number of his strangulated cases. Generally relieved by bloodletting, warm bath, nauseants, and taxis, if plethoric; and the free use of opium in the feeble and anæmic. Would use chloroform in all cases now, as a relaxive, if nothing to contraindicate. Has used the knife in three cases-two proved fatal, and one recovered, as follows, viz: First case.-Negro, male adult-produced by strain in lifting. Tumor size of almond; small enterocele of left side, protruding through internal abdominal ring only. Operation fourth day after strangulation, when patient was nearly moribund; strangulated bowel, dark red color; was returned. Death forty-eight hours after operation. Thinks an early operation would have resulted in restoration. Second case. - Old negro man; chronic; right scrotal, as large as two fists. Had been often strangulated and reduced by patient. Strangulation twenty-four hours when first seen. He appeared moribund. Taxis was tried before operation. Sac and contents (small intestine) gangrenous. Death two hours after operation. Third case.-Negro boy, eight years old. Congenital hernia on right side enterocele. Has been strangulated several times. Ordinary means of reduction were first employed, to which was added injection of tobacco infusion into the bowel. This produced alarming sinking, and did no good. Operated after reaction, and eight hours from commencement of strangulation. Recovery. Well in eight days. Two years afterwards, the cure appeared to be radical. Dr. Jno. C. Richardson, of Lexington, Ky., says he has been repeatedly called in consultation to operate in strangulated hernia, but declined, finding the patients moribund. Has had two cases of strangulated hernia, species of one not remembered; the other, right scrotal, in which, after failing to reduce by ordinary relaxives, the contents of the sac returned spontaneously after commencing the operation, and the preliminary incisions were extended to the sac. One other case of strangulation in a boy six years old—left inguinal—in which he was overruled by the entreaties of the mother after he had determined to operate. A delay ensued in consequence, of fourteen hours, during which tobacco poultices were applied over the hernial tumor, and spontaneous reduction followed at that period. Thinks the tobacco was instrumental in the reduction, but came very near killing the patient. Believed for some hours that he would die from the effects of it. He believes hernia to be a common affection, more so than is generally apprehended; and that more than one in fifty of the population are subjects of it. Some of his reasons for this impression are, the disinclination of a large majority of both sexes to disclose their infirmity, and who often ignorantly fail to recognize it in their own cases, where he has found it to exist. He has cured, radically, several cases of hernia in young dren by simple compress and bandage. chil Of the preceding cases of strangulated hernia-communicated by eight gentlemen-upon whom operations were made amounting in all to twenty-two, ten died, almost one-half. Including those that died without operation, the number is twenty-nine, of whom sixteen died, being a small majority. Adding to this list my own cases-seven in number, six operated upon, and two died—we have a total of thirty-six cases, twenty-one of whom recovered. Excluding the cases, eight in all, in which, for reasons stated, the operation was not made, we have twenty-eight operations and fifteen recoveries, rather more than half. Since the foregoing was written, I have been furnished by Dr. M. Goldsmith, twelve additional cases of strangulated hernia, which came under his observation, and in which he divided the stricture with the knife-ten of whom recovered, and two died, being a large per centage of recoveries. Adding these to the preceding, we have forty cases of strangulated hernia operated upon, and twenty-five recoveries. Dr. G. adds, "I never yet had occasion to regret operating too early. I believe as firmly as I believe any thing, that the fatality of the operation for strangulated hernia is due more to delay that precedes it, than to the operation itself." Again, the question recurs as to the cause of the great mortality in hernial operations, as indicated by the foregoing facts. We have already seen that it can not be from the operation in itself considered, but is referable to other causes, some of which are under the control of the profession. The operation for hernia is unquestionably to be ranked among the capital operations of surgery, requiring for its safe execution an accurate acquaintance with not only the healthy anatomy of the rather complex structures involved, but also of the modifications impressed thereon by those morbid changes to which they are subject. I suppose I may safely say that doubt in the mind of the physician as to his possession of this knowledge, whether correct or not, has in some instances caused delay in operating, or the entire abandonment of the patient to his fate. Hernia, when strangulated, admits of no delay. If not reduced by appropriate medication, taxis, &c., in a few hours, the patient dies, almost inevitably, unless the stricture is divided with the knife. There is no time, as in vesical calculus, aneurismal and other tumors, as well as numerous chronic