cases, and which is almost invariably a fatal symptom. And here we may find another reason for free, copious bleedings; since, in ordinary practice, blood-letting is employed at once, to prevent and to arrest hemorrhage. But, besides that blood-letting is less properly the remedy of hemorrhage than it is generally believed to be, experience has shown that the black vomit and black stools were not less frequent at the period when the physicians bled largely, than at that when they had nearly abandoned bleeding. Repeated and abundant bleedings cannot, then, be regarded as a means of preventing gastro-intestinal hemorrhage; and we find other reasons for abstaining from them, in the smallness of the pulse, and the diminution of the temperature accompanying the hemorrhage. What other means, then, are to be opposed to this symptom? "I have shown that the black matter vomited and voided per anum, did not come entirely from the gastric mucous membrane, but that, in all probability, a part of it was exhaled by the intestinal. Then, a remedy for gastrointestinal hemorrhage being found, it should be applied to the mucous membrane of the intestine, as well as to that of the stomach; and as we know how frequently this last was found in a state of inflammation, and how seldom the intestinal mucous membrane was in the same condition, we should be disposed to apply our remedies to the latter, and would suggest something astringent. This appears the more rational, inasmuch as the condition of the organs with which the deposit of black matter is connected, is not inflammation, the mucous membrane of the stomach not offering any traces of it in some cases where that viscus contained a good deal of brownish or blackish liquid. It would, perhaps, be well to prescribe astringents before the appearance of the black stools, when the temperature falls, at the end of the third, or in the course of the fourth day of the disease. "Undoubtedly writers have gone too far, and much too far, in considering the yellow fever as a hemorrhagic disease, and pointing out astringents as its true remedy. For, on the one hand, the quantity of blood lost affords an explanation of the fatal termination of the disease in but very few cases; and, on the other hand, patients die who have never had any hemorrhage at all, and this symptom is rarely met with in patients who recover. Still, it ought to arrest our attention, since, in the cases where it exists, it has more or less to do with the fatal termination of the disease. and "The condition of the liver should also engage our attention; since, in all the cases, its alteration appeared to commence with the first symptoms, perhaps many therapeutical agents might be directed against it. Unfortunately, the nature of that alteration is unknown to us, so that we cannot propose a remedy to be used against it with any chance of success. The discovery of the remedy must be left to time and chance, and to the acuteness of the observer, for experience has sufficiently proved that no dependence is to be placed on mercurial préparations of any sort. As the frequency of an inflammatory condition of the stomach would seem to contra-indicate the use of anti-spasmodics at all energetic, such as ether, we might try opiate preparations, which would be better adapted to the state of the stomach, and the free employment of which is permitted by the condition of the cerebral organs. "I have proposed here, merely to point out the principal indications to be fulfilled up to the period of convalescence, and as there is nothing particular in that state, so far as the treatment is concerned, I shall end by asking if some disturbing means might not be employed in the first period, when the heat is considerable, such as cold baths or cold affusions; and if, in the second period, when the temperature is diminished, and becomes below the natural heat, a hot water or vapour bath might not be advantageously used. "As to mild cases, where the febrile symptoms are inconsiderable, and the headach moderate, cool drinks and emollient enemata appear to be the only remedies which it is advisable to employ; the disease under this form advancing towards a favourable termination. I shall not bring the facts col lected by us to the support of this proposition, and I can only say that, having been called on to take charge of two persons of rather feeble constitutions, and in the prime of life, whose febrile symptoms were inconsiderable, and did not continue beyond the third day, I employed no other means than a bath in one case, at the commencement of the disease, and a little castor oil in the other, at the commencement of the convalescence, to overcome constipation. "Although I have already said that there are no particular indications in the convalescence, I may remind the reader that the inflammation of the mucous membrane of the stomach, usually slight, and never severe in fatal cases, is still less severe, judging by symptoms, in those who recover; that the gastritis is secondary, and disappears quickly; so that it is not necessary to keep the patient a long time on a strict diet. If the weakness was prolonged, or very great, we might follow the example of the Spanish physicians, and give some slight tonics, such as bark or quinine."