substance resembling dextrin (C H10O ) and starch (C6H10O5) in its chem- 
ical composition and reactions. 
Glycogen or animal starch like dextrin, is capable of conversion into 
sugar by albuminoid ferments. Glycogen always exists in the liver in 
larger amount during digestion than during fasting, attaining its maxi- 
mum about four or five hours after a meal. It has not yet been fully deter- 
mined what the materials are from which it is mainly formed; but although 
it may be formed during starvation, and be produced from a purely nitro- 
genised diet, there can be no doubt that its amount is increased by the 
use of starchy or saccharine food. 
Sugar enters into the composition of our food and plays an important 
partin the economy of life; as an alimentary principle it is derived fiom the 
vegetable kingdom in which it forms an abundant product, and its proper- 
ties are such that it requites to undergo no digestion or preparatory pro- 
cess for absorption. Sugar being of an exceedingly soluble and diffusible 
nature it can readily pass by the physical law of osmosis from the aliment- 
ary canal into the blood-vessels. The villi of the alimentary canal have 912 
Glycogenie Function of the Liver. 
ail absorbing power over certain portions of the food which cannot be 
explained by piiysics; they take up oleo-albummous matters and discharge 
them into the lacteal system, by which they are^transferred to the thoracic 
duct, and thrown forward into the general venous circulation of the body. 
On the other hand, sugar, in virtue of its solubility and its great diffusi- 
bility, requires no special absorbant apparatus for its passage into the 
circulatory system. From the interior of the blood-vessels ramifying upon 
the surface of the alimentary canal sugar is conducted not at once into the 
general circulation, as is the case with oleo-albuminous matter absorbed 
by the lacteals, but through the portal system of veins to the liver. 
Starch, an abundant constituent of food of vegetable origin, although 
presenting very different chemical and physical properties from sugar, is 
transformable into it when the requisite conditions are supplied. To be 
applicable to the purposes of life starch must first be converted into sugar, 
for without this transformation it will pass through the alimentary canal 
unabsorbed and thus prove useless to the economy. Diastase, a principle 
developed during germination, constitutes the agent that excites the trans- 
formation of starch (C6H10O5)in germinating grain first into dextrin 
(C6lI10O5), into cane sugar (C^ 2H99O! j), and glucose or grape sugar 
(C6HI3O6.) 
In the animal organism starch is converted into sugar by certain secre- 
tions poured into the alimentary canal; thus human saliva has the power of 
transforming starch into sugar. With a decoction of starch and at the 
temperature of the living body a few moments' contact with saliva suffice for 
sugar in quantity to appear. Although the human saliva possesses the 
metamorphosing power that has been mentioned, yet this is not the secre- 
tion that is designed by nature for affecting the conversion of starch into 
sugar. It is seldom that starch is received into the mouth in as favorable 
a state for transformation as it is in the decoction that may happen to be 
experimented with outside the body. The food is not long delayed in the 
mouth, and any chemical action that may be here commenced by the 
saliva, will be checked as soon as the stomach is reached and its acid secre- 
tion comes in contact with the saliva. Experiment has shown that a very 
small quantity of an acid suffices to render saliva inoperative as a trans- 
formative agent over starch. 
The conversion of starch into sugar is mainly, if not almost entirely, 
effected in the small intestine; the pancreatic juice, the intestinal juice, 
and the secretions of Brunner's, or the duodenal gland, all possess, in a high 
degree, a transformative power over starch. In the intestine everything 
is favorable to the occurrence of metamorphosis; the food has been reduced 
to a semi-fluid state before being brought in contact with the secretions; 
the acid of the contents of the stomach soon becomes more or less com- 
pletely neutralized after the intestine is reached; by means of the intesti- 
nal peristaltis the alimentary matters and the secretions are thoroughly 
incorporated together as they are urged slowly along the canal. Thus cir- 
cumstanced and exposed also to the elevated and equable temperature 
existing in the centre of the body, the starch is placed under the most 
favorable conditions for transformation, the sugar is absorbed by the blood- 
vessels and carried to the liver. 
The experiments of Bernard first published in 1818, opened a new field 
of inquiry and added largely to the knowledge whose limits were bounded 
by the facts which we have just recorded. Desirous of ascertaining how 
far the sugar absorbed from the alimentary canal could be traced within 
the circulatory system, Bernard experimented upon animals to which he 
had purposely administered food containing a plentiful supply of saccharine 
matter. He examined the contents of the circulation at different points, Glycogenic Function of the Liver. 
913 
and arrived at the conclusion that the sugar passed through the liver and 
then pursued its course along the inferior cava, and through the right heart 
to the lungs. Here he Thought the sugar was destroyed, for in his experi- 
ments only a minute amount was discoverable iu the blood of the arterial 
system-that is, blood which had just been derived from the lungs-whilst 
the blood removed from the right cavities of the heart, or that on the way 
to the lungs, gave evidence of containing a large amount. 
In order to verify his conclusion, Bernard performed an operation on 
a dog that had been for some time restricted to a diet of animal food, and 
to his astonishment found sugar in the blood derived from the right side of 
the heart. 
The question immediately arose, what was the source of the sugar that 
had been encountered? The current of blood was followed backwardsand 
it was ultimately found that it came from the liver, and hence originated 
the conclusion that the liver discharged a sugar-making function, in addition 
to the office of secreting bile. Nothing could seem to be wanted of a more 
conclusive nature than the well-known experiment upon which Bernard 
based his glycogenic theory. 
An animal after having been restricted to a diet devoid of starch and 
sugar, was killed and specimens of blood collected from the hepatic and 
portal veins, for chemical examination. That from the portal vein, blood 
flowing towards the liver, was found upon analysis to be free from sugar, 
whilst that from the hepatic vein (blood flowing from the liver,) contained 
it in quantity. The liver also to the exclusion of all other organs of the 
body, presented a marked saccharine behavior. From the quantitative 
examination that was made it was stated that sugar existed in the blood of 
the hepatic vein to the extent of about one per cent, during fasting, and 
from one and one-half to two per cent, at a period of full digestion. The 
mean quantity found in the liver was said to be from one and one-half to 
two per cent. The process of sugar formation appeared to be carried on 
upon an extensive scale, and hence was looked upon by physiologists as 
contributing to some important purpose in the economy of animal life. 
In 1854, 1855 and 1856 I endeavored to put this theory to a careful 
experimental test in all the various classes of animals of the vertebrate 
series, including the cold and warm-blooded divisions. After its produc- 
tion in the liver, grape sugar passes into the circulation and disappears in 
the lungs as long as normal respiration is maintained. I demonstrated, in 
1855, by numerous careful experiments upon cold-blooded animals, the 
following facts: 
1. Grape sugar is never normally a constituent of the urine. 
2. If the supply of oxygen be cut off from cold-blooded animals by 
placing them in carbonic acid or hydrogen gas, or by closing the trachea 
completely, grape sugar accumulates in the blood and is eliminated by the 
kidneys. The disappearance of this substance from the blood depends 
therefore upon the introduction of oxygen during respiration. 
3. In cold-blooded animals the functions of the liver in producing 
sugar continue after the exclusion of oxygen. 
1. The appearance of grape sugar in the urine was accompanied in 
every instance by remarkable alterations in the former appearance of the 
blood-corpuscles under the microscope. 
These experiments certainly show that beyond all question, contrary 
to the notion that was previously entertained, that sugar can be produced 
in the animal organism without any vegetable principle being concerned. 
It was formerly thought that sugar formed an article that was produceable 914 
Glycogenic Function of the Liver. 
only by the vegetable kingdom, but the preceding facts show that such a 
doctrine can no longer be upheld. 
The next step in the history of animal glycogenesis was the discovery 
and isolation of the principle from which the sugar takes its origin in the 
liver. 
Bernard ascertained that the production of sugar might be shown to 
occur after death had taken place. He passed a stream of water through 
the vessels of the liver of a recently killed animal until all the sugar with 
which it was impregnated was washed out-this being proved by the sub- 
jection of a specimen to the appropriate chemical examination. The organ 
was then placed aside and examined again after the lapse of some hours, 
and it was found that it had re-acquired a strongly saccharine character. 
It thus became evident that the production of sugar must be attributable 
to some simple chemical change, and not to any special action of life. The 
actual source of the sugar remained to be discovered; but whatever the 
principle from which it was formed, it was clear that it must consist of 
something less soluble and less diffusible than sugar, or otherwise it would 
have been washed away with this material by the stream of water that -was 
passed through the liver. 
It was announced in 1857, that the isolation of the sugar-forming 
material had been effected; and as sugar formation was supposed by Ber- 
nard to constitute its physiological purpose, it was named by him glycogenic 
matter or glycogen. The glycogenic theory remained unaltered by the dis- 
covery of this substance, and it was placed upon a more satisfactory foot- 
ing by the disclosure of a recognizable source for the sugar. 
In its chemical properties glycogen presents alliances to both starch 
and dextrin, but resembling the latter more strongly than the former. It 
constitutes a neutral, colorless, tasteless, inodorous and uncrystallizable 
body. It is largely soluble though not rapidly so, in water, the solution 
presenting an opaquely lactescent character. With regards to this lactes- 
cence, a certain amount of dilution is required for its production-in other 
words, in a highly concentrated state, the solution is clear, but becomes 
lactescent when water is added. When its solution is boiled, a scum collects 
upon the surface, and if this scum (which consists of glycogen) be removed 
and allowed to dry spontaneously, it forms a semi-transparent, hard, brittle, 
and gum-like or resinous body. It is insoluble in alcohol and glacial acetic 
acid, and by both these agents may be precipitated from its aqueous solu- 
tion, the precipitate assuming when dry a white pulverulent form. It is 
unaffected even at the boiling temperature by the caustic alkalies, but 
boiling for a short time in contact with a mineral acid leads to its transfor- 
mation into sugar. 
The susceptibility of glycogen of undergoing transformation into 
sugar must be regarded as one of its most noteworthy properties. Besides 
boiling with a mineral acid, contact with many animal products, regarded 
as ferments, will transform glycogen into sugar; saliva, pancreatic juice, 
blood, liver-tissue, etc., are found to constitute energetic agents in effect- 
ing its conversion into sugar. The behavior of glycogen with iodine 
resembles that of dextrine, the reaction being the production of a deep 
wine-red coloration. So long as it remains and exists as glycogen it gives 
no reaction with the copper fermentation or other sugar tests. Relations of Glycogen and Glucose to Disease. 
915 
Glycogen is devoid of nitrogen and belongs to the carbohydrate 
group. Bernard gave as its formula C12H12O12 which was derived from 
the analysis of E. Pelouze. Composition of glycogen (E. Pelouze*): 
Carbon 38.8 
Hydrogen . 6.1 
Oxygen 54.1 
RELATIONS OF GLYCOGEN AND GLUCOSE TO DISEASED STATES. 
One branch of this inquiry, instituted by the author in the Savannah 
Marine Hospital in 1856 and 1857, related to the effects of febrile poisons 
upon the glycogenic function of the liver. The questions propounded for 
solution were : 
1. Have febrile poisons any influence in causing an increase or dimin- 
ution in the amount of grape sugar formed in the liver'? 
2. Does animal starch increase or diminish during the progress of 
various fevers? 
Post-mortems were performed within a few hours after death in vari- 
ous diseases and the organs, especially the liver, subjected to chemical and 
microscopical examination. 
With reference to glycogen, the following process was most generally fol- 
lowed for its extraction : A portion of the liver was taken shortly after the 
death of the patient and plunged for a few minutes into boiling water, so 
as to destroy the ferment that might be present, and prevent any further 
loss of the substance by transformation into sugar; it was then well pounded 
in a mortar and thoroughly boiled in a moderate quantity of water. The 
decoction thus procured, after having been strained or filtered, is poured 
into five or six times its bulk of spirits, by means of which the amyloid 
substance is thrown down as a dense, white precipitate. This was col- 
lected on afiltre washed with spirit and dried, and also subjected to vari- 
ous reagents as tincture of iodine. When it was desired to obtain the 
* Subsequent analyses by Odling, of London and Professor Apjohn, of Dublin, do not strictly 
accord with those of Pelouze. Dr. Odling undertook the ultimate analysis of four specimens 
of glycogen procured from a rabbit's liver and specially prepared by Dr. P. W. Pavy, in the 
different ways indicated: 
Specimen No. 1. 
Prepared 
by precipitation 
and washing 
with alcohol 
only. 
Specimen No. 2. 
Precipitated 
and washed with 
spirits after 
being boiled with 
hydrochloric 
acid. 
Specimen No. 3. 
Prepared 
as No. 2, except in 
being boiled with 
glacial acetic acid 
Specimen No. 4. 
Boiled 
with carbonate of 
potash and 
precipitated by 
alcohol. 
'Carbon 
42-GR 
42 24 
42 80 
42 97 
Hydrogen 
6.47 
6.38 
6.15 
6^63 
Oxygen 
50.32 
49.99 
50.58 
50.29 
Nitrogen 
.53 
.39 
.47 
.11 
100.00 
100.00 
100.00 
100.00 
The nitrogen in all these specimens may be regarded as an accidental impurity. The follow- 
ing is the resultobtained by Professor Apjohn, from specimens procured from the livers of rab- 
bits prepared for analysis by Dr. McDonnell: 
Carbon 43.78 
Hydrogen 6.32 
Oxygen 49.28 
Nitrogen 62 
100.00 
"Neglecting," Professor Apjohn says, as quoted by Dr. McDonnell (Observations on the Func- 
tions of the Liver,, Dublin, 1865), " the trace of the nitrogen as an accidental impurity. I find 
that these results are very accurately represented by the formula C12HioOio, which is that repre- 
senting the composition of starch and dextrin. Researches on the Nature and Treatment of 
Diabetes, by Dr. F. W. Pavy, London, 1869. 916 
Glycogen and Glucose in Malarial Fever. 
amyloid substance in a state of purity, it was dissolved and boiled in a. 
solution of caustic potash, which destroys the impurities without acting 
upon the glycogen. The solution being poured into spirits, the glycogen 
is again thrown down and requires to be recollected in a filtre and well 
washed with alcohol. The organic impurities are thus removed by it 
clinging tenaciously to a small portion of potash, which cannot be removed 
entirely by washing. By re-dissolving in water and adding acetic acid 
beyond the neutralizing point the amyloid substance, when again thrown 
down by alcohol, is thoroughly freed from the potash; and after a little 
washing in a filtre to remove the acetate that has been formed and the 
excess of acid employed, it may be regarded as in a state of chemical 
purity. The effort was also made by means of mineral acids and tincture 
of iodine, applied in various ways to sections of the liver, under the 
microscope, to determine the presence or absence of glycogen, and also 
its true location with reference to the structures of the liver. 
The following conclusions were established in 1857 : 
The liver of those cases which died in the active stages of malarial 
fever contained animal starch (glycogenic matter, Bernard); whilst hepatic 
sugar was entirely absent. 
The liver of every fatal ca >e of malarial fever was carefully tested for 
animal starch and grape sugar, and the results never varied; in intermit- 
tent, remittent, and congestive fevers, animal starch (glycogen) was always 
present, while grape sugar was always absent. 
In many cases when the fibrous capsules of the livers were torn off, 
partially dried, and treated with tincture of iodine, the cellular tissue was 
not altered by the tincture of iodine, but whenever a particle of liver 
adhered to the fibrous tissue, these purple and blue masses could be 
detected with the microscope. In cirrhosed livers the fibrous tissue of the 
liver generally, and of the portal canals, were found to be completely infil- 
trated with this animal starch. When single cells of the malarial liver 
were treated with tincture of iodine, I was not able to demonstrate satis- 
factorily, whether they contained animal starch. When, however, a num- 
ber of them in mass were treated with tincture of iodine, the characteristic 
blue color was produced. 
In several cases the hepatic ducts were isolated and treated with tinc- 
ture of iodine, and carefully examined under the microscope; in some 
cases the ducts were dotted with blue particles, whilst the other portions 
were simply changed to the color of the iodine, and in other cases long por- 
tions of the hepatic ducts were changed to a bright blue color. These facts 
show that the hepatic ducts sometimes contain animal starch. 
From chemical examinations of the livers of the different forms of 
malarial fever, from the summer of 1856 to the present time, I have obtained 
similar results. In many cases the livers were set aside, and examined 
after intervals of twelve hours; the last examinations were made thirty- 
six hours after the first; and at every examination the result was the same 
-the presence of animal starch, without a trace of grape sugar. 
The mere presence of starch in the liver is not peculiar to malarial 
fever; it is not a pathological condition. 
In the month of September, 1856, 1 had an opportunity of examining 
chemically the liver of a patient who had been under the care of my friend 
and former colleague, Dr. J. B. Bead. This patient had black vomit, and 
all the symptoms of yellow fever, and the liver presented the yellow box- 
wood color peculiar to this disease. Chemical examination gave decided 
evidence of the presence of animal starch in the structure of the liver. 
The liver of a yellow fever patient brought from Norfolk by Dr. J. B. Read Glycogen and Glucose in Malarial Fever. 
917 
presented a similar appearance, and also yielded animal starch. I have 
detected this substance in the human liver, in normal condition after sud- 
den death from diseases of the circulatory apparatus, and apoplexy, and 
phthisis, and in abnormal states, as cirrhosis, fatty degeneration, and cirr- 
hosis and fatty degeneration combined. 
I have examined the livers of numerous vertebrate animals injected 
and uninjected, and in every instance animal starch has been found. 
Whether the elaboration of this product is confined specially to any 
one of the anatomical elements of the liver, I have not as yet been able to 
determine with certainty, for it has been found in the fibrous tissue of the 
portal canals, in the hepatic ducts, and in several cases, in the lower ani- 
mals, in the secreting cells. We would naturally infer that it was formed 
in and by the secreting cells of the liver, and was deposited in other posi- 
tions by endosmosis. The exact point at which it is converted into grape 
sugar is unknown. Bernard has shown that this change is due to the 
action of a,special ferment contained in the blood. Experiments have 
shown that the liver-cells contain grape sugar as well as the hepatic veins. 
If the starch is formed in the secreting cells, and grape sugar is formed in 
them also, then the special ferment of the blood must be absorbed by the 
secreting cells. A portion of the animal starch may be absorbed by the 
hepatic veins, and be acted upon by the ferment only partially if in large 
quantities, and finally be deposited in the organs and tissues. 
This view is partially sustained by the fact that this substance is not 
confined to the liver; for I havefound it in considerable abundance in mala- 
rial fever spleens, and in normal spleens taken from patients who had died 
from cirrhosis and fatty degeneration of the liver, combined, and in one 
case where the patient (an aged negro man) had died suddenly from apo- 
plexy. A carbo-hydrate, similar in its composition and properties to vege- 
table cellulose, has been found in some of the lower animals. C. Schmidt1 
discovered cellulose in the mantle of phallusia mammillaris (one of the 
mollusca), and Lowig2 and Kollikerhave discovered it in the outer tube of 
salpse, in the leathery mantle of the cynthiae, and in the cartilaginous cap- 
sule of the simple ascidiae. The researches of Odier,3 Lassaigne,4 Payen,5 
Children,6 and Danniel, and especially of C. Schmidt,7 have shown that a 
body closely resembling cellulose (vegetable fibre), which C. Schmidt 
regards as composed of a carbo-hydrate, and of a nitrogenous body having 
the composition of the muscular fibre of insects, forms the true skeleton of 
all insects and Crustacea. This substance, called chitin, constitutes not 
only the external skeleton, the scales, and hairs of insects, but it also forms 
their tracheae, and even one of the layers of the intestinal canal. Cellulose, 
or animal starch, has been discovered by Rudolph Virchow,8 in the brain, 
and in some of the higher nerves of sense. These observations were sub- 
sequently confirmed by those of George Busk. In 1853, Virchow announced 
the discovery of corpuscles, presenting the same reaction as the corpora 
amylacea of the brain, in the malpighian corpuscles of diseased human 
spleens, in the condition termed waxy spleen. Virchow, Bennet, and Car- 
ter, have also pointed out the existence of a peculiar amyloid substance in 
1 Zu Vergl. Physiol, der Wirbellosen Thiere, 1845, S. 62. See also " Contributions to the Com 
'parative Physiology of the Invertebrate Animals, being a Physiologico-Chemical Investigation,' 
by Dr. Carl. Schmidt; Taylor's Scientific Memoirs, vol. v, part xviii., 1852, p. 34. 
2 Ann. de Scienc. Nat., 3d series, tom. v. pp. 193-232. 
3 M6moire de la Soci6t6 d'Histoire Naturelie, tom. i, p. 29 etseq. 
4 Comptes Rendus, tom. xv:, p. 1087; Journ. de Chim. M6d., 1-9,p. 379. 
5 Comptes Rendus, tom. xvii, p. 227. 
6 Todd's Cyclopsedia of Anatomy and Physiology, vol. ii, p. 882. 
7 Zur Vergleichend, Physiol, der Wirbellosen Thiere, 1845, ,S. 32-69; trans, in Taylor's Sci. 
Memoirs, vol. v, 1852, pp. 14-28. 
8 Virchow's Archiv., b. vii, h. i., p. 135. 918 
Pathological Anatomy of the Liver in Malarial Fever. 
the liver, in some chronic forms of disease, as waxy or fatty degeneration. 
At a meeting of the Academy of Sciences, March 23,1857, M. Cl. Bernard 
announced " that the livers of dogs, fed exclusively on meat, possess the 
property of forming a glucogenic substance, analogous to vegetable starch, 
and alike susceptible of an ultimate transformation into sugar, passing 
through the intermediate condition of dextrine." Sanson, Longet, Bou- 
ley, Poggiale, Parry, and others, have recorded similar facts with refer- 
ence to the occurence of a substance having very much the same chemical 
constitution and properties of starch in the liver, and the results of the 
experiments and researches of Bernard and these observers prove that in 
herbivorous animals this substance may be found in other organs besides 
the liver. 
The presence of animal starch, and the absence of hepatic sugar, in 
malarial fever, would seem to indicate that the special ferment in the blood 
which transforms animal starch into glucose, had been destroyed, whilst 
the power to manufacture starch from both nitrogenized and non-nitrogen- 
ized materials was exercised by the liver, and hence the absence of glucose, 
and the accumulation of glycogen. 
SOME OF THE POINTS OF DIFFERENCE BETWEEN THE MALARIAL FEVER. 
AND YELLOW FEVER LIVER. 
The liver of yellow fever, as far as my observations extend, and accord- 
ing to the observations of Louis and many other observers, is of a bright 
yellow color. It is probable that this color, as in the case of that of the 
malarial liver, varies with the length of the attack, and the effects of pre- 
vious diseases. Thus Dr. Samuel Jackson, of Philadelphia, found the 
livers in cases which had died suddenly in the early stages, engorged with 
dark blood. As far as my observation extends, the decoction of the yellow 
fever liver is of a bright golden color, whilst that of the malarial fever is 
of a brownish yellow. The golden color of the yellow fever liver can be 
extracted both by alcohol and water. The yellow fever liver is much firmer 
and harder than that of the malarial fever, contains much less blood and is 
much less readily acted upon by liquor potasses and acids. Liquor potassae 
readily dissolves the malarial fever liver, and the decoction presents the 
appearance of venous blood, while no such effect is produced by the action 
of this substance upon the yellow fever liver. 
PHLEGMASIAL HYPEREMIA AND PARENCHYMATOUS INFLAMMATION OF THE 
LIVER IN PAROXYSMAL FEVER. 
The repeated congestions of the internal organs which characterize the 
action of the malarial ferment, must necessarily induce functional and 
structural derangements in the liver, the largest gland in the body, a secre- 
tory as well as an excretory organ, supplied for the performance of both 
functions with circulation from two distinct sources. By the hepatic artery 
the liver receives arterial blood from the abdominal aorta, and from the 
portal veins, from the abdominal viscera; the hepatic vein connects the 
returning venous current from this organ with the inferior vena cava. That 
the functional and structural derangements excited and constantly aggra- 
vated by the repeated paroxysms of malarial fever are of the most grave 
and important character, is rendered evident by the following general view 
of the physiological anatomy of the liver. 
This organ consists of a great number of lobules or individual glandu- 
lar organs, which are conjoined by avast network of large and small ves- 
* Journal of Microscopical Science, No. vi, p. 101. Pathological Anatomy of the Liver in Malarial Fever. 
919 
seis, their perivascular structure and ample framework of connective 
tissue, in which the liver-cells, the blood and lymph vessels, the biliary 
ducts and the nerves are embedded. The centre or apex of each lobule is 
formed by a branch of the hepatic vein, from each part of which are 
derived great (quantities of radiating branches, and these are connected by 
a vast network of anastomosing capillaries, in the meshes of which lie the 
liver-cells, in such a manner as to bring every little group of cells in imme- 
diate contact on all sides with the blood-vessels. 
In the interlobular spaces and covering, each lobule is a network of 
vessels, branches of the portal vein and their capillaries, which anastemose 
with those of the central vein, branches of the hepatic artery, with its 
abundant ramifications and the large and small bile ducts. The portal 
veins, which are the largest, the hepatic artery, and the bile ducts, run 
parallel to each other in the interlobular spaces, mark the limits of the 
lobules which they surround and are enveloped in a quantity of connective 
tissue derived from the perihepatic structure, the membranous continua- 
tion of which constitutes Glisson's capsules. 
A section of the liver perpendicular to the axis of the lobule, shows 
a spotted yellow and brownish appearance. The liver-cells of the lobular 
centre are more yellow than the brown venous zone. The lymphatics con- 
stitute fasciculi, and with the branchlets from the nerves of the hepatic 
plexus are sheathed in a firm layer of connective tissue coming from the 
hepatic duodenal ligament. 
It is admitted that the liver-cells within the acini secrete and store up 
glycogene, but whether or not the biliary components are wholly excreted 
within the biliary ducts has not been clearly settled. Some physiologists 
hold that it is a physiological impossibility that the liver-cells should at 
once produce glycogene and secrete bile. It is true that any glandular cell 
may at times, when certain irritant or noxious substances circulate wfithin 
the blood, even if they were produced in the body itself (urea, urobilin, 
glycogene, glucose, many poisons, etc.), or when even normally useful sub- 
stances accumulate in great quantities in the circulation-perform the 
work of elimination or excretion; yet that such a double work should be a 
normal function, seems very improbable. The liver-cells, like any other 
cells, and especially epithelial, are taking up great numbers of finely 
divided particles from the blood, use them for certain physiological ends, 
and eventually eliminate them, or remain impregnated with them for an 
indefinite period. The constituents of the disorganized blood-corpuscles 
accumulate in the intestines during the whole process of digestion, and are 
carried by the portal vein into the liver, and a great portion of them are 
taken up by the glandular cells and elaborated into substances still useful 
in the body, or eliminated with the bile, which appears to be constituted as 
a peculiar liquid within the finer biliary ducts in the manner of functions 
carried on in tubular glands. 
We are inclined to hold with Henle that in the liver, the finer biliary 
ducts are so covered with glandular organs in the shape of appendicular 
tubules and racemose structures, that they appear more like canals or 
channels conveying secretions from the glandular organs than anything 
else. If these little glandular organs were simple mucous glands, they 
would certainly exist in greater number in the largest ducts, and in the 
gall-bladder, when the mucous secreted would be needed for the protection 
of the walls against the action of the bile which exists in great quantity in 
these cavities; besides, their form greatly differs from those found in the 
depth of structures. Their enormous numbers certainly bespeak for them 
a different secretion than simple mucus. 920 
Pathological Anatomy of the Liver in Malarial Fever. 
Many anatomical peculiarities found in morbid conditions of the liver 
are much in favor of this hypothesis of Henle. 
According to Edward Hering, the intralobular (those running inside 
the lobules) gall ducts of the human liver, termed also gall capillaries, are 
separated from the blood-vessels by intervening cell substance. No gall 
duct can be found which is not separated from the blood-vessels by inter- 
vening cell substance. On the other hand, of the free cell edges which do 
not come in contact with a blood-vessel, every one, with but rare excep- 
tions, rests against a gall-duct, and every boundary surface between two 
liver-cells, either carries in its median line a gall duct, or at least touches 
one with one of its sides. Whenever, therefore, in a well injected lobule 
the boundary surface of two liver-cells is seen in profile, that is to say, as 
a straight line, there will also be seen, but with rare exceptions, the cross 
section of a gall duct, which will appear like a circular or oblong spot 
lying witbin that line, or more rarely at one end of it; or it may even 
appear, according to the position of the microscope, as a narrow staff run- 
ning parallel to that line, either by the side of, under, or over it. 
If it be remembered, now, in what manner the liver-cells are arranged 
between the capillaries, it will be easily understood how in their secretions, 
if any, a single row of cells is visible between two radial capillaries, the 
gall ducts must appear, either as cross sections, located within these trans- 
verse lines which run from one capillary to another and represent the pro- 
file views of boundary surfaces, or they must appear, when seen from the 
side, as ducts, more or less foreshortened, that run between the capillaries 
and are nearly parallel to them. If in these sections, however, the liver- 
cells appear in the form of an epithelium, then the gall ducts will be seen 
as a network with polygonal meshes, each one of which encloses a liver-cell. 
If in a thin section the divided ends of the radial capillaries are seen, 
then the gall ducts will either appear as cross sections-in which case they 
will be seen either in the course of these lines which, as profile views of 
the boundary surfaces of the cells, run from one capillary to another, or 
more rarely at those points where the boundary lines of several cells meet- 
orin the form of a net, and then every cross section of a capillary will lie 
within the mesh of this net. This description is given by Hering from 
injected specimens, and he affirms that in the human liver, which at the 
very earliest can be examined only a few hours after death-the gall ducts 
of the lobules cannot be injected, owing to the rigidity which by that time 
will already have taken place in the liver-cells. Nevertheless they can 
be distinguished with a very strong magnifying power even when uninjected; 
and from such observations it has been ascertained that their arrangement 
is the same as in mammals. The gall ducts of the human liver, like those 
of the rabbit, possess no membrana propria to separate them from the 
liver-cells, but come in direct contact with the latter; and the layer imme- 
diately covering the gall duct-in case its involute should ever be affected- 
may be designated as a thickened boundary layer of the cell substance, or 
as the cell membrane, or cuiicula-all of which is one and the same thing.* 
Besides the variable detritus of the blood structures, the portal vein 
carries in the liver lobules great quantities of fat from the intestinal con- 
tents, where it is taken up in great quantities by cells and retained for a 
time in the periphery of the lobules, in the vicinity of the portal circulation. 
This condition must be distinguished from acute fatty degeneration. When 
large quantities of fat or fatty substances accumulate in the blood, or the 
* Manual of Histology, by Prof. S. Stricker, p. 416. Pathological Anatomy of Ine Liver in Malarial Lever. 
921 
fatty substances are not sufficiently used up in the body, there is always 
fat infiltration in the liver lobules. 
In well fed individuals, taking little exercise, miliary tuberculosis 
and in consumption of the lungs, in diseases of the heart, with struc- 
tural alterations produced by venous stasis, in chronic alcoholism, the 
liver is always found impregnated with fat. In such conditions the portal 
zone of each lobule is exceedingly impregnated, the middle zone but little, 
and the central not at all with fat. The difference of color in the several 
hepatic parts has given this form of hepatic congestion the name of nut- 
meg liver, which it very much resembles in its general appearance. More 
massive infiltration with fat nearly altogether obliterates the lobular 
boundaries and the organ assumes a yellowish white appearance, and is 
rather soft. Such massive infiltration naturally leads to anaemia of the 
organ. 
Reabsorption of the fat by the veins or by the lymphatics can alone 
bring the impregnated tissue back to its normal standard. 
PARENCHYMATOUS INFLAMMATION OF THE LIVER IN MALARIAL FEVER. 
In certain cases of liver disease, resulting from the repeated and pro- 
longed action of the malarial poison, the hepatic cells appear to be the 
chief, if not the sole agents, in the morphological modifications in this 
organ. 
In this form of parenchymatous hepatitis the endothelial cells also play 
an important part. These cells line the interior of capillaries, and show 
great sensibility to the action of the malarial poison. From the beginning 
of the intoxication, which may be called the period of malarial con- 
gestion, hypertrophy and proliferation of the endothelial cells consti- 
tute the most characteristic lesion of the enlarged liver. Hyperaemia 
is the constant primoidial lesion of the malarial liver, and is the com- 
mon source of a series of inflammatory pathological changes resulting 
finally in atrophy and degeneration of the hepatic structures. These mod- 
ifications of structure and vital actions resulting from the state of hyper- 
aemia imprint upon all the series of malarial affections a special physi- 
ognomy indicating their origin. 
MALARIAL, HYPEREMIA OF THE LIVER. 
It is well-known that in malarial fever, the liver is congested, and that 
at the end of a series of attacks attended with congestion, this gland becomes 
permanently enlarged or hypertrophied. This characteristic change does 
not necessarily give place to symptoms characteristic of hepatitis, as ascites, 
jaundice and marasmas, but to a rigid swelling or tumifaction of the right 
hypochondrium, accompanied often by a sub-icteric hue of the epidermis. 
In this condition, the hepatic structures present alterations more extensive 
than profound, which are not necessarily incompatible with the perfor- 
mance of the functions of the liver. In malarious regions the physician is 
often called upon to note the occurrence of this condition of the liver, in 
fatal cases of pernicious fevers, pneumonia and casual phlegmasias, before 
the establishment of malarial cachexia. Ordinarily the pyrexia and 
phlegmasia, and more especially pneumonia, determine or excite the acute 
affections of the liver, attended by a rapid increase of its volume, severe 
pain, vomitings and bilious evacuations, and in some cases of pneumonia 
this condition is followed by hepatic abscess. 922 
Pathological Anatomy of the Liver in Malarial Fever. 
The most striking symptom in these cases, is the enormous augmenta- 
tion of the liver, the weight of which is rarely below 5.36 lbs. troy (2 kilo- 
grammes) and sometimes in extreme cases reaches 10.72 lbs. troy (4 kilo- 
grammes). The capsule is thin and distended; the color is a light or dark 
red, according as the congestion has been more or less marked during the 
last stages of the malady. In some cases the organ presents a slate or black 
color due to the melansemic pigment. The liver is engorged with blood 
which flows from the cut surfaces. The consistence of the organ is com- 
pact and firm where the hypenemia predominates in these inflammatory 
lesions. When the surface of the liver is pressed by the finger, a depres- 
sion of a yellow color is readily induced. The surface of the section is of 
a smooth dark red color, and shows the divisions of the acini. Sometimes 
the liver is hardened and the divisions of the acini exaggerated, on account 
of the thickening of the capsule of Glisson, and of the existence of a fibrous 
interlobular membrane. The liver is hypertrophied and congested, but at 
this early stage presents but slight evidences of hardening or cirrhosis. In. 
other cases the hypertrophied and congested liver presents a soft consist- 
ent mammelated appearance on the surface of the sections. The mammela- 
ted spaces protrude from a hyperaemic base. 
These changes constitute parenchymatous hepatitis. 
1st. Protoplasm of hepatic cells opaque; fatty granules not readily 
manifested by acetic acid; slight proliferation of nuclei. 
2d. The endothelial cells of the vessels finelv granular. 
3d. The nuclei dilated and surrounded with a thin coating of proto- 
plasm, proceeding partly from the hepatic and partly from the endothelial 
cells. 
The tubular and vascular tissues are generally enlarged, and the acini 
show the double arrangement of the trabecular and vascular tissue. The 
acini are often enlarged by the dilatation of the capillaries. The trabe- 
culae are generally opaque, without notable augmentation or diminution of 
their thickness. The opacity is due to the fatty pigmentary granular infil- 
tration of the cells. The nuclei of the cells show evidence of hypertrophy 
and proliferation. 
The capillary blood-vessels present a beautiful natural injection by the 
red corpuscles of the blood. The capillaries not congested present accu- 
mulations of the cellular elements. The capsule of Glisson is enlarged by 
the interposition between the fibrous meshes of numerous lymphoid cells 
and nodules. These elements do not send fibres into the acini or into the 
interlobular fissures. In this stage there is no marked pigmentation. The 
capillaries also contain numerous elements situated in the interior, mingled 
with the red globules. Sometimes these elements exist in groups of two 
or three, in other cases they fill and obstruct the vessels. As many as 
fifteen have been counted within the circumference of a single capillary. 
Some of these bodies have a rounded form, and the dimensions of the 
lymphatic globules and leucocytes. They are loose in the cavity of the 
vessels. Some are composed of a nodule or nucleus, surrounded by a thin 
coating of protoplasm with a clear or indistinct outline. Others are cells 
of granular protoplasm, with irregular outline. The protoplasmic masses 
often represent the endothelial cells, the nuclei of which are undergoing 
proliferation. 
We hold with Professors A. Kelsch and P. L. Kiener,* of Val-de- 
* Des affections PaludSenes du Foie. Les hyper^mies phlegmasiques et 1'inflammation par- 
enchymateuse, par MM. A. Kelsch, Professeur agrgge libre du Val-de-Grace, et P. L. Kiener, 
Professeur agrege du Val-de-Grace. Archives de Physiologie Normale et Pathologique 1878, pp. 
571, 611. Planche xxvi, xxvii, xxviii. Pathological Anatomy of the Liver in Malarial Fever. 
923 
Grace, France, that the phlegmasial, hypereemic and parenchymatous 
inflammation of the liver in malarial fever consists of- 
1st. An inflammatory hyperaemia of the liver with a granular and 
fatty infiltration. 
2d. Haematic pigmentation, and slight proliferation of the glandular 
parenchyma with an accumulation of the lymphoid elements in the cap- 
sule of Glisson. 
3d. The inflammatory hyperaemia is characterized by the haematic 
engorgement of the capillaries and their partial obstruction by the accum- 
ulated leucocytes, by the nucleated elements, and the cells resulting from 
an active proliferation of the capillary endothelium. 
Hyperaemia, and diffuse capillary endoarteritis, diffuse and parenchy- 
matous hyperplasia in the beginning, intense portal phlebitis, exudation 
of plasma and leucocytes between the fibres of the capsule of Glisson; these 
are the alterations which are present in the malarial liver, still involved in 
that initial period when all the lesions are indicated, but when the differ- 
entiation of the case by the preponderance of one or the other is not yet 
decided. These pathological phenomena are accomplished partly in the 
trabeculae, and partly in the blood-vessels. 
It is a characteristic of the liver, which differentiates it from the other 
glandular organs, and which is without doubt connected with the functions 
of the blood-vessels of this vascular gland, that the glandular epithelium 
is separated from the blood-vessels of this gland by the fluid of the blood 
itself, and not by a stroma composed of fibres and flattened cells; but by a 
simple homogeneous, indivisible, structureless, membrane, covered on its 
external face, and perhaps also on its internal face, by an internal endo- 
thelial lining. This membrane which has the physical characters of con- 
junctive substance, is passive in the pathological phenomena. It has the 
property of becoming thicker and softer, and giving passage by osmosis or 
absorption to the liquid and solid elements of the blood. 
The active elements in the phenomena are, in the one place, the epi- 
thelial cells, and in the other the endothelial cells. 
The capsule of Glisson is generally thickened by means of the develop- 
ment between the fibres of numerous rounded nodules or nuclei. These 
nuclei are more numerous and crowded in the denser portions of the cap- 
sule where there is the greatest accumulation of the portal capillaries. In 
the case of the melanaemic liver of malarial fever the fibres of Glisson's 
capsule are infiltrated with black pigments. As the development of the 
nuclei in Glisson's capsule has not been verified in linear series or fusi- 
form masses, there is reason to believe that they are not the direct pro- 
duct of the proliferation of the veritable cells of the connective tissue, but 
that they are none other than the leucocytes of the blood which have emi- 
grated from the loose tissue of the fibrous capsule. In some cases, how- 
ever, there is a new formation of connective tissue at the circumference of 
the interlobular spaces. These spaces are enlarged and penetrated with 
fibrous elongations which circumscribe more or less completely a certain 
number of acini, the perepheric trabecula® of which are atrophied and 
transformed into biliary canals. These facts belong already to the history 
of interstitial hepatitis. The biliary vessels contained in the capsule of 
Glisson are generally exempt from alteration. 
Intense general hyperaemia, with endothelial proliferation of the 
capillary vessels, accumulations in these vessels of leucocytes, and migra- 
tory cells often containing black pigment particles; hypertrophy and slight 
hyperplasia of the hepatic cells, lymphoid infiltration of the capsule of 
Glisson, and in some cases commencing annular cirrhosis-these are the 924 
Pathological Anatomy of the Liver in Malarial Fever. 
lesions which are encountered in the engorged malarial liver and which 
have received at the hands of Kelsch and Kiener the name Phlegmasial 
hypercemia and parenchymatous inflammation of the liver in malarial fever. 
It must be admitted that none of these affections, considered singly, are 
characteristic of malarious (paroxysmal) affections. Thus on the one 
hand we observe the mechanical and hydraulic lesions similar to those of 
cardiac origin, but with a different distribution, and on the other hand 
the irritative lesions of the glandular epithelium and of the vascular 
endothelium, such as have been described by different authors in infectious 
maladies. Pathologists have recorded the hyperplasic increased nuclea- 
tion of the hepatic cells in infectious fevers in general; Reindflesch, Kelsch, 
Kiener and others have observed the hyperplasia of the neuclei of the 
capillary vessels in this class of diseases; the effects of the endothelial pro- 
liferation in the formation of thrombosis and in suppurative phlebitis have 
been noted : alterations similar to those observed in the malarial liver have 
been observed in the hypersemic liver of remittent, typhus, typhoid fever, 
and in miliary tuberculosis of the liver. 
The deposit of pigment in the intervascular cells and in the meshes of 
the hepatic structures, though not absolutely constant, is nevertheless 
highly characteristic of the malarial plegmasial, hypermmic and parenchy- 
matous inflammation. What characterizes the engorged malarial liver is 
the union or concurrence in the disease, of irritative and hypersemic altera- 
tions iu their highest degrees, and the persistence of these lesions in the 
chronic state. 
We see in this complex process the sketch or rudiments of a certain 
number of processes, which in a period more advanced in the progress of 
malaria] disease tend to differentiate and to present in a more complete 
•evolution the disorders dependent partly on the endothelial proliferation, 
aud partly on the glandular hyperplasia, or on cirrhosis. 
In describing the devious aspects presented by the engorged malarial 
liver, it has been mentioned that it is not always found uniformly smooth 
and homogeneous in structure, but that in a certain number of cases the 
surface of the sections are interrupted with miliary granulations more or 
less protruding from a hyperaemic base. The clinical history of this gran- 
ular liver is associated with that of the simply hypertrophied liver, and is 
met with under the same circumstances among subjects who succumb to 
some accidental affection during the period of the malarial attack. The 
elementary lesions which characterize it consist of intense hyperaemia 
accompanied with endothelial proliferation in the capillary tissue, and of 
cellular hyperplasia in the epithelial trabeculae. But these lesions are not 
distributed uniformly and the parenchymatous lesion dominates the others, 
and attaining a more advanced degree, constitutes really a distinct pro- 
cess. The parenchymatous miliary hepatitis tends to fatty degeneration, 
and the intense hyperaemia around the nodules ends in atrophy of the 
glandular parenchyma. The inflammatory process is disseminated in con- 
sequence of the composition of the liver of a vascular tissue and a cellular 
tissue, in immediate juxta-position without the interposition of inelastic 
structures. 
It results that if the liver were limited by an inelastic capsule, one of 
these constituent elements, the vascular tissure or the cellular tissue, could 
not augment in volume except with the proportional decrease of the other 
element. In reality, the capsule of the liver is infinitely elastic and dila- 
table, so that one of the tissues or both of them might be dilated at the 
same time, without either of them being hindered in its development, pro- 
vided the dilatation was uniform in all parts of the gland; and this takes Pathological Anatomy of the Liver in Malarial Fever. 
925 
place in the uniformly enlarged liver. This is not the case when the dila- 
tation is partial and affecting small or miliary portions of the gland. If 
one of the lobules or small portions be surrounded by a zone of parenchyma 
which does not dilate, it cannot then develop without compromising and 
compressing the surrounding parts, which then become atrophied. 
When the limit of this constriction is obtained, the ulterior develop- 
ment in the granulation cannot take place without the detriment of the 
other tissue; that is to say, that if the cellular tissue continues to be 
enlarged, the vascular tissue will be necessarily decreased, and when the 
trabeculae touch each other, the advanced lobules will be forced to pass into 
a state of atrophy or necrobiosis. Such in fact are the phenomena which 
succeed each other in the miliary granulation of the malarial liver. If we 
consider here the intermediate territory between the groups of granula- 
tions it will be easy to understand the series of pathological changes. 
The groups of granulation represent solid parts, in which the blood 
circulation decreases more and more. It results from this that the blood 
flowing into the gland under the influence of malarial congestions, accumu- 
lates in the vascular tissues collateral to these granulations in those brown 
portions noticed in the sections of the liver. But as the^e territories 
bounded by the proximity of the granulations have a limited extension, 
the dilatation of the vascular tissue cannot take place except at the 
expense of the cellular tissue. The hepatic trabeculae also diminish in 
calibre, become atrophied and even disappear completely at some points, 
and in other places transform themselves into tissue which occupies less 
space than the epithelial tissue, the property of which is to contract or 
condense itself more and more into an embryonic connective tissue which 
afterwards becomes fibrous. There is in these inflammatory foci or mili- 
ary bodies a progressive degeneration or destruction. This is manifested 
in the centre of the trabecular granulations which obtain the greatest 
thickness and the largest nuclear and cellular proliferation. The termina- 
tion takes place by fatty degeneration or granular fatty softening. The 
fatty transformation commences in the nuclei or in the protoplasm of the 
cells. The hypertrophied nuclei become more clear, more restricted, and 
end by becoming transformed into a large oily drop; or the drops of oil 
appear in the protoplasm of the hypertrophied cells, unite themselves in 
larger' globules, and in the last stages the cell is transformed into a veri- 
table fatty cell, the nucleus of which is attached to the periphery enclosed, 
in a thin protoplasmal ring. 
In the second mode of termination the trabeculae are more aud more 
enlarged at the centre of the granulation, and approaching each other 
finally become confounded in a continuous opaque demi-fluid mass, emulsi- 
fied with proteid granulations and fine fatty granulations, in the centre of 
which staining fluids show the presence of innumerable nuclei, some of 
which have already degenerated into the fat granules. 
We select the following illustrations, engravings 95, 96 and 97, of the 
pathological anatomy of the liver in malarial fever, from the valuable 
writings of Professors Kelsch and Kiener, which have thrown important 
light upon this intricate field of pathology. 926 
Pathological Anatomy of the Liver in Malarial Fever. 
Pathological Anatomy of the Liver in Malarial lever. 
ENGRAVING- NO. 95. 
. FIG.3 
FIG!5 
FIG.I 
FiG.2. 
FIG.4- 
Engraving No. 95.-Pathological anatomy of the liver in malarial fever.* 
Figure 1.-Endothelial cells of the capillary tissues of the normal liver, and fragments of the 
lamellar membrane: one hepatic cell is adherent to the internal surface of this membrane. Mag- 
nified 500 diameters. Figure 2.-Portion of an acinus (lobule), of a case of pneumonia engrafted 
on malarial fever, and attended with inflammatory hypersemia of the liver; Obs. l,.p. 574. The 
dilated capillary vessels contain red globules leucocytes, endothelial cells adherent to the capil- 
lary walls during the hyperplasic changes of the migratory cells. The leucocytes, the endothe- 
lial cells, and the migratory cells contain melansemic pigment. The thickened trabeculae show 
the proliferation of the glandular epithelial cells. The mteracinus space shows the lymphoid! 
surcharge of the fibrous capsule, and the presence of melanaemic cellules in the orifice of the 
portal vein. Magnified 420 diameters. Figure 3.-Portion of the acinus of the liver of the same 
subject. The capillary net-work considerably dilated and containing the same elements as 
above. The trabeculae atrophied; brown pigment; the membrane proper of the trabecule pre- 
sented fusiform swelling. Magnified 420 diameters. Figure 4.-Extreme capillary dilatation; the- 
thickened partition is separated from the glandular cylinder by the serosity which here and there 
surrounds some leucocytes; at. certain points the hepatic cells are separated and isolated by the- 
cedematous infiltration and suspended in the serosity, which fills the tubular cavity. Obs.l'.. 
Figure 5.-Some hepatic cells showing progressive granular degeneration, from the liver of a 
case of cerebro-spinal meningitis, preceded by paludal lever; patient of intemperate habits. 
Hepatite miliaire proliferante. Obs. iv, p. 597. 
* Des affections paiudgennes du Foie les hypergmies phlegmasiques etl'inflammation par 
enchymateuse, par MM. A. Kelsch, professeur agrgge du Jibre du Val-de-Grace,et P. L. Kiener,, 
professeur'agrgge du Val-de-Grace. Archives ou Physiologic Norm ale et PathologiqUe, Paris-, 
1878, p. 571-611, plan, xxvi, xvvii, xxviii. Pathological Anatomy of the Liver in Malarial Fever. 
927 
ENGRAVING NO. 96. 
Pathological Anatomy of the Liver in Malarial Fever. 
FIG. I. 
FIG.2 
Engraving No. 96.-Pathological anatomy of the liver in malarial fever. Figure 1. Forma- 
tion of embryonic conjunctive (fibrous) tissue at the expense of hyperplasic hepatic cells. A. 
Hyperplasic glandular network (t.ravees). B. The hyperplasic glandular network (travees) in 
diffuse embryonic transformation (degeneration). Figure 2. Formation of embryonic connec- 
tive tissue, the with elements formed by the vascular membrane and with the elements formed, 
by the hepatic trabeculae, already transformed into a biliary canal. A. Hyperplasic glandular 
passages. B. Glandular passages transformed into embryonic tissue, but maintained in their 
form (canal or neo-form) by, C. The capillaries enlarged and filled with embryonic tissue. Plate 
xxvii, p. 610. Pathological Anatomy of the Liver in Malarial Fever. 
928 
ENGRAVING NO. 97. 
Pathological Anatomy of the Liver in Malarial Fever. 
FIG. 2 
FIG.I 
FIG.3 
mHURlCE 
Engraving No, 97.- Pathological anatomy of the liver in malarial fever. Figure 1. Surface and 
section of the liver (observation 3d, p. 581) of paludal fever: hyperGmie phlegmasique. hyper- 
plasie parenchymateux diffuse et nodulaire naissantes. A. Kelsch et P. L. Kiener. The liver 
weighed three killogrammes. Nodular hepatitis. The parenchymatous nodules form greyish 
pink elevations (sallies) on the surface of the liver and clustered or festooned (festonnees) spots 
of the same color on the sections of this organ. In the interval of the nodules, the parenchyma 
of the liver is red, congested with blood (hyperemic', and undergoing embryonic transformation. 
Figure 2. Drawing representing section ofa granular liver (observation iv, magnified 180 diame- 
ters. (Observation iv, meningite cerObro-spinale; ant6c6dentes et paludSenes alcooliques. Hepa- 
tite miliaire proliferante. A. Kelsch et P. L. Kiener, p. 597.) N. N. N. hypertrophied granulations 
simple and conglomerate: the hyperplasic granular (bdbecular) ducts and passages (travges) are 
placed consecutively on each other. The hypersemic (hyp6r6mie) space is between the groups of 
granulations: the capillaries are enormously dilated, and the trabecular tissue thin and (6tir6) 
stretched. H. H. The acini hypertrophied but preserving the radiated disposition of thin dual 
tissues. Figures. Magnified 180. A. Portion of a conglomerate nodule, bounded on the left by a 
branch of the portal vein, V. P.. and below by a strip of newly formed connective tissue, L. H. Pathological Anatomy of the Liver in Malarial Fever. 
929 
H. Normal hepatic tissue surrounding the tumor. Na. One of the nodules composing the 
■tumor Uuineur) with an abscess, abcede) in the centre. Three zones can be distinguished Z Z' Z". 
Z The central zone composed of enlarged trabeculae or fibres arabecuLes) crowded one against the 
■other. The trabeculse present an active hyperplasic cell growth, already infiltrated with fatty 
granulations; hence the opaque aspect of the zone. But in the centre the cells present a focus of 
puriform softness. Z'. The middle zone composed of trabecular tissue dispersed in concentric 
■circles. The vascular links of the enlarged tissue are figured empty, but in reality contain glo- 
bules of blood, a large proportion of which are leucocytes. The trabeculae are unequally enlarged 
and contain hyperplasic hepatic cells in clear protoplasm. Z". The external zone composed of 
.trabecular tissue folded and atrophied by the development of the eccentric nodule. Nb. Hyper- 
trophied acinus, in which may be distinguished the central vein, and three miliary (miliaires) 
nodules in excentric development, and formed at the expense of the trabecular (trabeculaire) 
tissue. Ne bid. Two other elementary nodules of the tumor. C. A portal vein surrounded by 
its capsule of Glisson in the interior of the tumor. From this capsule proceed three fibres in the 
form of a wedge penetrating into the nodules NbNcand Nd. At the point of contact of these 
wedges or columns of conjunctive tissue with the hepatic parenchyma the transformation of the 
hepatic • trabecular tissue into embryonic conjunctive tissue is imperfectly distinguished. 
Plate xxviii, p. 610. 
This form of hepatic disease has received the most careful examina- 
tion at the hands of Professors Kiener and Kelsch,* who have pointed out 
the differences caused in inflammatory affections of the liver by the action 
of the malarial poison. 
The term parenchymatous infiltration has been given by Virchow to a 
derangement of nutrition, characterized in its first period by abnormal 
cloudy infiltration, and. in a more advanced stage by the necrobiotic 
destruction of the glandular epithelium. It is in this sense that parenchy- 
matous hepatitis has been called the alteration of the cells of the liver 
which ends in acute yellow atrophy, and gives rise to clinical symptoms of 
grave and rapidly fatal icterus. Numerous objections have been raised 
against this manner of viewing this form of hepatic inflammation. Amongst 
modern writers some reject the existence of a parenchymatous hepatitis, 
and avoid using this term, whilst others do not employ the term without 
restriction, confining it to its proper use, being desirous to avoid the use 
of new terms. The question is still under discussion, whether the process 
which ends in acute yellow atrophy comprises an initial phase of hyper- 
mmia and of tumefaction, or whether the congested tissue is or is not 
charged with lymphatic cells ; and finally, whether or not the lymphatic 
cells manifest proliferation of their nuclei. We conclude from this diversity 
of opinion that the whole of these inflammatory phenomena, so fully char- 
acterized in the miliary parenchymatous hepatitis, occupy only a secondary 
rank, and might give place to the process of acute atrophy. The same 
remark applies to the chronic parenchymatous hepatitis. Certain facts 
spread over German medical literature seem to establish the existence of a 
process, the essential characteristics of which are the same as those of acute 
atrophy, but with a slower progress (43 days, observation of Waldeyer; 
nearly three weeks, observation of Forster; 21 days, observation of Their- 
felder), and with a less uniform distribution of the lesion. 
'ihe liver is atrophied as in the acute form, but instead of being uni- 
formly smooth, yellow and soft, it is composed of a bright red, or brown- 
red substance, firm and nodulated, and of variable size. These nodules 
project over the the section of the liver. They are yellow and colored 
with different bilious shades. In these yellow parts, the hepatic cells of 
the tumified acini are swollen and infiltrated with proteid granulations, 
with fatty drops and bilious pigment. 
In the red parts the alteration is more profound. The acini are no 
longer represented, except by a fibrous tissue loaded with pigmentary and 
CHRONIC NODULAR PARENCHYMATOUS MALARIAL HEPATITIS. 
tr / Affections Palud6ennes du Foie, par MM. P. L. Kiener et A. Kelsch, professeurs agr6g6s du 
v al-de-Grace; ill: L'H6patite parenchyinateu.se chronique et nodulaire.-Archives de Physio- 
Jogie Normale et Pathologique; DeuxiemeSdrie, TOme Sixieme; Paris, 1879; pp. 354-408. 930 
Pathological Anatomy of the Liver in Malarial Fever. 
fatty debris of the hepatic cells. It is in these red parts that different 
authors, Waldeyer, Klebs, Thierfelder and M. M. Cornil, have shown the 
existence of a network of biliary canals. This process has received differ- 
ent names; Forster distinguishes it under the title of chronic parenchy- 
matous hepatitis; Thierfelder confounds the description with that of yellow 
atrophy; and Klebs describes it under the name of red atrophy, which has 
the disadvantage of being commonly applied to another process, namely, 
that atrophy which is consecutive to the hepatic hypersemia of cardiac 
origin. 
The observations which we have conducted upon the origin and nature 
of the malarial hepatitis, acute and chronic, miliary and nodular, of the 
low-grounds and swamps of Virginia, North Carolina, South Carolina, 
Georgia, Florida, Alabama, Mississippi, Louisiana, Texas, Arkansas and 
Tennessee, correspond with those of Professors Kelsch and Kiener. These 
observations were gathered in a different field from those of Klebs, Vir- 
chow, Thierfelder, Forster and other German and French observers, and 
relate to the action of the malarial poison in the different degrees of inten- 
sity which it manifests in the swamps and marshes of the southern portions 
of the North American Continent, in the great delta of the Mississippi 
river, and in the corresponding latitudes in Algeria and along the northern 
coast of Africa. The hepatic affections terminating often in haemorrhages, 
intense icterus, delirium, coma and death, which characterize the Southern 
swamps, marshes and rice-fields of our Southern States, are connected ana- 
tomically not to the acute yellow atrophy of the German and French physi- 
cians, but to the miliary and nodular parenchymatous hepatitis; and these 
facts constitute a body of histological and pathological doctrine without 
analogy in medical literature. Whilst the observations of Waldeyer, Klebs 
and others present incontestible analogies in the macroscopical characters 
of the liver and the clinical aspects of the disease; the histological exami- 
nation, on the other hand, absolutely differentiatesthem; and we recognize 
the characteristics of parenchymatous inflammation in a process which, 
having for the point of its departure the epithelial cells, on the one 
hand, in the formation of hyperplasic epithelial masses and softening in 
the manner of an abscess; and, on the other hand, in the formation of an 
embryonic conjunctive tissue. 
We consolidate the following observation from the paper of Professors 
Kiener and Kelsch : 
Case 1082.-Malarial chachexia terminated by ascites, intense icterus, somno- 
lence and hcemorrhages. Nodular hepatitis with foci of softening.-NCreau, soldier, 
age 25. Entered the hospital of B. 15th of March, 1875. On the 18th of April fol- 
lowing, the patient was observed to be in the last stages of a malarial affection of 
the liver. Upon inquiry, found that the patient was first attacked with intermit- 
tent fever in 1873. During the last months preceding his admission into the hos- 
pital, this soldier had been subjected to some chastisement in Algeria, and a pro- 
longed sojourn in a grain pit. The ascites had existed for several weeks only, and 
pronounced icterus had been noticed a few days before the 18th of April, 1875. The 
patient was very emaciated with petechial spots scattered over the surface of the 
body. Dyspnoea led to the tapping of the abdomen, and about 45 litres of a red- 
dish-yellow serum was drawn off which gave a deposit of Inematin. After the 
evacuation of the abdominal fluid, it was possible to establish by percussion 
that the liver was diminished in size, and that the spleen was tumified. The 
ascites was reproduced in a few days, but a second operation of paracentesis was not 
necessary, as the patient grew rapidly feebler; fell into a somnolency and apathy, 
from which he could not be aroused without difficulty; the icterus became intense 
and death took place on the 26th of April. 
Autopsy April 27th. -The liver was somewhat lessened in volume; vertical 
diameter normal; transverse and anterior posterior diameter notably diminished. 
Notwithstanding the diminution of volume the liver was heavy, weighing I860' Pathological Anatomy of the Liver in Malarial Fever. 
931 
grammes. Capsule of liver somewhat thickened; borders of right lobe blunt, and 
sharp on the left lobe. 
The surface presented a black ground, from which projected yellow tumors, 
varying in size from a grain of millet to that of a walnut. The consistency was 
firm, though less firm than in a case of typical cirrhosis. The appearance of the 
sections of the liver was very remarkable; upon a smooth ground of an iron-grey 
color, marked with dark red hyperaemic, and white and yellow points, a large num- 
ber of nodules, varying in volume from a hemp seed to a walnut, projected. These 
nodules, of a rounded or festooned contour, usually surrounded by a dark red 
hyperaemic zone, had one surface of the section plain, showing an acinus division 
very smooth and very much enlarged. Their consistence is less than that of the 
iron-grey parenchyma which surrounds them. Some have a friable consistence, 
others are softened in their centre, and contain a syrupy matter in their centre, 
which is ordinarily brown. Sometimes the nodule is softened throughout its entire 
extent and transformed into a cyst, with a clear thin wall. 
The spleen was triple the normal volume, very firm, of a jet black color, and 
smooth and dry on section. 
The kidneys were noted as being normal, but the examination was imperfect. 
The peritoneum was of an iron-grey color, and mottled with petechial spots. 
The thickened mesentery contained red, somewhat softened lymphatic ganglia. 
The mucous membrane of the intestine presented no other lesion than an iron- 
grey color. 
Ijungs strongly pigmented; heart normal. 
The congested brain was without appreciable melansemic color. 
Histological Examination of the Live)-Examination in a Fresh State- 
The hepatic cells gathered upon the point of a scalpel, on the surface of 
the sections of the tumors, are, for the most part, of great size, and infil- 
trated with oily drops and biliary pigment. The pigment included in 
these cells, sometimes in the form of a vivid object, attained the size of the 
nucleus of an hepatic cell; whilst, in some cases, the entire hepatic cell is 
transformed into a golden yellow mass. These elements intermediate to 
the nodules were indurated, of a dark color, and were composed of hepatic 
cells, smaller than the preceding, and manifestly atrophied. Some contain 
also small fatty drops and biliary pigment, under the form of yellow and 
brown granules. The structures contain a large quantity of haematin, more 
or less altered. 
Examination of the Sections after being Hardened in Alcohol. 
The examination of portions representing the characteristic alterations 
of the liver revealed the following characteristic lesions: 
1. Parenchymatous hepatitis, with hypertrophied elements, tending 
to simple softening. 
2. Hyperaemia, accompanied by hyperplasia, of the nuclei of the 
hepatic cells. 
3. Cirrhosis. 
a. Parenchymatous Hepatitis with Hypertrophied Elements. 
Parenchymatous hepatitis is disseminated in spaces of various sizes, 
and constitutes those yellowish tumors projecting on the surface of the 
sections, the volumes of which vary from a grain of millet to a large walnut. 
In these tumors the acini seem to be considerably augmented in volume- 
an augmentation due at once to the enlargement of the trabeculae and the 
dilatation of the capillaries. The dilated vascular tissues are encumbered 
with cells of all dimensions, usually infiltrated with black melamemic pig- 
ment. The cells enclosed in the capillaries represent the accumulated 
blood leucocytes, and the elements proceeding from endothelial prolifera- 
tion. The trabeculae are composed of voluminous hepatic cells, infiltrated 
with oily drops and yellow masses of bilious coloring matter. In some 
acini the situation ends in the destruction of the hepatic cells, which fuse 
together and form a dense fluid, granular protoplasmic mass, contain- 932 
Pathological Anatomy of the Liver in Malarial Fever. 
ing oily drops and nuclei of cells. The tumors present no tendency to 
encystment. No conjuuctive neoplasia isolates them from the neighboring 
hepatic parenchyma, from which however they are perfectly distinct. 
Driven back and compressed by these tumors, in the eccentric development 
of which the environing parenchyma is deformed and atrophied, the 
trabeculse, stretched out and thin, are disposed in bands or layers concen- 
tric to the tumor. 
(5-) Hyperaemia and Nuclear Hyperplasia of the Hepatic Cells. 
The dark red portions of the liver show alterations which end in an 
unrestricted destruction of the parenchyma by a different process. The 
hepatic trabeculae have a dark sombre color, due to the infiltration of the 
protoplasm by a deep brown ochre pigment, or by a black and brown pig- 
ment of haematic origin, (the bilious pigment is rarely observed.) The 
dilated capillary tissues contain a large number of melaniferous cells. The 
sombre brown color and the iron-grey shades of portions of the liver pre- 
viously described are thus produced. 
The prominent lesion is hyperaemia; this is most generally pronounced 
in the periphery of the acini, which it consumes little by little, and finally 
destroys. In its greatest degree hyperaemia enlarges the vascular layers 
to the point of reducing the trabeculae to their partitions, in which the 
cells only subsist under the form of linear trains or bands, or chains, and 
even entirely disappear. Those portions comprising several acini are 
occupied by a cavernous tissue where the blood-vessels form an almost con- 
tinuous net. In other parts where the hyperaemia is less the trabeculae 
exhibit a considerable multiplication of the nuclei of the hepatic cells. In 
some points the hyperplasia results in an enlargement of the diameter of 
the trabeculae, which finally touch each other; and at the centre of these 
foci of proliferation it is not rare to encounter a continuous net constituted 
by an agglomeration of nuclei, some of the hypertrophic ones of which 
measure from eight to twelve mm., that is to say, a diameter double that 
of the normal state in the neighboring acini; these masses of nuclei are 
enclosed in a deficient protoplasm, which has no distinct cellular contour, 
and appears to be in a process of liquifaction. 
(c.) Interstitial Hepatitis. 
The capsule of Glisson is not thickened except in certain places, con- 
stituting rounded plaques, or stored with elongations or fibres, which insin- 
uate themselves between the acini. These partitions or divisions are con- 
stituted by a fibrous tissue rich in lymphatic elements and pigment parti- 
cles. It is possible to distinguish here the biliary canals with their normal 
epithelium, sometimes containing biliary concretions. 
In conclusion, the lesion consists of a proliferic and hypertrophied 
parenchymatous hepatitis of a nodular character, the last stage of which 
is steatose with considerable hyperaemia, resulting in the atrophy of vast 
tracts of the acini. In some points the active nucleus proliferation of the 
hepatic cells which ends in small foci of softening, is analogous to the 
miliary abscesses of parenchymatous origin. The interstitial hepatitis is 
but slightly pronounced. 
The preceding observation which, in its clinical march, presents the 
characters of a grave icterus, accompanied with ascites, exhibits a liver 
slightly atrophied, in which it is possible to distinguish at first sight, two 
states of the hepatic substance, profoundly distinct in aspect and structure; 
on the one hand, round, soft yellow tumors, in which the hypertrophied Pathological Anatomy of the Liver in Malarial Fever. 
933 
acini by cellular proliferation tend to fatty degeneration andpuriform soft- 
ening; on the other hand, a red, tough condensed tissue of a smooth or 
finely granular aspect, in which the microscope shows the acini in process 
of embryonic transformation when they are not atrophied by hyperaemia. 
This aspect of the liver recalls -what is described by Klebs under the 
hea'l of red atrophy; but it is difficult to consider the yellow tumors as 
portions of the parenchyma which are relatively healthy, isolated and 
separated from the atrophied process which has modified the rest of the 
gland. 
The two orders of the alterations do not constitute successive stages, 
but rather two almost opposite forms of an inflammatory glandular pro- 
cess. On the one hand, and on the other, the process has attained the last 
term of its evolution, and in the tumors the inflamed parenchyma has given 
birth to an exuberant generation of epithelial cells, destined to necrobiosis; 
and in the red portion the glandular tissue presents the return of the pri- 
moidial tissue to the condition of the embryonic tissue. 
Fatty degeneration is more or less pronounced in the different forms 
of parenchymatous hepatitis, especially amongst subjects addicted to the 
use of alcohol. It invades the hypertrophied acini from the periphery to 
the centre, commencing sometimes in the nucleus and sometimes in the 
protoplasm of the hepatic cells. It does not constitute, properly speaking, 
a mode of termination of hepatitis; as the acini thus transformed are 
ultimately invaded by an embryonic neoplasia which pervades them from 
the periphery to the centre. 
It is particularly in form of hepatitis that cellular hypertrophy pre- 
dominates, commencing in the central portions of the nodules. The trabe- 
culae of this central portion, so enlarged as to touch, form a continuous 
refracting mass, colorable by carmine, infiltrated with fatty globules and 
masses of biliary pigment. This mass rapidly melts into a diliquium, pre- 
senting the aspect of a fatty emulsion containing voluminous nuclei, still 
colored by the carmine, and debris of granulo-fatty cells, bathed in a 
plasma of demi-liquid exudation slightly colored by carmine; hence the 
gelatinous aspect of the centre of certain tumors. The blood and bile dif- 
fused and mixed in the deliquium give it a color sometimes, chocolate- 
brown, and sometimes bottle-green. 
Caseous softening, or degeneration into granulo-fat:-this process com- 
mences in the centre of the nodule; the trabeculae tumefied and crowded 
with small hepatic cells, approach each other, become confounded in a con- 
tinous opaque mass indifferent to carmine, which soon breaks up and 
throws out fragments of granulo-fatty trabeculae. Even at the centre of 
the focus of softening most of the cells are disintegrated, isolated and 
transformed into small angular and opaque blocks, the atrophied nucleus 
of which is either tinted in dark red by the carmine, or has completely 
disappeared. 
In divers points of the hyperplasic parenchymatous nodule, at the 
periphery or in the neighborhood of the cirrhotic tissues foci of softening 
appear of very rarely fixed dimensions of from one to two mm. in diame- 
ter. 
Three zones may be recognized, a central composed of very small nuclei, 
agglutinated in a plasma of red brown color, thick consistency and some- 
times overspread with fat granules; a medium zone composed of disassoci- 
ated hepatic cells and fragments of trabeculae; the cells contain numerous 
nuclei which become more numerous and smaller as the central zone is 
approached; finally, a peripheric zone composed of trabeculae compressed 
and transforming themselves into fibrous bands. There is no other name to 934 
Chronic Malarial Hepatitis. 
be given to these small foci but abscesses where the epithelial proliferation 
ends iu the formation of nuclei similar to the leucocytes loose in the plasma 
of exudation, and which are exteriorly surrounded by a zone of induration. 
The second order of phenomena (epithelial hyperplasia tending to indu- 
ration) predominate in the parts of the gland intermediate to the nodular 
tumors. 
In the interval of the nodules, the hepatic tissue is atrophied, indura- 
ted and of a smooth or finely granulated surface on section, overspread with 
dark-brown spots and with yellowish or greyish points. On the fine sections 
treated with picro-carmine, alow magnifying power, shows that the dark 
round spots correspond to the hypersemiated territories, in which the vas- 
cular tissues are dilated to the degree of complete atrophy of the trabeculae, 
and constitute a sort of bloody tissue. The yellow points correspond 
to the groups or portions of acini, sometimes affecting the nodular evolu- 
tion, or preserving the radiating arrangement of their tissue. 
Finally, the greyish points have taken, by the action of the picro-car- 
mine, a vivid carmine color, and present the aspect of an embryonic con- 
nective tissue When the lesion is very advanced, there can no longer 
be distinguished in this tissue any vestige of the acini. There is only to 
be seen at certain distances fibrous spaces or masses, corresponding with 
the sheaths of Glisson, infiltrated with leucocytes. But in other points the 
acinous disposition is still distinct; the embryonic cells instead of being 
confusedly spread in a fibroid stroma, form trains, the thickness of which 
nearly equals that of the hepatic trabeculae; these trains are united in the 
manner of a net work, and in places attach themselves to fragments of tra- 
beculae, still preserving the epithelial structure. 
This neo-formation of an embryonic connective tissue diffused in the 
indurated parenchyma is also observed, but in more limited proportions 
and in more systematic distribution in the nodular tumors. We have 
seen that the large tumors distend the environing parenchyma, the contig- 
uous trabeculae of which are dispersed concentrically about the tumor in this 
condensed hepatic tissue, the trabeculae are rapidly replaced by a connec- 
tive tissue, first embryonic and then fibrous. 
Finally, even in the interior of the tumors, between the element- 
ary granulations, some of which are softened at the centre, there may be 
seen fibres of embryonic tissue replacing the condensed trabeculae, isolating 
the granulations one from the other, and dividing the principal tumor into 
a certain number of secondary divisions. The cellular spaces are some- 
times the points of departure for the embryonic fibres which divide the 
nodule, as in figure 3, engraving 97. 
The first phenomenon which occurs in the trabeculae is the segmenta- 
tion of the hepatic cells, which multiply themselves by giving birth to a 
numerous generation of small epithelial cells, polyhedric by reciprocal 
pressure. When the distended trabeculae have obtained a size quadruple 
the normal thickness, and are so enlarged or near to each other as to have 
effaced the capillary tissue, the wall proper disappears; and the cellular 
contents thus liberated are disentegrated and broken into small masses or 
isolated cells. Up to this point the process is analogous to that which is 
presented by the nodule in the process of puriform softening. But instead 
of the young elements undergoing a necrobiotic transformation and being 
bathed in a liquid exudation, there may be seen insinuated and infiltrated 
between them a hyaline plasma, colored in rose color by the carmine-and 
presenting all the characteristics of the fundamental substance of the con- 
nective tissues. The protoplasm of the hepatic cells becomes less and 
less, reducing itself to a small mass of pigmentary granulations, and finally Chronic Malarial Hepatitis. 
935 
disappears; the nuclei persist, lose their nucleolus, become similar to the 
lymphatic elements whose functions they perform as constituent elements 
of the newly formed embryonic tissue. (Figure 1, B, plate 97.) The embry- 
onic transformation attacks the hepatic cells separately or in small groups. 
In the centre of the hyaline plasma are scattered masses of cells whose 
epithelium is still provided with yellow protoplasm, and other masses of 
embryonic cells crowded one against the other. A little further on these 
cellular groups are in turn disintegrated by the hyaline plasma, which 
interposes itself between their elements and ends by isolating them. Phe- 
nomena of the same order preside at the genesis of the embryonic tissue at 
the circumference of the nodules, and even in the interior, and at the cir- 
cumference of the elementary granulations. But in their new conditions 
the neoplasm is developed at the expense of the parenchyma, which is 
compressed, condensed, more or less atrophied, and poorly nourished, and 
composed of innumerable cellular elements. In the crowded trabeculae 
disposed in concentric layers, the glandular protoplasm disappears through 
atrophy and segmentation; at the same time that the trabeculae diminish in 
thickness it is filled with small embryonic elements, which give under a 
low magnifying power numerous small crowded vividly colored particles. 
Between the trabeculae at first, and later on between the embryonic cells 
themselves, are interposed bands of connective hyaline substance, and at 
this stage is formed the connective tissue. This tissue usually tends to a 
fibrous structure by the growing predominance of the fundamental sub- 
stance over the cellular elements, which diminish in number and size. 
Under certain circumstances the transformation of the glandular tissue 
into a fibrous tissue is accomplished without being preceded by any very 
marked stage of proliferation. This takes place at the circumference of 
the portal veins or the territories in which hyperiemia is great. 
Without entering into the pathogenesis of cirrhosis, we will remark 
that in some cases of insular cirrhosis there is neither hypertrophy of the 
liver, nor icterus. The disease is developed in seven or eight months; 
some disorders of digestion in the beginning; ascites during the last 
months; no icterus, but signs of progressive impoverishment and emacia- 
tion. Finally, marasmus, with a comatose somnolence, which leads to 
death. We find in the liver, besides the lesions of insular cirrhosis, a very 
advanced and general parenchymatous hepatitis, beginning, on the one 
hand, by induration, and on the other, in the formation of small abscesses. 
We may .conclude from these two facts that, in its association with cirrhosis, 
parenchymatous hepatitis possesses its essential characteristics, beginning 
with epithelial hyperplasia, and terminating sometimes by induration and 
sometimes by softening. 
We do not find in these mixed processes the nodules and the diffused- 
induration clearly separated; the two modes of termination of parenchy- 
matous hepatitis in being differentiated are not circumscribed in their struc- 
ture of absolutely different aspects. The division of the morbid product is 
more complicated, because it obeys two principles of development-one is 
indicated by cirrhosis, the other by parenchymatous hepatitis. 
RELATIONS OF THE CHRONIC PARENCHYMATOUS HEPATITIS OF MALARIAL 
FEVER TO UNCOMPLICATED CIRRHOSIS OF THE LIVER; ALSO TO YELLOW 
ATROPHY OF THE LIVER, AND ADENOMA OF THE LIVER. 
Cirrhosis of the Liver.-Cirrhosis has been generally regarded and 
defined as a chronic inflammation affecting the interstitial connective 
tis ue of the different organs. When the pathological processes of different 936 
Cirrhosis of the Liver. 
organs are considered, and more especially the various lesions of the liver 
in malarial fever, it is evident that the processes which often end in a 
cirrhosed condition of the organ are only partially described by the pre- 
ceding definition. 
It has been held by many that cirrhosis consists essentially in the 
effusion of lymph into the interlobular fissures, and that by the contraction 
and subsequent conversion of the lymph into fibrous tissue the circulation 
in the lobule is impeded or entirely prevented. It is easily shown that this 
supposed lymph is abundantly supplied with vessels, and Beale has demon- 
strated branches of the duct, in considerable number, and that, what is- 
generally regarded as lymph consists really of the altered hepatic tissues 
in the circumference of the lobule. In every part of the so-called fibrous- 
tissue, the remains of the cell-containing network, with shrunken, hardened 
and otherwise altered liver-cells, can be seen. 
In certain conditions the walls of the capillaries appear to be much 
thickened, or an albuminous material is effused between them and the tubes- 
of the cell containing network-or the thickening may, and probably does, 
affect both structures. In consequence the distance between the cells and 
the blood becomes much increased. The selective agency and attracting 
property of the bioplasm operate through a greater distance than in health, 
and the changes in the blood induced by the formation of certain substances- 
by the bioplasm of the cells, are imperfectly carried on. Such points as 
this cannot be demonstrated without great difficulty, and to ascertain the 
thickness of the capillary walls it is necessary to make very careful 
injections.* 
The initial process has ordinarily been divided into three stages: 
1st. Hypersemia. 
2d. Hyperplasia. 
3d. Contraction. 
The hyperaemia of the first stage may be simple, more or less pro- 
tracted, or it may be complicated as in malarial fever by more or less 
derangement of the glandular structures in addition to the connective tis- 
sue, and may be paroxysmal, the congestions occurring at various intervals. 
The first stage of hyperaemia is. marked chiefly by the presence of an 
abnormal amount of blood in the organ, slowing of the blood current, and 
increase of intra-vascular tension with distention of the vessels. In mala- 
rial fever the hyperaemia is the result of the action of a specific poison or 
ferment, which induces profound changes in the blood, secretions and 
excretions, aud aberrated nervous action. Whilst, therefore, the condi- 
tions exist for the establishment of the first stage of cirrhosis, other condi- 
tions of a grave character are added thereto. In uncomplicated cases the 
presence of an abnormal amount of blood, the slowing of the blood current 
and the dilatation of the blood-vessels, lead to a transudation of white 
blood-corpuscles, which accumulate in great numbers in the external coat& 
of the blood-vessels between the faciculi of the fibrous tissue and in the 
lymph spaces. The connective tissue corpuscles now acquire an increased 
assimilative power, and appropriate a part of the nutritive material so 
abundantly provided. A multiplication of the connective tissue corpus- 
cles results, and the second stage is initiated. 
The history of the process from this time on has been regarded as- 
similar- to that of the growth of any new formed fibrous tissue. The neo- 
plastic cells called fibroblasts, according to Sentflebeo, Tillsmanns and 
Zeigler, originate from the leucocytes, as well as from the fixed tissue 
corpuscles. -Weiss, Baumgarten. 
* Lionel S, Beale, M. D., F. R. S. Archives of Medicine; The Microscope in Medicine, 4th ed., 
p. 410. Cirrhosis of the Liver. 
937 
Botteher and other observers, on the other hand, deny that the 
migrated cells take any part in the process; while Conheim, Eberth and 
others claim that the fixed tissue corpuscles remain entirely passive. In 
regard to the formation of fibrous tissue from these cells, there are two 
theories: 
1st. The fibroblasts, at first round, by gradual extension soon become 
oval, then spindle or club-shaped, and finally are transformed into distinct 
fibrous bands, their nuclei disappearing during the course of their devel- 
opment. 
2d. The fibroblasts soon become spindle-shaped, club-shaped or 
branched, by elongating and sending out arms; these arms fuse with simi- 
lar prolongations from other cells, until a net-work is formed. From the 
bodies of the cells thus united, and in the homogeneous inter-cellular sub- 
stance fibril® develop, and as these multiply and unite with each other 
neo-fibrous tissue is formed. A reticulated tissue is rarely developed, and 
almost exclusively in the supra-renal capsulesand in the liver. 
While the growth of the neoplastic tissue is in progress, and starting 
with the first appearance of fibroblasts, numerous new blood-vessels are 
formed. They are chiefly offshoots and prolongations of vessels already 
in the neighborhood, and their walls consist of but a single layer of endo- 
thelium. As soon as the fibrous tissue has become thoroughly organized 
it begins to contract. 
This contraction constitutes the third stage of the process, and is iden- 
tical with the shrinkage that occurs in cicatricial tissue everywhere. The 
bands of young tissue crowd closely together, become dense and firm, and 
gradually compress the parenchymatous elements and the blood-vessels 
upon which they depend for nutrition. The extent and duration of the 
several stages of cirrhosis depend ultimately upon the cause of the disease- 
and the intensity and duration of its action. They also vary greatly in 
different localities and organs. 
The affected organ undergoes important changes peculiar to each stage- 
of the disease. In the stages owing to the increased amount of blood, the 
affected organ is slightly enlarged and increased in weight. The capsule 
at the same time becomes tense. When incised the surface is of a deep 
red color, and blood flows freely from it. With the occurrence of cell infil- 
tration and hyperplasia, the size of the organ is more markedly increased: 
the capsule becomes smooth and more tense, and on section the surface is 
still of a deep red color. 
In the third stage as contraction advances the size of the organ dim- 
inishes, the red color gradually subsides, and the capsule becomes thick 
and tense. For a time the parenchymatous structures retain their vitality 
and color, and on section are somewhat more prominent than the inter- 
stitial tissue, giving the organ a mottled appearance ; but later they, too, 
become an®mic. 
The contraction that accompanies the third stage may reduce the organ 
less than half its normal size, the density being increased to a correspond- 
ing degree. Capsulated organs become granular on the surface, and more 
or less deformed, owing to the thickening and subsequent contraction of 
fibrous bands that bind the capsule to the organ. In many instances 
depressions and grooves on the surface indicate the parts where the disease 
is most advanced. 938 
Cirrhosis of the Liver. 
CAUSES OF CIRRHOSIS. 
1. Cirrhosis caused by chronic irritation. This may be of a mechan- 
ical or merely functional nature, active or passive, and varies greatly with 
the organ affected. In the liver it is due almost exclusively to the action of: 
Alcohol. 
• Syphilis. 
Malaria. 
It is claimed that it has been transmitted from an inflammation of 
the gall bladder, or to arise from use of sugar and spices, or poisoning 
by phosphorus. Valvular lesions of the heart lead to a form of cirrhosis 
in the liver as well as in the kidneys and spleen. In the lungs it is due 
to the irritation of tubercles, chronic bronchitis or the inhalation of 
dust, carbon, silex, metals, etc. The action of malaria induces cirrhosis 
chiefly in the liver and spleen. 
Many other agents, as inflammation of serous membranes of organs, 
micro-organisms, poisons (chronic poisoning by various metals and drugs), 
excessive heat and cold, exposure to wet and residence in warm climates. 
In rare instances it has been believed to be congenital. 
The earlier stages of cirrhosis have been studied for the most part 
experimentally, and the statements concerning them are based largely 
upon the phenomena observed during the course of analysis of fibroustis- 
sues. If we examine the section of an organ in an advanced stage of the 
disease, we observe, instead of the delicate bands of supporting tissue, 
bands from twice to many times the normal thickness separating the par- 
enchymatous structures, at long intervals. Here and there rows or clus- 
ters of round or spindle-shaped embryonic cells are seen lying between the 
fibrous bands. The blood-vessels are converted into thick walled chan- 
nels chiefly by the thickening of their external tunics, but sometimes also 
by the increase in the thickness of the internal coat. As complications we 
observe extensive fatty calcareous or pigmentary infiltrations of either the 
parenchyma or the neo-formed fibrous tissue, cysts, haemorrhagic deposits 
or abscesses. 
Excretory ducts, when present, are frequently dilated into fusiform 
cavities by the retained fluids, or are entirely obliterated by pressure. 
Very rarely the amyloid degeneration accompanies the disease. Other 
complications peculiar to the organs affected are observed. 
Cirrhosis occurs primarily or secondarily in all the organs of the 
body. When secondary it is generally the result of parenchymatous dis- 
ease. The organs most frequently involved are the liver, kidneys, lungs, 
spleen, the brain and spinal cord, nerve trunks and ganglia, the heart and 
other muscles. The lymphatic glands, pancreas, testicles, ovaries and mamma, 
as well as the large arteries, and the pylorus is sometimes thickened as 
the result of gastric catarrh. By an analysis, however, fibroid thickening 
of the skin occurs. 
The irritation which produces cirrhosis most generally reaches through 
the blood. As a rule, therefore, the disease appears first around the 
blood-vessels or in their tunics. In most instances in the smaller arteries. 
In the liver it commences around the terminal branches of the portal 
or hepatic veins, less frequently perhaps around the smaller bile ducts. It 
is, therefore, chiefly confined to the interlobular spaces, but may extend 
into the interior of the lobules. In the brain and cord it is found mostly 
in the gray substance; in the kidney chiefly in the cortical portion. Cirrhosis of the Liver. 
939 
RESULT OF CIRRHOSIS. 
Associated with a cirrhosis there is always some complication of the 
parenchymatous structures. In the earlier stages au organ may functionate 
vicariously on account of the hypersemia that is present. In the later 
stages, however, the functional elements frequently atrophy or undergo 
fatty degeneration and absorption. The fatty degeneration is sometimes 
so rapid, especially in the lungs and supra-renal capsules as to lead to 
caseation and necrosis, or calcification. The functional activity of the 
organ is then lessened in proportion to the amount of induration, and the 
effects upon the health of the individual depends upon the organ involved. 
In secreting organs the secretion is diminished; or concentrating, is 
retained by cicatricial closure of the ducts, and causes the formation of 
cysts. As a consequence of fibrous induration, the blood-vessels lose their 
elasticity, thus greatly impeding the circulation of the heart and producing 
important changes, both local and general.* 
In the hospital practice of the author, cases of cirrhosis which had 
advanced to the stage in which ascites becomes a prominent and most dis- 
tressing symptom, remedial agents (diuretics and purgatives) and tapping 
may give temporary relief and prolong life, but they seldom effect a per- 
manent arrest of the fatal effects of the disease. In the first of the succeed- 
ing cases, tapping conjoined with the use of mercury in small doses 
appeared to arrest the progress of cirrhosis: and in the second after the 
successful removal of the liquid from the abdominal cavity, the patient was 
seized with high fever and inflammation of the peritoneum, which termi- 
nated fatally. 
Case No. 1083.-Of Cirrhosis of the Liver: Ascites; Water removed by Tap- 
ping; recovery: Death from double pneumonia. James Castello; native of Ireland; 
laborer; age 34; entered ward 29, bed 427, February 11th, 1878, with rheumatism; 
left the ward on the night of the 12th, got beastly drunk, lay in the streets, and 
was brought in on the evening of the 13th, pulseless cyanosed countenance, con- 
gestion of both lungs; died on the morning of February 14th. 
In 1876, this man came into my ward, with the symptoms of cirrhosis of the 
liver. The belly was greatly distended with serous effusion. I tapped him, and 
drew off about two gallons of liquid. After treatment for four months the patient 
was discharged apparently cured. 
During the Civil War, the man had been shot through the thorax, the ball 
entering in front, a little to the right of the base of the heart, and passed entirely 
through the right lung; recovery complete. 
Autopsy twelve hours after death. February 14th, 1878. Both lungs conges- 
ted and in first and second stages of pneumonia. Could trace the track of the ball 
through walls of thorax. Liver hard and cirrhosed. Habits had been intempe- 
rate. Other organs healthy. 
Case No. 1084.-Cirrhosis of Liver. Death.-J. Sullivan; age 50 years; native 
of Ireland; sailor by occupation; entered ward 16, Charity Hospital, October 1st, 
1883. Face and upper extremities and thorax emaciated; below diaphragm, 
abdomen and lower extremities distended with serous fluid. Abdomen greatly 
distended with fluid, which forces the diaphragm upwards, and impedes respira- 
tion. Blood-vessels of abdominal walls large and distended with dark venous 
blood, presenting an arborescent appearance. Patient says that he has drunk alco- 
holic stimulants freely all his life, but has suffered very little sickness until the 
fluid began to accumulate in his abdomen, about two months ago, and interfered 
with his respiration, and prevented active exercise. Urine scant, high colored, 
•but free from albumen and casts. Purgatives, (jalap extract of colocynth, mercu- 
rials, podophyllin, etc.) and diuretics (infusion of juniper berries and cream of 
tartar, digitalis jaborandi, etc.,) produced only temporary diminution of the liquid 
effused into the abdominal cavity, and into the cellular tissue of the lower extremi- 
ties. At one time when the fluid had greatly diminished, quinine and iron were 
given as tonics. 
* J. if. French. 940 
Yellow Atrophy of the Liver. 
The infusion of juniper berries and cream of tartar (bitartrate of potassa), an; 
ounce of each to the pint of water, administered in small doses during the twenty- 
four hours, produced free evacuations from the bowels and a great increase of the 
urinary excretion. 
When the fluid effused in the abdomen was almost entirely reduced by these 
means, the patient was seized with fever, intense pain in the abdomen, loss of 
appetite and great prostration, and died apparently from the supervention of peri- 
toneal inflammation, November 9th. 1883. 
Post-mortem examination.-Heart and lungs normal. Liver enlarged, hard- 
ened, with granular and nodulated surface and structure, cirrhosis and fatty degen- 
eration of hepatic substance existed. Abdominal cavity contained turbid fluid, and 
the peritoneal surface of intestines coated with yellow plastic lymph. Kidneys 
normal. 
Without doubt, the removal of the effused liquid from the abdomen by tapping, 
frequently prolongs life; thus I have tapped patients at intervals of from three to 
six months, and repeated the operation as many as from three to four times. In. 
several cases the amount of liquid removed from the abdomen has varied from 
80 to 150 pounds. 
I have never had cause to regret the evacuation of the fluid from the abdominal 
cavity, when it was impossible to remove that fluid by diuretics and purgatives, 
and when the amount impeded respiration and interfered with digestion and 
assimilation from its mechanical pressure, but I have upon more than one occasion 
regretted even that delay, which was granted upon the earnest solicitation of the 
patient, in order to try further remedies, which had ceased to produce the desired 
results. 
YELLOW ATROPHY OF THE LIVER. 
Yellow atrophy, a rare form of softening atrophy, is characterized by 
distinctive anatomical features of the morbid change, as well as clearly 
defined clinical symptoms of pernicious icterus. It is an acute process, 
and the decrease of volume of the organ may take place in a very short 
period, to one-third the normal. After death of the affected person the 
liver is found to have exceedingly shrunk in its thickness, very soft and. 
flabby, and its capsule shrivelled (Zenker). Section shows a mottled 
appearance of red and yellow, the red portions surrounding the yellow 
which form islands. The yellow portions are of a very bright tinge, very 
soft and spongy, and raised above the red portions, which are firmer, some- 
times very dense and tough. 
It has been held that the yellow substance forms the primary, and the 
red the secondary or later stage. 
In the early stages the lobular structure is still plainly recognizable in 
the absolutely anaemic and highly icteric yellow tissue. The large venous 
trunks in the lobules are then the only blood-vessels filled with blood, the 
interlobular small blood-vessels are utterly bloodless, and mostly obliter- 
ated and replaced by interlobular connective tissue. Very many glandular 
cells are fatty degenerated. When this degeneration becomes general the 
characteristic lobular structures disappear more and more, and the whole- 
lobular cell structure turns into a fatty mass, unequal in the different por- 
tions of the lobule in the extent of alteration. 
Both fat molecules and blood detritus-haemoglobin. hsematoidin bili- 
rubin-are diffused in a fibrous structure in which but few cellular ele- 
ments are to be found. More and more are the cellular elements wiped 
out by fat-metamorphosis-and the only remnants of the parenchyma are 
noticeable near the larger vascular branches, and even these are full of 
pigmentary granules. Eventually, when the person thus affected lives 
long enough for a partial regeneration of the affected liver tissue, strings 
of connective tissue, and numerous rows of peculiar cells make their appear- 
ance; the fat accumulation slowly disappears, massive invasion of lym- 
phoid cells and pigmentary matter now takes place, and highly protoplas- 
tic finely granular cells with many processes are formed. They are very 
likely the newly forming parenchymatous cells. Adenoma of the Liver. 
941 
From extensive destruction in such an organ as the liver no one ever 
•recovers; but where this form of lesion exists only in a small portion of 
the liver, there is now and then a partial regeneration of the destroyed 
tissue and formation of cicatricial tissue wholly unfit for function.* 
ADENOMA OF THE LIVER (ADENOME DU FOIE), A MORBID GROWTH, THE 
STRUCTURE OF WHICH IS OF GLANDULAR NATURE. 
Although the cases of adenoma of the liver which have come under 
my observation were accompanied by the action of the malarial poison, 
and manifested in their progress, symptoms of fever, jaundiceand pigment- 
ation, and after death presented the characteristic lesions of cirrhosis as 
well as those of the adenomatous or glandular changes, no relation of cause 
and effect with reference to the action of the malarial poison could be 
determined, as the cases occurred in individuals who had been subjected to 
the action of the malarial poison of the swamps and marshes of the delta 
of the Mississippi river. It is well known that the ill-defined group of 
tumors, the typical members of which are essentially non-malignant, and 
made up of tissues exactly resembling those of the glands from which they 
spring; at the same time the departures from the ordinary type are so 
many and so varied, and at times so indefinite, that it becomes impossible 
to draw a clear line between the adenomata and the carcinomata. No con- 
nection with the action of marsh malaria has been established with ade- 
noma of the sweat glands, of the sebaceous glands, of the mucous glands, 
-of the mammary glands, testicle, ovary, salivary glands, lachrymal glands. 
Professors A. Kelsch and P. L. Kiener have recorded a case entitled 
" Observ. 1. Adenome du foie; antecedents palustres. Symptomes tardites 
•consistant en ictere, ascite et coma. Nombreuses tumeurs adenomateuses 
a diverses periodes de leurs evolutions; cirrhose concomitante. Lesions 
paludeennes de la rate et des reins."f 
A careful examination of this case, and a comparison with the other 
case reported by the same authors (entitled, Obs. II. Adenome du foie. 
Ascite; symptomes terminaux, consistant en ictere, prostration, comateuse, 
marasme. Evolution rapide de la maladie. Tumeurs adenomateuses 
multiples du foie-cirrhose concomitante intense, avec neoformation du 
canalientes biliaries), establishes no relation of cause and effect with the 
malarial poison, although both individuals had been exposed to the toxic 
effects before and during the diseased state called adenoma of the liver. 
The facts thus far accumulated are insufficient to indicate the exact nature 
of the modification induced by the action of the malarial poisou upon the 
adenomic liver; and the supposition is reasonable that the jaundice and 
ascites may have been referable in large measure to the action of this cause. 
The hyperaemic condition of the liver characteristic of malarial fever, 
without doubt, conduces to the detachment and proliferation of the endo- 
thelial cells of the capillaries, and to the increase and hypertrophy of the 
elements of Glisson's capsule, but such changes cannot be viewed as being 
identical with those denominated adenoma. 
The case reported by Wagner occurred in a man 39 years of age, who 
died of pulmonary and laryngeal tuberculosis; and in like manner the 
observations of Wagner, Rindfleisch, Eberth, Friedreich, Klob, Lance- 
* J. S. Jaencon, M. D. 
t " Contribution al'histoirede I'AdSnoinedu Foie. Par MM. A. Kelsch, Professeuragr^gelibre 
du Val-de-Grace, etP. L. Kiener, ancien r6p6titeur de l'Kcole-de Medicine Militaire de Strasbourg." 
Archives de Physiologic Normale et Pathologique, 1876, pp. 628-656. 942 
Pathological Anatomy of the Liver in Malarial Lever. 
reaux, Hoffmann and Willigk, tend to establish no relation of adenoma of 
the liver to the action and effects of the malarial poison.* 
COMPARATIVE PATHOLOGIC AL ANATOMY OF THE LIVER IN MALARIAL 
FEVER AND YELLOW FEVER.-PATHOLOGICAL ANATOMY OF THE 
LIVER OF MALARIAL FEVER. 
Liver.-The weight of the liver is increased in malarial fever above the 
standard of health. This increase of weight is due in part to the stagnation 
and accumulation of blood in the capillaries and blood-vessels, and to the 
deposit of pigment matter in the structures of the liver. This observation 
applies to the liver in the acute stages. 
In all the different forms of malarial fever, intermittent, remittent and 
congestive, which had continued longer than five days, and in which there 
had been no previous alterations of the structures, as in cirrhosis and fatty 
degeneration, I found the exterior of a slate color, and the interior of a 
bronze color. Plate 11, Figure 41, represents the appearance of the malarial 
liver in the acute stage of remittent fever. Plate 42 represents the dark 
bronzed liver of malarial fever of long standing. Figure 43 represents 
liver of malarial fever loaded with pigment particles. Figure 44 represents 
a magnified portion of a section of a malarial fever liver, showing the deposit 
of pigment chieflly in the portal capillaries, in the periphery of each lobule. 
Figure 45 represents the appearance of the liver cells, and blood and 
bronzed pigmentary matter of the liver in malarial fever. This figure 45 
should be compared with figure 33. Plate 9, showing cells of liver and oil 
globules in yellow fever. In that form of cirrhosis of the liver which is 
directly induced by the prolonged action of the malarial poison, the liver 
is in like manner of a slate color upon the exterior, and olive green within, 
and loaded with dark pigment granules. The change in the color appears 
to be very persistent, and in several cases I have observed the liver to 
retain shades of light slate and light bronze several weeks, and even months, 
after the relief of the attack of malarial fever, the patients having been 
destroyed by other diseases or by violence. The liver, especially in the 
peripheral portions of the lobules, contains pigment granules, result- 
ing from the alteration of the colored blood-corpuscles and the Inema- 
tin. The pigment granules are frequently distributed uniformly through 
both the portal and hepatic systems of capillaries. There is no accumula- 
tion of oil globules, as in the yellow fever liver. If malarial fever precedes 
or succeeds yellow fever, the liver may contain both oil globules and pig- 
ment granules. 
* E. Wagner. Faile von Neubildung, von Libei Substanz im Ligamentum suspens, liepates. 
Archive der Heilkunde. 1861, H. 5.-Drusengesevalsh der Leber. Rindflesh. Arch, der Heilkunde. 
1864, p. 5, Lehrbuch der pathol., Histologie, p. 405. Eberth. Virchows Arch., Bd. xl, iii. Heft 3. 
Friedrich, Ueber multiple knotige Hyperplasie der Leber u. Miley. Virchow's Arch., Bd. xxxiij, 
Heft 1, Taft 1, fig. 8-10. NachtragNierzuin Heft 4. Klebs. Zur Pathologisce Anatomie der Leber, 
Scheinbare Leber Adenoide, Wein. Med. Wochensehritt Sepeter. Lancereaux. Gazette M6dicale 
de Paris, 1867, JNos. 45,50, 51. Hoffmann, C. E. Grosses Adenem derLeber, Arch., f. pathol, Anat, 
u. Phys, Bd. xxx, 9, Heft 1 pl U. Willigk. A. Beitrag, zur Histogenese der Leberedenem 
Arch. L. Pathol Anat. v. Physiol. Bd. L. 1. Heft 2. Pathological Anatomy of the Liver in Malarial Lever. 
943 
ENGRAVING NO. 98. 
Pigment Liver of Malarial Fever. 
Engraving No. 98.-Pigment liver of malarial fever. Fine section of pigment liver, pre- 
viously dried and treated with a solution of potash; magnified 90 diameters. 
The pigment is seen to be deposited, for the most part, in the interlobular veins, forming a 
black zone, surrounding each lobule, and to have penetrated but very slightly into the interior 
of the lobules. In most cases the pigment is distributed more uniformly than is here represented.* 
In persons who die from the effects of marsh poison, under symptoms of severe intermittent, 
remittent or continued fevers, the liver often presents a steel-gray, or blackish, or not unfre- 
quently a chocolate color; brown insulated figures are observed on a dark ground. This change 
of coloris due to the pigment matter accumulated in the vascular apparatus of the gland. 
In fine sections of the hardened tissue accumulations of pigment may be observed in the 
capillary net-work of the portal and hepatic veins, as also in the larger branches of these ves- 
sels; these deposits are either uniformly distributed or limited, for the most part, to certain 
regions. Sometimes the brownish colored lobules appear surrounded by black margins, owing 
to the inter-lobular veins being filled with colored particles, as in the preceding figure; in general, 
however, the pigment is more uniformly distributed, extending from the circumference of the 
lobules half way to their centre, or penetrating as far as the commencement of the hepatic veins,, 
or still farther into the vena cava. 
Magnified Section of Liver of Pernicious Malarial Fever. 
ENGRAVING NO. 99t 
* Diseases of the Liver. Dr. Fred. Frerichs, vol. 1, p. 317, 318. 944 
Pathological Anatomy of the Liver in Yellow Fever. 
Exgraving No. 99.-Section of liver of man who died comatose. Entered hospital September 
12th, 1884, at 5 o'clock in the afternoon, in a profound comatose condition; temperature in axilla 
1O1.°4; died during the early hours of the morning. Subsequent observation revealed that the 
patient was a laborer along the railroad; was taken sick at his boarding house, with drowsiness, 
loss of appetite and general weakness; this condition gradually becoming worse, the next morn- 
ing he fell into a comatose condition from which he never rallied. Post-mortem five hours after 
death. The cortex of the brain was throughout of a dull chocolate color, the white matter was 
slightly darker than normal. 
The central ganglia of the brain partook of the same color as the cortex; pia mater of the cord 
hypersemic: the cord itself darker; the gray matter of the same color as the cerebral cortex. 
Heart's flesli firm, valves normal. 
Liver enlarged (4 lbs. 12 ozs.), soft and of a dark slaty color; on section it was found to be very 
hypersemic Spleen very much enlarged, 7 inches long, and finches wide and 2 inches thick, and 
of an almost black color, with a tinge of gray. Kidneys of ordinary size; cortex full and hyper- 
semic; no pigmentation could be made out. 
In the above plate the brain work of the liver tissue is seen, and in the capillaries the large, 
pale, pigmented leucocytes. X. 500. The liver cells were of usual size, and contained rather more 
than the usual amount of bile pigment. In the capillaries there was a large quantity of pigment 
in the form of large irregular masses; it was seldom lying free in the vessels, but was for the most 
part enclosed in large cells. These cells were frequently of an enormous size, filling up the capil- 
lary blood-vessels for a considerable distance. They were composed of very pale protoplasm, 
and contained one and sometimes two irregularly shaped and tolerably bright stained nuclei. They 
were generally oblong. Hyaline masses were also observed free, in the colored and colorless 
•corpuscles.* 
The peculiar' -color of the malarial liver can, to a certain extent, be 
extracted by boiling water, and the filtered decoction presents a brownish 
mahogany color, from the presence of the dark coloring matters of the 
pigment granules^ the decoction of the yellow fever liver, on the other 
hand, presents a golden color. The blood issuing from the cut surface of 
the malarial liver presents a dark purplish hue, and does not change to a 
brilliant scarlet, as in the yellow fever liver. Upon chemical examination, 
the malarial liver contains animal starch, but no grape sugar; the yellow 
fever liver contains both substances. Whilst, by careful analysis (quanti- 
tative), I have shown that the oil may amount to over 40 per cent, of the 
dried yellow fever liver, I have also clearly demonstrated that there is no 
increase of oil in the malarial liver. I speak of uncomplicated malarial 
fever; of course, when this disease is engrafted upon cirrhosis or fatty 
liver, the effects of the malarial poison upon this organ will be marked. 
Liver.-Yellow color and bloodless, resembling this organ in fatty 
degeneration, but firmer and denser in structure. Plate 9, figure 29, rep- 
resents the general appearance of the yellow fever liver. The specimen was 
taken from a subject in the Charity Hospital in 1871. Plate 10, figure 35, 
illustrates the appearance of the liver in the case of cirrhosis, induced by 
spirit drinking, which died in the Savannah Hospital in 1856. There was 
not only cirrhosis but also fatty degeneration in this ease. Plate 9, figure 
30, represents the appearance of liver in yellow fever engrafted on mala- 
rial fever; figure 31 represents a portion of section of liver figured in 30, 
magnified, showing congestion of portal capillaries, with pigment deposit, 
and the yellow, fatty and degenerated central portions of the lobuli of the 
liver. Figure 32 represents the appearance of the liver in yellow fever 
engrafted upon malarial fever. The black pigmentary matter alters the 
yellow color characteristic of the yellow fever liver. Figures 29, 30, 31 and 
32, plate 9, should be compared with figure 35, plate 10, and with plate 11, 
figure 41, liver in acute stage of malarial fever (bilious remittent). Figure 
42, appearance of liver in malarial fever of longstanding; figure 43, appear- 
ance of malarial liver loaded with pigment particles. Under the micro- 
scope, textures of the liver infiltrated with oil, secretory cells of liver con- 
tain much oil. The liver of uncomplicated yellow' fever, as far as my 
PATHOLOGICAL ANATOMY OF THE LIVER IN YELLOW FEVER. 
* Councilman, Am. J. M. S., April, 1885, pp. 418-128. Pathological Anatomy of the Liver in Yellow Fever. 
945 
observations extend, and according to the observations of Louis and many 
others, is of a bright yellow color. It is probable that this color, as in the 
case of the malarial liver, varies with the length of the attack and the 
effects of the previous diseases. Thus, Dr. Samuel Jackson, of Philadel- 
phia, found the livers of those who had died in the early stages engorged 
with blood. The decoction of the yellow fever liver is of a golden yellow 
color, whilst that of the malarial liver is of a brownish yellow color. The 
golden yellow color of the yellow fever liver can be extracted both by 
alcohol and water. The yellow fever liver is firmer and harder than that 
of malarial fever, contains much less blood, and is much less readily acted 
upon by liquor potassse and acids. Liquor potassse readily dissolves the 
malarial fever liver; the decoction presents the appearance of venous blood, 
while no such effect is produced by the action of this alkaline solution upon 
the yellow fever liver. 
Chemical analysis reveals the presence of urea and fat in abnormal 
amounts; animal starch and grape sugar are also present in the yellow 
fever liver. As a general rule, grape sugar is absent from the malarial 
liver. 
In some cases the deposit of oil is confined to certain portions of the 
lobuli and may even differ in amount in different portions of the liver, 
but in the majority of cases the fatty infiltration, and fatty degeneration of 
the protoplasm of the hepatic cells extends throughout the whole organ. 
The oil is deposited both within and around the hepatic cells. Plate 9, 
figure 33, gives the appearance of the hepatic cells and the oil globules in 
the liver of yellow fever case of Griffin, November, 1876. This figure 
should be compared with figure 45, plate 11, representing the appearance 
of the hepatic cells and pigment particles in the liver of malarial fever. 
The liver of Griffin, figured in plate 9, figure 30, figure 31 and figure 
33 (a case of yellow fever engrafted on malarial fever), upon a superficial 
examination presented a purplish, congested appearance. Thin sections 
of this liver made with Valentin's knife, placed under the microscope, 
showed that each lobule consisted of an exterior portal peripheral border 
of deep red, with dark granular masses, illustrating the effects of preced- 
ing attacks of malarial fever, with the internal portions surrounding the 
hepatic capillaries, and being composed of hepatic cells loaded with oil 
globules, also granular matter and oil globules within and around the cells 
and inter-cellular spaces. See figure 30 and figure 31, plate 9. Upon 
analysis this liver contained in the 1000 parts, water 747.88; solid matters, 
exclusive of oil, 162.95; oil (fatty matters) 89.17- 
In the case of Samuel Kinsly, who died of yellow fever in the Charity 
Hospital, November 17th, 1873, the liver presented a mottled yellow and 
bronze color, as in figure 32, plate 9. Sections of this liver, washed with 
a stream of water, presented the yellow color of yellow fever. The liver- 
cells were filled with oil globules; oil globules, in great numbers, were also 
found around the liver-cells. The liver also contained much granular 
matter. Minute sections of the liver, made by Valentin's double knife, 
exhibited the hepatic cells filled with globules of oil or fatty matter, the 
outline and hexagonal shape of the cells being altered and obscured, and 
the nuclei rendered invisible. When matter was scraped from the hepatic 
texture and spread upon a glass slide, the whole field of the microscope 
and the interspaces between the cells were filled with granular, molecular 
and oily matter. 1000 parts of this liver contained: water, 677.20; golden 
yellow oil, 304.21; fibrous tissue, blood-vessels, etc., 18.59. We observed 
great increase of oil. Careful investigation of the relations of malaria to 
yellow fever, and an extended examination of the statements of various 946 
Pathological Anatomy of the Liver in Yellow Fever. 
observers, have convinced me that the apparent contradictory statements 
made by various observers, as to the presence or absence of the yellow 
color of the liver, which Louis regarded truthfully as the characteristic 
lesion of the disease, has arisen from two sources, namely, errors of diag- 
nosis, and failure to detect the preceding and concurrent, and subsequent 
action of malaria upon this organ. In uncomplicated yellow fever, the 
pigment particles so uniformly present in the malarial liver are entirely 
absent. When yellow fever has been engrafted on malarial fever, the pre- 
ceding changes wrought by the paludal poison alter and mask those 
developed by the yellow fever. And hence a mingling of the yellow color 
of acute fatty degeneration with the dark bronze and slate of the malarial 
liver, may produce a color very closely resembling the Spanish brown of 
the healthy liver. Careful sections and examinations of the organs under 
the microscope will reveal both the oil globules and the pigment particles. 
ENGRAVING NO. 100. 
Pathological Anatomy of Liver and Stomach in Specific Contagious Yellow Fever 
FIG. I 
FIG. 3 
FIG. 2 Pathological Anatomy of the Liver in Yellow Fever. 
947 
Engraving No. 100.-Illustrating the pathological anatomy of specific contagious yellow- 
fever. Comparison between ordinary fatty degeneration of the liver, and latty infiltration of the 
liver in yellow fever. Section of the gastric mucous membrane in yellow fever. Figure No. 1 
represents a magnified thin section of a fatty liver, in a moderate degree of advancement of fatty 
degeneration. The cells containing oil are seen to be distributed for the most part at the peri- 
phery of the lobules, in the vicinity of the branch of the portal veins. Figure 3.-Section of a 
yellow fever liver, magnified 275 diameters, showing the presence of oil globules. The capillaries 
still contain blood corpuscles. The group of ceds above the figure represent the hepatic cells 
undergoing fatty infiltration and degeneration Figure 2.-Section of a jellow fever stomach, 
showing the congestion of the veins, the Infiltration of haemoglobin, and the extravasation of 
blood caused by a rupture of the minute veins or larger capillaries. The glandular (A) and mus- 
cular layer (B) of the mucous membrane, and the subcutaneous connective tissue (C) are shown. 
The congested vessels descending through the glandular layer represent those straight vessels 
formed by the various radiclesarising from the network of large capillaries beneath the epithe- 
lium, and surrounding the orifices of the gastric glands. The dots seen throughout the muscular 
layer represent transverse sections of muscular fibrilire (magnified 50 diameters), after H. D. 
Schmidt, M. D. 
A distinction has been made by pathologists between fatty degenera- 
tion and fatty infiltration; the first, being a process of true degeneration, 
with a tendency to the disintegration of tissue; the latter we observe as 
simple deposition of fat in various cells and tissues, without any chemical 
alteration of their constituent elements. In fatty degeneration there is a 
conversion of the protoplasm of ceils into fat, which accumulates in the 
cell body; as the albuminoid principles disappear they are replaced pari 
passu by fatty particles. It is thus assumed that the nitrogenized, albu- 
minoid and proteid principles are converted into fat. The fat is usually 
present in the cell in very small particles or droplets, but these may 
coalesce and form larger drops. The protoplasm may even be almost 
entirely replaced by the fat. In fatty infiltration cellular protoplasm is 
displaced; in fatty degeneration it is replaced; in the former the corpus- 
cular organisms suffer mechanically; in the latter the cells suffer chemically 
and are ultimately destroyed. 
Fatty infiltration of cells is a common occurrence under normal as 
well as pathological conditions, but in this case the fat appears to originate 
outside of the cells, and simply accumulates in them, causing a passive 
atrophy of the protoplasm. In general the fat droplets are larger in fatty 
infiltration than in fatty degeneration, yet to this there are many exceptions. 
In spite of the differences just considered, it is often practically impossible 
to clearly separate one process from the other; and micro-chemical tests 
and histological appearances are not always sufficiently reliable for exact 
differentiation. The efforts of some writers to discard the terms fatty 
degeneration and fatty infiltration, and to substitute the words fatty meta- 
morphosis, simply expresses the theory that the two processes are one 
and the same. In the case of the liver, both in health and in disease, we 
meet with great difficulties in separating the two processes. Fatty infil- 
tration may occur as a result of excessive ingestion of oleaginous food, in 
chronic alcoholic, phosphorus and arsenic poisoning, in certain exhausting 
diseases accompanied by malnutrition, as in pulmonary phthisis, chronic 
dysentery, and in various conditions which are not fully understood. 
Fatty degeneration of the liver in many cases cannot be morpholo- 
gically distinguished from fatty infiltration; the fat is believed to be formed 
by a transformation of the protoplasm of the liver cells. The fat droplets 
are for the most part very small and abundant, though this is by no means 
constant. Fatty degeneration of the liver cells frequently follows, and is 
associated with cloudy swelling in the varying conditions in which they 
occur, or it may appear in profound anaemia, and in the exhausted condi- 
tion of the human system consequent upon the prolonged action of the 
malarial poison. 
The accumulation of fat in yellow fever appears to' be due both to degene- 
ration of the protoplasm of the liver cells and to infiltration of fatty matter. 948 
Liver in Typhoid Fever. 
Our researches upon the fatty degeneration and infiltration of the liver in 
yellow fever have led us to the following conclusions : 
1st. The muscular tissues of the heart show, under the microscope 
and under the proper chemical tests, rapid molecular change and fatty 
degeneration. 
2d. The liver cells exhibit rapid degeneration of the protoplasm of 
these cells and rapid increase of fat. 
3d. The albuminoid elements of the blood undergo rapid degenera- 
tion and rapid transformation into fat under the action of the yellow fever 
poison. I use the term rapid in contradistinction to the slower process of 
the development of fat in the normal condition. 
4th. It follows from the preceding propositions that the accumulation 
of fat droplets in the heart and liver in yellow fever, may arise from a 
chemical change of the albuminoid protoplasm of the blood and of the cells. 
5th. The increment of fat (oil droplets) in the blood, in the heart and 
in the liver in yellow fever, is due to the direct chemical action of the 
poison of yellow fever on the albuminoid protoplasm. 
6th. The fatty degeneration caused by the yellow fever poison ceases 
with the cessation of the action, and the elimination and destruction of the 
morbific agent. The degeneration of the protoplasm excited by the yellow 
fever poison is temporary and not permanent. 
7th. If the fatty degeneration caused by the yellow fever poison was 
permanent, and if the change thus induced by the yellow fever poison was 
an abiding and progressing degeneration, we would witness the effects and 
the continuous, and destroying, and destructive effects of fatty degenera- 
tion of the heart and liver, as a sequalse to many cases of yellow fever. In 
our experience such effects are rarely traceable to the action of the yellow 
fever poision. 
APPEARANCE OF THE LIVER IN TYPHOID FEVER. 
We will reserve the discussion of this important subject to the memoir 
devoted to typhoid fever; upon the present occasion we will only present a 
few results of our researches. 
1st. The liver in specific typhoid (enteric) fever is different in its 
appearance and microscopical character from the liver in malarial and 
yellow fevers. 
2d. The liver of typhoid fever approaches more nearly to the color 
of the healthy liver. 
3d. The black pigment particles and cells characteristic of the mala- 
rial liver are absent from the liver of typhoid fever. 
4th. As a general rule fat does not accumulate to any great extent in 
the typhoid fever, as it does in yellow fever, even of short duration. 
5th. The bile in typhoid fever is abundant, and of a light yellow 
color, of low specific gravity, and as a general rule without concretions. 
The bile in malarial fever is abundant, of a dark, puiplish black and deep 
green color in mass, and of a deep yellow in thin layers. In malarial fever 
the bile is thick, of high specific gravity and often contains concretions. 
The bile in yellow fever is very scant, and oftimes, the gall-bladder may 
be entirely without bile in fatal cases of yellow fever. The following 
engraving which I executed from the liver of a Confederate soldier, who 
died of typhoid fever, during the recent Civil War, 1861-1865, will Jlus- 
trate the appearance of the fever ceils. Gall-Bladder in Malarial and Yellow Fever. 
949 
Liver Cells of Typhoid Fever. Confederate Army, 1862. 
ENGRAVING NO. 101. 
Engraving No. 101.-Liver cells of fever of Confederate soldier, who died of typhoid fever, 
1862. From nature, by Joseph Jones, M. D„ Surgeon P. A. C. S. Magnified 420 diameters. 
Gall-bladder.-In most cases distended with more than 1000 grains of 
thick, greenish-black bile, having frequently a specific gravity ranging 
from 1.030 to 1.037. The bile is more abundant in malarial fever, and is 
of a deeper color than in yellow fever, and frequently contains concretions 
of epithelial cells, from the coats of tbe gall bladder and biliary ducts, and 
casts of the biliary tubes. In thin layers, and when added to water, it 
presents a deeper shade of green. The yellow fever bile presents a golden 
color in thin layers and when added to water. Whilst haemorrhage occa- 
sionllay occurs in the gall-bladder in yellow fever, I have never witnessed 
this remarkable condition in malarial fever; neither have I ever observed 
the entire absence of bile and the replacement of this secretion by an 
albuminous fluid in malarial fever. 
GALL-BLADDER IN MALARIAL FEVER. 
GALL-BLADDER IN YELLOW FEVER. 
Gall bladder.-The gall-bladder in yellow fever is, as a general rale, 
contracted, flaccid, small, and contains little or no bile. The amount of 
bile generally does not exceed 100 grains. Tn malarial fever, on the other 
hand, tbe gall bladder is, as a general rale, distended with dark, greenish 
black bile. In yellow fever the vomiting is rarely bilious, unless in the 
commencement of the disease, and the black vomit contains little or no 
biliary matter. The small intestines are rarely, if ever, discolored by bile 
in yellow fever, whilst in malarial fever it is common to find the gastro- 
intestinal mucous membrane discolored by bile. I have observed cases in 
which the gall bladder contained only a serous liquid coagulable by heat. 
In two cases, a decided haemorrhage had taken place into the gall bladder, 
which was distended with black blood. The bile in yellow fever contained 
numerous cells from the mucous membrane of the gall bladder, and casts of 
the hepatic ducts. 
Spleen.-The complexity and difficulty of pathological inquiries are 
again illustrated, by the different views which prevail with reference to the 
offices of the spleen. Whilst Gerlach, Virchow, and Bennet, consider the 
PATHOLOGICAL ANATOMY OF THE SPLEEN IN MALARIAL FEVER. 950 
Pathological Anatomy of the Spleen in Malarial Fever. 
spleen as the birthplace of the colored corpuscles, Kolliker, Ecker, Beclard 
and Gray, consider it the organ in which the blood-corpuscles die and are 
disintegrated. The difficulty of settling this question definitely, is 
increased by the equivocal and uncertain results of comparative anatomi- 
cal investigations, and of physiological experiments. If the function of the 
spleen be that of the formation and destruction of the blood-corpuscles, it 
is reasonable to suppose that it should be much larger in warm than in cold- 
blooded animals, because the number of the blood-corpuscles is greater, 
and all the changes of the elements of the fluids and solids much more 
rapid in the former than in the latter. To determine this point, I ascer- 
tained accurately the weights of the bodies and spleens of cold and warm- 
blooded animals.* The following table presents a condensed view of the 
results, the accuracy of which I have confirmed again and again, by numer- 
ous dissections and comparison of the spleen in the different classes of 
animals. 
Comparative Weights of the Spleens of Animals. 
Number of times 
the weight of 
its spleen. 
FISHES. 
Weight of the body of Trygon sabina (stingray), female 292 
il " Trygon sabina (stingray), foetus 1016 
" " Zygsena malleus (hammerhead shark) 601 
" " Zygsena malleus (hammerhead shark) 443 
" " Lepisosteus osseus (garfish) 587 
" " Lepisosteus osseus (garfish) 599 
Number of times 
the weight of 
its spleen. 
REPTILES. 
Weight of the body of Rana catesbiana (bullfrog) 2279 
" " Heterodon niger (black viper 25666 
" " Psammophis flagelliformis (coachwhip snake) 6426 
" " Coluber guttatus (corn snake) 9600 
" " Coluber constrictor (black snake) 7285 
" " Crotalus adamanteus (rattlesnake) 15450 
" " Alligator Mississippiensis (alligator),'male 1319 
" " Alligator Mississippiensis (alligator), female.. 798 
" " Chelonia caretta (loggerhead turtle) 2201 
" " Chelonura serpentina (snapping turtle) 800 
" " Emys terrapin (salt-water terrapin) 7958 
" " Emys reticulata (chicken terrapin) 965 
" " Emys serrata (yellow-bellied terrapin) 1618 
" " Emys serrata (yellow-bellied terrapin) 1125 
" " Testudo polyphemus (gopher) 2575 
" " Testudo polyphemus (gopher) 3600 
BIRDS. 
Weight of the body of Meleagris gallopavo (wild turkey) female 1538 
" " Meleagris gallopavo (wild turkey), female 2625 
" " Pious erythrocephalus (red-headed woodpecker).. 2120 
" " Tantalus loculator (wood ibis) 3579 
" " Tantalus loculator (wood ibis) 2044 
" " Syrnium nebulosum (barred owl) 1470 
" " Cathartes atratus (black buzzard) 1228 
MAMMALS. 
Weight of the body of Didelphis virginianus (opossum) 418 
" , " Common sheep 590 
* "Investigations, Chemical and Physiological, relative to certain American Vertebrata, 
by Joseph Jones, M. I)., Smithsonian Contribution to knowledge, July, 1856, pp, 116-122. Pathological Anatomy of the Spleen in Malarial Fever. 
951 
Weight of the body of Sciurus carolinensis (gray squirrel) 682 
" " Sciui us capistratus (fox squirrel) 919 
" " Cervus virgiuinnus (foetus of deer) 283 
" " Cervus'virginianus (foetus of deer) 350 
" " Mus rattus (rat just born) 498 
" " Mus rattus (rat just born) 505 
" " Mus rattus (rat half grown) 506 
" " Lepus sylvaticus (common rabbit) 1494 
" " Procyon lotor (raccoon), female 343 
" " Procyon lotor (raccoon), female 292 
" " Procyon lotor (raccoon), female 391 
" " Procyon lotor (raccoon just born) 156 
" " Pointer dog, male 577 
" " Common cat, female 522 
These tables show that the spleen is smallest in birds and ophidians, 
and largest in fishes and mammals. The temperature of birds is high, 
their blood-corpuscles numerous, their life actions vigorous, and the phys- 
ical and chemical changes of the elements of their fluids and solids cor- 
respondingly rapid. In fishes, circulation and respiration are sluggish, 
the blood corpuscles few in numbers, the temperature low, the metamor- 
phosis of the elements of their structure slow, and the intellect and all the 
life actions correspondingly feeble. If the function of the spleen be the 
construction, destruction, and elaboration of some of the important ele- 
ments of the blood, why is it so small and insignificant in birds, and of 
such great relative magnitude in many cold-blooded animals? Is it possi- 
ble that an organ, which, in many ophidians, chelonians, and birds, weighs 
only a few grains, or a small fraction of a grain, can exert any important 
influence upon the physical properties and chemical constitution of the 
blood? Do not these facts show conclusively that we do not understand 
the functions of the spleen? 
Mr. Gray* supposes that one office of the malpighian corpuscles is to 
store up nutritive matter when there is a surplus of alimentary mate- 
rials, to be restored again to the blood when there is a deficiency of these 
elements. It is, however, difficult to conceive how nutritive matter of any 
importance could be stored up in the malpiphian corpuscles of organs 
weighing a few grains, or only fractions of a grain. The amount accumu- 
lated in such organs would be microscopic in its character, and not much 
more than the hundredth part of a grain. Even in warm-blooded animals 
the amount of albuminous compounds contained in the malpighian corpus- 
cles of the spleen is insignificant, and unworthy of notice, when compared 
with that contained in the circulatory apparatus, the capacious reservoir, 
of the nutritive materials. The circulatory apparatus of an adult man 
contains about twenty pounds of blood, whilst the malpighian corpuscles 
of the spleen are capable of containing only a few grains. Would nature 
construct an organ, an important office of which would be to store up a 
few grains of nutritive matter, whilst the circulatory system contains more 
than ten thousand times the amount? 
My observations show that the increase of the spleen during active 
nutrition noticed by Mr. Gray in cats, rabbits and rats, is by no means a 
universal phenomena in the animal economy. The spleens of ophidians 
and saurians and chelonians did not diminish in weight more rapidly than 
the other organs and tissues, and the spleens of salt-water terrapins {emys 
terrapin), and of yellow-bellied terrapins Cernys serrata), which had been 
starved and deprived of water for a great length of time, and then trans- 
ferred to a tub of water and abundantly supplied with vegetable food, did 
*The Structure and Use of the Spleen, by Henry Gray, F. R. S. London. 1854. 952 
Pathological Anatomy of the Spleen in Malarial Fever. 
not exhibit any increase in weight. I have also observed, in numerous 
instances, that the spleen of cold-blooded animals does not act as a diverti- 
culum for any surplus water or nutritive materials in the circulatory appa- 
ratus. The spleens of many carnivorous chelonians, whose circulatory 
apparatus was so filled with blood, consequent upon a change of diet, that 
aqueous albumino-saline effusions took place into the cellular tissue, and 
all the cavities presented no increase in size or weight. The spleens of 
ophidians, which are voracious and swallow large masses of flesh, were 
not enlarged, notwithstanding the large amount of nutritive substances 
which were received into their circulatory apparatus. 
That the spleen is an organ of subordinate importance in the animal 
economy will be shown by the following facts: It is absent from all inver- 
tebrate animals without exception. It is also absent from the amphioxus, 
the connecting link between fishes and the higher forms of the mollusca. 
Thespleen of birdsand reptiles is too small to exert an important influence in 
the animal economy. Its size corresponds in no manner with the number 
of colored blood corpuscles, or the rapidity of the composition and decom- 
position of the organic and inorganic elements of the solids and fluids of 
animals. The function of the spleen is not essential to the maintenance of 
life, for it has been excised by numerous observers, without the death of 
the animal, or any manifest alterations in the blood or organs, or any 
diminution of the forces. 
On the other hand, that the spleen has some important office to perform 
in the animal economy, is shown by the fact that in the amphioxus and 
invertebrate animals, which are devoid of spleens, the blood-corpuscles 
are colorless. The occurrence of the spleen is accompanied by a change in 
the color of the blood. The question immediately arises, has the spleen 
anything to do with the production of the red blood-coi puscles of ver- 
tebrate animals? The blood of the invertebrata, with its corpuscles, exists 
before the formation of any special organs; and the same fact is noticed in 
the development of the foetus of warm blooded animals; a vascular system 
circulating a fluid containing colored blood-corpuscles exists before the 
formation of any special organs; and hence it is probable that the spleen 
has little to do with the formation of the corpuscles and the production of 
their red color. This question cannot, however, be settled by an appeal to 
comparative anatomy, or by extirpation of the spleen, because it is more 
than probable that other organs possess the power of performing the offices 
of the spleen when it is absent. 
Besides these facts in comparative anatomy, the microscopical exam- 
inations of the pulp of the spleen by Oesterlin, Remak, Handfield Jones, 
Kolliker, Ecker, Beclard and Gray, and the comparative analysis of the 
blood entering in the spleen, and of that passing out of these organs, 
render it highly probable, if not absolutely certain, that one of the most 
important offices of the spleen is the destruction of the colored blood- 
corpuscles. As, therefore, our knowledge of the functions of the spleen is 
not as extensive or as definite as the requirements of exact science demand, 
we should exercise caution in the construction of theories with reference 
to the effect of pathological alterations of the spleen in diseases. 
The following table confirms the statements of numerous observers 
that the spleen is enlarged in malarial fever: 
WEIGHT OF THE SPLEEN IN MALARIAL FEVER. Pathological Anatomy of the Spleen in Malarial Fever. 
953 
Weight of the Spleen in Malarial Fever. 
Avoirdupois lAvoirdupois 
Troy 
grains. 
pounds. 
ounces. 
( 3,062 
Weight of the spleen in its normal condition 
4 to 
( 2,187 
Case of intermittent fever in latter stages of 
phthisis 
14J 
6,343 
" remittent and typhoid fever 
1 lb. 2 ozs. 
18" 
7,920 
" remittent fever 
1 " 15 " 
31 
13^562 
" remittent fever 
1 " 13 " 
29 
12,687 
Two years after attack of remittent fever..... 
1 " 141 " 
301 
13 343 
Case of remittent fever 
1 " 2| " 
18| 
s'093 
" congestive fever 
13J 
5^895 
" congestive fever 
1 " 13 " 
29 
12'687 
" congestive fever 
1 " U " 
17j 
7,562 
This table shows that in seven cases of malarial fever, terminating in 
the active stages, the spleen was enlarged; the enlargement, however, was 
not so great as in those cases exposed to a longer action of the malarial 
poison. In such cases the spleen is often greatly enlarged, and can be 
often felt during life as a hard mass occupying a considerable poition of 
the abdominal cavity. Cases are recorded where the spleen has been said 
to weigh twenty pounds. I have found the spleen of those who died in 
the active stages of malarial fever not only enlarged but softened, and 
filled with dark brownish-purple and brownish-red mud. The malarial 
spleen presents upon the exterior a dark slate color; and the trabeculae 
and capsule appear to be completely altered in structure, so much altered 
in many cases that the slightest touch is sufficient to rupture them. I have 
seen the structures of the spleen in malarial fever so much disorganized that 
in attempting, even in the most careful manner, to remove this organ from 
the abdominal cavity the trabeculae have given way under slight pressure 
and the fingers plunged into its soft substance. 
The dark brownish purple mud (pulp and extravasated blood) of the 
spleen is composed, in great measure, of colored blood-corpuscles, altered 
in various degrees, according to the length of the attack, and which have 
lost the power of changing to the arterial hue when exposed to the oxygen 
of the atmosphere. In many cases, especially those of long standing, the 
pulp and extravasated blood (mud) of the spleen abounds in dark reddish- 
brown, and reddish-black granules and conglomerated granules, resem- 
bling the dark particles found in the malarial liver, and in the sediment of 
the black-vomit of yellow fever. Similar bodies, but apparently in less 
abundance, are found in normal spleens. In cases which have terminated 
fatally, after only a short illness of two or three days, these bodies, result- 
ing from the disintegration of the colored blood-corpuscles, were not so 
numerous as in cases of longer duration, and in some very recent cases, 
they were not more numerous than in the spleen of health. We will now 
illustrate the changes of the spleen in malarial fever, bj cases of varying* 
duration. 
In a case of malarial fever of the congestive type, of only for^y-three hours' 
duration, the spleen was slate-colored, softened, and enlarged; not as much 
softened and altered, however, as in cases of malarial fever of longer stand- 
ing. The mud of the spleen was of a dark purplish hue, and appeared to be 
in transition tothe color and state of the mud of the spleens of malarial fever 
of longer duration. After exposure for a few hours to the oxygen of the 
atmosphere, a large portion of the mud of the spleen assumed a color 954 
Pathological Anatomy of the Spleen in Malarial Fever. 
approaching the arterial hue; much brighter than the mud of the spleens 
upon which malarial fever had exerted irs full effects, and somewhat darker 
than the bright arterial hue, assumed by the splenic pulp of healthy nor- 
mal spleens. When the mud was spread in thin layers upon a glass slide, 
the change of color was much more rapid. Under the microscope, the 
splenic mud appeared to consist almost entirely of colored corpuscles, many 
of which appeared swollen and altered in appearance. After careful exam- 
ination, I was unable to find those conglomerations of black granules, resem- 
bling the black sediment of black-vomit, which were discovered in the 
spleens of malarial fever of longer standing. 
The spleen of a. stout Irish seaman, who died from an attack of congestive 
fever, fifty hours after the first appearance of disease, was enlarged, softened, 
disorganized, and of a dark slate-color ; and when pressed gently between 
the fingers, the trabeculae could be felt giving way. The cut surface pre- 
sented a dark, purplish-brown color; from the cut surface issued a dark, 
purplish-brown mud. After eight hours' exposure to the atmosphere 
small streaks, inclining to an arterial hue, appeared upon the cut surface 
of the spleen, and probably were due to the change in the blood which 
issued from the divided vessels. These streaks of splenic mud, inclining 
to the arterial hue, occupied but an inappreciable fraction of the whole 
surface. When the dark mud (effused blood) was examined under the 
microscope, it was found to consist chiefly of colored and colorless cor- 
puscles, and the cells peculiar to the spleen. Some of the colored cor- 
puscles were swollen and altered in shape ; the alteration was by no means 
universal or remarkably great. This spleen contained, as usual in malarial 
fever, animal starch. 
The spleen of an American seaman, who died of congestive fever seventy 
hours after the first appearance of disease, was enlarged, softened, and of the 
dark slate-color usual in malarial fever. When the mud of the spleen was 
exposed to the atmosphere, a part retained the dark-purplish and reddish- 
brown color; whilst another smaller portion changed to an arterial hue. 
The difference between these two portions of the splenic mud was clearly 
seen when a section of the or gan was exposed for several hours to the action 
of the atmosphere. The other portion of the mud of the spleen did not 
change its color. This phenomenon was, without doubt, due to the fact 
that the blood had been but recently effused into the spleen. The portions 
first effused had lost the power of changing to the arterial hue; whilst those 
last effused had not entirely lost their power. 
The spleen of an Irish laborer, ivho died suddenly in a, congestive chill, 
which had been preceded for three or four days by an apparently mild attack of 
intermittent fever, was slate colored, enlarged, softened, and disorganized, 
and could not be removed from the abdominal cavity without rupture of 
its capsule and trabeculae. The capsule and trabeculae appeared to be so 
altered in structure that the slightest touch was sufficient to rupture them. 
After careful washing under a stream of cold water the trabeculae, as usual 
in malarial fever, presented a red color. The mud of the spleen was of a 
dark reddish and purplish-brown color, and consisted principally of col- 
ored blood-corpuscles, which did not change to the arterial hue during fifty 
hours' exposure to the oxygen of the atmosphere. The mud and fibrous 
tissue of the trabeculae and blood-vessels of this spleen contained animal 
starch. 
The spleen of a large, stout German laborer, who died of congestive fever, 
supervening upon an attack of malarial fever of four days' continuance, was 
enlarged and disorganized, and presented a dark slate-color. To the touch 
the spleen felt like a sack filled with a viscid fluid. The capsule was torn Pathological Anatomy of the Spleen in Malarial Fever. 
955 
upon the slightest exertion of force. Whilst gently lifting the spleen, to 
sever its attachments and lift it out of the abdominal cavity, the capsule 
was torn off for the space of several inches, and my fingers, which grasped 
the organ, plunged through the disorganized trabeculae and pulp. When 
the spleen was laid upon tiie table and pressed, the mud within was forced 
into other portions, and the indentation remained, thus showing that the 
cells of the spleen communicated freely with each other. The spleen was 
filled with a substance resembling purplish-black mud. This splenic mud 
was very thick, and dried rapidly when spread upon glass slides. Under 
the microscope, this was found to consist principally of colored blood-cor- 
puscles. Many of the colored blood-corpuscles presented an altered 
appearance. In some cases the color appeared darker than normal, Many 
of the corpuscles were swollen; whilst others were corrugated. That the 
colored corpuscles had undergone some change was conclusively demon- 
strated by the fact that the color of this splenic mud did not alter during 
thirty.six hours' exposure to the oxygen of the atmosphere. The splenic 
mud also contained numerous dark granules and granular masses. The 
number of colorless corpuscles was apparently diminished. This diminu- 
tion was in all probability relative and not absolute; they appeared to be 
diminished relatively to the immense number ol colored blood-corpuscles. 
The spleen of an Irish seaman, ivho died ten days after the onset of remittent 
and congestive fever, was of a dark slate-color, and enlarged, softened, and the 
capsule and trabeculae gave way when pressed gently between the fingers. 
When first removed, the mud of the spleen coagulated very slightly; the 
coagulum possessed no consistency and no permanence. When the pulp 
and extravasated blood of the spleen were examined under the microscope, 
it was found to consist of colored and colorless blood-corpuscles, and 
numerous dark, black granules. These granules were frequently con- 
glomerated together, forming dark flakes, like the coffee-ground sediment 
of the black vomit of yellow fever. Many of the colored corpuscles appeared 
swollen. 
The spleen of an Irish laborer, who died two weeks after an attack of inter- 
mittent fever from congestion of the brain, was enlarged, softened, and of a 
light slate-color. The pulp of the spleen was of a purplish and reddish- 
brown color, and changed to the arterial hue upon exposure to the atmos- 
phere. 
The spleen of an Irish baker, who died during convalescence from remittent 
fever during an attack of pleuropneumonia, was slate-colored, enlarged, and 
softened. The pulp of the spleen was firmer than that of recent cases of 
malarial fever, and although it changed to the arterial hue more slowly 
than the pulp of healthy spleens, the change of color was much greater 
than that of the pulp of the spleen in the active stages of malarial fever. 
The spleen of a house painter, who had died in convulsions three tveeks after 
an attack of remittent fever, was enlarged and softer than normal, but much 
harder than usual in the active stages of malarial fever. The cut surface 
presented a compact, dark brown, almost black appearance. Numerous 
small white bodies, about the size of millet-seed, were found scattered 
through the pulp of the spleen. I had never before seen the splenic cor- 
puscles so numerous, large and distinct. The exterior of the spleen was of 
a slate color. The compact nature of the pulp of this organ shows that it 
was recovering from the effects of malarial fever. 
The spleen of a German butcher, who suffered with intermittent fever two 
months, without medical treatment, and. whose disease at the end of this time 
assumed the congestive type, and although relieved of the immediate effects of 
the malarial poison, fell a victim, after three weeks of the most intense and 956 
Pathological Anatomy of the Spleen in Malarial Fever. 
loathsome suffering, to the complete disorganization of the solids and fluids, 
resulting from the pathological alterations induced by the malarial poison 
during the period when it pursued its course unchecked; presented profound 
alterations. This organ was enlarged; surface covered with effused coagula- 
ble lymph, and bound to the liver and diaphragm by bands of coagulable 
lymph. A large quantity of pus, of a greenish-yellow color, issued from 
the anterior border of the spleen, which was firmly attached to the liver. 
Whether the abscess had opened and discharged the pus before death, or 
whether the abcess was accidentally ruptured during the opening of the 
chest and abdomen, I was unable to determine. 
The structure of the spleen felt firm, very unlike the soft yielding 
structure of the spleen of the active stages of malarial fever. When cut, 
many portions of the spleen resembled a dark bronzed and slate colored 
liver. The pulp of these portions was not soft, and did not pour out like 
the pulp of the spleen of the active stages of malarial fever. 
The liver-like substance of the spleen was found to consist under the 
microscope of fibrous tissue, and numerous colored corpuscles and flakes, 
composed of granules resembling the dark colored flakes of the black 
vomit of yellow fever. These flakes were without doubt derived from the 
coloring matter of the colored blood-corpuscles. The colorless corpuscles 
of this portion of the spleen appeared to be more numerous than usual. 
This dark liver-like substance appeared to be nothing more than the 
extravasated blood and the pulp of the spleen, effused and altered during 
the active stages of the fever, from which the serum had in a great meas- 
ure been removed, and in which alterations of the colored corpuscles have 
taken place, and fibrous tissue formed. After several hours' exposure to 
the oxygen of the atmosphere, the color of this portion of the spleen was 
not altered. In addition to the abscess opening upon the surface of the 
spleen attached to the liver, the substance of the spleen contained numer- 
ous smaller abscesses of various sizes (two or three of the largest were of 
the size of a bullet, and the smallest of the size of an English pea), filled 
with thick greenish-yellow pus. Portions of the spleen, especially sur- 
rounding the abscesses, were altered into a cheese-like substance. Under 
the microscope, these cheese-like portions consisted almost entirely of pus- 
corpuscles, and large cells containing granules and other smaller cells, and 
also black masses composed of granules, and also numerous oil globules. 
The large mother cells, resembling cancer-cells, were not numerous. The 
pus issuing from the large abscess resembled ordinary pus under the micro- 
scope, and contained a few of these peculiar cancer-like cells. The spleen of 
an American, who died from the formation of heart clots, consequent upon 
structural disease of the heart and liver, and ivho had suffered with an attack of 
malarial fever two years previous to his death, whilst residing upon the Ogee- 
chee river, in a low, miasmatic situation, was enlarged and indurated, and 
presented a purplish-red color. When pressed in the hand it felt dense 
and firm. When cut or torn, the color and structure resembled that of 
healthy spleens in all respects, except that it had a much larger quantity 
of fibrous tissue. The pulp of the spleen absorbed oxygen readily when 
exposed to the atmosphere, and changed to a bright scarlet color. The 
pulp of the spleen presented nothing peculiar under the microscope. Did 
not discover those black flakes and granules which were so abundant in 
the spleen of the patient previously described. This spleen contained 
animal starch. It is reasonable to suppose that the enlargement and indu- 
ration of this spleen were the effects of the previous attack of malarial 
fever. During the active stages of the fever the spleen was engorged with 
blood, softened, and the trabeculae in many places ruptured. When the. Pathological Anatomy of the Spleen in Malarial Fever. 
957 
action of the malarial poison ceased, the serum of the extravasated blood 
was removed, and the ruptured trabeculae repaired, and numerous bands 
of fibrous tissue formed throughout its substance. Finally, the colored cor- 
puscles of the extravasated blood were disintegrated and removed. 
These cases demonstrate that the alterations of thespleen occur amongst 
the first pathological effects of the malarial poison. The gradual enlarge- 
ment of the spleen in the bodies of those inhabiting malarious districts, 
without any distinctly marked febrile symptoms, shows that these altera- 
tions of the spleen may precede the active symptoms, and those disturb; 
ances of the nervous system attending the cold and hot stages of malarial 
fever. 
These cases demonstrate that the alterations of the spleen in malarial 
fever are of the most decided and serious character. The spleen might be 
readily ruptured, either by violent exercise or by blows, or even by rough 
handling, during the active stages of malarial fever. 
An immense number of colored blood corpuscles are destroyed in the spleen 
during the active stages of malarial fever. The effused colored corpuscles are 
gradually disintegrated; their haematin appears as dark granular masses, 
which are gradually altered physically and chemically, passing through 
several shades of color, and are finally eliminated. The serum of the 
effused blood is also removed; fibrous bands or trabeculae are formed 
through the extravasated blood, the capsule is thickened, and gradually 
the organ becomes firm and assumes its normal structure and offices. 
The cause of the peculiar pathological alterations of the spleen in 
malarial fever appears to depend upon the alterations of the blood and 
circulation, which produced similar congestions in the brain and liver, 
and upon the peculiar anatomical structures of the spleen. We have 
before shown that the fibrin of the blood is diminished and altered in mala- 
rial fever, and that the relations between the general and capillary circu- 
lations, and between the constituents of the blood and the walls of the ves- 
sels, are disturbed, and that the chemical changes upon which the capillary 
circulation depends are perverted and diminished, and that the action of 
the heart is greatly disturbed. Here, then, wre have causes sufficient to 
account for the stagnation of the blood in the important organs of the 
trunk, and especially in the spleen, on account of its anatomical relations 
to the other organs of the abdomen, the absence of valves in the splenic 
veins, and their communication with the intercellular spaces of the spleen- 
pulp. Mr. Gray has shown that many of the capillary vessels are not 
directly continuous with the veins, but that the blood, in passing from one 
set of vessels to the other, traverses intercellular spaces in the spleen-pulp, 
and that the veins in many cases commence in intercellular spaces. 
If these views are correct, it follows as a necessary consequence that the 
pathological alterations of the spleen in malarial fever are not the result of inflam- 
matory action. 
The red color of the trabeculae, after the pulp has been washed out, 
has nothing to do with inflammation, and is the result of the action of the 
coloring matter of the disintegrated blood-corpuscles, and is analogous in 
all respects to the staining of the endocardium and large vessels by imbi- 
bition of haematin, in many diseases entirely unaccompanied by inflam- 
mation. 958 
Anatomy of the Spleen in Malarial and Yellow Fever. 
ENGRAVING NO. 102. 
Engraving No. 102.-Illustration of changes of the blood, liver and spleen in malarial fever. 
Pigment matters from the portal veins.* A. From the trunk of the vessel. The epithelium of 
this lining membrane containing black pigment, andsome of thecells with a distinct rounded or 
spindle shaped nucleus; the younger cells were colored reddish-brown; normal blood-corpuscles. 
B. Cylindrical scales containing pigment. C. Fragment of black pigment, enveloped in a hya- 
line substance, from the splenic vein. The pigment exists in abundance in the blood of malarial 
fever, and particularly in that portion of it contained in the portal vein. The usual form in 
which the pigment makes its appearance, is that of small, rounded or angular granules, which 
are sharply defined or surrounded by a brownish or pale margin. These granules are occasionaly 
isolated, but more frequently several of them are connected together ingroups, by a pale sub- 
stance soluble in acetic acid and in caustic alkalies. In form they are rounded or elongated sausage 
shaped or irregularly branched. They have no defined membranous outline; the hyaline con- 
nectingsubstance which presents the characters of fibrinous matter, forms sometimes a broad,, 
and sometimes a narrow rim, without any sharply defined outline. True pigment cells are 
observed along with the granules and granular masses, though in somewhat smaller quantity. 
These part ly resemble in form and size the colorless corpuscles of the blood, and partly consist of 
large spindle, or club-shaped cells, with rounded nuclei, and sharply defined walls, like the cells 
with few granules, in the spleen. These also contain a greater or smaller number of black gran- 
ules. Besides the forms just described, larger fragments of pigment are observed, which, for the 
most part, have an irregular form, and upon pressure look as if they had been broken off from 
still larger masses. Sometimes these fragments appear to be cylindrical, and are bounded late- 
rally by two straight parallel lines; whilst their extremities are irregularly broken off, so that 
they remind one of the appearance of the smaller vessels of which they appear to be casts. Their 
size is not unfrequently considerable. Usually surrounded by rim of pale transparent substance. 
COMPARATIVE PATHOLOGICAL ANATOMY OF THE SPLEEN IN MALARIAL 
FEVER AND IN YELLOW FEVER.-MALARIAL FEVER. 
Spleen.-Enlarged, softened and loaded with altered blood-corpuscles 
and pigment granules; of a dark slate color upon the exterior; the blood 
of the spleen does not change to the arterial hue upon exposure to the 
atmosphere. In many cases the spleen is so soft that it ruptures when the 
attempt is made to remove it from the cavity. When the splenic mud is 
subjected to microscopical examination it is found to contain numerous 
pigment granules of various sizes, and pigment cells, many of which 
resemble the colorless corpuscles in size, whilst others are much larger and 
contain oval nuclei and resemble certain palmellie. 
Plate 12, figure 48, represents the appearance of the spleen in malarial 
fever. The figure is only one-fourth the size of the spleen from which the 
drawing was made. Figure 47 represents the appearance of spleen (section) 
in a case of pyaemia, following hospital gangrene. The deposits character- 
istic of pyaemia are well shown in the central yellow mass. The deposits 
were yellow and cheese-like, which, under the microscope, consisted of 
numerous cells, some of which were caudate and spindle-shaped, also 
numerous granules and oil globules. (See Surgical Memoirs of the U. S. 
Sanitary Commission, p. 415.) 
Plate 12, figure 49, represents the microscopical appearance of the 
splenic mud of malarial fever. Figure 50, splenic mud of pernicious 
malarial fever. 
* Diseases of the Liver. Frerich, vol. 1, p. 321. Atlas, Plate ix, Figure 2. Anatomy of the Spleen in Malarial and Yellow Fever. 
959 
Plate 9, figure 34, represents the appearance of the splenic mud in a 
case of yellow fever engrafted on malarial fever. E. Griffin, 1876. 
The changes of the spleen in malarial fever are referable, to a certain 
extent, to the peculiar relations of the organ to the blood-vessels and to 
the circulation; the blood, after passing through the various branches of 
the splenic artery and the limited system of capillaries which are associated 
with it, this liquid is not received at once into venous trunks, as in other 
parts of the body, but is poured directly into the pulp tissue, in which it 
circulates under conditions which vender it liable to stagnation and undue 
accumulation before it is taken again into well defined vessels, through 
the open walls of the cavernous veins. These conditions, naturally unfa- 
vorable to undisturbed and vigorous circulation, are aggravated by the 
association of the splenic with the often interrupted portal circulation. 
From the preceding anatomical arrangement, the spleen is more liable to 
variations in size than any other organ of the body; and, in serving as a 
blood filter, it is especially susceptible to the influence of deleterious 
materials and morbific agents, and micro-parasites which gain access to 
the blood. 
In acute cases of the various forms of malarial fever which terminate 
fatally in the active stages, the organ is hypersemic and enlarged, and 
sometimes the seat of numerous circumscribed haemorrhages. In this con- 
dition the capsule is distended by the dark colored altered blood; the entire 
organ presents a dark blue and black color, and feels to the touch like a 
bag containing soft mud. The distension may be so great as to lead to 
rupture of this organ, involving not merely the parenchyma, but also the 
capsule. In such cases extensive and fatal haemorrhage may take place 
into the abdominal cavity. The ease with which blows, falls, or even the 
jolts of rough vehicles might induce rupture of the spleen in the acute 
stages of malarial fever is showji by the fact that in some cases after death 
the capsule parenchyma and trabeculae of this organ are frequently rup- 
tured in the attempt to remove it from the abdominal cavity, and the hand 
plunges through the capsule and grasps the yielding dark grumous blood. 
Without doubt this condition of the spleen indicates a grave form of mala- 
rial fever, and may in some cases be one of the causes of death. 
Without doubt hypersemia of the spleen exists to a greater or less extent 
in every case of malarial fever; and the successive occurrence of the con- 
gestions of the various paroxysms may lead to a great increase of this 
organ. I have seen these enlarged spleens filling the left hyperehondriac 
region, the epigastric, umbilical, hypogastric and left lumbar and iliac 
regions. In some cases this organ has weighed thirty pounds. In such 
cases of enlarged spleen, when the lesion has existed for some time, there 
is thickening of the capsule trabeculae and reticular framework. The 
repeated congestions of the spleen in malarial fever produce chronic hyper- 
aemia with chronic interstitial splenitis. The active congestion of the 
spleen in malarial fever is, in many cases, with difficulty differentiated 
from acute inflammation of this organ, and is often associated with it. 
The spleen is enlarged, the capsule tense; on section, the pulp is soft, dark 
red in color, often swelling out from the cut surface, and concealing the 
glomeruli and trabeculae; the cavernous veins are distended with blood, and 
the interstices of the pulp infiltrated with a large number of colored and 
colorless corpuscles and pigment granules and pigment cells, and an increase 
in the cells which characterize acute inflammation or hyperplasia of the 
spleen. Embolic infarctions of the spleen are of comparatively infrequent 
occurrence in the various forms of malarial fever. 960 
Pathological Anatomy of the Spleen in Yellow Fever. 
The increased size of the spleen in the acute hyperplastic splenitis of 
infectious diseases is in all cases a secondary lesion, and is due in part to 
the hyperaemia; in part to the swelling and increase of the number of 
cells, of the pulp and glomeruli; large multinucleated cells; cells resem- 
bling the ovoidal and polyhedral cells of the pulp, but larger and with 
divided nuclei; cells resembling leucocytes; and large and small cells in a 
state of fatty degeneration, or containing pigment. The elongated cells 
lining the cavernous veins are swollen and incr eased in numbers; and large 
cells containing bodies, looking somewhat like red globules, are observed. 
The increased size of the spleen in malarial fever is also due to the presence 
in the organ of blood pigment, and of the altered blood corpuscles which 
have been attacked by the malarial micro-organism. 
In the chronic indurative splenitis of malarial fever, which follows 
gradually upon the acute hyperaemia of hyperplastic splenitis, there is a 
new formation of connective tissue in the nature of an hyperplasia. Chronic 
indurative splenitis is always associated with more or less extensive 
changes in the parenchyma, and is most marked in chronic malarial poison- 
ing, and may be found, not only in those who have suffered from repeated 
attacks of the ague, but also in those who have resided in malarial regions, 
but have never manifested acute symptoms of malarious disease. In the 
enlarged and indurated malarial spleen {ague cake} the capsule is thick- 
ened, and the consistency of the organ increased. The color may be light 
red, brownish-red, or deep purple inclining to black. The cut surface in 
like manner presents various shades in different cases ; the glomeruli may 
be scarcely visible or very prominent; the trabeculae are in some cases 
nearly concealed by the pulp, in others they are large, prominent and 
abundant; so that the surface is crossed in all directions by an interlacing 
network of broader and narrower bands, between which the red or brown or 
blackish pulp lies. The microscopical appearances of the spleen are varied 
in this condition of chronic indurative splenitis; in one class of cases there 
is more or less hyperplasia of both pulp and interstitial tissue; the paren- 
chyma cells are increased in size and number; the lining cells of the cavern- 
ous veins are swollen; the reticulum of the pulp, of the glomeruli and of 
the trabeculae is thickened. In some cases the thickening of the trabecular 
and reticular tissue, either uniformly or in patches, is the prominent fea- 
ture, whilst the changes in the pulp are secondary and atrophied. Irregu- 
lar pigmentation is frequent, the pigment particles being deposited either 
in the cells of the pulp or glomeruli, or in the new-formed interstitial 
tissue. 
The alterations of the spleen in leukaemia and psuedo leukaemia, appear 
to be microscopically essentially the same as acute hyperplasia and in 
chronic interstitial splenitis. In some cases of protracted anaemia and 
malarial cachexia, the spleen is atrophied; this change being largely due 
to the decrease in number of the parenchymatous cells of the pulp. Amy- 
loid degeneration of the spleen is seldom or never witnessed as the result 
of the action of the malarial poison. 
SPLEEN IN YELLOW FEVER. 
Spleen.-As a general rule, but slightly enlarged. In many cases, 
normal in size and appearance. In many cases of yellow fever the spleen 
is neither enlarged nor softened, nor altered in appearance, either upon 
the exterior or within. There appears to be no special alteration or destruc- 
tion of the colored corpuscles in the spleen of yellow fever, as in that 
of malarial fever. The enlargement of the spleen in fevers] does not, Pathological Anatomy of the Kidneys in Malarial Fever. 
961 
from these observations, depend upon the diminution of the fibrin, because 
this element of the blood is diminished to a much greater extent in yellow 
fever than in malarial fever, and at the same time the spleen is enlarged to 
a greater and more marked degree in the latter. Another fact worthy of 
consideration in this connection is, that in yellow fever, the blood-corpus- 
cles are not specially diminished in amount, whilst in malarial fever they 
are rapidly destroyed, and this destruction appears to be greatest in the 
liver and spleen. In malarial fever both these organs are loaded with the 
altered blood-corpuscles, and with the pigment granules resulting from the 
alterations of the colored corpuscles, whilst neither the spleen nor the liver 
in yellow fever affords any evidence of alteration of the colored blood- 
corpuscles. 
MALARIAL FEVER. 
Pancreas.-We have been unable to detect any alteration in the pan- 
creas peculiar to malarial fever. 
Supra-renal bodies.-Frequently discolored, of a dark brownish hue, 
from the deposits of melanotic or pigment particles, around the cortical 
and medullary cells and capillaries. No accumulation of oil has been 
observed in these bodies in malarial fever. 
SUPRA-RENAL BODIES-MALARIAL FEVER. 
SUPRA-RENAL BODIES-YELLOW FEVER. 
Supra-renal bodies.-These bodies appear to be subjected to similar 
changes with the liver and hear t, and oil is incr eased in amount, in the cells 
of the cortical and medullary substance. 
PATHOLOGICAL ANATOMY OF THE KIDNEYS IN MALARIAL FEVER. 
Kidneys.-In several cases of malarial fever, and in two which had 
yielded suddenly in the earliest stages, the kidneys presented slate-colored 
spots, which presented a bronze color upon section to the depth of one- 
fourth to one eighth of an inch. Microscopical examination demonstrated 
that the black granules were present in these bronzed portions, and that 
the structures of the kidney were altered in a recognizable manner. We 
have previously considered the bearing of this fact upon the slate and 
bronze color of the liver. The relations of the action of the malarial poison 
and of the various forms of malarial fever in the production of those dis- 
eases of the kidneys which are known most generally under the term 
Bright's disease of the kidney, demand the most careful and thorough 
investigation. This field is, to a large extent, unexplored, and American 
medical literature may be said to be almost barren of carefully recorded 
observations illustrating the pathological changes of the kidneys as induced 
by the action of the malarial poison. Whilst systematic and theoretical 
writers upon the "Theory and Practice of Medicine," are searching for 
the alleged increase of Bright's disease, in the use of some article of food, 
and more especially in "canned vegetables, meats and fruits," and in artifi- 
cially prepared glucose, it would be well for them to execute careful chemi- 
cal, anatomical, microscopical, physiological and pathological investiga- 
tions in the more enlarged field, embracing the effects of endemic and 
epidemic, non-contagious and contagious morbific agents on the kidneys, 
and the production of Bright's disease, or the group of diseases included 
under this general head. 962 
Pathological Anatomy of the Kidneys in Malarial Fever. 
Has Bright's disease of the kidney increased during the last fifty 
years? This question cannot be answered, because the attention of the 
medical profession was not directed to this disease, or group of diseases, 
until about the year 1836, or about fifty years ago. Before the description 
of the pathological lesions of the kidneys characterized prominently by 
albumen in the urine, and general anasarca, these symptoms, as well as 
the deaths resulting from lesions of the kidneys, were recorded under the 
general head of dropsy. As we well know at this time, dropsy is a mere 
symptom of one or more diseased states, and not the disease. Thus dropsy 
may be due to four causes : 
1st. Anaemia. 
2d. Structural diseases of rhe heart. 
3d. Diseases of the liver, and more especially cirrhosis. 
4th. Disease and structural alteration of the kidneys. 
Anaemia is characterized by diminution of the colored blood-corpus- 
cles, thin watery blood, diminished muscular and nervous forces, relaxation 
of the tone of the vessels, which states precede and lead to general anasarca. 
Obstructions to the proper and regular circulation of the blood lead to 
excessive arterila and venous pressure, congestion of the liver, lungs, 
spleen and kidneys, and general anasarca. Structural alteration of the 
liver, leads to portal obstruction, congestion of the intestinal vessels, 
increased pressure on the abdominal blood-vessels, transudation of the 
watery elements of the blood into the abdominal cavity, and ascites. Struc- 
tural alterations of the kidneys lead to impaired elimination of the water of 
the blood charged with such excrementitous products as urea, uric acid, 
phosphoric and sulphuric acid, and the extractive and coloring matters. 
Increased blood pressure, combined with the retention of the water and 
excrementitious matters, lead ultimately to general anasarca. 
Malarial fever is characterized by periodic hypenemia, congestion of 
the internal organs and more especially of the liver, spleen and kidneys. 
We have seen that serious anatomical changes result in the hepatic struc- 
tures from the oft-recurring periodic congestions of the cold stages charac- 
teristic of all the various forms of malarial fever. It is not philosophical 
to suppose that the kidneys should escape unharmed during the periodic 
congestions of malarial fever. 
We have sought upon many occasions to determine the relations of 
"Bright? s disease" in its origin to the action of the malarial poison. The fol- 
lowing observations and historical researches will illustrate the nature and 
objects of our labors: 
IN GENERAL ANAEMIA AND ANASARCA CAUSED BY THE PROLONGED ACTION 
OF THE MALARIAL POISON, THE KIDNEYS NOT NECESSARILY INVOLVED, 
AND IN MANY CASES, ALBUMEN IS ABSENT FROM THE URINE. 
We have observed a large number of cases of malarial fever, accom- 
panied with general anasarca in which albumen was absent from the 
urine. Pathological Anatomy of the Kidneys in Malarial Fever. 
963 
MALARIAL, PAROXYSMAL, ENDEMIC, NON-CONTAGIOUS FEVERS TREATED IN 
THE WARDS OF THE CHARITY HOSPITAL OF NEW ORLEANS, UNDER 
THE CARE OF JOSEPH JONES, M. D., 1869-1886. 
Malarial, Paroxysmal, Endemic, Non-Contagious Fever. 
c 
'ases. Deaths 
Intermittent fevers, including quotidian, tertian and quartan 
2,327 
5 
Remittent malarial fever v... 
Pernicious congestive malarial fever, including the comatose, algid 
other varieties (.a larsre proportion of the cases were brought into 
247 
7 
the hospital in a moribund condition) 
Chronic malarial poisoning (malarial toxaemia cachexia), with various 
complications, as enlarged liver and spleen, contracted liver and 
87 
56 
hardened spleen, anaemia anasarca 
212 
14 
Malarial haematuria 
12 
6 
Total malarial, endemic, non-contagious fevers 
Per cent, of deaths in the various forms of malarial fever, 3.05. 
Ratio of deaths in 1000 cases of the various forms of malarial fever, 
One death in 32.8 cases of the various forms of malarial fever. 
2,885 
30.5, 
88 
Of the 212 cases of malarial cachexia accompanied with general ana- 
sarca, only a comparatively small number presented symptoms of paren- 
chymatous inflammation of the kidneys; and those cases in which the 
disease of the kidneys was the most prominent symptom, were entered 
on the clinical record under the head of Diseases of the Kidneys. Dur- 
ing the period of medical service in the Charity Hospital specified-January, 
1869, to April 1, 1886-the following statistics relate to diseases of the 
kidneys: 
Diseases of the Kidneys. 
Bright's disease of the kidneys 
Acute nephritis 
Cases. Deaths. 
80 
2 
20 
1 
Diabetes niellitus 
3 
1 
Diabetes insipidus 
2 
Renal calculus 
1 
Total diseases of the kidneys 
88 
22 
Hepatic derangements are far more common during the progress of 
malarial diseases than distinct and permanent lesions of the kidneys; yet 
in the effort to present a truthful and comprehensive statement of the 
results of hospital service, we have included under the head of the Diseases 
of the Liver and Spleen only those cases in which the lesions of these 
organs cover the most prominent symptoms. The following are the results 
of hospital service during the period of time specified: 
Hepatitis 
Cases. 
.... 24 
Deaths. 
6 
Hepatitis and abscess of liver 
.... 12 
7 
Cirrhosis of liver, with ascites and anasarca of lower extremities... 
.... 31 
21 
Adenoma and cirrhosis of liver 
.... 1 
1 
Jaundice 
.... 10 
... 
Fatty degeneration of liver 
.... 3 
... 
Amyloid degeneration of liver 
.... 1 
... 
Hydatids of liver 
... 1 
1 
Tuberculosis of liver 
.... 1 
1 
Obstruction of common bile duct and jaundice 
... 1 
1 
Total diseases of liver 
.... 85 
38 
Diseases of the Liver. 964 
Pathological Anatomy of the Kidneys in Malarial Fever. 
Splenitis 
Cases. 
2 
Deaths. 
Hypertrophy of spleen 
1 
Leucocythsemia 
1 
i 
Total diseases of spleen 
4 
i 
Diseases of the Spleen. 
The difficulty of expressing by mere statistics the effect of various 
febrile poisons in the causation of lesions of such organs as the liver, spleen 
and kidneys is well shown by the following observations relating to the 
preceding record. The cases recorded as jaundice did not express the num- 
ber of cases presenting this symptom, for almost every case of yellow fever, 
and a large number of the various forms of malarial fever, as well as some 
cases of hepatitis, cirrhosis of the liver and pneumonia, were jaundiced. 
Every case of prolonged malarial fever presented more or less hepatic 
derangement and enlargement of the spleen, but the cases presenting the 
said derangements were included under the head of the original malarious 
diseases. 
Careful chemical and microscopical examinations of the urine of numer- 
ous cases of malarial fever of all the various grades and varieties and 
stages, in private and hospital practice (the cases examined amount to 
more than two thousand), have convinced the author that albuminuria, 
with granular casts occur in a certain proportion of cases, and that paren- 
chymatous inflammation of the kidneys, albuminuria and fatal anasarca, 
anaemia and cardiac failure may result from the action of the malarial 
poison. This proposition is in part sustained by the following cases and 
facts: 
Case No. 1085.-Bright's Disease of the Kidney, Complicated by Malarial 
Fever. 
John Fred, native of Germany; aged 41; height 5 feet 5J inches; weight 140 
pounds in health. Broad shoulders, dark hair and eyes. Came to United States 
in 1854. Resided in Illinois up to 1862, and had chills and fever in 1859; and in 
1861 lost the toes of both feet by frostbite. Came to Louisiana in 1862. During the 
winter and spring and summer of 1875 and 1876 worked as a laborer on a plantation 
on the banks of the Mississippi, above Carrollton. In August, went below the 
city and labored in the swamps, cutting willow boughs for the gabions of Ead's 
jetties. Was taken sick September 18th, 1876, with chill and fever, in the swamp. 
Was greatly depressed during his labors, working in the water and mud up to his 
knees. Had chills, followed by high fever, every other day. Patient states that 
he observed the swelling of his' feet three or four days after the first appearance of 
tkiG fever. 
Entered Charity Hospital, ward 29, bed 428, October 18th, 1876. October 24th, 
18T6. Pale, anaemic, sallow hue. Belly greatly distended with liquid. Features 
swollen and bloated. Lower extremities oedematous. Thighs, legs and feet dis- 
tended with dropsical effusion, pitting freely on pressure. The superficial veins 
of the abdomen are not visible and do not present the congested and arborescent 
appearance characteristic of cirrhosis of the liver. No apparent enlargement or 
obstruction of circulation in the liver. Action of heart feeble, but normal and 
without any recognizable murmur. Great oedema of lungs and oppression of 
breathing. Percussion revealed partial dulness; and upon auscultation, loud 
mucous and sibillant rales were heard over both lungs. The rales and oppressed 
breathing were referred to oedema of the pulmonary textures. Urine contains 
albumen and casts. The ascites and anasarca were referred to disease of the 
kidneys. 
October 25th, 10 o'clock A. M. Condition unchanged. Amount of urine passed 
during 24 hours, October 24th, 10 o'clock A. M., to October 25th, 10 o'clock A. M., 
1200 cubic centimetres. Specific gravity 1015. Acid reaction; reddish-orange color. 
Heat and nitric acid revealed the presence of albumen. Under the microscope the 
deposit in the urine was found to consist of numerous hyaline casts of the tubuli 
uriniferi, and lozenge-shaded crystals of uric acid, of a deep reddish-yellow color. Pathological Anatomy of the Kidneys in Malarial Fever. 
965 
1200 c.c. of urine contained- 
Grains. 
Urea 378.84 
Uricacid . 12.00 
Chloride of sodium 101.64 
Sulphuric acid 22.95 
Phosphoric acid 9.24 
Albumen (anhydrous) ; 54.00 
October 26th. Condition not improved. Difficulty of respiration increasing. 
Patient cannot lie down. (Edema of face and extremities increasing. Amount 
of urine passed during 24 hours 900 c.c. The amount of urine has diminished 300 
c.c. during the last 24 hours, and with this diminution there has been a marked 
increase of the ascites and anasarca, and the difficulty of respiration. Pulse and 
respiration greatly accelerated, but there has been no increase of temperature, 
Urine, orange colored and turbid from the presence of hyaline casts of the tubuli 
unniferi and crystals of uric acid. Specific gravity 1016. Reaction acid. 900 c.c. 
of urine excreted during 24 hours (October 25th, 16 o'clock A. M., to October 26th, 
10 o'clock A. M.,) contained- 
Grains. 
Urea 284.13 
Uric acid 
Chloride of sodium 100.88 
Sulphuric acid 24.70 
Phosphoric acid . 7.70 
Albumen (anhyrdous) 40.50 
From this date the urine progressively diminished in amount, and the pulmo- 
nary oedema progressively increased, as well as the difficulty of respiration. The 
patient could obtain no rest nor sleep, neither by day nor by night. Was com- 
pelled to sit up all night panting for breath. The pulse became very rapid and 
feeble, 120, 130 per minute. The temperature in the axilla oscillated from 98.°5 to 
101° F. Cream of tartar and jalap freely administered appeared to produce no 
perceptible diminution of the ascites and anasarca. 
October 31st. Great oppression in breathing, which has steadily increased since 
the first observation. This great aggravation of the pulmonary oedema and oppres- 
sion of breathing has been accompanied by a marked diminution of the urinary 
excretion, which has fallen from 1200 c.c. October 24th and 25th, to 360 c.c. October 
30th and 31st. 
Amount of urine passed during twenty-four hours, October 30th, 10 A. M., to 
October 31st, 10 A. M., 360 c.c. Sp. gr. 1024. Red color. Resembles urine contain- 
ing colored blood-corpuscles; but none of these bodies were discovered in the urine 
by the microscope. Urine turbid when passed: and upon standing lets fall a copi- 
ous deposit of hyaline casts and crystals of uric acid. 360 c.c. of urine, excreted 
during twenty-four hours, contained- 
Grains. 
Urea 252.83 
Uric acid 
Chloride of sodium 16.13 
Sulphuric acid 26.74 
Phosphoric acid 
Albumen (anhydrous) 10.80 
I extracted, by means of cut-cups, five fluid ounces of blood over region of the 
kidneys. The patient occupied the sitting posture whilst the cut-cups were applied 
to the back in the lumbar region, as he was unable to assume the recumbent posi- 
tion, on account of the great oppression of breathing. He experienced great relief 
during the operation, and broke out in a profuse sweat. 
The blood presented a scarlet hue. Coagulum firm. Under the microscope 
the blood-corpuscles ran together, forming rolleaux as in the blood of inflammation. 
Blood-corpuscles of deep color and clear outline. A few pigment granules and 
colorless corpuscles containing granules were observed. 
1000 parts of blood contained- 
Water . 850.27 
Solid matters 149.73 
Fixed saline constituents 8.07 966 
Pathological Anatomy of the Kidneys in Malarial Fever. 
1000 parts of serum contained- 
Water 925 47 
Solid matters 74.53 
Saline matters 7.27 
1000 parts of blood contained- 
Water 850.27 
Colored blood-corpuscles 77.83 
Fibrin 2.64 
Albumen 68.26 
Saline constituents 8.07 
The following purgative and diuretic pill was ordered : B. Quiniae sulph. $j; 
pulv, digitalis, grs. v; extract colocynth, extract jalapae; gambogae, extract rhei; 
extract alloes, aa grs. iv. Mix : Divide into 15 pills. Sig. two pills every 6 hours 
if necessary. 
November 1st. The cut-cups and purgative pills appear to have accomplished 
good results. Patient much relieved, and was able to lie down during the night 
for the first time in six days. Urine turbid when first passed from the presence of 
casts of the tubuli uriniferi and lozenge-shaped crystals of uric acid. Spermatozoa 
were also observed in the urine. Penis and scrotum greatly distended, with drop- 
sical effusion. Patient affirms that he has lost all sexual appetite. Specific gravity 
of urine 1017. Strong acid reaction. Amount of urine passed during twenty-four 
hours after the application of the cut-cups, 780 c.c. 780 c.c. of urine passed during 
twenty-four hours, October 31st to November 1st, 1876, contained- 
Grains. 
Urea 444.44 
Uric acid 
Chloride of sodium . 30 03 
Sulphuric acid 22.00 
Phosphoric acid 
Albumen 7.80 
November 2d. Continues to improve. Bowels have been freely evacuated. 
Urinary excretion increasing in amount. Amount of urine passed during twenty- 
four hours, November 1st, 10 A. M., to November 2d, 10 A. M., 1720 c.c. Sp. gr. 
1012. Light orange color. Acid reaction. With the increase in the amount of 
the urine excreted, the oedema of the lungs has diminished, and the breathing has 
become easy and regular. Heart carefully examined; nothing abnormal observed. 
1720 c.c. of urine excreted during twenty-four hours, contained- 
Grains. 
Urea 608.88 
Uric acid 
Chloride of sodium 139.79 
Phosphoric acid 
Sulphuric acid 31.85 
Albumen Trace. 
The patient had been placed upon a tonic and diuretic mixture as follows : 
B. Tinct. buchu, uva ursi, cinchonae, quassise, al f^ij; mix. Sig. Tablespoonful 
three times a day. 
November 3d. Continues to improve. Amount of urine passed during twenty- 
four hours, Nov. 2d, 10 A. M., to Nov. 3d, 10 A. M., 1550 c.c. Light color. Heavy 
deposit of urates and casts of tubuli uriniferi. Sp. gr., 1011. Acid reaction. 
1550c.c. of urine excreted during twenty-four hours, Nov. 2d to Nov. 3d, 10 A. M., 
contained: 
Grains. 
Urea 381.30 
Uric acid . 3.10 
Chloride of sodium 71.51 
Sulphuric acid 16.28 
Phosphoric acid 27.77 
Albumen Trace. 
Continued to improve, Nov. 28th, 1876. Pathological Anatomy of the Kidneys in Malarial lever. 
967 
Tabular Statement of the Pulse, Respiration and Temperature of John Fred. 
Pate. 
Pulse. 
Respiration. 
Temperature. 
1876. 
M. 
E. 
M. 
E. 
M. 
E. 
October 20 
90 
24 
100° 
October 21 
92 
24 
98° 
October 22 
October 23 
100 
88 
27 
24 
98°.5 
October 24 
106 
26 
99° 
October 25 
86 
82 
24 
22 
96°.5 
96°.5 
October 26 
99 
91 
25 
24 
96° 
96° 
October 27 
121 
37 
94° .2 
October 28 
119 
98° 
October 29 
120 
108 
44 
22 
99°.5 
100° 
October 30 
121 
44 
October 31 
124 
30 
101°.75 
November 1 
104 
36 
100° 
November 2 
108 
28 
98°. 5 
The paroxysmal character of this case is illustrated by the preceding data. The 
case left my medical service in the Charity Hospital, declaring that he felt entirely 
relieved; we have no data with reference to the subsequent history of John Fred. 
Case No. 1086.-Bright's Disease. Convulsions; coma; death; clots of blood found 
in left ventricle. Patrick Lynch; native of Ireland; laborer; age 38. Admitted into 
Wardol, bed 453, November 1st, 1877. Urine loaded with albumen, and containing 
casts. Appeared to be benefitted by cream of tartar and tincture of iron, and the 
dropsical effusion into the abdominal cavity and into the cellular tissue of the lower 
extremities was somewhat diminished. On January 11th, 1878, this patient vom- 
ited and suddenly became comatose with stertorous breathing. He continued in 
this condition until January 12th, 10 o'clock A. M., when he died. Post-mortem 
eight hours after death: Body oedematous; abdominal cavity filled with serous 
fluid. Brain appeared to be somewhat softer than normal, but this may have been 
due to an excess of fluid. The left lateral ventricle contained a clot of blood about 
the size of a pigeon's egg. The heart, lungs, liver and spleen were normal; kidneys 
hard, granular and contracted. 
Case 1087.-Intermittent Fever of three years duration General Anasarca, 
Ascites, Albuminuria, Pulmonary (Edema, Pneumonia of right lung, Pleuritis of 
right lung, Pericarditis, Death.-Peter Dally, age 40; native of Ireland; occupation 
stone-mason and brick-layer and laborer. Has been in America twenty-one years. 
Has resided the greater portion of this time in New York and California. Has 
been in Louisiana three years; has been working on plantation near Baton Rouge. 
Has had chills and fever for three years. Says that the chills were severest in the 
fall and winter seasons. About the 21st of September. 1876, whilst picking cotton, 
observed swelling of his legs, but he kept on working, being exposed to the rains 
and to the heavy dewsand fogs of the morning. Upon the appearance of the drop- 
sical swelling the chills and fever disappeared. Suffered with headache and ring- 
ing noises in his head. The swelling gradually increased, and invaded the belly, 
about two weeks before his entrance into the Charity Hospital, ward 13, bed 185, 
December 1st, 1876. At the time of his entrance, general anasarca. Upper and 
lower extremities distended with dropsical effusion and pitting upon pressure. The 
legs and thighs resemble shapeless pillars. Scrotum and penis greatly distended 
with dropsical effusion. Belly greatly distended with dropsical effusion, and 
appeared to contain about two gallons. The walls of the abdomen were in 
like manner oedematous and pitted deeply on pressure. Great oppression of 
breathing, as well from the effusion of the abdominal cavity, which compressed 
and embarrassed the diaphragm, as from the oedema of the lungs themselves. 
Trunk, thorax, upper extremities and face oedematous. OEdema greatest in right 
arm and hand; countenance swollen and oedematous; face congested and of a 
more ruddy hue than usual in prolonged malarial poisoning. Palpation revealed 
the fact that the liver was greatly enlarged, extending through the right hypo- 
chondriac, epigastric and left hypogastric regions and encroaching upon the right 
lumbar and the umbilical regions. Spleen enlarged. Heart sounds normal, but 
feeble and irritable. Urine high colored and scant; red color, high sp. gr., with 
heavy deposit of urates on standing, and contained albumen. 
Diagnosis-Enlargement and induration (cirrhosis) of liver, enlarged spleen, 
Bright's disease of kidney, general anasarca.-Cause : Prolonged action of mala- 
rial poison, exposure to cold and wet, and the free use of alcoholic stimulants. 968 
Pathological Anatomy of the Kidneys in Malarial fever. 
Age 40 years; medium height, well proportioned; dark complexion; full black 
beard and hair. In health weighs about 150 pounds. Emigrated to United States 
twenty-two yearsago, and enjoyed excellent health until he came to Louisiana in 
1873. Since that time has been farming, raising cotton, on low, swampy lands, 
often getting wet while in the field. Has suffered ever since his arrival in Louisi- 
ana, with chills and fever, for the cure of which he used quinine. This agent 
arrested the malarial fever for various periods, but the disease returned again and 
again. Admitted to the Hospital immediately upon his arrival in the city. 
During the first ten days pulse and respiration not much accelerated, and 
temperature of axilla normal. Abdomen so distended that the patient is unable 
to walk. Great soreness all over the body. Great tenderness upon pressure in the 
right hypochondriac and epigastric regions. Bowels constipated. Urine dark, 
scant, and contains albumen. The following was administered with marked ben- 
efit: R. Pulv. digitalis; gambogse, scillse, extract rhei, colocyntb, aloes, aa gr. 
ss., quinia sulph. grs. ii. Mix: ft. pill No. 1. One to two of these pills three 
times a day. These pills produced watery stools, and increased the flow of the urine. 
The diuretic and purgative effects of these pills were promoted by the use of 
cream of tartar largely diluted. December 10th. Urine passed freely, of a very 
dark porter color, with an abundant reddish-yellow deposit, which disapears upon 
the application of heat, showing the deposit to consist of urates; by increasing the 
heat a dense white coagulum of albumen is formed. 
