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THE

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES.

EDITED BY

ISAAC HAYS, M.D.,

SURGEON TO WILLS HOSPITAL,

PHYSICIAN TO THE PHILADELPHIA ORPHAN ASYLUM, &C., &C.

NEW -SERIES. VOL. IL

PHILADELPHIA: LEA & B L A N C H A R D .

LONDON: AV I L E Y & P U T N A ra .

1S41.

6942.9

Philadelphia : T. K. & P. G. Collins, Printers, No. 1 Lodge Alley.

TO HEADERS AND COEHESPONDENTS.

The communications of Drs. Flint, Shipman, Zabriskie, and Davis shall have a place in our next Number.

Tlie following works have been received: —

An Essay on the Connection of Mental Philosophy with I\Iedicine. By Nathan AiiEN, A. M., M. D., Editor of the American Phrenological Journal and Miscellany. Philada. 1841. [From the author.]

Lectures on Phrenology. By Frank H. Hamilton, M. D., Professor of the Theory and Practice of Surgery in Geneva Medical College and Vermont Academy of Medi- cine. Delivered before the Rochester Athenssum, February 9, 1S41. By request. Ro- chester, 1841. [From the author.]

A Discourse on the Characters, Properties, and Importance to Man of the Natural Family of Plants, called Graminese or True Grasses. Delivered as a Lecture before the Class of the Chester County Cabinet of Natural Sciences, Feb. 19, 1841. By Wai. Darlington, M. D. West Chester, Penn. 1841. [From the author.]

Letters on the College of Physicians and Surgeons, By Graviora Manent. New York, 1841. [From the author.]

Transactions of the Medical Society of the State of New York, vol. 5, part I, 1841. [From the society.]

Boyleston Prize Dissertations, for the years 1838 and 1839, on Scrofula, Rheumatism, and Erysipelatous Inflammation. By Edward Warren, M, D., Fellow of the Massa- chusetts Medical Society. Philada. lS41. [From the author.]

A Practical Treatise on the Human Teeth — showing the causes of their destruction and the means of their preservation. By Wm. Robertson. With plates. First American, from the second London, edition. Philada. Lea & Blanchard, 1841. [From the pub- lishers.]

Observations on Ergot. Read before the Medical Society of the State of New York, February, 1841. By John B. Beck, M. D., Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and Surgeons of New York. Albany, 1841. [From the author.]

On the Medical and Prophylatic Treatment of Stone and Gravel, with a memoir on the Calculi of Cystine. Bv Civiale, M. D. Translated from the French, by H. H. Smith, M. D., of Philadelphia. Philada. 1841. [From the author.]

State of the New York Hospital and Blooiningdale x\sylum for the year 1840. [New York, 1841. [From Dr. John B. Beck.]

Dissertations of Hemorrhages, Dropsy, Rheumatism, Gout, Scrofula, &c., &e., with a Formulary and General Index. Edited by Alexander Tweedie, M. D., F. R. S,, &c. With notes, by Wm. W. Gerhard, M.D. "'Philada. 1841. [From the publishers.]

Outlines of a Course of Lectures on Medical Jurisprudence. By Thomas Stewart Traill, M. D., F. R. S., &.c., &.c., Regfius Professor of I\Iedical Jurisprudence and Medical Police in the University of Edinburgh. First. American, from the second Edinburgh edition. Revised, with numerous notes. Philada. 1841: Lea & Blanchard. [From the publishers.]

The Sanative Influence of Climate, with an account of the best places of resort for Invalids in England, the South of Europe, &c. By Sir James Clark, Bart., M. D., F. R. S., Physician in ordinary to the Queen and Prince Albert. Third edition. Lon- don, John ]\Iurray, 1841. [From the author.]

Das Hamburgische Collegium Medicum und dcr arztliche Berein in Hamburg. Im auftrage des Bereins zur 25jahrigen Inbelfeier depselben arn 2 Januar, 1841. Heraus- gegeben von F. N. Schrader, Dr. Med. and Chir. Hamburgh, 1840. [From Dr. Rothenburg, Sec. Med. Soc. Hamburg.]

Rede am 2 Januar, 1841, als dem 25jahrigen Stiftungstiige des a.rztlichen Vereins in Hamburg, gehalten von D. Siemers, Vorsitz fiihrendcm Mitgliedc der Direction des Vereins. [From Med. Soc. of Hamburg.]

1*

6

TO READERS AND CORRESPONDENTS.

The Seventeenth Annual Report of the Directors of the Retreat for the Insane, at Hartford. Hartford, 1841. [From Dr. Brigham.]

Catalogue of Medical Graduates of the University of Pennsylvania, April 2, 1841. [From the faculty.]

Annual Report to the President and Trustees of the Medical College of the State of South Carolina, with the Valedictory Address to the Class. By Samuel Henry Dick- son, M. D., Professor of the Institutes and Practice of Medicine. Published by the Faculty. Charleston, 1841. [From the author.]

Proceedings of the President and Fellows of the Connecticut Medical Society, in convention. May, 1841, with a list of the Members of the Society. Hartford, 1841. [From the secretary. Dr. Welch.]

Zeitschrift fiir die gesammte Mcdicin, mit besonderer Rucksicht auf Hospital praxis und auslclndische Literatur. Herausgegcben von J. C. G. Fricke und F. W. Oppen- HEiM. November and December, 1840j January, February, March, and April, 1841. [In exchange.]

Jahrbuch der gesammten Staatsarzneikunde. Herausgegeben von Dr. C. F. L. Wild- berg. Bd. VI, H. J and 2, 1840. [From Dr. Oppenheim.]

Wenken en Meeningen omtrent Geneeskundige Staatsregeling en Algemeene Ge- neeskunde, von J. P. Heije. Vol. I, Nos. .3 and 4; vol. II, Nos. 1 and 2. [From Dr. Oppenheim.]

Repertorisches Jahrbuch fiir die Leistungen der gesammte Heilkunde, im Jahre, 1838, von J. J. Sachs, M. D, &c., &c. Leipzig, 1839. [From Dr. Oppenheim.]

Journal des Connaissances Medico-Chirurgicales, November and December, 1840; January, February, and March, 1841. [In exchange]

Revue Medicale Francaise et Etrangere, October, November, and December, 1840; January and February, 1841. [In exchange.]

Journal de Medecine et de Chirurgie Pratiques, November and December, 1840; January, February, and March, 1841. [In exchange.]

Gazette Medicale de Paris, November and December, 1840; January, February, and March, 1841. [In exchange.]

Journal des Connaissances Medicales Pratiques et de Pharmacologic, November and December, 1840; January and February, 1841. [In exchange.]

La Lancette Frangaise, November and December, 1840. [In exchange.]

Journal de Pharmacie, November and December, 1840; January and February, 1841. [In exchange.]

The Edinburgh Medical and Surgical Journal, for April, 1841. [In exchange.] The British and Foreign Medical Review, or Quarterly Journal of Practical Medi- cine and Surgery, for April, 1841. [In exchange.]

The Medico-Chirurgical Review and Journal of Practical Medicine, for April, 1841. [In exchange.]

Provincial Medical and Surgical Journal, edited by Hennis Green and Dr. Streeten, April and May, 1841. [In exchange.]

The London Medical Gazette, for January, February, March, and April, 1841. [In exchange.]

Tlie Boston Medical and Surgical Journal, April, May, and June, 1841. [In ex- change.]

The American Medical Library and Intelligencer, February and March, 1841. [In exchange.]

The Select Medical Library and Bulletin of Medical Science, for April, 1841. [In exchange.]

The New York Journal of Medicine and Surgery, April, 1841. [In exchange.] Tije Western Journal of Medicine and Surgery, April and May, 1841. [In ex- change.]

Tiie American Journal of Pharmacy, April, 1841. [In exchange.]

CONTENTS

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES. No. Ill, NEW SERIES. JULY, 1841.

ORIGINAL COMMUNICATIONS. MEMOIRS AND CASES.

ART. PAGE.

I. Statistical Researches elucidating the Climate of the United States and its relation with Diseases of Malarial Origin; based on the Records of the Medical Department and Adjutant General's Office. By Samuel Forry, M. D., of New York. 13

II. Notes of Observations in Obstetric Pathology. By Chandler R. Oilman, M. D., Professor of Obstetrics and the Diseases of Women and Children,

in the College of Physicians and Surgeons, New York. - - 47

III. Observations on Congestive Fever. By Thomas Barbour, M. D., of Pulaski, Tennessee. - 56

IV. Cases of Injury of the Head. By A. B. Shipman, M. D., President of the Cortland County, New York, Medical Society. - 66

V. Cases of Cleft Palate. By Thomas D. Mutter, M. D., Professor of the Institutes of Surgery in Jefferson Medical College. - - - 74

VI. Case of Congenital Tumour of the Eyeball. By W. T. Taliaferro,

M. D., of Maysville, Ky. 88

VII. An Examination of the Testimony relative to the Efficacy of the Hy- drated Peroxide of Iron as an Antidote to Arsenic, with Directions for its Preparation and Exhibition. By T. Romeyn Beck, M. D. - - 90

VIII. Case of Nephritis. By A. B. Snow, M. D., of Boston, Mass. Read before the Boston Society for Medical Improvement, March 23, 1841. 95

IX. Report of Cases Treated in the Baltimore Alms-House Hospital. By Samuel Annan, M. D., Senior Physician to the Institution. - 99

X. Obstetric Cases. By William Zollickoffer, M. D., Fellow of the College of Physicians and Surgeons of the University of the State of New York, &c. &c. 109

XI. Ligature of Subclavian Artery for the Cure of Axillary Aneurism caused

by Gun-shot Wound. By Josiah C. Nott, M. D., Mobile, Alabama. Ill

MEDICAL EDUCATION AND INSTITUTIONS.

XII. The Royal College of Surgeons, in London, with an Abstract of the Case of Thomas Tripple. By Pliny Earle, M. D. - . - 1I3

REVIEW.

XIII. The Library of Practical Medicine. A System of Practical Medicine, comprised in a series of original dissertations. Arranged and Edited by

8

CONTENTS.

ART. PAGE

Alexander Tweed ie, M. D., F. R. S. &c. &c. Diseases of the Digestive, Urinary, and Uterine Organs. 8vo. pp. 516; Philadelphia; Lea & Blanchard, 1841.

RETROSPECTIVE REVIEW.

XIV. Theodori Kerckringii, Doctoris Medici, Commentarius in Curruin Triumphalem Antimonii Bassillii Valentini, a se Latinitate donatuna. Amstelodami, 1671: 12mo. pp. 342.

The Triumphal Chariot of Antimony, by Basil Valentine, translated into Latin, and enriched with a Commentary, by Theodore Kerckringius, M. D., Amsterdam, 1671. 136

BIBLIOGRAPHICAL NOTICES.

XV. Recherches Anatomiques, Pathologiques, et Therapeutiques sur la maladie connue sous les noms de Fievre Typhoide, &c. Seme edition, considerablement augmentee. Par P. C. A. Louis, Paris, 1841.

Anatomical, Pathological, and Therapeutic Researches, concerning the disease known by the name of Typhoid Fever, &c. 2nd edition, con- sideraby enlarged. By P. C. A. Louis. Two vols., pp. 534, and 516. Paris, 1841. 150

XVI. Second Annual Report of the Registrar-General of Births, Deaths, and Marriages in England. London: 1840. 8vo. pp. 240. - - 155

XVI. Grundziige zur Dipsobiostatik, order Politisch-Arithmetische, auf arztliche Besbachtung gegriindete Darstellung der Nachtheile, vi^elche durch den Missbrauch der Geistigen Getranke in hinsicht auf Bevolke- rung und Lebendauer sich Ergeben. Von Dr. Fr. Wilh. Lippich. Erstes und sweites hundert der Beobachtungsfaller, 8vo., pp. 150. Liabach, 1834.

Sketches of Dipsobiostatics, or a Politico-Arithmetical Exposition of the Prejudicial Influence Resulting from the Abuse of Intoxicating Drinks, in respect to Population and the Duration of Life, based upon Medical Ob- servations. By Dr. F. W. Lippich. First and second century of obser- vations. 161

XVIL Manuel d'Hydrosudopathie, ou Triatement des Maladies per I'eau froide, la sueur, I'exercice, et le regime, suivant la methode employee par V. Priessnitz, a Grsefenberg. Par le Docteur Bigel, Medecin, &c. &c. &c. &c. Suivi d'un Memoire Physiologique sur la Chaleur Animale. Par M. Pelletan, Professeur, &;c., a Paris, pp. 396, 12mo. Paris. Bailliere: 1840. 168

XVIII. Die Lehre von der Zurechnungsfahigkeit bei sweifelhaften Ge- muthszustanden. Fur Aartze und Juristen praktisch dargestellt. Von Dr. Adolph Schnitzer. Berlin: 1840.

The Doctrine of Responsibility in cases of doubtful State of Mind. - 171

XIX. A Practical Treatise on the Human Teeth: showing the causes of their Destruction, and the means of their Preservation. By Wm. Robert- son. With plates. First American from the second London edition. Philadelphia: Lea & Blanchard, 1841. 8vo. pp. 229. PI. VI. - 171

XX. An Essay on the connection of Mental Philosophy with Medicine. By Nathan Allen, A. M., M. D., editor of the American Phrenological Journal and Miscellany. Philadelphia: 1841. 8vo. pp. 32. - - 173

XXI. Boylston Prize Dissertation, for the years 1838 and 1839, on Scrofula, Rheumatism, and Erysipelatous Inflammation. By Edward Warren, M. D., {Fellow of the Massachusetts Medical Society. Philadelphia: 1840. pp. 122. 172

CONTENTS.

9

SUMMARY

OF THE

IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES.

FOREIGN INTELLIGENCE.

Anatomy and PHYSiOLoar.

1. Fibres in the Walls of the Gall-Bladder. ByM. Barth. 173

2. On the varying Proportion of some of the Principles of the Blood in Diseases. By MM. Andral and Gavaret. - - 173

3. Existence of Fibrine in the Blood in the Shape of Globules. 174

4. The Physical and Moral Quali- ties observed in Adult Age are evinced at Birth. By M. Blan- chet. 174

Pathological Anatomy.

5. Acephalocysts in the Brain.

By Dr. Michea. - - - 175

6. Rupture of the Fallopian Tube from accumulation of the Cata- menial Fluid. By Dr. Munk. 175

7. Remarkable Spina Bifida. By

Dr. Verrall. - - - - 176

8. On Sudden Death. By Mr. Winslow. - - - - 176

9. Obliteration of the Inferior Vena Cava. By Dr Gely. - 178

Medical Pathology and Therapeutics and Practical Medicine.

10. Results of Re-vaccination in the Deaf and Dumb Institution of Paris.

1 1 . General result of the Vaccina- tions and Re-vaccinations in

France. By M. Villeneuve.

12. Anatomico-Pathological Re- searches on Cirrhosis of the Liver. By Alfred Becquerel, of Paris. - - - - .

13. Tubercle in the Cerebellum. By Mr. Long.

14. A Peculiar Form of Infantile Convulsions. By Mr. J. W. West, of Tunbridge.

15. Treatment of Variola by the

ectrotic method. By J. F. 01- liffe, M. D. - - - - 188

- 179 16. Smallpox — Vaccination — Re- vaccination. By George Grego- ry, Esq. - - - - 191

180 17. On Gouty Concretions, with a new Method of Treatment. By Alexander Ure, Esq. - - 196

18. On a Sedative Lotion in Head-

181 aches, Congestions, and Cerebral Fevers. By Professor Raspail. 196

184 19. Sulphur ointment in Small- I pox. By Dr. Midavaine. - 196 20. Treatment of Epilepsy by 187 1 Cauterizations with Potash. By I Dr. Fievee, de Jumond, - - 197

10

CONTENTS.

Surgical Pathology and Therapeutics, and Operative Surgery.

PAGE

21. Partial Injury of one of the Halves of the Spinal Marrow.

By M. Begin. - - - 197

22. On the Removal of Foreign Bodies in the Joints by means of Subcutaneous Incisions. By Dr. Goyrand, of Aix. ... 198

23. Successful Performance of Tracheotomy in a case of Croup.

By M. Saussier. - - - 199

24. Chloride of Zinc in the Treat- ment of Acute and Chronic Go- norrhoea. By M. Gaudriot. - 199

25. Ligature of the common Ca- rotid Artery, and Experiments on the Ligature of botii Carotids in Animals. By M. Jobert, de Laraballe. - - - - 200

26. On Resection of the Elbow- Joint. By M. Roux. - - 201

27. Reduction of Hemorrhoidal

PAGE

Tumours. By Dr. Marshall Hall. 201

28. Wound of the Heart. By Professor Malle. - - - 201

29. Clinical Lecture on Fissure

of the Anus. By M. Velpeau. 202

30. Case of Dislocation of the Cervical Vertebrae cured. By

Dr. Schuk, of Vienna. - - 207

31. On the Auscultatory Pheno- mena in externally situated An- eurisms, and on the difference between an independent and a communicated pulsation in Tu- mours. By Dr. Schuk, of Vi- enna. 208

32. On Pneumonia in connection with, or as a consequence of. Surgical Operations and Injuries.

By Mr. J. E. Erichsen. - - 209

33. Operations for the cure of Stammering. - - . - - 210

Ophthalmology.

34. Cure of Myopiaby division of the muscles of the Eye. By M. Jules Guerin and Bonnet. - 216

35. Partial Amaurosis cured by Division of the Recti Muscles. By Mr. James J. Adams, of London. - - - - 218

36 Physiology of the Iris. By

Mr. W. H. Brodribb. - 219

37. Influence of Supra-orbital wounds in the production of amaurosis. By Dr. F. De Wal ther. 219

38. On the action of the Oblique Muscles of the Eye. By A. W. Volkman. - 220

Dental Surgery.

39. On the treatment of the milk teeth from their first appearance until they are shed. By M.

Delmond. 40. On Plugging Teeth. O. Taveau.

By M.

221

222

Midwifery.

41. Case in which Six Pregnan- cies occurred during Amenor- rhcea. By Dr. Flechner, of Vi- enna. 225

42. Singular Case of Tumour in the Pelvis. By Professor von D'Outrepont, of Wdrzburg. - 226

43. On the best and surest way of inducing Premature Labour. Dr. Meissner, of Leipsic. - - 226

44. Compresson of the Aorta as a means of arresting Uterine He- morrhage. Dr. Piedagnel. - 227

CONTENTS.

11

Medical Jurisprudence and Toxicology.

45. Symptoms of Rupture of the Bowels.

46. Remarkable effect upon the Human Gums, produced by the Absorption of Lead. By Henry Burton, M. D. - - -

47. Brucine. By Dr. Fuss.

48. Detection of Arsenic. By Dr. Figuier.

49. Healthy Appearance of the Internal Surface of the Stomach.

50. Peculiar Action of Sulphuric Acid on the Stomach. By Dr. Hodgkin. . . _ _

51. Laburnum Seeds. By M. Bonney. _ - - -

52. Salt of Platina. By Dr.

- 232

232 232

- 233

233

234

234

PAGE

Hoeffer. 234

53. Appearances on Dissection in persons hung. By Dr. Watson. 235

54. Protracted Gestation. - 235

55. Poisoning with Binoxalate of Potash. - - - . - - 236

56. Poisoning by Ammonia, in the state of Vapour. By Dr. Souch- ard, of Batignolies, - - 237

57. Fracture of the Skull occur- ring during Labour. By Dr. Schultzen, of Insterberg. - 238

58. On the Length and Strength of the Umbilical Cord at the full term of Pregnancy. By Dr. Necrrier. - - - - 238

Medical Statistics.

59. Abstract of the Glasgow Mor- tality Bill for 1840. By Alexan- der Watt. - - - - 239

60. Statistics for the Vienna Mid- wifery Institution. - - -

240

Foreign Correspondence.

61. New operations for the radical cure of Stutterinof — new opera- tion for cure of Myopia—Sul- phate of Quinine in large doses

for the cure of Intermittent. By Dr. E. J. Lewis. - - - 240 62. Medical Schools of Berlin and Vienna. By Dr. T. H. Watts, of England. - - . , 241

Miscellaneous.

Necrologyr

Biography of Dupuytren.

- 242|H6pital de Charenton.

- 242

, 242

AMERICAN INTELIGENCE.

Dysphagia from Scrofulous degen- eration of the (Esophagus of five years standing, cured. By Ezra P. Bennett, M. D., of Danbury, Ct. - - - 243

Case of Congenital hypertrophy of the upper eyelids, and mucous membrane of the upper lip, with an inversion of the eyelashes.

By. H. H. Toland, M. D., of Columbia, S. C. - - - 244

An Essay, on the beneficial results of Statistical Inquiries; in their application to Charleston, tracing the increased mortality to Quacks and Quackery. By Dr. Thos. Logan. ----- 245

Cathartics in Retention of the Pla-

12

CONTENTS.

PAGE

centa. By Dr. Thos. H. Todd,

of Starkville, Miss. - - 248

Excision of the Elbow-joint. By Dr. Gordon Buck, of New York. 249

Rhatany in the Treatment of the Fissure of the Anus, Prolapsus Ani and Leucorrhcea. By Drs. W. P. Johnson & J. B. Biddle.

Case of Triplets. By Dr. A. H. Buchanan, of Columbia, Tenn.

Smallpox in Philadelphia— Ectro- tic Treatment. -

Annual Report of the Governors of the New York Hospital, made to the Legislature, February 23, 1841. -

Annual Report of the Inspectors of the Mount Pleasant State Prison (Sing Sing) to the Legislature of the State of New York, January

249

250

PAGE

Annual Report of the Inspectors of the State Prison at Auburn, to the Legislature of the Slate of New York, January 13, 1841. 252 Fourth Annual Report of the Trus- tees of the Vermont Asylum for the Insane. Presented to the Legislature, October, 1840. By William H. Rockwell, M. D. 253 Convention of the Physicians of

Kentucky. - 254 250 Jefferson Medical College. - 255 New York University. - - 255 Transylvania University. - - 255 Medical College of the State of

South Carolina. - - - 255 Tweedie's Library of Practical Me- dicine. 255

Traill's Medical Jurisprudence. 255 Climate of the United States. - 256

- 251

13, 1841.