—p. 339. Dr. Shattuck deserves great credit for the translation, which is much superior to the generality of the works done into English, that issue from the medical press. We would suggest, however, that "five small spoons full of serum," contained in the arachnoid cavity, means that the spoons were there, as well as the spoonfuls of serum ! The work is better got up by the Publishers than any one that we recolleet to have seen. Professor Gibson's Introductory Lectures.' These lectures contain interesting sketches of the prominent medical characters, who came under Professor Gibson's notice during a residence of several months of the present year abroad. They are graphic, and, we think, free from the objections, which it is difficult to avoid, in giving sketches of personal appearance and character. The professional characters most prominently, and we think-so far as we have personal knowledge-faithfully depicted, are-Sir A. Cooper, Sir B. Brodie, Mr. Lawrence, Mr. S. Cooper, Mr. Copeland, Mr. Guthrie, Mr. Bransby Cooper, and Mr. Liston. The author refers also, at some length, to Sir James Clark, the able and estimable physician to the Queen of England. In the second lecture, the prominent surgeons of Paris are described:-Velpeau, Roux, Lisfranc, Ricord, Civiale and Leroy d'Etiolles. The whole tone of the lectures is liberal, and generally laudatory. MISCELLANEOUS NOTICES. Nitrate of Silver in Phlogosis of Mucous Membranes (Journal des Connaissances Médicales Pratiques, May, 1838.)-M. Boudin has extended the application of nitrate of silver to the cure of inflammations and ulcerations of the ileum, which constitute one of the most constant lesions in 1 Sketches of prominent Surgeons of London and Paris, introductory to a course of Surgical lectures, by William Gibson, M. D., Professor of Surgery in the University of Pennsylvania, Senior Surgeon and Clinical Lecturer to the Philadelphia Hospital, &c. &c. Delivered November, 1839. 8vo. pp. 17. Philad., 1839. Edinb. Med. Journal, Oct. 1839, p. 579. typhoid fevers. When diarrhoea is the principal symptom, he administers the nitrate in enema, in the dose of from two to eight grains dissolved in six ounces of distilled water; and when gastric symptoms predominate he gives it by the mouth in pills, in the dose of a fourth to half a grain; and when the whole gastro-intestinal mucous membrane appears phlogosed he combines the two modes of administration. Surgical Pathology and Surgery. Section of the Muscles for the Cure of Lateral Curvature of the Spine. (Compte rendu des Séances de l'Academie des Sciences. Juin 24, 1839.)-M. J. Guerin informs us that he has already operated, with success, on twelve cases of lateral curvature of the spine; the operation consisting in the division of certain muscles of the back and of the spinal column. The muscles which he has already cut across, are the trapezius, the rhomboideus, the levator angula scapula, the sacro-lumbalis, the longissimus dorsi, the spinalis dorsi, and transversalis colli. "I have been convinced for a long time past," says he, "that the greatest Bumber of articular deformities arise from convulsive muscular contraction, depending on an affection of the brain, of the spinal marrow, or of the nerves themselves, which are distributed to the muscles. This opinion, therefore, led me naturally to the two following conclusions, viz. 1. That the different forms which each of the varieties of curvature are capable of assuming are the consequences of a retraction affecting this or that muscle; 2. That the active treatment of each of these should consist of section of the tendons or muscular fibres which were the cause of each particular variety of curvature. "These theories were put to the test of experiment on patients of both sexes and of different ages; the youngest operated on being 13 years of age, and the oldest 22. The curvatures were all of the second and third degree, with twisting of the spinal column and proportional gibbosity. In some patients a single section of the retracted muscles sufficed to produce a cure; in others two or three sections were required. In all, however, immediately after the operation, a marked improvement in the appearance of the spinal column was produced. In one young man of 21 years of age, who had undergone eighteen months of mechanical treatment for the cure of the curvature of the spinal column, an immediate restoration to the normal straightness was effected by division of the longissimus dorsi and corresponding spinal muscles. In others the cure was completed with the assistance of mechanical aid. In none of the twelve operations, which I have performed has there followed the slightest accident; there has been no hemorrhage, no pain, no fever; and in all, with the exception of one case, immediate reunion of the wounds took place without suppuration.” Obstetrics. New Test for the Detection of Pregnancy. (L'Expérience, July 25, 1839.)-M. Nauche found that the urine of pregnant women contains a particular substance, which, when the urine is allowed to stand, separates and forms a pellicle on the surface. M. Eguiser, from an extensive series of observations, has confirmed this fact, and found that the kisteine, as this particular substance has been called, is constantly formed on the surface of the urine of women in a state of pregnancy. The urine must be allowed to stand from two to six days, when minute opaque bodies are observed to rise from the bottom to the surface of the fluid, where they gradually agglomerate and form a continuous layer over the surface. This layer is so consistent that it may be almost lifted off by raising it by one of its edges. This is the kisteine. It is whitish, opalescent, slightly granular, and can be compared to nothing better than the fatty sub 'Edinb. Med. Journ. Oct. 1839, p. 581. 