December 15th. Urine light brown; 1600 c.c. excreted. Sp. gr. 1018. No sed- 
iment; albuminous. Patient very weak. Great dyspuoea. Slight dullness upon per- 
cussion over both lungs. Mucous rales in both lungs; troublesome cough. December 
17th. The patient had a chill, and his temperature, which upto the present time 
had remained stationary at 98.°5, rose to 104°. On the morning of the 18th right 
lungcongested; dull upon percussion; expectorates rusty, colored and bloody mucous. 
Tubular breathing ,and loud mucous rales over large bronchial tubes of right lung. 
Date. 
Pulse. 
Respiration. 
Tem. 
M. 
of Axilla. 
E. 
M. 
E. 
M. 
E. 
December 18 th 
124 
120 
34 
40 
103° 
104° 
19th 
110 
120 
30 
28 
100° 
102° 
20th 
100 
120 
26 
28 
100. °5 
103.°3 
21st 
102 
30 
100° 
December 21st. Right lung entirely solidified. Great prostration. Pulse rapid 
and irregular. Respiration hurried; cough during the last four days very dis- 
tressing. Patient suffers with dyspnoea and experiences great difficulty in talk- 
ing. Lower lobe of left lung involved iu pneumonic inflammation. 
Tabular view of Pulse, Respiration and Temperature of Pally. 
Date. 
Pulse. 
Respiration. 
Temperature'. 
Remarks. 
M. 
E. 
M. 
E. 
M. 
. E. 
December 1.. 
.... 86 
26 
100° 
2.. 
... 88 
24 
98 
3.. 
4.. 
.... 80 
22 
98 
... 
5.. 
.... 88 
24 
99 
6.. 
.... 86 
22 
99 
7.. 
8.. 
9.. 
... 92 
22 
98.5 
10.. 
.... 94 
28 
100 
11.. 
99 
12.. 
99 
13.. 
100 
28 
98.5 
14.. 
100 
28 
98.5 
15.. 
100 
28 
98.5 
16.. 
100 
24 
98.5 
17.. 
100 
28 
99. 
Had a chill at night. 
18.. 
....124 
120 
34 
40 
103 
104 
Pneumonia right lung. 
19.. 
....110 
120 
30 
28 
100.5 
102 
Pneumonia right lung. 
20.. 
....100 
120 
26 
28 
100 
103.25 
High fever; quite exhaust- 
ed; pulse rapid; respira- 
tion hurried and embar_ 
rassed; too weak tospeak. 
cough and bloody expec' 
toration. Pathological Anatomy of the Kidneys in Malarial Fever. 
969 
' Date. 
Pulse. 
Respiration. 
Temperature. 
Remarks. 
M. 
E. 
M. 
E. 
M. 
E. 
December 21... 
...102 
104 
30 
36 
100 
100.5 
22... 
...106 
100 
30 
36 
100 
101.5 
23... 
...120 
120 
32 
32 
97 
100 
24... 
...110 
120 
28 
28 
98 
99.5 
25... 
... 
20 
20 
97 
26... 
Died December 26, 1 A. M. 
The post-mortem examination revealed the characteristic lesions of chronic 
malarial poisoning. The liver was of a dark bronze color, and under the micro- 
scope numerous pigment granules and cells were observed. The structures of the 
kidneys revealed the presence of diffused parenchymatous nephritis involving the 
secretory structures and connective tissue. The sections of the kidneys examined 
microscopically revealed the presence of the remains of numerous circumscribed 
haemorrhages. 
Amount of urine passed during twenty-four hours, December 4th, 9 oclock, 
A. M. to December 5th, 9 o'clock, A. M., 1876, 725 c.c. Heavy deposit of urates 
soluble by heat. Casts and urates. Albumen. Heat and nitric acid produce a 
heavy deposit. 725 c.c. of urine excreted in twenty-four hours, color, deep red, 
acid reaction. Sp. gr. 1025. Heavy deposit of urates. 
Grains. 
Urea 378.61 
Uric acid 10.15 
Phosphoric acid 9,76 
Sulphuric acid . 14.57 
Chloride of sodium 11.13 
Albumen (yellow color). 43.50 
Amount of urine passed during twenty-four hours, December 5th, 10 o'clock, 
A. M., to December 6th, 10 o'clock, A. M. 910 c.c. Red color. No deposit. 
Loaded with albumen. Sp. gr. 1022. Reaction acid. 910 c.c. of urine excreted in 
twenty-four hours, contained- 
Grains, 
Urea 448.44 
Uric acid 10.92 
Phosphoric acid 17.51 
Sulphuric acid 50.86 ' 
Chloride of sodium 56.05 
Albumen (yellow color) 47.32 
Patient improving, swelling greatly reduced, difficulty of breathing diminished. 
Amount of urine passed during twenty-four hours, December 11th, to Decem- 
ber 12th, 9 o'clock, A M., 1100 c.c. Deep orange color. Sp.gr. 1015. Reaction 
acid. 1100 c.c. of urine excreted in twenty-four hours, contained- 
Grains. 
Urea 372.68 
Chloride of sodium 124.52 
Albumen . 34.10 
Increase of urine referable to action of squill and digitalis. Amount of urine 
passed December 14th, 9 o'clock, A. M., to December 15th, 9 o'clock, A. M., 1600 c.c. 
Sp. gr. 1013. Reaction acid. Very light orange color. No deposit when first 
passed; slight turbidity; from casts, upon standing deposit of urates and casts. 1600 
c.c. of urine excreted during twenty-four hours, December 14-15th, contained- 
Grains. 
Urea 469.60 
Chloride of sodium 147.84 
Albumen 33.60 
Amount of urine passed during twenty-four hours, December 15th, to Decem- 
ber 16th, 9 o'lock, A. M., 2980 c.c. Yellow color. Sp. gr. 1011. Acid reaction. 
Upon standing deposit of urates and hyaline casts. Urine slightly turbid when 
first passed. After standing let fall heavy deposit of urates. With the increased 
action of the kidneys, under the action of squills, digitalis, quinine and purga- 
tives, and tartrate of potassium, the swelling has greatly diminished; the belly is 
now flaccid and the enlarged liver can be more distinctly felt, and its dimensions 
Urine and Blood. 970 
Pathological Anatomy of the Kidneys in Malarial Fever. 
more accurately defined. 2980 c.c. of urine excreted during twenty-four hours, 
contained- 
Grains. 
Urea 596.59 
Chloride of sodium 183.56 
Albumen , 14.90 
The patient has a good appetite and nourishes well. The increased amount of 
nourishment taken is evidenced by the increase in the chloride of sodium. The 
patient walks about and insists upon going out to smoke his pipe. This imprudence 
has been refused. 
December 18th. Had a severe chill during the night of December 17th, 
between 11 and 12 P. M. There has been a marked change in the weather, which 
is quite cold. Patient states that during the chill and during the succeeding hot 
stage, the kidneys were very active. December 18th, 8 o'clock, A. M. Face flushed, 
bright red spots upon both cheeks as in pneumonia. Troublesome cough with 
expectoration of thick muco-purulent matter streaked with blood. There has been 
a marked diminution of the swelling of the abdomen, and of the lower extremi- 
ties, which are nearly reduced to the normal size. Mucous rales, and harsh respi- 
ration, with prolonged inspiration and expiration over both lungs. Right lung 
greatly congested and very dull upon percussion. Crepitant rale heard over lower 
lobes of right lung. Has fever, pulse 124; temperature of axilla 103.°. Renewed 
purgatives, also ordered fivegrains of quinine every two hours until twenty grains 
are taken. 
December 19th. Fever declining. Pulse, 110; temperature, 100.°. Respira- 
tion embarassed. Expectorates muco purulent matter with rusty colored matter or 
streaks of blood. Right lung flat upon percussion, with tubular'breathing. Pneu- 
monia well defined. 
Examination of blood.-Abstracted blood over region of liver, and lower lobe 
of right lung-below right nipple-about four ounces. Coagulum firm. Under the 
microscope the blood was found to contain many dark granulesand dark masses of 
hsematin, about four times the size of the colorless corpuscles, and also colorless 
corpuscles filled with dark granules as in the blood of malarial fever. 
1000 parts of blood contained- 
Water....................................................................................834.31 
Solid matters 165.69 
Saline matters 9.30 
1000 parts of serum contained- 
Water 937.40 
Solid matters 62.60 
Saline matters 5.70 
Fibrin in 1000 parts of blood 6.12 
1000 parts of blood contained- 
Water 834.31 
Colored blood-corpuscles 103.86 
Fibrin 6.12 
Albumen and extractive matters 55.71 
Fixed saline constituents 9.30 
We observe in the following analysis a marked diminution of the colored blood- 
corpuscles, and as in the dropsy of the marsh cachexia, a marked diminution of the 
albumen of the blood. On the other hand, the fibrin is increased, manifestly from 
the existence of pulmonic inflammation. The action of the malarial poison is also 
evident in the presence of the altered blood-corpuscles. Amount of urine passed 
December 18th, 9 A. M.. to December 19th, 9 A. M-, 950 c.c. Deep red color. Sp. 
gr. 1018. Reaction acid. Urine contains hyaline casts of tubuli uriniferi, cells of 
excretory tubes, granular tubes with oil globules, cells from pelvis of kidneys, and 
uretres and mucous membrane of bladder. These last organic bodies were evi- 
dently due to the absorption and stimulating action of the oil of turpentine, 
applied as stupes over the region of the right lung. 950 c.c. of urine excreted 
during twenty-four hours, December 18th to 19th, 1876, contained- 
• Grains. 
Urea 408.63 
Chloride of sodium - 51.21 
Albumen 20.90 Pathological Anatomy of the Kidneys in Malarial Fever. 
971 
We observe a marked diminution of the chloride of sodium, with the super-* 
vention of the pulmonic inflammation. 
Amount of urine passed December 19th, 9 A M., to December 20th, 9 A. M., 
1075 c.c. Deep red color. Contains blood. Sp.gr. 1020. Reaction acid. Heavy 
deposit of urates. Hyaline and granular casts and colored blood-corpuscles. 1075 
-c.c. of urine excreted during twenty-four hours, December 19th to December 20th, 
h A. M., contained- 
Grains. 
Urea 496.47 
Chloride of sodium 50.36 
Albumen 6.45 
PRESENCE OF ALBUMEN IN THE URINE OF MALARIAL FEVER AND THE 
DEPOSIT OF PIGMENT IN THE KIDNEYS IN MALARIAL CACHEXIA. 
Exact observations should be instituted to determine the conditions 
under which albumen occurs in the urine in the various forms and stages 
of malarial fever. The inquiry should also embrace the minute anatomy 
-of the kidneys in fatal cases of malarial fever. It will be observed that 
the malarial poison is characterized not merely by the periodicity of its 
acticn, but also by its power of producing both circumscribed and general 
hyperaemia and haemorrhages of the glandular organs. We observe the 
effects of hyperaemia and of circumscribed haemorrhages in the kidneys, as 
manifested by the deposit of pigment. As proof, we adduce the following 
illustration and observations: 
ENGRAVING NO. 103. 
Engraving No. 103.-Illustrating malarial melaneemia. Glomerulus of kidney, with its cap- 
sule reflected. Numerous pigment scales are seen in the interior of the capillaries.* The kidneys 
are frequently altered in structure and deranged in functions in malarial melaneemia. The 
larger pigment cells and granules which enter these organs, along with the arterial blood, not 
infrequently become impacted in the capillary coils of the malpighian bodies, and, by altering 
the pressure of the blood, give rise to derangements in the secretion of the urine, which exercise 
a powerful influence over the further progress of the disease. It has been affirmed by Ererichs that 
albuminuria makes its appearance to an extent which varies with the quantity of pigment found, 
in the kidneys. In the cases where this fever has presented a distinctly intermittent type, and 
where, as in quartan fever, thj intermissions have been of considerable duration, Frerichs has 
observed during each paroxysm a great increase in the albuminous contents of the urine, and 
during the intermissions a marked diminution, or a complete disappearance of them. The albu- 
minuria is frequently simple, and then the process may last a long time without leading to inti- 
mate structural changes in the kidneys. But in ot her cases fibrinous matter-fibrinous casts- 
including pigment masses and granules, of 'he same nature as those found in the blood, pass off 
in the urine along with the albumen. We have recorded cases in which bloody urine was 
excreted. Complete suppression of the urinary secretion is of frequent occurrence. 
* Diseases of the Liver,, Frerieh's Atlas, plate xi„ page 5. See also,pp. 330-354. 972 
Pathological Anatomy of the Kidneys in Malarial Fever. 
w In the account of a post-mortem of malarial coma, held by Dr. W. J. 
Councilman and Dr. A. C. Abbott, of Baltimore, Maryland,* the epithe- 
lium of the convoluted tubules of the kidneys was swollen and granular, in 
many cases entirely tilling the lumen. There was a slight degree of small 
cell infiltration around the glomeruli and in other places. 'Ihe staining 
of the nuclei of the convoluted tubules was often diminished in consequence 
of the extremely granular condition of the protoplasm. A considerable 
amount of pigment was found in the vessels of the glomeruli, and in vessels, 
of larger calibre, which were seen in cross section. This pigment was all 
contained in large cells. None of the small hyaline bodies found in the 
brain and liver were found in the kidneys. In another case reported by 
Drs. Councilman and Abbott the kidneys were of ordinary size, capsule in 
some places adherent, so that in pulling it off portions of the kidney sub- 
stance were torn away with it. Tissue of the kidneys firmer than normal, 
cortex slightly diminished in thickness. In the kidneys the epithelium 
of the convoluted tubules was swollen and granular. On examination with 
high powers the epithelial cells in many places were found to be converted 
into large granular masses, in which there was no trace of a nucleus. This, 
change was confined solely to the convoluted tubules. Immediately beneath 
the capsule and in a few other places some of the glomeruli were shrunken 
and converted into fibrous masses. In other places there was only a thick- 
ening of the capsule of the glomerulus. This change was by no means 
general in the kidney; in most places the glomeruli were completely 
unchanged; at two or three points there was a considerable amount of 
small cell infiltrations. Numerous casts were found both in the tubes of 
Henle and in the collecting tubes. The pigmentation of the tissues was 
most evident even under a very low power. The pigment seemed to be 
distributed in the kidneys with more irregularity than in any other organ 
examined. It was found in the blood-vessels, in the effused blood at one 
or two points of hemorrhage, and especially in the glomeruli. It was both 
free and enclosed in large cells. The small hyaline masses were not 
observed. 
According to Dr. Fried. Theod. Frerich,f in cases where the secre- 
tion of albumen and fibrinous matter has lasted for a long time along 
with intermittent fever, and after its cessation, alterations of comparative 
insignificance have been found in the kidneys. Numerous flat, scarred 
depressions have been observed on the outer surface of the organ, but no 
distinct granulations. In some cases there has been lardaceous degene- 
ration. 
In fifty-one cases of intermittent fever, observed by Frerichs, in Bres- 
lau, attended with the marked development and deposit of pigment in the 
liver, cutis, brain, spleen and kidneys, twenty four were acute, and twenty- 
seven chronic. Four forms of the disease were distinguished. I. Cases with 
predominant brain symptoms. II. Cases in which the kidneys are pre- 
eminently implicated. III. Cases with predominant derangement of the 
gastro-intestinal tract, and of the appertaining glands, but particularly of 
the liver. IV. In a fourth group we may include those forms in which 
the local derangements are not very conspicuous, and do not influence essen- 
tially the further progress of the disease, but when the anaemia and hydrae- 
mia, resulting from affection of the spleen, constitute the most important 
morbid conditions. The pigment contained in the blood is here of subor- 
dinate importance, inasmuch as its quantity and characters do not give rise 
to extensive lesions of the capillary circulation; it is productive of no- 
* Am. Jour. Med. Sci., April, 1885, p. 41C-129. 
f A Clinical Treatise on Diseases of the Liver, vol. 1, p. 331, p. 333. Acute and Chronic Malarial Nephritis.. 
973 
injurious consequences, provided we succeed in checking the anaemia. Of 
the fifty-one cases thirty-eight terminated fatally, and thirteen in recovery. 
Some brain symptoms, such as delirium, convulsions, coma, etc., occurred 
twenty-eight times out of the fifty-one cases; in seven of these cases there 
was no deposit of pigment in the brain; in two cases there was haemorrhage 
in the cerebral membranes along with the pigment; and there was one case 
of cysticercus cerebro. Out of the fifty-one observations, albuminuria was 
found in twenty cases, in two of which there was haematuria, and in five 
suppression of urine; albuminuria occurred without any pigment in four 
cases, whereof two were instances of lardaceous degeneration of the kid- 
neys; in five cases pigment could be detected where there had been no 
albumen in the urine, but the quantity was scanty. In seventeen of the 
fifty-one observations there was profuse diarrhoea, and five of these were 
cases of dysentery; profuse intestinal haemorrhage was seen three times. 
Jaundice was presentineleven cases, but was always slight; bile-pigment 
also was observed in the serous effusions of the pleural cavities without 
any distinct coloring of the skin and urine. In all the cases which termi- 
nated fatally, the liver contained a quantity of pigment; in ten it appeared 
enlarged and congested, and in eight atrophied; in nine cases the cells con- 
tained much oil; lardaceous matter could be detected in three cases, but 
only in small quantity. Except in one case pigment was always found in 
the spleen; three times this organ was lardaceous; and in thirty cases its 
volume exceeded the usual limits. 
STRUCTURAL ALTERATIONS AND PATHOLOGICAL ANATOMY OF THE KID- 
NEYS IN ACUTE AND CHRONIC MALARIAL NEPHRITIS. 
The secondary lesions of the kidneys in the pyrexiae, as typhoid fever, 
scarlet fever, diphtheria, small-pox, and in cholera, have generally been 
described as catarrhal nephritis, and have frequently attracted the atten- 
tion of the pathologist. These well-known pyrexiae are of short duration, 
terminating by resolution or by the abrupt arrest of the renal functions. 
Yellow fever, also, is, in common with scarlet fever, diphtheria and typhoid 
fever, frequently complicated by desquamation of the epithelial cells of the 
kidneys; the fatal issue is frequently consequent upon the sudden arrest of 
the renal functions. If Bright's disease is established at the end of the 
pyrexial process, it appears not as a continuation of the so-called catarrhal 
nephrites, but as a new disease, attached to the specific fever by an aetiolo- 
gical connection. 
Such pyrexiae as scarlet fever, typhoid fever and yellow fever are, so 
to speak, self-limited. In these diseases, the cycle of changes is definite, 
and in cases which terminate favorably, the specific poison of the disease 
is completely eliminated, and rarely, if ever, again manifests its toxic 
properties upon the same individual. The malarial paroxysmal fever, on 
the contrary, is a poisoning by reiterated and accumulating doses of a 
morbid ferment; each attack adds its effects to those of the preceding; and 
the diverse local alterations are thus repeatedly aggravated and involved 
in morbid processes of chronic evolution. It is therefore evident that the 
acute and chronic affections of the kidneys in malarial fever present 
peculiar lesions, resulting from the repeated congestions of these organs, 
and the constant tendency to local and general haemorrhages in the renal 
structures. The proliferation and desquamation of the epithelium of the 
straight tubes in the catarrhal nephritis of malarial fever are followed by 
more marked and characteristic lesions. Important changes also take 
place in the epithelium of the convoluted tubes and malpighian corpuscles. 974 
Acute and Chronic Malarial Nephritis. 
The series of pathological changes induced by the malarial poison in the 
kidneys have for their origin obstruction in the circulation. 
HYPERAEMIA OF THE KIDNEYS IN MALARIAL FEVER. 
In the progress of malarial fever we may observe, even in the same 
subject, the extremes of hyperaemia and anaemia. Tissues which have been 
the seat of a temporary and sometimes of a prolonged hyperaemia may 
exhibit to the naked eye nothing abnormal after death; or they may look 
redder than normal; they may be oedematous, and when sections are made 
abnormal quantities of blood flow from the cut surfaces. On microscopical 
examination the blood vessels may appear normal or more or less dis- 
tended with blood. 
Long continued hyperaemia frequently leads to haemorrhage or trans- 
udation; to hyperplasia and hypertrophy, or an atrophy of the tissues of the 
kidneys. Protracted and frequently recurring hyperaemia may lead to 
atrophy and even to the death of tissue through pressure. Anaemia may 
be recognizable by the microscopical changes; but if long continued may 
induce atrophy and fatty degeneration, and if excessive may cause the 
death of tissue from the absence of the proper nutritive constituents to main- 
tain the healthy nutrition of the structures. 
The prolonged and frequently recurring congestions of the internal 
organs, characteristic of malarial fever, may result in haemorrhage from the 
walls of the vessels (fcemorrhage by rhexisf, caused by enfeeblement of the 
walls of the vessels, which renders them too weak to resist the pressure of the 
blood from within; or it may occur from the blood pressure in the thin 
and incompletely formed vessels in granular tissue. In certain conditions- 
induced by the action of the malarial poison upon the constituents of the 
blood, and upon the ganglionic centres which preside over the circulation 
of the blood, even without recognizable changes in the walls of the vessels, 
all the elements of the blood may extravasate without rupture, through the 
walls of the vessels-hcemorrhage by diapedesis. In malarial fever, in that 
form known as Creole yellow fever, swamp yellow fever, rice fever, hcemorrhagic 
malarial fever-malarial hoematuria, these hcemorrhages may be small, not well 
defined, in the renal structures, or they may be very extensive. In some 
cases these haemorrhages occur in the smaller renal veins and capillaries, 
the fluid and cells of the blood passing out through the cement sub- 
stance between the endothelial cells. Although no marked morphological 
changes have as yet been detected which would explain this extravasation, 
it is probable that some change in the nutrition of the walls has been effected 
by the action of the malarial poison, which renders them more permeable. 
In malarial fever haemorrhage by diapedesis occurs as a result of the venous 
congestion, characteristic of the cold stage, and when the flow of the blood 
in the smaller vessels has been suspended for some time, in virtue of the 
action of the malarial poison on the vaso-motor centres. 
In this extravasation of blood by diapedesis, the white blood cells pass 
through the walls of the blood-vessels, partly in virtue of their amoeboid 
movements; whilst the red blood cells, on the other hand, having no force 
of spontaneous movement, are carried passively through the walls by 
minute currents of fluid, which under the peculiar conditions induced 
by the malarial poison, stream in increased force and volume through the 
endothelial cement substance into the lymph spaces outside. It is well 
established that the altered condition of the blood-vessels leading to 
haemorrhage may be local or general; and in the latter case it may be either 
congenital, as in some cases of the hcemorrhagic diathesis (as we have before Acute and Chronic Malarial Nephritis. 
975 
demonstrated), or it may be the result of the physical or chemical changes 
of the blood, characteristic of scurvy, purpura haemorrhagica and per- 
nicious malarial fever. 
The extravasated blood in the renal tissues of pernicious haemorrhagic 
malarial fever may coagulate; or may remain fluid, and form, according to 
their size, petechia, ecchymoses, haemorrhagic infarctions or haematuria. A 
certain number of the white blood cells may wander into the adjacent lymph 
vessels or they may remain entangled with the red cells in the meshes of 
the fibrin. In sthenic cases this renal haemorrhage may be rapidly 
absorbed ; the fibrin and portions of the white blood cells desintegrate and 
are absorbed; marks of the haemorrhage will be visible after death in many 
cases by the deposit of the haemoglobin of the blood in the parenchyma 
and fibrous tissue of the kidneys. 
The red blood corpuscles give up their haemoglobin, which may be 
decomposed and carried away in the urine through the excretory cap- 
sules, and convoluted, and straight tubules of the kidneys, or may be 
deposited in the epithelial cells or in the meshes of the intercellular sub- 
stance at or near the seat of the haemorrhage in the form of yellow and 
brown granules, or as crystals of haematoidin. The seat of these circum- 
scribed haemorrhages in the kidneys of malarial fever may be evidenced 
by a greater or less amount of pigment, or by newly formed connective 
tissue. In some cases the blood mass degenerates and becomes surrounded 
by a capsule composed of connective tissue forming a cyst. 
PROGRESS AND EFFECTS OF RENAL HAEMORRHAGES IN MALARIAL FEVER. 
The effects of renal haemorrhages in malarial fever will depend upon 
their size, number and position. Circumscribed haemorrhages may mani- 
fest themselves by the appearance of blood and amounts of albumen and 
haemoglobin in the urine, which assumes a bright red blood color during 
the active stage of the disease and lets fall a deposit of urinary casts of a 
brownish-yellow color, consisting of granular fibroid matter with enlarged 
pigmented epithelium, red corpuscles and leucocytes; also fine granules 
from the plasma of the renal epithelium, fine epithelial cells, and leuco- 
cytes containing pigment particles. The frequent discovery of dark masses 
and granules of altered haematin and of pigmented leucocytes in the urine 
of those suffering from repeated attacks of malarial fever, and with pro- 
found malarial anaemia, received a ready explanation after the author had 
satisfactorily demonstrated during the American Civil War, 1801-1865, and 
subsequently, the dependence of these abnormal constituents of the urine 
upon local haemorrhages in the capillaries of the kidneys into the malpi- 
ghian corpuscles, convoluted and straight tubes and connective tissue. 
When the haemorrhage has been extensive, involving a considerable 
portion of one kidney, or of both kidneys, whether the haemorrhage occurred 
by rhexis or by diapedesis, the function of the kidneys is so deranged as 
to lead to urinary suppression, coma, convulsions and death. Without 
doubt these renal haemoirhages constitute an important factor in the pro- 
duction of the so-called pernicious malarial fever. In the absence of 
careful analyses of the urine and of thorough post-mortem examinations, 
these haemorrhages most frequently escape observation, and the cause of 
death is imperfectly discovered. The results of treatment in every case of 
malarial haematuric fever will manifestly depend primarily, if not abso- 
lutely, upon the extent and character of the renal haemorrhage. If the 
haemorrhage or haemorrhages be limited and well defined, the effused blood 
may be partially washed away in the urine excreted by the glandular 
structures of the kidneys, and the remainder may be gradually absorbed, 976 
Acute and Chronic Malarial Nephritis. 
leaving traces of the former evidence of the clot by the pigment deposit, 
and in some cases by the formation of cysts. In such cases the parenchy- 
matous cells of the excretory structures of the kidney evidently possess the 
power of digesting, absorbing or appropriating the haemoglobin of the 
blood. The condition of the pigment cells, and their frequent presence in 
the urine of malarial fever, together with dark granular and spheroidal 
masses of haematin, even in cases where not a trace of albamen can be 
detected by the most delicate tests, have lead us to regard this symptom as 
of considerable diagnostic value. 
When a large proportion of the renal excretory capsules and tubes are 
impacted with coagulated blood, death is inevitable, and medical science 
has thus far failed to point out any means by which the coagula may be 
rapidly and successfully dislodged from the renal excretory tubes. Hap- 
pily, this fearful complication is not present in the majority of cases of the 
malarial haemorrhagic fevers of the swamps, marshes and rice fields of 
Georgia, South Carolina, Alabama, Mississippi, Louisiana and Texas. 
The extent and characters of the renal haemorrhage appear to differ 
in different seasons, in different localities, and with different endemic and 
epidemic visitations. To these differences may, in a measure, be attrib- 
uted the wide discrepancies which exist in the views and results of prac- 
tice amongst skilled and experienced physicians. 
ULTIMATE RESULTS OF THE PROLONGED AND REPEATED HYPERMSMIA OF 
THE PAROXYSMS OF MALARIAL FEVER UPON THE PARENCHYMA AND 
CONNECTIVE TISSUES OF THE KIDNEYS. 
From the increasing of the overflow of lymph from the blood-vessels 
and its accumulation in the large lymph trunks, and in the interstices and 
lymph channels of the tissues, a pathological condition necessarily results. 
In malarialfever this transudation is due to venous obstruction, to deranged 
nervous actions, and to alterations of the blood and of the walls of the 
blood-vessels. The final results of this congestion are swelling, hyperpla- 
sia and hypertrophy of the epithelial cells and parenchymatous tissue of 
the kidney, migration and transformation of the lymph cellulai' elements 
and multiplication of the elementary constituents of the cellular tissue of 
the kidneys, the discharge of numerous casts and epithelial cells and albu- 
men in the urine. 
There may be two varieties presented by the pathological alterations 
of the renal structures, according as the parenchymatous or connective 
tissues of the kidneys are evolved. In most cases, however, of the 
so-called Bright's disease of the kidneys supervening upon malarial fever it is 
difficult, if not impossible, to draw a strong line of demarcation between 
the changes of the epithelium cells and of the connective tissue, passing on 
the one hand into embryonic degeneration, and on the other into sclerotic 
hardening of the fibrous tissue. It will be observed that frequently both 
processes proceed together, and in addition to the structural changes 
which have been so accurately described by various observers on Bright's 
disease of the kidneys, there is observed the deposit of dark pigment in 
the structures of the kidneys. 
In both malarial hepatitis and nephritis the epithelial tissue and the 
fibro-vascular tissue assume each a distinct and important part in the pro- 
duction of pathological states. Daring the progress of parenchymatous 
inflammation the embryonic distinctions between the tissues of mesoblas- 
todermic origin and those of hyperblastoderinic origin disappear. The 
epithelial, the connective tissue, and the blood-vessels are involved in a . Malarial Nephritis. 
977 
hyperplasial process, which leads towards embryonic transformation, and 
is finally involved in a single and identical product, namely, the tissue of 
sclerosis, which is substituted for the parenchyma. While the nephritis 
of malarial fever has in its ultimate effects, in common with those forms 
of Bright's disease due to recognizable causes, as irritant poisons, alco- 
hol, lead, improper diet, and exposure to cold, at the same time it should 
be observed that the former is due to the action of a cause which is per- 
petually recurring in the abdominal viscera, where perpetually recurring 
congestions impress themselves on the progress of the disease. It is the 
intensity of these phlegmasial hyperaemias which abridges the process and 
alters the elements of exudation, and unites these in a hyperplasic evolu- 
tion more or less rapid, and increases or destroys them. The malarial poi- 
son impresses upon all the processes and results of morbid change, an essen- 
tially degenerative character. Death often intervenes to interrupt these 
morbid processes at various periods of their evolution. 
MM. Kelsch and Kiener* in their valuable memoirs upon the changes 
of the renal structures under the action of the malarial poison in the grave 
fevers observed amongst the French troops in Algeria, have adopted the 
term parenchymatous interstitial nephritis as best characteristic of these 
pathological changes. We select from the important researches of MM. 
Kiener and Kelsch with reference to the acute and chronic alterations of the 
kidneys in paludal fever (Archives du Physiologie, 1882, pp. 278, 331; pp. 
458, 498), the following illustrations, engravings 104, 105 and 1.06: 
* Les alterations palud^ennes du Rein. La nephrite paludfienne aigue et chronique, par 
M. M. Kiener, A. Kelsch, professeurs agreges du Val-de-Grace. Archives de physiologie normale 
et pathologique, deuxieme s&rie. Tome Neuvifime, Paris, 1882, pp. 278, 334, p. 458, 498. Planches 
6, 7et8, p. 336,497,498. 978 
Malarial Nephritis. 
ENGRAVING NO. 104. 
Pathological Anatomy of Human Kidney in Malarial Nephritis. 
Gl. I. 
FIG.I 
FIG. 4 
Gl 
GI.2 
FIG 2 
Gl.l 
FIG.3 
612; 
GI.2, 
G!.r 
GUZ 
Engraving No. 104.-Pathological anatomy of human kidney, malarial nephritis. Enlarge- 
ment about Figure 1. Section perpendicular to the axis of a renal lobule. Acute glomer- 
ular nephritis. Gl. Hea'thy glomeruli. Gl. 1. Hyperplasic glomeruli, surrounded by scle- 
rotic uriniferous tubes. Gl. 2. Fibrous glomerule with the same surrounding. Figure 2. Section 
perpendicular to the axis of a renal lobule. Chronic glomeruliar nephritis; the uriniferous tubes, 
influenced by sclerosis, are few in number and disposed in irregular groups about the healthy 
glomeruli, the same signification of the letters. Enlargement 1-350 Figure 3. Chronic glom- 
eruliar nephrits; Gl. the glomerule atrophied, hyperplasic, and in part adherent to the capsule 
of Bowman; thickened and lamellar. U. Uriniferous tubes in different degrees of sclerosis, result- 
ing at once from hyperplasia of the epithelium, and from the thickening of the wall proper. 
In the less altered tubes, the epithelium nuclei from the hyaline substance, and its nodules are 
multiplied. The conjunctive tissue is thickened and infiltrated with leucocytes. Figured. 
Chronic glomeruliar nephritis. Gl. Hyperplasic glomerule, partly adherent to the capsule; U. 
Uriniferous I ubes in divers degrees of sclerosis, characterized by an active hyperplasia of the epi- 
thelium; the masses of small cells are contained in the alveolar spaces. Malarial Nephritis. 
979 
Pathological Anatomy of the Kidney in Malarial Nephritis. 
ENGRAVING NO. 105. 
RM- 
GR 
Lscl 
rRM 
FIG. 5 
FIG. 7 
JIG. 6 
-SCL 
GL- 
RM 7 
,GR2 
!EB 
Engraving No. 105.-Pathological anatomy of human kidney in malarial nephritis. Same 
magnifying power. Fig. 5. Section passing by the axis of a renal lobule. Acute nephritis of the 
granulations of Bright. Gr. Granulations situated in the labyrinth. Rm. Granulations occupy- 
ing the medullary rays. Scl. Sclerosic parenchyma in the interval of the granulations. Fig. 6. 
Section perpendicular to the axis of a renal lobule. Nephritis of the chronic granulations of 
Bright. Gr. Labyrinthic granulations. Rm. Granulations corresponding to the medullary rays. 
Gr. Granulation traversed by a track of sclerosis. Gr. 3. Granulation invaded and almost com- 
pletely destroyed by sclerosis. Scl. Annular sclerosis occupying the intervals of the granula- 
tions. Fig. 7 Fragment of twisted tube and free epithelial cellules obtained by dissection in the 
fre'sh state, in a case of malarial cachexia; the kidney atrophied, fatty, and pigmented. F. Frag- 
ment of twisted tube showing the masses of ochre colored hematic pigment. A, B, 0. Epithelial 
cells and free nodules, showing the different phases of segmentation. 980 
Malarial Nephritis. 
ENGRAVING NO. 106. 
Pathological Anatomy of Human Kidney in Malarial Nephritis. 
FIG. 8 
FIG.e 
FIG. 10 j 
FIG. 15 
FIG. 14 
FIG.16 
FIG.12 
FIG.17 
!|EIE!I3 
FIG.IE 
MAURICE HI. 0 
Engraving No. 106.-Pathological anatomy of kidney in malarial nephritis. 
Figures. Three sections of twisted tubes in a hypersemic kidney with a tendency to 
sclerosis. A. Section of tube, whose epithelium secretes abundantly a granulous substance and 
pigment; this hyaline substance, emulsioned by the urine, fills the lumen of the tube under the 
form of a delicate reticulum. B. Section of the tube presenting the same alteration of the epi- 
thelium, with hyperplasia of the nodules. C. Section of tube enclosing a hyaline mould; ulcer- 
ated epithelium. Figure 9. Two sections of twisted tubes, in a hypersemic kidney, with a 
tendency to hypertrophy of the epithelium. A. Section of tube showing »he tumefied epithe- 
lium, infiltrated with fine fatty drops; the nodules are multiplied; the lumen encloses small fatty 
drops and moulds. B. Same alterations of the epithelium; the lumen contains a reticulum of 
oily substance. Figure 10. Moulds formed of granulous pigment and of blood-corpuscles incor- 
porated in a hyaline substance. Figure 11. Hyaline moulds containing granulous pigment and 
some epithelial cells. Figure 12. Colloid? mould. Figure 13. Colloid? fatty mould. Figure 14. Sec- 
tion of uriniferous tubes forming part of a granulation of Bright, in a case of acute nephritis. B. 
Section of distorted tube, whose epithelium, considerably tumefied is infiltrated with oily drops; 
the lumen shows an oily mould in different phases of its formation. A. Transverse section of a 
large tube of Henle, the same alteration of the epithelium; the lumen encloses a mould composed 
of a central cylinder of old formation, and an exterior cylinder, indented on its borders, in pro- 
cess of formation. (Hardening by osmic acid.) Figure 15. Section of distorted tube forming part 
of a granulation of Bright, in a case of chronic nephritis. A, B, B. Opaque epithelial layer, oily 
and fatty, thin, with an indented contour; small angular fragments detach themselves from the 
protoplasm and unite with the mass of fat colloid mould, in process of formation in the lumen of 
the tube. A, B. ( Epithelial lining, composed of cellules and granules in the clear protoplasm. Pathological Anatomy of the Kidneys in Malarial Fever. 
981 
Figure 16. Fragment of distorted tube, obtained by dissection in the fresh state in a case of acute 
nephritis; the epithelium is envelopedin a very thin, endothelial sheath, which is rolled up at 
one of the extremities of the fragment. Figure 17. Epithelial cellules proceeding from a mucous 
cyst in the cheek, and examined immediately after extracting the nucleus from the cyst, in the. 
mucilaginous liquid which enclosed them. A, B, C. Cells showing oily drops enclosed in the pro- 
toplasm or projecting from t he surface of the cell. E. Oily drops loose in the liquid of the pre- 
paration. D. Epithelial cells contracted after the expulsion of the oily drops. 
COMPARATIVE PATHOLOGICAL ANATOMY OF THE KIDNEYS IN MALARIAL 
FEVER AND YELLOW FEVER. 
Malarial Fever. 
Supra-renal bodies.-Frequently discolored, of a dark brownish hue, 
from the deposits of melanotic or pigment particles, around the cortical 
and medullary cells and capillaries. No accumulation of oil has been 
observed in these bodies in malarial fever. 
Kidneys.-Congested in appearance and altered in structure, especially 
in malarial haematuria, when the textures are congested and dark colored 
in some cases. Occasionally slate-colored spots appear upon portions of 
the kidneys. 
I have, bv careful clinical studies, and by analysis of the urine, at 
different stages of malarial haematuria, established the fact that many of 
the symptoms of this disease, as well as the fatal termination, are connected 
with the progressive failure of the kidneys to eliminate the constituents of 
the urine and of the bile. 
When sections were made of the kidneys of those who had died in the 
acute stages of malarial haematuria, the cortical and medullary portions 
presented a deep purplish red and bloody appearance. The color was 
deeper in some portions than others, resembling circumscribed effusions of 
dark blood. In many cases all portions of the kidneys were altered in 
appearance, and the tubuli uriniferi, especially at the termination of the 
pyramids, could be seen resembling dark red lines of coagulated blood. 
Microscopical examination of sections with Valentin's knife revealed the 
fact that many of the tubuli uriniferi throughout their entire extent were 
filled with coagulated blood. The haemorrhage appears to have taken 
place through the malpighian corpuscles chiefly; little or no blood was 
effused around the tubuli uriniferi. It would appear that during the pro- 
longed cold stage, the kidneys become in this form of malarial fever con- 
gested, in a manner similar to what occurs in the spleen. During thiscon- 
gestion, rupture of the blood-vessels and of the capsular membrane of the 
malpighian corpuscles occurs; such rupture being mainly due to their ana- 
tomical structure, and the greater tension of the blood in this portion of 
the renal capillary circulation. When from any cause the blood coagulates 
in the tubuli uriniferi, their function as excretory tubes is destroyed, and 
the extent of the impairment of the excretory function of the kidneys will 
depend upon the number of excretory tubes blocked up by coagulated 
blood. The grand cause of the severe, dangerous and often fatal character 
of malarial haematuria will be found chiefly in these structural alterations 
of the kidneys. Plate 13, figure 55, represents the appearance of a section 
of the kidney in malarial haematuria; figure. 56 represents the appearance 
of the extremity of a pyramid of a kiduey of malarial haematuria viewed 
under one inch objective. 
The following is our outline of the case of malarial haematuria from 
which the illustrations, figures 55 and 56, were taken: George Price, 
native of Louisville, Kentucky, aged 26; height 6 feet J inch; weight in 
health 170 pounds; occupation, laborer; during the months of August, 
September and October, 1877, visited my office several times, andappeared 982 
Pathological Anatomy of the Kidneys in Malarial and Yellow levers. 
to be suffering from the prolonged effects of the malarial poison; pale, sal- 
low, greenish yellow hue. As he was sick and destitute, I furnished 
him with medicines, and such assistance as lay in my power. On the 31st 
of October, I was called to see the man at the house of one who had allowed 
him shelter in a room over the stable. I found the patient jaundiced, sur- 
face of a deep golden color; incessant vomiting; urine resembled blood in 
color and odor; pulse rapid; patient very restless. On my recommenda- 
tion the patient was sent to one of my wards in the Charity Hospital. The 
patient entered the Charity Hospital, ward 13, November 1st, 11 A. M., 
1S77. The patient stated that he had enjoyed good health, until he moved 
to Claiborne parish, Louisiana, in January, 1876; and about a week after 
he was attacked with chills and fever. He remained in Northern Louis- 
iana, where he continued to have chills and fever, at intervals of two or 
three weeks, when he arrived in New Orleans. After remaining a few days 
in the city, he went to work on a rice plantation, about seven miles below 
the city; after remaining on the plantation a short time, he became sick 
and was sent to the Charity Hospital, where he stayed but one day. Con- 
tinued to have chills and fever about once every two or three weeks. The 
present attack commenced with a chill on the night of the 27th of October, 
1877; had another chill on the night of the 28th; October 29th, no chill. 
Had a chill on the night of the 30th, and in the morning observed blood 
on his clothing, and observed that his skin was of a yellow color. Vomited 
grass-green colored matter, and passed bloody urine during the 31st. I 
saw the patient at 8 o'clock P. M., directed his removal to the Charity 
Hospital. 
November J st, 11 A. M. The patient has just entered the Charity 
Hospital, suffering with headache, intense thirst, nausea, and vomiting of 
large quantities of grass-green liquid. Tongue swollen, coated, dry and 
very rough; gums pale; great pain and tenderness over the entire abdomen; 
respiration embarrassed, and the patient groans during respiration. Bowels 
moved twice this morning. Surface of a golden yellow color. Pulse weak 
and rapid, 102 per minute. Pulse, 102; respiration, 24; temperature of 
axilla, 102° F.; acid urine of a deep blood red color, with the odor of blood. 
Amount of urine excreted during twelve hours, October 31st, 6 P. M., and 
November 1st, 6 A. M.: 500 c.c.; reaction strongly acid; sp. gr. 1020; deep 
blood red color; upon standing, urine let fall heavy brownish-red deposit. 
Under the microscope the deposit consisted of colored blood-corpuscles, 
variously altered in shape, yellow granular matter, and casts of the tubuli 
uriniferi, some of which were of a deep orange color, others of a deep red 
blood color, and contained colored blood corpuscles. The deposits resem- 
bled closely those illustrated by figures 53 and 54, plate 13. Sp. gr. of the 
urine after the removal of the albumen and blood by filtration, 1016. 500 
c.c- of urine, passed during twelve hours, contained: Urea, grains 205.6; 
chloride of sodium, 38.5; albumen and constituents of the blood coagulated 
by heat and mineral acids, 119.75. November 1st, 6 o'clock P. M.: Pulse, 
102; respiration, 24; temperature of axilla, 102.4° F.; continues to vomit 
green matter; urine bloody. 
November 2d, 8 o'clock A. M.: Pulse, 98; respiration, 20; tempera- 
ture of axilla, 99° F.: vomited eiuht times during the night and morning; 
urine of a deep blood color. Whilst the bed clothes were being changed, 
the patient was seated upon a stool, he had a convulsion. 
Examination of Blood.-Coagulum small but very firm; serum golden 
colored, and contained coloring matter and acids of bile, urea and extrac- 
tive matters in greatly increased amounts. Under the microscope (420 
diameters) some of the colored blood-corpuscles presented a swollen and Pathological Anatomy of the Kidneys in Malarial and Yellow Fevers. 
983 
crenated appearance; a majority, however, presented a normal appear- 
ance. A few pigment particles were observed in the blood, and some 
of the colorless corpuscles contained the pigment granules characteris- 
tic of malarial fever. The blood also contained numerous vibrios and 
vibrating filaments about one-twenty-thousandth of an inch in diameter. 
One thousand parts of blood contained: Water, 844.29; dried blood- 
corpuscles, 47.55; moist blood-corpuscles, 190.2; fibrin, 14.51; albumen, 
57.27; extractive matters, salts, urea, coloring matters of bile, biliary acids 
and soluble salts, 23.80; fixed saline constituents, 12.85. One thousand 
parts of the blood afoer complete coagulation contained: Clot, 318.19; 
serum, 651.83. We observe great diminution of the colored blood-corpuscles; 
great increase of water; marked increase of the fibrin. The fibrin has actually 
risen to the high figure which we regard as characteristic of the phlegmasise, 
and especially of acute pneumonitis and pleuritis. Notwithstanding the 
increase of the fibrin, the body of the patient was covered during the past 
two days with small petechiae or a deep purple and red color. We also 
observe marked increase in the extractive and saline matters of the blood. 
Examination of Urine.-Amount of urine excreted during twenty-four 
hours. November 1st, 11 o'clock A. M., to November 2d, 11 A. M., 880 
c.c.; reaction strongly acid; sp. gr. 1016; color deep blood red; odor like 
that of blood. The microscope revealed the presence of casts of the tubuli 
uriniferi, some of which were composed of coagulated blood, and others of 
orange-yellow granular matter. Vibrios were observed in this urine. 
Upon standing a heavy crop of deep red lozenge-shaped crystals of uric 
acid were precipitated. 880 c.c. of urine passed during twenty-four hours, 
November 1st, 11 A. M., to November 2d, 11 A. M., contained urea, grains 
271.04; chloride of sodium, grains 13.55; albumen and matters coagulated 
by heat, grains 142 24. November 2d, 6 o'clock P. M.: Vomiting continued; 
urine greatly diminished; passed urine only once during the night, and 
then in small quantity, and apparently unconsciously, in bed; about three 
fluid ounces. Pulse, 112; respiration, 15; temperature of axilla, 98.8. 
Patient lies quiet in a stupor, and cannot be aroused. November 3d, A. M.: 
passed a quiet night; no vomiting; bowels not moved; suppression of urine; 
died unconscious during the morning; at 5 o'clock A. M. had a slight 
convulsion, gasped three or four times, with an interval of a minute between 
each gasp, and then ceased to breathe. 
Autopsy. Four and one-half hours after death. Surface of a green- 
ish-yellow color. When the skull-cap was removed the dura mater, arach- 
noid, pia mater, and surface of the brain presented no marks of inflamma- 
tion or structural alteration. No unusual amount of cerebro-spinal fluid 
was observed. When careful sections of the brain were made, so as to 
expose the ventricles, no unusual amount of fluid was found in their cavi- 
ties, and the gray and white textures of the brain, as well as its mem- 
branes, presented a pale, anaemic and firm appearance. The medulla 
oblongata and spinal cord presented a pale, anaemic appearance. Chemi- 
cal analysis showed the presence of urea in the cerebral structures in con- 
siderable amount. 
Thorax: lungs, normal in structure and appearance, but pale and anae- 
mic. Heart, pale and of a more decided yellow color than usual in mala- 
rial fever; it was also softer than usual in this disease, and resembled in its 
yellow color and soft textures more nearly the heart of yellow fever. Right 
side of heart distended with a fibrinous clot, attached to the carneae 
columnae, chordae tendineae, and edges of the tricuspid valve. Branches 
of the clot also extended into the pulmonary artery. Under the micro- 
scope the muscular textures of the heart presented a larger number of oil 984 
Pathological Anatomy of the Kidneys in Malarial and Yellow Fevers. 
globules, and more granular matter than is usual in the natural heart, or 
in that of malarial fever, uncomplicated by lesion of the kidneys, urinary 
suppression and jaundice. 
That there was an actual increase of oil in the heart, is shown by the 
following results of chemical analysis : Weight of heart 9} troy ounces; 
oil or fat in heart, 216.60 troy grains; oil or fat in 1000 parts of muscular 
tissue of heart, 47.5. The textures of the heart yielded urea in compara- 
tive abundance. Stomach pale and anaemic; mucous membranes stained of 
a deep green; stomach contained eight fluid ounces of dark green fluid sp. 
gr. 1012; 1000 parts contained, water 952.0; solid residue 48.0. Chemical 
analysis showed the presence of bile, acids and coloring matters and of 
urea, and the absence of albumen and all constituents of the blood. The 
microscope failed to reveal the presence of colored blood-corpuscles. Liver 
enlarged; color lighter than in malarial fever, and of a deep Spanish 
brown. Under the microscope the liver cells contained more oil globules 
than usual in malarial fever, but less than in yellow fever. Oil in 1000 
parts of liver 40.1; gall-bladder distended with 1600 grains dark green bile; 
sp. gr. 1038; 1000 parts contained, water 868.88; solid residuum 131.12; 
fixed saline constituents 17 35. Intestinal canal empty, and contracted. 
Spleen enlarged; under microscope numerous pigment particles. 
Kidneys.-Capsule adherent; external surface of a deep purplish-red 
congested appearance. Weight of kidneys nine ounces and one drachm. 
When sections were made of the kidneys, the cortical and medullary por- 
tions presented a deep purplish-red and bloody appearance. The color 
was deeper in some portions than in others, resembling circumscribed effu- 
sions of dark blood. All portions of the kidneys, however, were altered 
in appearance, and the tubuli uriniferi, especially at the termination of the 
pyramids, could be seen, like dark red lines of coagulated blood. The 
appearance of the section of the kidneys is represented in plate 13, fig- 
ure 55. 
Microscopical examination revealed the fact that many of the tubuli 
uriniferi, throughout their entire extent, were filled with coagulated blood. 
The haemorrhage appears to have taken place through the malpighian cor- 
puscles chiefly, as little or no blood was effused around the tubuli uriniferi. 
It would appear from this observation that during the prolonged cold 
stage the kidneys become congested in a manner similar to what occurs in 
the spleen. During this congestion, rupture of the blood-vessels and of 
the capsular membrane of the malpighian corpuscles occurred, such rup- 
ture being mainly due to their anatomical structure and the greater tension 
of the blood. When from any cause the blood coagulates in the tubuli 
uriniferi, their function, as excretory tubes, is destroyed, the extent of the 
impairment of the excretory function of the kidneys being dependent upon 
the number of excretory tubes blocked up by coagulated blood. The 
appearance presented by the tubuli uriniferi, as seen under low powers in 
sections of the kidneys, is seen in figure 56, plate 13. In this figure a view 
is given of the termination of one of the pyramids of the kidneys. We 
observe in these structural alterations of the kidneys the grand cause of 
the dangerous and often fatal character of malarial haematuria. 
URINARY BLADDER IN MALARIAL FEVER. 
Urinary bladder.-Often distended, with high-colored urine, free from 
albumen and casts. In malarial haematuria the urine contains casts and. 
blood-corpuscles, and desquamated cells of the tubuli uriniferi. Casts high 
colored, and often contain colored corpuscles. In some cases of bilious Pathological Anatomy of the Kidneys in Yellow Fever. 
985 
remittent fever, and also in some cases of chronic malarial poisoning, the 
urine contains albumen. 
PATHOLOGICAL ANATOMY OF THE KIDNEYS IN YELLOW FEVER. 
Supra renal bodies.-These bodies appear to be subjected to similar 
changes with the liver and heart, and oil is increased in amount in the 
cells of the cortical and medullary substance. 
Kidneys.-These organs, as a general rule, present a brownish-yellow 
color, much lighter than that of health. They, in common with the heart 
and liver, contain much free fat. 
Plate 10, figure 36, represents the appearance of the kidney in yellow 
fever; and figure 37 represents the appearance presented by a section of the 
same kidney. These figures may be regarded as representing the more 
decidedly marked kidneys in this disease; for in some cases they present 
greater degrees of congestion, and deeper coloration from the presence of 
blood in the capillaries. 
In the case of Griffin, who died of yellow fever in the Charity Hospital, 
November 17, 1876, sections of the kidneys, made with Valentin's knife, 
revealed, under the microscope, increase of oil globules and granular mat- 
ter. Many of the tubuli uriniferi presented a thickened and altered 
appearance, as if undergoing the changes characteristic of cirrhosis. 
One thousand parts of the kidney contained, water, 800.33; solid 
excretory volicular aud fibrinous matter, 158.39; oil or fat, 40.88. 
In the case of Samuel Kinsley, who died of yellow fever in the Charity 
Hospital, November 17, sections of the kidneys under the microscope pre- 
sented the appearance usual in yellow fever, namely: Malpighian cor- 
puscles and tubuli uriniferi, filled with oil globules, yellow granular 
matter, and detached excretory cells. One thousand parts of those kidneys 
contained, water, 789.9; golden colored oil and fat, 57,07; cellular tissue, 
blood-vessels, excretory structures, etc., 142.99. 
When thin sections of the kidneys are examined under the microscope,, 
the malpighiau corpuscles and tubuli uriniferi are found to be filled with 
granular albuminoid and fibroid matter, excretory cells detached and oil 
globules. As far as my observation extends, these structural alterations of 
the kidney have escaped the notice of preceding observers. The impor- 
tance of these changes in the kidneys cannot be over-estimated, for upon 
them apparently depends the suppression of the urinary excretion, which 
is an almost universally fatal symptom. The changes in the kidneys may 
depend upon several causes, amongst which may be mentioned as of prime 
importance, the alterations induced in the albumen and fibrin of the blood 
by the febrile poison, and the congestion of the capillaries induced by 
derangement of the vaso-motor system of nerves and by the altered blood. 
This condition of the kidneys is preceded by capillary congestion, as 
has been shown by the results of post-mortem examinations at different 
periods of the disease. The same observation applies to the liver. The 
fatty degeneration and structural lesions are preceded by hypersemia; but 
neither in the kidneys nor in the liver and other organs can the mere stag- 
nation of the blood in the capi llaries be regarded as the prime cause of the 
subsequent degeneration and disintegration of the textures, and more espe- 
cially of the secretory cells. The chief cause is the action of the yellow 
fever poison on the blood and textures. The yellow fever poison excites a 
train of chemical changes, the final result of which is fatty degeneration. 
Thus in the case of the muscular fibres of the heart there is fatty degenera- 
tion, although from the structure and action of this organ there could be 986 
Pathological Anatomy of the Kidney in Bright's Disease. 
no such passive congestions as we have in the liver and kidneys. It is 
probable that the fatty degeneration extends to all the unstriped muscular 
fibres, and may even disable the muscles of locomotion and animal life. 
The granules of the cells of the epithelium of the uriniferous tubes set free 
by the disintegration of the protoplasm, oil globules, detached cells, and 
albuminous matters and mucus, form opaque granular masses which block 
up the tubuli uriniferi. 
We have in these structural alterations of the kidney, which vary in 
kind and degree according to the stage of the disease, an explanation of 
the frequent occurrence of albumen casts, detached cells of the epithelium 
of the uriniferous tubes, and oil globules and granular matter in the urine 
of yellow fever. 
Pathological Anatomy of the Kidney in Bright's Disease and Yellow Fever. 
ENGRAVING NO. 107. 
FIG.4 . 
FIG. 3 Pathological Anatomy of the Kidneys in Yellow Fever. 
987 
Engraving No. 107.-Pathological anatomy of thekidneyin Bright's disease andyellow fever. 
Figure 1. Inflammatory division of Bright's disease. Bright's disease, first stage. 'Section of 
inflamed kidney, Bright's disease. Tubules with epithelium in situ with cloudy swelling, well 
•shown in transverse section, malpighian body large and opaque (F. Granger Stewart, M. D.), mag- 
nified 450 diameters. 
The inflammatory form of Bright's disease may be divided into three stages, each character- 
ized by very distinct anatomical characters. 
1st. That of inflammation. 
2d. That of fatty transformation; and 
3d. That of atrophy. 
Figure 1 represents an enlarged view of the tubules (450 diameters) in the stage of inflam- 
mation in Bright's disease. In this stage the kidney is of normal size or somewhat larger; its 
•capsule is unaltered, and strips off readily; its surface is smooth, more or less congested, often 
pink; it is sometimes of a dark purplish color, sometimes mottled, pale and purple. On section 
the cortical surface is relatively increased in volume. It is often congested, the malpighian 
bodies standing out prominently from the surrounding tissue and the congested vessels separated 
by a varying amount of white (somewhat opaque deposits, composed of the altered tubules). 
The vascular spaces between the conesand the cortical substance are uniformly distended with 
blood; the cones are usually redder than the cortical substance, and from the engorgement of 
these vessels, and thb altered condition of these tubules, they present a series of alternating red 
■and white lines converging to the apex of the cone, at which point the white distinctly predomi- 
nates. The pelvis of the kidney is natural. On microscopic examination with a low power, the 
congestion of the vessels and the alteration of the tubules become more distinct; the vessels are for 
the most part gorged with blood. The malpighian bodies appear as if injected with red material, 
or, what is more common, they appear dense and opaque, of an ashen gray color. In the earliest 
period of the inflammation the former condition occurs; in the more advanced period the latter. 
Many of the tubules, especially those of the cortical substance, appear darker and denser than 
natural; they sometimes appear as solid bodies, sometimes as tubes, with thickened and some- 
what opaque walls. In the groups of tubules passing down towards the cones, and in the cones 
themselves, individual tubules here and there are affected like those of the cortical substance 
and contrast strikingly with theii neighbors which are unaffected. On examination with a power 
of from 300 or 400 diameters, the malpighian bodies appear dense and granular, and when the 
tubules expand to receive the tuft of vessels, swollen and granular cells may be seen. 
The tubules are more bulky than natural, their epithelium is swollen, granular and dense, 
the cell wall indistinct, and the nucleus frequently imperceptible. On examining a transverse 
section the enlargement of the epithelium becomes very apparent, for the cells are large and 
granular, and the lumen is greatly reduced or altogether lost. In the tubules so altered, a trans- 
parent homogenous material is frequently seen, which fills up the lumen of the tube, and binds 
together, so to speak, and cakes into one mass the epithelium of these tubules; not unfrequently 
blood-corpuscles are associated with this exuded matter, as shown in figure 1. Figure 2. Bright's 
disease. Inflammatory form; second stage. Section of kidney in second stage, inflammatory form, 
■showing the fatty opacity in the tubules and malpighian bodies. Fatty tubules and malpighian 
bodies in stage of fatty degeneration, magnified 350 diameter. T. Granger Stewart, M. D. 
In the stage of fatty degeneration or transformation, to which term "large fatty kidney" is 
commonly applied, the inflammatory process has passed away, or as is more common, become 
chronic. 
But its effects remain. The organ is enlarged; the capsule is natural, easily stripped off; its 
surface is smooth, or slightly depressed here and there. It is pale and fatty in color, and on its 
surface stellate vessels are frequently conspicuous. The color is peculiarly mottled from the 
mingling of opaque sebaceous-looking fatty portions with the whitish more translucent tissues 
natural to the organ. On section, the cortical substance is pale, of a yellowish white color, and 
increased in volume, while the cones are pink, and of natural color and size. The malpighian 
bodies do not project prominently as in the first stage. On closer inspection the sebaceous- 
looking parts may be seen to correspond to distended convoluted tubules, and not unfrequently 
lines of this material may be seen running between the small arteries towards the cones. 
On microscopic examination with a low power (50 diameters) the tubules are seen in many 
parts distended with a black, untransparent material; this is most marked in the convoluted, 
but in the straight tubules, here and there, individuals or g'-oups may be found affected. 'The 
malpighian bodies are enlarged, but not prominent, and while they may be finely granular never 
present any black appearance of the tubules. Under a higher power (300 to 400 diameters) the 
distended tubules are seen to be filled with fatty granules, which for the most part are c mtained 
within the walls of epithelial cells, which again are embedded in a material that blocksup the 
tubules. The tubes, however, are found to be irregularly distended, in some parts much dilated, 
in others narrow or of the natural calibre. In the malpighian bodies oil globules and fatty cells 
are frequent, but the capillary tuft is unchanged, The parts in which the fatty condition is 
revealed by the microscope correspond to those in which the dense-looking material is seen by 
the naked eye, as in Figure 2. (Bright's Diseases of the Kidneys. J. Granger Stewart, M. D., 
F. R. 8., Second Edit., p. 12-16.) 
Figure 3. Vertical section of a yellow fever kidney from near the surface, (a) Albuminoid 
■cylinders deeply stained with carmine. The epithelium of the uriniferous tubules, the base- 
ment membrane, and the granules imbedded in the albuminous substance, are also displayed, 
•(magnified 275 diameters) after H. D. Schmidt, M. D- 
Figure 4. Five uriniferous tubules containing different kinds of infarctions in the yellow 
fever kidney, (a) Albuminoid cylinder, with epithelial cells, and the remaining fragments of 
broken-down cells imbedded in the albuminoussubstance. (b) Epithelium, (c) Basementmem- 
hrane. (d) Empty portion of the tubule, with cellular remains, (e) Remains of nuclei and cells, 
magnified 275 diameters, after H. D. Schmidt, M. D. 
In the yellow fever kidney we observe a fatty degeneration of the pro- 
toplasm of the epithelial cells lining the uriniferous tubules. This deo-en- 
'eration of the protoplasm of the renal excretory cells is without doubt 
preceded by hypersemia; but this hyperaemic condition of the renal cap- 
illaries must not be regarded either as the primary or the sole cause of this 988 
Pathological Anatomy of the Kidneys in Malarial and Yellow Fevers. 
condition. The primary cause is to be found in the action of the septic 
agent or ferment of the specific contagious yellow fever, upon the proto- 
plasm of the blood, and of all the active cells of the organism, including 
those of the liver and heart. In fatal cases of yellow fever the hypersemia 
of the renal vessels has become greatly diminished at the time of death by 
the degeneration of the protoplasm of the excretory structures, and also 
by the loss of blood through the stomach and bowels, and also by the slow 
but progressive accumulation of the great mass of blood in the large central 
blood-vessels during the last hours of life. When death occurs in the 
active stages of malarial fever, the kidneys on the other hand, present 
most generally a hyperaemic condition, and are without the fatty degene- 
ration of the parenchyma, so strongly marked in the yellow fever kidneys. 
The degeneration of the kidneys taking place in the renal parenchyma 
during yellow fever does not resemble in all respects the fatty degenera- 
tion of the kidney observed in parenchymatous nephritis. A number of 
the infarctions formed in the uriniferous tubes during the course of yellow 
fever represent albuminous cylinders, while others consist of the remains 
of desintegrated epithelial cells, or are composed of both. They are met 
with in all portions of the uriniferous tubules, and vary in thickness in 
correspondence with the diameters of these canals. The largest are found 
in the convoluted portions, the so-called tubuli contorte, and in the inter- 
mediate canals, which they frequently fill up through their entire length ; 
in the descending and ascending limbs, and in the collecting tubules, they 
are generally short. The number of these casts and the extent of their 
formation, as well as the extent and nature of the pathological changes of 
the kidneys, will depend upon the length and relative severity of the 
disease. 
Urinary bladder.-As a general rule the bladder contains little or no 
urine in yellow fever. The urine is of a light yellow color, without any 
crystalline bodies, and loaded with albumen, granular fibroid matter, urate 
of ammonia, casts of the tubuli uriniferi, and excretory cells of the kidney. 
In many cases the urine is entirely suppressed for as long a period as forty- 
eight hours before death. So long as the kidneys perform their functions 
freely and regularly the patient may recover, even though black vomit may 
have appeared, but if the action of the kidneys has been arrested by struc- 
tural changes, death is inevitable. Mucous membrane of bladder often 
congested and in some cases ecchymosed. 
URINARY BLADDER IN YELLOW FEVER. 
GENERAL CONCLUSIONS AS TO THE PATHOLOGICAL CHANGES OF THE KID- 
NEYS IN MALARIAL AND YELLOW FEVERS. 
(1.) The various forms of renal disease, grouped under the head of 
Bright's disease, appear all to have an initial stage of irritation, congestion 
and hypersemia. The hypevplasic and pathological changes consequent 
upon the irritant effects of morbific agents will vary according to the pre- 
ceding condition of the blood, and upon the structures of the kidney 
chiefly involved, as the vascular, glandular or connective tissues are pri- 
marily or chiefly involved. 
(2.) Without considering the diseased state of the kidneys induced 
by cancer, tuberculosis, renal calculi, parasites, valvular disease of the 
heart, dilatation of the heart, aneurism of the aorta, emphysema of the' 
lungs, hydro pneumo-thorax, pericarditis and thrombi of the veins; we 
have some diseased states which may be thus classified : Pathological Anatomy of the Kidneys in Malarial and Yellow Fevers. 
989 
1. Catarrhal desquamative nephritis, following prolonged congestion 
of the kidneys, or induced by irritating substances or medicines introduced 
from without; or by morbid chain of phenomena, excited by febrile poison. 
2. Acute and chronic parenchymatous nephritis. 
3. Acute aud chronic diffuse nephritis. 
4. Acute and chronic interstitial nephritis. 
(3.) In the preceding varieties of renal disease the lesions may be both 
ideopathic and secondary. The catarrhal nephritis resulting from the action 
of febrile poisons may be of only temporary duration, and leave no per- 
manent pathological effects. I have observed albumen, renal casts and renal 
cells either with or without blood-corpuscles in many diseases, as the various 
forms of malarial fever, in yellow fever, scarlatina, diphtheria, typhoid 
fever, pneumonia, small-pox and capillary bronchitis which disappeared 
entirely, being only a temporary sign of the hyperaemia and irritated con- 
dition of the kidneys. Many of these cases have recovered entirely with- 
out any trace of albuminuria or other renal affection remaining. If a case 
of febrile disease should terminate fatally in the early stage of congestion 
the kidneys may appear congested aud red, but no structural alteration in 
the malpighiau bodies, tubes, or stroma may be observed. When, how- 
ever, the congestion of the kidneys has continued for any length of time, 
the capsules may become adherent; in the cotex patches of new connective 
tissue inclosing atrophied tubules, or a more diffused growth of connec- 
tive tissue may be observed separating the tubules. The epithelial cells 
of the convoluted tubules are swollen and coarsely granular; the tubules 
contain detached epithelial cells and casts; the capsules of the malpighian 
bodies are thickened and the endothelium is swollen; in the pyramids the 
epithelium of the straight tubes is granular and detached, and casts may 
be found in both the straight and the looped tubules. Such are the changes 
of the renal structures resulting from prolonged hyperaemia and repeated 
congestions. These changes are common to all diseases in which these 
organs are congested, but the rapidity and extent of the changes will 
depend upou the nature of the morbific agent and its effects upon the 
blood glandular organs and upon the nervous structures. 
(4.) Acute parenchymatous nephritis is frequently witnessed in yellow 
fever as a secondary effect of the infective poison of this disease upon the 
blood plasma, aud upon the protoplasm of the glandular cells of the 
kidueys. As we have shown, the marked changes in yellow fever are 
confined chiefly to the endothelium of the malpighian capsules and the 
epithelium of the tubules. In this disease we have a rapid and marked 
degeneration of the glandular protoplasm into granular matter and oil 
globules. In yellow fever the acute parenchymatous nephritis rarely 
becomes chronic, and all traces of the renal affection vanish during conval- 
escence. In like manner the acute and chronic diffuse nephritis, and acute 
and chronic interstitial nephritis, are not characteristic of the action of 
the yellow fever poison. In some fatal cases pathological changes may 
be observed resembling the acute forms of diffuse and interstitial nephri- 
tis; but we must regard the conditions as being present almost entirely in 
fatal cases. 
The absence of all traces of renal disease in large numbers of those who 
recover from yellow fever would sustain the view that the action of the 
yellow fever poisou does not, as a general rule, produce permanent altera- 
tion in the parenchyma and connective tissues of the kidueys. 
(5.) The repeated congestions and^the tendency to haemorrhage in the 
severer forms of malarial fever impress distinctive characters upon the 
renal affections which may arise during the progress of malarial fever. In 990 
Pathological Anatomy of the Kidneys in Malarial and Yellow Fever. 
malarial fever, in addition to all the usual effects of renal congestion, we 
may have superadded those resulting from local and general haemorrhages. 
When in the progress of malarial fever nephritis is excited, or occurs, it 
tends to involve the parenchyma, as well as the connective tissue of the 
kidneys and unites these organs in a series of chronic degenerative changes. 
So also if malarial fever be a supervening disease upon any one of the 
forms of Bright's disease, it will impress its new characters upon its pro- 
gress in proportion to the obstructions of the spleen and liver, and the jaun- 
dice haemorrhages and haematic destruction and pigmentation and periodic 
aggravation of symptoms which characterize the action of the malarial 
poison. We may therefore have: 1st, Malarial congestion of the kidney; 
2d, Acute and chronic malarial parenchymatous nephritis; 3d, Acute and 
chronic malarial diffuse nephritis; 4th, Acute and chronic malarial inter- 
stitial nephritis; 5th, Acute and chronic malarial haemorrhagic nephritis. CHAPTER VII. 
TREATMENT OF MALARIAL FEVER. PREVENTION OF MALARIAL FEVER. INDI- 
GENOUS REMEDIES OF THE SOUTHERN STATES OF THE UNITED STATES OF 
AMERICA, WHICH MAY B EMPLOYED AS SUBSTITUTES FOB THE SULPHATE OF 
QUINIA IN THE TREATMENT OF THE VARIOLTS FORMS OF MAL a RIAL FEVER. 
PREVENTION OF MALARIAL FEVER BY HYGIENIC, DIETETIC AND THERAPEUTIC 
MEASURES. PRINCIPLES OE THE TREATMENT OF THE VAkIOUs FORMS AND 
EFFECTS OF MALARIAL FEVER. 
INDIGENOUS REMEDIES OF THE SOUTHERN STATES WHICH MAY RE EMPEOYED IN THE TREAT 
MENT OF MALARIAL FEVER. 
Necessity for the use of indigenous remedies at the present time. Georgia Bark (Pinckneya 
pubens). Its affinities with Peruvian Bark. Geographical distribution. Active alkaloid prin- 
ciple. Medicinalproperties. Use of by the inhabitants of Georgia in the treatment of Inter- 
mittent Fever. Testimony of Dr. John Stevens Law, of Sunbury, to its efficacy as an anti-periodic. 
Method of using it. Dogwood (Cornus Florida). Botanical description. Geographical distribu- 
tion. Chemical composition. Examination of Dr. Walker, of Virginia, 1803. Dr. Walker's 
recipe for making ink from the bark. Examination of Mr. Carpenter, of Philadelphia. Cornine. 
Examination of Drs. Staples, S. Jackson, James Cockburn and D. C. O'Keeffe. Medicinal properties 
and uses. Testimony of Dr. Walker, of Virginia, to the medicinal properties of Dogwood; of Dr. 
Gregg, of Bristol; of Drs. Jacob Bigelow, S. G. Morton, R. Coates, D. C. O'Keeffe and others. 
Method of preparing the extract. Dose. Cornus Circinata (pound-leaved Dogwood). Testimony 
of Morson and Ives to its medicinal value. Button wood shrub (( ephalanthus occidental is). Anti- 
periodic properties. Virtue as a febrifuge and tonic. Effective remedy in chronic pulmonary 
complaints. Poplar or Tulip Tree (Liriodendron Tulipifera). Botanical character. Examination 
by Dr. Rogers, 1802; by Dr. J. P. Emmet, 1832. Discovery of Liriodendrine. Chemical and physi- 
cal properties. Medical properties and uses of Poplar Bark. Testimony of Michaux, of Dr. Ben- 
jamin Rush, of Dr. I. T. Young, of Governor Clayton, of Drs. Barton Bigelow and Eberlie. 
Great value as an antiperiodic. Small Magnolia or Sweet Bay (Magnolia glauca). Botanical 
characters. Geographical distribution. Chemical composition. Examination of Dr. Jacob Bige- 
low. Medical properties and uses known to the Indians. Testimony of Dr. Bigelow. A domes- 
tic remedy in chill and fever. Dosq. Cucumber Tree (Magnolia acuminata). Big Laurel (Mag- 
nolia grandiflora). Umbrella Tree (Magnolia tripetala). Persimmon (Diospyros Vlrginiana). 
Catalpa (BignoniaCatalpa). Virginia Snakeroot (Aristolochia serpentaria). Botanical descrip- 
tion. Geographical distribution. Chemical constitution. Analyses of Bucholz, Chevallier, Dr. 
Jacob Bigelow, Conwell. Medical properties and uses. Experiments of Jorg on Virginia Snake- 
root. Used by the Indians and early settlers of America. Emploved and extolled by numerous 
Physicians. Testimony of Dr. Nathaniel Chapman, of Sydenham, of Dr. John Eberlie, of Dr. 
acob Bigelow, of Dr. George B. Wood and others. Dose and mode of administration. Indian 
Quinine or Ague Weed (Gentiana quinquifolia). Thorough Wort (Eupatorium perfoliatum). 
Botanical description. Geographical distribution. Chemical composition. Examination of 
Drs. Anderson and Bigelow. Discovery of a salifiable base in, by Mr. J. Scattergood. Medical 
properties and uses. The Indians acquainted with its uses. Use of by early settlers. Testimony of 
Drs. Chapman, Wood, Anderson. Ilosack, Baird, Eberlie, Ives, Bigelow and others. Dose, and 
mode of administration. Wild Cherry (Arasus Vlrginiana). Salicin. Chemical and therapeuti- 
cal properties of Salicin. Salicylic Acid. Chemicaland therapeutical properties of Salicylic Acid. 
Employment of Salicylic Acid in the treatment of fevers and acute rheumatism. Salicylate of 
Soda and Salicylates. Chemical and therapeutic properties of the Salicylates. Clinical facts 
illustrating the therapeutic value of the Salicylate of Soda. Effects of Salicylate of Soda in the 
treatment of rheumatism. Investigations of Dr. Sydney Ringer and others on the physiologic 
and therapeutic effects of Salicin, Salicylic and Salicylate of Soda and the Salicylates in the 
treatment of febrile diseases and acute rheumatism. Experience of the author in the treatment 
of acute and chronic rheumatism. 
Apocynum Cannabintim (Indian Herb). Corcellorhiza Adontorhiza (Coral Root). Hydrastes 
Cannadensis (Blood Root). Cotton Plant (Gossypium). Cartanea Vesca and Pumilla (Chestnut). 
Uima Sbulata (Alder), Polygnum Avicularie (Knob Grass). Prinos Verticillatus (Black 
Alder, Winter Berry). Verbascuin Thansus, Mullein Sabbatia Angularis Pursh, (American 
Centuary). Apocynum Cannabinum (Indian Hemp, Dog's Bane). Chionanthus Virginia (Old 
Man's Beard, Poison Ash). Ilex Opaca, or American Holly. Patanus Occidental is (Sycamore, 
Button Wood). Ptelea Trefoliata (Water Ash, Wingseed). Capsicum (Cayenne Pepper) Oil of 
Turpentine (Oleum Terebinthinee). Wild Horehound (Eupatorium Rotundifolium). Botanical 
description; geographical distribution; medical operation and uses; extensively employed 
in domestic practice in the treatment of intermittent fever; medical properties first brought 
prominently to the notice of the profession by George Jones, President of the Georgia Med- 
ical Society; testimony of Dr. Jones, showing that it serves as an excellent substitute for Peru- 
vian bark; testimony of Dr. Nathaniel Chapman, of Philadelphia, to its value in intermittent 
fever. Black Willow (Salix Nigra). Testimony of Michaux to its value in intermittent fever. 
White Willow of Europe (Salix Alba). Chemical composition; analysis of M. M. Pelletier and 992 
Indigenous Remedies of the Southern States. 
Caventou; discovery of the principle salicin by Buchner, of Germany; investigations of M. Fon- 
tana, Rigatalli, M. Leroux, upon the different species of willow; properties of salicin; medical 
properties and uses of willow bark; use of, by the ancients, brought to the notice of the profes- 
sion in 1763, by Rev. Mr. Stone; testimony of Air. Slone to its value; testimony of Messrs. James 
White and Wilkinson; use of by Haller; testimony of European physicians to the value o! salicin. 
Yellow Jessamine (Gelseminum Sempervirius). Accidental discovery of its value in malarial 
fever; use of in Western States; testimony of Drs. Cleveland, Nash, J. A. Mayes and others, to its 
medicinal properties and uses; dose and mode of administration, Milk Weed, or Root of Man, 
(Asclepias Syriaca). Testimony of Dr. Richard S. Cauthorn, of Richmond, Va., to its value in 
intermittent fever. Common Salt (Ohio-ide of Sodium). Dr. Seelie Montdezert the first to call 
the attention of the profession to the value of chloride of sodium in the treatment of intermit- 
tent fever; testimonyof Dr. W. P. Lattimore to the success of M. Piory with common salt in the 
treatment of intermittent fever; testimony of Drs. Moroschkin and Hutchinson; dose and mode 
of administration. Sal Ammoniac (Hydrochlorate of Ammonia). Testimony of Dr. Felix Jacquot 
to its value in intermittent fever. AUric Acid.-Testimony of Dis. George Mendenhall, Bailey, 
J. C. Thompson, and Dr. William A. Hammond. Arsenic. Testimony, experiments and investi- 
gations of Dr. Felix Jacquot upon its relative value in the treatment of malarial fever; testimony 
of M. Boudin. Ligature of the Extremities in Intermittent Fever-Testimony of J.DeBrauw and 
others to the effects of ligature of the extremities in intermittent fever. Cold water in the treat- 
ment of Malarial Fever.-Use of by Dr. Wright in 1786; practical rules for its use, by Dr. J. Currie, 
of England; testimony of M. Fleury to the value of cold douchesin the treatment of intermittent 
fever. 
Prevalence of Malarial Fever. Importance of determining the Character of the Drinking 
Water. Analyses of the Waters of various Geological Regions of the Southern Slates. Experi- 
ments illustrating the poisonous properties of stagnant Swamp Water. The Prophylactic Prop- 
erties of the Sulphate of Quinine. Treatment of Intermittent, Remittent, Congestive and 
Pernicious Malarial Fevers. Principles which govern the Administration of Purgatives and 
Antipyretics and Antiperiodics in the Treatment of the various forms of Malarial Fever. Treat- 
ment of the Sequelae of Malarial Fever. 
INDIGENOUS REMEDIES OF THE SOUTHERN STATES, WHICH MAY BE 
EMPLOYED AS SUBSTITUTES FOR SULPHATE OF QUININE IN THE 
TREATMENT OF MALARIAL FEVER.* 
ORIGIN AND OBJECTS OF PRESENT MONOGRAPH. 
During the recent war, when the ports were blockaded, and all com- 
mercial intercourse cut off from those countries and American States, from 
whence the South had received her supplies of medicine, it was deemed 
important-nay, absolutely necessary-that the indigenous remedies should 
be carefully examined. The employment of large armies in low, malarious 
regions necessitated the consumption of large amounts of quinine, and the 
question of its supply became one of most serious moment in the beleag- 
uered Confederacy. The following memoir was prepared during the .early 
periods of the war, in 1861, w'ith the design of advocating and aiding the 
substitution, as far as practicable, of the indigenous remedies for the uncer- 
tain supplies of quinine. The value of this inquiry, we conceive, has been 
in no manner lessened by the results of the recent war. As each plant is 
passed in review, we shall give- 
1. Botanical characters. 
2. Geographical distribution. 
3. Chemical constitution and relations-active principles-mode of 
preparation. 
4. Therapeutical properties and applications. 
♦Indigenous remedies of the Southern Confederacy which may be employed in the treat- 
ment of malarial fever. By Joseph Jones, M. D., Professor of Medical Ciiemistry in the Medical 
College of Georgia, etc. Southern Medical and Surgical Journal, Augusta, Georgia. Vol. xvii, 
September, 1861, No. 9, p. 673; p. 729. October, 1361, No. 10, p. 754. Georgia Bark {Pinckneya Pubens). 
993 
ENGRAVING NO. 108. 
Georgia Bark (Pinckneya Pubens^A 
Its affinities with Peruvian Bark-Geographical distribution-Active Alkaloid 
principle-Medicinalproperties-Use of by the Inhabitants of Georgia in 
the treatment of Intermittent Fever-Testimony of Dr. John Stevens Law, 
of Sunbury, to its efficacy as an Antiperiodic-Method of using it-Experi- 
ence of Confederate Surgeons with Georgia Bark. 
PINCKNEYA pubens 
Botanical characterCapsule two celled, bearing the partition in the middle of the valves 
corolla tubular; calyx, with one or two segments resembling bracteas; filaments inserted at the 
base of the tube; seed winged. A large shrub, fifteen to twenty feet high, with many stems from 
each root; branches branchiated, the younger tomentose; leaves opposite, large, lanceolated, 
entire, slightly acuminated, shining on the upper surface, though sprinkled with hairs, tomen- 
toseon the lower; petiole about an inch long, tomentose; panicles terminal and axillary, com- 
posed of fascicles, commonly five flowered; calyx superior, five parted, persistent, slightly col- 
ored; segments sometimes equal, lanceolated, and acuminate; frequently one, and sometimes 
two, segments, dilate into a large, ovated, veiny, rose-colored leaf. When two segments dilate 
they are never equal in size. Corolla tubular; the tube of an obscure, green color, tomentose; 
border five parted; segments oval, obtuse, purple; filaments Inserted into the base of the corolla, 
longer than the tube; anthers incumbered; two celled; germ turbinate; style shorter than the 
stamens; stigma obtuse; capsule nearly globose, opening at the summit across the dissepiment; 
seeds flat, orbicular, attached to a central receptacle. This genus is very nearly allied to cin- 
chona. It differs in its calyx, but principally by the transverse partitions of its capsule. Flowers 
May-June.f 
Geographical distribution.-This small tree, interesting not only by the 
elegance of its flowers and foliage, but also by its close affinity to the cele- 
brated genus cinchona, which yields the Peruvian bark, and by the valu- 
able medicinal properties of its bark, is indigenous, and confined to the 
most southern parts of the Southern States. It grows in wet and boggy 
soils, along the small streams which intersect the pine barrens, from New 
River, South Carolina, along the sea coast into Florida. I have found it in 
* Named by the Elder Michaux in testimony of his gratitude and respect to Charles Cotes- 
worth Pinckney, of South Carolina, an enlightened patron of the arts and sciences, irom whom 
Michaux received multiplied proofs of benevolence and. esteem during his residence in South 
Carolina. First discovered by Bartram, who considered it a species of mussenda. Found for the 
first time by the elder Michaux in 1791, on th ® banks of the St. Mary. 
t Elliott-A Sketch of the Botany of South Carolina and Georgia, vol. 1, pp. 268-269. 994 
Georgia Barh (Pinckneya Pubens. 
greatest abundance in the "branches " of Walthonville, in Liberty county, 
Georgia, where it is found in company with the elegant Buckwheat tree 
(Mylocarium ligustrinum-PurslC; several species of Andromeda (Andro- 
meda angusti folia-PursK); A. catesbsei-Walt; A. acuminata); Hypericum 
fasiculatum, Poison bush (Rhus vernix); Tupelo (Nyssa aquatica and N. 
grandidentata); Black Gum (Nyssa sylvatica); Red Maple (Acer rubrum); 
Cypress (Capressus distichia); Small Magnolia or Sweet Bay (Magnolia 
glauca); Loblolly Bay (Goidonia lasianthus); Red Bay (Laurus carolinen- 
sis; Sweet Gura (Liquidambar styraciflua), and Water Oak (Quercus aqua- 
tica). The branches which intersect the pine barrens of Georgia are 
capable of supplying large quantities of this important medicinal plant, and 
with care and the assistance of cultivation they might be made to yield 
sufficient bark to supply the entire country. If this plant fulfills its high 
promise, these barren and now valueless regions of country will yield one 
of the most valuable remedies. 
Chemical and Therapeutical Properties.-The inner bark of the pinckneya 
pubens is extremely bitter, and appears to partake of the febrifuge virtues 
of the Peruvian bark. Mr. Van, an able chemist, of Philadelphia, many 
yearsago instituted an analysis of this bark, which, although, by unfore- 
seen accidents, was not as satisfactory as he would have wished it, still led 
to the discovery of a crystallizable substance which resembled cinchonia. 
Previous to the extensive introduction of bark and quinine the inhabitants 
of Georgia and Carolina employed it successfully in the treatment of inter- 
mittent fevers.* 
Mr. John Stevens Law, of Sunbury, Georgia, in his Thesis for the 
Degree of Doctor of Medecine, presented to the Faculty of the University 
of Pennsylvania in the spring of 1825, states that he was induced to try 
it in intermittent fever from the estimation in which it was held by some 
of the inhabitants in the neighborhood where he resided. Mr. Law used it 
in seven cases of intermittent fever, six of which were very speedily cured 
by it. He affirms that in no case did it distress much the stomach, though 
in two cases it was given in the quantity of 51 at a dose, after the custom 
of West Indian physicians. This bark may be administered in powders, 
in doses varying from ^i to gi, according to the severity of the case. It 
may also be administered in extract, infusion or decoction, made and 
administered in the same manner as directed for the cinchona. Michaux 
states that the inhabitants were accustomed to boil a handful of the bark 
in a quart of water till the liquid was reduced oue-half, and to administer 
this decoction to the sick.t 
During the recent war, the Georgia bark was employed in combination 
with dogwood and wild cherry as a tonic and antiperiodic. In my own 
hands it proved a valuable tonic; and in several cases of malarial fever, in 
which I employed it in the form of decoction, it exerted a marked effect 
upon the circulation, reduced the febrile heat, and induced free perspira- 
tion . As far as my experiments extended, its antiperiodic powers appeared 
to be inferior to those of Peruvian bark. The Surgeon-General of the Con- 
federate army considered the pinckneya pubens of so much value as a sub- 
stitute for cinchona bark that he directed the attention of the medical 
purveyors especially to its collection, as will be seen from the following 
communication: 
* The American Dispensatory, by John Redman Coxe, M. D. Philadelphia. 1830. Page 499. 
t North American Sylva. Vol. 1, p. 181. Philadelphia. 1857. Georgia Bark (Pincknega Pullens'). 
995 
Confederate States of America, 
Surgeon-General's Office, 
Richmond, Virginia, October 17, 1862. 
, Medical Purveyor, C. S. A.: 
Sib-The pinkneya pubens being the indigenous remedy most highly recom- 
mended as the substitute for cinchona bark, it was proposed that it should be col- 
lected in sufficient quantities to give it a fair trial in the army. On examination, 
however, of the remedies thus far collected, it is found that three hundred and 
seventy-eight (378) pounds is the total amount already secured. As this quantity 
is considered altogether insufficient for the purpose proposed, you are instructed to 
give your immediate attention to this matter before the season is far advanced. 
Very respectfully, your ob't servant, 
S. P. Moore, Surgeon-General C. S. A. 
The only official report upon the value of this remedy which came 
under our notice during the progress of the war was that of Surgeon A. M. 
Fauntleroy, Medical Director, Wilmington, N. C., in which the following 
cases were reported as treated with the extract of pinckneya pubens : 
Case 1.-L. B. Bynum, private Company A, Second Regiment Engineers. 
Patient has had repeated attacks of fever since September, 1863. Form of fever 
"tertiana;" hour of expected attack 4 o'clock P. M. May 25, 1864, 7 A. M., pulse 
68; 6 grains (of the extract) administered, and the same ordered every hour. 
12 M., pulse 80; slight moisture of surface of body; patient comfortable; complained 
of no ill-effects from the medicine. 1 P. M., pulse 80; diaphoresis the same; patient 
quiet; 6 grains given. 2 P. M., 6 grains given. 3 P. M., 10 grains given; pulse 78; 
diaphoresis profuse; patient restless, but complains only of heat. 3.30 P. M., 10 
grains given; pulse 76; diaphoresis very profuse. The paroxysm did not appear. 
During the night the patient had two very copious, dark evacuations from the 
bowels. He improved in every respect; his appetite increased in an incredible 
manner. He remained well, attending to his ordinary duties, until about ten days 
ago (5th July), when he was attacked with remittent fever, from which he is now 
rapidly convalescing. Sixty-eight grains in all of the extract were administered. 
Case 2.-Spy, private Company B, Tenth North Carolina Batallion of Artillery. 
Patient strong and robust; has had five attacks of intermittent fever; quotidian 
form; hour of expected chill 11 o'clock. June 5,1864. At 6 A. M. six grains of the 
extract were administered in accordance with the directions given the evening 
before. Seven A. M., pulse 64; six grains given, and the same dose ordered at 8 
and 9o'clock. 10 A. M., pulse 85; very slight moisture on surface of body. 11 A. 
M., pulse 92; 10 grains given; no moisture; patient complained that the chill was 
coming on. llj A. M., chill came on at J 1:25 minutes, butslight. 12 M., chill has 
{>assed off; fever succeeded; pulse 110. The fever lasted two hours and a half, fol- 
owed by the usual degree of diaphoresis. June 6th. Patient reports himself as 
"right smart better;" pulse 72. 6 A. M., 6 grains, and the same ordered every hour, 
which had the effect of breaking thechill and fever; diaphoresis began at 10 o'clock. 
The patient returned to duty two days after. 
Case 3.-Poole, private, Company A, Second Regiment Engineers. Has had 
occasional attacks of intermittent fever throughout the winter; form tertiana; time 
of expected chill 10 o'clock P. M. June.9th, 7 A. M., pulse 75; rather weak; 10 
grains of extract given. 8 A. M., pulse 80; patient comfortable; 6 grains given. 9 
A. M., pulse 90; patient restless; complained of pain in his back. As the pulse had 
risen so rapidly 3 grains only were given at 10 o'clock. 10 o'clock A. M., chill 
came on two hours earlier than anticipated; both chill and fever, however, were of 
shorter duration than usual. June 10th, the extract of pinckneya pubens was 
administered in 6 grain doses every second hour during the day. June 11, 6 grain 
doses were given every hour, commencing at 6 o'clock A. M., and had the effect of 
warding off the chill; diaphoresis, as usual, supervened. 
From the careful study of these cases, and of others previously reported 
to the Surgeon-General on the 22d of April, 1864, Dr. Fauntleroy concludes: 
That the extract has undoubted antiperiodic properties; still it is too 
slow in its action to be used as a substitute for the sulphate of quinine. It 
has, with one exception, always produced diaphoresis. Its therapeutical Geographical Distribution of the Cinchona Tree. 
996 
action is principally that of a tonic, and it deserves a position in the front 
rank of vegetable tonics. From the tardiness of its action, and its effects 
upon the vascular system, together with its manifest invigoration of the 
digestive organs, I am induced to think its energy as an agent is displayed 
through the organic nervous system. 
The facts now presented with reference to this interesting vegetable, 
which so closely resembles the Peruvian barks, that it has, by several dis- 
tinguished botanists, been referred to the same genus, are sufficient to 
excite inquiry, and to lead to the extensive employment of the extract as 
an efficient and valuable tonic. From the supposed similarity of this to 
the cinchona tree, and the supposition'that the latter would grow in the 
same neighborhood as the Georgia tree, I shall devote a few words to that 
subject. 
OBSERVATIONS UPON THE GEOGRAPHICAL DISTRIBUTION OF THE CINCHONA 
TREE. 
Discussion of the possibilities of its introduction and possible cultivation in the 
United States. 
As the subject of the introduction and cultivation of the genus cin- 
chona is being agitated at the present time in the United States and 
Europe, we condeuse the following facts from the most reliable sources, relat- 
ingto the native soil and climate of this most valuable plant: The celebrated 
Baron von Humboldt, who is justly regarded as the most scientific trav- 
eler that this or any other age has produced, enjoyed superior advantages 
for the examination of the cinchona tree as an object of physical or botan- 
ical geography. Up to the time of the publication of Humboldt's valua- 
ble treatise on the cinchona forests of South America, amongst the numer- 
ous writers mentioning the cinchona there were none but La Condamini, 
Ruiz, Paven and Tea, who themselves had observed this tree in its native 
forests upon the South American Continent. Only the first of these gives 
a physical description of this plant; the others, as well as Jacquin and 
Swartz, who saw the cinchona in the West India Islands, and Vahl and 
Lambert, who occupied themselves with dried specimens, have merely 
treated on the natural history and the botanical diagnosis. During Hum- 
boldt's stay of four years in South America he had occasion to reside a 
long time in countries where the cinchona trees are indigenous. M. Bon- 
pland and Humboldt observed them north and south of the equator, in the 
kingdom of New Granada, betwixt Honda and Santa Fe de Bogota, in the 
province of Popayan, in the districts of Loxa, on the Amazon river, in the 
province of Jaen de Bracamos. and in the northerly parts of Peru. Dur- 
ing their abode in the house of Don Jose Celestine Mutis, in Santa Fe, the 
botanical treasures of that great natural philosopher were opened to these 
distinguished travelers. In Spain, also, they were enabled to collect; from 
the editor of the Hora Peruviana, in Guayaquil (the harbor of Quito, on 
the coast of the South Sea), from M. Tafalla, a pupil of Rudy, in the little 
town of Loxa, from Don Vincente Almedo, royal inspector of the cin- 
chona forests, many interesting accounts respecting objects, which, but for 
the obliging communications from those friends, would have remained 
unknown to them. In fact, for sixty years since the time of Joseph de 
Jussieu, whose observations moreover were never published, no traveling 
naturalist had preceded Humboldt and Bonpland in visiting the beautiful 
mountain plains of Loxa. Geographical Distribution of the Cinchona Tree. 
997 
Favored by these circumstances Humboldt was enabled to speak with 
confidence upon this difficult subject. 
Humboldt has shown that till the year 1772 all cinchona bark was 
collected in the forests of Loxa, Ayavaca and Jaen de Bracameros, con- 
sequently between the third and fifth degrees of south latitude, and that 
only from the year 1772 the medicinal cinchona on the South American 
continent became used in the Northern hemisphere; which species of cin- 
chona were discovered between the fourth and fifth degrees of south lati- 
tude. Until then none were known in Peru proper, especially in the 
mountains situated nearer to Lima, the capital. The vale of Rio Calvas, 
and the village Ayavaca, in whose neighborhood the cinchona condaminea 
grows, famed since the year 1738, belong indeed in a political respect to 
Peru, but both are situated close to the confines of the districts of Loxa; 
and the bark of Ayavaca, like that of Jaen, was sold by the name of cas- 
carilla fina de uritusinga, as well as that which was shipped in Payta. It 
was only in 1776 that the real commerce in Peruvian cinchona bark began. 
Don Francisco Renquiso discovered near Huanuco, in the mountain 
San Christoval de Cuchew, the C. Nitida, of Rudy, a species very nearly 
related to the orange-colored one of Mutis (cinchona lancifolia). The editors 
of the Hora Peruviana visited the beautiful valleys of Tharma, Xauxa and 
Huamalies, and in 1779 determined the botanical character of the north 
Peruvian species. Shortly afterwards, medicinal cinchona bark was dis- 
covered at almost one and the same time in the most northern and in the 
most southern parts of South America, in the mountains of Santa Martha, 
and in the kingdom of Buenos Ayres, near La Pady and Cochalamka. 
After the year 1780, therefore, Europe was superabundantly supplied 
from the ports of Payta, Guayaquil, Lima, Buenos Ayres, Carthagena and 
Santa Martha, with barks of various medicinal powers. The name of 
cinchona was often given to barks which, indeed, possess great febrifuge 
powers, but which are derived from trees which do not even belong to the 
genus cinchona. In this connection, an observation by Humboldt upon 
the pinckneya and two other plants of similar medicinal properties is 
interesting: ''The very same fruit of the genuine cinchona is also pro- 
duced by pinckneya pubens michaux, a tree which I found cultivated, 
together with C. Cariboea, in the excellent botanic garden of Mr. Hamil- 
ton, near Philadelphia. The pinckneya grows on Mary's river, in the 
province of Georgia, and is already described by Bartram, by the name of 
mussaenda bracteolata. The medicinal powers for the cure of ague pos- 
sessed by this plant, nearly allied to the genus cinchona, and growing 
without the tropics, have not yet been investigated. On the other hand, 
Mr. Walker has shown, in two excellent treatises, that the bark of cornus 
florida, from Virginia, and of C. Sericea, from Pennsylvania and South 
Carolina, and even the tulip (the liriodendron tulipera) may be used with 
advantage in North America as remedies against agues. In the kingdom 
of New Spain, where hitherto no species of cinchona has been discovered, 
as the curator of the Academical Botanic Garden at Mexico has assured 
me. the yet undescribed portlandica mexicana, discovered by M. Sesse, 
may supply the place of the cinchona bark of Loxa." According to this 
observer, almost every species of cinchona is peculiar to its own region 
and to its altitude on the mountainous declivities of the Andes. The fol- 
lowing are the observations of Humboldt upon the geographical distribu- 
tion of the cinchona, recorded under the head of each individual species: 
1. Cinchona Condaminea.-The cinchona condaminea, of Humboldt 
and Bonpland, grows under the 4th°, south latitude, on the mountainous 
declivity in the mean altitude, between nine hundred and twelve hundred 998 
Geographical Distribution of the Cinchona Tree. 
toises. It requires a milder climate than the orange-colored chincona 
(cinchona lancifolia mutis) from Santa Fe. It is exposed to a mean tem- 
perature from 15° to 16° Reaumur, which is about the mean warmth of the 
Canary Islands. 
2. Cinchona Lancifolia.-This species, known in Santa Fe by the 
names of quinia naranyanda, quinquina orange, or orange-colored bark, 
loves a rough climate. It grows between the 4th and 5th°, north latitude, 
on mountainous declivities, from seven hundred to fifteen hundred toises 
high. The mean temperature of this place of growth is about equal to 
that of Rome. It amounts to 13° Reaumur; however, the cinchona trees 
ascending highest towards the summit of the mountains are mostly exposed 
to a temperature of from 8° to 9°. During the cold at nights, the ther- 
mometer falls in these alpine forests for hours as low as the freezing pointy 
however, as far as fifteen hundred toises high no snow falls in this latitude. 
3. Cinchona Cordifolia.-This species, called by the common people in 
New Granada velvet bark, grows under the 4th ° of north latitude, in 
heights betwixt nine hundred and fourteen hundred and forty toises. 
4. Cinchona Oblongifolia.-Grows under the 5th°, north latitude, in 
heights from six hundred to thirteen hundred toises, and is particularly 
common in the neighborhood of Mariquita. 
5. Cinchona Ovalifolia.-Grows under the 3d° to the 6th, ° north lati- 
tude, in heights from betwixt seven hundred and fourteen hundred toises. 
6. Cinchona Brasiliensis.-1The only cinchona which grows on the 
easterly coast of the South American continent. Nothing decisive is 
known about the height of its place of growth; but as it has been sent 
from the neighborhood of the town of Gran Para, at the mouth of the 
Amazon river, and, as in this region, thence on only low hills found, we 
are allowed to suppose that this species belongs to the hot regions. 
7. Cinchona Excelsa.-The only cinchona hitherto discovered on the 
continent of the ancient world, about whose medicinal properties, however, 
but little is known. It grows in the mountain chain of the Circars, which 
runs along the north-easterly coast of the great peninsula of Hindostan. 
8. Cinchona Crandiflora.-It is fond of warm regions, and descends 
from the mountains in heights from two and three hundred toises. It 
grows in regions whose mean temperature is from 18° to 19°. 
9. Cinchona Parvifolia.-Has the smallest fruit of all the cinchona. 
10. Cinchona Dissimili flora.-Grows in heights between two hundred 
and seven hundred toises in warm regions. 
11. Cinchona Caribcca. 
12. Cinchona Congiflora. 
13. Cinchona Cineata. 
14. Cinchona Floribunda. 
15. Cinchona Angustifolia. 
16. Cinchona Brachy Carpa.-Grow well in the West India Islands, 
and love a temperature of from 17° to 22° R. 
17. Cinchona Corymbifera.-Native of the Friendly Islands. 
In his "Views of Nature," Humboldt gives the following description 
of the Cinchona forests: 
After having sojourned for a whole year on the ridge of the Andes, or Antis, 
between 4° north and 4° south latitude, amidst the table lands of New Granada, 
Pastos and Quito, and consequently at an elevation varying between S500 and 
13,000 feet above the level of the sea, it is delightful to descend gradually through 
the more genial climate of the Cinchona or Quinia Woods of Loxa into the plains 
of the Upper Amazon. There an unknown world unfolds itself, rich in magnifi- 
cent vegetation. The little town of Loxa has given its name to the most efficacious Geographical Distribution of the Cinchona Tree. 
999 
of all fever barks-the quinia, or the cascarilla fina de Loxa. This bark is the 
precious product of the tree which we have botanically described as the cinchona 
condaminea, but which (from the erroneous supposition that all the cinchona 
known in commerce was obtained from one and the same tree) had previously 
been called cinchona officinalis. The fever bark first became known in Europe 
about the middle of the seventeenth century. Sebastian Badus affirms that it was 
brought to Alcala de Henares in the year 1632; but, according to other accounts, it 
was brought to Madrid in 1640, when the Countess de Chinchon, the wife of the 
Peruvian Viceroy, arrived from Lima (where she had been cured of an intermittent 
fever),accompanied by her physician, Juan del Vego. The finest kind of cinchona 
is obtained at a distance of from eight to twelve miles southward of the town of 
Loxa, among the mountains of Uritusinga, Villenaco and Ramisitana. The trees 
which yield this bark grow on mica slate and gneiss, at the moderate elevation of 
5755 and 7673 feet above the level of the sea, nearly corresponding respectively with 
the heights of the Hospital on the Grimsel and the pass of the Great St. Bernard. 
The cinchona woods in these parts are bounded by the little rivulets Tamera and 
Cochyaca. The tree is felled in its first flowering season, or about the fourth or 
seventh year of its growth, according as it may have been reared from a strong 
shoot, or from seed. At the time of my journey in Peru we learned, with surprise, 
that the quantity of the cinchona condaminea annually obtained at Loxa by the 
Cascarilla gatherers; or Quinia hunters (cascarilleros and eacadores de quinia), 
amounted to only 110 hundred weight. At that time none of this valuable product 
found its way into America; all that was obtained was shipped at Payta, a port of 
the Pacific, and conveyed round Cape Horn to Cadiz, for the use of the Spanish 
Court. To procure the small supply of 11,000 Spanish pounds no less than 800 or 
900 cinchona trees were cut down every year. The older and thicker stems are 
becoming more and more scarce; but such is the luxuriance of growth that the 
younger trees, which now supply the demand, though measuring only six inches 
in diameter, frequently attain the height of from 53 to 64 feet. This beautiful tree, 
which is adorned with leaves five inches long and two inches broad, seems, when 
growing in the thick woods, as if striving to rise above its neighbors. The upper 
branches spread out, and, when agitated by the wind, the leaveshave a peculiar red- 
dish color and glistening appearance, which is distinguishable at a great distance. 
The mean temperature of the woods of the cinchona condaminea varies between 
60° and 66° Fahrenheit-that is to say, about the mean annual temperature of 
Florence or the Islands of Madeira; but the extremes of heat and cold experienced 
at those points of the temperate zone are more felt in the vicinity of Loxa. How- 
ever, comparisons between climates in very different degrees of latitude and the 
climate of the table lands in the tropical zone must, from their very nature, be 
unsatisfactory. 
In a memorandum which C. R. Markham submitted to the Indian 
Government, the ground was taken that it was important that the seeds of 
the hardy species which grew in New Zealand, and which yielded a large 
percentage of quinine, should be obtained for propagation in India. 
The Quinia Districts of the Andes have recently been explored by Mr. 
Cross. The Secretary of State made arrangements with Mr. Cross for this 
purpose. This gentleman accordingly made a tour of the Andes, in which 
he found dangers and hardships of no ordinary kind, and passed through 
districts which had not been previously explored, for it appears that even 
Humboldt, who visited Popayan, did not penetrate many of the forests 
which were visited in his search for seed. At the time of receiving his 
instructions, Mr. Cross was residing near the Red Bark Forests, on a high 
table land on the western slopes of Chimborazo, at an elevation of ten 
thousand feet above the level of the sea. From this district he commenced 
his ascent of the northern shoulder of the Chimborazo, and reached the 
highest part of the pass, which has an elevation of nearly thirty-five 
thousand feet. 
After passing through districts where barley and potatoes were culti- 
vated, he came upon an edible species of oxalis, and then reached immense 
tracts of land covered by a stipa, which, with gentians, chuquiraqua, insignis, 
and other plants of the order compesue, ran up to the very verge of per- 
petual snow. Passing along a wall hedged on both sides by monstrous 1000 
Dogwood (Comas Florida). 
specimens of Agave Americanly he comes to the snow-covered cone of the 
volcano Cotapaxi, from which a perpetual rumbling noise is heard, and 
which sends up flame to a height of one thousand feet above the summit 
of the crater. Mr. Cross next passed the borders of the Suguna de San 
Pablo, which was surrounded by tumuli, some of which were of the extra 
ordinary height of four hundred feet, and thence to the plains of Triquer- 
res, which, at a height of ten thousand five hundred feet, produces a Bar- 
nadesia, with white flowers, and where a dwarf species of gentian was in 
full bloom, and covering the ground as thickly as daisies do in a pasture 
field in England. At Pasta he came to a district which has a mild tem- 
perature, being surrounded by forest-covered mountains, where a species 
of cinchona is cultivated, chiefly for export to the United States. Pasta is 
also a market for vegetable dyes, which are brought there by the Indians. 
There was much cinchona bark stored up at this place, and also in sheds 
in the forest; but, as its yield of quinine was small, it did not sell readily. 
The tree producing this orange or yellow-colored bark, with a coarse and 
fibrous fracture, is described by Mr. Cross as the cinchona, lancifolia of 
Karston, with large, lanceolate, coriaceous leaves and bark, covered with 
silvery epidermis. This traveller, after passing through a series of adven- 
tures of no ordinary kind, arrived at the city of Popayan, which lies 
between two volcanoes, at nearly six thousand feet above the level of the sea. 
Mr. Cross next reached Sylvia, the headquarters of those who buy the bark 
of Pitayo, Hambola, Tortory and Punace. Passing on to Pitayo some 
choice plants were discovered, and here seed was collected from trees about 
fifteen feet high. Mr. Cross describes the soil as varying in color from 
light brown to nearly black, and in depth from three inches to three feet. 
In all situations the vigor of the cinchona plant appeared the same; but it 
was restricted to the dry slopes, or was never found on wet ground. After 
drying the capsules, he occupied himself in taking the temperature of the 
region, and he found, at the lowest limit of the cinchona, it rose during the 
hottest days to 59° or 60°, but at night fell to 46° or 48°, and at certain 
periods below the freezing point. At the upper limit the temperature 
ranged during the day from 40° to 48°, and at night fell to 35° or 36°. 
Hence, it would appear that in dry situations it favors the plant to have 
an occasional fall in the temperature of three or four degrees below the 
freezing point, and a daily range of from 8° to 12°. The general vegeta- 
tion of the region consisted of pipers, solanums, smilax, etc. The winds, 
which in summer are often violent, do not appear to affect the cinchona, 
but the forests are very rarely enveloped in mist. It appears to be a delu- 
sion, therefore, on the part of some persons who assert that torrents of rain 
and mist are necessary for its growth. Mr. Cross states that he has been 
in localities in the Andes which had altitudes similar to that of the cold 
cinchona region, where only a species of solanum would grow, and which 
looked as if on the point of extinction, from the abundance of mosses 
which twined around the smallest shoots to the points. No cinchona could 
live in such a climate, a certain amount of dry weather being necessary 
for ripening the capsules 
As far as we can judge from these explorations of Humboldt, Bonpland 
and Cross, the United States is unsuited to the cultivation of the South 
American cinchona, no portion of its extensive domain presenting the 
necessary combinations of great elevation, moisture and comparatively 
warm climate. It would be well worth the attention of the general gov- 
ernment to send an expedition for the purpose of exploration and the 
transportation of the seeds and plants of the species best adapted to the 
southern portion of the United States. The mountainous regions of some 
of the Southern States might afford favorable fields for experiments. We Dogwood (Cornus Florida}. 
1001 
would, however, look for the best results in Central America and Mexico. 
It is well known that many plants possess great powers of adaptation to the 
changes of climate and soil, audit is possible that ceitain species of the 
cinchona might be successfully cultivated and multiplied within the limits 
of the United States. The inestimable value of these plants to the human 
race justifies a lavish expenditure for their preservation and propagation 
in various countries. 
ENGRAVING NO. 109. 
Dogwood (Cornus Florida). 
Botanical Description-Geographical Distribution-Chemical Composition- 
Examination of by Dr. Walker, of Virginia, 1803-Dr. Walker's Recipe 
for Making Ink from the Bark-Examination of by Mr. Carpenter, of 
Philadelphia-Cornine-Observations of Drs. Staples, S. Jackson, James 
Cockburn, D. C. O'Keeffe-Medical Properties and Uses-Testimony of Dr. 
Walker, of Virginia, to the Medical Properties of Dogwood, of Dr. Gray, 
of Bristol, of Dr. Jacob Bigelow, S. G. Morton. R. Coates, D. C. O'Keeffe, 
and others-Method of Preparing the Extract Dose-experience of Author 
with in Southern Army during War, 1861-65, and as a Substitute for Qui- 
nine possesses Prophylactic Powers against Malarial Fever-Efforts of 
Surgeon General Moore and of Medical Purveyors to Supply Indigenous 
Remedies-Testimony of Assistant Surgeon Warren and of Surgeon F. P. 
Porcher to the Medicinal Properties of Dogwood. 
' DOG WOOD 
CORNUS FLORIDA 
Botanical Character.- Arborescent; leaves ovate, acuminate: involucrum large, obcordate; 
drupes ovate. A tree fifteen to twenty-five feet high, the trunk eight to ten inches diameter, 
with expanding branches, the smaller crowded at the extremities of the older. Wood fine- 
grained, hard, durable. Leaves opposite, deciduous,ovate, lanceolated, acuminate, entire, ribbed; 
the younger ones very pubescent, almost villous on the under surface. Flowers in terminal 
heads. Involucrum four-leaved; leaves large, obcordate, nerved, white; the serius callus, sessile 
at the base of each head, and enclosing it before the time of flowering. Calyx one-leaved, small, 
tubular, border four-cleft; segments erect, obtuse, shorter than the tube. Petals four, linear, lan- 
ceolate, inserted into the summit of the germ, yellowish. Filaments four, as long as the corolla, 
alternating with the petals. Anthers incumbered, two-lobed. Germ inferior, slightly angled. 
Style shorter than the stamens, surrounded at base by a glandular ring, around which the petals 
and fllaments are inserted. Stigma capitate. Drupe red. Flowers March to April.* 
* Elliott, Sketch of Botany of South Carolina and Georgia, vol. i, pp. 207-208. 1002 
Dogwood {Cornus Florida). 
Geographical Distribution.-The Cornus Florida is first seen in Massa- 
chusetts, between the 42d and 43d degree of latitude, and extends uninter- 
ruptedly throughout the Eastern, Southern and Western States to the banks 
of the Mississippi. Although abounding especially in the Middle States, 
it is, nevertheless, one of the most common trees over this vast extent of 
country. In New Jersey, Pennsylvania, Maryland and Virginia it abounds 
upon moist, gravelly and uneven soil. In North Carolina, South Carolina, 
Georgia, Florida and Alabama it is generally found most abundant and 
most luxuriant on the borders of swamps and low grounds, and scarcely 
ever in the pine barrens, where the soil is too dry and sandy to sustain any 
trees but the long leaf pinefpinus australis), the barren scrub oak (quercus 
catesbsei), upland willow oak (quercus cinerea), black jack oak (quercus 
ferruginea), and running oak (quercus pumila). In the most fertile dis- 
tricts of West Tennessee and Kentucky it is said not to appear in the 
forests except where the soil is gravelly and of middling quality. 
Chemical Composition.-The bark of the root, stem and branches of the 
Cornus Florida is a powerful bitter, possessing a bitter astringent and 
slightly aromatic taste. The chemical composition of this bark appears to 
have been first investigated by Dr. Walker, of Virginia, who published his 
observation in Philadelphia.* He found that water distilled from the 
bark in powder had a transparent, whitish appearance, with a slight aro- 
matic odor, and no perceptible taste. When the heat was increased, the 
fluid had a lemon color, with an unpleasant smell and an acerb taste, effects 
which were probably produced bj the volatilization and partial decompo- 
sition of portions of the bark in consequence of the continuance of the heat 
until the moisture was evaporated nearly to dryness. Dr. Walker also 
endeavored to ascertain the effects of different menstrua upon the extract 
furnished by evaporating a decoction of the root of Cornus Florida. Strong 
alcohol dissolved from the extract three-fourths of the entire quantity; the 
part which remained undissolved was destitute of taste, and underwent no 
change of color on adding the test of iron. The alcohol which contained 
the dissolved portion ol the extract possessed an intensely bitter taste, 
with astringency; presented a clear red color, and turned to a deep black 
on the addition of a salt of iron. When the alcohol extract was macerated 
in repeated portions of sulphuric ether, with a view to ascertain the quan- 
tity of resin, the ether acquired a dark color and a bitter taste, and dis- 
solved three-quarters of the extract. When tested with iron it was found 
that the remaining quarter only was changed to a black color.f Upon the 
examination Dr. Walker announced that the dogwood contained gum, 
resin, tannin and gallic acid. Dr. Walker thus sums up the results of his 
experiments: "A summary recapitulation of these experiments shows 
that the cornus Florida and sericea and the Peruvian bark possess the 
same ingredients-that is, gum, mucilage and extract, which last contains, 
the tannin and gallic acid, though in different proportions. The Florida 
possesses most of the gum, mucilage and extract; the sericea next, which 
appears to be an intermediate between the Florida and Peruvian bark, 
while the latter possesses most of the resin.'' 
The virtues appear equally similar in their residue. The extract and 
resin possess all their active virtues. The extract appears to possess all 
their tonic power. The resin, when perfectly separated from the extract, 
* Experimental inquiry into the similarity in virtue between the Cornus Florida and sericea, 
and the cinchona officinalis of Linnaeus, etc., etc. By Dr. John M. Walker. Philadelphia. 1803. 
t Dr. Walker gives a recipe for making an excellent ink, in which the bark of the cornus 
Florida is substituted for gall nuts: Put half an ounce of dogwood bark, two scruples of sulphate 
of iron and two scruples of gum arable in sixteen ounces of rain water. During the infusion 
shake it repeatedly. Dogwood (Cornus Florida). 
1003 
appears to be purely stimulant, and probably the tonic power of the extract 
is increased when combined with a portion of the resin, as in the spirituous 
tincture. Mr. G. W. Carpenter, of Philadelphia,* subsequently announced 
the discovery of a peculiar bitter principle, for which he proposed the name 
Cornine, and which he asserted to be the active alkaloid principle of the 
Cornus Florida, and to be fully equal, if not superior, to quinine in its 
tonic and febrifuge properties. In consequence, however, of yielding this 
salt in so very minute comparative proportion to what the quinine is 
yielded by the cinchona, it is even more expensive than the latter. It is 
greatly to be regretted that Mr. Carpenter did not publish the method by 
which he extracted this alkaloid principle. Some have even gone so far to 
affirm that he did not discover any alkaloid principle at all, because sub- 
sequent investigations have failed to detect cornine. We conceive this 
criticism to be entirely too severe, for three reasons : 
1. No absolutely accurate and complete examination of the bark of 
the cornus Florida has been made. 
2. As Mr. Carpenter did not state his method of obtaining the active 
principle, it might be supposed that the reagents used have exerted some 
influence in the transformation as well as the separation of the alkaloid 
principle. 
3. Mr. Carpenter affirms that he submitted the alkaloid cornine to 
the examination of several physicians. This subjet is of so much interest 
and importance that we quote the entire passage from the work of Mr. 
Carpenter : 
"It gives me much pleasure to announce the discovery which I made of an 
alkaloid base in the cornus Florida, which I have denominated cornine, and 
which, with acids, forms neutral salts, the sulphate of which has proved a highly 
valuable tonic and febrifuge. This article has been very carefully and accurately 
described by Dr. Samuel G. Morton, of this city, in the Philadelphia Journal of 
the Medical and Physical Sciences, and from the most respectable sources in the 
medical profession from various parts of the United States where this article has 
been sent, the most corroborating evidences have been received of the unequivocal 
success of the cornine in the treatment of intermittent and remittent fevers, in the 
same doses as the quinine; and the only circumstance which precludes its compe- 
tition with that substance, is the minute comparative proportion of cornine yielded 
by the cornus Florida. If, however, at any time we should fail in our supplies of 
cinchona, which is not impossible, or even improbable, we shall then be able to 
supply its place by this principle of the cornus Florida."-JEssays on the most impor- 
tant Articles of the Materia Medica. Page 203. 
Dr. S. G. Morton,f of Philadelphia, described cornine as a grayish- 
white powder, extremely bitter, and deliquescent when exposed to the air, 
and affirmed that he had exhibited it in cases of intermittent fever with 
much success. Dr. Morton considered it to be in no respect inferior to 
quinine. 
Dr. R. Coates, and several other practitioners, exhibited this salt in 
the same cases in which sulphate of quinine is employed, and with decided 
success. 
Cornia, according to Mr. Carpenter, does not crystallize, but forms, 
on evaporation, a viscid mass. It is a pale straw color, attracts the mois- 
ture of the atmosphere, and dissolves in alcohol and in sulphuric, acetic 
and muriatic acids, with which it forms crystallizable neutral salts. The 
sulphate crystallizes in acicular or needle-like crystals, deliquescent, and 
consequently soluble in water, of a grayish-white color, and its taste is 
* Essays on some of the most important articles of the Materia Medica, etc. By G. W. Car- 
penter. Philadelphia. 1834. Page 202. 
f Philadelphia Journal of the Medical and Physical Sciences. XL. , 1004 
Dogwood (Cornus Florida). 
intensely bitter. According to the testimony of Joseph Tongo,* M. D., 
and E. Durand, of Philadelphia, Dr. Staples obtained it by digesting the 
bark of the root of the cornus Florida in alcohol of 30° of Baume's areo- 
meter. After several days had elapsed, the latter was filtered and concen- 
trated by distillation in a water bath. On cooling a granular extract was 
obtained, of a light pink color, of a very bitter and astringent taste; when 
treated with diluted sulphuric acid, afforded a very small quantity of crys- 
tals of sulphate of cornia, without having been exhausted of all its bitter- 
ness and a«tringency. 
Mr. Ellis states that Dr. S. Jackson, lately of Northumberland, Penn- 
sylvania, informed him that he had subjected the bark to Henry's process 
for obtaining quinine from cinchona, and that without carrying the process 
so far as to obtain a crystalline salt, he used the concentrated alcoholic solu- 
tion with the most decisive results, and was satisfied that it contained a 
principle analogous to quinia. 
Mr. James Cockburn examined the cornus Florida in 1835 with the 
following results: 
The decoction, which was of a light red color, and slight mucilagin- 
ous appearance, formed a precipitate with a solution of subacetate of lead, 
which consisted of gum, coloring matter, and other foreign substances. A 
precipitate was also formed with pure alcohol. Upon the addition of 
water to the tincture, concentrated by evaporation, it threw down a curdy 
precipitate, which, upon examination, was found to be resin. 
The decoction and tincture redden litmus paper, and cause a yellow- 
ish precipitate in a solution of gelatine, and one of a dark olive green in a 
solution of sulphate of iron. They also afford precipitates with sulphuric 
and muriatic acids, lime water, alumina, the carbonates of ammonia and 
potassa, tartrate of antimony and potassa. The color becomes lighter on 
the addition of nitric acid, milky by the corrosive chloride of mercury, 
and has its color deepened by ammonia. A portion of the bark was 
digested in sulphuric ether for a few days and filtered. The ethereal tinc- 
ture was of a lemon color, and reddened litmus paper, and on evaporation 
deposited on the sides of the vessel a fatty matter, insoluble in water, but 
soluble in alcohol, leaving a greasy stain on paper. Besides this there was 
a compound of oil and resin combined with coloring matter, and a sub- 
stance of a light brown color, very bitter taste, friable and very regular 
appearance, supposed to be a compound of a peculiar bitter principle, 
mixed with tannin and other matters. This was dissolved in alcohol, and 
formed a beautiful red colored tincture, which reddened litmus paper. 
Lime was then added, boiled, filtered and evaporated. A substance resem- 
bling the ethereal residue remained, interspersed with small, shining acicu- 
lar crystals, of a bitter taste, which property I am disposed to believe they 
owed to the bitter extract with which they were associated. The bark 
used in the last experiment was submitted to the action of boiling ether, 
which, on cooling, deposited a substance of the consistence of wax, which 
it resembled in all its properties. 
Two ounces of the bark, coarsely powdered, were then introduced 
into sviii of alcohol, and exposed to a temperature of from 105° to 120° F. 
The alcohol was then decanted, and a fresh portion added and treated as 
before. The liquors were then united, and a solution of sub-acetate of 
lead added to separate the coloring matter. After the insoluble portion 
subsided the clear liquor was separated, a little sulphuric acid was then 
added to the solution to separate any excess of sub-acetate of lead. This 
« A Manual of Materia Medica and Pharmacy, comprising a concise description of the arti- 
cles used in medicine. Py H. M. Edwards, M. D., and P. Vavasseur, M. D. Translated from the 
French by Joseph Tongo, M. D., etc., and E. Durand, etc., Philadelphia, 1829. Dogwood (Cornus Florida}. 
1005 
was filtered, and the alcohol distilled off. There remained in the retort an 
oily-like substance, together with a principle of a dirty white color, cur- 
dled appearance, resembling the residue of the ethereal tincture. Ammo- 
nia was then added to the liquor to precipitate any principle remaining in 
solution. The residue was then treated with a little sulphuric acid, water 
and animal charcoal (previously treated with muriatic acid), which, upon 
evaporation, deposited an abundant crystalline mass, of a flaky appearance, 
resembling at first sulphate of quinine, but on cooling assumed a feathery 
appearance, with a sharp, saline taste, soluble in hot and cold water, 
insoluble in alcohol and ether, soluble in nitric acid, and resembled sul- 
phate of ammonia in all its properties. One pound of coarsely powdered 
bark was boiled for half an hour in one gallon of water, acidulated with 
gibs sulphuric acid. The tincture was poured off and treated with animal 
charcoal, and when evaporated left a brown extract of a resinous, waxy 
appearance, and very bitter taste, which appeared to have very much the 
flavor of Peruvian bark. This was again treated with animal charcoal, 
and left, on evaporation, a crystalline mass in an impure form, which was 
slightly soluble in alcohol, almost insoluble in ether, but very soluble in 
nitric acid. The alcoholic solution was evaporated, and left crystals of a 
very fine, long, flexible and silky appearance, which crystals decomposed 
when thrown upon red coals, and did not form a precipitate with oxalate 
of ammonia, but were without taste. The bitterness was entirely owing to 
the bitter extract, which was slightly soluble in water, soluble in alcohol, 
but nearly insoluble in ether. This I propose to call bitter extractive; and 
in this, I am inclined to believe, the active principle resides. 
A concentrated tincture yielded by evaporation of a dark brown 
extract, slightly soluble in water, soluble in alcohol and ether, bitter aro- 
matic taste, possessing the properties of resin. Both this and the watery 
extract possess the sensible properties of the bark in a concentrated form. 
There is a red coloring principle in this bark, taken up very feebly by 
alcohol and ether, but less so by water, and has its color rendered deeper 
by an alkali. Oue thousand grains of the bark yielded, by incineration, a 
product weighing sixty-five grains. This residue was submitted to the 
action of boiling water, and concentrated by evaporation; it then had an 
alkaline taste, effervescent strongly with acids, and restored the blue color 
to litmus, previously reddened by an acid. It was then neutralized with 
nitric acid, and upon evaporation yielded crystals of nitrate of potassa. 
The insoluble residue of the preceding experiment was dissolved by 
nitric acid (with the exception of a minute portion of carbonaceous matter), 
with violet effervescence. The colorless solution thus obtained threw down 
a white precipitate, on the addition of oxalate of ammonia, and a deep 
blue one with ferro-cyanate of potassa. It produced also a dark green or 
black with tincture of galls. Carbonate of soda, when added to the solu- 
tion, caused a white flocculent precipitate. On adding a solution of phos- 
phate of soda no change was immediately produced, which led to the 
belief that a salt of magnesia was present. From the result of these few 
and imperfect experiments we may venture to enumerate the following as 
among the principal constituents of the Cornus Florida : 1. Gum; 2. 
Resin; 3. Tannin; 4. Gallic Acid; 5. Oil; 6. Fatty Matter; 7. A Crystal- 
line Substance; 8. Bitter Extractive; 9. Wax; 10. Red Coloring Matter; 
11. Lignin; 12. Potassa; 13. Iron. To which may be added Salts of 
Lime and Magnesia.-Cornus Florida, by James Cockburn, Jr. Extract 
from Thesis. Phil. Col. of Phar. American Journal of Pharmacy, July, 
1835. . New Series. Vol. 1, pages 111-114. 1006 
Dogwood (Cornus Florida^. 
Dr. D. C. O'Keeffe, whilst a student of medicine in the Medical Col- 
lege of Georgia, published a valuable article on the chemical constitution 
and febrifuge properties of Dogwood Bark, in which he states that, with 
the assistance of Dr. Robert Campbell, he had determined upon and con- 
ducted the following process for obtaining Cornine: Pulverize two pounds 
of the well dried bark of the root; separate its tannin with sulphuric ether, 
and filter. Macerate the separated bark in alcohol for two days to extract 
its resin and cornine. Pour off the alcohol, and precipitate the resin with 
water. Filter off the resin, and precipitate the cornine from the liquor 
with a solution of sub-acetate of lead. Separate the sub-acetate of lead 
from the solution by passing a current of sulphuretted hydrogen gas 
throught it. Filter and evaporate the fluid down to the cornine. This sub- 
stance is possessed of decided acid properties, having a well-marked acid 
reaction. It is of a dark straw color, very bitter and astringent.-Southern 
Medical and Surgical Journal. January, 1849. Pages 6-7. Dr. O'Keeffe 
cites the testimony of Professor Geiger, of Heidleberg, as confirmatory of 
the results of his examination of the acid properties of Cornine. It is 
evident, from the discrepancies, in the statements and views of these vari- 
ous observers, that the analyses of Dogwood, thus far published, are not 
sufficiently thorough and accurate, and that the profession needs more 
extended and definite information with reference to the chemical and phys- 
ical properties of this valuable indigenous plant. 
Medical Properties and Uses.-The bark of the Dogwood has been known 
and successfuly used in the treatment of intermittent fevers for more than 
one hundred years. Upon the human body the bark of the Cornus Florida 
acts as a tonic, astringent and antiperiodic, and resembles in its general 
effects Peruvian Bar k. 
Dr. Benjamin Smith Barton in the Philadelphia Medical and Physical 
Journal, of 1805, says: "The bark of the Cornus Florida, or common 
Dogwood, does more than support its former reputation. It was used with 
much success in the generally prevailing intermittents of Maryland and 
Virginia in 1804. By some respectable practitioners it was deemed but 
little inferior to good Peruvian Bark." Page 181. Dr. Walker, by numer- 
ous experiments with it upon the healthy system, determined that it uni- 
formily increased the force and frequency of the pulse, and augmented the 
heat of the body. He instituted collateral experiments with the Peruvian 
Bark, and found that both its internal and external effects agreed with those 
of the Cornus. Dr. Gregg, of Bristol, '.Pennsylvania, states that after 
employing the Cornus Florida for nearly twenty-three years in the treat- 
ment of intermittents, he was satisfied that it was not inferior to Peruvian 
Bark, and that he had found it uniformly beneficial as a tonic in cases of 
debility. Among the number of cures by this medicine was that of his 
own case. Dr. Gregg estimated thirty-five grains of it equal to thirty 
grains of Peruvian bark, and observed that the only inconvenience accom- 
panying its use was, that if taken within a year after being stripped from 
the tree it sometimes occasioned acute pains in the bowels; but this evil 
was remedied by adding to it five grains of Virginia snake root (Aristolo- 
chia serpentaria). He recommends the bark as being in the best state after 
it has been dried a year. 
In an intermittent fever, which prevailed many years ago in West Jer- 
sey, it is said to have proved, generally speaking, more beneficial than 
Peruvian bark. Drs. Jacob Bigelow, S. G. Morton, R. Coates, and many 
other medical men have employed this bark with advantage in intermit- 
tents and in debilitated states of the system, accompanied with loss of 
appetite and indigestion. I have myself used it with good success in the Dogwood {Cornus Florida). 
1007 
treatment of our climate fevers. In the Southern part of Georgia, I have 
known the planters to employ it extensively amongst their people, in com- 
bination with the Wild Cherry bark and Wild Horehound (Eupatorium 
pilosumo), not only in the treatment of intermittent fever, but also in colds 
and dropsies, and in all cases of debility accompanied with loss of appe- 
tite and indigestion. 
Dr. B. S. Barton states that a decoction of the dogwood bark was 
found very useful in a malignant disorder of horses, called "yellow water." 
Dr. D. C. O'Keeffe, in the article previously referred to, gives an 
interesting account of the physiological as well as the therapeutic action of 
the extract of dogwood, and supports his views by fifteen accurately 
detailed cases of intermittent fever. 
In order to ascertain with precision the effects of large doses of the extract on 
the system in a physiological state, Dr. O'Keeffe instituted the following experi- 
ments upon himself: 10 A. M., first dose, 30 grs. extract; pulse previous to 
taking it, 72. 11 A. M., second dose, 30 grs.; pulse intermittent, 72-76; tempera- 
ture of surface somewhat augmented ; general perspiration; a sense of fullness 
and slight, dull pain over the frontal eminences, much increased on flexing the 
head forward and downward ; uneasy feelings in the stomach and bowels. 12 M., 
third dose, 30 grs.; pulse 76, not intermittent, but somewhat depressed ; sensation 
in the head uniform. On taking this dose a sense of warmth was felt in the 
stomach, and radiated over the surface of the trunk. 1 P. M., fourth dose, 30 grs.; 
pulse 76 and regular ; pain in the head augmented, and extended down the fore- 
head to the eye-lids, with a disposition to sleep; slight oppression in the precordia. 
Eating dinner neither mitigated nor heightened the dull headache, which con- 
tinued the same throughout the day. At night tendency to sleep much more 
urgent. Retired early; slept well during the night, and arose in the morning free 
from any uneasy sensations whatever.-Southern Medical and Surgical Journal, 
January, 18^9, pages 10-11. 
The discrepancies between the effects observed by Dr. O'Keeffe and 
Dr. Walker may have been due to the fact that the former used the 
extract and the latter the bark. Be this as it may, it is nevertheless true 
that the profession needs an extended series of experiments upon the 
action of the various preparations and constituents of the cornus Florida. 
Until these data are supplied it would be worse than useless to attempt 
any critical analysis and description of its physiological effects. Dr. 
O'Keeffe not only substantiates the testimony of various physicians to the 
great value of dogwood in the treatment of malarial fever, but he also 
establishes the fact that the extract has no tendency whatever to disturb 
the stomach and bowels. This is important, for the alleged tendency of 
the cornus to disturb the stomach and bowels mentioned by so many 
writers has exerted no little influence in causing this valuable remedy to 
remain neglected. 
According to Mr. Carpenter the cornus Florida yields a beautiful 
extract, resembling very closely that of cinchona; differing, however, in 
its sensible characters from the extract of the superior species of Peruvian 
bark, by being less bitter and more astringent. The following is the most 
eligible mode for preparing this extract: Evaporate in a sand or water 
bath a tincture of the bark, made by digesting it in proof spirits in the 
proportion of two ounces of the former to a pint of the latter, suffering it 
to stand for at least a week before straining, occasionally during this time 
submitting it for a few hours to a moderate heat, and thereby facilitating 
the solution. This extract, from its most prominent and sensible charac- 
ters, is unquestionably much more active than the common extract of 
Carthagena bark, and is a preparation admirably adapted in all cases 
where the cornus may be employed with advantage; and in consequence of 1008 
Dogwood {Cornus Florida}. 
being a concentrated preparation, separated from the ligneous and insol- 
uble portions, and containing less gum and mucous matter (which consti- 
tutes so large a portion), is certainly much preferable to the crude substance, 
and, no doubt, will be resorted to by many country practitioners as a useful 
expedient, particularly in those places where this article is in profusion, 
and where a bark of good quality is frequently very scarce, and sometimes 
even unknown.-Essays on Materia Medica, etc., by G. W. Carpenter, pages 
203-20^. The extract thus prepared has been exhibited with success by 
several practitioners, in the same doses as the alcoholic extract of cin- 
chona. Dose of extract of cornus Florida, from gr. x to $ii, repeated as 
often as the case demands. Dose in powder from twenty to thirty grains, 
to be repeated according to circumstances. It may also be given in decoc- 
tion, made with an ounce of the bark to the pint of water, of which the 
dose is from an ounce to two ounces. In some parts of the country the 
ripe berries infused in brandy have been used as bitters, and the infusion 
of the flowers is said to form a good substitute for chamomile tea. A 
decoction of the buds and twigs has been thought to agree better with weak 
stomachs than the other preparations. 
During the recent war, in both civil and military practice, I have used 
the decoction and tincture of dogwood to a considerable extent, and found 
the remedy of value in the treatment of malarial fever. In the severe cases 
the paroxysm was arrested with sulphate of quinine, and the patients were 
then put upon the dogwood, to secure the tonic as well as the antiperiodic 
properties. I also employed in military practice in the treatment of inter- 
mittent fever, with most satisfactory results, a mixture composed of tinc- 
ture of dogwood, nitric acid and common salt. The followingis the formula 
most generally employed: B.-Saturate tincture of dogwood bark, f^xij; 
nitric acid (concentrated), fgi; common salt (chloride of sodium), §i. Mix 
tablespoonful in cup of water every four hours, sucked through a quill. 
Under this preparation not only was the recurrence of the chills prevented, 
but the sallow, jaundiced complexion of the soldiers, who had long been 
exposed to the action of malaria, assumed the clear hue of health. Both 
the nitric acid and the common salt in this mixture were also efficient 
agents in breaking up the paroxysms, and in causing such an increased 
action of the liver and kidneys as removed the effete compounds resulting 
from the prolonged action of the malarial poison. As far as my personal 
investigations extend, I was led to the belief that the tincture of dogwood 
possesses decided prophylactic powers against malarial fever. The com- 
pound tincture of dogwood was issued by the Medical Purveyors to the 
Confederate troops serving in damp, swampy, marshy, malarious regions 
with good effects in protecting the troops against malaria. Thus the Eutaw 
(Twenty-fifth South Carolina) Regiment, whilst it was encamped upon 
James' Island, in a locality notorious for the prevalence of malarial fevers 
of the severest character during the summer and fall months. This regi- 
ment had a mean strength of near eight hundred officers and men. During 
the summer and autumn of 1862 as large a proportion as one-third of the 
mean strength were at times upon the sick list with the various forms of 
malarial fever. The assistant surgeon of this regiment, J. W. Warren, of 
South Carolina, communicated to the author, during his inspection of the 
sick upon James' Island, some interesting facts upon the prophylactic 
powers of certain indigenous remedies. 
A compound tincture, or medicated whisky, prepared by the Medical 
Purveyor from the dogwood, cherry, poplar and willow barks, was adminis- 
tered daily, in the proportion of one-half to one gill to each man during- 
two weeks in the month of September, 1862. Under the use of this tonic Dogwood {Cornus Florida}. 
1009 
mixture the number of new cases of malarial fever diminished one-half, 
although as the autumnal season advances upon James' Island, malarial 
fevers increase in number and severity. The supply of this medicated 
whisky being limited, at the end of two weeks it was exhausted, and in the 
course of eight days the cases of malarial fever had increased from thirty- 
six to eighty. A fresh supply having been obtained its use was again com- 
menced, and in the course of five days the number of cases of malarial fever 
fell to the original number. 
In the absence of quinine a strong tincture of these barks was used 
with good effects in the treatment of malarial fever. I requested Assistant 
Surgeon Warren to continue these experiments, with certain variations, 
designed to determine the active and the inert ingredients in the tincture, 
and also indicated a plan by which the prophylactic powers of dogwood 
might be fairly tested. Dogwood received the special attention of the 
Surgeon-General, S. P. Moore, of the Confederate States army, and of the 
Medical Purveyors, at an early period in the war, as will be seen from the 
following official papers: 
CIRCULAR. 
Confederate States of America, 
Surgeon-General's Office. 
Richmond, Va., Dec. 5, 1862. 
, Medical Purveyor, C. 8. A.: 
Sir-Below you will find a formula for a compound tincture of the indigenous 
barks, to be issued as a tonic and a febrifuge, and substituted, as far as practicable, 
for quinine. 
Very respectfully, your ob't serv't, 
Samuel P. Moore, S. G., C. S. A. 
Dried dogwood bark 30 parts; dried poplar bark 30 parts; dried willow bark 40 
parts; whisky 45 degrees strength. Two pounds of the mixed barks to one gallon 
whisky. Macerate fourteen days and strain. Dose one fluid ounce f^j three times 
a day. 
CIRCULAR NO. 12. 
Confederate States of America, 
Surveyor's Office. 
Richmond, Va., August 22, 1862. 
, Medical Purveyor, C. 8. A.: 
Sir-Although no orders have been issued to that effect, some of the Purvey- 
ors appear to be under the impression that they should make a mixture of the 
indigenous barks (dogwood, etc.,) and whisky. The arrangement intended by the 
Surgeon-General and Commissary-General is, that the Commissary Department 
shall furnish the whisky to the troops, giving each man one drink a day. The 
Purveying Department was to furnish the barks to mix with the whisky, to make 
a species of army bitters, as a preventive against malaria, etc. The arrangement 
is merely an issue of whisky by the Commissary Department to the troops, and 
the Purveying Department furnish the bark to mix with it. This office has not as 
yet been instructed whether the mixture is to be made at the Purveying depot or 
at the Commissary depot. Therefore whisky will not be issued in other than the 
medical preparations that have been, or may be, ordered as regular issues. 
Very respectfully, your ob't serv't, 
E. W. Jones, Chief Med. Purv. C. S. A. 
CIRCULAR NO. 19. 
CONFEDERATE STATES OF AMERICA, 
Medical Purveyor's Office, 
Richmond, Va., November 1, 1862., 
, Medical Purveyor, C. S. A.: 
Sir-Your attention is called to the following extract from Carpenter's Essay- 
on the Materia Medica: * * * "The cornus florida yields a beautiful extract 
resembling very closely that of cinchona, differing, however, in its sensible char- 1010 
Dogwood {Cornus Florida). 
acter from the extract of the superior species of Peruvian bark, by being less bitter 
and more astringent. The following is the most elegant mode for preparing this 
extract: Evaporate in a sand or water bath a tincture of the bark made by digest- 
ing itin proof spirits, in the proportion of two ounces of the former to a pint of 
the latter, suffering it to stand for at least a week before straining, occasionally 
during the time submitting it for a few hours to a moderate heat, and thereby 
facilitating the solution. This extract, from its most prominent and sensible char- 
acter, is unquestionably much more active than the common extract of carthagena 
bark, and is a preparation admirably adapted in all cases where the cornus may be 
employed with advantage, and in consequence of being a concentrated preparation, 
separated from the ligneous and insoluble portion, and containing less gum and 
mucous matter (which constitute so large a portion), is certainly much preferable 
to the crude substances, and no doubt will be resorted to by many country practi- 
tioners as a useful expedient, particularly in those places where this article is in 
profusion, and where bark of a good quality is frequently very scarce, and some- 
times even unknown. The extract thus prepared has been exhibited with success 
by several practitioners, in the same doses as the alcoholic extract of cinchona. 
Dose of extract of cornus Florida from ten grains to two drachms, repeated as often 
as the case demands." This preparation appears to be a desirable one, and you 
will accordingly include it among those to be prepared for issue. 
Very respectfully, your ob't serv't, 
E. W. Jones, Chief Med. Purveyor. 
Office Medical Purveyor, 
Montgomery, Ala., February 11th, 1863. 
, Medical Purveyor, C. S. A.; 
Sir-Yours of the 9th inst. has been received. I can send you thirty-five 
pounds spirits of nitre dulce. I am preparihg it, but will be out of nitric acid in 
a day or two. If you can send me some nitric acid I can manufacture spirits nitre 
for you. I have a few pounds of aqua ammonia to spare, and can make you some 
if you can procure for me muriate of ammonia. I can send you fluid extract 
sarsaparilla, tincture muriate iron, fluid extract of blackberry, tincture of dogwood, 
poplar and willow, solid extract podophyllum, syrup of squills, solid extract of 
dogwood, syrup of wild cherry. All these I am manufacturing in considerable 
quantity. lam now making ether snip, in order to make tannin, and chloride 
of lime for making chloroform, both of which I shall manufacture this month. 
The fluid extract of blackberry I can recommend as a capital astringent in dysen- 
tery and diarrhoea. The extract of podophyllum is a safe and thorough purge. 
The extract of dogwood is agood substitute for quinine. The tincture of dogwood, 
poplar and willow is used in the hospitals here in large quantities. All these pre- 
parations are made with care. 
Your obedient servant, 
Wm. H. Anderson, Med. Purveyor. 
The following observations upon the medicinal properties of the Cor- 
nus Florida (Dogwood) appeared in a valuable work, prepared by Surgeon 
Francis Peyre Porcher, M. D., of Charleston, South Carolina, and published 
by order of the Surgeon-General, C. S. A., 1863: 
Cornus Florida {Dogwood').-This well known plant possesses tonic and anti- 
periodic properties very nearly allied to those of cinchona. In periodic fevers, one 
of the most valuable of our indigeneous plants. Dr. Gregg states that after employ- 
ing it for twenty-three years in the treatment of intermittent fevers, he was satis- 
fied that it was not inferior to Peruvian bark. Generally given in conjunction 
with laudanum. It also possesses antiseptic powers. In the recent state it is less 
stimulating than the Cinchona bark, but it affects the bowels more. The dried 
bark is the preferable form. The fresh bark will sometimes act as a cathartic. It 
is more stimulating than Thoroughwort (Eupatorium), and, therefore, is less 
applicable during the hot stages of the fever * * In our present need of astrin- 
gent antiperiodics and tonics, the dogwood bark powdered will be found the best 
substitute for the Peruvian. Internally and externally, it can be applied where- 
ever the cinchona barks were found serviceable. The dogwood bark and root in 
decoction, or in form of cold infusion, is believed by many to be the most efficient 
substitute for quinine, also in treating malarial fevers. Certainly it might be used 
in the cases occurring in camp to prevent the waste of quinine, as it can be easily Round-Leaved Dogwood-Swamp Dogwood. 
1011 
and abundantly procured. Dr. Richard Moore, of Sumpter district, informs me 
that lie not only finds it efficient in fevers, but particularly useful, with whisky or 
alcohol, in low forms of fevers and dysentery occurring near our river swamps. 
During convalescence, when an astringent tonic is required, this plant supplies our 
need. See Eupatorium (Boneset) and Liriodendron. These, with the blackberry 
and chinquapin as astringents, the gentians and pipsissiwa as tonics and tonic 
diuretics, the sweet gum, sassafras and beni for their mucilaginous and aromatic 
properties, and the wild jalap (podophyllum) as a cathartic, supply the surgeon in 
camp with easily procurable medicinal plants, which are sufficient for almost 
every purpose. Nitrate and bi-carbonate of potash are most required, and, with 
calomel, may be procured from abroad. Our supply of opium can be easily pro- 
cured by planting the poppy and incising the capsules. Every planter could raise 
a full supply of opium, mustard and flaxseed. The wood of the dogwood, likethe 
willow, is preferred in making gunpowder. See Salix. A tonic compound, as 
advised by the herbalists, is made with the bark of the root of the dogwood, 
columbo (frasera), poplar, each six ounces; bark of wild cherry, six ounces; leaves 
of thoroughwort, four ounces; cayenne pepper, four ounces, sifted and mixed. 
Dose, a teaspoonful, in warm or cold water, repeated. It is stated in the Newbern 
Progress that a ripe dogwood berry taken three times a day, before meals, will cure 
ague and fever. My friend, Professor F. A. P., contributes the following to the 
Charleston Courier: [The dogwood bark, powdered may be used in place of the 
Peruvian mentioned. Dutch Remedy for Fever and Ague.-As quinine is very 
scarce, it may not be unprofitable, both to our armies and private families, to revive 
the memory of an ancient remedy, which was in almost universal use before the 
introduction of the former drug. It was known by the name which heads this 
article, and has been used from time immemorial among the Huguenot families of 
the Santee, among whom there is a tradition that it was brought to this country 
by the ancestor of one of the families, who was a physician. The remedy quoted 
below is copied from an old receipt book. Though not a professional man, I can 
speak for its efficacy when it was in vogue: The Recipe.-Two ounces of peruvian 
bark, two ounces of cream of tartar, sixty cloves. Manner of Using It.-These 
ingredients are to be rubbed together in a mortar. The mixture to be divided into 
twenty-four doses, four of which (mixed in water) are to be given the first day, 
four on the second, and two on every succeeding day, until the whole shall have 
been taken. It is probable that the disease will be arrested on the second or third 
day; but the object in taking the whole prescription is to complete the cure by its 
tonic property. The berries of the dogwood have also been highly recommended; 
given as a remedy for fever in place of quinine (1862). One or two given in form 
of pill.-Resources of the Southern Fields and Forests, Medical, Economical and 
Agricultural, etc., by Francis Peyre Porcher, M. D., Surgeon, P. A. C. S. 1863. 
Pages 59-62. 
Cornus Cirpinata, wild {Round-leaved. Dogwood}, and Cornus Sericea, wild 
{Swamp Dogwood.} 
The ten species of corn us indigenous to the United States are all sup- 
posed to possess similar medicinal properties. With the exception of the 
cornus Florida, the two now under consideration have been most carefully 
investigated. Our knowledge, however, of both their chemical and medici- 
nal properties is not only more imperfect than that of the cornus Florida, 
but is vague and meagre. Professors Mason and Ives appear to have been 
the first to introduce the cornus circinata into medical practice. They 
recommend it very highly for its astringent and tonic properties, and affirm 
that they have successfully used it in intermittent fevers and dysentery. 
Mr. Carpenter announced that the alkaloid principle, cornine, exists in 
this species of cornus. The alcoholic extract appears to be the most 
eligible mode of using this article. The extract is prepared in the same 
manner with that of the cornus Florida. It possesses more astringency; 
and is therefore better adapted to the treatment of dysentery. As this 
plant appears to be rare in most of the Southern States, it is not likely that 
it will ever be extensively employed, especially as the cornus Florida is 
not only more abundant, but also fully as efficient. The bark of the cornus 1012 
Buttonwood-Cephalanthus Occidentalis. 
sericea (swamp dogwood) was found by Dr. Walker to be equal to that of 
the cornus Florida, and but little inferior to the common pale Peruvian 
bark in the treatment of inter mittents. It forms a beautiful tincture with 
proof spirits. As the swamp dogwood inhabits the North American con- 
tinent from Canada to Florida, growing in moist woods, in swamps, and on 
the border of streams, especially in the mountains, it is well worth the 
attention of the physicians of the United States. The dose and modes of 
preparation and administration are the same with those of the cornus 
Florida. 
ENGRAVING NO. 110. 
Pond Dogwood-Cephalanthus Occidentalis {Buttonwood)- Walt. 
BUTTONWOOD J SHRUB 
CEPHALANTHUS OCCIDENTALIS 
Botanical Characters.-Common calyx; obconical superior, funnel-shaped. Receptacle globose, 
hairy. Capsule four-celled, not opening. Seed solitary. A shank six to fifteen feet high; the 
wood soft, spongy and pithy in the centre; bark rather smooth. Stem jointed, much branched, 
the branches generally opposite. Leaves opposite and terminate, ovate. Canceolate, slightly 
acuminated, veryentire; the upper surface glabrous, shining; the veins on the undersurface 
pubescent, four to five inches long and two to two ana one-half inches wide. Petioles half an 
inch long. Pubescent, slightly winged. Flowers, axillary and terminal. Pedundes (common) 
two to three inches long; pubescent. Calyx proper one-leaved, angled, superior, four-cleft, the 
segments obtuse. Corolla one-petalled, tubular, four times as long as the calyx; hairy within, 
white, the border four-cleft, segment obtuse. Filaments four, very short, attached to the base of 
the corolla at the base of each fissure. Anthers oblong; sagittate, pale brown. Germ angled. 
Style filiform, twice as long as the corolla. Stigma capitate. Capsule angled, inversely pyrami- 
dal, second celled. Receptacle globose, very hairy. Grows in swamps, ponds and stagnant 
waters. Flowers in July.* 
Geographical Distribution.-The swamps, ponds and stagnant waters of 
the United States, and especially of the southern portions of South Caro- 
lina and Georgia. Medical Properties-Uses.-Elliott says that the inner 
bark of the root is an agreeable bitter, and frequently used as a remedy in 
obstinate coughs. (Vol. 1, p. 187.) It is considered as a valuable domestic 
remedy in the country for various complaints. "A wash of the decoction 
of the plant is said to be good for the palsy." (View of South Carolina by 
John Drayton, p. 62.) Some botanists have thrown this plant into the 
same class as pinckneya pubens, cinchmacede (coffee tribe), and it has been 
used as both a tonic and febrifuge, and decided antiperiodic properties 
* Elliott, Sketch of the Botany of South Carolina and. Georgia, vol. i, pp. 186-187. Tulip Tree (Liriodendron Tulipifera). 
1013 
have been ascribed to it. Merat notices it as an antivenereal. A writer 
in the Mercury, of Charleston, South Carolina, during the recent war, says: 
" The root of the buttonwood or crane willow, a shrub which is conspicu- 
ous in our swamps in the spring; when boiled with honey and comfrey, 
makes a pleasant syrup, which is the most effective remedy known to me 
in diseases of the lungs. It is thought by many intelligent persons to be a 
radical cure for consumption."-Resources of the Southern Fields and Forests, 
by Francis Peyre Porcher, M. D., 186S. page 405. 
I have employed the decoction of the bark of this small tree or shrub 
with benefit as a tonic in depressed states of the system following malarial 
fever, and also with the best effects in obstinate coughs and affections of 
the lungs in the form of syrup and candy. We need further light, the 
result of careful investigation, upon the antiperiodic powers of the cepha- 
lanthus; its botanical relations, as well as popular belief in certain parts of 
the country, indicate that their properties are potent and valuable. 
ENGBAVING NO. 111. 
Poplar or Tulip Tree (JAriodendron Tulipifera')-Linn. 
POPLAR OR TULIPITREE 
LYRIOOENDRUM TULIPIFERA 
Botanical Characters.-Calyx three-leaved. Petals six. Capsules (Samaree) imbricated, form- 
ing a strobilus, one to two seeded, not opening. Leaves truncated, perminate, four-lobed; calyx 
three-leaved. This is one of the largest trees of the American forests. In the low countries of 
the Carolinas and Georgia it is somewhat rare, and seldom exceeds three feet in diameter, but in 
the fertile soils of the Western country-in Kentucky, Tennessee and Alabama-it is sometimes 
found twelve to thirty-six inches in diameter, and from fifty to even one hundred and twenty 
feet in height. The wood of this tree, though soft, is durable. The leaves are alternate, three- 
lobed, with the middle lobe truncate, and varying with the angles of the lobe obtuse, acute and acu- 
minate, glabrous, on petioles two to three inches long. Flowers solitary, terminal. Leaves of 
the calyx concave. Petals obovate, lanceolate; of a dull yellow color; tinged with red. Stamens 
numerous, disposed in a simple series shorter than the petals. Germs numerous on a conical 
receptacle. Grows in most fertile soils. Flowers in May and June.* 
Geographical Distribution.-According to Michaux, the southern extrem- 
ity of Lake Champlain, in latitude 45°, may be considered as the northern 
limit, and the Connecticut river, in the longitude of 72°, as the eastern 
* Elliott, Sketch of Botanj- of South Carolina and Georgia, vol. ii, pp. 40-11. 1014 
Tulip Tree (Liriodendron Tulipifera). 
limit of the tulip tree. It is only beyond the Hudson, which flows two 
degrees farther west, and below 43° of latitude, that it is frequently met 
with and fully developed. It is multiplied in the Middle States, in the 
upper parts of the Carolinas and Georgia, and still more abundantly in the 
western country, particularly Kentucky. Its comparative rareness in the 
maritime parts of the Carolinas and of Georgia, in Florida, Alabama and 
lower Louisiana, is owing less to the heat of the summer than to the nature 
of the soil, which, in some parts, is too dry, as in the pine barrens, and in 
others too wet, as in the swamps which border the rivers. The Western 
States appear to be the natural soil of this magnificent tree, where they 
have been found twenty-three feet in circumference, and from one bundled 
and twenty to one hundred and forty feet in height.-Forest Trees of Amer- 
ica. Vol. 2. p. 35. 
Chemical Composition.-The first chemical examination of the bark of 
the liriodendrou tulipifera, appears to have been made in 1802, by Dr. 
Bogers. From the state of organic chemistry at that time, this examina- 
tion was almost necessarily imperfect, and resulted in the determination of 
nothing more than gum resin, an acid supposed to be muriatic, iron, cal- 
careous salt, mucus and fecula, as its chief constituents. 
In 1832, Dr. J. P. Emmet,* of the University of Virginia, announced 
the discovery of a peculiar principle iu the poplar bark, which he called 
liriodendrou, and which he described, in the pure state, to be solid, white, 
crystallizable, brittle, inodorous at 40°, fusible at 180°, and volatile and 
partly decomposed at 270°, and of a slightly aromatic odor, and a bitter, 
warm, pungent taste; insoluble iu water, soluble in alcohol and ether; 
water precipitates it from its alcoholic solution; incapable of uniting with 
alkalies and acids; alkalies precipitated it from the infusion or decoction of 
the bark by combining with the matter which rendered it soluble in the 
water. It is obtained by macerating the root in alcohol, boiling the tinc- 
ture with magnesia until it assumes an olive green color, then filtering, 
concentrating by distillation until the liquid becomes turbid, and finally 
precipitating the liriodendrine by the addition of cold water. When care- 
fully heated in a glass tube closed at one end, it goes off a white vapor, 
which condenses again, without any signs of crystallization. Prof. Emmet 
regarded it as analogous to camphor. The fact that the bark of the lirio- 
dendronis weakened by age, and so far loses its bitter and aromatic tastes 
as to become almost insipid, gives force to the opinion that its peculiar 
properties reside in this volatile principle-liriodendrine. 
Medical properties and uses..-Formerly this bark was employed iu the 
United States, both in domestic and regular practice, and from the testi- 
mony which was then published in favor of its decided value as an aro- 
matic, stimulating tonic, diaphoretic and anti periodic, it appears to be 
well worthy of the careful examination of physicians at the present time. 
Michaux,f in his splendid work on the Forest Trees of America, states 
that in some parts of Virginia the inhabitants were accustomed to steep 
the bark of the roots, with an equal portion of dogwood bark, in brandy, 
during eight days. Two glasses of this tincture, taken every day, some- 
times cures intermittent fevers. 
Dr.,Benjamin Rush^ states that he employed the poplar bark in the 
treatment of intermittent fever "with as much satisfaction as any of the 
common bitters of the shops." 
*Journal of the Philadelphia College of Pharmacy, iii. 5. 
fVol. 2, p. 40. 
I Translations of the College of Physicians of Philadelphia, 1798. Tulip Tree {Liriodendron Tulipifera). 
1015 
The testimony of Dr. J. T. Young, of Philadelphia, to its value is 
decided, aud well worthy of consideration at the present time, when we 
are liable to be deprived of our most powerful and valuable remedies. In 
a letter* addressed to Governor Clayton, of Delaware, in 1792, he thus 
states the results of his experience: 
The liriodendron tulipifera, tulip or poplar tree, grows throughout the United 
Ftatesof America. The best time to procure the bark for medicinal purposes is in the 
month of February, as the sap at this time, being more confined to the root, increases 
its virtue. It possesses the qualities of an aromatic-a bitter, and an astringent; the 
bitter quality is greater, the astringent less than in the Peruvian bark. It likewise 
possesses an aromatic acrimony, hence I infer it is highly antiseptic and power- 
fully tonic. I have prescribed the poplar bark in a variety of cases of intermittent 
fever; and can declare from experience it is equally efficacious with Peruvian bark, 
if properly administered. In the phthisis pulmonalis, attended with hectic fever, 
night sweats and diarrhoea, when combined with laudanum, it has frequently 
abated these alarming and troublesome symptoms. I effectually cured a Mr. 
Kiser, fifty years of age, who was afflicted with a catarrh and dyspeptic symptoms 
for five years, which baffled the attempts of many physicians and the most cele- 
brated remedies, by persevering in the use of the poplar bark for two weeks. I can 
assert from experience there is not, in all the materia medica, a more certain, 
speedy and effectual remedy in hysteria than the poplar bark, combined with a 
small quantity of laudanum. I have used no remedy in ch lera infantum but the 
poplar bark, after cleansing the primse vise, for these two years. It appears to be 
an excellent vermifuge. I have never known it to fail in a single case of worms 
which has come under my observation. I prescribed it to a child when convul- 
sions had taken place. After taking a few doses, several hundreds of dead asca- 
rides were discharged with the stools. The dose of the powder to an adult is from 
a scruple to two drachms; it may likewise be used in tincture, infusion or decoc- 
tion; but its virtues are always greatest when given in substance. Governor Clay- 
ton, in his reply, observes : "During the late war Peruvian bark was very scarce 
and dear. I was at the time engaged in considerable practice, and was under the 
necessity of seeking a substitute for the Peruvian bark. I conceived that the poplar 
had more aromatic and bitter than the Peruvian, and less astringency. To correct 
and amend those qualities, I added to it nearly an equal quantity of the bark of the 
root of dogwood (cornus Florida, or boxwood) and half the quantity of the inside 
bark of the white oak tree. This remedy I prescribed for several years, in every 
case in which I conceived the Peruvian bark necessary or proper with, at least, if 
not superior success. I used it in every species of intermittent, gangrenes, mortifi- 
cations, and, in short, in every case of debility. It remains to determine whether 
the addition of those barks to the poplar increases its virtues or not; this can only 
be done by accurate experiments in practice." 
Dr. Bartonf recoin in ended the bark of the poplar in chronic rheuma- 
tism and in gout; and from its tendency to produce diaphoresis, together 
withits tonic powers, there can be little doubt of its value in certain con 
ditions of these diseases. Dr. Eberlie^ employed it repeatedly in conjunc 
tion with the almus aspera, in the form of decoction, in the treatment of 
the advanced stages of dysentery, with satisfactory results. Dr. Bigelow§ 
used it with success as a stomachic. The powdered bark, in union with 
steel dust, has been prescribed with great advantage in debilitated states 
of the stomach.|| The most efficacious form of administering the bark of 
the liriodendron tulipifera is in substance in the form of powder-$ss to jij. 
The infusion of powdered bark to one pint of water, may be adminis- 
tered f^j to f§ij, and the saturalent tincture in the dose of f^j. The 
infusion and the tincture are not as efficient as the powder. No use that 
* Carey's American Museum. Vol. 12. 
t Barton's Collections. 
t A Treatise on Materia Medica and Therapeutics, by John Eberlie, M. D., etc. Philadelphia' 
1830. Vol. 1, p. 282. 
g American Medical Botany, etc., by Jacob Bigelow, M. D., etc. Boston. 1818. Vol. 2, p. 112. 
' || Thacker's Dispensatory. 1016 
Small Magnolia {Magnolia Glauca'). 
we are aware of has, as yet, been made of theliriodendrine. The seeds are 
said by Rafinesque to be laxative; this fact, however, has been noticed by 
no other writer, and needs confirmation. The leaves have been used as an 
external application in headache; and an ointment prepared with them has 
been used with good effect in ulcers. In the administration of the bark in 
powder, the bowels should be first opened by a cathartic; and if the bark 
produces pain in the bowels, it should be combined with small quantities 
of laudanum. 
ENGRAVING NO. 112. 
Small Magnolia, or Sweet Bay-Magnolia Glauca-Linn. 
Botanical Characters.- Leaves oval lanceolate, glaucous underneath; petals obovate, tapering 
at the base. A shrub frequently becoming a small tree, remarkable for its white or somewhat 
glaucous bark. Leaves alternate, on petioles about an inch long, acute, shining, and when young 
pubescent, underneath glaucous, pubescent when young, having a silken lustre. Flowers soli- 
tary, terminal. Leaves of the calyx oval, glabrous, membranaceous, sprinkled with pellucid 
dots, as long as the corolla. Petals generally nine, obovate, white, as long as the receptacle. 
Filaments very numerous, compressed, with the point acuminate and extending beyond the 
anthers. Anthers attached to the inner side of the filaments. This is probably the most'fragrant 
plant in our forests. It grows in great profusion along the margin of the rich swamps which 
border our rivers, and in the morning and evening, duringthe periodofits flowering, the atmos- 
phere of our streams is often literally perfumed with its fragrance. Flowers April to May. We 
have a variety with perennial leaves, which sometimes become a tree fifty to sixty feet high. I 
have been able to discover no other distinction between these two plants' than the difference of 
habit.* 
SMALL MAGNOLIA JR WRITE SAY 
MAGNOLIA GLAUCA 
Geographical distribution.-The sweet bay has the most extensive range, 
especially near the seaboard, of any of the species of the magnolias. 
According to Professor Bigelow.y its most northern boundary appears to 
be in a sheltered swamp in Manchester, Cape Ann. about thirty miles north 
of Boston. It here attains to but small size, and is frequently killed to the 
ground by severe winters. It is common in the Middle States, and abounds 
in the maritime ports of the Southern States. In North Carolinaand South 
Carolina it is found in greatest abundance within the limits of the pine- 
barrens, growing abundantly in the blanches, marshes or swamps travers- 
ing the pine-barrens. It is not abundant in the large swamps bordering 
* Elliott-Sketch of the Botany of South Carolina and Georgia, vol. 2, p. 37. 
f American Medical Botany, vol. 2, p. 68. Small Magnolia (Magnolia Glauca'). 
1017 
the rivers, and is very rarely found upon the islands which border the sea 
coasts. 
Chemical composition.-As far as our information ext ends, no complete 
chemical analysis has been made of the bark of this tree. It is highly 
probable that its constituents will be found to resemble closely those of the 
magnolia grandiflora, which, according to the examination of Dr. Proctor,* 
contains a green resin, a volatile oil, and a peculiar crystallizable prin- 
ciple, analogous to liriodendrine, which, as we have previously stated, was 
discovered by Dr. J. P. Emmet in the bark of the tulip tree. Dr. Bigelow 
gives in his most valuable American Medical Botany the fullest account of 
the chemical constitution of the bark of the magnolia glauca with which 
we are acquainted. The following are the results of his examination : The 
bark of the magnolia glauca has a bitter taste, combined with a strong aro- 
matic pungency, which approaches that of sassafras and of the acorus cala- 
mus. The aroma resides in a volatile portion, which is probably an essen- 
tial oil, or a variety of camphor. It is lost from the bark in the dry state 
after it has been kept some time. Water distilled from the green bark has 
its peculiar flavor, with an empyreumatic smell. No oil appears on the 
surface when the experiment is conducted in the usual way. The dried 
bark affords a little resin, and more of a bitter extractive substance. 
Chalybeate tests produce a very slight darkening of the green color of the 
decoction, but gelatine occasions no change. This might be anticipated 
from the little taste of astringency inthe bark.-American Medical Botany, 
vol. 2, p. 70. 
Medical properties and uses.-The Indians used the bark of the magnolia 
glauca as a remedy for autumnal fever and rheumatism, and in many parts 
of this country it has been used with success in the treatment of malarial 
fever, both in domestic and regular practice. 
Dr. Jacob Bigelow thus testifies to its medicinal properties and value : 
As a medicinal article, the magnolia is to be considered an aromatic tonic, 
approaching in its character to cascarilla, canella, and articles of their 
class. Considered simply in regard to its tonic powers, it is probably of a 
secondary order, though from the additional properties which it possesses 
of a warm stimulant and diaphoretic, is found useful in certain disorders. 
Chronic rheumatism is one of the diseases in which it exhibits most effi- 
•ciency. Not only the bark, but the seeds and cones, which are strongly 
imbued with the sensible qualities of the tree, are employed in tincture 
with very good success in this disease. 
In intermittent and remittent fevers the magnolia is one of the many 
tonics which have been resorted to for cure by the inhabitants of the 
marshy countries where they prevail. Sufficient testimony has been given 
in favor of the bark of this tree to warrant a belief that it is fully adequate 
to the removal of fever and ague, when administered, like the cinchona, 
in liberal quantities between the paroxysms. In the more continuous forms 
of fever, of the typhoid type, it has also received the commendations of 
physicians.-American Medical Botany. Vol. #, pp. 70-71. The dose of the 
powdered bark is from half a drachm to a drachm, repeated according to 
the character of the case. A decoction may be made in the proportion of 
one ounce of the powdered bark to the pint of water. This may be admin- 
istered in doses of from f§i to fsij, and repeated every one, two or three 
hours, according to circumstances. An extract has been made from it, but 
its powers have not been sufficiently tested, An infusion of the bark in 
brandy has been employed in rheumatism. The cones and seeds have like- 
* American Journal of Pharmacy, vol. 14, p. 95. Large Magnolia {Magnolia Grandiflora). 
1018 
wise been employed to make a tincture, which has been a popular remedy 
in the treatment of chronic rheumatism, and as a prophylactic against 
intermittent fever. 
ENGRAVING NO. 113. 
Cucumber Tree {Magnolia Acuminata)-Mich. No. 8, Big Laurel {Magnolia 
Grandiflora)-Mich. No. 9, Umbrella Tree {Magnolia Tripetala}-Wild. 
LARGE magnolia 
OR BIG LAUREL, 
MAGNOLIA 
GRANDIFLORA 
Our information with reference to these three species of magnolia,, 
although less definite and far more meagre than that which we have pre- 
sented concerning the magnolia glauca, still, as far as it extends, tends to 
establish their value in the treatment of malarial fever. The cucumber 
tree (magnolia acuminata), which extends from the Falls of Niagara along 
the whole mountainous tract of the Alleghanies to their termination in 
Georgia, and also along the Cumberland mountains in Tennessee, has been 
employed by the inhabitants of the country bordering on the Alleghanies 
as a preventive of intermittent fever. Michaux* states that they gather 
the cones about midsummer, when half ripe, and steep them in whisky. A 
glass or two of this liquor, which is extremely bitter, they habitually take 
in the morning as a preventive against autumnal fevers. 
We are not aware that there are any recorded observations of the 
results of these attempts to ward off the malarial fever. It would, there- 
fore, be highly important that physicians living in the regions where this 
tree is found should carefully determine the value of the cones as a pro- 
phylactic. The discovery of a native prophylactic against malarial fever 
would be of incalculable value to our planters in the rich lowlands of the 
South, and especially to bodies of white men exposed during marches and 
in the defense of our coast to the destructive exhalations of marshes and 
rice fields. We have before alluded to the discovery by Dr. Stephen Proc- 
tor of a principle in the bark of the magnolia grandiflora, analogous to the 
* Forest Trees of America. Vol. 2, p. 16. Persimmon {Diospyros Virginiana}. 
1019 
principle liriodendrine of the tulip tree. In addition to this he found a 
valuable oil and resin. 
The medical properties of these different species appear, as far as our 
very limited information extends, to be almost identical, and it is proba- 
ble that they may be substituted one for the other without inconvenience 
in the same doses recommended for magnolia glauca. We need, however, 
accurate analysis and extended medical observations. 
ENGRAVING NO. 114. 
Diospyros Virginiana {Persimmon Tree}-Mich.-French name, Plaqueminier- 
Vulgar names, Persimmons, Yellow Plums, Winter Plums, Guaican, Seeded 
Plums, Pishmin, etc. 
PERSIMON 
Botanical Characters.-Genus Diospyros. Deciduous. Calyx four to eight cleft. Corolla 
rotate or urceolate, four to eight cleft. Staminate flowers, with eight to twenty stamen; filaments 
free, with one or two anthers. Pistilate flowers, with one pistil, a short style and four to six 
stigmas. Berry with eight to twelve seeds. Trees with alternated leaves. Species, Diospyros 
Virginiana. Leaves ovate, oblong, acuminate, entire, smooth, pale and reticulate beneath, petio- 
late, petioles pubescent. Berries solitary, globose. The persimmon is a common tree, risi ng from 
fifteen to sixty feet, with a smooth bark and spreading branches. The leaves are from three to 
five inches long, shining above, whitish or pale and reticulate beneath, oval or oblong, base 
acute, end or tip acuminate, margin entire, on short alternate and pubescent petioles. These 
leaves vary in size, andsome varieties have them glaucous or pubescent, beneath. Buds smooth. 
Flowers lateral, extra axillary, solitary, nearly sessile or on a short pedicle. Calyx spreading 
persistent, commonly four cleft, seldom five or six cleft; segments oval, acute, shorter than the 
corolla, which is yellowish, with as many segments as the calyx, broad, ovate, acute. Dichrious 
blossoms on separate trees or dioicol; sometimes a complete flower occurs, in which are many 
stigmas as segments to the calyx, and double the number of stamina. The filaments are short- 
few are inserted in the calyx instead of the corolla; depressed; anthers bilobed. One pistil; germ 
round; style very short; stigmas obtuse, spreading. Fruit a globular yellow berry, similar to a 
plum, with a thin skin; fleshy pulp and many compressed hard seeds. The blossoms are of a 
pale yellow or orange color; they appear in May and June, when the leaves are yet small and not 
quite unfolded. The fruits are only ripe late in the fall, and after frost; they resemble a yellow 
plum, but are globular; before their maturity they are exceedingly acerb and astringent, but 
when fully ripe and soft become sweet and have a fine flavor. These berries were one of the spon- 
taneous fruits used by the native North American Indian tribes, who preserved them in various 
ways; dried them and made a paste with them; also a kind of beer and wine; this liquor contains 
alcohol. 
DIOSPIROS VIRGINIANA 1020 
Persimmon (Diospyros Virginianus'). 
Geographical Distribution.-From New York to Louisiana and Texas, 
rare beyond the 42d degree of latitude; common in the South in woods 
and groves: more common in the plains than on the mountains. 
Medicinal Properties.-Bark bitter and acerb; contains tannin, extrac- 
tive, etc. Fruit sweet and well flavored when ripe, containing sugar, 
mucilage, gallic acid and several other substances. Bark astringent, styp- 
tic, tonic, corroborant, antiseptic, etc. Ripe fruit subastringent, nutrient, 
antiseptic, anthelmintic, etc. The inner bark is the most officinal part; it 
is extremely bitter, and a good astringent tonic; useful in sore throat, 
fevers, intermittents and dysentery. In tlie last disorder it is often united 
with rhubarb. It was in former times much used in Carolina and Tennes- 
see for intermittent fever. Brickel, in his "History of North Carolina," 
says that the inner bark has been used with success in intermittent fever. 
As far as our information extends, this interesting statement remains to be 
verified by scientific observations relative to the chemical and physio- 
logical characters and therapeutic effects of the active principles of the 
bark of the diospiros Virginiana. It is well known that its tonic and 
astringent powers have proved exceedingly valuable in the treatment of 
affections of the bowels,* haemorrhage and ulcerated sore throaty; there are 
many stages and complications of the different forms of malarial fever, 
where these tonic and astringent properties would fill most important 
indications; for malarial fever, as is almost always the case in China, is 
frequently accompanied with derangements of the bowels. 
The bark of the persimmon is also a powerful antiseptic, equal in the 
opinion of the learned and celebrated botanist C. S. Rafinesque, to the 
cinchona. Some physicians, says Rafinesque, consider the persimmon, as well 
as its equivalent, the sorbus Americana, as the best succedanum to cin- 
chona. It has been used in ulcers and ulcerous sore-throats. The doses 
are the same as common tonics, either in substance or extracts. It has not 
yet been analyzed, but probably contains a peculiar principle, diospyrene, 
which is by far more astringent than cor nine, owing to its union with 
gallic acid. 
In the south of Europe the diospyros lotus, which is very much like the 
persimmon, is called holy wood, and employed as a substitute for guiae 
wood. This may possess, perhaps, similar properties. The unripe 
fruit has nearly the same properties as the bark, but is too austere and 
very styptic. The ripe fruit is very palatable, sweet and very vinous; it 
has been used to kill the worms of children. 
The persimmon, wild grape, papaws (Asemiria}, hickory nuts, pecans, 
walnuts, chestnuts, chinquapins, filberts, whortleberries, cranberries, straw- 
berries, mulberries, raspberries, blackberries, crab-apples, wild plums, 
etc., were the fruits of the native aborigenal Indian tribes of North 
America. Several of these have been improved by cultivation, but the 
persimmon has not received the attention which its valuable properties 
indicate. 
* On the use of the unripe fruit of the Diospyros Virginiana as a therapeutic agent. By John 
P. Mettauer, M. D., of Virginia. The American Journal of Med. Sei., October, 1842, p. 297. Amer. 
Jour. Phar. xii, p. 161. Woodhouse, Inaug. Diss. 
t Dr. B. S. Barton's Collections. 11. Catalpa (Bignonia Catalpa'). 
1021 
ENGRAVING NO. 115. 
Catalpa (Bignonia Catalpa.)-Linn. 
CATALPA 
bignonia catalpa 
In a thesis supported at the Medical Department of the University of 
Pennsylvania, the bark of the catalpa was maintained to be tonic, stimu- 
lant and more powerfully antiperiodic than the Peruvian bark. I have 
been unable, after careful research with the best authorities to find any 
facts which bear either upon the chemical constitution, or the tonic, stim- 
ulant and antiperiodic properties of the bark of the catalpa, Physicians 
should exercise caution in their experiments with it, because it is generally 
believed to be poisonous. When the bark is wounded a very unpleasant, 
and according to the testimony of some, a poisonous gas is emitted; and it 
has been stated, on good authority, that the honey collected from its 
flowers is poisonous, producing effects analogous, though less alarming, 
than those produced by the honey collected from the yellow jasmine of 
Carolina. The seeds have been employed by several practitioners of con- 
tinental Europe in asthma. 
M. Automarchi recommends for this purpose a decoction made by 
boiling twelve ounces of water with three or four ounces of the seeds down 
to six ounces, the whole to be given morning and night. 1022 
Wild Cherry (Cerasus Virginiana). 
ENGRAVING NO. 116. 
Common Cherry Laurel. 
WILD CHERRY 
CERA5US VIRGINIANA 
The cherry laurel is a native of the Levant, and was cultivated in 
Britain as early as 1629; but the precise period of its introduction is 
uncertain. It is a hardy evergreen shrub, or small tree, and is planted 
near houses and in shrubberies, as an ornamental plant, producing its ele- 
gant spikes of odorous white blossoms early in May. We may remark 
that it is frequently taken for the bay, and is erroneously regarded as the 
plant which furnished crowns for the Roman heroes. There is no doubt, 
however, that it was the sweet bay (Taurus nobiUS'), which furnished the 
wreath worn on the brow of the victor, and of the Priestess of Delphi. 
The mistake is supposed to have arisen from the bay, which is true laurus, 
having formerly been called laurel, and the fruit of it only named bayes, 
while in modern times the cherry-laurel has usurped its name. The cherry- 
laurel attains the ordinary stature of a plum or cherry tree, sending off 
long spreading branches, covered with smooth brown bark. The leaves 
are alternate, and stand upon short foot stalks; they are elliptical or obo- 
vate, tapering towards the base, pointed or curved at the apex, minutely 
toothed, smooth and polished, with a prominent midrib, and of a deep 
green color. At their base, underneath, are two small yellow glands. 
The flowers are in spikes, on short, simple, axillary peduncles. The calyx 
is inferior, bell-shaped, and divided at the brim into five obtuse segments. 
The corolla consists of five small white concave, roundish spreading seg- 
ments. The filaments, which are alternately long and short, are about 
eighteen, oval-shaped, inserted into the calyx, and furnished with roundish 
yellow anthers. Before the petals unfold, the stamens are inflexed, and 
the anthers disposed in a circular form within the rim of the calyx. The 
germen is roundish, supporting a columnar style, and terminating by an 
orbicular stigma. The fruit, or drupe, is globular, of a shining black 
color, and resembling a small cherry, both in its external appearance and 
internal structure. The plum, the cherry, and the cherry-laurel, all 
included by Linnseus in his genus Prunus, were considered generically dis- Wild Cherry (Cerasus Virginiana"). 
1023 
tinct by the older botanists; and in modern times they are again admitted 
as sub-genera, even by those who deny their differences to be sufficient 
to constitute generic characters. The pruni are easily distinguished from 
the cerasi and Jauro-cerasi by the fruit being pruinose or covered with a 
resinous excretion called bloom, while in both the latter the drupes are 
glaucous, but in the cerasi, or true cherries, the inflorescence is in tufts or 
sertula; while in the 1 auro cerasi it is in racemes; the distinction is impor- 
tant, because it is in the latter group that prussic acid is most abundant. 
Poisonous effects.-The distilled water of this plant, the virtues of which 
depend on the prussic acid that it contains, is a deadly poison. When 
applied to wounds in animals it induces vomiting, convulsions, great pros- 
tration of strength, diminished sensibility, and death. Injected into the 
stomach and rectum, it excites a similar train of symptoms, excepting 
that, in the latter, the convulsions are more violent, and tetanus of the 
extremities is produced. Its action bus been found most rapid and intense 
when injected in the jugular vein. Many cases are on record of its effects 
on man; the earliest with which we are accpxainted are contained in the 
37th vol. of the Phil. Trans., in a paper communicated by Dr. Madden, of 
Dublin, part of which we give : " A very extraordinary accident that fell 
out here some months ago, has discovered to us a most dangerous poison 
which was never before known to be so, though it has been in frequent use 
among us. The thing I mean is a simple water, distilled from the leaves 
of the lauro-cerasus. The water is, at first, of a milky color, but the oil 
which comes over with it, being in a good measure separated from the 
phlegm; by passing it through a flannel bag, it becomes as clear as common 
water. It has the smell of the bitter almond, or peach-kernel, and has 
been for many years in frequent use among the housewives and cooks to 
give that agreeable flavor to their creams and puddings. It has also been 
much in use among our drinkers of drams; and the proportion they gener- 
ally use it in has been one part laurel-water to four of brandy. Nor has 
the practice (however frequent) ever been attended with any apparent ill 
consequences, till some time in the month of September, 1728, when it 
happened that one Martha Boyse, a servant, who lived with a person who 
sold great quantities of the water, got a bottle of it from her mistress, and 
gave it to her mother, Anne Boyse, as a very rich cordial. 
u Anne Boyse made a present of it to Frances Eaton, her sister, who 
was a shopkeeper in the town, and who she thought might oblige her cus- 
tomers with it. Accordingly, in a few days, she gave about two ounces of 
the water to a woman called Mary Whaley, who had bought some goods of 
her. Mary Whaley drank about two-thirds of what was filled out, and 
went away. Frances Eaton drank the rest. Mary Whaley went to another 
shop, and, in about a quarter of an hour after she had drunk the water, 
she complained of a violent disorder in her stomach. She was carried 
home, and from that time she lost her spirits and died in about an hour, 
without vomiting or purging or any convulsion. The shopkeeper, Frances 
Eaton, sent word to hex' sister, Anne Boyse, of what had happened, who 
came to hex- and affirmed that it was not possible that the cordial, as she 
called it, could have occasioned the death of the woman, and, to convince 
hex' of it, she filled out about three spoonsful and drank it. She continued 
talking with Frances Eaton about two minutes longex- and was so earnest 
to persuade hex* of the liquor being inoffensive that she poured out two 
spoonsful more and drank it off likewise. She was hardly well seated in 
hex* chair when she died, without the least groan ox' convulsion. Frances 
Eaton, who had drunk somewhat above a spoonful, found no disorder ixx 
hex' stomach ox* elsewhere, but, to prevent any ill conseqtxences, she took a 
vomit, and has been well ever since. 1024 
Virginia Snakeroot (Aristolochia Serpentaria'). 
