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*AI f*| -' « - /^A,.a'.A ^.AflAi flA^ftfi^ . ■ ^MiA^fc itfw !/\WJ 'HA %m^ 0 a * r^ M.m-J\fi£ A Ar>. ; ' '"■;*,< ^aA™M^M^ haA* & *. & .K.kKW, THE ^MERIC^lN MEDICAL MONTHLY. V © » PR ©*G SEDI E 8 T SEG1ED EDWARD R PARKER, M.D., EDITOR VOLUME VI. JULY, 1854, TO JANUARY, 1851 NEW-YORK : PUBLISHED BY EDWARD P. ALLEN. JSTCL 9 SPRUCE STREET, INDEX OF THE AMERICAN MEDICAL MONTHLY, VOLUME VI. A Lecture on Ethnology 440 Abnormal Heart 140 Abnormity of the Arterial System 50 Abscess in Prostate Gland 24 Academy of Medicine 315 Aconite Root, Poisoning- by 38 Alteratives 11, 241 Amputation of Leg 142 Aneurismal Development 140 Annual Report of the Governors of the Alms House 14 Aorta, Constriction and Obliteration of 50 Amussat, Larrey's Eulogy on 182 Appendix Vermiformis, Ulceration of 145 Appointments and Resignations 240 Apuplexy, Case of 138 Aqueous Solution of Iodine 238 Arcus Senilis, Symptomatic Yalue of 161 Arteries, Atheromatous Degeneration of 21 Artery, Wounded 51 Bellevue Hospital, Notice of 14 Biliary Calculus 137 Birth, Quintuple 222 Blackwell's Island Hospitals, Notice of It Brain, Wound of 54 Bronchi, Three, Springing from the Trachea 309 Bronson (J. O.), Translation of Case of Wet Gangrene 1 Bronzed Skin, Before the French Academy 375 Burns, Operation for I 'eformity from 81 Calculus, Large Biliary 137 Calculi, Uric Acid 221 Cancer of the Uterus 222 Carbonic Acid Gas as a Local Anaesthetic 360 Carbonic Acid as a means of producing Premature Labor.... 44 Cancerous Diseases 27 Carcinoma of (Esophagus, perforating the Trachea 29 Carey (Dr. H. G.) on Cephalic Version 87 Caries of Leg 143 Caries of Tibia and other Bones 294 it Carlyle on Medicine. ............. f23 Carpenter on Microscope, Notice of. 78 Case of Acute Meningitis. „ 298 Case of Amputation of Leg ».».,.,,■ 142 Case of Apoplexy 138 Case of Carcinoma of (Esophagus. ,. 29s Case of Caries of Leg 143 Case of Caries of Tibia * 294 Case of Cholera Infantum 295 Case of Disease of Heart,. 219-' Case of Excision of portion of Infra-Orbital Nerve for Neuralgia 141 Case of Excision of Radial Nerve for Neuralgia 294 Case of Extravasation of Urine r. 22 Case of Fatty Degeneration of Liver 31 Case of Fibrous Tumor of Uterus , 144 Case of Fracture of Frontal Bone 218 Case of Fracture of Skull 290 Case of Fungus Cerebri 298 Case of Ileo-Colitis 219* Case of Poisoning by Arsenic , 218 Case of Poisoning by Seeds of the I -atura Stramonium „'. 220 Case of Punctured Fracture of the Cranium ................ 54 Case of Remarkable Aneurismal Development 140 Case of Rupture of the Intestine 14T Case of Serous Cysts of Kidney „ ...... 298 Case of Single Heart 291- Case of Strangulated Hernia* „ 266 Case of Stricture of Urethra 24 Case of Tetanus 215 Case of Three Bronchi springing from the Trachea 309" Case of Ulceration and Perforation of Appendix Vermiforrais. 145 Case of Unclosed Foramen Ovale 140 Case of Wet Gangrene of the Skin of the Abdomen 1 Case of Wound of Internal Jugular Vein ..... 320 Cephalic Version, by H. G. Carey, M.D 81 ChiW (Dr. T.) Appointment as Professor of Anatomy 150 Cholera Infantum 24T Cholera Infantum, Case of. 295 Circumcision, Eunuchs, and Leprusy in the East *. * 101 Clark on Sight and Hearing, Review of 213- Climate, Seasons, and Zones of, Corresponding with Regions of Disease 378 Commencement in Medical Schools 390 Congress of German Nat's, and Physicians at Vienna 11; 238, 398 Constriction and Obliteration of the Aorta 50 Cranium, Punctured, Fracture of 54 Cysts of Kidney 298 Datura Stramonium, Poisoning by Seeds of 220 Deductions from Prussian Vital Statistics. 310 Deformities from Burns, Remarks on. 8 Deformities 80 Diseases peculiar to the Sandwich Islands 51 Discussion on Bronzed Skin 375 Drunkard's Stomach 136, 296 Ecraseur, Operation by 308 Ethnology, A Lecture on 440 Eulogy on Amussat, by Larrey 182 Eunuchs, Circumcision, and Leprosy in the East 101 Europe and the East, Intemperance in 467 Excision of Radial Nerve for Neuralgia 294 Excision of Supra-Orbital Nerve for Neuralgia 141 Excitants • 11, 241 Extravasation of Urine, Invading a Hernial Tumor of Groin. 22 Eye, Tumors of 144 Fatty Degeneration of Liver 31 Female Physicians 33 Flint on the Respiratory Organs, Review of 202 Florida, A Winter in 68 Formation and Sources of Atmospheric Ozone 272 Fracture of Skull 296 Frontal Bone, Fracture of 218 Fungus Cerebri 298 Gangrene of the Skin of the Abdomen 1 Gardner on Sterility, Review of. 107 German Naturalists and Physicians, Congress of 238 Gliick's (Dr. I.) Letter from London • 318 Green's (Horace) Selections from Favorite Prescriptions. 11, 241 Green's (Dr. Horace) Report on Use of Nitrate of Silver to the Throat 401 Honors to Medical Men 79 Harvey (Dr.), Memoirs of 152 Hematology 46 Heart, Abnormal 140 Heart, Disease of 219 Hernia of the Lung, Traumatic 353 Hernia, Strangulated, Case of 266 Hernial Tumor, Extravasation of Urine into 22 Homoeopathic Medical Preparations, Results of the Analysis of 301 Hospital (Childrens') of Munich, Therapeutic Results in 380 Hospital Nurses 311 Ileo-Colitis 219 Impurities of Water, and their Effects 193 Influence of Sea Life, and of Warm Countries on the Progress of Pulmonary Phthisis 40, 332 Intestinal Perforation 51 Intestine, Rupture of 147 Intemperance in Europe and the East 467 Iodine Water 76 Iodine, Aqueous Solution of 238 Kidney, Cysts of 298 Larrey's Eulogy on Amussat 182 Lawton (Dr. A. G-.), On the Impurities of Water ]93 Lee (Dr. B.), On the Symptomatic Yalue of Arcus Senilis.. 161 Leg, Amputation of 142 Leprosy, Eunuchs, and Circumcision in the East 101 Letter from London 318 Liver, Fatty Degeneration of 31 Local Anaesthetic in Uterine Diseases. 