*&■' !£'• wm '%.,« ^ PRIZE DISSERTATIONS 1. INFLAMMATION OF THE PERIOSTEUM 2. ENEURESIS 1RRITATA. 3. CUTANEOUS DISEASES. 4. CANCER OF THE BREAST. 5. MALARIA. By USHER PARSONS, M. D. LATE rROFESSOR OF ANATOMY AND SURGERY, BROWN UNIVERSITY, A NI> , SURGEON V. STATES NAVY; PRESIDENT OF THE RHODE-ISLAND MEDICAL SOCIETY; HONORARY MEMBER OF THE MAS- SACHUSETTS, NEW JERSEY, PHILADELPHIA, AND SOUTH CAROLINA MEDICAL SOCIETIES, AND MEMBER OF THE AMERICAN MEDICAL ASSOCIATION. SECOND EDITION. PROVIDENCE:- PRINTED BY B. T. ALBRO 1849. PREFACE. Several of the following essays have already appeared separately, in medical journals, at the times they were severally written. Having undergone some corrections, they are now presented in a separate volume. In preparing them for the press, it seemed proper to give the reader some account of the institution that gave rise to them, of the founder whose name it bears, and of the doings of its committees or trustees. The name of Boylston has long been associated with enterprizes that meliorate the condition, and adorn the character of man. Zabdiel Boylston, F. R. S. a native of Brookline, Massachusetts, introduced the practice of in- oculating in small pox into America, in 1721. He com- menced the experiment in his own family upon an only son, and, although it excited the strong opposition of the profession and the clamor of the populace, he soon tri- umphed, and had the satisfaction of seeing the practice adopted generally throughout the country. Nicholas Boylston, Esq., (son of Zabdiel) an opulent merchant in Boston, founded a professorship of oratory and rhetoric in Harvard University in 1771, which went into operation in 1805, Ex-President Adams, then a Senator in Congress, first occupying the chair. Mr. B. also estab- VI PREFACE. lished a fund to promote elocution and belles-lettres by awarding prizes annually to individuals of the upper classes of the University.*1 Ward Nicholas Boylston, nephew of Nicholas, has been called the medical Maecenas of New England. Besides making large donations of medical books and plates, he instituted a fund of $500, for the purchase of a Medical and Anatomical Library and Museum, with the assurance, that "during his life he should earnestly en- deavor to make every addition to enrich and enlarge the present list of books, so as to make it, if not the first, yet equal to any establishment of this kind in the United States of America," which pledge he amply redeemed. It was on one of these occasions, May, 1800, when trans- mitting a curious MS. volume to the Library, that he " begged to be. permitted to settle on the corporation the sum of one hundred dollars per annum, forever, intending, originally, that it should be applied to the purchase of Books till" the Library should be sufficiently enlarged for all the purposes of its institution, and that it should then be distributed in annual prizes for dissertations, on subjects connected with Medical Science. In his letter, he says, " I am not insensible of the task I impose on the executive part of your honorable and justly celebrated University; but when I contemplate the im- portance of the object, and the only hands from which it can derive either assistance or protection, I feel less dif- fidence in asking it, persuaded that to alleviate the pains of sickness, and misfortune, and to comfort that misery, to which the human frame is constantly exposed, will be * For the particulars here given, I am indebted to the kindness of D. Humphreys Storer, M. D., of Boston. PREFACE. Vll as gratifying to every individual engaged in it, as it will be consolatory to me, when the period of those days shall arrive in which it is said, ' we have no pleasure in them.' " In 1803, however, the payments due up to that time, amounting to $500, were set apart as the permanent fund for the increase of the Medical Library, and Mr. Boylston gave his bond of $1500, to provide a yearly income of $100, the intent of which, is thus specified in his bond:— " The President and Fellows of Harvard College, and their successors, shall yearly appoint a "Committee, con- sisting of not more than eleven, nor less than seven persons skilled in the subjects connected with medical science,* which Committee shall propose and give public notice of, on, or before the 20th of August, in each year, some one or more Theses, upon such medical, anatomical, physiolo- gical and chymical subjects, as they may deem useful, one thesis, at least, to be propounded upon a subject properly belonging to each of those classes. And the several authors of the best dissertation, in the judgment of said Committee, or of a majority thereof, upon each of the said subjects, which shall be transmitted and delivered to them on or before the 20th November next after their public notice given of said subjects, shall be entitled to receive from them a prize medal, or the amount in money at his own option, of such value as to the said Committee shall seem proper; provided that the value of all the medals distributed, and money thus paid, in any one year, shall not exceed $100. The judgment of said Committee, shall be made up and declared to the candidates for the prizes, on or before the 1st January next ensuing the * And in another place he desires that the Professors of Anatomy, Medicine and Chymistry, may always be of the number. Vlll PREFACE. declaration of the subjects, and the prizes delivered or paid to the successful candidates, on or before the 20th of the same January. " And, if after such public notice as is herein before directed, it should happen that upon either of the subjects propounded by the Committee, no dissertation should be transmitted or delivered to them, within the time appoint- ed, which in their judgment, or in that of a majority of them should be