" Mary Whaley was buried without being examined by anyone I can 
find, except the coroner. I went to see Anne Boyse about twenty-four 
hours after her death, but could not prevail to have her opened. She was 
about sixty years old; her countenance and skin appeared well colored, 
and her features were hardly altered, so that she looked as one asleep. 
Her belly was not swelled, nor had she any other external mark of poison. 
This accident brought into discourse another of the like nature, which 
happened about four years since in the town of Kilkenny. A young gen- 
tleman mistook a bottle of laurel water for one of ptisan. What quantity 
he drank is uncertain, but he died in a few minutes, complaining of a vio- 
lent disorder in his stomach. The affair was not much regarded at that 
time, because he labored under a distemper, to which, or to an improper 
use of remedies, his death was attributed. 
Fodere states that when he was attending his studies at Turin, in 1784, 
the chambermaid and man-servant of a noble family of that town stole a 
bottle of distilled laurel water, which they mistook for an excellent cordial. 
Fearing discovery, they hastily swallowed several mouthfuls and expired 
almost instantly in convulsions. The stomach was found highly inflamed, 
but the rest of the organs were in a sound state. A very interesting trial 
took place during the last century from a supposition that the distilled 
laurel water had been administered. A full account is to be found in Pro- 
fessor Beck's valuable work on ''Medical Jurisprudence." The oil of 
laurel also acts as a virulent poison, and in a similar manner to the distilled 
water. The watery extract, however, according to Orfila, is very feeble and 
comparatively innocuous in its operation.* There are in America forty 
wild species of cherry trees. Of these C. S. Rafinesque, A. M., Ph. D.r 
had prepared a monograph. The following short account is taken from his 
"Medical Flora:" Prunus Virginiana, prunus Canadensis and primus sero- 
tina are active medical berries in racemes, called black cherries. The bark 
is bitter, astringent, contains prussic acid, tannin, gum and mucus. Tonic, 
febrifuge, sedative. Very useful in fever, agues, hectic fever, dyspepsia, 
lumbar abscess, chronic asthma and hysteria, cardialgia, etc. Taken in 
powder, ten to forty grains, in infusion, tincture, etc. Heat drives off the 
prussic acid. Bark of the root stronger. Reduces pulse from 75 to 50 ' 
In large doses narcotic and vermifuge. Leaves poison cattle; berries intox- 
icate birds; used for cherry bounce baneful; kernels equal to bitter almond. 
* Medical Botany, by John Stephenson, M. D., F, L. S., and James Morse Churchill, F. L. S. Virginia Snakeroot (Aristolochia Serpentaria}. 
1025 
Virginia Snakeroot (Aristolochia Serpentaria}. 
ENGRAVING NO. 117. 
VIRGINIA SNAKE ROOT ' 
ARISTOLOCHIA SERPEHIARIA 
Botanical Description.-Leaves cordate, oblong, acuminate; stem flexuous; peduncles radical; 
lip of the corolla lanceolate. Root perennial, composed of many Aliform fibres, pungent and 
aromatic, Stem six to eight inches high, herbaceous, pubescent, erect, geniculate and knotty at 
base, as if formed of the remains of older stems. Leaves few, oblong lanceolate, slightly accumi- 
nate, a little hairy, cordate at base. Flowers few, at the base of the stem, laying on, or sometimes 
under, the surface of the earth. Peduncles one flowered. Corolla ventricose at base, slightly 
three cleft at summit; one lobe extended, lanceolate. Grows in dry soils. Flowers in summer* 
Geographical Distribution.-Middle and Southern States. The most 
northern situation from which Dr. Bigelow received specimens was from 
the vicinity of New Haven. There are many varieties, and, according to 
some botanists, several species, confounded in the market under the com- 
mon name of aristolochia serpentaria. In a medical point of view this con- 
fusion of species is of no consequence, as they are almost entirely identical 
in properties and remedial action. Chemical Constitution.-According to 
Buchok, who analyzed the root in 1807, 100 parts contain- 
Volatile oil 0.50 
Greenish, yellow, soft resin 2.85 
Extractive matter 1.70 
Gummy extractive 18.10 
Lignin". 62.40 
Water 14.45 
100.00 
It was again examined by Chevallier in 1820, and found to consist of 
volatile oil, resin, extractive starch, ligneous fibre, albumen, malate and 
phosphate of lime, oxide of iron and silica. Grassman obtained only half 
an ounce of volatile oil from one hundred pounds of the root, which he 
* Elliott's Sketch of Botany of South Carolina and Georgia. Vol. ii, pp. 511-512. 1026 
Virginia Sndkeroot (Aristolochia Serpent aria). 
describes of a yellowish color, strong odor, and moderately strong taste, 
and compares the odor and taste to those of valerian and camphor com- 
bined. The bitter principle, termed extractive by Bucholz and Chevallier, 
is very bitter, slight ly acrid, soluble in both water and spirit; its solution, 
which is yellow, is rendered brown by alkalies, but is unchanged by ferru- 
ginous salts. The root communicates its qualities both to spirit and water, 
but most to the former. 
Dr. Jacob Bigelow subjected a quantity of the root to distillation for 
one hour, and obtained in the receiver a whitish, pearly fluid, very strongly 
impregnated with aroma, but less bitter than the root. On standing 
twenty-four hours, this fluid deposited around the edges of the surface a 
considerable number of small white crystals, which proved to be pure 
camphor. They were inflammable, fusible with a sudden, and volatile with 
a gradual, heat.-American Medical Botany, p. 85. Dr. C. Conwell,* more 
than thirty years ago, announced the discovery in this root of a new alka- 
loid principle, for which he proposed the name of serpentara. It forms in 
a defined crystallized mass, of a bitter taste, and possesses all the alkaline 
properties. The sulphate crystallizes in quadrangular prisms, terminated 
in inclined facets. The hydrochlorate of serpentara forms brilliant plu- 
mose fibrils. Both these salts are insoluble, except in an excess of acid. 
The preparation is the same as that by which quassia is obtained. This 
principle may be the same as the yellow, bitter principle of Chevallier, 
which he considered as analogous to the bitter principle of quassia. Medi- 
cal Properties and Uses.-The experiments of Jorg and his pupils estab- 
lished that, in small doses, it promotes appetite, in large doses it causes 
nausea, uneasy sensations in the stomach, flatulence, and more frequent, 
but not liquid, stools; after absorption it increases the frequency and full- 
ness of the pulse, augments the heat of the skin, and promotes secretion 
and excretion, and in very large doses causes disturbance of the cerebral 
functions, producing headache, sense of oppression within the skull, and 
disturbed sleep. Snakeroot is said to have been in common use among the 
Indians at the time of the arrival of the first settlers, and was much 
esteemed by them as a remedy in snake bites. The early colonists soon 
adopted it as an excellent tonic and stimulant, and it is to this day exten- 
sively employed as a domestic remedy in fevers, and in debilitated states 
of the system. It has been employed and extolled by numerous physi- 
cians, and it will be profitable for us to review the testimony of several of 
the most intelligent and extensive American practitioners. Dr. Chapman 
considers the serpentaria as possessing the mixed qualities of a stimulant 
and tonic, with active diaphoretic and diuretic properties. 
"Among the more early uses of the medicine was its application in the cure 
of intermittent fever. Whether it is adequate alone to this purpose does not clearly 
appear, but it certainly proves an important adjuvant. It was used by Sydenham 
in conjunction with wine, to prevent the recurrence of the paroxysm, and, from his 
account, not without advantage. As a general rule, he says, that in all cases where 
it is expedient to combine wine with bark, the effect will be much increased by 
adding serpentaria. The correctness of this observation has been fully confirmed 
by subsequent experience, and it is now very much the practice to unite these arti- 
cles in the low states of disease. To remittent fever, serpentaria seems to me to be 
best adapted. It has here, in many cases, an indisputable superiority over the 
bark, inasmuch as it is rarely offensive to the stomach, and may be given, without 
injury, in those obscure states of the disease where the remission is not readily 
discernible. As a popular remedy, more particularly, it is much employed in the 
secondary stages of pleurisy. After bleeding, it is the practice, in many parts of 
* Manual of Materia Medica, by H. M. Edwards and P. Vavasseur, M. D. Translated by J. 
Tongo, M. D., and E. Durand. P. 188. Philadelphia, 1829. Virginia Snakeroot (Aristolochia Serpentaria'). 
1027 
our country, to resort to a strong infusion of this article, with a view to exciting 
perspiration, and the result is said to be generally favorable. Catarrhs, rheuma- 
tisms, and other winter affections, incident to rustic life, are managed in the same 
way. It is also a noted remedy in dropsy, to which, I should presume, it is adapted, 
and especially iftheease beofan intermittent type. In that species of pleurisy which 
is properly enough designated by the epithet bilious, I have repeatedly had occasion 
to recur to the serpentaria, and always with more or less utility. I know not, indeed 
any modification of disease in which it displays its power more advantageously. 
The bilious pleurisy has all the characteristics of pneumonic inflammation, with 
the addition of some of the symptoms incident to autumnal fever. There is con- 
siderable headache, much gastric distress, and almost always violent vomitings of 
bile. It differs also from ordinary pleurisy in having less activity of inflammation, 
and consequently in not bearing the sameextent of depletion. The system, indeed, 
will often be very evidently depressed by one or two bleedings. In this case, the 
practice which has been commonly pursued is, after the removal of a comparatively 
small portion of blood, and the thorough evacuation of the alimentary canal, to 
administer draughts of the infusion of serpentaria, in order to excite copious dia- 
phoresis. As an epidemic, the bilious pleurisy prevailed in the neighborhood of 
this city many yearsago, and, I am informed, was managed most successfully by 
the practice which I have detailed. It is not, however, one of the ordinary com- 
plaints of the climate of the middle States. The cases which I have seen of it have, 
for the most part, occurred in persons coming trom districts of country exposed to 
marsh exhalation, and who have previously had autumnal fever. I have only one 
more remark to make on the properties of this article, which is, that it is admira- 
bly suited to check vomitings, and to tranquilize the stomach, particularly in bili- 
ous cases. It is given for this purpose in infusion, in the small dose of half an 
ounce or less at a time, and frequently repeated."* 
Dr. John Eberlie thus testifies to the action and medicinal value of 
Virginia snakeroct: 
"When taken into the stomach, it increases the force and frequency of the 
pulse, excites a glow of heat throughout the system, and produces pretty copious 
diaphoresis. It is not, however, simply stimulant and diaphoretic in its effects, 
for along with these qualities it possesses very important tonic powers. Possessing, 
along with its tonic, pretty powerful stimulant properties, the snakeroot is pecu- 
liarly suited to fevers of a low grade of excitement; on the other hand, however, it 
can never be employed without danger when blood-letting is indicated. In every 
variety of fever, however, when the system is sinking into a typhoid state, the 
snakeroot is a remedy of unquestionable utility. It is especially serviceable in the 
latter stages of febrile diseases, when the skin and tongue remain dry and hot, and 
the pulse is feeble and frequent. When given in this state, it commonly excites a 
general diaphoresis; the tongue becomes moist, and the pulse and the general powers 
of the system are invigorated. A good deal has been said in favor of thepowers of the 
serpentaria in putrid fevers, and, from the general properties of this remedy, there 
can be little doubt of its applicability to the treatment of fevers of this kind. The 
snakeroot was formerly much employed in intermittents. Of its efficacy, however, 
in the cure of this disease, when administered by itself, not a great deal can be 
said. I have employed it in some instances, but always without success, and I am 
inclined to believe that it is not often capable of arresting the disease. When 
united, however, with bark, or some of the bitter tonics, it seems to increase their 
efficacy, and it is in this way that it is now commonly employed in intermittent 
and remittent fevers. It is particularly useful with Peruvian bark in those inter- 
mittents where the system is depressed and sluggish during the intermission, with 
a small and feeble pulse, and a cold and dry state of the surface of the body. 
During the prevalence of the late epidemic, pneumonia typhoids in this country, 
the serpentaria was much prescribed by some physicians. Being at once stimu- 
lant, diaphoretic and roborant. it was particularly calculated to produce beneficial 
effects in this disease, by equalizing the circulation, and imparting vigor to the 
vital powers. Dr. Dyckman states that he has prescribed the snakeroot in com- 
bination with seneca with marked advantage in this disease. It may also be 
employed with advantage in the latter stages of pneumonia and bronchial affec- 
tions. being useful not only by its tonic operation, but chiefly, perhaps, by exciting 
^Elements of Therapeutics and Materia Medica, by X. Chapman, M. D., etc., Philadelphia, 
1S22. Vol. 2, pp. 432-4-35. 1028 
Virginia Snakeroot (Aristolochia Serpentaria). 
the cutaneous emunctories, and thereby relieving the pulmonic system. The infu- 
sion of snakeroot may be used with advantage as a gargle in ill-conditioned ulcers 
of the throat."-Treatise on Materia Medica and Therapeutics, by John Eberlle, 
M. D., etc. Philadelphia, 1830. Vol. 1, pp. 258, 259. 
The following is the testimony of Dr. Jacob Bigelow: 
"Medicinally considered, serpentaria is a tonic, diaphoretic, and, in certain 
cases, an anti-spasmodic and anodyne. It has been abundantly used in fevers of 
various descriptions, and has been commended by a host of medical writers. 
There is no doubt that it has been injudiciously employed in many cases in fever 
attended with an active pulse and inflammatory diathesis. The early stages, also, 
of febrile diseases rarely admit the exhibition of so decided a stimulant without 
injury. But in the advanced stages of fever, and those attended with typhoidal 
symptoms, this medicine is resorted to with great advantage, both alone and in 
combination with other tonics and stimulants. It is peculiarly useful in support- 
ing the strength, and in allaying the irregular actions which attend great febrile 
debility, such as subsultus tenderium, delirium, watchfulness, etc. Its bitter ingre- 
dients, and the camphor which it contains, no doubt, contributed to these effects. 
It is most advantageously given in combination with bark, or with wine and 
opium."-American Medical Botany. Vol. 3,p. 86. 
Dr. George B. Wood, in his valuable work on Therapeutics and Phar- 
macology, considers Virginia snakeroot as simply tonic and stimulant to 
the circulation, with a tendency to produce perspiration, generally accept- 
able to the stomach in moderate doses, and probably without special 
influence on the brain or nervous system. 
"It may be employed in pure dyspepsia, attended with a degree of debility 
calling for something more stimulating than thesimple bitters, and especially when 
there is a disposition to dryness of the surface; but its most appropriate application 
continues to be that for which it was early recommended, to the treatment, namely, 
of fevers of a low or typhoid character. Whenever any febrile disease begins to 
exhibit this tendency, and stimulation is demanded, serpentaria is one of the first 
medicines to which we may have recourse, provided the stomach be wholly free 
from inflammation or vascular irritation. It may be used, therefore, with the con- 
dition of stomach mentioned, in typhus or typhoid fever when passing from the 
first stage of excitement into that of debility, in protracted remittent fever assum- 
ing a low character, in typhoid pneumonia, and in smallpox, scarlatina, malignant 
sore throat, and erysipelas, under similar circumstances. But it should be under- 
stood that, in none of these affections, does it possess any specific curative powers, 
that it can act merely as a tonic and gentle stimulant, and that it should be used 
only as an adjuvant in very serious cases, being alone wholly incompetent to the 
support of the system under powerful depressing influences. In many of these 
cases it may be very properly associated with Peruvian bark or quinia. From my 
observations, I should infer that serpentaria possesses no peculiar antiperiodic 
power, and that it cannot, therefore, be relied on for breaking the course of an 
intermittent or remittent fever; but in either it may be conjoined with sulphate of 
quinia when the system is feeble, and the stomach somewhat insusceptible. The 
association of Peruvian bark has long been a habit among practitioners. It exists 
in the compound tincture of Peruvian bark of the British and American Pharma- 
copoeias, better known under the name of Huxham's tincture of bark."* 
I have employed Virginia snake root in conjunction with quinia and 
brandy in the treatment of numerous cases of the various forms of mala- 
rial fever. As the results of these observations have been laid before the 
profession,f we shall merely state that whilst it has proved a valuable 
stimulant, diuretic and diaphoretic, we do not believe that it is, by itself^ 
* A Treatise on Therapeutics and Pharmacology, or Materia Medica, by George B. Wood, M 
D., etc. Philadelphia, 1856. Vol. 1, p. 302. 
f Observations on some of the Physical, Chemical, Physiological and Pathological Phenom- 
ena of Malarial Fever, by Joseph Jones, M. D. Transactions of the American Medical Associa- 
tion. Vol. 12. 1859. Southern Medical and Surgical Journal. 1858. Virginia Snakeroot (Aristolochia Serpentaria). 
1029 
capable of arresting, as a general rule, the more violent forms of malarial 
fever. Administered in conjunction with sulphate of quinia, brandy and 
carbonate of ammonia, I have derived great benefit from it, as well as from 
the other remedies, in the several forms of malarial fever, when the pulse 
is rapid and feeble, beating from 120 to 160 times in a minute, and feeling 
like the vibrations of a delicate silver thread; when the heart thumps 
feebly and spasmodically and rapidly against the walls of the thorax; when 
the respiration is full, panting, labored, varying from 30 to 50 in the minute; 
when the skin is hot, and parched, and rough, or bathed in a cold, clammy 
sweat; when the temperature of the extremities is far below that of the 
trunk, which by no means corresponds with the increased efforts at the 
introduction of oxygen; when the circulation of the blood in the capilla- 
ries of the extremities is almost entirely checked; when the chemical 
changes of the solids and fluids are in a great measure arrested and per- 
verted, and the development of the nervous and physical forces arrested, 
and their correlation disturbed; when the altered blood stagnates in the 
capillaries of the brain, and the intellect is either abnormally excited or 
depressed; when the altered blood stagnates in the capillaries of the tongue 
and stomach, and the brilliant red, dry, rough tongue is but a fit index of 
the consuming thirst of the restless patient, tossing from side to side, and 
pleading for a drop of water. In such cases, if brandy and snakeroot be 
used alone, the beneficial effects will be only temporary. To be permanent, 
some powerful antiperiodic, as sulphate of quinia, should be combined 
with the stimulants. 
The effects of carbonate of ammonia in such cases, although powerful, 
are in like manner evanescent, unless combined with large doses of the 
sulphate of quinia. If we should at any time be deprived of quinine, and 
are compelled to rely wholly upon the indigenous remedies, I should recom- 
mend in such cases the combination of large doses of brandy, carbonate of 
ammonia, Virginia snakeroot, dogwood, Georgia bark, poplar and magno- 
lia bark. We would thus obtain the stimulant diuretic, diaphoretic and 
antiperiodic virtues of several remedies, in a condition of the system when 
we need not merely active stimulation, but the excitation of the process of 
excretion, in all the structures and organs by which the morbid agents and 
offending products may be eliminated. I have also derived much benefit 
from the tincture of snakeroot in the debilitated state of the system suc- 
ceeding remittent fever. In such cases it is most beneficial when adminis- 
tered in conjunction with citrate of potassa or carbonate of soda. The 
latter remedies act in conjunction with the diuretic properties of the snake- 
root. Dose of the powder 10 to 40 grains. The infusion, made in the pro- 
portion of half an ounce to a pint of boiling water, may be administered 
in the dose of one to two fluid ounces, repeated, in chronic cases and where 
we wish more especially a tonic effect, three or four times a day; in fever, 
where we wish a more decided effect, it may be administered every half 
hour, or at longer intervals, according to circumstances. The tincture, 
prepared by macerating for fourteen days three ounces of powdered snake- 
root in two pints of diluted alcohol, and filtering, or more rapidly in two 
days by the use of the displacement apparatus, may be administeied in the 
dose of one to three fluid drachms. In the treatment of malarial fever, 
the properties may be conveniently obtained and combined with a suita- 
ble stimulant by pouring one pint of brandy on one ounce of the roots. One' 
tablespoonful of this may be administered every hour, or more seldom, 
according to the urgency of the symptoms. In congestive fever it may be 
administered every half hour until reaction takes place. Of course the 
maximum dose of stimulants here stated, would be used only to meet special 1030 
Black Willow (Salix Nigra). 
indications, and not, as a general rule, as a prolonged treatment. Dr. 
Eberlie recommends the following mixture as very useful in the dyspeptic 
affections of infants: B.-Pul. serpentarise; magnes. albi aa. gr. xvj.; pulv. 
rhaei. gr. xij. M: Divide into six equal parts. Huxham's tincture of bark 
(compound tincture of Peruvian bark) is prepared by macerating two 
ounces of red bark in powder, one ounce and a half of orange peel, three 
drachms of bruised Virginia snakeroot, cut saffron, and rasped red saun- 
ders each one drachm, in twenty fluid ounces of diluted alcohol for four- 
teen days, then expressing and filtering; or more rapidly, with the same 
formula, in two days, by the use of the displacement apparatus. 
ENGRAVING NO. 118. 
Black Willow (Salix Nigra.) 
BLACK WILLOW 
SALIX NIGRA 
This willow, which is the most common of the American willows, and 
the most analogous to the white willow (salix alba), of Europe, is found in 
all the States from New England to Florida, and west nearly to the foot of 
the Rocky Mountains. According to the younger Michaux, the roots of 
this small tree afford an intensely bitter decoction, which is considered in 
some parts of the country as a purifier of the blood, and as a preventive 
and remedy for intermittent fever. The extensive genus of willow, which 
comprises not less than one hundred and thirty species, which, with a few 
exceptions, are natives of Europe and North America, is especially worthy 
of the attention of the physicians of the United States, since in several of 
the European species a principle resembling quinia has been extracted, 
and upon a fair trial has been found to possess the properties of quinia. 
With the exception of the testimony of the younger Michaux, which I 
have just brought forward, I am not aware that any experiments or medi- 
cal investigations with reference to the American species have ever been 
laid before the profession. Black Willow {Salix Nigra). 
1031 
White Willow of Europe {Salix Alba). 
Although not indigenous to the United States, the white willow of 
Europe has been so extensively introduced that it is worthy of the con- 
sideration of physicians, as the source of the alkaloid salicin. 
Chemical Composition.-According to MM. Pelletier and Caventou, the 
bark of the salix alba contains bitter, yellow coloring matter, green fatty 
matter, similar to that found in cinchona, tannin, resinous extract, gum, 
wax, woody fibre, and a magnesian salt containing an organic acid. These 
chemists failed to isolate the most important of all its ingredients, salicin, 
which was most probably mixed with the bitter, yellow coloring matter. 
Subsequently, in 1828, Buchner, of Germany, discovered a peculiar alka- 
loid principle, which has since been discovered in fourteen species of salix 
and eight species of populus. MM. Fontana and Rigatelli, of Italy, dis- 
covered this principle shortly after Buchner. M. Leroux, of France, 
appears to have been the first to accurately investigate its properties. 
When pure, salicin presents itself as a white, shining, slender, inodorous, 
very bitter crystal; insoluble in ether and oil of turpentine, soluble in 
alcohol, much more soluble in boiling than in cold water; having the com- 
position of C42H29O22. According to Merck,* it may be prepared in the 
following manner: 
"Dried or fresh willow bark is cut small, and exhausted by repeated boiling 
with water. The decoctions are concentrated, and while boiling treated with 
litharge till the liquor appears nearly colorless. The dissolved oxide of lead is 
removed, first by sulphuric acid, afterwards by sulphuret of barium, and after the 
separation of sulphuret of lead, evaporated, when salicin crystallizes, and is puri- 
fied by repeated solution and crystallization. From willow bark, which is fresh 
and rich in salicin, it may be obtained by cautious evaporation of the cold aqueous 
infusion. The oxide of lead removes from the solution gum, tannin and extractive 
matter, which would impede the crystallization of the salicin. It also combines 
with the salicin, forming a kind of salt, which is decomposed by the sulphuricacid 
and sulphuret of barium. If the latter r>e carefully added, neither sulphuric acid 
nor baryta remain in the solution; and the sulphuret of lead, which, separated, acts 
as a displacing agent." 
Medical Properties and Uses.-The ancients are said to have employed 
the bark of the willow in the treatment of disease; it fell into disuse, how- 
ever, until 1763, when it was brought into notice by the Rev. Mr. Stone, 
who published in the Philosophical Transactions of the Royal Society of 
Loudon an article entitled ' On the Success of the Bark of the Willow in 
the Cure of Agues, by the Rev. Edm. Stone, of Clipping-Norton, Oxford- 
shire." Dated April 25th, 1763. As his observations are exceedingly 
interesting at the present time, we shall present a condensed view of them: 
"About six years prior to 1763, Mr. Stone tasted the willow bark, and was sur- 
prised at its extraordinary bitterness, which immediately raised in him a suspicion 
of its having the properties of Peruvian bark. As this tree delights in a moist, wet 
soil, where agues chiefly abound, the general maxim that many natural maladies 
carry their cures along with them, or that their remedies lie not far from their 
causes, was so very apposite to this particular case, that he could not help applying 
it; and that this might be the intention of Providence, he owns, had some weight 
with him. The plenty of this bark furnished him, in his speculative disquisitions 
on it, with an argument both for and against these imaginary qualities of it; for 
on the one hand, as intermittents are very common, it was reasonable to suppose 
that what was designed for their cure should be as common, and as easy to be pro- 
cured. But, then, on the other hand, it seemed probable, that if there was any 
considerable virtue in this bark, it must have been discovered from its plenty. His 
* Turner's Chemistry. Seventh edition. Page 816. 1032 
[Black Walnut {Salix Nigra}. 
curiosity prompted him to look into the dispensatories and books of botany, and 
examine what they said concerning it; but there it existed only by name. He 
could not find that it ever had any place in pharmacy, or any such qualities as he 
suspected ascribed to it by botanists. However, he determined to make some 
experiments with it; and for this purpose he gathered that summer near one pound 
weight of it, which he dried in a bag, on the outside of a baker's oven, for more 
than three months, at which time it was to be reduced to a powder by pounding 
and sifting, after the manner that other barks are pulverized. 
" It was not long before he had an opportunity of making a trial of it; but, 
being an entire stranger to its nature, he gave it in very small quantities-he 
thinks it was about twenty grains of the powder at a dose, and repeated it every 
four hours between the fits, but with great caution and the strictest attention to its 
effects. The fits were considerably abated, but did not entirely cease. Not per- 
ceiving the least ill consequences, he became bolder with it, and in a few days 
increased the dose to two scruples, and the ague was soon removed. It was then 
given to several others with the same success ; but he found it better answered the 
intention when one drachm of it was taken every four hours in the intervals of the 
paroxysms. He had continued to use it with success, as a remedy for agues and 
intermitting disorders, for five years successively. It has been given, he believed, 
to fifty persons, and never failed in the cure, except in a few autumnal and quartan 
agues, with which the patients had been long and severely afflicted. These it 
reduced in a great degree, but did not wholly take them off. The patient, at the 
usual time for the return of the fit, felt some smattering of his distemper, which 
the incessant repetition of these powders could not conquer. It seemed as if their 
power could reach thus far and no farther; and he supposed that it would not have 
continued to reach so far, and that the distemper would have soon returned with 
its pristine violence, but he did not stay to see the issue. He added one-fifth part 
of the Peruvian bark to it, and with this small auxiliary it totally routed its adver- 
sary. It was found necessary also in one or two obstinate cases, at other times of 
the year, to mix the same quantity of that bark with it; but there were cases where 
the patient went abroad imprudently, and caught cold, as a postchaise boy did, 
who, being almost recovered from an inveterate tertian ague, would follow his 
business, by which means he not only neglected his powders, but, meeting with 
bad weather, renewed his distemper. 
" One-fifth part was the largest, and indeed the only, proportion of the quin- 
quinia made use of in this composition, and this only on extraordinary occasions. 
The patient was never prepared, either by vomiting, bleeding, purging, or any 
medicines of a similar intention, for the reception of this bark, but he entered 
upon it abruptly and immediately, and it was always given in powders, with any 
common vehicle, as water, tea, small beer, and such like. This was done purely 
to ascertain its effects, and that he might be assured the changes wrought in the 
patient could not be attributed to any ocher thing; though had there been a due 
preparation, the most obstinate intermittents would probably have yielded to this 
bark without any foreign assistance; and by all he could judge from five years' 
experience of it on a number of persons, it appeared to be a powerful absorbent, 
astringent and febrifuge in intermitting cases, of the same nature and kind with 
the Peruvian bark, and to have all its properties, though perhaps not al waysin the 
same degree. It seems likewise to have this additional quality, viz: to be a safe 
medicine, for he never could perceive the least ill effects from it, though it had 
always been given without any preparation of the patient. The tree from which 
this bark was taken is styled by Ray, in his Synopsis, salix alba vulgaris, the 
common white willow." 
Messrs. James, White and Wilkenson published strong evidence in 
favor of the use of the broad-leaved willow in intermittents, foul ulcers, 
debility, and other affections. Dr. Cullen recommends the willow bark in 
his Materia Medica as a substitute for cinchona. Haller was in the habit 
of using with success a decoction of this bark as a bath to dip weakly 
infants in. Dr. Closs affirms that the bark of the willow given in the dose 
of a scruple every three hours has cured many cases of intermittents and 
bad scorbutic ulcers. Numerous other English physicians have testified 
to its value in intermittents, and its great value as a substitute for Peru- 
vian bark is established beyond all doubt. The testimony of numerous Black Walnut (Salix Nigra). 
1033 
European physicians show that the active principle of willow bark, salicin, 
is capable of arresting and curing intermittent fever, and stands next to 
quinine as an antiperiodic remedy. According to Buchner, twelve grains, 
in divided doses, will generally arrest ague, and Magendie affirms thar he 
saw fevers cut short in one day by three doses of six grains each. The 
dose of the bark in powder $ss to $ij. The infusion or decoction, prepared 
with one ounce of the bark to one pint of water, may be, administered in 
doses of from one to four fluid ounces. Salicin should be administered in 
the same manner, and to accomplish the same objects, as quinine, but in 
larger doses. From ten to forty grains may be administered every three 
hours. 
Salicin is the most efficient preparation in reference to the antipe- 
riodic effect of willow bark, (Salix, U. S. P.) Since the discovery of salicin, 
this preparation has been almost exclusively used for obtaining the effects 
of willow bark. At one time so favorable were the reports of its efficiency 
in intermittents, that the hope was indulged that it might supersede qui- 
nia; but further experience has shown that though it will often cure inter- 
mittents, it cannot be relied on with certainty; and the best that can be 
said of it is that, when quinia cannot be obtained, it is among the best sub- 
stitutes of vegetable origin. Salicin discovered by Leroux, an apothecary 
of Vitry-le-Francais, exists ready formed in the barks of several species of 
willow and poplar, especially according to Bracounot in that of salix helix, 
salix amygdatena populus tremula, and populus graeca. It appears also to 
be contained in the flower buds of meadow-sweet (spiraea ulmaria) and 
in the green parts of this and other herbaceous species. Salicin is produced 
artificially. 
1st. By the action of nascent hydrogen on helicin, when an aqueous 
solution of that substance is digested with sodium-amalgum and evapora- 
ted to dryness after supersaturation with carbonic acid, salicin remains in 
the residuum, and may be extracted therefrom by alcohol. 2d. Together 
with benzoic acid by boiling populin with lime or baryta water. 
Preparation of Salicin. 1st. Six pounds of dry chopped willow or 
poplar bark are boiled with water; the liquid is strained, concentrated, 
down to eighteen pounds, mixed whilst still hot, with two pounds of levi- 
gated oxide of lead, digested for twenty-four hours, and again strained; the 
residue is thoroughly washed; and the filtrate is evaporated to a syrup, and 
left to crystallize. An additional quantity of salicin is obtained from the 
mother liquids, after they have again been treated with oxide of lead, and 
the entii e product is purified by repeated crystallization. 
2d. The aqueous decoction of the bark is precipitated with basic acid 
of lead: the filtrate is boiled with chalk till the excess of the basic acetate 
is decomposed, and the liquid becomes clear and colorless; then evaporated 
to an extract; and this extract is exhausted with alcohol and left to crys- 
tallize. 
Properties. Salicin crystallizes in broad, tabular, or mostly scaly crys- 
tals, belonging to the trimetric system. It is white, soluble in water," and 
in alcohol, insoluble in ether and in oil of turpentine, water at ordinary 
temperatures, dissolves about five parts of salicin, alcohol much less. It 
melts at 120°, and does not give off water till heated to 200°, and decom- 
poses at a higher temperature. Its solutions leave a bitter taste and do 
not alter vegetable colors. The solutions turn the plane of polarization of 
light to the left. In solution salicin is not precipitated by neutral or basic 
acetate of lead, by gelatin or by infusion of galls. Salicin is decomposed 
SALICIN. 1034 
Black Walnut {Salix Nigra). 
by certain ferments, as saliva with the absorption of water, into sal i gen in 
and sugar. The saligenin is afterwards readily oxidised into salicylic acid. 
The conditions necessary for both these processes, exist within the body. 
Therapeutics.-As we have said salicin was formerly used as a substi- 
tute for quinia, though it did not render much more service then than its 
diuretic does now', in the limited range of febrile affections to which quinia 
was therapeutically applied. The new data which we possess with regard 
to the value of quinia in forms of fever other than malarial, as well as the 
discovery of the antipyretic property of salicylic acid, have recalled pro- 
fessional attention to the value of salicin. In doses of from 8 to 10 
grammes, it depresses the temperature in many diseases as a certainty, 
though to a less degree than salicylic acid. Salicin does not appear to pos- 
sess any poisonous effects, as Ranke is said to have taken nearly three 
ounces of it without any injurious effects. When administered internally 
it is absorbed rapidly chiefly as salicin, but once in the blood it is quickly 
decomposed, the products of its change appearing in the urine from fifteen 
to thirty minutes after the injection of a single dose. Huseman has shown 
that this change is not complete, as after the injection of salicin not only 
saligenin and salicylic acid, but also unchanged salicin occur in the urine 
of men and rabbits. The elimination is slow, as Senator has detected sali- 
cylic acid in the urine sixty hours after the injection of a single dose of 
salicin. 
Concentrated sulphuric acid dissolvesit with the production of a beau- 
tiful red color, but by carefully warming it with dilute sulphuric acid it is 
converted into glucose and saligenin. and it is therefore a glucoside. Upon 
chemical grounds, therefore, as well as upon physiological data, we must 
regard the therapeutic effects of salicin and its diuretics as different from 
those of quinia. 
Salicin promotes appetite and the digestion-properties which it pos- 
sesses in common with other bitters: it is an antiferment, and has antisep- 
tic powers similar to quinine aud salicylic acid. The latter is a derivative 
of salicin. It is destructive to bacteria and vibrio, and prevents the reac- 
tion of amygdalen and emulsion, and of ptyalin on starch. Salicin is an 
efficient stomachic tonic in atonic dyspepsia, and is a useful remedy in pre- 
venting the fermentation which takes place in food in cases of gastro- 
intestinal catarrh. It has also been employed in conjunction with other 
remedies in the treatment of dysentery in the Charity Hospital of New 
Orleans. It has been employed with some success in the chronic diarrhoea 
of children, the good results obtained in these cases being doubtless due to 
its power of arresting fermentation, and to its tonic and antifebrifuge prop- 
erties. Its lack of irritative properties is also of importance in the treat- 
ment of the diarrhoea of children accompanying dentition. The most 
important use of salicin is the treatment of acute rheumatism. 
In 1874, Dr. Maclagan began the use of salicin in acute rheumatism, 
and in 1876 (London Lancet. 1S76, vol. 1, p. 342), announced that it was a 
specific remedy, rapidly abating both the fever and the local symptoms. 
He concludes, as the result of his experience, that the more acute the case 
the more beneficial the remedy: that the good effects are always expe- 
rienced within forty-eight hours: that sometimes the disease is at ouce 
arrested: that relief of paiu and fall of temperature are the earliest effects 
produced. Dr. Maclagan gives from ten to thirty grains every two. three, 
or four hours, in powder mixed with water. Fifteen grains every three 
hours is a moderate dose. 
In the same year (1876) Senator confirmed the statements of Dr. 
Maclagan, and further affirmed that in various affections he had found Salicin and Salicylic Acid. 
1035 
salicin to have an antipyretic power entirely comparable to that of salicylic 
acid. If these views are correct, salicin, in its freedom from irritant prop- 
erties and disagreeable taste, is superior to salicylic acid. Senator recom- 
mends two to two and a half drachms as a moderate dose for adults. 
Dr. Buss on the other hand, after testing the value of salicin on a con- 
siderable scale, does not find that the drug is nearly so powerful as sali- 
cylic acid. If the acting of salicin depends upon its conversion in the 
blood, into salicylic acid, it is evident that its action should be slower and 
more uncertain than that of the acid. Dr. Maclagan (London Lancet, 
1872, ii, p. 179), has proof that salicin does not act as salicylic acid, but as 
salicin, that he has given salicin to rheumatic patients suffering from cere- 
bral symptoms due to large doses of salicylic acid, and seen both the rheu- 
matism and the cerebral disturbance abate. 
Salicylic Acid and Salicylates. 
Salicylic acid was formerly prepared from salicin, the bitter principle 
of the willow and poplar bark, and it occurs in the form of salicylate of 
methyl as one of the component parts of the essential oil of the American 
gaultheraprociembers (winter green) and of the European spinola ulmaria 
and menotropa hipopetya. Although long known to chemists, salicylic acid 
has only very recently been rendered available by Prof. H. Kolbe, who dis- 
covered that it could be prepared by treating a solution of carbolic acid in 
caustic soda, with carbonic acid at a moderate heat. 
The following is the process for the preparation of salicylic acid from 
phenol as originally prepared by Kolbe and Lautemann. (Am. Ch. Pharm., 
cxv. 177.) Dry carbonic anhydride is passed into warm phenol, with 
addition of small pieces of sodium. The metal then dissolves with evolu- 
tions of hydrogen, and a stiff paste is formed, containing the isomeric 
salts, salicylate and phenyl-carbonate of sodium together with unaltered 
phenol. On acidulating with acid the phenyl-carbonic acid is decom- 
posed with evolution of carbonic anhydride, and the salicylic acid which 
is set free may be separated from the phenol by solution in strong aqueous 
carbonate of ammonium. The solution boiled down till it acquires a slight 
acid reaction filtered from separated resin, and mixed with hydrochloric 
acid, yields salicylic acid to be purified by recrystallization with the aid of 
animal charcoal. Salicylic acid is also formed, though in much smaller 
quantity, by passing carbonic anhydride into a ready prepared solution of 
phenylate sodium in phenol. 
It is now prepared on a large scale by Kolbe's process, by heating car- 
bolic acid with hydrate of sodium in a suitable vessel, and passing a stream 
of carbonic acid through it. Salicylate of sodium is formed from which 
the salicylic acid can be set free by any stronger mineral acid. Prop- 
erties.-When pure, it appears io the form of beautiful white circular 
crystals, which have no smell and which are readily soluble in alcohol, 
ether, and alkalies. but only dissolve in water in the proportion of 1 to 
300. If heated with care it sublimes; too much heat decomposes it into 
carbolic acid and carbonic acid. 
Salicylic acid crystallizes by spontaneous evaporation of its alcoholic 
solution in large monoclenic four-sided prisms; from a hot aqueous solution 
it separates on cooling in slender needles often an inch long. Particularly 
large and fine crystals are obtained by slow evaporation of the ethereal 
solution. Sublimes at about 200° without boiling, iu slender needles 
having a strong lustre, and when pure may be completely distilled by care- 
fully heating. It has a sweetish-sour taste, and produces irritation of the 1036 
Salicin and Salicylic Acid. 
throat. Reddens litmus rather strongly. It does not act on polarized light. 
The aqueous solution imparts a deep violet color to ferric salts. Action.- 
Internally, its effects closely resemble those of quinia, even to the produc- 
tion of ringing in the ears and transient deafness. Large doses alone act 
as a direct poison on the heart and respiration. It is only partly destroyed 
in its passage through the organism, and reappears in the urine, as late as 
fifty hours after it has been taken, partly as such and partly as salicyl- 
uric acid. The curative properties of salicylic acid have been referred 
by observers: 
1st. To its resistance to decomposition. 
2d. To its harmlessness in comparative doses, and the consequent 
opportunity of saturating the blood and system with the remedy. 
3d. To the direct arrest of certain fermentative processes which we 
must regard as the exciting causes of various diseases. It is well known 
that it acts as a poison to many forms of protoplasm, by considerably 
reducing their power to absorb oxygen. Even in small doses it checks a 
variety of processes which depend on decomposition; but at the same time, 
like quinia, it does not interfere with the normal ferments of the organism 
itself. It is, therefore, a powerful antiseptic. Wagner maintains that it 
is a more potent application to wounds in its antiseptic effects than car- 
bolic acid; it is said to be three times more effectual in preventing fermen- 
tation than carbolic acid. 
4th. To its power of reducing animal temperature and thus modify- 
ing and arresting the course of fevers and acute inflammations. A dose of 
from four to five grammes only very slightly reduces the temperature of 
healthy adults, whereas it causes a marked reduction in many febrile dis- 
eases. Its antipyretic action in the human subject is often preceded and 
accompanied by copious perspiration, though the latter may be completely 
absent. The fall in temperature is independent of any alteration in the 
pulse or respiration and may occur without any perceptible deviation 
of either from the previous state. The depression of temperature is as 
decided in the interior of the body as in the axilla. It is a matter of 
doubt as to what form the acid circulates in the blood. If any substance 
is present which readily combines with salicylic acid, the carbonic acid of 
the blood replaces it in its former combination. Hence the carbonic acid, 
of which 700 grammes are excreted daily by an adult, and which is some- 
times increased as much as three fold in inflamed tissues, may prevent the 
formation of this neutral salicylate of sodium in the circulation and in the 
tissues. 
Uses.-1. As an antipyretic in various febrile conditions. In some 
forms of diseases attended with elevated temperature, as phthisis, erysipe- 
las, and especially acute rheumatism, it has a better effect than quinia, 
while in malarial fever it is inferior to this alkaloid. Cases of dangerous 
collapse have been recorded where the action of a large antipyretic dose 
coincided with the period when the disease itself tended to a natural and 
rapid defervescence, for example, in acute pneumonia. It has, also, in 
some cases, produced irritation of the structures of the kidneys, and 
depressed the action of the heart. 
2. In internal conditions, accompanied by decomposition, as in gan- 
grene of the lungs, stomatitis, gastric fermentation, dysentery, and cys- 
titis with ammoniacal urine. 
3. Externally to wounds and in operations, in the form of Lister's 
dressing. It may be applied to all unhealthy gangrenes or cancerous sur- 
faces as an antiseptic. In local applications, salicylic acid has the advan- 
tage over carbolic acid, in that it has no smell and causes less local irrita- Salicin, Salicylic Acid and Salicylate of Sodium. 
1037 
tion. Whilst it is true that salicylic acid is capable of accomplishing much 
in antiseptic surgery, it has not as yet superceded carbolic acid; and in 
the hands of many at the present day bichloride of mercury (corrosive 
sublimate) is taking the place of both agents, both as an antiseptic and 
disinfectant. The more poisonous properties of corrosive sublimate ren- 
der it less applicable to all cases of wounds and injuries than carbolic acid 
and salicylic acid. Mr. Callender, after twelve mouths' investigation and 
practical trial in the wards of St. Bartholem^w Hospital. London, has 
formally condemned salicylic acid as much inferior to carbolic acid. 
Miersch's salicylic acid wadding for hermetically sealing wounds, is 
made by dissolving two ounces of salicylic acid in two pints of alcohol 
(sp. gr. 0.83), diluting with twenty pints of water at 158° to 178° F.; sat- 
urating with the six pounds and eight ounces of cotton batting, deprived 
of oily matter, and afterwards drying. This wadding contains three per 
cent, of the acid; for some purposes a stronger batting containing ten per 
cent, is prepared. When the wound or abscess is discharging profusely, 
jute is substituted for the cotton batting, because it is much more perme- 
able of pus. An efficient ointment may be prepared by dissolving one and 
a half parts of the acid in two parts of alcohol, and adding lard, or the 
solubility of the drug in glycerine may be taken advantage of. The fol- 
lowing solutions are used in St. Bartholemew's Hospital: Phosphate of 
sodium three parts; salicylic acid one part; water fifty parts; salicylic acid 
one part; olive oil forty-nine parts; salicylic acid one part; bicarbonate of 
sodium half part; water one hundred parts; salicylic acid ten parts; borax 
eighteen parts; water one hundred parts. A twenty-five per cent, solu- 
tion which will bear dilution with water or alcohol, may be prepared 
according to the following formula: R.-Acid salicylic gij; sodii bitartrate 
5i; glycerine g. Mix the acid and borax with four fluid ounces of glycer- 
ine; heat gently until dissolved, then add enough glycerine to make one 
fluid ounce. Salicylic acid was originally brought to the notice of the 
profession on account of its inhibitory influence on putrefaction. Kolbe 
found that 0.04 per cent, had great influence in preventing the souring of 
milk. Bucholz found that 0.15 per cent, of the acid is sufficient to prevent 
the development of bacteria in ordinary organic mixtures, and that the 
influence of 0.005 per cent, is plainly visible; 0.3 to 0.4 per cent, of the 
acid killed bacteria in vigorous growth. The salicylate of sodium was about 
equal to the pure acid, 0 4 per cent, destroying the bacteria. 
In the preservation of urine, Meyer and Kolbe found that one part of 
salicylic acid to two thousand of urine, was sufficient to prevent putrefac- 
tion. According to Professor Kolbe, and others, salicylic acid arrests or 
prevents the action of the non-organized organic ferments. Thus it will 
prevent the action of emulsion on amygdalin, or upon myronic acid, and 
prevent the development of hydrocyanic acid, or of the volatile oil of mus- 
tard. Dr. Miller found that one per cent, of salicylic acid was sufficient 
to check the action of ptyaline upon starch; for the same effect ten per. 
cent, of carbolic acid was required. The digestive action of pepsine out- 
side of the body, w'as very seriously affected by 0.2 per cent, of salicylic 
acid in Dr. Miller's experiment; but in Kolbe's experiment the ingestion 
of twenty grains a day of this drug had no effect. 
Internal Administration of Salicylic Acid. 
The maximum dose of salicylic acid in acute rheumatism may be set 
down at a drachm in the twenty-four hours, although it is employed by 
some practitioners in much larger doses. The salicylate of sodium contains 
forty-eight grains of the acid to the drachm; since it is freely soluble in 1038 
Salicin, Salicylic Acid and Salicylate of Sodium. 
water, and is less unpleasant to the taste, and less irritant to the stomach, 
it has been preferred by many to the uncombined acid. From sixty to 
eighty grains of the salicylate of sodium may be administered in the course 
of the day in a strongly aromatic syrup. If ringing of the ears or other 
evidence of intoxication appear, the remedy shoulcl at once be partly or 
entirely withdrawn. 
Salicylate of Sodium. Soda Salicylate, U. S. P. 
The neutral salicylate of sodium, is an odorless, whitish powder, 
soluble in water in all proportions, and possesses an unpleasant sweetish 
taste. Therapeutically it resembles the free acid, but is more pleasant to 
the taste and more rapidly absorbed. Salicylate of soda has a stronger 
action on certain forms of bacteria than carbolic acid, quinia, boracic acid 
and alcohol, and one which is scarcely a third less powerful than that of 
free salicylic acid. Salicylate of soda may be prepared extemporaneously 
by the addition of salicylic acid to a solution of bi-carbonate of sodium. 
If the alkali is in excess, the remaining solution is brownish or purplish in 
color, and has a strong odor of wintergreen. This is not repulsive to most 
patients. The following formula has been used: 
It. Acidi salicylici, gij; sodii bicarb., $i; aquae, f§ij. M. Sig.: A 
teaspoonful every two, three or four hours. . Dose of salicylate of sodium, 
grains xv to 3j. The best mode of administration is in the form of a wafer 
containing five to ten grains. These may be given rapidly until the 
required quantity has been swallowed. 
Salicylate of Cinchonidia. 
The salicylate of cinchonidia has been recommended by Dr. Prosser 
James as a less costly substitute for quinia and as a useful tonic and anti- 
pyretic in neuralgia, rheumatism, sciatica, etc. In such cases five grains 
may be given every two hours, or ten grains may be given at once, and 
afterwards three or four doses of five grains at intervals of two or three 
hours. 
The salicylate contains about one-third of its weight of the acid, and is 
incompatible with iron. It is rather insoluble and, therefore, the bitter 
taste is not quickly perceived. It may be given as a powder in wafer paper, 
or in a pill. Dr. Prosser James has given the drug in pleurodynia, and in 
the pains of chronic rheumatism, as a stimulant to appetite and as a gen- 
eral tonic. It may be given in moderate doses; as, for example, two and 
a half to five grains, twice or three times a day, for comparatively long 
periods. (The British Medical Journal, March 19th, 1881.) 
Dr. Thomas has called attention to a method of administering salicylic 
acid in conjunction with the acetate of potash, which he has found to be 
useful in many cases of acute, subacute and chronic rheumatism. He 
claims for the formula which he recommends that it does not disarrange 
the digestive functions, that it is easy to take, that the salicylic acid is in 
complete solution, and that it is exceedingly active. 
It does not give rise to any cardiac affections, and it has a less 
depressing effect upon the heart than the salicylate of soda. The formula 
is as follows: Peppermint water, 1'20 c.c.; acetate of potash, 69 grammes; 
salicylic acid, 15 grammes; lemon syrup, 60 c.c. To make up the prepara- 
tion, the potash and peppermint water are put into a porcelain mortar 
and the acid is added gradually and is stirred until it is completely dis- 
solved. after which the syrup is poured in. The dose is a desertspoonful 
every two, three or four hours, according to the violence of the attack. Salycin, Salicylic Acid and Salicyllate of Sodium. 
1039 
The dose here indicated provides for the administration of twenty grains 
of acid with each eighty grains of acetate of potash. In patients of good 
constitutions, Dr. Thomas gives morphia hypodermically. Convalescence 
usually occurs in five to eight days. (Le Progres Medical, January 1st, 
1881.) 
PRACTICAL ILLUSTRATIONS OF THE THERAPEUTIC VALUE OF SALICIN, 
"SALICYLIC ACID, SALICYLATES (SALICYLATE OF SODIUM, ETC.) 
In connection with Dr. Bury, Dr. Sidney Ringer made some most 
important and practical investigations concerning the action of salicin in 
the human body, using healthy children, to whom they gave doses of this 
drug, sufficient to produce toxic symptoms. 
Drs. Ringer and Bury tested the effects of salicin in three sets of 
experiments on three healthy lads. To the two first they gave large doses, 
and produced decided symptoms; to the third they gave at first smaller 
doses, and increased them gradually till he took three drachms daily, 
producing scarcely any symptoms. In order to produce any symptoms 
characteristic of the drug, a single large dose of one drachm or more is 
necessary, or thirty grains repeated hourly, two or three times. Given 
less frequently, or in smaller doses, it induces no symptoms whatever. 
Toleration of tire salicin is soon established, so that at last large doses fail 
to produce any characteristic effect; though when given at first without 
any graduation, these full doses, even after their discontinuance, produce 
very decided symptoms, which may persist one or two days, and may even 
become intensified the day after the withdrawal of the medicine. The 
repetition of large doses may produce slight fever, shown in delaying and 
greatly lessening the evening normal diurnal fall, an effect probably due 
to irritation of the stomach. The aspect of a patient under a full medi- 
cinal dose of salicin, according to Dr. Sidney Ringer and Mr. Bury, is 
rather characteristic, being in many respects similar to that of a person 
suffering from cinchonism. 
The expression is dull and heavy, the face quickly flushes on slight excite- 
ment, and the eyes become suffused. The flush, of rather a dusky hue, suffuses 
itself uniformly over the whole face. The patient, made more or.less deaf, often 
complains of noises in the ears. He complains, too, of frontal headache, and his 
hands, when held out, tremble a little. His breathing is rather quickened and 
deepened. In some cases one symptom may predominate; thus deafness maybe 
almost complete, without headache or muscular trembling; but it rarely, if ever, 
happens that any symptom i§ unaccompanied with the dull heavy aspect and the 
readiness to flush. Under toxic, but not dangerous doses, the headache is often 
very severe, so that the patient buries his head in the pillow. There may be very 
marked muscular weakness and tremor, associated with great muscular irritability, 
so that a slight tap, say on the shoulder, causes muscular contractions so strong as 
to jerk the arm backwards. There are often slight spasmodic twitchings when a 
limb is raised. Tingling of the extremities or other parts of the body sometimes 
occurs. The voice may become thick and husky. The respiration is hurried, 
sometimes deepened, sometimes sighing and shallow and almost panting, as 
though it were performed rather laboriously, but the valient does not complain of 
any difficulty of breathing. The costal as well as the diaphragmatic movements 
are involved in the exaggerated breathing. Large doses, often repeated, quicken 
the pulse to 140 per minute, and it becomes very weak. In these healthy lads the 
drug did not cause delirium. It is very noteworthy that salicine renders the sweat 
neutral or alkaline. We think, too, that the urine becomes neutral or less acid; but 
on this point our observations are too few to justify our speaking confidently. The 
alkaline reaction of the sweat we noticed in many rheumatic patients under the 
influence of large and frequent doses, and the sweat may be alkaline, whilst the 
urine is acid. 
Subsequent observations incline me to doubt if this alkaline reaction of the sweat be due to 
the salicine: for in a good many observations on the reaction of the sweat in health and disease 
I find that the sweat is often neutral or even alkaline. 1040 
Salicin, Salicylic Acid and Salicylate of Sodium. 
We find that if moderate doses are first given, the medicine may then be 
increased, till a lad ten years old, beginning with 80 grains, may be brought to 
take 180 grains daily, without any symptoms. Salicylic acid and salicylates pro- 
duce the same symptoms. In my experience the acid produces these symptoms in 
much smaller doses than the alkaloid, Salicine is converted in the body into sali- 
cylic acid, and possibly this acid produces the symptoms. The alkaloid will not, 
of course, yield its own weight of acid, hence its effect in producing symptoms is 
less manifest than the acid. Other symptoms than those just described have been 
observed when salicylic acid has been given in disease. Thus Dr. Tuckwell, in 
addition to most of the symptoms just mentioned, observed delirium like delirium 
tremens, involuntary evacuation of urine and faeces, slow labored pulse, and olive- 
green color of the urine. When Dr. Tuck well first published his account, all the 
symptoms were thought to be due to a trace of carbolic acid contaminating his 
specimen. Possibly the olive-green color of the urine was due to the carbolic acid; 
but as salicine produces most of the symptoms enumerated, and as delirium has 
been noticed to occur after the use of a pure sample of the acid, these symptoms, 
excluding the olive-colored urine, must be due to the drug and not to carbolic acid. 
Dr. Weber has seen the acid cause acute nephritis with bloody albuminous urine 
containing casts; this effect following three moderate doses and lasting sixty hours 
after the last dose. Other observers refer to similar effects with the acid, in some 
cases the urine being almost suppressed. Dr. Murchison and some other writers 
are inclined to attribute the delirium, sometimes following the use of the acid, to 
its effects on the urine; but this view is not tenable, since the drug will produce 
violent delirium without effecting any change in the quantity or character of the 
urine. I have never seen salicine, even when given in very large doses, produce 
delirium, and possibly the acid may be more powerful in this respect than the 
alkaloid. In addition, these substances sometimes produce sickness, and more 
rarely diarrhoea, so that they cannot be continued; and further, salicylic acid often 
causes much distressing burning of the throat. When administered in fever sali- 
cylic acid not uncommonly excites very abundant perspiration; but this did not 
occur in our experiments on healthy persons. While administering these reme- 
dies in rheumatic fever, some observers have seen them produce an urticarial or 
vesicular eruption. These symptoms, Stricker asserts, appear sooner in old and 
feeble than in young and vigorous people, 
I shall now speak of the effect of these agents on the animal temperature, and 
shall first treat of the effect of salicine on the temperature in health. This subject, 
too, I have investigated with Mr. Bury, and our results are published in Vol. XI 
of the Journal of Anatomy and Physiology. Our observations show that even 
very large doses, as large as can be safely given, depress the temperature very lit- 
tle, and only after the first few doses, and subsequently, instead of lowering the 
temperature, the drug produces slight fever; thus it slightly raised the temperature, 
though not above the limits of health, but delayed the onset of the evening fall, 
and lessened the amount of diurnal variation, thus giving evidence of the febrile 
movement. This slight fever may, we think, be due to catarrh of the stomach 
caused by the medicine, which, in so many instances, excites vomiting. 
In two sets of experiments the temperature was taken under the tongue; in the other series, 
in the rectum. These lads took breakfast between six and seven; dinner between twelve and 
half-past, and tea between four and five. We took the temperature hourly, from 9 A. M. till 12 P. 
M. Observations were made hourly for six days on the first lad; on the second for eight days; 
on the third for thirty days. For a few days we gave no salicine, that we might compare the 
temperature of the body on salicine days with non-salicine days. Our first set of experiments 
was made on a lad aged ten, weighing 44% pounds. His temperature was taken under the tongue 
and during the investigation he was kept in bed but was allowed to sit up in it. He was admitted 
with belladonna poisoning, but our observations were not commenced till some days after his 
complete recovery. For the first three days he took no medicine, on the fourth we gave salicine 
in two doses, each of thirty grains, and on the following day a single sixty-grain dose. Observa- 
tions were continued throughout the sixth day, although he took none of the drug. The results 
of our observations are put into the following table: 
Maximum 
I temperature 
of day. 
Rise after 
dinner. 
Rise after 
tea. 
Evening fall 
begun. 
5 $ 
2* 
Average 
temperature 
of day. 
1st day 
99.1 
0.4 
8 
1.6 
98.4 
No sal ici ne 
2d day 
99.5 
0.6 
0.5 
1.4 
98.7 
No salicine. 
3rd day 
99 5 
0.4 
0.4 
6 
1.7 
98.7 
No salici ne. 
4th day 
99 
9 
1.7 
98.3 
GO grains in two doses 
5th day 
99.3 
0.2 
6 
1.7 
98.5 
60 grains in one dose. 
6th day 
99 
0.2 
9 
1.9 
98.2 
No salicine. Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1041 
In respect to this table we must first remark that the rise after dinner and tea lasted a very 
short time, and we think that part of this rise was due to the warm tea; for after warm drinks we 
have found that the mouth temperature is often considerably raised, sometimes even to the 
extentof a degree, remaining so a quarter of an hour or even longer. A reference to the above 
table might lead to the conclusion that the effect of salicine was inappreciable or nil, but a glance 
at the temperature chart showed that the drug produced a manifest effect. On the fourth day, 
after taking three observations at intervals of a quarter of an hour, we administered by the 
mouth thirty grains of salicine dissolved in water at 9:45 A. M., and another thirty-grain dose at 
10:50 A. M. The medicine produced a decided though slight effect on the temperature. Thus 
throughout the day the temperature remained more stationary than on non-salicine days. After 
the first dose there occurred a fall of 0.2° F.; during the next hour it rose 0.4° in spite of the sec- 
ond dose, and the maximum temperature of the day was attained at 11:40 A. M. Then instead of 
rising after dinner and tea, as on the previous non-salicine days, it slowly and continuously 
declined, so that at 8 P. M. it had fallen 0.4° F., then the diurnal variation commenced and 
amounted to 1.7° F. Thus the effect of the salicine on this day was to lower the temperature 0.2° F., 
and to prevent the rise after dinner and tea, effects very slight and unimportant. Next (5th) day, 
after three observations, we administered in one dose sixty grains of salicine dissolved in two 
ounces of water at 9:40 A. M. The temperature from this time gradually fell, reaching its maxi- 
mum fallof 0.8° at 11 -A. M., it then rose and had recovered itself at 12, and between 12 and 5 P. M. 
it rose0.3°; the evening fall then began and amounted to 1.7° F. There was no rise after dinner, 
and only 0.2 after tea. Thus on this day the effect was a fall of 0.8°, lasting about two hours, and 
no rise after food. The amount of diurnal variation was unaffected on both the salicine days. 
Next day he took no salicine, and his temperature remained remarkably uniform throughout 
the day, till the diurnal variation set in. The evening fall began between eight and nine, and 
the diurnal variation amounted to 1.9 F. The drug produced no effect on the pulse or respiration. 
Although on each of the two days we gave the same dose, the drug produced far more decided 
effects after the second than after the first dose. On the first day we gave two thirty-grain doses 
at sixty-five minutes intervals; on the next day sixty grains were given at once. This difference 
would indicate that the drug is quickly eliminated. The symptoms produced were slight nausea, 
probably due to the bitter taste of the drug: then, in a few minutes after the second dose, severe 
frontal headache set in, so severe that the lad shut his eyes and buried his head in his arm. Flush- 
ing of the face, especially on any excitement. Slight injection of the conjunctiva, and giddiness. 
In an hour these symptoms had almost left him, a fact confirmingthe conclusion that the drug 
is speedily eliminated. Sixty grains produced the same symptoms in a more marked degree. 
Severe headache and flushing came on in twelve minutes. Though a very lively boy. he became 
very dull and stupid, lying with his eyes closed, and answering questions slowly. He complained 
of tingling like pins and needles in his right ankle, and suffered from very decided muscular 
weakness, soon accompanied by muscular twitchings and tremblings of the legs and arms. At 
this time the pulse was much softer. 
In the following table we give the time these symptoms set in and their duration, calculating 
from the time of taking the medicine : 
Headache 
Set in. 
Ceased. 
12 minutes. 
12 minutes. 
15 minutes. 
35 minutes. 
15 minutes. 
50 minutes. 
1 hour 20 minutes. 
1 hour 20 minutes. 
1 hour 20 minutes. 
1 hour 45 minutes. 
Flushing 
Muscular weakness 
Musculai- twitchings 
Dullness and heaviness 
The quantity of urine was almost unaffected, as the following table shows: 
• 
Daily Amount. 
Without medicine 
22 oz. 
22 oz. 
Without medicine 
Salicine day .. 
20 oz. 
Salicine day 
20 oz. 
The next series of observations were made on a lad aged nine, convalescent 
from pneumonia, his temperature having become normal ten days previously. We 
experimented somewhat differently. 
The boy was kept in bed. His temperature was taken hourly in the rectum. For two days 
he took no medicine; on the two following days he took salicine in thirty-grain doses at 10 A. M., 
11 A. M., 2 P. M., 3 P. M., 5P. M., and 6 P. M.; thus in the course of the day he took three drachms. 
Next day we administered thirty-grain doses eight times (half ounce), at 10 A. M., 11 A. M., 
12 P. M., 1 P. M., 2 P. M., 3 P. M., 4 P. M., and 5 P. M. The results with this lad are rather singular. 
On the first day these large doses produced no symptoms, in fact symptoms did not set in till 
noon of the second day, but they increased during the night, after the discontinuance of the 
medicine, and were severe all next day, and for three days after. The temperature chart shows 
that on the first day the temperature rose between 9 A. M. andl P. M. 9.10° F. and then slowly 
fell; the diurnal variation apparently beginning about 6 P. M., and amounting to 2.9° F. Next 
day, also without salicine, the course of the temperature was very singular. It remained pretty 
stationary from 9 A. M. till 1. P. M. and then fell 1°, remaining about this point till 9 A. M. and 
again fell 1.6°; the diurnal variation amounting to 2.3°. Next day, the first on which salicine was 
given, the temperature fell after the first dose of 30 grains .4° in one and a half hours, and 
remained depressed for about three hours, and then rose to its original height in spite of the con- 
tinuance of the medicine. The evening fall began at 7:30 P. M., and the diurnal variation amounted 1042 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
to 1.9° F. The only effect, therefore, of the salicine was a very slight and temporary depression of 
the temperature, not maintained by the continuance of the medicine, and the diurnal fall was 
not quite so great as on the two previous days, though within the limits of variation of health. 
Next day, when 3 drachms of salicine in divided doses was given, the temperature was not even 
temporarily depressed; in lact it rose .6° between 9 A. M. and 1 P. M., and then slowly fell .3° till 
3:30 P. M. The evening fall began between 7 P. M. and8 P. M., and the diurnal variation amounted 
to 1.5°. Next day, with very marked symptoms, though without salicine, the temperature ran the 
same course, rising gradually from 9 A. M. till 1 P. M., and after 4 P. M., slowly tailing till 12 P. M.; 
the daily variation amounting to only 0.9°. On these two days the only apparent effect, there- 
fore, of salicine was to lessen the diurnal range, with a very slight increase in the maximum 
temperature ofthe day; and, strange to say, these effects were most marked on the day following 
the large doses of salicine, not on the day the large doses of salicine were taken, but on the follow- 
ing day. Next day, taking the temperature as usual, itremaiued pretty stationary, varyingonly 
.2° from 9 A. M. till 6 P. M., and then fell, the diurnal variation amounting to 1.8°. On the two 
days following the temperature returned to the course it is observed on the first non-medicine 
day, slight! j7 rising from 9 A. M. till 1 P. M., the rise amounting to 0.5° F., and then the diurnal fall 
began respectively at 7 P. M. and 6 P. M., and amounted to 2.2° and 1.7°. We now summarize our 
observations in the following table: 
Date. 
Medicine 
given. 
Amount. 
Maximum Temperature 
of the day. 
Amount of diurnal 
variation. 
Sept. 19 
None. 
99.1 
2.9 
2.3 
Sept. 20 
None. 
3 iii 
98.9 
Sept. 21 
salicine. 
98.9 
1.9 
Sept. 22 
Salicine. 
5iv 
99.3 
1.5 
Sept. 23 
None. 
99.5 
0.9 
Sept. 24 
None. 
99.4 
1.8 
Sept. 25 
None. 
99.5 
2.2 
Sept. 26 
None. 
99.5 
■ 1.7 
We may remark that in these observations, taken in the rectum, very little and generally no 
rise of temperature occurred after food-a circumstance strongly favoring a previous suggestion, 
that the rise after food, in cases where the temperature is taken under the tongue, is due to the 
hot food heating the mouth by direct contact. In this case the pulse and respirations were greatly 
affected, both being considerably quickened. As was the case with the temperature, so with the 
pu Ise and respiration, the effects of the medicine were most marked the day after the discontinu- 
ance ofthe drug. Thus the full effects as regards the pulse and respirations and other symptoms 
culminated about 1 P. M. on the day following the withdrawal ofthe drug, the pulse at that time 
being 140 and the breathing 40. On the following day, that is, two days after the administration 
had ceased, the pulse and respirations had greatly fallen, but were still quick, aud next day they 
became normal. The pulse when frequent was very compressible, but improved in quality as it 
diminished in frequency. The drug's influence on the pulse and respiration is shown in the fol - 
lowing table: 
Date. 
Medicine. 
Amount 
of medicine. 
Maximum and 
minimum pulse of the 
day. 
Maximum and 
minimum respiration 
of the day. 
Sept. 19 
None. 
66 to 84 
18 to 28 
Sept. 20 
None. 
68 to 72 
20 to 24 
Sept. 21 
Salicine. 
68 to 78 
24 to 28 
Sept. 22 
Salicine. 
88 to 116 
24 to 30 
Sept. 23 
None. 
3iv 
112 to 140 
22 to 40 
Sept. 24 
None. 
82 to 108 
18 to 28 
Sept. 25 
N one. 
72 to 100 
18 to 26 
Sept. 26 
None. 
■ 
76 to 88 
16 to 24 
We now give a r6sum6 of his symptoms. Nothing was noticed till noon of the second salicine 
day until the boy had taken in all 5 drachms of the medicine. Between one and two we noticed 
that his face was flushed and he looked dull, and that there was some tremor when his hand was 
held out. In the evening the tremors were more marked. At 5 A. M. the following day he twice 
vomited. On this day though he had discontinued the medicine since 5 o'clock the previous 
evening, his symptoms were very marked and for the most part of the same characters as in the 
other lad-namely dullness, so that he did not seem very well to understand questions; deafness; 
tingling in the right ear; slight tremor of the lips on speaking and thick husky voice; breathing 
rather labored; trembling of hands when held out; slight spasmodic movements of the upper 
limbs; slight jerks of the lower limbs when they are raised from the bed; grasping power weaker 
than before; much irritability of the muscles on percussion; but strange to say he never com- 
plained of headache nor buzzing. These symptoms were at their height at midday, and were so 
marked and the pulse and respirations so quick, that we must confess we felt a little relief when 
the toxic symptoms, which became far more marked than we had expected, abated, not that at 
any time the boy was dangerously ill, but as the symptoms progressed, after discontinuing the 
medicine, we did not know how longand to what degree they might increase. Next day, that is, 
forty-one hours after the last dose of medicine, he was still deaf, though less so, and was dull and 
unless spoken to lay with his eyes half closed, and very often fell asleep. Muscular irritability 
had diminished and the hands and arms trembled when held out; the pulse was still compressible. 
Even sixty-flve hours after the last dose he was still dull, rather deaf, and there was slight tremor 
of the hands and irritability of percussed muscles. Next day he had quite recovered. We tested 
the urine frequently for salicine, and found some even ninety-live hours after the last dose. Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1043 
Tn our third series of observations on a lad aged ten, and weighing 64 lbs., we 
experimented in a somewhat different way. We took the temperature under the 
tongue every three hours. For three days we administered no medicine; on the 
following twenty-six days we gave salicine in increasing doses, at first in 20 grain 
(80 grains daily), and latterly m 30 gr. doses several times daily, till he was taking 
in divided doses 180 grains daily. The boy got up and spent the day about the 
ward. We put our observations into the following table : 
OO 
to 
52 
o 
to 
o 
to 
co 
o 
to 
03 
to 
o» 
o 
4- 
to 
00 
LO 
LO 
O 
to 
o 
-I 
03 
Cl 
-u 
03 
LO 
o 
x> 
7th day 
8 .. 
$ 
1st dav 
None. 
80 grs. 
120 grs. 
100 grs. 
120 grs. 
A 
4 4 
4 4 
100 grs. 
150 grs. 
175 grs. 
150 grs. 
180 grs. 
4 4 
44 
30 grs. 
None. 
Medicine. 
cococopcococccocococococcccaocccocccScococococciScccDS^ 
k 4 bi k bi w cc k 4 bs w w k b; bo b- w k k bo It*. bo k k 1-* k 
Maximum 
temperature 
of day. 
98.66 
98.64 
98.6 
98.7 
98.8 
9S.7 
98.3 
98.8 
98.86 
98.96 
98.6 
98.62 
98.75 
98.48 
98.22 
98.66 
98.7 
99.06 
98.81 
98.94 
98.88 
98.68 
98.9 
98.91 
99.05 
99.36 
99.11 
98.48 
Average 
temperature 
of day 
till 9 p. M. 
98.4 
98.12 
98.5 
98.81 
98.78 
9k5 
98.60 
98.62 
98.32 
98 05 
98.51 
98.5 
98.78 
98.67 
98.68 
98.63 
98.41 
98.73 
98.71 
98.82 
99.1 
98.91 
98.60 
Average 
till 12. 
1.1 
1.2 
1.2 
1.1 
1.4 
1.4 
1.0 
1.3 
1.3 
0.9 
1.0 
1.0 
1.2 
1.9 
1.4 
1.3 
1.1 
1.1 
0.6 
1.5 
1.9 
1.5 
1.2 
0.9 
l.l 
2.1 
0.7 
1.7 
Diurnal 
variation to 
9 P. M. 
tO ►-* to to ►-* JO to to ►-1 LO *- t-1 f-1 [-* *-* ►-* to 1- 
w bo k o co be to o k bi co k bi os k 4 bo k 'so bo co k io 
Diurnal 
variation to 
12 P. M. 
W 
- & 
2 co co cz> co co o co co o co co oo co co oo oo co op 
o o - a c. co ci to oo oo to o as ciocitoaotocioo^o^ 
o ।-। 
P S- 
5'S' 
Highest pulse 
of the day. 
The preceding table shows that these large doses of salicinehad no appreciable 
effect on the temperature. It is true that on one day the temperature rose to 100°; 
butthat occurred during the use of the hot-air bath, employed to produce sweating, 
that we might test the reaction of the sweat; on the other hand the pulse was a 
little quickened. On the fifth day of taking salicine he complained of slight deaf- 
ness, and on the tenth it is noted that the deafness had a little increased, but two 
days afterwards it had disappeared. Beyond the influence on the pulse and hear- 
ing, the medicine produced no apparent effects, the boy eating well, sleeping well, 
and indeed appearing in all respects quite well. I shall next speak of the effect of 
salicylic acid on the temperature of the healthy body. Dr. Riess has investigated 
the action of salicylates on the healthy temperature in twenty-three experiments 
on seven healthy persons, and obtained in four to six hours a constant reduction of 
about 1° F. He finds that the same dose produces a greater fall in the febrile than 
the healthy temperature. I have made some investigations with Mr. Morshead, 
but the results are not so satisfactory as those with salicine, as we failed to get 
symptoms with the acid, though we gave large doses, as much as 160 grains in one 
day. This quantity did not in the slightest degree lower the temperature ; indeed, 
if the medicine produced any effect on the temperature it rather heightened it. 1044 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
A boy aged. 8, and weighing 411 pounds, the subject of our investigation, was convalescent 
from an attack of acute rheumatism complicated with pneumonia; his temperature during the 
greater part of the attack reaching 105° and on one occasion 100°; but for seven days his tempera- 
ture had been normal before we commenced and the lad appeared quite wel]. Throughout the 
experiment we took his temperature in the rectum hourly, from 9 A. M. to 12 P. M., and carefully 
noted his pulse and respirations each time we made a thermometric observation. We also noted 
the quantity of his food. For the two first days we gave no salicylic acid. The course of the tem- 
perature on these non-medicinal days was peculiar, possibly owing to the previous illness. From 
9 A. M. to 1 P. M. the temperature fell, the fall amounting to about 1° F.; the temperature then 
again rose, and remained at a normal height, about 99°, till the evening fall began, which hap- 
pened later than usual in boys of his age; and was rather considerable amounting to 2.7° F. On 
the next three days we gave him salicylic acid hourly in five or ten-grain doses the first day; and 
ten-grain doses the second and third. On the first day he took 110 grains; on the second, 116 
grains; on the third, 160 grains; in all, 425 grains. These doses had scarcely any effect on the tem- 
perature. Though on these days the temperature differed slightly from the non-medicinal days, 
it may be doubted whether the difference was due to the medicine. At all events the effect was 
very slight, and not. in the direction of depressing the temperature, but rather i he ether way. 
The salicylic acid produced no symptoms, the boy seeming in all respects just the same as usual. 
Perhaps it .will be said that larger doses would have had some effect, and we must admit that our 
observations as to temperature are not so conclusive as they might have been, had we got marked 
symptoms. We gave ten-grain doses because, first, it is difficult on accountof its insolubility, the 
potion is so large, to get a patientto take more, and next, during his rheumaticattack, we treated 
him with salicylic acid with the same dose at the same intervals of time, with the production of 
symptoms so marked that after he had taken 130 grains, we felt it necessary to discontinue the 
medicine. 
Kohler finds that, salicylic acid and its salt produce a considerable fall of blood 
pressure, even after the division of the vagi and of thespinal cord. Itthus appears 
that salicine and salicylic acid depress the non-febrile temperature but slightly, and 
that the continuance of the medicine fails to maintain this slight depression. Are 
we thence to conclude that these substances exert no influence upon the febrile 
temperature? By no means. There is no better attested fact than the power of 
salicylic acid and salicylate of soda to promptly and considerably reduce an ele- 
vated temperature. The reducing power is established by numerous observations, 
both in Germany and in this country, by Riess, Moeli, Furbringer, Ewald, Russ, 
Senator, etc. It has been employed in most febrile diseases, in typhoid fever, 
pneumonia, scarlet fever, diphtheria, etc. Many writers maintain that it is equal 
to quinia, but must be given in double the dose. As with quinia two methods are 
adopted, a massive single dose of $j, ^iss, gijonce daily, usually at night, or 
divided doses more frequently. Most observers recommend the massive daily 
dose. In a few hours it effects a reduction of 3° to 7° F.; the temperature can be 
kept low by a daily repetition of this dose. Jahn maintains that it is superior to 
the cold bath as an antipyretic. Salicylic acid and its salts have been especially 
used in typhoid fever, and though its power to reduce the temperature in this dis- 
ease is conclusively shown, it has not been proved, I think, that it lessens the mor- 
tality, the mortality in Reiss' cases amounting to twenty-four per cent. Most 
writers say that jj of the acid is the minimum dose for an adult, but 3 iss and ^ij 
sometimes produce serious collapse. I have myself many times seen salicylic acid 
effect a very great reduction of the febrile temperature; and, in one instance, when 
given to the boy, on whom we subsequently tested the effect of the acid when he 
became non-febrile, ten grains hourly, till 130 grains had been taken, reduced the 
temperature in about twelve hours from 106° to 97°, and the temperature-reducing 
effects of the drug continued for a day and a half. Though I have on very many 
occasions given salicine to fever patients in doses sufficient to produce deafness, 
headache and muscular tremor, I have never seen the quick and great reduction 
of temperature that follows the use of salicylic acid. 
It thus appears that like quinia and the cold bath, salicylic acid produces a greater and more 
lasting depression of the temperature of fever than of health. I have made some experiments 
conjoint ly with Mr. Morshead to ascertain therelativepower of quinia, salicylic acid and salicine 
on the febrile temperature; and we And that dose for dose quinia is far more potent than salicylic 
acid and salicylic acid than salicine. We chose patients with persistent fever running a very 
uniform course. Having ascertained this by many days' observation, taken at 3 a. M., 7 A. M.r 
11 A. M., 3 P. M., 7 P. M., and 11 P. M., we then on separate days gave quinia, and afterwards sali- 
cylic acid and then salicine in the same or an increased dose at the same hour. On three occasions 
wegave to a lad aged 9%. three doses of quinia, 20, 20, and 25 grains respectively, forty-eight hours 
elapsing between each"dose. The temperature on the first day was 103° when the quinia was 
given, and it reduced the temperature to 100°, and in the evening and all next day it varied 
between 98° and 99°. The second dose of quinia whilst decidedly reducing the temperature had 
apparently less prolonged effect, the temperature rising the day after to 101°. The third dose of 
25 grains produced still less effect, for though it reduced the temperature to 98°, and kept it low 
for many hours, at 11 P. M. on the day after the administration, the temperature rose to 103°. 
These doses of quinia produced no cinchonism. 
We next gave 25 grains of salicylic acid without affecting the temperature in an \ degree, and 
without producing any symptoms. Next day in two doses at two hours interval we gave 35 
grains with slight effect, the temperature falling that evening to 99°, but next morning the fever 
returned to the same height as before the administration of the drug. This dose produced slight Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1045 
deafness and drowsiness. Having ascertained that dose for dose, salicylic acid produces far less 
effect on the febrile temperature than quinia, we next varied our test, To the same lad we gave 
five grains of salicylic acid hourly, till he had taken 120 grains, the dosing continuing from 3 P. M. 
of one day to 11 P. M. of the next day. When thefirst dose was given, the temperature was 1O4.C5, 
and so remained that evening with little variation, but it fell during the whole of the next day, 
in the eveniugstanding at99°. On the day after the discontinuance of the acid the temperature 
was also low. rising, however, in the evening to 102°. These doses produced no symptoms except 
flushing and slight tremor. It thus appears that this 120 grains, given in divided doses, produced 
only an effect on the temperature, as 20 grains of quinia given in one dose. We then gave five 
grains of salicine hourly to the extent of 120 grains, but without producing any effect on the tem- 
perature, and scarcely any salicine symptoms. The experiments again showing how much more 
powerful in respect of its influence on the febrile temperature isquiniathan salicylic acid, and 
salicylic acid than salicine. To a lad aged 19, suffering from phthisis, the highest temperature of 
the day being U)2.°6, we began on June 16th with twenty grains of salicylic acid hourly, commenc- 
ingat3P. M., and ending at 7 P. M , June 17th. He took in all 200 grains, which depressed his 
temperat ure to 97° on June 16th, and it remained low next day till 3P. M., and then rose, reaching 
Wl.°4 at 7 P. M. Th6 salicylic acid produced very marked symptoms. On June 18th the highest 
temperature was 1O2.°4. We administered salicine, beginning at 3 P. M., and ending at 3 A. M., 
June 19th. He took in all 200 grains without any effect on the temperature, and with very few 
symptoms. On June 19th the highest temperature was 102.°7. At 3 P. M. we gave him 40 grains 
of quinia, which produced no effect on that day. but next day it somewhat delayed the rise and 
apparently increased the morning fall of June 21st; it produced no symptoms. On June 22d the 
highest temperature was 102.°8; we gave him gr. x of salicylic acid hourly, beginning at 1:30 and 
ending at midnight; he took in all 100 grains. This produced an equal effect on the temperature 
as g00 grains, with marked symptoms. On June 25th the highest temperature was 101.°6. At 1:30 
we gave him 40 grains of quinia without influencing the temperature, but he complained of head- 
ache and giddiness. On June 29th the highest temperature was 103.°8. We gave him hourly 5 
grain doses of salicylic acid, beginning at 5 P. M., and ending at UP. M. on June 30th. He took 
in all 100 grains'without affecting the temperature. It is noteworthy that 100 grains of salicylic 
acid in 10 grain hourly doses produced as much effect on the temperature as'200 grains in 20-grain 
hourly doses, and that in 5 grain hourly doses, continued to the extent of 200'grains, the tempera- 
ture was unaffected. Salicine is supposed to act by being changed in the system into salicylic 
acid; now if this be so, then seeing how much less is the effect of salicine, as compared with the 
same dose of salicylic acid, we must suppose that much of the salicine escapes unchanged, or that 
salicine loses considerably in weight through its conversion into salicylic acid. 
These remedies are now largely employed in rheumatic fever. Dr. Maclagan 
of Dundee first recommended salicine in this disease. Salicylic acid and the sali- 
cylates have since been also employed, and the almost unanimous opinion of the 
profession has confirmed the strong recommendation of Dr. Maclagan. Unsuc- 
cessful cases, it is true, have been reported, and cases of rheumatic hyperpyrexia 
that have ended fatally in spite of these remedies; but it is not to be expected that 
salicine nor any other remedy will be successful in every case of rheumatic fever; 
moreover, in many of the reported unsuccessful cases, the dose was far too small, 
so small and inadequate indeed that it could have little or no effect on the disease. 
Each substance is useful in rheumatic fever. We shall speak of their effect sep- 
arately and first of salicine. Dr. Maclagan insists on the necessity of giving large 
doses frequently, or as he terms it, of quickly "saturating the system," and advises 
a dose of twenty to thirty grains every two hours. Improvement, he says, becomes 
apparent in twenty-four to forty-eight hours, and the mitigation of pain is one of 
the earliest signs of improvement. Subsequent observershave, in the main, con- 
firmed his statements. I have employed salicine in rheumatic fever in several 
cases with very considerable success, t hus in eight cases reported by Mr. Bury, 
the temperature became normal on an average on the sixth day of treatment, and 
sixteenth of the disease. My experience completely confirms Dr. Maclagan's 
recommeh'dation regarding the dose. Little or no good follows small doses, and 
thirty grains every two hours are required to make an impression on rheumatic 
fever, and even this dose sometimes fails, and then thirty grains hourly are called 
for-a dose that generally produces the salicine symptoms in a mild degree, namely, 
some deafness, dullness, and the peculiar breathing due to this drug. 
Weare indebted to C. W. Brown, late House Physician at the Boston City 
Hospital, for the most valuable and extensive investigation into the action of sali- 
cylic acid on rheumatic fever. He records 160cases taken indifferently,.thepatients 
being of each sex and of all ages, between 13 and 61. The drug gave considerable 
relief from pain on an average in 1.46 days, and complete relief in 2 8 days. The 
average time of treatment was six days, and the average number of days in Hos- 
pital was eighteen days. "Two cases died, one from pericarditis, and one from 
cerebral complications. Eighteen cases had a relapse, three had two, and one had 
five while in the hospital. There were very few cases in which there was notocca- 
sional pains for a time after the omission of the acid." Nausea and vomiting 
occurred in 18.8 percent. Burningin the stomach occurred in one case, headache 
in six, singing in the ears in nineteen, and deafness in ten, numbness and prick- 
ing of the affected parts in three, delirium in three. "Nearly all of the cases in 
which nervous symptoms were manifested, were those of persons in poor physical 
condition." The patients were placed under treatment soon after admission into 1046 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
hospital, and, as a rule, took ten grains of the acid hourly for twelve or thirty-six 
hours, when the symptoms were wholly or partially relieved, and then either the 
acid was omitted or given every two or three hours. Stricker recommends 20 to 
30 grains every hour for six hours or 7 to lograins hourly, the acid being continued 
some time after the fever has subsided. 
Owing to the insolubility of salicylic acid, salicylate of soda has lately been 
largely employed, and with great success. It may be given in the same dose as 
the acid, or rather larger. Its disagreeable taste is a serious drawback in its use. 
Dr. Cavafy reports twenty-one cases treated by |he salt. He gives 30 grains every 
two hours, but he says "much larger doses have been given with good results, 40 
to 60 grains every hour, for six doses being not uncommonly employed without 
disadvantage." He, like other observers, has noted that the susceptibility of patients 
to these remedies varies greatly, and hence, during their use, the patient should be 
well watched. In his cases, "in the majority the pain wasabolished, and the fever 
subsided simultaneously within twenty-four to thirty-six hours. It is claimed for 
these remedies that they lessen heart complications in rheumatic fever. No exact 
observations have been made on this question, but as Dr. Maclagan observes, it is 
obvious that a remedy, which greatly shortens the duration of the disease, must 
lessen the risk of complications. It does not, however, afford perfect protection to 
the heart, as several cases of pericarditis are recorded where this complication set 
in after the patient was well under the drug's influence. This, indeed, we should 
expect, as the pericarditis is similar to the inflammation of the joints, and whilst 
this lasts, risks of heart complication must be encountered. I may draw attention 
to a fallacy to which I think most of the reporters regarding these substances have 
not paid sufficient heed: nearly all state that in twenty-four to forty-eight hours, 
these agents exert a marked influence on the temperature and pain. In all the 
recorded cases I have met with the patients were treated in hospital, and on admis- 
sion were at once put upon salicylic treatment. Now it is well known that the 
movement of the joints duringthe jonrney to hospital considerably increases both 
pain and fever, and that during the first two days in hospital the pain greatly 
diminishes, and the temperature fallsone to two degrees. When the patients have 
been at once put under salicylic acid treatment this improvement in the pain and 
fever, due to rest, has been credited to the drug. In my observations. I always 
allowed two days to elapse after admission before beginning the treatment. 
Which preparation is most efficient in rheumatic fever? It is at present impos- 
sible to decide this question, since most observers' experience has been mainly 
restricted to one preparation only. If, as seems probable, they all ultimately assume 
thesame form, probably that of salicyluric acid in the blood, and when thus con- 
verted manifest activity, they will be, of course, equally successful, if given in 
equivalent doses. My experience has been chiefly with salicine, and I must say 
that whilst it acted very efficaciously, it did not produce any of those disagreeable 
symptoms which I have seen follow the use of the acid in other diseases. More- 
over, owing to the solubility of salicine, it is more readily administered than the 
acid, and is far less disagreeable than salicylate of soda, moreover, there is no dan- 
ger of its containing the impurities not uncommonly met with in salicylic acid. 
Salicylic acid and salicylate of soda have been employed in many other febrile 
diseases, as pneumonia, scarlet fever, and especially typhoid fever. Salicine and 
its compounds, as I have shown, do certainly reduce the temperature of febrile 
diseases. But it has not yet been proved that these remedies can shorten the dura- 
tion, or lessen the mortality of a febrile disease; indeed, the mortality in the 
reported cases of typhoid fever is high, and this is attributed by Rees to the severity 
of the epidemic. Gotthammer, after testing salicylic acid in fifty-six cases of 
typhoid, seems to hold this medicine in little estimation. Several observers have 
employed salicylic acid in ague with contradictory results. Several obtained no 
benefit, whilst others find that it cured a minority of the cases, being most ser- 
viceable in recent cases. It seems useful occasionally as an adjuvant to quinia, 
Sarzance having obtained good results fram a combination of these remedies. 
JEbstein and Julius Muller report two cases of diabetes mellitus cured by salicylate 
of soda. They do not vaunt this remedy as a specific, but the two interesting cases 
they cite, after a prolonged trial of various drugs, notably of carbolic acid, got well 
under the salicylate of soda. DaCosta employs salicylic acid in five grain doses to 
correct the foul breath and offensive expectoration sometimes occurring in phthisis. 
Berthold of Dresden narrates a case which yielded promptly to salicylic acid, after 
the failure of turpentine inhalations and large doses of quinia. Berthold has like- 
wise employed salicylic acid topically in "catarrhal stomatitis." and in thrush. 
He calls attention to the anaesthetic virtue of the acid in stomatitis, in calming the Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1047 
gnawing, burning pain of the erosions after the rupture ot the vesicles. The solu- 
tion he uses is one part of acid dissolved in sufficient alcohol to 250 parts of water. 
Salicylic acid has been used with good results as an injection (1 to 300; in the dys- 
enteric diarrhoea of children. Weber has tried this group of renn dies in gout with- 
out much result; and in several puerperal cases, endo-metritis, and septicaemia, 
with rapid abatement of the temperature, and relief of the cerebral symptoms. 
Salicine and salicylic acid may be readily detected in the urine, sweat, saliva and 
sputa, by the purple color produced on the addition of a drop of the solution of 
perchloride of iron. It appears in, the urine in fowr or five hours, and seems to 
undergo speedy elimination, though a trace may remain four days after the dis- 
continuance of the medicine. It is stated that these substances appear in the urine 
in the form of salicyluric acid. 
Dr. Isambard Owen, in an elaborate statistical inquiry into the results 
obtained in St. George's Hospital in 1877 and 1878 by the use of salicylates 
in rheumatism, arrives at the following results: (1) The duration of paiu 
and fever after the beginning of treatment would appear to be independent 
both of the character of the cases (so far as defined by the range of tem- 
perature) and of their previous duration. (2) The duration of the primary 
attack does not appear to be affected by the amount of the initial doses of 
the salicylate (within the limits given, viz. one and a half to three drachms 
in the twenty-four hours), or by the combination of full doses of alkali 
with the drug. (3) The duration of the primary attack after the com- 
mencement of treatment was only about half as long as under full doses of 
alkali. (4) In administering the salicylates an advantage is gained in 
shortening the total duration of the case (i.e. until convalescence is estab- 
lished) by restricting the initial doses and by combining with them full 
doses of alkali. (5) In respect of actual suffering salicylate treatment 
showed a marked advantage when compared with alkaline treatment; the 
advantage was least marked where the salicylate was given in large initial 
doses without alkali, and hardly more so where the salicylate was given 
only in small doses; the advantage was more marked for the salicylate in 
moderate initial doses, and most marked of all where the salicylate was 
given either in large or moderate initial doses combined with full doses of 
alkali. In the two latter cases the total duration of suffering averaged 
hardly more than half that shown in the cases treated by alkali alone. (6) 
Summing up, the greatest aggregate of advantage is derived from a com- 
bination of salicylate and alkaline treatment, the salicylate (of sodium) 
being given in doses equivalent at the outset to two drachms in the twenty- 
four hours, and reduced as occasion requires. The alkaline treatment 
referred to consisted in the administration of doses of potass® bicarbonas, 
or potass® citras, of sufficient amount to render the urine alkaline. The 
salicylate was that prepared from carbolic acid. (The Treatment of Acute 
Rheumatism. Churchill. 1883.) 
The Medical Society of London has done good service to the cause of 
therapeutics, b.y eliciting through discussion the opinions and conclusions 
of those who have had the largest experience of the salicylates in the treat- 
ment of acute rheumatism. All the speakers agree that the fever and the 
joint affection are alleviated by the administration of the salicylates, and 
that so far this method is superior to other plans of treatment. On the 
question of relapses, of cardiac complications, of the dose of the drug 
which is most efficacious, the opinions are in striking contrast. Dr. Broad- 
bent, with Dr. Coupland and others, believes that relapses, as shown 
either by a renewed rise in the temperature, or by an accession of joint- 
pam, are perhaps even more common under the new than under the old 
method of treatment. The explanation is. however, to be found in the 
rapidity with which all the acute symptoms subside under the salicylate; 1048 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
patients are thus not so careful of themselves as when they have gone 
through the sufferings of an unalleviated attack. Dr. Coupland moreover 
believes that the withholding of the drug renders the patient more liable 
to relapses than if its administration be continued, while he finds that the 
relapses may occur in spite of tolerably large doses having been given; as 
many occuring under doses of sixty grains in twenty-four hours as under 
smaller doses. Dr. Douglas Powell supposes that relapse will follow upon 
any exposure, exercise, or improved diet, so long as the tongue remains 
coated and the secretions disordered, whatever be the treatment adopted. 
The joint-inflammation and the pyrexia are not the essential features of 
acute rheumatism, any more than pyrexia and diarrhoea form the essential 
points in enteric fever. Dr. Broadbent and Dr. Fagge agree in antici- 
pating that as the salicylates are brought to bear upon rheumatic fever in 
the first days of its existence, a notable diminution will occur in the pro- 
portion of cases in which cardiac lesions are manifested. At present Dr. 
Broadbent finds that his cases have presented about the usual proportion 
of card'ac complications: he also finds from experience that the salicyl 
compoundshave no influence whatever upon pericarditis, and only a very 
slight effect upon endocarditis. For this reason he discontinues the 
administration of salicylic compounds the moment he recognizes any car- 
diac inflammation. In no case has any permanent cardiac weakness been 
left behind, as a result of salicylate treatment. Dr. Gilbart Smith is of 
opinion that so far as hospital statistics are concerned, there is no evidence 
to show that the introduction of the salicylate treatment has led to any 
diminution in the amount of cardiac complication in acute rheumatism. 
Dr. Douglas Powell, on the other hand, thinks that the treatment tends to 
prevent and to alleviate, when already present, the heart-affection. Dr. 
Maclagan is similarly of opinion that this method of treatment diminishes 
to some extent both the frequency and the danger of heart complications; 
and the particular series of cases upon which Dr. Couplaud based his 
observations, showed in like manner that the percentage in which pericar- 
ditis appeared was below the average. The latter observer, however, states 
that no definite influence upon the cardiac or other complications can be 
observed, and that both pericarditis and endocarditis may develop whilst 
the patient is under the influence of the remedy. As regards the dose of 
the drug and the toxic symptoms which may arise during its administra- 
tion, Dr. Isambard Owen shows that with different dosage there is practi- 
cally no difference in the total duration of the illness. Dr. Broadbent gives 
twenty grains of salicylic acid in combination with soda, every hour for 
six hours, repeating it on the second day. The further administration of 
the salicylic compounds has been in the same dose perhaps thrice a day, or 
if the temperature has not absolutely gone down, four times a day for some 
days afterwards. In only very few cases did any unfavorable symptoms set 
in which could be attributed to the drug-delirium, sullenness, giddiness, 
deafness, etc.; in the majority of these cases he attributes the symptoms to 
impurities in thesalicylate used. Dr. Coupland has throughout endeavored 
to give as small an amount of salicylate of soda as was possible, the usual 
quantity being fifteen grains every four or six hours; relapses are as far as 
possible guarded against by continuing the administration long after the 
subsidence of the primary fever. Dr. Coupland finds also that the toxic 
effects are serious in proportion to the largeness of the dose, and perhaps 
also to the state of impurity of the drug, and in this latter point he is con- 
firmed by Dr. Fowler, who shows that no such toxic symptoms occur in 
the case of pat ients treated with the acid obtained from oil of wintergreen. 
Dr. Maclagan regarding acute rheumatism as a malarial fever, maintains Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1049 
that the salicyl compounds must be given in full and frequently repeated 
doses, in fact, that the larger the quantity that can be thrown into the sys- 
tem in a given time, the more rapid will be the destruction of the poison. 
Salicin is looked upon by Dr. Maclagan as equally powerful with salicylate 
of soda, whilst its use is infinitely preferable, inasmuch as it produces none 
of the deleterious effects of the salicylates; so that in several cases full 
doses of salicin have been given with the best results to patients suffering 
from the depressing and disturbing action of salicylate of soda. Dr. Bed- 
ford Fenwick, after a free purge, gives twenty grains of salicylate of soda 
every hour for six hours, adding digitalis and brandy to each dose if the 
heart-sounds are feeble and dull, and suspending the treatment if faintness 
or vomiting occur. The after-treatment consists in giving half-doses of 
citrate of potash every six or eight hours, until the saliva becomes alkaline 
to test-paper. The modus operandi of the drug in cases of rheumatism is 
explained by Dr. Latham thus : Salicylic acid enters into chemical com- 
bination with the antecedents of lactic acid and glucose, to whose presence 
in the circulation the disease is due. The presence of the excess of lactic 
acid in the blood is due to the inaction of an "inhibitory chemical centre," 
whose function it is to control the nutrition of the muscular and other 
tissues. Relapses will occur if the administration of the remedy has been 
suspended after the symptoms are relieved, but before the "inhibitory 
chemical centre " has recovered its tone. Dr. Maclagan, as we have hinted, 
regards the rheumatic poison as malarial, i. e. due to minute organisms. 
The local joint and heart-affections are the result of the action of these 
organisms on the fibrous textures of the joint and heart. The salicyl com- 
pounds produce their anti-rheumatic effects solely in virtue of their 
destructive action on these organisms. 
ON THE SALICYLATE TREATMENT OF RHEUMATISM. 
The treatment of acute rheumatism has been from time immemorial one which 
has yielded but little satisfaction to most practitioners; and when Dr. Maclagan 
first published his experience of the results obtained by the use of salicine, those 
who had tried most of the other methods of treatment were doubtless inclined like 
myself to look upon any new suggestion with great scepticism. But when I first 
put salicine to the test, Iwas agreeably surprised by the result, the pain rapidly 
subsiding and the acute symptoms being gone in a few days. I then used salicylic 
acid and its sodasalt with equally good results, the latter being, I believe, on the 
whole the most generally useful. The subject of the present paper is a series of 
twenty-seven consecutive cases of acute and sub-acute articular rheumatism occur- 
ring in private practice, the results being compared with those of other observers. 
Of the importance of statistics from private practice there can be little doubt, for 
there alone is acute rheumatism met with in its natural state, being under obser- 
vation from the very outset of the attack, instead of not until the 7th or 8th day as 
in hospital practice-a fact which cannot fail to influence prognosis as well as the 
results of any treatment. But, on the other hand, there is for statistical purposes 
the disadvantage that the notes of cases in private practice must frequently be 
very meagre. Of twenty of my cases the notes are tolerably full; but some of the 
remaining seven are so brief as to render the cases individually of little value. I 
thought it better and fairer, however, to record-even briefly-every case so as to 
show that [ have not selected only the more favorable ones. The ca^es are entered 
in the same order as they occurred; but I have arranged them according to their 
temperatures, the result being that there were 16 acute cases: 3 cases with a tem- 
perature of 103° or over; 5 cases with a temperature of 102° but under 103°; 8 cases 
with a temperature of 101° but under 102°; 11 sub-acute cases: 6 cases with a tem- 
perature of 100°-101°; 2 cases with a temperature under 100°; 3 cases with a temper- 
ature not noted. Of the three cases not noted, one was complicated with scarlatina, 
* C. S. Clouston, M. D. The Practitioner, May, 1882. This paper, 'with full notes of the 
appended cases, was submitted as a Graduation Thesis (1881 to the Medical Faculty of the Uni- 
versity of Edinburgh. 1050 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
and one with bronchitis, while the third occurred in an infant, the temperature 
being probably considerably raisedin all. The patients were confined to bed during 
treatment, but f never insisted on the bedding and clothing being entirely flannel 
as is sometimes done. The diet was light; milk, farinaceous, food, or light soup 
being given until the acute stage was over, after which solid food was gradually 
resumed, stimulants being seldom required until convalesence. Thirteen of the 
cases were first attacks; 6 were second attacks; 3 were third; 1, fourth; 1. fifth; 1, 
sixth; 1, seventh; and 1 an eighth. Thus more than half the cases occurred in 
patients who had previous attacks. One patient had 4 separate attacks (cases 14, 
15, 24, and 25), and another had 2 (cases 6 and 7). The number of patients was 
thus only 23. Salicine, salicylic acid, and the salicylates produce similar effects, 
and when given in acute rheumatism the action of the skin.is generally increased, 
and the severity of the pain much lessened, after about five or six hourly doses of 
ten or twelve grains of salicylate. The pain continues to decrease, and is generally 
gone in from two to four days, the sweating in most cases continuing more or less 
all this time. Meanwhile temperature falls steadily and rapidly to the normal 
point. The fall in temperature is not, however, generally noticed until after the 
pain is somewhat relieved, and on an average the normal temperature was not 
reached in many cases until rather after the total absence of pain. The pulse 
becomes slower and softer, and if much salicylate be taken, the first sound of the 
heart becomes much less pronounced, large doses acting as cardiac depressants. 
Convalescence was generally rapid and satisfactory, and I had no fatal case. 
I. RESULTS OF THE TREATMENT IN DETAIL. 
Under this heading I shall consider the effect on (1) pain; (2) the action of the 
skin; (3) temperature; (4) the circulatory system; (5) the respiratory; (6) the muscu- 
lar; (7) the digestive; (8) the nervous; and (9) the genito-urinary system. (1) Pain 
was in every case speedily lessened, and material relief (by which I mean that the 
acuteness of the pain was past, and but little, if any discomfort felt while lying 
still) was obtained-on the first day of treatment in twelve cases; second nine; 
third, two; fourth, one; not stated, three. Total twenty-seven. In the case not 
relieved until the fourth day two small doses were given at first; and in the three 
not noted, relief was no doubt early, as they were noted as free from pain in two, 
three and six days respectively. The average period until relief was afforded was 
sixty-six days. Pain was entirely gone, no tenderness remaining in the affected 
joints- 
In 1 day 
2 
3 
4 
5 
6 
7 
8 
9 
10 days. 
5 cases 
7 
6 
5 
- 
2 
- 
1 
- 
1 =27. 
Thus eighteen of the cases, or 66.6 percent., were Tree from pain within three 
days; and twenty-three cases, or 85.2 per cent, within four days. The average time 
until pain was gone was 3.22 days, being 3.25 in the acute and 3.12 in the sub-acute 
cases. If cases twenty-four and twenty-five (which occurred in the same patient 
in his seventh and eighth attacks, and ran a tedious though sub-acute course) were 
excluded, the average of the remainder would be only 2.76 days. (2.) The skin.- 
Sweating occurs in a large proportion of cases, how large I cannot well say. as I 
did not, in my earlier cases, note its significance, and have only entered it as spec- 
ially prominent in eleven, though I believe it occurred in most of the patients. It 
often comes on after five or six doses, about the same time that the pain is first 
notably relieved, and the patient, if hitherto sleepless, frequently falls into a quiet 
sleep. Sweating I consider a favorable sign, being generally associated with a 
diminution in the severity of the symptoms. Ringer states that salicylic acid is 
found in the sweat. Helme failed to find it. I have only tested for it roughly, and 
with negative results. A miliary rash has been observed in cases treated by sali- 
cylate, but as this is no uncommon occurrence in rheumatism, it may be doubted 
whether it is due to the use of the drug. Urticaria occurred in case twenty-six. 
(3.) Temperature. The temperatures were regularly noted in twenty-two of the 
cases until normal or almost so. The average on the first day was 101.°25; on the 
second 99.°7, and on the third 99.°2, or barely over the normal, being now under 
100° in all but three cases. The number of days until temperature became normal 
in the various cases was- 
Normal in 1 dav 3 
3 
4 
5 
6 
7 8 
9 
not noted. 
6 cases 
6 
1 
3 
2 
1 
1 
1 
1 
5 = 27. Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1051 
Thus of the twenty-two cases in which the date of normal temperature was 
noted, thirteen, or 59 per cent., had reached the normal point within three days, 
and sixteen, or 72.7 percent, within four days, all but four being normal within five 
days. Of these four, one had pericarditis, and the other three were fifth, seventh 
and eighth attacks. The cases not noted were probably not longer than the aver- 
age, as pain is stated to have been gone in them in two, two, six, three and one days 
respectively, making their average duration of pain 2.8 days, which was under 
the ordinary time. 
Theaverage time until temperature became normal in all the cases noted was 
3 31days, being 3.46 in the acute and only 3 days in the sub-acute cases. After this 
time temperature continued normal in all except some eases where relapses 
occurred, and which will be referred to afterwards. There was no case of hyper- 
pyrexia. The temperature charts are of but little individual interest, showing in 
every case a rapid fall to the normal point. Grouped together, however, as in the 
accompanying diagram, and showing at a glance the date of normal temperature 
in each case, they are interesting. The periods of material relief and of total 
absence of pain are also indicated, thus showing at a glance the more important 
points of each case. (4) The Circulatory System.-The effect on this is most 
important. Dr. Oliver Moore says that salicylates, like digitalis, at first increase 
the force of the heart's action. StillS and Maisch state that Danewski also claims 
that the primary action is to increase the force of the cardiac systole and arterial 
tension. I have not observed any such effect, nor does it appear to have been gen- 
erally noticed, and it is universally acknowledged that there is soon a well marked 
depressant effect on the circulation, a considerable fall of blood pressure persisting 
even after the division of the vagi and spinal cord (Ringer, Kohler). One grain 
injected hypodermically in a frog produces languor, and then complete motor 
paralysis and arrest of the heart (StillS and Maisch). The effect of salicylate in 
reducing the strength and volume of the pulse may generally be observed after four 
or five hourly doses of ten or twelve grains each, the pulse becoming soft and 
compressible. When given in sufficient amount to cause marked salicism it has a 
powerful effect in reducing pressure. This was specially noticed in cases 4 (in 
which salicine was used) and 18 (which was treated by salicylate). In both acute 
salicism occurred, accompanied in the latter by considerable cerebral disturbance. 
Marked weakening of the first sound of the heart is frequentlv observed, while the 
frequency of the pulse is rapidly diminished, larger doses, however, frequently 
accelerating it to 140 or more (Ringer), though this did not occur in any of my 
cases, the daily average of which was as follows: First day, 97 ; second, 88'; third, 
82; fourth, 78; fifth, 70; the pulse being below 100 by the third day in all but cases 
16 and 23, in the former of which there was pericardial effusion. Cardiac murmurs 
were heard in7 cases altogether. Three of these, all endocardial (cases 1, 10 and 23), 
were known to be of long standing from previous attacks, and there was no symp- 
tom of recent heart affection in any of them. In 2 others temporary endocardial 
murmurs were heard, case 13 having a murmur when first seen but never after- 
wards, and case 26 having a murmur for about a day during a relapse, both being 
probably of haemic origin. In 2 eases only, or 7.4 per cent., was there recent heart 
affection; one of endocarditis in case 21, a boy of eight, the acute stage lasting only 
three days under treatment; the other, case 16, being pericarditis in a lad of seven- 
teen. in whom the acute stage was prolonged by effusion to seven days. In both 
cases the heart was affected when first seen; and in none of the patients did heart 
disease arise after treatment was commenced. In the two cases just mentioned 
the salicylate treatment was pursued throughout with the best possible results, ft 
must, however, be noted that both were young and in their first attack, the heart 
affection being probably only of a few hours' standing. In eases where great weak- 
ness of the heart exists, and in elderly people, the powerful depressing effects of 
large doses of salicylate must be borne in mind, nutrients and diffusible stimulants 
being given on the slightest symptom of failure of the heart's action, or given along 
with the medicine in order to prevent the weakening effect (Stills and Maisch). 
Greenhow goes so far as to suggest that the "marked weakening of the first sound 
of the heart may indicate an influence on muscular structure which mau not 
always pass away entirely y It will be observed that this is put forward purely as 
a conjecture; and the hypothesis is not supported by any clinical or pathological 
observations so far as I am aware. Dr. Broadbent expressly states that he has 
never known salicylate cause permanent cardiac debility. Dr. Fowler considers 
that the toxic effects are chiefly caused bv impurities in the ordinary salicylate. 
He advocates the use of natural salicylate made from wintergreen, which he says 
is equally efficacious and but rarely causes toxic symptoms. For the same reasons, 1052 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
No. of Case. | 
Sex. 
Age. 
No. of Attack. 
Highest Temper- 
ature 
Length of Pre-| 
monitory Stage. : 
i of A cute 
; before 
lent. 
No. of days under 
treatment till: 
relieved. 
Pain gone. 
Temperature nor- 
mal. 
AcuteStage under 
Treatment. 
Total Length of 
AcuteStage. 
Amount of Sali- 
cylate taken. 
State of heart. 
Relapse. 
A, after resuming work. 
77, after exposure. 
C, without assignable 
cause. 
Symptoms of Salicylism. 
Duratio 
Stage 
Treatn 
12 
16 
18 
M. 
M. 
M. 
19 
17 
15 
38 
2d 
1st 
103.2 
103-1 
103.6 
102.' 
102.1 
102 
102 
Days. 
2 
1 
1 
1 
1 
0 
0 
0 
6 
4 
1 
5 
7 
1 
7 
1 
7 
8 
2 
Grains. 
630 
607 
140 
Acute pericar- 
dial effusion. 
B, on 8th day. 
Sweating, tinnitus. 
Sweating. 
Went out Sth day, relapsed. 
20 
M. 
2d 
1 
1 
o 
2 
2 
2 
3 
270 
.4,17 days after last seen. 
B, on 9th day. 
ness, delirium, etc. 
Sweating. 
Tinnitus, deafness. 
Tinnitus,deafness, sweat'g 
13 
4 
I 
M. 
M. 
M 
29 1st 
44 2d 
8,1st 
33 8th 
3 
1 
o 
0 
4 
4 
4 
4 
2 
4 
4 
4 
270* 
780 
Haemic bruit 
for 1 day. 
Doses too small at first. 
21 
1 
2 
3 
3 
4 
180 
Acute endoc'd 
Doses too small at first. 
102 
() 
o 
10 
9 
10 
10 
495 
Sweating. 
Tinnitus, sweating. 
Acute sympts.overin4days. 
23 
17,3d 
32 2d 
34 1st 
101.5 
101.4 
101.3 
I9 
o 
2 
3? 
2 
3 
4 
150 
Old bruit. 
10 
11 
1 
o 
2 
3 
2 
3 
3 
3 
180 
Old bruit. 
A, 13days after last seen. 
27 
F. 
101.3 
2 
0 
0 
1 
2 
2 
2 
120 
Tinnitus, giddiness. 
Tin nitus.vom it'g, h'dache. 
Tinnitus, sweating. 
9 
F 
19 1st 
14'1st 
101 2 
3 
o 
o 
3 
1 
3 
3 
270 
22 
M. 
101.2 
5 
o 
2 
2 
2 
4 
150 
17 
F 
SJst 
32 5th 
101 
3 
1 
J 
1 
2 
2 
3 
60 
14 
M. 
101 
8 
1 
4 
6 
6 
14 
540 
A, 8 days after last seen. 
Sweating. 
Alkalies tried for 4 days be- 
fore salicylate. 
Average 16 
acute cases 
1. 
19 
.60 
3.25 
3. 46 
3.75 
4.94 
10 
M 
10 
100.8 
100 6 
100 4 
100.4 
100.1 
100 
99.8 
9!) 
3 
1 
1 
1 
1 
4 
120 
(', on 14th day. 
A, 16 days after last seen. 
A, 18 days after last seen. 
C,17th dayandsubs'q'nly 
A, 13 days after last seen. 
8, M. 
24, M 
28 2d 
33 7th 
7 
1 
1 
1 
2 
8 
8 
2 
8 
9 
9, 
180 
600 
Tinnitus, sweating. 
Tried 9-gr. doses for 2 days. 
26 M. 
6 M 
36 1st 
408d 
32 6th 
40 4th 
28 1st 
3 
2 
1 
0 
4 
2 
4 
1 
4 
2 
7 
4 
270 
450 
Hsemic bruit 
duri'g relapse 
Sweating. 
Alkalies given for 3 days 
15 
7 
5 
M 
2 
3 
o 
3 
5 
5 
8 
450 
180t 
350* 
Tinnitus, sweating. 
M. 
F 
1 
1 
1 
1 
2 
3 
1 
1 
2 
3 
3 
4 
Tinnitus, deafness. 
before salicylate. 
1 
F. 
+ 
302d 
t 1st 
19 Srl 
- 
0 
3 
3 
3 
240* 
40* 
Old bruit. 
Came on dur.acutebronchit. 
2 
3 
6 
6 
6 
M 
0 
1 
1 
1 
120 
Came on abt.5th d.scarlatina 
- - 
Avr'ge 8 subacute cases 
2.62 
.75 
3. 12 
3 
3.12 
5. 62 
Average of all 
1.53 
.66 
3. 22 3. 32 
3.52 
5. 06 
* Salicine. 
t Salicylic Acid. J Infant, 22 months. 
TABLE SHOWING THE PRINCIPAL POINTS OF EACH CASE. Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1053 
Drs. Buchanan-Baxter, Maclagan, and Charteris advise salicine as specially valu- 
able where there is any serious cardiac trouble. I think, however, that even in 
cases of recent and acute heart-affection, whether endocardial or pericardial, 
occurring in persons of fair strength, the ordinary salicylate may be given with 
perfect safety if the patients are closely watched, and that such cases, more especi- 
ally if the drug be begun sufficiently early, do better under this treatment than 
under any other. The addition of carbonate of ammonia will generally obviate all 
risk in doubtful cases; while natural salicylate or salicine should be given where 
there is marked debility. 
(5.) The respiratory system.-Large doses of salicylate quicken the breathing 
to a very marked extent In case 18. where too large a quantity had been taken 
by mistake, the respirations were 28 after temperature had become normal and pain 
had gone. There was nothing in the case which could account for this accelera- 
tion, which appeared to be solely due to the large amount of salicylate taken, and 
which produced severe " tinnitus aurium," deafness and delirium for nearly two 
days. Ringer states that with very large doses the breathing is "sometimes deep- 
ened, sometimes sighing and shallow and almost panting, as though it were per- 
formed rather laboriously, but the patient does not complain of any difficulty of 
breathing. The costal as well as the diaphragmatic muscles,".he adds, "are 
involved in the exaggerated breathing." Bochefontaineand also Labordi consider 
that in fatal doses the respiratory movements are arrested before the heart ceases 
to beat. 
(6.) The muscular system.-Under large doses there is often marked musculaY 
weakness and tremor, associated with great irritability; so that a slight tap, say on 
the shoulder, causes muscular contractions so strong as to jerk the arm backwards 
(Ringer). These symptoms are apparently due to t he effecton the nervous system, 
and pass away rapidly when the salicylate is stopped. 
(7.) The digestive system.-Salicylic acid is a local irritant, and when given 
for any length of time produces soreness of the throat and fauces. This was very 
marked in case 5, the only one in which I gave the acid uncombined. Moore states 
that Dr. J. A. E. Stewart found that a "characteristic naso-pharyngeal catarrh" 
occurred whether the acid was given by the mouth or the rectum, a result not 
noted by any other observer so far ac I am aware. The inference from this would 
naturally be that the symptom was not due to local irritation, but was one of the 
constitutional effects of the drug, in which case we should expect a similar result 
from the use of the salt, which acts in all other respects precisely like the acid; but 
this is not the case. Both the acid and the salt frequently cause nausea. Their 
taste may have something to do with this, but the chief reason is doubtless the 
irritant effect which is produced on the mucous membrane of thestomach. Nausea 
occurred in several of my cases, and it is a symptom of no importance, unless so 
severe as to interfere with taking the medicine. Vomiting occurred in only two of 
my cases (9 and IS), but was caused in the former by the patient taking too large 
doses, amountingdo nearly 16 grains every hour; and in the latter by the salicylate 
being continued too long, nine doses having been given in the course of one night 
after " tinnitus aurium " had set in. Case 10 was sick before salicylate was begun, 
and the sickness was not increased, the medicine being generally retained. Dr. 
Greenhow, giving doses varying from 10 to 30 grains at various intervals, found 
vomiting occur in 44 per cent, of the cases. Dr. Helme, giving 15 grains every 
hour, noted it in 42.1 per cent. Dr. C. Brown, giving 10 grains every hour for 
from twelve to thirty-six hours, observed it in 18,8 per cent. I gave salicylate in 
doses of 10 to 12 grains every hour, until pain was relieved orslight tinnitus aurium 
felt, but sickness never resulted, except in the two cases mentioned, who had taken 
too much, which would give 7.4 per cent, as the proportion of cases sick; sickness 
being, I believe, generally evidence of too large doses, or too long continuance of 
the medicine. Ringer considers that the continued use of the drug in large doses 
in healthy subjects produces gastric catarrh, which he believes accounts for the 
elevation of temperature noted. Some patients appear to be unduly susceptible to 
this irritant action, which may give rise to symptoms so severe as to resemble the 
result produced by a corrosive poison (Still6 and Maisch). The bowels are, as a 
rule, confined while the drug is being taken; but at times profuse diarrhoea occurs, 
as in case 18, where the bowels acted freely after each of the first six doses, a 
result, however, which may have been partially determined by the administration 
of an aperient on the previous day. The diarrhoea did not, however, interfere 
with the action of the drug, the rheumatic symptoms, which were severe, being 
much relieved within four hours, and almost gone next morning. Salicine pro- 
duces but little disturbing effect on the digestive system. 1054 
Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
(8.) The nervous system.-Large doses of salicylate produce a powerful effect 
on the nervous system; the tendency to this being apparently very strong in cer- 
tain individuals, as well as, generally speaking, in old or feeble persons. It is 
increased by constipation, or a too free use of the medicine at the outset; toleration 
being, however, soon established if it be given with caution fora time. The chief 
nervous phenomena produced by salicylate are flushing of the face with headache, 
tinnitus aurium, deafness, restlessness, sleeplessness and delirium. Of these the 
most characteristic is the tinnitus aurium, and it is generally the first to attract the 
attention of patients, who describe it as being like the sound of a train or like 
machinery at work. From its being so clearly recognizable by the patient, it is a 
valuable guide as regards the continuance of the drug. I order 10 or 12 grain doses 
of salicylate every hour "till pain is relieved, or singing in the ears comes on." 
By this means a very rapid effect is produced on the disease, and without any risk 
of troublesome toxic symptoms, pain being generally relieved in five or six hours, 
slight singing in the ears coming on in most cases about the same time. Tinnitus 
was noted as well marked in eleven of my cases, in one of which (case 24) it was 
for a time felt in the left ear only. Flushing and headache may be the first symp- 
toms observed, especially after one or two very large doses, but with the ordinary 
doses flushing may not be observed; and headache is generally subsequent to tin- 
nitus and associated with deafness, as in cases 4 and 18, though the headache was 
only severe in the latter, 'rhe aspect of the former, who had taken about 240 
grains of salicine in twenty-four hours, was at this stage extremely characteristic. 
He was lying quietly asleep when I entered the room, his face bathed in perspira- 
tion. He awoke readily when spoken to, was perfectly collected, could hear ques- 
tions put in a rather loud tone, and reply to them distinctly. He then relapsed 
into silence, appearing perfectly comfortable, but with what I may call a "far-off" 
look on his face, as if the sound in his ears, which he said was " tremendous " and 
" like a railway train," was attracting all his attention; deafness being so marked 
that he could not hear the clock on the mantelshelf, as usual. Still larger doses 
produce restlessness and sleeplessness. All these symptoms rapidly subside on the 
withdrawal of the medicine. Its further continuance, however, may produce 
delirium, as in case 18, a boy of 15. Here the precaution of stopping the drug on 
the appearance of tinnitus was not understood, and nine doses were given between 
5:30 I'. M. on the first day of treatment (when, having taken six doses of 9} grains 
each, he was noted as having no tinnitus) and 10 o'clock next morning. Tinnitus 
had meanwhile set in immediately after the evening visit, and he passed a restless 
and delirious night. Pain was now almost gone, and temperature reduced in 
twenty-four hours, by 140 grains of salicylate, from 102.°4 to 99.°2, and the pulse 
from 102 to 87, being very soft and compressible. Fie was very deaf and restless, 
jumping up in bed, and wanting to go for a walk, while he told me had already 
had a morning walk of several miles. There was at times great difficulty in keep- 
ing him in bed; then again he would sink off into a state of comparatively quiet 
delirium, sometimes talking nonsense, at others looking as if absorbed by the noise 
in his ears, and with the " far-off" look on his face. Salicylate was discontinued, 
and he was ordered copious cool drinks. At 2:30 P. M. his temperature had fallen 
to 98°, the delirium remaining as before. At 6 P. M. he was as restless as ever, the 
pupils large, but contracting on exposure to light. At 9:30 P. M. delirium was still 
active; temperature 98.°8 F.; pulse, 94; respiration, 28. No urine had passed as 
yet, but shortly afterwards a considerable amount was voided. He continued 
very restless and delirious until 4 A. M., when he fell asleep, and was still sleep- 
ing when seen at 10:30 A. M- His pulse was then 64 (counted during sleep) and 
rather weak. During the night his chief object had been to get back to business, 
and he had various optical illusions, declaring that a bundle of clothes was the baby 
of a friend in whom he was greatly interested, and insisting on having it dressed 
up for him to nurse. This he did with great care for a considerable time, fre- 
quently calling attention to the good points of his protege. At 5:45 P. M. he was 
much more collected, though he still had illusions, which continued more or less 
till 10 P. M., when he fell asleep and passed a good night. Next morning, forty- 
eight hours after his last dose of salicylate, his mind was perfectly clear. Tinnitus, 
however, still remained, but was gone by the following morning. 
The delirium in this case was clearly due to salicylate, the rheumatic symp- 
toms having subsided and temperature being normal. Dr. Bastian, in reviewing 
•5 cases which occurred at University College Hospital,* drew attention to the simi- 
larity of the delirium caused by salicylate to that of acute rheumatism; and in 
British Medical Journal, January 29. 1881. Salicin, Salicylic Acid and Salicylates in Treatment of Rheumatism. 
1055 
!both of these again, he says, that the restlessness, jactitation, extreme loquacity, 
and wild delirium, accompanied frequently by perspiration, form a picture which 
is often the fac-simile of delirium tremens. The subsidence of temperature, and 
with it of the severer rheumatic symptoms, will generally prevent the salicylate 
delirium from being confounded with that of rheumatism; while the absence of 
tremulousness in hand or tongue will generally preclude delirium tremens. The 
delusions and hallucinations produced by salicylate too have generally less of the 
element of "horror" about them. In my case both the delusions and illusions 
were of quite an agreeable character. Cases may arise where there is a combina- 
tion of more than one of these causes; and several of the cases reported as follow- 
ing salicylate have, I think, been really due to rheumatism. Dr. Greenhow had 
eight cases of delirium in fifty cases, five of which were clearly due to salicylate, 
but his other three (cases 30, 39, and 41) were, I think, more probably of rheumatic 
origin. In case 39 there was pericarditis, with pleurisy and crepitation at the base 
of one lung; while in his other two cases (40 and 41) the temperatures were 104°.4, 
and 102°.4 respectively, when delirium was noted, and the continuance of the sali- 
cylate, even in more frequent doses in the former case, did not increase delirium, 
which passed off under the use of the drug. Five cases of delirium out of fifty 
seems a large proportion. Dr. Brown had three cases out of 109, and even this 
smaller proportion may probably be much further reduced, if not entirely done 
away with, by proper precautions, which are now better understood. Delirium 
has been said to be caused by uraemia, due to acute nephritis, which sometimes fol- 
lows the use of salicylate (Murchison); but this is disproved by the occurrence of 
delirium where there has been no albuminuria whatever (Bastian, Ringer, Green- 
how). Dr. Ackland, however, still thinks that uraemia, due to the great diminu- 
tion of the amount of urea excreted by patients taking salicylates, " may play an 
important part in the causation" of the delirium. Dr. Bastian agrees with M. 
S6e, that the chief action of salicylates is on the nervous system, and that in a 
patient already predisposed to delirium, the additional toxsemic state produced by 
salicylates mightsuffice to determine the on^et of an attack: I think there is little 
doubt that the direct action of salicylates on the nervous system is sufficient to 
account for the delirium, apart from either albuminuria, uraemia, ora rheumatic 
complication, though the presence of any of these might doubtless act as predis- 
posing causes, and tend to aggravate the symptoms. The amount of salicylate, 
which will produce delirium, varies greatly in different cases, much depending on 
the mode of administration. In one of the cases commented on by Dr. Bastian, 
delirium occurred after three 15 grain doses, given every three hours, a- most unu- 
sual event after such a small amount. In almost all the reported cases it has come 
on early, frequently within twenty-four, but almost always within forty-eight 
hours of the commencement of treatment. Dr. Fowler attributes the delirium to 
an impurity in the salicylate of soda as generally sold, and says that the natural 
salicylate made from winter-green never produces it. Drs. Maclagan and Charte- 
ris state that salicine never causes delirium. It is important to note that in all the 
cases where full notes are given, tinnitus, deafness, quickened respiration, head- 
ache, restlessness and sleeplessness were til, or most of tnem, observed before deli- 
rium; and its prevention is, I believe, almost certain if salicylate be given in fre- 
quent small doses, and stopped for a time on the first appearance of tinnitus. Dr. 
Prideaux thinks that the use of salicylate of ammonia, or the addition of carbonate 
of ammonia to the salicylate of soda, lessens the risk of toxic symptoms. Should 
delirium occur, the medicine should at once be withheld, and elimination through 
the kidneys promoted by copious cool drinks, such as lemondade, with cream of 
tartar. Tea and coffee are valuable, and stimulants should be given if required. 
In severe cases excitability is best reduced by bromide of potassium and chloral, 
to which opiates have in some cases been added with good effect; though they 
might be supposed to be contra-indicated on a priori grounds as being likely to 
diminish the urinary secretions. (9;. The Genito-Urinary System.-Salicine, sali- 
cylic acid, and salicylate of soda can be detected in the urine very shortly after 
being taken; their presence being shown by the addition of a few drops of the solu- 
tion of perchloridc of iron, which produces a purple color, which Ringer says is 
owing to salicyluric acid, in which form he says they are eliminated by the kid- 
neys. I have seen this purple color produced by the perchloride witbin thirteen 
minutes of the time when the first dose of salicylate was taken. Stills and Maisch 
record a case of exstrophy of the bladder in which it was seen within eight min- 
utes. The elimination goes on while the medicine is being taken, and generally 
for several days afterwards. I have seen it three days after the last dose of salicy- 
late. Ringer has found it nearly four days, and Dr. Habershon eight days, after 1056 
Various Forms of Treating Rheumatism. 
the last dose. The'quantity of the urine is generally diminished, probably owing 
to the copious perspiration which so frequently occurs. The excretion of urea and 
uric acid, which is generally so abundant in acute rheumatism, is greatly decreased 
by salicylate, and the water is thus proportionately increased (Stille and Maisch; 
Ackland). Albumen has been frequently found in the urine (Murchison, Green- 
how, Bastian, etc.) Ringer quotes instances of acute nephritis, with bloody albu- 
minous urine containing casts, and also instances of almost total suppression of the 
urine. On account of the irritant effects being at times severe, it may be well lo 
use salicylates with great caution, as Dr. Squire suggests, in cases of acute or 
chronic kidney disease, more especially as the kidneys appear to be unusually sensi- 
tive during acute rheumatism. Senator stating that blisters appear to cause renal irri- 
tation and hypersemia rather more easily than in health. The fear of renal irri- 
tation, however, need not stand in the way of the free use of salicylates, unless 
marked symptoms occur. Though I have used them very freely in a large num- 
ber of cases. I have never seen any bad effect of the sort from their employment. 
Ringer alludes to a case where the urine became of an olive-green color, which he 
thinks may have been due to a trace of carbolic acid in the specimen of the drug 
used. At the same time there was involuntary evacution of faeces. Moorestates 
that salicylates sometimes exert a powerful antiphrodisiac effect, which, however, 
he says rapidly disappears under the use of damiana. 
II.-THE EFFECT OF SALICYLATES ON THE COURSE AND DURATION OF 
RHEUMATISM COMPARED WITH OTHER METHODS OF TREATMENT, 
INCLUDING RESULTS BY VARIOUS OBSERVERS. 
Under this heading I propose to consider the effect on (1) duration, (2) compli- 
cations, (3) relapses, (4) convalescence. 
(1.) Effect on duration.-The effect on the duration of the disease is most 
marked. Temperature and pain are (complications excepted) the main points by 
which we judge of the progress of the disease. The number of days till temper- 
ature was normal and pain gone, or, in other words, the duration of the acute stage 
under treatment, in each case, was as follows : 
Days 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
No. of cases 
3 
8 
6 
3 
1 
3 
1 
1 
1=27 
Thus, in seventeen cases, or about 63 per cent., the acute stage did not exceed 
three days under treatment. In seven more, making 88.8 per cent., it did not 
exceed six days. The remaining three were all well within ten days, and com- 
prised a case of pericarditis with rapid effusion, and a seventh and eighth attack 
(both running very chronic and sub-acute courses). We have seen that the aver- 
age time till temperature became normal was 3.32 days, and that pain was gone 
in 3.22 days. The average time till temperature was normal and pain gone was 
3.52 days. Some of the cases were doubtless very mild, but that they do not unduly 
influence the average is shown by the fact that the acute eases averaged only 3.75- 
and the sub-acute cases 3.12 days under treatment. Favorable though this result may 
appear, the full value of the drug in relieving pain is not appreciated unless we 
further note that material relief was afforded in an average of .66 days, the remainder 
of the illness being free from severe symptoms, except in case 16 (who was "relieved" 
on the second day, but suffered great dyspnoea from pericardial effusion on the 
third day), and the cases in which relapses occurred. Alkalies were tried first in 
cases 14 and 15. In the former no relief having been experienced by the fifth day 
of treatment, salicylate was given and relief obtained in a few hours. In the lat- 
ter the results of the alkaline treatment were closely watched. The urine was ren- 
dered alkaline on the second day, and remained so until the fourth, but as the pain 
then increased, salicylate was given and relief obtained in a few hours, with no 
further return of severe symptoms. These two cases forcibly illustrate the great 
and almost immediate relief afforded by salicylates as compared with alkalies, a 
relief so marked as to appeal forcibly to the patients, more especially to those who 
have had previous attacks treated in any other way. Of the superiority of the 
salicylate treatment from every point of view, there can, I think, be no doubt. A 
number of series of cases have now been published, and the weight of evidence in 
favor of salicylates is, as Pollock says, " becoming overwhelming." The most 
adverse opinions are expressed by Drs. Southey and Greenhow. Southey admits 
that salicylates have a general soothing and anodyne influence in rheumatism, but Various Modes of Treating Rheumatism. 
1057 
says that neither is the duration of the disease shortened nor the tendency to heart- 
disease diminished. To this I shall refer further on when treating of the total 
duration of the disease. Greenhow, while also admitting the soothing influence 
and powerful antipyretic effect of salicylates, considers that they have no special 
effect on rheumatism. Salicine he considers less powerful. Greenhow's cases are, 
however, no fair test of the value of salicylate, as he purposely selected only those 
which he considered likely to run an acute course, and dismissed twelve others as 
too mild to be of any statistical value, which was obviously unfair. Of the unusual 
severity of the sixty cases reported by him there can be little doubt, as twentv-five 
of them, or 41.6 per cent., had pericarditis. The results of such a series can 
scarcely be considered a fair test of the treatment, and yet, as Dr. Fagge remarks, 
thirty-six of the cases, or sixty per cent., were well in five days, which is not gen- 
erally considered a bad result. With the exceptions of Southey and Greenhow, 
however, all the observers quoted are strongly in favor of salicylate. The follow- 
ing table gives the results obtained by each, the results of the expectant, blister, 
and alkaline treatments being also shown for comparison. Though a table of this 
sort, compiled from statistics which have been tabulated in different ways, must 
necessarily be imperfect, enough is seen to show the principal results by each 
observer. Several of them were contributions to the discussion at the Medical 
Society in December, 1881, which elicited, as Dr. Broadbent, the president, 
remarked, a vast amount of favorable evidence. The duration of the acute stage 
under treatment, then, which was with expectants 9.1 days, with blisters S.4, and 
with alkalies 6.75 or more, has been reduced, as Aitken says, to an average of 
about four days, while in my own cases in private practice it was only 3.52. It is 
important to note that the great majority of my cases were seen early, many of 
them before the attack showed itself definitely as acute rheumatism. In these 
cases salicylates were not given until the symptoms became well marked. The 
duration of the acute stage before treatment was begun was 
Days 
1 
2 
3 
7 
8 
Not noted (probably 1 day), 
No. of cases 
19 
2 
3 
1 
1 
1 
RESULTS BY VARIOUS OBSERVERS. 
NAME* 
No. of cases. 
Pain gone. 
Temperature nor- | 
mal. 
Length of acute 
stage under 
treatment. 
Total length of 
acute stage. 
Perc't'ge.of hearts 
affected after 
treatment began 
Time in hospital. 
Amount of drug 
taken. 
Relapses per cent 
REMARKS. 
Aitken 
Days 
4.1 
2.85 
Days 
Grs. 
A general summary of 
results obtained. 
Brown 
Cavafy 
Charteris 
Clark 
Clouston 
Coupland 
Fagge 
106 
1.46 
4.76 
18 
6 
343 
2 
3.54 
3.22 
7.1 
11 
27 
84 
355 
38 
19 
350 
100 
312 
2 
In uncomplicated cases. 
12.72 
3.32 
6.1 
3.52 
5.06 
340 
Private practice; recov- 
eries rapid. 
37.9 
35.3 
26.2 
Results highly favor- 
able; hardly any case 
where heart became 
affected during treat- 
ment. 
Hall 
7.25 
3.2 
3 
34 
20 
H elme 
4.2 
8.65 
5.5 
3 
4 
11.2 
Hood 
Jacob. 
6.6 
3.5 
20 
Excluding seven cases 
Ditto, collected cases 
Maclagan 
12 
in which no good ef- 
fect was obtained 
These results are from 
63 per cent, of the 
cases only. 
Ditto, results from 39 
hospitals. 
Miller 
Moore 
Owen 
S6e 
All favorable except one 
" not noted. 
22 
305 
210 
4 
2.92 
9.58 
23 
4 
3.75 
6.33 
1 5 
30 
2 to4 
Squire 
t 
* A list of the articles quoted is given at the end of the paper, 
t Under two. 1058 
Treatment of Rheumatism by Salicylates and other Remedies. 
RESULTS BY VARIOUS OBSERVERS-Continued. 
0 
T> 
5 
0 
2 
■i 
£ 
7 
D 
Alkalies- 
(rarrnd and Fuller 
Expectant treatm'nt 
Blister 
3 
p 
3 
T> 
StillS and Maisch 
NAME. 
X 
£ 
- 
- 
g 
Ji 
JO 
5 
No. of cases. 
Pain gone. 
- 
bi 
o 
:n 
ji 
Temperature nor- 
mal. 
X 
j' 
XCD 
Length of acute 
stage under 
treatment. 
5 
So 
13.50 
Total length of 
acute stage. 
o 
- 
JO 
8 
co 
bi 
Perc'nt'ge of hearts 
affected after 
treatment began 
22.26 
26 
27.5 
g 
x> 
Time in hospital. 
Amount of drug 
taken. 
£5 
x> 
35 
Relapses per cent. 
days on an average. 
In which the drug was 
only required for six 
REMARKS. 
Thus nineteen cases, or over 70 per cent., were under salicylate treatment 
within twenty-four hours of the attack; and twenty-four (probably twenty-five), 
or nearly 90 per cent., within three days, the average being 1.53 days. The total 
duration of the acute stage was- 
Days 
1 
o 
3 
4 
5 
6 
7 
8 
9 
10 
14 
No. of cases 
1 
2 
7 
7 
1 
1 
2 
2 
2 
1 
1 
[In the case which lasted fourteen days alkalies were given at first, salicylate 
being begun only on the 9th day.] Thus in seventeen cases, or 68 per cent., the 
total duration was less than four days. Only six cases (comprising a fifth, a sixth, 
a seventh, and an eighth attack, a case of pericarditis, and a case ill for a week 
before being seen) exceeded seven days' illness, the average of the whole being 
5.06 days. This helps to disprove Dr. Southey's explanation of the apparent good 
effects of salicylate, which isthat in acute continued cases the pain naturally sub- 
sides on the eighth or ninth day, and that as few cases are admitted to hospital 
before the fifth day (the average being nearer seven days), a remedy administered 
at this time gets more merit than strictly belongs to it. If this were true, my cases 
being seen early would compare unfavorably with hospital statistics, but this is 
not the case, and the great advantage of early treatment is fully shown by the fact 
that while 
Days ill 
before 
treatment. 
Acute stage 
under 
treatment. 
Total length 
of acute 
stage. 
Garrod and Fuller, using alkalies, found 
6.75 
6.75 
13.5 
Helme, using salicylate, found 
7 
4.2 
11.2 
My own cases 
1.53 
3.52 
5.05 
So that though my cases were under treatment only .68 days less than Dr. 
Helme's, their total duration was less than half, a fact of the greatest importance 
as regards convalescence and liability to complications. Compared with the results 
of alkaline treatment as given by Garrod and Fuller, the difference is still more 
striking. (2.) Effect on Complications.-As already stated, no heart affections 
developed in any of my cases after salicylates were begun. This happy result has 
not, however, been noticed by all observers, and heart disease has frequently arisen 
in patients fully under the salicylate treatment, as will be seen in the table given. 
Drs. Southey and Greenhov consider that the tendency to heart affection is not 
lessened by the salicylate treatment, while several other observers, though strongly 
advocating this treatment, yet doubt its efficacy in reducing the number of heart 
affections (Flint, Coupland, Gilbart Smith, etc.) Others, again (Aitken, Squire, 
Maclagan, Brown. Helme, Fagge, Jacob, etc.), consider that the tendency to heart 
affection must be decreased in the same proportion as the disease is shortened, and 
this I believe to be the case. But the full value of salicylates in preventing heart 
disease can never be shown by statistics of hospital practice, where the cases are Treatment of Rheumatism by Salicylates and other Remedies. 
1059 
rarely seen till the seventh or eighth day, by which time the great majority of 
heart affections are already fully developed (Gulland Sutton, Moore, Alonzo Clark, 
Fuller). The period of greatest tendency to heart disease appears to be the first 
five days, though from a third to a half of the cases develop afterwards, compara- 
tively few, however, arising after the tenth day. Now, nineteen of my cases were 
under treatment within twenty-four hours of the commencement of the attack, 
and they had thus to pass through the period of greatest risk, and this they did 
without heart mischief arising after treatment was begun in any case. The total 
duration of the attack in these cases was 4.26 days (the average of the whole series 
being 4.94), and I think it can scarcely be doubted that such an important shorten- 
ing of the period of susceptibility to heart disease cannot fail to exert a highly 
beneficial influence on its prevention. There was no other complication in any of 
my cases. Salicylates do not appear to prevent hyperpyrexia, nor to have much 
influence on it, but of this I have no personal experience. (3.) Relapses.--In ten 
of my cases, or 37.03 per cent., there was more or less return of the symptoms. 
Six of these, however (Nos. 6, 8, 11, 14, 20 and 24), had meanwhile been well and 
at work, and not seen for thirteen, sixteen, thirteen, eight, seventeen and eighteen 
days respectively. These were therefore fresh attacks for which the medicine could 
scarcely be blamed; and it is noteworthy that all of these cases except No. 11 had 
had at least one previous attack, and were thus evidently constitutionally predis- 
posed to the disease. Three of them were entered afresh as cases seven, fifteen, 
and twenty-five; the rest were very slight and are alluded to in the notes of the 
cases. Of the other four cases in which the symptoms returned, No. 12 went out 
against orders on the eighth day of a severe attack, pain being gone but tempera- 
ture scarcely normal. He remained out the whole afternoon in a cold wind, and 
had a very severe relapse. No. 13 had a slight return of pain four days after the 
medicine was left off-doubtless caused by moving about the house rather too 
freely. There remain two cases, nineteen and twenty-six, both of which relapsed 
without any assignable cause, on the fourteenth and seventeenth day of the dis- 
ease respectively, each having been free from acute symptoms for exactly nine days, 
though not sufficiently well to get out, the disease in each case assuming a low 
chronic type, which I believe to be specially subject to relapses. Salicylate had 
meanwhile been left off in each case. Thus in only two cases, or 7.4 per cent., did 
relapses occur without apparent cause-a result which my experience leads me to 
consider highly favorable. 
Much difference of opinion exists as to the relative frequency of relapses in 
rheumatism treated by salicylates and otherwise. Drs. Greenhow, Jacob and others 
state that patients treated by salicylates are much more liable to relapses, but their 
opinion is called in question by Drs. Squires, Coupland, Moore, and many others. 
In the table giving the results by various observers, it will be seen that relapses 
occurred in from 25 to 35 per cent, of the cases treated by salicylates. Coupland 
states that the risk of relapse is less if the medicine be continued, though a relapse 
may occur even while it is being taken. He lays special stress on the necessity for 
keeping the patients at rest for a considerable time. The immense relief from pain 
which he says renders salicylate the most valuable remedy known, has the disad- 
vantage of making the patients careless (Broadbent, Stills and Maisch, etc.,) and 
this I believe is the true explanation of the majority of the relapses. If the patients 
are closely watched, however, and the thermometer regularly used, relapses will, I 
believe, be rare. Should it be considered advisable to continue the medicine for 
some time as a precautionary measure, salicine is to be preferred on account of its 
tonic properties. (4.) Convalescence.-Though the length of the acute stage seems 
to have been invariably reduced by salicylate, the stay in hospital has not been 
correspondingly shortened. But this is probably due in a great measure to the 
length of the illness before treatment was begun, so that the total length of the 
acute stage in hospital cases (ten or fifteen days) is not lessened in the same pro- 
portion as the acute stage under treatment. In private practice, on the other hand, 
or when the cases can be treated at once, the total duration of the acute stage may, 
as shown by my cases, be reduced to five days or less, and that such a reduction 
must vastly affect convalescence is only to be expected, and this is my experience. 
Dr. Green how's statement that anaemia follows salicylate treatment is, so far as I 
know, endorsed by no other observer. Ansemia is a w:ell known result of rheuma- 
tism under other methods of treatment. Dr. Squire states that under salicylates 
it is less marked, convalescence being quicker than after treatment by iron. The 
recovery of the eases in which I used salicylate was certainly more rapid and 
favorable than after any other method of treatment I have used. 1060 
Treatment of Rheumatism by Salicylates and other Remedies. 
III. MODE OF ADMINISTRATION; DOSE; QUANTITY GIVEN; MODE OF ACTION. 
Salicine was used in my first three cases, salicylic acid iu the next, but on 
account of its insolubility and causing great burning of the throat. I combined it 
with soda on the third day. All the other cases were treated by salicylate of soda, 
either the salt as ordinarily sold, or in a solution made by mixing the acid and 
bicarbonate of soda in the proportion of 13 to 8, the amount of soda so added being 
the same as that in the salt. Dr. Prosser James recommends the salicylates of 
ammonia, potash, lime, quinia and cinchonidia in cases where it may be thought 
that any of the bases mentioned may be given with advantage. Being anxious to 
test the value of salicylate, I avoided any combination which might be supposed to 
affect the result; but doubtless the salts of ammonia, quinia, and some others may 
be specially serviceable in many cases. Dr. Fowler, as already stated, uses the 
natural salicylate, which he says is less liable to produce toxic effects. Drs. Mac- 
lagan and Charteris prefer salicine. The taste of salicylate is well disguised by the 
addition of half a drachm of syrup of ginger, a few drops of chloric ether, and two 
drachms of peppermint-water to each dose. Or a drachm of syrup f orange or 
lemon may be given instead; or half a drachm of syrup of ginger and the same 
quantity of tincture of orange. In this last form I have seen 10 grains of salicylate 
every hour well borne in a case where there was considerable nausea before the 
medicine was begun. 
Dose.-The whole success of the treatment depends on the amount and fre- 
quency of the dose, and on this great stress must be laid, for many of the so-called 
failures of salicylate are clearly due to giving too little. I give ten or twelve grains 
of salicylate of soda every hour till pain is relieved or singing in the ears comes on. 
Before using salicylate it is well to give an aperient if required. If this precaution 
be neglected headache or sickness is more likely to occur, in which cases the sali- 
cylate should be stopped and an aperient given. Marked relief is generally expe- 
rienced after the fifth or sixth dose, and slight tinnitus is frequently felt about this 
time. The further administration of the drug must depend on circumstances and 
the susceptibility of the patient to its influence. It ought, however, to be pushed 
as rapidly as possible until pain is gone and temperature normal, after which it is 
well to continue salicylate, or, perhaps still better, salicine three or four times a day 
for a few days, temperature being meanwhile carefully watched and more frequent 
doses given if it should rise. This precaution will generally prevent relapses. A 
smaller dose than I have stated was tried in case 24, but with less effect, and in 
some other cases (4, 12, 21 and 25) the doses were given by the attendants either too 
seldom or in too small quantity, the result being a delay in recovery. Again, a 
larger dose than I suggest, more especially if given at the outset, is apt to produce 
unpleasant symptoms, such as sickness or headache. I have seen 17| grain doses, 
though only given every four hours, produce severe tinnitus after about the second 
dose. In case 9 too large doses were taken by mistake (about 16 grains every hour). 
Tinnitus came on after the fourth dose and there was sickness next day. the intol- 
erance of the drug produced by the large doses at first not having passed off*. 
Thus we may conclude that a smaller dose than ten or twelve grains every hour 
will not produce sufficient effect, and that a larger dose, if given at the outset, is 
apt to cause gastric and other disturbance, which may delay the treatment for some 
days. The greatsecret of success is to give frequent small doses at first. Toleration 
is thus soon established, so that soon large doses may, if required, be given without 
unpleasant symptoms resulting. Ringer advocates a ten-grain dose every hour, to 
be increased'to fifteen or twenty grains if necessary after twenty-four hours. I 
have seldom been required to use the larger dose, though when the ordinary dose 
fails to produce a sufficiently rapid effect it should be had recourse to. In case 12 I 
raised the dose to 18J grains, the largest I have used, and only given after ordinary 
doses had been used for some time. After the drug has been given sufficiently 
long to show that the patient is not unduly sensitive to its influence the dose may 
be raised to twenty grains and given less frequently, the amount given daily being 
thus unaltered. The amount of salicylate given in each case for the first seven 
days is shown by the following table, but being taken from my prescription book, 
the quantities are entered on the day when they were ordered and do not indicate 
the exact amount taken each day. It will be seen that, males took a larger amount 
than females, and the severer cases required more than the milder ones. Salicine 
must be given in much larger doses-from 15 to 30 grains. I gave 240 grains in 
twenty-four hours, in case 4, who took the medicine for about five days, the total 
amount taken in that time being 780 grains. As a local application I used a solu- 
tion of salicylate of soda in water ( 3 ii-§ i) in cases 7, 15 and 26, where tenderness 
of a single joint remained after the acute attack was over, enveloping the joint 
with lint soaked in the solution. Rapid relief was afforded in each case, and I Treatment of Rheumatism by Salicylates and other Remedies. 
1061 
think this method is well worth a trial, though my experience of it is insufficient 
to warrant any more definite statement as to its value. 
Mode of action.-This appears to be the same whether salicine, salicylic acid, 
or salicylate of soda is given. Ringer, Still6 and Maisch, and Senator hold that 
salicine is converted in the body into salicylic acid, which probably produces the 
characteristic effects. Dr. Maclagan, however, considers that there is no evidence 
of this conversion. Ringer states that the alkaloid will not yield its own weight of 
acid, and its effect is therefore less marked. He has never seen salicine produce 
the quick and great reduction of temperature that follows the use of even smaller 
doses of the acid or salt. He gives a full account of experiments which were made 
with the view of testing the comparative value of the drugs, the result indicating 
the greater power of the acid. Salicylate of soda owes its activity entirely to the 
amount of acid it contains, which is equal to nearly seven-eighths of its weight. 
Whether the acid or its salt be given, Squire states that in the blood it is invariably 
found in connection with a base. Binz says that the nascent carbonic acid which 
is constantly being evolved from the animal tissues absorbs the soda in the blood, 
the acid, which is the active part, being then liberated. The modus operandi is 
stated by some observers to be at all events partly due to the physiological action 
of the drug, Kohler considering that its influence on the vaso-motor nerves leads 
to dilatation of the peripheric vessels and consequent lowering of the temperature 
of the blood, while Squire considers that the relief of pain is effected either by this 
relaxation of the small vessels or by a soothing effect on the peripheral nerves, the 
effect on pulse and respiration being due to its action on the pneumogastric nerve 
But I think it is clear that salicylates have a further specific action on rheumatism 
and this view is held by a number of observers (Broadbent, Maclagan, Charteris,' 
Buchanan-Baxter, etc.) The marked effect produced cannot be due to the anti- 
pyretic virtues of salicylate, which are inferior to those of quinine, and the physio- 
logical action cannot account for the rapid relief afforded in rheumatism, which is 
frequently well marked before the ordinary physiological effects of the drug are 
visible. How the specific action of salicylates is exerted we cannot at present tell. 
Those who maintain that rheumatism is "generated by and within the body" 
(Aitken) may accept Dr. Squire's view that the acid acts as an antiferment, being 
liberated from the soda in the blood, as held by Binz, "exactly where the fermenta- 
tion peculiar to rheumatism can be stopped at its origin," and there at once neutral- 
izing the poison. Again, those who hold that rheumatism has a malarial origin, 
and is due to the action of bacteria (Thoresen, etc.) must still look on the acid as 
the active principle, the salt having but small antiseptic power. But however 
interesting such speculations may be, we have not as yet any trustworthy evidence 
sufficient to warrant any positive conclusion as to the mode of action. 
No. of Case. 
Age.- 
Highest 
Temperature. 
Amount of salicylate given (grains). 
Total (grains). 
1st 
day. 
2d 
day. 
90 
90 
90 
135 
90 
90 
3d 
day. 
4th 
day. 
90 
180 
5th 
day. 
6th 
day. 
7th 
day. 
1 
I. (a) Males over 15, { 
with temperature 
of 101° or over 
12 " 
i 16 
20 
i 25 
i 11 
14 
19 
17 
38 
33 
34 
32 
103.2 
103.1 
102.1 
102. 
101.3 
101. 
180 
157 
90 
135 
90 
90 
90 
180 
90 
... 
90 
90 
90 
135 
90 
90 
90 
30 
630 
607 
270 
495 
180 
540 
453 
Average 
1 - 
124 
97. 5 
75 
67.5 
45 
1 
I. (&) Males over 15, 
with temperature j- 
under 101° । 
J 
Average 
. 19 
8 
24 
26 
6 
15 
7 
3 
19 
28 
33 
36 
40 
32 
40 
19 { 
! 
100. 8 120 
100.6 180 
100.4 75 
100.4180 
100.1 180 
100. 90 
99.8 90 
nOt 1OA 
stat'd 120 
... ,129.4 
... ... 
... 
75 i 90 
90 
90 90 
90 90 
90 
... ... 
54. 4 33. 75 
... 
... 
90 
... 
90 
22.5 
90 
90 
90 
... 
33.7 
180 
22.5 
120 
180 
600 
270 
450 
450 
180 
120 
296.2 1062 
Treatment of Rheumatism by Salicylates and other Remedies. 
II. Females over 15 ) 
temperatures all .- 
over 101° J 
13 
23 
9 
29 
17 
19 
102.1 
101.5 
101. 2 
180 
75 
90 
75 
90 
90 
90 
... 
270 
150 
270 
Average 
115 
55 
60 
230 
III. Males and fe-1 
18M. 
15 
103.6 
140 
140 
males from 10 to > 
27 F. 
13 
101.3 
60 
60 
120 
15 years of age... J 
22M. 
14 
101.2 
75 
75 
150 
Average 
92 
45 
137 
IV. Males and fe- 
21M. 
8 
102. 
60 
60 
60 
180 
males under 10... j 
17 F. 
8 
101. 
60 
60 
Average 
... 
60 
30 
30 
120 
The amounts taken may be summarized as follows: 
Maximum. 
Minimum. 
Average. 
(Grains.) 
(Grains.) 
(Grains.) 
I. Males over 15 years of age- 
(a) With temperatures of 101° or over 
630 
180 
453.6 
(6) With temperatures under 101° 
600 
120 
296.2 
II. Females over 15; temper't'rs all over 101° 
270 
150 
230 
III. Males and females, aged 10 to 15 
150 
120 
137 
IV. Males and females under 10 
180 
60 
120 
We have thus seen that when rheumatic fever is treated by salicylates- 
(1) The duration of the acute stage under treatment is reduced to three or four 
days, or about half its average duration under alkaline treatment; and this effect 
being at least as obtainable by treatment at the outset of the disease as later on, the 
total duration is reduced by early treatment to four or five days. 
(2) The tendency to heart complication is probably less than under any other 
treatment; but the full value of salicylate in reducing this risk can only be obtained 
by early treatment, which shortens so greatly the period of susceptibility, 
(3) Convalescence is generally rapid and satisfactory, while relapses are rare 
if adequate precautions are taken. 
(4) The best results can only be obtained by early treatment, and by rapidly 
saturating the system with frequent small doses (10 or 12 grains every hour) until 
marked benefit results and the acute symptoms disappear, after which the salicy- 
late may be gradually discontinued, the patient being meanwhile closely watched, 
and the medicine at once resumed in full doses if temperature rise or pain return. 
The present paper is limited to the consideration of the use of salicylates in 
articular rheumatism with elevation of temperature. Its effects are most marked 
in recent acute attacks affecting the larger joints, and least so in the adynamic type 
of the disease so frequently seen in those who have had several previous attacks. 
In chronic articular rheumatism its effects are less certain. In muscular rheuma- 
tism, which is a distinct disease, I need only say in passing that salicylate appears 
at times highly beneficial. Its action is, however, uncertain, and depends, I 
believe, in some measure on family idiosyncrasy. 
EPITOME OF CASES. 
I. Female, aged 30; second attack coming on daring acute bronchitis. 240 
grains of salicine given; acute stage three days. 
II. Infant, aged 22 months; first attack. 40 grains of salicine given; acute 
stage, about six days. 
III. Male, aged 19; third attack commencing on fifth day of scarlatina. 120 
grains of salicylate given. Pain gone next day. 
IV. Male, aged 44; second attack coming on while under treatment for an 
accident. Temperature 102°. 15 grains of salicine ordered every three hours, 
increased to 30 grains every two hours, 780 grains being given in about four days, Treatment of Rheumatism by Salicylates and other Remedies. 
1063 
by which time acute salicism was produced (" tinnitus," deafness, headache), and 
the acute stage was over. 
V. Female, aged 28; a sub-acute first attack, with temperature (with clothes 
on) of 99°. 10 grains of salicylic acid given every hour for four doses; then every 
two hours. Dose then increased to 15 grains. After taking 200 grains there was 
burning in the throat. 15 grains of bicarbonate of soda were now added to each 
dose. The burning in the throat soon disappeared, and ''tinnitus" came on. 
Acute stage under treatment, three days; 350 grains of acid taken. Salicylate of 
soda used in all the subsequent cases, generally a drachm and a half in eight doses, 
or 111 grains in each dose. 
Vl. Male, aged 40; third attack, with temperature of 100.°l. Sleepless for 
two previous nights. Salicylates given in 11| grain doses every hour. Much 
relieved before night, and had three hours sleep. Acute stage only lasted two days. 
Salicylate given two days longer; 450 grains in all. 
VII. Same patient as VI. After being well enough to resume work he had a 
fresh attack (twenty days after commencement of last), with temperature of99.°8. 
Believed next day. Acute stage two days. 180 grains of salicylate taken in doses 
of 11| grains, given hourly at first. 
VIII. Male, aged 28; second attack. Temperature 100°.6; pulse 108; 11| grains 
of salicylate with six minims of tincture ofcolchicum given hourly for eight doses; 
afterwards as required. Not seen again, as he lived at a great distance. Relieved 
next day, and pain gone in two days. 180 grains taken. 
IX. Female, aged 19; first attack. Temperature 101.°2; pulse 125. Salicylate 
ordered in ll|-grain doses hourly. She accidentally exceeded the quantity, how- 
ever, taking 16-grain doses. Relieved after two doses, and pain nearly gone after 
four (-64 grains), tinnitus coming on at the same time. Though sleepless on the 
previous night, she passed a quiet night now. She was sick next day. Acute stage 
three days; 270 grains taken. 
X. Female, aged 32; second attack. Temperature 101.°4. Old standing mitral 
regurgitant bruit and extremely tumultuous heart action and sickness. Ill grains 
of salicylate hourly, with morphia and digitalis. Pain gone in two days. 
XI. Male, aged 34; firstattack. Temperature 101.°3. Ordered 1 11 grains of 
salicylate hourly. Relieved in two days. Pain gone in three days; took 180 grains. 
At work shortly after this, and caught relapse sixteen days after the commence- 
ment of the first attack. This was relieved the next day, and he was well in a few 
days. 
XII. Male, aged 19; second attack. Intense pain, with temperature of 103.°2, 
and pulse of 110, after an almost sleepless night. Ordered 111 grains of salicylate 
hourly, which relieved him so rapidly that next afternoon he dressed and came 
down stairs against orders. On the third day I again found him down stairs, pain 
almost gone; temperature 10. .°4. Recovery protracted by this daily exposure, but 
in six days (having taken 630 grains) he appeared almost well. He then dressed 
against orders and went out for several hours, getting a severe relapse, which was 
relieved in four days, when he again exposed himself, getting another relapse 
relieved in two days, but leaving chronic rheumatism for some weeks, Acute 
stage entered as six days. 
XIII. Female, aged 29; firstattack. Temperature 1O2.°1; pulse 100 ; hsemic 
bruit; 111 grains of salicylate hourly. Relieved the same day and pain almost 
gone next morning, temperature having fallen to 99°. Bruit gone. Tinnitus and 
deafness. No more acute pain. Acute stage four days; 270 grains taken. Four 
days afterwards, having moved about too freely, she had a slight return, for which 
salicylate was again given ; relieved next day. 
XIV. Male, aged 32; fifth attack, for which alkalies had been used unsuccess- 
fully for four days, last night being sleepless. Temperature 101°. Ordered 111 
grains of salicylate every hour. Slept three hours the first night and much relieved 
next day, so that he got up and dressed without leave. Pain was gone in four 
days; temperature normal in six ; 540 grains of salicylate taken. 
XV. Same patient as the last. Had been feeling well and able to go out, but 
caught a fresh attack (sub-acute, with temperature of 100° to 101°) twenty-four days 
after the last commenced. To test the alkaline treatment, he was ordered half a 
drachm of bicarbonate of potash every hour for three hours; after that every two 
hours. Passed a sleepless night, but pain was slightly better next day and the 
urine faintly alkaline, 5 drachms of potash having been taken. He slept better the 
second night, and the pain on the third day was not so severe. On the fourth day 
the urine being thoroughly alkaline, and the temperature 100°, the pain got worse, 
the result of the treatment being much less favorable than from salicylate, which 1064 
Treatment of Rheumatism by Salicylates and other Remedies. 
was now given (11} grains hourly). He recognized the old medicine and took two 
large doses (about 18 grains each). After this he felt easier, and continued the mix- 
ture. He slept well that night, perspiring freely, and had slight tinnitus when 
seen next day. Pain was gone in three days ; temperature normal in five; 450 
grains of salicylate taken. Sub-acute pain remaining in ring finger, a salicylate 
lotion was applied with good effect. 
XVI. Male, aged 17; first attack, with temperature of 1O3.°1 and acute joint 
symptoms. Heart sounds muffled when first seen; no bruit nor pain, nor was dull- 
ness noticed as increased. Salicylate was ordered in ll}-grain doses every hour. 
Pain was almost gone next day, and temperature 100.°5. On the third day 250 
grains of salicylate having been taken, and all joint pain gone, great dyspnoea 
came on, and a "catch" was felt over the heart on drawing a long breath. Trans- 
verse cardiac dullness four and a half inches; sounds still muffled; temperature 
101.°6. Medicine continued and large poultices applied over the heart. In a few 
hours he could lie down. Next day he felt well; temperature 99.°7. Two days 
after this the transverse cardiac dullness had fallen to three inches, and there was 
a rubbing systolic murmur. Acute stage seven days. Took 607 grains of salicy- 
late. Heart appeared normal when examined twenty-five days after he was first 
seen. 
XVII. Female, aged 8; first attack, with temperature of 101°. Ordered 5 
grains of salicylate every hour. Next day she had taken 50 grains; pain was gone 
and temperature 99.°5; no return. Acute stage two days; 66 grains taken. 
XVIII. Male, aged 15; first attack, with temperature of 1O3.°6 the day before 
medicine was begun, and 1O2.°4 on the first day of treatment; 94 grains of salicy- 
late given hourly. Temperature fell in seven hours (10:30 A. M.-5:30 P. M.) to 
101.°2; pain much better; no salicism. "Tinnitus," however, set in just after he 
was seen, and the medicine being given all night he was very delirious next morn- 
ing, by which time he had had fifteen doses, or 140 grains. Pain was almost gone 
and temperature 99.°2. Salicylate stopped, and he was ordered to drink tea, 
coffee, etc., freely. In the afternoon pain was gone; temperature 98°. Active 
delirium, however, continued till 4 o'clock next morning, when he fell asleep, 
after which he was more collected; but he remained slightly delirious until night, 
when he slept well, awaking the next morning-forty-eight hours after the last 
dose of salicylate-free from delirium and without a trace of rheumatism. Acute 
stage one day; 140 grains taken. 
XIX. Male, aged 19; first attack, with temperature of 100°8. Ordered 10 
grains of salicylate every hour. Pain gone next day; 130 grains taken. Slight 
relapse on the fourteenth day from first seizure; relieved the following day. 
XX. Male, aged 38; second attack, with temperature of 1O2.°1, and pulse 102. 
Ordered 11} grains of salicylate every hour. Much easier next day after 6 doses. 
On the third day pain was gone; temperature 98.°7, and pulse 75; 143 grains of sali- 
cylate taken up to this time. Continued every four hours, and 270 grains in all 
were given. 
XXI. Male, aged 8; first attack, with temperature of 102°. Severe joint 
affection, and pain over heart with rough mitral systolic bruit. Ordered 5 grains 
of salicylate every hour. Next day only 40 grains had been taken, but pain was 
less, and temperature 100.°8. On the third day, after taking 75 grains, pain was 
almost gone; temperature 98.°8; bruit softer. Acute stage three days; took 180 
grains in all. 
XXII. Male, aged 14; first attack, with temperature of 101.°2, and acute joint 
pain. Has had two sleepless nights. Ordered 9} grains of salicylate every hour. 
The same evening, after taking about 60 grains, he said he had been free from 
pain for three or four hours, the joint only remaining tender on pressure. Has 
had sweating and "tinnitus." Acute stage two days; took 150 grains. 
XXIII. Female, aged 17; third attack, with temperature of 101.°5. Pain in 
several joints and old-standing bruit. Ordered 94 grains of salicylate every hour. 
Next day, after taking eight doses (75 grains), pain was all but gone, and tempera- 
ture 99.°6. Acute stage, three days; took 150 grains. 
XXIV. Male, aged 32; seventh attack, with temperature of 100.°4. rising to 
101.°2. Tried a 94-grain dose of salicylate every hour. Relieved next day, but 
pain continuing, the usual dose (^iss. in eight doses, or 11} grains in a dose) was 
given on the third day. Pain continued in a sub-acute form with gouty affection 
of toe for eight days. Took 600 grains. 
XXV. Same patient as XXIV; eighth attack, commencing twenty-eight days 
after the last began, with temperature of 102°. Ordered 11} grains of salicylate 
every hour. Pain, which was severe, was relieved the same day; but a sub-acute 
and gouty affection of the joints remained for ten days. Took 495 grains. Treatment of Rheumatism by Joseph Jones, M. D. 
1065 
XXVI. Male, aged 36; first attack, coming on when his health had been 
undermined by exposure. Temperature 100.°4. Ordered 11} grains of salicylate 
every hour. Relieved next day. Acute stage over in four days. Took 270 grains. 
Sub-acute rheumatism, however, continued, and on seventeenth day from com- 
mencement of first attack relapsed with temperature of 101°. Ordered 15 grains of 
salicylate every two hours. Much relieved next day; temperature 99.°5 ; pulse 80; 
systolic bruit (hsemic); no cardiac pain. Acute symptoms of relapse over in three 
days. Another relapse occurred four days afterwards; also speedily relieved. 
Salicylate had been discontinued each time before a relapse occurred. 
XXVII. Female, aged 13; first attack, with temperature of 101.°3. Ordered 
5 grains of salicylate every hour. Pain relieved the same evening, and tempera- 
ture reduced to 100.°4. Pain gone next day, and temperature normal in two days. 
Took 120 grains. 
List of Authors referred to.- Dr. D. T. Acland, British Medical Journal, March 5,1881. Dr. W. 
Aitken, Science andPractice ofMedicine,7th edition. Dr. Bastian. British Med. Jour., January 29, 
1881. Dr. E. Buchanan Baxter, Translator's note to Senator's article, Ziemssen's Cyclopaedia, 
vol. xvi, page 1039. Dr. Blake, Boston City Hospital Reports. Dr. Bristowe, Theory and Practice 
of Medicine, 3d edition. Dr. Broadbent, Lancet. April 8, 1876; December 24,1881, and January 28, 
1882 (Debate at Medical Society). Dr. C. W. Brown, Boston City Hospital Reports. Dr. Cavafy, 
St. George's Hospital Reports. Professor Charteris, British Medical Journal, February 12,1881. 
Dr. Sidney Coupland, Paper at Medical Society, Lancet, January 7 and 14, 1882. Dr.Hilton Fagge, 
Paper at Medical Society, Lancet, December 17, 1881. Dr. Austin Flint (New York), Clinical 
Medicine, 1879. J. K. Fowler, M.B., Lancet, December 31, 1881. Dr. Garrod, Article on Rheuma- 
tism in Reynold's System of Medicine, vol. i. page 928. Dr. Greenhow, Clinical Society's Transac- 
tions, vol. xiii. Drs. Gull and Sutton, Medico-Chirurgical Transactions for 1869. Dr. J. Milner 
Helme, Graduation Thesis, Edinburg University, 1879. Dr. D. W. C. Hood, Lancet, December 31, 
1881. Dr. E. H. Jacob, British Medical Journal, August 25, 1877. Sir W. Jenner, Remarks at 
Clinical Society, Lancet, January 20,1877. Dr. T. J. Maclagan, Lancet, March 4, 1876, etc.; Decem- 
ber 24, 1881; January 28, 1882; Braithwaite's Retrosp. 1879. Dr. Oliver Moore, New York Medical 
Journal. 1879. Dr. Murchison, Paper before Clinical Society, May 25, 1877. Dr. Napheys, Medical 
Therapeutics. Isambard Owen, M.B., Medical Society, Lancet, December 24,1881, and January 
28.1882. Dr. Prideaux, Practitioner. 1878. Dr. Julius Pollock, Notes on Kheumatism. R. Douglas 
Powell, Lancet, January 28, 1882. Dr. Sidney Ringer, Handbook of Therapeutics. 7th edition. 
Senator, on Acute Rheumatic Polyarthritis; Ziemssen's Cyclopaedia, vol. xvi, page 14. Dr. Gilbart 
Smith. Lancet, January 28, 1882. Dr. Reginald Southey, St. Bartholomew's Hospital Reports, 
1879. Dr. W. Squire, Lancet, December 20, 1879. Still6 and Maisch, The National Dispensatory. 
Thoresen, Note in British Medical Journal, October 23,1880. 
GENERAL RESULTS OF THE TREATMENT OF ACUTE AND CHRONIC RHEUMA- 
TISM IN THE CHARITY HOSPITAL OF NEW ORLEANS IN THE MEDICAL 
SERVICE OF JOSEPH JONFS, M. D., 1869-1886. 
The terms of service have previously been specified in the first chapter 
of this volume of the Medical and Surgical Memoirs. 
Cases. 
19 
Deaths. 
2 
Acute articular rheumatism 
152 
2 
Chronic articular rheumatism 
157 
2 ' 
Muscular rheumatism 
17 
Gonorrhoeal rheumatism 
6 
Syphilitic rheumatism 
30 
Gout (chronic) 
1 
Primary syphilis 
34 
2 
Secondary (constitutional) syphilis 
120 
Total 
536 
8 
ACUTE AND CHRONIC RHEUMATISM. 
It will be seen that we have classified the cases of rheumatism under 
the following heads: Acute Articular Rheumatism, Chronic Articular 
Rheumatism. Muscular Rheumatism, Gonorrhoeal Rheumatism and Syphil- 
itic Rheumatism. Of these forms of rheumatism, the clinical record 
reveals that 362 cases were treated, with four deaths; per cent of deaths, 
1.1. The mortality was small, being a little over one per cent, of the cases 
treated, or one death in 90.5 cases treated. The four deaths were distri- 
buted equally between the cases of acute and chronic rheumatism. As far 
as the experience of the author extends, rheumatism is not a fatal form of 1066 
Treatment of Rheumatism by Joseph Jones, M. D. 
disease either in hospital or civil practice. I did not employ salicin, 
salicylic acid or salicylate of soda to any extent, either in hospital or civil 
practice, previous to the year 1878; and up to this date no deaths had 
occurred amon^ the cases of rheumatism treated by the author in the 
wards of the Charity Hospital of New Orleans; the three deaths from 
acute and chronic rheumatism which occurred in 1881 were not, however, 
in any manner referable to the action of the salicylates, but rather to 
cardiac malarial and other complications Preceding the use of the salicy- 
lates, I employed the following general plan of treatment, in both private 
and hospital practice : 
1. The bowels were opened by a mercurial or saline purgative. In 
cases complicated with malarial influences, an efficient dose of calomel or 
blue mass, combined with sulphate of quinia, yielded the best results. The 
bowels were kept open, and the constipating effects of opiates, counter- 
acted by the occasional use of saline purgatives, as effervescing powders, 
sulphate of magnesia, sulphate of soda and citrate of magnesia. In 
uncomplicated cases of acute rheumatism, free from all syphilitic taint, 
mercurials are used as purgatives, and not to produce a decided consti- 
tutioi'al effect, as manifested by ptyalism. 
2 The temperature was controlled, and at the same time certain 
indications induced by the action of the malarial poison, met by the 
regular administration of the sulphate of quinia in doses of from five to 
ten grains. 
3. For the relief of pain, opium and its preparations were used at 
regular intervals and in amounts adapted to each case, and sufficient to 
relieve acute suffering. In many cases we combined the Dover's powders 
(pulv. ipecac et opii, U. S. P.) with the quinine, thus securing at once the 
antipyretic properties of the quinine, the sedative effects of the opium, 
and the diaphoretic and diuretic properties of the ipecac and sulphate of 
potash. The following formulae will give a general idea of the mode in 
which these remedies were combined and used : R. Sulphate of quinia, 
grains xxx; pulv. ipecac et opii (Dover's powders), grains xx. Mix: 
Divide into ten powders. Administer one powder every three, four or six 
hours. When the pulse was rapid and full, digitalis, in the form of 
tincture or powder, or the tincture of yellow jasmine, or the tinctures of 
aconite or veratrum viride, were used at regular intervals in conjunction 
with the quinine and Dover's powders. In some cases it was found advi- 
sable to administer a full dose of opium, from one to two grains at bed 
time. The administration of the opium was guided by the nature and 
intensity of the pain. Chloral hydrate combined with the sulphate of 
morphia, was used in some cases, in which the pain in the inflamed joint 
was of an intense spasmodic and jerking character. The following 
formulae were used according to circumstances to accomplish the results 
just indicated : R. Quiniae sulph., 9ii; pulv. digitalis, 9ss ; pulv. ipeca 
et opii (Dover's powders) Bi; pulv. potassi nitratis, Bij. Mix : Divide into 
twenty powders. One powder every four hours. R. Morphias sulph., 
gr. ij ; tincture gelsemium (yellow jasmine), f^ij ; chloral hydrate, ^ij ; 
aquae camphorae, f§vi. Mix : Tablespoonful every three, four or six 
hours, if necesary to relieve pain and induce sleep. 
4. The local treatment consisted of the application of the tincture of 
iodine, and of the combination of the tinctures of iodine, aconite and opium 
to the inflamed joints, and the use of these agents in combination with 
olive oil. The following formulae were used: R. Tincture of iodine, 
tincture of opium, tincture of aconite, aaf^iv; Mix: Apply directly by 
means of brush to the inflamed joints. R. Tincture of iodine, tincture Syphilitic Rheumatism and Constitutional Syphilis. 
1067 
•of opium, tincture of aconite, a a f^ss; olive oil fgiij; Mix: Use as a lina- 
ment to the inflamed joints. B. Tincture of opium, tincture of camphor, 
aTa fgiv; aqua ammonite, f^iij; olive oil, f^iv; Mix: U^e as a linament to 
the inflamed joints. B. Chloroform, f^iij; tincture of opium; f^iv; tinc- 
ture of camphor, f^ii; olive oil, fgiij; Mix: Use as a linament to the 
inflamed joints. 
Without doubt, the tincture of iodine was the most efficient applica- 
tion to the inflamed joints, in either acute or chronic rheumatism. The 
inflamed limbs, after the local applications were applied, were carefully 
wrapped up in cotton, surrounded with red flannel, and over this oiled silk 
was wrapped. The cotton equalized the pressure and absorbed the mois- 
ture and sweat, condensed by the oiled silk. In this manner the joints 
were subjected to a vapor bath, the oiled silk being confined by bands 
above and below the joints. The temperature of the vapor bath was a lit- 
tle lower than that of the surface of the patient. 
5. Since the year 1878, I have employed salicylic acid and the salicy- 
late of soda, in the treatment of rheumatism. These agents are used freely 
in both chronic and acute rheumatism fortheir antipyretic effects, and also 
for their marked power in relieving and mitigating pain. After careful 
observation I have been induced to consider the following as one of the 
best modes of administering salicylic acid and the salicylates: B. Sali- 
cylate of soda, gij; liquor ammonite ascetatis, f§vi; Mix: Tablespoonful 
with three tablespoonfuls of water every two, four or six hours. I have 
been led to regard the acetate of ammonia in the preceding combination, 
as of marked value in the treatment of rheumatism. 1 have also derived 
benefit from the wine of colchicum, combined with iodide of potassium, in 
the treatment of chronic rheumatism and rheumatic gout, as in the follow- 
ing formula: B. Vini colchici sem, fgi; potassi iodidi, gi; aqua menthae 
pip, Uvij; Mix: Teaspoonful in wineglassful of water every four, six or 
eight hours. B. Morphi® sulphatis, grains iv; Vini colchici sem, f^ii; 
potassi iodidi, gvi; aqua camphor®, f^viij; Mix: Tablespoonful every four, 
six or eight hours. 
v. The diet should be simple but nutritious. As a rule wines and 
malt liquors should be avoided, and when alcoholic stimulants are neces- 
sary, pure whisky or brandy, properly diluted with water, shduld be used 
in moderate quantities at regular intervals. 
Of the 362 cases of rheumatism, thirty cases, or less than one-tenth, 
were referred to the action of the syphilitic virus. Primary syphilis 
caused thirty-four cases, and secondary or constitutional syphilis caused 
120 cases. Total cases of disease referable to the action of the syphilitic 
poison, 184; total deaths, two. The cases of syphilitic rheumatism might 
have been classed with those of secondary or constitutional syphilis; the 
former is credited with no deaths, whilst the latter (120 cases) occasioned 
two deaths. The treatment of syphilitic rheumatism did not differ essen- 
tially from that of constitutional syphilis, with the exception of the local 
treatment of the inflamed joints, and the measures for the relief of acute 
pain. It is not our intention at this time to enter into an elaborate state- 
ment of the treatment of constitutional syphilis; we shall confine ourselves 
to the notice of the most efficient remedies. The chief indications in the 
treatment of constitutional syphilis are: 
1. The elimination of the syphilitic virus from the human system. 
SYPHILITIC RHEUMATISM AND CONSTITUTIONAL SYPHILIS. 1068 
Syphilitic Rheumatism and Constitutional Syphilis. 
2. The removal of glandular enlargements and of syphilitic deposits 
and tumors. 
3. The cure of syphilitic ulcerations, caries and cutaneous eruptions. 
4. The restoration of the blood to its normal state. 
5. The relief of nervous symptoms and lesions. 
6. The removal of the effects of syphilitic i inflammation from the 
joints. 
The first, second and third indications are best met by the use of the 
following remedies, which are placed in their relative positions of value 
and potency : 
1. Mercury. 
2. Iodide of potassium. 
3. Iodine. 
As far as the experience of the author extends, the best, most uniform 
and lasting results have been achieved by the employment of the preceding 
remedies, simultaneously as in the following formula: B. Biniodide of 
mercury (red iodide of mercury), grs. iv; iodide of potassium, §iss; tinc- 
ture of iodine, f^iij; peppermint water, fgviiss. Mix: One teaspoonful 
in four tablespoonsful of water three times a day. 
In the preceding combination, the red iodide of mercury is held in 
solution by the iodide of potassium; and the iodine exists in the free state, 
and in virtue of its physiological properties, in this condition, excites a 
profound effect upon the glandular system. Such a combination as that 
just given, is not merely a powerful alterative, but is also an efficient anti- 
septic and germicide. I have seen a large number of patients in hospitals 
and in private practice (the latter greatly outnumbering the former), 
restored to good health by the continued use of the above combination in 
the treatment of constitutional syphilis. 
The fourth indication may be met, and the natural tendency of the 
syphilitic poison to induce profound anaemia, overcome by the following 
formula : B. Red iodide (biniodide) of mercury, grs. iv; iodide of potas- 
sium, ^j; tincture of iodine, f^ij; syrup of the iodide of iron f^i; pepper- 
mint water, f^ij; syrup of ginger, f§v. Mix: Dissolve the iodide of 
potassium in the peppermint water, then add the red iodide of mercury 
and tincture of iodine, and finally, the syrup of the iodide of iron and 
ginger. Dose, teaspoonful in four tablespoonsful of water three times a 
day. We have the same dose of the red iodide of mercury (l-16th of a 
grain), in each wineglassful of both formulae, but in the latter we have the 
iodide of iron. When the nervous system is seriously involved during the 
progress of syphilis, in addition to the preceding remedies, strychnineand 
electricity should be employed. 
The following formula for the administration of strychnine, has proved 
beneficial in luemaplegia, paraplegia,, general paralysis and muscular and 
nervous debility, induced by the prolonged action of the syphilitic poison: 
B. Strychniae sulph., grs. ij; acidi nitro-muriatici dil., ^iij; tinct. ferri 
sesqui chloridi. f^vi; quininae sulph., si; aqua menthael pip., f^vij. Mix : 
Dose, teaspoonful in four tablesponnsful of water every eight hours; suck 
through a glass tube. This combination may be used alternately (that is 
preceding or following a continuous course) with either of the two preced- 
ing formulae. 