360 Louisville Review 157 Lunatic Asylum, Notice of 18 Lung, Traumatic Hernia of 353 M'Elheran (Dr.) on Variety in Mankind 440 Medicine, Carlyle on 223 Medical Life, Pleasures of a 321 Medical Men, Honors to 79 Medical Schools, Commencement in 390 Memoirs and Observations, Simpson's Obstetric, Review of. 287 Memoirs of the Celebrated Dr. Harvey 152 Meningitis, Case of Acute 298 Microscope, Notice of Carpenter on 78 Microscopic Appearances of Evacuations in Yellow Fever 369 Mott's (Dr. A. B.) Case of Wound of Internal Jugular Vein.. 326 Mott's (Dr. A. B.) Operation for Deformity from a Burn.... 81 New Hampshire Medical Society 72 New Instrument for Retroflexion and Anteflexion of the Uterus 160 Nelken on Sea Sickness, Notice of 214 Nerve, Portion of Radial, Excised for Neuralgia 294 Nerve, Portion of Supra-Orbital, Excised for Neuralgia 141 Neuralgia of Radial Nerve, Operation for 294 Neuralgia of Supra-Orbital Nerve, Operation for 141 New Orleans Medical and Surgical Journal 80 New Orleans School of Medicine 320 New York and Philadelphia 73 New York Medico-Chirurgical Society 136, 215, 294 New York Pathological Society 20, 144, 297 Nitrate of Soda in Peru 221 Notice of Bellevue Hospital 14 Notice of Blackwell's Island Hospitals 17 Notice of Carpenter on the Microscope. 78 Notice of Lunatic Asylum 18 Noyes (Dr. J. Oscar) on Eunuchs, Circumcision, and Leprosy in the East 101 Noves (Dr. J; O.) on Intemperance in the East 467 Nurses for Hospitals 225, 311 Obituary, Dr. James Dubois, Dr. J. L. Crane 320 Obstetric Memoirs and Contributions of Dr. J. Y. Simpson, Review of 287 Vll Omission 76 Operation by the Ecraseur. 308 Ozone, Atmospheric, Formation and Sources of : 212 Parker (Dr. E. H.) on Homoeopathic Medical Preparations... 301 Parker (Dv. E. H.) on Strangulated Hernia 266 Peaslee's (Dr. E. R.) Instrument for Retroflexion and Ante- flexion of Uterus 160 Peaslee (Dr. E. R.), Review of the Physiological Errors of Teetotalism 114 Physicians, Female 33 Physicians and Naturalists, Congress of, at Vienna.. It, 238, 398 Physiological Errors of Teetotalism, Review of. 114 Placenta in Child-birth, Preexpulsion of 52 Pleasures of Medical Life to a True Physician, Address. 321 Poisoning by Aconite Root 38 Poisoning by the Seeds of Datura Stramonium 220 Post-Mortem Examination 296 Premature Labor, artificially produced by Carbonic Acid 44 Preparations, Homoeopathic Medical 301 Prescriptions, Selections from Favorite 11, 241 Prize Essay (Dr. Stewart's), Remarks on 241 Proceedings of New York Medico-Chirurgical Society 136, 215, 294 Proceedings of New York Pathological Society 20, 144, 291 Professorial Appointment, Dr. Childs' 159 Prussian Vital Statistics, Deductions from 310 Quintuple Birth 222 Reese's (Dr. D. M.) Valedictory Address 321 Regions of Disease corresponding with Seasons and Zones of Climate 318 Removal of a large Sewing Needle from the Thigh 151 Remarks on Deformities from Burns 81 Report (Annual) of the Governors of the Alms House for 1855, 14 Report on the Use and Effects of Applications of Nitrate of Silver to the Throat either in Local or General Disease, 401 Resignations and Appointments 240 Results of the Quantitative and Qualitative Analysis of Homoe- opathic Medical Preparations 301 Retroflexion and Antiflexion of Uterus — Instrument for 160 Review of Clark on Sight and Hearing 213 Review of Flint on the Respiratory Organs 202 Review of Gardner on Sterility 101 Review of Nelken on Sea Sickness 214 Review of " The Physiological Errors of Teetotalism" 114 Review of Simpson's Obstetric Memoirs 281 Rogers (Samuel), Remarkable Life of 309 Rupture of Small Intestine 141 Sandwich Islands, Diseases Peculiar to 51 Scoutetten (Dr. M. JULY, 1856. ESSAYS, MONOGRAPHS, AND CASES. Notes of a Case of Wet Gangrene of the Skin of the Abdomen, following the Application of a Seton in the Right Hypochondrium, in the Treatment of an Affection of the Liver, accompanied with Ascites. By Pedro Yavasseur, M.D. Translated -from the Spanish [Anales de la Sociedad de Medecina Montevi- deana. May, 1855), by J. 0. Bronson, M.D. M. 0., an unmarried female, aged 50 years, of lymphatic ner- vous temperament, very delicate, and of extreme sensibility, had enjoyed very good health, menstruating regularly, until within three or four months past. She had always a good appetite ; her digestive powers were slow and weak j the alvine evacuations a little difficult, still there was no gastric pain. From time to time symptoms of flatulency appeared without vomiting, which yielded to some stimulating draught. She had always been very regular in her habits, but still suf- fered, as she had for the space of nine or ten years, much mor- al depression, on account of the political state of the Argen- tine Republic, of which she was a native. Being in the habit of reading works on popular medicine, she had used an infinite number of remedies for her minor ailments. 1 2 vavasseur's case op [July, For something like three months she had noticed a change in her digestive functions. Her appetite failed, and she suffered alternately, diarrhoea and constipation, and at last noticed a slight elevation in the lower part of the abdomen, for which she took drastic purgatives, especially Brandreth's pills. Experiencing no alleviation, and becoming alarmed at the swelling of the bowels, she consulted me on the 24th of April last. Her condition was as follows : — Emaciation, extreme ; com- plexion, sallow ; expression of countenance, febrile ; pulse, frequent (100 per minute), hard, and vibrating but a little, full ; tongue, white in centre, with red borders ; mouth, bitter ; and some tenderness of the epigastric region, which was noticed to be a little elevated. Percussion indicated the presence of an elastic fluid in the stomach and intestines. The urine was scanty, dark and tur- bid. Stools, small in quantity and dry. Her appetite was gone, but she had a constant desire for acid drinks. Examin- ation in the hepatic region by palpation and percussion discov- ered nothing pertinent ; but