251 Necrology.

256

THE

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES

JULY, 1841.

Article I. — Statistical Researches elucidating the Climate of the United States and its relation ivith Diseases of Malarial Origin; based on the Records of the Medical Department and Adjutant GeneraVs Office. By Samuel Forry, M. D., of New York.

In the investigation of that class of diseases generally imputed to sources of malarial origin, designed in the present paper, the same mode of classid- cation, as respects particular systems of climate, will be followed, as that adopted in the article contained in the number of this Journal for January last, entitled ^^Statistical Researches relative to the Etiology of Pulmonary and Rheumatic Diseases,''^ ^^c.

As the subject of climate in general is but little understood, and as that of the United States presents remarkable extremes, not only in different degrees of latitude but on the same parallels, it is proposed to elucidate still further the climatic peculiarities of the different regions of the United States in a series of condensed tabular results. The classification referred to above is the following:

Systems of Climate.

General Divisions of the United States.

1. Northern

1 Class.

Posts on the coast of New England, extending

as far south as the harbor of New York. Posts on the northern chain of lakes. Posts remote from the ocean and inland seas. Atlantic coast from Delaware Bay to Savannah. Interior stations. 2

Forry on the Climate of the United States,

[July

3. Southern.

1 Class. Posts on tlie lower Mississippi. 1 " Posts in the peninsula of East Florida. 1 . Tlie Northern Division presents the greatest variety of climate on the same parallels of latitude. These diverse effects, as was demonstrated in the No. of this Journal for January last, are the result of the modifying agency of the ocean and the lakes. Thus on tlie seacoast of New England and on the great lakes of our northern frontier, the temperature is so modi- fied that it pertains to the class of mild or uniform climates ; whilst in the intervening region and in that beyond the modifying influence of these ocean- lakes, the range of the thermometer becomes so augmented and the opposite seasons so contrasted in their mean temperatures, that these climates are classified as emphatically excessive. These results, however, are clearly exhibited in the following tabular abstract:—

Posts on the Ocean and the Lakes,

or

Mild and Uniform Climates.

Port Brady, Outlet of Lake Superior,

" Vancouver, Oregon Territory,

" Sullivan, Eastport, Maine, '

" Preble, Portland, Maine,

" Niagara, Lake Ontario, JV*. F.,

" Constitution, Portsmouth, Jf. H.

" Wolcott, JVewport, R. I.

" Trumbull, JVew London, Conn.,

" Columbus, JSTew York Harbour,

Posts remote from the Ocean and Lakes, or

Excessive Climates.

Hancock Barracks, Houlton, Maine, Fort Snellinff, near the junct on of the St. Peter's and Mississippi, Howard, Green Bay, Wisconsin, Crawford, Prairie du Chien, Wn Council Bluffs, nea?* the junction of the

Platte and Missouri. Fort Armstrong, Rock Island, III. West Point, JSTew York,

46039' 45037' 44044 43038' 43015' 43O04' 41O30' 41022' 40O42'

46O10'

44053' 44040' 43003'

41045' 41028' 41022'

410.39 51 .75 42 .95

46 .67 51 .69

47 .21 50 .61 55 .— 53 .—

410.21

45 .83

44 .92

45 .52

51 .02 51 .64 .52 .47

Mean Temp.

210.07 41 .33 22 .95 26 .03 30 .46 28 .39 32 .51 39 33 32 .39

160.74

15 .95 19 .77 19 .90

24 .47

26 .86 32 11

630.18 65 .00 62 .10 67 .06

72 .19 65 .72 69 .06 71 .89

73 .70

620.93

2 .75 69 .82 0 .79

5 .82 75 .91

72 .86

Difference of the Mean Temp, of

420 11 23 .67 39 .15 41 .03 41 .73 36 .33 36 .55 32 .56 41 .31

460.19

56 .60 50 .05 50 .89

51.35 49 .05 40 .75

CO £0

« o o

470.22 28 .00 43 .87 47 .89 49 .40 43 .39 41 .52 39 .37 45 .92

540.70

61 .86 54 .11 52 .08

54 .77 54 .14 46 .17

180.42 6 .67

17 .16

18 .42 16 .77

16 .83 14 .71 11 .67

17 .87

240.49

^0 .83

24 .10

25 .38

27 .47 23 .99 18 .82

1100

78 104 99 92 97 83 78 95

1180

119 123 120

120 106 91

Notwithstanding the posts on the same parallels exhibit in rapid succession four marked inflexions of the isotheral and isocheimal lines, (the mean sum- mer and winter temperatures,) causing a marked diversity in the contrast of these opposite seasons, yet the mean annual temperature presents little vari- ation. The diflference of climate is, therefore, owing to the unequal distri- bution of heat among the seasons. A single glance at the table serves to show these various contrasts. It will be observed that at the posts on large bodies of water, the mean temperature of winter is higher and that of sum- mer is lower than in the opposite localities; but these results are more satisfactorily perceived by comparing the difference between the mean tem- perature of winter and summer, and the warmest and coldest month, in each system of climate. Thus Fort Brady, at the outlet of Lake Superior, shows a difference of only 42°. 11 between the mean temperature of winter and

1841.] Forry on the Climate of the United States, 15

summer, whilst Hancock Barracks, half a degree farther south, in the state of Maine, situated not more than 150 miles from the sea-coast, exhibit a disparity of 46°.19; and comparing the warmest and coldest month, the difference of the former is 47°.22, and that of the latter 54°.70. Again— Forts Sullivan and Snelling, in opposite systems of climate, are very nearly in the same latitude, the former at Eastport, Maine, and the latter at the junction of the St. Peter's and Mississippi, Iowa. At Fort Sullivan, the difference of winter and summer is 39°. 15, and that of the warmest and coldest month, 43°. 87; whilst at Fort Snelling, these ratios are respectively 56°. 60 and 61°. 86. Fort Howard is also in the same latitude, but as it is situated at the extreme point of one of the smaller lakes, (Green Bay, Wis- consin,) the temperature is partially modified, these averages being 50°. 05 and 54°.ll. Next come four posts, all of which are nearly on the same parallel, three being of the class of uniform climates and one of that of excessive. Of the former, two. Forts Preble and Constitution, are on the ocean, and the other. Fort Niagara, is on Lake Ontario. At these posts in the order just named, the difference between the mean temperature of winter and summer is respectively 41°. 03, 36°. 33, and 41°.73; whilst, on the other hand, at Fort Crawford, Wisconsin, a point a few minutes farther south than the three former, the difference is 50°. 89. On reference to the table, it will be seen that the contrast in the difference between the mean temperature of the warmest and coldest month, is equally striking. The next points of com- parison as lying on the same parallel, are Forts Wolcott and Trumbull on the Atlantic, and Council Bluffs, Fort Armstrong, and West Point in the opposite localities. The difference in the mean temperature of summer and winter at Fort Wolcott, Newport, R. I., is 36°. 55, and at Fort Trumbull, New London, Conn., it is 32°.56; whilst at Council Bluffs, near the junc- tion of the Platte and Missouri, it is 51°. 35, at Fort Armstrong, 111., 49°.05, and at West Point, N. Y., 40°.75. Between the two posts on the ocean and the two far in the interior, the difference between the mean temperature of summer and winter presents a disparity of from 15° to 17°; and as respects Fort Trumbull and West Point, which are precisely in the same latitude, the difference between these two opposite seasons, notwithstanding the latter is not more than fifty miles from the ocean, is 8°. 19 less at the former post. As regards the difference between the mean temperature of the warmest and coldest month, these laws find confirmation in every instance. So remarkable is the influence of large bodies of water in modifying the range of the ther- mometer that although Fort Brady, at the Sault St. Marie, Mich., is nearly 7^ north of Fort Mifilin, near Philadelphia, and notwithstanding the mean annual temperature is more than 14° less, yet the contrast in the seasons of winter and summer is not so great at the former as the latter. Fort Colum- bus, in the harbour of New York, it is seen, offers, in some respects, an exception to the laws just developed, the range of the thermometer being greater than at some points farther north. As the results, which are based

16 Forry on the Climate of the United States. [.^^^^J

on nine years' observations, made on an island free from any agency which large towns may exercise, are doubtless correct, some causes of a local nature must exist to produce this effect. It is more than probable that this locality, in consequence of the configuration of the coast, does not lie in the direction of the most prevalent ocean winds, and that hence its temperature is only partially modified.

The climate of Fort Snelling, which is the most excessive among all the military posts of the United States, resembles that of Moscow in Russia, as regards the extremes of the opposite seasons, notwithstanding the latter is 11° farther north; but at Moscow, the mean temperature both of winter and of summer is lower, that of winter being as 10°.78 to 15°. 95, and that of summer as 67°. 10 to 72°.75. At Edinburgh, Scotland, in the same latitude as Moscow, the difference between the mean temperature of winter and sum- mer is, on the other hand, not one third as great, being only 17°. 90; and even at North Cape, on the island of Maggeroe, in lat. 71°, which is the most northern point of Europe, this difference in the two seasons, so great is the modifying influence of the ocean, is no more than 19°. 62; whilst at Uleo in the interior of Lapland, the difference between the mean temperature of summer and winter is 45*^.90.

In these comparisons, no reference has yet been made to the second post in the table. Fort Vancouver, in Oregon Territory, situated on the Columbia river, about seventy miles in a direct line from the Pacific ocean. This region bears the same climatic relation to our coast and to that of eastern Asia, as the western coast of Europe does. It is seen that the mean annual temperature is about 10° higher than that of the posts on the same parallel on our own coast. To attempt to explain these results would lead beyond the limits designed for this paper. Suffice it to say that they find a ready explanation in physical causes. So mild and uniform are the seasons at Fort Vancouver, that the difference between the mean temperature of winter and summer is only 23°. 67 — a mean which is less than that of Italy or southern France, and only about two fifths of that of Fort Snelling, notwithstanding the latter is nearly 1° farther south. This locality is even less contrasted in these opposite seasons than Cantonment Clinch near Pensacola or Petite Coquille near New Orleans. The mean temperature of spring, summer and autumn, are about the same as at Fort Wolcott, R. I., whilst the winter resembles that of Fort Gibson, Ark.

The next point demanding attention is the difference between the mean temperature of winter and spring. A glance at the table given above will show that this difference is much the greater in the excessive climates. Taking places in the same latitude and in opposite systems of climate, it is found at Fort Brady to be 18°. 42, whilst at Hancock Barracks it is 24.°49; at Fort Sullivan it is 17°. 16, whilst at Forts Snelling and Howard, it is respectively 30°.83 and 24°. 10, the latter being partially modified by Green Bay; at Forts Preble, Niagara and Constitution, the ratios are 18°. 42,

1841.] Forry on the Climate of the United States, 17

16°.77 and 16°.83, and at Fort Grawford, on the other hand, it is 25°. 83; and lastly at Forts Wolcott and Trumbull, is 14°.71 and 11°. 67, whilst at Council Bluffs, Fort Armstrong, and West Point, it is respectively 27°.47, 23°.99, and 18°. 82. Fort Columbus, as in the preceding comparison, stands as an exception, its ratio, notwithstanding it is lower than any one in the opposite class, being the highest in its own with the exception of two posts. This peculiarity in the increase of the temperature of spring, as manifested in the vegetable kingdom, constitutes a feature which strongly characterizes excessive climates; for, as Baron Humboldt remarks — '*a sum- mer of uniform heat excites less the force of vegetation, than a great heat preceded by a cold season." Accordingly we find that in these excessive climates, (unlike the uniform ones on the ocean and lakes, in which the air is moist and the changes of the seasons slow and uncertain,) summer suc- ceeds winter so rapidly that there is scarcely any spring, and vernal vegeta- tion is developed with remarkable suddenness. At Fort Vancouver, the difference between the mean temperature of winter and spring is only 6°. 67, which is about one third of the difference observed at the posts in our modi- fied climates on the same parallel, and little more than one fifth of the differ- ence exhibited in the excessive climate of Fort Snelling.

Another feature which characterizes these two systems of climate remains to be considered, viz., the mean annual range of the thermometer. On reference ■ to the table, this striking peculiarity is at once apparent. On a comparison of the posts on the same parallel, the following relations are found: — At Fort Brady, on the one hand, the range is 110°, and at Hancock Barracks, on the other, it is 118°; at Fort Sullivan it is 104, whilst at Forts Snelling and Howard, it is 119° and 123°; at Forts Preble, Niagara and . Constitution, it is respectively 99°, 92° and 97°, whilst at Fort Crawford, on the same parallel, it is 120°; and lastly at Forts Wolcott and Trumbull, it is 83° and 78°, whilst at Council Bluffs, Fort Armstrong and West Point, it is 120°, 106° and 91°. Fort Columbus, as before, presents an exception. These results, it may be necessary to add, exhibit the average range of a series of years. The extreme range, for example, at Fort Brady, during a period of eleven years, (from 1820 to 1830 inclusive,) is 130°, the mercury sinking in 1826 as low as -37°, and rising in 1830 to 93° Fahr. At Fort Snelling in 1821, the mercury sunk to -32°, and in 1827 rose to 96°, being a range of 128°. At Fort Howard, in 1823, it rose to 100° and sunk to -38°, being a range in the same year of 138°. At Fort Crawford we find the mercury in 1820 noted as high as 99% and in 1821 as low as -36°, being a range of 135°; at Fort Armstrong, in 1821, as low as -28°, and in 1830 as high as 98°, being a range of 126°; and lastly at Council Bluffs as low, in 1820, as -22°, and in 1822 as high as 108°, being an extreme range of 130°. At the last named post, the thermometer rose every year above 100°. When the Southern Division of the United States comes under investigation, it will be seen that the mercury there seldom rises as high as in our northern regions.

2*

18 Forry on the Climate of the United States, [July

2. T7ie Middle Division. — The numerical results furnished by this Divi- sion are, as in the Northern, presented in the following condensed summary:

1 Posts of the Middle Division.	No. of years of observation.	Latitude.	Mean Annual Temperature.	Mean Temp.	Difference of the AJean Temp, of	•5 < = 1)
	Summer.	Winter and	Warmest <Sc coldest Month.	Winter and , Spring.
Fort Mifflin, vear Philadelphia,	2	39051'	550.28	330.11	770.93	440.82	480.03	180.33	870
Washington Uity, D. C,	8	330.53'	56 .57	37 .76	76 .74	38 .98	42 .40	18 .43	84
Jefferson Bdrracks, neo.r St. Louis,	4	38028'	58 .14	37 .67	78 .45	40 .78	45 .15	21 .08	89
Fort Monroe, Old Point Comfort, Va.	5	37O02'	61 .43	45 .17	78 .31	33 .14	36 .82	13 .74	73
Fort Gibson, Arkansas, .	3	I35047'	62 .90	44 .31	81 .14	36 .83	42 .03	18 .18	89
" Johnston, Coast of JV*. Carolina,	5 134000'	66 96	52 .48	80 .31	27 .83	30 .15	14 .02	62
Augusta Arsenal, Oa.,	5	133028'	66 .01	51 .43	81 .06	29 .63	32 .54	14 46	73
Fort Moultrie, Charleston Harbour,	2 j32042'	65 .78	49 .93	80 .27	30 .34	35 .73	16 .35	69
" Jesup, near Sabine River, La„	8 13IO30'	68 .03	53 .19	82 .48	29 .29	31 .24	14 .74	77

It has not been deemed fitting to arrange these posts into the two classes of uniform and excessive climes, as the majority of them are of a mixed character. The first two are slightly under the influence of the Atlantic, whilst the south-western stations experience the powerful agency of the Gulf of Mexico. The laws of climate developed in the preceding Division, do not find so happy an illustration in this one; for as the physical causes act less prominently, the efiects are less marked. As we proceed south, the sea- sons become, as a general rule, more uniform in proportion as the mean annual temperature increases. Fort Mifflin and Washington City do not properly pertain to either class, being in a measure under the influence of the ocean ; but as we possess no thermometrical observations made directly on the Atlantic on the same parallel, we are unable to determine the differ- ence of climate. Fort Mifflin shows a greater contrast in the opposite seasons than Forts Brady, Sullivan, Preble, Niagara, West Point, Con- stitution, Wolcott, and Trumbull; and Washington City exhibits greater extremes than the three last named. Although the results given at Wash- ington City fairly place it in the class of excessive climes, yet on following the same parallel westward, a still greater contrast is exhibited. Thus the diflference between the mean temperature of winter and summer at Jefferson Barracks near Bt. Louis, notwithstanding it is about half a degree farther south than Washington City, is 1°.80 greater; and on comparing Fort Gib- son, Ark., with Fort Monroe, on the coast of Virginia, though the latter is 1°15' north of the former, the difference at Fort Gibson, in the same respect, is 3°. 69 greater. Fort Johnston, on the coast of North Carolina, which is 0°32' north of Augusta Arsenal, Ga., also exhibits a less extreme in the opposite seasons.

In casting one's eye over the column showing the difference between the mean temperature of winter and spring, the general laws already revealed are apparent. Jeff*erson Barracks shows a greater inequality than Washing- ton City, and Fort Gibson than Fort Monroe. Fort Jesup cannot be fairly- compared, by way of contrast, with a position in the same latitude on the

1841.]

Forry on the Climate of the United States,

19

Atlantic, as the warm atmospheric currents from the Gulf of Mexico exercise there a sensible influence.

As respects the mean annual range of the thermometer, it is found that the laws developed in the Northern Division are here corroborated. Wash- ington City has a mean annual range of 84°, whilst that of JetFerson Barracks is 89°; the ratio of Fort Monroe, on the one hand, is 73°, and that of Fort Gibson, on the other, is 89°; and lastly the range at Fort Johnston is 62°, whilst that of Augusta Arsenal is 73°.

3. The Southern Division, which is characterized by the predominance of high temperature, remains to be considered. The climate of this region is fully illustrated by the posts contained in the subjoined tabular abstract: —

Posts of the Southern Division.	Cm C J > C «	Latitude.	Mean Annual Temperature.	iMean Temp.	DilFerence of the Mean Temp, of	Mean Annual Range.
Winter.	Summer	Winter and Summer.	Warmest &, coldest Month.	Winter and Spring.
Cantonment Clinch, near Pensacola,	7	30O24'	690.44'	56°. 14	820.24	260.10	280.60	130.12	70°
Petite Coquille, near JVew Orleans,	4	30O10'	71 .25	59 .26	83 .46	24 .20	27 .97	10 .71	64
Fort Marion, St. j3ugustine, Florida,	4	29O50'	72 .66	62 .21	82 30	20 .09	22 .03	9 .29	53
" King, interior of East Florida,	3	290J2'	72 .66	61 .78	84 .20	22 .42	25 .69	10 .78	78
" Brooke, Tampa Bay, Florida,	5	07057'	73 .42	64 .76	81 .25	16 .49	18 .66	8 .35	56
Key West or Thompson's Island,	3 |24033'	76 .09	70 .05	81 .39	11 .34	14 .66	5 .99	37

On approaching the southern coast, climate undergoes a marked modifica- tion. The seasons glide imperceptibly into each other, exhibiting no great extremes. This is strikingly illustrated on comparing the difl'erence between the mean temperature of summer and winter at Fort Snelling, Iowa, and at Key West, at the southern point of Florida, the former being 56°. 60, and the latter only 11°. 34. The peculiar climatic character of the peninsula of Florida was, however, so fully considered in the number of this Journal for January last, that any additional remarks were supererogatory. The results given by Cantonment Clinch near Pensacola and by Petite Coquille near New Orleans, manifest strongly the modifying agency of the Gulf of Mexico, the latter post being also environed by large lakes.

The last four stations in the table may be considered as all belonging to the peninsula of East Florida, Key West being an island at the southern point. As Fort King is situated in the interior and the other three posts on the coast, we have an additional illustration, even in a climate characterized by very little distinction of the seasons, of the modifying agency of large bodies of water; for, the mean temperature of winter at Fort King is lower, and that of summer higher, than at the other three posts. Although Key West, which is 4° 39' south of Fort King, has a mean annual temperature 3°. 43 higher, yet the mean summer temperature is 2°. 81 lower. In the article to which reference is made above, the equalizing influence of the ocean was still further exhibited in the annual range of the thermometer, the mean of the monthly ranges, and the average diflference of the successive

20

Forry on the Climate of the United States.

[July

seasons. It "svas also shown that the peculiar climatic character of East Florida, as distinguished from that of more northern latitudes, consists less in the mean annual temperature than in the manner of its distribution among the seasons. At Fort Snelling, for example, the mean temperature of winter is 15°. 95, and of summer 72°. 75, whilst at Key West, the former is 70°. 05 and the latter 81°. 39. Thus, though the winter at Fort Snelling is 54°. 10 colder than at Key West, yet the mean temperature of summer at the latter is only 8°, 64 higher.

As the foregoing results are based on observations continued mostly from four to nine years, thus comprising from 4000 to 10,000 observations for each result, the average ratios may be depended upon as correct. Having also arranged in tabular abstracts for every post, the mean temperature of each month, the difference of each successive month, and the monthly ranges of temperature with the maximum and minimum degrees, (none of which tables is now given,) these preliminary remarks will be concluded with several general observations.

July, taking the mean of a series of years, is, throughout the United States, the hottest month in the year with scarcely an exception; and Janu- ary, generally speaking, is the coldest month, but sometimes December or February gives a lower temperature. The least difference in the mean tem- perature of any two successive months, is that of July and August, and the next lowest is that between January and February. Between October and November, the difference is greatest at the southern posts; but at the northern on the ocean and the lakes, the difference between March and April, and between April and May, is about the same as that between October and November, whilst at the points remote from large bodies of water in these northern regions, the difference between October and November is generally less than that of either of the two former.