deserving the prize, then the amount of such prize shall be paid to the treasurer of said Harvard College to be placed at interest and appropriated towards a fund for erecting a suitable and substantial building, to be always used for an Anatomical Museum and Library." In a subsequent letter he requested " that they would renew such question or questions that they may not think fully answered this year to the next, and so continue it from year to year until they are; and that such notice be renewed with the new questions (as may be your intention to propound for the ensuing year) as soon as may be, after the publication of the dissertations, you shall adjudge to merit the premiums, or if no such premiums are granted, as soon after as your judgments are made up upon those under consideration." The only alterations which have been made in the above directions, are, that the money is divided into prizes of $50, instead of $30 each, and also in the time of announcing questions and receiving dissertations, both of which were approved by Mr. Boylston before his death. It appears that the first Committee was chosen by the Corporation of Harvard College, April, 1S03, and that up to 1810, the following persons had been on that Committee at different periods:—Edward A. Holyoke, James Lloyd, PREFACE. ix Cotton Tufts, Samuel Danforth, Isaac Rand, Joshua Fisher, Benjamin Waterhouse, and William Eustis. In 1810, the following gentlemen composed the Commit- tee, viz.:—Lemuel Hayward, John Warren, Thomas Welsh, Aaron Dexter, John Brooks, Josiah Bartlett, Wil- liam Spooner, John Fleet, and James Jackson; and most of them have served several years. Questions were annually proposed, agreeably to the in- tentions of the founder, and premiums were adjudged on the following subjects, viz.:— 1804. James Mann. Cholera Infantum. 1805. No adjudication. 1806. James Mann. Dysentery. " George C. Shattuck. Mortification. 1807. Biliary Concretions. " " " On the Structure and Func- tions of the Skin. 1808. Daniel Newcomb. Cancer, and the best mode of Extirpation. 1809. Jacob Bigelow. Cynanche Maligna. " " " Phthisis. " Thomas Sewall. Complaints in the Breasts of nursing women. From this time we have regular records, lists of ques- tions, &c. The questions, then as now, were published in the newspapers, and the Dissertations received and dis- posed of as now, only before the 31st of October, instead of the first Wednesday in April. 1810. Questions. 1. Hydrocephalus Internus; particularly with respect to the symptoms by which it is distinguished B X PREFACE. from diseases resembling it. 2. Epilepsy; its varieties, and the mode of treatment of each. 3. The most proper mode of treatment in Burns and Scalds. Premiums. Jacob Bigelow on the third. One received on the first. 1811* Committee. Same. Questions. Nos. 1 and 2 of last year. 3. What sub- stitute can be had for Leeches, in order to draw blood gradually, with little or no pain, from small surfaces; and which, from cheapness and facility of application, in the hands of either the patient or the medical practitioner, shall be adapted to general use ? Prizes. George Hayward, Boston, on No. 1 of last year. Two were received on No. 3. 1812. Committee. Same. Questions. No. 2 of 1810, and No. 3 of 1811. 3. On the Medicinal Uses of Carbonic Acid Gas. Prizes. William J. Walker, of Medford, (now Charles- town), on No. 2 of 1810. John F. Waterhouse, on No. 3 of 1811. Two others were presented. 1813. Committee. Same. Questions. 1. No. 3 of 1812. 2. On the criteria by which to determine when the use of Mercurials, in cases of Syphilis, should be discontinued. 3. On the reciprocal changes which take place in the blood and in the air, in the process of respiration. * By this I must be understood that the questions were announced in 1811 and adjudged in 1812, &c. PREFACE. XI Prizes. John Fothergill Waterhouse, Philadelphia, on No. 3, 1812. Do. on No. 2, 1813. Enoch Hale, Gardi- ner, Me. (now Boston), on No. 3, 1813. 1814. Committee. Instead of Lemuel Hayward and John Fleet, I find David Townsend and John G. Coffin; but when elected I know not. Questions. 1. Structure and functions of the Urinary Apparatus. 2. Effects produced on the System by Blood- letting. 3. On the tests of Arsenic, the effects produced on the system of those who swallow preparations of this article, and the treatment best adapted to the removal of those effects. Prizes. John Ware, on No. 1. Abel S. Peirson, Bid- deford, Me. (now Salem), No. 2. J. Freeman Dana, Bos- ton, No. 3. Six others received. 1815. Committee. Same. Two questions, with $50 pre- miums, are offered instead of three of $30 each. Questions. 1. On Sweating as a remedy in disease: how does it operate 1 in what cases should it be employed, and to what extent or degree in each; and what are the best means of inducing this evacuation in the several cases in which it is advisable ? 2. On the composition of the substance commonly called Oxy-Muriatic Gas. Prizes. John Ware on No. 1. J. Freeman Dana on No. 2. Eight more received. In this year Mr. Boylston signified his wish that the Committee should be permanent, nominating for all vacan- cies by death. xii PREFACE. 1816. Questions. 1. Is there any communication from the stomach to the bladder more direct than that through the circulating system and the kidneys 1 2. On the vegetable articles, the growth of the United States, which have been, or may be, advantageously employed as emetics or cath- artics. Prizes. No dissertations offered. 1817. Questions. 1. On Haemoptysis: its different species, and the method of treatment adapted to each. 2. What are the best means of promoting Suppuration 1 Prizes. John Ware, Boston, No. 1. 1818. Questions. Same as 1816. Prizes. Enoch Hale, Jr., Boston, on No. 1. 1819. Questions. 1. No. 2 of 1817. 