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THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES
No. XXVII.— May, 1834. 1
COLLABORATORS.
M
Jacob Bigelow, M. D. Professor of Materia Medica in Harvard Univer- sity, Boston. Edward H. Baktout, M. D. of New
Orleans. PIe^trt Bkonsoi?-, M. D. of Albany , New
York. Walter Channikg, M. D. Professor of Midwifery and Legal Medicine in Harvard University, Boston. N. CnAPMA]!f, M, D. Professor of the Institutes and Practice of Physic and Clinical Practice in the University of Pennsylvania. JoHjf Redman Coxe, M. D. Professor of Materia Medica and Pharmacy in the University of Pennsylvania. D. FRA]<rcis Condie, M. D. of Phila- delphia. William C. DA:NriELL, M. D. of Savan- nah, Georgia. William P. Dewees, M. D. Adjunct Professor of Midwifery in the Univer- sity of Pennsylvania. S. Hekrt Dickson, M. D. Professor of the Institutes and Practice of Medicine in the Medical College of the state of South Carolina. Benjamin W. Dudley, M. D. Profes- sor of Anatomy and Surgery in Tran- sylvania University. Gouverneur Emerson, M. D. of Phila- delphia. Paul F. Eye, M. D. Professor of Sur- gery in the Georgia Medical College. John W. Francis, M. D. Late Profes- sor of Obstetrics and Forensic Medi- cine in Rutgers Medical College, New York. W. W. Gerhard, M. D. of Philadelphia. WiEEiAM Gibson, M. D, Professor of Surgery in the University of Pennsyl- vania. R. E. GmTmTn^M.I). of Philadelphia. E. Hale, M. D. of Boston. Robert Hare, M. D. Professor of Che- mistry in the University of Pennsyl- vania. George Hay ward, M. D. Junior Sur- geon to the Massachusetts General Hos- pital. Thomas Henderson, M. D. Professor
of the Theory and Practice of Medi- cine in the Columbian College, Dis- trict of Columbia.
William E. Horner, M. D. Professor of Anatomy in the University of Pennsylvania.
Dayid Hosack, M. D. Late Professor of the Institutes and Practice of Medi- cine in Rutgers Medical College, New York,
Ansel W. Ives, M. D. of New York.
Samuel Jackson, M. D. Assistant to the Professor of the Institutes and Practice of Medicine and Clinical Practice in the University of Pennsylvania.
Samuel Jackson, M. D. of Northum- berland, Pennsylvania.
Valentine Mott, M. D. Professor of Pathological and Operative Surgery in the College of Physicians and Sur- geons, New York,
James Moultrie, Jr. M. D. Professor of Physiology in the Medical College of the state of South Carolina.
Reuben D. Mussey, M. D. Professor of Anatomy and Surgery in Dart- mouth College, New Hampshire,
T. D. Mutter, M. D. of Philadelphia.
R. M. Patterson, M. D. Professor of Natural Philosophy in the University of Virginia.
Philip Syng Physick, M. D. Profes- sor of Anatomy in the University of Pennsylvania.
Thomas Sewall, M. D. Professor of Anatomy and Physiology in the Co- lumbian College, District of Colum- bia.
AsHBEL Smith, M. D. of Salisbury, North Carolina.
A. F. Vache, M. D. of New York.
John Ware, M. D. Assistant Professor of the Theory and Practice of Physic in Harvard University, Boston.
John C. Warren, M. D. Professor of Anatomy and Surgery in Harvard University, Boston.
J. Webster, M. D. Lecturer on Ana- tomy and Surgery, New York. Thomas H. Wright, M. D. Physician to the Baltimore Aims-House Injir' mary.
editor—Isaac Hays, M. d.
THE
AMERICAN JOURNAL
MEDICAL SCIENCES
VOL. XIV.
PHILADELPHIA: CAREY, liEA & BliASrCHARD.
1834.
c^iViHSOfv^-,,
TO READERS ^ND CORRESPONDENTS.
Communications have been received from Drs. Chapman, Jackson, Parrish, Daltopt, Monett, Miller, Dickson^ Finlet, and Perrine.
The following- works have been received:-—
Transactions of the Medical and Physical Society of Calcutta, Vol. VI. Cal- cutta, 1833. (From the society.)
The Value of a Great Medical Reputation, with Suggestions for its Attain- ment; a Lecture, Introductory to the Summer Course of the Medical Institute. By John K. Mitchell, M. D., Lecturer on Medical Chemistry in the Philadel- phia Medical Institute. Philadelphia, 1834. (From the author.)
Catalogue of the Trustees, Faculty and Students of the Medical Department of the University of Maryland. Baltimore, 1834. (From Professor Geddings.)
An Exposition of the Affairs of the Medical Society of South Carolina, so far as they Appertain to the Establishment of a Medical College in Charleston, and the Subsequent Division of the Latter into two Schools of Medicine. Pub- lished by order of the Medical Society. Charleston, 1833. (From the Secretary of the Society.)
An Address, Introductory to a Course of Lectures, Delivered in the Hall of the Medical Society of South Carolina, before the Trustees and Faculty, the Students of Medicine, and the Public generally, at the Opening of the Session of 1833-4. By John R. Rhilanber, M. D. Professor of Anatomy. Charleston, 1834. (From the author.)
Tables Exhibiting the Doses and Properties Ascribed to the Principal Me- dicines and Officinal Preparations. For the Use of, the Medical Class of the University of Maryland. By Professor Dtjnglison. (From the author.)
An Address, Delivered to the Graduates in Medicine, at the Commencement of the University of Maryland, on Wednesday, March 19th, 1834. By Professor DxjNGLisoN. Published by the Graduates and Students. Baltimore, 1834. (From the author.)
The Medico-Chirurgical Review, for January, 1834. (In exchange.)
The London Medical Gazette, for December, 1833, January and February, 1834. (In exchange.)
The Edinburgh Medical and Surgical Journal, for January, 1833. (In ex- change.)
The London Medical and Surgical Journal, for November and December, 1833. (In exchange.)
The Transylvania Journal of Medicine and the Associate Sciences, from Oc- tober to December, 1833. (In exchange.)
1*
VI TO READERS AND CORRESPONDENTS.
The Medical Magazine, for January, February, and March, 1834. (In ex- change.)
The Boston Medical and Surgical Journal. (In exchange.)
The Western Journal of the Medical and Physical Sciences, January, 1834. (In exchange.) The Western Medical Gazette, Nos. 19, 20, 1834. (In exchange.)
Memorial Encyclopedique et Progressif des Connaissances Huraaines, Stc. January to September, 1833. (In exchange.)
For the gratification of our contributors we present references to the works, recently received, in which their communications are noticed.
Professor Mott will find his case of Excision of Tuberculous Sarcoma from the Neck, noticed in the Gazette Medicale de Parisj Sept. /"th, 1833, and his case of Aneurism of the Arteria Innominata, in the Glasgow Medical Journal, for May, 1831.
Professor Wahkex's case of Non-existence of Vagina Is copied in the Boston Medical and Surgical Journal, for November 20th, 1833; and his case of Exci- sion of Osteo-Sarcomatous Clavicle in the Western Medical and Physical Jour- nal, for January, 1834.
Professor HoajfER's Experiment on the Vascular Connexion of Mother and Foetus is noticed in the Cincinnatti Medical Gazette, for Sept. 1st, 1833; and his case of Ligature of primitive Carotid in the Archives Generales, April, 1833.
Dr. Jackson's cases of Croup are noticed in the Glasgow Medical Journal, for January, 1833.
Dr. S. Jackson's Observations on the Use of Cold Water in Scarlatina Ma- ligna are noticed in the Boston Medical and Surgical Journal, for October 16th, 1833, the Western Journal of the Medical and Physical Sciences, for October, 1833, the liOndon Medical and Surgical Journal, for August, 1833, and in the Gazette Medicale de Paris, September- 7th, 1833; his paper on the Use of Rhu- barb in Haemorrhoids is noticed in the Glasgow Medical Journal, for January, 1833.
Dr. Hodge's Memoir on Puerperal Fever is noticed in the Western Journal of the Medical and Physical Sciences, for October, 1833.
Dr. J. K. Mitchell's cases of Rheumatism are noticed in the Western Jour- nal of the Medical and Physical Sciences, for October, 1833; and his case of Spasm cured by Ligature in the Archives Generales, April, 1833.
Dr. Pekrine's observations on the Use of Large Doses of Quinine are noticed in the Transylvania Journal of Medicine, for July, 1833.
Dr. Fahnestock's case of Partial Congestion of Cerebrum is copied in the Transylvania Journal of Medicine, for July, 1833, and in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Wright's observations on Hospital Gangrene are noticed in the Medical Magazine, for August, 1833; and his Illustrations of Cardiac Pathology in the
TO READERS AND CORRESPONDENTS. VII
London Medical and Surgical Journal, for August, 1833, and in the Gazette Medicale de Paris, for September, 1833.
Dr. C. A. Lee's observations on Cold Dash in Nervous and Convulsive Dis- eases are noticed in the Cincinnatti Medical Gazette, Vol. I. No. 17, and in the Western Journal of the Medical and Physical Sciences, for October, 1833.
Dr. W. M. Lee's case of Splenitis is noticed in the Cincinnatti Medical Ga- zette, Vol. I. No. 17.
Dr. Griscom's account of the Apocynum Canabinum is noticed in the London Medical Gazette, for November, 1833, and in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Mettaueh's case of Parturient Laceration of Recto-vaginal Septum is copied in the Boston Medical and Surgical Journal, for November 20th, 1833.
Dr. Robis"sok's case of Monstrosity is noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Williams' case of Stricture of Vagina is noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Heustis' case of Prolapsus of Rectum is noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Ward's case of Vagltus Uterinus is noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. ZoLLicKorFEB's remarks on the Euphorbia Corollata are noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Youkg's remarks on the Use of Cimicifuga Racemosa in Chorea are no- ticed in Broussais' Annals, for December, 1833; in the Glasgow Medical Journal, for January, 1833; in the Western Journal of Medical and Physical Sciences, for January, 1834; and his case Illustrative of the Use of the Cold Affusion for the recovery of persons struck with lightning is noticed in the Western Journal of Medical and Physical Sciences, for January, 1834.
Dr. Atlee's remarks on the Use of Prussic Acid in Hooping-Cough are no- ticed in the Gazette Medicale de Paris, for January 31st, 1833.
Dr. Wells' case of Tracheotomy for the Removal of a Foreign Body is no- ticed in the Glasgow Medical Journal for January, 1833.
Dr. Baldwin's case of Tetanus treated with success is noticed in the Gazette Medicale de Paris, for September 7th, 1833.
Dr. Pohcher's case of Retained Placenta is noticed in the Transactions Me- dlcales, for April, 1833, and in the Gazette Medicale de Paris, for July 13th, 1833.
Dr. Picton's observations on the Utility of Excluding the Light, to prevent Pitting from Small-pox, are noticed in the Gazette Medicale de Paris, for February 5th, 1833. '
Dr. Vale:'s cases of Traumatic Tetanus are noticed in the Boston Medical and Surgical Journal, for January, 1833.
Vlll TO READERS AND CORRESPONDENTS.
Dr. Younge's remarks on the Utility of Calomel in Pruritis, are noticed in the Boston Medical and Surgical Journal, for December 25th, 1833.
Dr. Joslin's observations on Vision are copied in the Archives Gen^rales, for February, 1833, and noticed in the Ann. de la Med. Phys. for March, 1833.
Dr. Parrish's paper on Spinal Irritation is noticed in the Archives Generales, for March, 1833, in the Review Medicale, for June, 1833, in the Transactions Medicale, for April, 1833, and in Anp. de la Med. Phys. for April, 1833.
Dr. Hall's case of Extirpation of Testicle is noticed in Archives Generales, for March, 1833.
Dr. AifDERsoN's case of Amputation of Lower Jaw is noticed in Archives Generales, for April, 1833.
Dr. Le Beau's case of Precocious Puberty is noticed in the Revue Medicale, for June, 1833.
Dr. Mo?fETT's observations on the Sulphate of Quinine, are noticed in the Western Journal of Medical and Physical Sciences, for January, 1834.
Dr. Labriskie's case of Amnesia is noticed in the Boston Medical and Surgical Journal, for March 12th, 1834, and his case of Pityriasis rubra in the same journal.
Authors of new medical books, desirous of having them reviewed or noticed in this Journal at the earliest opportunity, are invited to transmit to the Editor a copy as soon after publication as convenient, when they will receive prompt attention. Under ordinary circumstances, very considerable delay is caused by the circuitous routes through which they are received.
Papers intended for publication, should be sent, /ree of expense, as early after the appearance of the Journal as possible, in order to be in time for the ensuing number. Such communications should be addressed to *' Caret, Lea & Blan- CHARB, Philadelphia, for the Editor of the American Journal of the Medical Sciences."
All letters on the business of the Journal to be addressed exclusively to the publishers.
CONTENTS.
ORIGINAL COMMUNICATIONS.
ESSAYS.
Art. Page.
I. Observations of the Remedial ElTects of the Balsam of Copaiba in Ca- tarrh and Irritability of the Bladder, and in Leucorrhoea? with Cases. By
R. La Roche, M. D. of Philadelphia 13
II. Cases of the Epidemic Yellow Fever prevalent at New Orleans in the Summer and Fall of 1833. By E. B. Harris, M. D. [Communicated to Dr. Samuel Jackson, of Philadelphia] 41
III. Cases of Gastritis Superinduced. By Thomas J. Charlton, M. D. of Georgia 74
IV. Thoughts on the Bilious Remittent, commonly called Congestive Fever. By Theodore Bland Dudley, of Alexandria, Louisiana - 76
V. An Account of a New Instrument for Operating in Cases of Fistula in Ano. By Thomas D. Mutter, M. D. one of the Physicians to the Phila- delphia Dispensary, Sec. --------- 80
VI. A Case of Hepatic Abscess, in which Tapping was Performed before Adhesion of the Liver to the Side had occurred; and the Appearances after death. By W. E. Horner, M. D. Professor of Anatomy in the Uni- versity of Pennsylvania 87
VII. Case in which Sand was voided by the Mouth, Rectum, Urethra, Nose, Ear, Side, and Umbilicus, and attended by various other Anoma- lous Symptoms. By C. Ticknor, M. D. of New York . . - 91
VIII. Case of Purpura Hsemorrhagica. By Samuel Jackson, M. D. Assist- ant to the Professor of the institutes and Practice of Medicine in the University of Pennsylvania -------- 95
IX. Cerebral Affections of Children. By W. W. Gerhard, M. D. (Second Part) - . . 99
X. Description of a New CEsophagus Forceps. By Constantine Weever,
M. D. of Detroit - 111
XL On the Efficacy of a Mixture of Camphor and Muriate of Ammonia in the Treatment of Suppression of Urine. By Alexander Somervail, M. D. ofLoretto, Essex County, Virginia 113
XII. Cases of Neuralgia, with Remarks. By W. A. Gillespie^ M. D. of Louisa, Virginia - - J15
REVIEWS.
XIII. Experiments and Observations on the Gastric Juice, and the Phy- siology of Digestion. By William Beaumont, M. D. Surgeon in the United States' Army. Plattsburgh, 1833. 8vo. pp. 280 - - - 117
XIV. On the Influence of Physical Agents on Life. By W. F. Edwards,
X CONTENTS.
Art. Page.
M. D., F. R. S., Member of the Royal Academy of Sciences, and Royal Academy of Medicine of Paris, of the Philomathic Society of the same city, and of the Medical Society of Dublin, &,c. Translated from the French, by Dr. Hodgkin and Dr. Fisher. To which are added, in the Appendix, Some Observations on Electricity, by Dr. Edwards, M. Pouillet, and Luke Howard, F. R. S.5 On Absorption, and the Uses of the Spleen, by Dr. Hodgkin; on the Microscopic Characters of the Ani- mal Tissues and Fluids, by J. J. Lister, F. R. S. and Dr. Hodgkin; and Some Notes to the work of Dr. Edwards. London, 1832. 8vo. pp. 488 150
BIBLIOGRAPHICAL NOTICES.
XV. A New Exposition of the Functions of the Nerves. By James William Earle. Parti. Longman, Rees, & Co. 1833 188
XVI. Nouvel Apercu sur la Physiologie du Foie et les Usages de la Bile. De la Digestion Consideree en General. Par Benjamin Voisin, D. M. P. Paris, 1833. pp. 146.
New Observations upon the Physiology of the Liver and the Uses of the Bile, and upon the General Subject of Digestion. By Benjamin Voisin, M. D - 201
XVII. Dictionary of Practical Medicine, &c. By James Copland, M. D. Parts I., II. 8vo. London, 1833-4 209
XVIII. Essai sur le Madar, (CalotropisMadariilndico-orientalis,) contenant FHistoire Naturelle de cette Plante, ses proprietes Physiques, Chimiques et Medicinales. Par J. N. Cassanova, C. M. D. &c. &c. Calcutta, 1833.
pp. 69. 8vo. -.-..--►-.- 213
QUARTERLY PERISCOPE
FOREIGN INTELLIGENCE.
ASTATOMT.
Page. 1. Case of Malformation — Absence of Anus — Recto-Vaginal Canal. By M. Ricord - - - 215
Page.
2. On some points of the Anatomy
of the Eye - - - 216
3. Anomaly in the Venous System.
By M. Pexgot - - - 218
Phtsioiogt.
Tubercles Developed in the Origins of tlie Tliird, Fifth, Se- venth, and Eighth Nerves — loss of Hearing, Sight, and Smell — Preservation of the Sense of Taste, and of the Sensibihty of the Integuments of the Face. By M. Nelaton - - - 219
5. Functions ofthe Lingual Nerves.
By MM. Choisy and Montault 219
6. Instance of Superfoetation - 220
7. Life and Respiration continued after the total Destruction ofthe Brain. By Dr. Beyer - - ib.
CONTENTS.
XI
Pathology.
Page.
8. Case of Anoerala of the Kidney.
By James Wynn, Esq. - 220
9. Case of Hypertrophy of the Muscular Coat of the Stomach.
By Dr. Otto - - - 221
10. Observations on Epidemic Gas- tric Fever, as it appeared in Li- merick Garrison during the Months of May, June, and July, 1833. By Richard Poole, Esq. 222
11. Case of Paraplegia dependent on Chronic Inflammation of the Spinal Cord. By Dr. Craigie - 227
12. Case of Myehtic Paraplegia depending upon Disease of the Bodies of the Vertebrae. By Dr. Craigie - - - - 229
13. Case of Periostitis with Ozrena.
By David Craigie, M. D. - 230
14. Case of Meningeal Apoplexy.
By M. Alegre - - - 232
Page.
15. Case of Apoplexy of the Spi- nal Marrow. By M. Monod 232
16. Case of Meloena with the Dis- section. By David Craigie, M. D. ih,
17. On the Pendulous Tumour of the External Ear. By Dr. A. Campbell - - - 234
18. Swelled Leg resembling Phleg- masia Dolens, and Obliteration of the Iliac Vein. By J. C. Bos- well, Esq, .... ib.
19. Case of Engorgement of the Occipital and Vertebral Liga- ments— Palsy and Atrophy of the Left Half of the Tongue.
By M. Dupuytren - - 235
20. Remarks on Local Diseases — Pathology of the Diseases of the Digestive System. By William Stokes, M. D. - - - 237
Materia Medica.
21. Formulae for Preparations of Hydriodate of Iron. By M. Pier- quin
22. Ointment for the Cure of Por- rigo. By M. Biett
23. M. Aubergier's Pomatum for Preventing the Hairs from Fall- ing Out . - , -
240
ib.
24. Improved Method of Adminis- tering Epsom Salt. By Dr. James Henry .... 240
25. On a Preparation of Opium.
By J. C. Boswel!, Esq. - 242
26. Opium used at the General Hospital, Calcutta. By W. Twin- ing, Esq. ... - ib.
Practice of Medicine.
27. Sulphate of Quinine and To- bacco taken as Snuff in the Treatment of Intermittent Head- aches. By Dr. D'Huc - 243
28. On the Employment of Chlo- rine in Pulmonary Affections.
By Dr. Bourgeois ~ - ib.
29. Iodine in Mercurial Salivation.
By Dr. Kluge ... ib.
30. Treatment of Chronic Bron- chitis. By Dr. Craigie - 244
31. Remarks upon the Nature of Neuralgias, and their Treat- ment. By M. Piorry - - 245
32. Efficacy of Madar, (the pow- dered Bark of the Root of the Asclepias gigantea,) in Exten- sive and Obstinate Ulcers in Na- tive Patients. By J. L. Geddes, Esq. ----- 249
SURGERT.
33. Extirpation of a Necrosed Cla- vicle, followed by complete Re- production of the Bone. By Dr. Meyer . . - .
34. Reduction of a Double Luxa- tion of the Inferior Maxillary Bone, thirty.five days after the
250
occurrence of the Accident, ef- fected by a New Method of Treatment. By Dr. Stromeyer 15. Operation for Strangulated In- guinal Hernia, performed on an Infant eight days old. By Dr. Heyfelder . - - -
252
253
xu
C0NTEN1^S»
Page.
36. Lig-ature of the Subclavian Ar- tery below the Clavicle. By Professor Blasius - - 253
37. On Sanguineous Tumours of the Cranium - - . 254
38. Case of Compound Fracture of the Thigh, in which Amputa-
Page. tlon was performed. By R. N. Burnard ... - 255 39. Stricture of the Rectum treat- ed by the Introduction of a Tent, by a New Process. By M. Tan- chou ----- ib.
MlDWIEERT.
40. Malposition of the Spinal Co- lumn rendering Delivery impos- sible— Csesarean section — death.
By M. Bello - - - 258
41. New Method for the Division of the Pelvis in Cases of Diffi- cult Parturition. By M. Galbiati 259
By Dr.
42. Cesarean Operation, Tasse . . - -
43. The Advantages of Turning the Foetus by the Head rather than by the Feet
44. Luxation of the Pubis during Delivery. By Dr. Rieke
261
ib.
262
Chemistry.
45. New Method of Preparing Me- dicinal Prussic Acid. By Richard Laming, Esq. . _ - 263
46. Test for Hydrocyanic Acid,
and Method of appreciating the Quantity. By Mr. John T. Barry 264 47. On Cusparia from Angustura Bark. By M. Saladin - - 266
AMERICAN INTELLIGENCE.
Case of Adhesion of the Placenta to the Fundus of the Uterus, successfully treated by Ergot. By Edward Worrell, M. D. As- sistant Surgeon U. S. Army. [Communicated in a letter to the Elditor]
On the Climate of Florida. By H. Pemne, M. D. -
Sequel of Dr. Hulse's Case of Un- united Fracture of the Os Hu- meri, treated by the Injection of a Stimulating Fluid into the Wound - - -
Remarkable Location of Parturient Pains. By Chandler Bobbins, M. D. ....
Notes of a Case of Fistulous open- ing of the Stomach, successfully treated. By Dr. J. H. Cook
267
270
ib.
271
Observations on the Pathology of Fever. By John P. Harrison, M. D. - - - - 271
Professor Dunglison's Address de- livered to the Graduates of Me- dicine at the Commencement, March 19th, 1834 - - 272
The Value of a great Medical Re- putation, with Suggestions for its Attainment; a Lecture, Intro- ductory to the Summer Course of the Medical Institute. By J. K. Mitchell, M. D. Lecturer on Chemistry - - - - ib.