attention was attracted to a tumor, situated in the right hypogastrium, about the size of a child's head, extending from the crest of the ilium to the linea alba, and its upper border reached the breadth of three fingers above the last rib. It being indolent and exhibiting fluctuation, left no doubt of the existence of a large quantity of fluid. My first opinion was that it was encysted dropsy of the ovary. In fact, the suppression of menstruation, being unaccompanied with pain, and the situation of the tumor, confirmed me in this opin- ion, notwithstanding there was no distinguishing symptom to make it absolute. In view of the febrile symptoms, of the constipation, of the irritation of the intestinal tube, of the scantiness of the urine, I prescribed a light decoction of the root of asparagus, with one grain of the nitrate of potassa, and a laxative enema, rec- ommending, also, a strict diet. The family becoming alarmed at the opinion that was formed concerning the seriousness of the malady, proposed a consulta- tion, to which I at once acceded. On the following day, Drs. Cordero and Peralta met me. 1856.] GANGRENE OF THE ABDOMEN. 3 After examining the case we found as follows : — The febrile symptoms, gastro-intestinal irritation, and tympanitis had dis- appeared ; the tongue was more natural, but a little white ; the thirst less, and no bad taste in the mouth ; the pulse had lessened in frequency to 75 pulsations, a little vibrating, but much softer ; the urine sufficiently abundant, and less loaded ; the stools copious and natural. The tumefaction in the lower part of the bowels, appeared to me a little diminished ; and not without great surprise I noticed it had extended to the left side, and that the circumscription that had been noticed the day before, had entirely disappeared. This left me no reason for believing any longer in the existence of an encysted tumor. I caused my colleagues to take particular notice that I had employed all possible means for avoiding error, and that it was absolutely not possible to know whether she had had like changes on any previous day. May be it was so ; the manifest fluctuation in the lower part of the bowels, and the increase of the tumor upon the downward side whenever the woman was lying upon either side, left as little doubt of the presence of ascites. Was this collection of water idiopathic or symptomatic, and what was the cause of it ? In considering the case with the greatest care and without haste, every one of us was convinced that the functions of respiration, of the heart and the great vessels, presented no abnormality. It was necessary to fix the cause within the organs of digestion, and keeping in view the previous history of the case as she gave it — the old disorder of the digestive functions, though transient and light ; the irregularity of the alvine evacuations ; the sallowness of the complexion ; the scantiness and high color of the urine, &c; — we were induced to believe the disease was owing to an obscure, chronic affec- tion of the liver, although it was not possible to find anything in this organ, nor, indeed, in any other of the abdominal organs and vessels. In fact, there was nothing to be found in the right hypochondrium — no other tumor could be discovered. There was no abnormal hardness, and the patient did not at any time have pain or tenderness in her bowels. Consequently we class- 4 vavasseub's case of [July, ified the disease as ascites, caused by a chronic affection of the liver, the nature of which we were unable to determine ; but there was certainly obstruction in the portal system, and to it most certainly we could point, as accounting for the fluid in the abdomen. Our prognosis was unfavorable. Agreeably with the above exposition, Dr. Cordero proposed the application of a seton in the hepatic region. This propo- sition was assented to without discussion by Dr. Peralta. As to myself, I did not think such means efficacious in like cases ; and, moreover, the feebleness and extreme sensibility of the patient,, strengthened me against it. These objections were refuted, and I yielded to the opinion of my colleagues. Dr. Cordero proceeded at once to perform this small operation, which presented nothing worthy of notice more than unusual thinness of skin, entire absence of adipose tissue, and the very small quantity of blood following the incisions. We agreed, however, in the use of diuretic preparations and of iron. After the seton was inserted, friction with camphorated mercurial ointment was prescribed. Light but nutritious diet was rec- ommended. Agreeably with these resolutions, the prescriptions were as follows : — R Rad. asparagi (off.) §j Aq. fontanse, oj ft clecoc. et add Syrup, quinque radic. §ij haustus cyathus sumeudus. R Rad. scillaB, pulv. gr.vj Ferri pulv. gr.xij Eset cicbosu Rad. glycyr. pulv. aa q. s. ft pil xij tres gran, e quibus sing, quaque nocte. Upon the morning of the second day, the patient was with- out fever, and had passed a good night, with the exception of being disturbed by the pain of the seton. The urine was notably more abundant, clearer, and more natural, and during the night two copious, feculent stools were produced. Emollient cata- plasms were applied to the seton, and the previous remedies continued. Upon the third day, the pain from the seton was less, the 1856.] GANGRENE OF THE ABDOMEN. 