2 Ibid. p. 586. stance which swims on the surface of soups, after they have been allowed to cool. When examined by the microscope it has the aspect of a gelatinous mass without determinate form; sometimes cubical shaped crystals are discovered on it, but this appearance is only observed when it has stood for a long time, and are to be regarded as foreign to it. The kisteine remains on the surface for several days; the urine then becomes turbid, and small opaque masses become detached from the kisteine, and fall to the bottom of the fluid; and the pellicle soon becomes destroyed. The essential character of the urine of pregnancy, then, is the presence of kisteine; and the characters of the pellicle are so peculiar that it is impossible to mistake it for any thing else. A pellicle sometimes forms on the surface of the urine of patients labouring under phthisis, abscess, or catarrh of the bladder, but may easily be distinguished by this circumstance, that it does not form in such a short time as the kisteine, and that, in place of disappearing, as this last, in a few days, it increases in thickness, and at last is converted into a mass of mouldiness. There exists, likewise, a very marked difference between its mucous aspect and that of kisteine-a difference which it is difficult to describe, but which is easily recognised. Kisteine appears to exist in the urine from the first month of pregnancy till delivery. M. Rousseau has even recognised it in the urine of a few gravid animals. University of Virginia. Dr. Howard.-Dr. Howard-formerly Professor of Obstetrics in the University of Maryland-has been appointed to the Chair of Medicine in the University of Virginia, vacated by the resignation of Dr. Griffith. BOOKS RECEIVED. From Professor T. R. Beck (the author.)—Tables of the residence &c. of Medical Students in the different Medical Colleges, for a series of years. From Professor Gibson (the author.)-Sketches of prominent Surgeons of London and Paris, introductory to a course of Surgical lectures, by William Gibson, M. D., Professor of Surgery in the University of Pennsylvania, Senior Surgeon and Clinical Lecturer to the Philadelphia Hospital, &c. &c. delivered November, 1839, 8vo. pp. 17. Philad., 1839. From Professor T. D. Mitchell (the author.)—The Pains and Pleasures of a Medical Life: being an introductory to a course of Lectures on Materia Medica and Therapeutics. Session 1839-40. 8vo. pp. 24, Lexington, 1839. From the Committee of Publication.—A Lecture introductory to the course of Surgery, in the Jefferson Medical College, of Philadelphia, for the Session of 1839-40. By Joseph Pancoast, M. D., Professor of the Institutes and Practice of Surgery, &c. &c. Svo. pp. 16. Philad., 1839. From the same.-Introductory lecture to the course of Institutes of Medicine and Materia Medica in Jefferson Medical College, of Philadelphia, for the Session of 1839-40. By Professor Dunglison. 8vo. pp. 20. Philad., 1839. A report on the history and causes of the Strangers' or Yellow Fever of Charleston; read before the Board of Health. By Thomas Y. Simons, M. D., Chairman of the Board. 8vo. pp. 24. Charleston, 1839. THE AMERICAN MEDICAL INTELLIGENCER. Vol. III. December 16, 1839. No. 18. ART. I.-REPORT OF EXPERIMENTS ON THE ACTION OF ᎢᎻᎬ ᎻᎬᎪᎡᎢ, &c. BY C. W. PENNOCK, M. D., AND E. M. MOORE, M. D. Experiment 9th.-Experiencing great difficulty in analysing some of the movements and sounds of the heart in animals of the size upon which we had experimented, we resolved to inspect the heart of a horse, in which the pulse in health ranges from thirty to forty per minute. In this experiment we were assisted by Drs. Gerhard, Stewardson, Peace, Hardy, Fell, and Goddard, but to the latter gentleman especially we owe our thanks for the assistance rendered. We found in the animal we had selected that the pulse was about thirtysix, per minute, and respiration twenty-eight in the same time. In order to prolong life, the trachea was opened before the blow was given. Immediately after the blow was struck, which was directed to the forehead, that the skull might be depressed upon the anterior lobes of the brain, the bellows-tube was introduced, and artificial respiration commenced. The skin was dissected back from the median line upon the thorax, the cartilages of the ribs sawn through upon the left side of the sternum, and several of the ribs cut off about one third of their whole length from their sternal extremity. On account of the hemorrhage, we were obliged to secure many arteries, and twenty-five minutes had elapsed from the time the blow was given until the heart was exposed. It presented the left ventricle, the appendix of the left auricle, and a portion of the right ventricle. The pulsations were one hundred per minute, but on account of its size we were enabled to observe the relative contraction of the auricle and ventricle, which we found to succeed each other as follows:-During the contraction of the ventricle the auricle dilates; at the expiration of the systole, the auricle contracts, and the diastole of the ventricle commences, the auricular contraction apparently occupying about one half the time of the ventricular diastole. During its systole, the left ventricle flattens and elongates. During its diastole it shortens, and assumes a rounded form. The sounds were detected, but not loud; the second not existing over the pulmonary artery, but heard over the body of the left ventricle. Death arrested the further progress of the experiment, twenty minutes after the chest was opened. Dr. Moore coincides with the other gentlemen in reference to the relative contraction of the auricle and ventricle, and thinks his observation, in experiment 1st, erroneous. Although every experiment had confirmed our views of the agency of the valves of the aorta in the production of the second sound, we had heretofore failed in elevating them; we were also still doubtful respecting the relative |