University of Pennsylvania - ib.
Medical Department of the Uni- versity of Maryland - - ib.
Advertisements - - - 273
THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES.
Art. I. Observations of the Remedial Effects of the Balsam of Co- paiba in Catarrh and Irritability of the Bladder, and in Leucor- rhceaf with Cases. By R. La Roche, M. D. of Philadelphia.
vyHRONIC catarrh of the bladder is generally, as every practi- tioner must be aware of, a dangerous and often a highly painful dis- ease. In many cases it is of a secondary nature, arising from organic degeneration of the various coats of the bladder, from the presence of foreign bodies in the cavity of that viscus, or from diseases of the annexed organs; while in other instances, the cause of the formation of the fluid discharged is to be sought for in a chronic irritation of the mucous follicles or of the substance of the internal lining of the bladder^ — the sequel of acute inflammation, the effect of a translation of irritation from some other organ, or the result of the suppression of a gonorroehal discharge. It is evident that in the former class of cases, — those in which the disease is secondary or symptomatic, little benefit can be expected from the employment of means directed against the chronic irritation — the immediate cause of the increased secretion; inasmuch as before this morbid state can be corrected, the remote cause, the original disease, must, if possible, have been removed. If such means are occasionally found advantageous, they act only as palliatives. In those instances, however, in which the catarrhal symp- toms arise from a simple and primary chronic secretory irritation of the lining membrane of the bladder, and in which the disease assimi- lates to catarrhal inflammations of other organs, the case is very dif- ferent, and the object of the practitioner should be to select such re- medies as are calculated to remove the morbid state in question. No. XXVII.— May, 1834. 2
14 La Roche on Copaiba in Catarrh of the Bladder^ 8fC.
To present a monograph of catarrh of the bladder — to ofif'er an account of the symptoms, causes, nature, and treatment of that disease, might doubtless prove interesting and useful to some of the readers, and is a task which, though not devoid of difficulty, I should gladly undertake. But as it would occupy more time and space than can be conveniently spared on the present occasion 5 and as, in fact, it is rendered to a certain extent unnecessary by a reference for valuable information on those subjects, to works of easy access, I shall abstain from entering into details upon them, and leave the task to other hands, or postpone it to another and more proper occasion. The object of the present communication, will be to lay before the reader some facts in relation to the effects of the bal- sam of copaiba in the treatment of the disease above-mentioned, and to show that, if properly administered, and if the cases are carefully selected, this remedy will be found highly efficacious, as a curative means, in a large proportion of cases of the primary form of the com- plaint, and may be prescribed, as a useful palliative, when the symp- toms arise from a secondary derangement of the affected membrane. In presenting the results of my experience on this subject, it is very far from my intention to lay any claim to novelty of practice 5 for I am fully aware that the balsam of copaiba has long been employed and re- commended in this disease, and that it is frequently mentioned in va- rious publications we possess on the diseases of the urinary organs and on the materia medica, as well as in many periodical works of the last and of the present centuries. Cartheuser* remarks that the copaiba is useful in ulceration of the bladder; a condition of tis- sue which, at the time he wrote, was almost universally thought to exist whenever there occurred a discharge of mucous or purulent matter from any part of the body. HoffmanI speaks in high terms of its effects in the same complaint. At a much later pe- riod. Dr. StroemJ related a remarkable case of the disease which he treated successfully by means of the same remedy. The copaiba was likewise used with complete success by Dr. Bretonneau, of Tours, in a case of chronic inflammation of the lining coat of the bladder, brought on by the discharge into that organ of the contents of an ab- scess situated in the neighbourhood. § Mr. Cumin, in the article Cys-
* Materia Medica.
t Obs. Phy. Chim. p. 24.
% Rapport sur les Travaux de la Societe Medlcale de Suede. BIbliotheque de Therapeutique, 1. p. 412. Diction, de Mat. Med. 2. art. Copahu.
§ Velpeau — Memoire sur I'Emploi du Baume de Copahu en Lavement. Arch. Generales de Med. 13, p. 44. Bibliotheque de Therap. 1. p. 389.
La Roche on Copaiba in Catarrh of the Bladder, ^-c, 15
litis, contained in the London Cyclopedia of Practical Medicine,* remarks that in cases of the disease occurring; in enfeebled consti- tutions or scrofulous habits, the balsam of copaiba is used with greater advantage than astringents or the other stimulants of the urinary or- gans. RiBEst employed it with success in cases of the disease resulting from suppressed gonorrhcEa. Barrier, of Amiens,:{: and Lalle- MAND, of Montpellier,§ speak of it as of a useful remedy in catarrh of the bladder. Chrestien,!| the author of a remarkable work on the la- traleptic method, prescribed it in combination with turpentine, in small and repeated doses; and, finally, the late Professor Delpech, of Mont- pellier,^ remarks that he has succeeded in the most satisfactory manner in curing, by means of the copaiba, the gonorrhoeal inflammation of the bladder, evea when the disease was of long standing and had already assumed a very formidable character. This distinguished writer re- lates several cases of the kind, and makes the following remarks, which show the value he attached to this remedy in the treatment of the dis- ease in question. " Even did we think it proper to renounce the use of these two remedies, (the bals. copaiba and cubebs,) in order to combat by ordinary means simple gonorrhoea — a practice which we are very far from regarding as justifiable, we should not the less per- severe in the use of them in so serious a complaint, (catarrh of the bladder,) and thereby prevent the incurable infirmity which is the least of the evils to be apprehended from it."
The circumstance of the copaiba being spoken of by many physi- cians of high repute, as a useful and even efficacious remedy in the disease which forms the topic of these remarks, may perhaps be regarded by some as sufficient to render further details on the subject unnecessary. Nevertheless, when it is borne in mind that by a very experienced practitioner. Dr. Ferrus,** and several other writers, the remedy is represented as far inferior to turpentine in that complaint; that by many physicians who have published their views relative to the treatment of the latter, no mention at all is made of copaiba; and that it is often neglected in Europe and this country by those who can have no reasons to fear or doubt its effects, the reader
* Volume 1, p. 505.
t Bulletin de la Society Med. d'Emulation, Sept. 1822, p. 349. Biblioth. de Therap. 1, p. 359, &c.
^ Mat. Med. 2, p. 120. § Maladies des Voles Urinaires,
II L'HulHier — These sur le Catarrh de la Vessie, Montpellier, 1826, p. 22.
1 Clinique Chirurgicale de Montpellier, 4to. vol. l,p. 271. Revue Medicale^ 403. Biblioth. de Therapeutique, 1, 370.
** Diet, de Med. vol. 6, p. 331.
16 La Roche on Copaiba in Catarrh of the Bladder, 8rc.
will at once perceive the propriety of adding such facts to those already before the public, as appear likely to corroborate what has been said by preceding and contemporary writers on the subject of its remedial virtues.
Of the several cases of catarrhal irritation of the bladder in which I have myself resorted to the copaiba, or seen it used by others, I shall only offer the details of three, which appear to be sufficiently interesting to deserve a notice, and well calculated to demonstrate the efficacy of that remedy.
Case I. — A French gentleman, about sixty years of age, long a resident of this city, was seized in the year 1822, without any assigna- ble cause, with acute inflammation of the bladder. By means of an- tiphlogistic and emollient remedies, which were prescribed by the at- tending physician, the late Dr. Monges, the most violent and inflam- matory symptoms were in a few days subdued, and in a short time the patient was sufficiently relieved to leave his bed and even his room. Nevertheless, the disease was rather mitigated than effectu- ally cured. The irritation assumed the chronic form, and was at- tended with a copious secretion of mucoso-purulent matter, frequent desire to make water, some difficulty in passing it, and pain at the neck of the bladder. As, however, the patient suffered much less than he had done at the commencement of the attack, and as he had recovered some strength and appetite, he fancied that his com- plaint was of very slight importance, and completely devoid of dan- ger, and that it should therefore be left to the powers of nature. In conformity with these notions, after making use, during a short time, of appropriate remedies, he positively refused to adhere to any plan of regimen, or to follow any method of treatment. Of the impropriety of this course, however, he soon had a distressing proof, for before a week had elapsed, the pain, difficulty of making water, fre- quent desire of voiding that fluid, and the other symptoms became considerably aggravated I in short, the patient experienced a complete relapse. By a timely application of the means above enumerated, and which were now prescribed by Dr. Monges and myself, the in- flammatory symptoms were once more subdued, and the irritation again assumed the chronic suppurative form. An examination was now made, which enabled us to ascertain that the prostate gland was slightly enlarged, but that the urethra was free from obstruction.
The aggravation of the disease, resulting evidently from a total neglect of the remedial and hygienic means recommended, together with the pain he experienced, and the large quantity of mucoso-pu- lent matter voided with the urine, alarmed the patient, and serv-
La Roche on Copaiba in Catarrh of the Bladder, ^"C. 17
ed to open his eyes to the necessity of having recourse seriously to professional advice, and of submitting to an appropriate treatment. Antiphlogistics, proportioned to the strength of the pulse and to the state of the system, were employed with a view to dimi- nish, or if possible, to subdue entirely the remnant of inflam- matory action existing in the diseased membrane, and to prepare the latter for the operation of what have been denominated the stimulants of the urinary organs; and further, for the purpose of removing a gastro-intestinal derangement under which the pa- tient now laboured. These objects being at length attained, and se- veral remedies having been tried ineffectually to arrest the secretory irritation of the bladder, the balsam of copaiba was prescribed in mo- derate doses. Aided by a few others, which were from time to time employed in order to remove the symptoms of irritation supervening in the digestive and other organs, and subsequently by moderate ex- ercise and mild bitters, this remedy succeeded to the fullest extent of our wishes. Under its use the pain gradually diminished, and, together with the difficulty and frequent desire to void the urine, finally disappeared entirely. The secretion of mucoso-purulent matter be- came less and less copious, and at length ceased completely; the matter discharged assumed gradually a lighter colour and thinner con- sistence; and the patient after submitting to treatment during several months — the use of the copaiba being in the course of that period dis- continued and resumed several times, to avoid its irritating effects — had the satisfaction of finding himself completely relieved of the painful and dangerous disease I have described.
After enjoying good health during about eight years, this gentle- man experienced another attack of the same complaint, under which he finally sank. But in respect to the nature of the attack, to the real condition of the coats of the bladder, or of the prostate gland, and to the remedies employed, I know nothing, as the case came under the care of another physician, from whom I have not been able to obtain any information.
Case II. — The next case I shall mention is that of a gentleman, aged about sixty-five years, and who, after residing during a consi- derable portion of his life in Philadelphia, removed to the state of Ohio. On my way to the south, in 1825, I made a short stay in the place of his residence, and soon after my arrival was requested to visit him. I was informed that he had suffered to a greater or less ex- tent from disease of the bladder during more than two years. He was much emaciated, and was stretched on a settee, from which he could with difficulty move, on account of debility. The pain in the blad-
2*
18 La Roche on Copaiba in Catarrh of the Bladder, fyc.
der was very severe, and much aggravated by vv^alking. The desire to void water was frequent, and the discharge was attended with some difficulty. Together with the urine, the patient voided a large quantity of mucoso-purulent matter. The digestive functions were impaired, the appetite was much diminished, the bowels were con- stipated, the skin was dry and warm, and the pulse accelerated.
I was at the same time informed by the patient that much dift'er- ence of opinion had existed among the physicians, who, at various periods, had attended him, in relation to the nature of his disease, and to the treatment required for its cure. That some had attributed his sufferings to a disease of the prostate gland, and had treated him ac- cordingly; that by others the symptoms were all referred to the ex- istence of strictures in the urethra, which were endeavoured to be removed by bougies, caustic, &c.; that besides external and me- chanical means, a variety of internal remedies had been resorted to, and that among these the balsam of copaiba had been tried. But none of these methods of treatment or remedies seemed to have been serviceable; for the patient declared that so far from having improved during the time, his complaint had increased and con- tinued to do so every day.
At the period of my visit he was no longer under the care of a phy- sician, and had discontinued the use of internal remedies; limiting himself to the occasional introduction of a catheter to facilitate the discharge of urine, and to the frequent use of the tepid bath to sooth the irritation and pain of the bladder. My first impression was that the disease depended chiefly upon an obstruction at the neck of the bladder, arising from strictures or from an enlargement of the prostate gland. This view of the pathology of the case I was led to adopt, not only from a survey of the symptoms, but from being in- formed that the patient had, at an early period of life, experienced several attacks of gonorrhoea, — the usual excitant of the above-mention- ed complaints, and that, about ten years before, he was seized, while at sea, with inflammation of the neck of the bladder, attended with pain, fever, retention of urine, &c. In order to ascertain the fact in a more positive manner, I passed a bougie, and next a catheter, along the urethra, but did not experience as much difficulty in penetrating into the bladder as had been anticipated. By a different examina- tion, the prostate was found a little larger than in the natural state, though not sufficiently so to produce an obstruction in the passage; nor did it appear to be otherwise diseased. To this it may be added, that the difficulty experienced in making water and the pain attending this operation, were generally greatly relieved on the passage of a portion
La Roche on Copaiba in Catarrh of the Bladder, Src, 19
of the tenacious matter above-mentioned, which seemed to act as a plug at the neck of the bladder, and to occasion the greater part of the diffi- culty. These results very naturally led me to doubt the correctness of the views already stated, and to conclude that the affections of the urethra and prostate gland, though sufficiently marked to deserve at- tention, were not of a character to account for the symptoms, and that the principal complaint was seated in the bladder itself.
The treatment recommended was based on the above-mentioned view of the seat and nature of the case. It consisted chiefly of those means which appeared calculated to remove the chronic inflammation of the bladder, to diminish the secretion of the mucoso-purulent mat- ter, and restore the digestive organs to their healthy condition. Leeches were accordingly directed to be several times applied to the perinseum and hypogastric region, and, in the event of their not be- ing procured, cupping to the sacrum was recommended as a substi- tute- The tepid bath was ordered once or twice a day; emollient injec- tions and drinks; the occasional use of castor oil, or of any other mild purgative, to obviate the eSects of constipated bowels; opiates, to pro- cure sleep, and light nourishment, were likewise enjoined. Finally, directions were left with the patient to commence the use of the bal- sam of copaiba in small and repeated doses, in a mild bitter, as soon as the irritation of the bladder should be somewhat reduced by the above-mentioned means, and the state of the gastro-intestinal organs would permit.
The next day I left the place for the south, and on my return, six weeks after, was informed by a friend who visited me on board of the steamer, that the gentleman whose disease has just been describ- ed was probably better, inasmuch as he was now able to walk about the town. On reaching this city I sought further information from the patient's friends and learned that he had repeatedly stated in his letters, that the remedy prescribed by me had had the desired etfect— that he was comparatively well, and experienced little or no inconvenience from his painful disease.
This gentleman suffered some time after a severe relapse, and had recourse to the same means, and with an equally happy result. After enjoying a tolerable share of health during two or three years, he again became a sufferer from disease of the bladder; the obstruction in the urethra increased gradually and at length became almost un- conquerable, except by mechanical means; the pain became more and more severe; the discharge of mucus from the bladder in- creased, was attended with pain, and effected with considerable diffi- culty. In this condition he removed to Philadelphia, and in the spring
20 La Roche on Copaiba in Catarrh of the Bladder^ ^c.
of 1829, once more placed himself under my care. The usual re- medies for complaints of that kind were resorted to under the di- rection of two of the ablest surgeons of the city and myself; but were not productive of the least amelioration. The patient wasted away, and after suffering unexampled agony during several months, sank into the grave. On examination after death, an ill-conditioned ulcer of the bladder, (in the centre of which was found a small cal- culus,) was discovered. The prostrate gland was slightly enlarged.
Case III. — In June, 1831, I was requested to visit Mr. R. of this city, aged about fifty years. He informed me that he had for some time past suffered considerably from pain in the bladder, par- ticularly when he endeavoured to retain his urine; that the desire to void that fluid was very frequent, and that it usually contained a large quantity of thick whitish matter, which was discharged in flakes— -principally after the urine itself had been passed, and settled at the bottom of the recipient. The disease had come on gradually, and was at first attended with so little pain and inconvenience that it hardly attracted the attention of the patient, and caused no uneasi- ness. From this circumstance it was allowed to run on a considera- ble while before recourse was had to professional advice. Mr. R. had laboured under a gonorrhoeal attack, which subsided a week or two prior to the accession of tlie symptoms above-mentioned. At the period of my visit, the symptoms had become rapidly aggravated, and the patient was so much indisposed as to be obliged to keep his bed. He complained, independently of the aflection of the bladder, of gastro- intestinal derangement, loss of appetite, thirst, slight nausea, consti- pated bowels, furred tongue, and pain in the head; and had, besides, a hot skin and a febrile pulse.
Having ascertained by means of a catheter, and by the introduction of the finger up the rectum, that there existed neither stricture in the urethra nor enlargement of the prostate, it appeared that the in- dication was simply to remove the irritation of the mucous coat of the bladder, and to correct the morbid state of the gastric organs, on both of which diseases the febrile excitement probably depended. Leeches were freely applied to the perineum and above the pubes — emollient injections into the bowels and bladder were ordered, and the patient was subjected to the routine of remedies, drinks, &c. usually prescibed under circumstances of the kind. But al- though adhered to with scrupulous care, this plan of treatment was not as rapidly beneficial as had been anticipated, and some time elapsed before decided relief was obtained. As soon as the symp- toms of acute irritation of the bladder had given way, and the mor-
La Roche on Copaiba in Catarrh of the Bladder, S^c. 21
bid condition of the gastro-intestinal organs and the excited state of the arterial system had been amended, astringents, tonics and chalybeates, were successively resorted to, with a view to put a stop to the in- creased and deranged secretion of the bladder. But none of these remedies, or the terebinthi nates, were of much avail. Indeed, un- der the use of some of them, the inflammatory symptoms seemed dis- posed to return, and it was found necessary not only to discontinue the use of them, but to have recourse occasionally, to emollient and even to moderate antiphlogistic means.
The balsam of copaiba was the next remedy tried; but it at first disagreed with the stomach; laudanum was added, and various ve- hicles, (among which weak claret and water were found to answer best,) were tried. At length, however, the medicine was made to sit well on the stomach, and although administered in small doses, and discontinued occasionally for a day or two at a time, in order to guard against gastric irritation, it produced in about two weeks the most decided benefit. The irritation of the bladder decreased in a gradual but steady manner — the desire to make water became less frequent, the discharge of mucus diminished and after a while ceased entirely; and the patient was at length completely relieved of the distressing and painful symptoms under which he had so long laboured.
It is deserving of mention in this place, that during the course of the treatment, the gonorrhoeal discharge made its appearance, and continued some days, without, however, occasioning any relief to the affection of the bladder. It is now nearly three years since this cure was effected, and the patient has continued free from all un- easiness about the urinary organs, and in the enjoyment of perfect health.
It must appear evident to all who peruse these pages, that the balsam of copaiba was signally useful in the above cases, and constituted, in fact, the principal means of bringing about the favourable results I have recorded. Cystitis being always, though more particularly when it assumes the chronic form, and attacks persons of advanced age, a protracted and dangerous disease, it is hardly possible to deny, that the individuals who were the subjects of those cases, were fortunate in being so speedily — I speak comparatively— relieved. If this be admitted, we must allow, also, that the remedy which acted so conspicuous a part in their cure, is entitled to more commendation than is now usually bestowed upon it, and should be regarded as a highly useful article in the treatment of the disease in question. In all the above cases.
22 La Roche on Copaiba in Catarrh of the Bladder, 8rc.
the benefit obtained from the copaiba was, as must have been per- ceived, not long in manifesting itself j for the first patient was ena- bled very soon after commencing the use of that remedy to walk out for exercise; the second had so far recovered in the space of five weeks as to be able to leave his room, to which he had long been confined, and to walk about the town; while in the third case, relief was obtained in a much shorter time than in either of the preceding. It is not impossible that bj some it may be objected, that those individuals might have been cured without the aid of the co- paiba; and that there is no proof of the cure being attributable to that remedy rather than to the other means employed. In reply, it may be remarked, that no doubt can be entertained of many cures of chro- nic catarrh of the bladder being effected without the aid of the copaiba. To maintain the contrary would be equivalent to representing that remedy as the only one capable of being of service in that com- plaint, which would be not only inaccurate, but absurd. It is more- over highly possible — I will not say certain — that in the very cases in question, success might have been obtained without it. But neither of these circumstances appear calculated to detract from the praise bestowed upon the copaiba, since we have yet to discover the article of the materia medica so indispensably requisite for the treat- ment of any disease as not to be dispensed with, with perfect safety and with a fair chance of success, in many cases. Nor is it less true, that when we succeed with one remedy in the treatment of a disease, it is not always easy to prove in a conclusive manner that it is enti- tled to the honours of the cure. Nevertheless, although there may sometimes exist room for cavil and disputation on that subject, we are enabled, by comparing the effects of a remedy in a variety of cases of the same complaint, with those of other articles, and by observing the modifications which take place in the symptoms after their exhibition, to arrive at a tolerably accurate conclusion respect- ing the degree of the agency of each in occasioning those modifications. Hence, when an individual who has laboured during some time under a disease, makes use of a particular remedy, and when shortly after commencing it, the symptoms begin to yield and gradually disappear, we may safely conclude, particularly if similar results have been noticed after the exhibition of the remedy in other cases of the same complaint, that the benefit obtained is due to that remedy. The correctness of this conclusion is rendered still more apparent if the disease belongs to that class, which, when left to the recuperative powers of the system, are seldom if ever cured, and if it has been ineffectually combated by other means
La Roche on Copaiba in Catarrh of the Bladder, Sec 23
prior to the employment of the successful one. Now it need hardly be remarked, that this is precisely what took place in regard to the copaiba in the cases above described^ for the catarrh of the bladder is seldom if ever cured without the aid of art; in each instance the patient had suffered considerably before the remedy was employed^ and in all, the relief obtained follow^ed very closely its exhibition. With these facts before us it would be scarcely reasonable to enter- tain any doubt respecting the beneficial agency of the copaiba in the cases detailed. As the other means employed, at the same time or shortly before, consisted, except in one case, of antiphlogistics and emollients, which, so far as my information extends, have never alone cured a case of suppurative or secretory irritation of the blad- der, it is not presumable that any other effect can be attributed to them than that of having moderated the irritation of the organs pri- marily and secondarily affected, and prevented it from transcending the degree compatible with the advantageous administration of the copaiba.
Some difference of opinion prevails among practitioners in respect to the quantity in which the balsam of copaiba should be administer- ed to insure it success in the disease which forms the subject of these remarks. Messrs. Delpech, Ribes, and others, prescribe it in very large, while other physicians prefer using it in small and re- peated doses. So far as I am able to pronounce from the facts I have had occasion to observe, I am disposed to think that the copaiba answers as beneficial a purpose in the catarrh of the bladder, when administered in the latter, as in the former dose; and that when thus given, either in cold water, in milk, or mucilage, or in a slightly aro- matic infusion, according to the condition of the diseased parts or of the system at large, there is much less risk of distressing and ir- ritating the gastro-intestinal organs. Another advantage accru- ing from that method is, that the physician is thereby enabled to perse- vere in the use of the copaiba during a much longer period than when he administers it in drachm and table-spoonful doses; as in the latter case it is more apt to pass off by the bowels — it is less effectu- ally absorbed — the system becomes less certainly, as it were, im- pregnated with it, and less time is afforded for obtaining the desired effect on the diseased membrane.