The success of the physician in dealing with the nervous affections 
induced by the poison of syphilis will evidently depend upon the extent 
and nature and position of the lesions. Thus the effect of the syphilitic 
deposits or tumors, depend largely upon their location along the cerebro- 
spinal system. The effects of syphilitic deposits or tumors of the brain. Thoroughwort {Eupatorium Perfoliatum). 
1069 
will depend upon the position which they occupy, and rapidity of growth. 
The effects of syphilitic tumors of the brain and spinal cord will vary with 
the functions of those portions of the cerebrum, cerebellum, medulla 
oblongata and spinal cord, upon which they induce pressure. 
Thoroughwort-Boneset-(Bupatorium Perfoliatum). 
ENGRAVING NO. 119. 
THOROUGH WORT 
Botanical Description.-Leaves connate, perfoliate, rugose, tomentose underneath; stem vil- 
lous, from three to six feet high, striate, villous, almost tomentose, and with the leaves heavy 
and sprinkled with glandular dots. Lower leaves connate, the upper distinct, abruptly trun- 
cated at base, all tapering gradually to the summit, serrated, rugose, slightly pubescent on the 
upper surface, tomentose underneath. Involucrum many leaved, (fourteen to sixteen), eight to 
ten flowers, leaves linear-lanceolated, acute, pubescent, imbricated. Corolla small, white, gla- 
brous. Style nearly twice as long as th e corolla, two cleft, stigmas simple. Seed angular, peppers 
scabrous. A decoction of this plant is much used and recommended in fevers; it acts as an 
emetic or sudorific, according to the constitution of the patient. Grows in wet soils, r lowers 
in September and October.* 
EUPATORIUM PERFQLIATUM 
Geographical Distribution.-Inhabits meadows and boggy soils in all 
latitudes from Nova Scotia to Florida. 
Chemical Composition.-According to the experiments of Dr. A. Ander- 
son, of New York, this plant contains a free acid tannin, extractive matter, 
gummy matter, resin, lime, probably theacetate of lime; gallicacid, probably 
modified; and a uniform matter, soluble in water and alcohol, and which seems 
to contain a bitter principle. Dr. Anderson concluded from the results of 
this examination that this plant possesses active medicinal properties, and 
that many of its constituents and properties are similar to those which 
characterize the cinchona officinalis, the authemis nobilis, and othei valu- 
able articles of the materia mediea. He supposed that its virtues resided 
chiefly in the leaves. Dr. Jacob Bigelow states as the results of his exam- 
inations: Every part of the eupatorium has an intensely bitter taste, com- 
bined with a flavor peculiar to the plant, but without astringency 01 acri- 
♦Elliott. Sketch of Botany of South Carolina and Georgia. Vol. 11, p. 302. 1070 
Thoroughiuort {Eupatorium Perfoliatum). 
mony; the leaves and flowers abound in a bitter, extractive matter, in 
which the important qualities of the plant seem to reside. This bitter 
principle is alike soluble in water and alcohol, imparting its sensible qual- 
ities to both, and neither solution being rendered turbid, at least for some- 
time, by the addition of the other solvent; it forms copious precipitates, 
with many of the metallic salts, such as muriate of tin, nitrate of mercury, 
nitrate of silver, and acetate of lead; of the mineral acids, 1 he sulphuric 
and muriatic form, slight precipitates with the aqueous decoction; the muri- 
atic, a more copious one, and the nitric no precipitate, but changed the 
color red; in the alcoholic solution the muriatic acid alone formed an imme- 
diate precipitate. Tannin exists very sparingly iu this plant; a solution 
of isinglass produces a slight precipitate from the tincture, and a hardly 
perceptible turbidness in separate decoctions of the leaves and flowers: sul- 
phate of iron gave a dark green precipitate, which partially subsided in a 
short time. In distillation, water came over very slightly affected with 
the sensible equalities of the plant, and not alterable by sulphate of iron. 
-American Medical Botany. Vol. 1, page 35. According to the testimony 
of Dr. Joseph Long, Mr. J. Scattergood obtained from this plant a salifia- 
ble base, which forms, with sulphuric acid, tasteless prismatic crystals, 
and which he calls eupatoria. 
Medical Properties and Uses.-The effects of eupatorium vary accord- 
ing to the dose and mode in which it is administered; in cold infusion and 
in the form of powder in moderate doses it acts as a tonic, producing effects 
very similar to those of the simple bitters; in larger quantities, and in 
warm effusion, it sometimes proves emetic and laxative, and most com- 
monly produces a decided diaphoretic action. So decided and uniform is 
this action upon the skin that it has been called "vegetableantimony," 
and it has been with propriety termed a tonic sudorific. The Indians 
appear to have been acquainted with the medicinal properties of this 
plant, and they are said to have instructed the first settlers in its use, who 
used it as a febrifuge long before it was introduced into the regular prac- 
tice. From the settlement of the country to the present time it has been 
in use in various parts in the North and South, as a tonic and febrifuge, to- 
accomplish the same purposes for which gentian, chamomile, Peruvian 
bark, and other febrifuge tonics are employed; and many physicians have 
testified to its great value. Dr. Nathaniel Chapman, of Philadelphia, in 
his notice of this article, states that "many years ago we had throughout 
the United States, a species of influenza, which in consequence of the sort 
of pain attending it came to be denominated the break bone fever. The 
eupatorium, acting as a diaphoretic, so promptly relieved this peculiar 
symptom, that it acquired the popular title of bone set, which it retains to 
the present moment." Dr. George B. Wood, of Philadelphia, supposes 
that the epidemic alluded to by Dr. Chapman was that described by Dr. 
Rush as having occurred in Philadelphia in the summer and autumn of 
1780, called break-bone fever, from the violence of its pains, but which, 
there is every reason to suppose, was the disease since better known under 
the name of dengue. Dr. Wood, from this fact, suggests a trial of eupa- 
torium in that very painful epidemic disease. 
Various practitioners in the Middle and Southern States have testified 
to the great value of eupatorium perfoliatum, in the treatment and cure of 
intermittent fevers. Dr. Andrew Anderson, of New York, has borne une- 
quivocal testimony to the value of this remedy in malarial fever. He 
states that this remedy was used in nearly every case of intermittent fever 
that occurred iu the New York Almshouse in 1812, to the exclusion of the 
Peruvian bark, and with uniform success. It was given either in decoc- Thoroughly or t ^Eupatorium Perfoliatum). 
1071 
tion or in powder from 20 to 30 grains every second hour during the inter 
mission. Out of the large number which had been successfully treated 
with the eupatorium, Dr. Anderson detailed six cases of intermittent, quo- 
tidian, tertian, and quartan; in these cases the cures appeared to have 
been as expeditious as could have been expected from Peruvian bark. In 
remittent fever he found that as a sudorific it produced the most salutary 
effects. Dr. Anderson supports his own experience by the testimony of 
several distinguished practitioners. 
Dr. Hosack and Dr. Baird in the treatment of yellow fever, after 
proper evacuations, placed almost exclusive dependence on sudorifics, and 
amongst this class of remedies they considered the eupatorium, adminis- 
tered in the form of decoction, of great value. The disease called by some 
the petechial or spotted fever, and by others the malignant pleurisy, or typhoid 
pneumonia, has been more successfully treated by the class of remedies 
denominated sudorifics than by any other, and in many cases of this epi- 
demic which occurred in the city of New York in the winter of 1812-13, 
after the proper evacuation had been employed, the eupatorium was 
resorted to, and its sudorific, its tonic, and its cordial properties were 
clearly demonstrated and much benefit w'as derived from its use. The 
testimony of Dr. Eberlie to its use in intermittent fever is not so favorable 
as that of Dr. Anderson. In his notice of the medicinal effects of this 
plant in his therapeutics, he says: 
" Dr. Anderson states that this remedy was used in nearly every case of inter- 
mittent that occurred in the New York Almshouse in 1812, instead of the Peruvian 
bark, and that it uniformly proved successful. I do not doubt that it has sometimes 
proved successful in this disease; but the result of my own experience with it does 
not lead me to form a very high opinion of it in this respect. I have known it to 
remove the disease in a few instances, by producing vomiting and copious perspi- 
ration. But in the great majority of cases in which I have tried it no manifest 
advantage was obtained."-Therapeutics. Vol. %,p. 194. 
The testimony of Dr. Wood agrees with that of Dr. Eberlie : 
" From the inaugural dissertation of Dr. Anderson (New York, 1813), it would 
appear to have been employed with very great success in the treatment of inter- 
mittents in one of the New York hospitals. Subsequent observation of its effects 
has proved less favorable; and employed as a mere antiperiodic, in the ordinary 
mode of prescribing bark or quinine in the intermistions, it cannot be relied on. 
But I have known it to supersede the paroxysms of intermittent fever, when given 
in emetic doses, in the state of strong tepid infusion, shortly before the period for 
the return of the chills; and if jointly with this method of exhibition, it be admin- 
istered in moderate doses, at short intervals during the apyrexia, there is little 
doubt that it will often prove successful. Still it is greatly inferior to sulphate of 
quinia in certainty, while, in its effects as thus used, it is much more disagreeable. 
It may be very appropriately tried in obstinate and frequently recurring attacks of 
intermittent fever in which quinia has become offensive to the patient, or inoper- 
ative from repetition. The same remarks are applicable to its comparative efficacy 
in remittents, in which, however, its tendency to produce perspiration is some- 
what in its favor."-Therapeutics and Pharmachology. Vol. l,p. 298. 
Dr. Chapman, on the other hand, whose experience was certainly equal 
to, if not larger, than that of Drs. Eberlie and Wood, sustains fully the 
statements of Dr. Anderson: 
"I have had lately put into my hands a very well written tract, in which the 
properties and medical applications of this article are fully described. By the 
reports of the writer, it appears that in the public institutions of New York, it has 
been extensively employed in intermittent, remittent and yellow fever, in typhus 
pneumonia and catarrhal fevers, in several cutaneous affections, in dropsies, and 
for the removal of mere debility. By properly regulating the administration of 1072 
Thoroughwort {Eupatorium Perfoliatum). 
the medicine it has, according to him, fulfilled successfully all these diversified 
indications. After making due abatement for the confidence in which new and 
favorite remedies are always announced, I entertain little suspicion of the accu- 
racy of these accounts. My own observations, together with communications 
which I have received from highly respectable sources, would, indeed, nearly con- 
firm every part of the preceding statement relative to the efficacy of this medicine, 
and especially in intermittent and remittent fever. To these affections it seems 
particularly adapted, inasmuch as. having the united properties of a diaphoretic 
and tonic, its use may be continued in the successive stages of the paroxysm, as 
well as during the apyrexia."-Elements uj Therapeutics and Materia Medica, by 
N. Chapman. Vol. 2, p. 445. 
Dr. Ansel W. Ives, of New York, the editor of the Pharmacologia, 
(of Dr. J. A. Paris,) adds his testimony to the correctness of Dr. Ander- 
son's observations: 
"It was long ago used as a tonic by the aborigines of this country, but its prop- 
erties were not fully investigated and its remedial character appreciated by the pro- 
fession, till the publication of Dr. Andrew Anderson's excellent inaugural disser- 
tation on the eupatorium perfoliatum in 1S13. From that time to the present its 
reputation has been increasing. It is peculiarly valuable from the diversified effects 
that may be produced by it. by varying the preparation and the dose. These may 
be so modified as to secure its operation as a tonic, emetic, laxative, and sudorific; 
and from its effects in opening the secretions of the whole system, there is, per- 
haps, no other bitter or tonic of equal activity, that can be exhibited in febrile 
affections, with so little danger of increasing excitement or producing congestion. 
In the year 1814. while resident physician to the New York Alms-house, I had 
frequent opportunities of testing its tonic properties, as it was enjoined, from 
motives of economy, upon the medical department of the institution, to substitute 
this article for the Peruvian bark, when it could be done with safety to the patient. 
In many instances it proved an efficacious substitute. It is a valuable emetic in 
the early stage of autumnal intermittents."-Pharmacologia, etc., by J. A. Paris, 
M. D., etc., with additions, by Ansel IF. Ives, Jf. D. New York, 1823. Vol. 11, 
p. 145. 
Dr. Bigelow has prescribed an infusion of the eupatorium in various 
instances to patients iu the low stages of fever, where it has appeared instru- 
mental in supporting the strength and promoting a moisture of the skin, 
without materially increasing the heat of the body. He has also found 
the cold infusion or decoction a serviceable tonic in loss of appetite and 
other symptoms of dyspepsia, as well as in general debility of the system. 
-Ani. Med. Botany. Vol. 1, p. 37. We hope that we will be excused for 
multiplying testimonies to the medicinal value of this plant. We believe 
that at the present time such an examination of its merits as embraced the 
views of the distinguished and reliable writers, would prove valuable as 
well as interesting. At some future time we hope to be able to present an 
extended chemical analysis of its constituents, together with numerous 
experiments upon its physiological and therapeutic action. When employed 
as a tonic, from twenty to thirty grains of the powder may be taken three 
times a day: the cold infusion made in the proportion of to Oj of water, 
may be taken as a tonic in doses of one to two fluid ounces. When intended 
to act as an emetic an ounce of the plant is boiled in a quart of water down 
.to one pint, and this is taken to the dose of two fluid ounces every ten or 
twenty minutes, until the emetic effect is produced. The warm infusion is 
said by Dr. Bigelow to be a convenient substitute for that of chamomile 
flowers in facilitating the operation of an emetic. Dr. Anderson gave the 
powder in the treatment of intermittent fever in doses of from 20 to 30 
grains every second hour during the intermission. In the treatment of 
both intermittent and remittent fever, the warm decoction prepared in the 
proportion of one ounce of the leaves boiled in a quart of water, may be Ague Weed (Gentiana Quinqueflora). 
1073 
* 
administered in the dose of a wineglassful every two hours, or oftener. 
according to circumstances. Of course the amount administered will be 
regulated in great measure by its emetic and cathartic effects. Dr. M. B. 
Beck says: "The bone set (eupatorium) and the snakeroot (serpentaria 
Virginiana) have long been held in great repute, particularly in the 
treatment of all fevers of a low grade, whether intermittent, remittent or 
continued; and it is especially for these diseases, or the so-called typhoid 
and camp fevers, that I would press their merits upon the attention of the 
profession. About two years ago I had some eight or ten cases at one time. 
on a farm, of what is generally called typhoid fever, and. after giving some 
mild mercurial, I used a cold decoction-I prefer the decoction to the infu- 
sion-in the proportion of about half an ounce of the dried leaves of the 
boneset and the same quantity of snakeroot to a pint of water, giving of 
that a wineglassful every three or font hours, day and night, pro re nata. 
with entire success; that is, I mean to say. I used no other tonic, and all 
the patients had a good recovery. This decoction, as far as my limited 
experience goes, can be given when neither quinine nor cinchona may be 
admissible. It also makes an admirable menstruum for the tr. cinchona 
comp. 
Gentiana Quinqueflora {Indian Quinine)-Ague Weed. 
Dr. E. P. Wood, of Wisconsin, has given this plant with success in a 
number of cases of intermittent fever, and he states that it is used exten- 
sively in domestic practice.-Trans. Illinois Stade Medical Society,. 1857. 
Wild Horehound {Eupatorium Verbenna Folium.)! 
Botanical Description.-This species of the Eupatorium is an indigenous perennial plant, with 
an herbaceous stern, which is about two feet hign, and supports sessile, distinct, ovate, acute, 
scabrous leaves, of which the lower are coarsely serrate at the ba.se. and uppermost entire. The 
flowers are small, white, composed of five florets within each calyx, and arranged in the form of 
a corymb. It is in flower from August to November. The whole herb is employed as a medicine. 
U. S. Disp., p. 375. 
Geographical Distribution.-It abounds in low wet places from New 
England to Georgia, and is especially abundant in the Southern States. I 
am not aware that any special examination of its chemical composition has 
ever been made. Medical Properties and Uses.-This plant has been exten- 
sively employed in domestic practice in the treatment of intermittent fever, 
colds, and in debilitated states of the system. The medicinal properties of 
this plant appear to have been first brought prominently to the notice of 
the profession by the Hon. George Jones, President of the Georgia Medi- 
cal Society, who thus describes its medical virtues: 
"It serves as an excellent substitute for the Peruvian bark, and, indeed, among 
the planters, in or near the sea-board, it supersedes the bark in the cure of fevers. 
It is tonic, diaphoretic, diuretic, and mildly cathartic, and does not oppress the 
stomach, as the bark is apt to do-hence it may often be exhibited where the cin- 
chona is inadmissible. It is usually given in the form of infusion. One ounce of 
the dried leaves, infused into a quart of water, may be taken daily , in doses of from 
two to four ounces every hour or two. It may be advantageously combined with 
Peruvian bark, and, though it may sometimes fail of producing the desired effect, 
I think it well deserves a station among the articles of the Materia Medica." Dr. 
Chapman, in his Therapeutics, after quoting the testimony of the President of the 
Georgia Medical Society, says: " In this sentiment I entirely coincide. My own 
practice has not afforded me many opportunites of using it. but I distinctly recol- 
lect that in Virginia, my native State, it was a common and efficacious remedy in 
the cases which have been mentioned-and to these I might add the catarrhal 
affections, or obstinate coughs-and also a bitter tonic, in weak and depraved states 
of the stomach. It was indeed in these latter eases that it appeared to display its 1074 
Yellow Jasmine (Gelsemium Sempervirens^. 
best powers. The popular mode of using the horehound is as a tea; and sometimes, 
for coughs, it is made into a syrup or candy."-Therapeutics. Vol. 2, p. 447. 
I have employed the wild horehound, both by itself and in conjunction 
with Cornus Florida, in the treatment of intermittent fever, colds and 
debilitated states of the system, with very good success. In my native 
county, Liberty, it has for many years (as far as I can ascertain from the 
oldest inhabitants, probably from the first settlement of this portion of 
Georgia), been employed extensively as a domestic remedy in fevers and 
colds. It may be administered in somewhat larger doses than the preced- 
ing species. 
ENGRAVING NO. 120. 
Yellow Jasmine (Gelsemium Sempervirens). 
YEUUOW JASSAMINE 
According to Dr. Cleveland, of Cincinnati, the value of the yellow 
jasmine in malarial fever was accidentally discovered by a planter, suffer- 
ing under bilious fever, who took, by mistake, an infusion of the root of 
this plant, and was cured, although for a time he lost all muscular power. 
It has been announced as a speedy cure for intermittent fever, and has 
been largely used in this disease in the Western States. 
Dr. Nash, of Norfolk, who has employed it in many cases of fever, 
affirms that it has produced the most desirable effects, neither age nor sex 
interfering with its exhibition; and whilst he does not rely solely upon it 
in all cases, especially those of a high grade, he still thinks that it is 
entitled to rank as a co efficient with quinine in fevers. It has been chiefly 
used in the form of tincture. Dr. J. A. Mayes, who has published a most 
valuable paper upon the gelsemium, in the Charleston Medical Journal 
and Review, for March, 1857, recommends the following formula for the 
tincture: "Four ounces of the fresh root, clipped small, to one pint of 
diluted alcohol; macerate for fourteen days." Dose for adults from twenty 
to fifty drops, repeated as frequently as circumstances may require. Dr. 
Bachelor thus prepares the tincture : "A bottle is loosely filled with the Yellow Jasmine (Gelsemium Sempervirens'). 
1075 
bark of the fresh root; equal parts of whisky and water are added; and 
the bark is macerated for fourteen days; twenty to sixty drops of this 
infusion may be used at a dose, alone or combined with quinine." 
Whether or not the yellow7 jasmine possesses any antiperiodic proper- 
ties, it certainly possesses valuable sedative properties, and is capable by 
controlling irregular nervous action, of aiding greatly the powers of nature 
in fever, and also the action of other remedies. The testimony to its 
sedative powers is unequivocal. Dr. Mayes affirms that he has never been 
disappointed in a single instance in obtaining a direct sedative action from 
the use of the gelsemium : 
" The patient being speedily quieted, although he may have been excessively 
agitated previous to its administration. Under its influence restlessness is soon 
succeeded by calm repose, and the excited, frequent pulse tempers down to tran- 
quility. These favorable impressions must be secured, however, by a frequent 
repetition of the dose, as its effects are not very durable, wearing ofF in two or 
three hours. It will be found necessary to administer the medicine in doses of 
from twenty to fifty drops, according to the severity of the symptoms, every two 
or three hours, until, under the influence of more radical remedies, the disease has 
been permanently controlled." And his desire, by the strong advocacy of this 
medicine, is to bring it into notice as an admirable agent for controlling irregular 
nervous action, and bringing about in the system a state of repose favorable for 
obtaining the full action of other and more radical treatment." 
Drs. Cleveland, Branch, Nash, Douglas, and others have, in like man- 
ner, testified to its narcotic, nervine, anti-spasmodic and sedative eff ects. 
Dr. Durham, in a communication to the Medical Purveyor of the 
army, says : 
The gelsemium sempervirens or yellow jasmine is, without doubt, one of the 
most potent febrifuge remedies known to the profession. This potency seems to 
depend on its relaxing and anti-spasmodic properties, as may be inferred from its 
efficacy in the treatment of tetanus, in controlling which no other known agent is 
comparable. It is now used and highly extolled by many respectable physicians, 
in all fevers except the congestive form. It is said by some to be the only agent 
yet discovered capable of subduing, in from two to twenty hours, and without the 
least possible injury to the patient, the most formidable and most complicated, as 
well as the most simple fevers, incident to our country and climate, quieting all 
nervous irritability and excitement, equalizing the circulation, promoting perspi- 
ration, and rectifying the various secretions without causing nausea, vomiting or 
purging, and is also adapted to any stage of the disease. It may follow any pre- 
ceding treatment with safety. Its effects are clouded vision, double-sightedness, 
or even complete prostration and inability to open the eyes, and which pass off in 
a few hours, leaving the patient refreshed and completely restored; and as soon as 
the heaviness or partial closing of the eyes is induced, no more of the remedy is 
necessary, although those effects should follow the first dose. If carried to such an 
extent that the patient cannot open his eyes, the relaxation may be too great for 
the system to recover from; its use should cease as soon as the symptoms above 
named are produced. 
The control of gelsemium over the nervous system is complete. It 
may be used with advantage in all forms of neuralgia, nervous and bilious 
headache, chorea, haemorrhage, rheumatism, gout and various other dis- 
eases. It is, however, in fevers that its good effects are most observable. 
Dr. Francis Peyre Porcher, of Charleston, South Carolina, in his valuable 
work on the "Resources of the Southern Fields and Forests, Medical, Economi- 
cal and Agricultural," published iu 1869, gives the following interesting 
facts as to the therapeutic value of the yellow jessamine of the swamps and 
alluvial regions of the Southern States: 
"A spirituous tincture of the root is used with success in rheumatism. It is 
also employed in gonorrhoea. Ninety drops of the tincture of the bark of the root 1076 
Yellow Jasmine (Gelsemium Sempervirens). 
taken in three doses produces vertigo, perverted vision, etc. Its marked effect 
upon the nervous system has been repeatedly observed. It also acts as an arterial 
sedative, without producing nausea or purgation, and, though causing insensibility 
to pain when taken in large doses, it does not induce stupor or delirium. The root 
of the jessamine has been much more freely used since the publication of my report 
on the medical botany of South Carolina made to the American Medical Associa- 
tion in 1849. Special articles can be found descriptive of its uses in the Charleston 
Medical Journal. Dr. Mayes, of South Carolina, has contributed one of these, 
March, 1857. Dr. Nash, of Norfolk, has also used it in many cases of fever, with 
most desirable results. Four ounces of the fresh root are added by Dr. Mayes to 
one pint of diluted alcohol; dose, twenty to fifty drops, repeated every two or three 
hours. Drs. Ford and White used the tincture of the root as they did that of the 
veratrum viride in yellow fever, for its depressing effects upon the circulation. See 
Charleston Medical Journal. Many employ the tincture of the root in fevers; it 
acts in a manner similar to digitalis and veratrum viride, with the addition of 
some narcotic property. It has to be used with caution on these accounts, and 
because it induces delirium in over-doses. StiIIS's Therapeutics and Dunglinson's 
New remedies may be consulted. My venerable friend, Dr. John Douglas, of 
Chester, South Carolina, writes me that he had used it repeatedly, with advantage, 
in gonorrhoea. See his letter published in Charleston Medical Journal. The 
tincture forms a valuable ingredient in cough mixtures, particularly in those cases 
where a nervous sedative is required. It has been repeatedly prescribed in these 
cases by Dr. O. A. White and others during the war. Dr. Edward Porcher, of 
Mars Bluff, South Carolina, prescribes the tincture in doses of twenty drops with 
much success in neuralgia." 
In the Medical Press and Circular, 1867, Dr. R. P. Davis, of Virginia, reports 
two cases of poisoning by overdoses of the fluid extract of gelsemium; one died two 
hours and a half after taking the poison, having had widely dilated pupils, 
spasmodic breathing, a cold and congested surface, pulse almost imperceptible, and 
being totally unconscious. The other, a gentleman who had also taken about a 
tablespoofui of Tilden's Extract, had an emetic administered to him more promptly 
and recovered. The emetic was followed by one drachm of quinia in four ounces 
of wine. When first seen this patient was found in the following condition : He 
was lying on his left side, face somewhat congested, pupils dilated, but responding 
to the different degrees of light, eye-lids half closed with apparent inability to 
move them, and lower jaw drooping, and his tongue, to use his own expression, so 
thick that he could hardly speak; his skin was warm and moist, pulse small and 
feeble, and respirations somewhat diminished in number. He had neither purging 
nor vomiting. Dr. Parker gave quinine, and in a large dose because it was a cere- 
bral stimulant, and he thinks it was useful because the patient had taken the gel- 
semium nearly ten hours before he took the emetic, giving the system time to come 
under its influence. In reply to some queries addressed to Dr. J. A. Mayes, of 
South Carolina, 1868, who has extensively used the beratrum and gelsemium, 
Dr. Francis Peyre Porcher received the following statement: 
"I used the gelsemium in form of tincture very much as a sedative to an excited 
system, and locally for relief of neuralgia, or situations where it could be properly 
applied. For trismus nascentium, I found the tincture of gelsemium more success- 
ful than any remedy I ever used. I never lost a case in which it was fairly used. 
Had a case of tetanus been met, I should have prescribed it with much confidence. 
For the former I gave it in doses of three drops every half hour or an hour, accord- 
ing to the frequency of the spasms, and continued it with gradually lengthening 
intervals until the spasms ceased altogether. For tetanus I had long made up my 
mind to test it fairly by giving thirty to forty drops every hour until blindness was 
superinduced, hoping to seethe disease overcome when the system was fairly satu- 
rated with the gelsemium. A poultice made by boiling a quantity of gelsemium 
roots until a strong decoction was obtained, and then adding corn meal to give it 
consistency, applied warm to acute painful swellings, to the jaws, for neuralgia or 
rheumatic toothache, and for various local pains, was found during the war to be 
a valuable substitute for opiate applications. I have seen very great relief obtained 
in a few minutes in severe neuralgic pains of the side of the face."--Resources of 
the Southern Fields and Forests, p. 501-504. Yellow Jasmine (Gelsemium Sempervirens'). 
1077 
SUMMARY OF FACTS RELATING TO THE PHYSICAL, CHEMICAL, PHYSIOLOGI- 
CAL AND THERAPEUTICAL PROPERTIES OF GELSEMIUM SEMPERVIRENS 
(YELLOW JASMINE). 
The rhizoma and rootlets of gelsemium (gelsemii radix U. S. P.), are 
used for the preparation of the fluid extract and tincture. The frequent 
disappointment experienced by practitioners in the use of gelsemium pre- 
parations is due to the fact that they are made from the dried root; in the 
process of drying even spontaneously the active alkaloid principle gel- 
semina disappears therefore trustworthy preparations must be carefully 
prepared from the fresh root. 
Extractum. Gelsemii fluidum; fluid extract of gelsemium. Dose 
ij.; mx. Tinctura gelsemii-tincture of gelsemium: dose mv, mxx. The 
so-called gelseminine is obtained by evaporation of the tincture, and is 
a very uncertain preparation; the dose is gr. ss., gr. ij. Composition. The 
light fibrous, deep yellowish root, has a bitterish taste, and contains a 
powerful alkaloid, gelsemine or gelsemina, in combination with gelseminic 
acid, both discovered by Professor Wormley. (American Journal of Phar- 
macy, 1870, vol. xlii.) The physiological action of gelsemium has been 
investigated by Dr. Roberts Bartholow (Experimental Investigations into 
the action and uses of gelsemium sempervirens, The Practitioner, London, Vol. 
V, p. 200); Dr. O. Berger, Dr. Ott (Philadelphia Medical Times, Vol. V); 
Drs. Murrell and Sydney Ringer (The London Lancet, 1876 and 1877), and 
others. In addition to gelsemina, the root of gelsemium contains an acrid 
resin, volatile oil, gallic acid, a yellow coloring matter, besides some other 
unimportant ingredients. Gelsemine.-In its pure state gelsemine (gelsem- 
ina or gelsemia) is a colorless, odorless solid, having an intensely persist- 
ent bitter taste. It has strong basic properties completely neutralizing the 
most powerful acids, forming salts, of which the sulphates, nitrate, chlo- 
ride, and acetate, are freely soluble in water (Wormley); dose gr. 1-60,'to 1-20. 
Antagonists and Incompatibles.-The caustic alkalies and tanic acid are 
chemically incompatible. The physiological action of gelsemium is antag- 
onized by the diffusible stimulants, by alcohol, ammonia, opium, digitalis, 
etc. The poisonous effects are best treated by emetics, warmth, alcoholic 
stimulants, by faridization and artificial respiration, by morphine subcu- 
taneously, and according to Fredigke, by the tincture of xanthoxylum 
fraxineum. 
Physiological Actions. -According to Dr. Roberts Bartholow, the pre- 
parations of gelsemium have a bitter and somewhat aromatic taste; pro- 
duce no gastric irritation; the active substance being alkaloid diffuses into 
the blood with facility. In moderate doses, but sufficient to produce 
decided physiological effects, gelsemium causes a feeling of languor and 
mental calm, slowing of the action of the heart, drooping of the eyelids, 
dilatation of the pupil, and some feebleness of the muscular movements; 
in larger doses the effects are vertigo, double vision, amblyopia, paralysis 
of the levator palpebrse, so that the upper eyelid cannot be raised, dilated 
pupil, labored respiration in consequence of a paretic state of the respira- 
tory muscles, slow and feeble action of the heart, great muscular weakness 
and sensibility to pain and touch much reduced. These effects are pro- 
duced in about half an hour after the introduction of the drug into the 
stomach, and last two or three hours, when they subside. When lethal 
doses are taken, the symptoms above described occur in a more intense 
degree. The gait is at first staggering, but the power of muscular move- 
ment soon ceases, and a sense of numbness diffuses over the body. The 
eyelids close (paralysis of the levator), the pupils dilate widely, vision is 1078 
Gelsemium Sempervirens. 
lost, and the pupils cease to respond to the stimulus of light. The lower 
jaw drops, and the power of speech is lost in consequence of paralysis of 
the muscles of the tongue. The respirations are labored, shallow, and 
irregular; the action of the heart weak, feeble and intermittent. Generally 
the skin is covered with a profuse perspiration, but no other evacuation 
takes place. Death occurs from asphyxia, and the action of the heart ceases 
after the respiratory movements. Consciousness is preserved until near 
the close, and until carbonic poisoning ensues. In one instance Wormley 
noted extreme restlessness, but generally there is a condition of calm, a 
soporose state, or the unconsciousness of carbonic acid narcosis, and con- 
vulsions never occur. 
The investigations of Dr. Roberts Bartholow have demonstrated that 
gelsemium is a paralyzer of motility and sensibility; that sensibility is tirst 
affected in cold-blooded animals (frogs), and afterwards motility, and that 
in warm-blooded animals the motility is affected before sensibility. As 
respects the seat of the action this accomplished observer h-as ascertained 
that the end organs of the motor nerves and the nerve trunks do not lose 
their irritability, and that the muscular contractility is unimpaired. Its 
paralyzing effect is due to its action in the motor centre, and not to an 
action on the peripheral nerve-fibres. It acts also on the sensory portion 
of the cord, producing at last complete anaestheria; but this effect in warm- 
blooded animals and in men is toxic only, and follows the paralysis of the 
motor functions. Applying the precise observations made in animals 
to the explanation of the lethal effects which have occurred in man, 
Dr. Bartholow was conducted to the following conclusions : the disorders 
of voluntary movement, and the more or less complete paralysis of t he 
motor and of the sensory functions, are due to the effects of gelsemium in 
the motor and sensory portions of the cord, the functions of the sensory 
columns resisting longer the action of the poison. The labored respiration 
is due to the paretic state of the respiratory muscles, especially of the 
diaphragm. The depressed action of the heart is probably secondary to 
the diminished respiration movements, which produce this result by 
impeding the flow of blood through the pulmonary capillaries. The 
dilated pupil, the double vision, the ptosis, are due to paralysis of the 
third pair. 
A very considerable reduction of temperature occurs from lethal doses 
in warm-blooded animals. The experimental observations of Dr. Roberts 
Bartholow on the physiological actions of gelsemium have been fully con- 
firmed by Ott, by Ringer and by O. Berger in elaborate series of investi- 
gations. The observations of the late Dr. Sydney Ringer, and of Dr. 
Murrell ou this powerful drug were of great value, and we reproduce for 
the use of American physicians the following condensed account of their 
papers published in the London Lancet for 1876 and 1877. 
Gelsehiium Sempervirens. 
This powerful drug has long been employed in America. Its physiological 
action has been investigated by Dr. Roberts Bartholow, Dr. Ott and Dr. Berger. 
In conjunction with Dr. Murrell I have made numerous observations regarding the 
physiological action of this drug. The following is a condensed account of our 
papers published in the Lancet for 1876 and 1877: 
Gelsemium, lately introduced into this country as a remedy for neuralgia, is 
especially useful in non-inflammatory toothache, and in neuralgia of the nerves 
supplying the teeth and the alveolar processes of the jaw. Gelsemium is a power- 
ful paralyzer and respiratory poison. Its paralyzing action is best studied in the 
frog. In these animals it often produces tetanus as well as paralysis. Whether 
we produce paralysis alone or paralysis followed by tetanus, depends on the dose. Gelsemium Sempervirens. 
1079 
Thus, as a rule, with small doses of the alkaloid we only get paralysis; with rather 
larger, quiverings and tetanoid movements; and only alter large doses decided teta- 
nus. Is the paralysis due to the influence on the brain, the cord, the motor nerves, or 
the muscles ? It paralyzes the spinal cord, the motor nerves and the muscles being 
unaffected. Tbe tetanus is due to the action of the poison on the cord, and I draw 
especial attention to the fact that tbe paralysis of the cord always precedes the 
tetanus; that gelsemia (the alkaloid) has the property of first weakening and then 
tetanizing the cord, thus corresponding to iaborandi, buxus sempervirens and 
other drugs. 
Gelsemium is a powerful respiratory poison; indeed, this drug generally, 
if not always, destroys warm-blooded animals by asphyxia, before it produces 
complete paralysis. It produces no primary quickening of respiration, and 
does not paralyze the phrenic, nor the intercostal nerves, and it acts after 
the division of both vagi. It asphyxiates, as Dr. Burdon Sanderson has 
shown, by paralyzing the automatic respiratory centre. In order to test 
the effects of gelsemium on man, I gave it to six persons on seventeen occa- 
sions, in doses sufficient to produce decided toxic effects. The tincture used 
was made with one part of root to four of rectified spirit. To excite the symptoms 
characteristic of this drug, I found it generally necessary to give drachm doses 
hourly for three hours-a quantity which may be given with perfect safety. Some 
individuals, however, as might be expected, are much more prone to be affected 
than ochers. Thus, a woman suffered from diplopia headache and hazy sight after 
a second dose of ten minims; and in another case, two doses of twenty minims at 
two hours' interval produced well-marked symptoms presently to be described. 
On the other hand, I have given drachm doses hourly for six hours with very 
slight effect; and in one instance I gave twenty minims to a delicate young woman 
every three hours for several days, finally causing only slight heaviness in the 
eyelids. 
Unless given in dangerous doses, gelsemium affects firstand chiefly the eyes 
and brows. The symptoms generally occur in a certain order; not without excep- 
tions, however, both in the order and number of the symptoms. The drug ordi- 
narily first produces pain in the brows, followed soon by giddiness, then by pain 
in the eyeballs, and soon after by dimness of sight. A larger dose produces double 
vision without apparent squinting, with a sensation of great heaviness in or under 
the upper eyelids, with somewhat contracted pupils. A still larger dose causes 
drooping of the upper lid, sometimes so marked that the edges become nearly 
closed, and can be opened only by a strong and painful effort; and after straining 
to open them, sometimes the upper eyelid is so tired that ptosis for a short time 
becomes complete. The movements of the eyeball are restricted, and associated in 
one case with a strong double internal squint. The patient next complains of 
weakness in his legs, and we have never pushed the drug beyond the production 
of this symptom. When decidedly under the drug's influence the patient is pale, 
with a heavy sleepy look. Some say their eyes feel sleepy; other yawn frequently, 
and say they can hardly keep awake, and when left to themselves fall asleep. 
Others complain of dryness of the mouth, though the tongue looks moist, and to 
the finger feels so. Some keep moistening the mouth with a little water even hours 
after the discontinuance of the medicine. 
These symptoms, except the internal squinting, were all producedin the great- 
est number of cases; but in some instances even large dosesof the tincture induced 
only a few of the slighter symptoms. Thus a woman took a drachm dose hourly 
for six hours without exciting headache, diplopia, or giddiness-only great heavi- 
ness of the eyes and dimness, almost amounting to temporary loss of sight; though 
on a former occasion, in this very woman, we produced extreme diplopia with 
giddiness with four one-drachm doses of the tincture. Diplopia as we have shown, 
is generally preceded by headache, giddiness, and dimness of sight; but in one 
instance diplopia occurred without these preliminary symptoms, though, strange 
to say, on a subsequent occasion, in this same woman, with a larger quantity-that 
is, six one-drachm doses hourly-we produced much giddiness and mistiness with- 
out diplopia. The symptoms from gelsemium come on early and soon subside. A 
single drachm dose rarely produces any marked symptom, but in from ten min- 
utes to a quarter of an hour after the second hourly dose the symptoms appear, 
and reach their highest point in about half an hour, and then quickly subside, 
most of them ceasing in about an hour. With the repetition of four or six hourly 
drachm doses the symptoms may persist six or eight hours after the last dose; but 
the symptoms are most marked half an hour after each dose, and then decline. Gelsemium Sempervirens. 
1080 
I shall now describe each symptom separately and fully. Pain in the head 
and eyes.-Patients described this pain variously. It was generally limited to the 
forehead, and most marked just over the eyes. Some called it a dull sensation over 
the eyes; others, a heavy pain; others, a giddy pain; and one patient experienced 
pain over the occiput, with a sensation as if the crown of the head was being lifted 
off in two pieces. This headache was sometimes absent, sometimes followed instead 
of preceding the other symptoms. Dull aching pain in the eyeballs, now and 
then shooting in character, occasionally worse in one ball, sometimes followed and 
sometimes preceded the headache. The headache and pain in the eyeballs were 
often severe and were intensified on moving the eyes. When ptosis was well 
marked the effort to open the eyes widely caused considerable pain, and the patient 
seemed to gtt relief by closing his eyes. Giddiness was another prominent and 
early symptom. Some felt it over the whole head, but by far the larger number 
said it was limited to the brows. Standing or walking made it much worse. 
When well marked the patients staggered, and were afraid even to stand, much 
less walk. So giddy was one patient that he nearly fell off the form. Some 
described their heads as going round and round. They felt and seemed drunk, 
though without any incoherence, or mental excitement. Sight.-In every case 
the sight was affected; indeed, dimness of sight and giddiness appear to be the 
most constant symptoms, and may exist without headache, pain in the eyeballs, 
or double vision. At first the sight, without being misty, is not so clear as usual; 
then slight mist comes before the eyes, one patient comparing it to a "lot of smoke 
rising before his eyes," and another to a "thick veil." At last the sight becomes 
so affected that it fails almost completely, failing first with distant objects; then, 
with further impairment of vision, nearer and nearer objects look hazy. Gel- 
semium affects, too, the sight in animals. Thus we poisoned a dog, and, after the 
production of slight muscular weakness, the sight became almost lost, for the ani- 
mal ran straight against objects without trying to avoid them, evidently not seeing 
them. Diplopia.-The drug seems to produce two kinds of diplopia, one much 
more persistent than the other. As to the transient kind, we find it on many 
occasions a very passing phenomenon, lasting only a few seconds, then disappear- 
ing, then, after a few minutes, reappearing. In this transient form images in the 
median vertical line appear double, distant objects at first undergoing the duplica- 
tion. Sometimes the patient was conscious of the onset of the diplopia; thus one 
woman said, "I know it is now coming on; I feel such a heavy weight under my 
upper eyelid." The double vision then came on and with the heaviness passed 
away in a few seconds. One image was higher than the other; the images in this 
respect varying much. Mr. T. Fox rapidly recorded from the patient's lips the 
phenomena occurring as fast as they could be written: One gas jet appears about 
six inches above the other, and there are six inches between them horizontally; 
the upper one is to the left; now the right is uppermost; now the left slightly again; 
going over to right now again; exactly over one another now, and quite close 
together; now again separated, left the highest; now over one another." With 
other patients the two images seem on a level. Sometimes the drug producesonly 
this transient kind of diplopia; at other times both kinds; and sometimes one kind 
preceded the other, the transient usually preceding the more constant form, 
recurring from time to time, while the constant form persisted. 
The phenomena of the constant form of diplopia follow a definite order, and 
take place in the upper half only of the field of vision. They occur first with 
objects held at the extreme right or left of the visual field; and, as the patient passes 
more under the influence of the drug, then with objects held nearer and nearer the 
middle line; and at last, usually for a short time only, objects in the median verti- 
cal plane seem double. As the effect of the drug wears off, the double vision dis- 
appears in the inverse order. The outer lateral image is the higher, and the further 
the object is carried to the right or left the greater is the horizontal and vertical 
distance between the images. When a colored glass is placed before either eye the 
outer and higher the image is seen by the covered eye. When the object is carried 
high above the head the two images gradually coalesce, and the object looks very 
much thinner, "like a thread." With well-developed dipoplia there is impaired 
movement of the eyeball, chiefly affecting, as far as could be ascertained, the exter- 
nal and internal rectus, especially the external, for the outward and inward move- 
ment of the eyeball is less free than before the action of the medicine. The ball 
appears to be moved by a greater effort, so that when carried as far as the weakened 
muscles are capable, it oscillates; as though the patient with a great effort moved 
it as far as he could, and then the tired muscles gave way a little, but being roused 
to an effort they carried the eye back again; the frequent repetition of this effort Gelsemium Sempervirens. 
1081 
giving rise to an oscillation. The external rectus is generally first affected, and 
not infrequently one external rectus sooner than, and in excess of, the other. Even 
when the diploplia is strongly marked, the loss of power over the muscles is not 
very great, and there is no obvious squinting. (We may remark here that we could 
not detect any squinting during the transient form of diplopia.) Then, as the 
patient becomes still more affected, ptosis supervenes, and a great part or the whole 
of the upper half of the field of vision is cut off. The loss of power in the eye 
muscles is then more marked, but without the occurrence of obvious squinting. At 
this time the symptoms no longer follow the order previously described, but assume 
various forms, often changing rapidly. Thus, whilst on one side the outer image 
is the higher, if the object is carried to the other side of the field the inner image 
becomes the higher; or, perhaps, for the first few seconds the outer and then the 
inner is the higher. 
To test the effect of gelsemium on the circulation I made thirty-three series of 
observations on patients in whom we induced the full toxic effects. The observa- 
tions were taken every quarter of an hour whilst the patient was fully under the 
influence of the gelsemium, and subsequently, as its effects began to decline, at 
hourly intervals. In twenty-two out of thirty-three series of observations the pulse 
remained unaffected in frequency, whilst in the remaining eleven it was quick- 
ened, the increase ranging from six to twelve beats in the minute. Curiously 
enough, even in the same patients, the effects were variable, for although the drug 
quickened the pulse on some occasions, on others it failed to affect it. This was 
not a mere question of dose, for an increase in the dose did not affect the result. 
With a patient fully under the influence of the drug we were inclined to think that 
the pulse became a little smaller and softer. These observations show that gel- 
semium produces little if any effect upon the circulation; a conclusion confirmed 
by observations on the lowrer animals. Dr. Burdon Sanderson concludes from a 
kymographic experiment on a rabbit, that gelsemium exerts no influence on the 
•blood pressure. 
Gelsemium acts less powerfully upon the respiratory centre in man than in 
the lower animals, or, perhaps, to speak more accurately, wre should say that in 
the human subject other parts of the nervous system are affected before the respira- 
tory tract. Thus, in man, the drug produces giddiness, pain in the head, loss of 
sight, diplopia, and ptosis, before respiration is in any way affected. The ptosis 
may be so complete that the eyes cannot be opened, and the sight may be tempo- 
rarily almost destroyed, yet the breathing will not be altered in character, or, at 
all events, will become only slightly more superficial. It may be said that the 
symptoms we have enumerated may have been overlooked in the lower animals. 
I, of course, cannot answer for the pain in the head and giddiness, but I am 
enabled to speak positively as to the absence of ptosis. I frequently noticed that 
when an animal was so fully under the influence of the drug as to be on its side 
in a condition of absolute helplessness, it was still able to open its eyes widely, 
apparently without the slightest effort. In the lower animals gelsemium, as we 
have seen, acts first on the respiratory centre, then on the spinal cord. In man, 
however, the muscles of the upper eyelids, or more probably their motor nerves, 
are considerably affected before either the cord or respiratory centre. Moreover, if 
the cases of poisoning are correctly reported, we are justified in concluding that in 
man the drug acts upon the spinal cord before it involves the respiratory centre, 
for in several instances it is recorded that the patient has recovered from a condi- 
tion of complete paralysis. In my experiments on cats, rabbits, and dogs, we found 
that the animal died from asphyxia before there was any great impairment of 
voluntary power. 
Gelsemium, as I have already stated, has been highly praised in the treatment 
of cough. For practical purposes we recognize three different kinds of cough:- 
1. Where the expectoration is free, but the cough is not in excess of the 
expectoration. 
2. Where the power of expectorating is diminished, as in emphysema and 
fibroid degeneration of the lung. In fibroid degeneration, owing to the great indu- 
ration and thickening of the pleura, there is little or no expansion, and the air can- 
not be drawn into the small bronchial tubes behind the mucus, which is conse- 
quently not expelled. In these cases, although the expectoration is slight, the 
■cough is often troublesome, and not infrequently very violent. 
3. Where there is excessive excitability of the respiratory centre, and a small 
secretion of mucus consequently suffices to set up violent and frequent cough. The 
main object of our treatment is in every case to diminish the secretion of the 
mucus in the bronchial tubes. This method must be chiefly relied on in the first 1082 
Gelsemium Sempervirens. 
and second varieties. In the third we must have recourse to the administration of 
sedatives, and ether, chloroform, opium, and gelsemium will be found beneficial. 
I have carefully watched for, but have been unable to detect, any influence on the 
mental faculties. Patients when under the influence of gelsemium look dull and 
heavy from the drooping eyelids, and often feel sleepy, but when asked if they are 
conscious of any mental depression they always answer decidely in the negative. 
Nor is cutaneous sensibility affected. I have tested sensibility roughly by pricking 
the skin and pinching, and also in two cases by the use of the compasses, but was 
unable to detect any loss of sensation, either in the face or forearm, although the 
patients to whom 1 have more especially referred had taken for six consecutive 
hours drachm doses of the tincture and were fully under the influence of the drug. 
I was led to pay particular attention to the action of gelsemium on the gums from 
the success which has attended its administration in neuralgia of these parts. One 
patient on both occasions on which I experimented on him complained spontane- 
ously of a numb pain, and a little tenderness along the teeth and the edges of the 
gums of the upper jaw. I have never, however, in any case been enabled to detect, 
either by pinching or by the use of sharp instruments, any loss of sensation in the 
parts. Gelsemium, in the doses in which I have employed it, does not affect the 
temperature. In the first place I made two sets of observations, both on the same 
man. On each occasion he took drachm doses of the tincture hourly for four hours, 
and his symptoms were marked and characteristic. The temperature was taken 
on one occasion every quarter of an hour, and on the other every half hour or every 
hour, and the observations lasted respectively five and six hours. In one experi- 
ment it rose 0.2° F., and in the other 0.4° F., during the course of the observation. 
It is true in the evening the temperature fell, but this occurs naturally, and in 
these cases was probably due to the ordinary diurnal variation. I also tested the 
effect on the temperature in a little girl aged nine, who was suffering from chorea. 
On the first day I gave twenty-minim doses of the tincture every hour for three 
hours, without producing any constitutional effects, and the rectal temperature 
remained unchanged. On the following day I gave for five hours an hourly dose 
of forty, thirty, twenty, and thirty minims respectively, and produced well-marked 
constitutional effects. The temperature was taken hourly in the rectum, and on 
two occasions was 0.4° F., lower, but after the fifth dose it was the same as before 
the medicine was given. In addition to these observations on patients, I made six 
temperature experiments on rabbits, but the results obtained were simply nil. I 
soon found-a fact with which I was previously acquainted -that in these animals 
fright exerts a marked influence on the temperature. The mere holding the ani- 
mal's legs or placing it on its side with a view of introducing the thermometer into 
the rectum will rapidly reduce the temperature by two degrees. My conclusions 
on the point in question have consequently been drawn entirely from observations 
on patients. Strange to say, the effect of an internal dose of gelsemium, is opposite 
to that occasioned by its application to the eye itself. When given by the mouth, 
in doses sufficient to produce symptoms, the drug in every instance but one, caused 
contraction of the pupil; indeed, in the case in which the drug produced weakness 
of the legs, with a strong double internal squint, the pupils were contracted to a 
pin's point. In the exceptional patient just referred to, on whom I made two 
observations, though on each occasion I produced great giddiness, haziness, suscep- 
tibility to light, and diplopia, the pupils did not contract, but manifested a very 
unsteady condition, varying greatly in size, in rapid alteration without any appa- 
rent cause. In another patient, the pupils strongly contracted when exposed to 
light, but they dilated freely in a darkened room, and when they recontiacted on 
exposure to light, they seemed in an unstable condition, oscillating a good deal. 
The contraction of the pupil does not cease, on the disappearance of diplopia or 
dimness, indeed, when the dimness passes away, the contraction of the pupil may 
increase. 
In the cases of accidental poisoning, it is recorded that during complete gen- 
eral paralysis the pupils are widely dilated, whence it might be inferred that the 
condition of the pupil depends on the dose-a moderate dose contracting, a very 
large one dilating the jtupil. This inference is possibly in part true, but the dila- 
tation may be due likewise to the asphyxia, consequent on large doses. Dr. O. 
Berger finds, and my observations confirm his statements, that dilatation of the 
pupils in poisoned animals, occurs only when asphyxia from paralysis of respira- 
tion has set in, and that artificial respiration at once causes the pupils to contract. 
On the other hand, the topical application to the eye dilates the pupil. In the first 
instance I employed a tincture (1 in 10) of the American liquid extract. These 
preparations dilate the pupil slightly, but they excite great irritation. Subse- Gelsemium Sempervirens. 
1083 
quently I employed the alkaloid prepared by Mr. Gerrard-one grain in twenty 
minims of water, a solution which causes scarcely any smarting. Mr. T. Fox and 
Mr. Sydney Pearse made for me nineteen observations. A few drops of the solu- 
tion were put into one eye, and in eacli case this trial pupil became widely dilated, 
the dilation usually beginning in about thirty minutes. Not only does the pupil 
dilate, but the muscle of accommodation becomes paralyzed, and the sight affected, 
the vision again becomes nearly natural in twenty-four hours; but the pupil 
remains dilated much longer-sometimes, indeed, for a week, or even a fortnight. 
The fact that the internal administration contracts the pupil, led me to examine 
carefully whether the local application to the eye causes any primary contraction; 
and in three instances I thought I detected very slight contraction, lasting only a 
few minutes. The local application also dilates the pupil of rabbits and cats. The 
pupil of a cat being extremely sensitive 1 thought that if the local application did 
cause primary contraction, I should detect it best in this animal. In five observa- 
tions the pupil in each instance became decidedly contracted before dying. In one 
instance the contraction began in two minutes, in another it was delayed fifteen 
minutes; the average time being ten minutes. Its average duration was twenty- 
four minutes, and it was followed by wide dilatation. I have said that the local 
application dilates the pupils, but I must add that in rabbits absorption sometimes 
takes place so readily, and these animals are so easily affected by the poison that 
they become asphyxiated, and die before the pupil has time to dilate. The con- 
tracted pupils due to the internal administration of the drug, and the dilated pupils 
due to its local application, are both associated with dimness of sight. 
I have seen that the internal administration of gelsemium contracts the pupil 
in man and the lower animals, and that dilatation occurs only on the supervention 
of asphyxia, which at once disappears on the employment of artificial respiration; 
showing that this dilatation is due to the asphyxia and not to the drug. It occurred 
to me that the internal administration would probably dilate the pupil, but that a 
dose adequate to produce this effect so quickly paralyses the respiratory centre, 
that the animal dies asphyxiated before the drug has time to dilate the pupils. To 
ascertain the validity of our conjecture, I made a rabbit insensible with seven 
grains of chloral, then inserted a cannula into its trachea, and injected into the 
subcutaneous tissue of the axilla thirty drops of tlie liquid extract, and at once 
commenced artificial respiration, to prevent the advent of any asphyxia. In sev- 
enteen minutes I thought the pupils were a little contracted: in twenty-six minutes 
well marked signs of paralysis set in, shown at first by a difficulty in keeping up 
the head; in half an hour the animal could not raise its head off the table, whilst 
itstill retained considerable power over its trunk and extremities. At this point 
the eyes became prominent and the pupils began to dilate, and in thirty-four min- 
utes the animal tumbled over on its side, and then I noticed that the pupils were 
decidedly larger and the eyes more prominent; butas at the expiration of an hour 
the pupil had not become widely dilated, I repeated the thirty minims of liquid 
extract, injecting it in two places into the subcutaneous tissue. Paralysis rapidly 
increased till it was complete in the anterior part of the body, though still the 
rabbit had considerable power over its hind legs; but at last these also became 
almost completely paralysed, and the animal lay on its side in a helpless state. As 
the paralysis advanced the pupil dilated somewhat, till at last it became above 
double its original size, though it never reached the degree of dilatation ob-ervable 
in man and cats after the local application of thealkaloid. I noticed that the animal 
retained the power of closing its eyes quickly and strongly, even after almost com- 
plete general paralysis, whence I conclude that the seventh or some of its branches 
is one of the last nerves to undergo paralysis. While performing this experiment 
I noticed that the anterior part of the body was first and most severely paralysed, 
forafter the anterior limbs were almost helpless the animal retained a good deal of 
power over the posterior extremities, which likewise at last became helpless. 
On another occasion I repeated this experiment, and continued artificial respir- 
ation for two hours and ten minutes. During this time I injected under the skin a 
drachm of the liquid extract three times, completely paralysing the rabbit. At 
first the pupils became slightly contracted, but under the full effect of the drug 
they were slightly dilated. This experiment shows clearly that the internal admin- 
istration of a large dose will dilate the pupil, though not considerably. I have 
seen that gelsemium internally administered at first contracts and then somewhat 
dilates the pupils, and that it dilates them when locally applied. How does it pro- 
duce these effects? Through the third nerve or through its influence on the sym- 
pathetic? I am unable to answer these questions, and I shall rather indicate the 
difficulties to be contended with than hope to explain them. Assuming that gel- 1084 
Therapeutic Properties of Yellow Jasmine. 
semiuni first stimulates and then paralyses the third, it would seem that its action 
can thus be readily explained; but a little consideration will show that this view is 
inadequate. Thus we find that the internal administration contracts the pupil- 
due, we assume, to the stimulation of the third nerve; but this contraction persists 
even when the muscular branches of the third are paralysed. It may be said that 
to paralyse the branch of the third supplying the iris, a larger dose is required than 
is needed to paralyse the branches supplying the recti and other muscles, and 
hence, whilst these muscles are paralysed the pupil continues contracted. But this 
supposition is inadequate to explain why the topical application should widely 
dilate the pupil without paralysing the muscles. We are forced to accept the feas- 
ible assumption that, topically applied, gelsemium has a stronger affinity for the 
termination of the branches of the third supplying the iris than for the branches 
distributed to the orbital muscles. I have tried gelsemium with decided success 
in several cases of neuralgia of the dental nerves, even when the teeth were carious. 
Unfortunately, in several cases, the necessary dose to relieve pain produced much 
giddiness, haziness, and sometimes sleepiness, a considerable drawback to the use- 
fulness of the medicine. In some instances ten minims three times a day produced 
these toxic symptoms. To a girl of fourteen, suffering with neuralgia of the supra- 
orbital branch of the fifth, I gave ten minims of the tincture three times a day, 
and each dose produced complete ptosis of the neuralgic eye, lasting an hour or 
longer. 
Therapeutics.-Gelsemium was originally employed as an arterial seda- 
tive and febrifuge in the malarial fevers of the South, and subsequently in 
other sthenic fevers. It appears in someway to depress the bodily tem- 
perature, but appears to possess no controlling influence over the arterial 
system at all comparable to that of veratrum viride and aconite. Dr. 
Bartholow commends it highly in pneumonia and pleuritis; its influence 
for good in these diseases would seem to be chiefly associated with its 
power of lessening the rapidity of respiration and increasing the tendency 
to perspiration. Gelsemium is indicated in those maladies in which an 
exaltation of function has taken place in the motor and sensory spheres of 
the nervous system, as in tetanus, mania, delirium tremens, meningitis, 
cerebro spinal meningitis, neuralgia of the fifth nerve, intercostal neural- 
gia, sciatica, myalgia and convulsive or spasmodic cough. It might be 
expected that gelsemium would prove serviceable in tetanus, because its 
action on the spinal cord is opposed to that which takes place in tetanus; 
and several cases of this disease have been reported cured by this remedy; 
it is important, however, that a careful report of cases thus treated should 
be placed before the medical profession. In mania, with great motor 
excitement and wakefulness, this remedy is more useful thanconium; in 
this condition the best results are obtained by administering it in doses 
sufficient to produce def nite physiological effects, as dilated pupils, droop- 
ing of the eyelids and a feeling of languor. It has been administered with 
satisfactory results in delirium tremens, in wakefulness, and in insomnia 
resulting from over exertion. 
In alcoholism (mania a potu, delirium tremens) I have obtained good 
results in some cases by combining the tincture of gelsemium with either 
bromide of potassium or chloral hydrate. It is essential to make a thorough 
examination into the history and condition of each and every case of alco- 
holism {delirium tremens, mania a potu, the horrors from alcoholic excess) 
and to place the patient in the best possible condition for the administra- 
tion of cerebro-spinal sedatives. Thus, when the tongue is furred, the 
breath fetid and the bowels constipated, the bowels should be evacuated 
by an efficient purgative, and calomel in doses of from six to twelve grains 
will be found to be most efficacious. The administration of easily appro- 
priated nourishment, as beef tea, milk, milk and lime water, and occasion- Investigations by Joseph Jones, M. D. 
1085 
ally milk punch is essential to the conduct of grave cases of delirium 
tremens to a successful issue. When the stomach will permit of ther 
administration ol the solution of the acetate of ammonia, at short intervals, 
this latter remedy may be combined with bromide of potassium and tinc- 
ture of gelsemium. 
It has been well established that digitalis is beneficial in the treat- 
ment of some cases of delirium tremens. But the results of any mode of 
treatment in alcoholism will depend largely upon the habits and condition 
of the patient, for in the habitual drunkard we will frequently find wide- 
spread degeneration of the organs and tissues, cirrhosis of the liver, 
Bright's disease of the kidneys, fatty degeneration of the heart, and cere- 
bral softening and general muscular degeneration and debility. In the 
inflammatory affections of the meninges and in cerebro-spinal meningitis, 
sporadic or epidemic, attended with elevated temperature, rapid circula- 
tion (fever), gelsemium has accomplished good results when administered 
in small doses (about five drops) every two hours, so as to secure and 
maintain uniform physiological effects. 
In the convulsive affections of teething children, I have derived good 
effects by administering the tincture or fluid extract of gelsemium with 
bromide of potassium or chloral hydrate. To infants, about half a drop to 
one drop, with from one to two grains of chloral hydrate, were adminis- 
tered every two, three or four hours, in order to produce rest, sleep, and 
to prevent convulsions. In such cases quinia and mercurials are also 
administered when indicated. Gelsemium often affords remarkable relief 
in convulsive or spasmodic cough; in the spasmodic stage of wdiooping 
cough, reflex cough from irritation of the laryngeal nerves, the irritative 
cough of phthisis with scanty expectoration, and the nervous cough of 
hysterical subjects, and in some cases of spasmodic asthma. In small 
doses repeated at short intervals, in combination with quinia and Dover's 
powder. I have obtained good results from gelsemium in the treatment of 
pneumonia, pleuritis and acute articular rheumatism. Gelsemium, in 
pneumonia, proves beneficial by diminishing the activity of the respira- 
tory function; by allaying cough, it affords rest, and by depressing the 
cardiac movements it lessens stasis of blood in the pulmonary capillaries 
and lowers temperature. Great relief is afforded by the use of gelsemium 
in ovarian neuralgia and in dysmenorrhcea. It also suspends after pains, and 
mitigates the severity of the pains of the first stage of labor. It has been 
used beneficially in pruritus and eczema. I have employed the tincture 
of gelsemium with benefit for the diminution of cardiac action, for the 
reduction of temperature, for the sedation of the motor and sensory centres 
of the brain and spinal cord, in typhoid fever, relapsing fever, remittent 
malarial fever and yellow fever. 
Apocynum Cannnbinum (Indian Hemp). 
This, in appropriate doses, is emetic, cathartic, diaphoretic, diuretic 
and alterative. I have used it for twenty years in hepatic derangements, 
fevers, dropsy, scrofula, rheumatism, syphilis, and many other diseases, 
and can say most positively that I have found but few agents, in the cer- 
tainty and promptness of whose actions I have such confidence. 
Corallorhiza Odontorhiza (Coral Hoot). 
I believe from my own experience, and from the best sources of infor- 
mation accessible to me, that this is the most prompt and powerful dia- 
phoretic yet discovered. Diaphoresis follows its administration without 1086 
Febrifuge Remedies in Malarial Fever. 
any increase in the heart's action. As a diaphoretic in all fevers and 
inflammatory diseases, it has no equal. Its good effects in low stages of 
fevers are very marked. Its properties are probably diaphoretic, febri- 
fuge, sedative and tonic. It has been used with good effect in cramps, 
flatulency, erysipelas, pleurisy, night sweats, etc. In combination with the 
discorea villosa, it is almost a specific in flatulent and bilious colic. For 
the relief of after-pains, suppression of lochia, and the febrile symptoms, 
by which these are sometimes accompanied, there is no known agent supe- 
rior or equal to it. It relieves fever without producing debility. 
Hydrastis Canadensis {Blood Boot}. 
Dr. W. W. Durham says: This is a most powerful tonic. In the 
treatment of diseased mucous membranes I know no substitute for it. 
With itspeculiar action on mucous membranes I have been acquainted more 
than twenty years. Combined with geranium maculatum, liriodendron 
tulipifera and rhus villosus, in decoction, or tincture, it is an invaluable 
remedy in chronic diarrhoea and dysentery. In all chronic affections of 
the mucous membrane of the stomach and bowels, it is a most valuable 
remedy. In gonorrhoea and gleet, I consider it to be almost a specific. In 
these latter diseases, I sometimes find it advisable to combine a few grains 
of chloiide of zinc to the ounce of tincture. I have used it for years in 
gonorrhoea and gleet, and have never failed to cure when my directions 
were followed. It is equally potent in leuchorrhoea. Externally 1 have 
used it with much success in ophthalmic diseases. Whenever a tonic is 
needed hydrastis is applicable. 
Asclepias Syriaca {Common Milk Weed}. 
This species of the asclepias is very common in the United States, 
growing in sandy fields, on the road sides, and on the banks of streams 
from New England to Georgia. It flowers in July and August. The root 
is the part used in medicine. Dr. Richard S. Cauthorn, of Richmond, Va., 
has given the root of this plant with success in six cases of intermittent 
fever. Dr. Cauthorn has used the root in the form of pills, containing two 
or three grains, sometimes combined with capsicum, sometimes given alone. 
A cure has followed the use of one dozen of the pills, two having been 
taken at intervals of every two or three hours. He affirms that the root 
of this plant produces none of the distressing symptoms which often 
attend the administration of quinine. It is worthy of a more extended 
trial. 
Cotton Plant-{Gossypium}. 
The numerous varieties of cotton plant in the Southern States have 
been referred to two species, viz : the short staple, upland and green seed 
(G. Herbicium), and the long staple, black seed or Sea Island (G. Barba- 
dense). The former variety is said to be a native of India, Africa and 
Syria, and the latter of Barbadoes. The ancient Mexicans are said to have 
cultivated cotton at the time of the Mexican conquest; and the relation of 
the genuine Mexican variety to the plant, as it is found in India and 
China, would be of interest not only to the botanist, but also to the archae- 
ologist, seeking the origin of the Mexican and Peruvian nations, with their 
peculiar forms of civilization. It has been claimed by a number of practi- 
tioners of medicine in the Southern States that the root of the gossypium 
{cottonplant} possesses the power of stimulating the uterus, so as to cause 
abortion when administered to the pregnant female, or the return of the Febrifuge Remedies in Malarial Fever. 
1087 
menses in cases of amenorrhoea. It has also been said to equal ergot, in its 
power of exciting uterine contractions during labor. Dr. Bouchelle, of 
Mississippi, who believes it to bean excellent emmenagogue, and not infe- 
rior to ergot in promoting uterine contraction, states that it is habitually 
and effectually resorted to by the negroes of the South for producing abor- 
tion; and thinks that it acts in this way without injury to the general 
health. To assist labor he employed a decoction made by boiling four 
ounces of the inner bark of the root in a quart of water to a pint, and gives 
a wineglassful every twenty or thirty minutes. Dr. Ready, of Edgefield 
District, South Carolina, says that his attention was called to its emmena- 
gogue properties by an article which appeared in a medical journal pub- 
lished some years since. He has since used it in suppression of the menses, 
but more particularly iu many cases of flooding, with entire success. Dr. 
Ready believed it to produce as active contractions of the uterus as ergot 
itself. Dr. Porcher states that, in South Carolina much use is made of the 
root in the treatment of asthma-a decoction being generally employed. 
This plant has been used in the South and West as a substitute for quinine 
in intermittent fever. Professor H. R. Frost, of Charleston, S. C., commu- 
nicated to the Charleston Medical Journal and Review the following facts 
with reference to the use of the cotton seed (gossypium herbarium) as an 
anti-periodic in intermittent fever : 
"The information is derived from Dr. W. B. Davis, of Monticello, Fairfield 
District, S. C., in reply to inquiries made by him as to the medicinal properties 
and uses of cotton seed tea in some of the forms of fever. The use of cotton seed 
tea in iever originated with a planter in Newberry District, who has used it liber- 
ally among his negroes, and uniformly with success. 'I have never failed,' says 
he, 'to cure a patient with a single dose of it, even where large doses of quinine 
have failed. When the patient has been ill of third-day fever and ague, and for 
months, in such cases success has followed its use.' Professor Shepard's analysis 
of cotton seed shows it to be composed of many inorganic matters, some of which 
may really possess great medicinal virtue in this disease. The mode of using 
cotton seed tea is as follows: after having given a dose of calomel, the day or night 
previous to the attack, followed by castor oil in time to produce a cathartic effect 
before administering the tea, you put a pint of cotton seed with a quart of water, 
in a vessel, boil an hour or two. Before the usual recurrence of the ague give the 
patient a gill of the warm tea to drink. Without advancing any opinion in refer- 
ence to its exhibition, whether for or against, I present it to the notice of the pro- 
fession as a remedial agent becoming popular in domestic use in the section of 
country mentioned, and, therefore, claiming investigation on the part of the pro- 
fession." 
H. D. Brown, of Copiah county, Mississippi, communicated to one of 
the newspapers during the recent war the following notice of the use of 
cotton seed tea as a substitute for quinine : 
"I beg to make public the following certain and thoroughly tried cure for ague 
and fever: one pint of cotton seed, two pints of water, boiled down to one of tea, 
taken warm one hour before the expected attack. I have tried this effectually, 
and unhesitatingly say it is better than quinine; and, could I obtain the latter 
article gratuitously, I would infinitely prefer the cotton seed tea. It will not only 
cure invariably, but permanently, and is not at all unpleasant to the taste." 
Castanea Vesca and Pumila-(Chestnut.) 
Dr. Nelson Burgess, of Sumpter District, S. C., says that he had used 
the decoction of the root and bark of the chinquapin frequently as a substi- 
tute for quinine in intermittent fever with decidedly satisfactory results. 
Hot water is poured over the root and bark, and a large quantity taken 
during the twenty-four hours previous to the expected chill. 1088 
Febrifuge Remedies in Malarial Fever. 
Alnus Serrulata-Alder.) 
The inner bark is emetic and tonic; an infusion of it has been given inj 
intermittents with considerable success. 
Polygonum Aviculare-{Knot- Grass.) 
Dr. Bourgeois announced, in 1840, that this plant was an excellent 
febrifuge, and was used in Middle Africa and Algeria as a substitute for 
quinine m the fevers of this country. Jt has been used as a popular 
remedy in this country in intermittent fevers, but we have no positive data- 
at hand on this subject. 
Prinos Verticillatus-{Black Alder, Winter Berry.) 
The berries and bark of this plant are tonic and astringent, and are 
used in intermittent fevers, diarrhoea, and diseases connected with a debili- 
tated state of the system, especially gangrene and mortification. Dr. Amos 
Gregg, Jr., of Bristol, Pennsylvania, recorded the following observations 
"on the use of the prinos verticillatus, or black alder, in intermittent 
fevers and other diseases": 
" My experience is confined to its use in remitting and intermitting fevers; 
and it was the bark alone which T used. The first case was that of a boy, aged 
fourteen, in remitting fever. Four days before I saw him he was seized with 
vomiting and pain in the bowels. On the second day he was seized with chill and 
fever, attended with pain in the back, head, etc.; he was costive, his skin hot, 
without thirst, his tongue furred, attended with delirium. There had been no 
remission for more than twenty-four hours when I saw him. In the afternoon I 
drew six ounces of blood, and ordered a draught of antimonial wine and lauda- 
num at bed-time, and the next morning gave him a cathartic, which brought on a 
complete intermission. The decoction of the prinos was now ordered, which 
entirely prevented a return. He took three drachms in six ounces of water. The 
second case was that of a woman with quotidian fever, fixed pain in the side; hot 
skin; small; hard pulse; costiveness; and painful respiration. A purgative was 
exhibited, and afterward tonics, such as the bark of the cornus sericea, camphor, 
laudanum, etc., were given, for one week, with no material advantage; a chill 
came on at 3 o'clock in the afternoon, and the fever lasted several hours. The 
pulse became softer; I now ordered one drachm of the pulverized bark of prinos, 
to be given every hour during the apyrexia. She took only three powders, and 
suffered no relapse. When it is exhibited in powder, I am disposed to believe it is 
nearly equal to the Peruvian bark. When the stomach would retain the powder, 
I did not fail in a single instance; and in one case only was it rejected. Like the 
Peruvian bark, it succeeded best when it was given immediately after the sweat- 
ing stage. In general, I gave it alone; but, to prevent diarrhoea, an effect it occa- 
sionally produced (though less commonly than the Peruvian bark), and to prevent 
pain, I sometimes added a few drops of laudanum. In one instance only I 
applied it to the skin. One of my patients, a child, while using a decoction of 
prinos, discharged worms. It is no uncommon thing to see worm^ discharged 
during fevers; and future experiments must decide whether, in this respect, the 
prinos is superior to the other bitter tonics. The bark of this vegetable makes an 
agreeable bitter with proof-spirit." 
Verbascum Thapsus-{Mullein.) 
Equal parts of mullein leaves and the bark of the root of sassafras, 
boiled in water and concentrated, then mixed with powdered sassafras 
bark to form pills, are reputed valuable in the treatment of agues. The 
plant is tonic, demulcent and emollient, and is considerably used as a 
popular remedy. Indigenous Remedies in Malarial Fever. 
1089 
Sabbatia Angularis-{Pursh, American Centaury'). 
Employed in domestic practice in intermittent fever, but principally 
to invigorate the stomach and alimentary canal. 
Apocynum Cannabinum-{Indian Hemp. Dog's Bane). 
This is esteemed to possess great virtues in arresting intermittent 
fever, and is used as a substitute for quinine in popular practice. 
Chionanthus Virginia-{Old Man's Beard. Poison Ash). 
An infusion of the roots was once given in long standing intermittents, 
but at present not much used. 
Ilex Opaca, or American Holly. 
A few years since the leaves of the European holly gained some repu- 
tation in France as a cure for intermittents, and were considered by some 
as equal to Peruvian bark; but the first reports in their favor have not 
been fully confirmed. The leaves were used in powder, in the dose of a 
drachm two hours before the paroxysm; and this dose was sometimes 
repeated frequently during the apyrexia. Their febrifuge virtues are said 
to depend on a bitter principle, for which the name of ilicin has been pro- 
posed. M. Labone obtained this principle by boiling a filtered decoction 
of holly leaves with animal charcoal, allowing the charcoal to subside, 
washing it, then treating it with alcohol, filtering off the alcoholic solu- 
tion, and evaporating to a syrupy consistence. The liquid thus obtained 
was very bitter, and, on being allowed to evaporate spontaneously, yielded 
an amorphous substance, having the appearance of gelatin, which was the 
principle in question. The berries are said to be purgative, emetic and 
diuretic; ten or twelve of them will usually act on the bowels, and some- 
times vomit. Their expressed juice has been used in jaundice. 
Platanus Occidentalis-{Sycamore, Button Wood'). 
Dr. Benjamin Smith Barton, in 1805, in his journal, made the state- 
ment that the bark of this tree had been used with some success in the 
intermittents of Virginia and some other parts of the United States. It is 
sometimes used at the present day for its tonic effects in the bitters so often 
taken as a preventive of the return of ague. 
Ptelea Trifoliata-( Wafer-Ash- Wingseed). 
This plant has been recommended in the treatment of fevers by Dr. 
O. F. Potter, of St. Louis. It is a shrub of from six to eight feet in height. 
The leaves are trifoliate, and marked with pellucid dots. The flowers are 
polygamous, of a greenish-white color, and of a disagreeable odor. It 
flowers in May and June. It is common in the Central and Southern 
States, growing on rocky banks and at the edge of woods, from Florida to 
Ohio, and is especially abundant west of the Alleghanies. The bark of 
the root possesses its peculiar medicinal properties, which it yields to boil- 
ing water; but alcohol is its best solvent. The bark, when dried, is of a 
light-brownish, yellow color externally, and of a yellowish-white internally, 
and comes in cylindrical rolls or quills, from one to several inches in 
length. It has a peculiar, rather aromatic, smell, and a bitter, pungentand 
rather acrid taste, yet nothing disagreeable. Dr. Potter has been using it 
for a number of years as a tonic, following the use of quinine in all grades 
of fevers; also, in cases of general debility, connected with gastro-enteric 
irritation, as a prophylactic against malarial attacks, and as a sustaining 1090 
Chloride of Sodium. 
and strengthening tonic and stimulant in debility connected with or fol- 
lowing wasted ulcers or scrofulous sores. It is mild, unirritating, having a 
soothing influence on the stomach, promoting digestion. 
Capsicum (Cayenne Pepper.) 
The quick and energetic stimulant effects of capsicum render it valu- 
able in some cases of intermittents, especially in the stage of collapse. In 
some cases of intermittents, attended with a want of gastric sensibility, it 
may, with advantage, be added to the sulphate of quinia. In combination 
with other stimulants, as sulphuric ether or alcoholic stimulants, or alone, 
it may be usefully and effectually employed in warding off the chill. In 
those who are exposed to the constant action of malaria, a draught of red 
pepper tea every morning upon waking is said to be a valuable prophy- 
lactic; in like manner, it may be administered for the same end to those 
who have been chilled by drenching rains in the summer and fall in mala- 
rious regions. 
Chloride of Sodium (Common Salt). 
Dr. Seelie Montdegert appears to have been the first to call the atten- 
tion of the profession to the value of chloride of sodium in the treatment 
of intermittent fever; and however fanciful his notion that every paroxys- 
mal fever is caused by the presence of fibrin in the venous blood, which 
should, in the normal state, be removed by the process of assimilation, and 
that the salts of quinine owe their power of arresting paroxysmal fever to 
their ability to dissolve the fibrin present, and that chloride of sodium is 
also capable of arresting paludal fever, because, like quinine, it is a solvent 
of fibrin; we must, nevertheless, award to him great credit for having dis- 
covered one of the cheapest and most widely diffused agents which may be 
substituted for Peruvian bark and its active principle, quinine, which is 
not only very costly, but is liable to adulterations, monopolies, and to final 
destruction from the wasteful and reckless manner in which it is gathered 
and prepared for the market. In his memoir upon the treatment of inter- 
mittent fever, presented to the French Academy of Medicine, July, 1850, 
Dr. Seelie Montdegert declared that from the results observed during sev- 
eral years with the beneficial effects of chloride of sodium in the treatment 
of intermittent fever, this medicine should show, with the salts of quinine, 
the prerogative of arresting the paroxysms of intermittent fever. He says 
that half an ounce of salt, administered in half a glass of infusion of coffee, 
in the morning, before eating, during the apyrexia, will be sufficient to 
arrest the paroxysm. Its use in this manner should be continued three 
days. According to the testimony of Dr. W. P. Lattimore, M. Piony, who 
was one of the committee appointed by the academy to report upon the 
memoir of Dr. Seelie Montdegert, experimented extensively with the 
chloride of sodium in intermittent fever, and confirmed the previous obser- 
vations. This subject is of so much interest that we present the testimony 
of Dr. Lattimore to the success of M. Piony with the chloride of sodium in 
intermittent fever, in full: 
" M. Piony holds that in all paroxysmal fevers the spleen is enlarged; that the 
anatomical lesion is the cause, the fever only the symptom; that whenever the 
spleen has a greater length (measuring in a line extending from the middle of the 
axilla to the anterior superior spinous process of the ilium) than from thirty-one to 
thirty-three lines, intermittent fever exists. Believing thus, the symptoms for him 
are zero, while the state of the spleen stands at the other end of the scale, and is 
everything-percussion (pleumetric), of course, being the experimenturn crucis. 
We cannot resist the temptation of here paying a tribute to the skill with which Chloride of Sodium. 
1091 
M. Piony employs percussion in making a diagnosis. With him auscultation is 
but an infant when compared with its full grown brother, percussion. By its aid 
he interrogates the abdominal viscera as frequently as the thoracic, and with no 
less success, for he has brought it to an almost incredible degree of perfection. 
With his plate of ivory and his flattened Angers'ends he diagnosticates almost 
everything-tumors of the abdomen, abscesses everywhere, aneurisms, etc. All 
acknowledge the delicacy and accuracy of his test, while the looker on is lost in 
admiration, and wonders whether all his senses are not really concentrated in the 
ends of his fingers, which, by constant drumming, have at length become the very 
reverse of tapering. Wishing, then, to experiment with salt, a few cases of inter- 
mittent fever (old stagers), contracted in Algiers, were selected as subjects. Behold, 
then, Piony at the bedside. The patient asserts that he contracted the fever and 
ague several years since in Africa; that he has frequently been cured, but that the 
disease has constantly reappeared at the end of fifteen days, or one month at 
farthest. The type of the fever is tertian. The spleen is percussed and found to 
be abnormally dull throughout its whole extent; the entire splenic region is sensi- 
tive upon percussion, particularly over the dullest points, and each blow is accom- 
panied by marked contortions of the countenance. This sensibility extends but 
little beyond the region of dullness, which last occupies an extent of fifty-three 
lines, measuring in the direction indicated above. To this patient a drachm of 
salicin is administered without producing any change in the dimensions of the 
spleen. A few minutes subsequently half an ounce of salt, mixed with a cup of 
soup, is given, and upon carefully percussing the splenic region at the end of four 
minutes this organ is found diminished one inch from above downward. 
The next day the spleen is found to be of the same size, but upon the adminis- 
tration of a second dose of salt it suddenly contracts and measures nearly three- 
quarters of an inch less than yesterday. The resonance throughout the entire 
organ has increased, while the sensibility has diminished. The succeeding day the 
attack of fever is very slight, and, upon giving a third dose, the disease does not 
return; and when seen six weeks subsequently the patient is still free from his 
African enemy. Thus we see that a diminution of twenty-four lines in die length 
of the spleen was the result of the medicine, the fever being cured more effectually 
than ever before-i. e., the patient had remained free from all relapse for the space 
of six weeks, one month having previously been the longest period of immunity. 
" We have the notes of seven cases of well-marked intermittent fever, in all of 
which the administration of the chloride of sodium was followed by rapid decrease 
in the volume of the spleen and cure of the febrile symptoms. We also have the 
record of three cases, in which salt was unsuccessfully used; in oneof these, the sul- 
phate of quinine effected a cure; in a second it, too, failed, while in the third it was 
not tried. These were all well-marked cases of intermittent fever, such as would 
pass muster in any of our own malarious districts. Let it be remembered that 
most of the fever and ague met with in the Parisian hospitals is of long standing, 
and imported from the malarious districts of Algiers, which generated a form of 
the disease even worse than that found amid the marshes on the banks of the 
famed Maumee; that these cases have been treated again and again; have been 
cured now by the sulphate of quinine, now by arsenic, but only to reappear upon 
the slightest exposure or imprudence; in short, to recur as only the shakes can 
recur. We witnessed many of the experiments of M. Piony, and in the great 
majority of them the fever yielded to the salt quite as readily as to the salts of qui- 
nine. And as to the theory of M. Piony, the spleen diminished under the use of 
the remedy, pari passu, with the febrile symptoms, in every case where the dis- 
ease was cured, proving that this organ really shows the influence of remedies over 
this class of fevers-that it is, as it were, a febro-barometer-for the diminution of 
the spleen is a constant phenomenon accompanying the cure of the disease, what- 
ever the curativeagent employed. M. Piony's method of administering the chlo- 
ride of sodium is to give half an ounce in a cup of thin soup during the apyrexia 
and fasting. It usually agrees with the stomach perfectly well, but in some few 
cases we have seen it excite vomiting and diarrhoea. Three doses commonly suffice 
to effect a cure, the first two to be taken on succeeding days, and the third after an 
interval of one day. Should the spleen be undiminished in volume by the first 
dose, we may be sure that the remedy will not cure the disease; and the same is 
true of all the anti-periodics. Excepting in rare cases, the diminution ofthespleen 
occurs immediately upon the administration of the remedy (salt or snip, quinine), 
and may frequently be detected within one minute after which the organ remains sta 
tionary until a second dose of the medicament be administered."-On the employ- 
ment of Choloride of Sodium in the Treatment of Intermittent Fever by W. P. 1092 
Chloride of Sodium. 
Lattimore, M. D., American Journal of the Medical Sciences. July, 18-52. No. 
xlvii, new series; pp. 102, 104. 
The Observations of Dr. Moroschkin upon the Value of Salt in the Cure of 
Ague, with the testimony of the preceding Observers.-He states that during 
the prevalence of scorbutus and ague in the Trans-Caucasian province of 
the Black Sea, quinine sometimes entirely lost its powers. When no very 
prominent scorbutic affections were present, he administered one ounce of 
salt in water, in two doses daily, during the absence of the apyrexia. In 
patients, in whom the paroxysms were incomplete, very abundant sweat- 
ing followed, the skin resumed its natural appearance, and the various 
other signs of amendment followed, the disease becoming cured in a few 
days, and the dose having to be diminished. In cases in which the improve- 
ment was only partial, quinine now became more efficacious. Of one hun- 
dred and three cases, seventy were completely cured, and the others ameli- 
orated.-Hankin's Abstract of Medical Sciences, No. 25. January to July, 
1857; p. 36. Smith's Jahrb., No. 6. 1856. Dr. Hutchinson, of Brooklyn, 
has placed on record twenty-two cases of intermittent fever, which were 
treated with salt. 
The dose in which the salt was given varied from eight to twelve drachms dur- 
ing the apyrexia. At first eight drachms were given, but the amount was subse- 
quently increased to nine, ten, and even twelve drachms in one instance, with 
obvious benefit. Children required somewhat larger proportional doses than adults. 
Mucilage of elm was selected as the vehicle, on account of its convenience, and 
because it sufficiently disguised the remedy, which was deemed a matter of impor- 
tance, for it would have lost much of its efficacy, or have been repudiated altogether, 
had the patients known they were taking simply common salt. The following was 
the formula used: R. Chloride sodium, ^iij; Ulmi pulv., §iij; Aq. bullientis, 
f.^viij. Infuse two hours and strain. 
This forms a saturated solution. Dose, a teaspoonful every two, three or four 
hours, so that five or six doses may be taken during the apyrexia. It was not 
deemed necessary to precede its employment by evacuants, because the patients 
had recently used such remedies during their former attacks; and, moreover, Dr. 
Hutchison preferred to use the salt alone, because its real value could thus be bet- 
ter determined. When it is necessary to precede the use of the salt as an anti- 
periodic by emetics or cathartics, perhaps there is nothing better for the purpose, 
in ordinary cases, than the same remedy administered in emetic doses, which will 
usually produce, also moderate cathersis. In most of the cases the remedy was 
well tolerated by the stomach, nausea or vomiting having occurred in but four 
instances. Four cases also had moderatealvine evacuations, unattended with pain. 
There was considerable thirst in every case, but no other unpleasant effects. When 
given in the above manner (dissolving it in as small a quantity of water as possi- 
ble), it is less likely to disturb the stomach than the same or even a less amount 
would in a larger proportion of the solvent. The taste was objected to by some, 
while others disliked it much less than quinia. The following are Dr. Hutchisoiqs 
conclusions: 1. Although inferior to cinchona and its preparations, it yet forms 
a very good substitute for them in intermittent fever, having failed, as we have 
elsewhere seen, to produce a speedy suspension of the paroxysms in 31.8 per cent, 
of the cases only; in a majority of cases, therefore, itmay be substituted for quinine. 
2. Itmay be used instead of, and, indeed, preferably to, quinine. First, in cases 
not unfrequently met with, where the latter remedy is forbidden by the very 
unpleasant nervous and cerebral symptoms it produces (delirium, tinnitus aurium, 
cephalalgia, faintness, etc.,) an example of which I have recently seen in the New 
York Hospital, when sulphate of copper was substituted. Thirdly, it is com- 
mended on the score of economy, which is a consideration of importance to the 
poor especially, who are now, in a measure, debarred from the use of quinia by its 
high price. And fourthly, it is always at hand, whilst quinia sometimes cannot 
be obtained. 
It has been found to be more energetic in curing ague than any of the vegeta- 
ble or mineral tonics commonly used for that purpose, excepting bark, and should, 
therefore, be preferred to arsenic, which has been ranked by M. Andal, Prof. Wood, 
and, indeed, most other authorities, next in value to quinia. And, moreover, I Nitric Acid. 
1093 
think arsenic should never be used until after quinia and common salt have failed 
to do good, on account of its unpleasant, and sometimes disastrous consequences 
to the general system and stomach, and the increased facilities it affords for using 
the remedy as a toxicological agent. 
Nitric Acid. 
Dr. George Mendenhall, of Cincinnati, called the attention of the pro- 
fession to the use of nitric acid in the treatment of intermittent fever in 
1854; the facts upon which his paper was based were chiefly derived from 
an inaugural dissertation by Dr. E. T. Bailey, of Indiana. Dr. Bailey 
states that in the section of country in which he resides there is a large 
portion of marshy land, and therefore the circumstances are favorable to 
the development of autumnal fevers. His attention was first attracted to 
the use of nitric acid in the treatment of intermittent fever by noticing its 
effects in a case of chronic intermittent, which was attended with profuse 
night-sweats, and for which complication he administered the remedy. In 
this case there had been daily poroxysms for the preceding five days; night- 
sweats profuse, the tongue coated and the bowels constipated. Nitric acid 
was given in doses of six drops, diluted with water, in the evening, and 
he was agreeably surprised to. find that the paroxysms did not return on 
the following day, and this circumstance induced him to try its effect in 
other cases as an anti-periodic. Since that time he has treated over ninety 
cases of intermittent fever with this article with remarkable success. Of 
this number all recovered promptly except ten; and in every one of these 
unsuccessful cases the remedy was discontinued contrary to directions. 
Fifteen of the whole number were of the tertian type, and seventy-five of 
the quotidian. In fifty cases there was no return of the chill after com- 
mencing the use of the acid. The others were rarely attended by more 
than one paroxysm, and in no case by a third. When the patient had a 
paroxysm after taking the medicine, it was, in every case, diminished in 
intensity and in duration. 
In Dr. Bailey's practice this remedy has entirely superseded every 
other article for the purpose of interrupting the paroxysms of intermit- 
tents. His mode of proceeding is to give from five to eight drops of the 
commercial nitric acid, properly diluted, once in six hours, without regard 
to intermissions or exacerbations. Cathartics and alterants may be neces- 
sary for the purpose of changing certain conditions of the system; but so 
far as the interruption of the paroxysms is concerned, the acid may be 
given without any preparation of the system whatever, if we choose to do 
so.-American Journal of Medical Sciences. October, 1854, pp. 581, 582. 
Dr. J. C. Thompson, of Arkansas, has recorded in the Southern Jour- 
nal of the Medical and Physical Sciences, August, 1857, the successful trials 
of nitric acid in six cases of intermittent fever, in which the customary 
remedies had failed. In one case, in which there was menorrhagia, a 
powder, consisting of one grain of opium and two grains of sugar ot lead 
was given every two hours, until the discharge subsided; in two others, 
blue mass was prescribed, in conjunction with the acid, and in the remain- 
ing three cases, pills of sulphate of iron, aloes and rhubarb were given in 
addition to the acid. He recommends one ounce of the acid to be diluted 
with six ounces of water; of this the patient is to take one drachm in an 
ounce of water every two hours during the intermission. 
Dr. Wm. A. Hammond has added his strong testimony to the value of 
nitric acid in intermittent fever, published in the Maryland and Virginia 
Medical Journal for February, 1861. Dr. Hammond, after presenting the 
results of the employment of nitric acid, in tabular form, remarks: 1094 
Oil of Turpentine. 
"The table forms the basis of a report made about four years since to the 
Surgeon-General of the army, and has never been published. The cases were 
treated at Fort Riley, Kansas Territory, in the post hospital, then under my 
charge, in a period of six weeks in the summer. Upon referring to the table, it 
will be seen that, in all, forty-nine cases were treated, ten of these being of the quo- 
tidian type, and thirty-one of the tertian. Thirty-two cases were treated with the 
nitric acid and nine with the sulphate of quinine. Of the cases cured by nitric 
acid, three had previously used quinine without effect, and of those in which qui- 
nine had proved successful, nitric acid had been employed without benefit in two, 
and in one other had to be omitted on account of causing nausea, heart-burn, etc. 
The average period of treatment, before the disease was permanently arrested, was 
the same with each remedy-three days. The nitric acid was uniformly given in 
doses of ten drops (properly diluted with water) three times per day, the quinine 
in doses of eight grains three times a day. Besides the fact that the nitric acid was 
equally successful with quinine in arresting the disease, the difference in the cast 
of the two articles is so greatly in favor of the former substance as to render it an 
object of importance to make its curative properties more widely known. Since 
the foregoing cases were treated, I have very frequently employed nitric acid in 
the treatment of intermittent fever, and have rarely been disappointed in my 
expectations of its curative action. In fact, in simple, uncomplicated intermittent, 
I seldom have occasion to use anything else. In cases of enlargement of the spleen, 
consequent upon frequent attacks of the ague, the remedy in question has, in my 
hands, proved very advantageous." 
These facts demonstrate conclusively that nitric acid is a most valua- 
ble substitute for quinine: and we can readily conceive, by a reference to 
its powerful alterative effects, simulating even those of mercury, that it 
would be beneficial, also, in remittent, typhoid and typhus fevers. Its 
great cheapness and facility of administration, added to its most energetic 
and decided effects, should lead, at least, to an extended trial of its virtues 
by the profession. 
Oil of Turpentine-{Oleum Terebinthince.) 
From its decided stimulant and diuretic powers this valuable remedy 
has proved beneficial in the cold stage of malarial fever. Given before the 
supervention of a chill, it will in some cases prevent the occurrence of the 
paroxysm. This result may, in some cases, lead to an arrest of the disease; 
we need, however, accurate investigations as to its anti-periodic powers 
when thus employed. In ordinary stimulant doses the oil of turpentine 
appears to produce no dhect effect upon the brain, whilst producing most 
decided effects upon the capillary circulation, and hence its indication in 
certain states of depression or collapse in malarial fever. During the recent 
war some interesting investigations were conducted by Confederate sur- 
geons ''On the External Application of Oil of Turpentine as a Substitute for 
Quinine in Intermittent Fever." As far as our information extends, the fol- 
lowing embraces all the information bearing upon the subject which was 
made public during the progress of the recent war : 
At the present time, when the demand for remedies is constantly upon the 
increase, whilst the supply is actually diminished, and this supply procurable only 
with difficulty and at enormous rates, the discovery of what may, to any extent, 
supply the place of the costly salts of quinine in the treatment of malarious fevers 
becomes of deep interest to the profession. Very many native remedies have been 
found valuable adjuncts to this powerful antiperiodic, but as yet no substitute per- 
fectly reliable has been offered. That which at present appears to afford most 
promise is the pinckneya pubeus, or Georgia bark, one of thecinchonae, found from 
New River, South Carolina, along the seacoast to Florida, in which a considerable 
amount of cinchonine has been discovered, but of which no complete and per- 
fectly satisfactory analysis has yet been made. The use of the external applica- 
tion of the oil of turpentine as a substitute for the internal administration of qui- 
nine, not altogether novel, but to which the attention of the Medical Bureau has Oil of Turpentine. 
1095 
Special Report of cases of Intermittent Fever, treated by the external application of Turpentine, as a substitute for the 
internal application of Quinine. Station-General Hospital, Gayton, Georgia. Treated during the month of October, 
1863: 
Name. 
Rank. 
Regiment, 
Type of Fever 
Date and hour of 
first Chill. 
Date and hour 
of 
expected Chill. 
Time of 
application 
of 
Turpen- 
tine. 
How long; 
appplication 
continued. 
Total 
quantity 
employed. 
1. 
Jesse W Ward 
Private 
30th Georgia. 
Quotidian. 
Oct. 21, 5 P. M. 
Oct. 22, 5 P. M. 
4 P. M. 
4 hours 
1 ounce 
2. 
John Hanly 
Private 
63d Georgia. 
Quotidian. 
Oct. 28, 3 P. M. 
Oct. 29, 3 P. M. 
2 P. M. 
3 hours 
1 ounce 
3. 
J B. McCullers 
Private 
33d Georgia. 
Quotidian. 
Oct. 19, 7 P. M. 
Oct. 20, 7 A. M. 
6 A. M. 
4 hours 
1 ounce 
4. 
J. J. Guisharn 
Private 
Boston Art. 
Tertian. 
Oct. 21, 3 P. M. 
Oct. 23, 3 P. M. 
2 P. M. 
3 hours 
1 ounce 
5. 
W. C. Geddons 
Private 
29th Georgia. 
Tertian. 
Oct. 22, 10 A. M. 
Oct. 24, 1 A. M. 
9 A.M. 
3 hours 
1 ounce 
6. 
A. B. Funderbrook 
Private 
Eng. Corps. 
Quotidian. 
Oct. 23, 4 P. M. 
Oct. 24, 4 P. M. 
3 P. M. 
4 hours 
1 ounce 
7^ 
S. Wilson 
Private 
Eng. Corps. 
Quotidian. 
Oct. 22. 9 P. M. 
Oct. 23, 9 P. M. 
8^ P. M. 
1J hours 
1 ounce 1096 
Indigenous Remedies in Malarial Fever. 
been lately called by Surgeon Stiles Kennedy, is considered of sufficient import- 
ance to invite the attention of the profession at large. The special mode of action 
upon which this remedy bases a claim, so far, well sustained by experience, is 
solely and simply by means of a powerful impression upon the nervous centres, 
especially the central sympathetic system, to interrupt the morbid train of parox- 
ysms established and set in motion by the malarious poison, and to put the system 
in a proper condition for the employment of tonics and antiperiodics. The mode 
of application, as used and recommended by the officer above mentioned, is as fol- 
lows : Half an hour before the expected paroxysm, a bandage, wet with the tur- 
pentine, is applied around the body at the lower part of the chest, the linen 
replaced and the outside clothing buttoned. If convenient, the patient should 
then be placed in blankets; if not, he should be kept in sight, so that he may not 
remove the bandage. 
Surgeon K. reports the successful trial of this application, without failure, in 
over thirty cases ! The following report, however, from the General Hospital, at 
Gayton, Georgia, selected at random from those which have up to this time been 
received at the office of the Surgeon General, presents a fairer average of the 
results of a series of experiments instituted in several sections of the Confederacy, 
the blank used being that prescribed and issued from that office for special reports 
upon the subject. See table. 
Resuet.-Case 1. Expected chill did not occur, but chills returned November 
8th. Tonic bitters used in conjunction. No strangury nor any external injury to 
the tissues occurred. Subject to chills. Application made around the body, below 
ensiform cartilage, and patient kept in bed. 
Case2. Expected chill did not occur, nor again return. No other remedies 
used. No strangury nor external injury to tissues. Was attacked with quotidian, 
October 19th. Turpentine used in same manner and to same part as in case above. 
Case 3. Expected chill did not occur, nor again return. Liquor potass, arsenit. 
given for four days after first chill. No strangury nor external injury to the 
tissues. Subject to chills. Application as above. Neuralgia of left temple after- 
wards occurred and was relieved by application of turpentine to the part. 
Case Expected cbill did not occur, but chill returned on the 28th, and 
treated with quinine, no turpentine being on hand. No bad effects from use of 
turpentine. Fowler's solution used in conjunction till diarrhoea appeared. Mode 
of application as before. Patient subject to chills and disorder of hepatic function. 
Case 5. No return of chills. Treatment in conjunction, blisters and the ferri 
chloride. No strangury nor injury to tissues. Not subject to chills; had remittent 
in camp. Place and manner of application same as in other cases. 
Case 6. Expected chill did not occur, but chill returned on the 30th, and, on 
re-applying turpentine, did not again return. Fowler's solution after several 
attacks, and kept up until bowels became disordered. Subject to chills. Applica- 
tion as above. 
Case 7. Expected chill did not occur, nor again return. Bitter tonics in con- 
junction. No ill effects from use of turpentine. First attack. Application made 
around body below ensiform cartilage. 
" It will be seen from this report that where there is a probability of the return 
of the paroxysm on the seventh or fourteenth day, the repetition of the application 
is essential to its certain avoidance. To insure a fair trial of the remedy, the 
patient should, when it may be found necessary, have the advantage of prelimi- 
nary treatment, due attention being given to any visceral derangement or obstruc- 
tion, and to any unnatural condition of the skin. After the abortion of the parox- 
ysm, tonics and antiperiodics are, of course, indicated, and among them, most 
available at present, may be mentioned the cold infusion and extract of the eupa- 
torium and cornus florida, the powder of the liriodendron, or the compound tinc- 
ture of the barks of the liriodendron, salix and cornus florida. In chronic cases 
the after employment of Fowler's solution and of the tincture ferri muriatis will 
often, no doubt, prove serviceable. In conjunction with the special mode of the 
treatment of malarious fevers herein narrated, the use, before the paroxysm, of the 
warm bitter effusions as diaphoretics is recommended. Surgeon Hinkley has 
lately reported several cases from the wayside hospitals, at Demopolis, in which 
the paroxysm was completely prevented by the administration, at this period, of 
the warm infusion of the fresh root of the verbascum thapsus (mullein); strength 
-four ounces of the green root to one pint of water, reduced to one-half by boil- 
ing; twoouncesof this infusion given every hour, commencing four hours previ- 
ous to the expected chill. It is hoped that this economical mode of treatment, the Indigenous Remedies in Malarial Fever. 
1097 
results of which have thus far been so satisfactory, will still be persevered in, and 
that substantial reports of cases will be promptly forwarded, in order that a still 
more satisfactory conclusion may be reached and interesting information on the 
subject be to a larger extent given to the profession."-Confederate States Medical 
and Surgical Journal, Vol. 1, No. 1, pp. 7 and 8, January, 1864, Art. III. In the 
August number, 1864, of the Confederate States Medical and Surgical Journal, the 
following additional observations upon the '''External Application of T'urpentine 
as a Substitute for the Internal Use of Quinine in the Treatment of Intermittent 
Feverf was recorded by the editor : " Since the publication of the treatment of 
intermittent fever by the external application of the oil of turpentine (vide Janu- 
ary No., Art. 3), seventy returns, involving over four hundred cases, have been 
received from different hospitals and posts, owing to instructions received from the 
Surgeon General's office. With few exceptions, the remedy is regarded as one of 
great power, if not positive efficacy, in preventing a return of paroxysm. But, 
weighing the elements of these reports, candor compels us to say that our conclu- 
sions are not so positive. 
"We will for a moment consider the difficulties in determining such a proposi- 
tion. When we take into consideration the difference between intercurrent and 
recurrent chill, it is obvious that experimental treatment will be very likely to mis- 
lead us. A patient, suffering from debility or a dibilitating disease, may have a 
<jhill induced by climacteric, or even mental and usual influences; with proper 
care, and freedom from exposure to these causes, the paroxysm will not be repeated, 
and certainly turpentine, if used, could claim no specialty under such circum- 
siances. Even in recurrent chill, when the paroxysms occur periodically, it is 
impossible to determine the hour of recurrence, for the quotidian may pass spon- 
taneously into the tertian or quartan without any treatment at all. Therefore, if 
we attempt to meet the quotidian type with quotidian treatment, it may have 
already reverted to another type-even to the quartan; and we jubilated for two 
days over the value of a remedy that really has no results. 
"We know, however, that any powerful revulsion, whether mental, moral or 
physical, will prevent a chill, and over them turpentine has no special advantage, 
it only being one of that class. A blister in action, alcoholic stimulants, narcotic 
medicines, sudden shock-as from a plunge into water, exciting news-good or bad, 
stave off chills; and we all know this, but rarely resort to them therapeutically. In 
this view of the subject we may regard the labors of our reporters as useful, in 
•calling our attention to the value of such revulsive agents ! Again, many persons 
have chills, as it were constitutionally, that is, all their physical and intellectual 
disorders are characterized by this symptom! These cases will be cured by purga- 
tives, by tonics or nervines, but none of them by the anti periodic treatment, per se. 
Some never get well, no matter what the treatment, until they have changed either 
their habits or their location. In the cases before us, while a large number are 
reported as cured by this remedy alone, it does not weaken our position that many 
cases (especially intercurrent chill) get well without any treatment at all, and in 
the bulk of the cases, the turpentine application was either preceded by purgatives, 
simple or mercurial, or accompanied by remedies of known tonic, antiperiodic, 
alterative or nervine properties, thus introducing new complications which pre- 
vent a determination of the question. Again, these cases, generally speaking, 
being intermittent fever of a mild type, the patients were often reported to duty if 
in two or three days the chill failed to appear. Here is another grave impediment 
to frustrate our efforts after truth, for nothing is so common as that a chill will 
cease temporarily, except the certainty of its early recurrence. We may conclude, 
therefore, that the terebinthina externally applied is one of the largeclass of agents 
which may be rendered useful in the treatment of periodic fever, as an adjunct to 
other remedies, but that it does not deserve to be regarded as a specific in the treat- 
ment of such affections."-Confederate States Medical and Surgical Journal, vol. 
1, August 1864, pp 119-120. 
HYDROCHLORATE OF AMMONIA, SAL AMMONIAC. 
Dr. Felix Jacquot has carefully experimented with hydrochlorate of 
ammonia in the Military Hospitals at Rome, with a view to determine its 
value in the treatment of malarial fever. The doses employed were from 
eight to twelve grammes in the day. The experiments were made upon 
twenty-one subjects with the following results : In six cases the fever was 
cut short, giving28 per cent.; one case presented one paroxj^sm after the 1098 
Arsenic in the Treatment of Various Diseases. 
administration of the medicine, that is, 4 per cent, of the whole number; 
one case presented two paroxysms, also 4 per cent.; eleven cases, or 52 per 
cent., presented three or more paroxysms in spite of the medicine; and 
there were two cases which could not be placed in these categories, but 
which were not cut short. It will be seen from these experiments that 
more than one-half the cases were uninfluenced by the hydrochlorate of 
ammonia, and whilst the six ca^es (28 per cent.) of the entire number cut 
short, would appear to show a powerful febrifuge operation, it is only 
apparent and not real, for according to M. Jacquot more than one-third 
of the cases submitted to expectation recover spontaneously. The results 
of these experiments, as far as they extend, not only show that the greater 
part of the fevers are unaffected by this salt, but that where the fever is not 
arrested the marsh cachexia becomes quickly developed and assumes an 
accelerated course during its administration. 
According to this observer, sulphate of quinia succeeds admirably in 
arresting fevers against which sal ammonia is powerless; and he concludes 
that hydrochlorate of ammonia bears no therapeutical pretensions in the 
intermittents of hot countries, and that there is much doubt of its capacity 
of rendering any service in those of Europe. "Experiments with several 
pretended substitutes for cinchona in the Military Hospitals at Rome. By 
Dr. Felix Jacquot (Archives Generales, June, 1854, p. 678:) Abstract of a 
Report on Materia Medica, by Edward Ballard, M. D. Brit. & For. Med. 
Chir. Rev. vol. xvi, p. 191." 
Arsenic (Arsenious Acid). 
The value of arsenic in the treatment of malarial fever has been cele- 
brated by numerous reliable observers, and the medicine ranks with many 
practitioners second only to quinia. We shall not, therefore, enter into 
any extended examination of its medicinal properties, but shall content 
ourselves with the presentation of the recent and most valuable investiga- 
tion of Dr. Felix Jacquot in the Military Hospital at Rome, premising that 
arsenic exists in the Southern Confederacy and only needs an effort for its 
extraction from the earth. The paper of Dr. Jacquot is a summary of a 
memoir addressed to the Conseil de Sante des Armees on the employment 
of arsenic in the treatment of intermittent fevers in general, and of those 
of Rome in particular, based upon 102 observations, and we present it 
without alteration, as it appeared translated in the British and Foreign 
Medico-Chirurgical Review, vol. xvi, 1855, pp. 189 to 191. 
1. Mode of Experimenting.-In order to establish the efficacy of arsenic 
as a febrifuge its administration should be limited to those cases which 
have resisted treatment without the use of quinine. The author of the 
paper before us has not strictly followed this course, since, giving the 
arsenic at the outstep in the majority of the cases, he had no means of 
judging whether the fever was about to proceed steadily with its paroxysms, 
or whether, on the other hand, it had a tendency to spontaneous disap- 
pearance. But as the sulphate of quinia was administered in the same 
way, it was at least in a position to establish the comparative efficacy of 
the two medicines. His researches, too, permit him to consider separately 
the treatment with arsenic alone, and the complete treatment by this rem- 
edy, emetics, etc. Arsenic alone cut short the fever only in 8.33 per cent, 
of the cases, but the complex treatment in 16 66. But while the efficacy of 
the arsenic is doubled by the conjoined uses of emetics, the febrifuge pow- 
ers of the sulphate of quinine are so great, that those of emetics simulta- 
neously employed are lost or absorbed in them; thus, the percentage of Arsenic in the Treatment of Various Diseases. 
1099 
fevers cut short by sulphate of quinine without emetics is 49.52, and by 
sulphate of quinine with emetics 50.47, as calculated in 210 fevers. 
2. Formula, Dose, Duration of Use of Arsenic.-The formula used was 
the following: Arsenious acid, 1 gramme; distilled water, 1 kilogramme. 
The arsenic is boiled with more than this quantity of water till dissolved, 
and the latter reduced to the prescribed quantity, some soda being added, 
should the solution be imperfect. The dose of solution was administered 
in canella wine. The author could derive nothing but confused ideas of 
the proper dose from writers on the subject, nor yet of the rapidity of its 
action. 
3. General Accidents, Tolerance.-Most subjects bear, without general 
accidents, three centigrammes at the outset; yet, on the other hand, the 
tolerance has persisted sometimes in spite of long continued large doses. 
Out of seventy-two cases treated by arsenic, he has only noted general 
accidents six times, never fatal, and only once a source of anxiety. The 
local and general tolerances are quite independent of each other. The 
author considers the action of arsenic to be sedative, hyposthenic. In one 
of his subjects the pulse fell to fifty. General loss of strength, lassitude 
particularly affecting the legs and loins, have appeared to him the earliest 
phenomena of poisoning by moderate doses of arsenic; and while he thus 
differs from those who class it among the tonics, he asserts that it has no 
tonic operation, even upon subjects suffering under marsh cachexia. 
4. Local Accidents, Tolerance.-Out of the 72 cases treated by arsenic, 
24 or 25 presented gastro-intestinal accidents. The first dose of one centi- 
gramme may cause vomiting and epigastric pain; but, on the other hand, 
he has seen six centigrammes given by the mouth tolerated; and in others 
he has seen the arsenic continued for a month without the stomach revolt- 
ing against it. Although the conditions favorable to the tolerance are not 
well known, yet he can mention the smallness of the dose, its ingestion iu 
divided portions, and the quantity, and perhaps nature, of the vehicle. 
The local accidents are nausea, vomiting, diarrhoea, malaise, and some- 
times pinchings at the epigastrium, and an insurmountable disgust at the 
medicine. Either general or local accidents followed in 31 out of his 72 
cases, or in 43 per cent. 
5. Autopsies of Individuals Treated with Arsenic.-In three subjects 
examined nothing was discovered which could be imputed to the employ- 
ment of arsenic, either in the heart or in any other part of the body. 
6. Degree of the Efficacy of the Arsenic, Comparison with Sulphate of 
Quinine, etc.-The cases in which M. Jacquot founds his comparison are 
those which had not received any previous treatment calculated to interfere 
with the accuracy of his experiments. He thus tabulates his results: 
Sulphate of Quinine. 
Arsenic. 
Fevers cut short, i. e. which have not presented a single par- 
oxysm from the commencement of the medication 
50.00 
13.88 
Fevers which had presented one paroxysm in spite of the 
medication, but in which the second had been averted 
25.71 
22.22 
Fevers which have presented two paroxysms, but in which 
the third has been averted 
7.61 
12.50 
Fevers which have presented three or more paroxysms 
5.23 
34.72 
Fevers which cannot be introduced into these categories, but 
which must be regarded as not cut short 
11.42 
16.66 
The arsenic with or without the emetic has cut short the fever 13.88 
times per cent.; the sulphate of quinine, with or without emetics, 50.00 
times per cent.: that is to say, the arsenic has been efficacious as one, the 
sulphate of quinine three times and a fraction. The arsenic with emetics 1100 
Arsenic in the Treatment of Various Diseases. 
cut short the fever 16.66 times per cent.; the sulphate of quinine without 
an emetic, 50.47 times per cent.; that is to say, the arsenic has been effica- 
cious as one, the sulphate of quinine as three and a fraction. The arsenic 
without emetic has cut short the fever 8.33 times per cent.; the sulphate of 
quinine without emetic, 49.52 times percent.; the proportion being arsenic 
as one, to sulphate of quinine as five and a fraction. Lastly, in comparing 
the cases the most favorable to the arsenic, viz., those in which it was 
administered in large doses, three to ten centigrammes, accompanied by 
emetics, and a diet whose only limit was the appetite of the patient, with 
the cases least favorable to the quinine, we arrive at the following results: 
Fevers cut short by arsenic, 9.68 per cent.; fevers cut short by quinine, 
49.52 per cent. As respects the cases not cut short, it will be perceived, 
on referring to the first four figures of the two vertical columns of the table, 
that in the instance of the fevers treated with quinine, the numbers are 
smaller and smaller, according as we examine the categories of cases more 
and more refractory, whilst the contrary is noticed in the instance of the 
arsenical treatment. The contrast is perfect. 
In about thirty-five cases it was possible to compare the effects of the 
quinine and arsenic, the two medicines having been administered in suc- 
cession to the same patient, either for the same fever or in two separate 
attacks. In a sixth of the cases, the arsenical and quinine treatment were 
of little efficacy; in another sixth, the two medications were followed by 
some success; in the four other sixths the sulphate of quinine showed itself 
the most active, or the only active remedy of the two; and one observation 
furnished a very marked instance of fever resisting the sulphate of quinine, 
and cured by arsenic. In short, the author concludes that we see more 
fevers which resist arsenic yielding to quinine, than we do fevers refrac- 
tory to quinine disappearing under arsenical treatment. He believes, also, 
that he has established the fact of the greater activity of the sulphate of 
quinine in the cases which have received no previous arsenical treatment 
(54 per cent, cut short) than in those first submitted to the action of 
arsenic (40 per cent, only cut short). The general conclusion he draws is 
that the sulphate of quinine is not replaceable by arsenic, and especially is 
this true in respect to the fevers of hot climates, where it is necessary to 
apportion the dose to the intensity of the malady; under the latter circum- 
stances we are immediately arrested in the arsenical treatment by the fear 
of poisoning, in those countries where, from one paroxysm to another, 
the pyrexia may become more severe, remittent and pernicious, arsenic 
should not be employed during the endemo-epidemic season. 
Confirmation of Results by other Observers.-After mentioning MM. 
Mayer, Cordier, Pasquier and Gouge, as arriving at similar conclusions to 
his own, he states that in the Pontine marshes, Dr. Minzi, physician to the 
Central hospital of that country, has experimented with arsenic in more 
than 400 cases, giving it to the extent of three centigrammes a day, and at 
last abandoning it from want of success. M. Salvagnoli Marchetti also, 
out of sixteen cases, found fifteen resisting arsenic. Arsenic in inveterate 
cases and in marsh cachexia.-The observations of M. Jacquot do not encour- 
age recourse to arsenic in inveterate fevers; and M. Cordier also concludes 
from his experience in Algeria, that it is the more recent and slighter 
cases which yield most readily to arsenic. In the palustrial cachexia he 
thinks that arsenic may perhaps be used as an alterative, butthat it isinca- 
pable of replacing iron and other tonics, which it is necessary to conjoin 
with it. 
Relapses.-In preventing relapses arsenic is inferior to sulphate of 
quinine. Out of seventy-two oases treated with arsenic, the relapses were The Use of Arsenic in Gangrenous Wounds. 
1101 
twenty-two, or 30 per cent.-certainly a large proportion. They were less 
frequent in the cases treated with quinine. The relapses occurred even 
during the period of administration of the arsenic, which was continued 
after the cessation of the fever. This was not observed in the instances of 
the quinine treatment. Arsenic in the ingravescent and remittent fevers.-In 
five cases it was observed that in spite of and during the employment of 
arsenic, the simple fever became aggravated remittent, sub-continued and 
pernicious-a fortiori, then, this medicine would have no action upon a 
fever already of this character. Conclusions.-Arsenic is not for a moment 
to be regarded as a substitute for sulphate of quinine. It will probably 
find a limited place in the treatment of indigenous intermittent fevers, but 
it has absolutely no pretensions against the recent endemo-epidemic fevers 
of hot countries. We are scarcely authorized to employ it except in the 
fevers which resist all the preparations of bark. Uncertainty and contra- 
diction reign over almost all points relative to arsenic. It is a medicine 
which we cannot yet handle with the double certainty of obtaining the 
effect desired, and of avoiding the dangers connected with its administra- 
tion. 
These results of the careful observations of M. Jacquot, are worthy of 
most careful consideration by the physicians of the South, on account of 
the similarity of the field of experiment with a large portion of the South; 
and they are especially worthy of most careful examination from their 
antagonism to the most astonishing results which M. Boudin, of Paris, 
claims to have accomplished with arsenic in the treatment of intermittent 
fever. Mr. Boudin affirms that in 4,000 cases of intermittent fever treated 
with arsenic, in the hospitals of Marseilles, Versailles and Paris, from 
1843 to 1851, he had not had occasion to resort in a single instance to sul- 
phate of quinine; and out of 311 cases treated at Versailles in a period of 
thirty-two months, M. Boudin had but ten relapses. It may well be asked 
whether the intermittent fevers of Paris, Marseilles and Versailles do 
not differ greatly in severity and obstinacy from those at Rome; if it be 
true that they are far less severe, then the observations of M. Jacquot would 
express far more truly the value of this remedy to the inhabitants of the 
rich low lands, swamps and marshes of the Southern Confederacy. 
Hippocrates was acquainted with foul malignant, phagedsenic, gangre- 
nous ulcers, etc., gave many valuable precepts upon their treatment: 
Thus, he affirms, that gentle purging of the bowels, agrees with most ulcers, 
and in wounds of the head, belly or joints, when there is danger of gan- 
grene; in such as require sutures, in phagedtenic, spreading and in other- 
wise inveterate ulcers, he directs that the ulcer is to be frequently cleaned 
with a sponge, and then a clean piece of cloth is to be frequently applied 
to it, and in this way the medicine which it is supposed will agree with it, 
is to be applied, either with or without a bandage. Amongst the astrin- 
gent and caustic substances applied by Hippocrates to ulcers, may be recog- 
nized, many used at the present day in the treatment of hospital gangrene, 
as arsenic, sulphates of iron and copper, acetate of copper, oxide and ace- 
tate of lead, carbonates of soda and alum. The Caricum of Hippocrates, 
used as a caustic application to foul gangrenous ulcers, was composed ot 
black hellebore, sandarach, flakes of copper and lead, sulphur, arsenic and 
cantharides. In the long list of remedies recommended by Pliny, in his 
Natural History, for the treatment of foul phagedmnic and gangrenous 
ulcers and wounds, many, as the blood and mashed flesh of dragons, toads, 
serpents, worms and fish, appear evidently to have been recommended 
from superstitious notions, rather than from any real therapeutic virtues; 
but we recognize many really powerful agents, as the salts of copper, iron, 
lead and arsenic. 1102 
The Use of Arsenic in Gangrenous Wounds. 
The Sandarach of Hippocrates, of Pliny, and of the ancient physicians, 
is the realgar of the moderns, red opiment or red sulphuret of arsenic. 
Pliny describes thesandarach as being found both in gold and silver mines. 
The redder it is, the more pure and friable, and the more powerful its odor, 
the better its quality. It is detergent, healing and corrosive, but is most 
remarkable for its septic properties. Applied topically with vinegar, it is 
curative of alopecy. It is also employed as an ingredient in opthalmic 
preparations. Used with honey, it cleanses the fauces, and makes the 
voice more clear and harmonious. Taken with the food, in combination with 
turpentine, it is a pleasant cure for cough and asthma. In the form of a 
fumigation, also, with cedar, it has a remedial effect upon these com- 
plaints. B. xxxiv; C. 55. In combination with the wild astaphis, Pliny 
recommends it as a local application for itch, scabs, and pruirigo, and also 
for the destruction of vermin: in combination with black hellebore and 
copper filings, it removes warts. B. xvii: C. 47; B. xxiii: C. 13. B. xxv: 
C. 22. B. xxviij: C. 62. 
The ashes of blood, and of various plants, calcined shells and bones, 
as well as the excrement of various animals, recommended by Pliny as 
applications to ulcers, without doubt, possess valuable properties from 
their alkaline and stimulant natures; and to this day, the dung of domestic 
animals, and especially of the cow, is. used by the Africans, both in their 
native country and in America, as an efficient poultice to boils, carbuncles 
and phagedtenic ulcers. The various admixtures of myrrh, frankincense 
and balsams, and the astringent principles of certain plants entering into 
the composition of the ointments recommended by Hippocrates, Pliny, and 
the older writers on medicine, without doubt, exerted a most beneficial 
action upon unhealthy and foul ulcers, iu virtue of their stimulant, astrin- 
gent and antiseptic properties. Bile of the beef, which entered into some 
of the local applications to ulcers, is used by the common people to the 
present day, and its virtues are probably due, in part, at least, to its alka- 
line properties, its tendency to assist or modify certain forms of digestion 
and fermentation. 
The various remedies recommended by Hippocrates for the treatment 
of wounds and ulcers were, most probably, even in his day, of ancient 
origin, being derived, in part, at least, from the Egyptians, and from the 
votive tablets in the Temples of the Asclepiadae, and the subsequent medi- 
cal writers improved but little upon the formulae of the father of medicine, 
and their most valuable remedies for the treatment of foul ulcers, owed 
their virtues to the preparations of arsenic, iron, copper, zinc, lead, mer- 
cury and silver. It is evident that the discovery of many of these com- 
pounds were due to the labors of the miners, and the workers in brass and 
iron, and the precious metals; and even the actual cautery dates back even 
beyond the days of Hippocrates, and in such high repute was this method 
of arresting certain forms of disease with the father of medicine, that he 
placed it above all other remedies in power, in his celebrated aphorism: 
"These diseases which medicines do not cure, iron cures; these which iron 
cannot cure, fire cures; and these which fire cannot cure are to be reckoned 
incurable." The surgeon of the present day might learn a valuable lesson 
from Hippocrates, and the older writers, as to the great value of wine as a 
local application in the treatment of ulcers. In those portions of the 
* The St. Louis Medical Reporter, a semi-monthly record of medicine and surgery, edited by 
Oscar F. Potter, M. D. Vol. iii. No. 19. St. Louis, December!, 1868. Historical notes upon the 
employment of arsenic and other escharotics in the treatment of foul malignant, phagedsenic 
and gangrenous wounds and ulcers. By Joseph Jones, M. D., Professor ofCheinistry in the Medi- 
eal Department of the University of Louisiana, New Orleans. The Use of Arsenic in Gangrenous Wounds. 
1103 
writings of Galen, Guido, and other ancient authors, which relate to the 
nature and treatment of putrid phagedaeuic and gangrenous wounds and 
ulcers, may be found frequent references to the potent remedies recom- 
mended by Hippocrates, viz: the actual cautery, and the salts of copper 
and arsenic. Without doubt, the preparations of arsenic were the most 
potent of all the local applications employed by the ancients. And in 
modern times, the attention of the profession has been directed to the great 
value of this agent in hospital gangrene by surgeon H. Home Blackadder, 
in his valuable "Observation on the Phagedsena Gangrenesa." The expe- 
rience of this author is worthy of careful consideration in this conuection, 
and we extract his observations upon the use of arsenic in the British ser- 
vice : 
"Fowler's solution of arsenic is a medicine which is furnished to hospitals on 
foreign stations on account of its well known good effects, when used internally, 
in cases of inveterate intermittent fever. Its employment as an external applica- 
tion, was certainly never intended; yet, if too strong for that purpose, it could 
readily be diluted; and, if found too weak, it might be rendered stronger by evap- 
oration, and thereby made to supply the want of what may be considered a more 
appropriate preparation. 
Having accordingly resolved upon making trial of this solution, I selected two 
severe cases in the inflammatory stage of the disease. One of them had originally 
received a superficial gun-shot wound on the inner side of the knee joint, but at 
this period the sore was upward of three inches in diameter, highly inflamed, the 
whole knee being swelled, and the pain excruciating, so as to make the patient 
cry out incessantly. The other had been wounded through the leg and thigh, but 
in every other respect the state of his sores was similar to that of the former. 
Diluting the arsenical solution with an equal part of water, I commenced its use 
by applying it to the whole surface of the sores, by means of pieces of fine lint, 
having previously carefully removed the glutinous discharge. Each of the patients 
was then provided with a small gallipot, containing a quantity of the diluted solu- 
tion and pieces of fine lint, cut into the shape, but a little larger, than the sores; 
and they were ordered to keep their sores constantly moist with the solution, and 
to renew the lint at least once every two hours. As this application occasioned a 
considerable degree of smarting, when first applied, they were each provided with 
an opiate pill, but accompanied with a strong recommendation not to use it if it 
could possibly be avoided, and by way of encouragement, they were promised a 
certain and speedy cure. On visiting my patients next morning, it was impossi- 
ble not to be struck with a change in the expression of their countenance-from 
that of acute pain, mingled with despair, to that of ease and gratulation. Upon 
inquiry whether the instructions had been strictly adhered to, I was answered, 
'Yes; thank God, we feel now as if in a better world;' and upon examining their 
sores, I found them completely dried up, and covered with a dark, semi-trans- 
parent, and insensible slough, of a somewhat horny consistence. The smarting, 
which was occasioned by the solution when first applied, had ceased, without their 
having had recourse to the opiate pills; and the pain, with which they had been 
more or less tormented from the commencement of the disease, had also been 
removed, soon after the application of the solution. ****** 
The further progress of the disease was evidently completely arrested; and 
by suitable topical applications (to be afterward particularized) for assisting nature 
in throwing off the slough, and cicatrizing the sore, they were, in no great length 
of time, completely cured, without having used any internal medicine, further 
than what might be occasionally required to prevent constipation-and without 
any attention having been paid to the constitutional affection, which, indeed, 
■disappeared of itself, almost immediately after the destruction of the morbid action 
of the sores. ****** From this period the solution of 
arsenic continued to be employed with uniform success. Patients whose sores had 
resisted, as was said, almost every other treatment, were admitted from other hos- 
pitals, and cured by it; and it was also, I was informed, ultimately introduced into 
other hospitals, and proved equally successful." 
Mr. Blackadder further states that the external application of the solu- 
tion of arsenic was again resorted to with equal success, after the battle of 1104 
The use of Arsenic in Gangrenous Wounds. 
Waterloo, in the British hospitals at Antwerp. (Observations on Phagedana 
Gangrensa, pp. 21, 25, 49, 58.) This observer held the view that the 
arsenical solution was more efficient than the actual cautery, and that it 
not only acted locally, but also constitutionally by absorption from the 
diseased surface. The nitrate of the red oxide of mercury, and nitric acid, 
were much recommended, and seem to have been frequently applied locally 
as escharotics in cases of gangrene and foul ulcers, by surgeons in the 
sixteenth and seventeenth centuries. The value of these remedies appears 
to have been clearly demonstrated to the British surgeons by Dr. Roller, in 
1797. This physician, strongly impressed with the belief that a morbid 
poison was acting upon the foul ulcers in the Royal Artillery Hospital of 
Woolwich, which, like the venereal poison, had the power of assimilation, 
and, if being absorbed, thus producing general effects on the system, and 
a reaction on the sore, determined to adopt local measures of treatment, 
consisting in the chemical destruction of the poison, and in exciting a new 
action. 
"The oxygenated muriatic acid, and the nitrates of silver and mercury, were 
the applications employed, and lately the oxygenated muriatic acid and gas. 
When either of these were applied four or tive times the little ulcer soon put on 
the suppurating stage, and granulated. They did not give pain in any degree, and 
it was of short continuance. While the ulcer was directly touched with the 
nitrated silver, the whole sore was moistened with a dilute solution of nitrated 
mercury, or mixture of oxygenated muriatic acid, in distilled water, after which 
the whole was covered with lint that had been previously moisted with aether or 
the oxygenated muriatic gas applied to the ulcer, and over the sore the dilute solu- 
tion of nitrated mercury in distilled water. By these means, diligently persevered 
in, the poison and ulcer were destroyed, and the sore went on cicatrizing. The 
only failures were in those cases where the ulceration had so extended that the 
nitrated silver or oxygenated muriatic acid gas could not be completely employed. 
It is necessary to mention that washing the sore with warm water was always 
previously performed." 
A careful examination of the works of Blane Trotter and others, will 
show that up to the war in Portugal and Spain, in 1813, the British sur- 
geons, as a general rule, did not use the actual cautery as was done pretty 
generally by the French, but treated the disease chiefly as a constitutional 
affection, by blood letting, emetics and purgatives. The indifferent suc- 
cess which attended its treatment by constitutional means and simple 
detergent applications, caused the surgeons of the British army to view it 
more as a local disease, capable of giving rise to some coustitutional 
symptoms. A change of opinion, which was materially influenced by the 
knowledge that the French surgeons more generally considered with 
Ponteau, that it was local in the first instance, and treated it by the actual 
cautery. 
The introduction of the mineral acids, not as then generally used, as 
stimulants or detersives, but as caustics, into the English army, during the 
campaign in Spain, in 1813, under Lord Wellington, wras due to Guthrie. 
This distinguished surgeon affirms that in his hands constitutional treat- 
ment, and every kind of simple, mild, detergent applications, always failed, 
unless accompanied by absolute separation, the utmost possible extent of 
ventilation, and the greatest possible attention to cleanliness, and not even 
then without great loss of parts in many instances. 
This induced Guthrie, at Santander, in November and December, 
1813, to try the mineral acids as caustics. In his hands this proceed- 
ing was always, hovrever, accompanied by a constitutional treatment, 
regulated by the nature of the symptoms, which, at that station, were 
more benefited by bleeding. At Bilboa, in 1813, where caustic applica- Ligatures of the Extremities in Intermittent Fever. 
1105 
tions were most used, or only as detersives, and blood-letting to the amount 
of two, three or four pounds employed, out of 972 cases of hospital gan- 
grene thus treated, 387, or nearly one-half, died. Notwithstanding this 
fearful mortality, Dr. Boggie, who was stationed at Bilboa, strongly advo- 
cated the exclusive constitutional treatment, and affirmed that the disease 
was arrested by bloodletting! At Santander, where Mr. Guthrie intro- 
duced the mineral acids as caustics, out of 160 cases thirty-five, or less than 
one-fourth, died, and at Passages, where Blackadder employed the arsenical 
solution, only two deaths are recorded in forty-one cases of hospital gan- 
grene, or about one death in twenty cases. These preparations of Hippo- 
crates and the ancient physicians, which contained arsenic, as has been 
been shown by modern researches, were both potent and valuable in the 
treatment of foul ulcers and hospital gangrene. 
I have had no faith in and consequently no experience with this mode 
of treating intermittent fever. The following summary of a valuable arti- 
cle by Drs. J. DeBrauw and H. J. Braers, taken from the North American 
Medico-Chirurgical Review, of March, 1859, presents this method of treat- 
ment in a strong, and, in fact, the most favorable light which I have yet 
seen : 
"According to Drs. DeBrauw and Braers, the ligature of the extremities is a 
measure which has been already employed by ancient physicians to aid the treat- 
ment of intermittent fever, but has unjustly nearly fallen into oblivion. Already 
Pinius, (Hist. Nat. xxviii, 6) knew this antiperiodic, as Pittschaft (Hufeland's 
Journ., ii, 3, pp. 47, 48) states, and in Van Sweden's Commentaries to Boerhaaves 
Aphorisms, the 'levis brevisque compressco venaram in arbutus,' is strongly 
recommended as a means to relieve the burning heat of fever. Dr. V. Hildebrand, 
however, declares the remedy, in his Institutiones Practico-Medicse, to be unrelia- 
ble, and in many respects unsafe, and recommends caution in the use of it. Jos. 
Frank, (Prax. Med. Univ. Precepta), speaks of it in a very superficial manner, 
like many others, particularly more recent authors. One of the most enthusiastic 
commenders of this method is George Kellie, (Duncan's Medical Commentaries, 
vol. xix), who, during the siege of Willemstadt, by the French army, in 1793, 
cured many cases of intermittent fever (which had resisted the use of quinine) 
completely by compression of the extremities. Upon this recommendation several 
physicians in England-for instance, Veitch and Wallich, (Mediz. National Zeitung, 
July 1798, and in the Netherlands, Agemene Vaderl, Lettervefningen, 1808, 5), 
tried this method with signal success. Of the more recent communications on this 
subject, that of Prof. Chladni (Hufeland's Journal, xlii, p. 133), is worth particular 
attention. This celebrated savant being attacked in 1813 by an obstinate intermit- 
tent fever, used the remedy with much advantage. He discusses it as quite innoc- 
uous, and explains its curative influence by the supposition, that by ligature of the 
extremities, the return of blood to the heart, and to the centres in general, is hin- 
dered or partially suspended, and that the full development of one of the princi- 
pal symptoms, the chill, being thus interfered with, an interruption and disturbance 
of the whole type of fever takes place. This method belongs, moreover, to one of 
the oldest popular remedies used in Russia, England and France. In Canstatti 
Jahresbericht (Jaborg, 1848, p. 113), the cure of a quartan by application of Junod's 
boot is mentioned, a fact which seems to be intimately connected with the sub- 
ject in question. According to Jolly, (Diet de Med. et de Chir., tome xi, part i, p. 
363), who gives a detailed account of the ligatures circulaires des membres, the lig- 
ature should be applied to the four extremities at the same time, but in such a 
manner that only the circulation in the superficial vessels is suspended. Martinet, 
Robinau, Recamier and Husson, kept up the compression for not longer than 
twenty-five to fifty minutes, and commenced with it in the cold stage. Jolly recom- 
mends taking off the ligaturesone by one, at intervals of several minutes, as by the 
simultaneous removal of the same, too much blood would be at once introduced into 
the circulation. 
LIGATURE OF THE EXTREMITIES IN INTERMITTENT FEVERS. 1106 
Cold Water in the Treatment of Malarial Fever. 
The most complete information on the subject of his investigation, the 
author found in a dissertation of R. V. Baerle: "De valde multiplici febrium 
intermettentium medicatione speciatum de viembrorum viajorum, circumstridione 
tantaminibus in nosocomio academico explorata," Utrecht, 1809. In this 
treatise the ligature of the extremities is thoroughly illustrated by the 
report of seven cases, and highly recommended. V. Baerle commenced 
the treatment with the administration of a gentle purgative; the patients 
were kept in bed, and subjected to a rigid diet during the paroxysm; 
shortly before the commencement of the cold stage, the thighs and upper 
arms were encircled by ligatures exercising a moderate pressure, which 
were removed in from six to fifteen minutes, or later, according to the 
effect they produced; after Wallich's example, he forbade warm drinks 
during the cold stage, but recommended cold drinks in the hot stage. From 
observations of this kind, the author draws the following conclusions: The 
ligature of the extremities is a safe and powerful means of assistance in 
the treatment of intermittent fever; it is not only an adjuvant to other 
antiperiodics, but also a febrifuge by itself. It cures the febris intermit- 
tens simplex and duplex, as well as the quotidiana. In regard to the quar- 
tana no experiment has been made. The ligatures must be allowed to 
remain until the last stage begins; a longer application does not lessen the 
effect. The method seems to owe its curative property to the disturbance 
of the usual course of the fever, (Chladni.) Sometimes the paroxysm is 
transferred under this treatment from the third day to the second, but 
generally so that the tertian type is not interrupted, or that a febris duplex 
is developed. The compression of the extremities is always followed by 
some increase of the heat and perspiration, the signs of an energetic reac- 
tion. After repeated use of this method the fever gradually subsides. 
Contra indications to it never existed, but may be easily inferred from an 
examination of the modus operandi of the remedy. 
Dr. DeBrauer generally applied compression to the extremities only, 
but considers the ligature of all four far more efficacious in obstinate 
cases, and recommends the method as being capable in some cases to sub- 
stitute the use of quinine. In cases of relapse of intermittent fever in 
which the patients complain of that characteristic pain in the lumbar 
region (fifth lumbar vertebrae), against which cups are used without effect, 
Broers recommends the application of the galvanic current to the men- 
tioned spot as a highly serviceable, though occasionally inefficient means. 
After the second or third application of this remedy the cachectic appear- 
ance, as well as the depressed feelings of the patients, underwent a favora- 
ble change. Relapses of the fever, consequent upon a return of the patient 
into the malarious district, yielded quickly to this mode of treatment, 
even when quinine was administered without success."-Nederland Tijd- 
sche, 1858, and Medizinsche Neuigkeiten, 1858, No. 44. 
COLD WATER IN THE TREATMENT OF MALARIAL FEVER. 
It would be foreign to our purpose to enter into any discussion of the 
mode of action of water in fevers, for, as the most universal of all solvents 
in which the elements of the blood are dissolved or suspended, and as the 
largest constituents of the solid as well as of the fluid components, and as 
the great medium of the introduction of the nutritive elements, and of the 
chemical changes which develop the forces which work the machinery of 
the human body, as well as of the removal of the products of these chem- 
ical changes, water occupies such a prominent position in all the processes 
of health and disease, that it would be impossible to discuss either its Cold Water in the Treatment of Malarial Fever. 
1107 
value or its mode of action in fever in the limited space now at my com- 
mand, and we must content ourselves with a few practical observations and 
reliable testimony to the value of water as an external application, reserv- 
ing the extended discussion for a future occasion. Now that the old 
notions with reference to the injurious effects of water and fresh air have 
vanished with the progress of medical practice, based upon sound physio- 
logical principles, we cun scarcely realize the powerful effects of water in 
the treatment of fever, without a careful comparison of the symptoms, pro- 
gress and mortality of diseases before and after its free use. 
As an external application, the value of cold water, though not 
unknown and not unemployed by the ancients, was not appreciated by the 
profession until after the publications of Dr. William Wright,* 1586, and 
especially of Dr. J. Currie,f of England. Dr. Wright first adopted the 
practice in his own case and succeeded in arresting the progress of the 
fever after twice applying the cold affusion. The success of this trial led 
other physicians to adopt this mode of treatment; and Dr. Currie eleven 
years afterwards published in Liverpool his valuable medical reports 
founded upon accurate observations of the effects of cold water, which 
exerted a most beneficial effect in removing the strong and injurious preju- 
dices against the free use of cold water in fevers. 
We might adduce numerous testimonies to the value of the external 
application of water in various fevers, as typhus, typhoid, intermittent, 
remittent and congestive, from the time of Dr. Currie to the present, but 
we must defer these for a more extended discussion, having room merely to 
present a few points of practical interest: 
Precautions recommended by Dr. Currie when the Cold Affusion is contemplated. 
1. This remedy should never be used when there is any considerable 
sense of chilliness, although even the thermometer indicate a morbid degree 
of heat. If the affusion of cold water on the surface of the body be 
employed during the cold stage of the paroxysm of fever, the respiration 
is nearly suspended, the pulse becomes feeble and fluttering and of incal- 
culable frequency, the surface and extremities are doubly cold and shriv- 
elled, and the patient seems to struggle with the pangs of instant death. 
Under such circumstances the repeated affusion of a few buckets of cold 
water would extinguish life. 
2. Neither ought the cold affusion to be employed when the heat, 
measured by the thermometer, is less than, or equal to, the natural heat, 
notwithstanding the patient feels no sense of chilliness. This is sometimes 
the case towards the last stages of fever when the powers of life are weak. 
3. It is also necessary to abstain from the use of this remedy when 
the body is under profuse sensible perspiration, and this caution is more 
important in proportion to the continuance of this perspiration. In the 
commencement of sweating, especially if it has been brought on by violent 
exercise, the affusion of cold water on the naked body, or even immersion 
in the cold bath, may be hazarded with little risk, and sometimes may be 
resorted to with great benefit. After the sweating has continued some 
time, and flowed freely, especially if the body has remained at rest, either 
the affusion or immersion is attended with danger, even though the heat 
of the body at the moment of using it be greater than natural. Sweating 
is always a cooling process in itself, but in bed it is often prolonged by 
* Formerly of the Island of Jamaica, published an account in the London Medical Journal 
for 1786, of the successful treatment of some cases of fever, by the ablution of cold water. 
t Medical reports on the effects of water, cold and warm, as a remedy in fever. 1108 
Cold Water in the Treatment of Malarial Fever. 
artificial means, and the body prevented from cooling under it to the 
natural degree by the load of heated clothes. When the heat has been 
thus artificially kept up, a practitioner, judging by the information of his 
thermometer only, mav be led into error. In this situation the heat sinks 
rapidly on the exposure of the surface of the body even to the external 
air, and the application of cold water, either by affusion or immersion, is 
accompanied by a loss of heat and a deficiency of reaction which are alto- 
gether inconsistent with safety.-Medical Reports, etc. By J. Currie, 1797. 
According to the experience of Dr. Currie, if employed on the first or 
second day with the precautions recommended, the progress of the fever 
is often checked, but it is seldom successful when applied so late as the 
third or fourth day, though when administered about the eighth or tenth 
day, or even later, it moderates the symptoms and shortens the duration 
of the fever. More recent observations have shown, however, that whilst 
typhus fever may be thus cut short, this remedy fails almost universally in 
arresting typhoid fever, which runs a definite course and is characterized 
by as definite pathological alterations as scarlet fever, measles and small- 
pox. When the fever has run on for eight or nine days and the patient is 
weak, the heat of the water should be only a few degrees below that of the 
patient, and at this period it is preferable to sponge the body with cold or 
tepid vinegar and water. 
Testimony of M. Fleury to the value of Cold Douches in the Treatment of 
Intermittent Fever. 
M. Fleury, in his memoir on this subject, presented to the French 
Academy, states that he was led to these researches by the assertion of Dr. 
Currie, that the accessions of ague might be prevented by the affusion of 
cold water, and that by its repetition four or five times, the disease might 
be entirely cured. M. Fleury has employed this means one or two hours 
before the expected paroxysm in the form of a general douche, and in that 
of a local one to the region of the spleen. 
The ends attained by the above plan he believes to be: 1. A shock 
exerted on the nervous system and on the general capillary circulation. 
2. The opposing of a vigorous reaction and general stimulation of the sur- 
face to the cold stage of the fever. 3. A modification of the circulation of 
the spleen, combatting congestion of that organ. He has pursued this 
treatment in eleven cases of intermittent fever. In seven of them the dis- 
ease was recent, and there had been but from three to seventeen parox- 
ysms; quinine had not been administered in any one. In two cases the 
spleen preserved its normal size; in five it was enlarged; a cure was 
effected in all. In one a single douche sufficed to cut short the fever. In 
two others two affusions were necessary to do so, and to restore to the 
spleen its natural dimensions. In the remaining four affusion was prac- 
tised three times. In those patients where two or three douches were used 
the effects produced were constantly the same. By the first application 
the accession was retarded two or three hours, the rigors less violent and 
shorter by one-half or five-sixths the time; the heat and headache were 
equally lessened, and the total duration of the fit was diminished at leasu 
one-half. 
Age and the type of the fever did not exercise any appreciable influ- 
ence over the effects of the treatment. Where, however, the volume of the 
spleen was larger the time required for the cure was augmented. Four 
patients had suffered from the disease for from two to eleven months, 
having had several relapses, and having resisted the action of sulphate of 
quinine, and presented the anaemia, emaciation, anorexia, etc., seen in those Treatment of Fevers by Cold Water. 
1109 
who have long been affected by ague. Three douches were required in two 
of these cases and five in one other to remove the fever, but from eight to 
eleven were necessary to cause the splenic engorgement and the cachectic 
symptoms to disappear. In one case the liver was very greatly enlarged, 
but this condition disappeared by perseverance with the affusions. M. 
Fleury arrives at the following conclusions: 1. In the treatment of recent 
intermittent fever, simple and with little or no engorgement of the spleen, 
cold douches may be substituted for quinine. 2. In the treatment of old 
standing ague, where several relapses have occurred, and there is consid- 
erable enlargement of the spleen, or of the liver, with a cachectic condition, 
cold affusions are to be preferred to quinine, for they cut short the fever, 
restore the viscera to rheir natural volume, and remove the cachexy more 
safely than quinine, the latter in large doses not unfrequently acting inju- 
riously upon the nervous system, or on the digestive organs.-(Bulletin 
des Academies and Lancet.) Banking's Half Yearly Abstract of the Med- 
ical Sciences, No. 7, January to June, 1848, p. 68. 
ENGRAVING NO. 120. 
Apparatus for Bathing Patients during the Febrile Stages of Remittent and 
Typhoid Fevers. 
Engraving No, 120.-Apparatus for bathing patients in the febrile stages of remittent, 
typhoid and typhus fevers. 
The mechanical difficulties of carrying out the cold water treatment of 
fever in private practice are very great and in most cases almost insur- 
mountable. To avoid exertion on the part of the patient a sufficient num- 
ber of strong experienced attendants capable of lifting the patient in and 
out of the bath should be at hand. In hospital practice the necessary 
number of nurses and assistants may be commanded. 
In all cases the bath should be brought to the bedside, and the patient 
lifted in and out, so as to prevent any exertion on his part. We have 
represented in Engraving No. 120, an apparatus planned by Mr. D. A. 
Fardon, the resident medical officer of the Middlesex Hospital, and con- 
structed by Mr. Hawksley, the surgical instrument maker of Oxford Street, 
London. 1110 
Cupping in Malarial Fever. 
This apparatus consists of two uprights wTiich move on wheels, and 
a cross bar. A kind of hammock made of strips of webbing is placed 
under the patient, and then attached by a suspender to the cross bar. By 
mhans of pulleys and an endless chain the hammock is lifted from the bed, 
then slid along the bar till it is over the bath and let down into it, and 
drawn up again in the same manner. This simple and efficient apparatus 
not only entirely relieves the nurses of any strain, but also affords a safe 
and comfortable bath to the patient. It is equally adapted to the hot or 
warm baths. This apparatus has been extensively employed in the Mid- 
dlesex Hospital, and in the London Fever Hospital. In protracted cases of 
remittent fever, the temperature should be regarded as an important factor 
in the duration, pathological changes and final results. The author has found 
sponging with cool water, sedative water, bay-rum, and dilute alcohol or 
whiskey, beneficial in reducing the temperature in the elevated tempera- 
ture of malarial remittent fever. It must be observed, however, that unless 
quinine be freely and fully administered at the same time, that the reduc- 
tion of temperature occasioned by the cold water treatment in malarial 
remittent fever will be only temporary and in part, the rise of tempera- 
ture subsequently to the cold bath may be even greater than if it had not 
been used, if this measure alone is relied upon. As far as the experience of 
the author extends, the use of quinine by inunction, in conjunction with 
its internal administration, is a more potent means of reducing the febrile 
heat than the cold water applications, and the effects are more lasting and 
beneficial. 
Thus various methods may be employed iu the external application of 
quinine. We have frequently employed the following with benefit : 
R.-Quinia sulph., si; linamenti saponis, f^iij; olei olivm, f^iij. Mix. 
Use as a liniment over the spine, abdomen, in the bend of the elbows and 
knees and in the axilla. 
Not only is the sulphate of quinia thus introduced into the circulation, 
but the alcoholic solution of soap combined with olive oil tends to open the 
pores of the skin, promotes perspiration and aids the reduction of the 
animal heat. 
CUPPING IN MIL A RIAL FEVER. 
The cerebro-spinal nervous system is the seat of hypersemia in the 
congestive stage of malarial fever, and this congested state of the blood- 
vessels is presented to a greater or less extent in ali protracted cases of 
remittent malarial fever. Hence both dry and cut cups are often indi- 
cated in the treatment of the various forms of malarial fever. The appli- 
cation of dry cups over the region of the spinal cord will, in some cases 
which have proved refractory to the effects of quinine, be efficient means 
in arresting the paroxysms. I have myself experienced the great value 
of cupping over the region of the spine for the arrest of paroxysmal fever. 
In 1878, I was attacked with yellow fever on the 6th of October. My 
strength had been greatly reduced by incessant attendance upon the sick 
in New Orleans, and also by attending and nursing my own children 
suffering with yellow fever. By imprudence in attempting to resume my 
practice, I suffered a relapse about the fourteenth day of the disease. The 
relapse was attended with intense jaundice, and the formation of a large 
carbuncle on the neck just below the occiput. A blister applied by the 
physician over the chest and abdomen produced strangury and urinary 
retention. Worn down by incessant fever, delirium and intense pain in 
the head, back and in the large carbuncle, the only chance of life appeared 
to be a change of air from the infected atmosphere of New Orleans, and Prevention of Malarial Fever. 
1111 
accordingly, on the 1st of November, I was placed in a delirious state on 
the cars, and accompanied by my wife and son, Charles C. Jones, made the 
journey from New Orleans to Augusta, Georgia, and from thence to the 
hospitable home of my brother, Col. Charles C. Jones, on the Sand Hills 
near the latter place. Without entering into the details of the sufferings 
of this terrible journey and subsequently, we will simply state that fever 
was not absent for more than a short period upon any one day for the 
space of one hundred and twenty days; and although during this period 
from fifteen to twenty grains of quinineXabout 1500 grains in all) were daily 
administered, the fever did not disappear until a large number of dry cups 
were applied to the back over the region of the spine by the direction of 
my skilful physicians, Dr. Lewis D. Ford, Dr. L. A. Dugas, and Dr. 
Henry F. Campbell, of Augusta, Georgia. My final recovery was due to 
the skill of these eminent physicians, and to the devoted attention of my 
wife, son and brother. The relief which I experienced from the applica- 
tion of the cut-cups was marked and permanent, as far as the return of 
this fever was concerned. Although almost totally blind, and reduced to 
"a skeleton," I was able to sit up, then to walk the length of the bed, 
then in a day or two across the room, then twice across the room, and on 
the 24th of December, although still feeble, I was able to return by rail 
from Augusta, Georgia, to New Orleans, Louisiana. 
PREVENTION OF MALARIAL FEVER. 
No subject is of greater importance to the inhabitants of tropical and 
temperate regions of the earth than the destruction or removal of the cause 
or causes of malaria. The following propositions should be considered in 
the discussion of the measures which may be proposed for the destruction 
or removal of the causes of malaria: 
1. Malaria inflicts a vast amount of disease and suffering upon the 
human race, and directly and indirectly causes a considerable portion of 
the mortality in tropical and temperate climates. Notwithstanding the 
preceding facts, the arts and sciences, and the highest types of ancient and 
modern civilization had their rise and development in the most mala- 
rious portions of Africa, Asia and Europe. Along the banks of the Nile, 
in its hot malarious delta, we find the remains of an ancient and grand 
civilization, which gave birth to that of Greece and Rome; and the great 
commercial cities of the Phoenicians were located around the malarious 
borders of the land locked Mediterranean. Even medicine had its first 
birth along the marshy waters of the Nile and in the temples of Isis and 
Osiris. The works of Hippocrates (the father of European medicine) were 
based upon the knowledge which had crossed the Mediterranean from the 
shores of Africa, and the greater portion of the cases which he details relate 
to the various forms of malarial fever. Rome conquered the world with 
the sword and destroyed her citizens by malarial fevers; and through all 
her various changes from universal empire to a contracted hierarchy, 
through all ages, she has retained her deadly malaria. In the malarious 
regious of Italy and Spain were born and reared Columbus, Cortez, Pizarro, 
Ponce de Leon and Ferdinand de Soto. In the malarious regions of the 
Southern States were bred such men as Washington, Jefferson, Lee and 
Jackson. The star of empire which has been steadily passing from the East 
to the West, has halted in its progress in the great malarious Valley of the 
Mississippi, where it will remain as the centre of political power, physical 
development and scientific advancement. In those regions in which the 
earth gives malaria, she also bestows her most bounteous gifts, golden 1112 
Prevention of Malarial Fever. 
grain, luscious fruits, and every variety of animal and vegetable food. 
Thus the baneful effects of malaria are counterbalanced to a large extent 
by the mild and genial climate and the bounteous products of field, forest, 
river, lake and ocean. 
2. The labors of man in clearing the forests, opening and deepening 
the channels of rivers, draining and tilling the land, have altered the cli- 
mate and changed the character of the diseases of large portions of the 
earth's surface. The malarious belt of the earth has been thus pro- 
gressively circumscribed by the labors of the agriculturist. In the present 
century the removal of the causes of malarial fever has been greatly facil- 
itated by the extensive introduction of improved implements and machinery 
and the use of steam. The drainage of lagoons, swamps and marshes, as 
well as of the land generally, has removed certain conditions favorable to 
the development of simply constructed organisms and morbific ferments. 
With the increase of the human race and the advancement of agriculture 
and the mechanical arts there will be a progressive diminution of the 
empire of malaria. The labors of the agriculturist have banished mala- 
rious diseases from the greater portions of England, France and Germany. 
In the early settlements of South Carolina and Georgia the clearing off of 
the dense virgin forests, even in elevated, hilly regions, was attended with 
the development of the severest forms of remittent, intermittent and con- 
gestive fevers. At this day the old red clay hills of Carolina and Georgia, 
which have been denuded of their rich soil by an imperfect system of agri- 
culture, are proverbial for their freedom from malarial diseases. 
3. Centuries must elapse before the low grounds, marshes, ponds, 
lagoons and swamps of the United States of America, and more especially 
of the great Valley of the Mississippi, will be thoroughly drained and 
under cultivation. The rich returns yielded by sugar cane, rice and cotton 
will ever tempt the laborer to disregard the effects of climate; and the gaps 
in their ranks will ever be speedily filled with new recruits. The question 
arises, what can be done to protect the laborers in the swamps, rice-fields 
and marshes of the Southern States from the effects of malaria? The author 
has witnessed upon thousands of occasions the destructive effects of mala- 
ria upon the human constitution. If the hardy sons of Ireland, England, 
Germany and France, and even the dark Latin races of Italy, Spain and 
Portugal enter the swamps and marshes and rice-fields of our Southern 
States as laborers, they are almost universally attacked with the various 
forms of malarial fever during the months of July, August, September, 
October and November. Many who escape the immediate fatal effects of 
the acute form suffer with diffuse parenchymatous hepatitis, malarial 
nephritis, anaemia, anasarca, ascites and prostration of the muscular and 
nervous forces. Vast numbers of men have perished from the effects of 
malaria and exposure in building the railroads of the United States. This 
subject should be thoroughly investigated by the National Government. 
At the present time vast numbers of men from all parts of the civilized 
world are suffering and perishing from the deadly effects of the malaria of 
the Central and South American States, and more especially from the fevers 
of the Isthmus of Panama. How to protect the laborer from the effects 
of malaria should call forth the earnest consideration of every civilized 
nation. 
Preceding the American Civil War, in 1859 and 1860, the author under- 
took an extended investigation of the diseases of the various geological 
and physical divisions of the Southern (slave States). The investigation 
of the soil, waters and diseases of the rice plantations, low grounds and 
swamps of Georgia first engaged his attention. Upon the present occa- Poisonous Effects of Stagnant Swamp Water. 
1113 
sion we shall present only two results of these labors, namely, those facts 
which illustrate the poisonous nature of the stagnant water of the swamps and 
the rules formulated by the author for removing, at least some of the causes of 
malaria from amongst the laborers on the rice plantations. 
POISONOUS EFFECTS OF THE STAGNANT WATERS OF THE SWAMPS OF LOW 
MALARIOUS REGIONS. EXPERIMENTS ON LIVING ANIMALS.* 
Analysis 43. Stagnant swamp water, Arcadia swamp, Liberty Co., 8 miles from 
its Junction with the North New Port River, June Isi, 1860. Liberty County, 
Georgia. 
Water taken from a deep basin in the large canal which drains the 
rice-fields; the swamp was entirely dry with the exception of the deeper 
portions of the canal, the waters of which had ceased to flow for at least 
three months, the season having been unusually warm and dry. The fish, 
terrapins, frogs, alligators and snakes had all collected in these pools of 
stagnant water. Many fish had died in these pools of stagnant water, and 
the living catfish kept their mouths and feelers upon the surface of the 
water. As the eye rested upon the black and green, turbid waters, scarcely 
a spot could be discovered, not occupied by the mouths and feelers of cat- 
fish moving tremulously about upon the surface of the water like so many 
large spiders; in fact, upon a general view these pools resembled a dark 
surface of black and green liquid mud, upon which thousands of large spi- 
ders were dancing. Every now and then, the monotony would be broken 
by the splash of a mudfish or garfish, or conger eel, or the plunge of a bull- 
frog. The catfish appeared, in their distress and anxiety to absorb the 
oxygen from the atmosphere, to disregard alike the presence of man, and 
of the moccasins and water snakes which sluggishly moved in the stagnant 
pools, amongst their feelers, apparently satiated and disgusted. These 
stagnant pools, and in fact the whole swamp, under a burning sun emitted 
a most sickening and disgusting stench. Exposure to this atmosphere, 
contaminated with the gases arising from the decomposition of vegetable 
and animal matter, during the heat of the day from 10 o'clock in the morn- 
ing until 3 o'clock in the afternoon, obtaining specimens of water and 
capturing the cold-blooded reptiles, was followed before night by an active 
diarrhoea. I have before suffered in a similar manner from exposure to 
these swamps in the summer season. Sulphate of quinia taken upon the 
appearance of the first symptoms of lassitude and of undue action of the 
bowels, was the means of relieving the unpleasant effects of this exposure 
in two days; and I have upon other occasions, when I have been similarly 
exposed, in the prosecution of my inquiries, experienced beneficial effects 
from sulphate of quinia used as a prophylactic. The power which quinia 
possesses of averting an attack of malarial fever, is most valuable to the 
planters of these regions, who are often during the harvesting of rice, 
necessarily exposed to the deleterious effluvia of the swamps. That the 
diarrhoea was caused by the effluvia of these swamps inhaled during the 
collection of the waters and samples of the swamp mud, and of the natu- 
ral history specimens, was proved by the fact that my servant man (a 
strong healthy negro who resided upon the plantation one mile from this 
swamp), who assisted in procuring the specimens, was also attacked at 
night with diarrhoea. I was anxious to test the effects of these waters when 
absorbed directly into the blood. They were placed in bottles, hermeti- 
* First Report to the Cotton Planters' Convention of Georgia, on the Agricultural Resources 
of Georgia, by Joseph Jones, M. D., Professor of Chemistry, Medical College of Georgia, etc. 
pp. 269, 272, Augusta, Ga., 1860. 1114 
Poisonous Effects of Stagnant Swamp Water. 
cally sealed, and upon my return to Augusta, two days after, I injected 
several fluid ounces into the subcutaneous tissue of a large Newfoundland 
dog. The water was injected into the subcutaneous tissue of the back and 
right fore and hind-legs. At the time of the injection the water had the 
same sickening smell of the swamp. No special symptoms were induced 
by the injection of the water, at the time; but upon the next day, there 
was a slight rise in the temperature of the dog, and the parts upon the 
back and legs where the swamp water had been injected were greatly swol- 
len. Upon the third day the parts were lanced, and discharged much 
green and yellowish green, exceedingly offensive matter, together with 
much most foul and fetid air. The parts continued to discharge large 
quantities of foul matter and air for ten days. Tar was applied liberally 
around, and within the orfices of the abscesses, to keep away the flies, 
which would I am confident have destroyed the dog. The dog lost flesh 
to a considerable degree, but recovered entirely in three weeks. 
At the end of one month he was killed by the subcutaneous injection 
of acetate of morphia, and a careful examination with the naked eye and 
with the microscope was made of all the viscera; no lesions of the organs 
were discovered, and no alterations of the viscera were manifest, the color 
of the liver was natural, and the spleen was not enlarged. The swamp 
water was not injected directly into the blood-vessel system, for I felt con- 
fident that the animalcules and suspended matters which could not be 
removed by filtration would have produced death by interfering with the 
capillary circulation in the lungs, independently entirely of any direct 
poisonous effects. The highly complex nature of these waters will be seen 
in the following analysis : 
Specific gravity, 1000.661; solid residue in 100,000 grains, 23.400; sus- 
pended matters in 100,000 grains, 100.000. 100,000 grains contain sus- 
pended matters, 100 grains-Phosphates of lime and magnesia, 22.224; 
phosphoric acid, 13.958; lime and magnesia, 8.266; chlorides of sodium, 
potassium, calcium and magnesium, sulphates of soda, potassa, lime and 
magnesia, phosphates of soda and potassa, 5.733; organic matters, animal 
cules, microscopic plants, decaying, vegetable and animal matters, urea, 
uric acid, salts of ammonia, crenic, apocrenic and humic acids, 15.101; sili- 
cates of alumina, potassa and lime, silicic acid, peroxide of iron, 56.892. 
Gases.-Sulphuretted hydrogen, 3.488; sulphur, 3.283; hydrogen, 205; phos- 
phuretted hydrogen, carburetted hydrogen, carbonic acid gas, carbonic 
oxide gas, atmospheric air, oxygen, nitrogen, other undefined gases. Solid 
residue, 23.400-Carbonate of lime, 3.122; lime, 1.487; carbonic acid, L.635; 
carbonate of magnesia, 0.455; magnesia, 0.217; carbonic acid, 0.238; chlo- 
rides sodium and potassium, 2.946; sodium and potassium, 1.350; chlorine, 
1.596; sulphates soda and potassa, 4.223; soda and potassa, 2 050; sulphuric 
acid, 2.173; silicic acid, 0.213; phosphates of soda, potassa, lime and mag- 
nesia, trace; chlorides of magnesium, calcium and aluminium, trace; 
organic matters, humic, ulmic, crenic and apocrenic acids, animalcules, 
microscopic plants, ammonia, urea, uric acid, urate of ammonia, 2.450; 
putrefying vegetable and animal matters; undefined vegetable and animal 
matters. 
We thus demonstrated in 1860 the poisonous nature of the waters of 
swamps and their power to produce fever and dysentery in living animals 
when injected subcutaneously. 
During the treatment of 6311 cases of disease in the wards of the 
Charity Hospital of New Orleans, 1869-1886, nearly one-half of which 
were caused by the action of malaria, I have sought to investigate the 
proximate cause of the first and subsequent attacks. A large number of Waters of the Wells and Springs of the First Tertiary Plain. 
1115 
the cases of malarial fever, and of acute and chronic dysentery and diar- 
rhoea to be traced to the drinking of swamp water, and the waters of slug- 
gish bayous and streams, and of wells sunk in low malarious regions. 
In the month of October, 1880, during a personal inspection of the 
cases of Oriental leprosy alone: the banks of rhe Bayou Lafourche, I was 
accompanied by my son, Stanhope Jones, at that time a cadet of the State 
University of Baton Rouge (now doctor and assistant coroner). The water 
of the Bayou Lafourche (all that could be obtained for drinking purposes) 
produced a succession of violent haemorrhages from the bowels of my son, 
and had I not reached Lockport at midnight, and secured the kind assistance 
of physicians and friends and the necessary remedies, death would have 
been inevitable. A large number of ulcers of the lower extremities 
treated in my wards in the Charity Hospital, have been traced to the 
action of the poisonous waters of the swamps and rice-fields of Louisiana; 
and at the present time. November, 1886, I have under treatment a case of 
extensive ulceration of both lower extremities, complicated with amemia, 
jaundice, enlarged liver, enlarged spleen and fever, occurring in the case 
of a man who had been cutting cypress logs in the swamps near Plaque- 
mine, Louisiana. In dealing with such ulcers, the local treatment will not 
avail unless the constitutional treatment at the same time be carried on 
against the malarial fever and its effects. During my labors amongst the 
rice and cotton plantations of Georgia, in 1860, I was led to draw up the 
following rules with reference to the use of the waters and the general con- 
duct of the laborers. 
WATERS OF THE WELLS AND SPRINGS OF THE FIRST TERTIARY PLAIN.* 
The character of the waters of the springs and wells of the low lands 
bordering the sea coast of Georgia will depend upon the depth, the char- 
acter of the soil, and their distance from the rivers and swamps. The 
springs and the wells of water in sandy formations are of great purity, and 
their composition is correctly represented in analysis forty one of Walt- 
hourville branch waters. In many of these springs and wells which are 
formed by the waters percolating through sand-beds, which serve the pur- 
pose of natural filters, the saline matters are often not more than from one 
to three grains in the gallon. The waters of low swampy lands, and rice fields 
on the other hand, are impregnated with organic matters, which in certain 
seasons, and under certain conditions, exert most deleterious effects upon 
the health of the inhabitants. The great mortality upon rice places, many 
of which actually decrease instead of increasing, is due to the character 
of the waters, which induce bowel affections, and derangement of the blood 
and low grades of fever. The relations of malarial fever to the organic 
matters of the drinking waters, demand a most searching and extensive 
investigation, and without hazarding an opinion at this stage of the inves- 
tigation we would simply state that we have been engaged in an examina- 
tion of this complicated question as well as of the character and causes of 
these diseases of rice plantations, and hope to present a special report 
at some future day. Upon the present occasion I will point out a few 
practical rules which I know by experience, will greatly ameliorate the 
condition of the inhabitants of rice plantations. 
1st. Substitute cistern water for well and spring water. If this report 
should accomplish no other result than the introduction of cisterns upon 
rice plantations, and in the tertiary lime formation of Georgia, I shall feel 
* First.Report to the Cotton Planters' Convention of Georgia, etc., by Joseph Jones, M. D., 
etc., Augusta, Georgia, 1860, p. 286, 289. 1116 
Waters of the Wells and Springs of the Hrst Tertiary Plain. 
myself to be rewarded for my labors. The surface exposed by the cotton 
gins, sheds, and barns and dwelling houses, upon plantations will prove 
amply sufficient for the collection of an abundant supply of water. 
2d. If the cistern water should at any time fail, or if it be impossible 
to obtain the cistern water, then collect the well and spring water into 
large barrels or tanks, and add to the mass of water a solution of common 
alum. One pound of alum pulverized and dissolved in four gallons of 
water, will be sufficient to purify the drinking water of a large plantation 
for six months. Of this solution a wine-glass full may be added to every 
fifty gallons of water. The alum coagulates the organic matters, they set- 
tle and leave a clear sparkling wholesome water. The minute proportion 
of alum in the water will exert no injurious effects whatever, it will be 
only tonic in its action. 
3d. Never commence work in the rice fields and low grounds before 
sun rise. 
4th. Never allow the laborers to commence work upon empty stom- 
achs. Establish a law as unalterable as those of the Medes and Persians 
that no one shall leave the quarters without having first cooked and eaten 
breakfast. Breathing in the morning in the atmosphere loaded with the 
noxious vapors of the swamps is the most fruitful of all sources of disease. 
5th. Avoid, as far as possible, the dews of the mornings and nights. 
6th. Avoid wet clothes as far as possible. 
7th. Clothe the feeble during the fall and winter in red flannel, worn 
next to the skin. 
8th. Treat diseases of rice plantations and low grounds upon the 
stimulant plan. Avoid all depletion as far as possible, and in the climate 
fevers administer sulphate of quinia boldly, regardless of the symptoms of 
headache and delirium, for this is the great remedy in the diseases of 
swamps and rice fields, even in the pleurisy and pneumonia of the wiuter 
season, for they are in this section of the country modified by the slow 
action of malaria upon the system. 
9th. Do not attribute the diseases of children in the summer and fall 
to worms. At this period of the year when children are most liable to 
climate fever, it is the habit of many planters to dose them with various 
drastic and disgusting mixtures to rid them of worms, under the idea that 
the worms are the causes of the fevers of this season of the year, because 
when the children are taken sick the worms travel away from them through 
every avenue and in every direction. The explanation of this striking 
phenomenon, which upon a superficial view is liable to be taken for the 
disease, is simply this, during the attack of climate fever the secretions of 
the liver, and of the whole intestinal canal are so altered, that the worms- 
which have been quietly housed all winter in comfortable quarters, with- 
out exciting any injurious effects upon the unconscious landlords are sud- 
denly sickened and disgusted with their altered fare and habitations, and 
beat a precipitate retreat in the most convenient and natural directions. 
If you treat the disease for worms aloue, the real disease, climate fever, 
will march steadily on, and you may purge the child until the last worm is 
evacuated, and only hasten the fatal end, because you are working in con- 
junction with the disease, all the tendencies of which are depressing. If, 
on the other hand, you administer a gentle purgative mixed with a full 
dose of sulphate of quinia, and follow up with gentle stimulants and sul- 
phate of quinia, the termination of almost every case will be favorable and 
that too in a few days. We are persuaded that strict attendance to these 
simple rules will be the means of materially diminishing the diseases and 
the rate of mortality upon rice plantations. Quinine as a Preventive of Malarial Fever. 
1117 
QUININE AS A PREVENTIVE OF MAEARIAE FEVER.* 
The following observations have lost none of their interest or value 
by the course of events: in fact such inquiries are rendered more valuable 
than ever by the changes wrought by the war in the labor system of the 
South. The Southern States must do all in their power to promote and 
foster white immigration, and all facts are of interest which bear upon the 
health of white laborers in the cultivation of the rich swamps and rice- 
lands. which in many places are now lying idle and rapidly reverting back 
to their original state. 
At the commencement of the recent war I prepared and published an 
article in the Southern Medical and Surgical Journal, entitled. "Sulphate 
of Quinia administered in small doses during health, the best means of 
preventing Chill and Fever, and Bilious Fever, and Congestive Fever, in 
those exposed to the unhealthy climate of the rich low-lands and swamps 
of the Southern Confederacy.'7 Owing to the state of the country at the 
time, this publication was not circulated in the manner designed. The 
climate of the rich low plain, clothed with a luxuriant sub-tropical vege- 
tation. which forms a belt along the Atlantic Ocean and Gulf of Mexico of 
varying width, from thirty to a hundred miles, and which is intersected with 
numerous swamps which discharge their waters into sluggish. muddy 
streams, surrounded on all sides by extensive swamps and marshes, is 
necessarily hostile to the white race. To the pestilential exhalations of 
stagnant swamps and rich river deposits, excited and disseminated by the 
burning rays of the sun in this hot climate during the summer and fall 
months, no process of acclimation has ever accustomed the white man. 
In the early settlement of South Carolina and Georgia the inhabitants in 
most instances resided the whole year upon their rich rice and indigo 
plantations: many, however, soon fell victims to the climate, or dragged 
out a miserable existence, with constitutions broken and rendered prema- 
turely old. by repeated attacks of climate fever. The clearing of the 
forests, of the swamps and rich low-lands, and the consequent exposure to 
the sun of the vegetable matter which had been accumulating for ages, 
rendered the climate so deleterious to the white race that the planters were 
compelled to seek health during the summer and fall months in sea island, 
or in pine barren or mountainous retreats: and with the most efficient pre- 
cautions the mortality of these regions is far greater than in the more 
elevated portions of the Southern States. The preceding statement has 
been fully illustrated in the fourth chapter of the present second volume 
of these Medical and Surgical Memoirs-by reference to the mortuary 
records of Midway Congregational Church, of Liberty county, Georgia: by 
the mortuary records of Savannah, Georgia, and by the experience of the 
British Engineers in Africa. 
The facts which have now been fully presented are sufficient to justify 
the attempt to devise some means to ward off the climate fever. During 
the study of the relations of climate and soil to disease, the collection 
of the mortuary statistics and the investigation of the causes of diseases 
upon rice and cotton plantations: and during the discharge of the duties 
of chemist to the Cotton Planters' Convention of Georgia, the author has 
necessarily been greatly exposed to the agents which produce climate fever, 
and the results of his experience now presented, cannot therefore be said 
to be wanting the test of actual experiment. Under these exposures I have 
« Quinine as a Prophylactic against Malarial Fever, bang an appendix to the Third Report 
on Typhoid and Malarial Fevers, delivered to the Surgeon General of the late C. S. A_ A^^ist. 
Is6i. By Joseph Jones. M. D„ Surgeon P^ C. S. A. 1118 
Quinine as a Preventive of Malarial Fever. 
found the sulphate of quinia taken in from 3 to 5 grains twice during the 
day would, in most cases, prevent the occurrence of malarial fever, and if 
it failed to ward it off entirely, the attack would be of a very slight char- 
acter. I have still further observed that when the climate fever first 
appeared, with a sense of lassitude, headache and excitement of the pulse, 
with alternate flushings, it might be arrested by a dose of from 5 to 10 grains 
of sulphate of quinia, in combination with bicarbonate of potassa and Hoff- 
man'sanody ne. From 5 to 15 grains of the sulphate of quinia may be given, 
according to the urgency of the symptoms, united with 15 grains of bicar- 
bonate of potassa and f^ii of Hoffman's anodyne. From 5 to 15 grains of 
gum camphor; the whole to be dissolved in f§vi of water. The feet should 
be placed in hot water immediately after, or before, the administration 
of the remedies, and the patient after this bath should be covered up in 
bed, so as to promote free perspiration and induce quiet sleep. I have 
frequently gone to bed in a feverish, restless state, with a severe headache, 
excited pulse, and pain in the limbs, and dry, warm skin, and under 
the action of these remedies, arose in the morning refreshed and able to 
resume active operations. The bicarbonate of potash is here recommended, 
instead of the proto-carbonate (salts of tartar), which is in such common 
use, during fever, in the Southern country, because it is far less active in 
its effects upon the stomach, and may be taken in much larger doses, 
and accomplishes more effectually the neutralization of the acid wThich 
is so often abundant in the stomach at the commencement of malarial 
fever, and more effectually acts upon the liver and the kidneys, and pro- 
motes the removal of all offending matters from the blood. 
The late lamented Dr. Charles West, of Savannah, informed me that 
during his practice in Burke county, it was his custom to arrest attacks of 
climate fever at the outstep, when the first symptoms were manifested, by 
sulphate of quinia; my former colleague, Dr. Dugas, Professor of Surgery 
in the Medical College of Georgia, informed me that he had used this 
medicine in a similar manner ; and we have been informed that the ener- 
getic Superintendent of the Savannah and Charleston Road, which passes 
through a most sickly region of country, preserved the health of his white 
laborers by the daily use of small doses or sulphate of quinia. 
We would recommend the use of quinia as a preventive of climate 
fever, in the following manner : B. Sulphate of quinia, grains, iii; dilute 
aromatic sulphuric acid, drops, v; brandy, tablespoonful, i; water, wine- 
glassful, ii. Drop the diluted aromatic sulphuric acid upon the sulphate 
of quinia, and then add the brandy and water. Administer twice during 
the day, after rising in the morning, and just before bed-time. To render 
the value of this means of warding off climate fever still more evident, 
we have cited in the fourth chapter the practice and success of the British 
surgeons upon the coast of Africa, premising at the outset, that the endemic 
climate fever of Africa does not differ in any essential manner, except, 
perhaps, in its severity, either in its causes, symptoms or effects, from the 
malarial lever of North America. The value of sulphate of quinia in 
warding off the climate fever of Africa, has been determined by instituting 
a comparison between the effects of the disease before and after the use of 
this medicine as a prophylactic. 
It is worthy of notice that in the instances which the author has 
quoted from the experience of the British surgeons serving in Africa, when 
quinine wine was administered according to the instructions issued with 
it, no fever of any consequence followed exposure to land or swamp mias- 
mata; but on two occasions, wrhen quinine purchased on the coast was sub- 
stituted, and once when the wine w'as suddenly discontinued after the Use of Quinine as a Prophylactic. 
1119 
exposure, a considerable number of men were attacked, owing, it is to be 
supposed, to the discontiuuance of the quinine wiue in one instance, and 
to its bad quality in the other, for it is well known that, like other high- 
priced remedies, it does not escape adulteration when it falls into the hands 
of dishonest traders.-Statistical Report of the Health of the Royal Navy, for 
the year 1857. Ordered by the House of Commons to be printed. 2d August, 
1859, pp. 78-85. 
A comparison of these facts with the great sickness and mortality of 
the white explorers and residents and sailors of the African coast and 
rivers, demonstrates conclusively : 
1st. Quinine taken during exposure to the exhalations of miasmatic 
regions will, in most cases, ward off fever entirely. 
2d. If fever attacks those to whom the quinine has been regularly 
administered, its severity and duration will be far less than in those who 
have not taken the quinine; it therefore not merely wards off disease, but 
renders it less powerful and destructive when present. 
3d. To be entirely efficient the quinine must be administered for 
some time, at least ten days, after exposure to the causes of fever.-South- 
ern Medical and Surgical Journal, Augusta, Georgia, August, 1861, vol. xvii, 
No. 8, pp. 593-614. 
The observations which I have been able to make during the late 
war have confirmed the accuracy of the preceding statements; and I am 
convinced that the health and efficiency of the troops in certain malarious 
localities of the Confederacy would have been greatly promoted by the 
daily use of quinine in the manner recommended. The value of quinine 
as a prophylactic in preserving the efficiency of troops serving in damp, 
unhealthy, malarious regions, may be readily demonstrated by a direct 
calculation. The following table illustrating the numerical relations of 
malarial fever to the other diseases, and its effect in reducing the strength 
of the command serving at Fort Jackson and the surrounding river bat- 
teries, situated in the low rice lands of the Savannah river, will furnish 
sufficient data for the calculation. 
In an average command of 878 men, stationed at Fort Jackson and the 
surrounding river batteries, nearly one-half, or 410, on an average were on 
the sick list each month; and the new cases of malarial fever averaged 
each month 220. During this period of fifteen months 3313 cases of mala- 
rial fever in the form of congestive fevers, quotidians, tertians, quartans 
and remittents occurred; whilst all other diseases, including also those 
diseases, as neuralgia, which might be traced in a measure to the action 
of malaria, numbered 1935 cases, or only a little more than one-half the 
number of the cases of malarial fever. Throughout the entire period more 
than one-fourth of the command were unfit for duty; and during the fall 
months more than one-half of the garrison was, on an average, incapable 
of performing military duty. In case of an attack during the sickliest 
season of the year the effective force of the command, instead of being 878, 
would be less than 500. In using quinine as a prophylactic in such a com- 
mand it would be necessary to administer the drug at least five months; 
namely June, July, August, September and October. If three grains of 
quinine in a gill of whisky be administered daily to each soldier we may 
safely estimate the amount of quinine necessary to protect each man during 
these five months at about one ounce. This command of 878 men would, 
therefore, require for its protection annually about 878 ounces of sulphate 
of quinia. 1120 
Use of Quinine as a Prophylactic 
Cases of Malarial Fever, and all Diseases occurring during a period of Fifteen 
Months, October, 1862, to January, 1864, in the Command serving in and 
around Fort Jackson, on the Savannah Fiver. 
Total 
P B B 2i - as k P H <0 
cr^ u" 
2 2 2 
Month and Yi 
1862 
1863 
<< 
c. 
• ( 
LO 
Congestive fever. 
1 
w 
W 
^tt-O^jO^lOCSCO^lOOM^bOO^ 
HSN®®*l®b5M®01W»MM 
Intermittent fe- 
ver, quotidian. 
i 
71 
24 
58 
88 
104 
133 
157 
76 
66 
177 
149 
127 
108 
54 
62 
Intermittent fe- 
ver, tertian. 
co 
co 
::::::::: co • • ; • • 
Intermittent fe- 
ver, quartan. 
CD 
i-' to ca co co ca t-* <-1 i-i 
OtOK^4-<ICK>^tOCDChl-'OlbO 
Remittent fever. 
co 
co 
co 
345 
96 
197 
135 
198 
246 
198 
140 
142 
321 
380 
410 
267 
124 
114 
Total cases of 
these forms of 
malarial fever. 
cd 
126 
44 
118 
172 
149 
143 
226 
184 
131 
137 
103 
98 
133 
60 
111 
Total cases for all 
other diseases. 
oi 
IO 
on 
t O ' 4- O> 4- 4- IO CO4- CO CO CO CO 4- 
IOOOOOXCn<lK)iC)a»fiOH^M 
»it>OOowaw^>|i©MNOio*- 
Total cases of all 
diseases. 
tOtOM^CnOiCnCOCO^iJi-Hi-COCOtOOi 
-1 CO GO 00 CO O ►-* <X 00 61 to CO <01 1-* co 
co cn ot oo co 4- m o co oo oo h* o oo co 
Aggregate sick 
each month. 