5 border of the incision was red and somewhat swelled, the urine improved in quantity and quality, and one alvine evacuation of the same character as the previous day. The abdomen had come clown about half an inch under the use of the remedies. On the fourth day, the patient complained much of the seton, but in other respects felt relieved. All of that portion of the skin comprised within the two mouths of the seton and the immediate tumefaction, was very red and painful. I did not draw the string, in order not to irritate the wound more, dressed it with simple cerate, and prescribed a continuance of the emollient applications. On the fifth day, there was Jess pain. The redness and tumefaction was considerably diminished, the suppuration had commenced, and I drew the string secundum artem. Moreover, the urine was abundant and nearly natural, and there had been three copious evacuations. The bulk of the abdomen had decreased one inch and a half, as compared with previous measurement. The patient was easy, and had some appetite. The same remedies and applications to be continued. The two following days she remained much the same. The seton suppurated abundantly, and the pus was of good quality. In the meantime the patient complained of a sense of constric- tion and some pain. The abdomen had decreased one inch, one or two alvine evacuations had been produced, and the appetite and digestion became natural. Continue the same treatment. On the eighth day, the patient had not slept, on account of the pain from the seton. The skin was perceived to be swelled, reel, phlegmonous, and being gently pressed, a large quantity of reddish pus, of bad appearance, issued from the wound. In order not to irritate the wound, and to give free outlet to the suppuration, I made the string, which was of leather, smaller. On the following day, the ninth, the suppuration was active, and of a good character. Pain enough from the seton, and in the midst of the opening there appeared a little vesicle, full of serosity. This was broken, and in the bottom of it was to be seen a spot of a leaden color. I did not draw the seton, but ordered a continuance of all the remedies. On the tenth day, the spot had extended more than two lines 6 vavasseuk's case of [July, in all directions, and its black appearance left no doubt in my mind of its gangrenous quality. The pain was severe and accompanied with heat. Convinced that these symptoms of gangrene, as they appeared to me, were owing to the extreme irritation caused by a foreign body (the seton), and dreading its advancement, because of the effect which mortification would produce in one already so emaciated, I did not hesitate to remove the seton, and dress the wound with the cerate of Galen, and have the emollient applications oftener repeated. I hoped, in virtue of the axiom, sublata causa, tollitem efectus, to limit the gangrene to that portion of the skin comprised between the two incisions, and afterwards see the wound close very promptly. But my hopes were blasted. In fact, the three following days, in spite of more methodical dressings, and of the uninterrupted use of the most efficacious emollient applications, the gangrene continued to spread two or three lines in circumference every day. At the end of the fourteenth day, alarmed by the progress of the mortification, and con- vinced of the inutility of following that plan any longer, I resolved to change the method, and try antiseptics and tonics, in spite of the red color of the skin, and, in fact, dress the wound with a mixture of equal parts of powdered quinine, camphor, and charcoal of poplar wood, and apply one thickness of lint soaked in aromatic wine. I recommended, also, to cover all these with a large, thick compress, wet in the same wine. For four days I continued these remedies, without perceiving any very appa- rent change, excepting, it appeared to me, the gangrene pro- gressed a little more slowly. The general condition of the patient was a little more or less the same ; the appetite regu- lar ; the pulse natural through the day, but somewhat accele- rated at night. The urine had decreased, but the alvine evacuations, of which there had been two or three in twenty- four hours, were abundant and natural. Pained by the ill-success of my endeavors, and fearing the consequences of a great loss of substance, and such abundant suppuration in a person already so debilitated, I asked another consultation, and the following (19th) day was appointed for consultation with Dr. Peralta, alone. After examining all things, my colleague ascribed, as I had in the beginning, the 1856.] GANGRENE OF THE ABDOMEN. 7 cause of all these accidents to an excess of inflammation, and proposed to combat it by the most efficacious antiphlogistic measures ; verbi gratia, by an application of leeches around upon the red border circumscribing the gangrenous part, bath- ing with water of the root of althea and linseed, and contin- ual fomentations of the same articles, mixed with milk, and inwardly mucilaginous drinks, and very light diet. I combat- ted these ideas as well as I was able, arguing on the little or no advantage which accrued on previous days, when I had fol- lowed the plan proposed by him ; in the alleviation I had obtained by my second method in the spread of the gangrene ; in the state of extreme debility of the patient ; in the feeble- ness of the pulse ; and, finally, in the fear which seized me, that every one of the leech-bites might be converted into a new spot of gangrene. I moreover showed to him that the inflammation of the dermis which here existed, was not that of phlogosis clear and decided from excess of vitality, and it would be better to consider it as irritation, spurious and of bad character, owing to the unyielding of the tissues. After an animated discussion, we agreed to try vigorous antiphlogis- tic measures for 24 or 36 hours, with the exception of leeches, which I formally opposed. According to the agreement, I cleansed the ulcer and the surrounding integuments of the pow- ders with which it had been dressed, and dressed it with lint and simple cerate — applying the fomentations over that, and recom • mended her to use the lotion every three hours, and prescribed gum water with lemon juice, and a very light diet. At the end of 24 hours, Dr. Peralta came back to see the