It is, I hope, almost a work of supererogation to remark, that in advocating the use of the copaiba in chronic cystitis, it is far from my wish to recommend it as an infallible remedy. So far from this, I am ready to admit that cases occur in which, although the state of the gastro-intestinal canal, — the degree of irritation in the
24 La Roche on Copaiba in Catarrh of the Bladder, 8,*c,
bladder, and the condition of the arterial system may seem to in- dicate the probability of success, this remedy fails completely. In other instances the advantages resulting from its use are of a very restricted nature^ and in a third set of cases, the symptoms of irritation are aggravated soon after the remedy begins to pass off with the urine, although it would have been natural to antici- pate a very different result. But these cases, particularly the last, will, I feel confident, prove of rarer occurrence than is imagined. Even were they more frequent than we know them to be, it would be impossible to argue from that circumstance the impropriety of resorting to the copaiba, because the proofs of its efficacy in many cases are placed beyond the reach of doubt; and on trial it will be found that its failures are not more numerous than those of other remedies which are in daily use in the hands of many physi- cians. Indeed it is impossible to point out any article of the materia medica which succeeds invariably, and is not apt to fail or sometimes to act injuriously under particular circumstances. If therefore, we abandon the use of the copaiba on the strength of its sometimes fail- ing, or of its producing undue irritation, there is no reason why we should continue to employ other articles just as uncertain as it in their effects. Impressed with the correctness of this circumstance, and relying on what I have had occasion to observe myself, as well as on the favourable testimony borne as regards its effects in the vari- ous publications cited above, I feel no hesitation in affirming, that whatever may be its want of success in some cases, the copaiba deserves a trial in the disease before us; that in a few weeks, sometimes in a shorter period, — -provided the cases be well selected, the symptoms of acute inflammation properly subdued, and the stomach be free from irritation, the pain in the bladder will begin to subside, the flow of urine will become freer, and the de- sire to void it less frequent, and the quantity of matter will de- crease in a very sensible manner. In some instances the copaiba, after producing a marked amelioration of the most urgent symptoms, loses its effect. It often becomes necessary under such circum- stances to discontinue it entirely and to resort to other remedies; but in some instances it will be sufficient to suspend its employment during a few days. Indeed from some facts which have presented themselves to my observation, I am inclined to believe that when- ever we resort to the copaiba in affections of the mucous lining of the bladder, it is more advantageous to continue it only during a limited period — from a few days to one or two weeks; and to re- sume its use after a short interval. This plan I have pursued even
La Roche on Copaiba in Catarrh of the Bladder, Src, 25
in cases in which there was no evidence of diminished virtue in the remedy; the object being to prevent the membrane from becoming habituated to its action, or unduly irritated by it, and also to guard against the inflammation or derangement of the stomach, which it is sometimes apt to occasion.
That those who resort to the copaiba in catarrhal affections of the bladder may not be precipitate in abandoning it, when it does not prove promptly effective, we may observe that cases present them- selves in which this remedy is very slow in its effects, and that in one or two instances in the practice of a friend, in which the re- medy was ultimately successful, several weeks elapsed before any decided amendment was obtained. Had it been discontinued at an early period, it might have been accused of failure; but the issue showed how erroneous such a conclusion would have been, and proved the necessity of giving the remedy a fair trial in all cases. It is not unlikely that some physicians may exclaim that a remedy which is sometimes so tardy in its operation, does not deserve the attention here bestowed upon it, and should make way for others of a more prompt efficacy. This objection, however, need not occupy our atten- tion very seriously, because the cases in which the curative effects of the copaiba are slow in being obtained will be found of comparatively rare occurrence, and because it is doubtful whether the other remedies re- commended in the same complaint would really act more expeditiously. The disease has always, and with reason too, been regarded as one of a very formidable character, and little under the controul of the most ra- tional plans of treatment and of the most approved remedies, and there is not one of these with which I am acquainted that is not occasion- ally as slow in its operation as the copaiba is found to be in some in- stances.
The above cases and remarks will, it is hoped, tend to show that the balsam of copaiba may, under particular circumstances, be ad- vantageously used in the treatment of catarrhal inflammation of the bladder; that it is not necessary to prescribe it in very large doses; that it may be useful when the diseased parts are yet in a state of well-marked irritation; and that it is not simply useful by putting a stop, by its astringent qualities, to the copious discharge of matter resulting from a relaxed state of the mucous membrane. At the same time, they show that the copaiba is not an infallible remedy; that in some cases it fails completely; that in others it is very slow in pro- ducing its remedial effects; that in a few instances it may even be in- jurious; but that if due care be taken in the selection of the proper cases, and if the diseased parts be well prepared for its administra- No. XXVII.— May, 18S4. 3
26 La Roche on Copaiba in Catarrh of the Bladder, 6,^c.
tion, and the gastric organs in a proper condition, it will seldom give rise to those effects, and will act both safely and expeditiously.
Irritability of the Bladder. — From what has been stated in the course of the preceding remarks, it may perhaps be inferred, that in the opinion of the writer, the ujje of the copaiba should be restricted to those cases of diseases of the bladder, in which the mucous mem- brane is affected with a secretory or suppurative inflammation. Such, indeed, was long the sentiment he entertained on the subject, and to which he was led by the silence of writers in relation to the effi- cacy of that remedy in cases of a different character; by a considera- tion of its known astringent and stimulant properties, and by the want of opportunities to test its virtue in other than secretory inflam- mations. Subsequent experience, has, however, taught him the propriety of changing his former views, for in a few cases present- ing evident symptoms of chronic irritation of the mucous mem- brane of the bladder, but unaccompanied by increased morbid secre- tion, he has prescribed the copaiba with the most decided success. These results prove, in a most conclusive manner, that the copaiba does not act, in affections of the mucous membranes, simply by arrest- ing a profuse secretion, the effect of an atonic state, but that it operates, in certain diseases of those parts, either by virtue of a spe- cific action, or by revulsion. But whatever be the conclusion to which we may arrive from these facts, respecting the mode of operation of the copaiba, they show that the remedy may be used in a set of cases in which, so far as my information extends, it has not often been employed. Nevertheless, while expressing these senti- ments, it is far from my intention to suggest the propriety of resort- ing to the remedy in question in all cases of chronic irritation of the bladder. My opportunities of using it in that disease have been too limited to justify so indiscriminate a recommendation; and while I am inclined to think, from the trials I have made, that the copaiba will prove serviceable in some instances, 1 can easily comprehend that it should not be used without great caution.
The following case will, it is believed, justify the praise thus be- stowed upon it.
Case. — Mr. G. aged about forty-five years, and of a nervoso-san- guine temperament, applied to me for professional advice, in the au- tumn of 1826. He informed me that he had, for a long while prior to the onset of his present malady, enjoyed excellent health, — that, without being able to assign any cause, he had in a very gradual man- ner become affected with irritability of the bladder; and that this com-
La Roche on Copaiba in Catarrh of the Bladder, fyc. 27
plaint, which proved the source of much inconvenience and considerable uneasiness to him, was characterized bj very frequent desire to make water, and by pain whenever he endeavoured to retain it. As Mr. G. was, by the duties of his profession, — that of a teacher of music, under the necessity of remaining, often during an hour or two at a time, in attendance on ladies, and could not in consequence absent himself as frequently and as promptly as might be required to satisfy the calls to make water, he was at times placed in a very embarrassing predicament, and on several occasions was unable to get off with sufficient celerity to escape an unpleasant accident. Owing to these circumstances, and to the frequency of his disturbances at night, he expressed the greatest desire to place himself at once under me- dical treatment, and regretted his having lost much time in trying a variety of remedies recommended to him by officious friends. He informed me that he had experienced, a few years before, several at- tacks of gonorrhoea, which, however, appeared to have been entirely cured. He further stated that his genital organs were easily excited, that he was much prone to certain desires, and that he was not back- ward in gratifying them. With the exception of the vesical irrita- tion above-mentioned, and which was unaccompanied by a discharge of mucus, or by a gravelly deposit in the urine, Mr. G. was free from any disease of importance. He complained only of slight gastric derangement, and on examination the temperature of the surface and the pulse were discovered not to exceed the standard of health.
It appeared evident, from a survey of the symptoms under which Mr. G. laboured, that his disease could not depend merely on the ir- ritating quality of the urine,—a cause assigned by some writers to cases of the kind, because the disease had already lasted some time, and had continued uninfluenced by any of the articles of food or drink made use of, and because the fluid was in general pale, and always limpid. Nor did it seem at all likely, from this condition of the urine, as well as from the absence of pain in the bladder after voiding it, that the complaint depended on gravel or stone. Finally, the power of retaining the fluid, though at the expense of a little suffering, in- dicated that the symptoms could not be the result of an atonic or de- bilitated state of the muscular coat, or of the sphincters of the blad- der. The only view of the case, then, that appeared to be well found- ed, was that the disease — for so the complaint under which Mr. G. laboured, and which almost amounted to incontinence of urine, de- served to be called — arose from an irritation of the lining membrane of the bladder, which irritation was aggravated by the presence of the urine, and acting secondarily on the muscular coat elicited its con^
28 La Roche on Copaiba in Catarrh of the Bladder, ^c.
traction in order to effect the expulsion of the offending cause. Under the influence of this opinion, recourse was had to such means as might prove serviceable in removing and in guarding against the occurrence of circumstances capable of keeping up the morbid state in question. The patient was advised to abstain from sexual intercourse, and from all circumstances capable of arousing the excitability of the genital organs. Remedies calculated to restore the functions of the gastro- intestinal canal to the healthy point were prescribed, and to these were added, for the purpose of removing the affection of the bladder, moderate antiphlogistic, demulcent, narcotic, and antispasmodic means, both general and local. These remedies were persevered in during a considerable time, but proved of no avail. Recourse was next had to uva ursi, to the tincture of cantharides, to nux vo- mica, to muriated tincture of iron, &c. under the impression that the disease, after all, might depend on a different cause from that which had at first been assigned. But, instead of having the desired effect, these remedies appeared to aggravate the disease, and my patience, as well as that of Mr. G. was becoming exhausted, when it occurred to me that the balsam of copaiba might perhaps be employed bene- ficially. To this I was led, not by the result of any previous per- sonal experience with this article in cases of the kind, or by having seen it recommended by other practitioners, but by the recollection of the decided benefit obtained from it in chronic secretory irri- tation of the mucous membranes generally, and by reflecting that as the remedy probably produces its ettects through means of a pecu- liar action exercised on that tissue, and not merely through its astringent properties, it might display a beneficial effect in the case before me, although the irritation was not accompanied by increased or morbid secretion. In conformity with this view, the copaiba was prescribed in doses of thirty drops, three times a day, and, to the no small satisfaction of the patient, the disease began, in a very short time, to give way. The calls to make water became gradually less frequent, the pain diminished, Mr. G. was soon enabled to retain his urine much longer than he had done for a considerable period before, and in the course of a few weeks he was completely freed from his troublesome and painful complaint. He continued the use of the co- paiba, as a precautionary measure, during several weeks longer, and left it off gradually.
Another case similar to the one just described has since fallen under my observation. The copaiba was used in the same man- ner, and proved equally, and indeed more rapidly, successful. But as the details would occupy more space than can be spared, and
La Roche on Copaiba in Catarrh of the Bladder^ ^c, 29
prove of little interest to the reader, I shall abstain from present- ing them.
Since writing these pages, mj friend. Dr. Hays, to whom I com- municated the above facts, has tried the copaiba in a case of irrita- bility of the bladder, which had resisted the usual remedies, and ob- tained from it results as satisfactory as those I have recorded.
The balsam of copaiba has been used in other diseases of the uri- nary organs. Boerhaave, (Aph. 1001,) recommends for the cure of abscess of the kidneys, after the urine becomes purulent, simple diu- retics in soft and nitrous spa waters, together with the whey of new milk, balsams^ and the like^ and Van Swieten, in commenting on this Aphorism, speaks in terms of commendation of the above prac- tice, and remarks, in relation to the balsams, under which name he includes only the natural ones, the Peruvian, the copaiba, &c. that they have their merits in such ulcerations of the kidneys, if they are given in small doses, three or four times a day, with plenty of dilu- ents drinks. Otherwise, he adds, they are over-heating, and will often cause strangury and inflammation of the urinary passages. At a much more recent period, Nysten* stated that the balsam of copaiba is occasionally found useful in cases of nephritic calculi, and we learn from Mr. BRANDEt that he has seen it of service in allaying the irritation and diminishing the secretion of red or uric sand. Mr. Hooper, in his account of the sick landed from Corunna,:]; states that he employed the copaiba with immediate relief to those patients who complained of a suppression of urine; the disease under which they laboured being the dysentery. The medicine appeared to be of ser- vice in relieving the tenesmus, "and a small quantity of urine was eva= cuated soon after the administration of the second dose." It is likely that in all those cases the copaiba was serviceable partly from its effects as a diuretic; but in those instances in which Mr. Hooper found it useful, the benefit may in some measure be ascribed to the soothing effects of the remedy on the irritated mucous membrane of the intestines, the inflammation and pain of which probably served to keep the urinary organs in a state of vital orgasm, and thereby prevent the secretion or the discharge of the urine from taking place.
In a communication read before the Philadelphia College of Phy- sicians a few years ago, and which was published in the North Ame- rican Medical and Surgical Journal, vol. 6, Dr. John Ruan, of this city, related several cases of a distressing disease, the pruritus vulvas.
* Diet, des Sciences M^d. art. Copahu. f Manual of Phajjnacy. p. 17.
* Edinburgh Medical and Surgical Journal, vol, 5, p, 400,
3*
30 La Roche on Copaiba in Catarrh of the Bladder, ^c.
In the first case many remedies were employed. Some of these pro- cured some mitigation to the patient's sufferings, but nothing like a cure was effected until the balsam of copaiba was used. This, in doses of twenty drops, three times a day, acted like a charm. In a second case, a variety of remedies were ineffectually used. The co- paiba was at length resorted to, and proved speedily successful. Dr. Ruan tried the same remedy in two other cases, but it failed. When, however, we bear in mind the distressing character of the pruritus vulvae, and its unmanageableness with the remedies ordinarily em- ployed for its cure, we cannot help being gratified at the results ob- tained by Dr. Kuan with the copaiba. Two cases out of four do not constitute a trifling proportion, and the success must necessarily en- courage us to make further trials with that remedy. I have myself had no experience with it in this disease, or in any of those mention- ed above, and have only alluded to the subject for the purpose of completing the survey of the principal affections of the urinary organs in which the copaiba has been found serviceable.
Leucorrhoea. — The introduction of the balsam of copaiba in the treatment of leucorrhoea may be traced to a very remote period in the history of that article, for on consulting the various writers who, in the preceding and present centuries, have entered more or less in detail on its medicinal virtues generally, or spoken of it in reference to its effects in particular complaints, it will be found that it is often represented as a useful remedy in that disease. Ettmuller, and some other of the older physicians, recommended terebinthinate and balsamic medicines in the treatment of leucorrhoea, and although they do not make special mention of the copaiba, we may presume that they allude to it no less than to the other remedies of the same class. We find also that so early as the year 1710, Hoppe, in a disserta- tion on the medicinal virtues of the article,* speaks of its use in that disease in a manner calculated to show that in his times it consti- tuted a favourite remedy. Lewis! enumerates leucorrhoea among the diseases in which the copaiba is principally used, and in which it is found preferable to the other balsams. Motherby± and Lieutaud§ also mention it as a valuable remedy in the same complaint. If we pass to writers of a more recent period, we shall find, that although the remark of Dr. Cullen, who for a time was considered as high
* See CuUen's Materia Medica, vol. 2, p. 134, Barton's edition, t Materia Medica, 4to. p. 132. ^ Medical Diet. p. 200.
§ Matiere Medicale, 1. 321.
La Roche on Copaiba in Catarrh of the Bladder, fyc, 31
authority in practical medicine, that it is not often prescribed with success, <' owing to the stomach not being able to bear a suffi- cient quantity of it,"* deterred many from resorting to it, yet the number of its advocates has been, since the time of that illustrious professor, nearly as great as it was formerly. It is mentioned with more or less commendation by Dejaen,! Cattet and Lacombe,J Barbier,§ Armstrong,1| Fabre,^ Larrey, of Toulouse,** GooDjtt Montegre,^: Richard,§§ Nysten,||1| Locock,^^ Merat and Delens,*** and by some of these writers it has been frequently used with the happiest results, and recommended as an invaluable me- dicine in particular stages of the disease in question.
But although the copaiba has long been used and continues to be enumerated among the most useful remedies in the treatment of leu- corrhoea, some difterence of opinion prevails in relation to the form and stage of the disease to which it is more particularly appropriate. Some practitioners, for example, have resorted to it, and seem dis- posed to advocate its employment, at an early period | even when there still exists considerable activity in the capillary circulation of the dis- eased part, as manifested by pain, heat, and the dark colour and vis- cid nature of the matter discharged. Others, on the contrary, main- tain that it should be carefully abstained from under such circum- stances, and that it is only useful or safe in recent and sim- ple cases, when there exists from the commencement an atonic state of the parts, or else in the last stages of the inflammatory form, when the increased action in the affected membrane has been completely subdued by antiphlogistics; in a word, when the com- plaint has passed to the chronic state, and the discharge is kept up by a sort of vitiated habit.
It need hardly be remarked that in this country, where the copaiba is more generally and extensively employed in the treatment of ure- thral discharges than any where else, the number of physicians who re- sort to it to combat leucorrhoea — between which and the complaints just named there has generally been supposed to exist considerable
* Materia Medica, 1. 134. f Diet, des Sciences M^dicale, 6. art. Copahu,
^ Bibliotheque Med. 35. p. 202. § Matiere Medicale, 2. p. 120.
II Practical Illustr. of the Scarlet Fever, &c. p 359.
t De la Sophistication des Subst. Medicinales, p. 18.
** Annales Cliniques de Montpellier, 26. p. 292.
ft Study of Medicine, 5. p. 71, (American edition.)
++ Traite des Hemorrhoides, p. 351. §§ Elemens d'Hist. Nat. 2. p. 507.
nil Diet, des Sciences Med. 6 . If Cyclopedia of Pract. Med. 3.
•♦* Diet, de Matiere M^d. 2. p. 418.
32 La Roche on Copaiba in Catarrh of the Bladder, fyc.
analogy, is comparatively small. Such being the case, it is not likely we shall discover many among them capable of furnishing from the result of their own experience such information as may enable us to arrive at a de- cision in respect to the points above-mentioned, and from whose writings any knowledge of a valuable character relative to the use of copaiba in leucorrhoea can be obtained. Influenced, however, by a considera- tion of the effects obtained from that remedy, not only in gonorrhoeal discharges, but in the secretory irritation of the mucous membranes generally, as well as by the opinions expressed and the facts detailed by the writers whose names are recorded above; little satisfied, be- sides, with the effects produced in some cases by the articles usually resorted to in the treatment of fluor albus, I ventured, notwith- standing the silence of our writers on the subject, to make use of the copaiba in two cases which had resisted the usual plans and the most vaunted remedies. The results were such as to en- courage me to make further trials with it myself, and to urge the propriety of doing the same on some of my medical friends. This was accordingly done, and on comparing my own notes and those fur- nished to me on the cases treated by the copaiba, and on reflecting carefully on the eff*ects obtained, I have no hesitation in recommend- ing it as a useful remedy in the treatment of leucorrhoea, and in expres- sing the opinion that it is more efficient than some others much more loudly extolled by writers in Europe and this country; that when used in suitable cases, and with proper precautions, it will be found to be a perfectly safe article; and that it possesses an advantage over cer- tain remedies, in greater vogue, of never or very seldom giving rise to strangury and other painful accidents, which render those articles so objectionable to all patients, and to unprejudiced practitioners.
In saying thus much of the efficacy of the copaiba in leucorrhoea, it is not my wish to represent it as capable of being successfully em- ployed in all cases and under all circumstances, or as being superior to all the other remedies usually prescribed in that disease. Cases have presented themselves in which it has been productive of little bene fit, or has even failed completely. To claim for it a power over all cases, and beneficial effects in every stage of the disease, would be not only to present an exaggerated estimate of its real efficacy, but also to betray an unpardonable ignorance respecting the diversity of circumstances connected with the production of leucorrhoeal dis- charges, the degree of safety attending their suppression, and the variety of morbid conditions on which they may depend; as well as respecting the known properties of the remedy, and the difference of effects produced under different, and even under analogous circum-
La Roche on Copaiba in Catarrh of the Bladder, fyc. 33
stances in the same complaint, by the same medicinal agents. Every- one knows that leucorrhoea is often a symptomatic complaint, the state of the general habit being the cause of it, the fons et origo malL In such cases, the suppression or diminution of the discharge by the copaiba or other means, may doubtless be desirable and advantageous; because independently of the fact, that it is loathsome to the patient, this discharge tends in its turn to keep up that deranged state of the constitution on which it depends. But in all such cases this suppression can only be of secondary importance; the constitutional derangement claiming, of course, the principal share of attention. In another set of cases leucorrhoea depends on, and is symptomatic of an affection of the uterus or of some other organ; and before the discharge can be removed, the disease giving rise to it must be eradicated. Here again the copaiba and other anti-leucorrhoeal remedies can only be of secondary advantage; and very many cases will occur in which it cannot be used at all, or will prove far inferior to other means. In a third series the organs w^hich receive the first impression of the copaiba are so implicated as to require our prohibiting altogether the use of the remedy; although the disease itself, might, under different circumstances have been benefited by it. In a fourth set the discharge has assumed the character of an habitual drain, which it would be dangerous to suppress, unless we establish a substitute in some other part of the body, and which, indeed, it is often found impossible to put a stop to by any of the remedies in our possession.
But after making a deduction of the cases of the above descrip- tion, in all of which, by the way, cantharides and other remedies so pompously recommended would prove just as objectionable as the copaiba, there will remain a number of others, depending on causes of a very different kind, and connected with a different condi- tion of the system at large, or of the gastro-intestinal organs in par- ticular; in a word, which are local in their character; free from com- plications contraindicating the use of active anti-leucorrhoeal reme- dies, and which it may be possible and desirable to cure. It is in such cases that the balsam of copaiba will, unless I am greatly mis- taken, prove often useful. If other means are sometimes found to succeed in cases in which the copaiba has failed, the circumstances must be attributed to a particular idiosyncrasy in the patient, to a peculiar degree and kind of irritability of the gastric mucous mem- brane, either natural or acquired, by which it is rendered incapable of bearing the contact of that remedy, or to other causes, need- less for me to enumerate. But be the cause what it may, it is not possible to discover in those failures a reason for refusing to employ
34 La Roche on Copaiba in Catarrh of the Bladder, S^'C.
the copaiba, inasmuch as on trial it will be found that the cases in which it proves inefficacious are of rare occurrence; and because, as every physician must know, a similar objection might, with equal justice, be urged against every article of the materia medica.