2. On the diagnosis and treatment of Cynanche Trachealis, or Croup. Prizes. John Ware, on No. 2 of 1817. William Sweetser, Jr., Boston, on No. 2, 1819. 1820. In consequence of voting to propose questions two years in advance, no adjudication seems to have been made for this year. 1821. Questions. 1. On the diseases of the Liver, both func- tional and organic; their varieties, and the treatment adapted to each. 2. Can Medicinal Substances be safely PREFACE. xiii and advantageously introduced into animal bodies through the medium of the veins ? Prizes. John C. Dalton, Chelmsford, on No. 1. Enoch Hale, Jr. on No. 2. 1822. Questions. 1. Diagnosis and treatment of Pertussis, or Chincough. 2. Medicinal use of the Prussic Acid. Prizes. Abel L. Peirson, Salem, on No. 1. 1823. Questions. .1. On the functions of the extreme Capillary Vessels, in health and disease. 2. What textures of the body, when punctured or lacerated, are liable to bring on the disease called Tetanus ? Prizes. William Sweetser, on No. 1. I find Dr. Gorham's name among the Committee. 1824. Questioms. 1. On the Diseases resembling Syphilis, and the best method of treating such diseases. 2. How long may the human body remain immersed in water, without extinction of life; and at what period after im- mersion would it be useless to employ restorative means ? Prizes. Samuel Cartwright, of Natchez, Miss, on No. 2. 1825. Questions. 1. To what extent has the Vaccine disease been found to be a preventive of the Small Pox? 2. On the history of the Autumnal Fevers of New England. [Intending a mere description, &c.] Prizes. John Bell, New York city, on No. 1. 1826. Questions. 1. No. 1 of 1824. 2. Whether the Veins perform the function of Absorption. xiv PREFACE. Prizes. D. Humphreys Storer, Boston, on No. 1 of 1824. Samuel A. Cartwright, Natchez, on No. 2, 1826. A vacancy in the Committee by the death of John Brooks ; John Dixwell elected. Also James P. Chaplin, vice D. Townsend, resigned. 1827. Questions. 1. No. 2 of 1825. 2. On Inflammation of the Periosteum, both acute and chronic. Prizes. Usher Parsons, Providence, on No. 2. 1828. Questions. 1. What are the circumstances in which the drinking of cold water, in hot weather, proves injuri- ous? What are the diseases which arise from this cause, and what is the best mode of treating those diseases ? 2. On the disease called an Irritable state of the Urinary Bladder; its nature and treatment. Prizes. Usher Parsons, Providence, on No. 2. 1829. Questions. 1. No. 2 of 1825. 2. What Insects in the United States, and particularly in the northern part, are capable of inflicting poisonous wounds; the phenomena of such wounds, and the best means of remedying their ill consequences ? Prizes. No dissertations offered. Committee. Vacancies occurred this year by the resigna- tion of Drs. Spooner, Jackson and Coffin, and the deaths of Drs. Dexter, Gorham and Chaplin. Filled by Drs. Rufus Wyman, George C. Shattuck, Jacob Bigelow, John B. Brown, Walter Channing and George Hayward. PREFACE. XV 1830. Questions. 1. Whether Fever is produced by the de- composition of animal and vegetable substances, and if by both, their comparative influence ? 2. On the connection between Cutaneous Diseases which are not contagious, and the Internal Organs. Prizes. Charles Caldwell, Lexington, Ky. on No. 1. Usher Parsons, Providence, on No. 2. 1831. Questions. Same as 1829. Prizes. No dissertations. Added to the Committee; John Randall, vice Thomas Welsh, deceased. 1832. Questions. 1. What is the cause of Fistula Lachryma- lis; and what is the best mode of treating the disease ? 2. No. 1 of 1828. Prizes. Robert W. Haxall, Richmond, Va. on No. 1. 1833. Questions. Same as 1829. Prizes. No dissertations. 1834. Questions. 1. What is the true nature of Polypus in the nostrils; and in what manner may the disease be best treated ? 2. Are restrictions on the entrance of vessels into port, called Quarantine Laws, useful? If so, in what cases should they be applied ? Prizes. Charles Caldwell, Lexington, Ky. on No. 2. 1S35. Questions. 1. What diet can be selected which will en- xvi PREFACE. sure the greatest probable health and strength to the laborer in the climate of New England—quantity and quality, and the manner of taking it to be considered ? 2. What are the diagnostic marks of Cancer of the Breast; and is this disease curable ? Prizes. Luther V. Bell, Derry, N. H. on No. 1. Usher Parsons, Providence, on No. 2. Added to the Committee; Enoch Hale, vice John Dix- well, deceased. 1836. Questions. 1. How far are the external means of ex- ploring the condition of the internal organs, to be considered useful and important in medical practice? 2. To what extent is an active medical practice useful in the common continued Fever of this country ? Prizes. Oliver Wendell Holmes, Boston, No. 1. Two others were presented on the same subject, of such high merit that one of the Committee, Dr. George C. Shat- tuck, now President'of the Massachusetts Medical Society, with his characteristic liberality, furnished the same sum, which was awarded by a vote of the Committee to each of their authors, whose names were found to be Robert W. Haxall, of Richmond, Virginia, and Luther V. Bell, of Derry, N. H.; and the three Dissertations were pub- lished in one volume, under the auspices of the Massa- chusetts Medical Society. 1837. Questions. 1. To what extent, and in what places, has Intermittent Fever been indigenous in New England ? 2. What is the nature of Neuralgia, and what is the best mode of treating it? Prizes. Oliver Wendell Holmes, Boston, No. 1. " No. 2. PREFACE. xvii 1838. Questions. 1. What are the anatomical characters of Typhus Fever, and what is the best mode of treating this disease ? 