patient, and with him Di\ Gaffarot. I was astonished at the progress of the ulceration in so few hours (more than one inch and a half in all the circumference of the part involved, principally downwards and toward the linea alba). The heat of the inflammatory circle was scarcely red. There was discovered an oedema of the skin in all the lower part of the belly, and extending down to the mons veneris, retaining the impression when pressed upon by the finger. Moreover, we had not only lost all the gain on the size of the belly, but there was evidently an increase of the serous collection. Dr. Peralta confessed with much sincerity the inappropriate- 8 vavasseur's case of [July, ness of the course pursued, and acceded, without discussion, to my proposition to return to the treatment by antiseptics and tonics, in their breadth and strength, both externally and inter- nally. In this I was strongly supported by Dr. Gaffarot. Accordingly, then, we three agreed to dress the ulcer with the powdered quinine and camphor, with the addition of half a drachm of tonic acid to the ounce ; with lint spread with oint- ment of styrax, and fomentations over the whole extent of the abdomen, to be renewed every moment, of aromatic wine en- livened by one ounce of tincture of camphor, and a scruple of tan- nin for every ounce of wine. Moreover, we prescribed a light decoction of quina, distilled cinnamon water, and syrup of orange peel, with a nourishing diet, and a little good old port wine after eating. It is unnec- essary to say that she abandoned the use of the pills of squills and iron, which the patient had taken until then. Evidently the prognosis was serious ; since, to the danger of the previous and original disease was added, what we feared the most immediate danger from, the gangrene of so great extension. In fact, supposing it favorable for the limitation of the mortification, we could not but dread the effect, on a con- stitution so weak, of so great suppuration, or the absorption of pus. This course was observed with great care for the space of four days, and it appeared to me that the progress of the gan- grene was less rapid ; the strength generally was maintained well enough, and the pulse was much more natural. The patient had no pain, except an uncomfortable constriction in the abdomen, and she complained principally of want of sleep. On the fifth day, the 25th after the application of the wretched seton, I noticed that the gangrene had reached a limitation in the upper part of the spot where the seton had been ; since a circle of a legitimate color, and a line of white suppuration had appeared upon the border around, about three inches. Moreover, the slough appeared to be loose. On the the 29th day, the upper part of the slough had become loose, and I determined to cut away all that was separated ; that is to say, more than three inches long and over two inches broad. The wound underneath the escar was red, fair, and gave out 1856.] GANGRENE OF THE ABDOMEN. 9 pus of a good quality. That part was dressed with lint and simple cerate, using the other remedies on the remaining por- tion, as the mortification continued there, although with no great vigor. The oedema had completely disappeared, and I was led to conceive the hope of seeing a limitation entirely to the gangrenous action. The upper, clean part of the wound advanced properly and began to give signs of cicatrization. On the 32d day, another portion of the slough, 3| inches broad by 5 inches long, becoming loosened, I cut it away, and under- neath it could see, as in the first instance, the wound reddened and covered with healthy suppuration. I dressed it with lint and simple cerate. The progress of the gangrene, which con- tinued to extend towards the pudendum and linea alba, did not gain more than half a line in 24 hours. The bulk of the ab- domen appeared to remain stationary. In a few days, the gangrene had reached its limit, and nearly the whole slough was removed, leaving only a small portion at the inferior part, which fell off of its own accord on the following day. The ulcer in its other parts was clean, of a healthy color, and covered with granulations very much like a burn in the second stage, and poured out abundant sup- puration, but of a healthy character. Discontinuing the tonic applications, I dressed this immense suppurating surface — which extended from above, beneath the breast, as far as the mons veneris, and in breadth from a point on a level with the crest of the ilium to the linea alba, occupying, in a word, one-half the abdomen — with simple cerate. From that time it began to cicatrize with the same rapidity it had before passed into a state of gangrene. The suppura- tion was very abundant and of a better nature. The bulk of the belly decreased remarkably, and her general condition was very flattering. But by measuring — as the quantity of pus grew less, the sup- purating surface every day becoming smaller — the ascites began to make a little progress. At the end of twenty-one days from the time the gangrene was checked, there remained of this immense wound but three small suppurating points, not more than one inch in size. All the other surface was covered with a healthy, firm cicatrix. 