It has been seen that the extremes of heat and cold do not occur at our most northern and southern posts, as these are situated on large bodies of water; but that the western stations, Snelling, Gibson, Council Bluffs, &c., remote from inland seas, are remarkable for extremes of temperature. It is here that the mercury rises the highest and sinks the lowest, whilst Forts Brady and Mackinac, the most northern stations, as well as those on the southern coast, exhibit a less range of the thermometer; and in accordance with the same law, we find that the mean summer temperature is greater at Augusta, Ga., than along the coast of Florida. Whilst at Key West, during a period of six years, the thermometer never rose above 90°, it attained at Council Bluffs, a point 17° 12' north, every year, a height varying from 102* to 108°. The highest temperature in the shade noted at our various posts, was at Fort Gibson on the 15th August 1834, being 116°. Although the mean annual temperature, in proceeding from the equator towards the poles, gradually diminishes, yet the thermometer scarcely mounts higher at the

1841.]

Forry on the Climate of the United States.

21

equinoctial line than under the polar circle. Hence it follows that the cli- mate of the tropics is characterized much more by the duration of heat than its intensity.

The lowest temperature, taking the mean of a month, occurred -at Forts Howard and Snelling. At the former, the mean of the month of February 1829 at 7 o'clock A. M. is -3M7, and the mean of December 1822 at Fort Snelling is -3°. 61. This, it is to be observed, is merely the average of the morning observations for the month. The extreme severity of the winters at the posts in the Northern Division, remote from large bodies of water, has been already fully illustrated. The following remark, made by Surgeon Beaumont when stationed in 1829 at Fort Crawford, Wisconsin, which is in the latitude of Fort Wolcott, R. L, may be given in elucidation: — "The month of January w^as remarkably mild and pleasant, the ground dry and free from snow, and the Mississippi unusually low and unfrozen. February was extremely cold, the weather clear and dry, and the thermometer ranging during the month from the freezing point to 23° below zero. From the 1st to the 16th, the mercury stood every morning, with the exception of three, (the 6th, 7th and 8th,) between -4° and -23°, and did not rise above 20° above zero during these days. On the 2d, 3d, 4th, 5th, 9th, 10th, 1 1th, 12th, 13th, 14th and 15th, the mercury at sunrise stood respectively at 14°, 16°, 4°, 16°, 23°, 18°, 20°, 18°, 10°, 6° and 4° below 0; and on the 9th and 11th, it continued under -8° during the twenty-four hours. During the month, the prevailing winds were northerly and dry, and the proportion of fair and cloudy weather was, clear 22 days, cloudy 3, variable 1, and snowy 2. The mean depth of snow was about 6 inches. The month of March has been unusually cold and dry, with one or two light falls of snow, which, with the previous coat, has just been dissolved by the warmth of the solar rays without any rain. The ice on the Mississippi, which broke yesterday, (March 30th,) is now moving off en masse.^^

In the winter of 1780, the temperature at the city of New York was so low that cannon were transported over the ice in the harbour to Staten Island. In the interior of the state, the cold was correspondingly intense. All streams were so completely locked up that no grain could be ground in grist mills, and the inhabitants were obliged to bruize it in mortars; the snow was so deep that no efforts were made for weeks to reclaim the roads; in narrow ravines, it became so drifted as to cover the tops of the highest trees; even many habitations were so buried that their inmates Avere obliged to tunnel their way to the light of heaven ; and lastly, for the period of forty days, no water dropped from the eaves of houses. So say not only the chronicles of the day, but witnesses are yet living to testify to these facts. In the absence of the precise knowledge derived from thermometrical observations, we can at least infer that it was, even on our coast, a truly Russian winter; and the imagination is left to figure to itself the condition of things at the

22 Forry on the Climate of the United States, P^ly

present sites of Forts Snelling, Howard and Crawford. In this winter, as well as 1742, Long Island Sound was frozen over.

Scarcely does a winter elapse that the Hudson river is not frozen over even in the vicinity of the city of New York; whilst Philadelphia and even Baltimore, lying on the same parallels which in Europe produce the olive and the orange, have their commerce often interrupted from the same cause. The Delaware, which is in the latitude of Madrid and Naples, is generally frozen over five or six weeks each winter. Even the Potomac becomes so much obstructed by ice that all communication with the District of Columbia by this means, is suspended for weeks. Further north, the mouth of the St. Lawrence is shut up by ice during five months of the year; and Hud- son's Bay, notwithstanding it is in the same latitude as the Baltic sea and of more than twice the extent, is so much obstructed by ice even in the summer months as to be comparatively of litde value as a navigable basin.

But even in northern latitudes on our coast, we find climates comparatively mild. As Nova Scotia is perfectly insular with the exception of a neck of land eight miles wide, and is so much intersected by lakes and bays that nearly one third of its surface is under water, the mercury seldom rises above 88° in summer, or sinks lower than 6° or 8° below zero in winter. In addition to this, some influence must be exercised by the Gulf Stream, which strikes upon this part of the coast, "in tides of from sixty to seventy feet, overflows the country to the distance of several miles, and converts the mouths of streams, fordable at low water, into extensive arms of the sea where whole fleets might ride at anchor." On our western coast, the ex- tremely modified climate of the region of Oregon, on a parallel five degrees north of the city of New York, has been already illustrated. During a year's observations at Fort Vancouver, the lowest point is 17°, and the whole number of days below the freezing point are only nine, all of which are noted in January. We are told by Mr. Ball of the state of New York, by whom these observations were made, that he commenced ploughing in Jan- uary of the year 1833. "The vegetables of the preceding season," he says, " were still standing in gardens untouched by the frost. New grass had sprung up sufliciently for excellent pasture. Fruit trees were in full blos- som. * * * Though the latitude is nearly that of Montreal, mowing and curing hay are unnecessary; for cattle graze on fresh growing grass through the winter. * * Winters on the Columbia river are remarkably mild, there being no snow, and the river being obstructed by ice but a few days during the first part of January. Grass remained in suflicient perfection to aflford good feed ; and garden vegetables, such as turnips and carrots, were not destroyed, but no trees blossomed till March, except willow, alders," &c.

As the geographical distribution of plants appears to be chiefly regulated by the temperature of the atmosphere, these investigations become the more interesting and important. Although, in considering the organic life of

1841.]

Forry on the Climate of the United States,

23

plants, it is necessary to estimate the simultaneous influence of all physical causes — soil, heat, light, and the state of the atmosphere as regards its hu- midity and serenity; yet, among these the most important is the influence of heat, as exhibited in the extreme of temperature both in respect to heat and cold, and in the manner of its distribution among the different months of the year. Each plant has generally a particular climate in which it thrives best, and beyond certain limits it ceases to exist. Hence, having seen the great variations of summer and winter temperature on the same isothermal line, the absurdity of limiting a vegetable production to a certain latitude or mean annual temperature, is apparent. To say that the vine, the olive and the coffee tree, require, in order to be productive, annual temperatures of 53°. 60, 60°. 80, and 64°. 40, is true only of the same system of climate. As the annual quantity of heat which any point of the globe receives, varies very little during a long series of years, the variable product of our harvests depends less on changes in the mean annual temperature, than in its distri- bution throughout the year. Thus, climates in regard to the geography of plants are strongly characterized by the variations which the temperature of months and seasons experiences. The cotton plant finds its most favourite climate between the equator and latitude 34°; but it succeeds with a mean summer temperature of 75° or 73°, if that of winter does not descend below 36° or 38°. In the United States, it is cultivated in latitude 37°, and in Europe in latitude 40°. Whilst the sugar-cane is cultivated in Europe as far north as latitude 36°, in a mean annual temperature of about 67°, its cul- tivation in the United States, on account of the low winter temperature, is prevented beyond latitude 31°; but it succeeds on the great table plain of Mexico and Guatemala, where an altitude of 6000 feet converts a tropical into a temperate climate. In Europe, the olive ranges between latitude 36° and 44°, that is, in a mean annual temperature from 66° down to 58°, pro- vided the mean temperature of summer is not below 71°, nor that of the cold- est month below 42°, which last excludes all the United States beyond latitude 35°. For the same reason, the date, palm and sweet oranges grow in Lou- isiana only to latitude 30°. In Europe, the favourite climate of the vine is between latitude 36° and 48°, that is, between the isothermal lines of 62° and 47°. 50, provided the winter Ime is not below 33°, nor the summer under 66° or 68°. Such is the case in Europe to latitude 50°, and in the United States to latitude 40°; but on the Pacific coast of our territory, the requisite temperature is found at Fort Vancouver, which is in the latitude of Montreal. Indeed, we know that on our western coast the olive is cultivated in latitude 38°; and that cotton and sugar-cane would succeed on parallels correspond- ing to Europe, is an opinion that has for its basis the fundamental truth, that the laws of nature never vary.

The influence of the unequal distribution of heat upon vegetable geography, is beautifully illustrated in the four systems of climate demonstrated on the

24

Forry on the Climate of the United States.

[July

same parallels in the Northern Division of the United States; and if we extend the comparison to the Pacific coast, a fifth system may be enumerated on the same latitude. Taking the coast of New England, the region of the Lakes and the Pacific coast, the difference between the mean temperature of winter and spring varies from 6^.67 to 18°. 42; whilst in the excessive cli- mate of the regions west of the lakes and intermediate to them and the Atlantic, this difference ranges from 18°. 82 to 30°. 83; and accordingly we find, as already explained, that spring and summer are confounded with each other, and that the sudden excess of heat renders the progress of vege- tation almost perceptible. It is necessary, however, to add that the low ratio of 6°. 67 occurs on the Pacific coast, the lowest average in the Northern Division of the United States being 11°.67. In the Middle and Southern Divisions, this vernal increase of temperature gradually diminishes, until finally at Key West it is only 5°. 99. But there is another important feature to be observed. Not only is the vernal increase greater in excessive cli- mates; but, as it supervenes upon a lower winter temperature, the effect produced on the development of vegetation is in an inverse ratio. The vernal increase of 30°. 83 at Fort Snelling, for example, comes upon a mean winter temperature of 15°. 95, whilst at Fort Sullivan, on the same parallel, the increase of only 17°. 16 follows a winter temperature as high as 22°. 95. Between northern and southern latitudes, this contrast is still more marked; for, w^hilst at Fort Snelling there is a difference of 13°. 46 between the mean temperatures of February and March, and at Key West only 1°.56, the temperature of the month of February at the former is 18°. 66, and at the latter 72°.15.

In every work professing to treat of the climate of the United States, the opinion of Jefferson and Volney that, in regard to the temperature of the regions lying east and west of the Alleghenies, " there is a general and uni- form difference equivalent to 3° of latitude in favor of the basin of the Ohio and the Mississippi," is quoted as an established fact. This opinion arose from the fact demonstrated by us that the United States present on the same parallel difierent systems of climate, produced by the unequal distribution of heat among the seasons— causes upon which the geographical distribution of plants depend. Thus, as Volney and Jefferson discovered that the vegeta- tion of Philadelphia is found in the modified climate of our northern lakes, whilst the same plants will not flourish on similar parallels in the interior of New York, Vermont, and New Hampshire, the theory in regard to the dif- ference of temperature east and west of the Alleghenies was naturally sug- gested. In explanation of the supposed fact that the temperature of the wes- tern country is hotter by 3° of latitude than that of the Atlantic coast, M. Volney enters into a laboured and complex theory of the winds, forget- ting that it is a good rule in philosophy to ascertain the truth of a fact before attempting its explanation. Now had Volney and Jefferson chanced to

1841.]

Forry on Diseases of Malarial Origin.

25

observe the vegetation, by way of comparison along the coast of Rhode Island or Connecticut, and on the same parallels in Illinois or farther west- ward, instead of the lakes and Albany, the world would have been edified with the opposite theory, viz., that the climate east of the AUeghenies is milder by 3° of latitude than that west. Whilst at Fort Trumbull, Connec- ticut, the mean winter temperature is 39°. 33, at Council Bluffs, near the junction of the Platte and Missouri, it is as low as 24° 47. Hence plants sensible to a low temperature, which flourish in the climate of the former, will perish in the latter; for whilst the mean temperature of the coldest month at Fort Trumbull is only 34°. 50, at Council Bluffs it is 22°.61. This is also demonstrated by the average minimum temperature, that of the former being 9° above, and that of the latter 16° below zero; and equally so by the minimum temperature of the winter months, that of De- cember, January, and February, being at Fort Trumbull respectively 20°, 10°, and 16°, and at Council Bluffs, -4°, -13°, and -11°. On the other hand, it will be found that the vegetables which can endure the rigorous cli- mate of Council Bluffs, will flourish more vigorously than in the region of Connecticut; for at the former, the vernal increase is 27°.47, and at the latter only 11°. 67. Moreover the latter increase is added to a winter tem- perature of 39°.33; whilst the former, added to 24°.47, more than doubles itself.

Having thus condensed some of the more important practical deductions afforded by the " Army Meteorological Register," I shall now enter upon the second branch of the subject.

In the investigation of those diseases which are generally ascribed to, or supposed to have some relation with, causes of malarial origin, the same arrangement of the subject, as regards the influence of climate, will be adopted as in the inquiry relative to pulmonary diseases. Although in this attempt to establish a relation between climate and malarial diseases, the writer may not prove so successful as in the essay in reference to pulmonic affections; yet he will at least determine the relative prevalence of these diseases in the different regions of the United States, and develope at the same time some of the laws, as regards season and climate, by which the diseases attributed to malarial origin are governed. As the etiology of pulmonic diseases is more especially connected with mere temperature, we are enabled to arrive at some positive knowledge; but as regards malaria — that mysterious agent which has hitherto remained inscrutable in its nature — all our knowledge is derived from its effects on the human frarne. We know that terrestrial emanations dissolved in atmospheric moisture modify the constitution of climate, and that consequently the nature of soil, which consists of a stratum of comminuted mineral substances and organic remains upon which man is dependent for existence, constitutes one of the most important points in-

No. III.— July, 1841. 3

26 Forry on Diseases of Malarial Origin, [July

volved in the inquiry. Although malaria has hitherto defied the power of the chemical analyst, yet as caloric is the controlling element in the consti- tution of climate modifying its other properties, so it will be seen that the meteorology of heat is intimately connected with the laws of malarial dis- eases in the relation of cause and effect.

Having said thus much in relation to the inherent difficulties of the sub- ject, it may be well to refer to the doctrine of averages by which important relations in several sciences have been disclosed, discoverable in no other way. Applied to governmental objects, numerical analysis soon bestowed upon political economy the character of a science; and its application to the investigation of morbid actions, gives to medical inquiries the same character which pertains to statistical researches on other subjects. The success already realized bids fair in regard to the future; and as averages may be regarded in a great measure, as the mathematics of medical science, this method constitutes an unerring path in the region of its true philosophy. Instead of being bewildered by contradictory conclusions based on the few cases which fall under the observation of particular practitioners, we are enabled, by thus accumulating a vast aggregation of facts extending over thousands of individuals, to deduce the laws by which nature operates in inducing mortality by particular diseases.

The statistical data brought to bear upon the present subject have been furnished by official records in the Medical Department and Adjutant Gene- ral's office. They extend over a period of ten years, comprise every portion of the United States and Territories, and are based on an aggregate mean strength of 47,219.

The following table presents in a condensed form the Ratio of Intermit- tent Fever:

Divisions.	Systems of Climate.	Ratio of cases treated per 1000 of mean strength.
2 13 21 41 101 62 52 45	c tl 1 = 15 73 34 71 129 105 75	1 Third 1 Quarter.	Fourth Quarter.	Annual Result.
Northern Middle. Southern.	[ 1st Class. Posts on the coast of New England, 1 2d " Posts on Northern chain of Lakes, ] 3d " Posts north of latitude 39o, and remote from the ocean and inland seas, ( 1st Class. Coast from Delaware Bay to Savannah, I 2d " Southwestern stations, j 1st Class. Posts on Lower Mississippi,* ^ 2d " Posts in the Peninsula of East Florida, Average,	11 77 57 158 305 170 244 156	9 36 40 101 197 90 138 93	36 193 151 370 747 385 520 368

The low ratio of intermittent fever on the coast of New England com- pared with interior regions on the same parallels, is very surprising; but

* In default of a better arrangement, Augusta Arsenal, Georgia, and Fort Mitchell, Alabama, have been included in this class.

1841.]

Forry on Diseases of Malarial Origin.

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even the average given is entirely too high, inasmuch as by far the majority of cases arose among soldiers who had been exposed in malarial regions. Of the seven posts constituting this class, two-thirds of the cases were re- ported at Fort Columbus; and at this post, no case has ever been known to originate. Assistant Surgeon Sargent avers that in 33 years, during which period he was stationed at Fort Constitution, N. H., only one case, which he regarded as really of domestic origin, fell under his observation. The coast of New England may, indeed, be considered as exempt from this dis- ease. The same contrast as regards the prevalence of intermittent fever, is shown, in the statistics of the British Army, to exist between Canada, on the one hand, and Nova Scotia and New Brunswick on the other. Whilst several thousand cases are annually reported in the former Command, the disease is so rare in the latter, that scarcely one indigenous case has ever been known to occur. Even in Lower Canada, intermittents are almost unknown, the proportion, compared with Upper Canada, being as 13 to 89; and these cases have in most instances been traced to soldiers, who had laboured under the disease or had acquired a predisposition to it in the Upper Provinces. The fact seems inexplicable, that this disease should prevail extensively along the shores of the lakes and the margins of streams in Upper Canada, whilst situations abounding in similar supposed sources of malaria in Nova Scotia, should be exempt. As the soil of Halifax is arid and rocky, this exemption would have been inferred a priori; but it is sur- prising that it should extend equally to the troops and inhabitants at Windsor, Annapolis, Fort Cumberland and Frederickton, notwithstanding their posi- tion at the embouchure of rivers, and exposure to the influence of that com- bination of mud and marsh, regarded as its prolific source in Upper Canada. This seems the more remarkable when it is considered that the climate of Upper Canada and that of Nova Scotia are very similar. As the latter is a peninsula so much intersected by lakes and bays, that nearly one third of its surface is under water, the temperature, it has been seen, is so much modified, that the mercury seldom rises above 88° in summer, or sinks lower than 6° or 8° below zero in winter.

The posts of the second class, like the British military stations in the same region, exhibit comparatively a high ratio of intermitting fever. The mean aggregate strength of this class of posts is 5975, and the total of cases of intermitting fever reported is 1150; and of these, 560 cases are reported at Fort Gratiot, in a strength of 782. At this post, situated at the outlet of Lake Huron, the disease is exceedingly rife both among the troops and the inhabitants. As the annual ratio of cases treated per 1000, is 715, this post presents an average nearly as high as the southwestern stations, and higher than that of East Florida. Unlike the class of posts on the coast of New England, at which the majority of cases are of foreign origin, the class on the Lakes strongly manifests the influence of the seasons in the causation of the disease. For example, if 1000 troops were stationed at these seven

28

Forry on Diseases of Malarial Origin.

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posts, 13 would be attacked with intermitting fever during the first quarter of the year, 73 in the second, 77 in the third, and 36 in the fourth.

The average of the third class of the Northern Division is 151. Of the seven posts constituting this class, the occurrence of the disease is very unusual at Hancock Barracks, West Point, and Forts Snelling, Winnebago, and Armstrong, whilst at Forts Crawford and Leavenworth it is very preva- lent. If the statistics of Fort Leavenworth on the Missouri, which is nearly as far South as 39°, is excluded from the calculation, the annual average of the class is reduced from 151 to 71 per 1000.

The average of the Northern Division, comprising the three classes just examined, is 143.

The Middle Division, which comes next under consideration, shows that in proportion as Southern latitudes are approached, diseases of malarial origin increase pari passu. The average of intermittents in the three classes composing the Northern Division, is not more than two-fifths as high as that of the class now under examination, embracing Forts Delaware, McHenry, Severn, Washington, Monroe, Johnson, Moultrie, Bellona Ar- senal, and Oglethorpe Barracks. With the exception of Fort Moultrie, in Charleston harbour, none of these posts possesses an exemption from inter- mittent fever. At Fort McHenry, (Baltimore,) Fort Severn, (Annapohs,) and Fort Washington, (opposite Mount Vernon,) the disease has always been so rife, notwithstanding these garrisons generally formed summer encampments, that the average is higher than in Florida. The influence of the seasons in this class is very decidedly manifested, the ratio of the first quarter being 41, the second 71, the third 158, and the fourth 101.

The second class of this Division, consisting of the southwestern posts, viz., Jefferson Barracks, Forts Gibson, Smith and Coffee, Towson, and Jesup, piesents an average twice as high as the last class, and higher than any other in the United States. With the exception of Fort Jesup, inter- mittents are very rife at all these stations. At Fort Gibson, for example, the average number of cases exceeds the mean strength nearly one fourth. This post is situated about three miles from the junction of three rivers — a spot originally formed by the rich alluvion of these streams; and as the solar heat is intense, and the quantity of rain, though adequate to the maintenance of a certain degree of moisture, not sufficient to overflow the surface, the circumstances most favourable to the evolution of malaria, obtain. The high ratio of this class of posts, compared with the class on the Atlantic in simi- lar latitudes, is doubfless to be ascribed, in a great measure, to the great and long-continued summer heats. In the Northern Division, it is true, this law is not recognised; but there, notwithstanding the mercury rises very high, the period of this intense heat is veiy limited. In this class, the rela- tive influence of the seasons in the production of intermittents is very appa- rent, the four quarters presenting the following ratios: 101, 129, 305, and 197 cases per 1000 of the mean strength.