2. What are the causes, seat, and proper treat- ment of Erysipelatous Inflammation ? Prizes. Edward Warren, Boston, No. 2. From the foregoing account it appears that the questions, are proposed by the Boylston Committee two years before the time of adjudication. Thus, in 1834 there were four questions announced, the two first of which were announ- ced the year previous for adjudication in 1835, and the other two were intended for adjudication in 1836, and so of succeeding years. The four questions are announced in August, and the dissertations on the two first are presented on or before the first Wednesday of April following. From this time till the August following they are in the hands of the Committee, who examine them individually, and at their annual meeting in August, each gives his decision in writing before making it known to others, and the one most meritorious in the estimation of the Committee, even if at variance in doctrines with their private opinions, secures for its author the prize of $50, or a gold medal suitably inscribed, of that value, or, if the author prefer it, a piece of plate with an inscription. The names of suc- cessful writers are wholly unknown till after the premium has been awarded to their manuscripts, and the names of unsuccessful competitors are never known, unless they choose; as the packets inclosing them, are all burnt without breaking their seals, and their dissertations are re- turned them if demanded at any time within a year. The successful dissertation is at the disposal of the Committee, c xvm PREFACE. and the author of it is informed by the Secretary of his success and the manner of receiving his premium. The liberal policy adopted in inviting competition for the prizes from the profession at large, deserves special notice, as contrasting well with the selfish course pursued in some States, where the field of competition is restricted to the medical men within the State. The Boylston pre- miums of Harvard University are obtained sometimes on the branches of the Mississippi, and at others in distant cities of the sea-board. The present Boylston Prize Committee, appointed by the President and Fellows of Harvard University, consists of the following Physicians, viz. John C. Warren, M. D. George Hayward, M. D. Rufus Wyman, M. D. John Randall, M. D. George C. Shattuck, M. D. Enoch Hale, M. D. Jacob Bigelow, M. D. John Ware, M. D. Walter Channing, M. D. Some ten or twelve years since, Mr. Boylston established another prize fund in connexion with a society of young gentlemen belonging to the classes of the Boston Medical School, the object of which, was to improve them in the art of writing upon medical subjects. Beneficial results have been annually produced by this Institution. Such early exercises serve to discipline and strengthen the young pinions of candidates for fame, and to prepare them for soaring to loftier heights in after years, when their minds are enriched by study, and matured by reflection. Some of their essays would do credit to any graduates in medicine. The late Dr. James Jackson, Jr., presented a successful one on Pneumonia, before he had completed PREFACE. XIX his second year of medical studies, and which was a fit presage of the brilliant though brief professional career of this extraordinary and lamented gentleman. Whoever has made the attempt will avow that the careful observation, wide research, and cautious induction necessary to prepare an essay for adjudication, give to the mind a most whole- some discipline that will be felt through life. In conclusion, it is but common justice to say, that when munificent individuals give such strong incitements to exertion in the promotion of sciences that tend to meliorate the thousand sufferings that flesh is heir to, and to elevate and adorn the character of man, they deserve to be enrolled among the foremost of public benefactors, and to have their name and fame embalmed in the hearts of every philanthropist. Such men were, Zabdiel and Nicholas and Ward Nicholas Boylston. Ik CONTENTS. Preface. ....... 5 DISSERTATION I. On Inflammation of the Periosteum, both acute and chronic. Premium awarded 1827. .... 17 DISSERTATION II. On the disease called an Irritable state of the Urinary Blad- der; its causes and treatment. Premium awarded 1828. 67 DISSERTATION III. On the connexion between Cutaneous Diseases which are not contagious, and the Internal Organs. Premium awarded 1830. ...... 11? DISSERTATION IV. On the diagnostic marks of Cancer of the Breast; and whether it be curable. Premium awarded 1835. . 149 DISSERTATION V. On the comparative influence of Malaria, as a cause of Fever. Written 1830.......107 INFLAMMATION OF THE PERIOSTEUM. DISSERTATION. ON INFLAMMATION OF THE PERIOSTEUM, BOTH ACUTE AND CHRONIC. The remote situation of the periosteum, and the silence of most elementary writers respecting its dis- eases, lead the student of medicine to think it an unin- teresting subject for investigation, and one of the most sterile kind that could be proposed for a dissertation. A due consideration, however, of the functions and properties of this membrane; of its connexions and relations with the bones, which are often diseased and wounded ; of the reciprocal influence which the dis- eases of both textures have upon each other; and, lastly, the fact well known to practitioners, that both these textures frequently participate in secondary ve- nereal affections;—these considerations, I say, present the subject in an interesting point of view, and as one that, from the very circumstance of its being so casu- ally and briefly noticed by authors, is the more deserv- ing of particular investigation. In commencing this task, our attention is first drawn to the structure and nature of the periosteum. It is a 3 18 ON INFLAMMATION fibrous membrane, which, as its name imports, is ap- plied to the surface