The nature of the action exercised by the copaiba on the living tissues, and its mode of operation in disease would seem to indicate, a priori, the necessity of deferring the employment of that remedy, in leucorrhoea, until the imflammatory symptoms — heat, pain, febrile excitement, and dark colour of the matter discharged, — had been, to a certain degree, subdued by antiphlogistics and emollients. Now, experience will, I feel confident, be found fully to justify the suppo- sition; and no one who has used the copaiba to some extent in the disease in question, and marked its effects, will refuse to join in the sentiment that the practitioner, whenever he wishes to derive benefit from it, must carefully conform to the plan suggested. On this point it is necessary to be very explicit; because there are some physicians who, while admitting the inflammatory nature of leucorrhoea, dis- regard the necessity of depletion; and who, viewing the copaiba in the light of a specific, might feel disposed to use it in all the stages of the disease. Again, on the other hand, there are not wanting works, of some authority too, in which leucorrhoea is represented as being, in every case, and under all circumstances, — whatever symp- toms present themselves, a disease of debility, depending on a re- laxed or atonic state of the parts and of the system at large, and calling from the commencement, for the use of tonics and stimu- lants, among which are properly placed the balsamics. It need hardly be remarked to those who entertain different views of the nature of the disease, as well as of the remedies required for its cure, and of their mode of operation, that the opinions alluded to are calcu- lated to lead to an erroneous and dangerous practice. They will immediately perceive the propriety of insisting on the necessity of pur- suing the course I have recommended, — of resorting to antiphlogistics in the early stages, whenever the inflammatory symptoms run high, and abstaining from copaiba until these have been greatly moderated — and thereby preventing, if possible, others from adopting the mode of practice advocated by the physicians and in the works adverted to. It is necessary to add, that, in order that the copaiba may be used with effect and safety, in leucorrhoea and other complaints of the mucous membranes, all symptoms of gastric inflammation or ir- ritation should have subsided.
But while thus dwelling on the necessity of subduing, by proper remedies, symptoms of undue irritation previously to administering
La Roche on Copaiba in Catarrh of the Bladder, <^c. 35
the copaiba, I am far from admitting the propriety of limiting its use, as Lagneau, Pinel, Bricheteau have recommended, to those cases in which there really exists an atony of the diseased organs, and to the very last stage of the complaint, when nothing seems requi- site to be done but to give tone to the parts and to arrest the dis- charge. This would be going to another extreme, which may with propriety be regarded just as unfounded as the one already no- ticed. So far, indeed, from pointing out the necessity of restricting so greatly the use of the copaiba, experience teaches that it may be usefully employed in cases in which, though the inflammation has been considerably moderated by antiphlogistics and soothing applications, the parts are not only in a state different from atony, but present pheno- mena characteristic of a notable degree of irritation. That such is the state of the diseased tissue in many cases in which the copaiba is usefully employed, we have a proof in the circumstance, that with few exceptions, other stimulants are generally not only useless but detrimental.
But enough has already been said on this subject, and after re- marking, that the fact of copaiba being useful under the circum- stances mentioned, shows that the object to be obtained is not simply to astringe and strengthen an atonic tissue, but to produce an action capable of modifying and thereby removing the morbid one on which the disease depends, I proceed to present the details of a few cases which, it is believed, will serve to confirm the views I have thus advocated.
Case I. — A married coloured women, about thirty years of age, and of a lymphatic temperament, consulted me a few years ago for well-marked leucorrhoea. The disease was of two months standing, and proved a source of great inconvenience to her on account of the profuseness of the vaginal discharge, of the sensation of heat, and of the pain she experienced in the parts, particularly during coition. The matter was thick and of a dark colour^ the skin was rather warmer and drier than in the natural state; the pulse quick and tense; and the tongue red on the edges, and furred in the centre. There was little or no appetite for food, and the bowels were constipated. On examination per vaginam, the parts were found to be tender, but the uterus exhibited no signs of disease. The patient informed me that she had menstruated at the regular period, two weeks before, but that on that occasion, as well indeed as ever since the appearance of the leucorrhoeal complaint, the quantity of blood discharged was much smaller than it was in ordinary times. It may be added, that her health was naturally delicate; that she had some years before
36 La Roche on Copaiba in Catarrh of the Bladder, 4*c.
laboured under a protracted attack of the same disease^ that she had taken a vast quantity of medicine for its cure, and finally, that her habits of life were correct and temperate.
In order to subdue the vaginal irritation and the gastro-intestinal derangement, bleeding from the arm, emollient drinks and lavements, vaginal injections of the same nature, tepid baths, low vegetable diet, and complete abstinence from sexual intercourse, were recom- mended. In less than a week the woman again called to see me. Finding now that the gastro-enteritic irritation had greatly abated, and that the other symptoms were somewhat mitigated, mild purga- tives were ordered, and the patient was advised to continue the use of the above-mentioned means — venesection excepted. At the next visit the pulse was found to have lost its tenseness; the tongue pre- sented a more natural appearance; the appetite had improved; the heat and pain in the vagina had lessened, and the matter discharged, though still abundant, had lost to a certain degree its viscidity and dark colour.
Regarding this as a suitable case for the exhibition of the copaiba, twenty-five drops of the medicine were prescribed three times a day in a wine glassful of milk. The patient was desired to continue, if possible, the use of the copaiba during two weeks without intermis- sion, and to call on me at the expiration of that time. This was faithfully complied with, and when next I saw her, she informed me that the remedy did not in the least disagree with her stomach, that since she commenced using it the leucorrhoeal discharge had greatly decreased, and that in every respect her health was much improved. The copaiba was ordered to be continued in increased doses, and in a short time the woman called on me, and reported herself perfectly restored and free from her troublesome complaint.
It may be remarked, that in this case no astringent, tonic, or sti- mulant, no anti-leucorrhoeal remedy, except the copaiba, was pre- scribed, and that the latter was resorted to, although the parts were far from being in a state of atony. From these circumstance-^, and owing to the fact, that a cure could not have been effected by the means at first prescribed — antiphiogistics and emollients, it must follow, that the entire credit should be awarded to the copaiba, and that those who would limit the use of this remedy to atonic cases, have but a very imperfect idea of its efficacy and mode of operation. The attack just described, though, as appeared from the information communicated by the patient, more formidable than the one under which she had laboured formerly, was cured much more expedi- tiously; from which we may conclude, that the copaiba is, at least
La Roche on Copaiba in Catarrh of the JBladder, S^c. 37
sometimes superior to other anti-leucorrhoeal remedies. Whether this woman has continued free from the disease since that period, I am unable to say, as I have completely lost sight of her.
Case II. — Madame B. aged about forty years, of a nervoso-san- guine temperament, and usually enjoying good health, experienced about the year 18£6 domestic troubles, which brought on a state of melancholy. The catamenial functions were deranged, both in respect to the quantity of blood discharged, and to the regularity of the periods. The digestive functions became in a short time impli- cated, to such a degree indeed, that the gastric derangement assumed at length the characters of well-marked dyspepsia. A short time after the commencement of her disease, Mrs. B. was attacked with acute pain in the region of the bladder attended with frequent desire to make water, and with copious leucorrhoeal discharge.
Such was the state of Mrs. B. when I began my attendance. As may readily be presumed, the first remedial measures resorted to were such as appeared best calculated to relieve her from the pain she suffered, and to restore her digestive and urinary organs to their normal condition. Leeches, rest, hip-baths, emollient vaginal in- jections, fomentations, opiates, a suitable diet, were successively prescribed. By these means the irritation of the bladder was soon relieved, but the dyspeptic symptoms which evidently depended more on gastralgia than gastritis, continued unabated. With a view to remove them, a variety of remedies ordinarily used in such cases were administered, but without success. The prussic acid was now prescribed in small doses, and proved so highly and promptly effica- cious, that in a short time the gastric derangement disappeared com- pletely. This desirable object having been attained, an opportunity was afforded for administering such remedies as appeared required to put a stop to the leucorrhoeal discharge, which had been little, if at all, influenced by the treatment heretofore pursued, and was accompanied with heat and pain in the vagina.
After continuing the use of emollients a few days longer, I ven- tured, not without hesitation however, on a few drops of copaiba, and directed that the remedy should be taken in a small quantity of milk, and on a full stomach. But as this organ, though free from positive disease, was preternaturally irritable, some difficulty was at first ex- perienced in causing the copaiba to sit well upon it. Pain, nausea, and occasional vomiting, were the consequence of its use, and neces- sitated the suspension of it. At length this condition of the stomach being relieved by proper means, another trial of the copaiba was determined upon, v/hich proved more successful than the first.
No. XXVII.— May, 1834. 4
38 La Roclie on Copaiba in, Catarrh of the Bladder, ^c.
the remedj agreeing better than it had dor^e before, and pro- ducing none of the effects mentioned above, with the exception of a little nausea. The dose was in consequence gradually in- creased to twenty-five drops three times a day. For fear how- ever of its once more occasioning, if persevered in constantly, imdue irritation of the stomach, it was discontinued for one day at a time, twice a week, and the patient was directed to make use, on those days, of emollient drinks, and small doses of prussic acid. By attending to these precautionary measures, Mrs. B. was enabled to continue the use of the copaiba in the quantity stated during a month, at the expiration of which she was almost entirely relieved of her leucorrhoeal complaint. The medicine was, in consequence, gra- dually discontinued; and slightly astringent vaginal injections and washes were made use of. In a short time the menses returned; her mental depression disappeared, with the domestic troubles which had given rise to it; the digestive functions were restored, and Mrs. B.'s health became completely reestablished.
The case I have just described affords an example of a very serious derangement of health occasioned by mental depression, as well as of the beneficial effects of the prussic acid in gastralgia. But what is more to our present purposes, it exhibits the advantages that may be derived from the administration, with suitable precautions, of the balsam of copaiba in leucorrhoea. It may perhaps be ob- jected, that the cure was protracted beyond the usual limits, and that this circumstance detracts somewhat from the credit I have awarded to the copaiba. But if we bear in mind the com- plicated nature of the disease in this instance, and the difficulty usually experienced in putting a stop to fluor albus — whatever be the remedy employed, the objection must be found to lose much of its force. For my part, I think it probable that in the instance before us, no other article would have proved more ra- pidly serviceable; and certain it is, that in consequence of the im- paired state of the stomach, and the irritation which had existed at the neck of the bladder, several of the more popular remedies for leucor- rhoea would have been completely inadmissible. It is also probable, that if the copaiba had been prescribed before the removal of the gastral- gia, it would have acted very injuriously, or at least sufficiently so to necessitate its being laid aside altogether, for its action, as has been stated, is of a stimulating nature, and it cannot, on this account, be regarded as free from detrimental effects so long as the stomach remains in a state of morbid excitement. The truth of this remark will be rendered evident by the details of the following. case.
La Roche on Copaiba in Catarrh of the Bladder, Sec. 39
Case III. — In October, 1825, I was requested to attend Mrs. B. a native of New Orleans, who was labouring under an attack of mea- sles. This lady was about twenty years of age; had been two years married; had not borne children, and was generally regular in her catamenial functions. Her husband informed me, that she had been affected with leucorrhoea during the last eighteen months — that this disease had come on in a gradual manner, and had been treated un- successfully by means of cold bath, Peruvian bark, and other reme- -dies of the same kind.
Having been consulted by Mrs. B. solely for the exanthematic 'disease, my attention was directed exclusively to this complaint, from which my patient recovered in the usual period without having experienced any untoward accident, except a copious uterine haemor- rhage which supervened on the fourth day of my attendance: I after- wards lost sight of Mrs. B. for more than a year. At the expiration of this period, her husband called on me, and stated, that on the re- commendation of some officious friend, his wife had consulted an -elderly German physician, then a resident of this city, concerning her leucorrhoeal complaint; that this physician had at first prescribed .the Peruvian bark, both by the mouth and in the form of vaginal in- jections; that not succeeding with these, he had had recourse, in suc- cession, to an immense number of stimulating and astringent articles; that wearied, at length, at the continual changes of nauseous drugs, ^one of which had produced the desired effect, she had dismissed him, and had consented to apply to me. I further learned, that the patient discharged a very large quantity of matter from the vagina; that she experienced much heat and some pain in the part, and that these symptoms were much aggravated during, and for some time after coition; that during her menses, which, in general continued to appear in a pretty regular manner, the vaginal discharge evidently lessened in quantity; and that the patient had lost a good deal of flesh. Her skin was pale, and of an earthy colour, and generally became rather warmer than natural towards night; her appetite was tolerably good, but the digestive process was slow, and attended with sensations of fulness and uneasiness in the stomach and bowels; she was gene- rally thirsty, and finally, her bowels were very constipated.
From this enumeration of symptoms, I was led to the conclusion that the disease, for which advice was demanded, depended on a high grade of secretory irritation of the vaginal mucous membrane; that this irritation extended probably as high as the neck or mouth of the uterus, and that the internal lining of the digestive tube and ^he biliary organs were affected in a secondary ipanner. For th©
40 La Roche on Copaiba in Catarrh of the Bladder, ^"C,
purpose of removing this morbid state, bleeding from the arm or by leeches appeared to be called for, and were ordered; but owing to the fears and prejudices of the patient it was found impossible to draw blood in any way. It became necessary, in consequence, to have recourse to more slow and less efficient means, such as a low vegetable diet, acidulated and emollient drinks, saline purgatives, rest in a horizontal position, emollient vaginal injections, and tepid baths. At the expiration of ten days I was informed that the leucorrhoeal irritation, as well as the gastric derangement, had in some measure diminished, but that the discharge continued as before. The balsam of copaiba was now prescribed in moderate doses, and after a little persuasion Mrs. B. consented to take it in cold chamomile tea. By this means the quantity of matter discharged decreased somewhat in less than a week; but as the copaiba occasioned considerable distress in the stomach, pain in the bowels, and thirst, it was laid aside for two or three days. It may be proper to remark that during the con- tinuance of the gastro-intestinal irritation produced by the copaiba, Mrs. B. became affected with a depression of spirits, amounting almost to melancholy, and alternating with agitation and hysterical symptoms. At the end of the above-mentioned period, I was informed that the whole of these symptoms had subsided; but that the leucorrhoeal discharge was again on the increase. The patient was, in consequence, once more placed under the use of the copaiba; but after a few days, owing to a recurrence of the same symptoms, it was again discontinued. It was easy to find, from what was stated by Mrs. B. and her attendants, that although she could not continue the use of the copaiba more than four or five days in succession, and it required two or three days more before the ir- ritation occasioned by it had completely subsided, we were gaining ground on the disease. The plan was on this account persevered in during a few weeks; the vaginal irritation gradually decreased; slightly astringent and tonic injections per vaginam were had re- course to; a more substantial and nourishing diet was allowed, and at the period of my departure for Europe, a few weeks after, Mrs. B. was so greatly restored as to entertain the prospect of a speedy and complete relief from the distressing disease under which she had so long laboured, and for the cure of which a great variety of anti-leu- corrhoeal remedies had been tried in vain.
There can be no doubt, that in this case, the copaiba, although causing so much irritation of the gastric organs, as to force me to several times suspend it during a few days, evinced considerable power over the leucorrhoeal discharge. This we may infer from the
Harrises Cases of Epidemic Yellow Fever, 41
fact) that by its means a disease of already long standing, and which had baffled the efforts of art, and it may be added of empiricism, was, if not completely removed, at least greatly relieved. The patient herself was fully aware of its utility; and nothing, probably, could have induced her to resume so often the use of a remedy of a highly nauseous taste, and producing the unpleasant effects stated, except the conviction that it was producing the desired effects. As re- gards myself, I frankly admit, that it was only the courage and the wishes of Mrs. B. which induced me to persevere with the copaiba; and that on two or three occasions I suggested the propriety of sub- stituting some other remedy of a less irritating nature.
The second case of leucorrhcea described above, presents an in- stance of gastric irritation brought on by mental depression. In the third we have an example of the reverse — a state of mental depres- sion, as well as hysterical derangement, produced by a gastric affec- tion arising evidently from the action of a stimulating remedy on a preternaturally irritable mucous tissue.
In the next number of this Journal I hope to be able to offer some observations on the effects of the balsam of copaiba in diseases of the. alimentary canal.
Art. II. Cases of the Epidemic Yellow Fever prevalent at New Or- leans in the Summer and Fall of 1833. By E. B. Harris, M. D, [Communicated to Dr. Samuel Jackson, of Philadelphia.]
1 HE following is the history of twenty cases of the late epidemic fever prevailing at New Orleans. The number Dr. Harris writes could have been increased to eighty, with an additional mortality of two deaths.
The treatment pursued in these cases was based on physiological medicine. They furnish an evidence of its applicability to the dis- eases of the southern regions of our country: of this fact no rational doubt could be entertained, but many who do not understand its principles, and do not wish to recommence and continuously prose- cute their medical studies, have made this assertion. It may be sus- pected, this is often done as an apology for indolence, and a justifica- tion of an adherence to established routine, rather than from convic- tion, the result of deliberate examination.
It may be well to say a word in explanation of what is intended
4*
42 Harris's Cases of Epidemic Yellow Fever,
by physiological medicine, as it is grossly misunderstood, or quite as badly misrepresented, by individuals whose position should be a guarantee against either error.
In physiological medicine the pathology of disease is established on the structure of the organs, their vital actions and functions. Disease is a modification in the normal vital condition of structure, (which includes both the solid and fluid elements,) whence proceed change or disorder and disturbance of function and structure as ef- fects. Therapeutics is the appreciation of the modifications caused by medicinal agents in the vital condition of structure; and treatment or practice consists in the adaptation of the therapeutic modification, or vital reaction caused by remedial agents, to the pathological modi- fication or vital reaction of the organs proceeding from morbific causes.
Such are the fundamental principles of physiological medicine. It is rational as opposed to routine medicine. It is opposed to and ad- mits of no quackery, as it requires a profound knowledge of the ani- mal organism, of vital phenomena, and the positive actions of reme- dial means. This knowledge too is to be governed by the processes of reasoning as applied to each particular case.
Physiological medicine, either designedly or ignorantly, is con- founded with i\\Q physiological doctrine of Broussais. The medical doctrine of this distinguished physician, which is the physiology of irritation, is eminently physiological. It is the only general system of medicine promulgated in France which took physiology for its groundwork. It was, therefore, no presumption in Broussais to name it as he did — the physiological doctrine. The term would have been less applicable in Britain and this country, than in France. Brown, Darwin and Rush, had promulgated doctrines founded exclusively on physiology. The failures of these truly eminent medical philoso- phers, are to be ascribed solely to the defective state of the physiology of their time. With the paucity of their materials, and the imperfect- ness of the science, it was not possible for them to erect a durable fabric. The principles of Miller and of Rush, adapted to the phy- siology of the present time, would approach very nearly the doctrine of Broussais.
The doctrine of Broussais is an advance in the theory of medicine. It has fixed more entirely the ideas of irritation, before exceedingly loose, and given a clearer exposition of the numerous phenomena de- pending on that vital condition, than any other that had preceded it. It is to Broussais we are indebted for a more perfect knowledge of the chronic irritative and inflammatory diseases, which had been by
Harris's Cases of Epidemic Yellow Fever. 43
the great mass of practitioners wholly misunderstood; and to this knowledge is to be ascribed the present more successful methods of treatment adopted in those affections. The improvements of Brous- sais in these respects are incorporated in the body of the science, and it is almost forgotten whence they proceeded. In the reaction also, induced by the arrogancy, dictatorial spirit, and oftensive manners of the man, are overlooked, in a great measure at the present period, the services rendered by the philosopher and physician. Time, the vic- tor of prejudices, and the calmer of passions, will do justice in this respect.
The doctrine of Broussais will not be more permanent than its an- tecedents. Its base is too narrow. It is but a stepping-stone in the pro- gress of theory. No general theory of medicine, for a long period to come, can be perfect or lasting. The facts of vitality and organization are too little developed, and too little understood, to admit of an entire theory that will be found unexceptionable. The most that can be done, or that can be expected, is the temporary generalization of the facts as they are now understood to render their application to practical purposes more prompt and systematic.
Physiological medicine, or the arrangement and application to practice of the physiological and structural organic phenomena, as they become verified, has this advantage over a mere doctrine. It is not tied down to a fixed set of what are considered positive facts, but which are likely to be disproved as such in the rapid advance of our positive knowledge. Its character is expansive and adapting, re- pelling nothing that bears the impress of demonstration, and retaining nothing proved to be untrue. As it is the philosophy of organic phe- nomena applied to the purposes of medical science, every verified fact that comes within its scope, or bears upon its principles, must find its appropriate position and its useful application.
The strict pathology of yellow fever cannot be considered as posi- tively settled. Some of its important facts are determined — others remain obscure. That an intense gastro-duodenitis is its most promi- nent character — that the primitive symptoms proceed from this source, may be regarded as nearly unquestioned. The dissections of Dr. Physick in this city first attracted attention to this fact, which has since been confirmed by repeated observations. Dr. Rush made the stomach " the seat and throne of the disease." Edward Miller of New York, one of the ablest and most philosophical medical prac- titioners of this country, assigned the stomach as the source— /ons et origo — not only of yellow fever, but of all fevers of malignant cha- racter.
44 Harrises Cases of Epidemic Tetlow 'Fevef.
While this general fact is indisputable, and the leading features 6f the disease announce in unequivocal language the existence of an in- tense gastro-intestinal inflammation, there prevails, however, a con- stant disposition to heemorrhage, or at least to the escape of the colour- ing matter of the blood from the inflamed gastro-intestinal mucous mem- brane. This may be regarded as the specific character of the disease. •1 have never witnessed a fatal case of yellow fever in which this was • absent. Even when no black vomit is ejected during life, it is always found in the stomach on dissection. From the number of autopsies I have assisted at or performed in this disease, I regard this as one of the most positive facts of the disease. In very violent cases the same bsemorrhagic disposition is manifested in other points, as the mouth, the ears, the carunculse, the bladder.
This symptom is present only in the fatal cases — at least I have never known a recovery when it has existed. There are traditions of some few cases in the epidemics anterior to my personal observations, which commenced in 1805, in which recovery had taken place after black vomit and bloody discharges. They are exceedingly rare.
What is the immediate cause of this haemorrhagic disposition is un- known. It may reside in the blood itself. But it appears to be regu- lated by the intensity of the local inflammations. The treatment of the disease should then be directed entirely to the restraining of this last condition. If that be confined below a certain grade, the fatal complication is prevented. The recuperative powers of the organism are preserved, and will prove adequate to the safety of the patient- The physician can accomplish, and should attempt no more. The x:ase is precisely analogous to that of the exantheraatous fevers derived from specific contagions, and possessing a specific character. No one attempts to cure the disease. Their danger arises from the intensity of the local infiammations that invariably attend them, disturbing the functions of important organs, and disordering the whole constitution of the individual. The protection afforded against these inflamma- tions by a treatment that limits their too great activity, is the extent of our remedial proceedings. No remedies are possessed of specific powers adapted to the specific character of the disease capable of ar- resting its progress. By mitigating the intensity of local inflamma- tions, fatal complications are prevente<l, and then the patient reco- vers. When the too great virulence of the contagious poison or the state of the constitution, or organs of the patient, is such as to occa- sion inflammations of an activity beyond t!ie reach of &ur curative operations, disorganization and the destruction of fun<;tions essential to vital activity then ensue, and the patient perishes.