OO^aOOO5OO(»OOCOCO©HC0COOO 
ococ.tooooocoocococo4*cocoto 
Mean strength of 
command, offi- 
cers and men. i 
During a period of twelve months, from October, 1862, to November, 
1863, 2808 cases of malarial fever were treated, and if we allow fifty grains 
of quinine as necessary on an average to the treatment of each case, very 
nearly 300 ounces of quinine would be consumed in the treatment of these 
cases. It is important also to bear in mind that this amount of quinine 
would in many cases produce only temporary relief, after the disease was 
once established, and would be powerless when thus occasionally used to 
prevent the serious lesions of the spleen and liver, and the disease would 
be liable to return again upon the slightest exposure to the original cause, 
or to cold and damp, even in healthj regions. 
It should be farther considered that the process of acclimation in the 
white race is slow, if not altogether impossible in our Southern swamps 
and rice fields, and that an entire command might be gradually rendered 
unfit for service by the effects of malaria in such a locality as Fort Jackson; 
and even after the men are removed to healthy regions they are liable for 
many months and even for years to a recurrence of the various forms of 
malarial fever. 
Amount of quinine necessary to protect 878 men from malarious diseases, 
during twelve months, 878 ounces at an average cost of $5 per ounce. $4,390 00 
Amount of quinine necessary to treat 2808 cases occurring amongst a 
command of 878 men, during twelve months, at an average cost of $5 
per ounce 1,500 00 
Difference of cost of quinine in protecting and treating these cases... 82,890 00 
According to this calculation the quinine necessary to protect the sol- 
dier from malarial fever would cost $2890 more than that assumed to be 
necessary to treat the cases of fever arising where no quinine had been 
used as a prophylactic. We must, however, introduce into this calcula- Use of Quinine as a Prophylactic. 
1121 
tion the pay of the sick, officers and men, which may justly be considered 
as an unproductive expenditure. If we place the number of men con- 
stantly on the sick list and unfit for duty from malarial fever at 100, which 
is far below the actual number, and if we rate them as privates alone, each 
month $1100 would be expended in the payment of sick men, or $13,200 
would be annually expended without any return whatever to the Confed- 
eracy. If we add to this the pay of the sick officers the sum w'ould reach 
a much higher figure; but we desire merely to demonstrate the utility of 
the use of quinine as a prophylactic, beyond all cavil, even as a mere mat- 
ter of dollars and cents. 
Unproductive pay of 100 men for twelve months, laboring under the 
various forms of malarial fever ($10 per month for each man) $13,200 
Increased cost of quinine for the protection of the entire command 
during twelve months 2,890 
Difference in favor of the use of quinine as a prophylactic $10,310 
It should also be taken into the account that the expenses in food, 
nursing, hospital accommodations, other necessary medicines, and trans- 
portation for the sick, are greater than the expenses of the supplies of the 
well soldiers; and it would be just, even to consider that the expenditures 
for the sick are a total loss, for they certainly add nothing to the defence 
of the country, or the efficiency of the army. But leaving this entirely 
out of the calculation, we have demonstrated clearly that the use of quin- 
ine as a prophylactic would be attended with an actual saving of expense, 
for in exposed malarious localities a less number of troops properly pro- 
tected, could be made to perform more efficiently the duties of a much 
larger force. Surely the accomplishment of such a result is of value, in a 
contest in which we are opposed by a powerful enemy, who outnumbers us 
in the ratio of three to one, and who with almost exhaustless resources 
has his ports open to the commerce of the world. The argument which 
might be urged on the score of humanity, is even stronger than that based 
upon efficiency and economy. We must believe that the preservation of 
our soldiers from acute diseases, as well as from chronic affections, with 
enlarged spleens, impoverished and watery blood, dropsies and innumera- 
ble nervous derangements, excites some interest and concern in the minds 
of their officers, as well as of their relatives and friends at home. The 
difficulties of importing quinine at the present time, are without doubt 
numerous, but they are not greater, and are perhaps far less than the 
difficulties of the importation of the more bulky articles of clothing and 
luxury, which has been carried on to such an extent as to drain the coun- 
try of gold, and to seriously endanger the moral and financial condition of 
the Confederacy. With the large amount of cotton at the command of 
the people and of the government, it would not be an impossibility to 
import a sufficient quantity of quinine to protect the troops exposed to 
malaria. Owing to the limited supply, quinine was not used to any extent 
as a prophylactic in the Confederate Army, and in several instances where 
the attempt has been made to use it thus, it has failed to yield the most 
satisfactory results from its irregular and unsystematic employment. It 
appears that it is very difficult to induce soldiers to take quinine in the 
state of powder. The proper mode would be to mix the quinine with 
whisky (a certain number of ounces to a barrel of whisky), and issue the 
medicated whisky at a certain hour, each day, in the presence of officers 
charged with the duty of seeing that each man took his dose. As a gen- 
eral rule soldiers will not refuse whisky even when it contains quinine. 1122 
Use of Quinine as a Prophylactic. 
Several instances have come under my observation where medical 
officers serving in malarious localities have taken quinine daily as a 
prophylactic, and whilst almost the entire command have suffered with the 
various forms of malarial fever, they have escaped with impunity. In the 
summer and fall of 1863, during great changes from the Military Depart- 
ment of Georgia and South Carolina to Piedmont, Virginia, andfrom thence 
back to Carolina and Georgia, and during considerable exposure to mala- 
rious influence in localities like James Island, acknowledged to be sickly, 
I protected myself with quinine. Doctor J. N. Warren, Assistant Sur- 
geon of the Twenty-fifth Regiment, South Carolina Volunteers, stationed 
on James Island, S. C., in compliance with a request which I made him 
during a visit to the camps on James Island in the month of April, 1863, 
selected 200 men, from the regiment, and administered four and a half 
grains of quinine to each man daily. This was continued regularly until 
the 1st of October, when Dr. Warren was transferred to Augusta. During 
this period amongst this body of men, only four cases of malarial fever, 
and one case of typhoid fever occurred. The remainder of the regiment, 
between 300 and 400 men, did not take quinine as a prophylactic, and the 
majority of these men were attacked by paroxysmal fever; and over three 
hundred cases of the various forms of paroxysmal fever, together with 
t wen ty-three cases of typhoid fever and two deaths occurred amongst them. 
During the service of this regiment at Battery Wagner the men who took 
quinine daily, bore the fatigue better, and resisted the deleterious effects 
of the climate and the foul air of the bomb-proofs better than those who 
did not thus use quinine. 
On the 30th of April, 1862, Surgeon Octavius White of the Palmetto 
Battalion Light Artillery, was delegated by Gen. Ripley, then commanding 
Second Military District Department S. Ca., "to examine into and report 
the health of the various encampments on James Island and in St. Andrews 
parish, and also to furnish information upon the prophylactic virtues of 
quinine against country fever. The following is the report of Surgeon 
White: 
Headquarters Palmetto Battalion Light Artillery, 1 
James Island, May 7, 1862. j 
To Brigadier General Ripley, Commanding: 
General :-In obedience to your direction and in conformity with my duty, I 
respectfully state that I have carefully considered the subject of your order and here- 
with tender you the result of my deliberation and inquiries. * * * Inhere are 
four batteries located at various points on Wappoo Cut, each of which are held by 
detachments from the Palmetto Batteries of Light Artillery. One of them is at 
Simon's Landing, one at Minuott's Bluff, another at Heyward's, and a fourth at the 
mouth of a conduit to it, called Elliot's Cut. The camping grounds around these 
batteries are surrounded by marshes, which are never flowed by salt water, except 
by the very highest tides. Abundance of fresh water springs from either bank 
and the showers pour their contributions into them. Thus in many places stag- 
nant pools of brackish water form. Such, according to Sir John Pringle's state- 
ment. develop animalcular life with wonderful rapidity, and perpetually undergo 
alternate decay and replenishment. That peculiar forms of fever, malignant in 
their type, and the morbid changes they impress upon the system and several 
organs of the body, should result from so free an elimination of malaria, is by no 
means surprising. The batteries at Heyward's and Simon's Landing are in St. 
Andrew's Parish, on the south-western shore of Wappoo Creek. The grounds 
around these batteries are particularly low, and consequently damp. St. Andrew's 
Parish has ever had the reputation of being the most unfriendly to the white man 
in the summer, within the limits of the State. So insidiously does the charming 
spring glide in. that planters in that vicinity have not unfrequently been lured to 
remain until driven off by some unmistakable warning, and the unhappy fate of 
some belated individual, has too sadly indicated the danger of delay. From such Use of Quinine as a Prophylactic. 
1123 
experiences as these, the 10th of May has generally been agreed upon as the latest 
date, when it is prudent to remain within its unwholesome precincts. The migra- 
tion of residents in this section of country, takes place, therefore, with one accord, 
on or before that period. 
The Batteries at Minnott's Bluff and Elliot's Cut are on James Island. The 
grounds adjacent thereto, from their superior elevation, lighter and dryer soil, 
have every appearance of being healthier spots, and yet no prudent planter will 
venture to overstay the magic time. The period settled by experience to vacate 
the plantations on this island is much later than those in St. Andrew's Parish, by 
nearly one month. 1 learned from one planter that his brother remained one year 
with his family at the place known as Janton's until as late as the 27th of June. 
He immediately removed to Summerville, and shortly after paid the penalty of his 
rashness by not only being taken sick himself, but by having every member of his 
family prostrated with fever also. 
Effectual drainage is universally acknowledged to be a matter of the greatest 
consequence in our climate. This no doubt is the reason that the health ofso many 
malarious regions has been improved by railroads passing through them. I deem 
it my duty here to notify you. that the natural drainage of the island, as well as 
of the main, has been seriously interfered with by the line of breastworks which 
have recently been thrown across the country. These obstructions will no doubt 
largely contribute towards rendering the neighborhood around them more sickly 
than ever this summer. You are doubtless aware, sir, that we are every day 
approaching nearer and still nearer the period in our climate so dreaded in these 
localities. Soldiers who would leap without a single thought into the imminent 
breach, whose lips have never blanched before any other enemy, naturally quail 
at the bare thought of encountering so mysterious a foe. Fortunately, however, 
we are possessed of an efficient antidote, which if faithfully used and persevered in, 
will enable any to brave with safety the most serious exposure to this common 
enemy. 
Of the prophylactic virtues of quinine against malarial impressions, it may be 
asserted with confidence that fortified with that wonderful drug, none need fear 
venturing at any time into the heart of our hostile low-lands in summer-inhaling 
with impunity its deadly miasm. 
Abundance of evidence can be brought to prove this assertion. The experi- 
ence of numerous overseers could be adduced to prove the statement. This reli- 
ance in its virtue to resist malarial disease is unlimited. Many have lived pro- 
tected by it for ten years, and more, spending summer after summer in the sickliest 
regions. Dr. Barker and the Government members of the Niger expedition, being 
abundantly supplied with quinine, encamped with safety upon the banks of that 
fatal river for over twelve months. The A frican explorers under Dr. Livingstone, 
were preserved entirely free from the pernicious fevers of the climate, by the habi- 
tual use of quinine. Further evidence of the prophylactic virtues of quinine has 
also been afforded by many of the officers of the British Government stationed on 
the coast of Africa, in reports from their various stations collected and arranged by 
Dr. Alexander Bryson. The British Steamer Eliaia, steamed up the river Niger 
in July, ascended the river Chadden and returned to England without the loss of 
a single man. All owing to the proper administration of quinine. The party 
included sixty persons and the expedition was in the river one hundred and eight 
days; twice as long as the expedition of 1842, which, unprovided with quinine, 
ended in so fearful a loss of life. Surely no farther evidence can be needed to prove 
that the daily and proper use of quinine in malarious regions is capable of so modi- 
fying the system as to render it capable of resisting the deleterious influence of 
climate, and of protecting individuals from either intermittent or remittent fevers. 
The dose usually prescribed under such circumstances is from three to five 
grains, regularly taken every morning before breakfast. Each bottle as sold in 
the shops contains about one ounce (480 grains). This quantity, therefore, would 
be only sufficient for ninety-six men one day. All the companies of this battalion 
are over one hundred strong. Most having as many as one hundred and fifty men. 
The estimate, therefore, could be safely made that about eight ounces per diem 
would be needed to protect this battalion from the noxious influences to which 
they will be exposed, if compelled to remain upon the present camping grounds. 
Should it, however, become impracticable to supply us with the necessary 
quantity, I respectfully suggest that immediate measures be taken to have the 
companies composing this battalion removed to Sullivan's Island, or some other 
healthy locality. Though the summer months ordinarily present us with the first 
cases of country fever, it is not unusual for sudden heats of spring to develop cases 1124 
Use of Quinine as a Prophylactic. 
as early as the middle of May. I have heard Prof. Dickson assert that he has 
known instances originated from special exposure as early as April. It is a fact 
moreover, as formidable as curious, that a malarial impression may be received 
and remain dormant in the system until roused into intense action by simple 
change to a healthier locality. Speculation is at a loss as to the obscure cause of 
such additional malignity being occasioned by a mere removal during what has 
been called the "latent period." Experience, however, has established beyond a 
doubt, that such an attack is always attended with peculiar hazards and it is there- 
fore thought advisable in every case after exposure to use strict precaution against 
the apprehended attack from seven to twenty-one days." * * * 
[Signed] Your obedient servant, 
O. WHITE, Surgeon Palmetto Battalion Lt. Art'y. 
Surgeon Samuel Logan, Chief Surgeon of the Second and Third Mili- 
tary Districts, Department of South Carolina, Georgia and Florida, has, at 
the personal request of the author, contributed the following important 
facts upon the prophylactic powers of quinine : 
"The following table was compiled with the view of enabling the writer to 
arrive at some conclusion as to the prophylactic power of quinine. The items were 
collected, either by himself or the medical officer in charge, to whose cheerful 
co-operation he is 'much indebted. It will be observed that in no single camp was 
the agent unanimously adopted; in many, indeed, its use was resorted to by a 
minority only. 60 far as my object was concerned, this enables me to compare the 
results among those situated under the same identical circumstances in all parti- 
culars, except the use or neglect of the agent whose effect we are investigating. I 
would call attention to the fact that much more importance should be attached to 
the results developed under these circumstances, than when the experiments are 
made with separate corps, all of whom either took or neglected to take the quinine 
as a prophylactic. I know of no statistical researches, except of my limited extent, 
in which this peculiarity obtains-in fact our statistical knowledge on the subject 
is extremely limited-and I therefore deem it of some importance to invite the 
attention of the profession to the table I have collected. All the troops from whom 
these items have been gathered, were stationed in the most highly malarious regions 
in the Confederacy. 
With the exception of a few favored localities, the whole country has to be 
abandoned by its white inhabitants as the summer approaches. They usually 
resort to the pine lands or the sea-shore about the first of May, and return about the 
first of November. The peculiar topography of our Southern Atlantic low-lands 
is well known, but may be briefly mentioned. The coast line is indented with 
numerous inlets, bays, and salt water creeks, which form a complicated network 
extending from ten to twenty miles from the sea-shore proper. These creeks and 
estuaries are generally fringed with wide plains of salt marshes, except where the 
larger rivers freshen them and form the valuable fertile rice lands. The islands 
formed by this network of water-courses are, with the exception of the marshes, 
composed of a light sandy soil, in which the stratum of clay lies from three to six 
or eight feet below the surface. They were devoted to the culture of the famous 
"sea-island," or long-staple cotton. As we come more towards the interior, and 
especially near the larger streams, the light sea-island soil more or less disappears, 
and we have level tracks of a stiffer earth, occasionally sandy, but in most cases 
having a structure of red clay, either near or quite up to the surface. The under- 
growth is here extremely luxuriant, and reminds one of the pictures of African 
jungles. The country is intersected with swamps, some of them cultivated in rice 
and presenting a considerable alluvial deposit upon a bed of blue clay. 
Next to this belt of "low-lands" we come to the pine regions, a dry and porous 
sandy soil, with clay of a considerable depth, the sand in the higher localities being 
of a bright yellow or white, and in the lower ones dark grey. This flat belt of 
"pine barrens" gradually changes into the rolling country of the interior, and so 
on up to the mountain slopes. The malarial fevers prevail throughout the sea- 
islands, with a few exceptions; through the whole belt of level low-lands, and to a 
considerable extent in the lower of the pine lands. The higher portions of the 
latter, and certain favorable localities along the sea-shore, and among the sea- 
islands, are more or less exempt and are resorted to during the summer months. 
The enemy have occupied almost all of the healthy sea-shore, while our lines of 
defense extend through the sickly low-lands, just within the belt of sea-islands. Use of Quinine as a Prophylactic. 
1125 
In order to promote the health of the troops, such of them as are located along the 
lines in the neighborhood of healthy pine land resorts are moved in the summer 
months to such places. Those commands, however, who do the picket duty, even 
though their summer camps be pitched in a healthy pine land village, are still 
subjected to malarial influences while on this outpost duty along the line, day and 
night, at an average of about one-third or one-fourth of the time. Those commands, 
who were, as a general rule, retained during the summer in their healthy resorts, 
were not provided with quinine to use as a prophylactic, and have not, therefore, 
been made the subjects of investigation. They had little or no fever among them; 
while those whom it was necessary, for strategical purposes, to retain in the 
unhealthy country, and the cavalry who did picket duty in sickly localities, were 
provided; and a reference to the table will show to what an extent each command 
availed itself of the agent, and what were the results. 
In some cases the quinine was taken in the morning, in others at night, four 
grains being the quantity used. Some of the medical officers believed beforehand 
in its efficacy; others held their opinions in suspense, while a few disbelieved in 
its use as a prophylactic. I was among those who were not inclined to form a 
definite opinion until a larger mass of evidence had been collected in such a man- 
ner as to show the comparative results among those placed under identical circum- 
stances, in all particulars, excepting the use of the agent. It will be well to make 
a few remarks concerning the different corps and their precise localities. 
1st. The Rutledge Mounted Riflemen and Horse Artillery did picket duty 
along the line between the Coosauhatchie and the C'ombahee rivers, a section of 
country of an undoubted malarious character. They were encamped in a tolerably 
healthy pine land village, McPhersonville, three and a half miles from the Poco- 
taligo station, on the C. and S. R. R. 
2d. Captain Earle's Battery was stationed during the summer of 1862 on 
James Island, near Charleston, 8. C. (a location of notoriously bad reputation for 
health), until September, when it was moved to a position about six miles below 
the Hardeeville station, on the C. and S. R. R., not far from the Savannah river. 
They gained nothing from the change so far as a healthy camp was concerned. 
The next summer they were stationed near the Green Pond station, between the 
Combahee and Ashepoo rivers. This also is a highly malarious location. 
3d. Company I, Third S. C. C-, as I am informed by Dr. W. M. Bailey, who 
has charge of them, was stationed in the interior of Wadmalaw Island, a situation, 
from the evidence of the physician who practiced there before the war, exceedingly 
unhealthy as regards fevers, in the midst of swampy lands and numerous stagnant 
ponds. About four grains of quinine were given each day at retreat, in which 
quantity it was administered from the 1st July until 1st October. Dr. Bailey goes 
on to say that not being supplied wi ch a sufficient amount of the article he con- 
tinued, from that date, to administer it in reduced doses of two grains until about 
the 15th of October. Whether from the effect of climate, or from the reduced quan- 
tity given, I had at this time many more cases of fever. 
4th. Company B, Sixth Regiment S. C. C., was stationed near the river bank 
of the Edesto, a situation personally known to me as very unhealthy. With them 
also the quinine was reduced from October 1st, from four to two grains, and 
stopped on the 15th. 
5th. Company D, Fifth Regiment S. C. C., arrived at its camp, near the Com- 
bahee river, on the 27th September, having been stationed in Charleston during 
the midsummer. The men were exposed on picket in a very malarious country, at 
the most unhealthy season, but Captain L. Davis, in command, immediately com- 
menced to issue four grains of quinine in a wineglass of whisky every morning at 
reveille, and continued it until frost- 
6th. Blake's Battery was stationed during the whole summer on James 
Island. They moved camp three times, but were always located in positions 
which Assistant Surgeon Mallory C. Rives in charge-who has kindly furnished 
me with the details-knows to have been unhealthy, from his intimate acquaint- 
ance with the facts before the war. The quantity of quinine issued was, as in the 
other cases, four grains daily. 
7th. Kirk's Partisan Rangers and the five companies of the Fourth b. C. C. 
were situated in all respects as the Rutledge Mounted Riflemen, and had the same 
duty to perform. They also took the same quantity of quinine. 
'8th. The Washington Artillery spent the summer in a very malarious loca- 
tion, amid the swamps between the Edisto and Ashepoo rivers. Assistant burgeon 
W. S. Canneu writes that on the 1st of July, 1863, the administration of quinine 
was commenced in four-grain doses every night and continued until the 12th of 1126 
Use of Quinine as a Prophylactic. 
November. I have only to remark in conclusion that in no case has any cumula- 
tive effect been observed to follow the continued use of quinine. It would seem 
from these statistics that, though not an absolute prophylactic, the degree of pro- 
tective power possessed by the agent fully warrants its use. If four-fifths of the 
fever cases are prevented it should surely be used. It may be well to explain that 
under the head of "number who took quinine irregularly " are included those who 
would forget or neglect to take it some three or four days in the week, or take it 
one day and forget it the next, or omit it for a week at a time. 
Consolidated Table of Cases. 
Total number who took no quinine. 230; had fever, 134; ratio per 1000 of fever 
cases to patients, 582.60, or 1 in every 1.71 patients; ratio per 1000 of severe cases to 
total cases, 313.43, or 1 in every 3.19 cases. Total number who took quinine irreg- 
ularly, 246; had fever, 96; ratio per 1000 of fever cases to patients, 390.24, or 1 in 
every 2.56 patients; ratio per 1000 of severe cases to total cases, 291.66, or 1 in every 
3.71 cases. Total number who took quinine regularly, 506; had fever, 98; ratio 
per 1000 of fever cases to patients, 193.67, or 1 in every 5.16 patients; ratio per 1000 
of severe cases to total cases, 326.53, or 1 in every 3.06 cases. 
Nashville, Tenn., May 10, 1867. 
Professor Joseph Jones, D.: 
Dear Sir-In compliance with your late request I submit the following cases 
as having come under my observation as to the prophylactic powers of quinine: 
Case 1.-In the year 1847 a clergyman assigned to mission duty in the coast 
districts of South Carolina reported to me that for a number of autumns previous 
he had suffered from very severe bilious attacks of a congestive character. I saw 
him just before entering upon his next mission. I advised him to follow this pre- 
scribed course: The occasional use of blue pill and to take daily for some weeks 
from four to six grains of quinine. Then to intermit for some two weeks and 
repeat as previously ordered. The result was a perfect immunity from his accus- 
tomed attacks. 
Case 2. -A medical friend of Wilmington, North Carolina, informed me that 
his brother, a distinguished politician and lawyer, whose business and repeated 
canvasses subjected him to attacks of malarial fever in the coast counties of North 
Carolina, had been advised to a like course of treatment. The prophylactic pow- 
ers were complete. 
Cases3,4, 5 and 6.-Two rice planters on the Cape Fear river, North Carolina, 
who daily exposed themselves in superintending their planting and culture inter- 
ests, suffered very severely from bilious attacks, were advised to a like course. 
They invariably escaped when instructions were rigidly followed. And two over- 
seers in the rice farms of the same river were in a like manner shielded. I repeat- 
edly met these parties, and at the close of harvesting, and never saw better speci- 
mens of men in perfect health. 
The cases of negroes who were slow to become acclimated and who were greatly 
exposed and had repeated malarial attacks, were most generally thoroughly pro- 
tected, might be put down by scores and hundreds. With the latter the Pil. cath. 
comp., as an adjuvant to the quinia, was most generally used-p. 2 n. Between 
seven and eight years I practiced medicine in Wilmington, North Carolina, in the 
rice bottoms and upon the adjacent salt water coast. I can testify that the excep- 
tions were but few to thesuccessof this prophylactic treatment when systematically 
observed. Most truly, 
D. DU PRfi, M. D. 
In the use of quinine as a prophylactic against malarial fever the fol- 
lowing questions are worthy of consideration : 
1st. To what an extent can quinine be used daily as a prophylactic 
against malaria without inducing any injurious effects on the nervous sys- 
tem? 
2d. How long can quinine be used daily as a prophylactic against the 
effects of malarial fever, without losing its powers, or without inducing 
injurious effects upon the human system? 
3d. What proportion of the entire population in malarious regions 
could be preserved from malarial fever by the use of quinine as a prophy- 
lactic? Practical Observations on the Treatment of Malarial Fever. 
1127 
4th. What effect upon the total mortality, as well as upon the num- 
ber and character of various diseases, would the prophylactic use of 
quinine induce during given periods of time in malarious regions? 
5th. To what extent can arsenic (arsenious acid) and the compounds 
of arsenicum be substituted for quinine for the prevention of malarial 
fever? 
6th. What effect upon the human organism and upon the character 
and number and mortality of various diseases will arsenic produce when 
used as a prophylactic? 
The preceding questions are of great importance, and their investiga- 
tion should demand the attention of the medical profession in all malari- 
ous regions. Scientific commissions of experienced and accomplished 
medical men should be appointed by the leading powers of the civilized 
world for the thorough investigation of the origin, nature, propagation 
and prevention of the morbific ferment of malarial fever. To be properly 
constituted, each commission appointed by the individual nations, as 
Great Britain, Germany, Spain, Italy, Austria, Portugal. Turkey, Russia, 
France and the United States, should be constituted thus: Chemist, micro- 
scopist (batorologist), botanist, physiologist (experimental), hygienist, 
therapeutist, physician (practising, of enlarged experience as to malarious 
diseases). The first duty of the State is to protect the lives of the laboring 
classes from all causes of preventable diseases. To what extent the cause 
of malaria may be removed and its effects modified or avoided, can only 
be determined by the careful investigations of competent, honest, con- 
scientious scientific men, liberally supplied with all the instruments, 
reagents and processes of the nineteenth century. Whatever the results 
of such labors might be, they will illustrate the humanity as well as the 
science of the civilization of the present day. 
PRACTICAL OBSERVATIONS ON THE TREATMENT OF THE VARIOUS FORMS 
OF MALARIAL FEVER. 
We have in the preceding chapters of this work presented many 
observations upon the treatment of the various forms of malarial fever 
and the nature and value of the many indigenous remedies have been care- 
fully reviewed in the present chapter. Many facts illustrating the views 
and practice of eminent physicians in this country and Europe were 
recorded during the careful and extended investigation of the physical, 
botanical, chemical, pharmaceutical and therapeutical propeities of the 
indigenous remedies of North America, and more especially of the south- 
ern and south-western sections of the United States. The following tables 
present a consolidated view of the labors of the author in the Charity 
Hospital, from 1869 to 1886, inclusive. Those statistics are presented 
which relate chiefly to the results of treatment in the various forms of 
febrile diseases. 
Cases. 
Deaths. 
Clpnpr.Ql diRPDRPR . _ 
4034 
276 
Diseases of the nervous system 
442 
59 
Diseases of the heart and blood-vessels 
91 
36 
Diseases of the absorbent system 
3 
1 
Diseases of the respiratory system 
493 
82 
Diseases of the alimentary canal 
709 
123 
38 
Diseases of the spleen 
4 
1 
THReaseR of the kidneys 
88 
26 
Diseases of the bladder and male organs 
70 
1 
GENERAL SUMMARY. 1128 
Practical Observations on the Treatment of the Various Forms of 
Diseases of the female organs of generation 
Cases. 
... 20 
Deaths 
Diseases of the organs of locomotion 
Diseases of the cutaneous system 
... 15 
1 
Diseases of the eye, nose and ear 
... 25 
Injuries, ulcersand wounds 
.... 96 
8 
Poisons 
.... 21 
2 
Conditions not necessarily associated with local or general diseases .. 
... 89 
14 
Parasites 
.... 11 
Total 
...6311 
668 
Per cent, of deaths from all causes, 10.5; ratio of deaths per 1000 cases, 105; one 
death in 9.44 cases. 
Malarial, Paroxysmal, Endemic, Non-contagious Fever. 
GENERAL DISEASES. 
Cases. 
Deaths. 
Intermittent fevers, including quotidian, tertian and quartan 2327 
5 
Remittent malarial fever * 247 
Pernicious congestive malarial fever, including the comatose, algid 
7 
and other varieties (a large proportion of the cases were brought 
into the hospital in a moribund condition) 87 
56 
Chronic malarial poisoning (malarial toxaemia cachexia), with various 
complications, as enlarged liver and spleen, contracted liver and 
hardened spleen, anaemia anasarca 212 
14 
Malarial haematuria 12 
6 
Total malarial, endemic, non-contagious fevers 2885 
88 
Per cent, of deaths in the various forms of malarial fever, 3.05; ratio of deaths 
in 1000 cases of the various forms of malarial fever, 30.5; one death in 32.8 cases of 
the various forms of malarial fever. 
COMPLICATIONS OF MALARIAL FEVER WITH OTHER DISEASES. 
The poison of malaria like that of syphilis, produces a condition of 
the human system characterized by certain lesions of the blood or other 
organs upon which may be engrafted various acute affections, as pleuritis 
pneumonitis and acute articular rheumatism, diarrhoea and dysentery. 
Thus a careful analysis of the clinical record of 757 cases of diseases 
treated in the Charity Hospital, October 1st, 1874, to April 1st, 1875;°Octo- 
berlst, 1875, to April 1st, 1876, gives the following statistics with refer- 
ence to uncomplicated and complicated cases of malarial fevers: 
Cases. 
Deaths. 
Intermittent fever 
286 
1 
Intermittent fever and pneumonia 
Intermittent fever and dysentery 
2 
Intermittent fever and diarrhoea 
14 
2 
Intermittent fever and erysipelas 
1 
Intermittent fever and organic disease of the heart 
1 
Remittent fever 
37 
Remittent fever and diarrhoea 
1 
Remittent fever and malarial hsematuria 
1 
i 
Pernicious malarial fever 
2 
2 
Intermittent fever and rheumatism 
2 
Intermittent fever and epilepsy 
1 
Intermittent fever and coma 
2 
i 
Intermittent fever and bronchitis 
3 
Intermittent fever and anasarca 
1 
Intermittent fever and necrosis of humerus 
1 
Remittent fever and lead poisoning 
1 
Malarial fever 
3 
Malarial coma 
1 
i 
Congestive chill 
1 
1 
Malarial chachexia 
2 
Chronic malarial poisoning 
29 
2 Malarial Fever, by Joseph Jones, M. D. 
1129 
In the preceding 384 cases of malarial diseases with various complica- 
tions, eleven proved fatal, of this number uncomplicated intermittent and 
remittent fever, occasioned 323, with one death; the remaining sixty-one 
•cases complicated with intercutting diseases occasioned ten deaths; the 
various complications therefore greatly increased the otherwise slight mor- 
tality of malarial fever. It is worthy of note that chronic interstitial hep- 
atitis, terminating in cirrhosis of the liver, ascites and death, frequently 
results from the prolonged action of the malarial poison. 
Dengue 
Cases. 
15 
Deaths. 
Yellow fever 
70 
35 
Typhoid fever 
16 
3 
Measles 
10 
2 
•Scarlatina 
4 
1 
Diptheria 
2 
Mumps 
3 
Small-pox 
18 
] 
Asiatic cholera 
2 
2 
Total 
146 
44 
CONTAGIOUS AND INFECTIOUS FEVERS AND DISEASES. 
Per cent, of deaths in contagious and infectious fevers and diseases, 30.1. Ratio 
of deaths in 1000 cases of contagious and infectious fevers and diseases, 30.1. One 
death from contagious and infectious fevers and diseases in 3.31 cases. 
Phthisis pulmonalis 
Cases. 
413 
Deaths 
122 
Per cent, of deaths in cases of phthisis pulmonalis 
29.5 
Elephantiasis graecorum (Oriental leprosy) 
5 
3 
Elephantiasis arabum 
3 
Yaws, African 
1 
Scrofula 
14 
3 
Scurvy 
7 
Purpura haemorrhagica 
8 
Total 
38 
6 
An examination of the mortuary records of New Orleans will show 
that about one-tenth of all the deaths occurring in New Orleans, are due to 
phthisis pulmonalis. Thus, the total deaths in New Orleans during thirty- 
four years, 1844 to 1880, were 242,426, and of this number phthisis pulmo- 
nalis occasioned 24,071. During the same period fevers of all kinds 
destroyed in the city of New Orleans 56,468 citizens, yellow fever being 
credited with almost one-half this number, namely, 28,739. Phthisis 
pulmonalis has therefore destroyed nearly as many citizens as yellow fever. 
Enteritis, dysentery and diarrhoea caused 22,301 deaths; and Asiatic 
cholera, cholera morbus and cholera infantum, 15,144. Phthisis pulmonalis 
and bowel affections which are common to the entire valley of the Mississippi, 
caused 61,516 deaths, whilst fevers caused only 56,478 deaths. Fevers, 
bowel affections and phthisis pulmonalis alone caused in New Orleans 
117,994 deaths in thirty-four years, out of a total of 242,426 deaths from 
all causes. 
The statistics afforded by the Charity Hospital of New Orleans are no 
less instructive. During a period of thirty-four years, 1842-1880, 10,950 
cases of phthisis pulmonalis were treated in the wards of the Charity Hos- 
pital, 5690, or 54.1 per cent, of which terminated fatally. In comparison 
with phthisis pulmonalis, which every year destroys its thousands and tens 
PHTHISIS PULMONALIS. 1130 
Practical Observations on the Treatment of the Various Forms of 
of thousands, in every state in this Union, yellow fever should be regarded 
only as a casual and minor disease, visiting only certain limited portions 
of the tropical and temperate regions at long intervals. We hear much of 
the cost of epidemics, but nothing as to the fearful cost of such a disease 
as phthisis, which holds its doomed victims in its deadly embrace, for 
months and even years, and inflicts in addition to indescribable tortures, 
continuous and ruinous pecuniary injuries. 
DISEASES OF THE RESPIRATORY SYSTEM. 
Cases. 
Deaths. 
Bronchitis 
.... 160 
4 
Vesicular emphysema 
1 
Asthma 
.... 40 
3 
Gangrene of lungs 
1 
1 
Pneumonia 
.... 152 
32 
Pneumonia (double) 
.... 41 
21 
Pleuro-pneumonia 
16 
6 
Pleuro-pneumonia (double) supervening on malarial fever 
4 
4 
Pleuro-pneumonia supervening on phthisis 
2 
2 
Abscess of lungs 
o 
1 
Laryngitis (acute) 
2 
Pleuritis 
.... 47 
3 
Hvdrothorax 
6 
1 
Pneumo-thorax 
2 
1 
Hydro-pneumo-thorax 
3 
1 
Total diseases of respiratory system 
.... 493 
82 
DISEASES OF ALIMENTARY CANAL. 
Cases. 
Deaths- 
Inflammation of fauces and palate 
1 
Ptyalism 
1 
Tonsilitis 
6 
Pharyngitis 
3 
Trachitis . 
4 
Dyspepsia 
Gastritis ; 
10 
••• 
Gastralgia 
1 
Gastro-enteritis and jaundice 
2 
• -• 
Gastro-enteritis 
5 
... 
Cholera morbus 
10 
... 
Enteritis 
... 
Dysentery (acute) 
122 
17 
Dysentery (chronic) 
90 
Diarrhoea (acute) 
Diarrhoea (chronic) 
160 
12-5 
7 
25 
Dysentery and diarrhoea (chronic) 
Constipation 
131 
30 
5 
- 
Hernia 
6 
... 
Obstruction of the bowels 
2 
2 
Haemorrhoids 
8 
... 
Fistula in ano 
Prolapsus of anus 
2 
1 
... 
Abscess of rectum 
1 
... 
Cancer of rectum 
Peritonitis 
1 
... 
1 
... 
Total diseases of the alimentary canal 
- 
1 ■ 
709 
123 
It will be observed that in the class of diseases of the alimentary canal 
acute diarrhoea and acute dysentery occasioned 282 cases, with 24 deaths, 
and chronic diarrhoea and dysentery occasioned 346 cases and 97 deaths. Malarial Fever, by Joseph Jones. M. D. 
1131 
the mortality being relatively greater in the chronic than in the acute 
forms of these diseases. Many of these cases were brought in wretched 
condition from the swamps along the railroads, and from the rice fields 
above and below New Orleans, on the banks of the Mississippi and its 
tributaries, or were complicated by the action of the malarial poison. 
Many cases of dysentery were subjected to careful clinical study, and post- 
mortem examinations were frequently made in fatal cases. The more 
important lesions were: 
1. Inflammatory thickening and ulceration of the mucous membrane 
of the colon and rectum. 
2. The transudation of blood and gelatinous, fibrinous and bloody 
exudation from the ulcerated surfaces. 
3. The co-existence and pre-existence of abscesses of the liver. 
4. The co-existence and pre-existence of hepatitis. 
5. The co-existence of the characteristic lesions of malarial fever, 
such as enlarged pigmented liver and spleen and watery blood. 
The persistence of many cases of dysentery, as well as the oft-recurring 
relapses in the chronic stage of the disease, must be referred mainly to the 
existence of ulcerations of the mucous membrane of the colon and rectum. 
As long as one or more ulcers remain unhealed, any imprudence or diet, 
as well as exposure to cold and wet, and excessive fatigue, may light up 
the disease and excite the severest symptoms. 
Cases. 
Deaths. 
Hepatitis 24 
6 
Hepatitis and abscess of liver 12 
7 
Cirrhosis of liver, with ascites and anasarca of lower extremities.. 31 
Adenoma and cirrhosis of liver 1 
Jaundice 10 
Fattv degeneration of liver 3 
21 
1 
Amyloid degeneration of liver 1 
i 
Tuberculosis of liver. 1 
1 
Obstruction of common bile duct and jaundice 1 
1 
Total diseases of liver 85 
38 
DISEASES OF THE LIVES. 
Cases. 
Deaths. 
Splenitis 
2 
Hypertrophy of spleen 
1 
Leucocythseniia 
1 
1 
Total diseases of spleen 
4 
1 
DISEASES OF THE SPLEEN. 
The following facts should be noted with reference to the preceding 
classification of the diseases of the liver and spleen. The cases recorded 
as jaundice did not express the number of cases presenting this symptom, 
for almost every case of yellow fever, and a large number of the various 
forms of malarial fever, as well as some cases of hepatitis, cirrhosis and pneu- 
monia were jaundiced. Every case of prolonged malarial fever presented 
more or less hepatic derangement and enlargement of the spleen, but the 
secondary derangements were included under the head of the original mala- 
rious diseases. 1132 
Practical Observations on the Treatment of the Various Forms of 
Cases. 
Deaths 
Bright's disease of the kidneys 
80 
20 
Acute nephritis 
1 
Diabetes nielli t us..... 
3 
1 
Diabetes insipidus 
4 2 
Renal calculus 
1 
- 
Total diseases of the kidneys 
88 
26 
DISEASES OF THE KIDNEYS. 
If a comparison be instituted between the rate of mortality in these 
cases under the immediate care of the author and the general statistics of 
the Charity Hospital, we obtain the following data, which he has consolida- 
ted at the expense of much time and labor. During eighteen years pre- 
ceding the Civil War (1842-1861), the total admissions into the Charity 
Hospital of New Orleans were 207,356; total deaths, 29,614; per cent, of 
deaths, 14.2. During sixteen years following the Civil War (1864-1881), 
total admissions, 96,857; total deaths, 14,104; per cent. 14.5. Total admis- 
sions during thirty-four years, 304,213; total deaths, 43,718; per cent, of 
deaths in the Charity Hospital of New Orleans during the thirty-four years 
specified, 14.3. The greater proportion of the cases of fever, and of all 
other diseases treated by the author in the Charity Hospital during the 
period specified (1869-1886), were natives of foreign countries and of sur- 
rounding States. Many had resided in Louisiana only a short time, not 
exceeding one year in the United States, whilst many were brought directly 
to the wards of the hospital from the swamps and rice-fields of the delta 
of the Mississippi river, within a month after their arrival from Europe. 
Upon a careful examination and classification of the statistics of the 
Charity Hospital of New Orleans, during the period of forty years-1836- 
1876-we found that 310,659 patients were admitted: and of this number, 
248,011 were foreigners; 55,403 natives of the United States, outside of 
Louisiana, and only 11,761 were natives of Louisiana. During the entire 
period of the hospital service of the author, similar relations with refer- 
ence to nativity existed amongst the patients under his care and treatment. 
During a term of service extending from October 1st. 1884, to April 1st, 
1885, of a grand total of 547 cases treated by the author in the Charity 
Hospital, only 42 were natives of Louisiana, and of these only 18 were 
natives of New Orleans, the remaining 24 having been born in the various 
parishes of Louisiana. Of the 63 deaths occurring during this period, 
only two were natives of New Orleans, and the cause of death was the same 
in both-namely, phthisis pulmonalis. Among the 24 natives of the 
other parishes of Louisiana, four deaths occurred bv the following causes: 
chronic Bright's disease, chronic dysentery, pernicious malarial fever, 
malarial toxaemia, or cachexia of long standing, with enlarged spleen, 
anaemia and general anasarca. The natives of Louisiana constituted only 
7.6 per cent, of all cases treated, and the mortality 9.2 per cent, of the 
deaths from all causes. During a term of hospital service extending from 
October 1st, 1885, to April 1st, 1886, of a grand total of 323 cases of all 
diseases treated by the author, 11 were natives of New Orleans, and 60 of 
the parishes outside of the limits of the parish of Orleans. The foreigners 
and natives of other States of the Union numbered 252. 
MICROSCOPICAL AND CHEMICAL CHANGES OF THE BLOOD IN MALARIAL 
FEVER. 
The author has been led. by extended observations and investigations, 
during a period of thirty years-1855-1S86-to definite conclusions, some 
of which may thus be formulated: Malarial Fever, by Joseph Jones, M. D. 
1133 
1. The phenomena of malarial fever in the human organism are due 
to the introduction of a morbific ferment. 
2. The micro-organism concerned in the production of malarial fever 
attacks chiefly the red blood-corpuscles of man. 
3. The phenomena of malarial fever are due in part to the destruction 
of the colored blood-corpuscles, in part to the derangement of the normal 
chemical changes of the blood and organs, and in part to toxic action of 
the chemical compound developed by, and resulting from, the action of the 
micro-organisms. 
4. The chemical and physical changes excited in the blood and 
organs of the human body by the action of the malarial micro-organisms 
are in their highest and final results inimical to the development and mul- 
tiplication of the essential potential elements of the malarial ferment. 
5. The active febrile phenomena of malarial fever are, in their ulti- 
mate results and products, antiseptic; they tend to inhibit the development, 
and even to destroy the morbific ferment of malarial fever. 
6. Many of the most destructive and fatal effects of the malarial fer- 
ment occur in cases in which there has been comparatively little elevation 
of temperature, and in which the paroxysms succeed each other in an 
almost imperceptible manner. 
7. The recurrence of paroxysms in malarial fever is due to the partial 
destruction of the micro-organisms during the active and pronounced chem- 
ical changes of the fever. When not wholly destroyed during the febrile 
stage, the micro-organisms are reproduced, and again, at definite intervals, 
induce disturbances of the nervous system, alterations of the blood, and 
oscillations of the temperature. 
8. Such agents as quinia, arsenic, and the preparations of mercury 
act as poisons to the micro-organisms of malarial fever, excite an antiseptic 
effect upon the blood, bind the oxygen more nearly or chiefly to the haemo- 
globin, and proteids, and directly promote the elimination, through the 
alimentary canal, the skin and the kidneys, of the noxious products of the 
morbific ferment and of the increased and altered chemical actions. 
9. The changes induced by the morbific malarial ferments upon the 
blood differ chemically and microscopically from those induced by other 
morbific organisms, as those of small-pox, typhoid fever, typhus fever, yel- 
low fever, measles, scarlet fever, relapsing fever, diphtheria, Asiatic 
cholera, Oriental plague, tuberculosis, Oriental leprosy, pneumonia, pleu- 
ritis, carditis, erysipelas, rheumatism and pyaemia. 
10. The micro-organisms which we have observed in the blood of 
patients suffering from malarial fever may be thus briefly enumerated: 
(a.) Minute globular bodies from 10,000 to 30,000 of an inch in diam- 
eter, having the general appearance and chemical features of the spores of 
bacteria. 
(b.) Globular bodies of larger size than the preceding, often of a dark 
opaque character, found not only in the liquor sanguinis, but also in the 
colored blood-corpuscles and in the colorless blood corpuscles. These 
bodies, most probably true spores, appear to possess the power of invading 
and destroying the colored blood-corpuscles. These micrococci, or spores, 
are often observed in the blood, in groups, surrounded by protoplasm con- 
stituting zoogloea. 
(c.) Ovoid, cylindrical and rose-shaped bodies, not destroyed by acetic 
acid, and stained by aniline dyes. These bodies increase during the cold 
stage, and are also more numerous in pernicious malarial fever. 
(d.) Colorless blood-corpuscles containing minute pigments, granules 
and dark spherical bodies resembling sporules, many of them pigments, 1134 
Practical Observations on the Treatment of the Various Forms of 
corpuscles, or aggregations of dark spherical bodies, surrounded by proto- 
plasm, are about twice the diameter of the colorless blood-corpuscles of 
normal blood; and their behavior under the action of reagents, and also 
during the process of staining, leads to the view that a portion at least of 
these bodies must be regarded as vegetable organisms. These large pig- 
ment cells appear to be characteristic of malarial fever. 
(e.) Masses of hmmatin of various forms, irregular in size and shape, 
but most generally the sides and portions seen in profile are angular. The 
deposit of dark pigment masses in the liver and in the brain, in malarial 
fever, and especially in cases of repeated paroxysms, finds its origin in the 
changes of the colored blood-corpuscles induced by the morbific ferment, 
or micro-organisms of malarial fever. There is an actual destruction of 
the colored blood corpuscles in the living blood, and within the walls of 
the living capillaries and blood-vessels in.malarial fever; and this destruc- 
tion is not referable either solely or originally to the action of the bile acids 
accumulated in the blood as a consequence of biliary congestion or obstruc- 
tion during the febrile stage of malarial fever. We can detect the process 
of the disintegration of the colored blood-corpuscles by the microscope, 
and detect the very inception of that great pathological change which con- 
stitutes one of the most distinctive features of malarial fever, and which 
must be carefully considered in auy scientific and rational plan of treatment. 
(f.) Marked variations in the size of the colored blood-corpuscles. 
These variations, from small corpuscles to what might be called giant cor- 
puscles, twice the diameter of normal blood globules, appear to be charac- 
teristic of malarial fever. 
11. The destruction of colored blood-corpuscles does not take place with 
equal rapidity in all parts of the organism, but appears to be mostly marked 
in the spleen and liver. The blood pigment resulting from the haematin of 
the blood-corpuscles is frequently observed in the blood as it circulates in 
the vessels and capillaries, in masses of various sizes, and in the form of 
cellular elements. Without doubt local congestion may be caused by 
obstruction of the circulation in the capillaries by these pigment particles 
and cells; and such congestion may lead to local haemorrhages. The con- 
gestions and haemorrhages thus resulting are especially significant when 
occurring within the structures of the brain and spinal cord. The appro- 
priation of a portion of the altered coloring matter, haematin of the col- 
ored blood-corpuscles, by the leucocytes, is due to the physical and vital 
endowments of these elementary bodies. It is now generally admitted that 
the colorless blood-corpuscles are elementary organisms, which are endowed 
with the power of spontaneous motion, this power belonging to them in 
virtue of the protoplasm of which these bodies are composed. This motion 
is of two kinds, consisting of change of form and change of place; the 
latter resulting from the former. As movements of this kind are seen in 
greater perfection in rhizopods and amoebic. they are called amoeboid. The 
colorless corpuscles, when carefully examined in considerable numbers 
under high forms of the microscope, to inch objective, are seen to 
differ from one another both in size and aspect, and in their properties and 
spontaneous movements. 
The careful experiments of physiologists have established the impor- 
tant fact that it is possible to feed the colorless blood-corpuscles. It has been 
demonstrated that the colorless blood-corpuscles possess the faculty of taking, 
by virtue of their amoeboid movements, solid particles into their substance. This 
subject is of great interest to the histologist, in affording him a means by 
which to mark individual corpuscles so as to follow them in their wander- 
ings through the organism, and to the physiologist, in relation to the mode Malarial Fever, by Joseph Jones, M. D. 
1135 
in which amoeboid cells take in nourishment; to the student of fevers it is 
of transcendent importance in giving an important point of diagnosis for 
malarial fever, which distinguishes it from all other forms, and especially 
yellow fever. The author demonstrated, during the progress of his patho- 
logical researches, extending from 1856 to 1886, the power of the colorless 
corpuscles of human blood to feed upon and appropriate the haemoglobin, 
haematin and haemin of the colored blood-corpuscles in the blood-vessels of 
malarial patients, before physiologists had experimentally determined, by 
employing either finely divided fatty substances or coloring matters, the 
power of the colorless blood-corpuscles of taking solid particles into their 
substance. 
We have thus traced the pigmentation of the colorless blood-corpus- 
cles in malarial fever to 
(a.) The destruction of the colored blood-corpuscles by the morbific 
ferment, or micro-organism of malarial fever. 
(b.) The coloration of the haemoglobin, haemin, and haematin, and its 
appropriation by the colorless blood-corpuscles in virtue of their physical 
and vital principles and amoeboid movements. 
(c.) The invasion of the colorless corpuscles by the colored spores of 
the malarial bacillus. 
12. Increase of water in the blood of malarial patients.-Chemical analy- 
sis has shown that normal healthy human blood frequently yields 150 parts 
in the 1000 parts of blood, of colored blood-corpuscles in the dried (anhy- 
drous} state. The dried blood-corpuscles do not represent the true rela- 
tions of the moist blood-corpuscles to the liquor sanguinis of the living 
human blood as it circulates through the vessels. The number of moist 
(normal colored blood-corpuscles) is obtained by multiplying the dried cor- 
puscles by four. We thus obtain for healthy human blood the following 
composition : 1000 parts of healthy human blood contains, moist red 
globules, 600; liquor sanguinis, 400. In prolonged or chronic malarial 
fever (malarial toxaemia or cachexia) the author has found the dried blood- 
corpuscles to be reduced to 50 parts in the 1000 parts, and in some cases as 
low as 30 parts in the 1000 parts of blood. 
If we accept the first figures, the following will represent the consti- 
tution of the blood in chronic malarial poisoning : 1000 parts of human 
blood in chronic malarial fever contains, moist red globules, 250; liquor san- 
guinis, 750. We have in the preceding changes of the blood, induced by 
the action of malarial poison, an explanation of the sallow, anaemic com- 
plexion, the feeble, irritable action of the heart, the depressed muscular 
power and mental forces, and the bloated countenance, protuberant belly, 
and swollen, anasarcous limbs. 
13. Diminution of the fibrin of the blood.-The persistent and uniform 
deviation of this constituent of the blood in uncomplicated cases of mala- 
rial fever distinguishes this from the true inflammation and the fever 
accompanying local inflammation; and also affords an explanation of the 
tendency to haemorrhages in many endemics of malarial fever. 
PRACTICAL OBSERVATIONS ON THE TREATMENT OF MALARIAL (PAROXYS- 
MAL) FEVER. 
Of 2327 cases of the various forms of intermittent fever (quotidian, 
tertian and quartan, only five, or about 0.21 per cent., terminated fatally. 
The mortality in remittent malarial fever was greater, the deaths number- 
ing seven in a total of 247 cases: percent, of mortality 2.83. One-half (50 
per cent.) of the cases of malarial hmrnaturia terminated fatally; and more 1136 
Practical Observations on the Treatment of the Various Forms of 
than one-half the cases of pernicious congestive malarial fever died; or, 
more exactly, fifty-six deaths in eighty-seven cases (64.3 per cent.) The 
deaths from chronic malarial cachexia were more numerous than in the 
intermittent and remittent fevers, but less than in the pernicious and haem- 
orrhagic forms; fourteen deaths occurring in 212 cases, or a mortality of 
6.6 per cent. The fatal cases of intermittent fever were complicated with 
intercurrent diseases. It is evident from the preceding statistics, that the 
treatment adopted by the author yielded results corresponding with the 
nature, severity, preceding duration and effects of the various types or 
varieties of the malarial diseases. In an effort to formulate the general 
plan of treatmem pursued in these cases, it is evident that the remedies 
were necessarily adapted to the natural progress and history and visceral 
complications of each class and condition of the malarious manifestations; 
and for purposes of clearness and precision and brevity we will present the 
practical results under the following heads : 
1. ACUTE STHENIC, INTERMITTENT AND REMITTENT FEVER, OCCURRING 
FOR THE FIRST TIME IN HEALTHY INDIVIDUALS. 
Numerous cases have come under my observation of treatment of 
natives of Europe and of the healthy non-malarial districts of the United 
States of America who have been attacked by the various forms of inter- 
mittent and remittent fever for the first time in the history of their lives. 
Thus I have seen entire crews of Northeim sailors stricken with intermit- 
tent and remittent fever shortly after their arrival in the Southern rivers 
bordered by extensive swamps and marshes. Natives of Ireland, France, 
Germany, Italy, Spain and England who work for the first time upon the 
railroads and in the swamps, rice fields and marshes of Georgia, South 
Carolina, Alabama, Louisiana, Mississippi, Arkansas and Texas are subject 
to the most violent forms of intermittent and remittent fevers in the months 
of July, August, September and October. Such cases, if imperfectly 
treated or abandoned to the powers of nature, either perish in the acute 
stages of the malarious disease, or suffer repeated attacks of chills and 
fever, and during the repeated congestions of the internal organs, and the 
oft-recurring cold and hot stages, are gradually reduced to a most distress- 
ing and dangerous condition. The repeated and prolonged action of the 
malarial poison induces destruction of the colored blood-corpuscles, anaemia, 
hepatic and splenitic enlargements and indurations, aberration, nervous 
phenomena, neuralgias, muscular prostration and general anasarca. Whilst 
it may be true that a certain percentage of cases of intermittent fever in 
comparatively healthy localities, especially when the individual moves 
out of the malarial region in which the disease has been contracted into a 
non-malarious district, may recover spontaneously without the exhibition 
of quinine or any other remedy. This statement does not apply to the 
swamps, marshes and rice fields of our Southern States. In these low, 
moist, malarious districts the poison of malarial fever is ever present, and 
while it may slumber and hibernate daring the coldest weather of the year 
it returns in the spring time with the vegetation and attains its maximum 
intensity in the months of July, August, September and October. If this 
disease be often self-limited in its character, and terminates in health 
either from the elimination of its cause or the exhaustion of susceptibility 
to its action, or from the curative powers of nature," such favorable termi- 
nation is only possible in healthy non-malarious localities, and appears to 
be well nigh impossible in such regions as the swamps, marshes and rice 
fields of our Southern States. Manv cases of intermittent and remittent Malarial Fever, by Joseph Jones, M. D. 
1137 
fever which appear at the outset to be devoid of danger frequently assume, 
without warning, highly dangerous characters. It is, therefore, manifestly 
impossible to predict at the commencement of an attack what its subsequent 
symptoms, course and termination may be. In this disease, in which the 
virtues of quinine as an antipyretic and anti-paroxysmal and antiseptic rem- 
edy are well established, there is no excuse for delay and indecision; "to 
wait for a remission" may be "equivalent to the loss of a patient," and has 
been justly termed "a meditation on death." Holding these views, the 
author has used purgatives and quinine at the onset of the disease and con- 
tinues the use of quinine in full doses regardless of the stage of remission 
or intermission, or febrile excitement. Whilst unloading the portal circle 
and relieving the congestion of the brain, liver and spleen by mercurials, 
quinine also has been simultaneously administered. Thus ten grains of 
calomel and sulphate of quinia, followed in four hours by one fluid ounce 
of castor oil and from five to ten grains of quinine, administered promptly 
in the onset of intermittent and remittent fever, not only causes free evacu- 
ations of the bowels, but also arrests the fever and places the system in the 
proper condition for the subsequent action of quinine. Quinine was then 
administered in doses of five or ten grains until from fifteen to forty grains 
were administered during the twenty-four hours. After the complete sub- 
sidence of the fever quinine is not abandoned, but is administered, from 
ten to twenty grains each day, for at least one week after the fever, and 
subsequently from five to ten grains each day for at least ten days longer; 
and where the patient is compelled to remain in the malarious atmosphere 
exhaled from swamps, marshes or rice fields he was advised to use quinine 
as a prophylactic, often combined with iron and arsenic during the months 
of September and October. In those cases in which the stomach was too 
irritable to retain the quinine it was used externally or by enema. For 
external administration the following formula has been found to be useful: 
B. Quin, sulph., gi; linam. saponis, olei olivse, aa fgiij. Mix. Use as 
a liniment under armpit (axillae), on the inner surface of thighs, on the 
abdomen and spine, every two, three or four hours. This liniment is effi- 
cient also in the treatment of malarial fever occurring in children who 
take quinine by the mouth with great reluctance. 
When quinine is administered to the adult as an anti-malarious remedy 
in intermittent and remittent fever, neuralgia, brow ague, and incases of 
rheumatism, pneumonia and pleuritis resulting from cold, damp and marsh 
air, and which show a periodic or intermittent character, it should be given 
alone and in large doses at regular intervals; thus, beginning with ten 
grains, followed by the same or half this quantity (five grains) every four 
hours, until the frequency of the pulse is lowered, the fever heat is dimin- 
ished and the ears ring. Sugar-coated quinine pills as furnished "by 
the wholesale" from the manufacturing druggists and chemists should be 
universally abandoned by the medical profession in malarial regions, 
because their insolubility renders them incapable of rapid assimilation by 
the enfeebled and irritated stomach. The use of these and other manufac- 
tured pills often causes the loss of precious time, frequently deceives both 
physician and patient, and ensures a fatal result when recovery should 
have been certain if quinine and quinine alone had been administered by 
the mouth or rectum, or by subcutaneous injection. I have seen these 
sugar-coated quinine pills, and the so-called quinine capsules, pass through 
the bowels in intermittent and remittent fever unchanged with the dis- 
charges of the bowels. When the bowels are in active motion and the doc- 
tor is pouring in his 1 'elegant commercial manufactured sugar-coated and 
gelatine embalmed quinine pills" they may sometimes be heard falling 1138 
Practical Observations on the Treatment of the Various Forms of 
upon the bottom of the chamber rattling like buckshot or dried peas. In 
all serious cases of malarious disease, where the object of the physician is 
to produce a prompt and decided impression, quinine is best given alone-, 
each dose may be stirred in a wineglassful of pure water or wrapped up in 
moistened wafer paper (to be had of any pastry cook) and swallowed as a 
bolus. Pills of the bisulphate of quinia, which may be prepared extempo- 
raneously with dilute aromatic sulphuric acid, may be used in some cases 
with benefit, but it sometimes occurs that this form of the sulphate is too 
irritating to the gastric mucous membrane. In like manner the solution 
of the quinine in water by the aid of citric or sulphuric acid may prove 
useful, provided the acid solutions do not irritate the stomach. 
As a general rule, I have not employed digitalis, aconite, veratrum 
viride and gelsemium in intermittent and remittent fever, but trusted 
chiefly to the sulphate of quinia. In like manner, opium, hydrate of 
chloral, morphia, belladonna, hyoscyamus and the bromides, were used as 
adjuvants to quinine when necessary. Without doubt digitalis, veratrum, 
gelsemium, opium and its preparations, chloral hydrate, chloroform and 
bromide of potassium may be indicated in certain cases, and I have used 
one and all of these drugs to fulfil certain indications, but I have never 
lost sight of the fact that quinine was the great agent for the arrest and cure 
of the paroxysmal fevers. Chloroform used in large doses to arrest or abort 
the cold stage, has, according to my experience, proved destructive to life, 
when administered by others. I regard the practice of giving large doses 
of either chloroform or tincture of digitalis in the cold stage of malarial 
fever as dangerous. Salicine. salicylic acid and salicylate of soda have 
proved useful in the treatment of the various forms of fevers, and espe- 
cially in rheumatic fever, as depressors of temperature, and even as cathar- 
tic agents in malarious fevers, but these remedies have never, in my hands, 
equalled or superseded the sulphate of quinia. 
2. INTERMITTENT FEVER OF LONG STANDING. 
The prolonged action of the malarial poison will often cause congestion 
of the internal organs, induce profound alterations in the blood, and struc- 
tural changes in the liver and spleen. The frequent occurrence of intersti- 
tial hepatitis and jaundice, as well as irregular action of the heart, debility 
of the capillary circulation and general anasarca, characterize the chronic 
stages of malarial fever. The indications for treatment are : 
1. To arrest the paroxysms. 
2. The regulation of the hepatic and renal secretions. 
3. The restoration of the impoverished and watery blood to its normal 
condition. 
4. The improvement of digestion and assimilation, and the restora- 
tion of the nervous and muscular forces. 
To accomplish the first iodicition, quinine and arsenic are most relia- 
ble agents. The latter should be administered in such doses as not to 
irritate the stomach. Comparatively small doses of arsenious acid, admin- 
istered at regular intervals, often accomplish great good in obstinate, pro- 
tracted cases of malarial fever. I have freely used Fowler's solution of 
arsenic in doses varying from six to twelve drops, every four, six or eight 
hours. Ten drops of Fowler's solution, given one hour after each meal, 
has been beneficial in protracted intermittent fever, marsh cachexia, and 
especially when the tincture of iron was administered (properly diluted) in 
similar doses, one hour before each meal, in order to fulfil the third indica- 
tion. Quinine was also administered in these chronic cases, according to Malarial Fever, by Joseph Jones. M. D. 
1139 
the indications, in from 3 to 6 grains three times a day. The quinine was 
frequently added to and administered with the solution of the tincture of 
iron. During convalescence, infusions of Virginia snakeroot (aristolochia 
serpentaria) and of quassia were used, with the result of improving diges- 
tion and increasing the muscular force. Nux vomica (in powder, extract 
or tincture), and solutions of strychnia, proved of permanent benefit in 
protracted cases, especially when administered in conjunction with tinc- 
ture of iron and the mineral acids. 
In hepatic derangements caused by the action of the malarial poison, 
nitro-muriatic acid, administered internally, and applied externally in the 
form of the footbath, or u«ed locally over the region of the liver, possesses 
great value. The tincture of iron, as well as the nitro-muriatic acid, 
possesses the power of giving tone and power to the muscles, and especially 
to the muscular fibres of the heart-a remedy of great importance in the 
anaemic state induced by the action of the malarial poison. Although 
apparently not reduced in flesh, but, on the contrary, with bloated and 
swollen countenances and limbs, the miserable anaemic, sallow victims of 
the prolonged action of the malarial poison suffer from a feeble cardiac 
action, often accompanied with a murmur: they are incapable of prolonged 
muscular effort, panting for breath upon the slightest exertion, and suf- 
fering with violent palpitation of the heart, dizziness and imperfect vision. 
The distress is often very great when such patients attempt to ascend the 
stairs; the heart beats tumultuously, the "head swims," and the trembling 
patient sinks down exhausted-overwhelmed by muscular and nervous 
weakness, and irregular action of the circulatory and respiratory appara- 
tus. Both the cerebro spinal and the gauglionic (sympathetic) systems are 
depressed in their action and deranged in their functions; and the ganglia 
of the heart are necessarily deeply affected by virtue of their increased 
activity in sickness as well as in health; and the muscular fibres of the 
heart, supplied with anaemic blood, containing the micro-organisms of 
malarial fever and the noxious results of their chemical actions, neces- 
sarily manifest feeble and spasmodic actions. 
Under the judicious and persevering use of quinine, iron, arsenic, 
strychnine, and the tribasic phosphate of iron and lime, these distressing 
symptoms gradually pass off; the patient loses the local cardiac murmur, 
the action of the heart becomes slow, regular and vigorous, the cerebro- 
spinal and sympathetic systems regain their tone and vigor, the intellect 
is again able to perform its functions, the liver secretes normal bile, the 
blood regains its lost colored corpuscles, the surface of the face and body 
resumes its healthy appearance, and the patient is able to resume his nor- 
mal occupation. It is well known that neuralgia of a strictly periodical 
character often prevails in the same localities and seasons, preceding alter- 
nately with and succeeding to periodical fevers, exhibits the same types 
and phenomena of intermission and remission. Periodic neuralgia is 
therefore produced by the same morbific ferment as intermittent and 
remittent fevers, and yields most readily and surely to the same general 
plan of treatment. In this painful and most distressing manifestation of the 
malarial disease our reliance must be in the free administration of quinia, 
often combined with opium, morphia, hydrate of chloral, belladonna, and 
hyosciamus. One-fourth of a grain of morphia with gr. to of atropia, 
injected subcutaneously, has proved beneficial. Morphia and the prepar- 
ation of opium should be used with caution by the physician in obstinate 
cases of neuralgia, in order that the "opium habit" may be avoided. 1140 
Practical Observations on the Various Forms of Malarial Fever, 
3. PERNICIOUS OR CONGESTIVE MALARIAL FEVER. 
In the algid form characterized by rapid, feeble pulse, cold extremities, 
and prostration of the nervous and muscular forces, when the intellect is 
clear, the main indications are : 
1. To bring the patient under the influence of quinine at the earliest 
practicable moment. 
2. To restore the general and capillary circulations, and invigorate 
and support the action of the heart by the judicious administration of 
diffusible stimulants and by the external application of sinapisms and heat. 
In cases characterized by coma, blisters should be promptly applied to 
the back of the head and neck, and on the epigastrium, and if the bowels 
are not loose, a full dose of calomel should be administered by the mouth. 
Notwithstanding the profound coma which characterizes this class of cases, 
pressure over the region of the siomach and liver will almost always elicit 
groans, cries and signs of distress from the patient. The author has been 
led, by the results of his extended experience in civil and military practice, 
to regard the prompt application of a large blister, six by six inches, or 
eight by eight inches, over the region of the stomach and liver, as a 
measure of great value, which may, in some instances, be the means of 
preserving life. 
The use of such agents as chloroform, digitalis, aconite and veratrum 
viride in the pernicious forms of malarial fever, according to the experience 
of the author, is attended with great danger. The injudicious use of 
chloroform and of tincture of digitalis has, in some cases, caused death 
by depressing still further the feeble nervous cardiac powers. The large 
proportion of the so-called congestive cases have been the victims of the 
prolonged action of the malarial poisons before the sudden development 
of the dangerous (pernicious) symptoms, and manifest the profound action 
of the malarial poison in the sallow, anaemic, jaundiced countenance, and 
enlarged liver and spleen. In fatal cases the cortical substance of the brain 
is frequently found of a dark, almost chocolate color, from the deposition 
of pigment granules and pigment cells within and around the cerebral 
capillaries, the pigmentation being most marked in the gray substance of 
the cerebrum and cerebellum. The enlarged liver presents marks of 
interstitial hepatitis, with deposits of blood and biliary pigments in the 
capillary net-work of the lobules. The enlarged spleen resembles a bag of 
soft, dark, purplish-black mud, and has so little consistency that it can with 
difficulty be removed without a rupture of its capsules and trabeculae. This 
black splenic mud contains, in addition to the other constituents of the 
blood, numerous pigment particles and pigment-cells. The hopeless 
character of many of such cases is fully revealed by the results of post- 
mortem examinations, and the tedious character and slow progress of 
those who recover is in like manner rendered evident. 
If the physician succeeds in arousing his patient from the "fatal" 
paroxysm, his subsequent efforts to restore the blood and organs to their 
normal conditions must be based upon his knowledge of the characteristic 
lesions of malarial fever, and the therapeutic value and application of 
quinine, arsenic and iron. Change of climate is of great importance in 
the after-treatment of the pernicious forms of malarial fever, but few 
patients have the necessary means to enable them to make the change of 
locality and climate. By Joseph Jones, M. D. 
1141 
4. HJEMORRHAGIC MALARIAL FEVER; MALARIAL HEMATURIA. 
Haemorrhagic malarial levers prevail in certain seasons and in certain 
localities, and appear to be aggravated by the dangerous system of rice 
culture. The year 1880 was characterized by the prevalence of severe forms 
of malarial fever, often attended with haemorrhage from the stomach, 
bowels and kidneys. This haemorrhagic malarial fever prevailed in great- 
est severity in all those portions of the delta of the Mississippi in which 
rice was cultivated, namely, from the mouth of the Mississippi to the hills 
of North Louisiana and Tennessee. Those cases which came under the 
immediate observation of the author, in 1880, presented all the symptoms 
and characteristic lesions of chronic malarial toxaemia, various degrees of 
hepatic derangement and jaundice, profound anaemia, sudden remissions 
and intermissions. Beyond a tendency to passive haemorrhages, these 
cases presented nothing in common with yellow fever. Even under the 
most energetic and judicious use of such remedies as quinine, tincture of 
iron, and fluid extract of ergot, the results were unsatisfactory and uncer- 
tain, and a large proportion of the cases terminated fatally. Fortunately, 
haemorrhage from the kidneys is of comparatively rare occurrence during 
the progress of malarial fever in many portions of our Southern and South- 
western States; and the form of malarious disease called malarial hcematuria, 
is comparatively rare in New Orleans. If the kidneys suffered equally 
with the liver and spleen in the periodic congestions of the various forms 
of malarial fever, this would prove to be an almost universally fatal 
disease. 
The results of treatment in malarial hcematuria will depend largely upon the 
extent and character of the lesions of the kidneys. When these organs are 
profoundly involved, and haemorrhage occurs extensively into the malpig- 
hian capsules and tubuli uriniferi, the function of these organs is neces- 
sarily greatly impaired, and often completely arrested, and the patient 
dies from uraemic poisonings and in convulsions. In most cases of malarial 
haematuria, the physician has to deal with the profound lesions of the 
blood, nervous system, liver and spleen, induced by the preceding pro- 
longed action of the malarial poison; it is, therefore, not to be wondered 
at that many and very diverse plans of treatment have been recommended 
in this most dangerous and fatal form of disease. No specific rules can be 
laid down to meet the indications of each and every case; many are so 
slight as scarcely to be ranked with malarial hsematuria, and recover under 
the most mild measures; whilst in others the lesions preceding and attend- 
ing the attacks are so grave as to preclude all hope from any plan of treat- 
ment now known to the medical profession. In those cases in which the 
author has been able to institute chemical analyses of the blood, the fibrin 
has been increased to a marked degree, and in every case he has found 
derangements of the hepatic functions and secretions. Benefit has been 
derived in some cases by combining small doses of calomel with full doses 
of the sulphate of quinine. The fluid extract of ergot and the tincture of 
iron have accomplished good in some cases. When the patient vomits 
incessantly large quantities of green and blue bile, and at the same time 
is affected with profuse discharges (sometimes bloody) from the bowels, 
quinine, calomel and other remedies can be administered neither by the 
mouth nor rectum, and the physician must resort to inunction, and to sub- 
cutaneous injections. Quinia, morphine and minute quantities of atropia, 
also the fluid extract of ergot, have been administered hypodermically 
with benefit. 1142 
Treatment of Malarial Fever, by Joseph Jones, M. D. 
MEASURES FOR THE ARREST OF THE FEBRILE STATE. 
Fever is, without doubt, of itself, either from its intensity or from its 
long continuance, a source of danger, apart altogether from the cause 
which has induced it. Thousands of lives are annually sacrificed by the 
neglect of the physician to note carefully by means of the clinical ther- 
mometer and the consequent neglect of the prompt use of the great stand- 
ard antipyretic remedies, quinine, salicine, salicylic acid, salicylate of 
soda, antipyrin and kairin. As long as fever lasts, so long will there 
be increased chemical change and progressive emaciation and progressive 
mental, nervous and muscular debility. Proper nourishment, judicious 
stimulation and careful nursing are essential to the proper treatment of 
fever. These measures are calculated to mitigate the ravages of fever, and 
also to lower its intensity; but although indispensable to the maintenance 
of life, they cannot alone be relied on to reduce the temperature in serious 
cases. It is especially in typhoid and typhus fevers, hectic fever and 
tuberculosis that the great value of stimulation, nutrition and nursing are 
witnessed. In malarial fever, nutrition, stimulation and nursing are of 
value, but without the proper use of the great antiseptics, mercury, 
arsenic and quinine, at the proper periods, and in the proper doses, the 
measures indicated w'ould be utterly powerless. Without doubt thousands 
of valuable lives have been borne safely through the stages of typhoid 
fever by nourishment and nursing alone. But the experiment of curing 
malarial fever solely by "feeding fever," would end in utter defeat, dis- 
aster and death. The epitaph, " He fed feversf' might be a fitting tribute 
to the valuable labois of the eminent physician of Dublin, who treated 
almost exclusively continued fever, typhoid fever, typhus fever, and 
relapsing famine fever. 
The proper epitaph to be placed upon the monument of the physician 
who has successfully combatted the deadly malarial fevers of temperate 
and tropical regions, should be: 
HE COMBATTED AND ARRESTED FEVERS 
BY THE EMPLOYMENT OF MERCURY, QUININE AND ARSENIC. 
Of these remedies quinine holds the first place, and arsenic and mer- 
cury must be regarded as valuable aids in certain states and conditions. 
We may undoubtedly reduce the temperature in malarial fever by the 
[cold bath, and by the powerful antithermic.®, antipyrin, kairin, but 
such reduction of temperature is temporary and deceptive. When these 
effects wear off the fever will return with increased violence, if fatal col- 
lapse has not ensued. Quinine, and quinine alone, in the present state of 
our knowledge, possesses the power, not merely of reducing the tempera- 
ture, but also of preventing the rise of temperature in some of its anti- 
septic as well as its antipyretic and antiperiodic properties. Salicine and 
the salicylates control the rheumatic fever by alleviating and curing the 
rheumatic inflammation. In malarial fever salicine and salicylic acid pos- 
sess but doubtful properties as antipyretics. Quinine in from 10 to 40 
grains, or in large doses, administered at short intervals possesses powerful 
antipyretic properties. The artificial alkaloid kairin, in doses from 8 to 16 
grains every hour, is potent to reduce the temperature in fever. The fall 
of temperature is followed by profuse sweating. Antipyrin, in doses of 
from 15 to 30 grains, induces first, dilatation of the cutaneous vessels, which 
is soon followed by a fall of temperature accompanied by sweating. The 
normal temperature is not affected by anti pyrin, but we find that hourly 
doses of 30 grains quickly bring the temperature down to or below normal. Treatment of Malarial Fever, by Joseph Jones, M. D. 
1143 
Antipyrin is comparatively devoid of taste, readily soluble in water 1 
to 3 cold, and may be administered subcutaneously. Salicin is as certain 
in its power to lower temperature as kairin, and is more permanent in its 
effects; does not produce the nausea and vomiting which often character- 
ize the action of kairin. When applied simultaneously, the fall of temper- 
ature is more rapid and marked than when either antipyrin or kairin are 
given alone. These remedies are of direct value when from the intensity 
of the fever it is important to reduce the temperature rapidly. In mala- 
rial fever the temperature rarely rises to the height of endangering the life 
of the patient by immediate dissolution; and whilst in many cases of 
remittent and pernicious malarial fever the physician may be tempted to 
substitute the apparently more powerful antipyretic agents, kairin and 
antipyrin, for the more slowly acting quinine. He may, without doubt, 
reduce the temperature of his patient rapidly by kairin and antipyrin, but 
this reduction will be attended with profound perspiration, and, in some 
cases, dangerous prostration. 
When the remedies are withdrawn the fever returns, and it may be 
with increased violence. Quinine has the power of inducing a permanent 
reduction of temperature by rendering the blood antiseptic against the 
malarial microbes and by its action on the cerebro-spinal and sympathetic 
nervous systems. Antipyrin and kairin have not fulfilled the offices of 
quinine, and it would be a fatal mistake to substitute the use of these new 
remedies for that of the well established virtues of sulphate of quinine. 
The indications in the treatment of malarial fever may thus be formulated: 
1st. The arrest of the fever. 
2d. The prevention of the return of the fever. 
3d. The arrest and prevention of the characteristic lesions of the 
blood and organs. 
4th. The restoration of the blood to its normal condition. 
5th. The establishment of the normal functions of the organs affected 
by the malarial poison. CHANGES OF COLOR 
IN THE 
HUMAN RACE. 
OBSERVATIONS AND RESEARCHES 
ON 
ALBINISM IN THE NEGRO, CHAPTER VIII. 
CHANGES OF COLOR IN THE HUMAN RACE. 
Description of cases of albinism in the negro race. Two white children born in succession to 
two biack negroes, man and wife. On the mot her's side, the great-grandfather, the grandmother, 
and the mother of the two albino children spotted with white spots. The skin of the negro, origi- 
nally black, may at a period subsequent to birl h, gradually change its color from black to white, 
until the complete albino character is induced. Cases observed by the author, and by various 
observers, Will Byrd, James Bate, Samuel stanhope Smith, Blumenbach, and others. Albinos 
occur amongst all the races of men, as well as amongst many of the species of domestic and wild 
animals. The albino is not necessarily feeble or sterile; but is capable of procreation, and when 
two albinos are united, there is a tendency to the establishment of a permanent variety. Views 
of various observers and writers, seats and nature of the change of color in the albino, eyes, hair 
and skin. Investigations of various naturalists. Between the epidermis of the colored and 
white races, there is an identity of structure, and no specific differences. The hair of the head of 
the negro possesses all the characteristics of hair, and is not wool. 
OBSERVATIONS AND RESEARCHES ON ALBINISM IN THE NEGRO RACE. 
OBSERVATIONS AND RESEARCHES ON ALBINISM (LEUCOPATHIA, 
LEUC2ETH IOPIa) IN THE NEGRO. 
Description of Albinism in the Negro Race. 
My attention was directed to the following interesting ease of albinism, 
by my friend and colleague Doctor Thomas R. Jennings, Prof, of Anatomy 
in the Medical Department of the University of Nashville: 
ENGRAVING NO. 121. 
Margaret Aikins and her Albino Son Alfred. 1148 
Changes of Color in the Human Race. 
Alfred Aikins, age eighteen months, second son of Lewis and Marga- 
ret Aikins, negro man and woman. The skin over the entire surface of 
the little negro is perfectly white; rivalling in whiteness that of the fair- 
est and most delicate white child of the same age. Iris very pale, border- 
ing on pink, with light bluish and purplish reflections. Pupils bright 
pink. Strong light is painful to the eyes of this little albino; and the eyes 
present a constant tremulous or dancing motion. In a strong light the fea- 
tures are contracted, and contorted, and the impression is evidently pain- 
ful, and the vision rendered indistinct. Features "thoroughly negro"- 
flat nose, thick lips, and low forehead. Feet present the usual characteristics 
of the African race. Hair of head crisp and curled, perfectly white, and 
similar in all respects, with the exception of the color, to the crisp, curl- 
ing wool-like hair of the father and mother. The limbs and muscles gen- 
erally appear to be well developed; his spirits are excellent, and heappears 
to be disposed to domineer over his little negro companions, of the same 
color, biting, scratching, and striking them whenever they interfere with 
his childish plays. Whether the position which he assumes towards his 
black companions is due to the " superiority of color," or the necessary 
result of the great adoration and deference paid him by his mother and 
friends, we will not attempt to determine. Engraving No. 121 represents 
the little albino, in the arms of his fat, black mother, and conveys a fuller 
and more truthful idea of this " lusus naturae" and his sable origin than the 
most elaborate description. 
William Aikins, Albino Child of Margaret and Loxcis Aikins. 
ENGRAVING NO. 122. 
William Aikins (albino), brother of the child iMfred just described, 
and first born of Lewis and Margaret Aikins. This albino resembled in all 
respects the boy Alfred, his brother. Constitution rather feeble; died dur- 
ing the period of teething, at the age of fourteen months. Two of the 
fingers of the right hand were united-a congenital deformity. The eyes 
were pink, and the hair perfectly white, resembling in all respects that of his 
brother. The above engr aving is from a photograph taken of this child after 
death. Changes of Color in the Human Race. 
1149 
Margaret Aikins, mother of the albino, stout hearty negro woman, 
with glossy skin and hair, cheerful countenance and kind disposition. 
Features more regular, and nose somewhat more prominent than usual with 
negroes. The photograph presents a good likeness of this woman, with 
her albino child in her arms. Age 26. Has a few perfectly white spots 
upon the arms, and says that similar spots exist upon her thighs. The 
contrast between the dark skin and the milk white spots is very striking. 
The white spots are irregular in shape, and about three-tenths of an inch 
in diameter. Margaret enjoys good health, and has never been sick in her 
life. The mother appears to be very proud of her white child. 
Lewis Aikins, father of the albinos, Albert and William, and husband 
of Margaret. Stout, active negro man, with black complexion like that 
of his wife, and with similar black, curling, wool like hair. Age 30; has 
all the characteristics of the negro. 
Sarah Hill, mother of Margaret Aikins, and grandmother of albino 
children, age 54. Complexion considerably lighter than that of her daugh- 
ter, but features and hair that of the negro. About fourteen years ago, 
the mistress of Sarah called her attention to -white spots upon her arm, 
and fearing that it was the leprosy, sent for a physician. Until her atten- 
tion had been directed to the spots by her mistress, Sarah had never 
observed their existence. The physician who examined the spots declared 
that it was unnecessary to administer medicine, and Sarah applied to an 
old negro doctor, who gave her bitters (decoction of some vegetable leaves 
and roots). Sarah affirms that the spots which had been increasing rap- 
idly before the administration of the old negro doctor's medicine, ceased 
to increase in size and nubmer, and many of them commenced to turn dark. 
The auterior surface of her face, arms, and thighs presents a mottled 
appearance, with whitish and dark-brown spots upon the dark brownish- 
yellow skin. Twenty-four perfectly white spots of irregular shape and 
size, the largest being about four-tenths of an inch in diameter, were 
counted upon the anterior surface of the arm, between the elbow-joint and 
the wrist. There is a scar over the upper portion of the breast-bone, just 
at the junction of the neck with the trunk, resulting from a slight burn in 
childhood. A short distance below this scar there are three white spots 
about half an inch in diameter. Sarah Hill has always enjoyed good health; 
there is no appearance of any disease of the skin; has had five children, 
three of whom died in iufancy; she observed no spots upon them. We 
have already given the description of her daughter, the mother of the lit- 
tle albino. The other child of Sarah is a stout grown negro man, who, 
like his half sister and mother, has several white spots upon his arms and 
thighs. He is married to a stout, hearty black woman, and has onechiid, 
of a light-brown color and without spots. Sarah had four brothers, none 
of whom had spots, as far as her information extends; she had seven sisters, 
all of whom had white spots, and several of their children also have small 
white spots. The first husband of Sarah, the grandfather of the little 
albino, and father of Margaret, was a stout, large negro, weighing about 
two hundred pounds, of a dark skin, like that of his daughter, who resem- 
bles him in size and appearance. 
Abner Evans, father of Sarah, grandfather of Margaret, and great- 
grandfather of albino child. Described by his daughter as a small active 
man, with light complexion, like that of his daughter, with no admixture 
of white blood. Abner had white spots on arms and legs, which increased 
with age. This man enjoyed good health, was the father of fourteen chil- 
dren, eleven of whom were born to him by the mother of Sarah, and, as 
we have before said, the seven daughters had white spots like their father. 1150 
Albinism in the Negro Race. 
His first wife (the mother of eleven children), was a stout, active, dark- 
colored negro woman; she had no spots, and died at the age of 60 from 
dropsy. Abner reached the good old age of 80 years. 
Robert Crews, albino negro man; age fifty two; height about five feet 
eight and a half inches; weight one hundred and forty two pounds. Born 
in Halifax Co., Virginia; moved to Tennessee when eight years of age; has 
7 0 7 O <7 O/ 
been living in Nashville twenty-six years. Says that the hair of his head 
was perfectly white when young, and eyes pink; now the hair is of alight 
yellowish-brown, and his eyes of a clear brown color, with dark pupils. 
The hair is crisp, and wool-like, resembling in all respects the hair of the 
negro. Eyes restless and weak; strong light is painful, and the contraction 
of the muscles of the face, consequent upon the action of light, has given 
a permanent expression and cast to the features. When examining any 
object in a bright light, the eyes are nearly closed, and they are placed 
very near, and moved from side to side in a restless manner. His first 
master employed him as a cook, but his eyes were so painfully affected by 
the fire that he had to give this occupation up. Features those of a negro, 
with flat nose and low forehead; complexion florid, and capable of show- 
ing the blush of anger, and the effects of emotion upon the capillary cir- 
culation. Has always enjoyed good health, and for a number of years has 
driven a small wagon, and engaged in the moving of furniture. Has been 
married for twenty-four years, but has never had children. His wife had 
a child by her first husband, at an early age, before his marriage, and he 
says that the physician who attended her in the confinement "stated that 
she would not have any more children." Sexual organs of this albino 
well developed, and no deficiency or sexual appetite. Mother and father 
both dark-colored negroes. Had three brothers and two sisters, who were 
all dark-colored, and some of them black. This albino has more than the 
usual amount of intelligence amongst negroes, and has always led an active 
and industrious life. As a proof of his industrious and active habits, he 
purchased his freedom for $750 several years before the recent Civil War. 
The following engraving presents accurate representations of this albino. 
ENGRAVING NO. 123. 
Albino Negro Man Robert Creus. 
(Full Face.) 
(Side Face.) Albinism in the Negro Race. 
The Skin of the Negro, originally Black, may, at a period subsequent to birth, 
gradually change its Color from Black to White, until the complete Albino 
Character is induced. 
Two instances have come to my knowledge, one of which I examined 
myself, and the other I received upon reliable testimony, in which spots 
appeared in the skin of negroes, about the middle of life and progressively 
increased in number and size, as in the case of Abner Aikens. In addi- 
tion to these cases, I have recently (September, 1867) examined the follow- 
ing case: 
1151 
Spotted Negress, Lemisa Bert. 
ENGRAVING NO. 124. 
Lemisa Bert, spotted n egress. True African features, woolly head, flat 
nose, thick lips, low forehead, black skin; age forty-five; born in Tennes- 
see; at the present time follows the occupation of rag-picker in around 
Nashville, assisted by her youngest (mulatto) child. Mother and father 
native Africans. The father had sixteen children, and presented a condi- 
tion similar to that of his daughter, with white lips and hands. One of 
Lemisa's sisters was spotted like herself, only more extensively, and some 
of the spots presented a yellow color. Lemisa Bert has enjoyed pretty 
good health with the exception of "falling of the womb;" has had six 
children, three of whom she says, died of scrofula; the youngest child (by 
a white man), is a smart mulatto girl, of eleven years. One of her chil- 
dren, a young woman of eighteen years, whose father was a negro, is 
spotted like her mother, only to a greater extent, and many of the spots 
presenting a yellow color. Lemisa Bert has been turning white during 
the past nineteen years; the change commenced in small spots, which have 
progressively increased. Complains of some itching of the skin during 
warm weather; I could detect no disease of the skin, however, with the 
magnifying glass. The palms of the hands are white, and Lemisa has per- 
fectly white spots on arms and neck; on the right arm near the axilla, a 
large spot, about four inches in the longest diameter, and three inches in 
the shortest diameter. Both to the naked eye and under the magnifying 
glass these spots present mainly the same appearance as the skin of the 
white, and the blue veins are distinctly seen as in the fairest skin. 1152 
Albinism in the Negro Race. 
Several observers have recorded the gradual change of the skin of the 
negro from black to white. In 1697, Will Byrd, Esq., F. R. S., gave the 
following "account of a negro boy dappled in several places of his body 
with white spots." "This negro boy, of about eleven years of age, was 
born on the upper part of Rappahannock river, in Virginia; his father and 
mother were both perfect negroes, and the boy himself till he came to be 
three years old, was in all respects like other black children; and then, 
without any distemper, he began to have several little white specks on his 
neck and breast, which increased with his age, both in number and size; 
so that now from the upper part of the neck, where some of his wool is 
become white, down to his knees, he is everywhere dappled with white 
spots, some of which are broader than the palm of a man's hand. They 
are very white and do not show flesh and blood so lively through them as 
the skin of white people; the reason of which may be that the skin of a 
negro is much thicker. His face, arms, and legs are perfectly black."* 
Mr. James Bate, Surgeon in Maryland, published in the Philosophical 
Transactions of 1759, the following observations "Ou the Remarkable 
Alteration of Color in a Negro Woman." '•Frank, a cook-maid in Colonel 
Barnes' family, a native of Virginia, about forty years of age, remarkably 
healthy, of a strong and robust constitution, had her skin originally as 
dark as that of the most swarthy African; but about fifteen years before, 
that membrane in the parts next adjoining to the finger nails became white. 
Her mouth soon underwent the same change, and the phenomenon had 
since continued gradually to extend itself on the whole body; so that every 
part of its surface became more or less the subject of this surprising alter- 
ation. At the above date, four parts in five of the skin were white, smooth, 
and transparent, as in a fair European, elegantly showing the ramifications 
of the subjacent bloodvessels; the parts remaining sooty, daily lost their 
blackness, and in some measure partook of the prevailing color; so that 
a very few years would, in all probability, induce a total change. The 
neck and back, along the course of the vertebrae, maintained their pristine 
hue the most, and in some spots proclaimed their original state; the head, 
face and breast, with belly, legs, arms and thighs, were almost wholly white; 
the pudenda and axillae partly colored; the skin of these parts, as far as 
white, being covered with white hair; when dark, with black. Her face 
and breast, as often as the passions anger, shame, etc., had been excited in 
her, had been immediately observed to glow with flushes; as also when, in 
pursuance of her business, she had been exposed to the action of the fire 
on these parts, some freckles had made their appearance. This woman 
declared that, excepting about seventeen years before, when she was deliv- 
ered of a child, she had never been afflicted by any complaint of twenty- 
four hours' continuance, and that she never remembered the catamenia to 
have been either irregular or obstructed, only during this pregnancy; she 
had never been subject to any cutaneous disorders, nor made use of any 
external applications by which this phenomenon might be produced. The 
effects of the bile on the skin are well known to physicians, and had given 
rise to an opinion, that its color was determined by it; but this did not 
appear to have anything to do here, since from all the circumstances it was 
impossible to find the least reason to suspect that this fluid, whether cystic 
or hepatic, had undergone any alteration. As ustion is known to make 
the skin of negroes become white, and as she was daily employed in the 
business of cooking, it might perhaps be supposed the effect of heat; but 
this could never be the case, as she had ever been well clad; and the 
* Philosophical Transactions, 1697, vol. xix, p. 781, No. 235. Changes of Color in the Human Race. 
1153 
change was as obvious in the parts protected from the action of that ele- 
ment as in those most exposed to it. As an emunctory, the skin seemed 
to perform its office as well as possible, the sweat with the greatest freedom 
indifferently pervading the black and white parts."* 
The Rev. Samuel Stanhope Smith, D. D., LL. D., in his "Essay on the 
Causes of the Variety of Complexion and Figure in the Human Species," 
originally pronounced as an oration before the American Philosophical 
Society in 1787, relates the following interesting case: "Henry Moss, a 
negro in the State of Maryland, began upwards of twenty years ago to 
undergo a change in the color of the skin from a deep black to a clear and 
healthy white. The change commenced about the abdomen and gradually 
extended over different parts of the body till, at the end of seven years, the 
period at which I saw him, the white had already overspread the greater 
portion of his skin. It had nothing of the appearance of a sickly or albino 
hue, as if it had been the effect of disease. He was a vigorous and active 
man, and had never suffered any disease either at the commencement or 
during the progress of the change. The white complexion did not advance 
by regularly spreading from a single centre over the whole surface. But 
soon after it made its appearance on the abdomen it began to show itself 
on various parts of the body, nearly at the same time, whence it gradually 
encroached in different directions on the original color till at length the 
black was left only here and there in spots of various sizes and shapes. 
These spots were largest and most frequent where the body from the naked- 
ness of the parts or the ruggedness of his clothing was most, exposed to the 
rays of the sun. This extraordinary change did not proceed by gradually 
and equably diluting the intensity of the shades of the black color over the 
whole person at once, but the original black reduced to spots, when I saw 
it, by the encroachments of the white, resembled dark clouds insensibly 
melting at their edges. The back of his hands and his face retained a 
larger proportion of the black than other parts of his body; of these, how- 
ever, the greater portion was changed. And the white color had extended 
itself to a considerable distance under the hair. Wherever this took place 
the woolly substance entirely disappeared and a fine, straight hair of silky 
softness succeeded in its room." Dr. Smith adds, in a foot note, that "the 
extraordinary nature of this phenomenon strongly attracted the attention 
and benevolence of the public, and the man obtained from the liberality of 
those who visited him a sum sufficient to purchase his freedom, with a sur- 
plus to be applied afterwards to his own use. I examined him in company 
with the Rev. Dr. Rodgers and John R. B. Rodgers, M. D., of New York, 
gentlemen than whom none are more capable of observing and examining 
a fact of this nature with a sound and accurate judgment. Shortly after 
this period Henry Moss removed into the State of Virginia, since which 
time I have not had an opportunity of seeing him, but I have been informed 
by respectable authority that the whitening process was soon afterwards 
completed; he could not be distinguished from a native Anglo-American." 
Dr. Smith inferred from this case: "In the first place, that secretion 
in the skin which contributes chiefly to the formation of the negro com- 
plexion seems to be the chief cause also of the curl or woolly appearance 
of the hair, for wherever the white color in this man extended beneath the 
hair there the form of that excrescence was entirely changed. In the next 
place, although there was evidently a strong and general tendency in the 
constitution of this negro to a change of color, yet this tendency was much 
* The Philosophical Transactions of the Royal Society of London, vol. 11, p. 175; also Abridg- 
ment of same by Charles Hallon, Shaw and Pearson, vol. xl, p. 370. 1154 
Changes of Color in the Human Race. 
longer resisted in those parts of the body which were most exposed to the 
immediate action of the sun's rays than in others. As he was a laboring 
man, wherever there w*ere rents in the thin clothes which covered him there 
were generally seen the largest spots of black, whence I infer that when any 
dark color has been contracted by the human skin the solar influence alone 
and the free contact of external air will be sufficient to continue it a long 
time, even in those climates which are most favorable to the fair com- 
plexion. It is found by experience that different shades of the dark com- 
plexion are easily impressed by different causes on a skin originally fair, 
and when once impressed the slightest influence of the same causes is 
sufficient to continue it." 
rhe partial albino (or examples of individuals spotted with different 
colors, where the whiteness of the skin exists in certain parts of the surface 
only while the remainder of the body is of the ordinary color), was not 
unknown to the ancients, and other well authenticated cases where the 
skin of the negro has gradually changed its color from black to white have 
been recorded by Gaultier, Le Cart, Rayer and Rush. Blumenbach has 
described a negro of this kind whom he saw in London, a servant to the 
person who kept the animals at Exeter Change. He was a young man, 
perfectly black, excepting the umbilical and hypogastric regions of the 
abdomen and the middle of the lower limbs, including the kneesand neigh- 
boring parts of the thighs and legs, which were of a clear and almost snowy 
whiteness; but spotted with black like the skin of a panther. His hair was 
of two colors. On the middle of the front of the head, from the vertex to 
the forehead, where it ended in a sharp point, there was a white spot with 
a yellower tinge than those on the trunk and legs. The hair covering this 
was white, but resembled the rest in other respects. On comparing the 
picture of this man with three others (a boy and two girls), Blumenbach 
observes that the white spots occupied the abdomen and thighs, never 
appearing on the hands and feet, which parts, with the groins, are the first 
to turn black in the newly-born negroes, and that the arrangement of the 
white parts was symmetrical. Both the parents of this man and of the 
others of whom Blumenbach had collected accounts were entirely black. 
Blumenbach also records two instances in Germans; one of a youth, the 
other of a man sixty years old, both of whom had a rather tawny skin 
marked here and there with various sized spots of the clearest white. 
These spots appeared first in the former in infancy, and in the latter at the 
age of manhood. Jefferson mentions a negro, born black, of black parents, 
in whose chin, when a boy, a white spot appeared and continued to increase 
till he became a man, when it extended over the chin, lips, one cheek, the 
under jaw and neck of the same side.* Caldani states that a negro, who 
was a shoemaker at Venice, was black when brought, during infancy, to 
that city, but became gradually lighter and had the hue of a person labor- 
ing under slight jaundice; and Klinkosch mentions the case of a negro who 
lost his blackness and became yellow. An English lady, who had formerly 
resided in Virginia, informed Dr. Parsons that Admiral Franklin took a 
Spanish ship in war-time and brought her into Carolina, and in searching 
found a picture of a boy who was as beautifully mottled all over with black 
and white spots as any dog that ever was seen; it was uncertain which was 
the ground or which color the spots were of. Several copies of the picture 
were taken in Carolina, and they said it was a portrait of a child born of 
negro parents on the Spanish Main; the ship was bound to old Spain.f 
* Lectures on Comparative Anatomy, Physiology, Zoology, and the Natural History of Man, 
by William Lawrence, F. R. S.,-pp. 207-S. 
f Philosophical Trans. Roy. Soc. of London, vol. Iv. p. 45, 1765. Changes of Color in the Human Race. 
1155 
Albinos occur amongst all the Races of Men, as well as amongst many of the 
species of Domestic and Wild Animals. 
The occurrence of albinism amongst the negroes of the southern 
United States is by no means rare. I have myself met with several other 
instances, and in one case an albino woman in my native county (Liberty 
County, Georgia), whom I have seen upon numerous occasions, bore chil- 
dren to a black man, and the children had reddish woolly hair and yellow 
complexions, and I am inclined to attribute the yellow color in the great- 
grandfather and grand-mother of the albino child described in this paper, 
to the same causes which produced the white complexion, and not to any 
admixture of the blood of any white race. In the grandmother, the color 
of the entire body is mottled and not uniform; this is especially seen in 
the skin of the face. These facts support the opinion that there is a ten- 
dency to the development and propagation of this peculiarity in certain 
families. During my collegiate course I had two college mates, who were 
true albinos and brothers; and I was informed that several other members 
of this family manifested the same peculiarity. 
Some of the earliest writers did not hesitate to affirm that albinos were 
confined to the offspring of negroes. But it appears, from the testimony 
of various observers, that they were not only known from the earliest 
times, but that they occur amongst all nations; and that there is no race of 
men, nor any part of the globe, in which this freak of nature may not be 
manifested. It has even been asserted that whole tribes of albinos have 
been seen in Africa, Java, Ceylon, and the Isthmus of Darien. As this 
variation of the skin first attracted attention in the African, from the 
great difference of color, the individuals were termed leucsethiopes, or 
white negroes. From their avoiding the light, the Dutch are said to have 
given them in the island of Java, the contemptuous appellation of kak- 
kerlakken, cockroaches, insects that run about in the dark; whilst the 
Spaniards call them albinos, and the French blafards. 
Pliny, in the second chapter of the Seventh Book of his Natural His- 
tory, quotes Isigonus of Nicaea, who relates that in Albania there is a cer- 
tain race of men whose eyes are of a sea-green color, and who have white 
hair from their earliest childhood, and see better in the night than in the 
day. Cuvier, in his observations upon this passage of Pliny's Natural 
History, supposes that the variety of the human species to which the term 
albino has been applied, from the whiteness of their hair and skin, is more 
frequently found in the close valleys of the mountainous districts, and may, 
therefore, have been often met with in Albania, which is composed of val- 
leys in the Caucasian range. In the eighth chapter of the Fifth Book, 
Pliny calls a certain people of Africa Leucaethiopians, or white Ethiopians; 
the same term was used by Pomponius Mela and Ptolemy; but as these 
writers give no description of the people thus designated, some have sup- 
posed that the Leucsethiopes were a tribe of negroes whose complexion was 
less dark than that of Africans generally. 
Cortez, in his narrative of the conquest of Mexico, in describing the 
palace of Montezuma, amongst other objects of rarity or curiosity which 
were found in it, mentions male and female albinos. "In hujus palattii 
particula tenebat homines, pueros, foeminasquae a nativitate candidos in 
facie, corpore capilis, superciliis, et palpebris." 
Wafer, who accompanied Dampier in one of his voyages, relates that 
albinos are not unfrequently found amongst the inhabitants of the Isthmus 
of Darien. Wafer described their skin as milk-white, much like the color 
of a white horse, and covered with a short and whitish down, and the hair 1156 
Albinism in the Negro Race. 
upon their head and upon eye-brows of a milky white, and the former, which 
is exceedingly beautiful, is rather frizzled, and in length from seven to eight 
inches. "They see not very well in the sun, poring in the clearest day, 
their eyes being but weak, and running with water if the sun shines 
towards them, so that in the daytime they care not to go abroad, unless it 
be a cloudy dark day. But notwithstanding their being thus sluggish and 
dull in the daytime, yet when moonshiny nights come they are all life and 
activity, running abroad and into the woods, skipping about like wild 
bucks; and running as last by moonlight, even in the gloom and shade of 
the woods, as the other Indians by day, being as nimble as they, though 
not so strong and lusty." 
Various travelers, as Ribeyro, Percival, Cordiner, and others, aud 
various naturalists, have met with albinos in some of the oriental isles, 
and more especially in Java and Ceylon, exhibiting the white skin aud 
hair and pink eyes, while in other respects they conformed to the external 
characters of the native race. According to Dubois, albinos are not 
uncommon amongst the Hindoos. Cook, in his first voyage, saw six albinos 
in Otaheite; in his second voyage he saw one in New Caledonia, and in his 
third voyage he met with three in the Friendly Isles. Blumenbach saw 
sixteen albinos in various parts of Germany, and they have been noticed 
in England, Ireland, Denmark, France, Switzerland, Italy, Hungary, Aus- 
tria, the Grecian Archipelago, aud in North and South America. 
Captain Bernard Romans in his "Concise Natural History of East and 
West Florida," records the following observations: "I have in my dis- 
sertation on the origin of the savages, which has swelled beyond my inten- 
tion, made mention of a prevailing characteristic of the negro species. 
Here let me be allowed to mention that they, like all others of the different 
species and varieties of the human genus are born white, which color soon 
changes, but on the moment of birth in both sexes the exterior parts of 
generation will show whether the person will be black, yellow, brown, red 
or any other color known among mankind. There is among the negroes 
a kind of anomalous beings with white skins, feeble eyes, etc., which have 
been so often described by other authors that I shall not trouble my readers 
with a particular account of them; yet one observation I cannot forbear to 
make, which I believe will be found no less curious than new. Through- 
out all Northern America the red men are universally so, but as soon as 
we come on the Isthmus we find some of those unhappy anomalous indi- 
viduals among the savages; I have myself seen several of either sex of this 
forlorn kind among the Sant Blass nation, who call themselves Azomalas; 
they inhabit the south-eastern part of the Isthmus, and I understand from 
others conversant farther south, that in South America it is common; 
these people are of such an exceedingly tender texture of skin that it is 
disagreeably fair and very liable to become scurfy and freckled; their eyes 
are nearly as red as those of a white rabbit and very weak, seeing objects 
plainly only after sun-set, before sun rise, or on a cloudy day. Their hair 
is straight, long, lank, and red, not participating of the harsh strong tex- 
ture of the hair of common savages; their inability for labor, for want of 
sight, causes the others of the nation to support them; the offspring of 
these poor creatures, however, is again red and in the general course of 
nature." pp. lil-112. 
We are informed by Marsden that in Java the gallinaceous fowls are 
often affected with albinism, and many travellers assure us that this pecu- 
liarity often appears in the human species in the Sunda Isles. Charles 
Pickering, in his Races of Man, mentions an albino amongst the Malay 
race inhabiting the Ellice or Vaiterpan group of islands; albinos were also Albinism in the Negro Race. 
1157 
spoken of by the inhabitants as occurring in Tahiti. Dr. Pickering, at 
Reeva, observed a male albino of the Papuan race, whose complexion was 
even fairer than that of Europeans when equally exposed to the sun, but 
was not free from brownish specks; the iris was blue without any percep- 
tible tinge of red; and he had his brows always knit, as if affected by the 
light. The hair was not white but flaxen. Several albinos were enumer- 
ated by residents, and Dr. Pickering was inclined to think that they occur 
more frequently in the Papuan than in any other race. 
Dr. Azara, in his History of the Quadrupeds of Paraguay, has given 
numerous examples of albinos among the animals, as well as among the 
Indians and negroes in South America. It is thought, however, that albin- 
ism occurs most frequently amongst the negroes in Africa. Thus Dr. Win- 
terbottom observed eleven instances among the native tribes about Sierra 
Leone. De la Croix informs us that albinos compose a considerable body 
of attendants at the court of the King of Loango, and Ludolf has made a 
similar statement; and Bowditch observes that the King of Ashantee had, 
at his court, "nearly one hundred negroes of different colors, through the 
shades of red and copper to white." Dr. Winterbottom mentions an albino 
negro, born in Nova Scotia, and Mr. Jefferson, in his Notes on Virginia, 
gives seven examples of this peculiarity in the negro slaves of Virginia.* 
• Dr. Pickering observed two albino children amongst the negroes of 
Africa, in whom the negro as, ect had so entirely disappeared that they 
might have passed for the children of Europeans, but for the remarkable 
appearance of rhe hair, which could only be compared to a white fleece. 
Dr. Charles Bachman, of South Carolina, in his valuable work on The Doc- 
trine of the Unity of the Human Race examined on the Principles of Science, 
affirms that he has seen a number of examples of albinism amongst the 
blacks of South Carolina, and says that he has been informed that, in St. 
* Dr. James Parsons exhibited to the Royal Society a "white negro" (albino), and detailed the 
following history of the case : It appeared that the parents of this boy were brought, among 
many others, above 300 miles from an inland country, to the gold coast in Africa, and put on 
board a ship bound to Virginia, where they arrived in the year 1755. They became the property 
of Colonel Benjamin Chambers, of Cumberland county, in Pennsylvania, and were then 
employed on an estate of the Colonel's in Virginia; but. the Colonel lived with his family in Penn- 
sylvania, when he sold his boy to his then m ster-of which fact Dr. P. saw the bill of sale that 
passed between the Colonel and him. The parents were perfectly black, and both very young 
when landed; and the woman being asked how far she was gone with child, answered, so as to be 
understood to mean, that she was with child something more than six moons, and that this was 
her first pregnancy. They also declared that they had never seen a white person before they 
came to the shore where the Europeans were employed buying black slaves. The owner of this 
boy was Mr. James Hill Clark, whom Dr. Parsons informed of what had passed between Dr. 
Franklin and himself on this subject; for he paid him a visit, and in the course of conversation 
he informed him that, while he was in England before, he received a letter from his lady, in 
which was some of the wool of a white negro child's head, by way of curiosity; and when he 
mentioned it to Mr. Clark he assured him that this same boy was showu in Pennsylvania as a 
great rarity, and that, to his own [knowledge, the wool sent in this letter was taken from this 
child's head. He was born about six or seven weeks after his parents landed in Virginia, in the 
year 1755, and was purchased by Mr. Hill Clark of Col. Chambers in 1764, so that he appeared not 
to be quite ten years old; and his mother had had two children after, who were both as black as 
the parents. Dr. Parsons states that, instances of the same kind had happened before. There 
was one, about four years before, in London, which was a white girl, something younger than this 
boy, but exactly similar in color, wool, etc , and was said by the person who made a show of her, 
to have been the offspring of a black father and mother. The lady of a respectable family who 
came to live in Red Lion Square, after having lived in Virginia lor several years, related the fol- 
lowing case to Dr. Parsons: "About nineteen years previous, on a small plantation in Virginia, 
two slaves, both black, were married, and the woman brought forth a white girl. When the poor 
woman was told that the child was like the white children of white people, she was in great 
dread of her husband, declaring, at the same time, that she never had anything t > do with a 
white man in her life, and therefore begged they would keep the place dark that he might not 
see It. When he came to ask her how she did, he wanted to see the child, and wondered why the 
room was shut up, which was not usual. The woman's fears increased when he hadbrought it 
into the light; but while he looked at it he seemed highly pleased returned the child, and behaved 
with extraordinary tenderness. She imagined that he dissembled his resentment till she should 
be able to go about, and that then he would leave her. But in a few days he said to her, "you are 
afraid of me, and therefore keep the room dark because my child is white; but I love it the better 
for that-for my own father was a white man, though my grandfather and grandmother were as 
black as you and myself; and, although we came from a place where no white people ever were 
seen, yet there was always a white child in every family that was related to us,"-Philosophical 
Transactions of the Royal Society of London, 1765, vol. lv., p. 55. 1158 
Albinism in the Negro Race. 
Domingo, Guadeloupe and Martinico, the negroes of African origin pro- 
duce one out of six or seven children of this albino variety. He does not, 
however, vouch for the entire truth of this assertion. 
As far as my own observations extend, I have been led to the belief that 
this freak of nature occurs as often amongst the wrhite races as amongst the 
African ; the apparent disparity is perhaps due, in a great measure, to the 
more striking and wonderful contrast in the negro. Amongst wild animals, I 
have observed albinos in turtle doves (EctopistesCarolinensis), ground dove 
(Columba passerina), crow (Corvus Americanos), hooting owl (Syrniumneb- 
ulosum), leather-wing bat (Vespertilio Carolinensis), fox squirrel (Sciurus 
Capestratus), gray squirrel (Sciurus Carolinensis), and common rabbit (Lep- 
us sylvaticus). And amongst domestic birds and animals I have observed 
this peculiarity in theEnglish and Muscovy ducks, common chicken, pigeon, 
rabbit, horse, hog, cow, cat and dog, and mice. After extended investiga- 
tion and examination of thousands of living specimens, I have never 
observed an albino amongst cold-blooded animals. When this class of 
animals have been confined in dark caves, and excluded from the action of 
the light, they present the appearance of the albino; and it is probable 
that, if the negro children who are almost white at the time of their birth 
were reared in total darkness, they would in like manner be white. I have 
seen living sirens from the caves of Africa, without a particle of coloring 
matter in their skins, and so transparent that the form and pulsation^ of 
the heart, and the circulation of the blood, could be discerned through the 
walls of the abdomen and chest, and Dr. Blackie has informed me that he 
has seen similar colorless salamanders in the dark caves of Northern 
Georgia. 
I have in my possession specimens of the blind fish (Amblyopsis 
spelvens), the blind cray fish (Astacus pellucidusf and of the crickets, with 
eyes of the dark caverns of the caves of Kentucky, which are entirely 
wanting in coloring resembling albinos. The absence of the ball from the 
socket of the eye in the blind fish, and the absence of the eye from the 
peduncles of the blind cray-fish, may be most philosophically attributed 
to the absence of that agent upon which the production of color depends. 
And it is now well established that we may arrest and alter the develop- 
ment of the tadpole, and other animals, by raising the amount of the 
physical forces, heat and light. The white color of animals (or rather the 
colorless and transparent nature) which have been excluded from the light, 
is a different phenomenon from that of albinism, although the thorough 
discussion of the effects of physical agents in arresting or accelerating the 
development of the blood, color, organs and structures of animals is 
destined to throw7 much light upon the phenomena of albinism. 
The albino is not necessarily feeble or sterile, but is capable of procreation, and 
when two albinos are united, there is a tendency to the establishment of a 
permanent variety. 
Some writers have expressed the opinion that the albino possesses a 
general delicacy of habit and constitution, and even exhibits a deficiency 
of mental power; and is incapable of propagation. Blumenbach conceived 
that albinos labor under a disease, which he referred to the cachexise, and 
considers as akin to leprosy; and Dr. Winterbottom describes them, not 
under the head of the native Africans, but classes the affection under the 
head of diseases. G. St. Hilaire supposes that there are two species of 
albinism, one the effect of disease, the other a true anomaly. Mansfeldt 
ascribed the production of the albino state to some shock given to the foetus Observations and Researches on Albinism in the Negro Race. 
1159 
by an impression made upon the mother; and G. St. Hilaire essentially 
adopts this hypothesis, ascribing the peculiar state of the skin to an arrest 
of development, in consequence of which the coloring matter is not formed 
at the requisite period. Herodotus maintained that the difference of color 
in different races was manifest in like manner in the seminal fluid; thus, 
in his third book (Thalia 101), he describes the Indians, who have a com- 
plexion closely resembling that of the Ethiopians, as having intercourse 
openly like cattle, and emitting seed, not white as that of other men, but 
black as their skin. Herodotus also affirms that the Ethiopians emit 
similar seed. This idea, which was controverted by Aristotle, has been 
revived by Maupertuis, and the color of the negro has been referred by 
Le Cart to a peculiar substance which he names 'Ethiope Animal," which 
he supposes is contained in their fluids, and the absence of this substance 
converts the negro into an albino. 
The celebrated Count de Buffon considered albinism as a kind of 
malady, and albinos as ''individuals who had degenerated from their race 
by some accidental cause." Buffon says : " This last opinion appears to 
me, I own, the most probable; and had travellers given us as exact descrip- 
tions of the Bedas and of the Chacrelas as Wafer has done of the Dariens,, 
we should, perhaps, have discovered that the former could no more have 
been of European origin than the latter. What seems to give great weight 
to this notion is, that among the negroes there are also white children born 
of black parents. Of two of these white negroes we have a description in 
the history of the French Academy; one of the two I saw myself: and we 
are assured there are not a few to be met with in Africa among the other 
negroes. From what I have myself observed, independently of the infor- 
mation of travellers, I have uo doubt that these white negroes are negroes 
degenerated from their race. Instead of being a peculiar and established 
species of men, they are only particular individuals who happen to form 
an accidental variety. In a word, they are among the negroes what Wafer 
says our white Indians are among the yellow Indians, and what to all 
appearance the Chacrelas and the Bedas are among the brown Indians. 
Still more singular it is, not only that this variation never happens but 
from black to white, but that all the nations of the East Indies, of Africa, 
and of America, in which these white men are found, are in one latitude. 
The Isthmus of Darien, the country of the negroes, and Ceylon, are abso- 
lutely under the same line. White, then appears to be the primitive color 
of nature, which climate, food, and manners alter, and even change into 
yellow, into brown, or into black; and which, in certain circumstances, 
reappears, though by no means equal to what it was, on account of its cor- 
ruption from the causes here mentioned. Nature in her full perfection has 
made men white, and nature reduced to the last stage of adulteration, ren- 
ders them white again. But the white of the species, or the natural white, 
is widely different from thewhiteof the individual, or the accidental white. 
In plants, as well as in men and in animals, do we find examples of this 
truth. The white rose, the white gillyflower, etc., are greatly different, 
even in point of white, from the red roses, or the red gillyflowers, which 
become white in autumn, after suffering the evening colds and the frosty 
chills of that season. A farther proof still that these white men are in 
fact merely individuals who have degenerated from their species, is, that 
they are ail less strong and less vigorous than the others, and that they 
have eyes extremely weak. This fact -will appear less extraordinary when 
we recollect that, among ourselves, those men, who are remarkable for the 
flaxen fairness of their complexions, are commonly remarkable also for the 
weakness of their eyes. I have remarked also that such people are often 1160 
Observations and. Researches on Albinism in the Negro Race. 
slow of hearing, and it is pretended that those dogs, which are absolutely 
white, and without a spo.t, are deaf. Whether this observation is generally 
just, I know not; all I can assert is that, in a number of instances, I have 
seen it confirmed."* Flavius Josephus, in his great work on the ''Antiqui- 
ties of the Jews," on the other hand, in his account of the creation of the 
world, says that Adam implies, in the Hebrew language, red, because the 
first man was formed of the purest and richest kind of earth, which is of 
that color. John Hunter, in his interesting and curious remarks " On the 
Color of the Pigmentum of the Eye in Different Animals," contained in 
his Observations on Certain Parts of the Animal Economy, unlike Buffon, advo- 
cates the view that the changes of color in man and animals are always from 
the dark to the lighter tints. This celebrated observer says : 
"The propagation or continuance of animals in their distinct classes 
is an established law of nature, and in a general way is preserved with a 
tolerable degree of uniformity; but in the individuals of each species, 
varieties are every day produced in color, shape, size, and disposition. 
Some of these changes are permanent with respect to the propagation of 
the animal, becoming so far a part of its nature as to be continued in the 
offspring. Animals living in a free and natural state are subject to few 
deviations from their specific character; but nature is less uniform in 
its operations when influenced by culture. Considerable varieties are 
produced under such circumstances, of which the most frequent are 
changes in the color. These changes are always, I believe, from the 
dark to the lighter tints, and the alteration very gradual in certain 
species, requiring in the canary bird several generations; while in 
the crow, mouse, etc., it is completed in one. But this change is not 
always to white, though still approaching nearer to it in the young than 
in the parent, being sometimes to dun, at others to spotted, of all the vari- 
ous shades between the two extremes. This alteration in color being con- 
stantly from dark to lighter, may we not reasonably infer that in all ani- 
mals subject to such variation the darkest of the species should be reck- 
oned nearest to the original; and that where there are specimens of a 
particular kind, entirely black, the whole have been originally black? 
Without this supposition it will be impossible, on the principle I have 
stated, to account for individuals of any class being black. Every such 
variety may be considered as arising in the cultivated state of animals; but 
whether, if left to themselves, they would in time resume their original 
appearances, I do not know. 
" The color of the pigmentum of the eye always corresponds, I believe, 
with that of the hair aud skin, especially if the animals be only of one 
color, but it is principally determined by the hair; and the most general color 
is a very dark brown, approaching to black, whence it had the name 
nigrum pigmentum. * * The human species is a striking example of the 
color of the pigmentum corresponding with that of the skin and hair; and 
though the skin and hair of one person differ very considerably from the 
skin and hair of another, yet it is not in so great a degree as in many ani- 
mals. There are cattle perfectly white, white sheep, white dogs, white 
cats, aud rabbits; but there are few of the human species that we can say 
are perfectly white. They rather pass from the black into the brown, red, 
and even light yellow; and we find this pigmentum, although only of one 
color, varying through all the different corresponding shades. In the Afri- 
can negro, the blackness of whose hair and skin is a great distinguishing 
characteristic, this pigmentum is also very black. In the mulatto, who has 
* The Natural History of Animals, Vegetables, and Minerals, with the Theory of the Earth 
in General, trans, from the French of Count de Buffon, by W. Kendrick, LL.D., vol. i, pp. 269-270 Observations and Researches on Albinism in the Negro Race. 
1161 
not the skin so dark as the African, but the hair nearly as black, this pig- 
mentum is of a shade not quite so deep; yet still it does not approach so 
near to the middle tint as the skin, rather following the color of the hair. 
In people of a swarthy complexion, as Indians, Turks, Tartars, Moors, etc., 
we find the hair always of a jet black, and this substance of a much darker 
brown than in those that are fair. In those of very dark complexions, and 
having very black hair, although descended from fair parents, the same 
thing holds good. There are few species of animals, or even individuals 
of a species whose bodies are only of one color. Crows and some others are 
exceptions; but the greatest number are of two or more, being variously 
spotted or streaked either with different colors, or with shades of the same. 
Many species are constantly lighter in some parts of the body than in others, 
and, with a few exceptions, animals are generally lighter, as to color, on 
the lower, or what may be called the foreparts, than on the upper or back 
parts. The fair man or woman may strictly be considered as a spotted or 
variegated animal. In many persons the hair of the head, eyebrows, eye- 
lashes, beard, and hair on the pubes, all vary in color. The hair of the 
first three may be called foetal, and are oftener all of the same than of a 
different color; the last two are to be considered as adult hair, and are com- 
monly alike in color, which yet frequently varies from that of the foetus, 
which last is more liable to change its color than the other; and the change 
is generally that of growing darker, especially on the head and eyelashes. 
This difference in the color of the hair on different parts of the body is not 
so observable in those nations who are dark or swarthy, as in people inhabit- 
ing many of the northern climates."* 
But few observations have been recorded which show any actual dis- 
ease in the albino. The extreme sensitiveness of the albino to the action 
of light is not due to any peculiarity of organization in the nervous struc- 
tures; but to the absence of the black pigment, which has the important 
office of absorbing superfluous portions of light, and thus as it were dead- 
ening its effects. As the ultimate distribution and arrangement of the 
optic nerve are the same in the retina of the eye of the albino as in that of 
ordinary human beings having the usual amount of pigmentum nigrum, 
it follows as a necessary consequence ,that the action of the rays of light, 
and especially that portion of the rays which excites active chemical 
change, must be far more intense in the former. This abnormal excitement 
of the nervous system of the albino under the stimulus of light is due not 
to any inherent weakness, nor to any pathological condition of the nerve 
centres, but simply to a physical and mechanical defect in the apparatus 
of vision. It is, therefore, chiefly to the bright light and high heat of the 
tropics that we must attribute the apparent delicacy of albinos in Africa. 
The morbid condition of the skin induced by the heat is not observed in 
the European albino in cold climates. The effect of the hot sun in blister- 
ing the fair skin of the white man in warm regionsis well known; and from 
the far greater delicacy of the skin of the albino, the blistering and crack- 
ing effects of the hot sun are far greater. From these causes, as well as 
from the idea of imperfection, the albino is generally regarded in Africa 
with a degree of compassion and even contempt. Dubois observes that 
they are named lepers by birth, amongst the negroes, and that when they 
die their bodies are not buried or burnt, but cast on dunghills. According 
to Vossius, they are avoided by the other negroes, because they are Sup- 
posed to be diseased; and De la Croix says the negroes regard them as 
monsters, and do not permit them to multiply. 
* The works of John Hunter. F. R. S., edited by James F. Palmer, London, 1837, pp. 277-280. 1162 
Observations and Researches on Albinism in the Negro Race. 
Dr. Winterbottom saw a white African woman with a remarkably 
coarse and wrinkled skin. In this case he described the skin as dry and 
harsh to the touch and marked by deep furrows; it had a reddish tinge in 
parts exposed to the sun and was ot a dirty white in other situations, and 
black spots like freckles, of the size of a pea, were thickly scatteied over 
the skin. Another tall and well-formed white negro had a similar rough, 
harsh and freckled skin, and another white negress had the skin of an 
unpleasant dead-looking white, and, although pretty smooth, beginning to 
assume a cracked appearance from the action of the sun. Cook described 
the skin of the albino which he observed at Otaheite as of a dead white, 
scurfy, and covered with white down. As far as my experience and knowl- 
edge extend, the albino may be, nay, is most generally strong and healthy 
and executes all the functions of life in a vigorous and perfect manner. In 
the cases which we have recorded the grandfather, grandmother and 
mother, notwithstanding the marked tendency which they exhibited to 
albinism in the spots of the skin, were strong, healthy, robust and hardy;, 
the little living albino is one of the finest looking and most sprightly negro 
children that I have ever seen; the albino negro man pursues his daily 
labor and enjoys excellent health; and of several other instances which 
have come under my observation of grown negro and Anglo Saxon albinos, 
male and female, the usual amount of health and physical strength was 
enjoyed. In two cases of albino negro women that have come under my 
observation the individuals have been able to perform active labors and 
have borne children to their husbands. The albinos which I have observed 
amongst animals have been neither diseased nor wanting in strength, nor 
the power to propagate their species, and even to transmit the characteris- 
tic color to their offspring. In my boyhood I attended school in an exten- 
sive forest, on the coast of Georgia, and upon the banks of a small stream 
about a quarter of a mile from the school-house a family of white rabbits of 
the common species of the country (lepus sylvaticus) bred for years and 
were seen from time to time by the little company attending the log school- 
house. The ability of the domestic white jabbit and of the tame white 
mouse to procreate and to propagate a special variety is known to all nat- 
uralists. The original color of the domesticated rabbit (lepus cam cuius} 
iu its wild state in England and on the continent is, upon the upper sur- 
face, uniformly gray, without varieties in its native warrens; yet in its- 
domesticated state the European rabbit has produced an albino race which 
has been propagated for centuries. Dr. Bachman, of Charleston, South 
Carolina, has kept this variety separate from others and observed it closely, 
and he affirms that in the period of twenty years, when there must have 
been a hundred generations in that prolific breed, not one of a different 
color was produced, nor did they exhibit the slightest tendency to disease. 
The same may be said of the white mice, the albino rats and the albino 
ferrets of England and France. In proof of the assertion that albino varie- 
ties sometimes originate and maybe propagated continuously amongst wild 
animals, Dr. Bachman cites the existence of a family of white raccoons 
(procyon loter), which had existed in Christ Church parish, near Charles- 
ton, for many years, from which neighborhood this distinguished natural- 
ist had from time to time received specimens. Dr. Bachman observed that 
about half of these white raccoons had the pink eyes of the albino. 
Gray, of London, has described a raccoon from Texas under the name 
of procyon nivea, which Dr. Bachman ascertained by an examination of the 
original specimen to be of this white variety. Dr. Bach iq an has also seen 
several families of the Carolina gray squirrel that were albinos. This close 
observer and accomplished naturalist has said that he had "not a doubt Observations and Researches on Albinism in the Negro Race. 
1163 
that, could the albinos of various species of animals be prevented from mix- 
ing with the common varieties, they would perpetuate their breeds pos- 
sessing this peculiarity?'* 
It is well established, therefore, that in all the lower animals, albinos 
mated with each other produce albinos that are perfectly healthy, and 
propagate as rapidly as any other varieties. It has been still further shown 
by naturalists that the albino may lose the pink color of the eye, and at 
the same time, regain the usual tolerance of light and strength of vision 
of those who have the choroid coat of the eye of a black color. Dr. Bach- 
man examined about a dozen specimens of Virginia deer, that were either 
altogether or nearly white, and found but one possessing pink eyes; and he 
has also observed that in the domesticated white rabbits and other quad- 
rupeds, as well as in many wild birds, the smallest dark spot on the quad- 
ruped or bird is followed by the usual natural color in the eyes; in a white 
rabbit, having a black spot on one of its ears, the eye on the same side was 
of the common color, and the opposite one pink; and in domesticated ani- 
mals, birds, horses, cows, sheep, goats, pigs, turkeys, geese, ducks, fowls,, 
and pigeons, that are of a uniformly white color, pink eyes are scarcely 
ever observed. 
John Hunter has some interesting observations upon the same subject. 
When treating of the color of the pigmentum of the eye in different animals, 
he says: "In animals which are variegated let us observe the color of this 
pigmentum, and we shall find it regulated by some general principle, and 
corresponding with the color of the eyelashes. The magpie, for instance, 
is nearly one-third or fourth part white; and the two colors, if blended, 
would make the compound gray; but the eyelashes being black the pig- 
mentum is black also. We sometimes meet with people whose skin and 
hair are very white, and yet the iris is dark, which is a sign of a dark 
pigmentum; but if we examine more carefully we shall also find that the 
eyelashes are dark, although the eyebrows may be the color of the com- 
mon hair. * * In people remarkably fair, whether they are of a race 
that is naturally so, or what may be called monstrous in respect to color, 
as white Ethiopians, still we find this pigmentum following the color of 
the skin and hair, being in some of a light brown, and in others almost 
white, according to the color of the hair in such people. * * The variation 
of color appears most remarkable when a white starts up, either when the 
whole species is black, as in the crow or blackbird, or when only a certain 
part of the species is black (but permanently so), as a white child born of 
black parents; and a perfectly white child, whose hair is white, and who 
has the pigmentum also white, though born of parents who are fair, should 
as much be considered as a play of nature as the others. All these lusus 
natures, such as the white negro, the pure white mice, etc., have likewise 
a white pigmentum corresponding with the color of the hair, feathers and 
skin."f In some cases children born with red eyes and white hair, in 
their progress to maturity gradually lose these peculiarities, and their 
eyes, hair, and complexions assume more natural colors. 
Professor Graves, of Dublin, has given the following illustration of 
this change in the albino : "Last year Dr. Ascherson informed me that he 
had seen a case of the after development of the pigment of the eye in an albino 
boy three years old. This child had at its birth white hair, and violet- 
colored eyes, with dark red pupils. At the end of the third year its hair 
was light brown, and its eyes were blue, but they had still, in a remarka- 
ble degree, though less so than before, that restlessness peculiar to albinos. 
* Doctrine of the Unity of the Human Race, pp. 187-189. 
t Loc. cit., pp. 280-281. 1164 
Observations and Researches on Albinism in the Negro Race. 
This was the only case of the kind I ever heard of, except that communi- 
cated by Michaelis, in Blumenbach's Medicinische Bibliothek, vol. iii., p. 
679; which, however, rests only on the uncertain authority of some peas- 
ants. Singularly enough, I had soon the good fortune to meet with a sim- 
ilar case myself. In my younger days there were two children, a brother 
and sister, living near me, who presented such striking symptoms of leu- 
cosis in their eyes, hair and skin, that they were recognized as albinoseven 
by non-medical persons. My attention was lately drawn to them by an 
advertisement in the papers in which their name occurred; and I learned 
that the brother had become a tobacconist; but to my great astonishment, 
on going to see him, I found that his eyes had changed from violet-red to 
gray, and his hair from white to light brown, and that the susceptibility of 
the eyes to the light had greatly diminished." To the prolific, intelligent 
and vigorous nature of albinos, several writers have testified. 
Mr. Jefferson describes the seven examples of albinos, in the negro 
race, which came under his observation, as uncommonly shrewd and quick 
in their apprehension and reply. Three of these were sisters, having two 
other full sisters who were black. Two of them bore black children to 
black men; another white albino negress had a black daughter by a black 
man; and another albino negress much freckled, and with very weak eyes, 
bore an albino child to a black man. All the individuals observed by Mr. 
Jefferson were well formed, strong, and healthy. M. Sachs, who gives a 
minute account of this peculiarity in his own person and that of his sister, 
repels the charge that the intellect of the albino is weak. Winterbottom 
mentions cases of fertility among albinos, and in an example which he men- 
tions, the daughter of two mulattoes, born in Nova Scotia, who had all the 
negro features, with woolly hair of a dirty white color, and a skin equal- 
ing in whiteness that of a European, there were no signs of cachexia or 
leprosy, and the skin was without anything disagreeable in appear- 
ance or texture. No signs of disease were discovered in the two Swiss 
youths described by Blumenbach and Saussure; and Pallas considered the 
notion of disease in the African albinos as unfounded. 
Dr. William Lawrence considers the view that albinos labor under a 
diseased state as completely incorrect; in fact this distinguished surgeon 
and physiologist, in his Lectures on Physiology, Zoology, and the Natural His- 
tory of Man, affirms that they do not exhibit a single character of disease; 
all their functions are executed as in other persons; they are born of healthy 
parents, occur amongst the robust and hardy members of savage tribes, 
and can both beget and conceive. Dr. Lawrence sustains this assertion by 
ample and uncontrovertible examples. Dr. Bachman says that, to his cer- 
tain knowledge, both sexes of the albinos are prolific, and cites examples, 
proving this proposition, occurring in Virginia and South Carolina. And 
we conclude this section of our inquiry in the language of this naturalist: 
" If, as we here perceive, nature makes so wide a stride, as without a single 
step black races of quadrupeds or birds are converted by the process of 
nature into white races, and a black pair in the human race produces a 
white progeny, we may learn how many phenomena there are in nature 
which the knife of the anatomist cannot reach, and all the investigations 
in physiology are unable to fathom. Even admitting that the case cannot 
be reversed in regard to our species, and that the white pair never pro- 
duces a black offspring, they will recollect that they have afforded us no 
evidence that our white race, in the present acceptation of the term, is of 
the color of the original man; that, therefore, as in conformity with the 
other operations of nature a variety does not return to the characteristics 
of the original species, so we can have no well-grounded belief that any Observations and Researches on Albinism in the Negro Race. 
1165 
change will convert the white into a colored man; on the other hand, if 
the original color was dark, whatever may have been the shade, this was 
the very color of the races in which, in all ages and countries, the greatest 
number of white varieties have been produced. In the production of 
these albinos, however, we perceive at least how suddenly nature carries 
one extreme to the other, and how many admonitions are offered us not 
to pronounce a hasty judgment, without being supported by such facts as 
will warrant us in arriving at a correct conclusion."* 
Seat and Nature of the Change of Color in the Albino. 
Eyes.-M. Blumenbach accounted for the red color of the pupil, and 
the extreme sensibility of the eye to light, by the absence of the pigmentum 
nigrum. He observes that Simon Pontius, in his treatise, "DeColoribus 
Oculorum," long ago remarked that the interior membranes of blue eyes 
are less abundantly supplied with that brown or blackish mucus which, 
about the fifth week of conception, covers all the interior parts of the eye, 
and are, therefore, more sensible of the action of light. He adds that this 
sensibility of blue eyes is very conformable to the situation of northern 
people during their long twilight; and that, on the contrary, the deep 
black eyes of negroes enable them to bear the strong gl^re of the sun's 
beams in the torrid zone. As to the connection between the red color of 
the eyes and the whiteness of the skin and hair, Blumenbach held that it 
is owing to a similarity of structure. This black mucus is formed, as he 
asserts, only in the delicate cellular substance, which has numerous blood- 
vessels contiguous to it, but contains no fat, like the inside of the eye, the 
skin of the negro, the spotted palate of several domestic animals, etc., and 
the color of the hair generally corresponds with that of the iris. 
About the same time M. Buzzi, surgeon to the hospital at Milan, 
demonstrated by dissection the truth of the hypothesis of M. Blumenbach. 
In dissecting the body of a peasant who died at the age of thirty years, in 
the hospital of Milan, of a pulmonary disorder, and who was remarkable 
for the uncommon whiteness of his skin, hair, beard, and all the other cov- 
ered parts of the body, M. Buzzi found the iris of the eyes perfectly white, 
and the pupil of a rose color; and the eyes were altogether destitute of the 
pigmentum nigrum, or black membrane, which was not discernible either 
behind the iris or under the retina. Within the eye he found the choroid 
coat extremely thin, and tinged of a pale color, by vessels filled with dis- 
colored blood. The skin, when separated from different parts of the body, 
appeared to be almost wholly divested of the rete mucosum, nor was the 
least trace of it to be discovered by maceration, even in the wrinkles of the 
abdomen, where it is most abundant and most visible. The whiteness of 
the skin and hair were ascribed by M. Buzzi to the absence of the rete 
mucosum, which in his judgment gives the color to the cuticle and to the 
hairs that are scattered over it. Iu proof of this opinion, he alleges a well- 
known fact, that if the skin of the blackest horse be accidentally destroyed 
in any part of the body, the hairs that afterwards grow on that part are 
always white, because the rete mucosum which tinges these hairs is never 
regenerated with the skin. The peculiar appearance of the eye of the 
albino is due to the absence of pigment from both portions of the vascular 
tunic or uvea of the eyeball, the choroid, and the iris.. The color of the iris 
depends upon the fine vessels which are so numerous in its composition, 
and of the pupil on the still greater number of capillaries, which almost 
entirely form the choroid membrane; the black pigment which lines the 
* Loc. cit., p. 191.] 1166 
Observations and Researches on Albinism in the Negro Race. 
choroid, as well as the coloring substance of the iris, being defective, a red 
tinge is imparted to the light which penetrates the transparent blood-vessels 
of the iris and the anterior part of the eye. This absence of the black pig- 
ment, which has the important office of absorbing superfluous portions of 
light, renders the eye preternaturally sensible to this stimulus. In the natu- 
ral eye, the pigmentum nigrum which forms the inner layer of the choroid 
and rests upon the external thicker and vascular layer of this membrane, is 
a continuous purely cellular layer completely investiugthe inner or vascular 
surface of the choroid, and consisting, as far as the ora serrata, of a single 
layer of almost regularly hexahedral, contiguous cells, disposed in an ele- 
gant mosaic manner, and filled with brownish-black pigment. From the 
ora serrata onwards, the pigment cells are disposed in several layers, and 
are so entirely filled with pigment that the nuclei even are scarcely visible. 
The pigment of the choroid consists of minute, flattened, oval corpuscles, 
rhe largest of which are not more than 0.0007 of a line long. In albinos, 
only the pigment of the hexahedral choroid cells is wanting; the cells 
which, in other animals, contain this coloring matter, forming the pigmen- 
tum nigrum, exist, but they are perfectly colorless. The red color, there- 
fore, of the eye of the albino is due, not only to the absence from these 
cells of the pigmentary matter, but also to the blood tilling the vessels of 
the vascular layer of the choroid. 
Skin.-The varieties in the color of man and animals have their seat in 
the epidermis, or outer coating of the body, external to the true skin; and 
to this exodermal structure must be referred also such appendages as the 
hair, feathers, horns and hoofs. Careful microscopical research has shown 
that the rete mucosum of the epidermis, first described by Malpighi, and in 
which the color of the skin resides, is not a distinct membrane, but is 
nothing more than a soft epidermic layer of delicate polyhedral cells, which 
are incessantly transformed into the flattened and comparatively dry scales 
of the cuticle, and are constantly reproduced from the surface of the 
dermis. The three distinct parts of the integument of the negro described 
by Albinus, the four layers described by Cruikshank in his series of obser- 
vations on the skin of the negro affected by the small-pox, as well as the 
four layers described by M. Gaultier and M. Flourens, interposed between 
the cuticle and the true skin, have all been shown by the careful micros- 
copical researches of Henffi, Parkinge, Schwann, Kolliker, Bowman, and 
others, to be not distinct membranes, but only the complicated cellular 
structure of the outer skin. The series of layers of cells which compose 
the epidermis are continually wearing off at the external surface, and are 
being as continuously renewed at the surface of the true skin, so that the 
newest and deepest layers become the oldest and most superficial, and are 
at last thrown off by slow desquamation; and in their progress from the 
internal to the external surface of the epidermis the cells undergo a series 
of well-marked changes involving not only their form, but also their chemi- 
cal constitution and color. The innermost layer (rete mucosum) resting 
upon the true skin, in wffiich the coloring matter of the different races 
resides, consists of small, soft, easily destroyed nuclei and cells in various 
stages of development, held together, according to most observers, by a 
tenacious semi-fluid substance. In albino individuals, both of the negro 
and other races, and in the pure unmixed white races, this soft epidermic 
layer is colorless, and, like the cuticle, translucent, and hence it allows the 
color and vascularity of the dermis to be seen; in the negro, its cells, espe- 
cially the deeper ones, are filled with brown or black pigmentary matter, 
which produces the characteristic color of the race, smaller quantities of 
the same material give rise to the various shades of complexion of other Observations and Researches on Albinism in the Negro Race. 
1167 
races, and of different individuals of the same race, and even of different 
parts of the skin of the same person. The sunburnt complexion, the 
periodic changes in the color of the nipple in the female, the dark moles 
and congenital marks of the skin and freckles in the fair complexion, are 
all due to the development or increase of the same coloring matter in the 
developing cells of the deepest portion of the epidermis. According to 
Henle, the dark color of the negro is caused by the presence of pigment 
cells in this portion of the epidermis, resembling those of the choroid in 
almost every respect save their size, which is somewhat less. These are 
intermixed with colorless cells, and on the proportion of the two, the depth 
of the color of different parts depends. According to the same authority, 
the darker parts of the European skin owe their color to pigment cells like 
those of the negro, only still smaller in size, less defined in their outline, 
and less numerous. In the negro, Henle found the cells which contain the 
black pigment aggregated, especially on those parts of the rete which pro- 
ject and correspond with the furrows on the surface of rhe cutis. They 
resemble in form the cells in the pigment of the eye, that is, they are some- 
times completely hexangular, but more commonly only approximating to 
this shape, being polyhedral, or irregularly spherical. Their length, 
according to Henle, reached to 0.0039-0.0062 line ; their breadth to about 
0.005 line. Krause affirms that the dark color of the cuticle, both of the 
negro and white races, depends chiefly on the presence of cells which have 
dark brown nuclei, the substance of the cell being also tinged, but less 
deeply than the nucleus, and the color being diffused through the mass, 
and not caused by molecules. He admits that a few true pigment cells are 
found in the negro's skin. 
According to Bowman, the coloring matter, however various in quan- 
tity and hue, consists of oblong or oval grains of extreme minuteness 
(rc.oir °fan inch in their long diameter), and occupying the interior of 
some of the epidermic particles; in the negro it accumulates in large quan- 
tity and completely envelops the nuclei, immediately resting upon the 
cutis. On examining a vertical section of the whole cuticle of the negro 
the coloring matter will be seen to gradually diminish towards the surface 
and no true line of demarcation can be discovered between the two por- 
tions, and in the most deeply colored portions it is even impossible to dis- 
cover a sort of stream of colored grains advancing towards the surface. 
According to Kblliker, the horny layer of the epidermis in the white races 
is colorless and transparent or slightly yellowish, the mucous layer yellow- 
ish white or brownish. The color is deepest in the areola and in the nipple, 
passing even into blackish brown, especially in women during pregnancy 
and after they have borne children; it is less intense in the labia majora, 
the scrotum and the penis, where for the rest it varies greatly, being some- 
times almost entirely absent, sometimes very distinct, and is least consid- 
erable in the axilla and around the anus. Besides these situations which 
in most individuals are more or less tinged, in the dark complexioned more 
than in the fair, a lighter or more deeply colored, frequently very dark 
pigment is deposited in various other localities, in the stratum Malpighii; 
in pregnant women in the linea alba, and in the face (rhubarb-colored spots); 
in persons who are exposed to the sun in the face, especially the brow, chin 
and cheeks; in the neck, the thorax, the back of the hands, the forearm; 
and in dark persons over almost the whole body. These tints, according 
to Kblliker, are not produced by special pigment cells, but are seated in 
the common cells of the mucous layer, round whose nuclei a finely granu- 
lar or more homogeneous coloring matter or actual pigment granules are 
deposited. When the skin is only slightly colored, it is mostly only the 1168 
Observations and Researches on Albinism in the Negro Race. 
neighborhood of the nuclei, and in fact only the lowermost layers of cells, 
which are implicated, so that in perpendicular sections the papillse are 
seen to be surrounded by a yellowish fringe; dark shades are produced by 
the extension of the color to two, three, four and more layers of cells, and 
over the whole cell contents, sometimes by a darker coloration of the 
deepest layer of cells, the two conditions commonly coexisting. In the 
negro aud the other colored human races it is only the epidermis which is 
colored, whilst the corium completely resembles that of Europeans. The 
pigment, however, is far darker and more abundant. In the negro, in 
whom, as regards the arrangement and size of the cells, the epidermis 
is piecisely like that of the European, it is the perpendicular cells of the 
deepest part of the mucous layer which are darkest (dark brown or black- 
ish brown) and they form a sharply marked fringe contrasted with the 
clear corium. To these succeed clearer but still brown cells, which are 
accumulated particularly in the depressions between the papilla*, but are 
also found on their points and lateral portions in many layers; finally, at 
the boundary, close to the horny layer, there follow brownish yellow or 
yellow, or rather pale, more transparent layers. All these cells are colored 
throughout, with the exception of their membranes, and especially the 
parts round the nuclei, which, in the internal layers, are by far the darkest 
portions of the cells. The horny layer of the negro also inclines to yellow 
or brownish. In the yellowish skin of the Malay head in the anatomical 
collection at Wurzburg Kolliker found the same appearance as in a dark- 
colored European scrotum. This distinguished microscopist and anatomist 
concludes from his investigations "that the epidermis of the colored races 
is in no essential point distinguishable from the colored regions in the white 
man, and it even agrees in nearly all respects with that of certain locali- 
ties (the areola of the nipple, for instance)." 
Schwann has shown that the chemical properties of the cells of the 
epidermis become modified as they pass through their various changes and 
approach the surface, becoming finally hard, horny, and dry, and almost 
identical in composition with hair, horns, and hoofs; and there can be but 
little doubt but that the decrease of color in the superficial laminae in the 
colored races is due to this chemical change which gradually takes place 
in the interior of the epidermic particles. It is therefore more just to look 
upon the cuticle as a continuous cell-growth evolved from the superficial 
surface of the cutis or true skin; and the idea that it was formed of dis- 
tinctly organized membranes, continuous and independent of the contigu- 
ous structures, was inferred from the crude and imperfect methods of dis- 
section and examination with the naked eye. By the simple and compara- 
tively rude processes of maceration and dissection apart from microscopi- 
cal examination, the epidermis from the different physical and chemical 
properties of the different layers of cells was readily divided by the older 
anatomists into different layers or membranes, as they expressed it; but the 
results of such method of investigation hardly warrant the conclusion of 
M. Flourens and others, that the skin of the negro is specially different 
from that of the white race. Many facts, recorded by various observers, 
are wholly uuintelligible, if the proposition maintained by M. Flourens be 
true. It is well known that disordered states of the constitution may occa- 
sion marked changes in the complexion of the white races. Malarial fever 
renders the complexion sallow and dusky. Dr. Strach mentions the case of 
a man who, after a fever, became as black as a negro. We have before con- 
sidered the changes in the color of certain portions of the skin during the 
period of pregnancy. Observations and Researches on Albinism in the Negro Race. 
1169 
Bowman mentions a French peasant, whose abdomen became entirely 
black during each pregnancy. Camper has given an account of a female 
of rank who had naturally a white skin and beautiful complexion, but 
whenever she became pregnant began immediately to grow brown; after 
delivery the dark color gradually disappeared. Blumenbach possessed the 
part of the skin taken from the abdomen of a beggar, which was as black 
as the skin of an African. Blumenbach has seen two instances in Germans; 
one of a youth, the other of a man sixty years old; they both had a rather 
tawny skin, marked here and there with various sized spots of the clearest 
white. They appeared first in the former in infancy, and in the latter at 
the age of manhood. The offspring of the black and white races may be 
either black or white, instead of being mixed; and in some rare cases it has 
been spotted. 
Dr. James Parsons has recorded two singular instances which sustain 
this proposition. A black man married a white woman in York, England. 
The woman soon proved with child, and in due time brought forth one 
entirely black, and in every particular of color and features resembling the 
father, without the least participation from the mother. This was thought 
a very singular case, because people naturally expect the issue of such a 
marriage would be tawny; which indeed is the usual effect produced by the 
congress of black and white persons. The second case was that of a black 
man, servant to a gentleman who lived in the neighborhood of Gray's Inn. 
He mariied a white woman who lived in the same family; and when she 
proved with child, took a lodging for her in Gray's Inn Lane; when she 
was at her full time, the master had business out of town, and rook his man 
with him, and did not return till ten or twelve days after the woman was 
delivered of a girl, which was as fair a child to look at as any born of white 
parents, and her features exactly like the mother's. The black, at his 
return, was much disturbed at the appearance of the child, and swore it 
was not his; but the nurse who attended the lying-in woman soon satisfied 
him; for she undressed the infant, and showed him the right buttock and 
thigh, which were as black as the father, and reconciled him immediately 
to both mother and child. Dr. Parsons was informed of the fact, and went 
to the place, where he examined the child, and found it true; this was in 
the spring of the year 1747, as his notes specified which he took on the 
spot.* A negress had twins by an Englishman; one was perfectly black, 
with short woolly curled hair; the other was light, with long hair. Dr. 
Winterbottom says that in a family of six persons, which he knew, one half 
was almost as light colored as mulattoes, while the other was jet black. 
The father was a deep black, the mother a mulatto, f We have already 
given examples of negroes who were gradually changed into spotted and 
even white persons, without any accompanying disease. 
Dr. Gustav Simon, of Berlin, after a careful investigation of the vari- 
ous discolorations, or diversities of hue, which make their appearance on 
the skins of Europeans, including healthy aud natural varieties of tint, 
and those which occur in morbid states of the system (discoloration of the 
areola mammarum, brown discoloration of circumscribed spots, naevi 
materni, or congenital spots, moles, summer freckles, lentigo), arrived at 
the important conclusion that they depend upon the presence of similar 
cells filled with pigment, which impart the color to the skin of the negro 
and the dark races of mankind. The correctness of this conclusion has 
been established by the investigations of Krause. Barensprung, and Kolli- 
* Philosophical Transactions, 1765, vol. Iv. p. 45. 
f Laurence's Lectures, p. 205. 1170 
Observations and Researches on Albinism m the Negro Race. 
ker. These authors have also shown that in certain diseased states of the 
skin, as in ichthyosis, and in cicatrices after chronic inflammation of the 
skin, the pigment may be developed directly from the blood-corpuscles, 
and may be deposited in the corium and papillae. A colored epidermis 
may be also produced by a parasitic vegetable growth, as in yellow spots 
of ephelides, or pityriasis versicolor. Dark colorations of the white races 
may also arise from a deposition of the coloring matters of the bile, and 
also of certain metallic substances, as oxide of silver. Such cases, there- 
fore, must be carefully distinguished from the foregoing discolorations of 
the skin. The greatest variations of color are witnessed among animals 
and birds; and these marked changes are not confined to domesticated ani- 
mals and birds. Not only may white sheep produce black lambs, and 
every variety of color spring up in the same drove of horses, herd of 
cattle, and flock of ducks and fowls; but many species of wild birds and 
quadrupeds present themselves under two or more distinct liveries in the 
course of the year. 
Dr. Bachman, in an attempt to explain the process of nature in which 
these changes are produced, says : "These semi-annual changes in color 
are not confined to such species as have a constituted predisposition to 
such phenomena, but they spring up from causes which no one is able to 
explain, in species where color is generally uniform. We received from a 
friend a wild turkey, caught in a trap. At the moulting season, in the fol- 
lowing summer, the new feathers came out nearly white, but after some 
weeks gradually returned to the original color. Our friend, Dr. Campbell, 
of Charleston, directed our attention to a top-knotted hen, on his premises, 
which had been received from Baltimore, whose color had been originally 
black, but which, after the moulting season, had become pure white, and 
continued so for a year, until the next moult, when it once more became 
black. Thus it continued for several years to alternate between the two 
opposite colors. All this while the bird remained in perfect health, and 
laid the usual number of eggs. Horses brought across the Atlantic are 
found to have white patches of hair over those portions where the skin 
had been rubbed off on the voyage. We perceive from hence how easily 
the coloring matter under the skin becomes deranged, and from what slight 
causes it imparts an entirely opposite color." The congenital varieties 
arising amongst domestic animals may, as is well known, be eatablished 
as permanent varieties, if the individuals with these new characters con- 
stantly intermix. Thus, the white rabbit and ferret have become fixed 
varieties. And facts are not wanting to show that similar varieties of color 
may be propagated in the human race; and in addition to those which we 
have already recorded, we will quote the testimony of Hon. Joel R. Poin- 
sett, as given by Dr. Bachman, to show that a race of spotted men exist in 
Mexico. "Saw, in the capital of Mexico, a regiment to number of 600 men, 
called Los Pintados, who were all spotted with blue spots in some parts of 
the body. The people are found along the Pacific coast just north of Aca- 
pulco. This regiment was commanded by General Alvarez." Dr. Bach- 
man continues: "These persons were all in fine health and propagated 
these varieties from generation to generation. What there was in food, 
the climate, or the geological structure of the western coast of America, to 
produce this strangely colored variety in the human species we are unable 
even to conjecture. It was certainly not disease, as Mr. Poinsett represents 
them as a regiment of flue, healthy looking men, in which there was not a 
solitary individual who was not spotted in this manner."* 
* Loe. clt., p. 182. Observations and Researches on Albinism in the Negro Race. 
1171 
Dr. James Cowlis Prichard, in his learned and elaborate work on the 
"Natural History of Man," has well remarked that "it will be worth while 
to observe that the epidermic or horny tissue, corresponding in many 
tribes of animals to the extra-cutaneous texture which is the seat of varia- 
tions in color, and in the hair of human beings, is precisely that part of 
the organic system which undergoes the most striking and even surprising 
alterations. It is the tissue which displays the variety of horns in tribes 
possessed of such appendages, some races of the same species having a great 
profusion of frontal antlers, while others are entirely destitute of them; 
and these variations, as we have seen upon evidence, were known actually 
to arise within the limits of one stock.'2 The hoofs, which are parts of the 
same structure, undergo similar changes; and in the remarkable instance 
of the solid hoofed swine there appears an imitation of the really specific 
structures of other tribes of animals. The appearance and structure of the 
epidermis undergo remarkable changes during the domestication of many 
wild animals. Thus the rough, tuberculated skin of the wild asses of Persia 
disappears on domestication. And the history of the remarkable Porcu- 
pine family of England not only affords a striking illustration of the anom- 
alies which display themselves in the textures external to the true skin, 
and of the wide range of variation to which those external coatings of the 
human body are subject, but it also illustrates the possibility of transmit- 
ting these peculiarities, unchanged, from parent to child. "It appears, 
therefore, past all doubt," says Mr. Baker, who communicated an account 
of the father of the Porcupine family to the Royal Philosophical Society of 
London, "that a race of people may be propagated by this man, having- 
such rugged coats and coverings as himself; and if this should even happen, 
and the accidental original be forgotten, it is not improbable they might be 
deemed a different species of mankind." 
From these researches upon the changes of the color of the skin m the 
albino in its relations to similar changes in the different races of man and 
in the lower animals, we feel justified in drawing the following conclusion: 
Between the epidermis of the white and the colored races there is an iden- 
tity of structure, and no such organic difference as indicates a diversity of 
origin and species of the different races. The only difference is that the 
young epidermic cells of whites contain little or no coloring matter, or pig- 
ment granules, except in certain situations, while those of the black race are 
filled with coloring matter. The marked variations of hue in the same 
race, the sudden appearance of albinos in the races of man and animals, 
and the possibility of propagating this peculiarity; the gradual, and some- 
times even sudden appearance of pigment cells in various parts of the epi- 
dermis of the white races, and the gradual disappearance of the pigment 
cells from circumscribed portions, and even from the entire epidermis of 
the negro, all show that this difference can scarcely be regarded as perma- 
nent or structural, but is one of degree rather than of kind, and that the 
different complexions of mankind are not permanent and specific charac- 
ters. 
Hair.-The hair of the negro albino is peculiarly adapted for investi- 
gation and comparison with the hair of other varieties of the human race, 
and I spared no effort to obtain accurate results. The hair of the mother, 
father, grandmother, and of several other members of the family connected 
by marriage and by blood with the albino children, as well as the hair of a 
number of other "black, woolly-headed, flat-nosed and thick-lipped" 
negroes, and of mulattoes, quadroons, half-breed Indians and negroes, and 
of American and European white men, women and children, and the wool, 
hair and fur of several varieties of sheep and goats, and of various animals, 1172 
Observations and Researches on Albinism in the Negro Race. 
as the tiger, panther, conger, bear, dog, mink, mole, musk-rat, deer, etc., 
were carefully examined under the microscope and subjected to the*action 
of chemical reagents. It is not my intention at the present time to enter 
into all the derails of this investigation, especially as the differences in the 
hair, wool and fur of different animals would require long and elaborate 
descriptions and careful drawings for their elucidation. The hairs of the 
heads of the two albino children and of the albino man were, as in the case 
with the hair of the different varieties of the human race, composed of 
three well-defined portions. In presenting the results of this inquiry, we 
will proceed from the exterior to the interior of the structures composing 
the hair of the head. 
1st. The cuticle, or delicate external investment of fibrous substance, 
investing and closely united to the cortical substance. The cuticle was 
marked by numerous, dark, irregular, and jagged lines, formed by the pro- 
jecting edges of the component scales. In some parts of the outline of the 
hair, when viewed under high magnifying powers, small serrations were 
observed, which were due to the edges of the cuticular plates, which are 
directed upwards and outwards along the shaft. By the use of a solution 
of potassa we were able to separate the cuticle, and to determine that it 
was composed of altered cells in the form of transparent flat plates. The 
slight bristling or serration of the edges income hairs was due to the 
implicated manner in which these plates were disposed; and in many hairs, 
and in parts of the same hair, this serration was scarcely observed. Those 
writers are in error, however, who assert that the edge of the hair as 
viewed in profile is perfectly smooth. A perfectly smooth profile is man- 
ifestly impossible in a shaft covered with plates. This slight serration, 
however, originally must not be confounded with the deep regular serra- 
tions of wool. I found a magnifying power of 430 diameters the best for 
the clear definition of the edges of the cuticular plates enveloping the cor- 
tical substance of the hair. The appearance of the cuticle of the white 
hair of the albinos differed in no respect from that presented by the white 
hair of aged negroes, or of aged white persons. The examination of the 
cuticle of the jet black hair of the negro required more time and care, as 
it was not so readily distinguishable under the microscope, on account of 
the intense black of the entire structure. By the use of reagents, how- 
ever, and especially of liquor potassse, it was possible to detach the cuticle, 
and it was found to differ in no respect, either in its arrangement or gen- 
eral characters, with the exception of its color, from that of the albino or 
of the aged negro. The same result was observed upon a careful exami- 
nation and comparison with the hair of the white race, male and female, 
and of different ages. I could perceive no essential, marked or specific differ- 
ence between the cuticle of the hairs of the albino, the black negro, the mulatto, 
quadroon, half-breed Indian and negro, and the white race. On the other hand, 
the cuticle of the wool and for of various animals is far more varied in its 
markings, and the serrations formed by the individual plates more distinct. 
The wool of the sheep is far smaller in diameter than the hair of the human 
head, and the cuticular plates are more fully and regularly developed, and 
are not so thoroughly fused into each other. The chief difference between 
wool and hair appears to be in the mode of development and disposition of 
the plates composing the cuticle, and the smaller size and more flattened 
and ribbon-like form. Hair and wool, although differing in these pecu- 
liarities, must be considered as intrinsically the same in their horny 
texture, relations to the skin, mode of development and growth. Not only 
are both wool and hair found in the covering of most animals, but the rela- 
tive proportions of each may be altered by climate and other influences. Observations and Researches on Albinism in the Negro Race. 
1173 
It was known from the earliest times that wool possessed the property of 
felting, but it has been shown only at a comparatively recent date, by Mr. 
Youatt, that the true cause of the felting property of wool, and at the same 
time its distinguishing character, when contrasted with hair, consists in 
its external serrated structure. 
M. Monge was the first to assert that a feathered, or barbed edge, must 
be the structure of the surface of wool; that "the surface is formed of 
lamella, or little plates, which cover each other from the root to the point, 
pretty much in the same manner as the scales of a fish cover that animal 
from head to tail, or like rows placed one over another, as is observed in 
the structure of horns." It does not appear, however, that M. Monge 
actually saw this peculiar structure under the microscope; and the credit 
of the demonstration rests with Mr. Yonatt, who thus announced his dis- 
covery: "On the evening of the 7th ofFebruary, 1835, Mr. Thomas Flint, 
woollen manufacturer, resident at Leeds; Mr. Symonds, clothing agent, of 
Cateaton street, London; Mr. T. Millington, Surgeon of London; an esteemed 
friend, Air. E. Brady, veterinary surgeon, at that time assisting the author 
in his practice; Mr. W. H. Coates, of Leeds, veterinary pupil; Mr. Powell, 
the maker of the microscope; the author himself, were assembled in the 
parlor. A fibre was taken from a Merino fleece, without selection, and 
placed on the frame, to be examined as a transparent object. A power of 
300 (linear) was used; and after Mr. Powell, Mr. Flint had the first ocular 
demonstration of the irregularities in the surface of the wool, the palpable 
proof of the cause of the most valuable of its properties, its disposition to 
felt. . 'the fibre thus looked at assumed a flattened, ribbon-like form. It 
was of a pearly-gray color, with faint lines across if. The edges were evi- 
dently hooked, or more properly, serrated; they resembled the teeth of a 
fine saw. They were somewhat irregular in different parts of the field of 
view, both as to size and number. The area of the field was one-fortieth 
of an inch in diameter. By means of a micrometer, we divided this into 
four, and we then counted the number of serrations in each division. Three 
of us counted all four divisions-for there was a difference in some of them. 
The number was set down privately, and it was found that we had all 
estimated it at fifteen in each division. Having multiplied this by four, to 
obtain the whole field, and that by forty, the proportionate part of an inch 
of which the field consisted, we obtained, as a result, that there were 2400 
serrations in the space of an inch, all of which projected in the same direc- 
tion. viz., from the root to the point. * * We next endeavored to explore 
the cause of this serrated appearance, and the nature of the irregularities 
on the surface, which might possibly account for the production of these 
tooth-like projections; we therefore took another fibre, and mounted it as 
an opaque object. * * We were presented with a beautiful glittering 
column, with lines of division across it, in number and distance seemingly 
corresponding with the serrations that we had observed in the other fibre, 
that had been viewed as a transparent object. It was not at once that the 
eye could adapt itself to the brilliancy of the object; but by degrees these 
divisions developed themselves, and could be accurately traced. They 
were not so marked as the inverted cones which the bat's wool presented, 
but they were distinct enough; and the apex of the superior one, yet com- 
paratively little diminished in bulk, was received in the excavated base of 
the one immediately beneath; while the edge of this base, formed into a 
cup-like shape, projected, and had a serrated or indented edge, bearing no 
indistinct resemblance to the ancient crown. All these projecting edges 
pointed in a direction from root to point," The difference, then, between 1174 
Observations and Researches on Albinism in the Negro Race. 
wool and hair, according to Mr. Youatt, are as follows: The fibre of wool 
is crisped or curled, the curls increasing according to the firmness and felt- 
ing property of the wool; and in addition to this it is decidedly serrated; 
whilst hair, though sometimes curled, but in a very.limited degree in com- 
parison with wool, has its edge only scaly or rugose, and never truly ser- 
rated; and hence it is that hair, though it will entangle and barb to a cer- 
tain extent, will not fold into a compact mass. 
Dr. Eble, as quoted by Dr. Prichard, who examined with the micro- 
scope the wool of the merino and of the Chinese sheep, says that all wool 
displays filaments twisted and matted in all directions; and, moreover, the 
shaft of the filament of wool does not keep an uniform calibre, but appears 
thickened here and there, and often swelled out with an appearance of 
knots. He adds, "I could everywhere distinguish clearly the so-termed 
medulla or pith-the transparent canal; and could accurately discriminate 
between this and the cortical substance. Yet, in the various proportions 
which these parts bear to each other is to be found the chief difference 
between the finest and coarsest wool. The cortical parts appeared in both 
almost equally thick and untransparent, at least near the edge. But the 
canal in common wool seemed divided into more numerous spaces resem- 
bling irregular cells; while in the wool of the merino sheep the cells appear 
more regularly arranged. The whole canal of the sheath seems to be sepa- 
rated by regularly interposed fine transverse laminae. The hair of the 
Thibetan goat, of which the cashmere shawls are made, approaches in its tex- 
ture very nearly to the merino wool, only it is smaller in thediameter of the 
sheath, and the tranverse laminae appear not so regularly placed. The 
Chinese sheep has wool, and interspersed among it rough coarse hair." In 
the wool of the bat the scales are so prominent as to produce the appear- 
ance of a series of cups, placed one in another,.and having indented edges; 
the wool of the rabbit is fine, with sharp angular serrations, whilst the 
hair is covered with a scaly incrustation, and cannot be said to be serrated; 
the wool of the tiger, bear, seal, and Italian w'olf-dog, have distinct and 
numerous serrations, while the hair of the animals is covered with scales 
like the back of a sole. These well-known examples, which have been 
given by Mr. Youatt and others, illustrate the difference between wool and 
hair; it must be acknowledged, however, that we need an extended inves- 
tigation of this subject, embracing an inquiry into the mode in which 
changes of climate, culture, diet, and other circumstances, affect the growth 
and character of the clothing of animals. 
2d. The fibrous, or cortical longitudinally striated substance of the 
hair In the albino, and in the white hair of the aged negro, and of the 
white race, these fibres are transparent; in hair of different colors they 
vary in the depth of the shade, and in the negro they are black. The only 
distinguishable difference in these fibres in the hair of different races, is 
the greater abundance of pigmentary matter in the hair of the negro. In 
all the varieties of hair of the different races which we examined, the 
fibres of the cortical substance were resolvable under the action of strong 
chemical reagents into aggregations of flat, elongated fibre cells or plates, 
more firmly united longitudinally or at their ends, than in the direction of 
their breadth or sides. In hair of different colors, the cortex in like man- 
ner presented various hues, and in addition contained darker spots, due to 
the accumulation of pigmentary matter. The accumulation of the black 
pigmentary matter in the cortex of the hair of the negro is immense and 
complete (the black is " dyed in the wool "). and the entire hair under the 
microscope resembled an opaque black rod. By the application of reagents, 
however, it is possible to break up the component elements of the cuticle Observations and Researches on Albinism in the Negro Race. 
1175 
and cortex, in the hair of the negro, and by dividing the fibres and 
decreasing the intense black color, to reveal an entirely similar structure 
to that of the hair of other varieties of the human race. 
3d. The central or medullary substance was well defined in the hair 
of the albino, and in the white hair of old negroes. In many of the hairs 
of the albino children it presented a yellowish color, and this gave the 
light yellowish tinge to the hair when viewed in mass. The color of the 
medullary cells was also well marked and deeper in the brownish-yellow 
hair of the adult negro albino. In the light hair of the white race, the 
medullary substance was in like manner more highly colored than the 
cortex and cuticle, thus establishing a close correspondence, even in the 
distribution in the coloring matter of the two races. In the jet black 
opaque hair of the negro and mulatto, it was easy to demonstrate the pres- 
ence of the central medullary matter, by the use of the solution of potassa. 
These investigations were conducted carefully, and through comparatively 
long periods of time. The hairs were first examinedin their natural state, 
and then subjected to chemical reagents whilst they were still under the 
magnifying glass. The assertion that the hair of the negro is without a 
central medullary portion, distinct from the fibrinous cortex, is incorrect; 
with proper care and the proper reagents, it can be demonstrated under 
the microscope as readily as in the hair of the albino, or in the hair of the 
aged of other races, and in the lighter shades of hair of the white race. In 
the negro, as well as in the white race, the medulla was composed of simi- 
lar morphological elements, isolated cells, differing in form and arrange- 
ment from the fibres of the cortex. From this investigation of the hair 
we conclude : 
(1.) The hair of the negro albino differs in no respect from that of 
the black negro, and from the hair of the mixed and pure varieties of the 
human race, except in the absence of pigment. 
(2.) The hair of the negro is similar in its development and structure, 
and in its ultimate morphological elements, to that of the other varieties 
of the human race. Whilst the shape or roundness of the hair of the negro 
is not so uniform as that of the white race, mulatto, and Indian, on the 
other hand, there is a variation in this respect in the individual hairs, 
which are frequently perfectly round in some parts, and more elliptical 
and twisted in others. Similar variations of the form of individual hairs 
are met with in the closely curled black hair of individuals of the white 
race. 
(3.) The hair of the negro possesses all the characteristics of hair, 
and is not wool. LEPROSY IN AMERICA. CHAPTER IX. 
GENERAL OBSERVATIONS. 
Many authors on the subject of cutaneous diseases have experienced 
considerable inconvenience in speaking of leprosy, from the confusion of 
the older writers, who seem to have applied this term to endless varieties 
of the disease of the skin, which do not appear to have the slightest resem- 
blance to that which is properly so named. The details of the worst 
forms of all diseases of the surface appear to have been constantly selected 
as a foundation for that of lepra, as if this generic term for a class of dis- 
eases comprehended only what was disgusting and terrific in appearance, 
or uncontrollable by any known scientific means. By a strange misunder- 
standing, leprosy has been by many writers confounded with elephanti- 
asis; no two diseases of the skin, however, can possibly be less alike. The 
disease of the cutis which exists in the latter, moreover, is of infinitely less 
importance than that of other and more deeply seated parts, in making up 
the characters of this malady. By the term leprosy, a disease of the cutis 
only was originally meant, terminating sometimes, perhaps, unfavorably 
in unhealthy sores or spreading sloughy ulcerations, marasmus, and decay 
of mental and bodily strength; but in the majority of cases, where cleanli- 
ness may have been attended to, in a slow and gradual return to health. 
The abhorence which the unfortunate subjects of various diseases of the 
skin included under the general term leprosy were held by their fellow- 
creatures in the earlier periods of history affords no argument against the 
view that the disease described by Turner, Willan, Bateman, Rayer 
Plumbe, Erasmus Wilson, and others, under the term lepra, presents many 
degrees of severity and is often amenable to treatment. In the early history 
of medicine and in unenlightened times, the power of infection was sup- 
posed to be vested in any person, however slightly affected with lepraj 
and inasmuch as skin diseases prevailed chiefly among the lower classes, 
they were considered as bringing with them as much of disgrace as of mis- 
fortune. The connection also which the sacred writings seem to have 
established between the general prevalence of certain cutaneous disorders 
and the incurrence of the divine wrath on the people, would have led the 
latter to the exclusion of lepers (those suffering with cutaneous diseases) 
from their society, even though the disease, pathologically speaking, may 
have been exceedingly trivial. 
There seems to be little doubt that almost all diseases of the skin occur 
less frequently, and are less formidable and disgustingin their external 
characteristics than those observed by the ancient and mediaeval writers. 
The second order of cutaneous diseases of Willan includes those affections 
which are characterized by an appearance of scales, arising from a morbid 
state of the cuticle characterized by scales (squama^ or lamina of morbid 
Cuticle, hard, thickened, whitish and opaque. The cuticle is«not,howevert 1180 
General Observations. 
the only seat of these complaints; they often originate from indurated 
papulae, or larger elevations of the true skin, which by pressure or destruc- 
tion injure the texture of the cuticle and produce thickened irregular 
layers of it. The scales or crusts thus formed have not always been dis- 
tinguished from scabs (hard substances covering: superficial ulcerations, 
and formed by a concretion of the fluid discharged from them), succeeding 
confluent pustules, or superficial ulcerations, whence we find, in medical 
writers, several dissimilar diseases connected together. 
According to Willan the generic diseases of this order are lepra, pity- 
riasis, psoriasis and icthyosis; and by the term lepra he expressed the com- 
plaint as denominated by the most accurate of the Greek physicians. 
According to Willan lepra is characterized by scaly patches of different 
sizes, but having nearly a circular form, and he observed in England three 
varieties of the disease, which he described under the titles of lepra vulgaris, 
lepra alphoides and lepra nigricans. Willan's two species appear to be 
merely different degrees of the affection, or different stages of its progress, 
while the lepra nigricans is the result of a scorbutic state of the system 
operating in combination with the ordinary causes of the cutaneous dis- 
eases. Alibert adopted a similar plan and gave la lepre blanche, lepre noire 
and lepre Tyrienne as varieties of his lepre squameuse. His descriptions of 
lepre crustacee and tuberculeuse apply to varieties of psoriasis, ecthyma, 
rupia, etc., and elephantiasis. Alibert, though still retaining the term 
leprosy in connection with his description of elephantiasis, is not unaware 
of the material difference between the latter and the lepra of modern 
writers. P. Bayer, in his " Theoretical and Practical Treatise on the Dis- 
eases of the Skin," employs the word lepra, which was long used to signify 
almost the whole of these chronic diseases of the skin when they have 
attained a high degree of severity, in a limited and more determinate sense 
to designate a chronic inflammation of the integuments, characterized by 
scaly patches of different dimensions, of a round or orbicular shape, 
depressed in the centre, surrounded by a red and prominent circle, and 
either disseminated over the surface of the skin or united in one or more 
patches of larger size and more irregular shape. Samuel Plumbe, in his 
"Practical Treatise on the Diseases of the Skin," held that to describe 
lepra in the simplest and most correct form, the terms used by Willan and 
Alibert are not at all necessary, and that they may, therefore, be dispensed 
with, in that they have had their share in creating confusion and discour- 
aging the student in the prosecution of his inquiries. The understanding 
in which Plumbe uses the term lepra, is that of a disease exhibiting on 
superficial notice red and inflamed patches from which extensive and rapid 
exfoliation of scales of morbid cuticle are constantly taking place, but in. 
which no appearance of vesicular or pustular formation ever occurs. Eras- 
mus Wilson, under the designation of "squamous inflammation of the 
derma," has assembled a group of diseases which are especially character- 
ized by inflammation and hypertrophy of the derma; by the appearance of 
the disease for the most part in patches which are frequently circular in 
form, and by the production in the diseased skin of laminae or scales of 
abnormal epiderma. According to Erasmus Wilson, the diseases forming 
this group are three in number, namely: Lepra, psoriasis, pityriasis. 
All dermatologists since the time of Willan are agreed as to the close 
analogy between these diseases, and the only innovation which has been, 
suggested with regal'd to them is that of combining lepra and psoriasis 
under a single genus. As respects their pathological nature there can be 
no doubt of the analogy subsisting, not between lepra and psoriasis only, 
but between thethree diseases. Wilson describes lepra as a non-contagious General Observations. 
1181 
and chronic inflammation of the derma, consisting in the eruption on 
various parts of the body of raised and circular patches which are speedily 
covered by thin, semi-transparent scales of white and morbid epiderma. 
The patches are prominent around their circumference and somewhat 
depressed in the centre; they increase by the extension of their periphery, 
while the central area gradually returns to the natural state. During the 
progress of the patches the scales are often thrown off and replaced by suc- 
cessive formations. The local disorder is unaccompanied by constitutional 
symptoms; it is most strongly marked in the neighborhood of the knee and 
elbow joints, where it frequently forms patches of large size and endures 
for a considerable length of time, sometimes recurring at particular periods 
for several years and lasting for several months at each recurrence. The 
varieties of lepra, with the exception of the syphilitic form, are mere modi- 
fications of the same disease, dependent on trivial circumstances. Wilson 
treats of four varieties: Lepra vulgaris, lepra alphoides, lepra nigricans, 
lepra syphilitica. 
There is no part of the civilized world, to which medical research has 
been directed, where evidence of the extensive existence of lepra has not 
been obtained, if perhaps we except the Indians of North America in their 
aboriginal state; but a comparison of the statements of authors, as regards 
the degree in which it is found to prevail in different parts of the world 
and in different ages, clearly demonstrates that in proportion as civiliza- 
tion has advanced, and as commerce has extended its benefits, its frequency 
and severity has become diminished. The connection of cause and effect, 
which is here manifested, admits of read.y explanation; civilization gives 
that excitement to the mental powers on which the healthy performance of 
the animal functions are known to depend; while the improvement in the 
quantity and quality of food, and especially in the supply of fresh meat 
and vegetables, have banished scurvy, the facility with which cotton and 
linen goods and soap, may be everywhere obtained, prevents that negli- 
gence of cleanliness which favors the progress of every form of cutaneous 
disease. 
In treating of leprosy in America, it is not our intention to deal with the 
scaly disease of the skin, occurring generally in circular patches to the 
varieties of which we have just alluded under the head of lepra but shall 
confine the observations chiefly to the elephantiasis Graecoram (lepra Arab- 
rum'), elephantiasis Arabrum (Buchemia, the Barbadoes or chocin legs), 
and the African yaws (sibbens, sivens, pian, epian frambaesia). 
' ORIGIN OF AND NECESSITY FOR THE PRESENT INQUIRY. 
The subject of leprosy has of late excited considerable interest amongst 
the citizens of the Southern portion of Louisiana, and a formal resolution 
was passed by the legislature, suggesting an inquiry as to its existence in 
Lafourche, as will be rendered evident by the following communication to 
the late Dr. Choppin. 
Leprosy in Louisiana. 
House of Representatives, 
February 27, 1880. 
Hon. S. Choppin, M. D., President Board of Health: 
Dear Sir-At the last session of the Legislature a resolution was passed suggest- 
ing an inquiry as to whether leprosy existed in Lafourche. The Board has never 
acted under that resolution to my knowledge. Will you be kind enough to inform 
me as to whether the Board will make an inquiry, at an early day, in this matter 
of leprosy? * * * 1182 
Yaws and Leprosy in the Delta of the Mississippi. 
This matter is so important that I would respectfully urge early action on the 
part of the Board. 
I have the honor to be. sir, your most obedient servant, 
JNO. S. BILLIU. 
On the thirteenth of July, 1880, Major S. J. Grisamore, President of 
Police Jury of the Parish of Lafourche, Louisiana, addressed an earnest 
communication to the President of the Board of Health of the State of 
Louisiana, urging an immediate investigation as to the nature of the dis- 
ease called leprosy, which was reported to be prevalent more especially in 
the lower Lafourche. To this communication, the following reply was 
given: 
Office Board of Health, State House, State of Louisiana, 
New Orleans, July 26, 1880. 
Major S. J. Grisamore, President Police Jury, Thibodeaux, Parish of Lafourche: 
Dear Sir-In reply to your favor of the thirteenth instant, relative to an inves- 
tigation of tlie cases of leprosy said to exist on the Bayou Lafourche, allow me to 
say that the Board of Health has referred the matter to the President for investi- 
gation, and report, as soon as the occasion may offer. 
Please inform me as to the position of the various cases, and also as to the best 
route to be pursued. At present the Sanitary and Quarantine affairs of this great 
city, engage fully my time and energies, and it will be probably a month or two 
before it will be in my power to visit the Bayou Lafourche and institute the neces- 
sary investigation. 
Whenever the time arrives for the execution of the wishes of the Police Jury 
of Lafourche Parish, and I may add of the Legislature of the State, it will be neces- 
sary that 1 should be furnished with a guide thoroughly acquainted with the peo- 
ple and the roads of the country. 
I respectfully request the President of the Police Jury to write fully all particu- 
lars, and furnish all necessary information. 
Respectfully your obedient servant, 
JOSEPH JONES, M. D., 
President Board of Health, State of Louisiana. 
The investigation indicated in the preceding correspondence was not 
undertaken until the 2d of October, 1880, the results of which will be 
detailed in a subsequent portion of this report. In order to throw all pos- 
sible light upon this important subject of leprosy, and also to fulfill in the 
most liberal sense, the wishes of the Legislature of Louisiana, the following 
results of an extended investigation of the past and present history of lep- 
rosy and related diseases, more especially the African Yaws, were submit- 
ted to the consideration of the General Assembly of Louisiana. 
YAWS AND LEPROSY IN THE DELTA OF THE MISSISSIPPI. 
Observations on the African Yaws QFramboesia, Rubala, Plan, Epian, Syphilis 
ABthiopica, Syphilis Vel Lues AEthiopica. Syphilis Africanaf and on Leprosy 
(Ledra Tuberculosa, Lepra IlaErworum, Lepra AEgyptica, Ijepra Leontina, 
Lepra Arabiumf in Insular and Continental America. 
Leprosy, which is now a comparatively rare disease, was, one century 
ago, not an uncommon affliction in the delta of the Mississippi river, for it 
is a well established historical fact that Miro, the successor of Galvez, in 1785, 
founded a hospital for lepers. Ulloa, at an earlier date in the history of 
Louisiana, had attempted to prevent the spread of this loathsome disease 
by confining the lepers at the mouth of the Mississippi river in a place 
known as the Balize, but this measure created great discontent and was 
abandoned. Upon the recommendation of Miro the Cabildo, or council, Yaws and Leprosy in the Delta of the Mississippi. 
1183 
caused a hospital to be erected for the unfortunate victims of leprosy, who 
congregated about New Orleans, on a ridge of land lying between the river 
Mississippi and the Bayou St. John, in the rear of the city. 
The hospital of La Terre des Lepreux or Lepers Land, appears to 
have had a brief existence. In the course of a few years the number of 
these patients gradually diminished, either by death or transportation, 
the disease disappeared almost entirely; the hospital went into decay, and 
Lepers' Land remained for many years a wild looking spot, covered with 
brambles and palmettoes, until by the growth of the great city under the 
flag of the United States, it formed part of the suburbs Treme, and was 
embellished with houses and the appliances of civilization. Careful 
researches into the literary and medical records of the vast country then 
known as Louisiana, yield no unequivocal data for the determination of 
the exact nature of the disease which afflicted the patients of the hospital 
of La Terre des Lepreux during the clays of the Spanish domination; but it 
may with reason be assumed from the historical facts which we shall record 
that the diseases affecting prominently the cutaneous, osseus and nervous 
systems were in early times transplanted from Europe and Asia to Insular 
and Continental America. These diseases, as will be evident from the 
historical facts recorded, were: 
1. The African yaws (frambcesia rubra, plan, epian, syphilis AH thiopica, 
syphilis vel lues ASthiopica, syphilis Africana. 