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The Southern Division remains to be considered. The first class, com- prising Baton Rouge, New Orleans, and Forts Pike, Wood, and Jackson, all on the lower Mississippi, and Augusta Arsenal, (Georgia,) and Fort Mitchell, (Alabama,) gives an annual average of 385 per 1000, being scarcely- more than one half as high as that of the southwestern stations; and the second class, embracing the posts in East Florida, both permanent and tem- porary, presents a ratio of 520, which, with the exception of the south- western posts, is higher than that of any other class. In the first class, however, the troops were frequently removed to healthy summer encamp- ments. As the troops in Florida are occasionally relieved, whilst those at the southwestern posts generally there serve out the whole period of their enlistment, it may be supposed that the extreme liability of this disease to recur, may swell the ratio of the latter comparatively. This rule, however, does not hold good; for, by a parity of reasoning, the class of posts on the lower Mississippi ought to give an average twice as high as its actual ratio. It is more than probable, as the summer temperature never rises so high in the two classes of the Southern Division, as well as the first of the Middle, as it does at the class of southwestern posts, that the causes productive of intermittent fever are not generated so abundantly at the former. As the ratio of the third quarter is three and four fold greater than that of the first, it may reasonably be inferred, all other causes being equal, that the higher the temperature of this season, the greater will be the proportion of cases of intermitting fever; and this deduction is corroborated by the fact, that as we proceed south, the ratio of intermittents augments with the increased sum- mer temperature. On reference to the table, it v/ill be seen that the striking distinction in the average of cases in the different seasons, is equally appa- rent in the two classes of the Southern Division. As regards the relative prevalence of this disease in our northern and southern regions, it is found that in the former, comprising the first three classes, the annnal ratio per 1000 is 143; whilst in the latter, embracing the Middle and Southern Divi- sions, the average is 568.

The average ratios of intermittent fever per 1 000, among all the troops stationed throughout the United States, are as follows:

Annual

1st quarter. 2d quarter. 3d quarter. 4th quarter. result. 45 75 158 93 368

The ratio of mortality from this cause is very low. It is only in our southern latitudes, when violent congestions of internal organs occur, that death may be said to arise directly from intermittent fever. In the Northern Division, the total of cases reported is 3187, and one death; and in the Middle and Southern Divisions, 14,094 cases, and 13 deaths. The ratio of deaths from this disease, on an average of all the posts, is only 8 in every ten thousand cases. According to the British statistics, the annual ratio of cases, per 1000 of the strength in the West Indies, is 243, and the ratio of

3*

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Forry on Diseases of Malarial Origin,

[July

mortality, 6 per 1000 cases; in the Mediterranean commands, the ratio of cases is 58, and that of deaths 5; among the troops on the home station, the disease is ahnost unknown; and among those stationed in Canada, New Brunswick, and Nova Scotia, the ratio of cases is 47 per 1000 of the strength, and the mortahty 8 per 10,000 of the cases. In Nova Scotia and New Brunswick, however, there is almost an entire exemption from the disease.

Having completed the details relative to intermittent fever, the subject of remittent fever will be next investigated.

Ratio of Remittent Fever,

Divisions.	Systems of Climate.	Ratio of cases treated per 1000 of mean strength.
	Second Quarter.		Fourth Quarter.	Annual Results.
Northern. Middle. Southern.	f 1st Class. Posts on the coast of New England, i 2d " Posts on Northern chain of Lakes, 1 3d " Posts north of latitude 3yo, and remote from [ the ocean and inland seas, ( 1st Class. Coast from Delaware Bay to Savannah, \ 2d " Southwestern stations, ( 1st Class. Posts on Lower Mississippi, I 2d " Posts in the Peninsula of East Florida, Average,	3 3 2 3 12 17 9	9 6 3 20 19 47 20	8 21 13 110 104 86 55	6 4 6 48 38 56 33	26 33 24 181 180 196 102
7	15	58 ! 22	101

In the three classes of the Northern Division, there is little difference in the annual ratios — a result which, as the coast of New England is exempt from intermittent fever, may be regarded as militating against the doctrine of their common origin. As remittent fever is much under the influence of the seasons, the ratio of the third quarter being more than eight times as high as that of the first in the general average of the United States, and as this in- equality of the seasons is not manifested on the coast of New England, the ratio of the second quarter being higher than that of the third, it is more than probable that many of the cases reported as remittent were of the common continued type. In every other class, this preponderance of the third quarter over the first is very striking, being in the first class of the Middle Division as 110 to 3. Although there is no exact relation discoverable between these two forms of fever, yet the statistics of our troops prove, as a general rule, that where one is rife, the other is so too. In the British statistics, the same connection is established; for in the West Indies, and the Ionian Islands, both prevail extensively, whilst in England, Gibraltar, Malta, the Bermudas, and Nova Scotia and New Brunswick, the ratio of both is low. In Canada, as might be expected in a cold country, the average of intermittents is much higher than that of remittents. In the Middle Division, compared with the Northern, the ratio of remittents increases very rapidly, being more than six- fold greater. In the first class of the Southern Division, the ratio is still higher; and here, too, the mortality is greatest in consequence of the high

1841.]

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grade of intensity assumed by febrile action; but in the second class, comprising the posts in East Florida, the ratio is lower than that of any one of the three pre- ceding classes. In the first class of the Middle and of the Southern Divisions, as for example, Charleston and New Orleans, the form of fever designated febris icterodes or yelloio fever, appears annually; whilst in the second class of the Middle Division, it is perhaps unknown, and in the second class of the Southern appears very rarely. As to the proper distinction between the bilious remittent fever of warm climates and the genuine febris icterodes, an arbitrary classification has been pursued by our medical officers; the majority of them reporting all these cases under the common nosological term of "re- mittent fever." In the present state of our knowledge, we are not, however, warranted in admitting that the same miasm which causes common remit- tent fever can, in its more virulent form, induce yellow fever, or indeed that the latter is of paludal origin. To prove that the causes productive of inter- mittent fever were generated most abundantly under a high temperature, it was shown that the annual average increased with the decrease of latitude, and that the third quarter invariably presented the highest ratio; and in regard to remittent fever, a comparison of the tables will show that these facts are yet much more striking. In the three classes constituting the Northern Di- vision, the annual ratio of cases of remitting fever per 1000 of the strength is 26, and in the four classes constituting the Middle and Southern Divisions, it is 168; whilst the ratio of all the classes is 191. In like manner, the ratio of mortality in the Northern Division is five tenths; and in the Southern re- gions, 6 per 1000 of the strength; but the proportion of deaths to the number of cases, owing to the greater prevalence of the disease in our southern lati- tudes, does not exhibit so great a contrast in the two Divisions, being 1 in 49 in the former and 1 in 29 in the latter. In the West Indies, the annual ratio of cases of remittent fever, including yellow fever, is, among the British troops, 413 per 1000 of the strength, and the mortality from the same cause is 54; but it is in the Jamaica Command that this disease prevails with its utmost virulence, the ratio of cases being 745 and of deaths 102 per 1000 men — an average furnished by the statistics of 20 years, and comprising an aggregate mean strength of 51,567; and during the same period, the average of cases among the black troops was only 85, and of deaths, less than 8 per 1000. Among the troops in the United Kingdom, the disease is almost un- known. In the Mediterranean stations, including the fatal epidemics of yel- low fever at Gibraltar, the ratio of cases per 1000 is 53, and of mortality 6. And lastly, in British America, comprising the Commands of Canada and Nova Scotia and New Brunswick, the ratio of cases is less than 3 per 1000, and of deaths, less than 2 per 10,000.

As these statistical researches are intended to elucidate such diseases only as manifestly depend on malarial causes, the following table of Synochal Fevers would not be presented, were it not that the writer aims at giving a complete view of febrile affections. Under the term, Synochal, are con-

32 Forry on Diseases of Malarial Origin, [July

densed all the cases registered as synoclia, synochus, common continued, ephemeral, and inflammatory fever; but a great majority of them are reported under the last name.

Ratio of Sy no dial Fevers.

		Ratio of cases treated per 1000 of mean strength.
Divisions.	Systems of Climate.	li	Second auarter.	n	1 Fourth 1 auarter.	Annual Results.
Northern. Middle. Southern.	fist Class. Posts on the coast of New England, ! 2d " Posts on Northern chain of Lakes, 1 3d " Posts north of latitude 39^, and remote from 1^ the ocean and inland seas, \ Ist Class. Coast from Delaware Bay to Savannah, ( 2d " Southwestern stations, 1st Class. Posts on Lower Mississippi, \ 2d " Posts in the Peninsula of iiast Florida,	12 4 11 8 0 25 o	14 5 13 6 4 15 2	6 4 16 6 14 3 5	11 3 6 7 5 14 10	43 16 45 27 25 CO 18
	Average,	8	8	10	7	33

What strikes the mind at the first view of this tabular summary is, that the four seasons exert nearly the same influence upon this class of fevers, and that they are equally unaffected by difl'erence of climate and latitude. As these fevers are dependent neither on the exalted temperature of summer nor on that of southern latitudes, it follows that they arise from causes of a nature entirely distinct from those of intermittent and remittent fever. In the Northern Division, the ratio of cases per 1000 is 37, and the average of the Middle and Southern is 25, whflst the mean of the three is 33. The mor- tality, however, is greater in our southern than northern latitudes, the pro- portion of deaths to the number treated being in the former 1 in 65, and in the latter 1 in 412. Among all our troops, the annual ratio of mortality from synochal fevers is only 3 in 10,000. In Canada, Nova Scotia, and New Brunswick, the ratio of cases is 96 and of deaths H per 1000; in England, the ratio of the former is 71 and the latter 1; in the Mediterranean commands, these ratios are 174 and 2^; in the Bermudas, 108 and 2; and in the West Indies, 139 and 6 per 1000.

Although typhus fever may be liable to the same objections as synochal, as regards its introduction into an article purporting to treat exclusively of diseases of malarial origin; yet to carry out the idea of presenting a complete view of febrile affections, its consideration becomes necessary in order to show what fevers are not of malarial origin. The following table exhibits the ratio of cases reported as typhus in each class of posts: —

1841.] Forry on Diseases of Malarial Origin. 33

Batio of Typhus Fevers.

			Ratio of cases treated per 1000 of mean strength.
Divisions		Systems of Climate.	1 First Quarter.	o «	Third Quarter.	c S "-a	Annual Results.
	f 1st Class. Posts on the coast of New England, J 2d " Posts on Northern chain of Lakes, ^ 3d " Posts north of latitude 39o, and remote from [ the ocean and inland seas, { 1st Class. Coast from Delaware Bay to Savannah, ( 2d Southwestern stations, ( 1st Class. Posts on the Lower Mississippi, (2d " Posts in the Peninsula of East Florida,		2	2 .7 .4 1.2 1.4 3	1	5
Northern. Middle. Southern.	1 .3 .7 .2 2 .2	.5 .1 3 1 6	1.8 08 1 1.3 3 .5	4 .9 3 4 13 .7
		Average,	.5	1	1	1	3.5

Typhus fever is of comparative infrequency, and, according to the table, its prevalence is uninfluenced either by season or climate. As the term typhus is subject to vague and arbitrary application, it is no doubt often used to designate a typhoid state of fever — a supposition favoured by the fact that the ratio is higher in our southern than in our northern latitudes. That it is often caused by the same miasm which produces intermittent and remittent fever, is an opinion advanced by Armstrong — a doctrine which has found but few advocates. When these morbific agents act on a system depressed and debilitated from any cause, a low or typhoid state of fever will be developed; but the phenomena of these fevers do not accord with those which characterize genuine contagious typhus — a form generated by that species of miasmata which is evolved in crowded, ill-ventilated ships, jails, hospitals, and the sordid hovels of the poor, and which, when once developed elaborates, there is reason to believe, a peculiar virus communi- cable to those coming within the sphere of its activity. In our abundant country, real typhus is fortunately very unusual. In the Northern Division, there are reported 54 cases and 8 deaths, and in the Middle and Southern, 110 cases and 24 deaths. Among our troops, the annual mortality from this disease is one in 1476 of the strength; in Canada, 1 in 4944; in Nova Scotia and New Brunswick, 1 in 6635; in the Bermudas, 1 in 5860; in the West Indies, 1 in 12,644; in the United Kingdom, 1 in 1393; and in the Mediterranean Commands, comprising Gibraltar, Malta, and the Ionian Islands, the ratio is 1 in 10,712.

The average annual mortality from the class of fevers brought under investigation, is, among our troops, 4.6 per 1000 of the mean strength. Among the British troops it is as follows: Canada 2.3, Nova Scotia and New Brunswick 1.5, the United Kingdom 1.5, the Mediterranean stations 9, the Bermudas 11, and in the AVest Indies, the ratio of the Windward and Leeward Command is 37, and that of the Jamaica Command is 102 per 1000 of the strength. Among the white troops stationed at Jamaica, then, the ratio is 25 times higher than the average of our own forces; but the black

34

Forry on Diseases of Malarial Origin.

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troops which serve on the Island enjoy comparative exemption, the ratio being only 8 per 1000.

The ratio of Diarrhoea and Dysentery is exhibited in the subjoined tabu- lar abstract: —

Ratio of Diarrhoea and Dysentery,

		Ratio of cases treated per 1000 of mean strensrth.
Divisions.	Systems of Climate.		"3 a, P 2	larter.		Annua! Results.
				" C?	^5
Northern. Middle. Southern.	f 1st Class. Posts on the coast of New England, j 2d " Posts on Northern chain of Lakes, ) 3d " Posts north of latitude 39°, and remote from (_ the ocean and inland seas, fist Class. Coast from Delaware Bay to Savannah, <2d " Southwestern stations, ( 1st Class. Posts on the Lower Mississippi, <2d " Posts in the Peninsula of East Florida,	14 34 32 41 fi2 126 111	26 54 54 133 185 135 136	108 121 163 204 223 117 125	22 49 56 65 121 72 124	170 253 305 455 597 456 495
	Average,	54	107	166	75	405

The influence of season and climate upon these affections is very appa- rent; for, in the general average of the United States, the ratio of the third quarter is more than three-fold higher than that of the first, and more than twice as high as that of the fourth quarter. Compared with the ratios of intermitting and remitting fever, the laAvs developed in both exhibit a striking analogy. The average of diarrhoea and dysentery, like that of intermitting fever, is the lowest on the coast of New England, and the highest at the southwestern stations; and, like intermitting and remitting fever, the ratio augments with the increasing temperature of season and the decrease of latitude. Even the relative influence of the seasons, taking the average of the United States, is exemplified in proportions nearly equal: thus- Annual

1st qr. 2d qr. 3d qr. 4th qr. result. Intermitting Fever, 45 75 156 93 368

Diarrhoea and Dysentery, 54 107 166 75 405

In the Northern Division, the annual ratio of cases per 1000 is 269, and in the Middle and Southern, the mean is 526. In the former, the proportion of deaths to the number treated is 1 in 665, and in the latter 1 in 141. The mortahty per 10,000 of the strength is respectively 4 and 37. In the North- ern Division, no death from dysentery is reported, except at Forts Crawford and Leavenworth — two posts at which intermittents are very prevalent. In Florida, the statistics of our troops present a singular relation, on comparing the second and third quarters, between intermittent fever and the class of diseases of the digestive organs, which last comprises diarrhoea, dysentery, gastritis, enteritis, &c. In the second quarter, the ratio of intermitting fever

1.841.]

Forry on Diseases of Malarial Origin.

35

is 9, and that of diseases of the digestive organs is 23 per cent.; but in the third quarter, the ratio of the former is 19, whilst that of the latter is only 17. As the average of the former is more than doubled in the third quarter, whilst that of the latter is decreased, it would seem, assuming an identity of cause, that the same morbific agents operating in a less intense degree, produce in the second quarter diseases of the digestive organs, and when more concentrated in their action, as in the third quarter, intermittent fever. A reference to the table will show that, in East Florida, the ratio of diar- rhoea and dysentery is nearly the same in each season — a result arising mainly from the great prevalence of chronic diarrhoea, which supervenes upon febrile affections, continues throughout the year, and ultimately in many cases proves fatal.

In the West Indies, diseases of the stomach and bowels are very prevalent and fatal. Among the white troops, the ratio of cases per 1000 is 351, and the deaths 15; and among the blacks, the former is 89 and the latter six. It is in the Windward and Leeward command, that this class of diseases pre- vails most fatally, the proportion attacked annually being 421 per 1000, whilst in England it is only 95; and in the former, the ratio of mortality from this source, which is 21 per 1000, is forty times higher. The much lower ratio of gastric and intestinal aifections in the Jamaica Command, in which dysentery and diarrhoea in particular assume a mild and tractable form, is ascribed' by the Reporter to the circumstance that instead of salt meat, much fresh provisions are supplied. The statistics of 20 years show that in one Command in which the diet, for five days in the week, consisted of salt provisions, the mortality from this class of diseases was nine times as high as among the officers; whilst in another, in which salt provisions were issued but two days in the week, the mortality of these two ranks was nearly alike. In the Mediterranean stations, it is farther asserted that at Gibraltar where much salt provisions are consumed, this class of diseases is both pre- valent and fatal, whilst at Malta, where the troops enjoy the advantage of fresh provisions, the disease does not prevail in an aggravated form. Among our troops, as the same ration is issued everywhere, it is highly probable that a quantity of salted pork which may be eaten with impunity in our northern regions, will become, in our southern domains, the active source of disease. In Canada, Nova Scotia, and New Brunswick, the annual ratio of the class of diseases of the stomach and bowels, is only 123 per 1000, and the ratio of mortality, 2 per 3000 of the strength.

The opinion that Colic and Cholera are much dependent on exalted tem- perature is not corroborated by these statistical researches. In the Northern Division, the annual ratio of cases per 1000 is 145, and in the Middle and Southern 131. In the former, however, nearly one half of the cases (1445) are reported among the cadets at West Point in a mean aggregate strength of 3734. Excluding this post, the ratio of the Northern Division is reduced to 96. In the Northern Division, only two deaths in 3221 cases are reported; and in the Middle and Southern, seven in 3282.

36 Forry on Diseases of Malarial Origin. U^^Y

Of Epidemic or Jlsiatic Cholera, there were reported in 1832-3 and 4, .

686 cases, of which 191 proved fatal. This, however, does not include all, |

as many troops, in the campaign against Black Hawk in 1832, fell victims j

to the disease, of which no official returns were made. It is a singular fact | that this epidemic exerted its fatal influence in nearly the same ratio among

all the troops whose statistics have been investigated; for example — \

United Kingdom, Gibraltar, .... Nova Scotia and New Brunswick, Canada, .... «(

Black troops at Honduras, , United States,

Among our troops, the disease proved more fatal in the Northern than in ' the Southern and Middle Divisions, the ratio of deaths being in the former one to three cases, and in the latter one to 4.3. It is not, however, to be inferred from this fact that Cholera Asphyxia causes greater mortality in cold • than in warm countries; for it was in the summer of 1832, when the disease ; was producing its greatest havoc, that our northern troops encountered it on ■ its first invasion by way of Quebec and the lakes, along which it travelled j with post-like regularity. On the contrary, it is a well-established fact that ; this disease is, in a measure, controlled by exalted temperature, and conse- j quently influenced by causes of malarious origin. This was, at the time of \ its prevalence, inferred from the circumstances that it prevailed mostly in the ' summer and followed the course of our rivers; but statistical facts among our j troops, in reference to the influence of the seasons, places this opinion almost \ beyond a doubt. Thus, among the 191 deaths reported in 1832-3-4, there ' occurred in the first quarter four, in the second 22, in the third 153, and in , the fourth 12.

Another class of diseases ascribable, in a great measure, to malarious I causes, is that of dropsies. In the Northern Division of the United States, i there are reported fifty cases and four deaths, and in the Middle and South- i ern, 206 cases and 19 deaths, the annual average of cases being in the former two, and in the latter eight per 1000. As these eflrisions are the result | mostly of febrile affections, it foflows that malaria is the indirect cause; but in our southern latitudes, much is also attributable to the deleterious effects \ induced by ebriety. In the West Indies, the ratio of admissions and deaths j from these aflfections, which are mostly the sequences of fevers, is also very ! high. Compared with England, the ratio in the Windward and Leeward ■ Command is nearly as eight to one.

Hepatic affections, including acute and chronic hepatitis and icterus. In the Northern Division, there are reported 98 cases and three deaths, and in the Southern and Middle, 166 cases and four deaths. As these diseases are

1832-3-4 .	. 32 deaths per 100 cases.
1834 .	. 30 "
. 1834 .	. 28 «	((
1832 .	. 36 «	((
1834 .	. 34 "	((
1836 .	. 32 "	((
1832-3-4 .	. 28 "	((

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Forry on Diseases of Malarial Origin.

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generally believed to have an intimate relation with tropical temperature and with causes of malarious origin, this comparative result is very surprising; and, indeed, were the result not confirmed by the British statistics, the writer would have suspected some error in his own calculations. The ratios of cases and of deaths per 1000 of the strength, given in different countries, are as follows: —

	Cases.	Deaths,
United States, ;	6 .	. -2
Canada, and Nova Scotia and New Brunswick,	8	•3
United Kingdom,	8 .	. -5
Mediterranean Station,	16	•7
Bermudas,	14 .	. -5
West Indies, — White troops, . . . .	18	1-5
" Black " ...	6 .	. -7

When we refer to the fact that the high ratios occur among troops from northern latitudes, in the Mediterranean stations, the Bermudas, and among the white troops of the West Indies, it may be fairly inferred that these dis- eases are little influenced by temperature. In the British army statistics, it is remarked that considering the high temperature of the island of Jamaica, it will seem strange that the ratio of admissions from diseases of the liver, compared, with troops in Britain, is only as ten to eight, and the deaths as one to four-tenths. It is in the East Indies that hepatitis finds a climate pe- culiarly favourable to its development.

In reference to the ratio of mortality arising from specific diseases, it is necessary to add that as the causes of one-eighth part of the deaths among our troops are not designated in the returns, it follows that these averages are too low; but as a majority of these unspecified deaths belongs to the class of sudden or casualties, it may be faiily assumed that the ratio of mortality from each disease is a sixteenth or a twentieth below the actual result.

I shall conclude these statistical facts with a table exhibiting the relative monthly mortality in the northern and southern regions of the United States, based on the returns made by the commanding ofiicer of each post, during a period of ten years.