of the bones. It covers all the bones of the body, even the tfssicula of the ear. Some are covered by two membranes, as the flat bones of the head, where the dura mater partakes of the nature of periosteum. It pervades the whole surface of all the bones, their apophyses, eminences and cavities, with the exception of the articulating surfaces and crowns of the teeth. The ancients described it as extending from one bone to another over the articula- tions, and thus forming a continuous sac for the whole skeleton; and, indeed, so intermixed are its fibres with those of the capsular ligaments, that there seems to be some foundation for this opinion. It sustains direct connexions with the greater part of the fibrous sys- tem, and is considered by Bichat as the centre of this system. It furnishes points of support to the broad fascias that surround the muscles, and receives the tendons which are more or less expanded at their insertion. It is imperceptibly lost in the ligaments, and blended, in the different parts of the body, with sheaths and fibrous capsules. A large number of pro- longations establish intimate connexions between the periosteum and dura mater, both through foramina and through the sutures. The periosteum has not the shining whiteness of the dura mater, but is of a white greyish color through- out its whole extent. Its adhesion to the bone is greatly strengthened by age, to enable it to endure the greater pulling and wrenching, by muscular action, to which it is subjected. Of its two surfaces, one is contiguous and adherent to the bone, the other is OF THE PERIOSTEUM. 19 united to the surrounding parts by a cellular tissue. The bond of union between the periosteum and bone, is, by blood vessels passing from one to the other, and by very delicate fibrous sheaths transmitted from the periosteum as an envelope to the blood vessels. These prolongations are numerous in those parts of the bones where the cellular tissue prevails, as in the vertebrae and heads of the cylindrical bones. The periosteum furnishes also a sheath, which accompanies the nu- tritient artery of the long bones, and which is probably prolonged with a diminution of its thickness, throughout its ramifications. On the outside, the periosteum re- ceives the tendons, ligaments, and aponeuroses, and is separated from the muscles by cellular substance. The periosteum is composed, as before observed, of very compact unyielding fibres, arranged generally in the direction of the bone which it covers. "Ex- aminations of thickened periosteum in cases of ele- phantiasis prove," says Bichat, "that these fibres placed upon each other are of different lengths, the superficial ones being longest, and those contiguous to the bone running but a" short distance." The blood of the periosteum is derived from the surrounding parts. Its vessels may be seen in the minute injection of young subjects. They hold such an intimate relation to those of the bone, that they will be better understood, if we describe the vessels of both textures together. They consist then of three kinds; one, derived from the periosteum, being a con- tinuation of those vessels sent to the membrane from the contiguous parts, and which are distributed to the compact texture of the bones ; another set of vessels 20 ON INFLAMMATION is sent to "the heads of the cylindrical bones that have cells; a third kind, which is transmitted to the marrow of the long bones, through a foramen near the middle of their shaft." " The first two kinds going to the substance of the bone, appear to be especially destined," says Bichat, " to deposite the phosphate of lime." The third passes through the foramen above- mentioned by a single vessel to the marrow, where it divides into two branches, which proceed in opposite directions towards the ends of the bones, where they ramify ad infinitum " in the medullary organ, and their last branches are lost in the commencing cellular struc- ture of the heads of the bones;" or there meet and anastomose with the vessels that are sent to the cells. By this communication of the two sets of vessels, they mutually assist in performing each other's office. Bichat found, in a case where the nutritient artery going to the marrow, had been obstructed and oblit- erated at its entrance into the foramen; that its two great branches within the medullary cavity were, not- withstanding, completely filled with injection, which must have past to them from the anastomosing branches of the cells. Although lymphatics are not discoverable in the periosteum, no doubt can be entertained of their ex- istence. The same may be said of their nerves, their existence being proved by pathological observations. In respect to the properties of the periosteum, it is admitted to possess animal sensibility, but peculiarly modified. Those stimulants that put this property in action in other textures, as mechanical, chemical, &,c. cannot develop it here, unless it is in an inflamed state. OF THE PERIOSTEUM. 