Harris's Cases of Epidemic Yellow Fever, 45
In the following cases, reported by Dr. Harris, this course was fol- lowed. Neglecting the specific character of the disease, of which we have no positive information, and for which still less do we possess any positive remedy, the whole treatment consisted in the employ- ment of means the most directly calculated to diminish the local in- flammation in the organs where they are the most actively developed. The plan is rational, and the success was gratifying. By keeping down the too great intensity of the gastro-intestinal inflammation, the secondary symptoms and the hsemorrhagic disposition were con- trolled, and the cases remained within the ordinary curative powers of the economy.
Dr. Harris was a resident physician of the Alms-house Infirmary of this city, and he there witnessed the application of the method he has pursued in the treatment of fever. This method is simple. It consists in combating in its acute state, the gastro-intestinal inflam- mation, and the secondary train of symptoms it excites in the ner- vous organs, by the most powerful, yet simple and direct of the se- dative and antiphlogistic means we possess. These are general bleed- ing, to limit the two great activity of the general circulation. Capil- lary depletion to attack immediately the local or capillary affection. Cold, the only true sedative and positive febrifuge, to concur in the same object, and to allay the excitement of fever. Revulsion, accom- plished by warmth to the extremities and cold to the head, equa- lizing the excitement, and preventing cerebral congestions, and epis- pastics or sinapisms, when the violence of reaction has been subdued. Finally, the employment of the milder purgatives calculated to call forth the intestinal secretions, when the inflammatory condition has been properly combated, terminating its last remains, or carrying oiF a congestion that may have been formed. Mercurials administered at this period, and in some cases carried to the point of light ptyalisra, often are the most effectual for this last object.
The most important of these remedies in the commencing stages, the most efficient of all remedies in the acuity of fevers, (to employ an old phrase,) are local depletion and cold. This last is to be em- ployed in ablutions, or persistently to the head and to the abdomen when their temperature is elevated; cold affusions to the head, and injections into the bowels. I know of no remedy that so truly merits the ap- pellation of febrifuge as this last. Its effects in controlling, subduing, and calming a febrile paroxysm are often wonderful. When the tem- perature is sufficiently low, which must be regulated by the intensity of the febrile heat, it is more prompt and powerful than the most copious blood-letting, while no danger is incurred of producing ex-
46 Harris's Cases of Epidemic Yellow Fever^
Imustion should the disease progress, often fatal when too copious evacuations have been practised.
The experience of Dr. Harris of this method of treatment, in the fevers of the southern states, has been sustained by that of EVr. Ed\vari> Barton, formerlj'" of Louisiana, but at present of New Orleans. Dr- Earton has published the result of his observations in this Journal, ¥oL XI, p, 43, €t seqo ■ S. J.]
€ase L — 'Mr. M*C. aet. 28, sanguine-ljrnphatic temperament, first summer in New Orleans, was seized, August 20th, 1833, about 6 P. M. with chill, pain in stomach and head and lower part of spine, ge- neral uneasiness in his bones. I was called at 7 P. M. and found |3ulse 140 atid full, skin hot, pain in epigastrium, vomits mucus mixed with gruraous blood, great stupor, bowels constipated, tongue be- ginning to ^e furred and red at edges. 01. ricin. 5iss. ; injection of ol. ricin. 5ij., molasses, 5ss., and mucilage, §viij. mixed well. The injection to be repeated every hour until the intestines are fully evacuated. Fifty leeches to epigafctrium: cold aflfusion to head; iced barley water for drink, and diet. 10 P. M. The leeches have drawn well; sickness of stomach calmed; head-ache diminished; pulse re- duced to 120, and not so full; skin slightly disposed to moisture; bowels freely acted on. Ordered a warm bath, with cold aifusion to •head while in bathing tub.
21s^, 6 A. M. Still complains of his head; stomach tranquil; tongue furred in middle and red at centre; pulse 110; bowels freely acted on during the night; desire for his iced drinks, as cold water and barley water, which were given often, but in small quantity at a time. Ordered eight leeches behind each ear, warm bath with cold aftusion repeated, and injection as before. 12 M, Head felt much relieved after the leeches were applied; urinates freely, deep red; pulse 100; skin perspirable; tongue in same condition; head feels but slightly heavy. Continue treatment. 8 P. M. Head still feels heavy; bowels have been opened several times in the day; condition otherwise unchanged. Ordered eight leeches to inside of thighs; cold mucilage injection; at 10 P. M. the bath, and affusion to head.
22(i, 6 ^. M. Slept several hours last night; feels no pain or un- easiness; redness of tongue at edges much lessened; desire for cold drinks decreased; pulse 90; skin perspirable; a little nausea; urine becoming almost natural. Soda pulv. with tart, acid in effer- vescence occasionally. 8 P. M. Saw him several times during the day; the soda powders relieved the nausea of which he complained; pulse 85, and good; tongue improved in appearance. Ma«8. ex
Harris's Cases of Epidemic Yellow Fever. 47
liydrarg. grs. v. ; arrow root in addition to his barley watery injection of mucilage.
23 J, 6 A. M. Slept wellj bowels freej convalescing; pulse 89, Continue regime.
24M, 6 A. M. Continues to improvei stools present a dark aspect. Continue arrow root and barley water.
^5th. Condition unchanged; allowed chicken water.
26//i. Doing well. Allowed chicken soup.
27//i. Discharged, with restrictions as to his diet. On 28th he is up in his room.
Case II. — Mr. Wells, set. 30, sanguine-lymphatic temperament, first summer in the city, was taken at 8 A. M. August 22d, 1833, M'ith chill, pain in lower part of back and bones. At 10 A. M. I 'was called, and found him in the following condition: — Greatly frightened, and crying; pulse 130, and full; bowels constipated; heat, and soreness of epigastrium on pressure; skin of abdomen hot; head- ache. 01. ricin. §iss.; fifty leeches to epigastrium; injection of ol. ricin. 5ij.; molasses, 5ss. ; mucilage, 5viij. mixed together; the injection to be repeated every two hours, until there are free evacua- tions. Cold barley water for diet and drink; cold affusion to head. S P. M. Pulse reduced to 110; leeches drew well; pain in sto- mach but slight; head-ache diminished; skin hot; tongue becoming furred and red; urine of a deep red, and depositing a lateritious sedi- ment; bowels freel}^ opened. Ordered eight leeches behind each ear; repeat injection; tepid bath, with cold affusion to head; iced barley water. 8 P. M. Head-ache lessened after the application of the leeches; bowels freely evacuated; abdomen much diminished; mind less agitated; condition otherwise unchanged. Ordered cold muci- lage injection; bath, with cold affusion to head at 10 P. M. ; continue cold drinks.
23J, 65 Jl, M. Slept two or three hours last night; mind much re- lieved; tongue furred and red at edges; pulse 95; dullness of head but slight; forehead a little disposed to moisture; slight nausea; bowels open. Ordered a warm pediluvium, and pulv. sod, and tart. acid in etfervescence. 8 P. M. Has passed a tolerable comfortable day; several evacuations from intestines; no uneasiness in head: tongue not so red at edges; pulse 85; urine high-coloured, (red;) nausea relieved; thirst not very urgent. Cool flaxseed injection; continue drinks.
24//i, 62- A. M, Rested well last night; pulse 75; bowels open; larine less deep in colour, and sediment not so abundant; tongue not so red at edges, but furred, of a blackish colour in the middle; does
48 Harris's Cases of Epidemic Yellow Fever,
not complain. Thin arrow root by sips every hour or two, in addi- tion to barley water. 8 P. M. Saw him during the dayj no change. A warm pediluvium; mass. hydr. grs. v. at 10 o'clock.
25//i, 6i, A, M. Has slept several hours during the night, but as he has charge of an extensive concern, and all absent but himself, his mind is either much affected thereby, or by some other cause; he is now shedding tears; otherwise condition unchanged; tongue clean- ing off. Mucilage injection. Continue treatment. S P. M, I find now his condition much changed, and on inquiry ascertain that his friends have been continually coming in and talking to him during the day. His tongue is red and fiery; pulse 110, quick and weak; skin hot; partial insensibility. Tepid bath; continue barley water.
£6//i. Condition aggravated; prostrated; tongue red and chipped; mind so much disturbed as to be delirious; partial insensibility. Arrow root, (thin,) and barley water, with a continuance of in- jections of mucilage.
In the above condition, but more prostrate, he remained until the 29th, when his pulse became a thread, and I ventured, in opposition to my judgment, and a fear that he would sink during the night, an injection of carb. ammon. in mucilage, every three or four hours. They v/ere continued until next evening, when, no change for the bet- ter being perceived, they were discontinued. He was now put in a tepid bath, and confined to arrow root, barley and iced water. About the 5th of September his dryness of tongue and body began to disap- pear, and on the 7th all diseased appearances were absent. He was now almost a perfect skeleton. Allowed chicken soup. On the 12th he is enabled to walk with assistance. Discharged, with cautions as to regimen.
Case III.-— Mr. S. W. set. 20, sanguine temperament, has been in New Orleans several winters, but went north every summer; a native of Philadelphia; was seized on Monday afternoon, August 26th, 1833, with a slight chill and pain in the head and lower part of the back, succeeded by slight fever. I saw him about/ P. M. three hours after attack. His pulse was 110, and he complained as above but slightly; his bowels were constipated; slight sickness of stomach. 01. ricini, ^j. to be succeeded by injections of ol. ricini, ^ij. with molasses, 5ss. and flaxseed mucilage, §viij. The injection to be repeated every two hours until the bowels are fully acted on. Twenty leeches to epigastrium; cold affusion to head; cold barley water for diet and drink.
27//i 7, j3. M. Head -ache and nausea much relieved; pulse 100; skin but little excited; bowels freely evacuated; tongue slightly
Harris's Cases of Epidemic Yellow Fever. 49
furred and red at edgesj urine of a deeper red than natural; press- ing on stomach does increase its uneasiness; has an anxiety and dul- ness of expression I do not like, and is drowsy, although he slept much last night. Ordered injection repeated; tepid bath, with cold affusion to head; continue barley water. 8 P. M. Saw him several times in the day, but without any alteration in ob- servation or directions. Bowels freely opened; does not com- plain of any pain, except uneasiness in the head. There is, not- withstanding, an unnatural fulness of the abdomen for one who has been so copiously evacuated; tongue but little furred or red at edges; pulse 90. Repeat injection; tepid bath, with cold affusion; eight leeches to epigastrium.
QSth, 7 A. M, Still continues to be much disposed to sleep; pulse 85; urine now red, and depositing a lateritious sediment; does not com- plain of pressure made on epigastrium; bowels several times opened in the night, by the injection; skin cool and pleasant; appearance of ful- ness in the bowels still continues; tongue cleaning. Injection of .cool flaxseed mucilage, to be repeated at 12 M.; mass, ex hydrarg. grs. v. mane et midi. 8 P. M. Saw him several times in the day; does not complain; no difference in observation from last notice, ex- cept an increase in thirst. Tepid bath; repeat injection; ice to be allowed to dissolve in the mouth; continue barley water.
29^/«, 7 .^. M, Every organ except the brain seems now to be unem- barrassed and performing well its duty; there is continuance of a dis- position to drowsiness and listlessness; bowels open, and discharges yellowish; urine approaching to natural; tongue but little furred, and no redness at edges; very slight nausea; pulse 80. Sodoe carb. with tart, acid, in effervescence, to be repeated occasionally if nausea con- tinues; repeat injection of flaxseed mucilage; warm bath, with cold aftusion to head. 8 P. M. Does not complain; drowsiness much diminished; is tranquil; pulse 80, and good; skin on forehead moist; bowels open and yellow. Thin arrow root, by tea-spoonful at a time, every hour or two; sponge body, when not moist, with whiskey in the night; a warm pediluvium, with mustard.
SO^A, 7 A. M. A little restless in the night; all appearances good, except a fulness of abdomen to the touch; desires to eat. Con- tinue treatment.
31s/, 62 Ji, M. Saw him several times yesterday, but without any change from last observation; still desires to eat. Allowed weak black tea; continue arrowroot. 10./?. M, While passing, called in by accident to see him, and, to my surprise, found a change in his visage; lips slightly purpled; listlessness. Inquired, and ascertained that he had heard of
No, XXVII.— May, 1834. 5
50 Harris's Cases of Epidemic Yellow Fever.
the death of an intimate friend in the house, who died that morning, in the next room to him. Has not urinated since morning, Epispas. to epigastrium; flaxseed mucilage and spts. nitri. dulc. for an injec- tion; continue barley water. At 12 M. he sent to me, and stated he had hiccups, and wanted to know what would relieve him, as they were, to use his own words, "troublesome." I repaired to him immediately, and found his lips and visage still more changed to pur- ple; hiccoughs, which are convulsing. I stated his situation to his brother, who was unaware of the change. Dr. T. Hunt saw him with me at 3 P. M. Passes no urine yet; no delirium, but entire listnessness. Injection of mucilage and spts. nit. repeated; pe- diluvium with nitro-muriatic acid, ^j.; epispastics to ankles. At 8 P. M. we saw him again; his condition was unchanged. I was now sent for twenty miles below the city, to see my friend Dr. Rushton, who, on a visit the evening before to a friend, was severely seized himself. My friend Dr. Hunt had the kindness to attend my patients in my absence, and from him I learned, that this patient continued to grow worse, with complete relaxation of the sphincter ani, until the next evening, when he expired. An epispastic was put on the spine in addition to the above treatment. An opportunity for po&t mortem examination was not offered.
Case IV. — Mr. L. C. set. 31, a merchant, (iirst summer residence in the city, although he has resided here since 1829 during winter, spring, and in summer until about 1st August,) sanguine temperament, after a great deal of fatigue in sitting up with sick friends, was affected, August 27th, with slight head-ache, and pain in lower part of back, and uneasiness in bones. Saw him an hour after attack, at 8 P. M. when he presented the following symptoms: — Pulse 100; tongue, on projection, tremulous; uneasiness on pressing epigastrium; skin of abdomen slightly hot; bowels constipated; a lit- tle head-ache; pain in his lumbar region, and general uneasiness, as stated; thirst. Fifteen leeches to epigastrium; ol. ricini, §iss. to be followed in two hours by an injection of ol. ricini, molasses, and flaxseed mucilage; the injection to be repeated every hour until the bowels are freely evacuated. Cold barley water.
28fA, 6| *d. M. Leeches drew well; pulse 90; bowels freely acted on; pain of epigastrium and back much relieved; tongue furred and slightly red at edges; dull sensation in head; urine high-coloured, and depositing a lateritious sediment; slept several hours last night; temperature of skin decreased. Six leeches behind each ear; a warm bath, with cold affusion to head; repeat injection; continue barley water. 8 P. M, Saw him several times in the day. Doing well; pulse
Harris's Cases of Epidemic Yellow Fever. 51
now 85^ does not complain; had several stools; urine less high-colour- ed; slight sickness of stomach. Pulv. bi-carb. sod. and tart, acid in effervescence; warm pediluvium, with mustard; a cool mucilage injection at 10 P. M. Mass. ex hydrarg. grs. v. to be repeated early in the morning.
29/A, 6| Jl. M. Sickness of stomach relieved immediately after the exhibition of the soda; pulse 80; tongue cleaning; urine becoming natural; skin good; does not complain; desires food. Arrow root in small quantity and often repeated; continue drinks.
30^A, 6| *^. M. Saw him several times yesterday; doing well; dis- charges from bowels yellowish, tinged dark. Slst. Convalescent; allowed chicken water; forbid to take exercise. September Is?.— Discharged well, with restrictions as to regimen. Case V. — W. F. set. 21, a clerk, sanguine-lymphatic tempera- ment, (second summer in the city,) was attacked, September 8th, 1833, with chilliness, head-ache, pain in lower part of back, sickness at stomach. Saw him a few hours after attack, when he presented the following symptoms. Pulse 130, and full; tongue covered with a white fur, and red at edges; pain on pressing epigastrium; skin hot; head-ache; bowels constipated; pain in lumbar region; thirst. Twelve cups to epigastrium and right and left hypochondrium, and six to lumbar region; ol. ricini, ^iss., to be followed in three hours by an injection of ol. ricini, ^ij., molasses, ^j., and mucilage of flaxseed, §viij.; the injection to be repeated every two hours, until the bowels are freely acted on; cold aftusion to head; cold bar- ley water for diet and drink.
9^^, 65 A. M. Passed a restless night; pulse reduced to 100, and not so full; head-ache much lessened; sickness of stomach relieved; skin of forehead rather hot; bowels freely acted on; urine of a deep red, and depositing a lateritious sediment; thirst not so great; pain in lumbar region almost entirely abated. Eight leeches behind each ear; repeat injection; ice in small pieces allowed to dissolve slowly in the mouth, in addition to the barley water; tepid bath, with cold affusion to head. 8 P. M. Has passed a more comfortable day. Tongue covered with a white fur, but moist, and less red at edges; pulse reduced to 90; head much relieved by the leeches and cold affusion; bowels opened several times; thirst lessened. Injection of cool flaxseed mucilage, and at 10 P. M. a warm bath and cold affu- sion, as above.
10th, 65 A. M. Passed a tolerable night; slept several hours; pulse 85; tongue less furred and red; does not complain; urine less
513 Harris's Cases of Epidemic Yellow Fever.
deep colour; bowels open. Arrow root in small portions and often repeated; cool flaxseed mucilage injection repeated.
Wth, Continues much in same condition, except a desire for nour- ishment different from his arrow root, which was not allowed; he is much prostrated. Continue treatment.
\'2.th» Yesterday, after my mid-day visit, he attempted to sit up in bed to stool, and swooned away, from which he, however, soon re- covered. His tongue is cleaning, and his condition good. Con- tinue treatment.
loth. Continues to improve; stools yellow. Continue treatment.
14M. Desires urgently to eat. Allowed chicken soup.
\5th. Convalescent.
\^th. Discharged well, with restrictions as to regimen.
Case VI. — Mr. M. set. 22, fully developed, sanguine temperament, first summer in New Orleans, was attacked very severely, September 5th, 18SS, with chill, pain in head, back and bones, sick stomachs I saw him an hour after he was taken, and the following symptoms were observed. Pulse 140, and full; skin hot; abdomen hot, and epigastrium painful, pain increased on pressure; bowels constipated; ardent thirst. Twelve cups to epigastrium, right and left hypo- chondrium, and six to lumbar region of spine; §iss. of ol. ricini, to be succeeded by an injection of ol. ricini, molasses, and flaxseed mu- cilage, every one and a half or two hours, until the bowels are freely acted on; cold barley water for diet and drink. This was at 10 A. M. 9 P. M. Head-ache still continues, but much diminished in seve- rity; tongue furred and red; skin hot; epigastrium painful on pres- sure; pulse reduced to 120; cups drew well; urine of a deep red; bowels freely opened; thirst continues. Injection repeated; tepid bath with cold aifusion to the head; cold drink continued, with ice allowed to dissolve in the mouth.
6/A, k to 7 *B. M. Passed a restless night, without sleep; bowels several times opened; urine deposites a lateritious sediment; head- ache and other symptoms, as above, unchanged. Five cups to back of neck; injection of cold mucilage; warm bath at 10 A. M. with cold affusion to head. 9 F. M. Saw him during the day; pulse now reduced to 100, and much less full; only uneasiness in the head; redness of edges of tongue not so deep; heat of skin greatly lessened; bowels free; urine of a less deep red. Pediluvium; continue barley water; cold to head.
7th, 7 ^. M. Passed again a restless night, (a symptom, as far as my observation extends, in the commencement of yellow fever, of a
Harris's Cases of Epidemic Yellow Fever. 53
favourable character,) with only an hour or two of sleep; tongue coat- ed with a grayish fur, inclining to brown; dullness yet in head; pulse 95, bowels free, and discharges slightly yellow. Five leeches be- hind each ear; continue treatment. 9 P. M. Feels comfortable; does not complain; pulse 90; tongue and other appearances but little if any changed; slight moisture on forehead; bowels open. A pedi- luvium with mustard; thin arrow root, by tea-spoonfuls, every hour or two; a mucilage injection; barley water or orangeade, which latter he calls for, (thirst much lessened.)
8th, 7 Ji. M. nested well; does not complain; much pros- trated; pulse 85; tongue cleaning and less red at edges; stools yel- low. Continue treatment.
9/A, 7 ^. M. Saw him several times yesterday; no change in ob- servation, except that his eyes and body are becoming very yellow. He continued without material change until the 12th, when he de- sired chicken soup, and was discharged well on the 13th, though perfectly yellow. This soon disappeared.
Case VH. — Mrs. C. set. 22, sanguine-lymphatic temperament, spent the summer of 1831 in the city, has an infant about ten months old, was seized, on September 7th, 1833, at 8 P. M. with pain in head, lower part of back and stomach, preceded by a chill and uneasiness of bones, and languor; bowels constipated. I was called at 9 P. M. but owing to indisposition did not go, but prescribed the following:— Thirty leeches to epigastrium; ol. ricini, §jss. to be succeeded by injections of ol. ricini, molasses, and mucilage, in two hours; cold, affusion to head; barley water for diet and drink.
Sth, 7 Ji. M. Passed a restless night; pain of head and stomach not much lessened, as the leeches could not be procured, and a few that were applied by the family drew but a small quantity of blood; bowels have been freely evacuated for eight times; pulse 130, and full; skin hot; pain of epigastrium increased on pressure; tongue furred and red at edges; urine of a deep red. Forty leeches to epigastrium; repeat injection; cold affusion to head; continue cold barley water. Q P. M. Head-ache much lessened after the application of the leeches, the bites of which were allowed to bleed; pulse re- duced to 115, and less full; heat and pain of epigastrium much less; slight sickness of stomach; urine and tongue as last noticed; bowels open several times in the day. Bi-carb. sod. with tart, acid occasionally, in effervescence; six leeches behind each ear; warm bath, with cold affusion to head; an injection of cool flaxseed mucilage; as thirst is urgent, ice is held in the mouth and allowed slowly to dissolve.
9/A, 7 <^.. M, Slept several hours last night j was much calmed hj
5*
54 Harris's Cases of Epidemic Yellow Fever.
the leeches, which drew well, and the cold aflfusion was most grateful to herj sickness of stomach relieved^ tongue furred, white, but redness at edges nearly gone; bowels open several times, but discharges mostly mucus and water; pulse 95; still a slight pain in head; urine becoming of a paler red; thirst not so urgent; skin still warm on abdomen Mass. ex hydrarg. grs. v. to be repeated at 12 M.; warm pediluvium cold cloths to head after cold affusion; cold flaxseed mucilage injec tion; continue barley and iced water. 9 P.M. Head-ache but slight pulse 85 to 88. Add mustard to warm pediluvium; repeat injection; continue treatment.
11th, 7 *fi. M, Tongue much improved, and now but little furred; stools darkish-brown; complains but of slight dulness of head; urine nearly natural; pulse 80; skin slightly disposed to moisture, and pleasantly cool. Repeat mustard pediluvium and mucilage injec- tion; thin arrow root in addition to her barley water, (her thirst has been gradually declining.) 9 P. M. Condition good; continue treat- ment.