2. Leprosy: The Oriental leprosy or elephantiasis Grsecorum {lepra 
tuberculosa, lepra JTcebrcerum, lepra leontina, lepra Arabum, mediaeval leprosy. 
3. Elephantiasis Arabum: (elephants leg, Barbadoes leg, buchemia, 
lymphatic hypertrophy or varix of the lymphatics, scrotal tumor. 
We desire to record in this chapter: 
1. The early history of these diseases in Insular and Continental 
America. 
2. Facts illustrating their existence at the present time. 
3. Observations illustrating the gradual decline and disappearance 
of these diseases in the Mississippi Valley. 
4. Measures for the arrest of these diseases: Hygienic measures, thera- 
peutic methods, quarantine or isolation. CHAPTER X. 
YAWS, LIBBENS, SIVVENS, PIAN, EPIAN, FRAMBCESIA, SYPHILIS .ETHIOPICA, 
YAWS. 
The word yaws has its origin in the venacular dialect of Guinea and 
other parts of Africa, where it has been used to designate the fruit of the rubus 
idceus (raspberry), and from an imagined resemblance between it and cer- 
tain fungoid excrescences from the desmoid tissue peculiarly character- 
istic of a disease indigenous in that territory, the latter has obtained the 
same denomination. Yaws continues to be the popular name of this dis- 
ease in the English language, and in its translation into others its etymo- 
logical signification has been retained. On the coast of America it has 
been vulgarly called pian or epian, and by the French framboise, whence 
systematic writers generally have adopted die name framboesia. By Mason 
Good the term rubula, the diminutive of rubus (blackberry or raspberry), 
was substituted, and he classed it under this name as one species of the 
genus anthracis. The common distinctions into African and American 
yaws, adopted by Mason Good as they had been previously by Lauvages 
and Cullen, appear to be void of foundation. History. The yaws first 
became known to Europeans as an endemic disease in that part of Africa 
called Guinea, but from what period it had prevailed amongst its uncivil- 
ized inhabitants it is of course impossible to ascertain. James Copeland 
says that this distemper has existed in Africa certainly for ages before the 
epidemic outbreak of syphilis in Europe at the end of the fifteenth cen- 
tury; and if not identical with, is at least a form or modification of 
the disease which existed in the West Indian Islands when they were dis- 
covered by Columbus, and which was considered as intimately resembling 
if not the same as, the epidemic syphillis of the fifteenth and sixteenth 
centuries. Copland affirmed that the few cases of yaws which he saw in 
Africa in 1817, agreed with the early accounts of syphilis so prevalent in 
Europe in the fifteenth and sixteenth centuries, not only as respected the 
character and severity of the distemper, but also as regarded the modes of 
its communication and the treatment of it found most beneficial. Dictionary 
of Medicine, Am. Ed., vol. iii, p. 1473. 
Dr. John Hume, formerly surgeon to the Naval Hospital in Jamaica, 
was the earliest writer who drew the attention of British practitioners to 
the phenomena of the disease, in an account of it published in the sixth 
volume of the Edinburgh Medical Essays, in 1744. Dr. Hume pointed out 
the resemblance of yaws to the disease described in the thirteenth chapter 
of Leviticus, as affecting the Israelites in their passage through the wilder- 
ness; and Dr. Joseph Adams expressed his belief of their identity. (Obser- 
vations on Morbid Poisons, p. 206.) Dr. Hillary supposes that Haly 
Abbas, who lived in the tenth century, refers to the yaws under the gen- 
eral term lepra, both kinds of the Arabian leprosy having been described Yaws: History of. 
1185 
in a preceding chapter under the name lephantra. (Inquiry into the Means 
of improving Medical Knowledge, by W. Hillary, M. D.) After the pub- 
lication of the observations of Dr. John Hume, yaws was treated of by M. 
Virgile, who practiced for several years in the Island of St. Domingo; 
subsequently by M. Desportes, Peyrilhe, Dr. Hillary, of Barbadoes, Dr. 
James Grainger, of St. Christophus, Captain Bernard Romans, of Florida, 
and Drs. Winterbottom, Vancer, Mosely, Ludford, Thomson, Thomas and 
Wright. 
We shall give the testimony of several of these writers with reference 
to history of yaws in the Southern States and West Indies. Symptoms.- 
It appears that in general, if not always, the occurrence of the yaws is 
consequent to the anplication of its specific virus to an abraided surface of 
an individual in whom it has not previously existed, and this, although 
frequently by accident, not unfrequently by design-in some instances 
with a view of obtaining exemption from labor, but in many from a popu- 
lar though erroneous notion amongst the negroes that, like measles, scarla- 
tina and small-pox, its invasion at some period or another, is a fixed law of 
the animal economy. Observing, also, that the constitution is rendered 
insusceptible of a second attack, and that childhood is the most favorable 
period for its endurance, the parents are apt not only not to guard against 
the intercourse of their children with the infected, but even to contrive 
their exposure to it. The most usual circumstances, however, under which 
it is contracted are, first, by sleeping in the same bed, and the ichor getting 
in the wounds or scratches of the uninfected; secondly, by handling the 
infected, and allowing the virus to touch scratches or excoriations; thirdly, 
by the use of the same bowl or basin in washing their sores, which had 
been previously used for similar purposes by the infected negroes; fourthly, 
and most usually by small flies, which, having gorged themselves with the 
virus of the diseased, alight on the ulcers of the hitherto uninfected, its 
propagation being as certain by the minutest quantity as if it were ever so 
considerable.* 
The yaws is usually preceded by some pains in the limbs, often resem- 
bling those of rheumatism, which are most severe around the joints. The 
pains are attended with languor and debility, and often continue for several 
days without any other appearance of disease. These symptoms are gen- 
erally precursory, and are succeeded by more or less fever, sometimes pre- 
ceded by slight rigors. In many cases, however, the fever is so slight as 
hardly to be noticed. Generally the patient complains of headache, loss of 
appetite, and pains of the back and loins, which are excruciating towards 
evenings. These symptoms are continued for several days and are fol- 
lowed by an eruption of pustules, more or less numerous in various parts 
of the body, but especially upon the face, neck, groins, pudenda, and 
around the anus, vulva, etc. The eruption of these pustules is not com- 
pleted over the whole body at one time, nor do they appear in any regular 
succession oh the different parts; but while one crop is falling off another 
is making its appearance in other places. Every fresh eruption of pustules 
is preceded by a slight febrile paroxysm. The pustules are filled with an 
opaque whitish fluid; they are, at their first appearance, not so large as the 
head of a small pin; but they grow larger gradually, until they attain the 
size of a six-pence oi' even of a shilling. When the pustules burst, a thick 
viscid matter is discharged, which forms a foul dense crust or scab upon 
the surface. The number and size of the pustules is proportioned to the 
degree of eruptive fever. When the febrile symptoms are slight there are 
* Memoirs of Dr. Wright, p. 408. 1186 
Yaws: History of. 
few pustules, but they are mostly of a larger size wheu the complaint is 
more violent. From the larger pustules red fungous excrescences frequently 
arise of various magnitudes, from the size of a pea to that of a large mul- 
berry, which fruits, owing to their rough granulated surfaces they some- 
what resemble. These fungi, though they rise considerably above the 
surface of the skin, have but a small degree of sensibility. They never 
suppurate freely, but gradually discharge a glutinous matter, forming an 
ugly scab round the edges of the excrescence, and covering the upper parts 
of it, when much elevated, with white sloughs. When these eruptions 
appear upon any part of the body covered with hair the color of the hair 
is gradually changed from black to white. At the commencement of the 
disease, when there is any doubt of the nature of the complaint, the natives 
open one of the pustules and drop upon it a little of the juice of the capsi- 
cum; if it be of the yaws species little or no pain is excited. 
The eruption is more elevated and broader, and more numerous in the 
face, groins, axilla, verge of the anus, and labia majora, than in any other 
part of the body. The crops of yaws are various. The size of these fungi, 
as well as their number, depend on the state of the patient's health and 
habits of body; a healthy, strong person will have few, but of a large size, 
whilst those of a thin or reduced habit will have a vast number of small 
eruptions, scarcely exceeding the size of a millet. In some individuals 
there is only one copious eruption of a healthy nature, with well defined 
edges; it continues on the skin for a long time, the patient enjoying his 
usual health. This is the most favorable form, and in the robust and well 
fed is terminated in seven or nine months. More frequently small watery 
yaws appear, and recede in a month or so. The patients lose flesh, become 
cachectic and dropsical; but in these a nourishing diet will often, in a month 
or two, induce a return of the eruption in a more copious and larger form; 
and several crops of such eruptions may successively appear. When the 
disease attacks the throat the soft parts are always lost. If there be any 
tendency in the constitution to hereditary or visceral disease, it is gen- 
erally excited with action, especially upon the disappearance of the erup- 
tion, and caries of the bones, diseases of the joints, dropsy, etc., supervene. 
In the successive eruptions of yaws there is often an ulcer which does not 
heal, but becomes larger than the rest, and if neglected is apt to produce 
caries of the adjoining bones. Nocturnal pains, swellings of the perios- 
trum, ulcers of the pharynx, etc., generally attend the advanced course of 
the distemper, and are accompanied by chronic hectic and general 
cachexia. If the infection takes place in the mouth or lips, ulcerations 
appear in these parts and extend to the fauces, palate, the bones of the 
palate and those of the nose becoming implicated.* 
The duration of the period elapsing from exposure to contagion to the 
commencement of the eruption or febrile symptoms varied in several cases 
accurately observed by Dr. Thomson from seven to ten weeks. In some 
cases in which we had recourse to inoculation, the eruption appeared in 
seven weeks. The duration of the disease after the appearance of the 
eruption varies from some months to several years. It depends upon the 
complete eruption of the pustules. When the eruption is slight, the 
pustules being few and small, the hectic cachexia and complications super- 
induced, prolong the distemper and ultimately end in recovery, the eruption 
having long previously disappeared. In some cases the eruptive fever is 
pretty smart, but in others scarcely discernible; frequently, says Dr. James 
Thomson (Edin. Med. and Surg. Journal, vol. xv, p. 323), prior to the 
* James Copland, M. D., Dictionary of Practical Medicine, vol. iii, p. 1479. Yaws: History of. 
1187 
eruption, the whole surface is covered with a white scurf as if it were 
dusted with flour. It is stated by Dr. Hume, Dr. Hillary and others that the 
hair proceeding from the spot where the peculiar fungi of the yaws have 
grown changes gradually in color until it becomes perfectly white; others 
have contradicted this assertion, and it has been suggested from this dis- 
crepancy that it must have been mistaken for the leprosy. It is much 
more probable, however, that the occurrence is an occasional though by 
no means a constant one amongst the phenomena of the disease. Such is 
the progress of the symptoms when left to nature, and neither retarded nor 
forwarded by medicine taken internallj7 or used by application to the parts 
first infected; but if a yaw sore, for example, iu the leg or foot be treated 
as a common ulcer, or the patient continues to work or stand as in health, 
it soon assumes an unhealthy appearance, the neighboring parts become 
inflamed, the edges are ragged and turn back like those of cancerous ulcers; 
its surface looks foul and is covered with small specks and sloughs; the 
discharge is ichorous, black, and extremely offensive, and the patient's 
strength is wasted and worn out with pain. Under such circumstances 
the eruption of the yaws is retarded, and when it appears is of long con- 
tinuance, especially if mercurials have been employed too early. 
The fungous excrescences break out also in the soles of the feet and 
palms of the hands, where from walking barefooted, as the negroes com- 
monly do, and from hard labor, the integuments are excessively thickened. 
Hence the eruption of the yaws is very painful, and the excrescences are 
sometimes so large as to extend over a great part of the sole of the foot. 
In this situation they are called by the negroes in the West Indies "tubba" 
or "crab yaws." These, unless skilfully treated, are apt to continue for a 
number of years. Like corns they are frequently affected by different 
states of the atmosphere, but more particularly by rainy weather. When 
the yaws have been repelled by the too early use of mercury, or, as was 
frequently the practice in the ships employed in the slave trade, for the 
fraudulent purpose of enhancing the price of the damaged commodity, by 
various external applications, as the sulphate of copper and corrosive sub- 
limate, the risk has been considerable to the life of the sufferer. If the 
eruption has been thus suspended for any length of time it has subse- 
quently returned with redoubled violence. In some it has caused the 
most obstinate and ill-conditioned ulcers; in others erosions of the nose 
and palate, boneache and distortions of the limbs; occasionally the whole 
cellular substance has been infiltrated with serum or even purulent fluid, 
and the wretched sufferer has fallen a victim to the injudicious treatment; 
in many instances it is to be feared, instigated by a murderous cupidity. 
A glossy smoothness of the skin where this peculiar eruption commonly 
makes its appearance is often an indication that the disease has been sus- 
pended only, by the means already alluded to. It is a singular fact, with 
reference to the manifestation of yaws, that if a person with a large ulcer 
be infected he may pass through the disease without any eruption; at a 
certain time the sore begins to acquire a new granulated appearance and 
becomes elevated, the edges assume their characteristic form, and a con- 
stant discharge is kept up. If an attempt be made to heal the sore and is 
successful an eruption of yaws follows in the regular manner; otherwise it 
goes on and generally remains as an ulcer for life. The practice always to 
be pursued is to endeavor to heal the sore as soon as infection is suspected. 
(Dr. Thomson on Yaws, Edin. Med. and Surg. Journal, vol. xv, p. 325.) 
To some of the eruptive diseases of the inferior animals in the West 
Indies the appellation yaws has been indiscriminately applied, but com- 
parison has sufficiently disproved the identity of their nature, and repeated 1188 
History of African Yaws in America. 
experiments have shown the impossibility of the disease in question being 
transferred by inoculation beyond the human species. Desportes asserts 
and Alibert has taken it for granted, in support of his idea of the depend- 
ence of yaws upon unwholesome nutriment, that he has seen it declare 
itself in some of the gallinacae of St. Domingo, especially guinea fowls and 
turkeys, after feeding entirely upon the seeds of the holcus spicatus. But 
although we know by sufficient experience that the exclusive use of similar 
and equally unwholesome food has been conducive to the eruption of lepra, 
pellagra aud other diseases of the skin, it is the peculiarity of yaws in the 
human species to be propagated only by contagion; hence we are entitled 
to infer that the correspondence did not exist. 
HISTORY OF AFRICAN YAWS IN AMERICA. 
This singular and loathsome disease was, by the slave trade, transferred 
at an early date in European colonization, from the shores of tropical 
Africa to Insular and Continental America. African slavery existed in the 
Antilles and Mexico and South America, long before the establishment in 
1681, by La Salle, of the first French colony on the shores of the Gulf of 
Mexico; and we find that in 1724, only six years after the foundation of 
New Orleans, the black population of Louisiana was nearly double that of 
the white race, the former numbering 3300, and the latter 1700 souls. The 
African slave trade was commenced by the Portugese, fifty years before 
the discovery of America by Columbus. The year 1442 was distinguished 
by the inauguration of this infamous traffic. The trade, however, was but 
of trifling extent till the commencement of the sixteenth century. In con- 
sequence, however, of the rapid destruction of the Indians employed in 
the mines of St. Domingo at Hayti, Charles V authorized, in 1517, the 
introduction into the island of African slaves, from the establisments of 
the Portuguese on the coast of Guinea. The concurrence of the Emperor 
was obtained by the intercession of the celebrated Las. Casas, Bishop of 
Chiapa, who labored to protect the Indians by euslaving the Africans. The 
importation of negroes iuto the West Indies and America having once 
begun, gradually increased to gigantic proportions. Sir John Hawkins 
was the first Englishman who engaged in it; and such was the ardor with 
which the English followed his example, that they exported from Africa 
more than 300,000 slaves between the years 1680 and 1700; and between 
1700 and 1786, 610,000 Africans were imported into Jamaica only; to which, 
adding the imports into the other islands and the Continental colonies, aud 
those who died on their passage, the number carried from Africa will 
appear immense. The importations by other nations, particularly the 
French and Portuguese, were also very great. 
Some thirty years ago, I observed upon the cotton and sugar and rice 
plantations on the coast of Georgia, amongst the surviving natives of Africa, 
imported upon the slavers of former times, two cases of yaws and one case of 
Oriental leprosy; also a case closely resembling leprosy in the white race. In 
the same State I observed six cases of lymphatic hypertrophy, or varix of 
the lymphatics. In four of these cases the foot and leg were involved, form- 
ing the so-called elephant's leg. In two of the cases, the hypertrophy of the 
integument was confined to the scrotum, and in one the scrotal tumor was of 
enormous dimeusions, reaching nearly to the surface of the ground, and 
weighing eighty pounds. The cases of elephantiasis arabum were confined to 
the negro race. In Louisiana, I have observed two cases of yaws, in negroes 
born in the State, aud a case which will be detailed, the subject of which 
was a native of Africa; three cases of elephantiasis arabum (lymphatic History of African Yaws in America. 
1189 
hypertrophy) amongst the native whites; one case of this disease in a native 
of Austria, and another in a native of China. In the case of a white 
woman, a native of New Orleans, the entire face and much of the trunk 
and upper and lower extremities were disfigured by the nodular hyper- 
trophy of the skin. The absence of the constitutional symptoms charac- 
teristic of Oriental leprosy, as well as the freedom from ulcerations of the 
integument and osseous system, led me to regard this latter case as one of 
lymphathic hypertrophy, and not Oriental leprosy. Less than twenty cases 
of elephantiasis Graecorum, or medieval leprosy, have come under my 
observation in Louisiana. At a meeting of the New Orleans Medical and 
Surgical Association, held October 27th, 1877, I presented the following 
case of yaws, with accompanying observations upon the history of this dis- 
ease in the West Indies and Southern States, together with certain facts, 
establishing the existence of leprosy in Louisiana, during the French and 
Spanish domination, and at the present time.* 
Case of yaws.-Augustin Fain6, aged 22 years; 5 feet 7 inches in height; weighs 
about 150 pounds; black hair; dark eyes; copper-colored skin; in the color of the 
skin and his straight black hair, resembles more nearly the Mongolian race; native 
of the Isle of Bourbon, off the coast of Africa. The patient states that his father 
was a native of France and his mother a native of Africa. Sailor by occupation. 
Admitted to Charity Hospital, ward 30, bed 440, October, 1877. The patient states 
that he contracted the disease with which he is now suffering, on the coast of 
Africa three month ago. He says that the ship upon which he was employed was 
visited by natives, several of whom were suffering with a similar disease, and he 
supposed that the disease was contracted from them. Had lived on the Island of 
Bourbon until thirteen years of age, and from that time until his admission into 
the Charity Hospital has followed the seas, and ten months ago suffered from 
scurvy, his gums being swollen and livid, and the surface of the body mottled 
with purpuricspots. He states that the yaws first made its appearance on the face 
in the form of two or three vesicles, about the size of a pin's head, which gradu- 
ally enlarged to the size of a pea. The number of the vesicles increased, several 
of which united or became confluent on the face, forming irregular elevations 
about an inch in diameter. In ten or twelve days after their first appearance each 
vesicle became umbilicated and burst, discharging sanious fluid, and then dry- 
ing up formed scabs, which gradually fell off. In the meantime other vesicles 
formed upon the face and extremities. After the eruption had cont inued about six 
weeks, any abrasion of the skin upon any part of the body would result in the for- 
mation of raw suppurating sores, upon which scabs would form. The disease 
attacked with greatest violence the soles of the feet, toesand fingers, causing swell- 
ing, ulceration and destruction of the joints and phalanges. The patient states 
that he came on a sailing ship from Havre, France, to New Orleans, and suffered 
severely with pains in his head, back and extremities, attended with high fever 
and deiirium, which continued throughout the voyage. Entered the Charity Hos- 
pital in a prostrated and almost insensible condition. When I first saw this 
patient he complained of severe pain in the head, defective vision and memory, 
insomnia and pains in the limbs and back. Body emits an exceedingly offensive 
and disgusting odor. An eruption of raised pustules of various sizes and ages, 
varying from the size of a pin's head to the size of a half-dollar, and filled with an 
opaque whitish fluid, occupy various portions of the face and forehead and trunk. 
Marks of the successive crops of eruptions can be discerned upon the face and upon 
various portions of t he trunk and extremities. When the pustules burst a thick 
viscid matter is discharged, which forms a foul, dense crust or scab upon the sur- 
face. From some of the pustules, and especially those upon portions of the body 
most subject to pressure and abrasion, as the hips, elbows, knees and feet, red 
fungus excrescences have arisen, resembling a large mulberry, and emitting a foul, 
disgusting odor. On the right cheek, over the region of the malar bone, there is 
an aggregation, or confluent mass, of these eruptions, forming an elevated fungus 
surface of irregular shape, varying from one to two inches in diameter. On the 
left side of the angle of the inferior maxillary there is another irregular mass of 
* Observations on the American Yaws, and on Leprosy, * * etc., in Insular and Conti* 
nental A inerica. By Joseph Jones, M. D. The New Orleans Medical and Surgical Journal, vol. 5, 
N. S., March, 1878, No. 8-pp. 673-693, 1190 
Yaws in the West Indies. 
pustules, or fungous formation, which are covered with a scab of the dead exuda- 
tion. About twenty of the pustules of various sizes occupy the forehead. The 
right eyelid presents a nodulated appearance, and the left eyelid has three small 
pustules. Both elbows are occupied by oblong fungus, mulberry-like eruptions, 
discharging foul sanies, and a similar eruption is observed over both trochanters 
and both knees. Upon the left side numerous cicatrices, marking the site of 
former eruptions, are visible. This observation applies also to other portions of 
the body. The scrotum and integuments of the penis much swollen and very 
painful. No chancres nor chancroids, nor marks of syphilitic ulcerations observable 
upon penis. No induration or enlargement of the lymphatics of the groin or 
axilla are observable. 
Fungous eruptions exist upon the joints of several of the fingers, some of 
which have lost the first joint, and the nails are partially or entirely missing. Sev- 
eral of the fingers are retracted. The toes of the left foot are retracted and deformed, 
and several are without nails, having lost the first phalanges. The external sur- 
face of the left ankle is covered by a fungus nodulated eruption. The right leg, 
ankle and foot is much swollen, and presents somewhat the appearance of ele- 
phantiasis; but the enlargement of the limb is clearly due to the effects of inflam- 
matory action, in and around the bones of the instep and foot. A large corroding 
ulcer, discharging an offensive sanious fluid, exists on the posterior surface or 
palmar aspect of the right foot, about three inches in diameter. On the dorsal 
aspect of the foot there are several ulcers, resembling those formed over carious 
bones, which discharge a foul sanious fluid. These ulcerations communicate with 
the dead bones of the foot, and it appears that the continuous discharge is due to 
the presence of the dead bones, which act like foreign bodies. The outer or small- 
est toe, as well as the next toe, have been completely destroyed. The disease has 
also invaded the remaining toes, and the third toe from the exterior lost one of the 
phalanges, after the entrance of the patient into my ward; and upon careful exam- 
ination, I could discover no erosions of the surface of the bone, as in the sequestra 
of diseased bones and those segments thrown off after amputation of the extremi- 
ties. The increase in the size of the left foot and leg is shown by the following 
measurements: circumference of ankle, 13J inches; circumference of instep, 14 
inches.* 
The existence of yaws in the West Indies was, without doubt, coeval 
with the importation of slaves from the coast of Africa, but the first Eng- 
lish writer who observed and described the disease in the West Indies, 
was the learned physician and naturalist, Sir Hans Sloane, M. D., who, in 
1687, went as physician to the Duke of Albemarle to Jamaica. The great 
work of Dr. Hans Sloane, on the Natural History of Jamaica, was pub- 
lished in London in 1707. From that portion of the introduction which 
relates to the diseases which he observed in Jamaica, and the method by 
YAWS IN THE WEST INDIES. 
* Progress of this Case.-Up to this date, January 22d, 1878, the patient has presented various 
changes, in accordance with the phases of the disease, but upon the whole has improved upon 
the plan of treatment instituted. The appearance of fresh crops of pustules lias been attended 
with pain in the head and back, and extremities. anorexia, depression of spirits, moaning insom- 
nia, and febrile excitement. Opium was administered to induce sleep, and iodide of potassium 
and tincture of iodine administered to induce some constitutional impression on the disease. 
After a fair trial these remedies were abandoned, and the patient placed upon bitart. of potassa 
two drachms, three timesa day in a cup of water, and 15 drops of the tincture sesquichloiide of 
iron, three times a day in a wineglassful of water. Gentle purgation combined with the tonic 
action of the tincture of iron, and daily use of warm baths, and local application of carbolic 
and iodine salves, yielding the best results. At this present moment all the ulcers are healed, 
except the large ones on the right foot, and the pustules have ceased to form, and the patient is 
cheerful and walks about the hospital grounds. As a local application the following was found 
beneficial: R.-Acidi carbolici, one drachm; acidl tannici two drachms, tinct.'iodinii three fluid 
drachms, tinct. oppi, two fluid drachms, cerati simplieis two ounces; mix, apply locally to abraded 
surfaces with fungus growths, and to the corroding phagedepic ulcerations of the extremities. 
This ointment was spread upon soft prepared or English lint, and applied continuously to the 
ulcerated surfaces. Under this treatment, conjoined with frequent ablutions in warm water, 
the ulcerations and fungus surfaces have healed, and the patient is able to walk about the hos- 
pital grounds. About the middle of December, one of the phalanges of the middle toe was 
extracted. It presented no erosions. Since its removal the swelling of the foot has progressively 
subsided. I have used the above ointment, or oneofsimilar composition, since I860, with satisfac- 
tory results in the treatment of gun-shot wounds, and ulcerat ions resulting from various causes. 
October 1st, 1878. Upon resuming my wards at the Charity Hospital the patient had been trans, 
ferred to one of the surgical wardsi His condition was much improved. October 1st, 1879. Dur- 
ing the preceding summer the patient left the hospital and sailed for the coast of Africa. Yaws in the West Indies. 
1191 
which he "used to cure them," we extract the following observations relat- 
ing to the yaws: "A negro woman, belonging to Mr. Firwood, was brought 
to me. She had a great many ulcers in the extremities of the fingers and. 
toes, and about the joints. There were also several bladders filled with 
serum on several of her joints, as if cantharides had been applied there to 
raise a blister. These bladders or cuticula, filled with serous matter, came 
on either her fingers or toes every full and new moon, and in process of 
time each of the bladders brought an ulcer, leaving the flesh raw, and some- 
times deeper, sometimes shallower corroded, so that the longer the blad- 
ders had been raised the deeper were the ulcerations. The virulency of 
the humor was such that after it had eaten into the bone, the fingers and 
toes would drop off, and they die, as I have been assured by those who had 
lost several'negroes of this disease, I was assured was peculiar to blacks." 
* * * "A negro lusty fellow was taken ill of the yaws; he had not been 
long from Guinea, and was all broke out into hard whitish swellings, some 
greater, some lesser, from the bigness of a bean to that of a pin's head, of 
which last size there were many which appeared like the glands of the skin, 
swelled and white. When these tumors are large they are usually white 
at top, from some of the cuticula and humors, dried, lying in scales over it, 
and sometimes they weep out an ichor. At other times the ulcers are much 
larger. They likewise complained sometime of great pain in the bones, 
and the fellow whom I cured was broke out very much about the penis, 
scrotum and elbows. I fluxed him by unction in an out house, feeding him 
with as much water-gruel as he could eat or drink. The flux proceeding 
as it was expected to do, he was quite cleared of this filthy distemper, only 
on his elbow he had one swelling, not quite dry, to which I applied vitriol, 
which made the scales fall off and heal as the rest. This distemper is 
thought to be contagious and to be communicated from one to another, 
from blacks to whites, and from parents to children, but I couldn't observe 
it to be more or less contagious than the pox. There are few plantations 
without several of these diseased persons, who are usually cured as above. 
Though 'tis commonly thought th at fluxing does not cure without relapse; yet 
I, by what I could observe, find it does, and do believe the return of this dis- 
ease comes from not being thoroughly fluxed by anointing, or being kept 
too warm, or wrong treated afterwards, whence some remains of it staying 
behind in the body these dregs by degrees bring the same distemper again. 
* * Some sorts of this distemper seem to me to be the elephantiasis or 
true leproise of the ancient and Arabian physicians. Others said to have 
this disease were plainly scrofulous, or had the king's evil, and most said 
to have it, had the lues venera. Though this disease is thought to be prop- 
agated by ordinary conversation, or trampling with the bare feet on the 
spittle of those affected with it, yet it is most certain that it is mostly com- 
municated to one another by copulation, as some other contagious diseases 
are."* 
Dr. John Hume, surgeon to the naval hospital in Jamaica and a com- 
missioner of the sick and hurt, drew the attention of British practitioners 
to the phenomena.of this disease in an account of it published in the sixth 
volume of the Edinburg Medical essays, in 1744. Dr. Hume pointed out 
the resemblance of the yaws to the disease described in the thirteenth chap- 
ter of Leviticus, as affecting the Israelites in their passage through the 
wilderness, and Adams has expressed his belief of their identity (Obs. on 
* A voyage to the Islands of Madeira, Barbadoes, Nieves, St. Christopher, and Jamaica, with 
the Natural History of the Herbs and two and four-footed beasts, fishes, birds, insects, reptiles, 
etc., of the last of these Islands, etc. Illustrated with figures of the things described as big as 
life By Hans Sloane, M. D., Fellow of the College of Physicians and Surgeons, and Secretary of 
the Royal Society. 2 vols., London, 1707. Vol. 1, Introduction, cvi., cxxvi. 1192 
Yaws in the West Indies. 
Morbid Poisons, page 206). Dr. Hillary supposes that Haly Abbas, who 
lived in the tenth century, refers to the yaws under the general term lepra, 
both kinds of the Arabian leprosy having been described in a preceding 
chapter under the name (as it is translated) elephantia (Inquiry into the 
Means of Improving Medical Knowledge, by W. Hillary, M. D.) The yaws 
were next treated of by M. Virgile, who practiced for several years in the 
Island of St. Domingo, and subsequently by M. Desportes, Peryrilhe, Dr. 
James Grainger, of St. Christopher's; Dr. Hillary, of Barbadoes; Abbe 
Raynal, Bryan Edwards, Drs. Winterbottom, Dancer, Mosely, Ludford, 
Thomson, Thomas, Wright and others. Some twenty-five years ago I 
observed upon the cotton and sugar and rice plantations on the coast of 
Georgia amongst the surviving natives of Africa imported upon the slavers 
of former times two cases of yaws and one case of leprosy, also a case 
closely resembling leprosy in the white race. In Louisiana I have observed 
two cases of yaws in negroes born in the State, and the case in which the 
patient was a native of Africa; three cases of elephantiasis amongst the 
native whites, one case in a native of Austria, one case in a native of China. 
In the case of a white woman, a native of New Orleans, the entire face and 
much of the trunk and the upper and lower extremities, were disfigured 
by the nodular hypertrophy of the skin. Several cases of leprosy have 
come under my observation in Louisiana. The observations of Dr. Richard 
Towne, of Barbadoes, concerning the "joint evil," evidently relate to the 
African yaivs, and are as follows: 
Many of the negroes in the Leeward Islands as well natives as those imported 
from Guinea are subject to a cutaneous distemper, which in those parts is known 
by the name of the joint evil. This malady is equally remarkable in its appear- 
ances as it is fatal in its consequences, being of so virulent a nature that it eludes 
the force of the most powerful remedies hitherto discovered. The description of it 
is as follows: It first appears in superficial spots of a brown copper color, dispersed 
over several parts of the face, but especially on the nose, without any unevenness 
or sense of pain in the beginning. These spots spread by slow degrees till a great 
part of the body is covered with them. Then the nails curl inwards and the 
extremities of the fingers and toes begin to ulcerate. These ulcers which never 
digest, but generally look dry, without much foulness or foetor, gradually creep 
from joint to joint till they have invaded all the fingers and toes. The next attack 
this unconquerable enemy makes is upon the trunk of the body, where it spreads 
its patches and at this time the distemper becomes infectious. The defedations of 
the skin never penetrate very deep into the muscular flesh, but extend themselves 
in circumference, and discharge on them ichor which insensibly dries up and 
emaciates the patient, sometimes in a few years, though there have been some 
negroes under these circumstances who have protracted a miserable loathsome life 
for the space of ten, twelve yearsor longer. Among the numerous attempts which 
I have known to resist this stubborn disease, antimonial preparations afford the 
greatest relief, but I have never heard that they perfected a cure; on the other 
hand all preparations of mercury aggravate the distemper, exasperate the ulcers, 
and make them spread the faster. This is constantly true in whatever form or with 
whatever intention mercury be given, whether as alterative, purgative, or to 
receive a salivation, either internally exhibited or externally applied. The negroes 
wTho are great pretenders to the knowledge of specific virtues in simples, apply sev- 
eral kinds of plants on these occasions, but I could never observe the least bene- 
ficial effect produced by them. This being a disease not taken notice of, as far as I 
know, by any Author, I hope I shall be excused for giving the description of it, 
though I am forced to leave it to future industry and greater sagacity than my own 
to investigate the cure.* 
Abbe Raynal, in his "Philosophical and Political History of the Set- 
tlements and Trade of the Europeans in the East and West Indies," vol. 
v, pp. 272-274, says: 
* A treatise of the diseases most frequent in the West Indies, and herein more particularly 
of those which occur in Barbadoes. London, 1726, pp. 189-192. Yaws in the West Indies. 
1193 
The yaws, which is the second disorder peculiar to negroes, and which accom- 
panies them from Africa to America, is contracted in the birth, or by communica- 
tion between the sexes. No age is free from it, but it more particularly attacks at 
the period of infancy and youth. Old people have seldom strength sufficient to 
support the long and virulent treatment which it requires. '1 here are said to be 
four species of yaws: the yaws with pustules; large and small, as in the small-pox; 
that which resembles lentils; and lastly, the red yaws, which is i he most dangerous 
of all. The yaws attack every part of the body, but more especially the face. It 
manifests itself in granulated red spots, resembling a raspberry. These spots degen- 
erate into sordid ulcers, and the disorder at length affects the bones. It is not in 
general attended with much sensibility. Fevers seldom attack the persons who 
are affected with the yaws; they eat and drink as usual, but they have an almost 
insuperable aversion for every kind of motion, without which, however, no cure 
can be expected. The eruption lasts about three months. * * * All the negroes, 
as well male as female, who come from Guinea, or are born in the islands, have the 
yaws once in their lives. It is a disease they must necessarily pass through; but 
there is no instance of any of them being attacked with it a second time after 
having been radically cured. The Europeans seldom or never catch this disease, 
notwithstanding the frequent and daily connection which they have with the 
negro women. These women suckle the children of the white people, but they do 
not give them the yaws. How is it possible to reconcile these facts, which are 
incontestible, with the system which physicians seem to have adopted with regard 
to the nature of the yaws? Can it be allowed that the semen, the blood and the 
skin of the negroes are susceptible of a virus peculiar to their species? The cause 
of this disorder, perhaps, is the same as that which occasions their color. One dif- 
ference is naturally productive of another, and there is no being or quality that 
exists absolutely detached from others in nature.* 
Dr. William Hillary, in his treatise on the diseases of the West India 
Islands, or the Torrid Zone, devotes a special chapter to the yaws, from 
which we extract the following: 
"That disease which the negroes in Africa, and we from them in the West 
Indies, call the yaws, is a native of and seems to be indigenous in Africa and 
Arabia, and was first brought from the former by the negroes into America and its 
islands. This is a distemper which has been well known for many ages in Africa, 
and some of the neighboring countries which are situated within the torrid zone; 
but I do not find that any of the Greek physicians, nor yet any of the Arabians, do 
mention it, except Haly Abbas, the Persian Magus. * * * We are cred- 
ibly told that the yaws seldom fail to attack the negroes in Africa at one time or 
other in their lifetime, but most frequently the children and young people; and 
that they very rarely or never have it a second time, if they have been perfectly 
«urea the first time. * * * This disease generally makes its first appear- 
ance without any previous sickness or pain, and when the patient thinks himself 
perfectly well, in very small pimples, no bigger than the head of a small pin, and 
are smooth and level with the skin; these daily increase and become protuberant 
pustules. Soon after the cuticle turns whitish, cracks and rubs oft', and a very small 
quantity of serum or clear ichor exudes out and dries, and becomes white; but 
neither pus nor any quantity of ichor is found in the tumor, but a pretty thick, 
white slough appears, and under that a red fungus flesh thrusts itself out of the 
skin, which gradually increases to different magnitudes, some not so large as the 
smallest wood strawberry, some larger; others exceeding the size of the largest 
mulberry, which last they very much resemble, being red, and composed of little 
round knobs as they are. They appear differently on all parts of the body, but 
most frequently, and generally are the largest, about the groin, private parts, anus, 
under the amis and in the face; and it is remarkable, that in general when the 
yaws are very large, they are fewer in number, and b contra, when they are more 
numerous they are generally smaller in size. And as the yaws are thus increas- 
ing and coming to their height, the black hairs, which grow out of the places 
where the yaws are, gradually turn to be perfectly white, like the hairs of an old 
man; and the ichor which oozes out of the yaws, drying upon the skin, makes it 
appear of a whitish color, and renders the patient a disagreeable loathsome sight: 
* Philosophical and Political History of the Settlements and Trade of the Europeans in the 
East and West Indies. Revised, augmented and published in ten volumes, by the ^bbe Raynal, 
M. It., London, 1787, p. 272. 1194 
Yaws in the West Indies. 
and now the disease is become very infectious to those who handle or cohabit with 
them. * * * the time from their first appearance in the before men- 
tioned pimples to their full height or growth, is very different in different consti- 
tutions, as they are stronger or weaker, and according to the negroes being well 
fed or the contrary; for when the negro is strong, lusty and of plethoric habit, and 
is well fed, the yaws will often arrive at their full growth, and be as large as a mul- 
berry, in a month's time from their first appearance; but when the negro is weak, 
low in flesh, and poorly fed, the yaws will be small, and often no larger than a 
strawberry at the end of three months. This disease is known to be infectious, but 
there is also a peculiar aptitude in some constitutions to receive it more readily 
than others, and probably, in the same person to receive the infection more readily 
at one time than another." 
Dr. William Hillary presents the foregoing description as relating to the 
disease when left entirely to nature, but he adds that when improperly 
treated, and interfered with in its natural course, the fungus eruptions in 
the yaws may in time become phagedenic ulcers, which corrode and eat 
away the flesh even to the bones, and then produce nodes, exostosis and 
caries in them, and at last totally consumes and destroys them also. Bryan 
Edwards, in his History of the British Colonies in the West Indies (vol. ii., 
p. 352), says: 
"Among the diseases which negroes bring with them from Africa, the most 
loathsome are the cacabays and the yaws, and it is difficult to say which is the 
worst. The former is the leprosy of the Arabians, and the latter (much the most 
common) is supposed, by some writers, to be the leprosy mentioned in Leviticus, 
chap. xiii. * * * Young negro children often catch the yaws, and get 
through it without medicine or much inconvenience. At a later period it is sel- 
dom or ever thoroughly eradicated; and, as like the small-pox. it is never had but 
once, the Gold Coast negroes are said to communicate the infection to these infants 
by inoculation. I very much doubt if medicine of any kind is of use in this 
disease." 
Dr. James Grainger, in his Essay on West India Diseases, affirms that 
the yaws attacks the negroes but once, and is both tedious and difficult to 
cure, and when repelled, infallibly ruins the constitution. Dr. John Wil- 
liamson* says that 
"The yaws is a disease of such a contagious character that white people natu- 
rally feel a horror in exposing themselves to the risk of infection. It may be com- 
municated by flies alighting from the yawy patient and penetrating in the usual 
manner any part of the body by which inoculation is tffected, but I must acknowl- 
edge my doubts in the extent of this contagion in an equal degree to the whites as 
to the African or Creole negroes. White people may expose themselves with less 
risk than negroes. * * * Some few instances came within my knowledge- 
of white persons being infected with yaws from sexual intercourse, and it is dread- 
ful to imagine the hard fate to which such persons are condemned, but absolute- 
exclusion from society of their own color is necessary until a cure is completed. It 
is additionally unfortunate that the evil does not cease then. A white person who 
has had yaws, ever after has an onus attached to him, affecting his disposition, par- 
ticularly should he feel inclined to form a connection by marriage with any reputa- 
ble female of the country." 
It appears that in general, if not always, the occurrence of the yaws 
is consequent to the application of its specific virus to an abraded surface 
of an individual in whom it has not previously existed; and this, although 
frequently by accident, is not unfrequent by design. According to Dr. 
Wright, the most usual circumstances under which it is contracted are, 
first, by sleeping in the same bed, and the ichor getting on the wounds or 
scratches of the uninfected; secondly, by handling the infected, and allow- 
* Medical and Miscellaneous Observations relative to the West India Islands, vol. ii, Edin- 
burg, 1817, pp. 141-161. Yaws in the Southern States. 
1195 
ingthe virus to touch scratches or excoriations; thirdly, by the use of the 
same bowl or basin in washing their sores which had been previously used 
for similar purposes by the infected negroes; fourthly, and most usually, by 
small flies, which, having gorged themselves with the virus of the diseased, 
alight ou the ulcers of the hitherto uninfected, its propagation being as 
certain by the minutest cxuantity as if it were ever so considerable. The 
progress of the operation of the virus of yaws in the animal economy, 
unlike that of small-pox, is very variable in different individuals; but 
from the experiments of Dr. Thompson it may be inferred, that from seven 
to ten weeks is the usual period which elapses between the insertion of the 
virus and the development of the eruption. In one instance, however, for 
which we have the authority of Dr. Adams, the interval appears to have 
been ten months. It has been remarked that the blood of yaw patients 
does not differ in appearance from that of healthy persons, and that, when 
used for inoculation, it fails to communicate the disease; moreover, that the 
infected are as liable to other diseases as persons in a healthy condition. 
NOTES ON THE HISTORY OF YAWS IN THE SOUTHERN STATES. 
The first recorded observations on the yaws, as appearing amongst the 
negroes ol Louisiana, were those of the historian, M. Le Page du Pratz, who 
came over with a colony of eight hundred men in 1718, when New Orleans 
consisted of only a few huts, and who purchased slaves upon his arrival in 
the colony; was a planter for sixteen years, and was likewise overseer or 
Director of the Public Plantations, both when they belonged to the West 
India Company and afterwards when they fell to the Crown, by which 
means he had the best opportunities of knowing the nature of the soil, cli- 
mate and diseases of Louisiana. Du Pratz published his history of Louis- 
iana one hundred and twenty years ago, namely, in 1758. That the 
negroes of Louisiana, as early as 1718-1734, suffered with the yaws, 
syphilis and scurvy, is evideut from the directions given by M. Le Page 
du Pratz as to : 
" The choice of negroes; of their distempers, and the manner of curing themf1* 
from which we extract the following: " The first thing you ought to do when you 
purchase negroes, is to cause them to be examined by a skillful surgeon, and an 
honest man, to discover if they have the venereal or any other distemper. When 
they are viewed, both men and women are stripped naked as the hand, and are 
carefully examined from the crown ot the head to the sole of the feet, then between 
the toes and between the fingers, in the mouth, in theears, not excepting even the 
parts naturally concealed, though then exposed to view. You must ask your 
examining surgeon if he is acquainted with the distemper of the yaws, which is 
the virus of Guinea, and incurable by a great many French surgeons, though very 
skillful in the management of European distempers. Be careful not to be deceived 
in this point, for your surgeon maybe deceived himself; therefore attend at the 
examination yourself, and observe carefully over all the body of the negro, whether 
you can discover any parts of the skin which, though black like the rest, are. how- 
ever, as smooth as a looking-glass, without any tumor or rising. Such spots may 
be easily discovered, for the skin of a person who goes naked is usually all over 
wrinkles. Wherefore if you see such marks, you must reject the negro, whether 
man or woman. Thereare always experienced surgeons at the sale of new negroes, 
who purchase them; and many of these surgeons have made fortunes by that 
means, but they generally keep their secret to themselves. * * You must 
never put an iron instrument into the yaws; such an application would be certain 
death. Inorder to open the yaws, you take iron rust reduced to an impalpable 
powder, and passed through a fine search; you afterwards mix that powder with 
citron juice, till it be of the consistency of an ointment, which you spread upon a 
* History of Louisiana, vol. ii, pp. 255-260. 1196 
Relations of Yaws to Syphilis. 
linen cloth greased with hog's grease, or fresh lard without salt, for want of a bet- 
ter; you lay the plaster upon the yaws, and renew it evening and morning, which 
will open theyaws in avery short time without any incision. Theopening being 
once made, you take about the bulk of a goose egg of hog's lard without salt, in 
which you incorporate about an ounce of good terebinthine, after which take a 
quantity of powdered verdigris and soak it half a day in good vinegar, which you 
must then pour off gently with all the.scum that floats at the top. Drop a clothall 
over with the verdigris that remains, and upon that apply your last ointment. All 
these operations are performed without the assistance of fire. The whole ointment 
being well mixed with a spatula, you dress the yaws with it; after that put your 
negro into a copious sweat, and he will be cured. Take special care that your sur- 
geon uses no mercurial medicine, as I have seen, for that will occasion the death 
of the patient." 
Bernard Romans,* whose work on Florida was published in 1776, says: 
" I have seen three or four instances of the disease called body yaws (in the 
islands), and in Carolina the lame distemper. This is said to proceed from heredi- 
tary venereal taints. It appears in cancerous corroding sores in the mouth and 
throat ami spreading ulcers, together with fleshy protuberances, chiefly on the face, 
breast and thighs, with a swelling of the shin and knee bones, and commonly cor- 
rodes the cartilages of the nose, its first symptoms showing themselves about the 
throat and palate, having caused ignorant people to mistake it for the Angina 
Suffocativa before described. Mercurial medicines are used against it, afterwards 
diet drinks of China root, nut grass, etc.; the sores in the mouth are often to be 
rubbed with a feather dipped in syrup of roses, to an ounce of which two drops of 
sp. vit. have been added; unctuous, salt, spiced meats, and spirituous liquors are 
absolutely to be avoided; frequent sweats are also prescribed and a great care 
against catching cold." 
It is evident from the statements of these authors that the yaws afflicted 
the Africans imported to the colonies of America. It is also well estab- 
lished that this disease is of comparatively rare occurrence at the present 
day amongst the descendants of the native Africans. These facts sustain 
the following propositions: 
1st. The yaws is an African disease, and disappears gradually when 
introduced upon the North American Continent. 2d. The disease is not 
of a venereal nature and is not propagated and spread in the same manner 
as syphilis. 3d. If hereditary, the tendency to its production may be 
lost by change of climate, habits and dress and diet. It is probable that 
increased cleanliness, more abundant supplies of clothing and wholesome 
food, may have been the chief causes of its disappearance amongst the 
negroes born on the soil of the Southern States. 
RELATIONS OF YAWS TO SYPHILIS. 
The yaws and syphilis have frequently been considered as modifica- 
tions of the same disease. This view has found its most distinguished and 
able advocate in Dr. James Copeland, who says: 
'' This distemper has existed in Africa for ages before the epidemic outbreak of 
syphilis in Europe at the end of the 15th century, and if not identical with, is at 
least a form or modification of the disease which existedin the West India Islands, 
when they were discovered by Columbus, and which was considered as intimately 
resembling, if not the same as the epidemic syphilis of the loth and 16th centuries. 
The African syphilis, or the yaws as commonly termed, in all respects more 
closely resembles the earlier manifestations of syphilis in Europe than the modern 
occurrences of this distemper. Indeed, the few cases of yaws which I saw in 
Africa, in 1817, agreed with the early accounts of syphilis as prevalent in Europe 
in the lothand 16th centuries; not only as respected the character and severity 
of the distemper, but also as regarded the modes of its communication and the 
* Concise Natural History of East and West Florida, p. 256. Treatment of Yaws. 
1197 
treatment of it found most beneficial, That the yaws in Africa is identical with 
the yaws or piau of the West Indies, is also undoubted; and it is most probable 
that the identity existed before the discovery of America." 
A comparison between the symptoms of syphilis and yaws will at once 
establish some important distinctions. Whilst it is true that the yaws will 
affect the cartilages of the nose and palate, like syphilis, on the other 
hand, in primary syphilis neither eruptions nor fungi appear, as in the 
yaws, except in the pudenda, and then only in the form of warts. Syphilis 
will never cease spontaneously like the yaws. Persons suffering from the 
yaws may contract syphilis, and the latter disease cannot be cured until 
the yaws begin to decline. The febrile symptoms in yaws are more marked 
than in syphilis, and the progress of the disease depends largely upon the 
state of the constitution, habits and diet of the patient. The period of 
incubation after inoculation varies in the two diseases; in the case of yaws 
it varies from seven to ten weeks. The eruptions or cutaneous manifesta- 
tions in yaws are wholly different from those of syphilis. 
TREATMENT OF THE YAWS. 
The prevention of yaws may be, and is almost always successfully 
accomplished by the simple observance of avoiding the sources of its con- 
tagion, by an entire and distant separation from the infected, and by the 
strictest care in not participating with them in the use of any articles of 
clothing or domestic utensils through the medium of which the virus 
might by any possibility be conveyed. Isolation of those sick with the yaws 
should be rigidly enforced. The adoption of the usual means for the main- 
tenance of the general health, such as good clothing, personal cleanliness, 
well ventilated and properly located habitations, wholesome food, and 
habits and occupations conducive to mental content and cheerfulness, 
impart power to the constitution, if not of resisting the contaminating 
influence of the virus, of very much mitigating the conserjuent injury to 
the constitution and shortening the duration of the disease. On well- 
grounded suspicion, or the earliest appearance of yaws, its extension 
should be guarded against by the removal to a distance of the infected 
from the healthy, and by cutting off entirely all intermediate communica- 
tion. During the eruptive stage, accordingto Dr. Thomas and other West 
India practitioners, the efforts of the system should be assisted by some 
mild diaphoretic, and with this view precipitated sulphur, contrayerva in 
powder or infusion, decoction of chinaroot, or infusion of sassafras, and 
vapor or warm baths have been resorted to with beneficial results. When 
the eruptions begin to dry off, a course of the compound decoction of sar- 
saparilla is found to be of great service, and other tonics of the vegetable 
kingdom, such as contrayerva, sassafias, guiacum, etc., have been used. 
Towards the decline, says Dr. Wright, if the disease does not go off kindly, 
mild mercurials may then, and not till then, be given with safety and 
advantage, so as to act as alteratives and not occasion a ptyalism. Minute 
doses of a solution of the oxymuriate of mercury have generally been pre- 
ferred, together with the use of the compound decoction of sarsaparilla. 
Different opinions have been entertained as to the value of mercury 
in yaws; some of the French West India practitioners recommend it as 
highly efficacious; the English, on the contrary, declare that, though it 
will sometimes remove the eruption for a time, it is sure to return, and 
with increased violence. The latter, therefore, use it only as a gentle 
alterative towards the close of the complaint. Generous diet, warm cloth- 
ing and cleanliness are essential. Quinia, iron, iodide of potassium and 1198 
Treatment of Yaws. 
iodide of iron are important agents in the treatment of this and kindred 
diseases. The use of arsenic also is indicated. When erosions of the car- 
tilages. of the nose and of the palate, obstinate foul ulcers, bone-aches, 
etc., have taken place, the most appropriate counter-agents will be a gen- 
erous diet, a plentiful use of sarsaparilla both in decoction and powder. 
As to the local treatment, little is at first required besides cleanliness 
and emollient applications when inflammation is developed. Simple unc- 
tuous dressings and warm fermentations are very serviceable in the treat- 
ment of the ulcerations. Washing them with cold water and certain 
vegetable applications will often have a good effect. If the ulcers are 
small, it will be sufficient, says Dr. Wright, to cover them with a leaf of 
the cissus cicydes or snake-wyth, commonly called the yaws-bush, or with 
a leaf of the iatropia curcas, or English physic-nut. If the ulcers are 
large, a poultice of these leaves beaten and mixed with a little sugar or 
with the pulp of roasted Seville oranges and sugar, forms an antiseptic well 
adapted to the purpose for which it is required. To the master yaw, which 
is apt to degenerate into a troublesome ulcer, the ung, nitro-oxidi, is often 
a good application. A combination of carbonate of iron with citric acid 
and prepared lard is also much employed in the West Indies for the same 
purpose, and is said to be very efficacious. 
In the latter stages of the ulcerations, caustic applications sometimes 
become necessary in order to alter the action of the ulcerated surfaces and 
to destroy obstinate excrescences. For this purpose, nitrate of silver, 
sulphate of copper, red oxide of mercury, chloride of zinc, the mineral 
acids, or iodeform may be used. The arsenical paste of Frere Corne is 
recommended by Cazenaveand Schedel, as having been employed advan- 
tageously by M. Biott in this and other cases of obstinate ulceration and 
never with any in jury. The arsenical paste of Frere Corne is made by mixing 
with water a powder containing ten grains of arsenious acid, two scruples 
of sulphuret mercury and ten grains of animal charcoal. Cazeuave, Schedel 
and Biott give the caution not to apply the arsenical paste of Frere Corne 
at one time over a portion of surface larger than about half a dollar. Biott 
once employed the actual cautery successfully when other meanshad failed. 
When the excrescences proceed from the soles of the feet the thickness 
of the cuticle there occasions a resistance to the discharge, which leads to 
extensive ulceration very difficult to heal, but best treated by a poultice of 
the fresh casava root, a plant possessed of a narcotic quality, and well 
known in every West Indian Island. Hard swellings of a painful nature,, 
which do not suppurate, sometimes appear on the soles of the feet as a con- 
sequence of the yaws and occasion lameness. To remove them the patient 
should bathe his feet in warm water until the swellings are softened; they 
should then be seared with a hot iron, which produces an eschar. The 
consequent sore is readily healed by dressing it with some mild escharotic.* 
Under all the usual circumstances of yaws, and in every stage except the 
primary febrile one, it is necessary that the patient's strength should be 
supported by a generous diet, including a full allowance of animal food 
with a due proportion of wine or diluted spirits. The liability of persons 
afflicted with the yaws, and in every stage except, perhaps, the primary 
febrile one, to other exanthemata, as measles and small-pox, is a feature 
which has been taken advantage of for the purpose of expediting its cure. 
By inoculating for the small-pox, when the yaws are on the decline, the latter 
will entirely subside, or if, perchance, any of the excrescences should 
reappear their continuance will be of short duration. It has been proposed, 
* Practice of Physic, by R. Thomas, M. D., 8th vol., p. 645, Cyclopedia of Practical Medicine, 
A.m. Ed., vol. iv, p. 753. Treatment of Yaws. 
1199 
also, as in the small-pox, to inoculate the unaffected with the specific virus 
of the yaws, in order that the symptoms may be rendered milder in their 
nature aud quicker in their progress; but the inducements, if there be 
ground for the anticipation, which is very doubtful, are by no means 
equivalent to those of the analogous process in the former disease, as the 
latter is infinitely more easily avoided, never proves fatal when judiciously 
treated, and even after the operation, under the most favorable circum- 
stances, is often many months in going through its regular course. 
PIAN DE NERAC. 
Raubin has described an epidemic disease which seemed to be analo- 
gous to scherlievo and facaldine under the name pian de Nerac (depart- 
ment de Lot-et-Garonne). "At the end of the month of June, 1752, a singu- 
lar epidemic disease appeared at Nerac; it was a species of lepra or fram- 
boesia (pian) similar to that which affects the negroes in the Gulf of Mexico. 
It spreads among children at the breast; those affected by it begin to fall 
off; by degrees pustules appear on the face, hands, neck, buttocks and 
thighs. Nurses contract this eruption in the breasts and it afterwards 
appears over the whole body. The pustules are generally round, hard 
and rather callous; from some of them a yellowish ichor is discharged; 
others are covered with a pulverulent crust; these pustules covering the 
body become confluent and appear to form only a single incrustation; 
they degenerate into deep ulcers which lay bare the bones and occasion 
death; towards the end of December it was calculated that more than forty 
infants had already been affected with this disease. The treatment that 
was most successful was the use of an ointment made with one ounce of 
pure mercury rubbed till the globules disappeared in Venice turpentine, 
one ounce of lard, and one scruple of camphor, well mixed together. 
Mercurial friction was tried on several women, but mercury without cam- 
phor was often ineffectual. Children were cured in a fortnight, but it was 
necessary to continue the treatment for several days afterwards. The 
origin and cause of this disease were entirely unknown." 
PIAN. 
The description of pian by the French physicians who have seen it in 
St. Domingo, Guadeloupe, Cayeune and other places in Insular aud Tropi- 
cal America, differs in several respects from that given by the English 
physicians of the yaws (Framboesia) in the West Indies, and more par- 
ticularly in Jamaica. 
Pian, according to the descriptions of the French physicians, is 
announced by small red spots, which appear in different parts of the 
body; the patient at the same time experiences a slight degree of fever, 
pains in the limbs and. even in the bones; the skin becomes scaly; the 
patient becomes sensibly thinner. By degrees the intensity of these symp- 
toms decreases, the eruption is developed, and shows itself under these 
aspects : 1st. Large plans, or white pians; 2d. Small plans; 3d. Bed plans. 
The first, of great size, sometimes as large as the hand, are formed of fun- 
gous flesh, from whence a thick sanious matter exudes, The small pians, 
less in size than the former, are much more numerous; their excrescences 
are redder and less fungous. The red pians, larger than the latter, less 
than the former, round, and of a more marked flesh color, developed 
slowly and successively, are accompanied aud followed by much more 
serious symptoms than those of the other species, particularly than the 1200 
Pian. 
first, which is the mildest of all. One of the pustules of pian generally 
becomes larger than any of the others, and takes the form of a deep ulcer 
of bad character, but without fungi, from whence a sanious matter is 
discharged. If this ulcer is dressed with the usual remedies, it becomes 
irritable, and assumes a worse appearance than it had before. The ulcer 
is called the mother pian. It is dangerous to attempt to dry it up, or to 
effect a cicatrization before the symptoms of the general infection are mani- 
fested. If a patient have an ulcer on any part of the body, the first pus- 
tules are generally developed upon it, and the ulcer itself sometimes 
becomes the mother pian. Several affections have been attached to the 
pianic eruption, as consecutive diseases : 1st. Guignes, a species of 
excrescence which principally appears in the soles of the feet, palms of 
the hands, and tips of the fingers, which are so tender to the touch that 
the patient can neither walk nor lay hold of anything without experiencing 
the greatest pain. 2d. Certain whitish excrescences in the soles of the 
feet, named crabs, from their shape, from which a purulent matter is dis- 
charged. 3d. Laminous, considerable thickening of the skin of the soles 
of the feet, and of the insides of the hands; they are red, acutely sensible, 
and very painful in walking, without any exudation, but with simple 
increase and hardening of the parts. After pian, an affection of the bones, 
entitled mat aux os, or bone evil, occurs, characterized by wandering pains 
in the bones, generally by the tumefaction of those that are spongy, and of 
the extremities of long bones, by exostosis, softening, caries, etc. These, 
as may be imagined, are serious symptoms, and being accompanied by the 
formation of numerous ulcers, often reduce patients to a horrible state.* 
Chopitre, Dazille, etc., think that mercurial preparations, frictions of mer- 
curial ointment, the internal use of the bichloride of mercury, diluents of 
sarsaparilla and guiacum are the best remedies for pian. The diet should 
be mild and succulent; broths made from turtle, crabs, fresh vegetablesand 
white meats are recommended. 
In a comparative examination of the documents published by the Eng- 
lish and French physicians, it will be seen that the former have carefully 
described the elevations, pustules, scabs and ulcers which precede the fun- 
gus of framboesia, and that the latter have exclusively confined themselves 
to this latter appearance, and to several connective lesions (guignes, 
crabs, bone evil}, which the English writers hardly mention. Besides, 
most of the latter think that yaws only attack the same individual once 
during the course of his life, whilst the French physicians maintain the 
contrary, with regard to pian. Hunter and Thomas assure us that mer- 
cury is detrimental, whilst the French physicians recommend it as the 
most efficacious remedy. Notwithstanding this diversity of opinion, yaws 
and. pian are generally regarded as the same disease. Sauvages, Larry and 
Sprengel, however, are agreed in considering them as distinct from each 
other. (A Theoretical and Practical Treatise on the Diseases of the Skin, by 
P. Payer, M. D.,p. f-19. 
SIBBENS OB SIVVENS. 
The identity of many of the phenomena, as well as of the original 
signification of the names of the yaws, with sibbens or sivvens (sibbens in the 
Erse dialect signifies a raspbery), a malady well known in the western 
parts of Scotland, renders it a matter of interest not of importance that 
their characteristic distinctions should be noted. The first account of 
sibbens or sivvens, was published by Dr. Gilchrist in 1771, in the third vol- 
* The pian or yaws is represented to be a common precursor of leprosy in Brazil. Sibbens or Sivvens. 
1201 
ume of Essays and Observations, Physical and Literary, by a society in 
Edinburgh. His paper, however, had been read in 1765, and printed in a 
sheet for the benefit of the class of people to whom it was principally use- 
ful. From his paper we may learn that there were three forms of the dis- 
ease. The first, inflammation of the uvula, tonsils and neighboring parts, 
with sometimes a superficial ulceration appearing either raw or covered 
with a white slough. "Frequently," continues the same writer, "there 
was a thrush, with white specks or sloughs upon the roof of the mouth 
and inside of the cheeks and lips, which commonly showed itself at the 
corners of the mouth, in a small rising of the skin of a pearl or whey color 
where likewise a very small excrescence, or fleshy sprouting, like a rasp, 
often appeared, which turns into a scab, and is a pretty sure sign of the 
disease, although there be no sore throat." Another form of the disease 
is that of ulceration. "The uvula," continues Dr. Gilchrist, "has been 
destroyed by it. Children on the breast, seized with it, perished of hunger, 
not being able to suck or swallow." "When it affected the skin only, pen- 
etrating no deeper, or very little,, it appeared," says Dr. Gilchrist, "in 
various shapes. The whole surface of the body has appeared mottled or 
freckled, of a dusky copper color, or deep red, as the discolorings of the 
skin in this disease commonly are. A cluster of small pustules come out, 
the skin grows dry and peels off, leaving a new tender skin beneath, and 
this will happen a great many times. Scabby eruptions were often met 
within the scalp, forehead, inside of the thighs, and parts contiguous; 
where frequently small hardness, just within the skin, caused very trouble- 
some itching. Inflammation, soreness and excrescences about the funda- 
ment seem very frequent. 
Dr. Gilchrist describes the tubercle resembling the raspberry, from 
which the disease derives its name (sivven, in the Highlands, being a com- 
mon name for a wild rasp), but acknowledges that he had never seen it in his 
own neighborhood. Two years after this paper was read, and four years 
before the volume in which it was printed appeared, Dr. Adam Freer 
published his inaugural Thesis de Syphilitide Venerea in an appendix, to 
which he gives some account of Sivvens. He presents the following whim- 
sical opinion concerning the origin of the sivvens. Producing Dr. Mead's 
paper from the Philosophical Transactions, to prove that the itch is owing 
to an insect of the acarus tribe, and the authority of Hauptman, Zangius 
and others, to show that syphilis is also suspected to arise from the same 
cause, the author suggests the probability that coition of the male syphi- 
litic insect with the female itch insect, may have produced a hybrid race of 
animals the cause of sivvens! 
Dr. Adam Freer and his coadjutor, Dr. Hope, state that the sivvens 
was frequently spread by smoking with the same pipe,-that it is more easily 
cured by mercury than syphilis-and that some women have been per- 
manently cured, without the use of any remedy, during the alteration that 
their constitutions have undergone in gestation or parturition. Mr. Hill, 
of Dumfries, maintained that the disease is the same as common syphilis. 
"Dr. Barry, of Cork," he says, "gives an exact description of sivvens, under 
the name of the malignant lues venera, communicated from the ulcers in 
the mouth of a woman. Mr. Hill says : "when the infection is not imme- 
diately received by the mouth, the sore throat is the consequence of an 
universal taint in the blood; in which case, the first redness and hoarseness 
are not easily distinguished from a slight stuffing or common cold; but 
when these symptoms are the effect of cold, they are either more discussed, 
or bring on an inflammation with a quick pulse, which is not the case with 1202 
Sibbens or Sivvens. 
sivvens; for in healthy or cold constitutions, it sometimes continues for 
weeks, nay months, without any great change. But when the infection is 
communicated by a foul pipe or spoon, the angles of the mouth, the lips, 
gums, etc., are first affected. The first appearance of an ulcer on the lip, 
exactly resembles a bit of fine white soft velvet pasted in the skin. But 
after it has eaten in for some time, it has the appearance of a piece of red 
skin cut into and a white velvet patch put in its place. These ulcers spread 
broader than deep and the whiteness always continues, more or less, till the 
cure be completed, being sometimes as bright as the whitest paper, but 
more commonly yellowish. 
Dr. Joseph Adams made a journey through certain parts of Scotland 
for the purpose of carefully investigating the nature of sivvens. We con- 
dense the following from the account of these investigations by Dr. Joseph 
Adams, contained in his "Observations on Morbid Poisons, Chronic and 
Acute' 
"The first patient to whom I was introdueed had lost the whole of her 
uvula and part of the tonsils rthere are numerous foveolae about what 
remains ; her voice is affected, but not so as to excite a suspicion that 
any bones about the nose are injured. The loss of substance about the lips 
is very trifling, but the edges are covered with an opaque white cuticle, 
apparently newly formed. The complaint has remained with her now for 
nearly seven years, during which time she has frequently taken mercury, 
but never to any great excitement. She had at one time complaints about 
the anus, but these have disappeared long since and never returned after- 
wards. At this time she is taking mercury and her mouth is somewhat 
affected by it. She complains of some soreness in the throat, but as there 
is no appearance of ulceration, that soreness maybe the effect of mercury. 
Every part seems healing without granulations. The next patient was 
a young woman, the daughter of a respectable farmer. She had fortu- 
nately the primary and secondary symptoms upon her when I was intro- 
duced to her. She had been taking mercury for five days. The uvula and 
tonsils were suffused with a viscid mucus and in some parts covered with 
the white appearance before mentioned. The soreness extends from the 
edge of the lips along the inside of the cheek and side of the tongue; but 
if there be any loss of substance, it is only at the uvula and tonsils, which 
appear rather wasted than ulcerated. The mucus is so glutinous as to 
keep the uvula attached to one of the tonsils. The secondary symptoms 
she says are mended. These are small elevations above the cuticle ; she 
showed some on her legs and arms which seemed pustular, but were quite 
dry. She says the skin breaks and discharges a little. She had fever on 
their first appearance, but it subsided soon after she began mercury. * * 
A few days afterwards, I made a second visit and found her mouth sore 
and all the symptoms mended. None of the pustules had broken, but all 
appeared paler, though still somewhat elevated; the throat cleaner; the 
loss of substance, if any, did not affect the uniform appearance of the 
paits. In a few days she recovered having never been confined from her 
work, which at that time was getting in the harvest. The third and 
fourth cases were a gardener and his wife. They had no other syptoms 
than increased viscid secretions with inflammation and pain; they were 
soon relieved by mercury. Dr. Maxwell exhibits this remedy by making 
the parties inhale the fumes from a heated iron through the tube of a gun 
barrel which produces a surprising effect, with little trouble or waste of 
the mineral. * * 
"The next case was a young woman employed in the harvest, who 
admitted that she was accustomed to smoke with the peasantry and with Sibbens or Sivvens. 
1203 
the same pipe. She had no symptoms but in her throat and had taken no 
medicines for these. The sides of the cheeks, lips and angles of the mouth 
were all unaffected, but the uvula was highly inflamed, and to appearance, 
the upper part nearly detached. The part, however, was so smooth as to 
give no appearance of ulceration; she was feverish. She began the 
fumigation immediately and her mouth became sore in three days. The 
swelling and inflammation had then greatly subsided, which showed the 
throat more plainly. It now appeared that there was a hole through the 
velum pendulum palate, which was, however, perfectly clean, like the true 
phagedaena, with only a small quantity of mucus or pus attached to one 
part of the hole. * * 
" The last case was, of all others, the most satisfactory. A poor girl 
had been ill about twelve months. Her first symptoms were mere sore 
throat, and treated as such with little or no advantage. At length the 
secondary symptoms appearing, with some fever, were at first suspected 
to be small-pox, till the slow progress of the pustules evinced the contrary, 
and a surgeon being consulted, at once discovered the disease. From her 
situation she had not been able to persevere so regularly in her remedies 
as to produce a complete cure. Her throat exhibited only a dry scaly 
appearance in the left arch; whether it had ulcerated I cannot determine, 
only that the parts appeared to me as if diminished. She had several very 
hard dark-colored scabs in different parts of her body, cicatrices in other 
parts, and in others pustular appearances, like those developed in the 
second case. On visiting her afterwards, some of the cicatrices were 
breaking out afresh. She has all the symptoms of low fever, and an indo- 
lent superficial sinus appears on her neck. Whether these last symptoms 
were the effect of the disease, or of poverty cannot easily be ascertained. 
On inquiry, she recollected complaints she had about the pudenda and 
anus, which had healed under the mercury she had taken, and which, she 
assured us, remained well."-pp. 183-186. From the above account Dr. 
Joseph Adams concludes that sivvens is different from the venereal disease, 
though approaching nearer to it than any other morbid poison with which 
we are acquainted. According to Dr. Adams : " The venereal gonorrhoea 
differs from the throat in flamed by sivvens, in the appearance of the discharge, 
and in the greater disposition sivvens shows to excite the effusion of coagu- 
lable lymph. The ulceration differs-the venereal being attended with 
callous edge and base, and sivvens consisting only of the clean phagedsenic 
ulcer. Secondary local symptoms differ-the venereal retaining longer 
its copper appearance, and afterwards becoming more elevated, retaining 
more the color of the skin, and the scabs, when formed, being more scaly. 
In sivvens the appearance is very early pustular, though I never could 
detect pus under the cuticle. I should, therefore, conceive the pus still 
less than in syphilis. It is probably thinner, that is, more truly lymphatic, 
as it hardens into an irregular dark brown crusty or stony scab. There is 
nearly the same difference between this and the venereal scab, as between 
the cow-pox and small-pox scabs. Lastly, it is now universally admitted, 
that sivvens never attacks the bones but by spreading from the soft parts, 
and that it yields earlier to mercury than syphilis."-p. 186. Dr. Swe- 
diaur, and after him Mr. Bell, mention a disease in Canada in many 
respects similar to sivvens. Dr. Swediaur tells us his account is taken 
from the papers of Hamilton, on whose representation six surgeons 
were sent from England to give gratuitous assistance to the poor sufferers. 
Dr. Swediaur observes that in the year 1785 five thousand eight hundred 
persons in Canada were infected. It is probable many of the symptoms 
described were unconnected with the disease, not only because no morbid 1204 
Sibbens or Sivvens. 
poison can assume such a variety of forms, but because such appearances 
often occur from other causes. Among the rest, we met with mortification 
of the feet and other joints, which, in the north of Canada, would be more 
properly suspected to arise from frost-bite. There is evidence to show 
that in the latter part of the seventeenth century some disease very similar 
to sivvens appeared at the Bay of St. Paul in Canada. Dr. W. Kerr (Cyclo- 
paedia of Practical Medicine, article, Yaws), thus establishes the diagnosis 
between sivvens and yaws : The sivvens at first seizes the throat and nose; 
the yaws never, until after a length of time or improper treatment. The 
eruptions in sivvens are watery, of a dirty hue, and of intolerable foetor; 
those of the yaws are at first as small as a pin's head, hard, and without 
any peculiar odor. In sivvens boils appear here and there, forming deep 
and ill-disposed ulcers, a character which does not belong to yaws. In 
sivvens itchy tetters break out in form of ring-worms, and occasion either 
a deep ulcer or a scabby large spot with inflammation; the yaws have no 
such appearances. The sivvens rarely affect the bones; the yaws always, 
unless "well managed. 
In the yaws the excrescences succeed the pimples as well on the face 
and body, as on the axillae and pudendae; in sivvens the fungi appear on 
the groin and perinaeum in a very advanced stage of the disease. The 
sivvens is highly contagious without sensible inoculation, the only mode, 
as it appears, by which yaws is propagated. The sivvens may be cured 
easily by mercurials, but mercurials iu the yaws, at least iu the early 
stage, are pernicious. In constitutions otherwise healthy the yaws will 
usually run a definite course, be spontaneously exhausted, and terminate 
in health even without medicine; but if speedy and effectual means be not 
used to counteract sivvens it will almost certainly proceed to a fatal issue. CHARTER XI. 
LEPROSY, ELEPHANTIASIS GR2ECORUM. 
Synonyms.-Elephantiasis, djuram, lepra medii sevi; lepra jaurica; mal 
rouge de Cayenne; mal deS. Lazar; maladie de Jerusalem, spedalskhed (of 
the Norwegians); leontiasis; satyriasis; lepra of the Arabs; elephantiasis 
tuberculata; lepra tuberculora; isarath (of the Hebrews); osjuddam or jusam 
(of the Arabians); lepraelephantia; black leprosy; red leprosy; elephantiasis 
ansesthetica; joint-evil; the myckleail, or great disease. Synonyms of leprosj 
are numerous, as may be inferred from the extensive distribution of the dis- 
ease throughout the world, and its identification in different countries by 
different names. The term leprosy had its origin at a time when diseases 
of roughness comprehended a large majority of affections of the skin, and 
it was in fact a generic name for skin disease. The indefiniteness of the word 
is strikingly shown by the manner in which it is used in the Bible, where 
leprosy in one connection represents a trivial disorder, and in another a 
serious disease. In modern times it has been used to designate that terri- 
ble disease described by the Greek fathers of medicine as elephantiasis, 
widely spread over the world, and according to the saying of Aretseus, so 
much greater than the rest of diseases, as the elephant is bigger than all 
other animals-a disease which is universal in its diffusion through the 
frame, and in which all the tissues of the body are implicated to a greater 
or less extent. The terms leprosy and lepra, are consequently quite distinct 
from each other; leprosy and elephantiasis being synonymous; whereas the 
term lepra in the plural was applied by the Greeks to scaly white spots of 
the skin, a disease of roughness as in elephantiasis, although a disease of 
roughness in a very different sense. The analogy of the two words, both 
in derivation and sound, has given rise to some confusion, which has been 
increased by the misapplication of the term elephantiasis. Thus whilst the 
elephantiasis of the Greeks has the signification of leprosy, the lepra of the 
Greeks is a trivial affection sometimes styled lepra vulgaris, and very com- 
monly, though erroneously, psoriasis. The word elephantiasis has also been 
applied to a local disease of hypertrophic growth known as elephantiasis 
Arabum; whilst the Arabians, amongst whom leprosy is also found, call 
that diseace lepra. 
Definition. Elephantiasis Graecorum is an endemic, chronic malignant 
constitutional disease, characterized by alterations in the cutaneous, ner- 
vous and bony structures, resulting in anaesthesia, ulceration, necrosis, 
general athrophy and deformity. It is characterized at first by the devel- 
opment of tawny stains on the skin, the sensibility of which is most com- 
monly diminished, and less frequently increased; subsequently by yellowish- 
brown tubercles, and finally by ulcers which often extend deeply into the 
subjacent tissues. As the disease progresses it is attended with consider- 
able debility and mental dejection, and in most cases terminates fatally 
from ulceration of the bowels and colliquative dysentery. 1206 
Elephantiasis Groecorum. 
Description; symptoms; varieties. Leprosy (Elephantiasis Grcecorum) is a 
constitutional disease, and invades the whole organism most profoundly. 
Its invasion is slow and insidious. Premonitory symptoms of malaria, 
mental depression, languor, sleeplessness, loss of appetite, nausea, chills, 
repeated attacks of fever, general debility, nervous prostration, and pains 
in the bones are usually present, and may last for weeks, months or years, 
without other symptoms. Sooner or later, however, the more characteris- 
tic features of the disease, the bullous, macular, pigmentary or tubercular 
skin lesions make their appearance. These may appear separately, suc- 
cessively, or together. Sometimes the skin lesions are prominent symp- 
toms of the disease; at other times they are subordinate. Other organs of 
the body, as the nerves, are also affected. Two forms of leprosy are recog- 
nized, the tuberculosis and anaesthetic. No absolute line, however, sepa- 
rates them, and they often appear simultaneously upon different parts of 
the body, and one may pass into the other. The tubercular variety is char- 
acterized by the formation of masses of infiltration and tubercles. Other 
lesions are also found. An eruption of pimples like bulbs, showing them- 
selves irregularly for some time before the appearance as other lesions, is 
■one of the earliest symptoms, though it is said these more frequently pre- 
cede the macular variety of leprosy than the tubercular. Macules now 
make their appearance as smooth, shining erythematous patches, usually 
defined, infiltrated, not commonly raised above the level of the skin, yel- 
lowish or reddish in color, and growing dusky, yellow, and brownish as 
they grow older. Sometimes they are paler and look like a piece of cut raw 
bacon set in the skin. They are commonly surrounded by a pinkish, or 
lilac border of small blood-vessels. 
The sensibility of the skin is altered from the beginning, the patches 
being at first hyperaesthetic and later anaesthetic. They may appear any- 
where in the body, but most commonly upon the trunk and exterior sur- 
face of the extremities. Sometimes they are fluent in such numbers as to 
involve a considerable area of the body; they may disappear and reappear 
from time to time, or they may remain as permanent lesions, in which case 
they increase in size. The distribution of the maculae or blotches of 
leprosy on the surface of the body, corresponds with the nerve territories 
of the integument, and the same may be said with regard to the face and 
the extremities below the elbows and knees. On the face the parts spe- 
cially affected are supercilliary regions, the nose, and the ears; and on the 
arms, the territory of the ulnar nerve. In all these regions the blotches 
soon become blended; and the redness, pigmentation and infiltration are 
more general than elsewhere. The suffused redness of the skin has sug- 
gested the term elephantiasis erythematosa; and this state of congestion is 
frequently accompanied by prominence of the follicles, and more or less 
desquamation and exfoliation of cuticle. In some situations the hyperae- 
mic blotches are moistened by a greasy exudation, in others they are dry, 
parched and rough. In all the affected parts of the skin there exists a 
certain degree of numbness or anaesthesia. In the early stages of the dis- 
ease there is scarcely any pain; nevertheless, if the ulnar nerve be pressed 
against the inner condyle, the pain is frequently acute, and the same 
occurs from pressure on the perineal nerve. As a consequence of imper- 
fect innervation the fingers are frequently slender and benumbed; they 
are brown from pigmentation; and the metacarpal space between the 
forefinger and thumb is hollowed from defective nutrition of the abductive 
muscle. The development of the solid papules or tubercles in the centre of 
the hyperaemic spots follows the progressive exacerbations of the leprous 
fever; they grow while the febrile process continues, and become station- Elephantiasis Graecorum. 
1207 
ary when it abates; each exacerbation, however, adds to their bulk, and 
forces them on to maturity. Having reached the mature stage, they soften 
and break up; an ulcer is found, which discharges for a while, and then 
the ulcer heals. A common seat of the tubercles is the region of the eye- 
brows, which they denude of hair; they also give a frowning aspect to the 
countenance, and when of large size, add a lionessic fierceness to the 
expression, which has suggested the term eleplumthiasis lionteria. Similar 
phenomena to those already described manifest themselves in the fauces, 
the nasal cavities, and the larynx-at first hypersemic maculse, then tube- 
rous prominences, and next ulceration, so that the symptoms in this region 
are usually severe. 
The voice is hoarse; the nasal passages are clogged; occasionally the 
septum ulcerates, and sometimes the nasal bones fall in. Tubercles like- 
wiseform along the edges of the eyelids; the conjunctiva is inflamed and 
thickened; the corner becomes opaque, and sometimes the eyeball is 
destroyed. The lips are rendered protuberant by the tubercles, and ulcer- 
ate like the rest. The external ear is likewise enlarged and studded with 
tubercles, and the lobule of the prima is remarkably elongated, suggesting 
with the large tubercles on the forehead the features of the typical Satyr. 
Finally, the leprous congestion extends to the scalp; the hair falls off, as 
it does on the eyebrows, and the term elephanthiasis alopecita bears some 
corroboration. 
The following figure, No. 125, illustrates that hideous form of leprosy 
(elephantiasis Grrncorum), the so-called tubercular variety, in which there 
is an eruption of rounded, flattened patches on the eyebrows, ears and sur- 
face generally, giving an animal aspect to the face. 
ENGRAVING NO. 125. 
Tubercular Leprosy. 
Engraving No. 125.-Tubercular leprosy, drawn by Moonesawmy, illustrating the swollen 
forehead, protruding, corrugated, hairless eyebrows, swinish, projecting upper lip, pouting and 
swinish, and the flattened depressed nose. 
On the trunk of the body the ulcers are frequently of considerable 
extent, and occasionally the limbs have the appearance of being stripped 
of integument from the shoulders to the hands. The ulceration of ele- 1208 
Elephantiasis Grcecorum. 
phantiasis is not, however, restricted to the softening of tubercles; instead 
of, as in this instance, beginning from without, it starts in its most exteu- 
sive forms within. There is at first a general swelling of a part, such as a 
heel or the joint of a great toe; a blister is raised on the skin, covering the 
swelling, the cuticle is rubbed off and an ulcer is quickly established. All 
this may occur without pain and almost without the knowledge of the 
patient. A large quantity of a glairy, colorless fluid is poured out by the 
ulcer; the sore is asthenic and sluggish; in the case of a joint the bone may 
be exposed, and very probably the end of a phalanx will be forced through 
the opening, to be followed in due time by the rest of the bone, then the 
ulcer contracts, the cavity closes up and the integument heals. After a 
time a similar process commences in the great toe of the opposite foot or 
in the joint of a thumb and runs the same course, either the extremities of 
a bone or the healing up of an asthenic sore after a continuance of several 
weeks or months. The joints of the phalanges of the feet and hands are 
similarly attacked from time to time and a considerable amount of deform- 
ity of these members results. But it is worthy of note that while these 
morbid processes are all of them subject to the periodical canon of the dis- 
ease, they alternate in their occurrence; and it is to be farther noted that 
an excessive discharge from one of these ulcers has a derivative influence 
and communicates a sense of relief to the whole system. The anaesthetic 
variety of leprosy may occur in conjunction w'ith the tubercular variety, or 
alone, in which case it is characterized by a presence of a number of symp- 
toms in addition to the anaesthesia. 
Elephantiasis anaisthetica, differs from elephantiasis tuberosa, in the more 
decided manifestion of disorders of the nervous system. There are the 
same premonetary symptoms, the same hyperaemic spots and blotches on the 
skin; the same pigmentary maculae; but there is an absence of tubercles 
and ulceration, the numbness and anaesthesia are more decided, a general 
state of atrophy creeps through the system, and the sufferer is prostrated 
by exhaustion. Neuralgic pains, which are not wholly absent in elephan- 
tiasis tuberosa, are more marked in elephantiasis anaesthetica. A sense 
of dullness and heat pervades the surface; and there are sensations of ting- 
ling and prickling, and of burning heat. Whilst the integument is insen- 
sible, there are deep-seated burning pains, sometimes of a bone or joint, 
and sometimes of the vertebral column. These pains are greatest at ni^ht; 
they prevent sleep, and give rise to restlessness and frightful dreams. 
Moreover, the skin, robbed of its sensation, is prone to vesication and 
excoriation, and the latter frequently ends in ulceration. The anaesthesia 
is often so great that the contact of fire or of the severest caustics occasion 
no sensation. The skin becomes atrophic, dry, yellowish, or brownish in 
color, and more or less wrinkled. Following this alteration in the struc- 
ture of the skin, the subcutaneous tissues and muscles undergo atrophy, 
giving rise to deformity, especially of the fingers and toes; the hair and 
nails become altered in structure, or are shed; the hands and feet become 
greatly mutilated; the fingers and toes bent, crooked and contracted. 
Sooner or later the bones are attacked, causing destruction of the joints 
and of the bones themselves; the skin over the joints becomes excoriated 
and ulcerated; the ends of the bones undergo disintegration, and the pha- 
langes finally either become absorbed or drop off. Even the hands and 
feet may gradually be lost; the extremities become more or less completely 
anaesthetic, and are greatly wasted, at times to half their former size. 
The following wood cut figure will illustrate the form of atrophy fre- 
quently present, and characteristic of the Oriental leprosy, or elephantia- 
sis Graecorum. Elephantiasis Groecorum. 
1209 
ENGRAVING NO. 126. 
Atrophy of the Hand in Elephantiasis Grcecorum. 
Engraving No. 126. Atrophy of the hand in elaphantiasis Greecorum, showing the disease of 
the nerves, the muscles of the hand are atrophied, especially those which occupy the palmar aspect 
of the fifth metatarsal bone, and those in the fold between the thumb and forefinger. It will 
also be seen that the phalanges of some of the fingers have disappeared, through failure of the 
trophic or nutritive influence of the nerves. Drawn from a patient of Modeen Sherif, at the Tri- 
plicane Hospital, Madras, by C. Mooneswamy Moodelly: (Robert Druitt.) 
Elephantiasis mutilans is more local in its characters than either of the 
preceding; it is wanting in the tegumentary manifestations of elephantiasis 
tuberosa, and although essentially anaesthetic in its nature, the anaesthesia 
is local, and affects chiefly the limbs. In this form of the disaase loss of 
the bones of the hands and feet is a conspicuous symptom; and not unfre- 
quently the limb is lopped off painlessly at the ankle or knee, or at the 
wrist or elbows. When the phalanges and metacarpal or metatarsal bones 
are alone attacked, the last phalanx, probably from its higher vascular 
organization, is generally spared; this may be the case even when the bones 
of the wrist are eliminated; and the hand or foot in this case is crumpled 
up; resembling a confused bunch of tips of fingers or toes. Often the bones 
are ejected; in these cases the integument heals in the most complete man- 
ner, and it is in similar cases, where considerable power is obviously pres- 
ent, that spontaneous cure is most likely to occur. In elephantiasis ames- 
thetica the nervous system is too deeply and seriously implicated to admit 
of spontaneous cure; and in elephantiasis tuberosa the tegumentary system, 
both cutaneous and mucous, is likewise too extensively damaged to render 
cure a rational expectancy. The following figure illustrates the atrophy 
of the bones, and the loss of the fingers in anaesthetic leprosy (elephantiasis 
Graecorum.) 1210 
Elephantiasis Groecorum. 
ENGRAVING NO. 127. 
Anaesthetic Leprosy of the Hand of a Leper A 
In lepra ansesthetica, beginning probably with the nerves which supply the original leper 
spot, by degrees the chief nerves which go to the hands and feet become infiltrated with a pecu- 
liar deposit. which renders them of twice their natural size. It seems to invade the nerves as 
soon as they pierce the fascia, and they can often be felt under the skin, as rounded or nodulated 
casts; deeper trunks are affected later. The consequences of this nerve disease are the same as 
when nerves are irritated; that is to say, loss of sensation in the skin, atrophy of the skin, which 
loses its hair, bullce of pemphigus, which often lead to deep ulcers; atrophy of the muscles, and above 
all, atrophy of the bones, beginning with those of the last joints of the fingers or toes. The bones 
first become thin and slender, then absolutely vanish by absorption, so that the finger nails may 
find themselves on the ends of the metacarpal bones, through the disappearance of the parts 
beneath. This process of mutilation is often hastened by abscess and necrosis'of the bones. 
Common sensation, and sensation of heat and cold, seem to be properties of different nervous 
Tebrils, inasmuch as either one of them may be impaired or lost without the other. 
ELEPHANTIASIS GRJECORUM. LEPROSY IN THE WEST INDIES. 
That leprosy was introduced into the West Indies from Africa and the 
South of Europe at an early day is evident from the statements of various 
authors. Thus Dr. Hans Sloane, whose observations were commenced in 
1687, in the Island of Jamaica, records a case which he regarded as the 
lepra Grsecorum, and also describes the indigenous plants which were sup- 
posed to be useful in the treatment of this disease. Dr. James Grainger, 
in his "Essay on the More Common West India Diseases," published in Edin- 
burgh, 1802, says that, although the white people in the West Indies are 
not exempted from this dreadful calamity, the negroes are most subject 
thereto: 
"I could write a great deal upon this disorder and but little to the purpose. 
Like the gout, it is the disgrace of art. I am doubtful whether it be infectious or 
tnot. The children of infected parents are not always seized with the leprosy, and 
I have known the wives of the leprous remain free from it for years. It is, how- 
ever, the part of prudence to remove the distempered from the sound. * * I 
■once saw a negro man whose wool grew white and whose skin put on a farinace- 
ous appearance. He was a hideous spectacle. His appetite was gone." 
Dr. William Hillary states that the leprosy of the Arabians was first 
^brought to the West Indies by the negroes from Africa, and 
"Is undoubtedly a native of that quarter of the world and Arabia, and is not 
•originally of the western part of it; neither was it ever known here before it was 
•brought hither by the negroes, among whom it is now too frequent here, and bas 
•made its way into several families of the white people also; and it is much to be 
* Drawn by Mooneswamy, of Madras. Elephantiasis Groeeorum. 
1211 
feared that it will spread further in this warm climate, into many more both white 
and black families, if the legislative power do not interfere, and endeavor to pre- 
vent its spreading by some suitable, wise and effectual laws, as we see the French 
and Spaniards have done."* 
Dr. Richard Towne, in his "Treatise of the Diseases most frequent in 
the Indies, and herein more particularly of those which occur in Barbadoes, 
London, 1726, " has given the following description of the elephantiasis 
(Chapter x, pp. 187-188, of the Elephantiasis): 
"I shall put an end to this treatise by giving the description of two diseases to 
which the blacks are no strangers, butas far as I can be informed they are utterly 
unknown in Europe. I mean the elephantiasis. Under the circumstances it occurs 
in the Indies, and a distemper, called there the joint evil, and first of the ele- 
phantiasis. This disease, which is no rare thing, to be met with among the negroes, 
bears a great affinity to the best accounts we have of the lepra of the Arabians. 
Those blacks are more subject to its influence, who after some acute nervous, 
long continued intermittents, or other odious illnesses, are either much exposed to 
the inclemency of rainy seasons, and the cold penetrating dew of the evenings, or 
are constrained to subsist upon bad diet and undigestible, unwholesome food. In 
the beginning the person is weak, cachectical, and emaciated, till the glut of viti- 
ated humors subsides into the legs and feet, which are the seat of this distemper, 
and at this time begin to appear cedematous, and puffed up with water tumors as 
in an anasarca, but the swellings do not retain the mark of any pressure in the 
same degree, or so long as in that distemper. By degrees the leg becomes more and 
more tumified, and the veins are much distended with varicose swellings, which 
are very apparent from the knee down to the extremities of the toes. Then the 
skin begins to grow rugged and unequal, its vascular and glandulous compages is 
enlarged, and a scaly substance with a sort of chopsand fissures in the interstices 
appear upon its surface. These seeming scales do not dry up and fall off, but are 
daily protruded forward, and stretched in their dimensions till the leg is enlarged 
to an enormous bulk, so that in size, shape and all ocher external appearances, it 
minutely represents the leg of an elephant, from whence the disease receives its 
denomination. But notwithstanding that this scaly coat appears to be harsh, cal- 
lous and insensible, yet if it be touched, ever so superficially with a lancet, the 
blood will freely ooze out, and if the epidermis, which affords this monstrous 
appearance, be paired off to the thickness of the scarf-skin in those parts an infin- 
ity of orifices of the blood-vessels will present themselves to the eye when assisted 
with a microscope. Though the limbs continue to proceed to this inordinate mag- 
nitude, yet the appetite of the negro remains good, his digestion strong and his 
secretions regular, nor is he sensible of any other inconveniency than the burthen 
of carrying such a load of leg along with him. In this condition several have 
been known to live twenty years, and even to a longer period, and have performed 
cheerfully all the duties of servitude which were consistent with such dispropor- 
tionate limbs. This addition of bulk is generally confined to one leg at a time, but 
there have been several instances where it has invaded both together Amputation 
of the diseased leg has been performed many times, but has always failed of a cure, 
for the distemper constantly takes possession of the remaining leg. Sometimes 
white people, whom unhappy circumstances have reduced them to hardships, but 
little inferior to what the blacks are obliged to undergo, have given us proof that 
this disease is not limited to one color, any more than the bounds in which Lucre- 
tius has confined it. Est elephas morbus, quipropter flubiam nili gignitur Egypto, 
in media, neq; preeter er usquam. 
One of the forms of leprosy would seem to be not an uncommon dis- 
ease in Mexico. Kendall, in his "Natives of the Texan Santa Fe Expedi- 
tion," vol. id, p. 220, thus speaks of the lazarinos or lepers of Hospital San 
Lazaro: 
LEPROSY IN MEXICO. 
* A Treatise on such diseases as are most frequent in or are peculiar to the West India Islands 
or the Torrid Zone. 1212 
Elephantiasis Graecorum. 
The appearance of the unfortunate lepers is loathsome and hideous to a degree 
that beggars description. It makes its appearance by scaly eruptions on different 
parts of the face and body of the victim, and these eruptions are never perfectly 
healed. The limbs of many, and more especially the hands, at first appear to bo 
drawn and twisted out of all shape. Gradually the nose and parts of the feet are 
carried away, while the features become distorted and hideous. The voice assumes 
at times a husky and unnatural tone; and again the doomed patient is unable to- 
articulate except in a shrill, piping treble. With many, when near the last stages, 
all powers of speech are lost, and vainly do they endeavor to make known their 
wants by sounds which belong not to this earth of ours. Death steps in at last to 
relieve the poor creatures of their sufferings; and to them at least it would seem 
that the visit of the grim tyrant must be welcome. 
Mr. Kendall further states that there were some sixty males and mor& 
than that number of females affected with that disease in the Hospital San 
Lazaro when he was there; that he cannot say whether the disease is con- 
tagious or not; that there is little doubt of its being constitutional and 
hereditary, being never entirely eradicated from- the blood. He thinks 
that the climate has some effect in engendering and keeping alive the dis- 
ease; says that the common belief among the lower classes is that it is 
communicated by contact, and expresses the opinion that the only risk a 
person runs of taking it is from touching the person of one afflicted with 
it in its worst stages. It seems that when a person is known to be a leper 
in Mexico he is at once sent to the hospital, where he remains till death,, 
for we are told that none ever recover from the horrible disease (p. 222). 
"If all the Mexican inmates of San Lazaro," says Mr. Kendall, "were 
affected with leprosy, and we were told that such was the case, there must 
be three or four species of the disease. The faces of some of the lazarinos 
were covered with blotches and eruptions, while their hands and feet were 
unmarked. Others again had complexions exceedingly fair and unblem- 
ished, yet their feet and hands were distorted or decayed. Some of the 
victims of the dreadful scourge were covered from head to foot with sores 
and ulcers hideous to look at, and then there were two or three cases where 
the patients presented no other marks of disease than the loss of a nose. 
But the most singular case of all was that of an old Spaniard, whom I 
have previously mentioned as continually smoking his cigarillos. His 
flesh appeared to be entirely gone, dried up; his skin turned to a bluish 
purple, and his whole appearance was so strangely changed and distorted 
that he more resembled an animated mummy than aught else I can com- 
pare him to. His senses he still retained, while his actions and conversa- 
tion convinced us that he was a well-informed and gentlemanly man" (p. 
241). 
In 1862 Dr. S. Habel, in obedience to a long-felt desire, relinquished 
his medical practice, in order to make, at his own expense, a tour of 
exploration through Central America and the northwestern States of 
South America. In the course of the seven years devoted to these inves- 
tigations he made collections in natural history and observations in 
meteorology, topography, geology, archaeology and medical science. Dr.. 
Habel states that "the Indian population of Central America are 
afflicted with a cutaneous disease, the effect of which is a spotted appear- 
ance of the cutis." A cutaneous disease of an ulcerating character 
prevails in South America, not amongst the Indians, but amongst descend- 
ants of Europeans, or persons of a mixed race. It is known under the 
name of elephantiasis, and is considered of such infectious character that 
the police of Ecuador are instructed to arrest any person suspected of 
LEPROSY IN CENTRAL AND SOUTH AMERICA. Elephantiasis Grcecorum. 
1213 
being affected with it. Such a person is taken to Quito, and if, after 
examination by two physicians, the fact is established the person affected 
is sent to the hospicio and retained there for life, secluded from the world. 
This is done because the disease is thought to be incurable. It was impos- 
sible to find out whether this malady is of a recent origin or not. However 
ca«es of recent infection are known. One of them was that of a man who 
visited Columbia on business and returning afflicted with this disease 
infected the whole family. Besides the hospicio in Quito, there is in the 
province of Cuenca a piece of land between two rivers, on which persons 
afflicted with this disease are kept under guard and prohibited to leave. 
These poor wretches are left to their destiny, receiving no 'medical attend- 
ance whatever. 
" I visited the hospicio in Quito, in which I found a hundred and ten 
persons, from the age of nine years upwards, though none of a very 
advanced age, nor any of whom I thought to be of pure Indian blood. 
Forty-five of this number were males. All were afflicted with more or 
less distinctive ulceration in the face or other parts of the body. These 
ulcerations were of four different kinds. The smallest number proceeded 
from the real elephantiasis JBgyptiaca, while some were unquestionably of 
a syphilitic nature; and others, again, were lupus; the diagnosis of the 
rest was quite impossible to make out from a single inspection. All of 
these ulcers were in a most deplorably neglected coudition, which rendered 
any true diagnosis at first sight almost impossible. One thing is certain: 
that, under the name of elephantiasis, various diseases are embraced, on 
account of their not yielding to the application of drugs, with the neglect 
of all hygienic regulations. Moved by the feeling of humanity, and 
resolved to try and rescue some of these wretches from their deplorable 
condition. To this end, I proposed to the Government to devote my 
knowledge and time during my stay in Quito to these wretches, if the 
Government would furnish me with all the hygienic and therapeutic 
means I should require. This offer was not accepted, the Government 
having spent in former years money for the cure of these unhappy ones 
without success; and as the native doctors, who had seen the disease during 
many years, were unsuccessful, how could a foreigner, only recently 
acquainted with it, succeed better1? However, a physician of high stand- 
ing in the city came to me to buy my recipe for curing the malady, offering 
as much as ten thousand dollars. My answer, that I had no secret remedy 
whatever, that my hope of relieving the unhappy people was founded on 
the possibility of finding the true diagnosis of each case, and then to act 
accordingly, he took for a subterfuge. 
"I must allude here to the general neglect, in those countries, of 
hygienic measures. Any such contrivance as privies do not exist, except- 
ing in Lima, and perhaps a few in Quito. The streets of the cities and 
towns are more or less the receptacles of the excrements. The males void 
theirs in the yard, where they have access to any, and the females make 
use of the urinal, which is emptied after dark in the street. The hogs 
perform the duties of scavengers. In Guayaquil is a bathing establish- 
ment in the river, with a privy attached to it. To this resort the wealthier 
classes, not for the sake of bathing, but for the use of the closet. In Lima 
a barrel is placed in a small enclosure on the flat roof. In a hole on the 
top of the barrel is placed a wide funnel, to which a few steps lead. Per- 
sonally this barrel is seldom used, but the contents of the night-pot are 
emptied into it. Every few days it is removed to be replaced by an 
empty one." Smithsonian Contributions, No. 269, 1878. 1214 
Elephantiasis Groecorum. 
LEPROSY IN NEW BRUNSWICK. 
In the year 1844, the attention of the Canadian government was called 
to the existence of leprosy at Tracadie and Nequac, in the province of New 
Brunswick, near the Bay of Chaleur; and a commission was accordingly 
appointed, consisting of Drs. Key, Skine, Tolbdarvy and Gordon, to inves- 
tigate its nature and origin. The following is extracted from the report of 
the Canadian Parliament : 4'The disease is the Greek elephantiasis-the 
leprosy; not the elephantiasis of the Arabians, but the leprosy of the 
middle ages; the lepre tuberculeur of the French, or tubercular leprosy 
which raged over nearly every district of Europe, from the tenth to the 
sixteenth century. It is the decided opinion of the gentlemen comprising 
the commission that the disease is contagious; and so far as they could 
ascertain, no person in the above districts who contracted it is ever cured. 
It is also their opinion that it has no affinity to scrofula; and the idea very 
prevalent that it is owing to the poor diet of the French settlers and their 
filthy habits generally, is not correct, for they found it existing in some 
of the cleanest dwellings and most respectable families. It has spread very 
rapidly during the past year. They have discovered upward of twenty 
cases, all of which can be traced up to one source. They have every reason 
to suppose that there were a great number; but not having power to search, 
and the inhabitants showing a greater disposition to withhold information, 
or to point out the parties laboring under the disease, they could not make 
so minute an inquiry as they were desirous of doing." Dr. Boyle, of St. 
Johns, has also investigated the disease (London Medical Gazette, 1844), 
of which he has given an interesting account. Dr. Boyle agrees with the 
commission, that the disease is tubercular elephantiasis of modern patho- 
logists; the juzam of the Arabians, and the lepra G-rcecorum of the middle 
ages; and he regards the disease as non-contagious, and goes into a long state 
ment of facts to prove the position. He, however, thinks the disease is 
hereditary, traces its existence back to 1827, numbering some twenty cases 
and twelve deaths since that period, although he is of opinion that it was 
introduced into the province much earlier. He briefly describes a case of 
the disease, where "the breath was extremely offensive, the face, hands and 
legs covered with blotches and tubercles of a livid brownish color, and 
some of them were in a state of ulceration." 
(Meeting of the Board of Health, State of Louisiana.) 
ORIENTAL LEPROSY. 
New Orleans, November 11, 1881. 
Dr. Jones read the following communication and papers: 
Newcastle, Province of New Brunswick, 
Dominion of Canada, October 21, 1881. 
To His Excellency the Governor of Louisiana : 
Sib-I am physician to the hospital for lepers in this province. The hospital 
is supplied by the government. I am now preparing an annual report. 
The question of the possibility of contracting the disease of leprosy by contagion 
is still sub judice. Investigations are being made in different parts of the world. 
I have been informed that leprosy exists in the State of Louisiana, and that the 
attention of the government has been called to the spread of the disease by con- 
tagion. I do not know the name of any person in Louisiana-not even the name 
of the State Secretary. I therefore venture to address you in the humble hope that 
you will be pleased to favor me with any facts bearing on the question of contagion 
which may have come under your observation, officially or otherwise. I would Yaws and Leprosy in the Delta of the Mississippi. 
1215 
also like to know the supposed number of lepers in the State, the length of time the 
disease has existed, the probable origin, and whether your government intends to 
isolate persons afflicted with the disease. 
My report must be forwarded in about three weeks, and I would respectfully 
ask the favor of a reply, when convenient. 
I beg to subscribe myself, yours most respectfully, 
A. C. SMITH, M. D. 
State of Louisiana, Executive Department, 
State House, New Orleans, October 29th, 1881. 
Ihe letter of A. C. Smith, M. D., physician to hospital for lepers, Newcastle, 
New Brunswick, Canada, containing inquiries respecting leprosy in Louisiana, 
received October 29th, 1881, is respectfully referred to Dr. Joseph Jones, President 
of the State Board of Health, with request to answer the inquiries of Dr. Smith. 
By direction of the Governor. 
E. W. HALSEY, 
Private Secretary. 
Dr. Joseph Jones stated that he regarded the subject of leprosy of vast 
importance to the people of Louisiana, and had, during the past twelve 
years, embraced every opportunity in his power for its thorough investi- 
gation, and, as was well known to every member of this Board of Health, 
he had, in accordance with a formal resolution of the Legislature of Louis- 
iana, visited in person the districts on the Bayou Lafourche in which lep- 
rosy existed. The results of the entire investigation wrere embraced in the 
annual report of the Board of Health for the year 1880, pp. 193-223. The 
President of the Board of Health had treated of the subject under the fol- 
lowing diversions: 
YAWS AND LEPROSY IN THE DELTA OF THE MISSISSIPPI. 
Leprosy made its appearance at an early date in the history of Louis- 
iana, and the diseases included under the name of leprosy appear to have 
been : (a) The African Yaws (Framboesia Rubula, Pian, Epian, Syphilis 
JEthiopica, Syphilis vel Lues JEthiopica, Syphilis Africana); (&) Leprosy 
-The Oriental Leprosy or Elephantiasis Grtecorum (Lepra Tuberculosa, 
Lepra Hsebrcerum, Lepra J^gyptica, Lepra Leontina, Lepra Arabium, 
Mediaeval Leprosy); (c) Elephantiasis Arabium (Elephant's Leg, Barba- 
does Leg, Buchemia; Lymphatic Hypertrophy or Varix of the Lymphatics, 
Scrotal Tumor). It is an interesting fact, that a hospital for lepers was 
established in New Orleans in 1778, more than one century ago. One of 
the first measures of Miro's administration, which succeeded that of Galvez 
in 1778, was one of a most remarkable character in its purpose, namely, a 
foundation of a hospital for lepers. There being a number of persons in 
the province afflicted with leprosy, the Cabildo erected a hospital for their 
reception in the rear of the city, on a ridge of high land between it and 
the Bayou St. John, which is perhaps the ridge anciently separating the 
waters of the Mississippi from those of Lake Pontchartrain. Upon exami- 
nation of the report of the President of the Board of Health in 1880, it 
will be found that a special section was devoted to the consideration of the 
leprosy in New Brunswick, Canada.-Annual Report of Board of Health, 
State of Louisiana, 1880, p. %05. 
The President of the Board of Health of the State of Louisiana 
regarded the existence of leprosy in New Brunswick, Canada, at the pres- 
ent day, of great interest in its connection with the existence of the dis- 
ease in Louisiana, and it is well known that in virtue of the cruel and 
barbarous exactions of the British government during the period that 
Louisiana was under the French dominion, more than a century and a 1216 
Leprosy in New Brunswick. 
quarter ago, the inhabitants of this portion of the present dominion of 
Canada were cruelly driven from their homes, and many of them found a 
refuge upon the genial and hospitable soil of Louisiana. Without doubt a 
portion at least of the leprosy now existing in the State of Louisiana can 
be traced to the early French settlers of Canada. 
The following is the section referred to as presented in the report of 
President Jones : 
LEPROSY IN NEW BRUNSWICK. 
In the year 1844, the attention of the Canadian government was called 
to the existence of leprosy at Nacadie andNequac, in the province of New 
Brunswick, near the Bay of Chaleur, and a commission was accordingly 
appointed, consisting of Drs. Key, Skine, Tobdarvy and Gordon, to inves- 
tigate its nature and origin. The following is extracted from the report of 
the Canadian parliament : " The disease is the Greek elephantiasis-the 
leprosy; not the elephantiasis of the Arabians, but the leprosy of the 
middle ages: the lepre tuberculeur of the French, or tubercular leprosy, 
which raged in nearly every district of Europe, from the tenth to the six- 
teenth century. It is the decided opinion of the gentlemen composing the 
commission that this disease is contagious; and so far as they could ascer- 
tain, no person in the above districts who contracts it is ever cured. It is 
also their opinion that it has no affinity to scrofula; and the idea prevail- 
ing that it is owing to the poor diet of the French settlers and their filthy 
habits generally, is not correct, for they found it existing in some of the 
cleanest dwellings and most respectable families. It has spread very 
rapidly during our past year. They have discovered upward of twenty 
cases all of which can be traced up to one source. They have every reason 
to suppose that these cover a greater number, but not having power to 
search, and the inhabitants showing a greater disposition to withhold infor- 
mation or to point out the parties laboring under the disease, they could 
not make so minute an inquiry as they were desirous of doing." 
The President, Dr. Joseph Jones, presented the following as the prac- 
tical conclusions of the results of his personal investigation of leprosy on 
the Bayou Lafourche, Louisiana, during the month of October, 1880 : 
1. The number of cases of leprosy upon the banks of the Lower 
Lafourche appear to be less than has been represented. A sufficient num- 
ber of cases, however, have occurred to excite the earnest attention of the 
public authorities charged with the education, sanitary and legislative 
affairs of the people of Louisiana. 
2. Those afflicted with leprosy should be isolated. Such seclusion or 
isolation may be accomplished by the construction of a leper house, ward 
or hospital in those districts in which the disease exists, to be placed under 
the direction and control of one or more local practitioners of medicine. 
3. It is manifestly the duty of the State to provide for the mainten- 
ance of the victims of leprosy. 
4. The practice of introducing patients suffering with leprosy into 
the crowded wards of the Charity Hospital of New Orleans should be dis- 
continued, and the public authorities of the city or State should provide a 
suitable building or ward where the lepers may be properly isolated and 
secluded. CHAPTER XII. 
The earliest description of leprosy in these Southern States, drawn 
from direct observations, appears to be that given by Captain Bernard 
Romans, in his rare and valuable "Concise Natural*History of Nast and 
West Florida," printed in New York in 1776. The account given by Ber- 
nard Romans of the diseases of the negroes in Western Florida, shortly 
after its passage into the hands of the English, and, which, without doubt, 
also applied to Louisiana under the French and Spanish, is much more 
circumstantial and important than that of Du Pratz. Bernard Romans 
says that the chronic diseases amongst the blacks were leprosy, elephantiasis 
and body yaws, called in Carolina, the lame distemper. The following 
description of elephantiasis and leprosy, as they prevailed in Florida more 
than a century ago, as given by this writer and accurate observer, will 
enable us to understand why, about the same time, there should have been 
any necessity for the foundation of a hospital for lepers near New Orleans. 
A loathsome disease appears sometimes among the negroes after severe acute 
disorders, especially if the patient has been obliged to keep his bed long, likewise 
after a violent exercise has brought on a surfeit, this is called the elephantiasis, 
from the swelling of the feet and legs. It is most frequently seen to affect one leg 
only. In the first stages of this disorder the patient becomes wretched through 
excessive lassitude, which bring on an emaciation of the body; then the corrupted 
juices subside into the leg or legs and feet, these swell; the skin becoming distended, 
shines and shows the distended veins everywhere below the knee; now the skin by 
degrees loses its gloss and beeomes unequal and sometimes scaly. After this chaps 
make their appearance, the glands are stretched and the scales are daily enlarged, 
appearing as hard and callous as the bide of an alligator, notwithstanding which, 
the slightest prick with a pointed instrument will cause the blood to exude. This 
disease affects neither the appetite nor the digestive powers of the body; on the con- 
trary the patient in this, and cheerfulness of spirits resembles the healthiest of men, 
and'the inconvenience of his heavy leg only prevents his ability for the more labo- 
rious part of his duty. No manner of cure has yet been found for this cruel dis- 
order, but the patients often live to a very advanced age under the pressure of its 
yoke, even when it has been contracted in early youth. It is said that the ampu- 
tation of the affected limb is no cure, for the disease will immediately attack the 
sound leg; this I find also affirmed by Hughes, in his Natural History of Barba- 
does. * * * The leprosy, so-called, whether the same as was the cause of pro- 
scription to the unhappy patients under the Mosaic laws, I shall not pretend to 
determine. Certain it is, that it is a nauseous, loathsome and infectious disease, 
sometimes seen among the blacks. This appears first with the loss of beard and 
hair from the eyebrows, swelling of the lobes of the ears; the face begins to shine, 
and brown protuberances appear thereon; the lips and nose swell to a monstrous 
size, the fingers and toes will in the end drop off', and the body becomes at last so 
ulcerated as to make the poor incurable patient really a miserable object, of pity.* 
NOTES ON THE HISTORY OF LEPROSY IN THE SOUTHERN STATES. 
* Concise Natural History of East and West Florida, etc., by Captain Bernard Romans, 1776, 
pp. 255-257. 1218 
Leprosy in Louisiana. 
ESTABLISHMENT OF A HOSPITAL FOR LEPERS IN NEW ORLEANS, IN 1778. 
One of the first measures of Miro's administration, which succeeded 
that of Galvez, in 1778, was one of a most remarkable character in its pur- 
pose, namely, the foundation of a hospital for lepers. Judge Martin says: 
" There being a number of persons in the province afflicted with leprosy, 
the Cabildo erected an hospital for their reception, in the rear of the city, 
on a ridge of high land, between it and the Bayou St. John, which is pro- 
bably the ridge anciently separating the waters of the Mississippi fiom 
those of Lake Pontchartrain."* 
The account given by the historian Gayarref is more detailed and cir- 
cumstantial, and is as follows: 
It is remarkable that leprosy, which'is now so rare a disease, was then notan 
uncommon affection in Louisiana. Those who were attacked with this loathsome 
infirmity generally congregated about New Orleans, where they obtained more 
abundant alms than in any other part of the colony. They naturally were objects 
of disgust and fear, and the unrestrained intercourse which they were permitted 
to have with the rest of the population was calculated to propagate the distemper. 
Ulloa had attempted to stop this evil by confining some of the lepers at the Balize, 
but this measure had created great discontent and had been abandoned. Miro now 
determined to act with more efficacy in this matter, and, in his recommendation 
the Cabildo or Council caused a hospital to be erected for the reception of these 
unfortunate beings in the rear of the city, on a ridge of land lying between the 
river Mississippi and Bayou St. John. The ground they occupied was long known 
and distinguished under the appellation ofZa Terre des Lepreux, or Lepers'1 Land. 
In the course of a few years the number of these patients gradually diminished, 
either by death or transportation, the disease disappeared almost entirely, the hos- 
pital went into decay and Lepers' Land remained fora considerable length of time 
a wild-looking spot, covered with brambles, briars, woods and a luxurious growth 
of palmettoes. It is in our day a part of Suburb Treme, and is embellished with 
houses and all the appliances of civilization. 
I possess no data by which to determine the precise nature of the lep- 
rosy of Louisiana, during the days of the French and Spanish Domination; 
but it may with reason be supposed that several affections were confounded 
with the leprosy of the ancient Egyptians, Hebrews and Greeks, such as 
constitutional syphilis, elephantiasis and the yaws of Africa. In 1872, a 
case was brought from Vermillion parish, for the purpose of obtaining my 
medical advice and treatment. Upon examininatiou, I concluded that the 
case was one of leprosy. I lost sight of this case up to October, 1877, when 
the following information was furnished by Dr. W. G. Kibbe, of Abbeville, 
Vermillion parish, Louisiana: 
New Orleans, October 12, 1877. 
Professor Joseph Jones, New Orleans: 
Dear Sir-I have been requested by Dr. W. D. White and Dr. R. Segrera, of 
Abbeville, in Vermillion parish, to present the following facts with reference to 
certain cases of leprosy. lam informed by Drs. White and Segrera that one of 
these cases, Felicien Ourblanc, visited New Orleans in 1872, for the purpose of 
obtaining your medical opinion and advice as to treatment. I am informed that 
your former student, Mr. Isaac Wise, of Abbeville, Vermillion parish, accompanied 
this patient to your office. After a careful examination you pronounced the case 
one of leprosy. I have seen several of the cases and was consulted by Joseph 
Drouet, fifth case. You will oblige Drs. White and Segrera, as well as myself, by 
giving us all the facts in your possession upon the history of this disease and 
related diseases in the Southern States. Respectfully yours, 
W. G. KIBBE. 
* The History of Louisiana from the Earliest Period, by Francois Xavier Martin, vol. ii, p.75. 
+ History of Louisiana: Spanish Domination, pp. 166-167. Leprosy in Louisiana. 
1219 
LEPROSY IN VERMILLION PARISH, LOUISIANA. 
The first case was an old lady, Mme. Ourblanc. She was the daughter 
of Drouet (who came from the south of France many years ago). In 1866 
or 1867 she showed symptoms of disease. There was no physician called 
in. Her husband being a native of and raised m France seemed familiar 
with the disease and recognized it to be that of leprosy, and it was useless 
to have her treated as it was incurable. From the time of its appearance 
in his wife Ourblanc separated himself from her, fearing contagion. 
During the year 1870 she died, I am told, from exhaustion, as there was 
extensive ulceration.* She raised four sons and two daughters. Oue of 
the daughters died during the late war from an acute disease; was grown 
and married at time of her death. The second daughter is living in Ver- 
million parish and is reported to have leprosy, but I have no positive 
proof of its correctness. 
The next case was Felicien, second son of Mme. Ourblanc, aged about 22 years 
when it made its appearance in 1871. He was clerking in a dry goods store in 
Abbeville at the time and remained there about the year after, when he came to 
New Orleans to be examined by Professor Joseph Jones, who pronounced the dis- 
ease leprosy. Soon after this he went to New York to be treated and then to the 
Hot Springs in Arkansas; from there he went to Shreveport, La., and engaged in 
business, and is there at present, still suffering fiom the disease.! The third and 
fourth cases appeared near the same time about 1872, in the oldest son, Denanceux, 
aged about 30 years, and the youngest son, Pierre, aged about 18 years at time of 
its appearance. In the case of Denanceux the disease seems to be running its 
course more rapidly than in the others. He is unable to do any kind of work and 
much reduced in flesh and strength; is completely disfigured, scarcely looking like 
a human being, his beard, eyebrows and eyelashes having all fallen out and hair 
is growing very thin on his head. Dr. Youngf, of Abbeville, informs me that 
there is complete anaesthesia of face, and hands and toes are in state of ulceration. 
He also tells me that the first thing he observed in all the cases he saw was a bright 
red spot on forehead. The above four cases originated in the town of Abbeville. 
The fifth case is that of Joseph Drouet, aged about 35 years, and lives about 
eight miles from Abbeville. He is the son of Baptiste Drouet, who was a brother 
of Mme. Ourblanc. He applied to me during the summer of 1877 to be treated. 
* Her fingers and toes had dropped off at the joints, and her body was covered with extensive 
fetid sores. She was not treated by any physician. N. O. M. and S. J., June, 1879. 
t It first appeared as a bright red spot on the forehead, gradually increasing in size with the 
opening of the skin until it covered the whole face. As the disease progressed the bright red 
assumed a dusky appearance. New Orleans Medical and Surgical Journal, June, 1879. In the 
early part of the spring of 1878, before the great epidemic of yellow fever, an individual bearing 
the above name, suffering with Oriental leprosy, called at my office and said that the nature of 
his disease had become known to his neighbors and that they had ordered him to close up his 
store and to leave Shreveport. He attributed this result mainly to my article in the New Orleans 
Medical and Surgical Journal, from whence he said the neighbors had obtained their information 
as to the nature of his affliction. Upon my advice this patient entered the Charity Hospital. 
The following notes were recorded upon the hospital register: Case, Felix Ourblanc (C. 136), 
ward 80, bed 435, native of Fayette parish, Louisiana, age 23 years, occupation merchant. Suffered 
with intermittent fever before the appearance of his presentdisease. Has two brothers suffering 
with the same disease as that which now afflicts him. Disease appeared in 1870 in Vermillion 
parish. Admitted to Charity Hospital June 28, 1878. Skin on face and hands nodulated and red. 
Partial anaesthesia of hands. Disease leprosy. During the eight days between June 30 and July 
10 the temperature of the axilla ranged between 99° to 99.°5 in the morning, and from 100° to 100.°75 
in the evening. He passed from 60 to 70 fluid ounces of urine daily, of sp. gr. 1008 to 1010. No 
albumen in the urine. Patient complained of the hospital fare and was discharged at his own 
request on July 11, 1879. These notes were recorded by C. A. Bourgeois. 
I He was very reluctant to speak about his disease, but we succeeded in eliciting from him 
that when first taken he felt more or less erratic pains, particularly in the posterior part of the 
thigh and back of leg. At present he suffers no such pain and boasts that his general health is 
good. His fingers are quite hard and stiff and as cold as marble. He has lost several finger nails, 
and the ends of one or two fingers show a tendency to ulcerate; his toes are ulcerated. His voice 
is quite coarse and husky, and, unless quite near, one cannot understand him when speaking. 
The pharynx, larynx and palate seem much ulcerated. There are several nodules on his hand; 
his eyebrows and eyelashes have entirely fallen out and beard gradually becoming thin. His 
nose is much altered in shape, being flattened and drawn to one side, having a mashed appear- 
ance. Has the usual leonine expression described by writers. He says he has occasional sexual 
desire; sleeps well; does his own cooking, and performs light work at his trade. The younger 
brother is almost as bad as the one described and presents much the same appearance. Has 
inordinate sexual desire. Reports by Drs. Young and Kibbe, N. O. M. and S. J.. June, 1879. 1220 
Leprosy in Louisiana. 
He states he first noticed the disease in J 875-a small red spot on his face first 
attracted his attention. When I saw him the redness was general over the face 
and slightly purpled; there were several large red spots on chest and a few yellow 
spots, and large dark brown spot on inner side of thigh, extending nearly to knee. 
He said it had been bright red and gradually turned dark. His general health did 
not seem to be much impaired; his eyebrows had become very white, also lashes. 
He has a wife and five small children. As I was not practising I declined treating 
the case. 
< 'ase six was Madame Albert Guedry, daughter of a Dubois, who is of French 
descent, but as far as I have learned, is not related to the Ou rblancs or Drouets. She 
has two children, and I am told the disease is making rapid progress. She was 
married, I think, in 1873, and Dr. Young informs me, had the disease at the time. 
She is supposed to have contracted the disease from nursing Madame Ourblanc 
during her last illness. This young girl was the only one who would remain con- 
stantly with her, except an old negro woman who attended to the room. The old 
negro woman says the young girl would frequently lie on the bed occupied by 
Madame Ourblanc. 
Seventh case is of more recent occurrence. It is a young man by the name of 
Clemens, aged about twenty years; lived a few miles west from Abbeville, and is 
said not to be related to either of the families just named, and is suspected to have 
contracted the disease by contagion. In 1875 Pierre Ourblanc was peddling through 
the parish, and would frequently stop over night at the house where this young 
man was staying, and they slept in the same bed. In 1877 the young man applied 
to a physician to be examined and treated; the disease was recognized at once as 
leprosy.* There are several other cases reported to be in the parish, but there is 
not sufficient evidence to justify me in stating the cases to be leprosy. The hus- 
band of the old lady who died of leprosy is now living in Abbeville, apparently in 
fine health.J 
The description of the preceding cases by Dr. Kibbe corresponds with 
my own observations on this disease in Louisiana, which presented in well 
marked cases discoloration of the skin, dusky red or livid tubercules of 
various sizes on the face, ears and extremities; thickening or rugous state 
of the skin, a diminution of its sensibility, and falling off of the hair, 
excepting that of the scalp; hoarse nasal or lost voice; ozoena; foul stinking 
breath; loss of mobility in the fingers and toes; ulceration of the surface, 
and especially about the joints of the toes and fingers; extreme fetor; diffi- 
cult respiration, swelling of the fingers and toes, with fissures on the integ- 
uments; muscular atrophy; the face and countenance so disfigured with 
tuberous knots as to appear deformed and horrid, like that of a satyr or 
lion. The following cases of Oriental leprosy have been observed by me 
* Only two of these cases have been under treatment, the fourth and sixth, but w'ithout any 
benefit therefrom. They all belong to the anaesthetic variety. It is our opinion that cold 
weather is better borne than warm, for the above cases all seem to suffer more in summer than 
winter." Drs. Young and Kibbe, N. O. M. andS. J., June, 1879. 
I Dr. L. F. Solomon, in his Report to the Louisiana State Medical Association, April, 1879, 
says: "In the city of New Orleans I have learned of six cases, as follows: One in the Third Dis- 
trict, exact residence not known at present; one case, formerly at the corner of St. Charles and 
Poydras streets; one case on Common street, near the Charity Hospital, and three cases in the 
female surgical ward 38 of the Charity Hospital., These cases, with one exception, belong to the 
tubercular variety, and all present about the same history, with the exception that none are able 
to trace the disease to heredity. The history of one of the cases in the hospital will serve as a 
type of the others: She is a white woman, aged twenty-four. About nine years ago the disease 
began by fleeting pains in the limbs, followed in a short time by red spots about the face, which 
soon became of a red color. On these spots small tubercles made their appearance and have 
increased in size until some of them have reached that of a marble. The whole cutaneous sur- 
face is of a bronze color. There are ulcerations at the ends of the fingers and toes; sensation is 
almost entirely left in the hands, though this did not occur until a very short, time ago. The 
mucous surfaces are all affected. Her voice is harsh, hearing and sight diminished to a great 
extent. At present she complains of no actual pain, but a burning sensation in her limbs occa- 
sionally. She menstruated before the disease developed, but has ceased to do so since the first 
appearance of the tubercles. She sleeps and eats well. Her face and hands are studded with 
nodules varying in size. Dr. Pratt, house surgeon of the hospital, informs me that the three 
cases have been put under various treatments, but without beneficial results. I will here add 
that I have been informed of another case, of the tubercular variety, in the person of an adult 
female residing on Tchoupitoulas street, between Richard and Orange, in this city, thus making 
fourteen cases in all, of which eleven remain in the State. There may, doubtless, be other cases 
which have not come under the notice of physicians." Proceedings of the Louisiana State Med- 
ical Association, at its meeting held in the city of New Orleans, April 9,10 and 11, 1879, p. 23. Leprosy in Louisiana. 
1221 
in the Charity Hospital, and two of them have been under my treatment 
in ward 13: 
Case 1088.-Numa Kern; age 25; native of Louisiana; Bayou Lafourche, near 
Labadieville. Farmer; height, 5 feet 4 inches; weight, 110 pounds; parents and 
grandparents natives of Louisiana, Bayou Lafourche, in Lafourche parish. Brown 
hair, grey eyes, mild uncomplaining disposition. Cannot tell whether his ances- 
tors came from France or Canada, to Louisiana. Gives no history of leprosy in his 
family. Both parents dead; mother died in confinement; father of unknown cause; 
two brothers died some years ago of yellow fever; one brother and sister living in 
good health. Affirms that he has never had any form of venereal disease. Gives 
no history of any constitutional disease in his family; and knows of no similar dis- 
ease to that with which he sutlers, amongst his neighbors. Says that he has little or 
no sexual appetite. Has less sexual desire now (December 8, 1879) than before the 
advent of the disease three years ago. Entered Charity Hospital, ward 30, July 
17, 1879. December 5, 1879, patient says that he has suffered with leprosy for three 
years; complexion clear and apparently healthy before the advent of the disease. 
At the present time the surface presents a dark, yellowish brown, bronzed and livid 
appearance. Patient states that the disease commenced with some pain in the left 
thigh above the knee joint, which was followed by a large ulcer. About the time 
of the appearance of this ulcer the patient states that he was attacked by an acute 
inflammatory affection in the feet and legs, which was swollen above the knees. 
This was accompanied with fever, and the physician attending called the affection 
erysipelas. Ulcers of the lower extremities subsequently made their appearance, 
and the feet presented symptoms of altered sensation; they felt benumbed. Above 
the knee joints on the left thigh lower third, there is a distinct circular cicatrix 
about three-fourths of an inch in diameter, which the patient affirms to be the ori- 
ginal ulcer which ushered in his disease. There is a similar scar upon the outer 
aspect of the left elbow which the patient affirms had no relation to the disease, 
but was caused by fire. Inferior portions of the lower extremities; feet and ankles 
deeply discolored, enlarged cedematusaud extensively ulcerated. There are seven 
ulcers of considerable size on the left leg. The largest ulcer on the left leg is about 
one and three-quarter inches in longest diameter and a little over one inch in the 
short diameter, oval in form, deeply eroded with elevated edges (rounded and not 
everted), and with central greyish foul moist looking centre. This ulcer is situated 
in the outer aspect of the foot and ankle joints. Right foot swollen, discolored, 
with thickened or nodulated integument as in the case of the left foot. A large 
ulcer two inches in diameter is situated in the bottom of right foot. The edges of 
this ulcer are not so regular nor so elevated as in the case of the ulcers upon the 
legs. This difference appears to be due to pressure in walking. Surface of the 
ulcer like those elsewhere of a grey, foul, unhealthy hue, with a moist aspect. The 
discharge, however, is thin, and bears no resemblance to laudable pus. Another 
large ulcer, with elevated rounded edges and dark grey surface (one and one-quarter 
inches in diameter), is situated on outer aspect of leg about two inches above the 
ankle joint. The nails of the toes present a discolored and diseased appearance; 
those of the big toes especially appear to be diseased, the surrounding integument 
being swollen and discolored. Integument of face of bronzed color thickened 
and nodulated. Sensation benumbed or destroyed over the integuments of the 
feet and legs, as far upas knee joints. Skin of integuments of a mottled, purplish 
bronzed hue; with a scaly cracked unhealthy epidermis. The nails of the toes are 
discolored, opaque, wrinkled and partially detached. The skin of the upper 
extremities is ridged, scaly and semi-opaque. The sensation in the upper extrem- 
ities is impaired, but not to so great an extent as in the lower extremities. The 
capillaries of the face appear to be dilated. Patient says that the ulcers of the 
lower extremities give him pain only when he stands or walks. 
Observations upon the pulse and temperature and urine have been made under 
my direction at various times, thus: October 16, M. temp, of axilla 98.°5; E. temp. 
99°; pulse 86. October 17, M. temp. 98.°8; pulse 78; E. temp. 99.°5; pulse 84. Octo- 
ber 18, M. temp. 97.°5; pulse 80; E. temp. 99°; pulse 82. October 19, M. temp. 98°; 
pulse 81; E. temp. 99.°4; pulse 85. October 20, M. temp. 98°; pulse 76; E. temp. 99°; 
pulse 90. October 21, E. temp. 99.5°; pulse 82. October 22, E. temp. 98.°8; pulse 
82. October 23, M. temp. 98.°8; pulse 91. October 24, M. temp. 99.°2; pulse 94. No 
distinct intermission or remission was observed in the temperature, and the oscil- 
lations were within those limits which might be regarded as normal, The pulse 
was, as a rule, feeble. The appetite and digestion have been good and the bowels 1222 
Leprosy in Louisiana. 
regular. The patient, during the period which he has passed in the Charity Hos- 
pital, has been up and dressed in the day time, and walks about the hospital 
grounds. Always manifests a quiet and docile disposition, and readily consents 
to an examination of his entire person at any time that I saw fit to exhibit him to 
my students. 
Up to the 1st of December, from time of entrance into the Charity Hospital, 
took pill containing | grain nitrate of silver, and 1-13 grain arsenious acid and 2| 
grains subnitrate of bismuth, morning and evening. No beneficial results were 
observed. At the date above mentioned the stomach became irritable and the 
appetite failed and the medicine was discontinued, and I substituted 10 grains of 
the sulpho carbonate of sodium three times a day. The ulcers were, during the 
months of October and November, dressed with an ointment comprised as fol- 
lows : B. plumbi iodidi, 1 drachm; acidi carbolici (sat. sol.), 2 fluid drachms; pulv. 
opii, 10 grains; cerati simplicis, 2 ounces; mix. Apply locally to ulcers and sur- 
round with soft English lint. No marked benefit was observed from the use of 
this ointment, and on the 1st of December I substituted the following: B. pulv, 
opii, 10 grains; acidi carbolici, 2 drachms; acidi tannici, 1 drachm; simple cerate 
2 ounces. 
Examination of blood, December 6th, 1879.-When drawn the blood presents a 
thin, watery appearance; under the microscope the colored corpuscles presented tt^e 
usual bi-concave figures. The colored corpuscles tended to run together and form 
rolleaux as in the blood of inflammation. Large pigment corpuscles and pigment 
granules-similar to those which I have often observed in the blood of those suffer- 
ing under the prolonged action of the malarial poison-were seen. The colorless 
corpuscles presented a more granular appearance than usual, and many of then! 
contained small globules, which appeared to consist of oil. 
Examination of the discharge from the leprous sores.-The leprous sores dis- 
charged a saneous, foetid liquid, which under the microscope was found to contaip 
much granular matter, pus corpuscles, fibrous tissue, fragments of blood-vessels 
(the small vessel, with its branches, was of an opaque, crimson color from the 
coagulated blood) and bacteria. The bacteria were most probably introduced from 
without, and did not appear to have any distinct relations to the leprous ulcera- 
tions. The odor of the body of this patient was most disgusting, resembling very 
nearly that of a mangy, unwashed, filthy dog. The breath was foul and foetid. I 
have examined the urine of Kern upon several occasions, without detecting any 
albumen. The urine is clear, of an orange color, acid reaction, and without 
deposits. Albuminuria is said to be present in some grave cases of leprosy. This 
patient died from the immediate effects of an exhausting and uncontrollable diar- 
rhoea during the summer of 1880. 
The autopsy was performed by Professor H. D. Schmidt, pathologist of the 
Charity Hospital, who furnished the following notes : 
" Heart of normal size. Both the tricuspid and mitral valves were thickened 
throughout by new plastic growth in the form of nodules. Corpora of the semi- 
lunar valves of the aorta greatly enlarged. Valves of the pulmonary artery 
healthy. Considerable portions of the lining membrane of the aorta and pulmon- 
ary artery were of a scarlet tint. The cut muscular walls of the left ventrical of a 
dark red color. Lining membrane over the foramen ovale, much thickened and of 
a white color. 
Alimentary canal.-Blood-vessels intensely congested throughout the whole 
alimentary canal (stomach included). Solitary glands and Peyer patches swollen 
and many of a brownish color, lymphatic glands of the abdomen greatly swollen. 
Kidneys.-One of these organs was of the natural size, but misshapen. When 
cut longitudinally the cortical substance of about two-thirds of the organ presented 
a condition of intense congestion, while the remaining third presented the yellow- 
ish tint, indicating degeneration of the parenchyma. The other kidney was below 
the normal size and was still more misshapen, consisting of three large and two 
small lobes. When divided this organ presented the yellowish tints of degenera- 
tion, with a narrow red congested border directly under the capsule. 
Spleen.-- Enlarged, nearly twice the normal size, and misshapen, though nor- 
mal in color and consistence. When cut the trabeculje and parenchyma exhibited a 
normal appearance. 
Liver.-Normal size, quite soft, normal color, though in many places paler 
than usual and somewhat yellowish. When cut the cut surface exhibited many 
small white points. The gall-bladder contained a golden-colored bile. Lungs 
normal. Leprosy in Louisiana. 
1223 
Case 10S9.-Donacien Ourblanc.-Age 36 years; native of Lafayette Parish, 
Louisiana; has resided in the town of Abbeville, Lafayette Parish, during the last 
twenty-two years; is a carpenter by trade; habits temperate. Admitted to the 
Charity Hospital of New Orleans January 14th, 1880, ward 29. Immediately upon 
the completion of my examination of this case, I decided that it was undoubtedly 
Oriental leprosy, and transferred him to ward 13, where the preceding case (1088 
-Numa Kern) was under treatment. He states that his mother was, during the 
last five years of her life, subject to an affection of the skin, which produceci dis- 
figurement and discolorations of the countenance, and more especially of the nose, 
and falling of the eyelashes. She died from this disease at the age of 55 years. 
On inquiry, it was ascertained that a man by the name of Felix Ourblanc, who 
was admitted to the Charity Hospital, ward 30, with leprosy, during the early part 
of the summer of the year 1878, was a brother of this patient. Donacien Ourblanc 
stated that he has two other brothers and a sister in good health, and without any 
evidence of being afflicted with leprosy. He also affirmed that he has a first 
cousin whom the doctors of his neighborhood pronounced had leprosy. The fol- 
lowing history of his case was elicited after much questioning: Previous to the 
occurrence of his present ailment, the only physical trouble with which he had 
ever suffered, was a gun-shot wound of the thigh, inflicted about nine jears ago. 
Five yearsago he first noticed an erythematous eruption upon the right half of his 
chin, causing a furfuracious desquamation, and the loss of his beard at the situa- 
tion of the eruption. This was followed by the loss of the eyelashes and eyebrows. 
About the same time, the skin on those parts began to present the peculiar discol- 
oration, which at present extends over the greater portion of the body. From 
these points the disease spread gradually over the whole face, invading the mouth, 
tongue, pharynx, larynx and oesophagus. About one and a half years ago, the 
lower and upper extremities were invaded. Occasionally, oedema of the lower 
extremities supervened when at his work, which disappeared at night upon assum- 
ing the recumbent posture. Patient suffered a great deal from dyspnoea, and with 
orthopnoea previous to and subsequently to his admission to the Charity Hospital, 
which symptoms occasioned much loss of sleep. In order to relieve the difficulty 
of breathing from the thickening and ulceration of the mucous membrane of the 
larynx, it became necessary to perform the operation of tracheotomy. This opera- 
tion, without doubt, prolonged life, but was also the source of much subsequent 
suffering. The patient also states that repeated epistaxis preceded the first appear- 
ance of the leprous eruption. 
At the time of the admission of Donacien Ourblanc, the disease affects the 
whole of the face and neck, hands and forearms, and 'the legs up to the knees. 
These parts present a brownish hue thickened nodulated skin and rigid epidermis, 
with entire absence of pain. Sensation does not appear to be greatly impaired 
about the face and neck, whilst anaesthesia is well marked in the fingers, and more 
especially in the last three of the left hand. The feet and legs also in the neigh- 
borhood of the ulcers have lost their normal sensation and sensibility. The skin 
in these parts presents a more reddish, smooth and glossy hue than elsewhere. 
Nodulations exist upon the fingers, which are most numerous upon those of the 
left hand. The nails of the right hand present an abnormal translucent appear- 
ance; those of the middle and ring finger of the left hand are invaded by the dis- 
ease; the former is nodulated and presents a small dry non-granulating ulcer on its 
outer edge. The ulcers upon the legs began to make their appearance two years 
ago, in the neighborhood of the ankle joints. At the time of his admission to the 
Charity Hospital, there are five ulcers, three on the left leg, and two on the right 
leg around the ankles, the largest being about three and a half inches in the long 
diameter and two inches in the short diameter. These ulcers are deeply eroded, 
uncovered by scabs and of a purplish, greyish unhealthy hue, without granula- 
tions, and discharge a foul foetid ichorous discharge. Under the microscope the 
blood of the patients as well as the discharges from the ulcers presented appear- 
ances similar to those recorded in the preceding case. The eyebrowsand eye- 
lashes have fallen; the lips are somewhat deformed, and present nodulations: nodu- 
lations were also observed in various portions of the face, and also upon those por- 
tions from whence the eyebrows have been removed. The mucous membrane 
of his lips and mouth presents a smooth and dry appearance. The nose has lost 
portions of the bone, and is flattened and drawn down towards the left side. Num- 
erous small dilated blood-vessels are seen in various portions of the face. But the 
ramifications of these vessels are easily detected in the nose and chin. The tongue 
presents bluish, smooth and elevated areas, along the middle line; the papilae 
enlarged and nodulated. On the tip of the tongue, to the left of the meridian line, 1224 
Leprosy in Louisiana. 
an excavated n on-granulated and painful ulcer is found. The whole organ, as well 
as the mucous membrane of the mouth and fauces and pharynx, give painful sen- 
sations when used. A circumscribed arc of congestion is seen in the left anterior 
pillars of the fauces; the rest of the mucous membrane of the mouth and fauces 
presenting on the contrary a lighter color than usual. At the roof of the pharynx, 
the mucous membrane is nodulated and hypersemic; complains of dysphagia and 
dyspnoea. The voice is much altered, being husky; articulation is difficult. The 
patient is harassed by a croupy cough, which is worse at night, and attended with 
a scanty mucous expectoration. The breath is foul, disgusting and sickening. 
Appetite and digestion good; does not complain of the lossof taste, sight, audition 
or smell. The eyes do not appear to be affected at all by the disease. The patient 
appeared to be adverse to the free expression of the past history of his disease, and 
was very reticent about his family. Says that he continued to work at his trade 
until a very recent period, then the dyspnoea, depending upon an invasion of the 
respiratory passages by the leprous disease, prevented the performance of labor of 
any kind. The difficulty of breathing increased to such an alarming extent that, 
in the month of February, 1880, it was found to be necessary to perform tracheo- 
tomy, and to introduce a silver tube into the larynx, through which the patient 
continued to breathe for several months up to the time of his death on the 10th of 
December, 1880. The nitrate of silver, red iodide of mercury; iodide of potassium 
and free iodine and other remedies were in turn employed, but without any bene? 
ficial effect. No local application appeared to stay the march of the ulcerations. 
On the first of April, when my duties at the Charity Hospital were temporarily 
suspended, the patient, although able to move around the hospital, was evidently 
weaker than when he had entered the hospital and erosion of the textures was 
progressing. I attributed the accelerated progress of the disease in a measure to 
the confinement and impure air of the hospital. Although free ventilation was 
maintained in ward 13 and disinfectants were freely used the patient and Kern 
communicated a most foul and disgusting smell. Upon resuming my duties at the 
Charity Hospital, I found Donacien Ourblanc in even a more pitiable condition 
than when I had left him in April; he was confined to his bed; coughed incessantly; 
the ulcer of the legs had made extensive ravages, exposing the tendo Achilles; 
and the bowels were loose, the discharges being of the most offensive and foul 
character. The entire ward was pervaded by a heavy, fetid smell, which, in spite 
of good ventilation and the free use of the chloride of lime and other disinfectants, 
was almost unbearable. Death happily came to the relief of this wretched man on 
the 10th of December, 1880. The fatal issue appeared to have been hastened by 
the foul and exhausting discharges from the bowels. It is worthy of note that 
although the preceding cases, 1088 and 1089, were trea'ed in ward i3, which con- 
tained at all times some twenty patients suffering from paralysis of various kinds 
and induced by various causes, chronic articular rheumatism, epilepsy or constitu- 
tional syphilis, in no instance was the disease transmitted. 
The following case presents special points of interest and appears to 
sustain the generally received opinion as to the contagious nature of Ori- 
ental leprosy: 
Case 1090.- Charles Boglloli, Catholic priest. Charity Hospital, DecemberGth, 
1879; age 66 years; height 5 feet 111 inches; weight, in health, 205 pounds; power- 
ful, well formed, erect, active muscular man. Native of the Appenine mountains, 
in the province of Lombardy, about forty miles from Genoa, Italy. Resided 
amongst the mountains in this portion of Italy until he attained the age of 26 
years. From Italy he went to Paris, France, where he remained two months, and 
from thence crossed the Atlantic directly to New Orleans, which port he reached 
December, 1840. Remained in New Orleans three months and then went to Mis- 
souri and remained in this State and Ohio (Perry county, Cape Girardeau and St. 
Louis, Mo., Brown county, Ohio), until the month of February, 1850, when he 
returned to New Orleans. During the years 1847-1848 he filled the chair of 
geography in the Catholic College at Cape Girardeau. In 1850 he remained only a 
short time in New Orleans, and went to Donaldsonville, Louisiana. Had yellow 
fever in this place in 1856, and was attended by Drs. Johnson and McCormick. 
Was regarded as dangerously ill. Served as chaplain to the Donaldsonville Can- 
noneers for eleven months, 1861-1862, and then returned to Donaldsonville, where Leprosy in Louisiana. 
1225 
he remained until 1866, when he removed to New Orleans. I made the acquaint- 
ance of Father Boglioli in the winter of 1868. He was then in good health; erect 
and strong, with clear, ruddy complexion. The first symptoms of ill-health were 
manifested during the winter of 1875. Up to this date he had enjoyed robust and 
uninterrupted good health, with the exception of the attack of yellow fever in 1856. 
During the winter of 1876, during a visit to Donaldsonville, took a "severe catarrh" 
in his head, which caused swelling of the mucous membrane of the nostrils and 
impeded respiration. In 1877 Father Boglioli consulted me with reference to the 
"catarrh in his head." The mucous membraneof the nostrils wasswollen and nod- 
ulated and it was difficult for the patient to " breathe through his nose." Grad- 
ually the skin of the nose and face become nodulated and lost their healthy hue, 
assuming a dirty bronzed color. The mucous membrane of the mouth and tongue 
also became ulcerated and painful, both hot and cold liquids being disagreeable. 
A sore on the left leg appeared in 1878, and at the same time the lower extremities, 
especially the soles of the feet, manifested aberrations of sensation. The integu- 
ment of the lower extremities became thickened and discolored. Standing and 
walking felt painful, and at night the parts burned and tingled as if they had been 
withdrawn from a "very hotwater bath." The leprous ulcer was about one-half of 
an inchin diameter, and appeared after the affection of the Schneiderian mem- 
brane. This ulcer is now healed and no other ulcerations have appeared upon the 
upper and lower extremities. The nails became affected about one year ago. At 
the present time, December 6th, 1879, the nails are thin, corrugated, opaque, with 
a scaly deposit underneath, and their extremities are lifted up from the Angers 
from the pressure of this scaly deposit. Skin of hands scaly, with a densely mot- 
tled, purplish and bronzed hue. Skin of lower extremities thickened, nodulated 
and discolored. Lips and fauces of patient of an unhealthy purplish and bronzed 
hue. Large ulcer about one inch in the long (transverse) diameter, elevated edges, 
depressed raw surface of a grayish yellowish coat in the fauces. 
Father Boglioli says that he has lost the sense of smell and to a great extent 
that of taste. Suffers greatly when cold or hot liquids are taken into the mouth. 
When he sleeps at night is compelled to keep his mouth open on accountofthe 
difficulty of breathing through the thickened, nodulated mucous membrane of his 
nostrils. The burning sensation in the soles of the feet especially (and a painful 
sensation in the lower extremities, generally when walking), was most intense 
during the first three months of his illness, and, for a time, greatly impeded loco- 
motion. has almost entirely disappeared, and, with the exception of the difficulty 
of breathing through the nostrils and the painful sensations in the mouth and 
throat during the act of swallowing, Father Boglioli affirms that, at the present 
•time, he feels strong and well and has sufficient strength to attend to his duties 
amongst tbe sick and dying. During the earlier and more active stages of his dis- 
ease lost considerable flesh, but has been increasing in weight of late and now 
weighs about 170 pounds, his weight in health being 205 pounds. 
Examination of Blood, December 6, 1879. Blood presents a much richerand 
more concentrated appearance than that of the preceding case. Blood corpuscles 
(colored) well formed, not distorted in shape, and after abstraction adhere together, 
forming roulleaux, as in the blood of inflammation. Colorless corpuscles appeared 
in the usual proportion to the colored corpuscles, and no bacteria or extraneous or 
abnormal bodies were observed. I did not observe the colored pigment corpuscles 
which existed in the preceding case. The sensation in the hands is impaired and 
that in tbe lower extremities almost entirely lost. Hair has fallen from the eye- 
lashes and eyebrows. He has, however, a full suit of gray almost white hair upon 
his head. During the month of August, 1879, took nitrate of silver in pill, but 
without any appreciable benefit; in fact, this agent administered in doses of equal 
strength, as were administered in the preceding case, appeared to derange the 
stomach and impair the appetite. Says that coal oil was recommended as a local 
application to the surface of the extremities and that he had used it with some 
apparent benefit in hardening the integument and rendering it less sensitive to 
pressure and to extremes of heat and cold. During the first two years of the disease 
had little or no appetite and lost flesh progressively until his weight was reduced 
from 205 pounds to 157 pounds. During the past six months his appetite has 
returned, his physical strength has increased and he now weighs 170 pounds. 
With reference to the origin of the disease, Father Boglioli states that he was reared 
in a high, mountainous country in Italy, where such affections, as far as his 
information extends, were unknown. Neither his parents, nor grand parents, nor 
any of his relations, as far as his information extends, had ever suffered from any 
constitutional or cutaneous disease. 1226 
Leprosy in Louisiana. 
During the past fourteen years Father Boglioli has attended daily in the wards 
of the Charity Hospital, administering religious consolation and extreme unction 
to the sick and dying in both the male and female wards. During this period he 
has probably come in contact with over 50,000 cases of disease in the Charity Hos- 
pital. I have myself for eleven years been witness to his faithful labors in behalf 
of the Catholic Church. He says that about six years ago he attended two cases of 
leprosy in ward No. 7 and administered extreme unction to them, and rubbed their 
hands with oil during the administration of certain religious rites. Has in like- 
manner attended the several cases of leprosy in his capacity of religious adviser and 
pastor in the male and female wards. This case has given rise to the belief that he 
has contracted his distressing disease, which has altered his aspect, causing a thick- 
ened and nodulated and bronzed, mottled appearance of the entire cuticle, by con- 
tact with those suffering with leprosy in the wards of the Charity Hospital. 
Case 1091.-Oriental leprosy.-Madame Rosetta Francisco.-Ward 38, Charity 
Hospital, New Orleans, Louisiana. Age 63 years; native of Richmond, Virginia. 
Has resided in Algiers, Louisiana (opposite New Orleans, on the banks of the 
Mississippi), during the past forty years until her admission into the Charity Hos- 
pital, April, 1874. Admitted in her 59th year. Came to Algiers when she was 18- 
years of age. Gives the history of constitutional disease in her family. Her 
father, of Spanish descent, but born in England, died of apoplexy in Richmond, 
Virginia. Mother died in child-bed at her birth. Had two brothers who went to 
Kentucky during her infancy; has never heard of them since. Had no sisters. 
Both father and mother enjoyed good health up to their last illness. Had never 
seen or heard of a case of leprosy until she entered the Charity Hospital in 1874, 
for the purpose of having her breast amputated, when she was told by the attend- 
ing surgeon that s-he was suffering with leprosy. After the amputation of the 
mamma was sick only eleven days-the wound healed in this period. Has been 
married; has never borne children. Her husband was of intemperate habits, and 
suffered from no ailments but those caused by alcoholic drinks. Just before the 
recent civil war he went to France, where he died of apoplexy, supposed to have 
been induced by " excessive drinking.1' Previous to the American Civil War she 
owned a plantation and slaves and lived in comfort. During the war lost her 
property and was compelled to earn her living by keeping a small store. 
In the winter of 1863, after a day of great fatigue and exposure, whilst cross- 
ing and recrossing the Mississippi river, the ground being covered with snow, 
her feet were frost-bitten. The toes of both feet became purple, and the skin 
sloughed off in different places, but the toes were not destroyed. Mrs. Francisco, 
in recalling her various symptoms, fixes the date of her present disease (leprosy) at 
the time, or immediately after, the "frost-bite" of her feet. The integuments of 
the toes were not only of a purple, mottled hue, but there was a tingling and 
aching sensation when she approached them to the fire. The feet never regained 
their normal sensation, and the integuments became gradually thickened, nodu- 
lated and discolored. Sensation in the lower extremities gradually diminished, 
and was completely lost in 1873. The discoloration of the skin of the face com- 
menced about six years ago, and the lobes of the ears assumed a thickened, nodu- 
lated appearance. In 1874 the integument of her hands became thickened and 
scaly, and during this and the following year (1875) sensation was lost in the backs 
of her hands; and one day she discovered that a pin stuck in the back of her hand 
gave no pain. During the past year hard nodules have appeared upon the fingers 
and hands; and during the same period there has been a progressive and gradual 
failure of vision, hearing and taste. There appears to have been no impairment of 
the intellectual faculties. At this time, December 3d, 1879, the patient is confined 
to her bed; complains of a numb and burning sensation in her hands and arms, 
which has gradually progressed from the fingers, upwards above the elbows. The 
nodular swelling of the hands and face appear to lie beneath and adjacent, and 
attached to the discolored bronzed integument. These nodular masses are not more 
painful than other portions of the integument. During the past six months these 
nodules have at various times in different portions of the integuments of the handa 
and arms, ulcerated; but they have never suppurated, being bathed in a sanious 
fluid and emitting a disagreeable odor, presenting dark brown and gray surfaces. 
Breath foul and stinking. The ulcers heal and then break outagain. The patient 
finds relief in covering the nodules and ulcers with surgeon's plaster. In 1876 she 
suffered with catarrh of the Schneiderian membrane, which has continued up to- Leprosy in Louisiana. 
1227 
the present time. The catamenial discharge disappeared in her forty-fifth year. 
Up to the past year had never suffered with fever, but during this year has suffered 
with three attacks of fever and one of dysentery. The catamenia returned about 
six months ago. The patient is feeble from age and from the attacks of fever, 
which appear to have resembled tertian intermittent. The ears are lohulated; the 
integument of the face thickened, nodulated, with a bronzed color; the eyebrows 
and eyelashes have disappeared; the conjunctiva is thickened, and the face has a 
peculiar "frog-eyed expression.'1'1 Appetite poor; says that she was always a mod- 
erate eater. Pulse full and strong, 92 per minute; temperature of axilla 98.°5. 
Case 1092.-Leprosy.-Miss Wilhelmena Boyens.-Age 22; native of New 
Orleans; father died about seventeen years ago of disease of the liver; mother died 
about two years ago of leprosy; father and mother natives of Germany. Has three 
sisters living, one in the hospital at the present time (December 9th, 1879), suffer- 
ing with leprosy; the others are in good health. Had one brother who died seven- 
teen years ago of " consumption.'1'1 States that her mother was sick with a similar 
disease to that with which she and her sister are now afflicted, for ten years before 
her death, which occurred at the age of fifty-one years, on the 19th of January, 
1877. Disease appeared after she came from Germany. Miss Boyens first noticed 
symptoms of disease about five years ago; "catamenia disappeared, and yellow 
spots appeared upon the legs; did not feel sick at this time, but consulted a physi- 
cian." Entered Charity Hospital, ward 21, during the latter part of November, 
1879. December 9th, 1879.-Patient presents an aged and decrepit appearance; the 
surface of the face is nodulated and of a livid bronzed appearance; mouth and lips 
deeply eroded and partly eaten away by leprous sores. Nodulations of the skin 
greatest around the ulcerations of the lips and mouth. An irregular broken scab 
exists around the mouth; the purplish discoloration being greatest in the integu- 
ments bordering the leprous ulcerations. The integument of the chin below the 
lower lip, is the seat of two ulcers, which occasion a burning pain. There are two 
leprous ulcers on the right leg and four on the left. Joints of fingers swollen and 
purplish; leprous ulcers on hands. Eyes present an unnatural appearance with 
thickened conjunctiva. Palate and nares eroded by leprous ulcers; suffers with 
sore throat; voice husky and weak. Pulse weak, 88; temperature of axilla 98.°0. 
Speaks in a whisper, but articulation is more distinct than that of her sister. The 
change in her voice appears to be due to the alteration and ulcerations of the palate, 
fauces and larynx. Tongue smooth, and red and ulcerated; patient cannot pro- 
trude the tongue beyond the lips, and the mouth is opened with pain and diffi- 
culty. Suffers with a cough and muco; purulent, offensive expectoration. Says 
that her tongue gets very dry at night. Complains of disturbed and insufficient 
sleep. After eating suffers with pains in the abdomen. Has most generally two 
actions on the bowels daily. Has occasional cephalalgia in the daytime, which is 
relieved by moving about. This unfortunate woman died May 28th, 1880.* 
Case 1093.- Leprosy. Miss Glendena Boyens, sister of Miss Wilhelmena 
Boyens, whose case has just been briefly detailed. These sisters have resided on 
Esplanade street; age 19 years; has had leprosy about five years, and although 
younger than her sister, the disease appeared in her case one year earlier. Entered 
the Charity Hospital, ward 21, at the same time with her sister, in November, 1879. 
With reference to the origin of her disease, she states that at the age of 14 
years she first felt a rush of blood to her head, then slight headaches followed 
every day; then her nose began to bleed; then headaches came on alternate days, 
commencing at sunrise and disappearing at sunset, subsequently yellow spots 
appeared upon the legs, which she states resembled "pieces of yellow leather," 
unattended with pain. Then a node or nodule appeared upon right leg, which 
pained very much when the patient kneeled. The integument of the face be- 
came nodulated and changed to a bronze color. The patient has never had the 
* Dr. H. D. Schmidt has furnished the following notes of the autopsy: Lungs-Apparently 
healthy, but flabby, collapsing to an unusual extent when the thorax was opened. Heart-Nor- 
mal. Alimentary canal-The blood-vessels of the stomach and intestines were congested. The 
mucous membrane of the duodenum and portions of the small intestines were colored brownish- 
yellow as if stained by bile. A considerable number of the solitary and Peyer's glands were 
thickened and of a brownish tint. The glands of Peyer in the lower portion of the ilium 
appeared to be more diseased than those in the upper part of the intestine. Some ulcers were 
observed in the mucous membrane of the ilium and ascending transverse color. Some brown 
and black spots were observed in the fibrous coat of the ascending colon. The mesenteric lym- 
phatic glands were swollen, and of ablue color from congestion. The lymphatic glands generally 
of the abdomen and thorax were in the same condition. Kidneys-Normal in size; cortical sub- 
stance when cut presented a yellowish appearance; surface of these organs smooth, but they 
appeared to be rather flabby. Spleen-Rather smaller than usual, narrow and elongated m form. 
Supra-renal capsules-Elongated in form. Uterus and ovaries-Quite small. Bladder-Normal 1228 
Leprosy in Louisiana. 
catamenial discharge (menses), the disease having appeared at the time. Two 
years ago her face became nodulated (fourteenth year) and disfigured, and the com- 
plexion, which was originally fair, has become changed to a brownish hue. 
December 7, 1879.-Has lost one toe and part of the first toe from left foot; had 
ulcers upon right foot, but they have since healed. Has lost the nail from second 
toe of right foot; the nails are also partially destroyed from first and third toe of 
right foot. Extremities of a purplish brown appearance. Ulcers broke out upon 
hands about two years ago. Patient cannot breathe through the nostrils. Mouth 
fauces, and hard palate ulcerated. Voice weak. Integument of face of a mottled 
and bronzed appearance, and seamed and scarred with cicatrices of healed ulcers. 
Mouth very much disfigured by leprous ulcerations and nodulations, and cannot 
be opened but to a slight extent. The eyelashes and eyebrows have disappeared; 
the lower eyelids are oedematous, cornea semi-opaque and eyesightmuch impaired. 
Articulation of words very indistinct and difficult. Tongue ulcerated, glazed and 
red, and purple with red streaks. Feels sore and painful during deglutition. 
Hands discolored and scarred, as in the case of the face; the fingers presented a 
mottled purplish and ulcerated surface. Ten deep brown scabs are evident upon 
the left hand; the largest ulceration, round in form with elevated edges, is situated 
just behind the third metacarpeophalangeal articulation. Thirteen scabs and 
ulcers on the right hand. The palms of both hands present ulcerations on the 
lower extremities; the integument of which is thickened; muscles of leg atrophied. 
Appetite good, bowels regular, sleep disturbed, restless. Pulse 94, temperature of 
axilla 98.°75. This patient, although only 19 years of age, looks and speaks like a 
decrepid old woman of at least 70 years of age. Both sisters, Miss Glendena and 
Miss Wilhelmena Boyens, express the belief that their disease was contracted from 
their mother, upon whom they attended during her protracted illness. These 
facts in like manner sustain the view of the contagious nature of Oriental leprosy, 
as well as its hereditary constitution. Miss Glendena Boyens was discharged from 
the Charity Hospital, November 6th, 1880, and returned to her home in the city, 
382 Barracks street, where she lies in a critical condition. 
The following cases of leprosy have been discharged from the Charity Hospi- 
tal during the past year: 
Case 1094.-Charity Hospital, Ward 38.-Johann Domingo. Admitted May 
6th, 1880, native of Germany; homeless; from lower coast; in New Orleans 1 day; 
married; has been sick 13 years. Discharged June 4, 1880. 
Case 1095.-Charity Hospital, Ward 13.-Antonio Gaspaire. Admitted June 
21st, 1880; native of France; gardener by occupation; residence 74 St. Philip street; 
aged 58 years; resident of New Orleans 20 years; widower; sick 4 years. Discharged 
July 24, 1880. 
Case 1096.-Ward 4|.- William Ross. Admitted May 18th, 1880; native of 
Russia; cook; residence 196 Camp street, came to New Orleans from Boston; has 
resided in New Orleans 10 years. Discharged October 21, 1880. The disease has 
only recently manifested itself. 
At the present date, December 27th, 1880, I can learn of but one case 
of leprosy remaining in the Charity Hospital, namely, case 1091, Madame 
Rosetta Francisco, Ward 38. 
RESULTS OF INVESTIGATION OF LEPROSY ON THE BAYOU LAFOURCHE, 
LOUISIANA. 
The Legislature of Louisiana having considered the reported existence 
of leprosy on the Bayou Lafourche of sufficient importance to pass a reso- 
lution requesting the Board of Health to make an investigation, and the 
Police Jury of Lafourche having urged the necessity of the proposed 
inquiry, the President of the Board of Health responded at the earliest 
practicable moment. Ou the second of October. 1880, the town of Thibo- 
deaux, on the Bayou Lafourche, was selected as the starting point of the 
inquiry, and the following document was prepared by the President of the 
Police Jury: Leprosy in Louisiana. 
1229 
To whom it may concern : 
Dr. Joseph Jones, President of the Board of Health of the State of Louisiana, 
is now at the request of the Police Jury of this parish, on a visit inquiring into the 
facts concerning leprosy said to exist on the Lower Lafourche. All citizens are 
requested to furnish him with such facilities as are possible, to enable him to 
accomplish his object. 
S. J. GRISAMORE, President. 
Colonel Grisamore appointed Mr. John Reagan as guide, a citizen 
well acquainted with the section of the parish in which it was proposed to 
prosecute the investigation. An excellent conveyance was also provided 
by the Police Jury, under the efficient management of Mr. H. Tetrau, a 
resident of Thibodeaux. I was also accompanied by my son, Stanhope 
Jones. It having been reported that the children of lepers, and some who 
were suffering with this disease, were attending the public schools and 
mingling with healthy children, an intense feeling of anxiety and distrust 
had been excited in the minds of some of the citizens of Lafourche. A 
consultation was held with the President of the Police Jury, Colonel S. J. 
Grisamore, and with Drs. Dancerau, Rogers and Fleetwood, practitioners 
of surgery and medicine in Thibodeaux, and it was ascertained that at this 
time no case of leprosy existed in this neighborhood, and only two had 
come within the knowledge of the physicians above named since the close 
of the Civil War in 1865. During this conference the belief was expressed 
that cases of leprosy would be found in and around Lockport, some twenty- 
one miles below Thibodeaux, on the Lower Lafourche. Major Grisamore 
furnished a memorandum of cases which had been reported to the Police 
Jury. 
After leaving Thibodeaux on the 2d of October, the inquiry was con- 
ducted along the banks of the Bayou Lafourche towards the Gulf of Mexico. 
A consultation was held with Dr. Gazzo, Sr., at his office and residence, 
about ten miles below Thibodeaux. This old practitioner stated that no 
lepers would be found before the President of the Board of Health had 
passed beyond Lockport. Dr. Gazzo also expressed his belief as based 
upon an extensive practice extending over near half a century, that there 
were at present, fewer persons afflicted with this disease in Lafourche than 
formerly. When Lockport was reached, a consultation was held with Drs. 
J. Caillouet, C. Melanson, Dr. J. Gazzo, Jr., and Mayor Barker, and it was 
ascertained that nearly all the authenticated cases of leprosy were situated 
below Harang's canal on the Lower Lafourche. 
The general results of this investigation may be thus formulated: 
1. The entire region of country traversed by the Bayou Lafourche is 
low level alluvial laud, which slopes back from the river to the cypress 
swamps and marshes. The waters of Bayou Lafourche are restrained 
within high artificial embankments or levees, which have been annually 
accumulating in height. It has been held by many that the system of arti- 
ficial levees, has caused a gradual rise in the bed of this river. The low 
inhabited strips of land on either side of the Bayou are elevated but a few 
feet above the level of the Gulf of Mexico, and are at all times several feet 
below the line of high water in the turbid bayou, and the entire area of 
habitable and cultivatable land is subject to overflow from floods and 
crevasses. This region is adapted by soil and climate, to the cultivation 
of rice, sugarcane and the orange. Large tracts of country below Harang's 
canal are devoted solely to the cultivation of rice, the fields of this grain 
being irrigated with water from the bayou. Below Harang's canal along 
Office Poeice Jury, Parish of Lafourche, 
Thibodeaux, La., October 2, 1880. 1230 
Leprosy in Louisiana. 
both, banks of the bayou, towards the Gulf of Mexico, the narrow strips of 
land are thickly populated by small farmers; and in many instances the 
habitations arranged behind the levees are surrounded by rice fields. I 
observed places where rice was cultivated up to the very doors of the 
houses. It is evident, therefore, that the inhabitants of the Lower 
Lafourche, are subject to the constant action of a low moist ma'arial atmos- 
phere.* Another point of interest in this inquiry, is that the diet of these 
people consists largely of rice, fish, and wild birds and animals, as the 
various varieties of duck, cranes, snipe, wood cock, raccoon, opossum, squir- 
rels and rabbits. 
It is said that a fish-eating people are ill-nourished, and in Eastern 
countries are particularly liable to become leprous. If this be so, it must 
be associated with such poverty as prevents the inhabitants from obtain- 
ing a proper variety of fresh food and vegetables. Certain districts on the 
Mediterranean Coast of Spain, are cited in illustration of these facts, where 
there is a fish-eating and a poverty-stricken population; and if we turn to 
another fish-eating community-that of part of the west coast of Norway- 
we find the disease, although some of the people are characterized by 
robustness of health and great physical strength. It is possible that the 
prolongation of the leprosy in this and similar regions, whilst it appears 
to have gradually become extinct in the more elevated and healthier por- 
tions of Louisiana, may in a measure be due to the effects of climate, soil 
and food; but from the result of our investigation we are convinced that in 
its first origin the disease must be traced beyond the confines of this State, 
to the Southern States of Europe and to the coast of Africa. In other 
words, the disease on the lower Lafourche has been propagated by heredi- 
tary influences, and by personal contact, rather than engendered by cli- 
mate, soil and food. The latter causes may of course form important fac- 
tors in the prolongation of the disease through several generations. It is 
possible that the seed of the disease imported originally from the south of 
Europe, and from the French settlements of Canada, would have perished 
in more elevated and healthy regions. 
The habits of the Creoles of the lower Lafourche appeared to be tem- 
perate and simple; the education of many of the citizens appeared to be 
limited from the nature of the country, and the necessity of maintaining 
large families upon comparatively small areas of land. It is evident there- 
fore, that under these circumstances, the contiguous settlements were often 
closely related by ties of friendship and blood. A rumor having been cir- 
culated amongst these people that the object of the inquiry suggested to 
the Board of Health by the Legislature of Louisiana, was simply to ascer- 
tain who were lepers, in order that they might be forcibly seized and car- 
ried off in ships and abandoned upon some uninhabited, isolated, lonely 
island in the sea, they were exceedingly cautious about communicating any 
substantial or detailed information as to the number and precise location 
of the unfortunate victims of leprosy. This rumor appeared to find some 
confirmation in the minds of these unfortunate beings, by the dread which 
their neighbors manifested to hold communication with them, and by 
* To what extent the water of the Bayou Lafourche affects the health of the inhabitants, I 
was unable to determine. On the evening of the 3d of October, my son Stanhope, was suddenly 
seized with severe vomiting and purging, on the banks of the bayou near the cut-off The vom- 
ited matters contained blood, and the discharges from the bowels consisted of almost pure blood. 
Had not Lockport been reached about l o'clock at night, when the appropriate remedies were 
procured, his case would have terminated fatally. He had suffered with yellow fever in 1878. I 
attributed this attack of "malarial haemorrhagic fever," to the combined influence of the 
malaria of the rice Helds, and to the waters of the Bayou Lafourche. My thanks are due to I)rs. 
•Caillouet, Melanson and Gazzo, and to Mayor Barker, for efficient and kind assistance. Leprosy in Louisiana. 
1231 
the exclusion in certain localities of the children of families tainted with 
leprosy from the public schools. 
2. Undoubted cases of Oriental leprosy were met with on both banks 
•of the Bayou Lafourche below Harang's canal. No measure short of an 
accurate census of the eutire district, can reveal the total number of cases, 
but after diligent inquiry and personal investigation, I was unable to ascer- 
tain the undoubted existence at the present time of more than twelve cases 
of this disease in the tenth ward, parish of Lafourche. Major S. J. Grisa- 
more. President of the Police Jury, estimated the entire number at about 
fourteen cases. The testimony of one of the most active and intelligent 
citizens living above the cut-off, was to the effect that at the present time 
•only six families are known to present cases of this disease. The following 
important information was furnished by a citizen of great activity and 
intelligence, who although not a graduate of a regular school of medicine, 
has worthily rendered aid to the citizens of the lower Lafourche, and more 
especially of Cheniere Caminada, where he now resides. It should be 
noted that the settlement of the Cheniere Caminada lies near the mouth of 
the Bayou Lafourche, the observations of this citizen, therefore, who has 
an extended experience from Thibodeaux to the Gulf apply to the entire 
region of the parish of Lafourche, in which the leprosy has been reported: 
Cheniere Caminada, October 3, .1880. 
Dr. Joseph Jones, Professor of Chemistry, Medical College, and President of the 
Board of Health, State of Louisiana, New Orleans, La.: 
Dear Sir-In conformity with my promise to give you all the information 
within my knowledge on the subject of scrofula or leprosy, in the parishes of 
Lafourche and Jefferson, I beg leave to represent, 1st. That I am acquainted with 
almost all the cases under discussion, as well as with all the families either tainted 
or affected with the awful disease; in behalf of science and humanity, I feel I must 
tell the whole truth about it, so far as my knowledge extends, leaving you to judge 
from my statement of facts and from your own personal information, whether 
there is any adequate remedy for either the prevention or relief of that awful mal- 
ady. The families affected or tainted with that malady ought to be divided into 
two distinct classes: 1st, those who, through inheritance, may only be tainted with 
elephantiasis; and 2d, those who are actually affected with the malady. There 
are in the parish of Lafourche, 1st. Tainted or subject to it by inheritance. The 
* * family living around Raceland. The * * family living around 
Crossing. Proof.-Mme. * * Sen., was a * * by birth, and died 
of elephantiasis. Mme. * * was born a * * and is now lingering under 
the affliction, her husband * * died of it two years ago, I believe, he hav- 
ing been affected through the close connection from his wife. We have lower down 
the Lafourche, at the cut-off, * * , who is now affected with elephantiasis, 
and in my opinion has gone too far without medical aid to be relieved. I am una- 
ble to say whether that case has come through inheritance or through contact. 
Then again, at the cut-off, two sons of * * , whom I believe are affected 
by inheritance from their grandmother, the family of * * , six miles below 
the cut-off, may be tainted with it, but to my knowledge no member of that family 
are presently affected; two years ago I was called upon to attend upon one of * * 
daughters, * * , aged eleven years; her whole body was covered with what 
seemed to be a ringworm affection, her fingers were clutched together, and since 
the last seven years she had lost the use of her hands; the sole of her right foot 
was tinged with a thick scrofulous ejection or crust, a quarter of an inch thick, and 
she had two very bad scrofulous ulcers to the same; by the use of generous diet, and 
proper and judicious tonics, that girl is entirely cured, not a trace of the awful 
sickness being visible on her; she has recovered the use of her hands, and now 
that she has reached the age of puberty, I hope she will never relapse. "This cure 
is entirely due to prescriptions from you received." Lower down, * * , sister 
to the aforenamed, * * , and her husband, * * , are affected with 
it, and passed human relief. Further down you have * * and son, who 
are affected, but who, I believe, may be yet cured by a judicious treatment. I know 1232 
Elephantiasis Grcecorum in Louisiana. 
of no hereditary tinge in this case, and I am certain they had it by contact with 
* * and her husband. Few. mi les down the bayou you have the family 
of the late * * , who may be set as tainted with it, although there is no 
actual case of sickness from the malady amongst them; * * , the head of 
the family, died of confirmed elephantiasis four or five years ago; he was a brother 
of * * , wife of * * , stated above. In the case of * * , my 
belief is that you have been misinformed; lam well acquainted with the family, 
and I am free to state that the sickness now existing in that family, is due only to 
disorder in the function of the liver, owing to poverty and the malaria existing 
in their locality; their sickness is jaundice or icterus. AtCheniere Caminada, we 
have three cases of elephantiasis in the family of * * , a cousin to the 
* * from Lafourche; his wife and two children are now affected with it. 
These are all the cases under my immediate knowledge, Doctor, and should I be 
able to be helpful to you in any way, shape or form, in assisting to the relief orthe 
prevention of the sickness, you may call on me for help at any time you may elect, 
and I will be ready at your call. 
Resnectfully and truly your obedient servant, 
F. C. * 
P. S.-I must state something about elephantiasis in Lafourche which I had 
omitted above. The family of the * * are tainted with it. Proof. ,* * 
Sen., now diseased, joined in matrimony with one * *. He had previously 
been married to one * * ; out of his first marriage he had five or six chil- 
dren, none of which were ever affected, nor did I ever hear the * * fami- 
lies were ever tainted with it, but out of his second marriage with * *. Old 
man * * had a numerous family, two of whom died of confirmed ele- 
phantiasis, the balance of the issue being now in good health. Those must be 
classified as tainted from inheritance by their mother. 
Respectfully yours. F. C. * *. 
3. The leprosy of the Lower Lafourche, in many of the cases if not in 
all, can be shown to be inherited. Thus, in the case of Mr. G., living on 
the left bank of the Bayou Lafourche, about two and a half miles below 
Harang's canal, the following facts were ascertained by actual investiga- 
tion: Mr. G., aged about forty years; father of ten children, six boys and 
four girls. Wife of Mr. G. living in good health. The mother of Mr. G. 
was attacked with leprosy before the recent Civil War and suffered with the 
disease fourteen years, and died at the age of sixty years, in 1872; the dis- 
ease, therefore, is supposed to have commenced about 1858. The mother 
of Mr. G. had five children, three males and two females. Up to the pres- 
ent time only one of her children, Madame B., living below the cut-off, is 
afflicted with leprosy. Madame B. has suffered with leprosy eight years, 
and is said to be in a most deplorable condition. The father of Mr. G. was 
a native of St. John the Baptist parish, Louisiana, and died of heart dis- 
ease in 1880. It does not appear that he contracted the disease from his 
wife. Grandfather and grandmother of Mr. G. born in Louisiana; could 
not ascertain anything further than that they were of French descent. Of 
the ten children of Mr. G. only one is afflicted with leprosy; a young lad 
of sixteen years of age. Although sixteen years of age he presents the 
appearance of a boy of about ten years of age. 
Although the remaining nine children appear to be in good health and 
present clear healthy complexions, this young lad presents the sallow, 
bronzed, unhealthy hue which is so common in the lepers of Louisiana. 
The face presents a nodulated appearance; has lost one or more joints of 
the fingers off each hand; also the joints of several toes. Has suffered with 
ulcers upon the legs and feet, which are swollen and discolored. Walks 
with a halting, uncertain gait. He is, however, cheerful and industrious, 
and assists in the lighter duties about the rice field (which completely sur- 
rounds the house), as the preservation of the rice from the ravages of the 
jackdaws and rice birds. The leprosy is of the ansesthetica variety, as is 
manifest from the want of sensibility in his hands. His father and mother Elephantiasis Graecorum in Louisiana. 
1233 
state that he frequently seizes the birds which are roasting upon the burn- 
ing coals of fire in his hands, and can even handle the burning embers 
without apparent pain. The eldest son of Mr. G. is twenty years of age; 
married and the father of a fine healthy infant. We have then the follow- 
ing facts: 
a. Mother of Mr. G. attacked with leprosy in 1858, died 1872, from 
ravages of the disease. 
b. The husband of Mrs. G. did not contract the disease, but died of 
heart disease in 1880. 
c. Of the five children resulting from the preceding marriage up to 
the time of the investigation, October 3, 1880, only one daughter, Madame 
B., has manifested symptoms of leprosy, which appeared five years after 
the disease had been developed in her brother. 
d. Of the ten children of Mr. G. only one manifests symptoms of 
leprosy. 
e. The eldest son of Mr. G. is the father of a fine healthy infant. 
Such facts would seem to indicate that the disease may apparently 
skip over one or more generations, and that an apparently healthy man, 
although descended from a leprous mother, may engender both healthy and 
leprous children without contaminating his wife. 
4. Some of the cases of leprosy appear to have been contracted from 
contact or contagion. Instances were cited where the disease was said to 
have been propagated to men by contact with leprous women. 
5. The ravages of the disease were in some of the cases of a most dis- 
tressing character. Thus, in company with my son Stanhope, a case was 
visited and carefully examined on the right bank of the Bayou Lafourche, 
about three and a half miles below Harang's canal. The patient, Mr. L., 
occupied a small hut, thatched with palmettoes, which he had erected with 
his own hands. This leper, who had lived alone and isolated from his 
neighbors, had lost one eye from the ravages of the disease, the face pre- 
sented a nodulated, scarred appearance; several of the fingersand toes had 
been destroyed, and the legs were covered with large, foul, stinking ulcers, 
which the poor sufferer had wrapped in large green leaves of some succu- 
lent plant. This man formerly owned a lugger and peddled goods amongst 
those suffering with leprosy further down the bayou, below the cut-off. 
He attributes the disease to the effects of cold, and said that upon one 
occasion in digging a grave in winter his feet were frost-bitten. I was 
unable to gain any accurate information as to his ancestors. This man 
also had to a great extent lost the sensation in his feet and hands, and 
affirmed that he could handle fire (burning coals) with his hands, without 
experiencing any unpleasant sensation. This man supported himself by 
planting a small field of rice. Nobody associated with him, he was avoided 
by his relations, and was almost as completely isolated as if he had lived 
upon an island. This was clearly a case of lepra ansesthetica, in which the 
disease of the nerves presented a high pathological interest. 
Pathologists have shown that beginning probably with the nerves 
which supply the original leper spot, by degrees, the chief nerves which 
go to the hands and feet, become infiltrated with a peculiar deposit, which 
renders them of twice their natural size. It seems to invade the nerves as 
soon as they pierce the fascia, and they can often be felt under the skin, 
as rounded cords, perhaps nodulated; deeper trunks are affected later. The 
consequences of this nerve disease are the same as when nerves are irri- 
tated by injury, that is to say, loss of sensation in the skin, atrophy of the 
skin, which looses its hair, bullae of pemphigus, which often lead to deep 
ulcers; atrophy of the muscles, and above all atrophy of the bones, begin- 1234 
General Conclusions. 
ning with those of the last joints of the fingers or toes. The bones first 
become thin and slender, then absolutely vanish by absorption, so that the 
finger nails may find themselves on the ends of the metacarpal bones, 
through the disappearance of the parts between. This process of mutila- 
tion is often hastened by abscess and necrosis of the bones. Dr. Macrea 
has pointed out the interesting fact, that common sensation and sensation 
of heat and cold seem to be properties of different nervous fibres, inasmuch 
as either one of them may be impaired or lost without the other. (Medical 
Times and Gazette, July 31, 1875. A Manual of Modern Surgery, by 
Robert Druett, 1878, p. 75). 
PRACTICAL CONCLUSIONS. 
(a.) The number of cases of leprosy upon the banks of the Lower 
Lafourche appear to be less than has been represented. A sufficient num- 
ber of cases, however, have occurred, to excite the earnest attention of the 
public authorities charged with the educational, sanitary and legislative 
affairs of the people of Louisiana. 
(b.) Those afflicted with leprosy should be isolated. Such seclusion 
or isolation may be accomplished by the construction of a leper house, 
ward or hospital in those districts in which the disease exists, to be placed 
under the direction and control of one or more local practitioners of medi- 
cine. 