10 GANGRENE OF THE ABDOMEN. [JULY, Still the volume of the abdomen increased every day ; the oedema manifested itself first in the right leg, and soon after in the other — the urine, in the meantime, becoming scanty. It appeared to me au opportune time for the exhibition of diuretics with iron, but they were without effect, excepting the alvine evacuations were more abundant and more frequent. The swelling of the belly, and the oedema, continued to increase. The work of cicatrization suddenly ceased, which, to this time, had been so active, and the three openings put on a bad color, and poured out pus of a grey, glutinous nature ; and three or four black spots appeared in various parts of the cicatrix principally in that part where gangrene commenced the first time. I had recourse again to the tonic and antiseptic plan, but all to no purpose, for the mortification made new progress. The oedema and the dropsy increased more and more every day, until they extended on both sides to the waist ; the appe- tite and sleep were lost ; the pulse was feeble and small. From time to time there appeared a little dyspnoea, and some sharp pain in the hepatic region, which extended to the heart. In a word, the general condition left no hope of pre- serving the poor patient's life, but a very short time. At last, on the morning of the seventh of July, the patient asked the consolations of our sacred religion. She kneeled to partake of the sacrament, and being raised up, breathed two or three times, and quietly died without a struggle. In spite of all my efforts, it was not possible to have an autopsy, consequently these observations are incomplete. This case appears to me to present some points worthy of faithful attention, viz : 1. The circumscription of the ascites in the right side at the beginning, which led me to believe it to be encysted dropsy. 2. The danger which is likely to follow the application. of a seton, in one so much debilitated, and, moreover, whose tissues are so very thin, and almost without vitality. 3. The difference presented between certain inflammations, and the treatment indicated. 4. The diminution of the collection of water under the influ- ence of very abundant suppuration. 1856.] green's selections. 11 5. Lastly, the rapidity with which cicatrization occurred, after the limitation of the gangrene, and the throwing off the escar. Selections from Favorite Prescriptions of Living American Prac- titioners. By Horace Green, M.D. Excitants and Alteratives. {Continued.) Not only in the preceding diseases — severe folliculitis, and secondary, or constitutional disease, — has this combination of the iodides, the hydrar gyro-iodide of 'potassium, been found use- ful, but its administration in many obstinate cutaneous affec- tions has proved, in our hands, to be highly advantageous. R Extract Conii, 3iss Proto-Ioclid. Hydrarg. gra. iv Potassge Iodidi 3iij Tinct. Cardamon, §ij Syr. Sarsa. Co. §iv Fiat mistura. Capiat, cochl. parv. bis terve in die. This preparation, administered as above, may be employed in the treatment of lupus, lepra, and other obstinate cutaneous affections, especially those of a scaly character, with safety and advantage. With my colleague, Prof. J. M. Carnochan, Sur- geon-in- Chief to the State Hospital, Donovan's solution — which is a combination of iodine; arsenic, and mercury — is a favorite remedy in the treatment of lupus, venereal eruptions, impetigo, and other chronic, cutaneous diseases. R Liquor Arsenici et Hydrarg. Iodid. §ss Syr. Sarsa. Co. §viij M. Sumat cochl. una parv. ter quotidie. In laryngeal and bronchial disease, and also in the early stage of phthisis, when any degree of febrile action is present, the iodide of potassium, in combination with antimony, will frequently prove more useful than when administered alone. R Potass. Iodidi. 5ij Antimon. et Potass, tart. gra. ij Syr. Zinziber. Aquae font. aa §iij Fiat mistura. cujus sumat. cochl. parv. bis in die. 12 green's selections [July, Or we may, under the same circumstances, exhibit the fol-. lowing : — R Potass. Ioclidi 5iiss Syr. Ipecac. §ij Aquae font. §iv M. Copiat cochl. parv. bis terve in die. A combination of the medicinal hydrocyanic acid, with a solution of iodide of potassium, constitutes a favorite remedy with some practitioners in the treatment of phthisis. R Potass. Iodidi 5ij Acidi Hydrocyanici, gtts. xl Syr. Sarsa. Comp. Aquas font. aa §ij Ft. mist. Sumatur cochl. min. mane ac nocte. Although, as we have stated, the iodide of potassium is a better preparation for administration than the iodine, in most forms of disease ; yet, when indications of a scrofulous diathe- sis are present, especially in young persons and children, it will be preferable, and will frequently prove more efficacious, to exhibit the two preparations in combination. R Iodini gra. x Potass. Iodid. 3i Syr. Rhei. Aquae purae. aa §ij Fiat mistura, date cochl. parv. ter in die. Few remedies will be found more efficacious for promoting the absorption of glandular swellings in the neck, or of those in other parts of the body, than the following preparation : — R Iodini gra. x Potass. Iodid. 5i Liquor Potass. §i Syr. Sarsa. Siij Fiat solutio. Capiat cochl. parvum bis in die. In the treatment of hypertrophy of the heart, and in other diseases of this organ, when it is important to reduce vascular action, the subjoined mixture may be advantageously exhibited. R Potass. Iodidi 5iiss Tinct. Hyoscyami " Digitali. aa §ss Syr. Sarsa. Co. §v Fiat mistura, date cochl. min. mane ac nocte. The combining of iodine and iron was first practised by Dr. Pierquin, and the product of this combination — the iodide 1856.] FROM FAVORITE PRESCRIPTIONS. 