12/A, 7 A. M, Slept well; desires to eat. Continue treatment. l%ih. Condition improving; all organs doing their duty. Pa- nada in addition to her other nourishment.
l\th. Desires imploringly to be permitted to eat more; allowed chicken soup.
15/^ and 16th. Discharged well, with restrictions as to regimen. Case VIII. — D. F. from New York, a youth of sixteen, was here last summer, sanguine-nervous temperament very highly de- veloped, was affected on the 11th of September, 1833, about 11 A. M. with chilliness, pain in bones after exposure on the day before to the direct rays of the sun on the levee, attending to the re- ception of goods. I saw him about 1 P. M. when he had severe pain in head and lower part of back; pulse 140, and full; skin very hoU particularly over epigastrium and abdomen; pain in epigastrium much augmented by pressure; tongue red and tremulous on projection; bowels constipated; thirst. Ten cups to epigastrium, right and lefthypochondrium, five to lower part of back; ol. ricin. ^j. to be fol- lowed in two hours by an injection of oil, molasses, and flaxseed mucilage every two hours until bowels are freely acted on; cold affusion to head; cold acidulated barley water for diet and drink. 85 P. M. Feels a little relieved by what has been done; the cups drew well; pulse 130; pain in head still intense; bowels freely acted on; skin hot; strong desire for cold drinks; tongue becoming much furred and red at edges; stomach not so painful on pressure; urine of a deep red, and depositing a lateritious sediment Four cups to
Harris's Cases of Epidemic Yellow Fever. 55
nape of neckj repeat injection; at 10 P. M. a tepid bath, with cold affusion to head; ice in gauze allowed to dissolve in the mouth; occa- sional sponging the body during night with whiskey, and cold to head.
12^^, 6? Jl. M. Passed a restless night; pulse 120; tongue greatly furred, white and red at edges; bowels open several times last night; head-ache continues, but diminished in violence; slept none; urine and other symptoms as noticed, except a slight pain in stomach, with nausea. Cold flaxseed mucilage for injection; two cups to epi- gastrium, which he strongly protests against; tepid bath, with cold affusion to head; carb. sod. and tart, acid occasionally in effervescence.
85 P' M, Saw him during the day, and directed repetition of cold injection; pulse 115; head still painful, yet slight sickness of stomach; condition otherwise unchanged. Repeat injection; tepid bath, with cold affusion, to remain in the bath for twelve or fifteen minutes; sponge body every hour or two through the night with whiskey; con- tinue drinks.
13//i, 65 A. M. Passed another restless night; pulse 105, and less full; head-ache much lessened; not so furred a tongue, nor redness of edges; urine less deep in colour; skin too warm, and not perspirable; bowels open in the night; thirst continues; sickness of stomach re- lieved. Repeat injection; tepid bath, with cold affusion to head, and cloths wrung out of iced water constantly to head after the affu- sion; mass, ex hydr. grs. iv. to be repeated at 12 M. ; continue drink; orangade as he desires it. 85 P. M. Saw him during the day; pulse 95; head still aches; condition unchanged; the family became alarmed, and Dr. Hunt saw him with me. Eight leeches be- hind each ear; repeat bath, with cold affusion to head; repeat injec- tion; continue sponging body with whiskey; drinks continued.
14?/i, 6| d. M. Was much relieved by the leeches; bowels open; head aches but slightly; complains of a little pain when pressure is made at region of scrobic. cord.; pulse reduced to 85; skin disposed to moisture, and greatly reduced in temperature; tongue less furred, and redness of edges almost absent; slept several hours in the night; is extremely sensitive, and fears the application of a cup to seat of pain in epigastrium. One cup to scrobic. cord. ; repeat injection, and bath with cold affusion; a little thin arrow root in addition to his other drink. 8 P, M. Saw him in the day, and directed repetition of injection; pulse now 80; urine assuming a natural appearance; tongue cleaning; skin moist; slight nausea. A warm pediluvium, with addition of mustard; repeat injection; a small epispastic to epi- gastrium, to remain on for three or four hoursf continue sponging
56 Harris's Cases of Epidemic Yellow Fever.
abdomen with whiskey every two or three hours; otherwise continue treatment.
15th, 6i J3. M. Passed a comfortable night; rested well; discharge from bowels assuming a dark colour, and of some consistence, and does not complain since the removal of the epispastic, which entirely relieved sickness of stomach; tongue nearly natural; pulse 80. Con- tinue treatment.
16th, 7 A. M. All organs in a good condition; desires to eat; al- lowed a small piece of toast, and weak black tea.
17th and ISth. Allowed chicken soup, and discharged well on 19th, with restrictions as to regimen; he is much reduced.
Case IX. — Mr. A. B. H. a merchant, has been in New Orleans several years, but absent for the last two or three summers, most of the time to Omoa, Tuxillo, &c. ; he is of a sanguine temperament, and arrived within a week from Omoa; set. 32. He was taken with a chill and pain in his bones, and sick stomach, September 13th, about 12 M. I was sent for, but did not see him until 2 P. M. when he presented the following symptoms: — Pulse 135; bowels consti- pated; tongue red and tremulous on projection; severe pain in head and lower part of back; thirst great; skin hot. Twelve cups to epigastrium, right and left hypochondrium, six to lower part of back; ol. ricin. ^iss., to be followed every two hours by oil, molasses, and mucilage, as an injection, until bowels are freely acted on; cold barley water for diet and drink. 7 P. M. Pulse reduced to 115, and less full; tongue furred and red at edges; bowels acted on seve- ral times; urine of a deep reddish colour; pain in head, back, and stomach much lessened after the application of the cups, which drew well; abdomen hot; thirst continues. Repeat injection; and at 9 P. M. a tepid bath, with cold affusion to head; continue barley water iced.
lAth, 7k «^' M, Passed a restless night; bowels opened four or five times during the night; pain in head, particularly across the eyebrows; urine deep as last noticed, and depositing a lateritious se- diment; no pain or sickness of stomach; pulse 110; skin reduced slightly in temperature; thirst not so intense. Warm bath with cold allusion to head; an injection of cold mucilage; continue iced barley water; four cups to nape of neck. 9 P. M, Visited him during the day; head much relieved after cupping; tongue furred, as last noticed, but redness of edges decreased;^ pulse 100; bowels open; urine not so high coloured; temperature of skin becomings more natural; does not complain. R. Mass. ex hydrarg. g;rs. v» nocte et mane.
Harris's Cases of Epidemic Yellow Fever, 57
15th, 6| A. M. Passed a tolerable comfortable night, having slept several hours; pulse 90; bowels open; skin disposed to moisture; tongue beginning to clean; not much thirst. A warm pediluvium; thin arrow root by tea-spoonfuls at a time every half hour or hour; cool mucilage injection; continue barley water. 9 P. M. Pulse 85; complains of slight uneasiness of head; urine nearly natural. A warm pediluvium, with the addition of mustard; cool mucilage injection repeated; continue barley water and arrow root.
l6;/i, 7 S., M, Bowels assuming a dark colour, and of some con- sistency; no uneasiness in head; tongue yet furred in middle, but no redness of edges; skin and pulse good. Continue treatment, with the addition of the juice of an orange, which he desires.
17//i, 7 Ji. M, Saw him last evening, but without observation; he slept well; desires food, which was refused; continue treatment.
18//«. All disease gone; stools yellow; desires to eat. Allowed weak black tea and toast, and chicken water during the day.
20^/j. Discharged well, with restrictions as to regimen.
Case X. — Mr. H. a bookseller, set. about 35, has been in the city for twelve or fourteen years, temperament sanguine-lymphatic, the latter most strongly developed, tall stature, has his family across the lake, was seized September 13th, 1833, about 1 P. M. with chilliness; pain in bones; languor, succeeded by fever; severe pain in head, lower part of back, and stomach; (he had been in the habit for some time of taking a small quantity of brandy and water once or twice daily. ) I was sent for, and saw him at 3 P. M. when the following observations were made: — Pulse 125; skin hot; pain in head, lower part of back and epigastrium, the latter increased on pressure; tongue red and tremulous on projection; bowels constipated; uneasiness of mind; thirst great for cold drinks. 01. ricin. ^iss. to be suc- ceeded by an injection of oil, molasses, and flaxseed mucilage in two hours, to be repeated until bowels are freely acted on; ten cups to epigastrium, right and left hypochondrium, six to lower part of spine; cold barley water for diet and drink. 9 P. M Pulse reduced to 110, and less full; temperature of skin diminished; tongue beginning to be furred and red at edges; sensibility of epigastrium and pain in head lessened; urine of a deep red colour; bowels have been acted on several times; the cups drew well; thirst continues. Repeat injec- tion; tepid bath, with cold affusion to head, if head-ache then not re- lieved, eight leeches behind each ear; continue drink.
14//i, 6 A, M. Passed a restless night; the leeches were not ap- plied, as the pain in head diminished; urine depositing a lateritious sediment; tongue furred deeply, and red at edges; pulse 105; skin of
58 Harris's Cases of Epidemic Yellow Fever.
abdomen hot; bowels open duringthe night; a little sickness of stomach. Apply the leeches as directed last night; warm bath, with cold affusion to head; cold mucilage injection; carb. sod. and tart, acid occasionally in effervescence; continue barley water and ice water in small quantity. 9 P. M. Head much relieved; tongue not so furred and red; bowels open several times during the day; pulse 95; urine as noticed; sick- ness of stomach relieved; skin of forehead a little disposed to mois- ture. Mass. ex Hydrarg. grs. v.; a warm pediluvium; continue treatment.
15/A, 6 Jl, M, Got into a slight perspiration after the pediluvium; slept several hours in the night; complains only of a slight ful- ness in the head; pulse 90; tongue improved; urine less deep in co- lour. A warm bath, with moderate cold affusion to head; injec- tion of cool flaxseed mucilage; thin arrow root, in addition to other drinks. 9 P. M. Visited him during the day; feels much relieved; abdomen reduced very greatly in size; bowels open. Continue treat- ment.
16M, 6 A. M, Stools now present a dark colour, and more con- sistence; does not complain; tongue improving. A warm pedilu- vium with mustard added; continue treatment.
17 th and IStk. Continues to do well.
19/^. Desires porteree — allowed a small portion at a time, also chicken soup.
20th, Discharged well: and on 23d, was enabled to go across the lake.
Case XL — Mr. A. M. a merchant, set. 25, sanguine-lymphatic tem- perament; the latter most strongly developed; of a very tall stature; has been in New Orleans for three summers; had intermittent fever last spring, and is subject for some time during every change of wea- ther, when it becomes damp and cool, to attacks of St. Anthony's fire, in many of which I have attended him; had a severe attack not more than ten days ago.
He was seized about 11 A. M. with chilliness, pain in head, back, and stomach, succeeded by high fever. I was called, but being ab- sent did not see him until 4 P. M. when the following symptoms were observed: — Intense pain in head, stomach, and lower part of back; pulse 140 and full; bowels constipated; skin hot; pain of epi- gastrium increased on pressure; tongue red and tremulous; very much alarmed. Twelve cups to epigastrium and right and left hypo- chondrium; eight to lower part of back; ol. ricini, ^iss., to be fol- lowed by injections in two hours of oil, molasses, and mucilage, re- peated every hour until bowels are freely acted on; cold affusion to
Harris's Cases of Epideinic Yellow Fever, 59
head, and cold cloths constantly applied to abdomeni acidulated bar- ley water for diet and drink. H P- M, Bowels now operating freely; tongue red at edges and furred brownish; pulse reduced to 120; pain in head, back and stomach, much relieved; urine of a deep red; thirst great. Tepid bath, with cold affusion to head; ice in small pieces allowed slowly to dissolve in the mouth; sponge body with cold water every hour or two; repeat injection; continue barley and iced water.
16//*, I to 7 A. M, Passed a restless and uncomfortable night; is much reduced; head aches; bowels freely evacuated; tongue furred brown in middle, and very red at edges and sides; slight pain of epi- gastrium, increased on pressure; skin of abdomen hot; strongly so- licits ice, and a repetition of bath with cold aff'usion; urine as last no- ticed; pulse 110, and not so much force Two cups to epigastrium and four to nape of neck, all of which drew well; repeat bath with cold affusion; injection of cold mucilage; sponge body every hour or two with whiskey; continue drink; repeat injection at 12 M. 9 P. M. Saw him during the day, but without material change; pulse is now reduced to 100; head-ache absent, but to a dull sensa- tion; complete evacuation of bowels; no pain of stomach; temperature of skin lessened; tongue less furred and red; urine as last noticed. Repeat bath with cold aff'usion, to be put in the bath without any exertion on his part; if dullness of head continues, to have five leeches behind each ear; a cool flaxseed mucilage injection; barley and iced water continued.
17/A, 7 *d, M. Slept several hours last night; as dullness of head decreased, did not apply the leeches; is very excitable; pulse reduced to 90; skin assuming a disposition to slight moisture; urine not so deep as last noticed; scarcely uneasiness in the head; tongue becoming more natural; skin of abdomen rather excited; bowels open and now yellowish; thirst much diminished; greatly prostrated. Thin arrow root in addition to barley water, repeated every hour or two; continue sponging abdomen with whiskey, and occasionally a cool flaxseed mucilage injection. 85 P. M. About 12 o'clock this morning slight sickness of stomach came on, which is now rather in- creased than diminished, with a disposition to eructation; skin feels pleasant over abdomen and body; pulse 85, and not far from natu- ral; bowels open and yellow in colour. When sickness of stomach came on, carb. sod. with tart, acid, in eff*ervescence, was occa- sionally administered with but partial relief; much alarmed, and greatly prostrated; (he has been made to use, as all the others were, a bed -pan from the second day of attack.) Emplas. epispas. fort..
60 Harris's Cases of Epidemic Yellow Fever,
four bj six inches, to epigastrium; hot pediluvium with mustard; arrow root every hour or two by tea-spoonfuls; flaxseed mucilage injection.
18/A, 65 A, M. Epispastic has raised well, and has just been re- moved; entirely relieved of sickness of stomach a few hours after it was applied; tongue cleaning and good; every organ seems to be doing its duty well; desires the juice of an orange, which was allowed. Continue arrow root.
I9th^ 7 S.. M. Continues to do well; saw him last evening, but without an additional observation; very slowly convalescing; desires to eat. Continue arrow root.
9S)th, As last reported. Allow weak black tea and toast, and chicken water occasionally by table-spoonfuls in the day.
21s/. Great desire to eat more; allowed a soft-boiled egg in addi- tion for morning, and chicken soup through the day.
22(/. Is so well that he can sit up for a short time to-day. Conti- nue regimen. From this day to the 24th he improved very rapidly, and is enabled to walk about his room. Discharged, with restrictions as to regimen.
Case XII. — Mr. J. T. set. about 26, sanguine temperament, full habit of body, ordinary stature, first summer in New Orleans, was seized this morning, September 14th, (four miles below the city, where he slept every night, at the country-seat of Mr. L.) at 2 o'clock, with chilliness, pain in his bones, and sick stomach, follow- ed by fever, head-ache, &c. ; his brother, who was with him gave him §iss. of castor oil. I was sent for, but did not reach him until 10 o'clock, when the following observations were made. Pulse 140 and full; is constipated; oil that he took has not acted; great heat and pain increased on pressure of epigastrium; tongue furred in middle and red at edges and sides; thirst for cold drinks intense; pain in head very severe. Repeat ol. ricin. to be succeeded in two hours by oil, molasses, and mucilage, as an injection, repeated every hour until bowels are finally acted on; twelve cups to epigas- trium and right and left hypochondrium, and six to lower part of back, (they were applied by myself, as it would occupy' too much time to send to the city,) they drew between xx. and ^xxiv. of blood; this evening a tepid bath with cold affusion to head; repeti- tion of injection also; barley and iced water in small quantity, and often repeated.
15//i, 8i P. M, Bowels acted on eight or ten times since I saw him; still head-ache; pulse 120, and less full; great diminution of pain in epigastrium; tongue furred and red; urine of a deep red, and
Harris's Cases of Epidemic Yellow Fever, 61
depositing a lateritious sediment; diminution in temperature of body; passed a restless night; thirst; was delighted with his cold affusion and bath, (cold cloths were applied also after the cold affusion.) Three cups to epigastrium; three to back of neck; warm bath with cold affusion; cold flaxseed mucilage injection. This evening at 9 o'clock repeat bath and affusion and injection.
16/A, 8| A. M, Pulse reduced to 100; tongue still covered with a white fur, but less red at edges; urine not so deep a red; bowels acted on several times in the night; a little sickness of stomach; no pain of epigastrium on pressure; dull sensation in head; temperature of skin improved; passed a restless night. Warm bath with cold affusion to head; cool mucilage injection; carb. sod. with tart, acid occasionally in effervescence; barley and iced water continued; if dullness of head not relieved by 9 o'clock this evening, eight leeches behind each ear.
17th, 8^ Jl. M. Passed a restless night, but slept two or three hours; sometimes a little wandering when dozing; the leeches were not well applied, and did not drav/ at all; stools darkish, and more consistent than before; pulse 85; condition otherwise much improved^ is cheerful, and desires to eat something; no sickness of stomach; temperature good; urine almost natural. A little thin arrow root every hour or two; repeat injection of mucilage; continue cold drink, although thirst not urgent; owing to the extreme solicitude for this patient, I continued to visit him again at 5 P. M. when no change for thfe worse had taken place. This evening at 9 o'clock a warm pediluvium with mustard, and if any uneasiness of head comes on, a cool mucilage injection; continue otherwise treatment.
18^A, 85 ./?. M. Slept several hours last night, and rested well; no indication of wandering; tongue moist, and nearly clear; pulse 80; skin good; does not complain; bowels open, and yellow; still desires to eat. Continue treatment; to calm him and procure sleep this evening if necessary, five drops of tinct. op. Rousseau.
19^A, 85 Ji- M. Slept several hours last night; took the tinct. op. Rousseau about 12^ A. M. which composed him; was a little restless previously; bowels open; skin good; tongue clean; does not complain, except of very slight disposition to nausea; desires to eat; thirst gone. Emplas. epispas. four by six inches to epigastrium, to remain on for four or five hours; continue treatment. I left him about 11 o'clock, and his brother came with me to the city, not having left him before for any length of time during his illness; he slept composedly during his absence; the brother returned about 3 o'clock, and found him tranquil and composed, but wishing his blister
No. XXVIL— xMay, 1834. 6
62 Harris's Cases of Epidemic Yellow Fever.
removed, which was done; all sickness of stomach removed; I left po- sitive instructions if any change took place to have a messenger des- patched forthwith for me.
On my visit of the 20th, same hour as the preceding days, I found that his condition was hopeless, resulting from a violation of my di- rection in permitting him to get up to stool; he fainted, and the injury done was now too late to be repaired; his brother and a friend who had gone down the afternoon previous were so deluded, that until my arrival they considered him doing well; I found his pulse scarcely perceptible; low muttering delirium; picking of the bed-clothes; tongue and teeth, (sordes,) blackish; brandy injections were repeat- edly given; and flying sinapisms to extremities; (deglutition was soon lost;) the injury sustained was past renovation; he died at 12 o'clock; a post mortem examination could not be effected.
Case XIII. — Mr. A. C. W. a merchant, second summer in New Orleans, set. 26, sanguine-lymphatic temperament, the former most developed, ordinary stature, was seized with chilliness, pain in bones, sick stomach in the night, about 12i o'clock, September 16th, 1833. I was sent for, but did not see him until 21 A. M. and found him in the following condition: — Pulse 140, and full; costive habit of body; skin hot; great sensibility of epigastrium on pressure; tongue red and tre- mulous when projected; pain of head and lower part of back very severe; ardent desire for cold drinks, particularly iced water. Twelve cups to epigastrium, right and left hypochondrium; and eight to lower part of spine; ol. ricini, ^iss. ; to be followed by injec- tions of oil, molasses, and mucilage, every hour until bowels are freely acted on; cloths dipped in cold iced water to head; iced barley water, and water in small quantity at a time for diet and drink.
65 t^. M. Cups drew well, with much relief to head and back and stomach; pain in head; tongue furred, and red at edges and sides; bowels freely evacuated; pulse reduced to 115; urine of a deep red; diminution of temperature in skin slight; sickness of stomach; thirst continues, and cold drinks and application to head most grateful. Repeat injection; tepid bath with cold affusion to head; continue treatment, with addition of carb. sod. and tart, acid, occasionally in eS'ervescence. 9 P. M. Saw him several times during the day, with- out difference in observation; his bowels have been acted on four or live times; head still aches; pulse 100; other condition as last noticed^ has been drowsy in the day; sickness of stomach relieved. Four cups to nape of neck; warm bath with cold afifusion to head; a cool mu- cilage injection; continue treatment.
I7th, 62 ,i, M. Head much relieved by thecups; pulse 90; tongue
Harris's Cases of Epidemic Yellow Fever. 63
a little less red at edges, but furred, as noticed, inclining to a brown- ish-white| urine deposites abundantly a lateritious sediment; skin dis- posed to moisture on forehead; slept two or three hours last night; slight dullness of head, and nausea. Carb. sod. occasionally re- peated; a cool mucilage injection; a warm bath; continue treatment. 9 P. M. Dulness in head still continues; sickness of stomach re- lieved; bowels open; pulse and other appearances unaltered; except a slight diminution in thirst. Two cups behind each ear; a warm pediluvium; continue treatment; repeat injection. 1 remained to cup him; while they v/ere applied the candle by accident set fire to the mosquito-net, I instantly pulled it down and extinguished it, but it so alarmed him that he sprang out of bed on the floor; he returned to bed in a very short period, not so much agitated as I feared.
18^/i, 62 Jl, M. Passed a restless night until 2 o'clock this morn- ing, after which he slept several hours; head aches, which is not so severe as I dreaded; bowels open; forehead warm; tongue of a dark- brown fur, with the papillae projecting through it; pulse in same state as noticed; urine as deep in colour, without depositing sediment; no sickness of stomach; skin warm over epigastrium. Eight leeches behind each ear; warm bath with cold affusion to head; a cool mu- cilage injection; continue treatment. 9 P. M. Paid several visits to him in the day; head is entirely relieved by the leeches, &c. ; has slept several hours; tongue less brown, and papillae not so projecting, edges diminished in redness; urine not so deeply coloured; pulse 85; skin nearly natural. A warm pediluvium with mustard, and at 8 o'clock a cool flaxseed mucilage injection; continue treatment. Saw him again at 9 P. M. but without any change for the worse, except a lit- tle drowsiness; the injection was directed to be repeated.
19^^, 65 Jl. M. Rested well last night, yet a little drowsy; pulse 80; skin disposed to be perspirable or moist; tongue cleaning and im- proving; urine approaching natural; thirst absent; desires to eat; bowels open and yellowish. Thin arrow root, by tea-spoonfuls, every hour or two; continue treatment.
2l5^, 7 J3. M. Continues to improve; saw him again last night; desires urgently to eat. Allowed in addition weak black tea and a small piece of toast; this afternoon chicken water.
22c?. Doing well; nourishment agreed well with him; desires this morning a soft-boiled egg, which was allowed; chicken soup through the day.
23(/ and 24th. Discharged well, with restrictions; is up in his room.