(c.) It is manifestly the duty of the State to provide for the mainte- 
nance of the victims of leprosy. 
(d.) The practice of introducing patients suffering from leprosy into 
the crowded wards of the Charity Hospital of New Orleans should be dis- 
continued, and the public authorities of the City or State should provide a 
suitable building or ward, where the lepers may be properly isolated and 
secluded. CHAPTER XIII. 
ETIOLOGY : CAUSES AND ORIGIN OF LEPROSY (ELEPHANTIASIS GR^CO- 
RUM) IN NORTH AMERICA, AND MORE ESPECIALLY IN THE VALLEY 
OF THE MISSISSIPPI RIVER. 
We cannot fail to recognize in the cases observed in New Orleans and in 
other parts of Louisiana the elephas or elephantiasis, as described by Are- 
tseus, the Cappadocian, and other celebrated Grecian and Roman authors. 
Thus, in describing elephantiasis, Aretaeus says: There are many things in 
common as to form, color, size and mode of life between the affection elephas 
and that wild beast the elephant; but neither does this affection resem- 
ble any other affection, nor the animal any other animal. The disease is 
also called lev, on account of the resemblance of the eyebrows, and satyri- 
asis, from the redness of the cheeks, and their irresistible and shameless 
impulse ad coitum. Moreover it is also called the heracleian affection, inas- 
much as there is none greater and stronger than it. Wherefore, the affec- 
tion is mighty in power, for it is the most powerful of all in taking life; 
and also it is filthy and dreadful to behold, in all respects like the wild 
animal the elephant. And from the disease there is no escape, for it 
originates in a deadly cause. But the commencement of the disease gives 
no great indication of it; neither does it appear as if any unusual ailment 
had come upon the man; nor does it display itself upon the surface of the 
body, so that it might be immediately seen, and remedies applied at the 
commencement; but lurking among the bowels; like a concealed fire, it 
smoulders there, and having prevailed over the internal parts, it after- 
wards blazes forth on the surface, for the most part beginning like a bad 
signal fire on the face, as it were, its watch-tower; but in certain cases from 
the joints of the elbow, the knee, and knuckles of the hands and feet, in 
this way the patient's condition is hopeless, because the physician, from 
inattention and ignorance of the patient's ailment, does not apply his art 
to the commencement when the disease is very feeble. The patients are 
torpid and drowsy; and upon the increase of the affection the respiration is 
fetid from the corruption within of the breath (^pneuma). Tumors promi- 
nent, not continuous with one another anywhere, but thick and rough, 
and the intermediate space cracked, like the skin of the elephant. Veins 
enlarged, but not from abundance of blood, but from thickness of the skin, 
and for no long time is the situation of them manifest, the whole surface 
being elevated equally in the swelling. The hairs on the whole body die 
prematurely, on the hands, the thighs, the legs, and again on the pubes; 
scanty on the chin, and also the hairs on the head are scarce. And still 
more frequently premature hoarseness and sudden baldness; in a very short 
time the pubes and chin naked of hair, or if a few hairs should remain they 
are more unseemly than where they are gone. The skin of the head 
deeply cracked; wrinkles frequent, deep, rough; tumors on the face hard, 
sharp; sometimes white at the top, but more green at the base. Pulse 
small, dull, languid; veins on the temples elevated, and also under the 
tongue; bowels bilious; tongue roughened with vair, resembling hailstones, 
and not unfrequently the flesh is full of these tubercles. 1236 
Etiology of Elephantiasis Grcecorum. 
If the affection be much raised up from the parts within, and appear 
upon the extremities, lichens occur on the extremities of the fingers; there 
is pruritus on the knees, and the patients rub the itchy parts with pleas- 
ure. The lichen sometimes embraces the chin all around; it reddens the 
cheeks, but is attended with no great swelling. Eyes misty, resembling 
bronze; eyebrows purrient, thick, bald, inclining downwards, tumid from 
contraction of the intermediate space; color livid or black; eyelid, there- 
fore, much retracted to cover the eye, as in enraged lions; on this account it is 
named leontinum. Nose with black protuberances, rugged; prominence of 
the lips thickened, but lower part livid; nose elongated; ears red, black, 
contracted, resembling the elephant, so that they appear to have a greater size 
than usual; ulcers upon the base of the ears, discharge of ichor, with pru- 
ritus; shrivelled all over the body with rough wrinkles; but likewise deep 
fissures, like black furrows on the skin; and for this reason the disease has 
got the name of elephas. Cracks on the feet and heels, as far as the middle 
of the toes, but if the ailment still further increase, the tumors become 
ulcerated, so that on the cheeks, chin, fingersand knees, they are fetid and 
incurable ulcers, some of which are springing up in one part, while others 
are subsiding in another. Sometimes, too, certain of the members of the 
patient will die, so as to drop off, such as the nose, the fingers, the feet, the 
privy parts, and the whole hands; for the ailment does not prove fatal, so 
as to relieve the patient from a foul life and dreadful sufferings, until he 
has been divided limb from limb. For it is long-lived, like the animal, the 
elephant. But if there be a sudden pain of the limbs, it attacks much 
more greviously, spreading sometimes to this part, and sometimes to that. 
Appetite for food not amiss; taste indiscriminate, neither food nor drink 
affords pleasure; aversion to all things from a painful feeling; atrophy; 
libidinous desires of a rabid nature; spontaneous lassitude; the figure of 
each of the limbs heavy, and even the small limbs are oppressive to the 
patient. Moreover, the body is offended with everything, takes delight 
neither in baths nor abstinence from them; neither in food nor in absti- 
nence from it; neither in motion nor in rest, for the disease has established 
itself in all the parts. Sleep slight, worse than insomnolency, from its fan- 
tasies; strong dyspnoea, suffocation, as if from strangling. In this way 
certain patients have passed from life, sleeping the sleep which knows no 
wakening even unto death. 
After citing the foregoing dreadful description of this disease, Are- 
treus, the Cappadocian, exclaims : ''When in such a state, who would not 
flee; who would not turn from them, even if a father, a son or a brother? 
There is danger, also, from the communication of the ailment. Many, 
therefore, have exposed their most beloved relatives in the wilderness, and 
in the mountains, some with the intention of administering to their hunger, 
but others not so, as wishing them to die. There is a story that one of 
those who had come to the wilderness, having seen a viper creep out of 
the earth, compelled by hunger or wearied out with the affliction, as if to 
exchange one evil for another, ate the viper alive, and did not die until all 
his members had become putrid and dropped off; and that another person 
saw a viper creep into a cask of new wine, and after drinking of the same 
to satiety, vomited it up, and discharged a great deal of its venom along 
with the new wine; but when the viper was smothered in the new wine 
that the man drank of it largely and greedily, seeking thus to obtain a 
rescue from life and the disease; but when he had carried the drinking to 
satiety and intoxication, he lay down on the ground, at first as if about to 
die; but when he awoke from his sleep and intoxication, first of all his 
hair fell off, next the fingers and nails, and all the parts melted away in 
succession. But as the power was still in the semen, nature formed the Etiology of Elephantiasis Grcecorum. 
1237 
man again, as from the act of generation; it made other hairs to grow, and 
made new nails and clean flesh, and put off the old skin, like the slough of 
a reptile; and he was called back, like another new man, to a growth of 
life. Thus goes the fable; not very probable, indeed, nor yet entirely 
incredible. And that from the existing spark nature should renew the 
man, is not so incredible as to be held to be a prodigy."-The extant works 
of Aretceus, the Cappadocian, Trans, by Adams, pp. 366-373. 
The learned Francis Adams, LL. D., holds that Aretseus, when describ- 
ing the lichens on the extremities, alludes to mentagra, a malignant disease 
of the face, very prevalent in Rome at his time, that is to say towards the 
end of the first and the beginning of the second century. The first descrip- 
tion of mentagra which we possess is contained in Pliny's " Natural His- 
tory." xxvi, at the beginning, and is to the following effect: That it was 
one of the new diseases of the face which at one time had spread over most 
parts of Europe, but was then mostly confined to Rome; that it had been 
called by the Greeks lichen, but that latterly the Latin term mentagra had 
been applied to it. He further states that it was unknown in former times, 
and made its first appearance in Italy during the reign of Tiberius; that 
the men of the middle and lower classes, and more especially women, were 
exempt from the ravages of this disease, being confined principally to the 
nobility, among whom it was propagated by kissing. He adds, respecting 
it, that it was cured by caustics, the effects of which often left unseemly 
scars on the face. Pliny also asserted that the disease had come originally 
from Egypt, the mother of all such distempers. 
Another account of the disease, under the names of lichen and mentagra, 
is given by Marcellus, the empiric, in chapter cxix, wherein elephantiasis, 
lepra and other inveterate diseases of the skin are discussed. Marcellus 
also gives an account of the elephantiasis which he says was endemical in 
Egypt, attacking not only the lower ranks but even kings themselves. 
This appears to be the disease to which frequent allusion is made by the 
poet Martial as prevailing extensively in Rome and as being propagated 
by the fashionable practice of persons saluting one another by kissing in 
the streets. From these descriptions it has been held by some writers that 
the disease then so prevalent in Rome was of a malignant and contagious 
nature, which attacked principally the face, and was propagated by kiss- 
ing; and further that it was a disease of the same class as elephantiasis. 
Dr. Francis Adams decides confidently "that it was a disease akin to 
the sivvens of Scotland, which it strikingly resembles in all its characters. 
" Sivvens, in short, is a species or variety of syphilis which is readily com- 
municated both by the mouth," as in kissing and per coitum. Further, 
that syphilis and its congener sivvens are the brood of the ancient elephan- 
tiasis, no one at all acquainted with the history of the latter in ancient, 
mediaeval and modern times will entertain a doubt."* 
The origin of syphilis will be discussed more fully in another memoir, 
the view held by Dr. Adams and others as to its connection with elephan- 
tiasis and sivvens is worthy of careful examination and record in connec- 
tion with the history of leprosy in America. Elephantiasis was noticed 
by the poet Lucullus and was described by Celsus, Pliny, Scribonias, Tar- 
gus, Caelius Aurelianus, Marcellus, Serenus Samonicus, Octavius Hora- 
tianus, Isidorus, Vegetius, Aretaeus, Plutarch, Galen, Oribasius, Aetius, 
Actuarius, Nennus, Psellus, Leo, Myrepsus, Avicenna, Serapian, Avendy- 
bar. Albucasis, Haly Abbas, Alsahararius, Phases, Paulus JEgineta, and 
other Greek, Roman and mediaeval writers. 
* The Extant Works of Aretseus, the Cappadocian, edited and translated by Francis Adams, 
LE T) Sydenham Society, London, 1856, p. 370. See the note by Francis Adams, LL.D., to -'Paulus 
JEKineta," t. ii, 14,15, 16, and the authorities there referred to; also the history of syphilis as given' 
in Sprengel's and in Renouard's "History of Medicine." 1238 
Etiology of Elephantiasis Groecorum. 
Celsus says that elephantiasis is a chronic disease, almost unknown in 
Italy, but very common in certain countries. He calls it an affection of 
the whole body, even of the bones. The upper part of the body is covered 
with frequent spots and tumors, the redness gradually changes to black, 
the skin is thickened and covered with hard asperities like scales, the body 
wastes, but the face, legs and feet swell, and when the disease is protracted 
the fingers and toes become buried in the swelling, and a slight fever comes 
on which finishes the patient's sufferings. Although Cselius Aurelianus' 
account of elephantiasis has come down to us in an imperfect state, it 
appears to us, however, that his views were similar to those of Celsus, and 
that he considered it a malignant disease affecting principally the skin; 
and there can be no doubt, from the circumstances which he mentions, 
that the disease was thought contagious in his time, Octavius Horatianus, 
who lived under the Emperor Valentinian, contended that the whole sys- 
tem is attacked with the disease, and that the flesh is corrupted. Marcel- 
lus, the empiric, speaks of it as being endemic in ^Egypt. Plutarch states 
that it was disputed in his time whether or not elephantiasis was a new 
complaint. 
Paulus JEgiueta in his fourth book, remarks with reference to elephan- 
tiasis, that Aretfeus, the Cappadocian, had well said, that the power of 
remedies ought to be greater than those of diseases; and that for this rea- 
son elephantiasis is incurable, because it is impossible to find a medicine 
more powerful than it. For if cancer, which is, as it were, an elephantia- 
sis in a particular part, is ranked among the incurable diseases by Hippo- 
crates himself, how much more is not elephantiasis incurable, which is, as 
it were, a cancer of the whole body? After giving various measures and 
remedies for the cure of elephantiasis, Paulus 2Egineta, expresses his belief 
in its contagious nature, and recommends isolation of the infected individ- 
uals in the following terms: "But since this affection is one of those 
which are easily communicable, no less so than the plague, they are to be 
removed as far as possible from cities, and lodged in inland and cold situ- 
ations, where there are few inhabitants, if this can be accomplished for so they 
may descend from thence to surrounding places. This is proper partly on 
their own account and also on account of those whom they might come in 
contact with. For they themselves will thus enjoy the use of a more com- 
modious air, and they will not communicate the evil to others." Paulus 
JEgineta; Book Fourth, Section I, On Elephantiasis. 
Galen in his work, " De Causis Morborum," mentions that in elephan- 
tiasis. the nose becomes flattened, the lips thick, and the ears extenuated, 
the whole appearance resembling that of the satyr; and in his work enti- 
tled "De Cmiatione and Glauconem," he ranks elephantiasis with cancer- 
ous swellings, and says that the disease is common about Alexandria, 
owing to the heat of the place, and the food of the inhabitants, which con- 
sists principally of lentils, snails, pickles, the flesh of asses and the like, all 
of which things have a tendency to engender the melancholic humor. The 
temperature of the place likewise, he remarks, determines the superfluities 
of the system to the skin. Galen called the disease contagious. Aetius, 
said that suspicionshad been entertained of elephantiasis being contagious, 
and he expressed the opinion that it is unsafe to hold intercourse with those 
ill of the disease, as the air becomes contaminated by the effluvia from 
their sores, and by their respiration. Actuarius calls elephantiasis a can- 
cer of the whole body, which preys upon all the flesh, and derives its ori- 
gin from black bile corroding everything like fire. Avicenna gives a cir- 
cumstantial account of elephantiasis, under the name of judzam or judam, 
which his translation renders lepra. He calls it a cancer of the whole body Etiology of Elephantiasis Grcecorum. 
1239 
which arises from black bile, and is sometimes attended with ulceration, 
and is sometimes without it. The disease he says is contagious; it is pro- 
duced by living upon the flesh of asses, lentils, etc., and is endemic in 
Alexandria. Avendyoar describes the lepra as a cancer arising from con- 
tact with lepers, or from unwholesome food. 
The translation of Haiy Abbas, namely, Stephanas Antiochenis, who 
says he wrote about the year 1127, describes the disease which we have 
been treating of by the name of elephantia. Like the others Haly Abbas 
represents it to be a general cancer arising from black bile. He says it 
proves contagious by respiration. Alsaharavius describes four varieties 
of lepra, namely, the lionina, elephantia, serpentina, and vulpena. The dis- 
ease he says, may be contracted. 1st. By an hereditary taint. 2d. By the 
use of corrupted food, such as the flesh of buck-goats, cows, etc. 3d. By 
contagion through the medium of the respiration. Phases also applies the 
term lepra to the elephantiasis of the Greeks, calls it a general cancer, 
arising from black bile, and affirms that it is hereditary and contagious. 
The earlier of our modern writers on medicine, describes elephantiasis as 
a species of lepra, of which they enumerate four varieties, namely, ele- 
phantia, lionina, alopecia, and tyria. This arrangemement is evidently 
taken from Alsahararius. Guido de Cauliaco states decidedly that the dis- 
ease is contagious; and Rogerius remarks that the disease is contracted 
per coitum. It is probable that the several diseases which were considered 
as leprous, in remote ages, among the Jews, and in more recent times in 
Eastern and intertropical countries, were more or less closely allied, and 
it is not unlikely that in these ages, and even in modern times, several 
squamous and chacectic maladies assumed a more inveterate and irreme- 
diable form, in consequence of the nature of the food used by their inhabi- 
tants, and that these maladies have been remarkably modified from the 
states now presented. 
In England, five centuries ago, vast herds of swine constituted the 
great provision for the support of the people, and they were principally 
fed upon acorns and beech mast. In Domesday Book, a valuation of the 
time of William the Conqueror, it is always mentioned how many hogs 
each estate can maintain. Hume, the historian, in his Essays, alluding to 
the great herds of swine described by Polybias as existing in Italy and 
Greece, concludes that the country was thinly peopled and badly culti- 
vated; and there can be no doubt that the same condition of things existed 
in England in the fourteenth century, although many swine were main- 
tained in forests preserved for fuel. The hogs wandered about the country 
in a half wild state, destroying, probably, more than they profitably con- 
sumed; and the hog's flesh of England was constantly salted for the win- 
ter's food. The people had little fodder for the cattle in the winter, and 
therefore they only tasted fresh meat in the summer season; but salted 
flesh is not food to be eaten constantly,and with little vegetable food, without 
some injury to the health. It is said that in the early part of the reign of 
Henry VIII not a cabbage, carrot, turnip or other edible root, grew in 
England. Two or three centuries before, certainly, the Monasteries had 
gardens with a variety of vegetable; but mostly all the gardens of the 
laity were destroyed in the wars between the. houses of York and Lancas- 
ter. Harrison speaks of wheaten bread as being chiefly used by the gentry 
for their own table; and adds that the artificer and laborer are "driven to 
content themselves with horse corn, beans, peason, oats, tares and lentils." 
The average duration of human life was at that period far less than at the 
present day. The constant use of salted meat, with little or no vegetable 
addition, doubtless contributed to the shortening of life, to say nothing of 1240 
Etiology of Elephantiasis Grcecorum. 
the large numbers constantly swept away by pestilence and famine. Before 
lemon juice was used as a remedy for scurvy among seamen, who are also 
compelled to eat salted meat without green vegetables, the destruction of 
life in the navy fiom scurvy, scorbutic ulcer and adanamic fevers was terri- 
ble. The English Admiral Hosier buried his ship's companies twice dur- 
ing a West India voyage in 1726, partly from the unhealthiness of the 
Spanish coast, but chiefly from the ravages of scurvy. 
Bad food and want of cleanliness swept away the people of the mid- 
dle ages by ravages on their health, that the limited medical skill of those 
days could never resist. Matthew Paris, a historian of that period, states 
that there were in his time twenty thousand hospitals for lepers in Europe. 
The learned and accomplished Dr. James Copland has well said: When 
we consider that the use of salt was by no means general in some countries 
during the early and middle ages, that this substance was procured with 
difficulty in many countries, and is still scarce and valuable in several at 
the present day; that all kinds of animal food, even the richest and coarsest 
flesh, meats and fish, were often eaten in a ransid or semi-putrid state; that 
they were rarely cured otherwise than by smoking, or by drying them in 
the aii; that in many countries most of the food used during the greater 
part of the year was preserved in this manner, and that vegetable food was 
in most of them but little employed; that periods of scarcity, or of want 
of vegetable substances or of grain, often heightened the injurious influ- 
ence of unwholesome animal food; that the clothing worn next the skin was 
generally woolen, and retentive of the secretions from the surface, thereby 
irritating and contaminating it; and that habits of personal cleanliness 
were very imperfectly adopted, it will not appear surprising that chronic 
cachectic maladies were of frequent occurrence in the ages and countries 
thus circumstanced; that they assumed various forms, with the nature and 
combination of the densified causes producing them, and that they have 
changed their forms with the changes in the intensity and concurrence of 
these causes. 
This author, from his personal observation of leprosy chiefly in Africa, 
as well as from other sources of information, held that it owed its origin 
principally to the use of smoked, wind-dried and semi-putrid or rancid 
flesh meats and fish, and of rancid oils; to the want or disuse of salt; to the 
unripe, or spoiled, or mouldy grain; to the want of vegetable productions 
as articles of food; to inattention to personal cleanliness; to the nature of 
the clothing, and to the contact of the matter discharged from the leprous 
sores, when the disease was far advanced, and when the matter came in 
contact with the skins of those who were already predisposed to it by the 
modes of living alluded to, and by want of cleanliness. 
The historian, Dr. Fuller, was in error when he asserted that the lep- 
rosy was brought into England by the crusaders from the Holy War, and 
that this disease was altogether unknown before. The first Englishmen 
that went over to the Holy War made their first voyage in 1096, as histo- 
rians generally agree, and some of them returned in 1098, two years after 
that expedition. But it is certain that the leprosy prevailed in England 
before this date; for Wharton, de Episcopis Londinensibus and other histo- 
rians, assure us that Hugo de Orivalle, one of the bishops of London, died 
in that city of the leprosy in the year 1084. 
The account William of Malmesbury gives of this bishop's disease is 
as follows: "Is post paucos ordinationis annos in morbum incurabilem 
incidit. Siquidem regia valetudo totum corpus ejus purulentis ulceribus 
occupans ad pudendum remedium transmisit. Nam credens asserentibus 
unicum fore subsidium si vasa humorum receptacula, verendu scilicet, Etiology of Elephantiasis Groecorum. 
1241 
exsecantur, non abnuit. Itaque et oprobrium spadonis tulit episcopus, et 
nullum invenit remedium, quoad vixit leprosus." 
The disease seems to have been long known, for the remedy made use 
of for itscure had been recommended by JEtius and other medical writers 
several hundred years before this time. The cutting off of the testicles 
was by them thought to be of peculiar service. (A letter to Dr. Halley, 
R. S. S., in answer to some objections made to the history of the antiquity 
of the venereal disease, by Mr. Beckett, Surgeon, F. JR. S., No. 366, p. 
108. Anno 1720). 
Dr. Simpson, of Edinburgh, published in the Edinburgh Medical and 
Surgical Journal, vols. Ivi and Ivii, a series of learned papers, entitled 
' ' Antiquarian Notices of Leprosy and Leper Hospitals in Scotland and England." 
From information collected by him from English and Scottish MSS., and 
records from Dugdale's Minasticen Anglicanum, SemleSs Historice Ecclesias- 
ticce Silecta. Capita, Schelling's Commentio de Lepra, and other authorities-he 
shows that a disease, popularly known as leprosy, was everywhere endemic 
from the tenth to the sixteenth century; that against it princes and courts 
enacted laws and popes issued bulls, particularly Alexander III, who 
issued a famous bull-" De Leprosis"-regarding the ecclesiastical separa- 
tion and the rights of the infected. A particular order of knighthood, 
that of St. Lazarus, was instituted to care for the sick, particularly lepers, 
one of whom they had to elect as their master, until countermanded by 
Pope Innocent IV. They separated from the Knights Hospitallers about 
the twelfth century. In the middle ages leper hospitals were common 
everywhere. In 1226 there were 2000 of them in France, limited as its 
territorial extent then was, while in England they were numerous and 
wealthy. They were receptacles for infected persons-not medical insti- 
tutions, because the disease was considered incurable-and were mostly 
religious establishments under the sway of some neighboring abbey. By 
papal order they all had chapels and ecclesiastics. 
The lepers had abundant and good diet and clothing, and in some of 
the hospitals sanitary rules of the best kind prevailed. They were often 
regarded as objects of compassion, and yet were often persecuted. The 
kings and queens used to visit them, wash and sometimes kiss them, to 
exhibit pious humility; while, on the other hand, Philip V and Charles 
VI, of France, enrolled themselves among scoundrels of the first water by 
burning these poor wretches alive, to grasp their hospital endowments. 
Dr. Simpson proves that the disease existed in Europe before the Crusades, 
and was not brought to England by the returning warriors, as is generally 
supposed, since leper-houses existed in various places long before the 
occurrence of the first crusade of Peter the Hermit. The largest leper 
hospital in England wras at Sherburne, near Durham, and was built by 
Bishop Pudsey, in 1181. 
In the sixteenth century, when this disease had nearly disappeared, 
secondary cases of the then new disease-syphilis-were largely admitted 
to the leper hospitals, which at that period were almost empty. In Scot- 
land the lepers used a rattle to warn persons of their approach, and some 
similar usage prevailed in Italy. By English law they were classed as 
idiots, or insane, were counted dead and could not inherit. The church 
performed burial rites over a leper on his admission to hospital; he was 
clothed and in every respect treated as a corpse in fero ecclesice. In France, 
until lately, the rituals retained the offices for the separation of the leper 
from the living. They appear to have been most touching and must have 
been heart-rending to the miserable outcast. They were concluded by the 
significant act of throwing a shovelful of earth on the leper. Ledevich 1242 
Etiology of Elephantiasis Grcecorum. 
says that the ancient Irish were subject to the leprosy; contracted, accord- 
ing to general opinion, from their constant use of raw meat, and that aqua 
vita or whiskey was held in great repute among them as an unfailing spe- 
cific for its cure. Hence, perhaps, the deep national attachment of the 
Irish to this medicine. Sir William Wilde is of opinion that the Irish dis- 
ease was elephantiasis. Mr. Erasmus Wilson ("Diseases of the Skin," 5th 
ed.) says the earliest records of this disease in Great Britain are those of 
the Welsh King, Hoel Dha, A. D. 950. In 1547-1553 (Edward VI) a com- 
mission for suppressing colleges, hospitals, etc., reported most of the leper 
houses as empty. Dr. Simpson remarks that the earliest house in Scotland 
dates at 1150; and so late as 1604 a leprous woman was ordered into a 
lazar house at Aberdeen by the town council, whilst there was a leper 
patient in the Edinburgh Infirmary in 1798. Mr. Erasmus Wilson says it 
still exists among the English as morphoea (1, tuberosa; 2, alba atrophica; 
3, nigia; 4, alopoeciata), and that it has always existed in the north of 
Europe. Dr. Edmonston, of Limerick, says that it was in Zetland sixty 
years ago (before 1848) and still is in Iceland and the Faroe Islands. So 
great a plague has it been in Sweden and Norway that a government com- 
mission investigated it, and the valuable report of Dr. Danielssen, of Ber- 
gen, and Dr. Boeck, of Christiana, was published at Paris in 1848. Dr. 
George Macleod saw four cases of leprosy in Iceland in the summer of 1863, 
and was told by the chief surgeon of this island, Hajattelen, that the disease 
is still very common, and is attributable to dirt, badly ventilated houses 
and an unvarying diet. By improving the hygienic condition of young 
persons Hajattelen has arrested the complaint. Dr. George Macleod also 
states that he has seen much of this disease in Spain, Africa and Palestine. 
Dr. F. More Madden, of Dublin, has observed the disease lately in Spain 
and in Tangiers. Drs. Danielssen and Boeck believe the spedalskhed of 
Norway to be identical with the elephantiasis Grafcorum, and they affirm 
that it is not the radesgge, a Norwegian disease with which it has some- 
times been confounded. Elephantiasis or spedalskhed is by them divided 
into E. tuberculosa and E. ancesthetica. 
From the preceding facts and observations the following general con- 
clusions may be drawn with reference to the history of leprosy {elephantia- 
sis Grcecorum): 1st. The testimony of Pliny is clear as to the time of the 
appearance of the disease amongst the Romans, and as to the country from 
which this loathsome disease had its birth; elephantiasis was unknown in 
Italy before the time of Pompeius Magnus; it was originally peculiar to 
-Egypt- Book xxvi, chapter 5. Pliny states that whenever it attacked the 
kings of Egypt it was attended with peculiarly fatal effects to the people, it 
being the practice to temper their sitting-baths with human blood for the 
treatment of the disease. Pliny also affirms that its career in Italy was 
very soon cut short. The same author also states that the leaves of the 
mentastrum, or wild mint, chewed and applied locally are a cure for ele- 
phantiasis, a discovery which was accidentally made in the time of Pom- 
peius Magnus by a person afflicted with this malady covering his face with 
the leaves for the purpose of neutralizing the bad smell that arose there- 
from. Book xx, chapter 52. Pliny says that the lichen or mentagra was 
unknown to the ancients, having entered Italy in the reign of the Emperor 
Tiberius Claudius Caesar, where it was introduced from Asia, in which 
countiy it had lately made its appearance by a member of the equestrian 
order at Rome, a native of Perusium, secretary to the quaestor. Upon this 
occasion several physicians repaired to Rome from Egypt, that fruitful 
parent of maladies of this nature, men who devoted themselves solely to 
this branch of medical practice, and very considerable were the profits Etiology of Elephantiasis Groecorum. 
1243 
they made. Manlius Cornutus, a personage of praetorian rank and legatus 
of the province of Aquitania, expended no less a sum than two hundred 
thousand sesterces in his case. Book xxvi, chapter 3. The amount paid 
by Manlius Cornutus upon his cure was upward of £1500 ($7500). 
First observed in Egypt, then in Italy during the time of Pompey, the 
Grecian elephantiasis subsequently extended, until it embraced the four 
quarters of Asia, Africa and Europe. It spread over the whole of Europe 
like an epidemic during the middle ages, especially about the period of the 
crusades, and about this time, homes destined for the reception, or rather 
for the confinement of lepers, were established in great numbers. During 
the sixteenth and seventeenth and eighteenth centuries it was carried to 
the shores of America by European adventurers and by African slaves. 
Since the commencement of the seventeenth century this dreadful disease 
has disappeared from almost all parts of the European continent; and 
Greek elephantiasis of the present day, is confined chiefly to the equatorial 
and intertropical regions of Africa, Asia and America. In the low moist 
malarious regions of these countries this dreadful disease is much more 
common among the poor than the rich, principally attacking those who are 
in indigence, and strangers after a residence of longer or shorter duration. 
2d. The exciting cause of this malady, once the most generally dif- 
fused, the most surely and slowly fatal, and the most permanent of all 
those which have prevailed at any time in the human species, are veiled in 
obscurity. It appears to have been prevalent for several centuries; and 
although it may not have been for a considerable portion of that time so 
common as syphilis and scurvy, which followed it in succession, yet it was 
more certainly fatal and dangerous than they to the posterity of those who 
became the subjects of it The question whether the disease originated in 
various countries, or was imported and communicated by contact and also 
became hereditary, has been discussed by learned writers. That it was 
believed by the people and medical profession to be contagious, is proved 
by the strenuous efforts made to seclude the diseased, and prevent their 
communication with the healthy; and we have adduced the testimony of 
the most eminent medical writers of the Greeks and Romans as to its con- 
tagious nature. In an account of the Shetland lepers, it is mentioned that 
the disease is found by experiments to be very infectious, and seems also 
to run in the blood, most people that have taken it without infection from 
another having been related to these families in the isle. 
Rev. L. J. Debes, in his rare and curious work, says : "I find the 
cause of the leprosie to be the air and the dyet; for here is a pretty cold 
and moist air, which usually causeth the scurvy to those that lead a solitary 
life, and this hath a great affinity with leprosy. Besides, the meat of all, 
especially of the poorer sort, is half rotten flesh or fish, all their nourish- 
ment in summer being likewise fresh fish and sour milk, without any salt; 
wherefore, he that is not of a strong and good complexion, may easily 
have his blood corrupted, the sickness gnawing itself through the body 
before it breaketh out, and when any one is so infected he may easily give 
it to another that is of the same complexion with the sick." Dr. Ainslie 
expresses a doubt of the contagious nature of the disease; but he admits, 
with all others who have had opportunities of investigating the disease, 
that it is hereditary. On this subject, Dr. A. Edmonston remarks that this 
disease is hereditary, "and has been transmitted to successive generations 
without extending itself to individuals living under the same roof, or even 
to all the offspring of the same parents; nor does it seem to propagate 
itself by infection, unless in those cases where a matter is generated and 
discharged from the sores. This is a certain medium of communication, 1244 
Etiology of Elephantiasis Grcecorum. 
and an inattention to this circumstance has given rise to contradictory 
views of its nature" (Edin. Med. and Surg. Journ., vol. vi, p. 169). He 
adds at another part, " that it was propagated by contagion cannot admit 
of a doubt. We have seen that it prevailed very generally in the Shetland 
Isles, about seventy-five years ago, and all the inhabitants were deeply 
impressed with a conviction of its contagious nature, and the history of 
the disease but too well confirms the accuracy of the opinion." 
The investigations of Mr. Stewart at Tranquebar, where tubercular 
leprosy is very prevalent, has induced him to give the following as the 
results: 
1st. That women are less liable to this malady than men. 
2d. That it is hereditary. 
3d. It being contagious is extremely problematical. 
4th. That every leper, suffering from an advanced stage of the mal- 
ady, doubts whether he is able of propagating his species. 
5th. That a fish diet is found to render every symptom worse. 
6th. That poor living, want of cleanliness, mendicant misery, and 
exposure to cold and damp, are but too constant attendants of this dread- 
ful affection. 
P. Payer, M. D., in his Theoretical and Practical Treatise on Diseases of 
the Skin, thus expresses his views as to the causes of this disease : "Other 
causes have been stated, the influence of which in the development of 
Greek elephantiasis is less apparent. The stagnant waters of marshy dis- 
tricts, the moist heats of autumn, low and sheltered situations, filthy 
habits, bad food, exposure to wet, etc., have one after another been set 
forth as adequate to produce the disease; but the whole of these causes 
occur combined in places where Greek elephantiasis has never been seen. 
Though inadequate to excite the disease, however, they may unquestion- 
ably favor its development and keep it up in certain districts. Aretmus, 
Galen, Schelling, Forest, etc., and in latter times Darwin and Cullen, have 
held that Greek elephantiasis was contagious. Had the disease truly this 
character in the olden times, when it prevailed epidemically in Europe? 
The cases observed in India by Robinson and Ainslie (Medico-Chirurgy, 
trans., vol x.) in Madeira, by Adams and Heberden, and the few I have 
myself seen in France, where I have observed West Indian Creoles living 
in the midst of large families without communicating the horrible malady 
to a single individual, and the concurring testimony of all observers, lead 
to the conclusion that Greek elephantiasis is never communicated by an 
individual affected to an individual in health-that the disease in a word 
is not contagious. One of my pupils, M. Raisin, Jun., has oftener than once,, 
and for several days in succession, worn the clothes of a person affected 
with elephantiasis, without suffering the slightest inconvenience. Many 
facts prove that Europeans have contracted this disease during a residence 
in the East and West Indies. Women laboring under elephantiasis have 
produced children who have never suffered in the same way; but the fact 
of the hereditary transmissibility of the disease is one not less certainly 
ascertained. After the most careful study of the affection in the Lazaretto 
of Madeira, both Adams and Heberden are of opinion that not only is the 
disease transmitted hereditarily, but that it occasionally descends through 
several successive generations. The researches of Dr. Ainslie in India, 
tend to confirm the views of these excellent observers. 
M. Alibert tells us that he had met with two women who inherited 
elephantiasis from their parents. "In the Lazaretto of Fenehol, the major- 
ity of the individuals affected with Greek elephantiasis had not yet attained 
the age of puberty. From the other documents examined by Adams it Etiology of Elephantiasis Grcecorum. 
1245 
would appear that in the course of a century five hundred and twenty-six 
men and only three hundred and seventy-three women had been received 
into that establishment, a difference of nearly a third in favor of women." 
Mr. Robert Druitt, who investigated the disease in India, says that one 
■distinguished officer in the Indian Medical Service became affected by it; 
it seems quite independent of climate, elevation and food; it may affect the 
monarch or the beggar, and flourishes in Norway as much as under the 
Equator; like all imported diseases it is usually most prevalent on the sea- 
coast; of all articles of food, milk is that by which there is most probabil- 
ity of its being propagated, especially the milk of the buffalo, which is a 
very foul-feeding animal; it is generally conceded to be hereditary, and the 
hypothesis of contagion seems to be gaining ground. (The Surgeon's Vade 
Mecum, 11th edition, 1878, p. 73.) 
Erasmus Wilson, in his article on leprosy in Dr. Richai d Quain's Dic- 
tionary of Medicine, holds that the cause of leprosy is endemic; the dis- 
ease has been met with from time immemorial in certain countries and 
localities, therefore the cause must be one which will be capable of abiding 
in different countries and in different climates. The cause of leprosy is 
miasma, no other cause is of such general distribution, suiting every cli- 
mate and every part of the world, ;unless it be such countries as have been 
relieved of the cause by land culture and improvements. Time was when 
leprosy prevailed in Great Britain, and it took up its abode there for thir- 
teen centuries; but the disease has gone, and therefore we may presume 
that the cause has ceased; whether it has ceased in-consequence of drainage 
and more general cultivation of the soil, is a question to be carefully con- 
sidered. Leprosy has been assumed to be caused by bad food, and by a 
fish diet; there can be no doubt that an improper diet may be quite equal 
to the production of debility and disease, and might predispose, like any 
other lowering cause, to the invasion of a miasma; but the disease prevails 
amongst the well nourished as well as amongst the ill-nourished, and in 
countries where fish is rarely or never eaten, whilst fish in moderation must 
be regarded as a most healthful and nutritious article of diet. 
3d. The contagious nature of leprosy appears to be settled beyond all 
doubt, by its appearance in a healthy population after the immigration of 
foreigners from a leprous country, as in the example of the importation of 
leprosy into the district of Surinam, in South America,'and the origin and 
spread of the disease among the Sandwich Islanders after an immigration 
of the Chinese. At the present day this loathsome disease is being con- 
stantly introduced into San Francisco, California. How far the white 
inhabitants of San Francisco and other American cities in which Chinamen 
are employed as cooks and laundrymen may be contaminated by these 
leprous Asiatics, will be developed by time. The question as to whether 
the specific form of bacillus found in the lymphatics and sores of the leper 
can be transmitted through the medium of food, water and clothing, or by 
inoculation, may not yet be clearly settled; but there are no doubt in the 
Chinese laundries of San Francisco, New Orleans and New York, Asiatic 
men now at work who are in the early stages of the disease; and their 
practice of taking water in their mouths and spitting it out on the clothes 
they iron, is more than ever disgusting when considered in connection with 
the possible transmission of disease by this means. 
Although there are no statistics to show the exact time and manner of 
the introduction of leprosy into the Hawaiian Islands, and although the 
means for importing the disease were unlimited; and although the Haw- 
aiians, from various causes, degenerated before leprosy was introduced 
into the Sandwich Islands, and when the first case appeared about thirty- 1246 
Etiology of Elephantiasis Grcecorum. 
five years ago, tlmy were in a condition favorable to its reception and 
growth. Nevertheless, the natives call leprosy ''mai pabe'' (Chinese dis- 
ease), and hold the tradition that the Chinese brought it with them. After 
its introduction it is said to have spread quite slowly until about 1850- 
1860, when it became so plentiful that the government instituted measures 
to prevent its spread, and founded the leper hospital on Molakai. Accord- 
ing to the report of the Board of Health of Honolulu, the leper hospital 
on the Island of Molakai contained 684 patients on March 31st, 1880; 424 
males and 260 females. The greater portion of the lepers are treated as 
out-patients, and it is stated that a large number remain mixed with the 
people in the several islands. The average mortality among the lepers in 
the establishment at Molakai has been nearly fifty-eight per thousand per 
annum. Dr. N. B. Emerson, physician to the Molakai establishment, is 
convinced that the disease is contagious, and states that though first intro- 
duced into the Sandwich Islands about 1856, there are now thousands of 
lepers, and the disease is still rapidly increasing among the native popula- 
tion. 
4th. The inhabitants of Louisiana have received leprosy from several 
sources, the chief channels of which were: 
1. The early settlers on the shores of the Gulf of Mexico. 
2. The slaves imported from Africa in the slave ships of France, 
Spain, England and of the American colonies and United States. 
3. The Acadian refugees driven from Canada by British injustice 
and cruelty. 
When Columbus discovered the islands of Conception, Isabella, Fer- 
nandina, Cuba and Hispaniola, in 1492, leprosy prevailed to a greater or 
less extent in all the countries of Europe, and this disease was not extinct 
in France, Spain and Italy when the first French colony was founded in 
1540 by the Count de Roberval four leagues from the port of St. Croix, in 
Canada; and the disease was not extinct in 1699, when Iberville landed on 
the shores of the Gulf of Mexico. A few years after the French established 
their colony at Biloxi, the African slaves, with their peculiar diseases, the 
yaws and the Grecian and Arabian leprosy, were imported, and in a quar- 
ter of a century the black population was nearly double that of the white 
race in Louisiana. About 130 years ago the distressed and conquered 
inhabitants of Acadia who had declined swearing allegiance to Queen 
Anne, sought the land of their countrymen on the banks of the Mississippi. 
The levee and squares of the city presented, on their arrival, a spectacle 
not unlike that they afforded about a quarter of a century before, on the 
landing of the women and children rescued from the fierce Natchez. The 
Acadians were greeted with tenderness and hospitality; Kerlerec and 
Auberville allowed a tract of land to each family; they settled above the 
German coast, on both sides of the Mississippi, and in course of time their 
plantations connected the latter settlement with that of Baton Rouge and 
Pointe Coupee, and it is at this day known by the appellation of the Aca- 
dian coast. 
Those cases of leprosy which have arisen amongst the descendants of 
the Acadians without dotibt derived their origin from the French settlers 
of barren and rocky coast of Nova Scotia, where the winter lasts seven 
months and is of dreadful severity, where the summer comes suddenly, 
and where perpetual fogs render the country equally unwholesome and 
unpleasant. At the present day Louisiana is threatened with an influx of 
Chinese and Malays, with filth, rice and leprous diseases. An inferior and 
barbarous race transferred from the burning heats of Africa has already 
been the occasion of the shedding of the blood of more than one million of Elephantiasis of the Middle Ages. 
1247 
the white inhabitants of the United States, and in the shock of arms and in 
the subsequent confusion and chaos attending the settlement ef the ques- 
tion of African slavery, the liberties of the country have been well nigh 
destroyed, and it is but just that patriots should contemplate with dread 
the overflow of their country by the unprincipled, vicious and leprous 
hordes of Asia. The contact of a superior with an inferior race must lead 
eventually to two results: The annihilation of one or the other, or the 
amalgamation of the two. The mixture of the blood of a noble race with 
that of one of inferior mental and moral constitution may depress the 
former to the level of the latter, but can never endow the brain and heart 
of the African and Asiatic with the intelligence, independence, love of 
liberty, invention and moral worth of the Anglo-Saxon race. 
LEPROSY (ELEPHANTIASIS GRtECORUM) OF THE MIDDLE AGES. 
The history of Europe from the sixth to the fifteenth century, is 
scarcely less full of the descriptions of the physical distresses of the peo- 
ple, occasioned by famine, pestilence, and diseases of the most loathsome 
kind, than of the political and moral evils which beset them. Among the 
maladies of those times, leprosy, under all the forms to which the term has 
been applied, appears to have existed so generally and unceasingly as to 
have claimed a more universal attention than even the plague itself. It 
was one of the first subjects on which the active benevolence of the early 
Christians exerted itself, and ultimately it absorbed a very large propor- 
tion of the wealth of Christendom, which was appropriated by the dona- 
tions of the pious to the maintenance and relief of those who were afflicted 
with it. These immense charities, however, were at length administered 
under great abuses, and offered no accurate grounds upon which to calcu- 
late the extent of the prevalence of the malady. In the middle ages the 
elephantiasis or tubercular disease (the lepra of the translators of the 
Arabian medical writers), was the principal form against which the pre- 
cautionary laws were framed; but almost all cutaneous diseases were popu- 
larly considered of a leprous nature; in fact many mistakes were commit- 
ted, and many willful deceptions practised, by which other diseases were 
confounded with elephantiasis. The disappearance of this disease from 
Europe is probably the result of the amelioration of the moral and physical 
condition of society, which the progress of civilization and science has 
brought about. 
The general opinion which was prevalent amongst the Greeks and 
Bomans, that leprous diseases originated in Egypt, is, in some measure, 
confirmed by the particular consideration given to them in the first history 
of man; and the more copious and distinct description of these diseases, 
subsequently given by the Arabian physicians, as well as the accounts pub- 
lished by travellers in more recent times (see those of Prosper, Alpinus, 
Tournefort, Niebuhr, Bruce, etc.), who witnessed their frequent occurrence 
in that and neighboring countries, have led to a common belief that the 
infection was brought into Europe in the eleventh century, by the armies 
that returned from the crusades. There is. however, sufficient evidence 
recorded, especially amongst the transactions of the Saints, to prove the 
prevalence of leprosy in the West at a much earlier period than the cru- 
sade. Thus lepers are mentioned in many acts according to Muratori 
(Antiquit. Itai. Med. JEri., t. ii, den. 16), in the sixth century; and Gregory, 
of Tours, speaks of a place where these unfortunate persons were accus- 
tomed to wash themselves, as well as of a hospital appropriated for them. 
Gregory the Great, the same century, likewise alludes to the subject, and 
particularly mentions one leper, "quern deniis vulnerebus morbus elephan- 1248 
Elephantiasis of the Middle Ages. 
tinus defaedavuat." In the following century Rhotarias, king of the Lom- 
bards, published an edict against lepers, by which they were considered as 
dead in the law, and enjoined not to come near to sound persons, but to 
apprise them of their approach by making a noise with a wooden clapper. 
There was a river near Asti, in Lombardy, famous in those times for the 
cure of leprosy; wheuce, in the eighth century, the Lombards were consid- 
ered as a filthy leprous people; and the wise Pope Sylvester, upon the plea 
of leprosy, dissuaded the King of France from marrying a Lombard prin- 
cess. 
So early as the eighth century, St. Othmar, in Germany, and St. Nich- 
olas de Corbie, in France, instituted leprous houses, which had already 
been numerously established in Italy. King Pepin, in 757, and Charles 
the Great, in 789, issued ordinances by which the marriages of lepers were 
dissolved, and their association with the healthy prohibited. In the life of 
St. Athanasius, in the middle century, lepers are also mentioned; and in- 
deed in general the acts of the Saints, compiled by the Bolandists, are 
replete with examples of the malady, throughout Europe in the mid- 
dle ages; even in the life of St Antoninas, so early as the fourth century, a 
case of leprosy 'houendis sima elephantine lepra," is mentioned. These 
facts imply the general prevalence of leprosy in Europe long antecedent 
to the crusades. However many severe diseases afflicted Europe of a much 
greater extent, and with destructive violence, about the period when those 
fanatical expeditious were executed, from the tenth to the sixteenth cen- 
turies, than before; and among the rest the leprosy appears to have been 
everywhere prevalent. Every country abounded with its hospitals, estab- 
lished for the exclusive relief of lepers, although the number of these 
institutions has been probably exaggerated. 
Several authors have, by an error in translation, quoted Matthew 
Paris (Hist. Ange, ad annum 1244) for an assertion that nineteen thousand 
lazarettos existed in Christendom; but that author only states that the 
Hospitallers were at that time possessed of 19,000 manors. It is affirmed, 
however, that Louis VIII, King of France, made^equests in the year 1227, 
to two thousand leproseries within his own kingdom. In England there 
were a great number of these establishments. It is affirmed that the city 
of Norwich alone contained five. The most extensive institution of this 
kind was at Leicestershire, at a place thence called Burtons-Lazars; it was 
founded in the reign of King Stephen, and dedicated to the Virgin and 
St. Lazarus, and became possessed of great riches; so that all the inferior 
lazar-houses in England were in some manner subject to the master of it, as 
he himself was to the master of the lazars at Jerusalem. In London there 
were six, according to Becket, the largest of which was that of St. Giles, 
without Temple Bar. The general existence of leprous diseases is further 
evinced by the erection of an order of knighthood, which sprang from the 
singular combination of military ardor with a zeal for the religion of peace, 
so prevalent in those times. In the parable of the rich man and the poor 
man covered with ulcers, recorded in the New Testament, the latter was 
mentioned by the name of Lazarus; whence the devout disposition of the 
times invented a St. Lazarus, whose name was given to the order of the 
knighthood, and who was deemed the tutelary saint of the leper-houses, 
and of each individual leper. So far, indeed, did the mistaken piety of 
the age extend, that not only was every man who returned from Palestine 
affected with foul sores deemed a Saint Lazarus, but was particularly 
recommended to the devout, as one under the special punishment, of God, 
for the benefit of his soul. Wherefore pious persons of the highest rank 
believed that they could bring themselves no greater favor in the eyes of 
the Deity than by their attention to these holy sufferers, by washing, hissing, Elephantiasis of the Middle Ages. 
1249 
and even licking their wounds. Not only priests and archbishops, but even 
kings are recorded to have this nauseous piety at certain seasons. King 
Robert of France, and Louis IX have been particularly mentioned as 
practising these ceremonies. 
The Knights of St. Lazarus had the double duty assigned them of holy 
warriors and attendants upon lepers; and the lazarettos even were placed 
generally under their control. Lepers were admitted into the Order, and 
the master of it was also required to be a leprous knight. The immense 
wealth which they accumulated became at length a temptation to the 
rapacity of some of the sovereigns, and Philip V, especially, accused all the 
hospitallers in France of high treason, by conspiring with the Turks and 
Jews, seized their property and ordered them to be burnt. In all the 
towns where lazarettos were established medical officers were appointed by 
the police to examine all persons who were supposed to be affected with 
leprosy, previous to their seclusion iu these receptacles; indeed, where no 
such establishments existed, huts were erected a little way out of the 
town for each individual leper. The rules and edicts, with regard to the 
conduct of the lepers, were, as far as the circumstances admitted of it, 
nearly copied from the Mosaic laws. It is obvious, however, from the 
writings of those physicians who held the office of examiners after the 
revival of learning, that the tubercular leprosy, or elephantiasis, was the dis- 
ease to the detection of which their inquiries were particularly directed. 
The earliest writers who appeared in the dawn of modern learning- 
described the elephantiasis under the appellation of lepra. It is obvious, 
however, from the observations of various learned physicians that the ele- 
phantiasis was by no means the only disease of the kind admitted into the 
lazarettos. 
These leprous complaints began to decline in number and violence, in 
Italy, about the end of the fifteenth century, and in France and Europe iu 
general in the sixteenth. About the middle of the sixteenth century 
Francis I ordered the number of lepers in each lazaretto to be reported, 
and after appropriating a sufficient sum for their support, ordered the 
remainder of their revenues to be given to the grand almoner for general 
use. In the seventeenth century, leper houses were still continued, and 
were greatly abused by the admission of beggars and idle vagabonds of all 
descriptions, who employed every species of tricks to imitate leprosy, or 
to produce appearances of cutaneous disease. The elephantiasis itself 
still occasionally appeared. Some writers have supposed that the changes 
which took place from the close of the fifteenth century downwards, were 
rather changes of names than an actual disappearance or diminution of 
leprosy; and that the venereal disease, which was first noticed at that 
period, was in fact the leprosy with a new appellation. Some authors 
actually denominated the morbus gallicus, or syphilis, a leprosy ; but 
although the secondary symptoms of syphilis might be mistaken for 
leprosy, or called leprous, in common with other ulcerations and cutaneous 
affections, in a considerable number of instances, and for some time, yet, 
as the learned Astruc, after Leonicences and others, has shown, there were 
so many points of obvious and decided difference in the symptoms and pro- 
gress of the two diseases as to render such a confusion to any extent impos- 
sible. When we reflect upon the unvarying adherence to ancient authors, 
which characterized the profession for centuries after the revival of learn- 
ing, and when we consider that the measles and small-pox were considered 
the same disease, including also scarlet fever, so late as the time of Die- 
merbroeck, we shall readily conceive how slow the early physicians would 
be in acknowledging a new disease, which had not been mentioned by the 1250 
Elephantiasis of the Middle Ages. 
Arabians, and with what facility they might confound it with the old, 
under a denomination so vaguely interpreted as that of leprosy. During 
the middle ages most erroneous notions prevailed respecting the leprosy, 
and the terrors of the ancients, respecting the contagious and unclean 
nature of this disease, were transferred almost indiscriminately to every 
chronic cutaneous disease, whether scaly, scabby, pustular, or ulcerous, 
contagious or non-contagious, which then occurred. 
It has been satisfactorily shown by learned writers, from a review of 
the domestic history of the times in which frequent and fatal epidemic* 
have raged, how much these were connected with the uncultivated and 
marshy condition of the soil; the consequent humid and miasmatic con- 
dition of the atmosphere; the salt, putrid, indigestible aliments, and the 
frequent scarcity even of that which the physical and political disorders 
of the times produced; the insalubrious condition of the towns and habi- 
tations, both in respect to bad situation, want of cleanliness, and other 
pernicious circumstances; in short, these combined evils, which appear to 
have existed in those times and countries where the leprous, among other 
frequent and distressing maladies prevailed, were in all probability the 
sources from whence these characteristic diseases sprung. Without 
attempting to trace the progress of leprous diseases in connection with 
the physical and political derangements in various countries, we shall 
merely examplify this view of the subject by a slight notice of the state of 
Europe in the middle ages, where leprosy and pestilence of every species 
prevailed. From the fifth century, when the Roman Empire at length fell 
under the repeated assaults of the Northern invaders, to the north, the 
finest parts of Europe lay in a state of devastation; little cultivation was 
practiced; all the arts were neglected or lost, and clothing, habitations aud 
food were alike insufficient and unwholesome; and for three centuries 
more, this desolation was increased, if possible, by the incessant wars that 
were waged. There were fourteen plagues in the fourteenth century, with 
intervals of but six years between each, and frequent famines. The food 
consisted, even in England, of much salted provisions, especially in the 
winter, and of a hard and black bread, chiefly of rye, to the scarcity of 
which corn, rather than to its ergoted or diseased condition, the ignis sacer, 
maladies ardens, and other similar maladies, should doubtless be attri- 
buted. 
So little were vegetables cultivated or gardening understood even in 
the sixteenth century in England that in the year 1509 Queen Catherine 
could not procure a salad till Henry sent to the Netherlands and engaged 
a gardener to come over to raise the proper articles. How totally des- 
titute of such diet must the people have been even at a much later period. 
In whatever country an uncultivated soil, a marshy surface and a humid 
atmosphere have been found, together with a diet generally consisting of 
a salted, semi-putrid, insufficient, or indigestible element, aud composed 
chiefly of animal flesh or fish, with a small proportion of nutritious vege- 
table matter, there, from the earliest times, human life has been shortened 
by the multiplication of pestilential fevers and cachexies of a leprous and 
scorbutic nature. Therefore, as Raymond observes, even if the ecclesias- 
tical writers of the middle ages had left us no records of the history of such 
maladies, the history of the soil, of the circumstances of the times and of 
the food generally used, would afford an incontestible monument of leprosy. 
CONTAGIOUS NATURE OF ELEPHANTIASIS GRASCORUM. 
The testimony of Baron Larrey is of importance as he observed this 
disease during the campaigns of Napoleon Bonaparte in Egypt. Baron Elephantiasis of the Middle Ages. 
1251 
Larrey, in his memoir on the leprosy, states that several soldiers of the 
French army took the disease from the causes no doubt which produce it 
among the Egyptians. This disease appeared to Baron Larrey to be con- 
tagious when the ulcers were deep and extensive and when the subject was 
reduced in strength. In this case a fetid and nauseous odor arises from 
the ulcers and the whole surface of the body. It was impossible to inhale 
this odor for a few minutes without inconvenience. The linen and apparel 
worn by lepers appeared to be impregnated with a deleterious substance 
suitable to the production of the same in those who might wear these 
clothes and be predisposed to absorb it. A knowledge of these facts and 
the advice which the ancient Arabian physicians give to isolate lepers 
induced Baron Larrey to assign a separate apartment to the French soldiers 
who were thus afflicted. Still circumstances did not always allow him to 
make this isolation complete, and he saw it contracted by persons who had 
more or less intercourse with them. During the siege of Alexandria, 
while attending an officer of the Twenty-fifth demi-brigade for a well- 
marked leprosy which had confined him six months to the hospital, Baron 
Larrey remarked that another officer who was far removed, although in 
the same ward, was affected some time after with the same disease, but he 
also had frequent communication with the leper. It became complicated 
with a wound that was almost cicatrized, the consequence of the amputa- 
tion of his left arm. The cicatrix then became covered with a thick yellow 
crust, furrowed with deep cracks, from which issued a fetid and ichorous 
humor. The circumference of the stump assumed a bluish color and 
became insensible; the remainder of the limb swelled and hardened and 
the skin partook of this bluish tinge. Leprous pustules then appeared in 
different parts of the body, chiefly on the wrists, legs and face. The least 
motion produced acute pains in the extremities; his fingers became hid- 
eous and his skin dry and rugose. He ate but little and had a depraved 
taste; his strength diminished, extreme leanness succeeded, and he died 
after having spent the last days of his life in a horrible state of inquietude, 
pain, and a kind of anxiety difficult to describe. This officer, by his own 
confession, never had had the venereal disease in any form, nor any her- 
petic eruption; his regimen bad been much better than that of soldiers. 
The wound of the stump had been disordered by no accident until the 
cicatrix was nearly completed, when the leprosy showed itself. Hence 
Baron Larrey was led to believe that it was communicated by contagion 
alone. 
The sudden attack of leprosy which an infantry guard (Charles 
Fourrat) experienced, appeared also to Baron Larrey to afford undeni- 
able proof of the effects of this contagion; and in this respect he held 
the opinion of a greater part of the ancient Tunis and Arabian physicians, 
and those of Egypt at this day. The circumstances of the communication 
of leprosy to the French soldier were briefly as follows: Charles Fourrat, 
a foot guide of the army of the east, of a robust constitution, having never 
had the venereal disease, about the latter end of the year 1801, during the 
siege of Cairo, was attacked by an eruption of pustules in different parts 
of the body. He knew not to what cause to attribute it; he was sober, and 
his diet had never been unwholesome; but he recollected having laid several 
nights on a mattress taken from the house of an inhabitant in the suburbs 
of Cairo, where he had seen a woman, the surface of whose body was cov- 
ered with blackish crusts and who appeared to be very ill. He had rea- 
son to believe that she had constantly used this mattress, which being 
impregnated with this leprous contagion, had communicated it to him. 
These pustules at first distinct and separate, although in groups, soon 1252 
Elephantiasis of the Middle Ages. 
united and formed ulcers of various extent, and of a blackish color cov- 
ered with thick crusts of a yellowish brown; they were divided by deep 
cracks which discharged a very fetid and ichorous humor. (Memoirs of 
Military Surgery, vol. 1, pp. 264, 275). 
The history of leprosy in the Hawaiian Islands, strongly maintains 
the doctrine of the contagious nature of this disease, and it is to be earn- 
estly hoped that the sad experience of these distressed and rapidly waning 
people may not be repeated in California and Louisiana through the instru- 
mentality of the filthy, vicious, debased, heathen leprous Chinese. Accord- 
ing to the report of Surgeon J; R. Tryon, of the United States Navy, lep- 
rosy, according to the popular belief of most natives, is supposed to have 
been introduced into the Hawaiian Islands about forty years ago from 
China. The disease from that time has gradually spread from year to year, 
and has increased to a marked degree since the indiscriminate and care- 
less vaccination practised during the severe epidemic of small-pox in 1853, 
until, according to the last report of the Board of Health, the number of 
lepers in the kingdom is estimated at 2000, or five per cent, of the whole 
native race, and it is also stated that as many more have the seeds of the 
disease. Ten per cent, of the entire native population have been tainted 
by this foul disease in forty years. There is not only a larger proportion 
of recognized lepers in the Hawaiian Islands than in any other country in 
the world, but the proportion from statistics and observation is steadily 
increasing. During the epidemic of small-pox referred to there were 3546 
recorded cases, and 1276 deaths. The universal spread of the disease must 
be largely due to the general belief that it is considered only slightly or 
nor at all contagious, and treated as such from the beginning-allowing 
free individual intercourse-with weak enforcement of laws for its sup- 
pression. The whole history of leprosy in the Islands points directly to 
its being contagious in nature, a disease certainly communicable to healthy 
persons, and propagated by the general mode of living to such natives 
coming in contact with it, who are rendered susceptible to the poison 
through want of cleanliness, insufficient or poor diet of raw fish, seaweed, 
pork, etc., combined with a condition of system, impoverished perhaps by 
syphilis, from which the native population have no doubt largely suffered. 
It is an historical medical fact that leprosy has spread in isolated vil- 
lages from a single imported case, and reliable professional men, who have 
had opportunities of observing the disease, in countries where it exists all 
declare in favor of contagion, viz.: McNamara, of Bengal; Lob, of Hong 
Kong, Wolff, of Madeira; Miliray, of Trinidad, and many others. (Am. 
Jour. Med. Sci., April, 1883, p. 443). CHAPTER XIV. 
Composition of the Blood in Leprosy. 
MORBID ANATOMY OF LEPROSY. 
The blood contains albumen and fibrin in excess, even before spots 
appear upon the skin. Local congestions and hyperaemia then ensue. 
Danielssen and Boeck have made several analyses of the blood after the 
the method employed by Simon; and these results have been condensed by 
Dr. Parks in the following tables : 
(a,) Analyses of Venous Blood in Norwegian Tuberculous Elephantiasis by 
Danielssen and Boeck. 
No. 
Sex. 
Age. 
Period of Disease. 
Sp. G r. 
of whole 
Blood. 
In 1000 Parts. 
Fibrin 
Fat. 
Albu- 
men. 
Glob- 
ulin. 
Hfe- 
rn atin 
Salts 
and 
Ext's. 
Water. 
1 
M 
24^ 
Early precursory symp- 
toms. 
1.046 
3.201 
2.531 
100.609 
65.831 
3.273 
11.244 
813.311 
2 
M 
26 
Advanced. 
1.049 
4.539 
3.421 
73.139 
96.186 
5.465 
10.93 
807.521 
3 
M 
38 
Advanced, 12 years. 
1.051 
4.265 
4.240 
116.971 
39.672 
6.135 
17.382 
811.335 
4 
M 
36 
Advanced, 8 years. 
1.042 
4.722 
2.80b 
93.092 
46.719 
4.153 
6.921 
851.687 
5 
M 
29 
Advanced, 6 years. 
1.048 
4.878 
5.309 
93.913 
74.504 
2.713 
15.861 
802 822 
6 
M 
22 
Advanced, 10 years. 
1.053 
3.592 
4.623 
128.785 
65.336 
2.830 
15.332 
779.522 
7 
8 
F 
F 
34 
43 
Advanced, 3 to 4 years. 
Advanced, 6 years. 
Complicated with anees- 
thetic elephantiasis. 
1.048 
1.052 
3.111 
4. 
2.336 
6.1 
106.926 
113.6 
66.774 
68. 
3.547 
4.1 
13.532 
1.4 '? 
803.771 
802.8 
1 J F 120 ^Healthy. 1.051 j 2.205 | 2.12o| 79-353^ 94.43?| 3.299 | 11.339| 807.228 
Healthy Blood Analyzed by same method. 
(&.) Analyses of Venous Blood in Anaesthetic Elephantiasis, by Danielssen. 
1 
F 
48 
Advanced, 17 years. 
1.052 
2.578 
2.457 100.500 
84.420 
4.020 
10.497 
205.524 
2 
M 
29 
Advanced, 13 years. 
1.046 
2.409 
4.854, 135.975 
SO.850 
4.900 
17.150 
247.184 
3 
M 
41 
Advanced, 9 years. 
1.045 
6.027 
3.4401104.649 
62.189 
7.077 
14.582 
199.010 
Same. Second Analysis years. Albuminuria. 
1.042 
4.361 
3.5671 66.733 
72.209 
4.449 
6.844 
159.205 
4 
M 
29 
Advanced, 12 years. 
1.058 
3.092 
2.777 52.221 
139.404 
5.089 
8.851 
212.492 
5 
F 
40 
Advanced, 24 years. 
1.052 
2.967 
4.662| 60.150 
121.652 
6.757 
9.011 
199.251 
MORBID ANATOMY OF LEPROSY. 
The principal morbid changes have been carefully investigated by 
Drs. Danielssen and Boeck, and they have been especially confirmed by 
Dr. Carter of Bombay (Journal of Medicine and Physical Society, Volume 
viii; N. S.) Tubercular leprosy has been seldom seen in Europe since the 
development of pathological anatomy; and hence its morbid anatomy has 
.been until a recent date imperfectly studied. But the most exact accounts 1254 
Morbid Anatomy of Leprosy. 
which have been furnished, concur in showing that persons who are the 
subjects of it are almost always carried off by acute or chronic inflamma- 
tions of the respiratory organs, and of the digestive viscera; and less fre- 
quently by low fever. On dissection Peyer's glands have been found 
enlarged; the intestinal tubercles ulcerated or about to become so; and the 
mesenteric glands enlarged and tubercular in persons who have died of 
the disease. Small cicatrices have also been observed in the intestines. 
The liver and spleen have not been materially altered. A thickened state 
of the mucous folds of the larynx, tubercles on the vocal chords, occasion- 
ally ulcers which had destroyed the ligaments, etc., and small ulcers 
of the mucous coat of the trachea, have been found after death, and 
account for the affection of the voice during life. The lungs generally 
contain crude or softened tubercles scattered through them. Three patients 
examined by M. Rayer had the lungs thus affected. In a colored man 
examined after death, Dr. James Copeland observed that the heart was 
smaller and softer than natural. 
P. Rayer has given the following history of a case of leprosy, with a 
detail of the post-mortem examination, the subject of which was a native 
of New Orleans, Louisiana. 
Case 1097. Greek elephantiasis, various and unavailing modes of treat- 
ment. Death. M. A native of New Orleans, was sprung of par- 
ents in easy circumstances. At the age of eleven, a number of blotches 
of a pale yellow color, and little apparent at first, were observed in the 
thighs and forearms; these were ascribed to the heat of the weather and 
no attention paid to them. Two years afterwards these spots were both 
more numerous and more conspicuous, and were now pronounced scorbu- 
tic by the physician who was consulted. Another year elapsed, during 
which the blotches extended to the face, and a number of small tubercles 
were evolved in the subtance of the skin. A glass of the expressed juice 
of endive, water-cress, lettuce, and other herbs, was ordered by his physi- 
cian every morning, fasting, and a glass of a decoction of sarsaparilla and 
the woods, twice during the course of the day. This treatment did no 
good. The disease made constant progress during the next year; tuber- 
cles were evolved at the entrance into the nostrils, which caused a very 
copious secretion of mucus; the/ace began to swell insensibly, the feet were 
readily excoriated, and healed with difficulty. M. feeling him- 
self full of life and vigor, thinking little of his ailment, and laboring on 
the strength of his constitution, gave himself up, without restriction to the 
pleasures of the field, of the table, and of Venus. It was only in the 
spring of 1821, that he again put himself into the hands of his medical 
attendant, who prescribed, whey, a sudorific tisan, the warm, and occasion- 
ally the artificial sulphurous water bath, made by the addition of the 
sulphuret of potash, at a high temperature. These means were followed 
by no amendment. The patient indulged in his usual habits through the 
succeeding winter. In the spring of 1822, M. applied to another 
practitioner, who gave him hopes of a speedy cure, from a tisan of sarsa- 
parilla, carrot, etc., saponaceous baths, Belloste's pills,* and lotions of 
althea thrown into the nostrils. During the three or four months that this 
system was followed, several fresh blotches appeared. 
In despair at seeing his infirmity increase, M now resolved to 
undertake his case himself; he purchased Leroy's book, and began taking 
an emetic one day and a purge the next; he then rested a few days and 
repeated the medicines; allowing a few more days to pass by, he returned 
* Compounded of mercury, extinguished by rubbing aloes, scammony and some aromaticj Morbid Anatomy of Leprosy. 
1255 
to his vomit, etc., and so on for twenty days continuously. A great degree 
of weakness, emaciation, and some pain of the stomach, were the only 
results of this emeto-purgative plan of treatment. In the spring of 1823, 
M , with the advice of due of the physicians he had already con- 
sulted, used a tisan of the leaves of the plantago psyllium internally and 
the inunction of the sulphur ointment to the arms only. Four months of 
this system did no good. M --, from having been of a lively turn of 
mind, was now subdued and melancholy. In the course of the same year, 
1823, he put himself under the care of a quack, from whom he took a stone 
bottle (damejeanne) and a half of medicine, the composition of which was 
a profound secret; but having accidentally broken one of his large bottles, 
M- - found about three pounds of garlic in pieces and a glass and a 
half of antimony at its bottom. This medicine was as unavailing as every- 
thing else. During 1824 M took sea-water baths without benefit, 
and next year left his native country for France, where he landed on the 
15th of May, 1825, and immediately came on to Paris. There he entered 
a Maison de Saute, where he underwent an anti-syphilitic course, and at the 
same time took simple and vapor baths. One of the submaxillary glands 
was inflamed and suppurated. Au antiscorbutic plan of treatment was 
now proposed, but rejected by the patient. Under another physician, 
however, he passed through a course of iodine, and some time afterwards 
began taking the pilules asiatiques, which soon causing gastro-intestinal dis- 
turbance, had consequently to be suspended. The iodine was tried again 
at different times. On the 1st of September, 1825, the patient was in the 
following state: 
The face was beset with tubercles, and had a puffy appearance; the 
complexion was of the dark or bronze color which distinguishes the 
mulatto; the scalp was white and showed no tubercles; the skin of the fore- 
head was in the same state as that of the face, bestrewed with tubercles; 
and further, furrowed with deep wrinkles. The supercilliary ridges were 
covered with similar tubercles, very numerous and much crowded, yet 
without being confluent. Their surface was traversed by oblique folds, 
which gave them a mammillated or nipple-like character; they projected 
considerably above or beyond the orbits. The hair of the eyebrows had 
almost all fallen out; the eyelids were swelled and hard at their edges; the 
whole of the eyelashes had been lost. The nose was larger and much flat- 
tened ; the nostrils were dilated, misshapen, and ran upwards. An 
immense number of tubercles were clustered on the ake nasi, the surface 
of which was knobby and uneven; on the lobe and neighboring parts they 
were so numerous that they formed a continuous irregularly mammillated 
mass. Several of these tubercles, which had been inflamed, were covered 
with small brownish crusts, and the little sores, which secreted the matter 
that formed there, were long of healing. The cheeks were swollen and 
also beset with tubercles, though not so thickly as the nose. The lips were 
large, thick, shining and covered with tubercles; the chin was likewise 
swelled, tubercular, and mammillated at the point. A few hairs of the 
beard appeared here and there, on those parts especially where the skin 
was merely broken without being affected with tubercles. The ears in like 
manner enlarged and tumid, stuck our from the head, and were of a dusky 
violet hue, but not occupied by any tubercles. The skin did not present 
the bronze like and morbid hue of which mention has been made, lower 
than the inferior part of the neck. The integument of the trunk was 
extremely white and fine. The hands, especially the fingers, were swelled, 
and the color of their backs, as also the outer aspects of the forearms, was 
the same as that of the face. Several brown patches and bauds, which 1256 
Morbid Anatomy of Leprosy. 
stretched down along the angles of the ribs, were apparent on the lower 
and outer extremities of the shoulder. The skin of the thighs and legs 
was of a dark brown. The feet were so much swelled that the patient 
appeared plain-soled. 
The arch of the palate was beset with a band of small tubercles, less 
bulky than those of the skin, but more numerous; they formed a kind of 
mammillated band stretching along the median line. The upper part of 
the pharynx was visibly beset with tubercles. The mucous membrane of 
the nasal fossra seemed to be affected with chronic inflammation and poured 
out an abundance of purulent secretion. The sense of smell was almost 
extinct, hearing and sight were enfeebled, taste was perfect, and it was not 
remarked that touch was blunted. The voice was rough, delivered through 
the nose, and at times almost suppressed. The organs of generation were 
in a normal state, the pubes covered with hair as well as the axillm and in 
a slight degree the breast also. M exhibited none of the libidinous 
appetite mentioned by some writers on elephantiasis. During his stay at 
Paris he avowed towards the sex he felt precisely as other young men 
of his age. The patient passed the winter without submitting to any 
kind of treatment. He went little abroad and often continued in bed all 
day. He could not now run rapidly, a great sense of weakness in his haras 
compelled him to stop; the slightest pressure caused excoriations and 
ecchymoses; and the least contusion of the legs was followed by a sore 
which was very long of healing. 
In the month of May M consented to another mode of treatment 
proposed to him, a diaphoretic tisan; frictions along the spinal column with an 
ammoniacal liniment, and cauterization of several of the tubercles of the face 
with the incandescent iron-, all that were thus treated suppurated and soon 
cicatrized. In September M complained of violent pain in the right 
side of the chest, and two days afterward he expectorated some blood. He 
was bled to twelve ounces and felt relieved. The blood extracted was 
buffy. He did not recover completely, however; the slightest departure 
from the strictest regimen caused painful indigestion and sleeplessness. 
October 29th the patient had another attack of pain in the right side; fif- 
teen leeches were applied to the part which did little to relieve him; he 
coughed a great deal and expectorated little. The tongue was red, foul, 
and marked with white streaks. A week afterwards a number of leeches 
were applied to the epigastrium. The appetite had now failed; the bowels 
were obstinately confined. All that was done proved of little avail in 
relieving the symptoms. The expectoration became purulent; pectorilo- 
quy was detected on the right side, and the patient lost flesh and strength 
rapidly. The tubercles of the face were now for the most part in a state 
of suppuration; the ears were no longer livid or swollen; the hands were 
emaciated and brown, instead of violet, as they had been. November 30th 
a profuse diarrhoea succeeded the obstinate constipations which had con- 
tinued all this time. On the 1st of December the patient became delirious, 
and on the 3d he expired. 
The body was opened twenty-four hours after death in the presence of 
M. Rayer (the narrator of the case) and of M. Gaide, his pupil. The skin 
of the face alone bore traces of the elephantiasis under which the patient 
had labored whilst he lived. The greater number of tubercles had been 
cicatrized, shrunk away, or had ulcerated of themselves. The side of the 
chin, to the lower lip, is of a livid or sallow and yellowish hue. Several 
small strife are observed on this lip, along the edge, where it joins with 
the mucous membrane of the mouth, from which the cuticle, in a semi- 
pultaceous state, is readily removed. The skin of the chin presents a few Morbid Anatomy of Leprosy. 
1257 
irregular, circumscribed nipple-like eminences covered with cuticle or 
hidden by slight squamse, under which the chorion has a slightly reddish 
tint; appears in some places softened to various depths in a very remark- 
able manner. Incised perpendicularly it appears hypertrophied, and on 
the sides of the chin is at least two inches thick; by scraping with the scal- 
pel, and still better by maceration, the softened portions of the chorion are 
readily removed. The bronze tint of the skin is not owing to any deposi- 
tion of pigmentary matter upon the surface of the papillary body, for a 
perpendicular section through it shows the chorion itself to be altered and 
the color to be a consequence of changes undergone in the intimate struc- 
ture. The integument of the point of the nose, softened in a less degree 
than that of the chin, is the seat of a number of ulcers of different depths; 
the surface of this region is covered with a whitish layer, owing to aug- 
mented secretion from the sebaceous follicles. This layer removed, a con- 
siderable number of small projecting points of a pearly white are perceived 
which are nothing more than the extremities of the minute epidermic pro- 
longations that dip into the cavities of the follicles and form little tubercu- 
lar offsets that may be drawn out, after which the skin appears to be per- 
forated by a multitude of conduits capable of receiving the head of a large, 
pin, which may then be made to penetrate to the depth of nearly a line 
into the chorion. The integument of the forehead and cheeks was covered 
here and there with a small incrustation which had followed the ulceration, 
suppuration or use of the actual cautery. The same alteration existed in 
several places of the limbs. 
The nasal fosste, connected together by the almost entire destruction 
of the septum, presented the following alterations: The mucous membrane, 
completely destroyed in some places, left the bones of the nose exposed; 
in several places it was covered with a pretty thick layer of muco purulent 
matter, in others it was softened and whitish, and here and there was com- 
ing off in irregular flaps of small extent. When the muco purulent layer 
was removed a considerable number of small nipple-like projections were 
exposed, from which little filiform bodies from half a line to a whole line 
in length, could be extracted, formed in all likelihood by the concrete fluid 
of the follicles. In the mouth two superficial sores, a line and a half across, 
were discerned on the tongue; these were the only morbid appearances 
which this organ exhibited. The anterior aspect of the velum paluti mollis 
was slightly whitish on the leftside, and was beset on its edges with a num- 
ber of very small ulcers. The anterior paries of the pharynx, through its 
whole extent, but especially superiorly was of a peculiar dull white color; 
its free surface was covered wffh irregular small mammillae, a number of 
which could also be traced along that of the oesophagus, projecting on an 
average about a line and a half beyond the level of the mucous membrane. 
Between this indurated and mammillated state of the mucous membrane 
of the pharynx and oesophagus, and the morbid alterations of the skin, 
there was a very great analogy. The mucous membrane of the larynx was 
lined on its inner surface by a purulent or pseudo-membranous deposit of 
considerable thickness, and easily removable'with the back of the scalpel. 
Under this layer the mucous membrane appeared to be much paler than it 
is in the normal state. It was also everywhere thinner than usual, and 
presented an ulcer two lines in length by one in breadth, which exposed 
the circo-arytenoid muscle of the right side. The posterior aspect of the 
epiglottis was possessed by a number of very minute sores, like those of 
the pendulous velum of the palate. The edges and apex of this organ, 
everywhere the seat of ulceration, were of a very decided grayish color. 
In the place where the epiglottis is continuous with the larynx, and above 
the margin where the mucous membrane of this part joins that of the 1258 
Morbid Anatomy of Leprosy. 
pharynx, a small quantity of black matter was observed to have been 
deposited. The trachea was not sensibly altered, and the bronchi did not 
exhibit any morbid changes other than the communication of a few of these 
tubes with the tubercular cavities. The subcutaneous cellular tissue of the 
anterior part of the right side of the neck was infiltrated with pus. Sev- 
eral lymphatic glands in the vicinity were enlarged, of a yellowish-gray 
color, and softer than normal. 
The right lung was much more affected than the left, and its superior 
lobe was thickly beset with small miliary tubercles, especially upwards, 
where there was a cavity large enough to hold a pigeon's egg. Between the 
tubercles the substance was of a reddish-brown color, and a good deal indu- 
rated. The inferior lobe was affected in the latter way, and showed no 
signs of tubercles. The left lung contained a good many tubercles, and 
several small cavities. It adhered slightly to the pleura; on the right side 
the adhesions were more extensive and stronger, and the pleura contained 
about a couple of pints of sero-sanguinolent fluid. The heart, soft and 
small, was unaltered. The mucous membrane of the stomach somewhat 
thickened near the pyloric end of the organ, was, on the contrary, extremely 
thin near the cardiac extremity, and in some places appeared to be even 
destroyed. Almost the whole surface of the viscus was covered with very 
distinct vascular ramifications. A vascular injection of the same kind was 
visible through the whole extent of the intestinal canal, which was also 
ulcerated in three different places, and the mucous membrane softened in 
the lower part of the colon. The liver was healthy, as were the kidneys, 
and the mesenteric glands and the spleen. The external organs of genera- 
tion were of the usual size. The glands of the groin were very much 
enlarged, and when divided they had the consistence and appearance of 
greasy liver. A Theoretical and Practical Treatise on the Diseases of 
Skin, by P. Payer, M. D.; Phila., 1845, p. 280. 
Dr. Charles Morehead, in his Clinical Researches on Disease in India, 
regards leprosy as a striking instance of a chachexia causing structural 
change of organs, by exudation deposits from the blood, with subsequent 
degeneration of the deposit and more or less of the adjacent structures. 
This view is evidently based upon the results of the labors of Drs. Daniel- 
ssen and Boeck, who have stated that in the amesthetic form much of the 
deposit takes place about the spinal cord, as between the arachnoid and 
pia mater, and the cord becomes hard, tough and reduced in size. Dr. 
Charles Morehead states that the morbid anatomy of leprosy has been 
altogether neglected in India, and he reports only one case in which an 
examination after death was made, and in this, though of the anaesthetic 
form, the appearances described by the Norwegian physicians do not seem 
to have been present.* According to the investigations of Drs. Danielssen 
and Boeck, and of Dr. Carter of Bombay, and others, the anatomical signs 
of elephantiasis Greecorum are derived from the infiltrating of a peculiar 
exudation into the skin, the mucous membranes, the glands, the serous 
membranes, and the parenchyma of some of the organs. In the developed 
stage of the tuberculated form, the chorion or cutis vera of the affected parts 
is tumefied and thickened. On squeezing it between the fingers a yellow- 
ish white, viscid, or gruelly fluid exudes, and a gelatinous or lardaceous 
effusion infiltrates the areolar tissue underneath the skin, to which it 
firmly adheres. The subcutaneous veins and nerves are also thickened 
and enlarged from the effused material on their surface. 
* Clinical Researches on Diseases in India, by Charles Morehead, M. D., etc., London, 1856, 
vol. 4, p. 66s, 671. Morbid Anatomy of Leprosy. 
1259 
In the more advanced stages of the disease, the deep-seated parts, as 
well as the superficial nerves, especially lying near to the ulcerations, are 
very much thickened and enlarged, in consequence of the results of inflam- 
mation of their sheaths. The mucous membrane of the nares, fauces and 
larynx is swollen, occupied with tubercles or nodules, soft, and of a yel- 
lowish color, and often ulcerated. The opening of the larynx is frequently 
the seat of morbid deposit, so as to nearly close up the rima glottides. Simi- 
lar nodules are occasionally found in the mucous lining of the trachea and 
larger bronchi. The curical glands are occasionally much enlarged. The 
substance of the lungs is seldom altered, but the pleurae are often much 
thickened, in consequence of the exiidation into the tissue, and the forma- 
tion of and infinite crowd of tubercles which sometimes run together. The 
subp'eritoneal connective tissue may also be similarly infiltrated. The mes- 
enteric glands are generally more or less enlarged. Isolated rounded ulcers 
are occasionally found on the inner surface of the intestines. The liver is 
sometimes the seat of the deposit of the nodules. In the advanced stages 
of the disease the kidneys are usually affected with a form of albuminous 
nephritis. 
In the nonduberculated form, when anaesthesia is the characteristic fea- 
ture, and where paralysis of muscles as well as of the skin exists, the skin 
is often very much attenuated, and the muscles atrophied. All fat has dis- 
appeared. The connective tissue in the parts surrounding the seat of the 
ulceration or necrosis, is infiltrated with a serous or lardaceous deposit; 
and the nerves are excessively swollen, their sheaths being filled with a 
flue albuminous matter, in which the ultimate nerve filaments are imbedded. 
The axillary glands and the inguinal glands are often much enlarged. The 
central organs of the nervous system are usually the seat of notable mor- 
bid changes, chiefly congestion of the posterior or dorsal veins of the spinal 
marrow, effusion of an albuminous serum within the arachnoid membrane, 
and between it and the dura mater, and consolidation or hardening of the 
surface of the spinal cord at the part affected. The cord is generally some- 
what contracted in size, and sometimes so atrophied as not to be much 
larger than a quill in dimensions. The concretions substance has gener- 
ally acquired a deep yellow color, so as to resemble the medullary sub- 
stance. The roots of the nerves within the vertebral canal are invested with 
albuminous exudation. The axillary cord ischiatic plexuses, and the prin- 
cipal nerves issuing from them, may be visibly atrophied. The crural 
and lumbar regions of the cord are always most conspicuously affected. 
Within the cranial cavity the lesions are sometimes similar to those in the 
vertebral canal, but less decided and advanced. In well marked anaesthe- 
sia of the face, the gasserian ganglion is always the seat of lesion; usually 
it is imbedded in a sero albuminous exudation, so considerable that the 
part bulges out, and the nerve filaments are glued together by the exudation. 
RELATIONS OF THE PATHOLOGICAL CHANGES OR LESIONS OF THE NERVOUS 
SYSTEM TO SOME OF THE PHENOMENA OF LEPRA AN^ESTHETICA. 
The morbid anatomy of leprosy centres chiefly in the skin, nervous 
system and lymphatics. It is the disease of the nerves which gives so high 
a pathological interest to leprosy. Beginning probably with the nerves 
which supply the original leper spot, by degrees the chief nerves which go 
to the hands and feet become infiltrated with a peculiar deposit already 
described, which renders them of twice their natural size. It seems to 
invade the nerves as soon as they pierce the fascia, and they can often be 
felt under the skin as rounded nodulated cords; deeper trunks are affected 
later. The consequences of this nerve disease are the same as when nerves 1260 
Morbid Anatomy of Leprosy. 
are irritated by injury. The investigations of physiologists and patholo- 
gists have shown that the nerves have great power over the circulation of 
the blood, and on local disease generally. The present state of our knowl- 
edge may be thus condensed and formulated: 
INFLUENCE OF THE SPINAL NERVES. 
Division of spinal nerves, though it pr oduces less of sensation and 
motion and warmth with other remote changes, yet is not necessarily fol- 
lowed by disease. In a limb all of whose nerves have been divided, inflam- 
mation with traumatic fever may be excited as in an ordinary limb. There 
is no doubt, notwithstanding that division of a spinal nerve indirectly len- 
ders the parts supplied by it more liable to inflammation, because the 
patient cannot feel and does not try to evade the beginnings of mischief. 
Thus, foreign particles on the conjunctiva are not felt, and consequently 
are not wiped away; the paralyzed patient cannot feel pressure on the hips, 
and so does not shift his posture. When nerves are not simply divided, 
but are torn, or partially divided, then the whole tract which they supply 
may be subject to disturbed nutrition or to inflammation in many remark- 
able ways. Therefore, some inflammations, especially of the skin, are not 
so much true diseases of the parts affected as they are expressions of irri- 
tation of the spinal nerve which supplies them. 
VASO-MOTOR NERVES OR BRANCHES OF THE SYMPATHETIC WHICH SUPPLY 
THE BLOOD-VESSELS. 
Division or paralysis of vaso-motor nerves causes relaxation of the 
vessels and profuse circulation of arterial blood. If the cervico-cephalic 
branch of the sympathetic be divided, or the superior ganglion extirpated,, 
the ear and side of the face becomes hot, red and vascular, but not of neces- 
sity inflamed. If the cervico-cephalic branch of the sympathetic or the 
superior ganglion be irritated, or galvanized, the opposite effects are pro- 
duced, namely, the blood-vessels contract, the quantity of blood in the cir- 
culating blood in the parts diminishes, and the temperature is lowered. 
There is a vaso motor centre in the medulla-oblongata, to which the vaso- 
motor nerves are connected, which keeps up the constant and normal tonus 
of the vessels, and which may be excited by irritation of its afferent nerves. 
Excitation produces general increased arterial pressure, and at the same 
time the degree of excitation of a sensory nerve which produces general 
contraction of the arteries in other parts of the body, diminishes the tonus 
of the arteries of the parts to which the excited nerve is distributed. One 
result of the division of the sympathetic nerve is that the blood contains 
fibrine as in inflammation. The state of parts produced by division of 
vaso-motor nerves is one of accelerated circulation, more active absorp- 
tion, and higher temperature; with these there is less resistance to disease. 
If food be deficient the part is liable to fall into inflammation.* 
The consequences of the nerve disease in elephantiasis Graecorum, 
are: loss of sensation in the skin; atrophy of the skin, which loses its. 
hair; bulla-. which often lead to deep ulcers; atrophy of the muscles, 
and above all, atrophy of the bones, beginning with those of rhe last 
ioints of the fingers or toes. The bones first become thin and slender, 
then absolutely vanish by absorption, so that the finger nails may find 
themselves in the lead of the metacarpal bones, through the disappearance 
of the parts between. This process of mutilation is often hastened by 
* Burdon-Sanderson, Handbook, p. 245. Paget, Med. Times and Gazette, 1864, vol. i; S. Weir 
Mitchell, M. D., George R. Morehouse, M. D., and William W. Keen, M. D., on Gunshot Wounds 
and other injuries of nerves, Philad., 1864; Stanley, (Med. Chir. Trans., vol. xxiv); B. Ball, M. D., on 
Disease of Joints in locomotor ataxy (Med. Times and Gazette, 1868, vol. li); S. Weil- Mitchell, 
Trans. Col. Phys, of Philadelphia, 1876; Laycock, Lectures, Med. Times and Gazette, 1871, vol. i. 
Robert Druitt, Manual of Modern Surgery, 1878, p. 8. Morbid Anatomy of Leprosy. 
1261 
•abscess and necrosis of the bones. Dr. Macrae (Medical Times and 
Gazette, July 31, 1875) has pointed out the interesting fact, that common 
sensation, and sensation of heat and cold seem to be properties of different 
nervous fibriles, inasmuch as either one of them may be impaired or lost 
without the other. 
MINUTE ANATOMY OF THE INFILTRATION MATERIAL OF ELEPHANTIASIS 
GR^ECORUM. 
Virchow is of opinion that the pathological elements of elephantiasis 
differ in no essential respect from those of the gummata of syphilis, nor 
indeed from those of lupus and glanders. The leprous deposit appears to 
consist of nucleated cells of different sizes, which are with difficulty dis- 
tinguished from the tubercular matter of scrofulous tuberculosis. Like 
the matter of the latter disease, it has a certain duration of life, then 
becomes brown and degenerate, and is absorbed, leaving the tissue it inva- 
ded in a permanently withered and degenerate state. It is found in the 
skin, in the nerves, and in the lymphatic glands, but only in recent cases, 
for after a certain duration in one place it withers. The disease may fall 
into abeyance for a time, and then break out elsewhere. In these respects 
it resembles scrofula and syphilis. Granulation tissue is the characteristic 
of syphilis, lupus, glanders, scrofula and elephantiasis; the granulation tis- 
sue of the latter is however, more permanent than others of tire same class, 
and tends in a less degree to degeneration and softening. 
Dr. Moxen, in a well-marked case of elephantiasis tuberosa that fell 
under his examination in Guy's Hospital, regarded the pathology of the 
disease as especially evinced by the integument, which he found atrophic 
and disorganized, the nerves apparently healthy, but the cutaneous nerves 
and veins alike involved in dyscrasic degeneration. The immediate cause 
of death was amyloid or lardaceous disease of the alimentary canal, liver, 
kidneys, and spleen, with marasmus of the most extensive degree, occur- 
ing as in altered lingering but not otherwise mortal maladies. The min- 
ute anatomy shows that the material of infiltration into the skin compos- 
ing the tubercles, and into the sheaths of nerves and spinal cord, has the 
same microscopic and chemical composition. When newly formed it con- 
sists of a delicate fibrous net work or stroma, in the meshes of which lie 
a great number of adherent whitish granules, which cannot easily be sepa- 
rated by washing. Acetic acid renders the fibrillae transparent, but 
increases the opacity of the granules. At a later period the fibrous net- 
work and granules disappear, and a great number of cells can be seen, 
rather larger than the so-called exudation corpuscles, oblong in shape, and 
inclosing a large nucleus, which leaves only a small space between itself 
and the cell wall. This space resembles a shining ring. The nucleus is of 
a gray color, and less transparent than the ring, it encloses fiom seven 
to eight well-marked brownish granules, and which probably account for 
the general brown color which old nodules of leprosy acquire. The outer 
cell wall is rendered transparent by acetic acid; but the nucleus is not 
much changed. The texture of the cutaneous vessels and nerves is all 
destroyed; the sudoriferous glands have disappeared, and only a homoge- 
neous mass is left. The hair follicles are in part destroyed; but the seba- 
ceous follicles are enlarged. 
Chemical analysis of the exudation in the anaesthetic form by Dan- 
ielssen, gave the following results: Water, 80.45; albumen, 17.38; fibrin, 
trace only; salts, 2.10. Before softening, in the tuberculated form, no 
effect was produced on test-paper; after softening, the reaction was alka- 
line. The firm mass contained fibrin, albumen in large quantity, fat and 
salts. After softening there was less fibrin. CHAPTER XV. 
BACILLUS LEPRAE. 
Armauer Hansen first ascertained the existence of large numbers of 
minute bacilli in the peculiar large leprosy cells of Virchow, which occur 
in the nodules of leprous patients. Virchow's Archiv.,vol. Ixxix, and Quart. 
Journ. of Micro. Sci., 1880. Neisser confirmed this observation of Arm- 
auer Hansen, and extended our knowledge of the bacilli, showing that 
they can be readily stained pink with fuschin or with Eslich's acid solu- 
tion of eosin-luematoxylin. The observations of Hansen on the bacillus 
of leprosy, confirmed by Huberg, Bidenap and Winge, have received 
additional confirmation from MM. Cornil and Suchard. These investi- 
gators found that when a portion of leprous tissue was washed out in 
water, numerous bacilli were seen in active movement. In sections stained 
with methylanoline the characteristic cells of the diseased tissue and the 
endothelium of the blood-vessels were seen to contain rods and elongated 
spheroids. The cells of the epidermis covering the leprosy nodules con- 
tained no parasites, which may account, the authors suppose, for the rarity 
with which the disease is propagated by contagion. In one case in which 
the liver was found in a condition of hypertrophic cirrhosis, the bacilli 
we<e found in the newly formed cells present in the interlobular connective 
tissue, and were also found in some of the hepatic cells. (Aunales de 
Dermatologie et de Syphiligraphie, 2d series, vol. ii, No. 4, Practitioner, 
March, 1882.) 
The bacilli of leprosy are fine rods about 0.004 to 0.006 millimetres long 
and less than 0.001 millimetres thick. They are pointed at their ends, and 
always occur in masses within the large leprosy cells of the leprous tubercles 
of the skin and internal organs. But they are also present in the interstitial 
tissue of the nervous branches in the anaesthetic variety of the disease. 
(Cornil, Union Medicale, 1881, Nos. 178, 179; Babes, Archives de Physiologie, 
July, 1883.) Some bacilli are motile, others not; some possess bright oval 
spores, and others are more or less beaded, owing to local collections of the 
protoplasm within their sheath. Neisser and Armauer Hansen have culti- 
vated them artificially in blood-serum and in solutions of meat-extract. 
Neisser has also shown that the characteristic leprosy-cells are only wan- 
dering cells modified by the growth and multiplication in them of the 
bacilli. In the blood the bacilli do not occur, but they spread probably 
only by the way of the lymphatics. In December, 1879, I made careful 
microscopical examinations of the blood and the discharges from the leprous 
sores of patients suffering with Oriental leprosy in the wards of the Charity 
Hospital, and also in the City of New Orleans. In natives of Louisiana, 
living in low, moist malarious situations, as on the Bayou Lafourche, the 
following general results were noted: When drawn, the blood presented 
a thin watery appearance; under the microscope the colored corpuscles Bacillus Leprce. 
1263 
presented the usual bi-concave figures. The colored blood-corpuscles 
tended to run together and form rolleaux as in the blood of inflammation. 
Large pigment corpuscles and pigment granules, and dark round bodies 
resembling the spores of bacteria-similar to those which I have observed 
in the blood of those suffering under the prolonged action of the malarial 
poison-were seen. The colorless corpuscles presented a more granular 
appearance than usual, and many of them contained small globules which 
appeared to consist of oil. 
In the case of Charles Boglioli, a Catholic priest, who contracted Ori- 
ental leprosy in the Charity Hospital of New Orleans, and who was at the 
time of his affliction with this disease free from all appearance or symp- 
toms of malarial (marsh or paludal) poison, the blood abstracted in 1879 
presented the following appearance: The blood presented a much richer 
and more concentrated appearance than the natives of Louisiana from low, 
swampy, marshy, malarious locations. Blood-corpuscles (colored) well 
formed, not distorted in shape, and after abstraction adhere together, 
forming rolleaux, as in the blood of inflammation. Colorless corpuscles 
appeared in the usual proportion to the colored corpuscles, and the bacte- 
ria, or extraneous, or abnormal bodies were absent. I did not observe the 
colored pigment corpuscles which existed in the previous malarial cases. 
Klebs and Tommasi-Crudeli have described a bacillus occurring in the soil 
of the Roman Campagna which they cultivated in gelatine. The rods are 
about 0.002 to 0.007 mm. long. They grow in cultures with long lepto- 
thrix filaments composed of short joints. The rods form spores either in 
the centre or at their ends. The}7 grow well also in other media, as albu- 
men, urine and glue. They require oxygen for their growth, and are, 
therefore, aerobic. (Archives and exp. Path. vol. xi.) 
According to Marchiafara (Archiv exp. Path. vol. xiii) the so-called 
bacillus malarice occurs also in the blood of patients suffering with malaria. 
At the Italian Medical Congress held in September, 1880, at Genoa, Dr. 
Marchiafara, assistant to the professor of pathological anatomy at Rome, 
announced that he had found the bacillus malarife in the blood of those 
patients during the cold stage of the malarial fever from which they suf- 
fered. Subsequently twenty-four cases were examined by this physician 
with the alleged result, in every instance, of showing the presence of the 
bacillus in the blood during the period of invasion, while the spores alone 
could be seen when the fever was at its height. The same observer had 
previously found the rods and spores of the bacillus in the lymph, blood, 
spleen and medullary cavities of the bones at the post-mortem examinations 
of three persons who had died from pernicious fever, but it was affirmed 
that as we had hitherto succeeded in demonstrating the presence of the 
bacillus in the blood of living patients, owing to the specimens examined 
having been always taken during the hot stage of the fever. Professor 
Perroneito, of Turin, has repeated Dr. Marchiafara's observations in the 
Hospital of Vercelli, in Piedmont, which annually receives about 4000 
cases of malarial fever, though not of a pernicious type, from the sur- 
rounding district, which is covered with rice fields. The result was that 
he found the bacillus, occasionally in large quantity, in the blood during 
the cold stage of all the cases examined, and sometimes also in the last 
hours of the intermittent period. British Medical Journal. Nov. 6, 1880. 
Inoculation of rabbits with the cultivated or original bacilli produced a 
febrile disease which Klebs and Tommasi-Crudeli consider analogous to 
the human intermittent fever, but doubt has been thrown upon the ques- 
tion of the identity of the febrile movement thus produced with that of 
genuine human malarial fever, by recent experiments and more accurate 1264 
Bacillus Lepra. 
and extended clinical observations are needed with reference to the 
effects of bacilli from non-malarious as well as from malarious soils. As 
Oriental leprosy appears to be confined to the lowest and most malarious 
regions of the valley of the Mississippi, I regarded it of great importance 
to determine the relations of this disease to the cause of the various forms 
of malarial fever of tropical and temperate America; but these observa- 
tions which I have been able to institute upon the condition and changes 
of the pulse, temperature and urine in leprosy in Louisiana established no 
distinct relations between the two diseases. In the leprosy of Louisiana 
in those cases in which the appetite or digestion was good and the bowels 
regular, no distinct intermissions or remissions were observed in the tem- 
perature, and the oscillations were within those limits which might be 
j-egarded as normal. 
The question of the relations of the bacillus malaria) to the bacillus leprce 
is one of importance and should be determined by careful experiments and 
investigation in those countries in which leprosy and malarial fever pre- 
vail. In the discharges from the leprous sores of various leprous subjects 
which I examined in 1879 in Louisiana the following facts in addition to 
those recorded with reference to the blood were observed and placed on 
record: The leprous sores discharged a saneous, fetid liquid, which, under 
the microscope, was found to contain much granular matter, pus corpus- 
cles, fibrous tissue, fragments of blood-vessels (the small vessels with their 
branches were of an opaque crimson color from the coagulated blood) and 
bacteria and bacilli. As no case of death occurred in my wards in the 
Charity Hospital under circumstances which permitted me to make a 
post-mortem examination of any cases observed during 1878, and 1879 
and 1880, I was unable to connect the bacteria and bacilli with any definite 
portion of the human organism, and was led to hazard the opinion that as 
these bodies had not been found in the blood they had been introduced into 
the leprous ulcers from without by the medium of the atmosphere. (Yaws 
and Leprosy in the Delta of the Mississippi: Report of Joseph Jones, M. D., 
President of the Board of Health of the State of Louisiana, for the year 
1880. pp. 194-223.) 
It is oT the utmost importance to determine the mode and the exact 
agent by which leprosy is communicated or transmitted from one human 
being to another. Inoculation experiments with the bacillus leprce, on 
domestic animals and monkeys, have hitherto failed. (Kobner, Virchow's 
Archiv., vol. Ixxxviii; Hansen, ibidem,', vol. xc.} Damsch maintains, how- 
ever, that he was able, by inoculation with leprous tissue into the peri- 
toneal cavity and into the skin, to produce in cats a distinct increase and 
sprouting of the bacilli. (Virchow's Archiv., vol. xcii.) Preparations of 
leprous nodules of the larynx and skin made by Mr. A. Lingard, and 
stained with Weigert's solution of magenta and vesurin, showed the 
leprosy-bacilli completely filling all the cells, small and large, spherical 
and spindle shaped, contained between the connective tissue bundles. In 
a section through the liver of a bird (rhea) that died in the Zoological 
Gardens in London, prepared by Dr. Gibbes, after his method of staining 
for tubercle-bacilli, there were seen innumerable aggregations of larger and 
smaller pink masses (visible to the naked eye as clots of the size of a pin's 
point to that of a pin's head or millet seed, and larger). Under the 
microscope these pink masses were seen to be composed of cells of various 
sizes, each filled with an enormous number of what appeared under a high 
power very short bacilli, much shorter than tubercle-bacilli. But they 
gave the same reaction as tubercle-bacilli. Here and there isolated cells 
■of various sizes could be seen filled with the bacilli. In the large cells Bacillus Leprce. 
1265 
the cell outline was becoming indistinct, and in some the cell-substance was 
seen to break down, whereby the bacilli became free. In these respects, in 
the size, distribution and character of the bacilli, there exists a remarkable 
similarity between the nodules of leprosy and the nodules just mentioned. 
(Micro-Organisms and Disease, by E. Klein, M. D., F. R. S., chapter x, pp. 
421-423. The Practitioner, June, 1884.) The appearance presented by the 
bacillus leprse in the tissues of man and animals is illustrated in the fol- 
lowing figure : 
ENGRAVING NO. 128. 
Bacillus Leprce in the Tissues of Man and Animals. 
Engraving No. 128.-A. From a section through the larynx of a patient dead of leprosy. 
Hyoid cells in fibrous connective tissue; the cells are filled with the leprosy bacilli. Magnifying 
power, 600 (stained with magenta and vesurin). B. Bacilli of the same preparation as in pre- 
ceding figure more highly magnified; 1000 diameters. C. Cells of the leprous nodules of man, filled 
with the leprosy bacilli after Neisser. D. Two cells of the leprous nodules of the liver of a 
bird (Rheaa). The cell substance is crowded with minute bacilli similar to leprosy bacilli. Mag- 
nifying power, 700. (Stained with magenta.) 
THE LEPROSY BACILLUS.* 
The general characters of the leprosy bacillus (bacillus leprae) have been so 
thoroughly investigated, and so well described, within the last five or six years, 
that my chief reason, and also excuse, for recording the results of the examination 
of the 'following ease are (1) that I may add to the, as yet at least, comparatively 
small number of investigations on this subject, and (2) that I may point out 
how far niy own somewhat limited observations agree with what has been 
recorded by others. Since the publication of Virchow's book on tumors, there 
has been but little difficulty experienced in assigning to leprosy its place amongst 
those diseases whose chief morbid feature consists in the development of areas of 
granulation-tissue in different parts of the body. Next to Virchow, perhaps, we 
owe one of the most careful and accurate accounts of the histology of leprosy to 
Dr. R. Thoma, and we are also much indebted to the labors of various Norwe- 
gian investigators on this subject. 
* By John Lindsay Steven, M. D., Assistant to the Professor of Clinical Medicine, Glasgow 
University, etc. 1266 
Bacillus Leprae. 
The next advance in our knowledge of leprosy was made when it was demon- 
strated that a bacillus was always to be discovered in the areas of morbid tissue. 
The bacillus was first demonstrated in 1873, to the Medical Society of Christiania, 
by Hansen, of Bergen. The discovery does not seem to have excited very much 
attention, until the publication in 1879 and 1880 of Neisser's very careful and 
elaborate investigations, when Hansen at once proceeded to establish his claim to 
priority by publishing, contemporaneously in English, French and German, a 
paper on the subject. In addition to the work done in Norway and Germany, 
very careful investigations have been carried out in France by Cornil and Suchard; 
and in England the labors of George Thin, of London, in this particular depart- 
ment of research, must also be mentioned. Following upon the discovery of the 
organism came the attempt on the part of many to reproduce the disease in the 
lower animals by means of inoculation. The results of these experiments have 
been rather conflicting, some seeming to show that it is not possible to reproduce 
the disease, whilst others would indicate that at least a localized leprosy may take 
place. With special reference to this department of the inquiry may be mentioned, 
in addition to the above, the works of Kobner and Damsch. 
The man whose skin I have had the opportunity of examining is a patient in 
the cutaneous wards of the Western Infirmary, Glasgow, under the care of Pro- 
fessor McCall Anderson, at whose request I undertook the investigation, and to 
whose kindness I am indebted for the following particulars of the clinical history. 
He is a hawker of coals, aged twenty-five, and was admitted to the infirmary on 
February 4th, 1885, complaining of a tubercular eruption of the face, armsand legs of 
nine years' duration, and of aphonia of one year. The following is the note entered 
in the ward-journal of his condition on admission. There are patches on the upper 
and lower extremities, rounded in form, and varying in size from a cherry to a 
walnut. These patches have always tended to grow to a certain size, to remain so 
for an indefinite period, and then gradually to become less and disappear, leaving 
only a staining and slight thickening of the skin. The features are greatly dis- 
torted, the tissues being infiltrated, and the natural lines of the surface much 
exaggerated. The skin of the forehead is thickened and corrugated, and the tis- 
sues above the eyelids project and hang down so much as to interfere with vision, 
especially of the left eye. The eyelashes and eyebrows are almost gone. The lips 
are enormously increased in size, and, since he fell on his face a year ago, there has 
been on the forehead and nose a tendency to ulceration. On the arms the erup- 
tion is chiefly confined to the extensor surfaces, extending from the shoulder to 
the wrists, being macular over the shoulder, but elsewhere tubercular. The hips 
and front of the knees, and the posterior surfaces of the leg and feet are also 
involved. The skin of the feet has a more or less white and silvery appearance, 
and there is a tubercular condition of the scrotum and prepuce. He cannot speak 
above a whisper; the tongue presents deep fissures, and there is a slight difficulty 
in swallowing. From these notes it will be seen that the case is one of typical 
tubercular leprosy, and as the history and treatment have been fully recorded by 
Dr. Anderson, it is unnecessary to dwell further upon it. I may simply add that 
the patient was born and brought up in India, where he contracted the disease; 
that he has been under observation more or less for a period of six years, and that, 
in 1879, when he was for a lengthened period under Dr. Anderson's care, he was 
considerably benefited by treatment. 
Having thus briefly described the main features of the case, I now proceed to 
indicate the methods by which the bacilli were sought for and found. The surface 
of a large and not very old tubercle on the left forearm was frozen with ice and salt, 
and then a small elliptical portion of the skin was excised. This was at once 
placed in absolute alcohol, in which it was kept for some days to harden, after 
which sections were made. As the portion of the skin I was able to get was very 
small, it had to be very cautiously dealt with; notwithstanding, I managed care- 
fully to prepare and examine about thirty specimens. Two dyes were made use of 
to stain the bacilli, namely, fuchsin and gentian-violet; and two different methods 
of procedure were employed, namely, Ehrlich's method for tubercle-bacilli and 
Gram's method. As the former of these methods is now well known and exten- 
sively employed, it is unnecessary to describe it further; but, as Gram's method is 
much more recent and gives very beautiful results, 1 may perhaps be excused for 
referring to ita little more in detail. Ehrlich's solution of gentian-violet in anilin- 
oil water is prepared in the following way: Four parts of anilin-oil are placed in 
100 parts of water, shaken well for about a quarter of an hour, and then filtered- 
the filtrate should be perfectly clear. To 100 parts of this anilin-oil water solution 
five parts of a saturated solution of gentian-violet in alcohol are added, and the Bacillus Leproe. 
1267 
dye is ready for use. Now comes the first step in Gram's method; the sections, 
which must have been hardened in alcohol, are transferred from absolute alcohol 
to the above solution for a few minutes. They are then transferred for from one 
to three minutes to an iodine solution prepared as follows. Iodine, one part; iodide 
of potassium, two parts; distilled water, 300 parts. They are then brought into 
absolute alcohol, which practically decolorizes them, and, after treatment with oil 
of cloves, are mounted in Canada balsam in the usual way, or they may be pre- 
served in glycerine. With either of these methods the bacilli were easily demon- 
strated, although, perhaps, the most beautiful results were obtained by Gram's 
method. In order to study the exact relationship of the organisms to the tissue 
elements, a number of the sections were double-stained, the contrast dye being 
Bismarck-brown; and a few sections were carefully examined without staining, in 
order, as far as possible, to investigate the histology of the condition. 
Having thus indicated the methods of investigation, I shall now proceed to 
describe the appearances observed. With regard to the histology of the skin it 
may be stated that the results of the examination, both of stained and unstained 
preparations, agreed in the main with those of Thoma. The epidermis was 
unbroken, and showed all the layers of epidermic cells in a healthy state, with the 
exception, perhaps, that the deeper layers were unduly pigmented. As has been 
described and figured by Thoma, the rete mucosum was separated from the under- 
lying leprous tissue by a thin layer of connective tissue. Beneath this thin layer 
came a dense infiltration of cells, which was more or less unbroken and continuous 
under the skin in a horizontal direction, and extended in depth from the rete 
mucosum to the subcutaneous fatty tissue. In the subcutaneous adipose tissue, it 
was found that the continuous character of the cell-infiltration had disappeared and 
had given place to more or less rounded masses of granulation-tissue (sometimes 
not at all unlike tubercles) which were often of considerable size. It was evident 
that these masses had replaced the normal adipose tissue, because they were often 
observed to be surrounded by coarse connective tissue bands, apparently the nor- 
mal connective tissue trabeculae of the subcutaneous tissue; and here and there, 
where the infiltration was less dense, round cells were seen insinuating themselves 
between the individual fat globules, and obviously exercising pressure upon them. 
Often, too, a few fat-globules were observed still remaining in the midst of a nodule 
of new cell-growth. As regards the nature of the cells composing this new growth, 
there can be no doubt that they mostly presented the characters of ordinary leuco- 
cytes or lymphoid corpuscles. Here and there they presented the appearance of 
epitheloid cells, and very rarely, if at all, were any cells of the nature of typical 
giant-cells observed. It is not at all improbable, I think, that the presence of large 
or epitheloid cells in the growth is to be explained, asshail be pointed out after- 
wards, by the action of the bacilli upon the round cells of the leprous tissue. 
As regards the bacilli, they were present in the skin in simply enormous num- 
bers, so much so as at first sight to suggest the idea that the swelling was probably 
in some measure due to the aggregation of the organisms. Examined with the A. 
A. of Zeiss (about sixty or seventy diameters), the sections presented the appearance 
as if the nuclei of the connective tissue were stained; this nuclear appearance being 
by far the most pronounced in the areas of granulation-tissue, and scarcely at all else- 
where. (In what follows I shall describe the appearances as observed in specimens 
prepared with gentian-violet, in which the organisms are blue or violet in tint, 
although exactly the same remarks apply to specimens treated with fuchsin, for 
which dye the organisms have great avidity.) With the D. of Zeiss it was seen 
that the blue staining of the sections was caused by two conditions: (1) by the 
presence of innumerable exceedingly minute rod-shaped bodies, and (2) by 
rounded blue-stained corpuscles, often of considerable size. The bacilli were situ- 
ated in the rounded masses of granulation-tissue, as well as in the more diffuse infil- 
trations of round cells, but they were scarcely, if at all, to be discovered in the more 
normal portions of the sections. Thin states that in one of his specimens he found 
the organisms in the epidermis, but I have been unable to verify this, my observa- 
tions in this regard agreeing with those of Cornil and Suchard. A more careful 
examination of the rounded blue-stained corpuscles already mentioned, showed 
that they were lymphoid cells swollen out and distended by the numerous bacilli 
contained in their interior. This observation was confirmed by the examination 
of sections which had been treated with Bismarck-brown as a contrast-stain. It 
was then seen that while the great mass of lymphoid corpuscles composing the 
new morbid tissue absorbed the brown color greedily, those containing bacilli 
retained their original violet color, and were generally somewhat larger and 
rounder than the other cells of the part. It thus became evident to me that the 1268 
Baeillus Leprce. 
presence of the bacilli exercised some important alteration in the constitution of 
the cells, leading them to give a different color-reaction from the others, and, in 
this, as I found out afterwards, my observations agreed entirely with those of 
Neisser, who showed that the effect of the bacilli was to bring about an alteration 
in the chemical constitution of the affected cells. It thus becomes not at all 
improbable that the so-called "lepra-cells" are simply the granulation-tissue cells 
altered by the presence of the organisms in their interior. 
The general arrangement of the organisms was often suggestive of their being 
contained within the lymphatic spaces; and I have more than once observed a nar- 
row line of cells containing organisms or of free bacilli, extending through one of 
the strands of connective tissue already described, the whole appearance suggesting 
that these elements were contained in a minute lymphatic channel. I have also 
occasionally observed that the large bacillus-holding cells assume an elongated 
shape, as if they were contained within a very minute space or tube. These remarks, 
with reference to the intimate relationship existing between the morbid process 
and the lymphatics, are in agreement with the earlier histological researches of 
Thoma, and the more recent observations of George Thin and others, on the bacil- 
lus of leprosy. In addition to being contained within the cells, lam also of opinion 
that the bacilli exist abundantly in the free state, and then, they are generally situ- 
ated within the lymphatic spaces. Sections of blood-vessels were frequently 
observed in the specimens; but, so far as I could make out, no bacilli were contained 
within them. With regard to the presence of the organisms in the blood-vessels, con- 
siderable difference of opinion seems to exist; but Thin states that he has insome 
instances discovered them in the blood-vessels of the tubercles, and in this he is 
borne out by Kbbner and others. 
In order to study more particularly the characters of the bacilli themselves, the 
sections were subjected to examination by means of Zeiss' one-eighteenth oil- 
immersion lens, the entire system, by careful measurement, having been found to 
magnify about 1000 diameters. The bacilli were then seen to be fine, minute rods 
of considerable length, occurring either singly or in groups, or in the interior of 
cells, as has been already described. They were often sharply pointed at each 
extremity, and almost all of them contained small rounded spores, which varied 
considerably in size in some instances, the larger spores being in the centre. The 
beaded appearance produced by the spores is very striking, and has been tolerably 
well reproduced in the wood-cut, the drawing for which was made to scale with 
the aid of the camera lucida. Neisser states that the bacilli may contain from two to- 
three spores; but, as may be seen in the illustration, I was frequently able to count 
five. In addition to being sharp at the extremities, the bacilli are often slightly 
curved. According to Neisser the organisms are often surrounded by a mucoid 
covering; but this I have been quite unable to demonstrate. So far as I have been 
able to measure the bacilli my results agree with those recorded by other observers; 
namely, from four to six micromillimetres (that if, about one-five-thousandth of an 
inch, or from about one-half to three-fourths of the diameter of a red blood-cor- 
puscle). I compared the organisms with specimens of the tubercle-bacillus, and 
while there can be no doubt that there is a great similarity in many points between 
them, I am of opinion that the leprosy-bacilli are considerably smaller and finer. 
With regard to the size of the bacilli, it is interesting to note that Cornil has 
shown that they are much smaller in the skin than in some parenchymatous 
organs; for example, the testicles, where they may measure from twelve to fifteen 
micromillimetres. In the wood-cut I have endeavored to show the appearance 
presented by the bacilli when they are contained in the interior of cells, and for 
this purpose I have drawn three of the large distended cells already described. 
I have thus endeavored to give an accurate account of my examination of the 
skin in this typical case of leprosy, and so to add to the number of those observa- 
tions which, I think, indubitably prove that leprosy is a disease entirely depend- 
ent upon the presence and development of a specific organic virus. As my inves- 
tigations have been wholly limited to the examination of a portion of the skin 
excised from a living patient, I have not thought it either necessary or right to 
discuss the condition of the internal organs or to enter into the question of inocu- 
lation; but I may add that the researches of others, especially those of Neisser, 
have abundantly shown that wherever the lesions of leprosy are situated there the 
bacillus is to be found, and that while the results of attempts to induce the disease 
in animals are still conflicting, some trustworthy experiments would seem to indi- 
cate the possibility of its inoculation.-British Medical Journal. 
Ptomaines, -in connection with the bacillus lepne, we record the following 
facts, illustrating the development of virulent animal poisons under certain cir- Ptomaines. 
1269 
cumstances. This subject is of vast importance in connection with the febrile 
phenomena and degenerative changes accompanying the action of various morbid 
ferments and micro-organisms on the human organisms, such as the bacillus of 
tubercles, of leprosy, and of typhoid fever and other diseases. Alkaloids as agents in 
the causation of symptoms of disease have grown, into great prominence during the 
past few years. Theinterest that attaches to "cadaveric alkaloids" is both pharmaco- 
logical and forensic. Perhaps no one has done more for the advancement of our 
knowledge of ptomaines than Professor Brieger, who has recently published "Wei- 
tere Untersuchungen uber Ptomaine."* As far back as 1866 DuprSand Bence Jones 
noted the presence of alkaloid-like substances in all the organs, tissues and fluids of 
human and animal bodies. Owing to the fluorescent appearance of the solutions 
of this alkaloid in weak sulphuric acid, the name of "quinoidin" was given to it. 
Nevertheless. Dupr6 and Jones did not succeed in obtaining ponderable quantities 
of the pure substance. In 1869 Sonnenschein and Zulzer obtained from a macera- 
tion of muscle an alkaloid having the property of dilating the pupils of rabbits and 
dogs. When injected into the jugular vein of rabbits it increased the number of 
beats of the heart, and in two animals completely stopped the peristaltic action of 
the intestines. Borsch and Fassbender found, in 1871, in the liver spleen and 
kidneys, by the Otto-Stass method, a body having alkaloidal properties. It was a 
tasteless, uncrystallisable substance, and gave, with phospho-molybolic acid, a 
precipitate which by warming and the addition of ammonia assumed an intensely 
blue color. In the same year Schwanert extracted from the putrefying intestines, 
liver and spleen ot a child that died suddenly a peculiar smelling fluid body that 
dissolved in ether. On the supposition that this was an alkaloid formed during 
putrefaction, Schwanert analyzed the completely putrefied abdominal organs of a 
male corpse and obtained a golden oil that smelt of propylamine, had a somewhat 
bitter taste, and gradually evaporated. The hydrochlorate of this body gave 
various reactions like those of alkaloids, but its toxicology was not investigated. 
L. Lieberman extracted from a putrefying stomach a coniine-like substance, 
which was taken up by ether from either alkaline or acid solutions. This sub- 
stance had no poisonous properties. Traces of arsenic were found in the same 
stomach. In a trial for murder by poisoning, held at Brunswick in 1874, an 
expert in chemistry discovered, besides arsenic, a coniine-like base that Otto 
regarded as a ptomaine. It did not give the characteristics of nicotin, though 
resembling it in some respects. It was deadly poisonous and killed a frog 
and a pigeon very rapidly. A similar kind of alkaloid was detected by Brou- 
ardel and Boutmy in the corpse of a woman who had died with symptoms of 
cholera, and who had partaken of a stuffed goose with ten other individuals. The 
base was also detected in the remains of the unwholesome goose. The substance 
wras volatile, smelt strongly of mice's urine, and gave several reactions like those 
of coniine, though it differed in remaining colorless with muriatic acid, and could 
not be oxidized into butyric acid. It proved poisonous to frogs. In the cadaver 
resulting from prussic acid, and also in another due to charcoal fumes, the same 
authors discovered an alkaloid having a likeness to veratrin. Somewhat similar 
substances were also found in a body dead from arsenic, in one that had lain in water 
eighteen months, and in another that had succumbed from asphyxia. Wolken- 
haar, again, extracted from the intestines of a woman who died from the excessive 
use of alcohol an alkaloid-like body having many features in common with nicotin; 
it was not toxic in its action. Morriggia and Battistini stated that dead bodies 
yielded much larger quantities of poison eighty days after burial in warm summer 
weather than when they were investigated in a shorter time after interment. 
These statements were made as the result of physiological experiments on frogs 
and rabbits. Extracts of the putrid tissues were made with pure or acidulated 
water, ether, ethyl-alcohol, or amyl-alcohol, and injected into the animals men- 
tioned. Falling oft in the number of heart-beats, loss of motility and sensation 
and stopping of the heart in systole were the phenomena noted. The name of 
Selmi stands out most prominently in this field of work. It was he, if we mistake 
not, who first coined the word "ptomaine," which indicated the.cadaveric origin 
of the alkaloids. It is now known that bodies undistinguishable from those dis- 
covered in the cadaver occur under many other circumstances. We may refer our 
readers to the article by Dr. Wolfenden, published in the Lancet of 1883, vol. ii, p. 
852. The investigations of Guareschi and Mosso may also be mentioned {The 
Lancet, vol. i, p. 827,1883). Brieger lays much stress on the following propositions: 
That in the different stages of decomposition in the human body different basic 
* Berlin, A. Hirschwald, 1885. 1270 
Ptomaines. 
products are formed; that many ptomaines disappear, their place being taken by 
others; and that certain bases, though present in sparequantities at the beginning 
of decomposition, gradually acquire a great prominence as other basic substances 
disappear. A certain analogy exists between the above-mentioned changes and 
those met with in the putrefaction of albumen. Nencki has shown that for the 
formation of indol a certain temperature is necessary, whilst the production of 
phenol, according to Baumann and Brieger, is independent of temperature. Oder- 
matt has proved for indol what Brieger has for phenol-that it disappears com- 
pletely to make place for other aromatic products. In the course of putrefaction, 
cholin, which is probably derived from lecithin, is perhaps the first alkaloidal sub- 
stance to make its appearance. On the third day what Brieger has called "neuri- 
din" (U5H14N2) can be found. Neuridin forms with picric acid a picrate which 
crystallizes in feather-like masses of needles, which are almost insoluble in cold 
water and very difficult of solution in hot water. Neuridin is always found in 
company with cholin, but the latter gradually diminishes in quantity, whilst the 
former increases day by day. The fact that in slow putrefaction of human organs 
no strongly poisonous ptomaines can be shown to exist during the first few days 
deserves attention. About the time of the disappearance of cholin may be reck- 
oned as the period when strong toxic products are developed. It is not known 
whether trimethylamine results from the decomposition of cholin or neuridin, but 
both these bodies contain its elements. Brieger refers to the appearance of a pto- 
maine on the seventh day, which has hitherto been unknown. One of his obser- 
vations showed that this new base was present even on the third day, though 
in very minute traces. With platinum salts the new base formed dark red masses 
which were composed of needles mixed up with spangles and spicules. The puri- 
fied crystals were of a somewhat brighter color, and were found by Dr. Hirschwald 
to be about two millimetres in length, and to belong to the rhombic system of crys- 
tals. The crystals proved, with polarized light, to be doubly refracting. The base 
also forms a beautiful double salt with gold. This new diamin (U6H16N2) is 
termed "cadaverin," and boils at a temperature of 115° to 120° C.; unpleasant its 
odor is, reminding one of coniine. A third diamin has also been differentiated, 
having the composition of a butylendiamin (C4Hi4N2), but its reactions prove it to 
be a secondary diamin. The absurd name of "putrescin" is given to thissubstance, 
which may be detected on the fourth day of natural putrefaction, but is not pres- 
ent in large quantities until a week later. A fourth diamin called "saprin" has 
also been isolated from the products of decomposition of human organs. Neuridin, 
cadaverin, putrescin and saprin are physiologically almost harmless; cholin in 
large quantities produces physiological effects like those of muscarin; whilst tri- 
methylamin must also be given in large quantities in order to cause toxic effects. 
Brieger has, however, found two powerfully poisonous ptomaines in the cadaver. 
These poisons existed in large quantities on the fourteenth and twenty-first days 
of decomposition. One of these bodies is named "mydalen;" it exercises marked 
effects on the various functions of the body, increasing the nasal and lachrymal 
secretions, dilating the pupil, stopping the heart and breathing, and causing par- 
alysis and death. After large doses the heart is found to stop in diastole. Severe 
diarrhoea and vomiting were observed in a cat as the result of the injection of a 
minute dose of the poison. Brieger has also investigated the nature of the products 
resulting from the action of bacillii in various media. He has separated highly 
poisonous bases from cultivations of the Koch-Eberth bacillus of typhoid fever. 
Intense salivation, diarrhoea and paralysis were some of the toxic effects produced 
by these poisons.-Lancet. CHAPTER XVI. 
TREATMENT OF ORIENTAL LEPROSY (ELEPHANTIASIS GR^CORUM). VIEWS 
OF THE OLDER WRITERS. 
Aretaeus, the Cappadocian, remarks, with reference to the cure of ele- 
phantiasis, that the remedies ought to be greater than the diseases, for the 
relief of them. But what method of cure would be sufficiently powerful 
to overcome this malady, which does not attack one part or viscus, nor 
prevail only internally or externally, but inwardly it possesses the whole 
person, and outwardly covers the whole surface-a spectacle unseemly and 
dreadful to behold. Aretaeus affirms that, moreover, there is a danger in 
living or associating with it no less than with the plague, for the infection 
is thereby communicated by the respiration; iif fully developed, and if it 
has firmly established itself in the inward parts, and moreover has attacked 
the face, the patient is in an hopeless condition. Nevertheless, he says 
that it is proper to apply every medicine and method of diet-even iron 
and fire-and then, indeed, if you apply to a recent disease there is hope 
of a cure. Aretaeus advocated repeated and copious blood-letting, and free 
purgation, emetics, and the drinking of large quantities of milk for open- 
ing the bowels. 
The following directions by Aretfeus illustrate the therapeutics of his 
time and that of his cotemporary Galen. "Wherefore we are to open the 
veins at the elbow, and on both sides, and also those at the ankles, but not 
the same day, for an interval is better both in order to procure a greater 
flow of blood, and for the resuscitation of the strength; for it is necessary 
to evacuate the blood frequently and copiously, as being the nutriment of 
the disease, but the good portion of which is the natural nourishment is 
small. Wherefore whilst abstracting the vitiated portion, consisting of 
melted matters, we must form an estimate of the suitable part mixed up 
with it, until the disease has given way from want of pabulum; for the 
new part being incorporated with the body, in the course of a long time, 
obliterates the old. Then we are to give the hiera in a potion not once 
only, but let everything be done several times after recovery and recur- 
rence. And let the other medicinal purgation by the food be practiced; 
and let the treatment be that which I have described under ischiatic dis- 
ease, and let the patient drink undivided milk, and that in great quantity 
for opening the bowels. Let it receive the fifth part of water, so that the 
whole of the milk may pass through. They are quickly to be treated with 
emetics, at first those given when fasting, next those after food, then those 
by radishes. Let all things be done frequently and continuously, adminis- 
tering the hellebore at all seasons, but especially in spring and autumn, 
giving it every alternate day, and again next year. And if the disease has 
acquired strength, we must give whatever liquid medicines any one has 
had experience of, for it is a good thing to administer medicines frequently 1272 
Treatment of Oriental Leprosy. 
as a remedy. And I will now describe those with which I am acquainted. 
Mix one cyathus of cedria,* and two of brassica, and give. Another: Of 
the juice of sideritis,f of trefoil one cyathus, of wine aud honey two cyathi. 
Another: of the shavings of an elephant's tooth one drachm with wine, to 
the amount of two cyathi. But likewise the flesh of the wild reptiles, the 
vipers, formed into pastils,^ are taken in a draught. From their heads and 
tail we must cut off to the extent of four fingers' breadth, and boil the 
remainder to the separation of the backbones; and having formed the flesh 
into pastils they are to be cooled in the shade, and then are to be given in 
a draught in like manner as the squill. The vipers, too, are to be used as 
a seasoner of food at supper, and are to be prepared as fishes. But if the 
compound medicine from vipers be at hand, it is to be drunk in preference 
to all others, for it contains together the virtues of all the others, so to 
cleanse the body and smooth down its asperities. There are many other 
medicines of the Celts, * * which are men called Gauls, these alkaline 
substances made into balls, with which they cleanse their clothes, called 
soap, with which it is a very excellent thing to cleanse the body in the 
bath. And purslain and houseleek with vinegar, and also the decoction 
of the root of dock the sulphur vivem proves an excellent detergent. 
The compound medicine from levigated alcyoniam, natron, the burnt lees 
of wine, alnm, sulphur vivum, costus, iris and pepper; these things are all 
to be mixed together in each case according to the power, but in propor- 
tionate quantities; and this compound is to be sprinkled on the body and 
rubbed in. For the callous protuberances of the face, we are to rub in th 
ashes of vine branches, mixed up with the suet of some wild animal, as the 
lion, the panther, the bear; or if these are not at hand, of the barnacle 
goose; for like in the unlike, as the ape to man, is most excellent. Also the 
ammoniac perfume with vinegar and the juice of plantain, or of knot-grass, 
and hypocistis and lycium. But if the flesh be in a livid state, scarifications 
are to be previously madefor the evacuation of the humors. But if yoii wish 
to soothe the parts excoriated by the acrid defluxions, the decoctions of 
fenugreek, or the juice of ptisan, will form an excellent detergent applica- 
tion; also the oil of roses or of lentisk. Continued baths are appropriate 
for humectating the body, and for dispelling the depraved humors. 
The food should be pure, wholesome, of easy digestion, and plain; and 
the regimen every way well adjusted, as regards sleeping, walking, and 
places of residence. As to exercising, running, tumbling, and the exercise 
with the leather bag; all these with well regulated intensity, but not so as 
to induce lassitude. Let vocification also be produced, as being a sea- 
sonable exercise of the breath (pneuma). The clothing should be clean, 
not only to gratify the sight, but because filthy things irritate the skin. 
While fasting the patients are to drink the wine of wormwood. Barley 
bread is a very excellent thing, and a sausage in due season, and a little of 
mallows or cabbage half boiled, with soup of cumin. For supper, the root 
of parsnip and granulated spelt (alica), with wine and old honey adapted 
for the mixing; and such marine articles as loosen the bowels-the soups of 
limpets, oysters, sea-urchins, and such fishes as inhabit rocky places. And 
of land animals, such as are wild, as the hare and the bear. Of winged 
animals, all sorts of partridges, wood-pigeons, domestic pigeons, and the 
best which every district produces. Of fruits, those of summer. Sweet 
wines are preferable to such as are strong. The natural hot baths of a 
sulphurous nature, a protracted residence in the waters, and a sea voyage." 
* Probably gum vernix. 
t Probably the sideritis scordioides. L. 
J Or troches. Treatment of Oriental Leprosy. 
1273 
The Extant Works ofAretaeus, the Cappadocian. London Sydenham 
Society, 1856, pp. 494, 497. Paulus JEgineta in his directions for the treat- 
ment of elephantiasis, follows Aretaeus, the Cappadocian, closely, and 
amongst the local applications gives a formula into the composition of 
which arsenic, sulphur and quick lime enter, as follows: "Of arsenic dr. 
x, of sulphur vivum dr. viii; of costus dr. xii; of quick lime dr. iv; of 
wax dr. iv; of dried bay berries dr. xii; these things are mixed with the 
juice of white poplar leaves, or with a thick decoction, and they are rubbed 
in, having the consistence of honey." 
The treatment of celsus consists in bleeding at the commencement, 
abstinence, then supporting the strength, purging, exercise, sudorifics and 
friction. Baths are to be rarely used; fatty, glutinous and flatulent arti- 
cles of food are to be avoided, but wine is to be allowed, except at the 
beginning. The body is to be rubbed with pounded plantin. Caelius 
Aurelian us approves of rubbing stimulant ointment into the skin, and of 
using medicinal baths, especially the aluminous and chalybeate. When 
the applications produce ulceration of the skin, the disease should be 
treated upon general principles. He makes mention of vomiting by rad- 
ishes, and latterly by means of the white hellebore. He approves of a sea 
voyage and change of scene. Caelius says that Themesin was the first 
author who described elephantiasis, and blames him for recommending 
bleeding and vomiting unseasonably, and disapproves of his directions 
respecting the applications to the skin. It appears that he also disap- 
proved of the thesiae of vipers, and of giving to drink water in which red 
hot iron had been extinguished. There can be no doubt, from the circum- 
stances which he mentions, that the disease was thought contagious in his 
time. Octavius Horatianus, in common with many other authors, recom- 
mends bleeding, purging, vomiting, the thesiae of vipers, and rubbing with 
the usual applications for scabies; lie also speaks favorably of the natural 
and the sea-water baths. Marcellus, the Empiric, like Serenus, recom- 
mends mint, juniper, and mezereon. Galen recommends the treatment 
already mentioned, namely, bleeding, purging and the thesiae of vipers. 
He also particularly commends the black and white hellebores, and calls 
the disease contagious. Oribasius recommends the thesiae of vipers, and 
in certain cases purging and bleeding. The treatment of JEtius is about 
the same as that of Aretaeus and Paulus Aigineta: venesection at the begin- 
ning, purging with colocynth orhiera, and vomiting with radishes or while 
hellebore. Some, he says, having remarked that eunuchs escaped taking 
this complaint, have castrated themselves as a preventive. He makes men- 
tion of all the medicinal substances recommended by Paulus JEgineta, 
namely, iron-wort, cyronaic juice, the thesiae of vipers, etc. For the cutan- 
eous affections he recommends a great many external applications, con- 
taining white hellebore, sulphur, rue, natron, aloes, and even arsenic. He 
also speaks of cataplasms, depelatories and detergent ointments. He is 
very particular in directing that the diet be light and wholesome. 
The treatment recommended by Actuarius, is exactly the same as that 
recommended by Aretaeus, namely, bleeding, purging with hellebore, 
detergent and desiccated applications to the skin. Myrepsus mentions 
some of the common remedies for elephantiasis, such as arsenic, turpen- 
tine, lithage, etc. Amongst the Arabian physicians, Avicennal directs 
that elephantiasis be treated at first with local bleeding and astringents; 
but when ulceration takes place, it is to be remedied only by amputation. 
Serapien says that elephantiasis takes its origin from the liver, in which 
the office of sangninification is improperly performed; his remedies are 
bleeding, hellebore, the thesiae of vipers and various external remedies. 1274 
Treatment of Oriental Leprosy. 
Avinzoar describes the lepra as a cancer arising from contact with other 
lepers, or from unwholesome food; he recommends to purge away th& 
melancholic humor with scammany, colocynth, black hellebore, etc. Haly 
Abbas directs for the cure of elephantiasis to bleed from the arteries 
behind the ears, those of the temples, or from a vein in the arm, to give 
emetics, such as hellebore; to avoid cold; to apply cupping instruments to 
the scorbiculus cordis; to administer the thesim, etc. He recommends 
externally decoctions of beans and vitches at first; and afterwards stimu- 
lating lotions, containing arsenic, sulphur, quick-lime, and so forth. Alsa- 
hararius describes four varieties of lepra, namely, the leonina, elephantia, 
serpentina, and vulpina; his treatment varies according to the circumstances 
of the case; but upon the whole, it is scarcely different from that of the 
authors preceding him. Rhases calls the lepra (elephantiasis) hereditary 
and contagious, and says it is a general cancer, arising from black bile. 
For the sivellecl leg, he recommends bloodletting and emetics, with stimu- 
lating applications, containing pearlashes, sulphur, etc., and also light 
bandages.* 
There are no clinical records to show how far the ancient physicians 
were successful in treating and curing the Oriental leprosy or elephanti- 
asis of the Greeks; but the decided advocacy of its contagious nature and 
the enforcement of good diet, cleanliness and isolation in this disease, 
without doubt accomplished much good in diminishing the number of 
cases and limiting its spread amongst mankind. After the appearance of 
syphilis in the latter part of the fifteenth century, the view was held by 
some medical writers that the disease was a modified form of elephantiasis, 
and the effort was made to cure the latter by those remedies which were 
efficacious in the former. But it has been well established that a large 
number of cases of syphilis are benefited and even cured by the proper 
and prudent use of such remedies as the chlorides and iodides of mercury, 
iodide of potassium and gum guiacum, which have no effect upon the pro- 
gress of elephantiasis. The origin and causes of the two diseases is radi- 
cally different. Elephantiasis, besides that it was described long before 
we have any mention of syphilis, has been observed in many instances 
when there could be no suspicion of venereal affection, either of recent 
date or older standing. The blotches and tubercles of syphilis have by no 
means the same appearance as the tuberculations of elephantiasis. 
The constitutional or secondary symptoms of syphilis can be traced to 
two sources, either a distinct sore or chancre resulting from contact with 
a person infected with syphilis, or by inheritance from parents who have 
been constitutionally affected with the poison of this disease. The syphil- 
itic fever manifest distinct periods and stages, which differ materially 
from the progress of elephantiasis. The tuberculations of elephantiasis 
have a shining brownish tint, and oily look, and are attended with a gen- 
eral puffiness, and occasionally with a great degree of insensibility of the 
skin in their vicinity; the tubercles of syphilis are red or livid, hard, devel- 
oped in the substance of the chorion, clustered together, and almost always 
connective to venereal ulcers of the genital organs; very different therefore, 
from the soft, tawny, irregular tubercles, separated from each other by 
deep fissures, proper to Greek elephantiasis. In those rare cases in which 
Greek elephantiasis is characterized, nor by yellowish blotches and oily- 
looking tubercles, but by fungous and sanious sores resting upon soft and 
* The Seven Books of Paulus 2Egineta, translated from the Greek, with a commentary 
embracing a complete view of the knowledge possessed by the Greeks, Romans and Arabians, 
on all subjects connected with medicine and surgery. By Francis Adams, in three volumes- 
vol. ii, pp. 1-15. Treatment of Oriental Leprosy. 
1275 
flabby bases; these are not less distinct from ulcers of syphilitic origin, 
for the most part so well-marked by their induration and sharply cast but 
irregular edges, and their greyish bottoms of variable depths. 
The tubercles of cutaneous cancer, or of lupus, cannot be confounded 
with those of elephantiasis. Neither of these is attended with the loss of 
the hair and the part they affect, with the development of tubercles on the 
arch of the palate, or any material alteration of the voice; they have, in 
addition, peculiar and very contrary characters, clearly and widely differ- 
ent from those of Greek elephantiasis. We shall endeavor to present a 
clear view of the modes of treatment advocated by the most eminent mod- 
ern authors, such as Bayer, Emerson, Wilson, Plumb, Copeland, Neligan 
and others. 
Despite the praises that have been lavished on certain remedies, 
almost all the well-marked and inveterate cases of the disease are incura- 
ble. Those who are attacked with it before the age of puberty, commonly 
die between their twentieth or twenty-fifth year. Those who contract it 
later in life, may drag on a painful existence for some considerable time. 
Some have been seen presenting all the outward symptoms of the disease 
for more than twenty years, without any notable disturbance of the prin- 
cipal functions of the system. The fatal termination is almost always 
owing to the sequahe of inflammatory affections of the organs of the voice 
and respiration, and of those of digestion. 
GENERAL RESULTS OF TREATMENT. 
Isolation of the sick should be rigidly enforced. Without doubt the 
arrest of the disease in Europe, was in a measure due to the seclusion of 
the lepers in hospitals and asylums specially devoted to this disease; and 
if from any cause or combination of causes, the disease should.show a ten- 
dency to increase, the same measure should be practiced. When elephan- 
tiasis reigned epidemically during the middle ages in Europe, those who 
were suspected of being affected underwent an examination, and those pro- 
nounced lepers were shut up in one of the houses appropriated for that 
purpose. The Hospital for lepers should be situated in a dry well-drained 
locality, should be freely and thoroughly ventilated, and supplied with 
abundant supplies of pure water for drinking, cooking and bathing. The 
bedding should be constructed of light, cheap, but comfortable materials, 
susceptible of constant destruction and renewal. This supply of clothing 
should be abundant and inexpensive, and all soiled garments and rags 
should be destroyed by fire. The bodies of the deceased lepers should be 
destroyed by fire. 
As far as practicable the hospital should be made self-supporting, the 
lepers being employed in the raising of vegetables, and in the weaving of 
cloths and the manufacture of clothing, bedding and furniture for their 
own use. Uncivilized heathen, barbarians affected with leprosy, should 
be either rigidly isolated, or else returned to their native countries. 
HYGIENIC MEASURES. 
MEDICAL TREATMENT. 
Many specifics for this disease have been brought forward, but none of 
them have acquired anything like a lasting reputation, and it is more than 
doubtful whether any of them can be truly said to exercise control over the 
progress of the complaint. The avoidance of such predisposing causes as 1276 
Treatment of Oriental Leprosy. 
hereditary transmission, contagion, and special climatic conditions, depend- 
ent upon heat, moisture, depressed level and malaria, and of such exciting 
•causes as uncleanliness, unhealthy habitation, intemperance, unwholesome 
diet, debauchery, great fatigue and nervous exhaustion. The internal 
administration of cod-liver oil, of arsenic, of iodide of potassium, of iodide 
of iron, and the employment of stimulating applications to the stains or 
tubercles, and of caustics to the ulcers are the best measures which can be 
adopted. When enteritis or diarrhoea have supervened the diet should be 
carefully regulated, and the use of opium practised. Quinine combined 
with the most nourishing food, exercise and bathing, change of climate and 
residence in a temperate and bracing climate, is important as a tonic. The 
disease may be amended or may even be brought to a standstill, if lepers 
are well fed, kept clean, and furnished with some employment, especially 
when it gives a little hope. The local treatment should consist of baths, 
plain or medicated with iron or sulphur, and soothing astringent and anti- 
septic applications to the skin when in the ulcerated state. 
The use of sarsaparilla and guiacum, and of mild alterative doses of 
mercury with antimony, has, along with change of residence, occasionally 
produced a temporary amendment. In the case of a patient treated at the 
Hospital St. Louis, by M. Biett, though in a very advanced stage, con- 
siderable improvement was affected by the use of such simple means as 
confining the patient to milk diet, and mucilaginous drinks with minute 
doses of opium, and baths to allay irritation. A great variety of more ener- 
getic treatments had previously been employed with no permanent benefit. 
All agree that the large employment of mercury aggravates the disease, 
and this too, is often the case with arsenic, though in the form of the 
Asiatic pills, in which it is combined with black pepper, it enjoys a high 
reputation among the native physicians in the East. The bi chloride of 
mercury (corrosive sublimate) internally, and mercurial frictions exter- 
nally, have been employed in elephantiasis without success. The various 
preparations of arsenic have been particularly upheld, for their power 
of bringing about the revolution of the tubercles of elephantiasis; but 
patients have frequently been found to droop and then to die under the 
fever which these medicines are apt to light up; in two cases, which were 
watched by M. Raisin with particular attention, the Asiatic pills, taken 
regularly for a short season, had soon to be given up on account of the 
irritation of the gastro-intestinal membrane they occasioned, without bene- 
fiting a single symptom of the disease for which they were prescribed. 
As to the specific properties of the viper in this complaint, modern 
observers are mostly agreed in regarding them as fabulous. M. Sigaud 
(Du Climat et des Maladies du Brezil, pp. 389-93) gives the details of the 
case of a Brazilian who, having suffered for more than four years from 
leprosy in its worst form, determined to try the effects of the bite of a rat- 
tlesnake. The wound was received between the first joints of the little and 
ring fingers, at ten minutes before twelve (noon), and at half past eleven 
the following morning, the man was dead, after great suffering. No autop- 
sic examination was made, owing to the rapid decomposition and the 
extreme fetor of the body. Two hours after the bite there was a great 
depression of the tubercles in the arms and face. Bark has been extolled 
by Dr. Thomas Heberden in Madeira, and the mineral tonics have been 
recommended by others. Heberden states that he cured a patient in five 
months, who had taken antimony and mercury fruitlessly for some years. 
The medicine employed was a mixture of an ounce and a half of pow- 
dered cinchona bark, and half an ounce of powdered sassafras root, made 
into an electuary with simple syrup, of which the patient took a piece the Treatment of Oriental Leprosy. 
1277 
size of a nutmeg twice a day. He, at the same time, rubbed his arms and 
legs, night and morning, w'ith a mixture of an ounce of oil of tartar, two 
ounces of sal ammoniac, and eight ounces of brandy. Blisters were also 
applied between the shoulders. Several cases seem to prove the utility of 
the muriate of gold, administered in doses gradually increased from the 
tenth to the fourth of a grain, during several months, by way of friction 
under the tongue. These cases, however, are very far from satisfactory. 
The East Indian practitioners have spoken of the asclepias gigantia 
as a.kind of specific. Playfair has published an interesting account of the 
therapeutic effects of this plant in the first volume of the Transactions of 
the Medical Society of Calcutta; and Robison (Med. Clin. Trs. of London, 
first part) thinks that, it may be useful in anaesthetic elephantiasis. Sar- 
saparilla and squills have also been recommended to attention. Turner 
and Vidal have seen tubercles resolved under the use of alkaline frictions. 
The tubercles and stains of the disease may be destroyed by the applica- 
tion of caustic when they are not numerous; but it almost always happens 
that new tubercles are developed in other situations. The discussion of the 
tubercles of elephantiasis has also been attempted by means of the sulphur, 
the vapor, and the sea-water douche, ammoniacal frictions, etc.; but these 
remedies have been attended with very uncertain results. The baths recom- 
mended by some authors have been held useless by others, as Walesius 
and M. Cassan. Robison has advised the application of blisters to the 
insensible patches of elephantiasis ancesthetica. 
Dr. Schilling, at Surinam, found much benefit from the use of the warm 
bath, and stimulant vapor baths, spirituous frictions, and gentle exercise; 
and, in truth, the more frequent occurrence of the disease on the extremi- 
ties, than on the trunk renders it possible that it is somehow connected 
with deficient vitality or imperfect circulation in the skin of those parts 
and leads to the use of such measures. 
Dr. P. Rayer held that the treatment of Greek elephantiasis should be 
directed with a view to prevent the development of tubercles; to favor the 
cicatrization of sores; to obtain the resolution of such spots and tubercles 
as exist, when any have been formed; and to check the progress of chronic 
inflammation of the larynx, lungs, stomach and intestines, if it has already 
occurred, or to prevent it entirely, in case it has not yet made its appear- 
ance. To attain these ends, removal into a mild and temperate climate has 
been recommended, and many persons affected with elephantiasis have 
quitted intertropical countries for the south of France and Italy, but in 
general without deriving any benefit from the change. The practitioners 
of the Antilles were in the habit of sending their patients to the Island of 
Derideraden, remarkable for the mildness of its climate and the excellence 
of its fruits, a two fold recommendation, which, it was presumed, would 
modify the constitution favorably, and retard the natural course of the 
disease. Besides the morbid alterations of the skin, some patients exhibit 
unequivocal symptoms of chronic inflammation of the pharynx and stom- 
ach, of the larynx, trachea, and occasionally of the lungs. These ought to 
be put upon the use of mucilaginous drinks, with a diet consisting of 
milk, white meats, veal, chicken, turtle, broth, etc. Other persons affected 
with elephantiasis show no symptoms of any serious disorder of the larynx, 
trachea, lungs or intestines; in the majority of these cases Rayer preferred 
recommending bland diet and a regulated plan of life, great attention to 
personal cleanliness, gentle exercise, to prosecuting a course of active 
medicines, often uncertain in their primary effects, and occasionally dan- 
gerous in their secondary or remot e consequences, for it cannot be a matter 
of indifference whether or not individuals are put upon a course of can- 1278 
Treatment of Oriental Leprosy. 
tharides, of arsenic, of decoction of mezereon bark, etc, who, from all con- 
curring testimony, are known commonly to die at an early age of some 
inflammatory gastro-pulmonic affection. 
EMPIRICAL REMEDIES. 
The principal empirical remedies which have been recommended in 
this disease are : the asclepias gigantia; hydrocotyle asiatica; veronica 
quinquefolia; chaulmoogra oil (Dr. Rham-Dage's remedy); gurjun oil or 
balsam (recommended by Dr. Dougall); the navadee muttee; carbolic acid; 
salicylic acid; salicylate of soda, and hoang-nan. The asclipias or rumex 
gigantea, the mudar of Hindostan, has received the name of vegetable mer- 
cu^. The part of the plant employed medicinally is the root-bark, 
reduced to powder; and the dose of the latter is half a drachm daily. The 
hydrocotyle asiatica, in the form of powder of the dried plant, is given in 
doses ranging between one and six grains daily, and is also administered 
as an infusion, a syrup and an extract; its active principle is vellarine. 
The medicinal part of the veronica quinquefolia is its root, and ten ounces 
of the root has been mentioned as a quantity sufficient to cure a leprosy. 
The chaulmoogra oil is produced from the seed of an Indian tree, the 
chaoul-moogra or gynocardia odorata. It is administered both internally 
and externally, the dose for the former purpose being six to twelve min- 
ims three times a day. A tincture of the plumbago roses has also been 
found serviceable in cases of anaesthetic leprosy; the dose being one drachm 
three times a day. Dr. Joseph Dougall has recommended gurjun balsam 
or wood oil as a very promising and successful remedy. It is an oleo-resin, 
obtained from one of the species of the diptero carpus tree of India; and 
is given in the form of an emulsion, in combination with an equal propor- 
tion of lime-water, the dose of the emulsion ranging between two and four 
drachms twice a day, or it may very conveniently be administered in cap- 
sules, each containing a drachm. 
Mr. Wyndham Cottle, senior assistant surgeon to the hospital for dis- 
eases of the skin, Blackfriars, has recorded the following cases illustrating 
the use of chaulmoogra oil in an early stage of elephantiasis Grsecorum 
occurring in England: Case 1098, J. W.. 18-years of age. His father, an 
Englishman, born in England, went to India. His mother was born in 
that country of English parents. He affirms that his parents and his three 
brothers, with whom he lives in London, are free from disease, and that 
there is no history of skin affection in his family. Born in Calcutta, he 
resided and travelled in India until November, 1875, when, with his family, 
he moved to London, where he has since remained in comfortable circum- 
stances. In England he has always lived well, and he tells us that in India 
his food was much the same, with no excess of fish. The first symptom of 
the disease showed itself in June, 1877, as a spot as large as a sixpence 
over the angle of the jaw on the left side, the site of which was marked by 
a dark stain. Previously to this his health had been excellent. The 
development of this spot was followed by pains in the limbs that lasted 
about two months. He then noticed that the right forearm, on its outer 
aspect, had become marked by a brownish discoloration. From August 
to October, 1877, small, round tubercles, dark colored, about the size of 
split peas, with somewhat depressed centres, appeared on the backs of the 
hands, similar tubercles showed themselves over the face, but in these the 
central depression was absent and the color lighter. Conjunctival injection 
took place from the first attack. These symptoms persisted and increased. 
Tubercles of like character developed on the feet; and in May, 1878, Treatment of Oriental Leprosy. 
1279 
patches of brown staining, which at first were of a dark red color, swollen 
and hyperaemic, and visible upon both arms and legs. The back of the 
right hand and portions of the right leg were also distinctly anaesthetic. 
In October, 1878, his condition was as follows: He had tubercles, as 
described, on the face, the back of the hands and feet, and the inner sur- 
face of the lower lip, with one on the left conjunctiva. The limbs, especially 
on their outer aspects, were deeply pigmented, dry and scaly, most marked 
on the right side. The back of the right hand and outer surface of the 
right leg were anaesthetic. The finger points were also uniformly enlarged. 
There was no loss of hair and the ears were unaffected. At the end of 
March, 1879, all these symptoms had passed awray, except a more limited 
and less pronounced anaesthesia in the above-mentioned parts, and srnne- 
what raised dark spots on the face and backs of the hands, corresponding 
to the positions occupied by the tubercles, with some thickening of the 
finger joints. 
From March 11th till September 18th, 1878, all the ordinary remedies 
were employed, but the disease steadily advanced, when Mr. Wyndham 
Cottle administered chaulmoogra oil in five-minim doses twice daily. 
The patient experiencing no inconvenience, he succeeded in successively 
increasing the dose to ten and twenty minims three times daily, then to 
forty and sixty minims thrice a day. The disease began to mend from the 
time the chaulmoogra oil was given, and very much more rapidly with 
the larger doses, the improvement being noticeable week by week during 
the last six weeks, while he has been taking the oil in drachm doses. An 
ointment consisting of twenty grains of the chaulmoogra oil to an ounce 
of lard was applied to the affected parts. 
Case 1099.-J. M. was born and spent his youth in England. After 
residing twenty-seven years in Jamaica, he returned to London in Novem- 
ber, 1877. He noticed the first symptoms of his disease in May, 1878, when 
large patches of discoloration appeared on his legs, followed by similar 
spots on the face and arms. A tonic treatment was first employed; and in 
September, 1878, chaulmoogra oil in small doses was given, which was 
increased to twenty minims three times daily. This he continued to take 
till March 10th, 1879, when Mr. Wyndham Cottle first saw him. He 
stated that his condition improved when he commenced to take the oil, 
but the complaint recurred in a more marked degree. Ou March 10, 1879, 
he presented the following appearance. He was hale and well nourished. 
There were dusky red patches, two or three inches in diameter, scattered 
over the face, neck, body and limbs, with the characteristic lionine expres- 
sion of the countenance and thickening of the ears and of the tissues in the 
portions occupied by the spots. A superficial ulcer existed on the outside 
of the left leg, and one spot on the right thigh; and the insides of the feet 
from the great toes to the heels were anaesthetic. He was directed to take 
chaulmoogra oil in drachm doses three times daily. The only incon- 
venience he experienced was slight constipation, which an occasional mild 
purgative removed. He has continued this same treatment. The ulcer on 
the leg rapidly healed; the spots faded in color; some disappeared; the 
anaesthesia was less marked, and his general health improved. 
The preceding results appear to be encouraging. (British Medical 
Journal, June 28, 1879.) Mr. James Martin also bears favorable testi- 
mony to the value of chaulmoogra oil, based upon the progress toward 
recovery of a case of the anaesthetic variety. He gave it in capsules five 
minims for a dose, gradually increasing from three to fifteen doses a 
day. Mr. John D. Hilles speaks favorably of his trials of chaulmoogra 
oil, and guijun oil in leprosy; he gives the former in ten minim doses in 1280 
Treatment of Oriental Leprosy. 
emulsion with milk, and also applies externally a liniment to the affected 
parts, composed of one part of chaulmoogra oil to fifteen of olive oil. He 
has, however, obtained better results with the gurjun oil, and thinks that 
it is destined to come into general use for leprosy. Its failure in certain 
cases he attributed to the advanced stage of the disease to hereditary 
taint, or previous attacks of small-pox, syphilis or yaws. (Brit. Med. 
Jour., April, 1881.) 
Chaulmoogra is the oil expressed from the seeds of the gynocardia 
odorata. Its melting point being high, it is semi-solid at the ordinary tem- 
perature. Its taste and odor are not disagreeable, and in India it bears a 
high reputation as a remedy for scrofula, skin-diseases, and leprosy. It 
should be given at first in small doses of three or four minims, which, as 
the stomach becomes more tolerant of it, may be increased to a drachm. It 
should always be taken after food. It is apt to produce constipation and 
sickness; this is best combatted by administering some mild purgative to 
insure the regular action of the bowels, when the tendency to nausea gen- 
erally disappears. The oil may be prescribed as a mixture suspended in 
gum, or as an emulsion, or it may be administered in perles or capsules. 
Dr. D. C. Danielssen, in charge of the Leper Hospital at Lungegaard, Nor- 
way, mentions in his reports of 1871-73, the use of carbolic acid, and 
its results which were not satisfactory; Dr. Danielssen was led to the 
use of carbolic acid because of the conviction that the bacteria found 
under the microscope in the blood of the patient was the cause of the 
disease. "But similar organisms are found to be not more frequent in 
the blood of lepers than in healthy blood. Dr. Hansen found by micro- 
scopic investigation aggregations of large brown cells which were thought 
to be the cause of the disease." Dr. Danielssen has since modified his 
opinion so far as to consider these cells the results of the morbid changes 
occurring in the disease and not the exciting cause of leprosy. Hence it 
is that he gave up the use of carbolic acid, and experimented with sali- 
cylate of sodium and salicylic acid. 
Of the new remedies used by Dr. Danielssen during the three years, 
1877-1879, salicylic acid, salicylate of sodium, and hoaug-nan, were the 
most interesting. Hoang-nau is a so-called specific sent to Dr. Hansen by 
a priest in Trinidad. The salicylic acid was used alike in both the tuber- 
cular and anaesthetic forms, and generally in the following manner. B.- 
Salicylic acid, grams 4; water and rectified spirits, grams 125. Mix and 
take tablespoonful three to four times daily. A continued use of this, how- 
ever, sometimes produced albuminuria, and salicylate of soda was substi- 
tuted for it in one gramme doses, dissolved in water, four times daily; this 
produced no renal irritation. Carbolic acid caused eruptions and a conse- 
quent fever, and when increased to i grain doses, gastritis. Salicylate of 
soda has less effect upon the tubercular form of the disease than the anaes- 
thetic, but it reduces the eruptions and the consequent fever. When used 
in the anaesthetic variety it reduces the blotches and has other good effects. 
Jaborandi was also used, but beyond producing very free diaphoresis had 
no satisfactory effects. Hoang-nan was also tried, but furnished no results. 
LOCAL TREATMENT. 
The local treatment of leprosy consists in the stimulation of the skin 
by means of hot air baths, followed by frictions and inunction with bland 
and stimulating oils. Ointments and liniments of the specific remedies 
already mentioned, namely, mudar, hydocotyle, chaulmoogra and gurjun, 
have been used for this purpose, as well as for dressing the ulcers. Dan- Treatment of Oriental Leprosy. 
1281 
ielssen and Boeck employed counter-irritants in the course of nerves pre- 
sumed to be affected, with cupping and moxa to the spine in ansesthetic 
leprosy; whilst they treated the tubercles of tubercular leprosy with the 
acid nitrate of mercury, and with strong solution of potassa fusa. Beau- 
perthuy found benefit result from the acrid irritating oil of the shell of the 
cashew nut (anacardium orientate), used as a blister to the tuberous skin; a 
copious exudation followed the application, and relieved both the local 
and constitutional symptoms. The gurjun treatment is accompanied by 
energetic fr ictions with a liniment composed of equal parts of the balsam 
and lime water, the same as the emulsion taken internally; and asthenic 
ulcers are pencilled with a solution of chloride of zinc. 
Fr om the preceding considerations we conclude: 
1st. The treatment of elephantiasis Graecorum should be chiefly sani- 
tary, hygienic and preventative; to a large extent it is a poor man's disease, 
and improvement in the habits and supports of life constitute the best 
safe-guards against it; and as a general ru'e diet and cleanliness are of 
equal if not greater consequence than treatment. 
2d. Remedies to promise favorable results should be employed in the 
earliest stages of the disease, for the various fruitless experiments of phys- 
icians, remind us of the accuracy of the prognosis pronounced by Holler- 
ius-confirmata elephantiasio non curatur. 
3d. A review of the various methods of treatment, and a considera- 
tion of the personal attention required by the patient, suffering under this 
terrible disease, render it evident that it can only be effectually treated in 
an asylum devoted especially to the purpose, hence it should be the policy 
of all governments to establish hospitals in which lepers shall be cared for, 
and kept apart from the rest of the population. 
The treatment of leprosy which Surgeon-Major Peters has adopted at 
the Leper Asylum at Belganum, during the last two years, (1881-1882). 
consists of: 1. Local applications.-The patient was made to rub carbolic 
acid and sweet oil (1 in 40), «arly in the morning for a couple of hours, all 
over the body, and then bathe at about 9 o'clock A. M. with soap and 
warm water; afterwards to rub in an emulsion of gurjun oil made accord- 
ing to Dr. Dougall's formula (viz: gurjun oil one part, lime water three 
pa^ts, churned well together so as to form a thin ointment of a creamy con- 
sistence) over the affected parts, and fill in the ulceration with cotton-wool 
smeared with the emulsion. The ulcers healed rapidly, even such as had 
remained open for several years, but the anaesthetic parts and tubercles 
remained much the same; and except in one or two instances, where it was 
alleged by the patient that the tubercles were softening. Surgeon-Major 
Peters, noticed no change in them. This induced him to try the cashew- 
nut oil, which has been so successful in the hands of Dr. Beauperthuy. 
Briefly then Surgeon-Major Peters has used externally: 
1. As a general application carbolated oil (1 in 40) rubbed over the 
whole body, to promote healthy action of the skin, followed by soap and 
warm water ablution. 
2. For ulcerated parts, an emulsion of gurjun oil and lime-water (1 
in 3) applied by means of cotton-wool and bandages as well as by friction. 
3. For anaesthetic parts and tuberculur growths, the application of 
cashew-nut oil. Internally, chaulmoogra oil in five minim doses, in combi- 
nation with bicarbonate of soda five grains, and peppermint-water one 
fluidounce. In some cases gurjun oil aggravated the symptoms of indiges- 
tio ., i ivariably present in leprous subjects, whilst in others it gave rise to 
diarrhoea; in such emergencies, it is not desirable to weaken the strength 
of the patients by continuing its administration when we have a much bet- 
ter remedy in chaulmoogra oil. As an external application, however, gur- 1282 
Ainhum. 
jun oil is very valuable in the treatment of chronic leprous sores and ulcers, 
which heal rapidly under its action. The advantages of gurjun oil are the 
following: 
1st. Its rapidly healing action in chronic leprous ulcers. 
2d. It softens the skin, and preserves the newly-formed cicatrices from 
cracking. 
3d. It prevents the collection of flies. 
4th. Its efficacy in the treatment of chronic skin diseases. 
5th. Its cheapness. 
The cashew nut oil is a potent remedy for the dispersion of tubercles. 
The cashew-nut oil is applied daily over the tubercles until blisters are 
formed, when it is discontinued. This causes the tubercles to soften and 
disappear, discharging in some cases an ichorous matter, and leaving an 
open ulcer. To the ulcerated surface thus formed, the gurjun oil emulsion 
is applied under which it cicatrizes rapidly. The application of the 
cashew-nut oil has to be repeated again when the skin has healed, until 
complete absorption of the tuberclehas taken place. Care should betaken 
not to Jet it run over the heathy skin or into the eyes. The cashew-nut 
oil appears to be beneficial, also, in the anaesthetic form, applied in a simi- 
far way over the surface covered with the anaesthetic patches. Chaulmoogra 
oil, as an internal remedy acts as an alterative and stimulant tonic. Given 
in combination with carbonate of soda and peppermint-water, it relieves 
in the first instance the distressing burning sensation in the stomach aris- 
ing from dyspepsia, and the constant morbid craving for food which lepers 
generally complain of; at the same time it improves the appetite and pro- 
motes digestion, and thus leads to the healthy assimilation of food. Chaul- 
moogra oil has been found to have a direct influence in causing absorption 
of the tubercles, (Edinburg Medical Journal, March, 1883.) 
AINHUM: 
With the Report of a Case in Ascension Parish, Louisiana, by A. C. Love, M. D. , 
Donaldsonville, Louisiana. 
Dr. J. F. Da Silva Lima, physician to the Charity Hospital, Bahia, 
Brazil, first in 1867, and again in 1880,* described the affection known as 
ainhum. Since 1863 it had attracted his attention as prevailing among the 
Nago negroes of Bahia, and, after years of observation and study, he rec- 
ognized in it a disease altogether different from elephantiasis, with which 
it had formerly been confounded. Among the African negroes of Bahia, 
Rio Janeiro and Buenos Ayres, probably brought by them from the west 
coast of Africa, where it is said to be common, in the Nosse-be, an island 
off the coast of Madagascar, and among the Indians of the Tamul branch in 
Pondicherry, French India, cases of the disease have been observed and 
reported by medical men. Dr. N. J. Pitman, of Tarboro, North Carolina, 
reported a case of ainhum to the North Carolina Medical Society, May 
10th, 1880, and Dr. E. A. Hornaday, of Willow Green, North Carolina, 
another to the same body in June, 1881. In the American Journal of 
Medical Science for January, 1884, there appears a report of another case 
by Dr. L. A. Duhring, of New York. Of itsexistence elsewhere no account 
has been found in the meagre literature on the subject. So the case 
reported by the writer should prove of interest to the profession, if for no 
other reason, because it is so far as the writer is informed, the first case 
of the disease noticed and reported as appearing in Louisiana. 
Of the numerous names proposed for it, the term gnijila, by which the 
disease was formerly designated, is now considered objectionable on the 
ground that the word, a corruption of the Portuguese gafeira, has long 
* American Dermatological Association, Newport, R. I., August 31,1880. Ainhum. 
1283 
been applied to the localized morbid action of another disease, the muti- 
lating lepra of the fingers and toes. Dr. A. Collas,* of the French Navy, 
suggested the terms exerese spontanee, as descriptive of the affection; while 
Dr. C. Beauraguardf applied to it the name dactylosis essentialis. No nom- 
enclature, however, appears so appropriate as that of ainhum, to which 
preference is given by Dr. Da Silva Lima. This word, of African origin 
and meaning "to saw," is suggestive of the morbid process pathognomonic 
of the disease, the formation of a sclerodermous band at the root of the 
small toe which by constriction, ecraseur-lihe, causes strangulation, obliter- 
ates the nutrient vessels, and finally destroys the digit. 
Ainhum is peculiar to African negroes and their descendants. It is 
supposed to be most prevalent where slavery exists. If given no treat- 
ment its course is run in a space of time varying in length from four to ten 
years, and there is on record no evidence indicating that the general health 
of the patient is affected during the time of its continuance. An attack is 
ushered in by intense and persistent pruritus on the internal surface and 
at the root of the small toe about the site of the digito-plantar fold, followed 
by thickening and induration of the skin. In the course of time the base 
of the toe is, by this process of induration, encircled with a sclerodermous 
band, and by reason of the pressure this band exerts on the subjacent tis- 
sues its course is marked by a circular depression. Great tenderness and 
pain are experienced in the part and soon inflammation appears under the 
band on the internal aspect of the digit. Devoid of pus, but pouring out 
a thin ichorous discharge, the inflammation extends along the course of 
the band until the external surface of the toe is reached. From the con- 
stant pressure of the constricting band the inflamed tissue sloughs away, 
leaving a sulcus with concave bottom encircling the root of the toe. In 
time greater constriction and renewed pressure of the sclerodermous band 
are again followed by active inflammation and a subsequent process of 
sloughing. Thus, time and again, by constriction the indurated skin 
encroaches on the subjacent tissues, causing strangulation and interfering 
with nutrition until the nutrient vessels are obliterated, muscular power 
lost, the phalangeal bone diseased and absorbed and, finally, by gangrene, 
the digit is destroyed. During the last few weeks of the disease the toe is 
attached to the foot by a mere pedicle, which if not clipped by the patient 
or some attendant, is often severed by accidental violence. With the drop- 
ping of the toe the course of the disease is ended and the stump heals 
kindly, leaving a small cicatrix. Instances are numerous in which the 
small toes of both feet were affected, but usually that of the right foot. 
The larger toes are rarely affected. 
No satisfactory explanation has been given respecting the etiology of 
ainhum. Dr. J. L. Patterson, of Bahia, Brazil, has suggested that "the 
great obliquity of the flexor tendons of the two last toes of the splay-footed 
black " may be the possible cause of the disease. " It is very probable," 
writes Dr. Da Silva Lima, "that this anatomical disposition may hasten 
the development and progress of the disease, but in my judgment it cannot 
explain its origin and initial symptoms." It appears more probable, how- 
ever, that in the habits and mode of life of this race of people, affected as 
they are by unsanitary surroundings and climatic influences, the cause of 
the disease might be discovered. The pathological anatomy of ainhum 
has been described by Dr. Wucherer in the following words: "On 
microscopical examination of the component textures of the toe, the 
cuticle is found to be little altered, the area occupied by the subcu- 
* Archiv. de Med. Navale. November, 1867. 
f Des Difformit6s des Doigts, Paris. 1875. 1284 
Ainhum. 
taneous fatty tissue is extensively increased at the expense of the tendons, 
bones, and other tissues, and in this space there are scarcely any traces of 
connective tissue (Bindegewede), specially around the blood-vessels. Of 
the two arteries of the toe the external alone remains. The articular car- 
tilage of the second and last phalanges is thinned, its corpuscles are smaller 
in size and fewer in number than normal. In the hyaline substance 
between the corpuscles of the cartilage are developed numerous fatty 
points. The cavities of the spongy substance of the bones are larger than 
natural, and enlarged at the cost of the concentric lamellm around the 
Haversian canals, being also filled with large yellow globules of fat. The 
bones present a worm-eaten appearance, although no caries exists. The ?e 
is no vestige of pus. Here and there the bone corpuscles are scarcely 
visible. The disease appears to consist essentially of an atrophy or fatty 
degeneration of the parts from want of nutrition, an effect of the construc- 
tion to which the toe has been subjected." The anatomical and patho- 
logical examinations made in London in 1867-68 by Campbell de Morgan 
and John Wood; in Paris, 1870, by Cornil; in Tubingen, 1872, by Prof. 
Schuppel, and in Rio Janeiro, 1876, by Pereira Guimares and Martins, do 
not differ materially in their results from those given above. 
ENGRAVING NO. 129. 
Diseased Toe of Spenser Israel. 
The accompanying cut is from a photograph showing the diseased t( e 
of Spenser Israel, a colored laborer and resident of Ascension Parish, 
Louisiana. A native of Virginia, about thirty years ago he was brought to 
Louisiana as a slave. He was a common laborer on a sugar plantation 
until 1863, when he enlisted in the Federal Army, and after two years' 
service became a squatter on government land, living in a rude hut, and 
leading a life of indolence. He is about thirty-five years of age, of a dark 
copper color, height five feet and one-fourth inches, compactly built, and 
weighs one hundred and forty-seven pounds. In May, 1882, when he 
applied to have the small toe of his right foot amputated, he presented the 
appearance of one in excellent health. According to his statement his toe 
had been diseased for about five years, at times so slightly affected as to 
give him no inconvenience, and again so inflamed and painful as to hinder 
him from active work and even confine him to his hut. A wash consisting 
of a ten per cent, solution of carbolic acid was prescribed, but after a 
week's trial without any perceptible benefit was discontinued. Then the 
sclerodermous band on the outer surface of the toe was pared away, reliev- 
ing the pressure, and causing the inflammation in the course of ten days 
to subside. The treatment recommended by Dr. Da Silva Lima, as since 
learned, consists of an incision dividing the constricting band. The 
patient was not seen again until February, 1883, when it was found that 
the sclerodermous band had re-formed and excited inflammation, that the 
bone of the digit had become diseased and been destroyed, and the treat- 
ment of the case was brought to a close by clipping the pedicle and sever- 
ing the diseased member from the foot. ELEPHANTIASIS ARABUM. 
Elephant'sLeg; DalRil; MorbusElephas; 
Barbadoes Leg; Yarn Leg; Galle Leg; 
Cochin Leg; Anay Kaal. CHAPTER XVII. 
ELEPHANTIASIS ARABUM, ELEPHANT'S EEG, BARBADOES LEG. 
Definition of Terms. Historical Notices. Definition and Description; Cause of the Disease. 
^Etiology. Agency of Filariae. Theory of the Cause of Leprosy. Symptoms of Elephantiasis Ara- 
bum. Cause, Duration and Termination. Diagnosis. Anatomical Researches. Pathology of 
Elephantiasis Arabum. Relations of Haematozoa to Chyluria, Elephantiasis Arabum and other 
diseases: Filaria. Jaundice produced by Filaria. Description of the species of Filaria in Mala- 
rial Hsematuria. FilariaHominis. Bronchides. Filaria Medenensis. Filaria Sanguinis Hominis. 
Relations ot Chyluria and Elephantiasis Arabum to Filaria Sanguinis Hominis. Periodicity of 
Filaria Migrations to and from the circulation. Treatment of Elephantiasis Arabum. 
There are two different diseases which possess the common name Ele- 
phantiasis; they are usually denominated Arabian and Grecian. We have 
already treated of the latter. 
Elephantiasis Arabum (elephant's leg). The earliest account we have 
of this disease is by Rhazes, an Arabian physician, who lived in 850. In 
the Arabian language this affection is denominated dal fil, which imports 
literally morbus elephas, elephant disease. The Arabians sometimes con- 
tracted dal fit into UI alone, literally elephas, elephant affection. (Fil alfil, 
Arabic; ulfeel, Sanscrit; hl ulfwall telphant, Greek; elephas, Latin.) This 
appellation was applied to the disease by the Arabians, in consequence of 
the huge misshapen appearance of the affected limb being supposed to bear 
some resemblance to the form of the leg of the elephant. Elephant leg is 
known in the West Indies by the name of Barbadoes leg-, sometimes it is 
denominated yam leg, from the supposed resemblance the affected extrem- 
ity has to the fantastic forms whicu this root occasionally assumes. In 
Ceylon it is called Galle leg, and on the peninsula of India, it is denomi- 
nated Cochin leg, from its being indigenous to that place. In the Malabar 
language it is called Anay Kaal, a term which, like fit, imports elephant's 
leg. We have already considered the elephantiasis of the Greeks-a 
loathsome, contagious, incurable disease of constitutional origin and 
chronic progress; characterized by the appearance of tubercles, producing 
great deformity of the face and limbs, with a thickened, rough and wrin- 
kled state of the skin, loss of hair on the chin and body, insensibility of 
the extremities, ulcerations in the throat, nose, fingers, hands, feet and 
other cachectic symptoms. 
A great degree of confusion has prevailed in the writings of physicians 
with regard to this disease in consequence of the circumstance that the 
Arabians have described the same symptoms under the denomination of 
lepra, or leprosy, to which the Greek physicians had assigned the appella- 
tion of elephantiasis, where the term leprosy has been indiscriminately 
applied to both diseases. But in this inquiry it should be clearly borne in 
mind that the leprosy of the Greeks (lepra Grrecorum) and the Arabian 
leprosy (lepra Arabum) are altogether different in nature, and that the 
leprosy of the Arabians is the elephantiasis of the Greeks. The leprosy, 
DEFINITION OF TERMS. 1288 
Elephantiasis Arabum. Definition of Terms. 
properly so-called, as described by the best Greek writers, is a disease of 
the skin only, and much less formidable than the elephantiasis. Hippo- 
crates speaks of the former as an affection merely superficial, and to be 
ranked among the blemishes rather than among the diseases of the body; 
and Galen, Actuarius and Paulus JEgineta make similar observations. 
The Arabians have described the different varieties of the leprosy (lepra 
Grcecorum) under the generic terms of morphea and albaras, with the specific 
titles alba and nigra. What has contributed still farther to augment this 
confusion in which these diseases have been involved is that most of the 
Arabians have also described a disease under the title of elephantiasis 
which is altogether different from both the lepra and elephantiasis of the 
Greeks, and which does not appear to have been known to the latter. 
The elephantiasis of the Arabians is a local enlargement or thickening 
of the legs, with a change of the color and texture of the skin, producing 
a resemblance to the leg of the elephant; and it was compared in its nature 
and origin to the enlargement from varicose veins. Thus Avicenna, in his 
chapter "De Elephantia," observes that it consists of "an intumescence of 
the feet similar to what occurs in the varix of the veins; sometimes, and, 
indeed, most frequently, it arises from a melancholic humor, and some- 
times from a thick phlegm, and occasionally, also, from the same causes 
which render the veins varicose; it is at first red and afterwards black, and 
is relieved by the same circumstances which relieve the varices. Thus, 
also, Rhazes writes respecting the elephantia'. " Est cum pedis crassities 
angeri videtur, et color obfuscari, genae quoque quae vites vocantur, apparere 
caeperint." Avendyan asserts that "a preternatural swelling happens in 
the legs which is called elephantia, and this on account of its resemblance 
in thickness to the legs of the elephant. 
Haly Abbas stands alone among the Arabian writers upon this subject 
in point of correctness, for under the term elephantia, both in his descrip- 
tion of the symptoms and his observations in the practical treatment of the 
disease, he has in view the proper elephantiasis of the Greeks; and he 
treats of the leprosy of the Greeks under the head of lepra. But he also 
describes the thick leg, distinguishing it by the term elephas. After 
noticing the ulceration of the face and nose belonging to elephantiasis 
properly so-called, he says, "but the disorder which takes place in the legs 
and feet is called elephas," and he also terms it the elephant-like disease- 
elephanticus morbus. This distinction has been noticed by Sennertus as a 
contradiction on the part of Haly Abbas, when it is obvious that the dis- 
tinction of the terms employed by the Arabian is overlooked. 
The ELEPHANTIASIS OF THE ARABIAN WRITERS aS DISTINCT FROM THE 
elephantiasis of the Greek writers is the subject of our considera- 
tion in the present memoir. 
HISTORICAL NOTICES. 
The first accurate observations regarding the elephantiasis Arabum, 
are to be found in Rhazes (cum Serapio, Avenhoe, edit. G. Fianks), 
1853; in Haly Abbas, and in Avicenna (Libri de re medica omnes, in fol, 
Veneties, 1564, vol. 1. p. 952, elephantia'), and it is in this account that the 
disease we are discussing, received the name of elephantiasis Arabica, or 
Arabian elephantiasis. The disease has been since noticed by Forestus, 
(Opera lib. xxiv, p. 453), by Mercurial! (de morbis cutanesis, lib. ii, cap. v.) 
and by Koempfor Amoenit, Exot, fase, 3, p. 58). Elephantiasis Arabica 
has been observed in Egypt, by Prosper Alpinas (medicina methorbica. 
Tugd Batar, 1719), and by the medical officers of the French Army that Elephantiasis Arabum. Historical Notices. 
1289 
invaded Egypt, Larey Relation hist, et chir. de Vexpedit. d^Egypte in 8 vol. 
Paris, 1812, 1817.) 
The following is the account of the elephantiasis by D. J. Larrey, 
M. D., First Surgeon of the Imperial Guards, Inspector-General of the 
medical staff of the French Armies, etc , Baron of the Empire, etc., in the 
first volume of his Memoirs of Military Surgery and Campaigns of the 
French Armies: "Elephantiasis appears to be a disease of the lympha- 
tics; it attacks the skin and the cellular texture of the inferior extremi- 
ties, which become of such immense size, and so deformed, as to be com- 
pared to the feet of the elephant. Hence, according to authors, we have 
the word elephantiasis (see Avicenna.) This disease differs in many 
respects from the leprosy, although like the latter, it commences with gen- 
eral lassitude, debility of the inferior extremities, and difficulty of motion 
in these parts. 
The soles of the feet are very sensible; and on the least locomotion, 
the patient feels pains of the bones, nausea and distress; the face is dis- 
colored, -the lips thickened and the gums become pale. The feet and legs 
are enlarged by an obstruction of the membranes of the cellular substance, 
and of the skin. The leg and foot is covered with distinct tumors, like 
small military buttons, of a reddish violet color. These ulcerate, and the 
ulcers and fissures are covered with black, thick, and irregular crusts. 
The humor which is discharged from these chaps or ulcers, is similar to 
that from leprous pustules. The skin of the leg becomes marbled from the 
number of small varicose veins which enlarge in its substance. These 
extremities lose their sensibility, gradually increase in size, and in propor- 
tion to their increase become hard; for in pressing them we find a resist- 
ance; the print of the finger does not remain as in oedema, which differs 
from elephantiasis, again by its diminution of heat and retention of sen1 i- 
bility, as we know by the acute pains of which the patient complains. 
In elephantiasis, the heat, far from decreasing, increases, according to the 
progress of the disease, until it becomes very unpleasant. 