13 of iron, was employed by him for the treatment of disease, in L824, although the credit of first introducing the remedy into medical practice, is attributed to Dr. Thompson, of London. The iodide of iron is a valuable therapeutic agent. In its operation on the system it is considered to be more nearly allied to the preparations of iron than to those of iodine. In scrofulous debility, in strumous enlargements of the glandular system, in chlorosis, and amenorrhcea, and in most affections, where ferruginous preparations are indicated, the iodide of iron has been found especially useful. It is most frequently admin- istered in the form of a syrup. Syrup of the iodide of iron may be used as a tonic in doses of from xv to xxv drops, twice daily, in the treatment of any of the preceding diseases. Several years ago. Dr. Dupasquier, of Lyons, published some interesting statements in regard to the favorable effects of the proto-iodide of iron in the treatment of pulmonary phthisis. An eminent physician of New Orleans, who has had much experience in the treatment of thoracic disease, strongly rec- ommends in phthisis, chronic bronchitis, &c, the following com- bination : — R Syr. Ferri. Iodidi 5vi Potass. Iodidi gra. xii Grlycerinse pur. Syrupi. Limonis aa §i Aquas font. |iv Fiat mistura, cujus capiat cochl. ampl. ter in die, ante cibum. It is highly desirable that so important a therapeutic agent as the iodide of potassium should be of such a degree of purity as not to affect its medical use. But, unfortunately, not only impurities, but adulterations of the commercial article are often found to exist. It is frequently found adulterated with car- bonate of potassa, with the chloride of sodium, and when not prepared with care, will often contain the iodate of potassa. Some test, therefore, which will enable us to detect these adul- terations easily and with certainty, is quite desirable. When adulterated with carbonate of potassa, it may readily be detected by dissolving the suspected article in alcohol. Iodide of potassium which contains no water of crystallization, is freely dissolved by alcohol ; but the carbonate of potash will not dissolve. A very simple and certain test is given in a late 14 SEVENTH ANNUAL REPORT OP [JULY, number of the London Pharmaceutical Journal, to detect the presence of either carbonate or ioclate of potash. This is the syrup of the iodide of iron. To a small amount of the iodide of potassium in solution, add a drop or two of the syrup of iodide of iron. If pure, no change will be produced ; but if carbonate of potash be present, a pale blue precipitate is formed at once. If the specimen contain iodate of potassa, a red pre- cipitate occurs immediately. If both carbonate and iodate of potash are present, on adding the test, first a deeper blue, and then a red precipitate will be found. If the usual precautions, as to equal quantities, &c, are observed, with the samples exam- ined, the resultant precipitates will show the relative amount of the adulterating agents in each. We have used this test frequently, in examining different preparations of the iodide f potassium, and have found it efficient in detecting their pres- ence, when these adulterations have existed. Seventh Annual Report of the Governors of the Alms House, New York, for the year 1855. This Report is of great interest to medical men, as it con- tains the Reports of the following Hospitals, viz : Bellevue Hospital, Blackwell's Island Hospital, Small Pox Hospital, Nursery Hospital, Colored Home, and Lunatic Asylum. In these Hospitals, twelve thousand eight hundred and sixty-six patients were treated during the year 1855. Our limits will only permit a brief abstract of the Medical Reports of each of these Hospitals. Bellevue Hospital. Medical Officers. Jan. 1st, 1856. Consulting Physicians — Drs. John W. Francis, (Pres't of the Board), and Isaac Wood. Visiting Physicians — Drs. Alonzo Clark, Benj. W. McCready, Isaac B. Taylor, George T. Elliot, B. Fordyce Barker, and John T. Metcalfe. Consulting Surgeons — Drs. Valentine Mott, and Alexander H. Stevens. 18 6.] THE G0VEN0KS OP THE ALMS HOUSE. 15 Visiting Surgeons — Drs. James R,. Wood, Lewis A. Sayre, John A. Li dell, John J. Crane, Stephen Smith, and Charles D. Smith. House Staff. House Physicians — Drs. C. L. Ives. Wm. H. Draper, and James D. Gait. House Surgeons — Drs. George K. Amerman and William Frothingham. Assistant Physicians — Drs. Henry C. Pointer, Henry Janes, and Homer 0. Hitchcock. Assistant Surgeons — William Gentry, John M. E. Wetmore. Apothecary — John Frey. The whole number of patients treated during the year 1855, was - - 6,697 Died, 629 In the lying-in department, there were — Births, .... 306 Labors, ..... 303 Deaths, - - - 7 The deaths were — Puerperal Fever, - - - 3 " Convulsions, - - 2 " Peritonitis, - - - 1 Rupture of Uterus, - - 1 Of the whole number of deaths, one hundred and sixty-seven died within five days after admission ; and one hundred and ninety-two from consumption. There were fifty Coroner's cases. The Governors have made a noble addition to the Hospital during the last year, a four story building of stone, containing fifteen wards, each having twenty beds, a bath room and a water closet. The other arrangements for heating and venti- lating the wards are very complete. The Governors are about to add another story to the main building, so that when these improvements are completed 1200 patients will be amply accommodated. This Hospital will then surpass, — in its size, the perfection of its arrangements, in salubrity and beauty of location, and advantages for clinical teaching, — any other gen- eral Hospital in the world. 16 seventh annual eeport of [july, Blackwell's Island Hospitals. These Hospitals are under the charge of Wm. W. Sanger, M.D., Resident Physician. His staff are the following assist- ant physicians : Drs. Reed, Hurd, Abrahams, Flournoy, Magof- fin, White, and Packard. Dr. Sanger's report is a model one, and exhibits him as a working executive officer, of the highest order of talent. It contains 21 tables, grouping a series of facts of great interest and importance. The first table is a complete and comprehensive medical history of the Hospital during the year 1855. The whole number under treatment was 2,657. We have not space to analyze the series of interesting facts presented in the other tables. We can only glance at a few of them. Table E shows the proportion of natives admitted was 29TV per cent. ; foreigners, 70ft per cent. Of the foreign born patients, 88To per cent, were British subjects ; from Ger- many, 7ft per cent. ; from all other countries, 3ft per cent. From Table G- we learn the