Divisions.	Mean agaresatf streiiiith.	Jan.	J3	March	April.	May.	Ju ne.	July.	<	s. o 72	Oct.	Nov.	Dec.	Total.
Northern. Middle and Southern.	22240 24979	22 77	27 76	26 74	26 61	32 84	28 105	55 117	41 144	39 160	25 139	37 115	40 82	398 1234

In the Northern Division, there is little disparity in the relative mortality of each month, as the high ratio of July is caused by epidemic cholera; but in the Middle and Southern Divisions, the inequality is great in exact accord- ance with the increase and decrease of temperature. The lowest ratio (61) is in April, from which month it increases gradually until September (160),

Vol. III.— July, 1841. 4

38

Forry on Diseases of Malarial Origin.

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and then it decreases in the same unvarying gradation, in proportion as the influence of the " sickly season" upon the animal economy subsides, until the re-appearance of April. In this gradation there is no exception, the in- crease and decrease being a regular progression step by step. The influence of causes of a malarial nature upon mortality in our southern latitudes is thus illustrated; but these eff'ects are not manifested in our Northern Regions, owing to the circumstance that the diseases developed by malarious causes, such as intermittent fever, unlike the violent remittents of the south, do not exert a fatal tendency. In the Northern Division, according to the post re- turns given above, the annual ratio of mortality is 1.8 per cent., and in the Middle and Southern 4.9, whilst the mean of the three Divisions is 3.5 per cent. According to the regimental returns, the mortality for the same ten years, is 4.4 per cent. In the Middle and Southern Divisions, the ratio of cases under treatment is 50 per cent, higher than in the Northern; and the proportion of deaths to the number treated is nearly twice as high, the average being 1 in 75, and of the latter 1 in 144.

Having completed the investigation of the results aff'orded by the statistics of the United States troops, so far as diseases imputed to malarious sources are concerned, it remains to make some practical application of the laws de- veloped. The subjoined classification of infectious agents, adopted in Cop- land's Dictionary of Practical Medicine, is presented merely as expressing the general sentiment of the profession upon the subject. Under the class of ideo-infectants or non-disseminating and non-perpetuating infections, his first order of agents, is. Miasms or mephitic vapours — endemic infection acting through the air.

Species of agents.

1. Miasm from decayed vegetable mat- ter aided by moisture, in temperate ranges of atmospheric heat.

2. Exhalations from absorbent, or deep exuberant, or marshy soils, suspended in atmospheric humidity at temperate grades of warmth.

3. Miasms or vapours from decayed veg- etable matter, or from marshes and rich, deep, and humid soils, at high ranges of temperature.

Diseases resulting therefrom.

Catarrhal fever. Rheumatic attacks. In- termittents. Enlargements of the spleen, and torpid states of the liver.

Intermittents. Remittents. Simple Dys- entery. Simple Cholera. Bilious fevers. Obstructions and other dis- eases of the liver and glandular organs.

Inflammatory, bilious, and gastric fevers of both a remittent and continued type. Diseases chiefly of the abdomi- nal viscera.

Epidemic and exanthematic typhus and true yellow fever are put under the head of specific infections, which propagate their kind by a diffused and impalpable effluvium or vapour, emanating from the secretions, excretions, and surfaces of persons already affected. It need scarcely be added that the propriety of placing yellow fever in the same category with typhus, may be reasonably doubted. It is probable, however, that fevers which have, or are

1841.]

Forry on Diseases of Malarial Origin,

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supposed to have, their source in vegetable miasms, or at least in efEuvia from marshes, may subsequently spread by contagion.

Upon what evidence it is asserted that " catarrhal fever" and " rheumatic attacks" arise from " miasm from decayed vegetable matter aided by moisture, in temperate ranges of atmospheric heat," it were no easy matter to deter- mine. In medicine, we are too apt to revere the verba magistri, one teacher blindly repeating, and one writer blindly copying, the dicta of predecessors, as if oracular. That catarrhal fever has not the remotest connection with mala- rial causes, is demonstrated by the statistics of our troops. As the ratio of intermittent and remittent fever is about five times higher in our southern than in our northern latitudes, and as that of catarrhal affections is twice as high in the latter, it follows that as the results are in an inverse proportion, no relation of cause and effect is discoverable. As the classification, however, limits the production of catarrhal fever to " temperate ranges of atmospheric heat, aided by moisture," it may be said that it applies only to our northern regions. In diametrical opposition then to this view, it is found that in the winter, when no miasm from decayed vegetable matter" arises, the ratio is twice as high as in summer; and that the annual ratio in the moist climate of the lakes and the coast of New England is not more than half as high as that of the dry climate of the regions remote from large bodies of water. In reference to Rheumatism, the same remarks are applicable, but in a less marked degree.

Thus far the writer has dealt pretty much in facts; but in entering upon the investigation of the essential nature of the effluvium from marshes, termed malaria, he feels that he has passed into the regions of speculation. The history of medical science shows that the subject of Fever has, at all times, been regarded as presenting the most extensive and inviting field for observa- tion and the exercise of a philosophic mind. This arises from its paramount importance among the long list of human maladies. It is a subject, at the same time, eminently calculated to humble the pride of human reason; inas- much as the mind of man, engaged upon it for near 3000 years, has failed to determine its essential nature or causes.

The causes of epidemic, endemic, and contagious diseases, have never re- ceived satisfactory elucidation. Notwithstanding we are acquainted with some of the laws which govern malaria, we can no more describe the consti- tutio aeris, which gives rise to endemico-epidemics, than we can define the inscrutable vapors which generate typhus fever or small-pox. In these re- searches, the object has been rather to point out effects than to speculate upon causes; and although some of the laws by which diseases of malarial origin are controlled in reference to the seasons and our systems of climate, have been developed, yet our knowledge of meteorology is wholly insufficient for the explanation of the precise nature or operation of such influences.

As endemic diseases are produced by a concurrence of causes acting con- stantly or periodically in certain localities, so it may be supposed that the diseases of each are no less dependent upon peculiar physical causes than its

40

Forry on Diseases of Malarial Origin.

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animal, vegetable, or mineral productions. As the influence of a certain soil or climate gives an inexplicable peculiarity to vegetation, which we cannot imitate by artificial means, so certain diseases are confined to specific locali- ties— some appear periodically in certain situations — whilst others are rife in particular seasons, influenced by the various causes which modify the constitution of climate. Difference of climate, as it regards its agency upon health and the organic modifications which the human frame experiences from this cause, depends no less upon certain emanations from the soil, which is composed of organic remains and comminuted mineral substances, than upon those other conditions of the atmosphere, arising from its hygromet- rical, thermometrical, barometrical, and electrical states. Although the morbific cause may be general and widely diffused, yet it is mostly modified by local influences, constituting an endemico-epidemic. An example in point is presented in the history of epidemic cholera, the visitations of which, in the United States at least, were much favoured by the high temperature of summer and by the peculiar atmosphere of towns situated on seas and rivers. We sometimes see a district signalized for its salubrity, desolated by a malignant fever, the production of which required a combination of certain local and general causes; but as this precise concatenation of causes may never re-occur, so the inhabitants may remain exempt from a similar scourge. The occasional appearance of yellow fever in our northern cities may be thus explained. When, on the contrary, a particular disease appears every year in a certain locality, it may be presumed that the local causes, influenced by season alone, are always present, and that it requires but little change in the general atmospheric constitution to induce the necessary cau- sation. We may thus account for the high ratio of intermittent fever in many parts of the United States and of remittent fever in the southern regions, and for the annual appearance in some of our southern sea-ports of yellow fever, — a disease which seems to be indissolubly connected with soil and climate. As an illustration of the remark that malaria sometimes makes its appearance in places which had previously enjoyed a complete exemp- tion, I may mention that, at the Narrows near New York, intermittents and remittents appeared, in 1828, in their severest forms among the labourers employed in the erection of Fort Hamilton; and, at the same time, Staten Island and the elevated coast of Long Island in the vicinity of the Narrows, where a case of intermitting fever had been almost wholly unknown, became so subject to these febrile diseases, as to drive the inhabitants from their possessions. In like manner, on the elevated banks of the Schuylkill, villas were erected at a time when intermittents were scarcely known; but, in consequence of their great prevalence in late years, many of them have been abandoned.

The modifications of the atmosphere which give rise to epidemic, ende- mic, and contagious diseases, have proved totally inappreciable by endiome- tic researches. That the comparative unhealthiness of low, swampy situa-

1841.]

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tions, depends upon an admixture of terrestrial emanations with the common atmospheric elements, is obvious; but these agents, if we except the recent experiments of Majendie, have always escaped the researches of the chemi- cal pathologist. As our false facts are numerous, the speculatist has conse- quently found, in the obscurity of this subject, ample scope for hypothesis.

Yet the unprejudiced mind, in viewing the whole question, notwithstanding the impracticability of demonstrating the precise nature of marsh 'poison, is inclined to adhere, satisfied to argue from effects, to the opinion sanctioned by the general consent of mankind, viz., that malaria has its source in organic remains. One fact is evident, viz., that a marshy soil, previously sub- merged, exposed to the action of solar heat, will develope that mysterious and subtle agent called malaria; and that this emanation is the result of the decomposition of dead organic substances, producing new compounds by the combination of their elements, is an opinion warranted by the strongest evidence short of demonstration. We know from experience that marshy districts in almost all countries are the foyers of disease, and that the deltas of large rivers are apt to teem with malarious exhalations. The detritus thus annually brought down rivers, no matter whether united with earths of a sandy, a calcareous, or an argillaceous nature, will give rise to these miasmata; but soils of a humid character are doubtless best calculated to maintain these organic remains in a condition favourable for solar action. It was remarked of old, that the inundations of the Nile, at the same time, scatter fertility over the valley of Egypt, and sow with a liberal hand the prolific seeds of disease. The knowledge that we possess on this subject would enable us, on viewing the climate and topography of the lower Mis- sissippi, to pronounce at once upon the true character of the soil; and in surveying the locahty of Fort Gibson, originally a canerbrake, formed of the alluvion of three streams, whilst the exhalations of miry lagoons are, during the extraordinary heats of summer, wafted over the fort by the prevailing winds, the presence of the physical conditions causing malarious diseases, would be immediately recognized.

One of the circumstances most essentially connected with the production of malaria, is heat; for, in proportion as the equatorial regions are approached, do febrile endemics become more rife and malignant — a remark which applies equally to the relative influence of the seasons. Heat alone is not, however, sufficient, inasmuch as the diseases of the Nile never extend into the neighbor- ing desert; and in like manner, in our southern regions, whilst the margins of streams, lakes, and marshes are rife with malarial diseases, the sandy pine woods are exempt from them. As all those cities and military stations, which have been, in every quarter of the world, the graves of unnumbered thousands, have occupied the banks or deltas of rivers, in low flat countries, it would seem that moisture is also an essential ingredient in its production; but these two agents, heat and moisture, however requisite, are not in themselves ade- quate causes; for vessels at a small distance from the land, in the rainy season

4*

42 Voxxy on Diseases of Malarial Origin. [July

of the hottest climate, will continue healthy, if proper police regulations are maintained. It appears then that heat and moisture, however essential, re- quire the co-operation of other agents. What these conditions are, has been plainly indicated at all periods of the world. The same causes that were in action on the banks of the Nile, the Lernean marshes, and the Campania di Koma, are now found in operation in the rice swamps of our southern States and the marshy lowlands that skirt the coast and rivers from DelaAvare Bay southward, viz:, a soil abounding in organic remains. In the operation of heat and moisture, however, this striking distinction obtains, that heat acts in proportion to its intensity, whilst excess of moisture is no less inimical to the generation of malaria than its deficiency. Hence it is necessary in consid- ering the conditions most favourable to the evolution of malaria, to distinguish between a moist and rainy season. To submerge completely marshy lands, it is well known, is one of the means of obviating their insalubrity. Animal and vegetable decomposition is regulated by the degree of heat and moisture combined. If moisture be increased until the air is excluded from the vege- table matter, decomposition is suspended; and the same efi'ect is induced, if the temperature be reduced to the freezing point, or increased until all mois- ture is dissipated. The body of an animal is no less preserved in the arid deserts of Africa than in the frigid regions of the north. In the one case, the fluids are congealed, and in the other so quickly evaporated that it actually becomes a dried preparation.

Although the essential causes of malaria may remain forever involved in obscurity, yet the important agency of heat and moisture in its causation, as shown in the statistics of our troops in the fact that the annual ratio of inter- mittents and remittents is five-fold greater in our southern than northern lati- tudes, and that a contrast equally great is exhibited between the first and third quarter of the year, is satisfactorily demonstrated. These laws are confirmed by the results of the British statistics, which, as the average of each month is given, illustrate still more fully the influence of the seasons. As the sun pro- ceeds northward in the ecliptic, bearing in his train heat and moisture, the northern colonies of the West Indies experience later than the southern ones, the period termed the unhealthy season. It has also been observed that in the Mediterranean stations, the ratio of admissions and deaths between July and October is nearly twice as high as at any other period of the year. The statistics of Canada lead to the same result, but in a less marked degree. The most striking exemplification of the law that the " sickly season" coincides with the time when the greatest degree of heat and moisture is combined, is aff'orded in the fact that positions north and south of the equator, in conse- quence of the seasons being reversed, become most insalubrious at periods precisely opposite.

In the ratio of diseases of malarial origin, there is great variation from year to year. At Fort Crawford, Wisconsin, Lat. 43° 03', for example, there were reported, in the third quarter of 1830, 154 cases of intermittent and remit-

1841.]

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tent fever, and in the same quarter of 1836, there occurred but one case, notwithstanding the strength was greater. Believing that temperature had some relation with this wide disparity, I arranged the results as under:

	Mean temperature.		duantity of	Ratio of cases of
			July	Highest	rain in inch	intermittent and
Years.	July.	August.	and	Degree.	es, in July	remittent fever,
		August.		and August.	per lOOofstr'gth.
1829	74.33	73 76	"^05	84		3
1830	81.47	77.07	79.27	94	a>	72
1831	76.56	71.93	74 24	98	tc	33
1832	74.41	70.09	72.25	94	'5}	1
1833	78.73	76.58	77.65	98		8
1834	80.49	77.55	79.02	98	o	14
1835	73.80	69.62	7] .71	94	'Z	3
1836	73 00	66.66	69.83	90	5-50	.4
1837	73.83	70.87	72.35	95	5.48	17
1838	78 61	73.90	76.26	97	8.24	19

As there are doubtless many modifying causes, the precise influence of elevated temperature cannot be determined; but it is seen in the above table that in 1830, when the mean temperature of July and August was highest, the ratio of intermitting and remitting fever was 72 cases per 100 men, and that in 1836, when the temperature was lowest, the average was only .4 per centum. The years 1835 and 1832 are the lowest next in order, both in regard to temperature and the prevalence of fevers. The observations on the pluviometer are too limited to afford data for comparison.

In elucidation of the influence of temperature, another example will be given. In the island of Jamaica, as the elevation of the lands in the interior causes a corresponding modification of temperature, almost every variety of climate is presented. At the height of 4,200 feet, the vegetation of the tro- pics gives place to that of temperate regions; and here the inhabitants enjoy a complete exemption from the violent bilious remittents which cut ofl" thou- sands annually along the coast. In these elevated regions, we are told that the inhabitants, far from presenting the pallid and sickly aspect of those that dwell along the coast, exhibit that ruddy glow of health which tinges the coun- tenance in northern cHmes. At Maroon Town, elevated more than 2000 feet above the level of the sea, the annual mortality of the troops is only 33 per 1000, notwithstanding many of the deaths originated from disease contracted at other stations; whilst at Montego Bay on the coast, the ratio rises to 179, and at Savannah La Mar, even to 200. That yellow fever is never found above the height of 2,500 feet, was long since determined by Humboldt.

In the production of malaria, there may be other agents at work equally essential with heat and moisture. As the developement of electric phenomena has an intimate connection with heat and moisture, electricity may also be an indispensable auxiliary. Between miasmata and mere eflluvia, there is no doubt a wide distinction. The latter, which are nothing more than the ele- ments of a compound body, are generally as innoxious as the compound itself; but the former may be new compounds, resulting from the play of affinities among these liberated atoms. As the ordinary operations of nature do not tend to her own destruction, so organic substances, it may be supposed, are

44

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decomposed, and the atoms re-united in such combinations as generally prove harmless to man. The workshop of the " knacker," whose occupation is to convert dead animal matter to various useful purposes, though repulsively offensive, is not unwholesome; and the tainted atmosphere of the dissecting room, breathed month after month, generates no endemic fever. Morbid action seems, therefore,'not to be induced by the mere decomposition of matter, but by the combinations which, under peciiliar circumstances, result. Thus it is an ordinary law of nature that the human body, when life is extinguished, shall return to its original elements; but under certain modifying circumstan- ces, it is converted into aclipocire. The mere effluvia of dead animal or vege- table matter may differ as much from miasmata or malaria, as oxygen or hy- drogen does from the various compounds of which it forms a component part. These miasmatic compounds, generated under different circumstances, or the same causes acting upon different constitutions or upon different states of the same constitution, produce, it may be assumed, in one case intermittent, in another remittent, and perhaps in a third, that higher grade known as yellow fever.

To prove that malaria is not the product of vegetable decomposition, fre- quent reference is made to the fact observed by Dr. Ferguson, that malarious fevers prevailed to a great extent among the British troops when encamped on the rocky and arid tracts near Lisbon in Spain. " In the month of June and July," he says, " the British army marched through the singularly dry, rocky, and elevated country on the confines of Portugal, the weather having been previously so hot, for several weeks, as to dry up the mountain-streams. In some of the hilly ravines, that had lately been ivater-courses, several regiments took up their bivouac, for the sake of being near the stagnant pools of water that were still left among the rocks. Many men were seized with intermittent fever." Notwithstanding a country may be arid and parched, the heavy dews at night, without reference to the moisture beneath the surface, may be sufhcient in " ravines that had lately been water-courses,^ to cause the generation of miasmata. As every soil productive of vegetation contains organic remains, so it is impregnated with one at least of the ele- ments of malaria. Should the temperature be low as in winter, no poison is generated. Should moisture be wanting or water superabound, the same result may be predicted. Even admitting that these " water courses " were rocky channels, enough of organic remains may have been deposited by the recent " mountain-streams " to produce, when acted upon by the moisture of dews, the results that followed.

In the recent statistical Reports of the British army, the Reporter arrives at the conclusion, from an examination of the subject in every quarter of the globe, that the prevalence of intermittent and remittent fever does not depend materially on the influence of moisture or high temperature; aye, and more than this, it is alleged " that though the vicinity of marshy or swampy ground appears to favor the developement of that agency [malaria], it does not necessarily prevail in such localities, nor are they by any means essential

1841.]

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either to its existence or operation." This opinion is based, among other facts, upon the circumstance that intermittents are very rife in Upper Canada, whilst in Nova Scotia, under circumstances apparently similar, the inhabit- ants enjoy an exemption; and that yellow fever frequently appears at Ireland island, one of the Bermudas, a rocky and barren spot, containing no marsh and little or no vegetation. In reply to this, it may be said that in reference to the cause of yellow fever, we know but little, and are wholly unauthorised to ascribe it positively to paludal origin; and as to the induction by which intermittent fever is traced to the agency of a marshy locality, notwithstand- ing the exceptions adduced in Nova Scotia, as well as the singular exemption on the coast of New England, the every day experience of our army surgeons and of the practitioners of our newly settled regions, confirms its truth.

In Canada and the United States, it is a fact well known from their earliest history, that although cultivation renders a climate more salubrious, yet its endemic diseases, for several years after the soil is cleared from its more bulky vegetable productions, often become more severe than previously, and not unfrequently assume an epidemic character. The surface of the earth exposed to the sun's rays, yields a more noxious effluvium than when pro- tected from its action by a dense and exuberant vegetation. That a partially cultivated region is more sickly than a wilderness or country in the highest state of agricultural improvement, is a well known fact. The soldier, the hunter, and the wild borderer, suffer less from disease than the actual settler. The diseases of the former class are mostly of an inflammatory character resulting from fatigue and exposure; but as soon as the permanent settler begins to fell the forest, leaving the branches to undergo decomposition, and to turn up to the action of our intense summer heats the marshy ground, composed of the accumulated vegetable and animal deposition of years, dele- terious agents are exhaled, giving rise to the most malignant endemics.

An example of this kind fell under the observation of the writer, when stationed at Fort King, in the interior of East Florida, in the summer of 1837. This post, the old Seminole agency, which had been maintained for some years prior to Indian hostilities, was always remarkable for its heaithfulness; but in the latter part of the summer just mentioned, violent fevers of the remittent form and intermittents running into the same type, occurred, ascribable apparently to the circumstance of the smaller trees and under- growth of a vicinal jungle, called a hammock, having been cut down as a precaution against Indian ambuscade. Much of the surface of this hammock consisted of a trembling soil, to many yards of which motion might be com- municated by an effort simply of the foot. This crust which would bear the weight of a dog, would not sustain that of a horse, as was proved by several sad illustrations.

I may here allude to the recent experiments of Majendie, without attempt- ing to base any argument upon them. He states that having condensed, by means of cold and other agents, a quantity of marsh atmosphere, a considera-

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ble residuum of animal or vegetable matter was obtained, which had a ten- dency to run into putrefaction with the greatest rapidity. Having performed a series of experiments upon animals by injecting this matter into the veins, M. Majendie discovered that the lesions pathognominic of yelloiv fever, were induced. In an animal, which died two hours after the injection of a little putrid matter into the veins, autopsy revealed the following lesions: — The blood was liquefied, and the muscles exhibited a remarkable punctuated red colouration, caused by a vast number of petechise; and the mucous coat of the intestines was found raised by a deposition of blood in the subjacent cellular tissue, and the surface covered with large patches of albumen and mucus. The partizans of inflammation would, according to Majendie, regard this as a case of decided gastro-enteritis; but he can see nothing more in it than the dis- tension of the capillary vessels with blackish fluid blood, which having become dissociated in its elements, partially transudes the intestinal tunics. These experiments oft repeated presented the same pathological phenomena, more or less marked in proportion to the duration of the disease before causing death.