21 " Separated, in fact, by its deep position from every external excitement which can act upon it chemically or mechanically, it has no need like the cutaneous system, for example, of a sensibility which would trans- mit the impression of such agents." " The vital^ activity is much greater in the perios- teum, than in the bones or cartilages;" this is proved by the greater rapidity of its cicatrization. In laying bare fractures made for the purpose in animals, it has constantly been observed, that the fleshy granulations coming from the periosteum and medullary organ, are all formed, whilst those furnished by the bone itself have hardly commenced. Still, however, " there is a remarkable slowness in the vital activity of this sys- tem." We see it in mortified limbs, where gangrene, like the inflammation that precedes it, makes rapid progress in the cellular texture, muscles, &,c, while the periosteum still remains sound. "The periosteum, as well as other parts of the fibrous system, is remarkable in its not contributing to the formation of pus," the matter which sometimes collects from inflammation being a gummy exudation. Like all the fibrous system, the periosteum has very little extensibility; yet it is not altogether void of this property. It yields when tumors form on the bone, or when matter is effused under it, and is enlarged in rickets. It possesses a cellular substance, which sometimes becomes swollen and distended, and con- ceals the fibre which is the base of the periosteum. Respecting the functions of the periosteum, it de- fends the bones which it covers from impressions of the movable parts that surround it, and probably also 22 ON INFLAMMATION moulds the surface of the bones, since this becomes changed and deprived of its smoothness, whenever the membrane is separated from it and prevented from again reuniting, as will appear in experiments hereafter to be mentioned. Besides giving shape and protec- tion to the bones, this membrane sustains the circula- tion in the exterior part of them, and gives passage to the nutritient arteries going to the medullary organ of cylindrical bones, and to the diploe of such as are tabular. PATHOLOGICAL EXPERIMENTS AND OBSERVATIONS. It was formerly believed, that the periosteum, when raised from the bone, could not reunite and resume its functions, and that necrosis, more or less extensive, would necessarily ensue. Tenon first proved that the opinion was erroneous, and the same is confirmed by the experiments of many physiologists, among the most recent of whom are the celebrated anatomists, Beclard of Paris, and Cruveilhier of Montpelier. Their numerous and ingenious experiments prove, that the periosteum supplies the outer surface of the bone with osseous matter, yet when cleaved from the bone, it may be readily reunited without the intervention of exfoliation or necrosis, even where the bone itself has been wounded, provided the subject be young and healthy. To remove all doubt in respect to the power of the periosteum to reunite to the bone, and resume its functions after having been separated, Mr. Cruveilhier detached it from the tibia, in a great number of hares, OF THE PERIOSTEUM. 23 to two thirds at least of the circumference and extent of the bone. After ten, twenty, thirty, and sixty days, he found the periosteum reunited, and scarcely any perceptible difference between the surface of the bone and that of the opposite side, excepting a slight increase in thickness. A hare, upon which he sepa- rated the periosteum from the whole circumference of the bone, died in consequence of the injury two months after. The exterior wound was cicatrized, but the denuded bone was surrounded two thirds of its circumference with a copious deposition of matter of a caseous appearance. The anterior face of the bone was covered by a thick bed of new formation which shot forth irregular sprouts, two of which were more than an inch long, stretching backward like wings. These experiments prove, that the periosteum furnishes the external layers of bone. That it secretes and deposites osseous matter on its internal face, when detached from the bone, is proved by the following experiments:—Upon a very young hare, Mr. Cruveil- hier separated the periosteum the whole length and circumference of the bone, and interposed slips or lamina of brass between it and the membrane. On killing the animal one month after, the tibia presented considerable diminution of volume at the place of the brass rings; a slight effort served to break the bone at this place; a cartilaginous and osseous bed was form- ed over the brass, and the periosteum was reunited throughout the rest of the length of the bone. Upon another hare, Mr. Cruveilhier passed between the tibia and periosteum a layer of sheet lead, half an inch broad, fastening it to the bone by waxed threads: and 24 ON INFLAMMATION two months after, an osseous swelling of considerable magnitude was formed around the foreign body. "Every time," says Mr. Cruveilhier, "that I have seen the periosteum in contact with pus, I have never known ossification to take place; and surgeons have long since observed, that pus or blood interposed would effectually prevent a reunion of detached peri- osteum, so as to prevent exfoliation." How is this phenomenon to be explained? I think it may be done by considering the nature of the process of ossification. Thus, when the periosteum is separated from a dead bone, it retains its attachment to the heads or articulating ends of the bone. These swell and soften, and continue to retain between them the sequestrum or mortified bone. The periosteum thus detached, swells and secretes from its internal face a small quantity of reddened fluid, at first very thin, like moisture bedewing the membrane. Its quantity and consistence gradually increase till that which was a limpid fluid becomes a jelly, which thickens daily and passes into a state of cartilage. In this, osseous fibres are deposited, and finally the fluid and cartilaginous substance disappear, leaving the new bone perfectly formed. Now, while pus or blood are lodged between the bone and detached periosteum, the very thin fluid secreted from the latter to form cartilage and bone mixes with the blood or pus, instead of congealing and ossifying, as it does where, in place of such fluids, flakes of bone or metallic substances are interposed. The foregoing experiments establish satisfactorily the nature of the office of the periosteum in the cure of superficial necrosis. No one can conclude other- OF THE PERIOSTEUM. 