Case XIV. — Mr. C. H. H. a merchant, third summer in New Orleans, set, about twenty-eight, sanguine-lymphatic temperament,
64 Harris's Cases of Epidemic Yellow Fever.
the former most developed, was seized, Wednesday, September 18th, about 10 A. M. with chilliness, pain in bones and back, nausea, &c. I was sent for, but being absent from the city, did not see him until 1 P. M. He had taken, about lOi o'clock, gjss. of castor oil. The following observations were made when I saw him. Pulse upwards of 140 and full; severe pain in head, lower part of back, and epigas- trium; the latter much increased on pressure; skin hot; tongue red; bowels constipated; thirst intense for cold drinks. Twelve cups to epigastrium, right and left hypochondrium, and six to lower part of back; ol. ricini repeated, to be succeeded by an injection of ol. ricin. gij., molasses, §j., mucilage, §viij. mixed together, in two hours, and repeated every hour until there are free discharges from the intestines; cold cloths wrung out of ice water constantly applied to head; iced water and barley water in small quantity, and often repeated, for diet and drink. 8 P. M. Feels much relieved since the application of the cups, which drew well; bowels evacuated four or live times; still severe head-ache; pulse reduced to 120, and not so full; is disposed to laugh constantly; tongue beginning to be furred; urine of a deep red. Forbid all company except his nurse; a tepid bath, with cold affusion to head; repeat injection; sponge body every hour with whiskey; ice in gauze allowed slowly to dissolve in mouth, otherwise continue drinks. Four cups to nape of neck.
19^^, 62 A, M. Passed a restless night; pulse 110; cups drew well, and greatly relieved head; bowels open freely in the night; skin reduced in temperature, and pain of epigastrium diminished on pres- sure; tongue covered with a white fur and projecting papillae, and red at edges; thirst not so intense; urine depositing a lateritious sedi- ment; slight nausea; more tranquil, and assuming an usual appear- ance from such symptoms. Soda pulv. with tart, acid occasion- ally in effervescence; v>^arm bath with cold affusion to head; a cool mucilage injection; continue treatment. 8 P. M. Saw him during the day; pulse now 95; head relieved, excepting a dull uneasy sen- sation; tongue very much furred; otherwise condition unchanged; nausea relieved. Eight leeches behind each ear; repeat bath with cold aff*usion; a cool mucilage injection; mass, ex hydrarg. grs. iv. nocte et mane; continue treatment.
20M, \ to7 Ji> M. Head relieved; slept several hours last night; pulse 85; no nausea; tongue assuming a brownish aspect, but papillae much less projecting, and less redness at edges; several stools in the night; skin disposed to moisture; urine pale and deposites less sedi- ment; thirst less. A warm pediluvium with mustard; thin arrow root by tea-spoonfuls every hour or two; continue barley water, and
Harris's Cases of Epidemic Yellow Fever. 65
the piece of an orange as it is desired. 8 P. M. Has had several alvine discharges of a yellowish colour; tongue improving; condition otherwise improving. Repeat cool flaxseed mucilage injection and warm pediluvium with mustard; continue arrow root, &c.
Sllst^ 7 Jl. M. Slept several hours last night; pulse 80; skin good; tongue still a little dark-coloured, but cleaning; urine nearly natural; stools yellowish; thirst nearly gone. Continue treatment, increas- ing the arrow root.
22of. Condition improving; desires to eat. Continue treatment.
236?. Tongue nearly natural; does not complain; desires to eat. Allowed jelly in addition to his arrow root.
Mtlu Improving; his appetite greatly increased. Allowed black tea with boiled milk and toast, and chicken water during the day.
25//i and SlGth. Chicken soup; a soft-boiled egg. Discharged well, with cautions as to diet and regimen.
Case XV. — -Mr. J. V. a merchant. Frenchman, set. 36, first sum- mer in New Orleans. I was requested to visit him in consultation with Dr. Lacroix, Tuesday, September 17th, at 1 P. M. From Dr. L. I learned that he had been taken with chilliness, pain in bones, back, and epigastrium, succeeded by fever, on the Saturday previous. When I saw him, the following observations were made. He had suppression of urine since the previous afternoon; tongue deeply furred with projecting red papillae, and red at edges; pulse 140, and quick; bowels had been acted on by injections of Cassiafistularis; epigas- trium hot and painful on pressure; pain and heat in region of blad- der; no turgidity; slight pain in lower part of back; has been taking table-spoonful of saline draught every hour or two since suppression of urine came on; thirst; slight delirium. Four cups to left hypo- gastric region, four to lower part of back, four to epigastrium; injec- tion of ol. olivse, molasses, and mucilage; tepid bath with cold affu- sion to head; mucilage sem. lini. with spts. nit. dulcis for drink; a warm flaxseed poultice to hypogastric region after application of cups; ked barley water, and ice in small pieces allowed slowly to dissolve in the mouth.
18th, 7k A. M. Urinated freely last evening; pulse reduced to 110; redness of tongue lessened; bowels open; urine of a deep red colour, (or brick;) no pain in epigastrium or lumbar region; tempe- rature of skin diminished, as also thirst; no delirium; slept several hours last night. Repeat bath with cold aftusion; a cool mucilage in- jection; continue treatment. 4 P. M. Pulse 95; tongue less furred and red; bowels open; otherwise no change in condition. A cool
.6*
66 Harris's Cases of Epidemic Yellew Fever.
mucilage injection; at 9 P. M. bathe feet in hot water; continue treatment.
19//j, 7 Ji. M, Passed a restless night; pulse 90; skin but little excited; urinates freely and much paler; tongue improved and cleaner; his mind is disturbed in relation to his business, and a little flighty; bowels open; thirst lessened. Cold affusion to head; a warm pedi- luvium with the addition of mustard; a cool mucilage injection; ex- clude company; five leeches behind ears. 8 P. M, Feels calm; no flightiness after the affusion and leeches. Continue treatment.
20//i, 7\ Ji. M. Slept several hours last night; bowels open and yellowish; pulse 80; tongue cleaning; skin disposed to moisture; still a slight injection of eyes. A cool mucilage injection; thin arrow root; continue treatment. 8 P. M. Slept several hours during the day. A warm pediluvium, with mustard; repeat injection; continue treatment.
9.1st, 7 ^. M. Slept several hours last night; all organs appear to be performing their duty; tongue scarcely furred; bowels open and yellowish; desires to eat. Continue treatment.
22c?. Doing well; black tea and toast, and chicken water through the day.
23^. Appetite greatly increased; desires and allowed a soft-boiled egg for morning, chicken soup through the day.
24^^. Is able to be up in his room; discharged with restrictions.
Case XVI. — Mr. J. S. P. set. 20, second summer in New Orleans, sanguine-lymphatic temperament, was taken in the morning of Sep- tember 25th, 1833, with chilliness, nausea, pain in bones, &c. This was about 10 o'clock. I was sent for, but did not, (owing to ab- sence,) visit him until 1 P. M. w^hen I found him covered up with thick blankets, (although a hot day,) and in a forced profuse perspira- tion; severe pain in head, lower part of back and epigastrium, the latter increased on pressure; tongue tremulous and red; skin hot; pulse 140, and full; bowels constipated; considerably agitated; great thirst. The covering directed to be removed, so as not too suddenly to check transpiration; warm or tepid lemonade occasionally for drink; ol. ricin. giss. to be succeeded every two hours by injections of oil, molasses, and mucilage, until al vine discharges are freely pro- duced; ten cups to epigastrium, right and left hypochondrium, four to lower part of back. 8 P. M. Owing to the injection pipe not be- ing sufficiently large, the injections have not had the desired effect; bowels have only been once acted on; much relief of head, back, and epigastrium; pulse 120; tongue beginning to be furred; urine ©f a deep
Harris's Cases of Epidemic Yellow Fever. 67
red colouri skin warm; perspiration gradually declined; thirst as above. Repeat injection as directed; tepid bath, with cold affusion to head; ol. ricin. 5j.; cold barley water for diet and drink; sponge body every two or three hours during night with whiskey.
26//i, 6i ^. M. Passed a restless night; bowels freely opened; ;pulse 100, and not so full; temperature of skin much reduced; tongue covered with a white fur, (papillae red and projecting,) red at edges; urine as noticed, and depositing a lateritious sediment; slight nausea; thirst not so intense; pain in head, back, and epigastrium absent, ex- cept a dull sensation in head; skin of forehead hot. Tepid bath, with cold affusion to head; repeat injection; sponge body every hour or two with whiskey; ice slowly allowed to dissolve in mouth, and if dullness of head continues to 12 M. four cups to nape of neck; carb, soda with tart, acid in effervescence occasionally; continue treat- ment. 8 P. M. Saw him since last report; head so much relieved, that the cups were not applied; pulse 95; skin rather warm; sickness of stomach removed; bowels entirely free; other symptoms not mate- rially varied. Warm bath, with cold afiusion to head; cold mu- cilage injection; continue occasional sponging; continue treatment.
27//i, 6§ Jl. M. Slept several hours last night; pulse 90; injection passed soon after its administration; skin less hot, and slightly dis- posed to moisture on forehead; tongue furred, but papillae less pro- jecting, and not so red at edges; urine as noticed; thirst much de- creased. Repeat cold mucilage injection; a warm pediluvium; thin arrow root by tea-spoonfuls. 8 P. M. But little change since last visit; bowels open and discharge yellowish. Repeat injection; add mustard to pediluvium, and repeat it; occasional sponging continued 5 continue treatment.
28//i, 65 A. M. Slept several hours last night; pulse reduced to 85; skin pleasant to touch; tongue improving; bowels open; urine im- proving fast; thirst nearly absent. Continue treatment.
29^/t. Tongue nearly natural; all organs seem to be regaining their normal action; pulse 80; slept well; desires to eat. Chicken water, and continue treatment.
Was discharged well October 1st.
Case XVII. — Mr. S. set. 30, sanguine temperament, second sum- mer in New Orleans, was taken October 5th, 1833, v/ith chillinessj pain in bones, back, and epigastrium, succeeded by fever, head-ache? &c. Dr. Barton saw him a few hours after attack, and detracted blood to the amount of twenty-four or thirty ounces by the lanceti ordered injections of ol. ricin,, molasses and mucilage, every two or three hours, until bowels were freely acted on, (they were consti-
68 Harrises Cases of Epidemic Yellow Fever.
pated;) cold to head; barley water for diet and drink. Dr. B. having to be absent from the city for a week, requested my attendance upon him.
Oct, 6th, 7 P. M. I found him in the following state:— Pulse 120: bowels freely acted on; pain of epigastrium slight on pressure; abdo- men and skin hot; intense pain in head; tongue furred, and red at edges; eyes injected; thirst great; urine of a deep red, and deposit- ing a lateritious sediment. Repeat injection; tepid bath, with cold affusion to head; sponge body during the night every hour or two with whiskey, and should head still continue painful after the affu- sion, eight leeches behind each ear; ice in small pieces allowed slowly to dissolve in mouth, in addition to cold barley water.
7tli, 7 Ji. M. After the bath and affusion, he was so much relieved, that the leeches were not applied; slept several hours; pulse reduced to 90; skin much improved, and not far from natural; bowels freely opened; fur of tongue a little blackish in the centre; thirst greatly diminished; no pain in epigastrium; otherwise unchanged. A cold mucilage injection; occasional sponging; continue treatment. 6 P, M. Condition but little varied since morning, except now a slight pain in the head. Kepeat bath, with cold affusion; occasional sponging continued; continue treatment.
8^/i, 7 ^. M. Passed a restless night; appearance improved; other- wise no excitement felt; pulse 80; a little sickness of stomach, the consequence of neglect of his attendants permitting some exertion when getting out of the bathing-tub, which brought on syncope; tongue but little changed in colour in centre, but redness of edges neverthe- less; bowels open; urine deposits less sediment, and more pale; not much thirst; skin good. A sod. pulv. with tart, acid occasionally in effervescence; a warm pediluv. with mustard; a cool mucilage in- jection; desired and allowed the juice of an orange; continue barley water. 6 P. M. No sickness of stomach; tongue improved, and be- ginning to clean; does not complain. Continue treatment.
^th, 7 A. M, Slept well; desires to sit up, but forbid; all organs fast assuming their normal actions. Continue treatment.
lO^A, 7 Ji. M, Continues to improve; desires to eat, allowed arrow i-oot in small quantity at a time.
11/A. Tongue clean; bowels open and yellowish evacuations; con- valescent; allow chicken water.
\9ih. Continues to improve; appetite greatly increased. Chicken soup in the day, black tea and toast for morning.
\^ih. Discharged well.
Case XVIIL — Mr. H. set. 30, sanguine-lymphatic temperament,
Hdsvh^s Cases of Epidemic Yellow Fever. 69
second summer in New Orleans, an intimate friend of mine, was seized about 6 P. M. August 26th, 1833, with chilliness, pain in bones, lower part of back and epigastrium, succeeded by fever, &c. I was sent for, and saw him about 9 P. M. when he presented the following symptoms: — Fain in head, back, and epigastrium, the latter increased on pressure^ pulse 140, and fall; skin hot, particularly over abdomen; bowels constipated; great desire for cold drinks; tongue red and tremulous. Twelve cups to epigastrium, right and left hypochondrium, six to lower part of back; ol. ricin. §iss. to be suc- ceeded in two hours by injections of oil, molasses, and mucilage, re- peated every hour until bowels are freely acted on; cold afiusion to head; cold barley water, and iced water for drink in small quantity at a time, but often as desired.
27^/i, 6| A. M. Passed a restless night; bowels freely acted on^ pulse 120, but less full; pain of epigastrium, head and back, greatly relieved; nausea; urine red, and deposites a lateritious sediment; tongue furred and red at edges; the eyes injected; cups drew wen<j (about gxvi. of blood;) heat of abdomen and thirst but little varied. Repeat injection; tepid bath with cold aftusion to head, and cold cloths afterwards constantly applied to epigastrium and head, other- wise continue treatment, (except in addition carb. sod. with tart, acid, in effervescence, occasionally repeated.) 12 M Nausea rather increased; bowels freely opened; pain on pressing epigastrium; skin hot. A cold mucilage injection; three cups to epigastrium; continue treatment. 9 P. M. Pulse reduced to 100; sickness of stomach much relieved; yet head-ache; other symptoms but little changed. Repeat cold injection; warm bath with ailFusion of iced water to head; sponge body every hour or two with whiskey; continue treatment.
28//i, 6 Jl. M. Again passed a very restless night; was much re- lieved after the atfusion and bath, and calls for its repetition; bowels open; pulse 95; skin much reduced in temperature; thirst not so in- tense; other symptoms as noticed; head aches much less. Con- tinue sponging! repeat injection and bath, with cold affusion; conti- nue iced barley water and water; desires of being allowed to alter- nate his drink with orangeade. 9 P. M\ Much prostrated; pulse 90; does not complain but of dullness of the head; slept about an hour during the day; urine (and tongue not so deeply red, and furred a lit- tle brown) less deep in colour; eyes slightly injected, and a little wayward in appearance; bowels open; temperature of skin improved, but no disposition to moisture; thirst increased; but little nausea. .Eepeat cold mucilage injection; warm bath with cold affusion; four
70 Harris's Cases of Epidemic Yellow Fever.
leeches behind each ear^ continue sponging every two or three hours in the night; continue treatment.
29//2, 6 A. M. Slept several hours last night, and felt entirely re- lieved; tongue is less brown and red, and evincing a disposition to clean; no uneasiness in head; bowels open and yellowish; pulse 85, but weak; temperature nearly natural; urine deposites scarcely any sediment; no injection of the eyes, and complains only of a little nausea; disposed to sleep this morning; thirst almost absent; de- sires the juice of an orange, which was allowed. Sod. pulv. in ef- fervescence, when much nausea; a warm pediluvium about 9 A. M. Continue treatment. 9 P. M. Saw him during the day, but without difference in observation; nausea; pulse 80; bowels open; no pain on pressing epigastrium. Emplas. epispas. four inches square to epigas- trium, to remain on until morning, unless nausea is sooner relieved; in this event, to remove it in four or five hours; mucilage injection; repeat pediluvium, with the addition of mustard; continue barley water.
QQth. Epispastic soon relieved nausea; it was therefore removed, and dressed with cerate, after which he slept several hours; tongue cleaning; bowels open and discharge yellow; skin good; urine almost natural; pulse feeble; does not complain. Thin arrow root every hour or two; continue barley water.
From this time to September 4th, he continued very slowly to con- valesce; he now desires to eat something else, and chicken vs^ater is allowed.
5th. Appetite and strength fast increasing; allow chicken soup in the day; black tea and toast for morning.
6/A. Fast improving; desires and allowed an egg.
7th. Discharged well, with restrictions as to regimen.
Case XIX. — Mademoiselle -, set. 16, a Creole of the city, but
educated for the last seven or eight years in France, returned home in December last: temperament sanguine-lymphatic, ordinary stature, has menstruated for the last two years, was seized, August 24th, 1833, about 12 M. with rigors, pain in epigastrium and bones, par- ticularly lower part of back, succeeded by head-ache, fever, &c.; her menses should have appeared the day previous, but no indication was presented. I was called at 6 P. M. when the following observations were made. Pulse 130 and full; pain of head, epigastrium, andlower part of back; the pain of epigastrium increased on pressure; skin hot, particularly over abdomen; tongue red; eyes injected a little; bowels constipated; constant desire for cold drinlis. Forty leeches to.epi«
Harris's Cases of Epidemic Yellow Fever. 71
gastrium; ol. ricin. §i., to be succeeded bjan injection of ol. ricin., molasses, and mucilage in two hours, to be repeated every two hours until free discharges from intestines take places a tepid hip-bathj cold barley water for diet and drink.
25//i, 6 A, M. Passed a restless night, v/ith but little sleep; pulse reduced to 115| bowels freely opened; pain in head, back, and epi- gastrium much relieved by the leeches, which drew well; urine now of a deep red, and deposites a lateritious sediment; tongue furred, white, and red at edges; temperature of skin diminished; eyes much less injected; thirst great. Repeat injection; tepid bath with cold affusion to head; sponge the body every hour or two with whiskey; ice allowed slowly to dissolve in mouth; continue treatment. 9 P. M. Saw her during the day, but no material variation; pulse now 110; desired repetition of the bath and affusion; head still aches, and slight pain of epigastrium; bowels freely evacuated, (five or six times in the day;) eyes scarcely injected; other symptoms as noticed. Ten leeches to epigastrium; a cool mucilage injection; re- peat bath with affusion; continue treatment.
26jfA, 6 .^. M. Passed a less uncomfortable night than the preced- ing, having slept two or three hours; only complains of dullness in the head; no pain in epigastrium, and skin much reduced in tempera- ture; pulse 100; bowels open; tongue not so red at edges, but furred9 slightly brownish; thirst not so great; urine of a paler red, and depo- sites not so abundant. Sixteen leeches to inside of thighs; continue treatment. 8 P. M. Feels entire relief of the head; complains of nausea since 12 M.; other symptoms as noticed, except pulse, 90. Carb. sod. with tart acid, in effervescence, every hour or two, while nausea continues; a warm pediluvium; continue treatment.
27^/i, 6^ A. M. Passed a comfortable night; does not complain | pulse 80; skin good; thirst nearly absent; tongue showing a disposi- tion to clean; is much prostrated and reduced; all appearances good; slight appearance of her catamenia. Thin arrow root every hour or two, in small quantity at a time; desires orangeade, which is allowed. 28^/i. Saw her several times yesterday; tongue cleaning; appetite increasing; bowels open and yellowish. Continue treatment.
29^/i. Slight nausea came on this morning, owing to an attempt to be elevated in bed, but now has nearly disappeared. Continue treatment.
30//«. All nausea gone; desires to eat; allow chicken water. From this date to September 4th, she very gradually improved in strength. Now chicken soup, and a soft-boiled egg was allowed, the latter with black tea and toast in the morning.
72 Harris's Cases of Epidemic Yellow Fever,
6th. Is enabled to be up in her room. Discharged with restrictions.
Case XX. — The following case presents in the strongest light the truths of physiological medicine. Mr. J. N. H. a merchant, and par- ticular friend of an intimate professional friend of mine, the latter of whom was taken ill and absent from the citj. Mr. H. was of san- guine temperament; corpulent habit of body; first summer in the city; aet. about 33. He was affected with the ordinary premonitions of fever, in the night of September 7th, 1833. I was sent for, but the messenger procured another physician. On the night of the 12th of the same month, his friends came imploring me to visit him, as his condition, to use their expression, was hopeless. They had taken upon themselves the responsibility, and left the case, if I would see him, entirely under my guidance. This was at 11 P. M. When I saw him, I requested Dr. Hunt to be called, and, in conjunction, we would attend him, though with extreme reluctance, on account of public prejudice and public excitement. I learned that he had been treated, from the first commencement of the attack, with calomel, charcoal, and pulv. nit. potassse, in combination, Seidlitz powders, porter, &c. The powders of calomel, &c. I found were still being administered to him, together with the above articles. At this time we noticed his condition as follows: — Convulsive hiccoughs; mind much disturbed, and wandering delirium; discharges of charcoal from the intestines every fifteen or twenty minutes; continually crying, and momentarily expects his dissolution; skin cool; fulness of abdo- men; pulse small and tremulous; irritability of stomach; tongue red at edges; thirst considerable, and heat of stomach. Discontinue all previous treatment, and substitute the following. Epispas. ten inches square, to abdomen; cold barley and iced water for drink. In the morning, about 2 o'clock, we were aroused by there having been constant purging, since we left, of the above-described character. We prescribed syrup morphia, which fortunately checked the dis- charges, and calmed his great nervous excitability.
8th, 12 M Slept, but disturbed an hour or two after our visit; rambling and delirium continue; epispastic drew well, produced strangury; complains of intense heat; hiccough continues, and acid eructations all morning, and one fit of black vomit about half an hour since, and is preserved on a napkin; the hiccoughs convulse him. Three cups to nape of neck, and administered ourselves a warm bath with iced affusion to head; ice in small pieces allowed slowly to dissolve in mouth; continue barley water. Solut. of hyd. bismuth, table-spoonful every hour or two, so long as eructation continues. 8 F. M. Condition but little changed; bowels have been opened
Harris's Cases of Epidemic Yellow Fever, 73
two or three times to-day, of same character as abovej desires a repe- tition of his bath and affusion, which was most grateful to him; dis- charge of urine constantly by drops; no more black vomit. Eight leeches behind each ear; repeat bath and affusion; cool mucilage in- jection; continue treatment, with the addition of a tea-spoonful of thin arrow root occasionally.
Q^A, ^ Ji, M. Black discharges have occasionally taken place during the night from the intestines; hiccough continues, but less con- vulsing; delirium less; mind more calm; company has been ordered to be excluded ever since we have seen him; expresses his delight at the sensation of relief produced by the cold affusion. Cool mucilage injection; repeat bath and cold affusion; continue treatment. 8 P. M, Saw him several times during the day; getting more tran- quil; black discharges less frequent and less deep colour; hiccough, but rather less frequent and much less convulsing; thirst not so intense; head not entirely relieved; urinates rather more freely. Repeat bath and affusion; continue treatment; occasionally the solution of bis- muth.