That these disorders are not the result of a general cause is evident from the fact, that the injection of diflerent substances will produce specific lesions of diflerent organs. Thus subcarbonate of soda disorganizes the thoracic viscera; the lungs become distended with blood, which gushes out when an incision is made into their substance, and a bloody fluid is eflfused into the pleura, constituting, in the nomenclature of pathologists, a case of pleuro- pueumonia. The blood when liquefied by the subcarbonate of soda, exer- cises, indeed, a specific influence; for the various tissues and organs of the abdominal cavity are found in a normal condition.

In those cases in which death very quickly follows the introduction of a few drops of putrid water into the veins, causing the ejection by vomiting of blackish clammy liquid, like that in yellow fever, and the mucous membrane is found covered, throughout its whole extent, with extravasations of blood, Majendie attributes the result to a change in the constitution of the blood, and not to a modification in the properties of the walls of the vessels. This change in the properties of the blood, which is no longer adapted to that of the ducts in which it flows, he regards as the first link in the chain of abnor- mal actions, whilst the organic lesions are secondary phenomena.

These experiments aflbrd corroborative evidence of the opinion that mala- ria has its source in organic remains. Heretofore, the etiologist could argue only from eflects; and when he found that certain results always followed the conjoint operation of certain causes, he was justified, upon every principle of analogy, to assume the existence of the relation of cause and eff"ect. Now, however, it may be said that miliaria has, in a measure, been compelled to put on a tangible shape, and to confess its secret power, thus almost demon- strating its eff'ects on the animal economy. The subject, however, is still enveloped in deep obscurity; and to him fortunate enough to enrich science by unravelling its mysteries, a proud immortality is destined.

1841.]

Gilman's Observations in Obstetric Pathology.

47

Art. ll.-— Notes of Observations in Obstetric Pathology. By Chandler R. Oilman, M. D., Professor of Obstetrics and the Diseases of Women and Children, in the College of Physicians and Surgeons, New York.

I SUBMIT to the notice of the readers of the American Journal of the Medical Sciences, the following notes of some of the observations in Obstetric Patho- logy, made by me during the past winter. I am aware that detached obser- vations of this sort, when merely noted down in their simplicity, and presented without any elaborate detail, have but little attraction for the generality of medical readers. Still, before pathology can become what we all desire to see it, a science of facts, many single observations must be added to the already accumulated store. In this state of the case, it seems to me that no one who will observe facts with care, and record them with fidelity, need fear that his labour should be entirely without value. I have another and a personal reason for offering these notes to the public. By the kindness of my medical friends, I have many opportunities of making autopsies and procuring preparations from cases which occur in their prac- tice. It appears to me that I shall best show my sense of these acts of kindness, not only by striving to improve to the utmost the opportunities thus afforded me, but by disseminating as widely as I can the knowledge of the facts I thus collect.

Case I. Case of Tubal Pregnancy. — I was requested by my friend Dr. Weeks, to assist him in the examination of the body of a female patient, about the nature of whose case there had been great difference of opinion among those medical gentlemen who had seen her. I had called on this patient once, with Dr. W., but she would not then submit to an examination, so that I had no knowledge of her case except from Dr. Weeks. From him I obtained the following history: —

Mrs. , setat. 43, who had several times miscarried, but never

had a living child, supposed herself pregnant in October, 1839. She passed the first months of gestation without accident, and quickened about 1st March, 1840. In April, she was taken with a flooding after an attempt to lift a heavy weight. Fearing a miscarriage, and being exceedingly anxious to have a living child, she immediately sent for Dr. W. The usual means were employed, and the symptoms gradually passed away. In the course of the next month or six weeks, she had two or three slighter attacks of the same sort, which readily yielded to rest and mild remedies. In May, being then between six and seven months, she had a violent attack — profuse haemorrhage and very severe paroxysmal pain, a miscarriage was now deemed inevitable, and but litde was done to prevent it. Nothing, however, except blood was discharged, and after several hours of suffering, the symptoms

48

Gilman's Observations in Obstetric Patliology.

[July

abated and finally disappeared. To this time, the motion of the child had been felt distinctly, but after this, it ceased entirely. The patient kept about most of the time, but during the next three months, had several attacks of pain, tenderness in the belly, fever, and the other symptoms of peritonitis. She was treated by such antiphlogistic means as her state of general health permitted, leeches being frequently employed. From these repeated attacks, her health gradually failed; after one of more than ordinary severity in Octo- ber, 1840, fluctuation was detected in that part of the tumour which occupied the right iliac region — the skin became red and thin, an abscess was evi- dently pointing; it was freely opened, and a very large quantity (the doctor thinks two gallons at least) of gray and very fcetid pus was discharged. A slight improvement of the general health followed, but it was only tempo- rary— the patient soon began to sink, and died December 7, 1840.

Before death the abscess opened in the two other places in the right groin and pus was discharged from the bladder and the rectum.

Post mortem examination — 20 hours after death. Body much emaciated. The abdomen was distended below the umbilicus by a tumour about the size of the uterus at six months. It did not present in the median line, but rather to the right of it. There were three openmgs in the right groin, one, the largest, from which the pus was first discharged — was oval, an inch in its greatest diameter, situated two inches inwards and downwards from the anterior superior iliac spine. The others were smaller and just below the first.

The abdomen was now laid open. The whole hypogastric region — the right iliac and a part of the left ^vere occupied by a tumour which was em- bedded among the pelvic viscera and closely adherent to all the parts with which it was in contact, particularly to the bladder and the rectum. This tumour was a sac or cyst with thin walls, in which were three openings, answering to those in the skin. These openings were necessarily enlarged in removing the abdominal walls, to which they adhered intimately and extensively. In the cyst was a pultaceous mass of an ash gray colour and most abominable foe tor; in this mr.ss the bones of a fcEtus of about the sixth month were found, some quite detached, others, particularly those of the legs, adhering together and covered with shreds of decayed soft parts. These were removed and the sac cleared out; next it, together with the whole con- tents of the pelvis, was reaioved and taken to the college for examination.

The parts were so completely matted together, that it was only after con- siderable labour and great care that our demonstrator of anatomy, Dr. Quack- enboss succeeded in unravelling them and making them out satisfactorily. The sac was found to consist of the left Fallopian tube largely dilated. This dilatation began about a half inch from the uterus to which point the tube was normal in external appearance, though not pervious. The sac had five open- ings, three answering to those in the skin a3 before noted and two into the bladder. Of these latter one would barely admit the tip of the finger, the

1841.] Gilm^LXi's Observations in Obstetric PatJwlogy. 49

other was an inch in diameter. The coats of the bladder were thickened and its internal lining membrane very much corrugated. As this was the first case of tubal pregnancy I had ever seen, I took the opportunity to examine as carefully as I could, the intimate structure of the tube, as to its muscularity. The peritoneum was removed and muscular fibre was I think clearly made out — indeed it would not have been easy to distinguish between the tube at that point and any portion of a gravid uterus when uncontracted.

The uterus was next examined; it had been crowded down into the cavity of the pelvis, on the right side, where it had contracted the most intimate adhesions with the sac above, the rectum and the pelvic paries. The right ovary, tube and broad ligament were all matted together, closely adherent to the uterus. When separated the uterus was found perfectly normal in appearance except that I think the walls were slightly hypertrophied. The cavity was quite empty.

There was no evidence that decidua'had ever been formed in it; but of course this case will prove nothing, as to the now disputed point whether decidua does form in the cavity of the uterus in tubal pregnancies, as the membrane if formed may have been thrown off" by the parturient efforts and escaped notice among the coagula. Thus far the examination had been satisfactory in every point except as to the pus which had passed per anum.

But the tubal cyst did not communicate with any part of the intestinal canal. On examining the rectum, the cavity of an abscess, large enough to hold a small orange, was found in the recto-vaginal septum pretty high up. This abscess communicated with the rectum by a minute opening, through which its contents had been evacuated, for it was nearly empty. Pus was therefore poured out in this case, from the sac through the openings in the abdominal walls and through the bladder; and from the abscess in the recto- vaginal septum through the rectum.

This case is interesting in a practical point of view, as proving how easily and how safely the Caesarian section might have been performed. The sac was so extensively adherent to the peritoneum, that an incision might have been made into it, large enough to have delivered the child, without any danger of opening the cavity of the peritoneum. In this respect the state of the parts was exactly similar to that found by Michaelis, of Keil, in the patient on whom he operated in 1836 for the fourth time.

Case II. Examination of the Uterus twenty-four hours after Delivery, tenth some Remarks on the Utero-Placental Circulation. — I was requested by Dr. Archer, the coroner, to assist in the examination of the body of a young woman, who died, soon after delivery, at the house of a Mrs. Bird, a self-styled midwife. The examination was made by Drs. Kissam, Coolidge, and myself. The girl was said to have died of hemorrhage. The case was of no interest in a medico-legal point of view, and I shall only detail the appearances of the uterus, which I examined with great No. IIL—JuLY, 1841. 5

50 Oilman's Observations in Obstetric Pathology, [July

care. Viewed externally, it was pale, and it felt flabby to the touch; on laying open its cavity the cervix and os were found very much ecchymosed, as was also the inferior portion of the vagina. I note this ecchymosis merely to say that it is normal, and will be found in most, if not in all cases; yet I have recently seen it noted as a pathological state, and charac- teristic of metritis. The placenta had been attached to the posterior Avail, on the right side, its upper margin just overlapping the orifice of the tube. The place of attachment was indicated by many large openings in the internal lining membrane; these were evidently the orifices of the uterine sinuses; ihey were for the most part plugged up with pretty firm coagula, a few of them, however, were empty. The coagula were next carefully removed by subjecting the part to a stream of water for a long time. The openings into the sinuses were now examined. They varied in diameter from two to six lines; they were generally elliptical or semicircular in shape and the edges so arranged as to form either a single or a double valve. To comprehend this fully it is necessary to bear in mind that the inner layer of uterine structure, though at other parts imperforated by large vessels, is where the placenta is attached, traversed by so many and such large veins and curling arteries, that its whole texture is cribriform, and in many places the vessels are separated by a septum of uterine structure scarce thicker than membrane. Now when the large sinuses are about to terminate on the inner surface of the uterus, the orifice is diminished sometimes from one side and sometimes from both, by a flap of thin fibres which projects over it, in the one case leaving a semicircular, and in the other an elliptical open- ing always much smaller than the sinus just within. These thin flaps can be lifted up with the probe, and thus, without tearing any thing, the orifice be doubled in size. This valvular arrangement seems to me to obviate one of the objections to Lee's view of the utero-placental circulation, viz., that the decidua is not sufficiently strong to confine the blood in the sinuses. It would seem that these openings are for the most part closed, not by super- imposed decidua, but by a valvular flap of true uterine structure. But I am digressing; the orifices of these sinuses were now examined with all the care possible under a microscope of high power. The margin M^as per- fectly smooth, clean, regular in its minute structure, and every where well defined. I then examined the inner lining membrane of the sinus from the depth of a line or more to the orifice; it was smooth, regular, and termi- nated at the verge of the opening in a clean edge free from shreds or any other evidences of laceration.

This observation, though of infinitely less value than it would have been had the placenta still adhered, yet seems to me to be worth recording, as throwing some rays of light on the subject of the utero-placental circulation, a subject involved in great obscurity, and still made matter of many and pretty fierce disputes. The opinion of the Hunters that the uterine sinuses passed the decidua and terminate in the cellular structure of the placenta,

1841.J Gilman's Observations in Obstetric Pathology, 51

was, I believe, first controverted by Dr. Robert Lee of London. One of his strongest proofs is the fact which my observation confirms, viz., that the opening's of the uterine sinuses have perfectly smooth, well defined and regular margins, which they certainly would not have if they were the torn extremities of vessels which passed through the decidua. That these mar- gins were perfectly smooth in my case, I can prove by the testimony of Dr. Gray, whose researches in botany have made him for years familiar with the microscope. Now if we adopt t?ie opinions of Hunter, as many of the English physiologists still seem inclined to do, how is it possible to explain this regular and clean state of the termination of the sinuses, since they must have been torn off when the placenta was removed. To my mind it appears purely impossible. By the January number of the Edinburgh Medi- cal and Surgical Journal, I see that Professor Reid has advanced a new opinion on this subject. He believes that tufts composed of minute arte- ries and veins, continuous with the umbilical placental vessels, project into the uterine sinuses, and that the internal lining membrane of the uterine sinuses is reflected upon these tufts, sometimes at the point where they enter the sinus, and sometimes merely at their apices. Thus every one of the minute terminal vessels of the placenta "is closely ensheathed in prolonga- tions of the inner coat of the vascular system of the mother, or at least in a membrane continuous with it."

"When the blood of the mother flows into the placenta, it passes into a large sac formed by the inner coat of the vascular system of the mother, which is intersected in many thousand different directions by the placental tufts projecting into it like fringes, and pushing its thin wall before them in the form of sheaths which closely envelope both the trunk and each individual branch composing these tufts." "From this sac the maternal blood is returned by the utero-placental veins, without having been extrava- sated and without having left her own system of vessels." Now, as to one part of this theory, and that its distinctive feature, viz., the prolongations of the foetal placental vessels, into some of the uterine sinuses, my case does not authorise me to speak; but as to the other portion of it, the prolongation of the inner lining membrane of the sinuses into the placenta, it seems to me that the perfectly smooth margin that the orifices of these sinuses present, is as fatal to it as to the view of Hunter; indeed, I do not see that there is any- thing but a diff'erence of phraseology to distinguish the view of Hunter from that of Reid. The sac which according to Reid, is formed by the prolonga- tion of the inner coat of the vascular system of the mother, is, it appears to me, in every thing but name identical with the placental cells of Hunter, " in which the curling arteries terminate, and into which the venous sinuses are prolonged."

Case HL Dissection of a case of Spina Bifida, with Remarks. — It was very justly remarked by the editor of the Medico-Chirurgical Review, in a late number, that the exact nature of this malformation is by no means

52 Oilman's Observations in Obstetric Pathology. [July

accurately apprehended by the mass even of the surgical part of the profes- sion. For many seem to regard it merely as an expansion of the dura mater, consequent upon the absence of that support which, in the normal state of the parts, the bony canal gives to it. The existence of this sac, its being filled with serum, constitutes the disease — and when mischief follows pres- sure upon this sac, it is generally referred with great confidence to the return of its fluid contents into the cavity of the spinal dura mater.

This is the view of this malformation taken by Cooper in his Dictionary of Surgery; by Good, who calls the disease Hydrops Spinae, and by most of the writers of text books of surgery and of obstetrics. The fact that the sac frequently, or indeed that it ever has any other contents than the serum that distends it, is never so much as hinted at by these authors. In this case, as in most others, mischievous plans of treatment have been the natural consequences of imperfect pathological knowledge. Hence we hear every now and then of the sac being tied — laid open, of pressure being applied — all remedies adopted to get rid of the fluid, and pursued under the impression that to evacuate the sac and prevent serum from again collecting in it, is all that is required to cure the disease, and that on doing this, little more care is necessary than in evacuating a psoas abscess or a hydrocele. It is true that a better notion of the nature of this malformation has been taught by some authors; but their views do not seem to me to have fallen into the current of medical literature, or to have been brought fairly and fully before the profes- sion. In this state of things, I have thought it worth while, taking advan- tage of a very well marked case of this somewhat rare malformation, which has recently come under my notice, to describe as fully and accurately as I can, the exact morbid anatomy of this case. If by so doing, I succeed in preventing in any one case that rash and mischievous meddling which too often hurries these cases to the fatal issue, my labour will not be in vain.

'^Iys. B , 3stat. 40, mother of six healthy children, was delivered

March 7, of a dead child, after a labour of six hours. The child was above the average size, and very well nourished; limbs and body plump, features regular, nails and hair well grown, and in every respect fully developed. It was hydrocephaUc and a tumour six inches in circumference projected from the spinal column, opposite the middle lumbar vertebra. The child had both feet clubbed and one knee was stiff— and I would here mention, as illustrating the well known law that several malformations often occur in the same individual, that in the subsequent examination we found that there was but one umbilical artery and that both ureters were double, the canals uniting just as they penetrated the coats of the bladder. These malformations follow the law laid down by St. Hilaire, who says that "spina bifida co-exists often with anomalies affecting the organs placed in front about the level of the loins." Hist, des Anornalies, &c., tome i, p. 435. The tumour was a thin semi-trans- parent bag, through which the reddish colour of the contained fluid could easily be distinguished.

1841.] Oilman's Observations in Obstetric Pathology, 53

The spinal canal was now laid open from the atlas to the second lumbar vertebra, at which latter, the opening through which the sack protruded, began. The upper portion of the medulla was normal in appearance, but about opposite the fourth dorsal vertebra, it suddenly diminished in size nearly one half. The spinous process of the last dorsal vertebra was com- pletely ossified, its two lateral portions having united by bone; this union was not complete in the first lumbar, and in the second all was cartilage. In the third, fourth, aud fifth, this was wanting, and through the space thus left, the sac, which consisted only of the spinal meninges covered with epi- dermis, protruded. Before examining the sac farther, the sacral canal was laid open below the tumour, it did not contain any dura mater, but the nerves passed out as usual through the sacral foramina. It was now evident that the sac did not consist of a mere tumour in the course of the spinal dura mater and bearing the same relation to it that an aneurism does to its artery, but that it was the termination of that canal enlarged into a sort of bulb, and protruded through the space left open in the bony canal. The sac was now laid open and its contents made the subject of careful observation. The Cauda equina passed in at the upper edge of the spinal opening and over the greater curvature of the sac. It adhered pretty firmly to the inner surface. Was it owing to these adhesions, that it had been protruded from the spinal canal? While passing over the great curve of the sac the cauda equina gave ofi"two pair of lumbar nerves, which passed down the sides of the sac to which also they adhered at two or three points. The cauda equina thus diminished, having traversed the greater curvature of the sac, perforated it at its inferior margin and passed into the spinal and sacral canal to its usual distribution.

Remarks. — We have here a case in which the whole cauda equina passed into the sac of the spina bifida. To what extent this protrusion of the nerves was dependent on their being adherent to the inner surface of the sac, it will require farther observations to establish — in the meantime, the fact that such an adhesion did exist, is not without interest. Cases in which the posterior branches of the spinal nerves have passed into the sac are not very rare, and some, I am aware, have been recorded in which the whole cauda equina had passed from the spinal canal, constituting what Lecat (Traite du Mouvement Musmlaire) calls hernia of the medulla: still it would seem from the manner in which the important variety yet remains unnoticed by the systematic writers, that something is yet wanting to bring the fact that the tumour of spina bifida frequently contains large nerves, and sometimes the whole cauda equina, fairly before the profession.

Case IV. Corroding Ulcer, ivith complete destruction of all the internal organs of generation. — Jipril llth, 1841. I was invited by Dr. James Kis- sam to assist in examining the body of a female patient who had died of corroding ulcer of the uterus. The history of the case as I obtained it from

5*

54

Gilman's Observations in Obstetric Pathology. [J^ly

the doctor, ard from a gentleman who had previously attended her was as follows: — Mrs. F., setat. 50, having frequently had leucorrhoea, began to have foBtid discharges from the vagina, attended with pain in the uterine region; under proper treatment the symptoms were mitigated, and the patient lost sight of. From this time to the fall of 1840, the state of health gradually became worse and worse, the vaginal discharge more profuse and constant. Advice was had from several gentlemen, but I cannot find that either of them made any vaginal examination! The patient now, Octo- ber, 1840, came under the care of Dr. Kissam who was first consulted in the alarm consequent upon a profuse hemorrhage from the vagina. This he learned was the third of these hemorrhages, the first having occurred about a year before.

The immediate difiiculties being relieved, Dr. K. made a careful vaginal examination; the patient did not complain of much pain; the state of parts could not be satisfactorily made out; the os and cervix uteri were evidently gone, and there was no morbid deposit; the cavity of the pelvis seemed unusually empty, the finger moving about from side to side very freely. Corroding ulcer, far advanced, was diagnosticated, and nothing done except to palliate the sufferings, which were very great, (the pain in the pelvis being often agonising), by opiates, by fomentations, and by hip baths. Under this treatment she lived on for several months, the strength gradually failing, the body emaciating, the discharge of a horrible foster continuing unabated. During the winter she had two attacks of hemoniiage, which reduced her very much; still she felt well enough to see company on New Year's day, and got up to have her bed made so lately as the last of ]Mareh. In the afternoon of April 10th, she had a slight hemorrhage (a few ounces), but it prostrated her very much, and about 10 P. M. she died.

Sectio Cadaveris. ^The body was emaciated to the last degree; I never saw a more perfect specimen of leanness. On dividing the paries of the abdomen, which vv^as very thin, not over a quarter of an inch thick, the cavity of the abdomen was fairly exposed, the small intestines and stomach were normal, the sigmoid flexure of the colon was unfolded, and adhered by one edge to the bladder and to the margin of the superior strait, thus forming a sort of diaphragm, by which the cavity of the abdomen w^as separated from that of the pelvis; this diaphragm formed a complete septum except that at its posterior part it was traversed by the rectum. Having satisfied ourselves of this we next tore away the anterior edge of tlie colon from the bladder (the adhesion between the two was not very strong) an^i exposed the cavity of the pelvis. It was nearly filled by a gray semi-fluid mass, of the most horrible fcetor. This was carefully removed by the sponge and then the cavity examined. Here a most extraordinary state of parts was discovered. The whole cavity of the pelvis was empty, the superior and posterior wall of the bladder was eaten away, all that remained of that viscus being a cup about two inches in diameter, from the centre of which the urethra passed out. Behind the bladder the superior extremity

1841. "1 Oilman's Observations in Obstetric Pathology.