This appearance has led me to believe that the adipose substance pre- 
dominates in the tumefied parts, which appear to acquire a greater consis- 
tence from the additional hydrogen, that I suspect is found in the venous 
system in consequence of its want of elasticity and the slowness of the cir- 
culation. The external ulcers extend in breadth, and but little in depth; 
the skin of the feet and legs acquires a considerable thickness; the nails 
are disorganized and converted into yellowish scales; the cellular texture 
thickens and becomes as hard as lard; that between the interstices of the 
muscles undergoes the same change, compresses the moving fibre, weakens 
its power, and almost suspends its contraction; motion and sensibility are 
gradually extinguished, and when the disease is at an advanced stage the 
feet and legs are heavy, almost paralytic, and resemble masses of matter 
without shape. The patient is obliged to keep in one place, the body 
becomes emaciated, the face tawny, the lips thick, and commonly cracked, 
and the breath fetid as in the leprosy. Pustules of a herpetic appearance 
arise in the scrotum and sides of the thighs. The features of the face, 
with the exception of the lips, are not altered; the eyes are even bright 
and lively, the skin of the back becomes white and shining when rubbed, 
but it does not scale off as in the leprosy; the hair retains its length and 
color; the beard, instead of falling out as in leprosy, thickens on the chin, 
and the pulse remains natural. The elephantiasis does not destroy the 
appetite, is not contagious, but may be hereditary; according to Bruce, it 
never appears until manhood, or some time after. The natural functions 
are not always even disordered, and the subject may live with this disorder 1290 
Elephantiasis Arabum. Historical Notices. 
to extreme old age. In this it differs from leprosy, for although the latter 
is of long duration, it gradually increases, and almost aways has a fatal 
termination. * * " It is probable that elephantiasis attacks the whole 
system; but from particular causes which we shall attempt to explain, it 
acts primarily on the legs, where it appears to settle and becomes local, 
like the taint of scrofula, which having produced a deep ulcer in one 
extremity, often becomes concentrated there, and forms a local disease that 
must be removed by amputation. 
"The cultivators of rice, and they who inhabit marshy situations, are 
most obnoxious to this disease. The predisposing causes of elephantiasis 
are nearly similar to those of leprosy. To these may be added the imme- 
diate and continued action of moist air, or stagnant water on the feet and 
legs, such as the waters of rice plantations, which are very unwholesome 
on account of the great decomposition of vegetable and animal substances, 
which is constantly going on in them. They seem to relax the texture of 
the skin, and afterwards to tumify and disorganize it. AtDamietta I saw 
a great number of agriculturists who had this disease in its various stages, 
but it is seldom seen in dry airy situations, and on the borders of the des- 
ert and upper Egypt; but according to Bruce, it is found in the marshy 
countries of Abyssinia. The leprosy, on the contrary, prevails in the 
desert regions of Egypt, and I have never seen it on the seacoast where 
the elephantiasis is common. 
"The elephantiasis may be found in three different stages. In the first 
stage the feet and legs are slightly swollen, of diminished sensibility, cov- 
ered with a miliary eruption, of a reddish-brown color, with slight painful 
pricking, increase of heat, irregular pains, especially on the soles of the 
feet. If the skin be pressed, the patient suffers pain, and the impression 
does not remain as in oedema. There is also a difficulty in motion. 
"In the second stage, the eruption is succeeded by small ulcers covered 
with thick yellow and tuberculous crusts. The skin is intersected by 
varicose veins, which give it a muckled appearance. The heat is more 
considerable, as well as the difficulty of motion; the limbs increase in 
thickness, and the sensibility is further diminished. 
"In the third stage, we find a hardness and augmentation of size of the 
extremities, more extensive ulcers, and tuberculous black scabs; a total 
failure of locomotion from loss of sensibility, general debility, emaciation 
and melancholy. Although the persons who have this disease generally 
survive it, the prognosis is by no means favorable. It renders life a bur- 
den, and when it has arrived at this stage, admits of no remedy. Unlike 
the leprosy, it does not appear to be contagious; none of our soldiers 
were attacked by it. I consider it as endemic in warm climates, for I 
have seen it, with some varieties, in different countries of Europe. 
The means of cure are nearly similar to those pointed out for the leprosy. 
Yet we should depend more on topical remedies, viz: discutients, reper- 
cutients, caustics, and especially the application of fire and gradual com- 
pression. By these means I cured a captain thirty-eight years of age, who 
had an incipient elephantiasis. An opportunity has never been given me 
to undertake the cure of this disease when it had reached the second or 
third stage. But I still think that if it were confined to one of the feet, 
and had resisted a well-directed course of treatment, as above detailed, 
we might, as in chronic scrofulous ulcers of the articulation of the tibia 
and tarsus, remove it by amputation of the limb." Vol. 1, pp.276-280. 
Baron Larrey uses the term elephantiasis as synonymous with elephan- 
tiasis Arabum, and leprosy as synonymous with elephantiasis Grtecorum. 
J. Hendy'(m the glandular disease of Barbadoes, translated into French by Elephantiasis Arabum. Historical Notices. 
1291 
Alard, in Mem. de la Societe Medicale d'Emul., t. iv, p. 44), studied it 
among the natives of Barbadoes. M. Alard, who has published an essay 
upon the disease (De Vinflammation des Vaisseaux Absorbans, Lymphatiques 
Dermoides et sous Cutanes (elephantiasis des Arabes) new ed., Paris, 1824), 
thought that the anomalous development which characterizes it was con- 
stantly preceded by inflammation of the lymphatic vessels and glands. 
M. Alard, after giving the Anatomy, Physiology and Pathology of the 
absorbents, examines the state of the knowledge of elephantiasis amongst 
the ancients and Arabians. He merely indicates the region in which it is 
met with and analyzes the description of it by different writers. Then 
follow cases occurring in Europe, the precise seat of the disease, the tex- 
tual and organic changes to which it gives rise, its symptoms, causes and 
treatment. The cases of M. Bouilland (Observations d1 Elephantiasis des 
Arabes, Archives Generales de Medecine, t. vi, p. 567), and some others 
published subsequently in the first edition of the great work of P. Bayer, 
on diseases of the skin, and dictated under his own eye by M. Gaide 
(Observations sur V Elephantiasis des Arabes, Archives Generales de Mede- 
cine, t. vii, p. 353), led to the view that varicose states, and contractions, 
and obliteration of the veins, as also eczematous and erysipelatous inflam- 
mations were in many cases not less efficient causes of these intumescences. 
Researches of M. Fabre. (Observations de Velephantiasis des Arabes. 
Revue Medic., October, 1830). Case of Arabian elephantiasis, by Martini 
and Horack. (Observations rariores degenerationis cutis in cruribus elephan- 
tiasis simulantis, Lipsite, in 4 to., 1828. Various cases, published on ele- 
phantiasis of the hairy scalp, (Ricord, Revue Med., t. lx, p. 13), of the 
arm (Heinsler, Hist or. brachu pcertumedi, in Haller disputat, chirurg, vol. v, 
Ludoft, casus elephantiasis in brachio observatoe, 4 to., Euford, 1703); of the 
scrotum and penis (Tairich, Revue Med., t. i, p. 180; Wadd, cases of dis- 
eased prepuce, 4 to., London; on the pathological anatomy of the skin in 
elephantiasis, by M. Andral (Revue Med., t. xiii, p. 224), and on the treat- 
ment of this disease, by Tomasson (Influence salutas d'Un erysipele sur une 
elephantiasis des Arabes. Journ. hebd. 2d s^rie, t. iv, p. 408); on elephantia- 
sis cured by antiphlogistics (Revue Med., 2d serie, t. iv, p. 489); cases of 
amputation published by Nsegele (Archives Gen. de Med., t. xiii, p. 126), and 
by Clot (Gazette des Hopitaux, 1833, p. 388). 
M. Sigaudsays that the elephantiasis Arabum is endemic in parts of 
Brazil, where it is called the erysipelas of Rio de Janeiro; also elephan- 
tiasic leprosy, and foot of St. Thomas. Dr. Pennock ''Observations on Ele- 
phantiasis," Am. Journ. Med. Sciences, vol. xiv, details a case of elephan- 
tiasis of the Arabs complicated with framboesia, which terminated fatally, and 
of which the post-mortem appearances are described. The following is the 
account of the case as detailed by Doctor Pennock: "Barbier, aged twenty, 
by profession a joiner; entered the Hospital St. Louis, service of M. Brett, 
in the autumn of 1833. He was born in the Department of Haute-Saone; 
has never been in tropical climates, but has always lived in France, and 
his parents were free of all cutaneous disease. His nourishment has always 
been good. During the first years of childhood until he was nine years of 
age, he enjoyed good health; from that period until the age of seventeen he 
was afflicted with a succession of abscesses in the groins, on the neck, arms 
and at the external extremity of the left clavicle. From the appearances of 
the cicatrices there is no doubt but that these abscesses were scrofulous. 
They are of a brown color, almost livid, intermixed with white, of an 
irregular form, and an uneven surface. The present affection commenced 
two years ago, immediately above the great toe of the right foot, by a slight 
elevation and discoloration of the skin, attended with local pain and some 1292 
Elephantiasis Arabum. Historical Notices. 
fever; these symptoms were followed by a small, soft, projecting tumor of 
a red color, which bled upon the slightest touch. Six months afterwards- 
the patient contracted a blenorrhagia, which ceased in a month under the 
treatment of injections of infusion of marsh-mallow, drinking the decoc- 
tion of sarsaparilla, and the liquor of Van Sweeten. No secondary symp- 
toms followed, but the cutaneous affection was subsequently augmented^ 
since that time he has not had any venereal symptoms. The disease 
extended itself by the successive formation of the spongy tissue from the 
toes to the superior part of the thigh. It presents according to its degree 
four principal forms. 
First. A small, indolent, subcutaneous tubercle of the size of a pea, 
causing a slight elevation of the skin. This is the commencement. 
Second. Convex elevations, exactly circular, rising from one to four 
lines above the skin, surrounded by a brown circle, varying in diameter 
from a quarter of an inch to one and a half inches, of a red color, soft, 
spongy, analogous to the fungus of wounds, and bearingsome resemblance 
to raspberries lying side by side, and exuding a red serosity. 
Third. Masses formed by the union of the above, but of irregular 
forms of variable size, covering the leg and the inferior part of the thigh. 
The greater pare of these tubercles have the same appearance as those 
which are isolated. Where the healing process has commenced the sur- 
face is drier, less elevated, and not so irregular. At the superior and infe- 
rior parts of the leg the vegetations have the forms of small, fleshy tonguesr 
imbricated, resembling the crest of the cock. 
Fourth. Cicatrices, which are sometimes large, smooth, of a white 
color, slightly elevated above the healthy skin; sometimes the fungosities 
seem to have dried up without changing form and have assumed a brown, 
livid appearance. The union of all these alterations has changed the 
form of the limb and gives it the appearance of the elephantiasis of the 
Arabs. The circumference of the superior two-thirds of the diseased leg 
is one inch more than that of the corresponding part of the other; the infe- 
rior third is one inch and three quarters more than the left. The limb is 
the seat of excessive itching, and when cauterization is attempted by the 
per-nitrate of mercury the patient suffers excruciating pain. With the 
exception of the cutaneous affection, his general health appeared good 
during the winter of 1833-4. 
Treatment: Infusion of hops for habitual drink with $ij sub-carb, 
soda per Oj ; alkaline baths daily, and cauterization with per-nitrate of 
mercury {nitrique acide de mercure'). April and May; after the first of 
April excessive diarroea commenced, attended with extreme prostration of 
strength; the tongue was red, dry; thirst extreme; abdomen slightly pain- 
ful upon pressure; the pulse frequent (88) and feeble; his usual cheerful- 
ness forsook him, his mind became depressed, and he complained bitterly 
of his situation. The diarrhoea was arrested at intervals by regulating his 
diet and by opiates and astringents, but was renewed by the imprudent 
excess of the patient. During this time the vegetations (fungosities) and 
the tissue of the cicatrices ulcerated, and the diseased limb was covered 
with extremely painful ulcers, very irregular in their forms, their edges- 
perpendicular, and internally grayish color; the slightest pressure upon 
them produced an exudation of very fetid pus. With these symptoms the 
patient died on the second of June. 
Autopsy thirty hours after death.-The skin on every part of the diseased 
limb was thickened, and, with the cellular tissue beneath, was from one- 
fourth of an inch to an inch and half thick. On the cicatrized points the 
epidermis was smooth, and beneath this the entire thickness of the cellular Definition. 
1293 
.and adipose substance, with the exception of a few isolated masses of adeps, 
was replaced by a white, fibrous, aponeurotic tissue, which was firmly 
attached to and blended with the dermis. In the points in which cicatriza- 
tion had not commenced the epidermis appeared detached from the der- 
moid mucous tissue, which was reddened, thickened, slightly uneven, 
bearing some resemblance to the intestinal mucous membrane, and could 
be raised without dissection from the subjacent adipose layer. 
In the middle of the thigh between the sartorius and rectus femoris 
tubercles, was an abscess of the size of a goose-egg, containing a white 
tenacious pus; and on a level with the internal malleolus, all the cellular 
tissue, for the space of two inches, was changed into a sanious mass of a 
slate-gray color, and of a foetid odor. At the external healthy parts of the 
leg the adipose substance was two lines in thickness, soft, and of a clear 
light-yellow color; in the diseased parts, on the contrary, it was an inch 
thick, and separated into masses by a white tissue. This tissue was firm, 
resistant, and was penetrated with difficulty by the scalpel; the cells 
formed by,the interlacing of its fibres contained besides the adeps, a great 
quantity of serous and gelatinous fluid. In the parts which were highly 
diseased, the skin was entirely destroyed, and the ulceration extended to 
the adipose layer; on the internal and superior part of the leg and beneath 
the aponeurotic farcia was an abscess of the size of a hen's egg, containing 
greenish pus, and partly lined with a false membrane. The tissues of the 
internal saphenous vein were thickened, and when cut across, the cut 
extremity remained open like an artery. The tendons, bones and perios- 
teum were healthy. 
Thorax, a small group of tubercles were found at the summit of the 
right lung. Near there was a cavity traversed by fibrous bands, and was 
evidently a cicatrized tuberculous cancer. The rest of the lungs crepitant, 
and floated when thrown in water. 
Heart.-The heart was soft, and the parieties of the ventricles thin. 
Abdomen.-The liver was much enlarged; it not only occupied the epigas- 
tric region, but extended into the left hypochondriac; the volume of the 
left lobe was almost equal to that of the right, its entire weight eight 
pounds. Externally and internally it was yellower thau usual. The gall- 
bladder contained a greenish bile; its ducts were unobstructed. The 
mucous membrane of the stomach and the intestines in their entire extent 
had its normal color and consistence. There was neither redness nor soft- 
ening, nor induration of this tissue. 
A Theoretical and Practical Treatise on the Diseases of the Skin, by 
O. Payer, M. D., etc., with notes and additions by John Bell, M. D. Phila., 
1845, pp. 408-420. 
DEFINITION. 
Certain enlargements of the limbs, scrotum, labia major a, face, etc., 
usually accompanied by hypertrophy of the skin, distinct from phlegmen, 
from oedema and from bloody tumors, have long been described under the 
name of clephanttas arabum. In general terms this has been described as a 
non-contagious disease, characterized by recurrence of febrile paroxysms, 
attended by inflammation and progressive hypertrophy of the integuments 
and areolar tissue, chiefly of the extremities and genital organs; and occa- 
sionally by swelling of the lymphatic glands, enlargement and dilatation 
of the lymphatics, and in some cases by the co-existence of chyluria, and 
the presence in the blood of cirtracia, hsematobia, haematozia; together with 
various symptoms indicative of a morbid or depraved nature. 1294 
Definition. 
Elephantiasis of the Penis and Scrotum. {Elephantiasis Arabum.} 
ENGRAVING NO. 130. 
Engraving No. 130.-Elephantiasis of the penis and scrotum. (Elephantiasis Arabum.) The 
elephantiasis arabum consists of a slow hypertrophy of the skin, areolar tissue and bones. The 
epidermis is thickened and the papillse enlarged; the true skin is immensely thickened; its 
fibrous structure dense and almost rigid; the areolar tissue thickened, its areolae expanded and 
filled with gelaiinous-looking stuff. The bones of the affected limbs become enlarged and heavy, 
and the nearest lymphatic glands are enlarged. Its favorite seats are the legs, which it converts 
into a huge pachyde matous resemblance to an elephant's leg (Barbadoes leg, Bucnemia, etc.); 
and the male genitals, which it converts into a large tumor, reaching often down to the knees. 
It is a disease of warm climates, and dark races are more liable to it than the fair. 
ENGRAVINGS NOS. 131 AND 132 
Elephantiasis Arabum in the Negro. 
Engraving No. 131.-Elephantiasis Arabum inthe negro. Elephantiasis oflower extremities. 
EngravingNo. 132.-Elephantiasis Arabum in thenegro. Elephantiasis ofscrotumand left leg. Elephantiasis in the Negro. 
1295 
The scrotal tumors grow to an immense size. Dr. Panlo, of Madras, 
cut off one which weighed eighty pounds before it was drained, of fluid. 
They continue to increase, and if left to themselves often undergo offensive 
ulceration and sloughing, which destroy life. The only treatment is extir- 
pation. Elephantiasis Arabum is a disease of warm climates; dark races 
are more liable than the fair; it has, without doubt, fits of aggravation, 
attended with paroxysms of fever, like malarial fever; if left to itself it 
continues to increase, making life literally a burden, and is subject to 
ulceration and sloughing, which may destroy life. The only radical remedy 
is amputation of the thigh or scrotum. Dr. Bryant, in one case, tied the 
femoral artery with the effect of stopping the disease. 
ENGRAVINGS NOS. 133 AND 134. 
Elephantiasis Arabum in the Negro. 
(Before Operation.) 
ENGRAVING NO. 135. 
(After Operation.) 
Elephantiasis of Scrotum and Penis. 
Engraving No. 135.-Elephantiasis of scrotum and penis Dr. Weblin's patient. The curled 
prominence in the front of the tumor is the hypertrophied prepuce. Operated on by Dr. Weblin 
at Southampton, in 1862. 1296 
Cause of the Disease. Etiology. 
CAUSE OF THE DISEASE. 2ETIOLOGY. 
Elephantiasis Arabum is endemic in India, the Malayan Peninsula, 
China, Egypt, Arabia, the West Indies, and parts of America, chiefly in 
localities within the influence of the sea air; and it occurs sporadically all 
over the globe, excepting, perhaps, in the extreme North aud Sorth. 
Certain conditions of soil and climate, such as humidity, heat, malarious 
influences and proximity to the sea-coast, seem to be concerned in pro- 
ducing the disease and influencing its development. Removal from the 
territorial endemic area checks the disease, whilst return there reproduces 
it. Elephantiasis affects both sexes and persons of all ages and conditions 
of life. No race is exempt, but it is much more frequent in dark than in 
fair races, and more men suffer from it than women. It occurs at all ages, 
but is most common in adults and middle life, comparatively rarely begin- 
ning in young children or in the aged. There is doubt as to its being- 
hereditary; but Tichard found that of 236 persons, 73 per cent, had one or 
both parents affected. Various causes have been assigned for the disease : 
air, water, food, and as it is common near the sea-coast, eating fish have 
been frequently credited with producing it. The presence or vicinity of 
certain forms of vegetation, and the geological formation of the soil, have 
also been regarded as predisposing and determining causes. 
Climate and locality, combined with bad living, are doubtless the real 
predisposing causes; and it is probable that, as Dr. F. Lewis has suggested, 
it may be found to be intimately associated with the presence in the blood 
of certain parasites. No race is exempt from the disease, but whatever 
may be the explanation, the white suffer less than the dark races. It does 
occur occasionally, though very rarely, in the pure European in India, but 
most frequently in tho®e of mixed descent; it will generally be found that 
where it occurs in persons of apparently European parentage, there is a 
mixture, however slight, of dark blood. 
It is quite uncertain as yet how this disease ought to be classified. 
Mr. Dalton, of Guiana, and Mr. F. Day, place it among malarious diseases, 
and believe it may be arrested in an early stage by quinine and purgatives. 
(Lancet, vol. ii, 1846, p. 453; Pathological Transactions, xiii, p. 304). But 
of late rew views have prevailed. Vandyke, Carter and others, some years 
ago, pointed out the possible connection of this malady with the singular 
affection called varicosity of the lymphatics. 
Lymphatic hypertrophy, or varix of the lymphatics, consists in an active 
growth, anu turgescence of the lymphatics, generally of the secretion, or 
perhaps of the leg; these dilated vessels project on the surface of the skin. 
If punctured or accidentally injured, they give rise to a liquid, which may 
be serous or bloody, ox' milky like chyle, and which when collected sponta- 
neously coagulates, and thus shows that it comes from the lymphatic sys- 
tem. The neighboring glands are greatly enlarged. 
Attention was also drawn to the possibility that the disease known as 
chyluria, in which quantities of chyle are from time to time passed with 
the ^rine, might depend on a varicose state of the lymphatics, discharging 
themselves into the kidney or bladder. 
HYPOTHESIS OF FILARIA. 
The hypothesis was next started that the condition, which was the 
common cause of chyluria, of varicosity of the lymphatic® and of the 
elephantiasis Arabum, was the presence in the blood, or in the tissues, of a 
small worm, to which Dr. Lewis has given the name filaria sanguinis humanis. Theory of the Cause of Leprosy. 
1297 
Similar filariae, both in their adult and immature state have been found in 
Indian dogs. I have in two dogs killed, in certain physiological experi- 
ments, discovered numerous elongated delicate worms, which distended 
the cavities of the heart; the minute larvte of these worms were also visible 
by means of the microscope in the blood of these animals. In the human 
subject they have been found in the blood abundantly, though only in the 
immature state. 
The immature filaria sanguinis hominis is described by Dr. Lewis as 
averaging of an inch in length by of an inch in diameter, not dif- 
fering from the young of many other nematodes, except by the fact of their 
being enclosed in delicate translucent sheaths. The propositions con- 
structed by Drs. Cunningham and Lewis have been thus stated. 
1. In all the individuals suffering from chyluria or elephantiasis 
filarice were detected, and it is possible that the mature entozoa might pro- 
duce petty encysted swellings along the course of the blood-vessels and 
lymphatics, impeding the flow of fluid, either by pressure or by interfering 
with the functions of the nerves. 
2. The immature parasite may perforate and injure the tissues. 
3. The embryo worms might make their way from the capillaries 
into the adjoining lymph spaces. 
Thus the escape of fluid from the lymphatics, either of a secreting sur- 
face, as the urinary organs (as in chyluria), or from the surface of the skin 
(as in the varix of the lymphatics), or into the areolar tissue (as in ele- 
phantiasis), and its passing into a low state of organization, are accounted 
for. 
Mr. Robert Druitt states that when at Madras he spent some hours in 
examining the blood, urine and lymphatic liquid of patients affected with 
chyluria, lymphatic varix and elephantiasis without finding any filariae, 
and he expressed the belief that the phenomena of lymphatic varix and 
elephantiasis are better explained by assuming a condition of active 
growth than by one of mere obstruction, or perforation of lymphatic ves- 
sels with extravasation of their contents. It is more like actively growing 
naevus than mere varix. See Vandyke Carter, Trans. Med. and Phys. Soc. 
of Bombay, vol. vii, 1861; Manson on Lymph Scrotum, Med. Times and 
Gaz., Nov. 20th, 1875; Cunningham and Lewis' Tenth Annual Report of 
the Sanitary Commissions with the Government of India, for 1873; Manual 
of Modern Surgery, Robert Druitt, 1878-79. Mr. Manson has applied this 
theory for the explanation of the cause of leprosy in a communication to 
the Linnsean Society. 
Microscopists have discovered in human blood and in the blood of 
dogs in certain conditions numerous, small, thread-like worms, filaria san- 
guinis hominis. If they could grow and breed in the body in which they 
first appear that body would soon die. "If the blood of embryo filarice at 
any one time free in the blood of a dog moderately well charged with them 
were to begin growing before they had attained a hundredth part of the 
size of the mature filaria their aggregate volume would occupy a bulk 
many times greater than the dog itself. I have calculated," says Mr. 
Manson, author of the paper in question, "that in the blood of certain 
dogs and men there exists at any given moment more than two millions of 
embryos." This minute creature is a very formidable parasite. Were it 
not that large numbers disintegrate and perish or are voided with the 
secretions, having even been found in the tears, the natural functions of 
THEORY OF THE CAUSE OF LEPROSY. 1298 
Theory of the Cause of Leprosy. 
the blood would be impossible. Nature requires that for further develop- 
ment the filaria, as well as other parasites, should enter some other body. 
Knowing that mosquitoes suck human blood Mr. Manson made arrange- 
ments by which he captured a number of the insects which had gorged 
themselves on the blood of a filarious Chinaman who had been persuaded 
to sleep in a mosquito chamber. On examining the insects by aid of the 
microscope the subsequent development of the filaria could be well made 
out; it passes through three stages, in the last of which "it becomes 
endowed with marvelous power and activity. It rushes about the field of 
the microscope, forcing obstacles aside, moving indifferently at either end 
and appears quite at home." Referring to the papillae which appear at 
one extremity of the creature, are supposed to be the boring apparatus, 
Mr. Manson says: "This formidable looking animal is undoubtedly the 
filaria sanguinis liominis equipped for independent life and ready to leave 
its nurse, the mosquito." 
The filaria " escaping into the water in which the mosquito died is, 
through the medium of this fluid, brought into contact with the tissues of 
man, and either piercing the integument, or, what is more probable, being 
swallowed, it works its way through the alimentary canal to its final rest- 
ing place. Arrived there its development is perfected, fecundation is 
effected, and finally the embryo filar ice we meet with in the blood are dis- 
charged in successive swarms and in countless numbers. In warm climates 
the presence of these microscopic worms is most to be feared, and it has 
been but too clearly made out, and that their presence is associated with 
painful and disgusting diseases, and not improbably with leprosy itself.'' 
-Scientific News, 1880. 
SYMPTOMS. 
Elephantiasis Arabica, generally attacks the lower limbs; one limb 
only is most frequently affected, but both may be implicated either at the 
same time or successively. The ordinary form in which it presents itself, 
is hypertrophy of the integument and areolar tissue of some part of the 
trunk or limbs, and notably of the legs and genital organs. The skin 
becomes enormously thickened by hypertrophy of all the fibrous elements 
of its structure, attended by the deposit of a quantity of albuminous fluid 
in the cells of the areolar tissue. The papilke are prominent and much 
increased in size. The integument is formed into hard masses or folds, 
with a rugose condition of the surface, not unlike the appearance of an 
elephant's leg. The feet and toes are almost hidden, and the scrotum or 
labia form enormous outgrowths. The scrotum often attains great weight, 
and may be accompanied by large hydroceles. Scrotal tumors have been 
removed weighing upwards of one hundred pounds. 
In a great number of cases the enlargement of the lower extremities 
is announced in an acute manner by a more or less severe pain in the 
groin and ham, following the course of the vena saphena, and principal 
trunks of the lymphatic vessels, and next by the appearance of a red line, 
or hard, knotty, tenucord, resembling a chain of small subcutaneous tumors 
extending from the bend of the groin to the knee or ankle, or from the 
ankle to the groin, or still otherwise by an attack of erysipelas. In almost 
all cases, the skin assumes an erythematous hue, and the subcutaneous 
cellular tissue becomes the seat of considerable tumefaction. The neigh- 
boringjoints are stiff and contracted; frequently from the commencement, 
there are longcontinued shivering fits, great thirst, uneasiness, restlessness, 
violent retching, vomiting, occassionally delirium, then intense heat, Symptoms. 
1299 
accompanied with palpitation of the heart, followed by general or partial 
sweating, and the cessation of the febrile symptoms. In the course of one 
or more months these phenomena return in the shape of paroxysms at 
shorter or longer intervals, which may vary in number from ten to four- 
teen in course of a year, or may only recur at the end of seven years. 
These fits, the number and duration of which can neither be formed nor 
calculated, are followed by a progressive increase in the size of the limb, 
which would appear at first to be owing, in a great measure, to the depo- 
sition of a certain quantity of serum or coagulable lymph within the cell- 
ular tissue. The limb afterwards becomes hard and no longer retains the 
impression of the finger. The lymphatic ganglions of the groin and ham, 
often being, much increased in size, are sometimes otherwise apparently 
healthy and indolent. 
In this second stage of the disease, it exists without any further incon- 
venience than that which the deformed state of the limb necessarily occa- 
sions. It sometimes assumes extraordinary shapes, and becomes entirely 
out of proportion. In one case, the tumor is full and uniform, like a well- 
filled bag or bladder; in another, it is in divisions as if each successive fit 
had formed and left its own particular swelling. After the first attack the 
skin is usually pliant and does not exhibit any change of color; vessels 
sometimes appear creeping beneath it, and give it a brownish hue; by 
degrees, however, it becomes hard, particularly in the neighborhood of the 
ankle joint, and is covered with elevations and small veins; the epidermis 
often becomes thickened as in ichthyosis. Finally chaps and fissures are 
sometimes formed on the limb, which now becomes excessively deformed. 
The knee-joint occasionally becomes the seat of very obstinate chronic 
inflammation in these cases. 
The onset of elephantiasis is frequently violent and attended with 
great suffering. There is high fever, intense pain in the lumbar region, 
groin, spermatic cords and tubes, which become swollen; white acute 
hydroceles form. These symptoms are often attended with sympathetic 
vomiting, nausea and rapid erythematous swelling of the external parts; 
and if the extremities are attacked, the swelling may be tense and painful, 
accompanied by much effusion into the areolar tissue. The surface of 
the integuments is much inflamed, and sometimes discharges a serous 
ichor or chyle-like fluid, according to the extent to which the lymphatics 
are engaged in the particular case. The great swelling and tension of the 
spermatic cords are apt to dilate the abdominal rings so widely that after 
recovery the patient may suffer from hernia. 
In some cases of elephantiasis the integuments are also the seat of a 
dilated and turgid condition of the lymphatic vessels, which, during the 
periods of vascular excitement, when the febrile attacks occur, give way and 
discharge a chyle-like fluid; in other cases the surface temporarily assumes 
a herpetic condition, which emits an acrid and offensive serum exudation. 
Elephantiasis not infrequently occurs without much or any obvious injury 
to or disturbance of the general health during the intervals between the 
febrile attacks, which in some cases are few and slight. The appetite, 
spirits and strength are good, the functions are all normally performed, 
and the only inconvenience is that due to the size and weight of the out- 
growths. On the other hand, it is frequently quite the reverse; the rap- 
idly recurring febrile attacks, pain, exhaustion, suffering and visceral 
complications induce a state of cachexia and debility sometimes so serious 
as to render surgical interference impracticable. Hepatic and splenic 
enlargements do not, as a rule, result from the persistence of the elephan- 
toid fever alone; though not infrequently, as a more direct result of mala- 1300 
Cause, Duration and Termination. Diagnosis. 
rious poisoning, they seriously complicate the evils of the sufferer's 
condition. Albuminuria, as well as chyluria, is occasionally present. 
In some cases, after the outgrowth has attained a certain bulk, it 
ceases to grow altogether, or increases slowly and insidiously without febrile 
disturbance, and in such cases the general health remains good. But there 
is generally a tendency to the recurrence of the fever once or twice a 
month, when the parts affected become tense, hot, painful and swollen, 
and often discharge a serous or lymph-like fluid, which may be acrid and 
offensive. Some tumors, on the other hand, are very slight, if at all, so 
affected, and remain perfectly dry. In all cases, however, some growth 
goes on, and even then, as occasionally happens, fever has ceased to recur, 
there may be a gradual, but slow and painless, increase of the hypertrophy. 
The greatest variety and uncertainty obtained on the duration and pro- 
gress of the growth; sometimes it is very rapid; at other times it is slow, 
with intermissions of activity and indolence of development. The disease, 
elsewhere than in the genitals, unless it be accompanied by exhaustion and 
debility, causes no failure in the generative powers in either sex. Women 
may have a tendency to miscarry when suffering from elephantiasis. 
According to Richard, the average duration of the disease, as deduced 
from the observation of 636 cases, was eleven and a half years; and he 
notes that the earliest age was nine years, whilst the latest at which he 
observed it was eighty years. It appears from this that the disease has little 
influence in shortening life. According to Dr. Hurdy, in some rare cases, 
elephantiasis Arabica has been known to get well spontaneously. A man 
affected with elephantiasis of the scrotum, after having had several attacks, 
was awakened one morning by an uncomfortable dampness round the 
thighs; this proved to be water which had been effused through a crack in 
the diseased skin. About six ounces of the fluid were collected in a basin. 
A few months after this the patient had another recurrence of a similar 
evacuation from the scrotum, after which this part was reduced almost to 
the natural size. 
CAUSE, DURATION AND TERMINATION. 
DIAGNOSIS. 
When Arabian elephantiasis is announced by febrile symptoms, 
accompanied with pains along the course of the veins, vessels and lym- 
phatic glands of a limb, it presents almost the same characters as certain 
cedemas observed in puerperal women, in whom the principal veins of the 
extremities have been found obstructed by fibrinous clots. Where the 
skin has become uneven or tubercular in Arabian elephantiasis, the altera- 
tion which takes place is somewhat similar to that which is seen in ele- 
phantiasis Graeca, but in the latter the inequalities or tubercles follow spots 
of a tawny color, and do not constitute its principal outward character; 
whilst in Arabian elephantiasis the lesser swellings and tuberculations are 
accidental, only appear during the last stages o'f this disease, and are 
always accompanied by other lesions of parts under the skin. The point 
which it is of the greatest consequence to ascertain in cases of elephanti- 
asis Arabica, is whether the tumification of the parts affected be produced 
by indurated cellular tissue, impregnated with serum and hypertrophied, 
by adipose tissue, or by an anomalous development of the skin, muscles 
and other tissues which enter as component parts into the organization of 
the limbs or parts affected, whether the vessels and lymphatic glands be 
inflamed or not, and whether the enlargement be the result or not of some 
obstruction to the course of the blood occasioned by compression, dilata- 
tion, contraction or obliteration of one or several of the veins. Anatomical Researches. 
1301 
ANATOMICAL RESEARCHES. 
Despite the enlargement of the lower extremities, the distended skin, 
may retain its natural thickness and almost its natural color; but hyper- 
trophy more frequently takes place, at least in some parts, and then it 
bears a close resemblance to a fibrinous deposit, the epidermis covering it 
also generally very much thickened. Mr. Chevalier (Med. and Chirug. 
Transactions, vol. ix, p. 63), found the papillae of the skin exceedingly 
enlarged, lengthened and projecting from the surface of the dermis; on 
the points where these papillae were less developed, the epidermis was 
thinner; the chorion was so much hypertrophied that in some places it was 
half an inch thick, and presented the granular appearance which is observed 
in large quadrupeds. On the inner surface it adhered to the indurated 
cellular tissue with which it was evidently blended. In other respects it 
was neither injected nor altered in its color. 
In the body of a woman, who, fifteen years previously, had suffered from 
an ulcer in the right leg, which had increased to an enormous size, and 
the skin of which was very hard, rough, and of a dark brown color, and 
in some places absolutely black, like that of the band of a negro, M. 
Andral found the subcutaneous and intermuscular cellulai' tissue sensibly 
hypertrophied and hardened more and more so as it lay near the dermis; 
this had also increased considerably in thickness, and in several places 
could not be separated from the indurated cellular tissue, each seeming to 
be but different degrees of the same organization. The papillary body, 
lying over the chorion was greatly developed, evidently distinct from the 
dermis, and appearing to stand in the same relation to it as the villi do to 
the intestinal mucous membrane. Situated over the papillary body again, 
and between it and the epidermis, there were three very distinct layers ; 
the innermost of the three penetrating between the eminences of the papil- 
lary body, receiving no vessels, and consisting of a fibro-cellular tissue; 
the second, situated more externally, composed of extremely delicate 
blackish filaments, interwoven in the true sense of the word, forming a 
network which was exactly similar to the colored rete of the negro; finally, 
a third, quite close to the epidermis, and in particular places forming only 
a white line similar to the epidermic layer of the papillae, but thicker in 
others, and hardened as though formed of a series of superposed scales. 
(Archives Generales de Medecine, March, 1823.) 
Bayer made similar observations on the structure of hypertrophied 
skin. M. Bayer and M. Gaide made the following anatomical researches 
in the cases of the individuals named Allard and Fournier. After having 
incised the skin in the direction of its thickness the following layeis were 
discovered, reckoning them from the more internal to the more superficial 
strata: 
1st. Small lobules of adipose tissue, connected together by a healthy 
laminated tissue, forming a subcutaneous layer. 
2d. Above this was placed the chorion, represented by a transverse band 
of a pale yellow color, evidently hypertrophied, the arelose of which were 
less distinct than in the natural state; it was, besides, loaded with a great 
quantity of serum, which was easily made to How only by compressing it 
between the fingers. From its inner surface it sent off whitish fibrous pro- 
longations, which penetrated some depth into the subcutaneous tissue. 
3d Above the chorion a second layer was seen, composed of parallel 
fibres, running from the outer surface of the chorion towards the epidermis. 
This second layer, evidently formed by the papillm elongated, and of a 
reddish violet color, was of unequal thickness in several parts, and varied 1302 
Anatomical Researches. 
from two to three lines and a half in length. These two first layers of the 
skin were rendered distinct one from the other, both by the opposite direc- 
tions taken by their fibres, and by a transverse line which resulted from 
their difference in color. Between the parallel fibres of the papillary 
layer small vessels might be distinguished by the naked eye; these were, of 
course, more distinctly perceived when examined under the magnifying 
glass. The superficial surface of this second layer presented small emi- 
nences mostly lenticular, separated from one another by deep furrows, 
evidently formed by the most elongated papillae, whilst the smaller ones, 
united in the same line, gave rise to the formation of the wrinkles. By 
maceration, the papillae which formed these elevations became free, and 
appeared, when examined under water, like the pile of velvet or plush. 
Above the papillae a third layer exists, distinct from the epidermis which 
covers it. In detaching this third layer, very delicate filaments are seen, 
tending towards little whitish bodies, situated, and, as it were, attached to 
the inner surface of the lamina albida (follicles) ; these small bodies, 
variously disposed, either singly and scattered, united in parallel series, or 
agglomerated in the form of larger or smaller patches, all or almost all 
come away with the lamina albida, to which they adhered. Some of those 
follicles are perfectly round; others are longer, and terminate in a point at 
one of their extremities in the form of tears; others, again, still longer, 
appear cylindrical; some present, over their centre, or on their outer 
aspects, a blackish point, which would seem to be their orifice. The epi- 
dermic layer, disposed like the preceding, in the form of a membrane, and 
like it, transparent, where it is not formed of accumulated squamae, is also 
in contact, on its inner surface, with small follicles similar to the preceding 
ones. United in general in the form of patches, these were more particu- 
larly apparent on the parts which correspond to the squamae. From 
the inner surface of the epidermis small prolongations are sent off, which 
surround the hairs to their bulbous extremities, and are very distinct from 
the follicle. (Diseases of the Skin. P. Bayer, p. 402.) 
In elephantiasis Arabica the subcutaneous cellular tissue has been 
found harder in proportion as it was nearer to the dermis. The adepose 
tissue has been known to become enlarged in a very extraordinary manner. 
M. Bayer has also found the cellular tissue infiltrated as it is in dropsies of 
long standing. M. Fabre has seen the subcutaneous cellular tissue con- 
verted into a thick, hard, almost fibro cartilaginous layer, presenting in 
several places, small ossified plates, adhering so closely to the aponeurosis 
of the leg, and to the nerves and vessels which traverse it, that it was 
impossible to separate them. The subaponeurotic and intermuscular cell- 
ular tissue participated in the same alterations, but in a less degree. 
In a woman who died in the Hopital de la Charite in 1820, whose 
lower limbs were affected with elephantiasis. M. Andral found under the 
skin, and in the place of the muscles of this limb, which were reduced to 
some thin discolored shreds, an enormous mass of hard, condensed cellular 
tissue, with cavities here and there filled with serum, and partaking, in 
more than one place, of all the qualities of cartilage. Hendy has found 
the lymphatic glands hardened, or in a state of suppuration, and much 
larger than they are in their natural state. The absorbing vessels were 
dilated, and their coats so much weakened as to be incapable of standing 
injection. Bayer never observed these large absorbing vessels in any of 
the cases of elephantiasis Arabica which he dissected. M. Fabre says that 
he found it quite impossible to discern these vessels in the midst of degen- 
erated subcutaneous cellular tissue. Bayer frequently found inguinal 
glands of much larger size than they are in a healthy state; but in scrofu- Anatomical Researches. 
1303 
lous subjects, the same morbid development is observed, without dropsy or 
any morbid increase in the limb having taken place. 
In the body of Allard, whose case M. Gaide has published, the lym- 
phatic glands were not found to be larger than those of several other 
bodies examined by himself and M. Bayer, for the sake of examination on 
the same day; the glands of the left groin only were of a deep red, whilst 
those of the right side were of a milky whiteness. The vessels which were 
distributed to these glands were not larger than they are in the healthy 
state. In another patient who died of elephantiasis of both of the lower 
extremities (case of Fournier), the lymphatic vessels situated on the back 
of the left foot, and inner edge of the great toe, were as small and delicate 
as in the healthy state. The glands of the popliteal region had undergone 
no alteration; but from the left groin to the point where the aorta sends off 
the renal artery, a string of lymphatic glands existed, each of which was 
almost of the size of an almond; some of the glands of the groin were red, 
or redish, others were white, and easily crushed between the fingers; those 
lying over the femoral artery, all those which extended along the outer 
side of the iliac vein, and in front of the psoas muscle, were white, crush- 
ing easily between the fingers, and discharging a whitish fluid like pus, or 
softened cerebriform matter. 
Besides this string of altered glands, Rayer and Gaide discovered 
others in the cavity of the lesser pelvis beneath the common iliac vein and 
forming, by their union, a .sort of glandular layer, which extended over 
the internal surface of the ischium. The lymphatic vessels which were 
distributed to the glands of the groin were not larger than in the healthy 
state; and although the chain of glands adhered to the iliac vein, this ves- 
sel did not appear to be evidently compressed by it. 
M. Bouilland called the attention of the profession to the obliteration 
or obstruction of veins as an occurrence, the influence of which he had 
already pointed out, in causing the development of local dropsical affection 
(Archives Generates de Mede cine, vol. ii, pp. 215 and 372). M. Rayer had 
an opportunity of observing the contraction of one of the venre saphen®, 
and the obliteration of the other, in a case of elephantiasis of both legs. In 
the left leg the vena saphena, laid bare along its whole extent, appeared in 
the form of a cylindrical cord of a yellowish-white color, and not trans- 
parent, about a third less in size than the same vein in its natural state; 
the cavity of this vein was found almost obliterated at the point of junc- 
tion between its middle and lower third; the vessel having been cut across 
in this place, a central point was distinguished upon each of the cut 
extremities into which a fine wire of the diameter of that which is usually 
inserted into silver catheters could be introduced though not without diffi- 
culty; the calibre of this vessel had become, in some sort, capillary, through 
an extent of about two inches; its sides being double their usual thickness; 
the vein cut across transversely in any point where it was contracted, con- 
tinued gaping in the same manner as an artery. The femoral vein towards 
its junction with the vena saphena, contained clots of recent formation; 
most of the other veins of this extremity presented no alteration. The 
vena saphena of the left leg contained fibrinous clots of old formation, and 
adhering by their surface to the internal membrane of the vessel; the 
calibre of this vessel was not contracted, but its sides, like that of the 
right vena saphena, were thickened, and resembled those of an artery. 
In a case of elephantiasis of the leg, published by M. Fabre, the vena 
saphena laid bare from one end to the other, could not be traced in the 
middle part of the leg; it was only found at the distance of about four 
finger-breadths below the point; a very fine probe introduced into the 1304 
Anatomical Researches. 
upper and lower part of the vein led to two short sacs. This vein in the 
remainder of its coarse was so much contracted as only to allow the pas- 
sage of a small silver stiletto with great difficulty along it. Its sides were 
hypertrophied and like those of an artery. The external saphena, except 
that it was nowhere obliterated, presented the same appearance; the ante- 
rior fibri he and tibial veins contained blood. The posterior tibial vein 
was obliterated in a part of its course. No obstacle to the course of the 
blood existed in the popliteal, femoral or external iliac veins. Henle 
found the small arteries of parts affected with elephantiasis larger than 
they are in a healthy state. In two cases seen by NF. Gai de, at the Hopital 
St. Antoine, the arteries of the extremities presented no alteration. In a 
case, related by M. Fabre, the anterior tibial and fibular arteries were ossi- 
fied; they contained a little blood; the posterior tibial vein was converted 
into a cylindrical bony stem, into which the blood no longer penetrated; 
the femoral and popliteal arteries were also equally ossified; similar ossifi- 
cations were found in the arteries of the other extremity. 
In a case which Naegle examined, he found the tibial vein increased 
in size, presenting on its surface and in its interior round and oval-shaped 
nodosities, forming so many small cysts, which contained a clear fluid, limpid 
in some places and turbid in others. In the cases of elephautiasis Arabica 
which M. Bayer dissected with great care, the veins presented no alteration. 
In M. Fabre's case the great sciatic nerve, after having preserved its 
natural size to the middle of the thigh afterwards increased continually in 
its dimensions till it reached the ham, where it was of such magnitude 
that its several branches were each much larger than the trunk which sent 
them off. In the thickness of the external popliteal nerve a gelatinous, 
hydatiform mass was found, of a pale red color and the size of a small 
almond, pretty firm in its consistence, and having the medullary fibrils of 
the nerve parted and applied around it. The branches of the external and 
internal popliteal nerves were themselves so much increased in bulk that 
the tibial nerve, the cutaneous muscular branch and the anterior tibial 
nerve were each four times their natural size and presented several enlarge- 
ments. These nerves, although very hard, still preserved pretty evident 
traces of their peculiar organization. M. Ferrus met with a similar dispo- 
sition of the nerves in the leg of an old woman affected with elephantia- 
sis. Hendy commonly found the muscles softened and blanched. Bayer 
has also seen them less deeply colored than in the healthy state; in a 
patient of M. Fabre's several of the muscles were increased, others 
decreased in size; each of them was converted into a fatty substance. 
They were very hard and creaked under the scalpel; the solaeus muscle 
presented this degeneration in a greater degree than any of the rest; here 
and there a kind of streak of bony matter appeared, which seemed to 
occupy the spaces between the muscles, and some of which were connected 
with certain bony excrescences that rose from the surface of the periosteum 
of the tibia. 
In the cases of elephantiasis of the lower limbs which M. Bayer had 
the opportunity of examining anatomically the bones had undergone no 
change. But in several patients and among others a woman that M. Bayer 
attended in the Hopital St. Antoine the tibia of the diseased leg was three 
times the size of that of the opposite side; in M. Fabre's patient the inter- 
osseous ligament of the leg only existed for the space of about an inch in 
the situation where the anterior tibial vessels pass through it; no further 
vestiges of it were seen; it was replaced by an osseous, uneven lamina cov- 
ered with asperities and a line in thickness in some places. This bony 
lamina adhered so intimately to the tibia and fibula that these two bones, Elephantiasis Arabica. 
1305 
thus soldered together in their whole extent, really formed no more than 
one. The surfaces of the lower peroneo-tibial articulation were so com- 
pletely united that no trace of division between them could be discerned, 
even after more than three months of maceration. The circumference of 
the tibia was almost the double of that which it is in its natural state; that 
of the fibula in the middle was fully more than triple. These bones, thus 
closely united, were covered with a prodigious number of shorter or longer 
asperities, bedded in the soft parts, their edges being prolonged in the 
form of prominent ridges, twisted in various ways, so as to represent in 
some sort a series of canals crossed by vessels and nerves which ramified 
upon their surface. The upper surface of the bones of the foot presented 
similar ridges to those ou the tibia and fibula. The density of the tissue 
of the tibia was such that it could only be sawed across with very great 
difficulty; in color and compactness of texture it resembled ivory. The 
bony surfaces of the tibio-tarsal articulation were healthy; none of the 
hard or soft parts of the plantar aspect of the foot participated in these 
alterations. Messrs. Ferrus and Cruveilhier have observed similar morbid 
appearances, and M. Larrey, in his description of elephantiasis, speaks of 
violent pains felt along the course of the bones. 
With respect to the lesions of the viscera accompanying or coinciding 
with elephantiasis Arabica in the lower extremities, M. Bayer observed in 
the body of the man Fournier: the larynx, the trachea and bronchi were 
natural; each of the pleurae contained from eight to ten ounces of serum; 
the left lung was crepitating and loaded with serum, which flowed out 
when pressed between the fingers; there was no trace of sanguineous 
engorgement in this lung, but in the posterior part of the lung of the right 
side there was, and the whole mass of this organ felt firmer and resisted 
pressure more powerfully than that of the left side. 
The pericardium was in a healthy state; the heart of the natural size; 
the thoracic aorta healthy; the cavity of the abdomen contained a small 
quantity of transparent serum. The changes observed in the stomach and 
intestines were post-mortem, and due to the gastric and intestinal mucous 
juices. The mesenteric glands presented no particular' appearance, the 
liver was enlarged and its yellow substance abundant; the finger could 
with difficulty be pushed into its substance. The kidneys larger than in 
the healthy state, presented a more decided alteration on the left than on 
the right side; their whole substance, but particularly the cortical part, 
was of a morbid, yellowish-white, very different from the usual color of 
these organs. The brain and its membranes had undergone no alteration. 
In another case, of a woman named Mary Allard, Bayer describes the 
peritoneum as covered with numerous granulations over' almost its whole 
extent, particularly where it formed the epiploon; the cavity of the lower 
pelvis was partly filled with a sero-purulent effusion; in the large intestine, 
and particularly in the descending colon, small, round ulcers were met 
with, surrounded by the mucous membrane, blanched and of a dead white. 
In the situation of the sigmoid flexure of the colon, the subperitoneal 
cellular tissue was loaded with a profusion of purulent matter; large sin- 
ules existed here, but without communicating with the intestine; this alter- 
ation extended a considerable way into the cellular tissue of the lower 
pelvis; the other viscera of the abdomen appeared to be in a healthy state. 
Elephantiasis Arabica seldom attacks the superior extremities. M. 
Allard, however, quotes four cases of the disease occurring in the arms. 
In one case the hard and permanent swelling of the arm occurred after the 
application of a blister. In another the right arm increased to such a size 
that it weighed two hundred Genoese pounds, forty of which consisted of 1306 
Elephantiasis Arabica. 
serum; the swellings of the arm and forearm resembled a distended blad- 
der of skin; the arteries, the veins and the nerves had undergone no alter- 
ation; but the lymphatic vessels were very much dilated, and loaded with 
lymph. M. Bayer observed three cases of elephantiasis of the upper 
extremity, but the progress of the disease in all was chronic. One occur- 
red in a woman who had the right breast taken off for a cancerous affec- 
tion of the mammary gland, and in whom the lymphatic glands became 
scirrhous, compressed the axillary vein; in the second case, the subclavian, 
axillary and brachial veins were filled with a fibrinous clot of long stand- 
ing, adhering to the inner membrane of these vessels, and of a yellowish 
gray in the centre. In the third, the left forearm was affected, the basilic 
vein was hard and filled with a coagulum which adhered closely to its 
inner membrane; this hard and solid clot was blanched or of a grayish 
color, intermixed with red striae. 
The history of elephantiasis occurring in other regions of the body is 
less complete; elephantiasis of the scrotum is almost the only case which 
has been made the subject of correct anatomical research. Elephantiasis 
of the hairy scalp is very rare; M. Ricord has given two cases of it in the 
Revue Medicale, vol. ix, p. 13. Elephantiasis of the face sometimes only 
attacks it on one side. In a remarkable case of elephantiasis, a man, after 
committing a debauch at table, the patient experienced a violent pain in 
the left cheek and below the zygomatic arch; this pain soon extended under 
the chin; the submaxillary glands enlarged and felt painful; the face 
swelled and became erythematous, and he experienced nausea and slight 
shivering fits. 
At the end of six months, another attack, after which the patient per- 
ceived that the face continued puffed; this attack was followed by several 
others, and the face became larger and larger. In similar cases tumefac- 
tion may arrive at such a height that Schenck speaks of a man whose head 
exceeded that of an ox in size; the lower part of the face was entirely cov- 
ered with the nose, which had to be raised to enable this unhappy being 
to breathe. 
Rayer saw only one case of elephantiasis of the face which super- 
vened after repeated attacks of erysipelas. This disease causes the breasts 
to increase to such a size as to require the support of bandages passed 
around the neck. Salmertius speaks of a woman whose breasts increased 
to such a size that they hung down to her knees. She had, at the same 
time, glandular tumors as large as the head of a foetus, under the axillae. 
M. Alard relates as a case of elephantiasis, that of a lady of Berlin, who 
had an abdominal tumor, the lower part of which reached to the knees. 
This tumor, situated under the skin, outside of the cavity of the perito- 
neum, was formed of a congeries of small pouches, agglomerated, and 
adhering to one another, like the swimming bladders of some large fish. 
Seven of these cells, adhering very closely together, formed the circum- 
ference of this tumor, and an eighth occupied the centre. Each of these 
cells was itself divided into several small compartments, which enclosed a 
clear and limpid fluid, like the white of an egg, but of greater consistence 
in some, and in several similar to the boiled white of an egg. The con- 
tents of others again, were yellowish, greenish or reddish. On the peri- 
toneum being opened no vestige of disease was found in the abdominal 
cavity. No sensible alteration had taken place in the veins, which were 
only found to be a little out of place. 
Next to the lower limb the scrotum is the part of the body which is 
most frequently attacked with elephantiasis Arabica; this part and the 
penis often acquire an enormous size when affected with the disease. This Elephantiasis Arabica. 
1307 
alteration has been improperly designated by Larrey under the name of 
sarcocele d'Egypte; by Prosper Spinas under the name of hernia carnosa, 
and by Kaempfer under the name of endemic hydrocele of Malabar. M. 
Delpeeh relates two cases of it, one of which afforded him the opportunity 
of performing an extraordinary operation. His last patient, who was 
thirty-five years of age, had been afflicted with his infirmity for ten years. 
The skin of the scrotum had become excessively hard, thickened, tuber- 
culated, and intersected with deep wrinkles; the enlargement, pasty at 
first, had afterwards acquired a greater consistence, and become hard and 
very heavy. The tumor formed by the scrotum weighed, when it had 
attained its maximum size, about sixty pounds: under or within this shape- 
less mass the penis and the testicles were buried; it seemed to be divided 
into three unequal masses, two lateral and one anterior, where a sort of 
ulbilicus was seen through which the urine passed. This patient did not 
experience the erysipelatous affections accompanied with fever, shivering, 
vomiting, etc., observed by Kaempfer. Several other inquirers have ascer- 
tained that the disease is not always accompanied by these phenomena; 
and in the patient operated on by M. Delpeeh, the same alterations of the 
skin and cellular tissue which are observed in elephantiasis of the limbs 
were observed; the organs of generation were healthy. In an individual 
Operated upon by M. Larrey, one of the testes was found to be healthy, 
the other smaller than in its normal state. In a third case, which has 
been republished by M. Alard, independently of the alteration in the skin 
and cellular tissue of the scrotum, it was discovered after death that the 
testicles were inflamed like the rest of the parts. The right testicle after hav- 
ing been been stripped of the tunica vaginalis was not less than a goose's 
egg in size. It was divided into three compartments; a gelatinous and 
thick matter infiltrated the upper and lower parts, and the middle was 
occupied by a substance nearly the size of a walnut, into which the vasa 
efferentia emptied themselves, without appearing to have undergone much 
alteration. The tunica albuginea was much thicker than in the healthy 
state, and contained a pale fluid, lodged in small divisions like those of a 
lemon. On opening the tunica vaginalis of the left side, two quarts of 
serous and almost colorless fluid were discharged; the same state of things 
was found on the opposite side. Upon removing the integuments cover- 
ing the penis, which were three fingers thick, this organ was found to be 
of the natural size, or even smaller than it should have been ; the corpora 
cavernosa could not be inflated, as they usually may. All the rest of the 
body was healthy, except the right kidney, the ulceration of which had no 
doubt caused the patient's death. 
Elephantiasis Arabica may also be complicated with scrotal hernia of 
greater or less magnitude. M. Bayer observed a prostitute under the care 
of M. Dupuytren, in the Hotel Dieu, in whom elephantiasis Arabica was 
developed in the labia majora, which were of an enormous size. Similar 
cases have been recorded by Gilbert, Larrey, Tairich and others. It may 
also be developed on the verge of the anus. Upon dissection the enlarge- 
ment of the cellular tissue in elephantiasis Arabica does not present any 
appearance similar to scirrhus in any part it is incised. No scirrhus indu- 
ration or cribriform matter is discerned, but merely a kind of very hard 
oedema, a cellular tissue full of a colorless fluid which can be at all events 
partially squeezed out by strong pressure. The enlargement is hardly 
ever confined to the verge of the anus: it generally extends to a greater or 
less distance into the cellular tissue of the buttocks, where it terminates 
gradually. 1308 
Pathology of Elephantiasis Arabica. 
PATHOLOGY OF ELEPHANTIASIS ARABICA. 
The outgrowths in elephantiasis are the local expressions of a consti- 
tutional disease and are not to be regarded merely from their local points 
of interest. They are the results of certain climatic influences whose exact 
nature is not at present determined, though considering the geographical 
range of the area where the disease is endemic it seems probable that what- 
ever other causes may be at work the so-called malarious influences play 
an important part in its production. Thus this disease is in a remarkable 
degree endemic in the island of Barbadoes, on the southwest coast of 
Ceylon, in the neighborhood of Cochin, on the Malabar coast, in some 
parts of Japan, in Egypt, and in Abyssinia. It occurs not infrequently in 
almost all the West Indian islands and British settlements of South 
America, in the Polynesian Isles, and in the provinces of Castile and Astu- 
ria, in Spain. Only sporadic cases occur over Europe and the United 
States and English provinces of North America; the disease, however, is not 
uncommon amongst the low malarial regions of the Southern States. 
In Ceylon the disease is confined to the indigenous inhabitants, includ- 
ing the half-caste and Creoles. Imported inhabitants, comprehending 
Europeans, Africans. Malays, or natives of the peninsula of India, may be 
said to be exempt from its influence. Soldiers and other imported Euro- 
peans are said not to be liable to it in Cochin. It would appear, however, 
that a prolonged residence and the development of several generations in 
warm climates may so alter the constitution of Europeans as to lead to the 
appearance of this disease. 
The history of this disease in Barbadoes is curious and instructive. 
In Barbadoes elephants leg was, until about the year 1704, confined to the 
black population. A white inhabitant was attacked in that year; and 
before the year 1760, when he died, the disease was common among the 
white population. In general it would appear that imported Europeans 
are not liable to the disease unless they reside for a considerable time in 
the island. It is perhaps owing to this circumstance that soldiers are very 
rarely affected with it. Dr. Hendy states that horses are liable to the dis- 
ease in Barbadoes, and that it had been reported to him that dogs, horned 
cattle and poultry were sometimes affected with it. 
In the month of February, 1755, a fever prevailed in the Island of 
Barbadoes, characterized by a cold stage of four or five hours duration, a 
hot fit, etc, headache, and frequent severe pains in the back. This fever 
was sometimes ephemeral, and occasionally lasted no more than four or 
five days; it, however, much more generally continued longer; and then 
there supervened inflammation of the leg similar to that which accom- 
panies the fever of elephantiasis, but without swelling of the lymphatic 
glands, and without any hard cord in the limb. The inflamed part was of 
a vivid red; small phlycteme arose bore and there over its surface, as in 
erysipelas, and desquamation took place after the cessation of the inflam- 
matory symptoms. 
An epidemic of the same description recurred during the month of 
February, 1757, but marked by several important varieties, which were 
probably ascribable to the excessive heat of the weather upon this occa- 
sion. The fever was now accompanied with pain in the stomach, nausea, 
cough, and sometimes with delirium and coma. The local affection was 
exhibited in the feet, legs or arms of either side, but never of both sides 
at once, and was distinguished by the same redness and swelling as in ele- 
phantiasis; the swelling, moreover, increased after the fever had ceased. 
During the next month many persons were not otherwise affected than with Pathology of Elephantiasis Arabica. 
1309 
a troublesome cough, which ceased as soon as the tumor appeared on the 
arm or hand. 
The disease continued with this phasis till the month of June, when it 
assumed new features; the heat became more considerable, the thirst greater, 
the pains in the back and limbs much greater than at first, and the tumors 
and swellings were apt to fall into suppuration, instead of being resolved, 
as they were through the preceding stages of the disease. James Hendy, 
A Treatise on the Glandular Disease of Barbadoes, 8vo., London, 1784. W. 
Hillary, Observations on the Air and the Concomitant Epidemic Diseases 
in the Island of Barbadoes, 8vo., London, 1759. Dr. Gf. R. B. Horner, of 
the United States Navy, in his "Medical Topography of Brazil and Uruguay " 
Phila., 1845, states that in these countries, elephantiasis exists in every 
form and degree; spares no sex, age nor condition; pays no respect to 
natives or foreigners; affects the poor and rich; harasses servant and mas- 
ter; affects the plebeian and patrician. The poor and laboring classes, 
however, are most annoyed by this disease; and the negro population, both 
the slaves and free portion, have a full share. The persons most afflicted 
with elephantiasis of the lower extremities, are those who live miserably, or 
who are obliged to make much use of their feet, and have them frequently, 
and for a long time, exposed to the sun without shoes or anything else to 
protect them. 
According to Dr. Horner, the chief remote causes of elephantiasis at 
Rio de Janeiro, are the heat and moisture of the climate, rendered more 
injurious by the miasmata and impurities without and within the crowded 
city, situated chiefly in valleys overhung by high mountains, and divided 
by hills. That these are the most efficient causes is proved by the 
acknowledged fact, that since John VI came from Portugal, and landed at 
Rio, and drained, cleansed and otherwise freed the city of noxious sub- 
stances, the disease has declined considerably. The luxury and indolence 
of the people, and the general relaxation of their systems from climate 
and other debilitating agents, may likewise be mentioned as remote causes. 
The exciting are, heat directly applied to the parts, and different irritating 
things put upon or lodged in them. Of the latter, chigoes may be called 
the most common and efficient among the slaves and other people who are 
in the habit of leaving their feet uncovered. Erysipelas is one of the excit- 
ing causes, and when this attacks the scrotum, this becomes enlarged very 
rapidly; but the erysipelas is probably brought about by the same causes, 
primary and secondary; and as it affects the same tissues-the tegument- 
ary and cellular-it may be looked upon as a mere premonitory symptom 
of ordinary elephantiasis, or that attended with increase of substance in 
the parts diseased. 
RELATIONS OF H2EMAT0Z0A TO CHYLURIA, ELEPHANTIASIS ARABUM AND 
OTHER DISEASES. 
The recent researches of Dr. F. Lewis into the pathology of chyluria 
in India, and his discovery of certain hccmatozoa in the blood of those 
affected with that disease, conpled with the fact that the subjects of chy- 
luria and haematozoa, are also frequently, if not always, affected by ele- 
phantiasis with its febrile paroxysms, hypertrophied integument, and lym- 
phatic disturbance, are very suggestive of a commencing or origin of these 
morbid conditions. It is important that this subject should be fully and 
thoroughly investigated by competent observers, armed with the bestinstru- 
ments of modern research. To this end it is important that the established 
facts relating to the haematozoa and the diseases which they induce, should 1310 
Filaria. 
be carefully collated, consolidated and placed within the reach of prac- 
tising physicians. As elephantiasis Arabum is of comparative rare occur- 
rence in large portions of Europe and America, every case should be 
examined with the greatest care, and all the microscopical changes of the 
blood and tissues be noted and recorded with the greatest accuracy. The 
tracing of leprosy to a certain bacillus, and of elephantiasis to the effects 
of hsematozoa, is an advance in the direction of scientific pathology, and 
such discoveries may ultimately lead to a successful application of hygienic 
and therapeutic preventatives and remedial agents. We propose to examine 
the facts bearing upon the origin and nature of elephantiasis and related 
diseases and diseased states in detail, in the hope that the labors of future 
investigators may be facilitated by the possession of facts which now lie 
scattered through many works on natural history and medicine. 
FILAR [A. 
The entozoa included in this genus are of either a white, yellow or red 
color, and of a soft consistence; they are cylindrical and filiform in shape, 
and are very long, the lengths of the body being from eighty to two hun- 
dred times greater than the breadth: the body usually tapers off slightly 
at one of its extremities; the head is continuous with the body, and is 
sometimes furnished with projecting papillae, or with horn-like processes, 
which constitute a protection for it; the mouth is round or triangular; the 
integument of the body is smooth, or minutely striated, in the transverse 
direction. The filariae are found in vertebrated animals, principally in the 
mammiferae and in birds, and more rarely in reptiles. 
ENGRAVING NO. 137. 
Filaria, Sanguinis Canis {Joseph Jones, M. D.') 
Engraving No. 137.-Filaria sanguinis canis (Joseph Jones, M. D.). Heart of pointer dog 
(canis avicularus L), left ventricle opened by an incision exposing a large number of filaria. Filaria. 
1311 
In another dog, which unlike the preceding, was not of a pure breed, 
but was commonly called a cur and appeared to be a cross between the 
spaniel (canis extrarius L) and the hound (canis lagar L), the heart in like 
manner contained filaria. In both dogs the blood contained living larvae 
of the filaria. The discovery which I made of the living filaria in the 
blood and heart of these dogs was as follows : 
In the month of September, 1855, at Maybank Plantation, on Colonel's 
Island, Liberty County, Georgia, in an experiment on the absorption of 
fatty matters, the abdominal cavity of a remarkably large and voracious 
pointer dog, noted for his powerful digestive powers, was opened along 
the linea alba, and two fluid ounces of lard oil secured in the stomach by 
ligatures above and below, and one fluid ounce was injected and secured 
in the same manner in the intestines. The viscera were then carefully 
retained and the wound sewed up. At the expiration of six hours the dog 
was killed, and the contents of the stomach and intestines had neither 
increased nor diminished, and were changed neither in physical nor chemi- 
cal properties! and the lymphatics of the mesentery did not appear to 
contain any milky emulsion. Under the microscope the lard oil presented 
an appearance differing in no respect from that of ordinary oil.* 
This dog was killed by severing the carotid artery, and the blood was 
immediately subjected to careful microcospical examination. The blood 
contained numerous thread-like worms, endowed with active movements. 
These minute filariae were in many cases not more than one five-hundredth 
of an inch in length and one fifteen-hundredth of an inch in diameter. 
From the incessant elongation and contractions and convulsions of these 
minute haematozoa, it was difficult to obtain exact microscopic measure- 
ment. 
After careful observation of these haematozoa under the microscope, 
it was evident that as the movements became slower that there was an 
outer thin delicate transparent tube closed at both ends, within which the 
body of the animal is enclosed. The constant movements of the hsemato- 
zoa were due to the continuous expansions and contractions of the cen- 
tral living bodies within these structureless hyaline coatings or shells. I 
observed in these embryonic worms no means or organs for directly pene- 
trating the walls of the blood-vessels. I was led to examine the heart of 
this dog with great care, and found that the cavities of the heart contained 
numerous thread-like worms, several inches in length, having the same 
general form and appearance as the larvae, moving actively about in the 
blood. 
The drawing, figure 137, represents a portion (apex and portion of the 
base) of the heart of the pointer dog; an incision has been made into the 
left ventricle and the worms are seen in situ in this cavity of the heart. I 
still have this specimen in my possession at the date of this writing 
(December 16th, 1886). The length of the large worms in the cavities of 
the heart of this dog varied from three inches to twelve inches. The 
breadth varied from to of an inch in diameter. The worms were in 
the right ventricle and auricle, but not in the left auricle and ventricle. 
Their onward progress appears to have been arrested by the tricuspid 
valves and pulmonary blood-vessels. The appearance of the large worms 
was similar to those of the larvae; both extremities presented a pointed 
closed appearance. 
* Experimental investigations instituted with a view to ascertain the action of saline solu- 
tions of different densities upon living animals, and also the reciprocal action through dead 
animal membranes, of serum water, and saline solutions. By Joseph Jones, student of medi- 
cine in the University of Pennsylvania (with a wood-cut). American Journal of the Medical 
Sciences, January, 1856, pp. 63-64. investigations, chemical and physiological, relative to certain 
American vertebrata, by Joseph Jones, M. D., professor of chemistry in the Savannah Medical 
College. Smithsonian Contributions to Knowledge, March, 1856, p. 108. 1312 
Filaria. 
In a series of experiments upon the absorption and action of various 
medicinal substances on the animal economy, I performed the following 
experiment on September 4th, 1855, at the same locality as in the preced- 
ing experiment. Made an incision along the linca alba of the abdomen of 
a dog; punctured the duodenum, introduced the nozzle of a syringe, threw 
into the stomach f §j of a solution of the sulphite of magnesia, and passed a 
ligature around the duodenum between the puncture and the stomach. 
The blood of this dog obtained during the operation contained numerous 
filariae similar in size and appearance to those found in the blood of the 
preceding dog. After the death of the dog the blood was again examined 
(death occurred September 5th, 1855,) microscopically and found to con- 
tain numerous minute worms, the larvae of larger ones, several inches in 
length, which were packed away in great numbers in the cavities of the 
right ventricle and auricle of the heart and in the pulmonary artery and its 
branches in the lungs. The left auricle and ventricle, as in the preceding 
case, were free from the entozoa. It may be interesting to state that this 
dog was extremely poor and the skin was covered with numerous sores 
(mange). The dog might be described as a walking skeleton. After more 
than a month's careful attention I found it to be impossible to improve the 
condition of this dog, although he was liberally supplied with vegetable 
and animal food. 
It is remarkable that the docility, courage, physical powers and 
tenacity of life in this dog did not appear to have been impaired by its 
condition, induced no doubt by the presence of these worms in the heart, 
lungs and blood-vessels. There appeared also to be a relationship between 
the ulcers of the skin and the entozoa in the blood. The appearance of 
these worms in the heart of this dog was similar to that shown in the fig- 
ure. These and many similar facts observed during the prosecution of my 
physiological investigations in 1854, 1855, 1856 and subsequently, until the 
commencement of the Civil War, when I entered the Southern (Confeder- 
ate) Army, made a profound impression on my mind, and I was led to the 
belief that not merely domesticated but also wild animals were frequently 
the source through which man received diseases, and more especially the 
diseases which depended upon the presence and effects of entozoa. 
I have sent numerous specimens of these entozoa to Professor Leidy, 
of the Medical Department of the University of Philadelphia, before the 
Civil War. 
The dog would appear to be especially adapted to the communication 
of parasite entozoa to man, for almost every nation of the earth, inter- 
tropical, temperate and polar, possesses its own peculiar variety of the 
dog; the theatre of the observation of the diseases of the dog, therefore, 
is the world itself; therefore, anything like a full description of canine par- 
asites would require a much more intimate knowledge of the surface of the 
earth and its inhabitants, than we at present possess. There is indeed 
ample room for a separate and extensive work on canine parasites, replete 
with original and instructive matter; for all that has been hitherto clone, 
is but partial and unsatisfactory, at least when the subject is considered in 
a comprehensive point of view. During the physiological and anatomi- 
cal investigations which I conducted in the State of Georgia, during the 
years 1854, 1855, 1856, and 1857, I captured, shot, killed and dissected 
almost every known species of quadruped, bird, reptile and fish, inhabiting 
the forests, swamps, rivers, salt-water bays, marshes and islands of the 
sea-coast of Georgia. Numerous specimens were prepared, and minute 
injections, and anatomical preparations preserved. During these labors I 
was forcibly impressed that many mammalia, birds, and cold-blooded ani- Filaria. 
1313 
mals (saurians, chelonians and ophidians) were infested with entozooa, 
peculiar to each genus and species. 
Thus the common rabbit lepus sylvaticus (Bachman) is infested with 
numerous tape worms resembling the teenia solium of man, but more deli- 
cate in structure. I have frequently seen the large intestines of the lepus 
sylvaticus, literally packed with tape worms. 1 was led to attribute the 
frequent occurrence of tape worms in the African race in a great measure to 
the large number of rabbits which they consumed. On the contrary, the black 
bear (ursus Americanus, Pall), the raccoon (procyon lotor. Linn.), the mink 
(putoiins vison, Linn.), the otter (luti a Canadensis, Var), the wild cat (lynx 
rufus, Guld), the fox squirrel (sciurus capistratus, Bose.), grey squirrel 
(sciurusCarolinensis, Gmel.), flying squirrel (pteromyce volualla,Gmel.) and 
the deer (cervus Virginianus, Gmel.), were remarkably free from entozoa. 
After observing the great number of tape worms in the rabbit (lepus palus- 
tres) and lepus sylvaticus), I have refrained from eating the flesh of these 
animals. 
Amongst birds the field lark (strumella ludoviciana, Linn.) was almost 
always infested with large round worms, and I have frequently found the 
intestines perforated by these parasites, producing inflammation of the 
peritoneum. On the other hand the turtle doves (ectopistis Carolinensis, 
Linn.), ground dove (columba paserina, Linn.), wild turkey (meleagris 
gallopavo, Linn.) and the partridge (ortjx Virginiana, Linn.) were almost 
always free from entozoa. The various species of wild ducks were also free 
from parasites in the stomach and intestines. The fresh water chelonians, 
as the musk cooter (kinosternon Pennsylvanicum, Edward), the mud 
cooter, (strenoth acrus odoratus, Bose.), the yellow belly terrapin (emys 
serrata), chicken terrapin (emys reticolata, Bose.), and the alligator 
cooter (chelonura serpentina, Linn.) was frequently infested with intes- 
tinal worms, whilst the saltwater terrapin (emys terrapin, Schoepf) and the 
green turtle (chelonia hydras, Linn.) were exempt from intestinal entozoa. 
The various species of saurians and ophidians were often the hosts of 
gastro intestinal worms. Even the poisonous ophidium, such as the bead 
snake (elaps falvius, Linn.), water moccasin (trigonocephalus piscivorus, 
Linn.),the copperhead (trigonocephalus contortrix,Linn.), the ground rattle- 
snake (crotalophorus miliarius, Linn.), the banded rattlesnake (crotalus 
duressus, Linn.), and the water rattlestake (crotalus adamantius), were not 
exempt from the intestinal worms. The Civil War, 1861-1865, suddenly 
interrupted these investigations. I sent a number of the entozoa from various 
cold and warm blooded animals to the eminent anatomist and naturalist of 
Philadelphia, Dr. Joseph Leidy. The subject of the relations of these 
parasites to the diseases of man and animals is of vast importance. 
Although it has been long known that various species of filaria pro- 
duce a variety of diseases, it has only within the past few years been ascer- 
tained that a small microscopic species could induce jaundice, by the dis- 
covery of Dr. Evans that the disease among horses called ilsurrafi which 
prevails in the Derajat, west of the Indus, is due to filaria. Dr. Evans 
describes the disease in the following terms: "A specific, parasitical, non- 
inflammatory, entozoic blood-disease, characterized by fever with jaun- 
dice; petechise of mucous membrane, especially of the eye and vagina; 
dropsy; albumen sometimes in the urine; great prostration of strength, 
rapid wasting, and with a specific parasite in the blood during life; but no 
characteristic structural organic lesions are found after death. It may be 
JAUNDICE IN THE HORSE PRODUCED BY FILARIA. 1314 
Filaria. 
transmitted by the subcutaneous injection of blood, and by drinking freely, 
blood containing the parasites alive, but is not contagious or infectious in 
the ordinary way. The average duration of the disease is probably not 
less than two months, but reliable statistics are wanting on that point." 
The parasite is described as having a round body, tapering in front to 
a sort of a head, and ending behind in a tail, about three or four times the 
diameter of a white corpuscle in length; and one eighth to one-tenth in 
breadth. 
Dr. Evans inquires whether this disease, the "surra" of the Derajat 
has been known to exist in any other part of India, and if so, whether the 
localities were marshy and water unwholesome, and whether the animals 
had been particularly exposed to the sun or to fatigue before they showed 
symptoms of disease? In reviewing the above description of "surra," 
Professor George Hailey, M. D., F. R. 8., in his work on " The Diseases of 
the Liver" (p. 290), says: "I was forcibly reminded of a specimen of 
jaundice urine from an old Indian officer I once examined, in which were 
found a few exceedingly minute worms, which I exhibited to my histology 
class at University College under the title of filaria infinitesima. First, 
because, though of minute size, they still exactly resembled in shape and 
form an ordinary round filarial nematoid worm-such, for example, as the 
stringyla-and secondly, though a real worm, from its being in many cases 
not bigger than an ordinary human spermatozoon, the form and appear- 
ance of which it so closely resembles, that if two headless spermatozoa 
were united together by their necks, and their taperingtails left free, they 
would conjointly be a good portrait of a filaria infinitesima which they 
resemble equally well in mobility and shape." 
Haematozoa of nematoid development, but not always of the same 
species, have been found also in the dog, wolf, horse, ass, sheep, and in 
various wild animals, and various names have been given to them. In the 
wolf, Bohe-Moreau discovered them, and these were identified as similar 
to the spiroptera sanguinolenta of Rudolphi. One haematozoon from the dog 
is the filaria immitis, and another, according to Dr. Cobbold, is the filaria 
papilosa hcematica (Dr. F. S. Cobbold, Lancet, p. 463, 1873. See also con- 
tributions to this subject by Patrick Manson, M. D., in Medical Times and 
Gazette for 1877). 
On the 4th of September, 1855, I found in the blood of a dog upon 
which I was performing certain physiological experiments, numerous min- 
ute filariae, in the larval state, still inclosed in the shell, and endowed with 
active movements. These minute thread-like worms were found upon dis- 
section, to be the larvae of larger thread worms some inches in length, 
packed away in great numbers in the cavities of the heart and in the 
larger blood-vessels. It may be interesting to state that this dog was 
extremely poor, a mere skeleton, and I had found it to be impossible to 
improve his condition, although he was liberally supplied with vegetable 
and animal food. And it is also remarkable that the docility, courage, 
physical powers and tenacity of life in this dog did not appear to have been 
impaired by its condition, induced no doubt by the presence of the worms 
and their larvae in the heart, blood-vessels and blood. In the blood of a 
large pointer dog used in some experiments upon the absorption of fatty 
matters by the stomach, in 1855, the same larvae of the filariae were found 
presenting all the characteristics of the larvae of the filariae sanguinis 
hominis. This large, powerful and sagacious pointer dog, possessed the 
characteristics of the preceding dog, a vociferous appetite, without any 
lasting benefit resulting from the consumption of enormous quantities of Filaria. 
1315 
animal and vegetable food. His heart contained numerous worms, several 
inches in length, and resembling those previously described. 
Both these dogs suffered with ill conditioned sores upon certain por- 
tions of the integument, and emitted a most disgusting mangy smell. 
(Medical and Surgical Memoirs, containing Investigations on the Geograph- 
ical Distribution, Causes, Nature, Relations and Treatment of various Dis- 
eases, 1855-1876, by Joseph Jones, M. D., volume 1, New Orleans, 1876, p. 
565. The preceding facts observed twenty-nine years ago, establish the 
fact that the dog may be an important agent in the dissemination of the 
filariae sanguinis, and in this manner be the vehicle for the conveyance to 
food and water, and to the surface of the body of the parasite supposed to 
be active in the production of chyluria and elephantiasis Arabum. These 
species, or varieties of filaria, have been observed in the human eye. 
(a). Filaria lentis.-This has been found in the crystalline lens of the 
eye in persons affected with cataract. 
(&). Filaria of the anterior chamber.-A nematoit&worm observed by 
Quadri in the aqueous humor of the anterior chamber of the eye. 
(c). Filaria of the orbit.-This is a variety of nematoid worm which, 
according to Guyot, occurs beneath the conjunctiva of the negroes in Congo 
and the Gaboon. Entozoa have been found in the eyes of horses, horned 
cattle, pigs, sheep, birds and fishes, and most probably exist occasionally 
in the same situation in all other species of vertebratse. A nematoid worm, 
the filaria papilloso, has been often met with in the anterior chamber of the 
eye of horses which have been permitted to graze.in certain low-lying dis- 
tricts of India, soon after the periodical rainy season. The entozoa which 
are found in the anterior of the eye in man and in animals, belong to those 
species which live in serous cavities or in the areolar tissue of other parts 
of the body. Those which have been hitherto observed in the organs of 
vision in the human subject are-the hydatid and the cysticercus tcenia cellu- 
loses, from amongst the class of certoid worms; the monostomum lentis, and 
distomum ophthalmobium, belonging to the trematoda and the filaria lentis, and 
another species of filaria belonging to the nematoid class of entozoa. 
With the exception of the cysticercus, all of these species have only 
been observed in a very small number of cases. The filaria lentis, the 
monostomum, and the distomum were found in the crystalline lens of 
patients suffering from cataract; the other filaria which was seen by Quadri, 
occurred in the anterior chamber and in the deep seated parts of the eye, 
with the exception of the lens. It has been suggested that the cases of 
hydatids stated by the earlier writers to have been observed in the ante- 
rior chamber of the eye were more probably cases of displacement of the 
lens owing to rupture of the capsule. These cases are very doubtful, as 
the nature of substance seen in the eye was not properly determined in any 
of them. The cysticerci have been more frequently observed in the deep- 
seated than in other parts of the eye, and, according to Graefe, who has 
recorded upwards of a dozen cases, they usually occupy the vitreous humor 
and choroid membrane, or the retina. Their development is not generally 
attended with pain, although some patients have expressed a sense of pres- 
sure within the eyeball and headache. Loss of vision comes on gradually 
until the sense of sight is at last completely destroyed. The iris sometimes 
changes its normal color, but in the majority of cases no apparent altera- 
tion of the eye is perceptible; the other symptoms are similar to those 
which are present in all affections of the eye which are accompanied by 
dimness or loss of vision, and the aid of the ophthalmoscope is necessary 
in order to determine the existence of a cysticercus. 1316 
filaria. 
By means of this instrument a small object may be seen, which is gen- 
erally of a spherical shape, at least when the eye and entozoon are quies- 
cent and of a bluish, greenish or gray color; its relation, with respect to 
the retinal vessels, varies according to the position which it occupies. 
When it is situated immediately in front of the retina, or in the vitreous 
humor, the retinal vessels do not pass in front of the object, but stop at 
its circumference; or are altogether invisible; but when the entozoon is 
lodged in the substance of the retina, or between this structure and those 
which are more deeply placed, the retinal vessels may be seen to ramify 
upon the object, or to run across it in order to divide further on, as in the 
healthy condition. The tumor, situated at the bottom of the eye is appar- 
ently formed by a cyst, whose delicately thin and transparent wall allows 
the entozoon to be seen, and its form and movements to be recognized. 
When the cysticercus is developed behind the retina, this structure is some- 
times ulcerated, and the worm escapes into the vitreous humor. In some 
cases the cysticercus perishes and becomes atrophied. Graefe mentions two 
cases of this kind, in which the eye was preserved but the sight was lost. 
Several cysticerci might exist at the same time in the vitreous humor, as 
has been observed in the pig: One eye only is ordinarily affected, so that 
the prognosis would generally be more favorable than that of an ordinary 
attack of amaurosis; but the frequent multiplicity of cysticerci would war- 
rant the apprehension in some cases that these entozoa were also present in 
the nervous centres. 
Some benefit maybe derived from an early operation if the cysticercus 
can be extracted through the cornea. In one case where Graefe made an 
opening through the cornea and removed the cysticercus unbroken, the 
eye and sense of vision were both preserved; in others the sight was 
destroyed. The entozoa which has been observed in the appendages of the 
eye are: the trichina spiralis, the filaria medinensis, the cysticercus teke 
cellulos®, hydatids and a small nematoid worm of uncertain species; this 
last was perhaps the guinea worm, although Guyot, who described this 
entozoon, states that the guinea worm is not found in Congo, where he 
observed it among the negroes. 
This is a nematoid worm, about one inch in length, which was observed 
by Treutler, who gave to it the name of hamularia lymphatica, in conse- 
quence of the two projecting hooks upon its under surface and of the cir- 
cumstance of its having been found in the bronchial glands. This appears 
to be identical with the strongylus bronchialis of Cobbold. 
Cobbold describes the strongylus bronchialis as a moderate-sized nema- 
tode helminth, the male measuring rather more than half an inch, whilst 
the female is upwards of an inch in length; caudal appendage of the male 
furnished with a bi-lobed, membranous, semi-bell-shaped bursa, or acces- 
sory organ of copulation which surrounded the cloacal outlet, the latter 
concealing an intromittent organ consisting of a double spiculum; tail of 
the female sharply pointed, the anal orifice being a little in front or above 
the narrow part; body filiform, of a pale yellow color, of an inch broad 
in the male and in the female; mode of reproduction viviparous. The 
original specimens were discovered by Treutler, in Germany, during the 
winter of 1791, in the bronchial glands of an emaciated subject; whilst 
those sent to Diesing for description were discovered by Dr. Fertsitz, at 
Klausenberg, in Transylvania, in the lungs of a boy six years old. 
FILARIA HOMINIS BRONCHIALIS. Filaria. 
1317 
Tnis parasite, like the closely allied species {strongylus paradoxus} from 
the pig, and that from the calf (8. micrurus}, is undoubtedly capable of 
causing death by suffocation, at least when present in any considerable 
numbers. As to treatment, it is obvious that a powerful expectorant 
might facilitate the discharge of the worms from the larger bronchial pas- 
sages, and thus considerably relieved the patient. 
FILARIA MEDINENSIS : DRACUNCULUS MEDINENSIS (THE GUINEA WORM). 
Dr. T. Spencer Cobbold gives the following as the general and specific 
characters of the dracunculus medinensis. A nematode helminth, the 
female only at present known, measuring from one to six, or even (accord- 
ing to Gal(andatus) twelve feet in length, and about one-tenth of an inch 
in thickness; body uniformly cylindrical, terminating inferiorly in a more 
or less curved or reversed murconate tail; head somewhat truncate or 
flatly convex, with a central, simple, oral cavity, surrounded by four 
equidistant, crucially-disposed papillae; mode of reproduction viviparous 
the numerous young invested by the uterine walls, almost filling up 
the entire cavity of the body. The male of this species is unknown; the 
female is of a whitish color, and is marked by two longitudinal lines situ- 
ated upon opposite sides of the body; the ova bursts within its cavity. 
Distribution. The guinea-worm possesses a comparatively limited 
range, for not only is it confined to tropical regions of the globe, but within 
those intertropical limits it is almost exclusively confined to certain dis- 
tricts in Asia and Africa; thus it occurs endemically iu Arabia Petrem, on 
the borders of the Persian Gulf and Caspian Sea, on the banks of the 
Ganges, in Upper Egypt, Abyssinia, and the Coast of Guinea. In Amer- 
ica the guinea-worm is unknown, except in persons who have had commu- 
nication with Africa or other parts where it is indigenous. The Island of 
Curagoa is the only locality in the New World which offers an apparent 
exception to this fact. The later observations of Chisholm show that the 
dracunculus is really prevalent in several of the West India Islands, espe- 
cially in Granada; it is not impossible, therefore, that all the numerous 
islands lying near, as well as between Curagoa and Granada may turn out 
to be guinea-worm districts. 
Though endemic only in the above-mentioned parts of the world, it 
would yet appear that all races of mankind are obnoxious to the attacks of 
the filaria when exposed to what may be called the contagion, that is when 
placed in circumstances under which it might be supposed a contagious 
seminium could be conveyed to them. This liability is incurred by the 
exposure of the bare surface of any part of the body to water in which the 
infection may be supposed to reside. There is at present no evidence of 
any other source of infection. There are many instances to prove that in 
order that a European should become infected with the guinea-worm on 
the coast of Africa it is not necessary that he should have been on shore at 
all; it being quite sufficient for him to have exposed the bare surface of 
some part of his person to the water in the native canoes alongside, or, it 
may be, to the discharge from the sores of those laboring under the dis- 
ease. This mode of introduction accounts for the frequency with which 
the legs and feet are attacked by the parasite to other parts of the body, 
as it will always be found that the men who have become so affected have 
been in the habit of going almost with bare feet, as is common among 
sailors in warm latitudes. That the contagious material is conveyed in 
water is also further indicated by the well known fact that in India, where 
it is the custom of natives to carry7 water in skins on their backs, the worm 1318 
Filaria. 
makes its appearance on the back and shoulders and upper parts of the 
body. 
The dracunculus gains access to the human body without reference to 
age or sex, race or country, the only necessary condition being that the 
skin be exposed to water in those localities where the dracunculi flourish. 
The recorded experience of eminent medical officers attached to the Brit- 
ish Indian armies, has shown that their troops which have been most 
exposed during the rainy season have subsequently exhibited a more or 
less marked evidence of having been invaded by the dracunculus; and as 
the period of incubation of the entozoon usually extends from twelve to 
fifteen months, it necessarily happens that the disease has frequently shown 
itself in localities far distant from the spot where the troops originally 
contracted the disorder. 
It has been said that the period of incubation of the worm is not less 
than a year, but Carter, of Bombay, mentions that in a school of fifty boys 
bathing in a certain pond where muddy sediment swarmed with micro- 
scopic tank-worm (urobales palustris, Carter), twenty-one were attacked 
with dracunculus durinq the year, whilst the boys of other schools, bathing 
elsewhere in the island, were not infected, with the exception of one or two 
individual instances here and there. 
Dr. F. Spencer Cobbold, after a careful survey of all the more promi- 
nent facts and phenomena connected with the life-history, development, 
and propagation of the guinea worm, arrives at the following conclusions: 
1. The guinea-worm, as commonly known, .is the adult female con- 
dition of a nematode parasite, forming a distinct generic type for which 
the title of dracunculus ought still to be retained. 
2. The female dracunculus is parasitic only during the final stages of 
its life period, after it has taken up its residence in the subcutaneous and 
intermuscular cellular tissues of men, dogs, and horses. 
3. The adult female reproduces viviparonsly, and, in consequence of 
an enormous development of the internal reproductive organs, contains 
myriads of embryos in all stages of development. 
4. The embryos, when set free, are capable of sustaining an inde- 
pendent existence; their vitality is so teuacious that, after a more or less 
desiccation, they will revive on the application of moisture. 
5. The proper habitat of the free active embryos may be either the 
freshwater of natural stagnant pools, the damp mould and mud of low- 
lying marshy districts, or especially the soft, ocherous, argillaceous clayey 
soil forming the bottom of wells, tanks and other artificial reservoirs. 
6. The male sexually-mature dracunculus is at present unknown; in 
all probability it is very much smaller than the female, non-parasitie as 
far as animal brains are concerned, and constant inhabitant of freshwater, 
mud and moist earth. 
7. In all likelihood the male dracunculus bears a close resemblance 
to urobalespalustris, or to some other of the numerous allied microscopic 
forms of filariae, which abound in the natural and artificial water reser- 
voirs of India. 
8. The young dracunculi probably acquire sexual maturity shortly 
after their escape from the parent; the sexes associating in muddy water 
during the monsoon, after which period the males, in all likelihood, rapidly 
perish, the females being left to watch their opportunity for further devel- 
opment by migration into the human body. Filaria. 
1319 
9. The impregnated females do not gain access to these bearers by the 
mouth or stomach of the latter; on the contrary, there is every reason to 
believe that they enter the body in a direct manner, probably by penetrat- 
ing the sudorific ducts of the skin. 
10. Within the tissues of the bearer they grow with considerable 
rapidity, and in about twelve months, more or less, gives rise to a formid- 
able entozootic disease (dracontiasis) which, after prolonged monsoons, is not 
unfrequently severely endemic. The guinea worm does not give rise to 
any marked symptoms until its embryo are formed. The earliest sign by 
which the presence of a filaria is manifested is usually an unpleasant feel- 
ing of irritation on the parts of the limb which is occupied by the worm; 
and a tumor, which assumes the appearance of a boil, is shortly afterwards 
formed in the same situation. In some cases, the formation of the tumor 
is preceded by general indisposition, by pains in the head or stomach, and 
by nausea and vomiting. When the guinea worm is situated in parts 
which are almost destitute of soft tissues, as in the toes, or near the joints, 
for example, it produces acute pains but when it is deeply eaten amongst 
the muscles, it gives rise to a painless swelling, which may last for several 
weeks, and even months In all instances when the tumor is about to break, 
the pain becomes intense, the constitution sympathises with the local dis- 
orders, the part is much inflamed, and the tumor is eventually converted 
into an abscess, which furnishes a means of exit for a portion of the 
entozoon. 
The tumor is occasionally of considerable size, and the worm which 
is contained within it, is then discharged whole; the fluid which escapes 
from the opening is usually of a serous character. The diagnosis of the 
existence of a guinea worm is sometimes very difficult, and it is not until 
after the appearance of a portion of the filaria externally that the nature 
of the affection can be fully determined, as it is liable to be mistaken for 
an inflamed vein, or lymphatic vessel, or for some other species of tumor. 
The best method of treatment consists of the gradual removal of the 
worm, which is effected by daily winding the protruding portion of it 
round a small piece of wood, or a roll of adhesive plaster, great care being 
taken so as not to break the worm by too forcible traction; a bandage 
should be employed so as to prevent the portion of the worm which is 
extracted, from being again drawn beneath the skin. If this parasite be 
broken, serious results often follow, and there is great local inflammation 
and sympathetic fever, together with the formation of abscesses, and sinuses; 
gangrene is sometimes produced in consequence of the accidental rupture 
of the worm. Under these circumstances, even death itself may some- 
times supervene. These complications are attributed by some observers to 
the presence of dead animal matter, and by others to the escape of the 
embryonic filaria into the various structures by which the adult filaria is 
surrounded. 
Numerous medicaments have been suggested and tried both for the 
prevention and for the cure of the affliction. Assafoetida has been especi- 
ally recommended as a prophylactic, and several writers state that the use 
of this substance prevents the attacks of the guinea-wrorm, and causes its 
more speedy expulsion, should it happen to be present. Bremser mentions, 
on the authority of Dubois, that the Brahmins who season their food very 
strongly with assafoetida, are never affected with guinea-worm. Aloes, 
garlic, pepper, camphor, tobacco, sulphur, and the different mercurial pre- 
parations, have all been administered internally, or applied externally; and 
various plants, known only to the natives of Africa and of India, are said 
to be successfully employed by them to produce the death of the worm. 1320 
Filaria. 
The protection of the feet and other parts of the body against dust and 
moisture by means of suitable covering, ought to be always adopted in 
those countries in which the guinea-worm is endemic. (Entozoa: An 
introduction to the study of Helmenthology, with reference more especially 
to the Internal Parasites of Men, by F. Spencer Cobbold, M. D.; F. R. S., 
p. 375. On Human Entozoa, etc., by Wm. Abbotts Smith, M. D., etc., p. 
206. A Theoretical and Practical Treatise on the Diseases of the Skin, by 
P. Rayer, M. D. Am. Ed., 1815, p. 398. 
FILARIA. SANGUINIS HOMINIS (H2EMATOZOON OF HUMAN BLOOD) - 
TIMOTHY RICHARD LEWIS. 
Two of the most important and interesting discoveries recently made 
by the microscope are : 
1st. The discovery by Dr. Timothy R. Lewis, in 1869, of filaria in 
the urine of patients suffering from chyluria. 
2d. The discovery by Dr. Timothy R. Lewis, in 1871, of the same 
filaria in the blood of living human beings. 
Dr. Lewis discovered multitudes of filaria in the blood of several 
patients suffering from chylous urine; and there appears to be no longer 
any doubt concerning the nature of this hitherto obscure affection. The 
filaria?, after causing obstruction in the capillaries, make their way through 
the stretched, distended vascular walls into lacteals and lymphatics, and 
growing and multiplying in these channels form obstructions, in conse- 
quence of which extravasations occur, and in many instances communica- 
tions are opened between some part of the lacteal system and the urinary 
organs. Chyle, and with it many of the filariae, find their way into the 
urine. 
This subject is one of great practical importance to the inhabitants of 
tropical and sub-tropical countries. Ever since Dr. Lewis discovered this 
parasite, evidence has been accumulating to show that the haematozoon is 
more or less intimately connected with several severe and intractable, and, 
unfortunately, by no means rare diseases, in those regions. It has been 
shown that disorders of the lymphatic system, especially in the tropics, 
are found frequently associated with, if not caused by, filaria. -Naevoid 
and ordinary elephantiasis {Elephantiasis Arabum), chyluria, haematuria, 
lymph, varix and abscess, hydrocele, affections of the cord and testis, 
diarrhoea, flux, cachexia, deterioration of general health, certain skin 
diseases, deafness, eye disease, have been ascribed to the existence of such 
filaria, although it is not contended that they are always so caused. A 
great impulse has also been given towards the further investigation of the 
relation of the filaria sanguinis hominis to disease, by the discoveries of Dr. 
Manson in China, and of Dr. Bancroft in Australia. Dr. Manson has 
found that the musquito is an active agent in the propagation of the filaria. 
The embryos are taken into the musquito's stomach with the blood of per- 
sons affected with the hsematozoon, the further development of which 
begins in the stomach of the musquito. Thence they are transferred to 
water, whence it is assumed it again finds entrance into the body of man. 
The condition of those in whom the parasite abounds is one in which 
the whole blood is infested with living active worms about of an inch in 
length and with a transverse diameter of about of an inch, a condition 
m which they are so persistently ubiquitous as to be obtained day after 
day by simply pricking any portion of t he body, even to the tips of the 
fingers and toes of both hands and both feet of one and the same person, 
with a finely pointed needle. Filaria. 
1321 
ENGRAVING NO. 138. 
Filaria Sanguinis Hominis. 
Engraving No. 138.-Filaria sanguinis hominis, Timothy Richard Lewis. A and B, embryos 
of filaria sanguinis hominis. C ova of filaria sanguinis hominis. Lewis. The filaria sanguinis 
hominis was discowered by Dr. Timothy R. Lewis, of the English Army Medical Service, in the 
year i869. Dr. Lewis observed this round worm in the urine of patients in the General Hospital 
at Calcutta suffering from chyluria; and a reporton cholera in which this discovery was noted 
was communicated to the government of India in that year and published in 1870 (Sixth Report 
of the Sanitary Commission for Government of India for 1839, p. 113), and in the same year (1870) 
a specimen ofthewbrm was sent to the English Army Medicalschool atNetley. In the follow! ng 
year (1871) the same filaria was discovered in the blood by Dr. Lewis, and several specimens were 
sent to the late Dr. Parkes for the museum at Netley. 
The appearance of this filaria or hrematozoon of the human blood 
(filaria sanguinis hominis} is very characteristic. On first being removed 
from the body in a drop of blood it moves about incessantly, coiling and 
uncoiling itself incessantly, lashing the blood-corpuscles about in all direc- 
tions and insinuating itself between them. Each filaria is enveloped in an 
extremely delicate structureless and transparent tube, closed at both ends, 
within which it is capable of elongating and shortening itself. That it is 
so enclosed is a proof that in such a stage of existence it is immature, with 
its "home" in the blood. It has no visible means of penetrating the tis- 
sues, depending on the currents of the blood for its transferrence from 
place to place. The following table by Dr. Lewis shows the relative size 
of the trichina spiralis, the embryo guinea-worm and this hfematozoon: 
1 Average 
Breadth. 
1 Average 
Length. 
Proportion of 
Breadth to 
Length. 
Aspect of 
Tail-to Total 
Length. 
Head. 
Tail. 
Trichina spiralis, human mus- 
cle 
m in. 
A i'L 
1 to 28 
Pointed. 
Blunt. 
Dracun.culus embryo 
imin- 
A in. 
1 to 31 
Rounded. 
Acut'ly 
pointed 
Acut'ly 
pointed 
1 to 31 
Human hfematozoon,y?ZaHa san- 
guinis humanis 
in. 
75 in. 
1 to 46 
Rounded. 
1 to 8 
ADULT FORM OF THE FILARIJE OF HUMAN BLOOD. 
In the spring of 1876, Dr. Bancroft, of Brisbane, confirmed the obser- 
vations of Dr. Lewis, and forwarded some blood containing filariae to Eng- 
land. These were examined by Dr. Cobbold, who requested Dr. Bancroft 
to continue his researches, and suggested that the adult form of the worm 
should be sought for in the human brain. 1322 
Filaria. 
The following is Dr. Bancroft's communication to Dr. Cobbold, dated 
Brisbane, Queensland, April 20th, 1877, and published in the Lancet of 
July 14th, 1877: "I have labored very hard to find the parental form of 
the parasite, and am glad to tell you that I have now obtained five speci- 
mens of the worm, which are waiting to be forwarded by a trustworthy 
messenger. 1 have on record about twenty cases of this parasitic disease 
and believe it to be the solution of chyluria, some forms of hmmaturia, one 
form of spontaneous lymphatic abscess, a peculiar soft varix of the groin, 
a hydrocele containing fibrinous fluid, another containing chylous fluid, 
together with some forms of varicocele and orchites. These I have verified. 
In the colony there are no cases that I can find of elephantine leg, scrotal 
elephantiasis or lymph scrotum; but, from the description of these dis- 
eases in the volume on skin and other diseases of India by Fox, Farquhar 
and Carter, and from Dr. Roberts' article on the latter in the volume on 
urinary diseases, I am of opinion that the parasitic nature of the same will 
be established. 
The worm is about the thickness of a human hair, and is from three to 
four inches long. By two loops from the centre of its body it emits the 
filarise described by Carter in immense numbers. My first specimen I got 
on December 21st, 1876, in a lymphatic abscess of the arm. This was dead. 
Four others I obtained alive from a hydrocele of the spermatic cord, hav- 
ing caught them in the eye of a peculiar trochar I use for tapping. These 
I kept alive for a day and separated from each other with great difficulty. 
The worm when immersed in pure water stretches itself out and lies quite 
passive. In this condition it could be easily washed out of hydroceles 
through a large sized trocar from patients known to suffer from filariae. 
Dr. Cobbold (Lancet. October 6th, 1877), gives the following account 
of his examination of the worms received from Dr. Bancroft, on August 
28th, 1877: 
"The filariae were enclosed in four small tubes and preserved in gly- 
cerine. Three of the tubes (marked 1, 2, 3), contained sexually mature 
worms; the fourth being labelled, specimen of adult Filaria sanguinis- 
young and ova. I shall describe their contents in succession. 
"On the 6th of September I examined the filariae in tube No. 3. The 
specimen was injured and in four portions; these collectively measured 
three inches in length. Although to the naked eye the worm appeared to 
Dr. Bancroft to be of the thickness of an ordinary human hair, yet actual 
measurement showed it to be at the thickest part. Notwithstanding 
mutilation and partial evisceration, I made it out to be a female. 
"At the same time I likewise examined the specimen in tube No. 1. 
This was also a female. Towards the centre of the body an accidental 
hernial protrusion of the uterine horns and intestine had taken place. In 
a rough lithograph sent by Dr. Bancroft, this specimen is figured and 
described as the parent worm of the filaria sanguinis, emitting young filaria 
from twTo horns. 
"On the 14th of September I examined the contents of tube No. 2. In 
it I found one tolerably perfect female filaria, and also a delicate shred 
forming part of one of the uterine horns of another worm. This filament 
measured one inch and a half in length and was coiled round the complete 
worm. On transferring it to a watch-glass containing water, numbers of 
embryos made their escape. Owing to the transferring of the worms I 
had much difficulty in finding the reproductive outlet in the perfect worm, 
and the effort to find the opening was all the greater because my interpre- 
tation of Dr. Bancroft's figure had put me off the right track. It seemed 
so natural to suppose that the Joops' protruding from the centre of the Filaria Sanguinis Hominis. 
1323 
body resulted from an ordinary prolapsus uteri, so common in preserved 
specimens of nematoids. At length I found the vagina and its orifice to 
be situated close to the head (about from it), the anal orifice being placed 
within the of an inch from the extremity of the tail. Figure No. 2. 
"Presumably, these openings were both in the ventral line, but I could 
not determine the points with certainty. The vaginal pouch, 1-lOOth inch 
long, was crowded with embryos, and a construction marked its conjunc- 
tion with the uterus proper, which appeared to me to divide lower down 
at a distance of l-10th inch from the head. Towards the tail a fold of the 
tuba fallopii was seen to extend to within l-20th inch of the extremity. 
All sections of the uterine system were crowded with germs, eggs, and 
embryos in their usual relative situations. My examinations of the ova 
and embryos were chiefly made from the sediment sent in the special glass 
tube. The fully formed embryos were l-125th inch in length by l-2500th 
inch in breadth. They each showed a double skin, the outer envelope 
in the more advanced specimens having clear space at either end of the 
body, resulting from commencing ecdysis. I saw no trace of intestinal 
tube, but a central line of condensation marked an early differentiation of 
the somatic granular contents. The less advanced embryos were mostly 
enclosed in a chorional envelope, the smallest few embryos measuring only 
l-200th inch in length by l-3500th inch in breadth. These had no double 
contour. The ova, whose yolk contents were still in various stages of 
change, gave an average long diameter of l-900th to 1-lOOOth of an inch. 
"Such are the facts I have been able to make out. If they do not 
supply all that one could desire, they nevertheless enable me to extend 
and amend the characters of the species as follows : Filaria Bancroft! 
(mihi), body capillary, smooth uniform in thickness. Head with a sim- 
ple circular mouth, destitute of papillte. Neck narrow, about one-third of 
the width of the body. Tail of female simple, bluntly pointed; reproduc- 
tive outlet close to the head; anus immediately above the tip of the tail. 
Length of female, 3? inches; breadth, l-90th inch; embryos, l-200th inch 
to l-125th inch in length, by l-3000th to l-2250th inch in breadth, eggs, 
1-1 OOOth inch by l-1650th inch. The male of this worm I have not seen." 
ENGKAVING NO. 139. 
Anatomy of Mature Filaria Sanguinis Hominis. 
Engraving No. 139.-Anatomy of mature filaria sanguinis hominis. The mature filaria has 
been found by Dr. Bancroft, in a person suffering from lymphatic abscess of the arm in 1876, and 
Dr. Lewis found two specimens in blood-clots from a young Bengalle lad, who had been operated 
on for nsevoid elephantiasis in 1877. Specimens were sent by Dr. Bancroft to Dr. Cobbold, who 
gave account of their anatomy in 1877. The following are the dimensions given of the mature 
niaria female: Length, 3LJ inches; breadth, 1 line; embryo, l-125th to l-200th of an inch; breadth, 
l-3000th to l-2500th of an inch. (Brit. Med. Jour , 22d Feb.. 1879.) Figure 1. Filaria Bancroft! 
(sanguinis hominis), natural size. Figure 2. Head and neck shows oesophagus (a) and vagina (b). 
Figure 3. Tail of the same, showing fold of tuba and termination of intestine, x55. 1324 
Relations of Chyluria to Filaria. 
On the 7th of August, 1877, two living specimens were found by Dr. 
Timothy Richard Lewis, a male and a female, in the person of a young Ben- 
galle, afflicted with well-marked nsevoid elephantiasis of the scrotum asso- 
ciated with the presence of embryo-filaria in the blood. Unfortunately the 
specimens were much injured by the needles used to tear the clot in which 
they were found. They were attenuated, fine thread-like worms, of a white 
color; the cuticle was smooth and devoid of transverse markings. The frag- 
ment of the male specimen measured half an inch in length, and l-180th 
inch, transversely, it was thinner than the female, but of firmer texture, 
and manifested greater tendency to coil. 
The intestinal canal measured l-633d inch, (=.039 m.m.) across, and 
the sperm-tube 1 1500th inch, (.016 m.m.) The length of the portion of 
the female worm which had been secured was 1J inch, and its greatest 
width aboutl-100th inch, it was packed with ova and embryo in various 
stages of development; the latter especially, those which were mature, mani- 
fested active movements. The head is slightly club-shaped; the mouth 
does not manifest any very distinctly marked labial sub-divisions, nor are 
there any chitinous processes evident either before or after death. The 
ova do not posess any distinctly marked shell; from the smallest to the 
largest. Nothing but a delicate pellicle can be distinguished as envelop- 
ing the embryo in all its stages. The average of six measurements of the 
least advanced kinds of ova, that is, those in which the outline of the 
embryo was not distinctly evident, was 1 1904th inch, (.018 m.m.) by 
l-2000th inch, (.012 m.m.) whilst the average measuremen ts of three ova 
in which the embryo was visible were 1 666th inch, (0.37 m.m.) by l-790th 
inch, (.03 m.m.) When the latter, after having arrived at this stage of 
development, are examined during life, it is in many instances difficult to 
state whether they are to be considered as freed embryos or not, as the 
"shell" has become so attenuated and translucent as only with difficulty 
to be distinguished. It is possible that when the embryo acquires worm- 
like proportions the envelope is not lost in this species so long as it con- 
tinues in the blood. 
RELATIONS OF CHYLURIA AND ELEPHANTIASIS ARABUM TO FILARIA 
SANGUINIS HOMINIS. 
The relations of filaria sanguinis hominis to elephantiasis was first 
suggested by the results of the careful investigation of chyluria. The 
systematic researches of Dr. Vandyke Carter into the pathology of chy- 
luria, published in 1862-63, tended to show that a direct admixture of 
chyle and urine occurred-a leak from the lymphatic tract into the urinary. 
(Transactions Med. and Phys. Soc., Bombay, vol. vii, 1861. Medico-Chir. 
Trans., vol. xiv, 1862.) In March, 1870. when examining a specimen of 
milky urine passed by a man under the charge of Dr. R. J. Lyons, in Cal- 
cutta, Dr. Timothy Lewis found that it contained numerous microscopic 
nematoid worms in a living condition. These were described and figured 
in a report published in 1870 by the Indian Government (see abstract of 
this description in British Medical Journal November L9th, 1870). Under 
the impression that no nematoid parasites had previously been found in 
the urine, specimens were furnished to the late Dr. Parkes, and by him 
shown to Professor Burk, who suggested that probably they belonged to 
the filaridse. Similar entozoa were detected in the urine of chyluria 
patients in Calcutta by Dr. W. J. Palmer and Dr. Charles in the course of 
the next few months. Towards the beginning of July, 1872, Dr. Timothy 
Lewis found nine minute nematoid worms in a state of great activity on a Relations of Chyluria to Filaria. 
1325 
slide containing a drop of blood from the finger of a Hindoo. Since this 
period, Dr. Lewis has traced the filaments named filaria sanguinis hominis. 
to the blood direct in about fifteen, and in one or other of the various secre- 
tions of the body, in about thirty-five individuals. All were known to 
have suffered with chyluria or some closely allied pathological condition 
(Eighth Ann. Rep. of Sanitary Commiss. with Govt, of India, 1872; Indian 
Ann. Med. Science, vol. xvi). 
These observations have, moreover, been confirmed by others in numer- 
ous instances. 
The more recent history of the variety of the disease usually referred 
to as hematurie grasseuse, hcematuria Braziliansis, hcematuria Egyptica, is also 
associated with an entozoon-or rather with two distinct kinds of entozoa 
-a fluke and a nematoid. The former was discovered in 1851 by Bilharz. 
His observation was followed up, and now it is estimated that about a 
third of the inhabitants of Brazil harbor this parasite in their bodies. In 
1868, Dr. Otto Wercherer, of Bahia, discovered a microscopic entozoon 
which he forwarded to Leuchart to be identified, who suggested that it 
might be the embryo of some round worm, probably belonging to the 
strongylidse. Dr. Jules Crevaux, a French naval surgeon, succeeded in 
confirming Wercherer's observation, by finding (July 27th, 1870,) similar 
parasites in the urine of a young creole affected with hematurie chyleuse 
(Gazettada Bahia, Dec., 1868). Dr. Sonsino, in January, 1871, found sim- 
ilar parasites in the blood and iu the urine of a Jew lad at Cairo, affected 
with haematuria. 
In the latter fluid distomata also were found. This observer, how- 
ever, considers that these parasites, though bearing a very close resem- 
blance, differ in some respects from those found in chyluria, and has 
accordingly added the word Egyptica to the original designation for the 
purpose of distinguishing it. It is possible that the microscopic nematoid 
which was discovered by Wercherer in Bahia, may also be traced to the 
blood eventually, and that the slight differences in the recorded characters 
in the worm as found in Egypt and in the Brazils from that'found in India, 
may be shown to be sufficient to indicate a specific difference in the para- 
sites, and thus offer a satisfactory explanation of the discrepancies observed 
in the character of the urinary disorder in the different countries. In 
Europe chyluria has been investigated by several observers. The cases 
which have come under their care have occurred with very rare excep- 
tions in persons who have at some time or other resided in countries situ- 
ated between about 30° north and 30° south latitude. With regard to the 
microscopical examination of the blood in chyluria Dr. Timothy Lewis has 
observed that the corpuscles and serum did not present any evidence of 
the presence of fatty matter in an abnormal amount-the serum has seemed 
as clear and as free from molecular matter as normal blood. So far as his 
experience goes the only feature worthy of special note in connection with 
microscopical examination of the blood in chyluria is the presence of the 
haematozoon already referred to. 
Dr. Lewis says that in searching for it, it will be advisable to abstract 
by means of a needle a drop of blood from several fingers, and to submit 
each slide to a thorough examination, which may have to be very pro- 
longed, employing for this purpose a comparatively low power-f inch or 
2 inch objective-a higher power being resorted to when the entozoon has 
been detected. It must not be expected that the blood will present any 
peculiarity to the naked eye, even though every ounce may contain thou- 
sands of these microscopic worms. The average length of the parasite is 
l-75th inch (=0.34 millimetres); its breadth l-3500th inch (=0.007 milli- 1326 
Relations of Chyluria to Filaria. 
metres), or about equal to the diameter of a red blood-corpuscle. It is 
enclosed in a transparent tubular sac within which it can be seen to 
alternately contract and elongate itself. This sac is extremely delicate 
and translucent, and may sometimes, when the worm has shortened itself 
more than usual, be seen collapsed and folded like a ribbon, and the next 
moment be instantaneously straightened again by the extension of the 
filaria to its ordinary length. 
We have already referred to the researches of Dr. Manson, of Amory, 
which have been confirmed by Dr. Lewis, showing that embryo filariae in 
the blood are imbibed by the musquito, or other intermediary host; undergo 
developmental changes; and are discharged into water with the larvae of 
the insect. Dr. Manson has stated that the habitat of the parent filaria is 
in the lymphatic trunks (Medical Times, June, 1881). Of the aetiological 
significance of the presence of the filariae in the circulation. Dr. Timothy 
Richards Lewis holds that there can scarcely be much doubt-more especi- 
ally when the number of observations recorded within the short period 
that has elapsed since attention has been drawn to its existence therein, 
is taken into consideration. These suggest more than a fortuitous connec- 
tion; indeed, it might rather be said that chylo-serous effusions may be 
said to be symptoms of the parasitism. Filariae have even been detected 
shortly before chyluria had manifested itself. Whether they act injuri- 
ously by giving rise to rupture of the walls of the delicate channels in 
which they circulate and thus cause the escape of the different nutritive 
fluids into the urinary tracts, or whether, as M. Robin suggests, they pro- 
duce derangements of the liver and other organs which give rise to pian- 
haemia, and probably to rupture of the capillaries, so as to permit of the 
escape of the abnormally fatty blood. The disease presents many phases, 
and it may also be possible that, in addition to giving rise to the escape of 
fluid in a purely mechanical manner by causing ruptures, local congestions, 
and so forth, the entozoon may in some way tend to the production of 
minute secreting structures (analogous to those described by Roberts in 
the subcutaneous tissues), along the urinary tract, or in other situations 
which might permit of the filtration of the ordinary nutritive fluids of the 
body in a more or less modified condition. Analyses tend to show that 
the constituents of these fluids do not reach the urine in the proportions in 
which they are normally found in the body. 
The filaria sanguinis hominis, was discovered in 1869, by Dr. Timothy 
R. Lewis, of the British Army Medical Service, in the urine of patients in 
the General Hospital at Calcutta, suffering from chyluria; and in 1871, Dr. 
Lewis discovered the living filaria in human blood. Its appearance is very 
characteristic. On first being removed from the body in a drop of blood, 
it moves about incessantly, coiling and uncoiling itself unceasingly, lash- 
ing the blood-corpuscles about in all directions. Each embryonic filaria 
is enclosed in an exceedingly delicate structureless and transparent tube, 
closed at both ends, within which it is capable of elongating and shorten- 
ing itself. That it is so enclosed is a proof that in such a stage of exist- 
ence, it is immature, and its in the blood. It has no visible means 
of perforating the tissues, depending on the currents of the blood for its 
transmission from place to place. Treatment of Elephantiasis Arabum. 
1327 
ENGRAVING NO. 140. 
Female Filaria Sanguinis Hominis, from Abscess in Human Thigh 
Engraving No. 140.-Fragment of Female Filaria Sanguinis Hominis, from Abscess in 
Human Thigh, showing remains in Alimentary Canal, decomposing body; dead embryos escaped 
from Ruptured Uterus; one ovum visible.-Manson. 
Within the past four years, the investigations of microscopists and. 
pathologists, with reference to the filaria sanguinis hominis, have assumed 
great practical importance for the inhabitants of tropical and sub-tropical 
climates in which elephantiasis Arabum is endemic. Ever since Dr. Lewis 
discovered the parasite in 1869, evidence has been accumulating to show 
that this hsematozoon is more or less intimately connected with several 
severe and intractable, and, unfortunately, by no means rare diseases in 
these regions. It has been shown that disorders of the lymphatic system, 
especially in the tropics, are found frequently associated with, if not caused 
by filaria. Nsevoid and ordinary elephantiasis Arabum, chyluria, haema- 
turia, lymph varix, and abscess, hydrocele, affections of the cord and testes, 
diarrhoea, fever, cachexia, deterioration of general health, certain skin 
diseases, deafness, eye disease, have been ascribed to the existence of such 
filaria, although it is not contended that they are always so caused. A 
powerful impulse has been given towards the further investigation of the 
relations of the filaria sanguinis hominis to disease, by the discoveries of 
Dr. Manson in China, and Dr. Bancroft in Australia The mature filaria 
has been found by Dr. Bancroft in a person suffering from lymphatic 
abscess of the arm in 1876; and Dr. Lewis found two specimens in the 
blood-clots from a young Bengalle lad who had been operated on for nae- 
void elephantiasis in 1877. 
Dr. Manson has shown by his elaborate and valuable researches in 
China with reference to the relations of the filaria sanguinis to man, that: 
1. The parent filaria live in the lymphatics. They do not live in the 
glands, but in the lymphatic trunks at the distal side of the gland. 
2. They are oviparous, their egg-* are carried by the current to the 
glands and being too large to pass, they are arrested until they are hatched. 
After hatching, the free embryo passes along the lymph vessel and enters 
the general circulation. 
3. Resting in some organ during the day, it circulates with the blood 
during the night. Unless there is some disturbance as fever, interfering 
with the regular physiological rythm of the body, filaria embryos invari- 
ably begin to appear in the circulation at sunset; their number gradually 
increases till midnight; during the early morning they become fewer by 1328 
Treatment of Elephantiasis Arabum. 
degrees, and by 9 or 10 o'clock A. M., it is a very rare thing to find one in 
the blood. The embryos have more recently been shown to circulate during 
sleep, regardless of the night time. 
4. The mosquito abstracts the filaria from the blood and thus becomes 
an intermediary host, and a means of its propagation. 
5. In certain cases the ova or embryos produce obstruction of the 
lymph circulation through the glands either directly by their size or indi- 
rectly, by causing inflammation. 
6. If the obstruction be partial, varicosity of glands and afferent lym- 
phatics result, but by means of the anastomosis, the lymph circulation is 
continued carrying the embryos into the blood. Lymph-scrotum, or chylu- 
ria, or varicose g'ands with luematozoa are therefore the symptoms of par- 
tial obstruction of the lymphatics. 
7. If the obstruction be complete, one or the other of two things 
happens: (a.) The accumulating lymph so distends the vessels that they 
rupture, and a lymphorrhagia results, which is more or less permanent, 
(b.) If the lymphatics fail to rupture, there is complete stasis of lymph 
and excessive accumulation in the tissues on the distal side of the glands: 
solidification of the glands and tissues, and elephantiasis results. London 
Lancet, vol. ii, 1880, p. 792. 
The preceding facts are of great interest in their relations to elephan- 
tiasis Arabica, and every case of this disease should be investigated in the 
most thorough manner by aid of the microscope. Some light will without 
doubt be thrown upon this subject by a careful investigation of the history 
of the filariae in the lower animals. 
Arabian elephantiasis has been regarded by certain writers, as a con- 
stitutional disease with febrile action and phlogosis, which, if not checked, 
ends in a deposit in some organ or limb. The treatment recommended by 
Bhazes, of general blood-letting, with emetics, laxatives, diet and rest, 
was adopted by M. Bayer, and also by Dr. Musgrove, who also used to 
apply leeches and fomentations to the limb, and administered calomel 
until the mouth was affected. 
According to Bayer, the inflammatory symptoms observed in the first 
stage of elephantiasis Arabica should be treated by emollient applications, 
tepid baths, and bleeding; the fears which have been entertained against 
bleeding are unfounded. Bayer employed this measure with success in the 
paroxysms, the length and intensity of which it certainly moderates. In 
the chronic stages of the disease, bleeding has been followed by momentary 
relief at least, when the patient has complained of a feeling of painful 
distention of the parts affected. Bayer affirms that he has seen very 
happy effects produced by local bleeding, from the groin, the hollow of the 
ham, the axillae, etc. He recommends that the part affected be placed as 
constantly as possible in a position that facilitates the return of the blood 
towards the heart, and should be covered with emollient cataplasms, or 
wrapped in flannel steeped in soothing and narcotic decoctions. If the 
enlargement is developed on one of the lower extremities the* patient 
should keep his bed for several weeks. 
Emetics and purgatives have been administered with various success. 
The anti-spasmodic effects of the sublimed oxide of zinc in doses of eight 
grains a day, has been highly recommended. Hendy assures us that this 
remedy allays the sickness and uneasiness which the patients experience 
in the periodical exacerbations of elephantiasis. Several physicians of the 
Island of Barbadoes struck with the frequency of the vomiting during the 
TREATMENT OF ELEPHANTIASIS ARABUM. Treatment of Elephantiasis Arabian. 
1329 
paroxysm, have thought it necessary to encourage the sickness, and even 
to provoke vomiting by the exhibition of emetics. Dr. Hendy objects to 
this practice. 
In women, pregnancy is a very unfavorable circumstance. A young 
woman of Havre, having married against the advice of Rayer, became 
pregnant three times; after each pregnancy the right leg, which was afflicted 
with elephantiasis, became more and more enlarged. Instances have 
been related (Brit, and For. Med. Rev. April, 1865) of the cure of elephan- 
tiasis by the use of the Carlsbad waters. It must however be acknowledged 
that but little has yet been done by constitutional treatment in cases of ele- 
phantiasis Arabica. Remedies useful during the febrile paroxysms have 
little power in preventing recurrence or in checking the disease. Iodine, 
and iodide of potassium combined with quinine, arsenic and iron have 
been found useful to a certain extent. During the febrile state saline dia- 
phoretics, and such remedies as are needed during the pyrexial state of 
miasmatic fevers are indicated. The sulpho carbolate of sodium, in doses 
ranging from five to ten grains every four or six hours should be carefully 
tested as an agent capable of destroying the filariae sanguinis hominis. 
Opium and its preparations used both internally and locally may be 
necessary to relieve the intense pain which often accompanies the outset of 
the stage of excitement. When the febrile stage has passed, quinia is use- 
ful, which if anaemia exists, should be combined with iron. The local 
application of iodine in such forms as the iodide of lead and the biniodide 
of mercury has been thought useful, but as this is generally combined with 
pressure in the recumbent position, the benefit is probably due to the latter. 
Such measures, along with improved hygienic conditions, may no doubt 
control the progress of the disease and relieve suffering. No remedy how- 
ever, is so potent as change of climate, by removal from the endemic site 
of the disease. This, if effected in the earliest stages, may completely 
arrest the disease, and perhaps even disperse any incipient structural 
change. This has been observed in the rare cases in which elephantiasis 
occurs in Europeans, who after returning to Europe, have after a time lost 
the disease, and almost or entirely any hypertrophic changes that may have 
occurred. 
English surgeons have observed that natives of India improve if they 
leave the endemic area during the early stages, and go and reside in other 
and drier localities. However, when the hypertrophy is advanced, the 
paroxysms of fever are still liable to recur, even when the climate is 
changed, though with less violence. 
LOCAL TREATMENT OF ELEPHANTIASIS ARABUM. 
A great number of patients have been cured by compression, either 
alone or combined with other means. This method was successful in the 
hands of Bayle and M. Alard in one of their patients who had been affected 
with elephantiasis for twelve years. A strong man was employed to press 
the leg of the patient every morning in all directions during three-quarters 
of an hour or an hour, after which a roller was firmly applied fiom the 
toes to the knees. M. Lisfrance has also been very successful in these 
cases by the judicious combination of scarification and compression and 
local bleedings. M. Bayer has also obtained good results from this method. 
It is more especially applicable in cases of elephantiasis of the limbs con- 
sisting of simple hypertrophy of the cellular tissue without infiltration of 
serum. If it does not succeed completely, when the tumefaction is partly 
owing to anomalous development of the muscles and bony tissue, it deter- 1330 
Treatment of Elephantiasis Arabum. 
mines at all counts the absorption of a certain quantity of fat and serum, 
and this is a result which it is always important to obtain. Comptession 
alone has been found to be efficient iu many cases; scarifications are now 
rarely used. Patients who have been affected with elephantiasis of the 
lower extremities should wear laced stockings, tight bandages or elastic 
stockings after recovery, and particularly when several of the veins of the 
extremity are in a varicose state. 
SURGICAL TREATMENT OF ELEPHANTIASIS ARABUM. 
Harassed and worn out by the enormous weight of the parts affected, 
many patients have insisted upon amputation. M. Alard affirms that 
those who have survived such au operation have become affected with ele- 
phantiasis in other parts of the body, or that they seldom tailed to sink 
alter one or more attacks of au inflammatory affection of the viscera, to 
which they seemed to become liable. 
According to Hendy, a woman, who, from the age of fifteen years, had 
suffered frequent attacks of the Barbadoes malauy, was so much incom- 
moded by the size of the affected limb that she begged it might be ampu 
rated. This was done, but a short time afterwards she had so violent an 
attack of the disease in the other leg that she sank under it. A woman 
named Mary Pecont, whose case was noted by M. Bayer, underwent ampu- 
tation of tne right thigh in the month of March, 1823, after having been 
affected with Arabian elephantiasis from the age of ^even years. In Janu- 
ary, 1825, the disease attacked the right arm and was successfully treated 
by M. Disfrauce by local bleedings, scarifications and blisters. M. Delmas 
amputated an arm affected with elephantiasis without a return of the dis- 
ease. A patient operated upon by Baron Larrey for elephantiasis of the 
scrotum was in a fair way of recovery when the celebrated surgeon left 
him to proceed to Alexandria. 
A patient operated on by Delpech on the 11th of September, 1820, left 
the hospital of Montpelier in the early part of February, 1821, apparently 
in good health, but with a slight cough. On his arrival at Perpignan he 
was pale and completely blanched in appearance; his pulse was extremely 
small. He died on the 23d of the same month of inflammation of the liver, 
of the peritoneum of the right hypochondrium and of the pleura of the 
same side. M. Falrich operated with success, in 1811, on a young woman 
affected with elephantiasis of the sexual organs. Naegle was equally suc- 
cessful in the amputation of a leg in a case ol elephantiasis. A case of ele- 
phantiasis of the scrotum occurring in a negro boy nineteen years of age, 
in^the Island of (St. Croix, is related by Dr. W. H. Ruan (Am. Jour. Med. 
Sciences, vol. vi), in which he amputated the diseased part. The opera- 
tion was performed on the 8th of November, 1828, and on the 26th of Janu- 
ary following tne youth returned to his work on the plantation. The 
communication was made by Dr. Ruan in February, 1830, leaving the 
inference that up to that date all had gone well in this case. The disease 
had begun in early boyhood with erysipelatous inflammation of the penis, 
scrotum and surrounding skin and cellular substance. 
Dr. G. R. B. Horner says that this operation has been repeatedly per- 
formed at Rio de Janeiro, "and it is said with success in some cases." Mr. 
Robert Druitt extirpated a tumor of thirty pounds of the scrotum in the 
General Hospital at Madras. 
The operation is thus detailed by Mr. Druitt. The patient is on his 
back chloroformed; the surgeon passes his left forefinger into the orifice 
from which the urine is discharged, and thrusts it up as high as he can; if Treatment of Elephantiasis Arabum. 
1331 
he cannot pass his finger in. he must use a long and large steel director; 
then introducing a knife on his finger (or on the director) he cuts upwards 
so as to slit up the hypertrophied prepuce; the knife must be a stout one, 
or it may snap as it is being pushed through the hard and gritty tissues. 
As soon as the glans penis is reached it must be gently stricken out whilst 
the incision is prolonged upwards so as to completely uncover that organ, 
which must next be dissected out and held up against the pubes out of the 
way. The second step is to disengage the left testicle. The surgeon makes 
a bold incision over the track of the spermatic cord till he reaches the 
testicle, which is usually found enveloped in a huge hydrocele. The sper- 
matic cord may be distinguished by its pinkish hue from the blubbery 
yellowish-white tissues around it. The testicle when found must be seized 
and be carefully dissected out with the cord, and be held up out of the top 
of the incision. The right testicle must be dealt with in a similar 
way. The surgeon having thus dissected out the penis and two testi- 
cles, which are to be carefully held up out of harm's way, must now 
make a clean sweep and cut off the diseased mass, remembering only that 
as the skin is a good deal dragged from the thighs and pubes, he must be 
careful not to cut too closely nor to take away too much skin. The sur- 
geon will next stop bleeding by ligatures or a touch with the cautery. He 
will next trim off any loose portions of blubber. The penis and testicles 
are wrapped in carbolic.oil and well supported; the large wound is dressed 
with lint and carbolic oil and the patient put to bed. The surface of the 
wound casts off any portion of the morbid tissues remaining, then it begins 
to granulate and cicatrize from the edges, and the penis and testicles are 
covered with a new skin and the patient discharged in about three months. 
In order to avoid loss of blood, it is usual when the tumor is very large 
to keep it raised by a pulley as the patient, lies on his back an hour before 
the operation. Care must be taken that there is no hernia; if so, the sur- 
geon had better be content with cutting a good part out of the tumor and 
leaving it to cicatrize. The process of cicatrization goes on rapidly, and 
from two to four months all is closed in by cicatrized tissue which grad- 
ually perfects itself, and has no liability to become the seat of the return 
of the disease. If the shock has been severe the patient should be left on 
the table until reaction has thoroughly set in. Of 193 cases of scrotal ele- 
phantiasis operated on at the Medical College Hospital in Calcutta, 18.2 
per cent, proved fatal. In 161. cases of elephantiasis of the scrotum oper- 
ated on by Mr. Esdaile only five per cent, proved fatal. 
LTGA.TURE OF THE FEMORAL ARTERY FOR THE CURE OF ELEPHANTIASIS 
ARABUM. 
Owing in part to an improper understanding of the nature of this dis- 
ease, and also to a reluctance on the part of physicians to endanger the 
life of their patients by mortification and death, ligation has been rarely 
resorted to for the cure of elephantiasis Arabum. Wise, of Calcutta, and 
others, look upon elephantiasis as being essentially an inflammatory dis- 
ease of the venous system; the obstruction of the veins of the affected 
parts checking circulation, and causing irritation and inflammation, fol- 
lowed by plastic exudation and subsequent organization of the same in the 
surrounding cellular tissues. 
On the other hand, Gross, Bardleben, Koch and others refer the dis- 
ease to a disturbance of the functions of the lymphatic vessels. The inti- 
mate connection between the lymphatics and the connective tissues would 
easily tend to make the latter a ready participant in any pathological con- 1332 
Treatment of Elephantiasis Arabum. 
ditions in which the former were involved. Any lesion of the lympathics 
might tend to be the direct initial cause of pathological changes charac- 
teristic of elephantiasis. With an obstruction of the lymphatics there 
would ensue an inflammatory condition followed by a retention as well as 
an exudation of plastic organizable matter, causing obstruction, and, per- 
haps, obliteration of the calibre of the vessels. An organization of the 
plastic matters thus retained and checked in its normal flow would be the 
direct sequence, and this would resemble in its structure the cutaneous and 
cellular tissue of the surrounding parts. 
It seemed rational to suppose that the removal of the supply of blood 
by ligation of the artery would lead to the diminution, if not the absolute 
removal, of the hypertrophied tissues. Dr. Carnochan, of New York, has 
been regarded as the pioneer in this direction, and conceived the idea that 
by mechanically shutting off the supply of blood to the affected limb, the 
internal morbid proliferation of tissue might be checked. Acting upon this 
inference, his remarkable success with his case of elephantiasis in January, 
1851 (subsequently published in a memoir in 1858), appeared to sustain 
the theory advanced, and caused other surgeons to emulate his brilliant 
example. Dr. Carnochan was followed by Mr. Richard G. Butcher, of 
Dublin, in 1861, whose case of a woman, 44 years of age. reported in his 
work on "Operative and Conservative Surgery," still further illustrated 
the value of this simple method. Bryant, of Gray's Hospital, met with 
success, in 1865, in his first case of a Welsh woman, 25 years of age; he was 
not, however, equally successful in several subsequent operations. Alcott, 
in 1866, also operated successfully. Aside from the above cases, however, 
few, if any, instances are recorded wherein this method of surgical inter- 
ference was crowned the hoped-for results. 
Dr. G. C. E. Webre, of Cleveland, Ohio, in March, 1883, operated suc- 
cessfully upon a German, aged 40 years, who was suffering with an exten- 
sive hypertrophy of the integument and underlying tissues of the leg and 
ankle-a marked and typical case of elephantiasis Arab am, or " Jambe de 
Barbadoes" of the French. 
On March 8th, 1883, the left leg measured twenty-two inches in cir- 
cumference around the ankle, and twenty one around the calf, with a gen- 
eral enlargement of the knees and thigh, diminishing towards the groin. 
The lower portion, from the ankle to the middle of the calf, consisted of a 
decided papillomatous hypertrophy. The cauliflower corrugations were 
very marked, the papillae being gigantic in size, rough and hairy to the 
touch, dark with pigment, and divided by numerous fissures of various 
depths, from which a thin bloody fluid continually oozed. 
On March 16th, an incision was made parallel to the course of the 
femoral, commencing three inches below Poupart's ligament, and continued 
four inches downwards. With much difficulty the femoral was found, 
owing to its depth in the softened infiltrated tissues, and securing ligation 
at the point where the sheath of the vessel is crossed by the sartorious 
muscle, at the apex of scarpa's triangle. The edges of the wound were 
then carefully brought together by two silver-wire sutures, and addition- 
ally strengthened by transverse strips of adhesive plaster, Between three 
and four weeks after the operation, the ligature permitted itself to be 
easily detached, and four days after this, or about thirty days after the 
operation, the patient was discharged from the hospital. The leg now 
measured eleven inches in circumference around the ankle, and thirteen 
inches around the calf, a difference of eleven and eight inches respectively 
between the present and former measurements. (Am. Jour. Med. Sciences, 
January, 1884, p. 164.) INDEX. 
Pages. 
ABSORBENT SYSTEM. Diseases of. 35 
ACUTE ARSENIC POISONING 39 
ADENOMA OF THE LIVER 941 
AFRICA, Malarial Fever in 506-509 
AGUE WEED, Gentiana Quinqueflora 1073 
AINHUM, J. L. Patterson. Da Silva Lima, Wucherer and Love, on... 1283-1284 
ALBINISM, Samuel Smith, Gaultier, Le Cart, Rayer, Rush, Pliny, 
Bernard Romans, Azara. Bachman, Winterbottom, John 
Hunter, Graves, Blumenbach, Buzzi, Bowmann, Schwann, 
James Parsons, Gustav Simon, on 1149-1173 
In the Negro Race 1151-1175 
ALBUMEN, Digestion of. 290-292 
Mulder and Sterry-Hunt on 494 
Products of Fermentation of. . 492-494 
ALGID MALARIAL FEVER 798-799 
ALIBERT, on Malignant Fever 61 
ALIMENTARY CANAL, Diseases of 35 
Pathological Anatomy of, in Malarial Fever 880, 882-885 
Pathological Anatomy of, in Yellow Fever 881-882, 885 
ALKALOIDS, Cadaveric 451 
ANDRAL. On Alterations of the Blood in Pyrexiae and Phlegmasiae, 270-271 
ANDERSON, 'PERRY H., on Malarial Haematuria 577 
ANEURISM OF ARCH OF AORTA 32-34 
ANIMALS, Odor of. 78 
Cold-blooded, Structure of the Colored Blood-corpuscles in 107-108 
Effects of Gases upon the Blood of. 109 
Water and Solid Matters of Blood and Serum of Different 80 
ANTISEPTICS IN MALARIAL FEVER, Relations of the Action of 482-483 
APHASIA AND PARALYSIS 31 
ARISTOLOCHIA SERPENTARTA, Virginia Snakeroot 1025-1029 
AROMATIC ACIDS OF THE ACETIC SERIES 450 
AROMATIC COMPOUNDS, Relation to Bacterial Life 448-449 
ASIATIC CHOLERA, Comma Bacillus of 412-416 
BACILLzE, Marchiafava on 1263 
BACILLI in Septicaemia of Man 400 
Klein on 453-454 
Pathogenic 404 
Pigment 404 
Zymogenic 404 
BACILLUS (Desmobacterium) 402 
Anthracis 408 
Comma of Asiatic Cholera (Koch) 413-416 
Comma of Asiatic Cholera, Lewis, Finkler, Prior and Koch on.... 417 
Leprae 412 
Leprae. Armauer Hansen, Marchiafava, on 1262-1264 
Malariae. Distinctive Character of. 420-421 
Non-pathogenic Forms.... 403 
Of Malignant (Edema (Koch) 408 
Of'Typhoid Fever of Man 405 
Of Typhoid Fever of Man, Eberth, Koch, Klebs, W. Mayer and 
Gaffky on 405 
Streptothrix and Cladothrix 404 
Tuberculosis (Koch) 410 1334 
INDEX. 
Pages. 
BACTERIA 353-355, 101 
Bacterium 401 
Klein, on... 353 
Pathogenic Bacteria 401 
Pigment Bacteria 401 
Septic Bacteria 401 
Zymogenic Bacteria 401 
BACTERIAL LIFE, Relations to Aromatic Compounds 448-449 
BAIRD, J. T. Case of Malarial Hsematuria, by 569-571 
BECQUEREL AND RODIER, on Blood 238-263, 265-267 
Formula of Human Blood, by 124 
On Cholesterin 658 
On Dropsy 239 
BERNARD. On Glycogenic Functions of the Liver 914 
BIGNONIA CATALPA 1020 
BILE. Composition of Bile of Man and Animals Compared 648 
Composition of 641-644 
Bile and Blood, Coloring Matters of, Berzelius, Funke, Kunde 
and Lehmann on 674-676 
Chemistry and Physiology 645-656 
Coloring Matters of. 673-678 
Composition of, Demar^ay. Berzelius, Kemp, Theyer, Schlosser, 
Platner, Lehmann, Frerichs, Gorup-Besanez and Robinson.... 643-647 
Ducts, Ligature of the 681 
Ducts, Ligatures of, Sir B. Brodie, Tiedmann and Gmelin, on... 681 
Effects of. in the Blood 690 
In Malarial Fever 910-911 
Micro-organisms in... 154-155 
BILHARZIA H^MATOBIA 207-209, 542-544 
Manson and Bancroft, on 207-546 
BLADDER, Diseases of 37 
BLOOD. Actual amount in Animals during starvation 89 
Alteration of, in Pyrexise and Phlegmasiee 270-271 
Amount of, in Cold-blooded Animals 76-77 
Amount of. in Living Human beings 125 
Analyses of, in Diabetes Mellitus and Malarial Fever 271-286 
Analysis of. in Norwegian Tuberculous Elephantiasis, by Dan- 
ielssen and Boeck 1252 
And Bile, Coloring Matters in 675-678 
And Serum of Animals, specific gravity of 78-79 
And Serum of Animals, water and solid matters of 83 
And Serum of Man. specific gravity of, in various Diseases 137 
Blumenbach, Reil and Valentin, on 77 
Brain of Malarial Fever, deposit of Pigment in 863-866 
Causes of Coagulation of 179-189 
Changes in Color of 135 
Changes of, in Malarial Fever 129 
Chemical and Microscopical Examination of - 4Q8 
Chemistry and Physiology of. bv Joseph Jones 92-93 
Condition of, in Malarial and Yellow Fever 691-692 
Constituents consumed during starvation 91 
Constitution of. in Various Diseases 263-267 
Colored Corpuscles. Effects of Reagents on 133 
Colored, in Health, number of 422 
Corpuscles. Number of in Health, bv Vierordt, Melassez, Hayem, 
Gowers, Keyes, F. P. Henry and Kelsch 422-423 
Corpuscles, changes in Saline Constituents of. in Malarial Fever.. 250-251 
Corpuscles, Colored, Destruction of. in Malarial Fever 268,423-442 
Corpuscles, Colored, Destruction of. in Malarial Fever. Kelsch on 440 
Corpuscles, Colored, structure of. in cold blooded Animals 107-108 
Corpuscles, Moist and Liquor Sanguinis 81, 84 
Corpuscles, Moist and Liquor Sanguinis, during starvation 91 
Corpuscles, number of, bv Malassez, Vierordt and Welker 421-422 
Corpuscles, number of Human 113 
Corpuscles, Red, variation In size and appearance 104 
Corpuscles, size of Colored and Colorless , 103 INDEX. 
1335 
Pages. 
BLOOD. Corpuscles, Size of Colored and Colorless in Mammals 
and Birds 105 
Corpuscles, Structure of 112 
Corpuscles, White or Colorless 106 
Difficulty of Establishing a Standard Formula of 68-69 
Direct action of Malarial Poison upon 248 
Dumas and Provost, J. F. Simon, Wittstock, Jones, Nasse, 
Schmidt, Andral, Gavarretand Delafond, Becquerel and Rodier, 
Zimmermann, Guenaud deMussy, Glover, Genth, Harless and 
Bibra, on 80-86, 137-139, 263-267 
Effects of Bile in the 690 
Fordyce, Langish, Thackrah, Scudamore, Brucke and Rich- 
ardson, on 67 
Haemorrhagic Fevers, dependent on the constitution of 510-513 
Healthy and Diseased, Fibrin in 138-139 
Human, changes of amount in Disease 126-128 
Human, Formula of 124 
Human, Medico Legal Evidence relating to 363-374 
Human, salts in, fats in 123 
In Jaundice 682 
Lake 136 
Letting, in Malarial Fever 252-255 
Microscopical characters of, in Malarial Fever 192-197 
Of Animals, Fibrin in 1000 parts of 85 
Of Animals, Effects of Thirst and Starvation on 87-88 
Of Birds, Investigation of Joseph Jones on 72-73 
Of cold blooded Animals, Effects of Carbonic Oxide Gas 110 
Of cold blooded Animals, Effects of complete deprivation of air 
on Ill 
Of cold blooded Animals, Effects of Gases upon 109 
Of different Animals, Saline Constituents in 86 
Of Intermittent Fever, Andral and Gavarret, on 238 
Of Invertebrate Animals 70 
Of Mammals, Composition of Blood of 74-75 
Of Man and Animals, Filaria in 200-201 
Of Men and Animals 71 
Physical and Chemical Changes of, in Malarial Fever 66-67 
Plasma, Morbid conditions of 122 
Red Corpuscles, Source of, by J. Mitchell Bruce, Neumann, 
Melassez, Creighton. Bizzozero, Hoyer, Rindfleisch, Foa, Sav- 
iola, Monod. Hayem and Norris 116-117 
Theory of Coagulation of 190-191 
V< ssels, Fibrinous Concretions in the Heart and 175-177 
Williams and Wills, on 69-70 
BRAIN, Pigmentation of, in Malarial Fever, Observations of Bailly, 
Ballard, Bright, Meckel, Frerichs 864-867 
BUTTON WOOD, Cephalanthus Occidentalis 1012 
i o 
CADAVERIC ALKALOIDS 451 
CANCER of Testicles and Mesenteric Glands 23 
Of Stomach and Liver 24 
CARBONIC OXIDE GAS, effects of, on Blood HO 
CATALPA, BignoniaCatalpa 102i 
CEMETERIES, Statistics of, in New Orleans...., ' 463-465 
CEREBRO-SPINAL SYSTEM. Lesions of, in Malarial Fever 852-854 
And Sympathetic, Classification of Fevers into " 871-87? 
CHANGES OF COLOR IN THE HUMAN RACE 1147-1149 
CHERRY, Wild, Cerasus Virginiana 1O?°-1O24 
CHLORIDE OF SODIUM L'Z.7 1090-1092 
CHOLERA. Recent observations on 417 
CHOLERA, ASIATIC, Comma Bacillus of 412-416 
Koch, on Comma Bacillus of Asiatic Cholera 413-414 
Klein, on Comma Bacillus of Asiatic Cholera 415 
Lewis, on Comma Bacillus of Asiatic Cholera 417 1336 
INDEX. 
Ppges. 
CHOLESTERIN, Chemistry and Physiology of, Demargay, Berzelius, 
Pettenhofer, Lehmann, Cloetta, Bertholet, Becquerel and 
Rodier, Simon, Golding Bird, Lionel S. Beale, Girardin, 
Von Bibra, George, E. Lay, Austin Flint, Jr., and W. Marcet. 657-672 
CHRISHOLM, on Epidemic Polypus 167 
CHYLURIA, Lewis on 1325 
Cullen, Nosology of 49 
CINCHONA TREE, Geographic Distribution of 996-999 
CIRCULATION, Rapidity of, in different Animals 98-99 
And loss of Weights of Animals 96 
And Respiration, Rapidity of, in different Animals 102 
CIRRHOSIS. Causes of 938 
CLARK on Fevers 909 
CLINICAL INSTRUCTION 41 
COLORED BLOOD-CORPUSCLES, Effects of Reagents on 133-134 
CONGESTIVE FEVER 836-837 
CONGESTIVE MALARIAL FEVER 13-14, 802-804, 819-829 
CONGESTIVE PERNICIOUS MALARIAL FEVER 793-797 
CONTAGIA 443-445 
CORNUS FLORIDA, Dogwood 1000-1011 
CORPUSCLES, Red, Chemical Composition of 115 
Red, Source of 116-117 
White or Colorless 118 
White or Colorless, Chemical Composition of 119-120 
COUNCILMAN AND ABBOTT, on Brain in Malarial Fever 866-867 
CUTANEOUS SYSTEM, Diseases of 38 
DAY, Cases of Malarial Hsematuria, by 564-569 
DESLATTES, Cases of Malarial Haematuria by 572-577 
DIABETES MELLITUS, Analysis of the Blood in 277-286 
Treatment of 287-289 
DIABETOMETER of Robiquet 315 
DIGESTION of Albumen and Flesh 290-292, 297-298 
DIOSPY'ROS VIRGIN IAN A, Persimmon 1019 
DISEASES, Local 30 
Of Absorbent, Respiratory Systems, and Alimentary Canal 35 
DISTOMA R1NGERI AND PARASITICAL HEMOPTYSIS 545-551 
DLVERSUS, on Malignant Fevers 61 
DOGWOOD, Cornus Florida 1001 
Carpenter, Walker, S. G. Morton, Coates, James Cockburn, on... 1011 
DROPSICAL EFFUSION OF MALARIAL FEVER 242 
DROPSY, Becquerel and Rodier on 239 
Acute 240 
Cachectic 241 
Treatment of Malarial 249 
DYSENTERY, Acute 36 
ELEPHANTIASIS Graecorum 1206 
Etiology of 2235 
Arabica 1305-1307 
Arabica, Rayer, Gaide, Bouilland, Ferrus, Cruveilheir and 
Horner, on 1301-1309 
Arabum, Definition of 1293 
Arabum, Historical Notices of 1288 
Arabum, P. Rayer on 1287-1328 
Arabum, Rhazes, D. J, Larry, Fabre, Sigaud, John Bell, on 1288-1293 
Arabum, Treatment of 1327 
Graecorum, Paulus Egineta, Haly Abbas, Matthew Paris, Wil- 
liam of Malmesbury, Simpson,'P. Rayer, Erasmus Wilson, on.. 1237-1250 
In Louisiana 1233 
Of the Middle Ages 1247 
Pathology of 1308 
Tuberculous, Analyses of Blood in a Norwegian, by Danielssen 
and Boeck .' 1258 INDEX. 
1337 
Pages. 
ENTOPHYTA HOMINIS 349 
Leidy on 350 
ENTOZOA HOMINIS 348-349 
EUPATORIUM PERFOLIATUM, Thoroughwort 1069 
TP 
FEBRIFUGE REMEDIES in Malarial Fever 1086-1088 
FEBRILE POISONS, the Nature and Relations of Various 46 
Methods of Determining the Nature of 47 
FEHLING'S Standard Solution for the Determination of the Pres- 
ence of Diabetic Sugar 306 
FERMENTATION, Products of Albumen and Fermentation 492-494 
Products of, and Action of Quinine 496 
FEVERS, Classification into Cerebro-Spinal and Sympathetic 871-872 
Cerebro-Spinal and Sympathetic, James Copland and Henry F. 
Campbell, on 871-872 
Classification of, by George B. Wood 53 
Congestive Malarial 13-14 
John Huxham, on 511-514 
Pernicious Malarial 12 
Statistics of. in Charity Hospital of New Orleans 334 
Theory of, by Benjamin Rush 50-51 
FIBRIN and the Coagulation of the Blood 181-189 
Ba,umhauer and Verdeil. on 183 
Carpenter and Paget, Hewson, Hay, Prater, Hunter, Mulder, 
Lebonte and Goumoens, on 182 
Conditions Favorable to Deposition of 151 
Dumas, Cahours and Strecker, on 182 
Hammarsten, on Method of Obtaining 186 
In 1000 Parts of the Blood of Animals 85 
In Diseased and Healthy Blood 138-139 
Mulder, on 182 
Richardson, Zimmermann, Hammarsten, Andrew Buchanan, 
Schmidt, Ranvier, Hayem and Bizzozero, Dumas and Provost 
on '. 178-189 
FIBRINOUS CONCRETIONS in Heart and Bloodvessels, Authori- 
ties on 176-177 
Formation of. Andrew Buchanan and Schmidt, on 187 
FILARIA 1310 
Dr. F. S. Cobbold on Chyluria 1315-1317 
Relations of, to Chyluria 1321 
Sanguinis Hominis 206,1323 
FLINT, J. AUSTIN, JR., on Cholesterin 665 
FRAUENHOFER on the Lines in the Solar Spectrum 376 
FRERICHS, on Malarial Hsematuria 580-581 
On Bile 649 
On the Liver 864-866, 943, 971-972 
GANGR2ENOPSIS, Cases of 227 
GELSEMIUM SEMPERVIRENS, Yellow Jessamine 1075 
GENTIANA QUINQUEFLORA, Asrue Weed 1073 
GEORGIA BARK, Pinckneya Pubens 993 
GEORGIA, Mortality from Malarial Fever in 503 
GLYCOGEN AND GLUCOSE, Relations to Disease 915 
In Malarial Fever 916 
GLYCOGENIC Function of the Liver 912 
GLYCOGEN. Bernard, Odling, Apjohn, Pelouze and Pavy, on 915 
GORUP-BESANEZ, on Bile 649 
GULLIVER on the Measurement of Red Blood-Corpuscles 104 
H^MATOBIA BILHARZIA 207 
HJEMATOZOA, Relations of, to Chyluria, Elephantiasis and other 
Diseases 1309 1338 
INBEX. 
HEMATURIA _ 530 
Authorities on ........ 557-562 
Blood in Urine of 530 
Blood escaping from Kidneys in, Result of Febrile Poison and 
Irritating Substances 537 
Cases of, by C. Glidden Young, R. H. Day, George Harley, 
T. W. Baird, J. L. Deslattes, Terry H. Anderson, F. D. Hall, 
J. E. Oxamendi, Janies Copeland, William Roberts, Freid. 
Theod. Frerichs, Joseph Jones, Francis Barnes, S. F. Starley, 
H. L. Ghent, D. S. Joynes, Edward H. Sholl, T. C. Osborne, 
Benjamin H. Riggs, E. S. Sharpe, R. F. Michel, M. H. 
Taylor 58-59, 562-596 
Cases Reported by Drs. Willis, Barsham, Chopart, and others 532-534 
Causes of 555 
General Conclusions as to 696 
Greenhow on 554 
Idiopathic and Vicarious 531 
Induced by the Bilharzia Haematobia, observations of Chapotain, 
Salesse, Griesinger, Bilharz, Cobbold and John Harley 540-544 
Investigations of Joseph Jones on 594 
Malarial. Authorities on 594 
Malarial, causes of death in 694 
Malarial, History of 553-556 
Malarial. Gall-Bladder and Intestine in 591-614 
Malarial. Blood of, Joseph Jones, on 597-599 
Malarial. Changes of Liver, Spleen and Kidneys in 599-600 
Malarial. Jaundice in. Joseph Jones, on 600-681 
Malarial, Treatment of, by Joseph Jones 602 
Malarial. Chemical and Microscopical Examination of Blood 
in, by Joseph Jones 605 
Malarial. Chemical and Microscopical Examination of Urine 
in, by Joseph Jones 606 
Malarial, Complicated, with Pleuritis 
Observations of Vogel, Oppolzer, Mettenheimer, Thudichum and 
the Author, on the Blood escaping from the Kidneys, in 537 
Of Yellow Fever, Investigations of Drs. Nodes Dickinson and 
Daniel Blair 536 
HEMORRHAGIC FEVER 510 
HEMORRHAGIC MALARIAL FEVER. Due to Prolonged Ac- 
tion of Malarial Poison upon Fibrin and Colored Corpuscles 539 
History of. 517 
Hippocrates, Galen, Aretseus, Celsus, Paulus Egineta, Theo- 
philus, Actuarius, Prosper AI pin us, Lancisi, Ramazzini, Laut- 
ter, Alibert, Torti, Lind, Senac, Hillary, Todd, McLean, Charles 
Faget and Berenger-Feraud, on 517 -533 
HEMORRHAGIC PERNICIOUS MALARIAL FEVER 17 
Causes of, in different countries 514 
Extensive prevalence of. 500-530 
HEART CLOTS, In Various Diseases 174 
Authorities on 149-150 
Destructive Effects of 178 
In Malarial Fever 140 
Relation of malarial fever to 152 
Treatment of . 210 
HEART, Fibrinous Concretions in 175 
Misplacement of 31 
HEPATIC CELLS 903 
HEPATITIS INTERSTITIAL 932 
HOSPITAL PRACTICE, Results of Practice of Joseph Jones 343 
HYGIENE, Public and International 7 
HYPEREMIA AND NUCLEAR HYPERPLASIA of the Hepatic 
Cells 732 INDEX. 
1339 
Pages. 
I 
INDIGENOUS REMEDIES OF THE UN ITED STATES which 
may be employed as Substitutes for the Sulphate of Quinine in 
Malarial Fever 993-1105 
Pinckneya Pubens 993 
Cornus Florida 1001 
Cornus Circinata and Cornus Sericea 1011 
Cephelanthus Occidentals 1012 
Liriodendron Tulipifera .• 1013 
Magnolia Glauca 1016 
Magnolia Grandiflora 1018 
Diaspyros Virginiana 1019 
Bignonia Catalpa 1021 
Cerasus Virginiana 1022 
Aristolochia Serpentaria 1025 
Salix Nigra 1030 
Salix Alba 1031 
Salicin 1033 
Salicylic Acid and Salicylates 1035 
Salicylate of Sodium 1038 
Salicylate of Cinchonidia 1038 
Eupatorium Perfoliatum 1069 
Gentiana Quinqueflora 1073 
Eupatorium Verbennse Folium 1073 
Gelsemium Sempervirens . . 1074 
Corallorhiza Odontorhiza 1085 
Apocynuin Cannabinum 1085 
Hydrastis Canadensis 1086 
Asclepias Syriaca 1086 
Gossypium 1086 
Castanea Vesca and Pumila 1087 
Ain us Serrulata 1 1088 
Polygonum Aviculare 1088 
Prinos Verticillatus , 1088 
Verbascum Thapsus 1088 
Sabbatia Angularis 1089 
Chionanthus Virginia 1089 
Ilex Opaca 1089 
Platanus Occidentalis 1089 
Ptelea Trifoliata 1089 
Capsicum 1090 
Chloride of Sodium 1090 
Nitric Acid 1093 
Oleum Terebenthinse 1094 
Sal Ammoniac 1097 
Arsenious Acid 1098 
INTERMITTENT MALARIAL FEVER, Constitution of Urinein... 711-840 
INTERMITTENT FEVER, Cold Stage 832 
Charleston, 1863 744 
Hot Stage ' " 833 
Investigations of, by Joseph Jones 725-737 
Ligatures of the Extremities in 1115 
Pulse, Temperature and Urine in 758 
Tongue in 710 
Urine in 722 
J 
JAUNDICE, Composition of Blood in 686 
Classification of the Causes of. 688 
Hippocrates, Aretseus, Senac, Paulus 2Egineta, Collins, Aurelia- 
nus and Abbas, on 633-641 
Historical Account of 634 
In Various Fevers 693 
Nature of. 679 1340 
INDEX. 
Pages. 
JOSEPH JONES, M. D. Investigations on Malarial and other Fevers.. 5 
Acute, Sthenic, Intermittent and Remittent Fever occurring in 
Healthy Individuals 1136 
Chemical and Microscopical Examination of Blood in Malarial 
Haematuria, by 605-624 
Chemical and Microscopical Examination of Urine in Malarial 
Haematuria, by 606-617, 622-633, 747 
Changes of Pulse, Respiration, Temperature and Urine in Inter- 
mittent Fever 702, 713-723, 739, 758, 764, 774, 781-840 
Chemical and Microscopical Characters of Urine in Typhoid 
Fever, supervening on Malarial Remittent Fever 787 
Change of Pulse, Respiration, Temperature and Urine in Mala- 
rial and Congestive Fever 793 
Classification of Phenomena of Mortification, by 231-233 
Differences between Symptoms and Pathological Lesions of 
Cerebro-Spinal Meningitis and Congestive Pernicious Fever... 860-861 
Effects of Malarial Poison on (Sympathetic and Cerebro-Spinal 
Systems, Fibres of the Heart and Circulation 795 
Heart Clots in Malarial Fever, Investigations by 147-149, 164-180 
Head, Thorax and Abdomen in Post-mortem Examinations in 
Malarial Haematuria, by 619-625 
History of Investigations in the Microscopical Characters of the 
Blood in Malarial and other Fevers 333-347 
Investigations of, on the Changes and Composition of Blood in 
Malarial Fever 214-226,234-238 
Investigations of, relative to Animal Heat 699 
Investigations on the Nature and Relations of Fevers in the 
Confederate Army 739 
Intermittent Fever of Long Standing 1139 
Measures for the Arrest of the Febrile State . 1142 
On Action of Malarial Poison 468-497 
Ou Albinism 1147-1175 
On Appearance of Tongue in Intermittent Fever 710 
On Appearance of Exterior of Body in Fatal Cases of Malarial 
Fever 843 
On Appearance of External of Body in Fatal Cases of Yellow 
Fever 844 
On Blood in Malarial Haematuria 597-599 
On Changes of Kidney, Liver, Spleen and Bladder in Malarial 
Haematuria 599-616, 626 
On Changes of Blood in Malarial Fever and Disturbance of Pulse 
and Respiration in Congestive Fever 797-814 
On Comparative Anatomy and Chemistry of the Blood of Man 
and Animals 71-103 
On Constitution of Urine in Intermittent Fever 711-722, 745-752 
On Diabetes Mellitus 277-290 
On Digestion of Albumen and Flesh and the Comparative Anat- 
omy and Physiology of the Pancreas 290-299 
On Enlarged Spleen in Malarial Haematuria 629 
On Filaria in Blood of Animals and Man 201 
On Heart, Liver and Spleen in Malarial and Yellow Fever 840 
On Hyperaemia of Brain and Spinal Cord after Death from Ner- 
vous forms of Malarial Fever 831 
On Hyperaemia of the Kidneys in Malarial Fever 974 
On Jaundice in Malarial Haematuria 600-601 
On Jaundice, its Phenomena and Symptoms in Malarial Haema- 
turia and other forms of Malignant Fevers 633 
On Leprosy 1219-1235 
On Lesions of Acute and Chronic Dysentery 893 
On Lesions of Intestinal Canal in Typhoid Fever 886-892 
On Liver Cells of Typhoid Fever 949 
On Malarial Fever . 275 
On Medico-Legal Evidence relating to Human Blood 363-375 
On Membranes of the Brain 846-854 
On Micro-organisms in Typhoid Fever 155-162 
On Microscopical Characters of Blood in Malarial Fever 192-198 INDEX. 
1341 
Pages, 
JOSEPH JONES, M. D., on Pathological Anatomy of Cerebro-Spinal 
and Sympathetic Nervous Systems in Malarial and Yellow 
Fever 844 
On Pathological Changes and Lesions of the Brain and Spinal 
Cord in Acute Sthenic Cases of Malarial Fever 846 
On Phenomena during Hot Stage and Period of Intermission 708 
On Relations of Leucocythsemia and Leukaemia to Malarial 
Fever 316-321 
On Relations of Pneumonia to Malarial Fever 321 
On Relations between Remittent and Intermittent Fever 763-768 
On Renal Haemorrhages, Progress and Effects in Malarial Fever. 975 
On Treatment of Malarial Haematuria 602 
Pathological Anatomy of Spleen in Malarial Fever 949 
Pernicious and Congestive Malarial Fever .., 1141 
Periods and Duration of Remittent Malarial Fevers 768 
Principles Governing Administration of Purgatives in Malarial 
Fever 815-829 
Questions relating to Public and International Hygiene, by 6-10 
Result of Hospital Practice of 11-64 
Urinary Deposits Characteristic of Remittent Malarial Fever 772 
k: 
KELSCH on Destruction of Colored Blood-Corpuscles by Malarial 
Poison 421 
KELSCH AND KEINER on Acute Parenchymatous and Chronic 
Nodular Parenchymatous Malarial Hepatitis 923, 929, 930 
On Pathological Anatomy of Liver in Malarial Fever 926-928 
On Parenchymatous Interstitial Nephritis . 978-980 
KIDNEY, Diseases of 37 
Pathological Anatomy of, in Bright's Disease 986 
Pathological Anatomy of, in Malarial Fever 96 [ 
Pathological Anatomy of, in Malarial Fever, Frerichs on 972 
Pathological Anatomy of, in Yellow Fever 982 
Diseases of, by P. Rayer 533 
In Malarial Haematuria. Observations by Michel and Sholl 591 
Fatty Degeneration of, Case by Lionel S." Beale 661 
Structural Alterations and Pathological Anatomy of, in Acute 
and Chronic Nephritis 973 
Hyperaemia of, in Malarial Fever 974 
KLEIN on Bacteria 353, 354 
On Pathogenic Micrococci 394 
KOCH on Relations of Micro-Organisms to Malarial Fever 397 
On Bacillus Anthracis 408-410 
EAROCHE on Yellow Fever 909 
LEIDY on Parasites 349-351 
LEPRAE BACILLUS 1262 
LEPROSY in Mexico, Kendall on 1211-1212 
And Yaws in the Delta of the Mississippi 1180-1215 
Case of, by P. Rayer 1254 
Cause, Duration and Termination, and Diagnosis 1300 
Composition of Blood in, Danielssen and Boeck, on 1253 
Danielssen, Boeck, Carter, on 1257 
In Central and South America, Dr. 8. Haber on 1212-1213 
In Louisiana 1217 
In New Brunswick 1214 
Morbid Anatomy of ' 1253 
Moxen, on 1261 
Oriental, Aretseus, Sigaud, Playfair. Schilling, Rayer, oil" 1271-1278 
Oriental, Treatment of, by Surgeon-Major Peters....' 1281 
Theory of the Cause 1296 
Theory of the Symptoms 1299 
Virchow, on 1261 1342 
INDEX. 
Pages 
LEUCINE AND TYROSINE 6S0 
LEUCOCYTH2EMIA, Relations to Malarial Fever 316 
LEWIS, on Chyluria..... 1325 
LIQUOR SANGUINIS and Moist Blood-Corpuscles 81 
LIRIODENDRON TULIPIFERA, Tulip Tree 1013 
LIVER, Diseases of 36 
Adenoma of. 941 
Anatomy of Human 901 
Cirrhosis of 683-936 
Color of, in Malarial Fever 904 
Comparative Weight of the... 898 
Differences between Malarial and Yellow Fever Livers 918 
Effects of Preceding Diseases on Color of 905 
Functions of 899 
Glycogenic Functions of. 912 
Henle and Hering, on 919 
In Typhoid Fever 948 
Keiner and Kelsch, on 929 941 
Lesions of Liver and Spleen in Malarial Fever 894 
Lobules of 902 
Lobules of, Edward Hering, on 902 
Pathological Anatomy of, Cl. Bernard, Kblliker, Thackrah, 
Simon, Handheld Jones, H. D. Schmidt, on 895-897 
Pathological Anatomy of, in Malarial Fever i 895-917, 942 
Pathological Anatomy of, in Yellow Fever 944 
Phlegmasial Hypersemia and Parenchymatous Inflammation of, 
in Paroxysmal Fever 918-919 
Parenchymatous Inflammation of, in Malarial Fever 920 
Relations of Parenchymatous Hepatitis of Malarial Fever to 
Uncomplicated Cirrhosis of the Inver and to Atrophy of Ade- 
noma of Liver .' 935 
Sources of Color in Malarial Fever 909 
Weight of, in Malarial Fever 900 
Yellow Atrophy of 940 
LOBSTEIN, Cause of Intermittent Fever, Disorder of Sympathetic 
Nervous System, Theory of .' 867 
LOCAL DISEASES 30 
LOVE, on Ainhum 1283 
IVE 
MAGNOLIA GLAUCA 1016-1017 
Grandiflora 1018 
MALARIA, relation of climate and soil to ; 44 
Investigation of causes and conditions of 45 
MALARIAL BLOOD, Black Pigment and Pigment Cells in 335-342 
MALARIAL DISTRICTS. Diseases of 272 
MALARIAL DROPSY, Treatment of 249 
MALARIAL FERMENT, chemical actions of 495 
MALARIAL FEVER. Alimentary Canal, Stomach and Intestinal 
Canal, in 880-884 
Algid 798-799 
Analysis of the Blood in Diabetes Mellitus and 277-286 
Bile in 910-911 
Blood Letting in 252-255 
Brain, Spleen, Liver and Kidneys in, Bailly, Ballard, Bright, 
Meckel, Frerichs and Planer on Lesions of 864 
Changes in Saline Constituents of Blood-corpuscles in 250-251 
Changes of Blood in 129-130 
Classification of Forms by Joseph Jones 55-56 
Cold Stage 702-703 
Cold Water in the Treatment of. 1106-1109 
Cold Water Treatment in, Currie on 1107-1109 
Color of Blood and Serum in'. 131-132 
Color of Liver in 904-909, INDEX. 
1343 
Pages. 
MALARIAL FEVER. Comatose Cases of 243-244 
Comparison between Yellow Fever and 840 
Composition and Changes of Blood in 212-226, 234 
Composition of Urine in 830 
Condition of the Blood in Yellow Fever and Investigations of 
Joseph Jones on 699-701 
Congestive 13-14, 802-804 
Congestive, Pernicious 793-797 
Constitution of Urine in 470-472 
Cupping in 1110 
Deposit of Pigment in the Brain of 863-866 
Destruction of Blood-corpuscles in 268 
Destructive Effects in Warm Climates of 505 
Dropsical Effusion of. 242 
Effects of Pathogenic Organisms of 479-48] 
Effusion of Serum into the Ventricles of the Brain in ;... *245 
Experiments on the Micro-organisms of 473-478 
Explanation of the Action of Antiseptics in 482-483 
Febrifuge Remedies in 1086-1088 
Gall Bladder in Yellow Fever and 949 
General Conclusions Concerning 838 
General Conclusions Relative to Cause and Nature of 484-491 
Glycogen and Glucose in 916-917 
Heart Clots in 140-150 
Hot Stage 704 
In Africa 506-509 
Indigenous Remedies in 1089, 1096-1097 
In the Confederate Army 748-752 
Investigation of the Phenomena and Treatment of 62-64 
Lesions of the Cerebro-Spinal System in 852 
Lesions of Liver and Spleen in 894 
Lesions of the Nervous Structures in 862 
Lesions of Organs in 269 
Microscopical Examination of Blood in 192-197 
Mortality in Georgia from 503-504 
Natural history and relations of 740 
Nervous Origin of, Lobstein, Lewis, D. Ford, L. A. Dugas, Mil- 
ton Antony and James Copland on 867-870 
Pathological Anatomy of 842-851, 860-861 
Pathological Anatomy of the Alimentary Canal in 880, 882-885 
Pathological Anatomy of Kidneys in 961-972, 981-984 
Pathological Anatomy of Liver in 895-897, 918-933 
Pathological Anatomy of Spleen in 950-960 
Pernicious 12-16, 800-801, 805-818 
Phenomena of 709 
Physical and Chemical Changes of the Blood in 66-67 
Practical Observations on the Treatment of 1127-1143 
Prevention of 1111-1112 
Pulse, Respiration, Temperature and Urine in 712-721 
Quinine as a Preventive of 1117-1118 
Relation of, to Heart Clots 152-153 
Relations of Leucocythsemia to.> 316-320 
Relations of Pneumonia to. 321-332 
Relations of the Malignant Forms 855-859 
Symphographic Tracings of the Pulse in 839 
Temperature, Pulse and Respiration in 346 
Theories with Reference to 867-870 
Treatment of. 256-262, 497 
Weight of Liver in ' 900 
MALARIAL H2EMATURIA, Structural Alterations of the Kidneys 
in, by Dr. John Johnson 535 
Causes of death in 694-695 
General conclusions as to 696-697 
History of 553-633 
MALARIAL HAEMORRHAGIC FEVER, extensive prevalence of.. 500-502 
MALARIAL HEPATITIS, Chronic 934r-935 1344 
INDEX. 
Pages. 
MALARIAL NEPHRITIS, Acute and Chronic 973-980 
MALARIAL, PAROXYSMAL FEVER, malignant form 499 
MALARIAL POISON, direct action upon the nervous system 246-247 
Alterations produced by 273-275 
Direct action upon the blood 248 
Views of Joseph Jones on the action of 468-469 
MALIGNANT INTERMITTENTS, Senac on 59-60 
Senac, Diversus, Valesius, Torti and Alibert on 61 
MANSON, PATR CK, on Distoma Ringeri 545-550 
MARCET, Method of Extracting Excretine by 669 
MEDICO-LEGAL EVIDENCE, relating to human blood 363-374 
Investigations, Spectroscopic Analyses in 375-391 
MEGGS on Malarial Fever 
MELAN^MIA 136 
MESENTERIC GLAND, Cancer of 23 
MICROCOCCI, Pathogenic 394-395 
Ascococcus, Sarcini Ventriculi 
MICROCOCCUS Varioleeet Vaccinias, Erysipelatosus, Diphtheriticus, 
Pneumoniae 395 
Gonorrhoea, Endocarditicus, Scarlatinas, of Acute Infectious Oste- 
omyelitis .6 
MICRO-ORGANISMS in Bile and Intestines 154-155 
Davaine, Nageli, Rabenhorst, Cohn, Robin, Billroth and Klein on 353 
In Splenic Mud 360-362 
In Typhoid Fever 156-162 
Of Malarial Fever 353 
Of Malarial Fever. Bolestra, Lanzi, Eklund, Klebs, Tommasi- 
Crudeli, Laveran and Richard Marchiafava, Gerhardt, Mariotti 
and Ciarrochi, on 474-479 
Of Malarial Fever, comparison of, with well known pathogenic 
forms 393 
Spherobacteria or Micrococci, Bacteria or Micro-bacteria, Bacilli 
or Desmobacteria, Spirilla, Spirochaetae 359 
MISSISSIPPI VALLEY. Cause of Phthisis in 19-20 
Area of Alluvium and Delta in 500 
Extensive Prevalence of Haemorrhagic Malarial Fever in ... 500-501 
MORBIFIC FERMENTS 443-445 
MORTALITY OF NEW ORLEANS 43 
Relative, in white and negro races 42 
MORTIFICATION, classification of, phenomena of 231-233 
MORTUARY AND VITAL STATISTICS of New Orleans 455-460 
1ST 
NEGRO RACE, Albinism in 1151 
Relative mortality in white and 42 
NEPHRITIS, Malarial 973 
NERVOUS SYSTEM, direct action of Malarial Poison on 246 
NITRIC ACID 1093 
NOSOLOGY of Cullen and Alexander Philips Wilson 49 
O 
OSBORN, T. C., on Malarial Heematuria 585 
OXY-HAEMOGLOBIN, chemical composition of 114 
Hoppe-Seyler, Schmidt and Kissel, on 114 
PANCREAS, comparative anatomy and physiology of 293-296 
M. L. Oorvisart on 259 
PARASITES 40 
In man and animals 347-352 
PARASITICAL HAEMOPTYSIS and Distoma Ringeri 545-551 
PAROXYSMAL HEMATURIA 552 
Malarial Fever, malignant forms 499 INDEX. 
1345 
Pages. 
PASTEUR on Relations of Bacteria to Putrefaction 445 
PATHOGENIC MICROCOCCI 394-397 
PATHOLOGICAL ANATOMY OB' HEART in Malarial and Yellow 
Fever * 875 
PAVY'S Cupro-potassic solution for sugar 309 
PEPSINE, Authorities for the Use of 258 
PERNICIOUS MALARIAL FEVER 12, 800-818 
Elevated Temperature in 16 
Forms of, by Torti 52 
Pernicious Haemorrhagic Malarial Fever 17 
PERSIMMON, Diospyros Virginiana 1019-1020 
PHTHISIS PULMONAL1S in New Orleans 18 
Causes of, in Valley of Mississippi 19-20 
Treatment of 21-22 
PI AN 1200 
PIFFARD'S Formula for Fehling's solution 310 
PIGMENT CELLS and Black Pigment in Malarial Fever 335-342 
PINCKNEYA PUBENS, Georgia Bark 993-995 
PLASMA 121 
Blood Plasma, morbid condition of 122 
PNEUMONIA, relations to Malarial Fever 321-332 
Pulse, temperature and urine in 753-757 
POISONS . 38 
POISONING, Acute, arsenic 3o 
POISONS, Febrile 46-47 
POLARIZATION, estimation of sugar by 313-314 
PRODUCTS OF PUTREB'ACTION, agency of, in the production of 
disease 452-454 
PULSE AND TEMPERATURE, cases illustrating the changes of.... 705-707 
PUTREFACTION, relations of Bacteria to 446 
Andral on chemical products of 447 
PYREXEE AND PHLEGMASI2E, alterations of blood in 270-271 
QUININE, Products of, fermentation and action of 496 
As a Prophylactic 1119-1126 
Administration of, in Congestive Pernicious Malarial B'ever 787 
Effects of, in Malarial Fever 482-483, 799 
Indigenous Remedies of the United States which may be em- 
ployed as Substitutes for, in the Treatment of Malarial Fever: 
Pinckneya Pubens 993-1104 
Cornus Florida. 1001 
Cornus Circinata and Cornus Sericea 1011 
Cephelanthus Occidentalis 1012 
Liriodendron Tulipifera 1013 
Magnolia Glauca . 1016 
Magnolia Grandifiora 1018 
Diaspyros Virginiana 1019 
Bignonia Catalpa 1021 
Cerasus Virginiana 1022 
Aristolochia Serpentaria 1025 
Salix Nigra ' 1030 
Salix Alba 1031 
Salicin ' 1033 
Salicylic Acid and Salicylates 1035 
Salicylate of Sodium 1038 
Salicylate of Cinchonidia ' 1038 
Eupatorium Perfoliatum 1069 
Gentiana Quinqueflora 1073 
Eupatorium Verbenme Folium 1073 
Gelsemium Sempervirens 1074 
Corallorhiza Odontorhiza 1085 
Apocynum Cannabinum 1085 
Hydrastis Canadensis 1086 
Asclepias Syriaca ; 1086 1346 
Pages. 
QUININE. Gossypium 1086 
Castanea Vesca and Pumila 1087 
Alnus Serrulata 1088 
Polygonum Aviculare 1088 
Prinos Verticillatus 1088 
Verbascum Thapsus , k 1088 
Sabbatia Angularis 1089 
Chionanthus Virginia 1089 
Ilex Opaca 1089 
Platanus Occidentalis 1089 
Ptelea Trifoliata . 1089 
Capsicum 1090 
Chloride of Sodium 1090 
Nitric Acid 1093 
Oleum Terebinthinse - 1094 
Sal Ammoniac 1097 
Arsenious Acid 1098 
RELAPSING FEVER, Spirilla of 198-199 
REMITTENT KEVER, Investigations, by Joseph Jones..765-769, 774-786, 791-792 
Changes of Urine in 771-773 
Cold Stage 834 
Hot Stage 835 
Varieties of 770 
William Aitken on 769 
RESPIRATION, Rapidity of, in different animals 102 
In different animals 99 
RESPIRATORY SYSTEM, Comparative anatomy of 100-101 
Diseases of 35 
RHEUMATISM, Treatment of 25-26 
Treatment of, by Joseph Jones 1065 
Treatment of, by Salicylates and other remedies 1058-1064 
Various modes of treating 1057 
RICHARDSON, BENJAMIN WARD, on Fibrinous Concretions and 
Heart Clots 150, 156, 178 
RICHARDSON, J. C., Measurement of red blood-corpuscles, by 106 
ROBIQUET, Diabetometer 315 
RUSH, Benjamin, Theory of Fever of , 50-51 
SALICIN, Ringer, Bury, Kohler, C. W. Brown, Isambard Owen, 
Coupland, Douglass, Powell, Gilbart Smith, Latham, Macla- 
gan on 1040-1049 
Salicylic and Salicylate of Sodium 1033-1041 
In treatment of Rheumatism 1041-1055 
SALICYLATES AND OTHER REMEDIES, Treatment of Rheu- 
matism, by 1067-1068 
SALINE CONSTITUENTS, Fixed, in Blood of different animals 86 
SALIX NIGRA, Black Willow 1030-1033 
SCHIZOMYCETES 400 
SCHMIDT, H. D., Post-mortem Examination of Cases of Leprosy 1227 
On Liver of Yellow Fever 897, 946, 986 
SEN AC, On Malignant Intermittents 59-61 
SEPTIC SPIRILLA 418 
SEPULTURE, Intra-Mural, in New Orleans 460-462, 466 
SEROLINE, Account of, by Flint, Boudet, Lecanu, Sanson, Becque- 
rel and Rodier 673 
INDEX. 1347 
Pages. 
SERUM AND BLOOD, Specific gravity of, in animals 78-79 
Effusion into Ventricles of Brain in Malarial Fever 245 
SIBBENS OR SIVVENS 1201-1204 
Gilchrist, Adam Freer, Hope, Maxwell, on 1201-1204 
SORBY. Improvement in the Spectrum Method of Detecting Blood. 386-392