10/A, Q A. M. Rested several hours last night; hiccough disap- pearing; sensation of heat fast vanishing; head as last reported Cool mucilage injection repeated; ice to head to be discontinued when uncomfortable to feelings; continue treatment.
llth^ 6 .^. M. Saw him several times yesterday, and the forepart of the last night; the ice to head was discontinued in two or three hours from its application; hiccough nearly ceased; all evidence of ir- ritation absent; urinates well; is tranquil; discharges from bowels be- gin to assume a natural appearance, (yellowish.) Continue treatment; barley water and arrow root. 4 P. M, Hiccough gone; is cheerful; pulse good; no wandering; continue arrow root and barley water. 8 P. M, Company in our absence have intruded, and conversed with him on business transactions, which has produced symptoms threat- ening more than ever his dissolution; he has parching thirst; ex- tremities cool; pulse quick and feeble; tongue red| delirium. Epis- pastic to nape of neck; a cool mucilage injection; continue treatment. 2 A. M, We were aroused from bed, and found him exceedingly restless, tossing in every direction in bed; such was the condition of his mind, that we feared to let him see us at that hour of the night, but unobserved by him we prescribed a cool mucilage injection; a warm pediluvium with mustard; and the epispastic to be removed and dress- ed, it had drawn well.
12^^, 6 A. M. Got more calm after the above directions were executed, and dosed for an hour or two; is now more quiet;
No. XXVIL— May, 1834. 7
74 Charlton's Cases of Gastritis.
delirium greatly abated, &c. pulse weak; extremities improved id temperature; thirst diminished greatly; discharges from intestines yellowish. Injection of weak beef tea every two or three hours; ice in mouth. 8 P. M. Saw him several times during the day; appear- ance has been fast improving; has become entirely calm; no wander- ing. Injection of beef tea repeated; a warm pediluvium with mustard; thin arrow root occasionally.
13/A, 6 Jl. M. Rested and slept calmly several hours last night, is again cheerful and free from any trace of irritation. Allow a little jelly occasionally through the day. From this date to 19th his nourishment was gradually made more nutritious and increased^ and is on last date enabled to be up in his room,
9.0th. Discharged well.
New Orleans J January, 1834.
Art. III. Cases of Gastritis Superinduced. By Thomas J. Charlto% M. D. of Georgia.
JL HE physiological practice is entitled not only to the positive merit of curing disease, but also to the no less important negative one of preventing the use of injurious and empirical remedies. In truths when we remark the delicate structure of the mucous membrane of the primae vise, and the essential nature of their normal condition to health and vitality, and at the same time reflect what improper and corrosive substances were lavishly placed in contact with it, we can scarcely refrain from asserting that in very many cases the dis- ease was less dangerous than the physician. Most especially in the fevers of warm countries has this membrane suffered from injudi- cious treatment; the more intense its inflammation the more indus- triously was this added to by tonics and diffusible stimuli, and when by these means it approached disorganization, evincing itself by the black tongue, cold skin, and the debility, it was said to be reaching its ultimatum, and to be only remediable by the most profuse administra- tion of the most powerful excitants. Is it wonderful that the sup- posed typhus state of fever, was common and fatal under a modus medendi, as rational as that which in Turkey loads the sufferer from small-pox with warm clothing, applies hot plasters to the eruption^ and diets him on hot caviare? The truth of the inferences which the able founders of the physio-
Charlton's Cases of Gastriiis. 15
logical school have drawn, not only from the fallible, (and heretofore principal basis of medical systems, ) ontology, but also from numer- ous and minute post mortem examinations, will eventually carry conviction to all minds sufficiently candid to reject error when con- vinced of it, however fatal such rejections may be to favourite theories. Broussais' works are already in the hands of nearly every intelligent physician of our country, and the plan of treatment inculcated in them is becoming established in chronic disease of the viscera, but those of an acute character are still frequently subjected to the '' incendiary practice," and as long as this is the case, it is the duty of every me- dical practitioner to furnish such facts as may have occurred to him, leaving the inferences to the candour and discrimination of the profes- sion. It is with this view that I offer for publication the following cases taken from many others of a similar character, and equally conclusive. Francis Demere, nine years old, had been attacked with the usual symptoms of climate fever, five days before I saw him; being at some distance from medical aid, he was treated by his parents. On the second day a cathartic was given, which increased the nausea and vomiting, which had existed from the onset; another M^as given on the third day, with the same effect, and from the continuance of this symptom he was supposed to be suffering from a redundancy of bile, and that an emetic was indicated; one grain of tartar emetic was ad- ministered, which increased the distress and nausea, but did not cause much vomiting; all his symptoms became worse, and when I saw him, (12th August,) his pulse was small, and 125 a minute; his skin very cold; complexion palled; and the tongue brown; I recog- nised gastritis, and ordered blisters to his extremities, and small quantities of gum water, acidulated with orange juice for drink; the tongue in six hours became cleaner, the skin warmer, and the pulse fuller and slower; but at the accession of the cold stage of the nest paroxysm, (the type was double tertian,) the debility appeared so urgent that I was induced to give a tea-spoonful of wine «very fifteen minutes; this stimulant evidently increased the gastritis, the tongue became dark again, the skin cold, and at the same time there was in- tense suffering from internal heat, and an urgent demand for cold drinks. I determined to resume and adhere to the plan of treatment first adopted; at each accession of the paroxysms I endeavoured to sustain the system by the application of mustard plasters to the ab- domen and extremities, and during the paroxysm I gave the gum Arabic water and lemonade. I was gratified by seeing the evidences of gastritis slowly subside, and by a gradual resumption of food, the patient acquired his usyal health.
76 Dudley on Congestive Fever.
The next case I have selected is that of a negro. Catherine, twenty years old, had been attacked with pleurisy seven days before I saw her; she had been bled, but not sufficiently, and had taken a cathartic and two emetics of the sulphas zinci; when I saw her, gastritis had been superinduced, her pulse was quick and small, there was great distress and oppression in the epigastrium, the tongue was dark, and she was comatose when not roused. The cough was not troublesome, the expectoration was copious, and iho, respiratory murmur as dis- tinct as usual, there was no evidence of etfusion in the thorax. Be- lieving her to be suffering more from mal-practice than from the ori- ginal disease, I directed my efforts to the purpose of subduing the gastric irritation which I attribute to the emetics. I cupped her over the epigastrium, and gave her small quantities of flaxseed mucilage cold frequently. The disordered intelligence soon improved, and the tongue became clean; but having indulged in the use of food at night, all her symptoms became worse, and her disease appeared to be ap- proaching a fatal termination. I directed blisters to the legs and abdomen, purgative enemata and gum Arabic water. The termina- tion of her disease was long doubtful, but she eventually recovered by a persistence in the use of mucilages and a rigid diet.
Bryan County, Georgia, January 15th, 1834.
Art. IV. Thoughts on the Bilious Remittent, commonly called Con- gestive Fever, By Theodore Bland Dudley, of Alexandria, Louisiana.
OOME one has said quaintly, but forcibly, that "words are the counters of wise men, but money of fools." It is much to be lamented, that in medicine, as well as in religion and politics, there should be so much of fanaticism prevail; words or names are substituted for things, and reasoning in a specious but delu- sive garb, often misleads even those who are most proud of assent- ing to nothing that is not sanctioned by its dictates. Why else is it, that some favourite dogma in our science, from the days of Paracel- sus to the present time, always has its day? Sangrado with his warm water; Brown with brandy and opium; Rush with his lancet; to a host of minor luminaries, with their drachms of calomel, which they unceasingly pour down without scruple.
These reflections have grown out of the present prevailing notion,
Dudley on Congestive Fever, 77
that calomel, and calomel alone, should be our sole reliance in the treatment of the various grades of remittent fever of southern cli- mates. It is a Samson indeed, and its strength may be applied to useful and salutary purposes; but that does not vi^arrant, in the eye of dispassionate and philosophical reasoning, the tearing down the temple, to the utter destruction of the edifice and its inmates.
The mode of reasoning of the advocates of this Herculean system is simply this, that in a certain form of fever commonly called con- gestive, there is an engorged state of that complex and important organ called the liver, whose office is the secretion of bile, so essen- tial to the healthy action of the animal economy — that calomel having a more decided specific action on that organ than any other known ^gent, it must be given ad infinitum, till the liver is brought into subjection, and a healthy performance of its functions. This is plau- sible reasoning, and would be valid enough, if the fact be admitted, that it will generally produce the desired result without any con- comitant evils; and it were equally well established, (as they as- sume,) that there are no other agents, which alone, and especially as adjunct to the mercurial system moderately enforced, will produce the desired result without its concomitant evils.
The theory that the mercurial fever is essential to subduing that already existing^ is, I think, toto coelo, fallacious. It has arisen from the fact, that in particular grades of morbid excitement in this con- gestive fever, when salivation is induced, the patient becomes con- valescent; it is inferred from a very common, but fallacious mode of reasoning, (the placing effect for cause, and vice versa,) that saliva- tion is essential to cure. But I believe that in every instance, where this state of things results, the same effect would have ensued from a much more simple and harmless procedure, the evacuant and sedative course; convalescence is more speedy, and the horrible consequences that occur when salivation cannot be induced, viz. mercurial gan- grene often, and chronic mercurial disease generally would be ob- viated. I have witnessed in numerous cases the most shocking and deplorable consequences from this pernicious abuse of mercurials, the patient dying by inches, an object of the most intense and agonizing sympathy to the friends, and of loathing and hoi-ror to the spectator, of hopeless wretchedness.
The autumnal remittent, commonly called congestive fever, as it usually prevails in the southern part of the United States, and espe- .cially on Red River, where the writer of this article has seen and marked its character, commonly commences with the usual precur- ,sor9 of fever— languor; lassitude; indisposition to action; loss of appe-
.7*
78 Dudley on Congestive Fevef.
tite; chill, not always distinctly sensible to the patient, but with, evident shrinking of the extremities, followed by febrile paroxysm, more or less sensibly developed^ yellow discoloration of the skin, and especially of the conjunctive coat of the eye. The patient for seve- ral days is able to go about, but finally confined by aggravation of all symptoms. Excessive irritability of stomach now comes on, accom- panied by torpor of the bowels, which are with difficulty moved by ordinary cathartics. During the cold stage, which often continues from four to six hours, the irritability of stomach is greatly aggra- vated, and is indeed one of the most distressing and uncontrollable symptoms of the disease. The pulse is feeble and thready, not much, increased in frequency, and greatly diminished in volume. The tongue is furred, and of various colours, from light brown to a dark inky hue 5 generally moist.
If this state of things is not met with promptitude and energy, there is a rapid decline of all the vital powers, and the patient dies on the seventh, ninth, or eleventh days. The disease invariably as- sumes the tertian type, the paroxysms being more violent on the al- ternate days5 there is however a daily chill, which on the odd, or critical days, is greatly aggravated.
The indications of cure are obviously to equalize action, to ab- stract from organs most labouring under a suffocated state of excite- ment, and to invite action to those parts where there is an evident deficiency. With this view during the remissions, it is desirable to produce a prompt action on the bowels by cathartics, and of this class of medicines, I have found calomel combined with rhubarb alone, and sometimes with aloes, as in the following prescriptions, the most efMcient. R. Merc. mit. gr. x. vel xij.5 pulv. rhsei, 9j. Or the following: — R. Merc, mit., pulv. rhaei, pulv. aloes socot. aa. gr. X. M. ft. pill, vel bolus. In from three to six hours, should there be no decided effect on the bowels, give an active dose of castor oil, and should this fail, cathartic enemata should be freely adminis- tered, till the desired effect be produced. During the hot stage, the free use of saline diaphoretics has the happiest effects in counter- acting the unequal distribution of the excitement, tending to an evi- dent mitigation of all the violent symptoms^ as soon as diaphoresis manifests itself, with this view, whenever the hot stage is decidedly developed, unaccompanied by irritability of stomach and vomiting, the following prescription will prove highly beneficial. R. Antimon. tart. gr. j.j pulv. nitri. Jss.; aq. font. ^vi. M. ft. mist. A table- spoonful to be given every hour till free perspiration supervene. Should the inflammatory action run high, and the above prescription
Dudley on Congestive Fever, 79
fail to produce the desired effect, the lancet should be called into its aid. But should there be great irritability of stomach, as is often the case, the following prescription should be substituted. R. Carb. potassae, gr. x.j aq. font, ^j.^ succ. limon. q. s. ad ejus saturatio- nem — ^quaque hora adhibenda donee supervenirit diaphoresis.
Should this fail to allay the irritability and vomiting, apply a large blistering plaster over the region of the liver and stomach, and recur again to the purgative enemata, either of which remedies alone has the happiest effects in arresting vomiting, and relieving the sensation of anxiety and oppression, which are in most cases horribly severe.
In this state of things the patient often complains of intense burn- ing sensations, and anxiously beseeches the use of the fan to produce ventilation; when the parts so complained of are greatly below the natural temperature; when the extremities are cold, and the general temperature of the body is below the healthy standard.
During the existence of this stage of the disease, so distressing to the patient, (for this is the period of greatest anxiety and suffering,) I have found the semicuprium followed by frictions, with a warm in- fusion of Cayenne pepper in brandy, to act most powerfully in pro- ducing revulsion: sometimes sinapisms or blistering are necessary to keep up a permanent impression: often hot bricks or bladders, or bot- tles filled with hot water, will have the desired effect.
There is always a marked alleviation of all the urgent symptoms of this fever as soon as free alvine evacuations are produced, which ex- hibit in colour and consistence almost every variety of shade. Some- times in milder cases simple bilious discharges are produced, and such cases are soon brought to a favourable crisis, by keeping a con- stant eye to the free evacuation of the bowels during the remissions, and the use of the saline diaphoretics above-mentioned during the fe- brile paroxysms; but in other cases of aggravated forms of the dis- ease, this desideratum is with difiiculty obtained. There seems to be so great an accumulation of morbid secretions producing torpor of the bowels, that the most active cathartics appear feeble and inefficient; in this state the exhibition of active cathartic enemata as adjuvants is attended with the happiest and most decided good effects.
The writer has witnessed cases where the degree of exhaustion was so great that the patients had become pulseless, and all the ordinary precursors of approaching dissolution were rapidly developing them- selves. When the exhibition of strong purgative enemata has been re- sorted to, bringing away copious acrid, vitiated secretions, there has been a return of pulse, and an increased strength and fulness after
80 Mutter's Instrument for Operating in Fistula in *^no.
each discharge, and this in cases too, where a timid and cautious practitioner would dread exhaustion from purgation.
Whenever local congestions exist, cupping and leeching are highly salutary — the pulse becoming slower and fuller, even after a very small abstraction of blood has taken place. As soon as this happy re- sult occurs, viz. a more generally diffused state of the excitement, a remission of all the urgent symptoms immediately follows, and con- valescence is speedily established, which requires little further to complete the cure than a due attention to the state of the bowels, and a strict regard to diet.
Art. V. An Account of a New Instrument for Operating in Cases of Fistula in Ano. By Tkomas D. Mutter, M. D. one of the Physicians to the Philadelphia Dispensary, &c.
Jr ROM the time of Hifpo crates down to the present day, no disease has excited more attention, and been studied with more success, than the one termed, (though very incorrectly in most cases,) fistula in ano: its causes, its phenomena, the indications to be fulfilled in its management, have all been clearly and positively demonstrated; it would therefore be worse than useless for us to enter, at this late period, into an elaborate history of the disease. It will be neces- sary, hov/ever, to notice the usual divisions of fistulas, in order to render apparent the design and modus operandi of the instrument about to be described. When a discharge by incision of the contents of an abscess situated in the neighbourhood of the rectum has been too long delayed, the matter will of its own accord force for itself an opening, either through the external parts in the neighbourhood of the anus, or through the parietes of the rectum. Occasionally it happens, that we have both an internal and external orifice, existing at one and the same time. These different conditions have given rise to a division of anal fistulse into three species— 1st, those in which the matter escapes by one or more openings through the integuments alone, and which are called ''blind external fistulssj" 2d, those in which the matter empties into the cavity of the rectum, and no ex- ternal opening exists, which are called "blind internal;" and 3d, those in which an opening exists both in the gut and skin, which are termed <' complete fistulae." Notwithstanding the assertion of MM«
Mutter's Instrument for Operating in Fistula inJino. 81
FouBERT and Ribes, and to which opinion Sabatier inclines, " that no such thing as a blind external fistulas can exist, and that in all cases there is an opening into the gut," both experience and reason lead us to contend, that so far from this state of things never occur- ring, it is the most common variety of fistula in ano^ and this I be- lieve is the opinion of the most experienced surgeons of the present day. The difficulty with which a sinuous ulcer, when located in loose cellular tissue, heals, has long been fully appreciated, and numerous methods of effecting this end have been introduced into practice; caustics, stimulating applications, incision, extirpation, &c. have all been tried at different periods, and with varying success. The father of medicine long ago taught this fact, and to him are we indebted for the very measures made use of at {he present day in the treatment of fistulse, though modified it is true, both as regards the cases to which they are applied, and the instruments employed. The indication to be observed in the treatment of fistula in ano, (a disease belonging to the class of *' sinuous ulcers situated in loose cellular tissue,") is the division of the barrier existing between the sinus and the cavity of the gut, and formed chiefly by the walls of the latter, by which means the two cavities will be thrown into one, and an open sore, instead of a hollow sinuous one, established.
The ancients were fully aware of the importance of this indi- cation, and their remedies for the most part were directed to ob- tain its fulfilment. In some cases, however, they attempted to heal the sinus by the introduction of caustic substances into its cavity. It may not prove uninteresting or inapposite to pass in review some of their different plans of treatment, and first of Caustics. Hippocrates formally recommends the application of caustic substances to the in- ternal surface of a fistulous canal. He applied them by means of a linen tent, (of sufficient length to pass from one orifice of the fistula to the other,) which was first rolled in cerate, and then dusted over with the substance to be used. It was introduced into the tract of the fistula by means of a probe, to which it was attached by a thread; this was introduced through the external orifice and brought out through the anus. A suppository of horn was then inserted into the rectum. On the sixth day the caustic tent was removed, and a simple one introduced in its place; the horn suppository was like- wise removed, and replaced by one of alum. This practice was founded upon the supposition, that the parietes of every fistulous canal were necessarily callous, an opinion which it is almost needless to say, is erroneous. The plan, however, seems to have never ac-
82 Mutter's Instrument for Operating in Fistula in Ano.
quired much reputation, and had nearly fallen into oblivion, when it was revived by Dionis, in France. Since his time, though frequent- ly spoken of by surgical writers, it has never been introduced for obvious reasons into general practice.
Cautery. — Passing a bistoury heated to a white heat along the tract of the fistula, has also been recommended; this method of course never obtained much reputation. The rationale of its operation is obvious.
Ligature,—-ThQ treatment of fistula by the ligature is no less ancient in its origin than that by caustic. To the Coan sage we are also indebted for this practice, though Celsus, among the ancients, may be considered as having given the most lucid and useful descrip- tion of its applicatic n and modus operandi. Almost every writer since his time has taken especial notice of this practice, some recom- mending it as the most certain, least painful, and least dangerous of all methods hitherto made use of; others again condemning it as tedious, painful, and uncertain. Desault, among the more modern authorities, directs it to be employed in all cases where the fistula extends beyond the reach of the finger, and where from the position of the neighbouring vessels they must unavoidably be wounded in any operation i erformed with a cutting instrument. His practice was to pass a leaden wire through the fistula, and then bring it out at the anus. The ends of the wire were then twisted together, and the loop gradually tightened every day. By this means, ulceration and absorption of the barrier between the gut and sinus would in time be effected, and the two cavities converted into one. The liga- ture is sometimes made use of at the present day in similar cases, though for the most part it has been entirely abandoned.
Extirpation. — It is as yet a mooted point to whom the credit of this operation is due. Pott gives it to Guy de Chauliac; Bertrandi to iETius, who wrote about the end of the fifteenth century. Celsus also mentions it. However this may be, the modern surgeon never thinks of employing it, except perhaps in those cases in which several fistulse communicate with each other, the parietes of which are ex- ceedingly callous or scirrhous. In all others it should be rejected, as it is frequently followed by hsemorrhage, fever, profuse suppuration, diarrhoea, and contraction of the orifice of the anus from loss of sub- stance. It consists in the extirpation of a slip or narrow portion of the barrier between the gut and sinus, by means of two. parallel in- cisions, and its object is to prevent the too rapid healing of the wound.
Incision. — The most experienced surgeons of the present era have
Mutter's Instrument for Operating in Fistula in Jino. 8^
for a long time abandoned these different methods, (with the excep- tion of the ligature occasionally used,) and confine themselves to the operation, in v/hich the tissues situated between the sinus and cavity of the rectum, are merely divided or incised. It is to Hippocrates again^ that we are indebted for this operation, which, although re- stricted by him to those cases in which there existed no communication between the fistula and the cavity of the gut, has been applied by mo- dern surgeons to almost all conditions of the disease. Various instru- ments and plans of operation have been invented to effect this end "with the greatest facility to the operator, and with the least pain to the patient. The French method differs materially from the English and American. In the French operation, a kind of director, called a gorget, which is usually made of ebony wood, and intended to be in- troduced into the rectum, with its concavity turned towards the fis- tula, is made use of. After this has been properly placed, a steel di- rector, inflexible, slightly pointed, and without a cul-de-sac, is passed through the fistula until its point comes in contact with the wooden gorget. A long, narrov/, sharp-pointed, straight bistour}^, is now in- troduced along the groove of the steel director, till its point meets the groove of the ebony gorget, by cutting upon which all the parts are divided which lie between the internal opening of the fistula and the anus. The English operation is performed with merely the fore- finger of the left hand introduced into the rectum, and a knife, which is passed through the fistula until it arrives at the finger, in ano. The two, after being properly balanced, are then withdrawn together, di- viding as they pass along the barrier between the rectum and sinus. This operation is superior to the French, inasmuch as it is more sim- ple, and more easily performed. There exists, notwithstanding, a difficulty to be overcome of no trifling importance in some cases, and which is occasionally a source of embarrassment to the surgeon, when the latter operation is performed: it is the introduction of the knife into the cavity of the rectum when no communication between it and the sinus exists. The ingenuity of different surgeons has led to the introduction into practice of several variously-contrived knives, which have been invented with the design of effecting this indication, and at the same time guarding the finger of the surgeon from all danger of being wounded. For the most part, all of those which have come under our observation are faulty in some respect or other. Before, however, entering upon an analysis of their merits, it may be as well to state what indications an instrument intended for operating in fis- tula in ano, should be capable of fulfilling. In the first place it should be so constructed that it may be used in all cases of fistula,
84 Mutter's Instrument for Operating in Fistula in Ano,
whether complete or incomplete. 2d. Its blade should be shielded so as not to cut the tract of the fistula as it is introduced? by which means the patient is saved a great deal of pain. Sd. Its point should be so formed, that the finger of the operator, during the division of the parts, will be in no danger of being wounded by it. 4th. It should be sufficiently small to admit of easy introduction into fistula of the usual size. 5th. It should be simple and cheap. Let us see if the in- struments usually employed fulfil all of these indications.
Prohe-pointed bistoury. — To the common probe-pointed bistoury, the instrument generally recommended as the most simple and easily used, it may be objected, in the first place, that in cases where it is necessary to make an opening into the rectum, it will not answer from the bluntness of its point; for it will be found almost impossible to make it penetrate the gut, provided the latter