melancholy fact that over 73 per cent, were under 30 years of age. Table H shows the degree of education possessed by those admitted. The 52ft per cent, that " can read and write imper- fectly " are hardly one degree removed from the 33 per cent. " uneducated." Of the total number admitted, Can read and write well, - 13ft per cent. " " " imperfectly, - 52ft " Uneducated, - 33 " Unascertained, - - - - lft " Table K shows the fact that 88ft per cent, of all admitted during 1855 were drinkers of intoxicating liquors ; and there is no disguising the fact that those marked as " Temperate " or " Moderate Drinkers " could be classed under the heads " Intem- perate'" or " Habitual Drunkards." Take the three tables G, H and K, and do they not present to the Christian and Philan- thropist facts of the most melancholy nature, namely : that 73ft per cent, of those were under 30 years of age ; 85ft per cent, were almost entirely uneducated ; and 88ft per cent, were intemperate drinkers of intoxicating liquors ? Table Q shows the duration of treatment, and Table R the 1856.] THE GOVERNORS OF THE ALMS HOUSE. 17 results of treatment. The ratio of mortality of patients treated in the Hospital is 2T\ per cent. If the patients treated in the Penitentiary are included, the ratio of mortality is but lT6o per cent. The new Small Pox Hospital is now nearly completed. It will accommodate all classes, separate from each other, where they can have all the conveniences and comforts of home. The upper story is divided into private rooms for gentlemen or ladies, where they can enjoy all the privacy and more atten- tion than they could command in their own houses. We cannot forbear saying in this connection, that Dr. Sanger, by his wise suggestions and untiring energy, is effecting great changes in the institutions on BlackwelPs Island, equally advan- tageous to the interests of science and of humanity. Nursery Hospital. This Hospital is very similar in character to the " Hospital for Sick Children," of Paris. Henry N. Whittlesey, M.D., is the Resident Physician. His assistants during the last year were Drs. A. Wilkinson and C. Knight. Dr. Whittlesey's report is very short, but to the point. During the year 1855, 2,310 patients were treated in the Hospital. There were 202 deaths. The per centage of mortality is 9TV Scarlet fever and measles appeared simultaneously among the children in April, 1855, numbering during the months of April and May, 215 cases. This epidemic, with some mitigation in intensity, has continued until the present time, and has increased the bill of mortality, not only directly, but by its complications and the constitutional diseases which it has served to develop. A table of the diseases of those who died, is appended to the report. There died from Measles, and its complications, - 50 Scarlet Fever, and do. - - 29 Cachexias of various forms. - 26 Marasmus, - - - 11 There were but 7 deaths from Dysentery, 4 " " Diarrhoea, 1 " " Cholera Infantum, 8 " " Pneumonia. 2 18 seventh annual report of [july, Colored Home. James D. Fitch. M.D., Resident Physician ; Benjamin Lee, M.D., Assistant do. Whole number of patients treated during the year 1855, .... 868 Deaths, ..... 108 38 deaths were from Phthisis, 7 " " " Dropsy, 6 ■ " " " Tabes Mesenterica, 9 " " " Pneumonia. Lunatic Asylum. M. H. Ranney, M.D., Resident Physician ; J. 0. Lansing, M.D., F. A. Smith, M.D., Assistant Physicians. The whole number of patients treated during the year was - - - 926 Discharged during the year, - - 253 Died, 100 Remaining Dec. 31st, 1855, - - 573 The causes of death were as follows : — Consumption 29, Paralysis Generale 18, Epilepsy 7, Chronic Diarrhoea 7, Typho- mania 6, Old Age 5, Congestion of the Brain 5, Inflammation of the Brain 2, Hemiplegia 3, Apoplexy 2, Typhus Fever 2, Hypertrophy of the Heart 2, Pneumonia 2, Bronchitis, Pleurisy, Hydrothorax, Ascites, Erysipelas, Scurvy, Submersion, each 1, Anasarca 3. It will thus be seen that the opportunities for clinical study, for seeing disease, is nearly as great in New York as in Paris. In addition to the above, under the charge of the Board of Governors, we have also the State Emigrants' Hospital (nearly as large as the Hotel Dieu, of Paris), the New York Hospital, St. Vincent's Hospital, the Woman's Hospital, the New York Lying-in Asylum, and the Ophthalmic Hospital. St. Luke's Hospital, a large and beautiful hospital, will also soon be opened for the reception of patients, and for clinical instruction. It is not improper to call the attention of the parents and guardians of young men pursuing the study of medicine, to the comparative advantages of New York and Paris in some other respects. " See Paris and die," is a saying which has some influence in professional as well as in other ranks, but it cannot 1856.] THE GOVERNORS OF THE £LMS HOUSE. 19 be concealed that one who devotes a year of time and a thou- sand dollars of money to the study of medicine in Paris, does not necessarily bring away his " quid pro quo." Both time and money are required for the voyage, and still more of each in becoming so familiar with the language, as to make attend- ance on the lectures really profitable. It will be placing the average of available time quite high, if we suppose that it is six months. Now, in this city there is enough to occupy a young graduate fully and constantly for more than a year. More can be seen of disease, medical and surgical, than in any other American city ; for New Orleans alone has any thing like the same amount of hospital accommodation, and but few are able to remain there during the Summer months. New York, on the other hand, is a healthy city, and with the reason- able care one should every where exercise, perfect health may be enjoyed. Study may be pursued either publicly or privately, and full occupation can be found by the most industrious. 