25 wise than that the new bone is the product of this membrane. Dupuytren has, however, ascertained that where a small portion of the periosteum is excised from the bone, and the integuments are carefully brought in contact with the denuded part, that even muscle will adhere to the bone and fulfil the office of the periosteum in furnishing osseous matter. Still, however, the opinion of Wiedman holds good in the main, viz. that in order for good bone to form, the periosteum and medullary membrane concerned in the nutrition of the original bone must have been spared from destruction; for, in cases where the tube of a cylindrical bone has suffered necrosis through- out, the bone is never after reproduced, if the peri- osteum has also by inflammation, or other causes been destroyed. The periosteum limits its work of furnishing osseous matter of cylindrical bones to their surface, at the same time it gives passage to the nutritient artery going to the medullary organ, and numerous vessels to the cells of the bones. The first mentioned set of vessels going to the surface of the bone can, however, build up its whole shaft, provided the dead bone in the centre be extracted; and from these same vessels, probably aided by the vessels in the heads of the bones, there will ultimately be formed a new medullary organ. When, however, the outside of the cylindrical bone is necrosised, and the supervening inflammation is prevented from extending to the medullary organ to destroy it, this organ by means of the blood sent to it through the nutritient artery, will secrete new bone, and supply it to the internal layers or central portion 4 26 ON INFLAMMATION of the bone; or, even should this artery be destroyed with the external layer of bone, the branches within may derive blood from the cells, as the case mention- ed by Bichat of obstructed nutritient artery proves, and the central portion may, in this way, receive a supply of nutriment from this source and be preserved. So that, while one pathologist shall present a cylindri- cal bone inclosing a dead one, in proof that the periosteum is the organ of ossification in necrosis, another may produce a living bone inclosed within a dead one, to prove that the medullary membrane is the organ of ossification. Various opinions have been entertained in respect to the share of labor performed by the periosteum in consolidating fractures. M. Beclard has bestowed such attention on this subject, that the point in question seems now to be well settled. He has observed that " when a bone has met with a simple fracture, it may easily be perceived many days after, that the surround- ing integuments are swollen ; this first phenomenon," he says, " is already accompanied with some degree of strength in the part fractured." After some days the tumefaction diminishes, and is concentrated almost immediately around the place of fracture; still later, the tumor which surrounds the bone becomes hard, solid, and, finally, after more than three months, the tumor has nearly subsided, leaving the bone firmly united. If the fracture be examined during the re- solution of the tumor of the soft parts, when it hardens and applies itself immediately upon the bone, there will be clearly seen a kind of belt or ferrule of * bone formed by the ossified periosteum; the thickness OF THE PERIOSTEUM. 27 and consistence of which goes on diminishing towards the point of the fracture, to within an inch above and below it. At this time, the surfaces of the fractured ends have scarcely undergone any change, but soon they become softened, and the softened texture fills up all the intervening space. Eighty or one hundred days after the fracture of a tibia or femur, the per- iosteum has recovered its organization, the medullary canal has formed itself, and the cicatrix of the bone is completed. Thus, after these researches, it is evident that when callus forms, the periosteum swells in the place of the fracture, becoming in some degree a cellular and vascular net-work, and is afterwards transformed into a bony hoop or belt, which preserves the two fragments in contact during the progress of ossification ; and, finally, when the cicatrix of the bone is completed, the periosteum recovers its original texture and natural organization. Mr. Cruveilhier, whose authority was before quoted, repeated the ex- periments of Beclard, and obtained the same results. Mr. Bell, in his usually positive manner, asserts, that " callus may be produced equally well from any part of the osseous system ; from its periosteum, from its medulla, or from the substance of the bone itself;" and in proof of it, states, that " in fractures of the patella or kneepan, where there are no medullary vessels, the pieces are united by a callus, which is secreted from the vessels of the bone itself." Before acceding to this doctrine, it may be well to examine the bone and ascertain if, as he states, it can of itself repair fractures without the aid of the covering and lining membranes. The instance he cites is not so 28 ON INFLAMMATION well adapted to his theory, as some others; for the patella, though destitute of medullary vessels, has a periosteum, and is plentifully supplied with blood from it. A case more in point is, where the head of the os femoris within the capsular ligament, which is destitute of both a medullary and of a periosteal membrane, is fractured transversely; and are such fractures often consolidated ? Sir Astley Cooper thinks they never are. It is true a union took place in this part after a longitudinal fracture, made by Sir Astley, on the thigh bone of a hare, where the socket acted as a compress and support, and preserved them in exact apposition, so that the divided vessels in the bone may have had their communication reestablished. But here, simply a bony union or adhesion was all that took place, a process very different from that of forming callus, in the manner and to the extent that is done by the membranes of the bone. Sir Astley, in his attempt to prove that apposition is necessary to effect the formation of callus to any extent, relates cases which show, that ossification by the bone alone, is very limited, if it take place at all. Where the tibia alone had been fractured, and the ends sawed off, were prevented from coming in contact by the fibula, a consolidation never took place. "Again," he says, " I sawed out one seven-eighth of an inch from the radius of a rabit, and the ends of the bones never united to each other, but only to the ulna. In another rabit I took out one-ninth of an inch, with the same result. The failure of ossification, in this case, was evidently attributable to the destruction of both OF THE PERIOSTEUM. 