55

of the vagina was found eaten off by ulceration; not the slightest vestige of uterus, ovaria, fallopian tube, broad or round ligament, could be seen. The walls of the pelvis were coated every where with lymph and condensed cellular substance, which formed thus a limit for the vast abscess by which the cavity of the pelvis was occupied. There was an ulcerated opening half an inch in diameter, in the anterior wall of the rectum, about four inches from the anus, and just below this point the gut was so much stric- tured as scarcely to admit a quill. If my description has been intelligible, the reader will perceive that the cavity of the pelvis, in this case, formed a sort of cloaca, into which the urethra, the vagina, and the rectum opened. It is not a little curious that life should have been sufliciently prolonged to allow of so great a destruction of parts. Yet this woman sat up a portion cf every day till the tenth, before her death.

The other organs, except the brain, were carefully examined, to ascertain w^hether there had been, in any of them, any morbid deposit — cancerous — but nothing of the sort was found. The case illustrates very well the diag- nostic mark between ulcerated cancer and corroding ulcer; deposit of morbid matter being in the former case made more rapidly than the ulcerative pro- cess can remove it, while in the latter this process goes on alone, no deposit taking place, but the original structures being gradually removed. In the great work of Cruveilhier, liv. 24, there are several cases given, which are strictly analogous to this; but Cruveilhier calls the disease gangrene of the uterus. This gangrene, he says, may be primitive or consecutive. On examining his cases they appear to be all gangrenous ulcerations rather than true gangrene. Those which he considers consecutive were cases of cancer in the progress of which, ulceration, with discharge of a horribly offensive detritus, occurred. To distinguish this from the ordinary cases of cancer in the ulcerative stage, Cruveilhier seems to rely mainly on " gangrenous fostor very distinct from the foBtor of cancer.''' This I confess seems to me rather a narrow basis on which to found a diagnosis. He distinguishes those cases which he calls primitive gangrene, by the gangrenous fetor, by the absence of all morbid deposit, by the absence also of fungous growths, and by the gangrenous aspect of the ulcerated surface. That these cases of primitive gangrene were not cancerous, no one can doubt,* and it appears nearly equally clear to me that they v/ere of the samiO character as the one I have detailed, and of those to which Dr. John Clark gave the name Cor- roding Ulcer. "Whether the disease should be called by the one or the other name, gangrene of the uterus or corroding ulcer, is of secondary im- portance, the main point being to establish the identity of the two affections.

* I fjnd, however, that the two are confounded by Hemnriing, the translator of Boivin and Duges, who adds a note to the chapter on Cancerous Ulceration, to say, that the dis- ease there spoken of, was probably the corroding ulcer of Clarke. That it was not, is evident from the facts that fungous growths are spoken of by the French authors as common, and cancerous deposit as occurring in some cases. Neither of these are ever eeen in the true corroding ulcer.

56

Barbour's Observations on Congestive Fever,

[July

Art. 111.— Observations on Congestive Fever, By Thomas Barbour, M. D., of Pulaski, Tennessee.

In the brief investigation of the interesting subject of the present paper, it is not my intention to consider the accidental cases of congestive disease, dependent on sporadic causes; nor those congestive superventions which are incident to every form of fever, but to confine my observations to that pecu- liar modification of febrile disease which is characterised from its very inci- piency, by strongly marked symptoms of deep internal congestion, and a great oppression of the powers of life; in other words, that aff'ection which is denominated in the south, pure congestive fever. The frequency of its occurrence, and the fatality attending it in the southern portions of the United States, concur to render it worthy of the most serious consideration of the profession; and demand from every practitioner, who has had good opportu- nities for observation, the results of his experience, which may serve in some degree to lessen the fatality of this destructive malady, by contributing to the improvement of its treatment. Having had numerous opportunities during the last four years, of witnessing this disease, and in some instances, in its most malignant form, in what is called the Tennessee Valley, in North Alabama, I indulge the hope that a few observations, principally with the view of pointing out the best method of treatment, will not be altogether unacceptable to the profession, and especially to medical men residing in the south, whose painful duty it may often be to observe, and to treat it.

I will cursorily notice, 1st, the etiology — 2d, the pathology — and 3d, the symptoms of genuine congestive fever; then detail the plan of treatment which I have found the most efiicacious.

In regard to the causes of this form of fever, as indeed of all other forms of what is called essential fever, but little is certainly known. Its almost universal occurrence in localities which are favourable to the production of malaria; its co-existence with all the common varieties of miasmatic fever; — and all of its distinguishing phenomena clearly demonstrate the identity of cause, and that that cause must be some powerful and concentrated poison, generated by the decomposition of organic matter.

It requires but a superficial observation of the phenomena of this disease, to be convinced that this cause, whatever it may be, makes its primary impression upon the nervous system; and that all of its characteristic symp- toms are the immediate sequences of diminished nervous sensibility. The suddenness of the attack, the numerous indications of nervous derangement, and the rapidly fatal tendency of the disease, conclusively show, that the brain and the whole nervous system, the main springs of life — are almost overwhelmed in the very first assault of the enemy.

The impression made upon the nervous system is proportionate to the intensity of the poison applied; and the eff'ects on the constitution are vari-

1841.]

Barbour's Observations on Cmigestive Fever.

57

ous according to the relative force of vital resistance; hence, whenever it prevails, there is every gradation of the disease from slight manifestations of congestion, to the most malignant cases, in M^hich the vital forces are com- pletely empowered. This leads me to the consideration of the pathology of congestive fever, which I will point out in a few words.

The whole nervous system being oppressed by a powerful morbific poison, as necessary consequences, all of the vital functions over which it presides, as respiration, circulation, secretion, &c., become greatly impaired; the capillary circulation throughout the entire system becomes much impeded; and there is a centripetal movement in the circulating fluid, in consequence of which the pulse becomes weak, and the general surface cold and con- tracted; whilst the internal organs become gorged with blood.

The phenomena dependent upon internal engorgements, are various ac- cordino^ to the seat and extent of the cono-estion. When the brain is the chief seat of congestion, the countenance appears contracted, oppressed, and besotted; there is pain or giddiness, or a sense of heaviness in the head; and there is a strong tendency to coma and insensibility. "When the lungs and heart are principally congested, there is great precordial oppression; the respiration is short, hurried, and oppressed; and there is generally a peculiar livid appearance in the face; the pulse is irregular and oppressed; and there is general coldness of the surface. WTiCn the abdominal viscera are the chief seats of congestion, there is a sense of great heat and oppression in the region of the stomach, attended with great thirst, and a constant disposition to retching and vomiting; there is also indescribable restlessness; sometimes the bowels are torpid; but most generally they are very loose — thin, serous discharges passing oiF in enormous quantities, which contribute rapidly to prostration and death. Autopsic examination usually reveals the true source of all the foregoing symptoms. The various organs are found more or less gorged with blood; which v/as the cause of their oppression and embarrass- ment during life.

With this brief view of the pathology, I pass on to the consideration or the symptoms of congestive fever. The premonitory symptoms, which are, generally, of short duration, are those which commonly precede other forms of fever, such as languor, and lassitude, a sense of weariness, and general uneasiness, loss of appetite, and disturbance of the stomach and bowels. Next to these succeed chilly sensations — alternated by flashes of heat, soon after which the patient has a regular paroxysm, characterised by a protracted cold stage — the system, most generally, being unable to recover its natural temperature before the occurrence of the second paroxysm.

The type of this fever corresponds with the double tertian of the old authors, being subject to quotidian paroxysms, but on each alternate day, to an increased aggravation of the symptoms. Thus on the third and the fifth days, the paroxysms are usually very severe, and followed by a protracted cold stage, from which the system reacts very feebly. The anxiously

58 Barbour's Observations on Congestive Fever. [July

looked for hot stage is rarely or never fully developed, even in what might be called mild cases. But instead of it, the temperature of the whole surface is greatly diminished and irregular — the extremities being much colder than the trunk. The pulse becomes exceedingly weak and quick; the respiration is short, hurried, and difficult; the patient complains of a painful sense of heat, and weight in the epigastrium, accompanied with insatiable thirst; there is uncontrollable restlessness; the patient tosses himself from side to side, and often rises up, as if to relieve the oppression of the lungs; there is either pain, or giddiness, or sense of weight in the head; and the countenance looks con- tracted, pale, anxious, and often livid; the tongue is generally moist; and the bowels in a large majority of cases are loose, and the dejections serous.

The above sketch presents a tolerably correct delineation of the symptoms of ordinary congestive fever, as they present themselves at an early period of the disease.

They are, however, subject to considerable modification, according as the brain and spinal marrow, the lungs, or the abdominal viscera are the chief seats of congestion; the most prominent symptoms in each case being par- ticularly referable to the chiefly engorged organs.

If the condition above detailed is not soon removed by the recuperative efforts which nature makes to throw off the oppressive load under which she is labouring, aided by proper remedial agents, there is a rapid tendency to total collapse. This usually occurs either on the tliird or the fifth days, when, as has been remarked, the paroxysms are unusually severe. This condition is marked by all the symptoms, which indicate profound conges- tion. The extremities, and, indeed, the whole surface, become as cold as ice; the whole body is bathed with cold clammy sweat; the skin loses its elasticity, resuming, very slowly, its natural situation, when pinched up; the pulse is very quick, and scarcely perceptible; the thirst is insatiable; and there is uncontrollable anxiety and restlessness; the respiration becomes shorter, more hurried, and oppressed; and there are strong marks of dimi- nished sensibility; as a disposition to lethargy, and even to coma, with great muscular prostration. If unchecked, these symptoms increase with a rapid pace, and soon terminate in death.

But congestive fever does not always follow the regular course above described. Sometimes, instead of suffocated excitement, after the first or second regular paroxysms, there is full and violent reaction, and the stage of excitement continues for twenty-four, thirty-six, or forty-eight hours, with little or no remission, when the system, seeming to be exhausted by the violence of the excitement, rapidly sinks into collapse.

This modification generally occurs when there are internal inflammations, as indicated by pressure over the epigastrium, the right hypochondriac region, or over some portion of the bowels.

In other instances, the first regular paroxysm is succeeded by the strong- est mark of deep congestion, and complete collapse of the powers of nature.

1841.] Barbour's Observations on Congestive Fever.

59

So far as my observation has extended, this last modification almost uni- versally occurs either in aged persons of feeble or broken down constitutions; or in those who have debiUtated themselves by the use of harsh purgatives, or by the use of a too common remedy among southern planters, the emeto- cathartic, salts and tartar, which most generally causes great gastric and intestinal irritation, which induces a rapid fluxionary movement in the circu- lating fluid towards the chylopoietic viscera, which causes inequality of the circulation, and rapidly prostrates, by the copious serous discharges which ensue.

We now come to the most important part of our subject — the treatment of the different modifications of congestive fever. What are the leading indications in the treatment of this disease, founded on the pathological views which have been taken of it? There is a perfect unanimity in the opinions of medical men, that the great objects at which we should aim in the use of therapeutic means, are — 1st, to restore the lost balance of the circulation; — 2d, to relieve the engorged organs; and 3d — to restore the suspended secretions.

How are we to attain these desirable objects? The discrepant views which have been entertained, and the great diversity of agents which have been applied to fulfil the plain indications of treatment, clearly show that, however well the pathology may have been understood, great uncertainty has existed in regard to the treatment. Under circumstances favoura- ble to its adoption, reason as well as ample experience, points out the propriety of general, and topical bloodletting. This practice, I know, is strongly condemned by some; and others, who upon pathological grounds, approve it, adopt it with a trembling hand. Why? Because the patient may have a feeble, quick pulse, and a cold skin, and other marks of prostra- tion. But if Ave reflect upon the important lesson taught by the pathology of this disease, we must be convinced that the above symptoms do not arise from actual debility, but only from engorgement of the internal organs, which, most generally, are not, at first, structurally diseased, but only oppressed by the undue quantity of blood forced into them. The cautious abstraction of blood under such circumstances, unquestionably promotes reaction, by dimi- nishing the load under which the heart and other vital organs are labouring. General bloodletting is altogether inadmissible in some conditions; — for exam- ple, it would be highly detrimental in aged persons of feeble or broken down constitutions; in persons of very intemperate habits; also in the ad- vanced periods of any cases, — because, in all of these, the powers of life are generally at a low ebb, and most probably, the loss of blood by venesec- tion would preclude the possibility of reaction.

But suppose a practitioner is called, at an early period, to a patient of generally good constitution and health, and under the meridian of age, and finds him suflfering with all the symptoms of suffocated excitement, already noticed, surely, if he had ever witnessed the good effects of bloodletting

60

Barbour's Observations on Congestive Fever.

[July

under such circumstances, he would not hesitate to draw blood cautiously. Nor would he ever incur any risk if he follows this simple rule; open a good orifice, and keep the fingers carefully applied on the opposite pulse, and if the pulse becomes weaker, stop the operation instandy, and if neces- sary, administer some diffusible stimulant. If, however, the pulse rises, and becomes fuller and more regular, as it often does, continue the operation imtil the pulse becomes well developed. AYhen this effect is produced by bloodletting, there generally ensues a rapid improvement in all the symp- toms, in consequence of the reaction of the system.

Bloodletting is particularly indicated in those cases where high excitement continues for two or three days after the paroxysm, with little or no abate- ment. Under such circumstances, it is certainly one of the best means we possess to lower excitement, and cause a perfect remission, during which we can make use of such remedies as are calculated to prevent the recur- rence of a severer paroxysm, which would, most probably, be followed by collapse.

When general bloodletting is considered inadvisable, free cupping should be substituted. Cups should be applied along the whole course of the spine, over the chest, over the epigastrium, over the right hypochondriac region, or over the bowels, according as the indications of internal conges- tion predominate in one or other of those situations. The revulsive influ- ence exerted by this operation, often acts very beneficially. Having bled or cupped as circumstances indicated, it is important to attend to the con- dition of the alimentary canal. The stomach is, generally, very irritable, and the patient complains of great thirst, and heat in the epigastrium; to relieve which, a large sinapism should be applied over the stomach, and small portions of cold water, or iced lemonade, or small quantities of ice, should be given; these are exceedingly grateful; they lessen the burning heat and thirst; and often compose the stomach. If they fail, cups should be applied over the epigastrium, and if necessary a large blister should fol- low them. These combined means rarely fail to tranquillise the stomach. The bowels are sometimes torpid, when the evacuations are either clay- coloured, or of a muddy or tarry colour — conditions which indicate either a suspended, or a greatly vitiated secretion. Most frequently, however, the bowels are very loose, and the discharges serous, with a great quantity of small black particles in the bottom of the vessel containing them, resem- bling coffee grounds. This appearance is attributed by most southern prac- titioners to the oxydizement of the mercury which is so plentifully adminis- tered in the form of calomel. My own impression is that it is the result of morbid secretion from the liver and bowels. If the bowels are torpid, and the dejections are unnatural, the best combination I know of is, five grains of calomel, five grains of rhubarb, and one half grain of ipecacuanha, made into two or three pills, and given every four or six hours, so as gently to evacuate the intestines once or twice in the course of the day. Some prac-

1841.] Barbour's Observations on Congestive Fever. 61

titioners, in such cases, recommend pills of calomel, rhubarb, and aloes; but in a large majority of instances such a combination is too harsh, and calcu- lated to excite great irritation in the mucous coat of the bowels. Others recommend enormous doses of calomel as 50 to 100 or even 200 grains, and repeat them often; and they assure us that they have done more good with it thus administered, than with all other remedies besides.

My own experience is opposed to the use of calomel in such large doses. I am convinced that small portions, say from five to ten grains, repeated every two, four, or six hours, according to circumstances, are better calcu- lated to fulfil the indications for which it is administered. When given in very large doses, it often produces copious watery discharges; a consequence which might be very reasonably expected, when it is remembered that the liver and bowels are in an engorged condition, and of course not possessed of their natural susceptibility of impression; hence, I believe that such quan- tities of an agent like calomel become a great source of irritation.

It is extremely doubtful whether calomel, in any doses, is capable of pro- ducing its specific effect upon the liver, so long as it continues gorged with blood; and when reaction takes place, and this viscus becomes disburdened, small portions much more easily afiect it, because they are much less apt to pass ofi" by the bowels.

If the discharges are very thin, it is important to suppress them as soon as possible. For this purpose, I generally use the following combination: five grains of calomel, five grains of camphor, and from one half to one, or, if necessary, two grains of opium made into pills, and given every four or six hours, according to the copiousness and the frequency of the discharges. The above means, thus combined, are admirably calculated to restrain the bowels, to unlock the liver, and, at the same time, to determine to the sur- face. Having attended to the alimentary canal, the most important indica- tion which demands our attention is to restore the lost balance of the circu- lation, by the adoption of every revulsive means in our power.

In the worst cases, the pulse is as small as a thread, sometimes impercep- tible, and the whole surface is as cold as ice, attributable to a complete re- cession of the vital fluid from the extreme vessels, and to the engorgement, and consequent oppression of nature's calorificator, the lungs, and unless these conditions can be soon overcome by means calculated to equalise the circulation, nothing can effect any good.

What are the best means for accomplishing this paramount object? The views of authors, and practitioners in Europe and America are exceedingly discrepant in regard to this. We are informed by Armstrong, that the hot vapour bath, or the common hot bath, with bottles of hot water to the feet and hands, &c., together with hot ginger tea, pure dry brandy, and calomel and opium are incomparably superior to every other agent for the promotion of reaction.

With due deference to such distinguished authority, I would remark that No. IIL— .July, 1841, 6

62 Barbour's Observations on Congestive Fever, [July

whilst I do not doubt the efficacy of the above treatment in the congestive diseases of the great metropolis of England, my experience convinces me that it is, in a large majority of cases, altogether inadequate to the removal of the genuine congestive fever which is incident to unhealthy localities in southern climates.

In the first cases of congestive fever which I ever saw, I confidently relied on the treatment of Armstrong, because I knew of no better practice, and because it seemed to be altogether consonant with reason to give inter- nal stimulants and apply external heat. The conclusion to which my obser- vations have led me is, that this treatment is adequate to the restoration of the lost balance of the circulation, only in those cases which are occasioned by common causes; or in the mildest cases of pure congestive fever. In all the worst cases of this disease which have come under my notice, the hot bath and most diffusible stimulants have done injury rather than good, the patients appearing, generally, more relaxed and oppressed after they had been used. The remedy which I estimate above all others in the treat- ment of congestive fever is the affusion of cold water. My own compara- tively limited experience, and the ample experience of many intelligent practitioners in the South, sustain me in the declaration that the affusion of cold water upon the naked body, is capable of producing the most beneficial effects; and in a large majority of even the most malignant cases, of induc- ing complete and permanent reaction. I acknowledge that when I first used this potent and novel agent, I rather distrusted its propriety, because I could not very well understand how cold applied to a surface, already as cold as ice, could effect any good purpose. But no sooner had I tried it and wit- nessed its effects, than I became convinced of the erroneous view which I had taken of its modus operandi, and which had deterred me from adopting it sooner. So well am I assured of its invaluable efficacy as a powerful excitant to the nervous system, that I now feel no more hesitation in its adoption, than I do in the use of the lancet in inflammatory affections; for the principle upon which it operates, is just as obvious to my mind.

Who would hesitate to dash cold water on a patient who was overwhelmed by the effects of opium? Surely no practical medical man would, if he knew its efficacy. Why? Because it is known to be capable of arousing and sustaining the oppressed nervous system by the stimulant impression which it makes upon it. Why then should there be a doubt about its appli- cability to a disease which we believe to be dependent upon a poison which oppresses and paralyzes the whole nervous system? The analogy as re- gards the condition in the two cases is perfectly just; and the principle on which the remedy acts is identical. That this is the fact, its almost univer- sal effects abundantly testify.

The modes of application which I have adopted, are the following; — Have a broad plank placed upon two chairs, at a convenient distance apart, and place two vessels of hot water on each side, corresponding with the feet

1841.] Baxhoui^s Observations on Congestive Fever. 63

and hands; then strip the patient and lay him on his back, on the plank, with his extremities in the hot water, and having at hand twenty or thirty gallons of spring water, or what would be better, water made colder by ice or salt, pour the water from a pitcher, in a full and rapid stream over the chest and abdomen. The advantage of this mode is, that the cold is di- rectly applied over the most common seat of congestion, whilst the circula- tion is invited to the extremities by the hot water.

The second mode which I adopt, particularly in cases where the brain and spinal marrow are the chief seats of congestion, is to place the patient upon a blanket on the floor, and cause him to turn upon his side, and dash cold water as forcibly as possible over the head, and down the spinal co- lumn. This method is often the most effectual, because its influence is more immediately felt by the great nervous centres. Having applied the water, the patient should be quickly wiped and placed in bed, and be covered with two or three blankets. I have sometimes had the patient sur- rounded with hot stones, or bottles filled with hot water, after being'placed in bed; but I am now satisfied that it is improper to do so, on account of the relaxing influence of the heat, and the debilitating eff*ects of the copious perspiration induced by it. Instead of heating the patient, I cause him, as soon as he has received the cold dash, and is placed in bed, to be extensively and forcibly rubbed, either with dry mustard, flour, or salt, or with spirits of turpentine.

Under the combined influence of these agencies, reaction if at all possi- ble, soon ensues; the surface rapidly recovers its natural temperature; the pulse from being quick and thready, becomes fuller, softer, and more regu- lar; the respiration becomes easy and regular; the countenance becomes fuller, and more animated; and from insatiable thirst, and uncontrollable rest- lessness, the patient often experiences so much relief, that it is not uncom- mon for him to fall into a quiet and refreshing sleep, from which he awakes greatly improved.

The effects of the cold dash are, frequenfly, permanent, and complete reaction takes place, followed by rapid convalescence. In many instances, however, the effects of the first effusion subside, and the patient relapses into his former condition of coldness, restlessness, and insensibility. In such cases, it is proper to repeat the affusion, until complete and permanent reaction takes place, which may be confidently anticipated in a large majo- rity of even the worst cases, provided it is applied sufficiently early.