cases requiring operations of more or less importance, to send (perhaps a distance) for, or transport the patient to, the operative surgeon. It therefore behooves every physician, if not already master of the subject, and every student of medicine, to study the whole matter with the greatest zeal and assiduity, and never to relax his efforts to acquire a knowledge of the anatomy, healthy and morbid, of hernia, scalpel in hand, until he has fully mastered it. Private preceptors, as well as teachers in our medical schools, should not only counsel, but demand this knowledge of every student, and especially of every candidate for the degree of M.D. I am satisfied that our public teachers of anatomy, surgery, pathology, and other branches of medicine, have it in their power to accomplish much in this matter, by making an acquaintance with the subject a sine qua non to graduation. It has been said of a distinguished teacher of medicine and surgery, in this country-the late Dr. Physick-that he never failed to interrogate students, "in the green room," on the anatomy and surgery of hernia, and that he invariably rejected them if deficient in their knowledge of this subject. SICK HEADACHE.-Dr. J. C. Norton, of Homer, Minnesota, in a report on the botany of Winona county, says of the cicuta: "In small doses, it is, according to my experience, a sure cure for nervous sick headache." YELLOW FEVER. -Dr. Fenner reports, that he has used both chlorine and veratrum viride in yellow fever, with much success. The terrible mortality of the late epidemic, furnishes a most telling commentary on this statement, however. DR. S. M. BEMISS: EASTERN LUNATIC ASYLUM, Dear Sir,-In your favor of the 23d inst., you ask if I have observed any "increased tendency to death by gangrene of the lungs among the insane."* I have not, nor have I ever witnessed a case of gangrene of the lungs among the insane. The records of this Institution do not show a single death from that cause, and I presume none has ever occurred. It is scarcely possible that such a case could have passed unobserved, or could have been mistaken for any other form of disease. Gangrene of the lungs presents such unmistakable phenomena so distinct and characteristic-that an error in diagnosis is infinitely improbable. From the 1st day of January, 1849, to the 31st day of December, 1858, a period of ten years, 405 persons died in this Institution. The following table exhibits the causes of death, as appears by the Asylum records: Of this large number, 155 died, directly or indirectly, of cholera, and we might, perhaps, add others from the 28 who are reported as perishing of chronic diarrhoea in 1850. Cholera prevailed in this Institution in 1849, 50, and '55. Diarrhoea formerly prevailed at every season of the year, and hurried the end of many who were not reported as having died of that malady, but no case has occurred since the spring of 1856. Exemption from this troublesome and often fatal disease, is attributed to a change of water for ordinary purposes. The spring previously supplying the Institution was abandoned, and another source opened by deep boring. Diarr The inquiry was suggested by an opinion expressed by a member of the College of Physicians and Surgeons. hoa, then rife in the house, ceased at once, and has not again appeared. If you will designate any statistics that you desire, I will be pleased to furnish them, as far as our records will enable me to do so. Yours, truly, Messrs. BEMISS & BENSON: W. S. CHIPLEY. GLASGOW, Ky., March, 1859. If the following item of Obstetrical incident shall be thought to possess sufficient interest, from its rare nature, to entitle it to a place of record in your valuable journal, it is herewith submitted. At 12 o'clock on the night of March 4th, I arrived at the residence of Mr. S E, three miles from town, where I had been summoned in professional haste to see a negro girl. I found the girl writhing under the pains of active labor, which, after progressing regularly and satisfactorily, terminated at 3 o'clock A. M., in the delivery of a vigorous, wellformed male child, weighing six pounds and eight ounces. Thus far I have alluded to no circumstance connected with this case, sufficiently striking to render it note-worthy; but when I add, that this mother was just eleven years, eleven months, and twenty-two days old, it will be admitted that the case is extraordinary, if not unique. Connected with the progress of this labor there was no feature notably out of the usual order of natural parturition. It was comparatively brief in its duration, and easy-no deficiency of pelvic amplitude or contractile vigor. The girl was better grown than girls of similar age usually are, with, of course, decidedly superior sexual development. Her weight was about one hundred pounds, stature four feet seven or eight inches. The catamenial function was established early in her eighth year, and continued to return with physiological regularity up to the period of her conception. As to the age of this girl, it is established upon evidence as incontestible as that of any other child, white or black, in the State of Kentucky. The juvenile, child-like expression of her features, will fully confirm the accuracy and verity of Mr. E.'s Bible record of her age. J. P. HALL. VOL. 1, NO. 6-12. |