29 membranes by the operation. Had these remained entire, as in simple fracture, or had the medullary membrane only been broken, as when the fractured ends are thrust by each other, or are separated from each other more than half an inch, callus, even then, might have formed, and filled up the intervening space. " Desirous of observing the comparative agency of the periosteum, and the bone, in the formation of fractures, I fractured the radius and ulna of a hare, and with the aid of counter-extension, separated and con- fined asunder the fragments one-third of an inch. Callus formed and filled up the intervening space, and the limb was that measure longer than its fellow of the opposite side. Again, I fractured the radius of another rabbit, then dissected down carefully to the bone and raised the periosteum for quarter of an inch each way from the fracture, then applied a thin plate of silver round the ends half an inch wide, which served to keep the bones in exact apposition. I then healed the integuments by the first intention, keeping splints on the limb, in addition to the support it received from the belt and from the unbroken ulna. After fifty days I found the outside of the silver belt covered with cartilaginous and osseous matter, the broken ends were diminished in size and some change was induced at their junction, but no progress made towards con- solidation. Again, I fractured transversely the radius of a hare, and interposed between the fractured ends a thin layer of silver, the diameter of which was equal to that of the bone, so as to project no further than the surface of the bone, the periosteum being cut 30 ON INFLAMMATION through on one side only to receive the plate. The integuments were closed over and dressed, and after ninety days the bone was found united by a belt of callus surrounding the fracture, and which must have been furnished by the periosteum alone. These ex- periments fully established my opinion, that the mem- branes of the bones, particularly the periosteum, are the chief organs that form callus; and that the bone itself is not, as Mr. Bell boldly asserts, equally con- cerned and active in the consolidation of fractures, as the membranes." * * Mr. Bransby Cooper, of London, has recently undertaken a series of experiments, to determine with accuracy the phenomena which occur in the reparation of fractured bones. This is the most recent attempt of the kind, and is therefore worthy of notice. The conclu- sions which he draws from his inquiries are nearly as follow:— " The first effect of the fracture is extravasation of blood between the cancelli, and into the surrounding parts; by this, when the blood coagulates, the limb is stiffened, and farther bleeding prevented. v There is little farther change for the first twenty-four hours. On the third day the limb is rendered still more rigid by the effusion of lymph, the product of inflammation, between the bones, and amongst the surrounding muscles. From this period the effusion, which is at first gelatinous, gradually thickens, forming a distinct tumor around the fracture, limiting motion, and preventing the muscles being irritated by irregular ends of the bone. Mr. Key is of opinion that this coagu- lum becomes organized, and assists in the reparation. " About the sixth day, the effused matter has the appearance, firm- ness, and elasticity of cartilage, and by its contraction tends to bring the hitherto separated ends of the bones, even though overlapping, parallel and in contact with each other. At the broken part, the peri- osteum is absorbed; but elsewhere it is thickened and more loosely connected with the bone than with the textures around. The denuded part of the bone becomes softened and more vascular. The first deposit of bony matter takes place on the surface of the old bone ; " and from this Mr. Cooper infers, that the osseous system alone is in such cases the source of the bony deposit. He supposes that " the surrounding textures so far assist in the reparation of a fractured bone OF THE PERIOSTEUM. 31 The view here taken of the structure, properties, and functions of the periosteum, as also of its con- nexions with neighboring parts, particularly with the bones, prepares the way for a clearer and more satis- as to induce approximation, limit motion, and diminish the irritability and contraction of the muscle; whilst the osseous system itself deposits the earthy matter essential to hardness, the grand characteristic of bone." Mr. Cooper finds an argument in favor of this view in the fact that bones little organized, such as the cranium or neck of the femur, are badly able to work out their own reparation. "The only two points of novelty," says the Reviewer of Mr. C, " which Mr. Cooper's experiments would appear to suggest, are,__the power of the callus to replace the deranged bones, and the secrelion of the new osseous matter by the vessels of the original bone, exclu- sively."—•£.