Unfortunately for the reputation of this invaluable remedy, it is deferred too long, and most generally, resorted to only as a dernier resource; in con- sequence of which, the system loses all susceptibility of its impression; or some vital organ or organs become irreparably injured, and hence its use proves abortive.

There is no just reason why its adoption should be delayed. If it is capable of producing such salutary effects in the latter periods of the disease

64 Barbour's Observations on Congestive Fever, U^Y

"when the vital principle is almost extinguished; how much more triumphant would be the success attending its use at an earlier period, when the vital organs, most generally, are not seriously injured, but only burdened with an undue quantity of blood, and when the susceptibility of impression is but little impaired?

As auxiliaries to the cold affusion, I generally apply cups along the course of the spine, over the epigastrium, over the right hypochondriac region, or over the bowels, according to the indications: and at the same time have warm mustard plasters applied to the extremities, and over the different seats of congestion; or have the whole surface well rubbed with strong mustard flour. I have sometimes derived considerable benefit from the application of a narrow mustard plaster along the whole course of the spine.

When, however, there are strong marks of cerebral congestion, a blister to the back of the head, and over the cervical portion of the spine, is deci- dedly preferable. Diffusible stimulants seem to be indicated; and I usually indulge the patient with occasional portions of any of them which appear to agree best with the stomach. Brandy and almost all the common spirituous liquors, in most instances which have come under my observation, appear to increase the oppression and sickness of the stomach. Good porter is far preferable to all other internal stimulants, and patients are, generally, very fond of it.

If we succeed, by the above means, in producing complete reaction, what course of treatment should be afterwards pursued? If the reaction is mode- rate, which is most usually the case, all that will be necessary will be to administer mild aperient and alterant medicines in combination, in order t regulate the bowels, and restore the biliary and other secretions to a healthy condition; and at the same time remedies calculated to sustain the weakened powers of nature, and to prevent the recurrence of the paroxysm, to which there is always a great liability. The combination I use with the view to the fulfilment of the first indication is from three to five grains of blue mass, five grains of rhubarb, and a half grain to one grain of opium, every six or eight hours, until the secretions become of natural colour and con- sistence. To fulfil the second indication, I give from ten to twenty grains of quinine, combined with from five to ten grains of Dover's powder, every three or four hours. I generally confine the use of this combination to the forenoon, beginning with it at about four o'clock in the morning, and repeat it at eight and twelve; after which I substitute infusion of serpentaria, be- cause there is commonly some tendency to excitement in the afternoon. For the same reason, if it is deemed necessary to administer aperient medi- cines, it should be given in the evening, as there is then much less liability to a depression of the system, from depletion in any form.

Sometimes, however, the reaction is violent, and unless it is moderated, the organs which have just been gorged with blood, and consequently weak-

1841.]

Barbour's Observations on Congestive Fever.

65

ened and irritated, will rapidly become the seats of violent inflammation, which will be difficult of removal, on account of the inability of the system to bear depletion to any great extent. In such cases, it is necessary to apply cups over the various seats of congestion, administer calomel, and after it oil or infusion of senna with ginger, and repeatedly use either the cold or the tepid affusion. If these means fail, it may be proper to draw blood from the arm; but this should be done with great caution, as the power of resistance in these cases is generally so low, that not unfrequently high excitement is suddenly followed by symptoms of prostration. In cases where bloodletting seems to be demanded, the pulse should be very care- fully watched, and upon the slightest manifestation of failure, the orifice should be closed; and, if necessary, a little wine, brandy, or porter should be given.

The above means are usually sufficient to reduce the excitement to a proper standard, when the alterant and aperient combination, together with quinine, can be administered, as above directed.

Suppose, however, that notwithstanding the diligent use of all the means which have been recommended for the purpose of arousing a patient from the collapse of congestive fever, he still continues for several days without any reaction, what should be done? I seriously apprehend that nothing can be effectual, as in such cases, generally, the injury done to the vital organs is irreparable. Still as we should never give up the ship until it sinks, and as sometimes patients recover contrary to all reasonable expectations of phy- sicians and friends, it is our duty to continue, unremittingly, to apply every means which can possibly do good. Under such circumstances, I would chiefly rely upon the occasional use of the cold bath, large and numerous sinapisms, blisters, hot spirits of turpentine, calomel often repeated, large doses of quinine, and the free use of brandy or porter.

In conclusion, I will briefly notice the most appropriate regimen during the continuance of the disease, and in convalescence. It will be remembered that in congestive fever, the stomach and bowels are in an engorged and oppressed condition, and that of consequence, their important functions, digestion and chylification, are greatly impaired; hence it is very necessary to adapt the aliment to the weakened digestive organs; otherwise it is sure to become a source of increased irritation. Rice water, barley water, arrow root tea, well made gruel, or chicken water, are the best articles of diet, during the course of the disease, and also for several days after convales- cence commences. After the strength of the digestive organs has somewhat improved, chicken broth, boiled milk, or milk and mush, would be altoge- ther appropriate for a few days, after which the patient can return to his usual diet. For drink during convalescence, nothing is so good as old por- ter, as it is decidedly tonic, and as it generally serves to relieve the unplea- sant sickness, and sense of sinking so often complained of by patients who have suffered from congestive fever,

6*

66

Shipman's Cases of Injury of the Head.

[July

Art. IV. — Cases of Injury of the Head, By A. B. Shipman, M.D., President of the Cortland County, New York, Medical Society.

Case L Fracture — Lesion of Brain — Death. — Fox, aetat. 17, while riding a horse at a race in Homer, in this county, on the 20th of August, 1833, was thrown, and the left side of his head struck upon the hard road. He was taken up insensible, a surgeon sent for. Dr. Lewis Riggs of Homer, who bled him on the spot. There was a small wound in the scalp at the left side of the head, and an abrasion of the cuticle on the forehead, with extensive ecchymosis of the eyelids and around the eyes. He re- mained insensible for some hours; but in the evening he was rather restless with delirium,

I saw him on Friday evening, the 22d, the third day from the receipt of the injury, in consultation with Dr. John Lynds of Homer, who had bled him and given him a cathartic the day before. He had been restless most of the time with stupor; at this time he was rather comatose, but could be roused to take drinks and medicines; restlessness; occasionally stertorous breathing; involuntary stools and urine; pulse regular in strength and fre- quency; no paralysis or fever; skin cool and natural. The pupil of the left eye (the side injured) greatly dilated, yet slightly contracting on holding a lighted candle near; right eye pupil natural; eyelids closed and greatly distended by ecchymosis.

23£?. I again visited him, found him apparently better. Cold applica- tions had been kept to his head, and blisters to his legs and between his shoulders. His senses had returned so as to enable him to converse with his friends, who had been sent for from a distance, calmly and rationally; he recollects how his injury was received; complains of no pain; in the after- noon relapsed into a drowsy state, with incoherent talking.

24th. Symptoms more favourable; pretty rational; stood upon his feet; no fever or pain; slight delirium in the evening.

25/A. Remains in nearly the same condition as yesterday.

26^^. Was bled, when he became worse almost immediately; he sank into a comatose state; the surface became cold and the face sunken; the €cchymosis in great part disappeared from the eyelids; the breathing labo- rious. He continued gradually to sink, and expired at 5 P. M., on the 28th, just one week from the injury.

Autopsy 12 hours after death, in the presence of Drs. Boies, Lynds and Bradford. Very little blood was found in the scalp; the left temporal mus- cle was filled with a coagula of eflfused blood, and under the pericranium, near the seat of the wound, there was also suffused blood. On removing the skull cap, a fissure was discovered extending from the upper part of the frontal bone, on the left side, through the superciliary ridge and through the orbitar process, across the suture connecting the lesser wings of the sphenoid

1841.]

Shipman's Cases of Injury of the Head,

67

bone, into the foramen lacerum of the orbit; another fissure extended across the orbitar process to the christi galii of the ethmoid bone, then downwards, terminating near the anterior clinoid process, in the foramen lacerum near the termination of the other fissure, leaving a triangular portion of bone entirely insulated and depressed about one-eighth of an inch. Corresponding to the perpendicular fissure, there was a laceration of the dura mater, two inches in length, and a wound of the brain of the same length and three- fourths of an inch in depth, in the anterior lobe of the left hemisphere, about an inch and a quarter from the falx, and parallel with it. On each side of the fracture the dura mater was separated from the bone with extravasation between it and the bone, to the amount, perhaps, of two ounces. There was also some extravasation in the middle fossa of the skull on the opposite side. The sockets of the eyes also were filled with extravasated blood. The wound in the brain was filled with coagula and disorganized brain broken down into a pulp. The laceration of the dura mater and lesion of the brain were produced by the fractured edge of the bone being driven inwards by the force of the fall, but springing back, by its elasticity, to near its natural state. There were no marks of inflammation to be discovered in any portion of the brain; the vessels of the pia mater slightly injected; no suppuration or coagulable lymph; the parts, on inspection, appeared like a wound of very recent occurrence.

The diagnosis in this case was not so perfectly clear as might have been sup- posed from the degree of injury discovered in the post mortem examination. The symptoms might have been the result of violent concussion, and when, on the fourth day, returning sense and consciousness took place and continued a portion of the time for three days, some hopes might have been reasonably indulged in that no fatal lesion had taken place. The extravasation most likely took place immediately after the injury, and it is rather surprising that so few symptoms of compression should have been present. The wound of the brain was enough, we should think, to have caused paralysis or some more disturbance of the functions of the optic nerve; but when he was rational, no such effect was discovered. The injury was of so grave a character as to prevent that degree of reaction necessary to the development of the inflammatory process. The last bleeding was unnecessary, and pro- bably hastened the fatal termination of the case. No operation would have been of any service if the precise nature of the injury had been known.

Case II. Fracture, with Depression — Recovery without an Operation. — October 15/A, 1833. — M. VV., a young gentleman of the medical profession, was thrown from his horse during a violent shower of rain. He was but little stunned with the fall, remounted his horse and rode to this village, a dis- tance of more than a mile. I saw him within a short time after the accident; found a wound on the left side of the forehead; the scalp was torn up in a triangular flap, extending to the cranium; the pericranium was also lacerated.

68

Shipman's Cases of Injury of the Head.

[July

exposing the bone; a fracture was discovered, with depression to a small extent, as though made by coming in contact with a sharp stone; this was in the upper and left side of the frontal bone. He was able to sit up; while the wound was dressed, the hair shaved off, and the wound cleansed from the dirt and gravel, the flap laid down and retained with adhesive straps. There were no symptoms of concussion or compression, or any disturbance of the mental faculties; he rested well during the night, and in the morning, as his pulse was somewhat strong and full, he was bled, took a cathartic, and in three days rode four miles to his home, and recovered without any bad symptoms. The force which fractured the skull in this case was confined to a small point of the bone, and whatever injury there was, it was circum- scribed; the depression was not sufficient to cause compression, and it is probable that there was not any effusion beneath the bone.

Case III. Fracture, without Depression — Recovery without Operation. — September I5th, 1836. George Martin, hostler, aetat. 21, was kicked by a horse upon the upper portion of the right side of the frontal bone; the scalp and pericranium was torn up from the bone the size of a crown piece, and also a piece of the external table of the bone the size of a shilling; a fracture of the bone also traversed the skull in a perpendicular direction and both above and below in the sound skin. He was at first insensible from the blow, but partially recovered his senses; was carried into the hotel and placed in bed. I saw him within an hour. He was drowsy and torpid, but could be roused to answer questions, quickly however relapsing into stu- por; his extremities were cold; pulse slow; pupils dilated. Ordered bottles of hot water to his extremities, and a glass of warm brandy and water. In the evening, six hours from the time of the injury he was nearly in the same situation, except that he was rather warmer and the pulse somewhat more frequent. In the course of the night reaction took place with stertor and heat of the skin.

IGth, 8 o'clock A. M. Bled him twenty ounces, which seemed to rouse him in some measure. Twelve o'clock, noon, as there was some stupor, with much reaction, he was bled again sixteen ounces; took a cathartic of jalap and calomel, which operated well by nine in the evening. He then became perfectly sensible, and the heat of skin and activity of the pulse subsided. The scalp which was torn had been placed back in its natural position, and the loose piece of bone removed, and the wound was now dressed with adhesive straps, with light dressings to the head; cold applications were also made use of, with sinapisms of mustard to the feet and arms.

I7th. Got out of bed, dressed himself and walked down stairs. From this time he went on doing well, and resumed his labor without any unplea- sant symptoms; the wound healed in a few days, and he never had any farther inconvenience while he remained under my observation for six months afterwards.

1841.] Shij)m2LD^s Cases of Injury of the Head. 69

This was a strongly marked case of concussion, and from the length of time which it remained after reaction came on, must have led to the con- clusion that extravasation had also taken place, demanding the operation of trephining. The prompdy salutary effect of venesection was striking; had the trephine been resorted to the next morning after the hurt, and there were some symptoms indicating its employment, no cause of compression would have been discovered, and the danger would have been increased. The injury was probably done with the cork, and struck the bone in a glancing manner; which chipped off a piece of the outer table of the bone and caused the fracture. The force of the blow was confined to a small surface, or the result would probably have been more serious.

Case IV. Fracture, tvithout Depression — Recovery ivithout Operation. « — November 28th, 1836. Mrs. Stafford, of Virgil, setat. 50, was thrown from a wagon upon the frozen ground. She was taken up insensible, and car- ried home, the distance of a mile. I saw her in the evening four hours after the accident. She had partially regained her senses, and complained of vio- lent pain in her head and jaws. Her friends stated that she was very cold when they first got home, and they had but partially succeeded in getting her warm when I arrived. The eyes were both closed by the ecchymosis, and on examining the head a small wound was found in the scalp on the left side of the frontal bone, which would admit the point of the finger; at the bottom of this wound a fracture was distinctly felt, which separated so as readily to admit the finger-nail; the scalp was much bruised, and infiltrated with blood over the left side of the head; pupils much dilated; pulse slow and feeble; complains of difficulty of swallowing; she can be easily roused, and answers questions rationally. Ordered her warm sling, with bottles of hot water to the extremities. In about two hours she became warm, with a stronger pulse. Venesection to eight ounces, when she fainted; gave a cathartic of calomel and jalap; cold applications to the head. During the night she was restless with slight delirium.

"Zdth. Cathartic operated well; is stupid most of the time, but answers questions rationally when roused; no fever; complains of severe headache, and is very restless a portion of the time; starts frequently in her sleep; moans and grinds her teeth; face and scalp much swollen, and dark colored; pulse slow and full; skin and extremities warm; venesection, twelve ounces, after which she became faint.

30^^. Considerable febrile action; had chills in the morning; pulse quick; skin hot; restlessness, and delirium; complains of no pain, but starts at noises, and moans; pupils of the eyes much contracted. Venesection twelve ounces; calomel to be followed by senna and salts; blister to each arm; ordered the head to be kept elevated, with cold iced water to be applied.

December 2d. Febrile action less than on the 30th, but still considerable; pulse more full and less frequent; bowels have kept acting for the last

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thirty hours; is rational, but her friends say she was delirious most of the night; complains of pain in the head, neck, and jaws; pupils still contracted. Blister to the back of the neck and calves of the legs; cold applications to the head continued.

4^th. Found she had been feverish and delirious through the night with starting and picking at the bed-clothes; but is more calm in the day time; blisters drew well; less fever; pulse more natural; swelling of the face and eyes subsiding; pupils more dilated; but not more so than would be natural; has had strangury in a slight degree. Ordered the blisters to be dressed with epispastic ointment and lard. Continue the cold applications, and the general antiphlogistic regimen.

Qth. Symptoms improved; less fever; no delirium since the 4th; some pain in the head; begins to call for more substantial food; has had strangury most of the time since the 4th, which she complains of more than any thing else; blisters discharge freely. From this time she gradually im- proved without any alarming symptoms, and without any other treatment than a mild antiphlogistic course; the blisters were kept running for ten days longer; a low diet with an occasional laxative to obviate costiveness was all she required.

She has enjoyed her usual health since that time, with the exception of occasional attacks of headache — for which it has been necessary to resort to venesection and active cathartics. The dilated pupils at hrst, and the stu- por and general torpor of the system, might have led to the fear that extra- vasation had taken place; and the early development of fever and inflamma- tion which followed was of an alarming character; but the happy termina- tion of the case renders it probable that no effusion of blood, at least of any consequence took place; but cerebral inflammation was unquestionably pre- sent to a certain degree. The strangury I hailed as a favorable omen, as I always do in cases of cerebral disease, having frequently seen most striking benefits immediately follow its appearance.

Case V. Fracture — Trephining. — Death. — David Robinson, of Virgil, in this county, aetat. 73, while in the woods felling timber, February 25th, 1835, received a blow from the fall of a tree upon the left side of the head. When picked up he was totally insensible; nor did he exhibit any signs of returning sense until he had been conveyed to his house, which occupied perhaps half an hour. Dr. Bronson was called, and on his arrival opened a vein, but obtained little blood. Soon after the patient regained his senses, was able to converse three quarters of an hour, when he relapsed into insensibi- lity. I saw him II A. M. four hours after the accident; he was then coma- tose; could not be roused; breathing stertorous; pupils dilated and insensible to light; writhing of the body from side to side; slow feeble pulse; cold extremities; oozing of blood from mouth, ears, and nostrils. He had swal- lowed some warm sling before I arrived; on examining the head the scalp

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was found detached from the left parietal protuberance, and the bone com- pletely denuded to the size of the palm of the hand; on cleaning the wound with a sponge and warm water, and closely inspecting the bone, a small capillary fissure was found running across the bone in a perpendicular direction, and a little posterior to the middle of the bone. The ends of hairs which had been caught in the fissure, made it evident that the bones had been separated by the force which produced the fissure; there was a slight oozing of blood from this, but it could not be opened with the point of a knife. From the symptoms it was evident that extravasation had taken place, and that the operation of trephining was indicated, but from the size of the body which produced the injury, and the force with which it struck — the age of the patient, the probability that the fracture extended into the base of the cranium, and the injury, consequently, most extensive, all led me to give an unfavorable prognosis.

It was finally decided to use the trephine which was applied to the upper point of the fracture and a piece of bone removed, when a coagula of blood was found beneath; as the opening was so small it was applied three times, and a large quantity of coagula removed. The dura mater was found widely separated and all the space filled with coagulated blood. I removed as much as possible, but it was found to extend down as low as the petrous portion of the temporal bone; and how much farther, I did not think it expedi- ent to explore. After removing the coagula, the brain was observed to be col- lapsed; it did not fill the cranium by more than an inch upon the upper surface of the dura mater. The pulsations of the brain were very feeble and slow; the hemorrhage was profuse, probably from the rupture of the meningeal artery; and the cavity soon filled with blood of an arterial colour; the bone was very thick, nearly one-fourth of an inch. After the operation, the patient appeared more sensible, opened his eyes when spoken to, and answered some questions. He was placed in bed; bottles of hot water were applied to his extremities; a dose of croton oil was administered. The scalp was laid down over the opening, and loose dressings applied; the hemorrhage continued through the night pretty profuse; he never became perfectly con- scious, but remained insensible most of the time until he died which took place the next day towards evening. As it was some distance from my residence, I was not able to make an autopsic examination. I think the hemorrhage in this ease would have proved fatal independent of the ex- travasation; by appropriate dressing the blood could have been confined in the cavity of the cranium, and there suffered to form coagula, when com- pression would have been the result, either of which would have been fatal. The stages of concussion and compression were distinctly marked in this case: the first went off within three quarters of an hour, and was succeeded by an interval of consciousness, which lasted three quarters of an hour, then the extravasation took place as soon as sufiicient reaction was present ta throw out blood from the ruptured vessels.

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Case VI. Compound Fracture with Depression — Operation. — Beco- very. — On the 5th of December, 1837, I was requested to visit George Ochs, of Virgil, in this county. The messenger informed me that in a quarrel with his brother the day before, he had been struck a blow on his head, but for certain reasons best known to his friends, the accident had been kept secret from the neighbours up to that time. On arriving there at 3 P. M., twenty-five hours after the injury, I found the patient a strong, athletic man, setat. 29, in bed, with a handkerchief over his head. He was labouring under headache, confusion of ideas, restlessness, writhing of the iDody, and scowling of the countenance; he \Vas able to converse a little, but has no distinct recollection of being injured- On questioning the family, it was ascertained that the blow was given with a heavy mallet. The first blow was on the forehead which knocked him down, when another was given on the side of the head which rendered him insensible for a few minutes, when he recovered so as to be able to walk from the barn to the liouse with some assistance; he had been restless during the night; had slept but little, and was delirious a portion of the time. On examining the head, two wounds were found, one on the forehead which penetrated to the bone, :and one on the left side, over the superior and posterior angle of the parietal bone. This wound was two inches long, and was widely open, and on passing the finger into the bottom of it a fracture with great depression was discovered. After shaving the scalp, the wound was enlarged to ascertain the extent and situation of the fracture. I found the depression correspond- ing with the sharp corner of the mallet, depressing the bone to the depth of three-fourths of an inch at least. It being decided best to raise the depressed portions of bone, with the assistance of my brother. Dr. J. A. Shipman, the crown of a small trephine was applied, and a portion of bone removed from the edge of the depression; then with the help of the elevator and forceps, ten pieces of bone were removed from their wedging position, and one sharp spicula from the inner table of the skull was driven through the dura mater into the substance of the brain to the depth of half an inch; this was also carefully removed with the forceps. There was much hemorrhage from an artery within the cranium to the extent of at least three pints. The patient made no complaint during the operation, except when the incision was made in the scalp, when he struggled and cried out. The wound was next sponged, and the flaps of the scalp laid down and dressed with adhe- sive plaster, a night cap put on, the head elevated, and a cathartic of calomel and jalap administered with directions to apply cold to the head if heat fol- lowed.

6th. Found that he had rested but little through the night; complained of pain in the head and frequent startings; pulse regular and full; considerable heat of skin; intellect clear; bowels not yet moved; gave ol. ricini; ordered cold to the head; room darkened, and head elevated.

7th. Cathartic operated freely last night; fever, headache, thirst, and