Cases and observations; by the Medical Society of New-Haven County, in the state of Connecticut, instituted in the year 1784. Approx. 147 KB of XML-encoded text transcribed from 86 1-bit group-IV TIFF page images. Text Creation Partnership, Ann Arbor, MI : 2008-09. N16570 N16570 Evans 21296 APY3131 21296 99030229

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Early American Imprints, 1639-1800 ; no. 21296. (Evans-TCP ; no. N16570) Transcribed from: (Readex Archive of Americana ; Early American Imprints, series I ; image set 21296) Images scanned from Readex microprint and microform: (Early American imprints. First series ; no. 21296) Cases and observations; by the Medical Society of New-Haven County, in the state of Connecticut, instituted in the year 1784. Medical Society of New-Haven County. viii, [9]-86 p. : ill. ; 21 cm. (8vo) Printed by J. Meigs,, New-Haven: : 1788.

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eng Medicine -- Connecticut -- New Haven County. 2007-04 Assigned for keying and markup 2007-04 Keyed and coded from Readex/Newsbank page images 2007-07 Sampled and proofread 2007-07 Text and markup reviewed and edited 2008-02 Batch review (QC) and XML conversion

CASES and OBSERVATIONS; BY THE MEDICAL SOCIETY OF NEW-HAVEN COUNTY, IN THE STATE OF CONNECTICUT.

Inſtituted in the Year 1784.

PLUS ULTRA

New-Haven: Printed by J. Meigs, 1788.

PREFACE.

A number of Phyſicians in the city and county of New-Haven, ſtimulated by the importance of the object, and the laudable example of the faculty in the various nations of Europe, and in ſome parts of America, formed a ſociety in the year 1784, for the purpoſe of improving themſelves in Medical knowledge.

The caſes and obſervations, which have been exhibited to the ſociety, are given to the public, in the following ſheets, who it is hoped will regard with a favourable eye, the firſt eſſay of this infant inſtitution. All attempts to improve a ſcience which is ſubſervient to the deareſt intereſts of humanity, muſt meet the approbation of every benevolent mind. Attempts of this nature are particularly neceſſary, and muſt be peculiarly uſeful, in an infant empire, where the ſeeds of ſcience, though widely diſſeminated, are but juſt beginning to germinate. Their future growth and increaſe depend on the care and attention with which they are nurtured. To excite others to this laudable and ſalutary work, is one principal object of this publication. It has not we preſume proceeded from incapacity, or a criminal inattention to the intereſts of humanity that the faculty in this country have hitherto contributed ſo little to the general ſtock of Medical knowledge. In a widely extended country, at a diſtance from each other, it has not been in their power to unite their efforts in this noble purſuit. The late war brought many ingenious and learned Phyſicians together from all parts of the continent, and the army formed them into a temporary ſociety, whoſe unreſerved communications have contributed to the improvement of medical knowledge, and the eſtabliſhment of a new and important aera in the healing art. By this mean the faculty have become more ſenſible of the importance of uniting their endeavours, and ſeveral Medical ſocieties have been formed in different parts of the United States. Should ſimilar inſtitutions become general, and permanent, there is reaſon to hope that Medical literature will ſoon be in as flouriſhing a ſtate in this country as in any part of Europe. A ſpirit of emulation will take place, ſloth and ignorance decline, and the art appear with dignity and luſtre. Should this effort of the ſociety contribute in the ſmalleſt degree to effect thoſe deſirable ends, it will afford them ample ſatisfaction for their labour.

This ſociety was formed on the moſt liberal and generous principles, and was deſigned firſt to lay a foundation for that unanimity and friendſhip which is eſſential to the dignity and uſefulneſs of the profeſſion; to accompliſh which, they reſolved ſecondly, to meet once in three months: thirdly, that in all caſes where counſel is requiſite they will aſſiſt each other without reſerve: fourthly, That all reputable practitioners in the county, who have been in the practice for one year or more, may be admitted members: fifthly, that they will communicate their obſervations on the air, ſeaſons and climate, with ſuch diſcoveries as they may make in phyſic, ſurgery, botany or chemiſtry, & deliver faithful hiſtories of the various diſeaſes incident to the inhabitants of this country, with the mode of treatment and event in ſingular caſes: ſixthly, to open a correſpondence with the Medical Societies in the neighbouring ſtates and in Europe, for which purpoſe they have a ſtanding committee of correſpondence: ſeventhly, to appoint a committee for the purpoſe of examining candidates for the profeſſion, and to give certificates to the deſerving.

In purſuance of theſe reſolutions, the Society have punctually attended their meetings, examined and approved a number of candidates, many of whom bid fair to be ornaments to the profeſſion: and of late they have made ſome advances towards the eſtabliſhment of a fund, which promiſes permanency to the inſtitution.

Any communications which may tend to the advancement of the ſcience, from gentlemen of the faculty in other parts of this and in the neighbouring ſtates or elſewhere, will be thankfully received, and ſuch as may be deemed worthy of publication preſerved for a future volume.— Such communications may be ſent to the SecretaryDr. SAMUEL DARLING., or any other member of the Society, by whom they will be exhibited to the Society, and lodged on their files for future uſe.

New-Haven, June 14th, 1788.
CONTENTS. CASE of a Singultus from an Adheſion of the Liver to the Diaphragm, proving fatal. Communicated by Dr. Samuel Neſbitt. F. M. S. Caſe of a Puerperal Fever ſucceſsfully treated. Communicated by Dr. Elnathan Beach, F. M. S. Two caſes of difficult Deglutition from extraneous bodies lodged in the Gula. By Dr. Abraham Tomlinſon, F. M. S. Caſe of a fractured cranium ſucceſsfully treated. By John Spalding, Surgeon, F. M.S. Caſe of a Gangrene of the Scrotum. By Dr. Leverett Hubbard, F. M. S. Caſe of the Lock'd Jaw ſucceſsfully treated by Electricity. By Dr. Eneas Munſon, F. M. S. Caſe of an Hamatemeſis, ſucceſsfully treated. By Dr. Samuel Neſbitt, F. M. S. Caſe of an Enteritis. Communicated by Dr. Ebenezer Beardſley. F. M. S. Caſe of a deformed Foetus, with a cut, communicated by Dr. Leverett Hubbard, F. M. S. Caſe of the fatal effects of the corroſive ſublimate of Mercury. By Dr. Levi Ives, F. M. S. Caſe of the fatal effects of drinking cold water when heated. By Dr. Samuel Neſbitt, F. M. S. Caſe of an Aſthma from an extraordinary cauſe. By Dr. Samuel Neſbitt, F. M. S. Caſe of an Hydrocephalus Internus, By Dr. Ebenezer Beardſley, F. M. S. Caſe of a Schirrous Tumour in the Pylorus. By Dr. Ebenezer Beardſley, F. M. S. Caſe of a ſingular wound in the Eye. By John Spalding, Surgeon, F. M. S. Caſe of a Peripneumony. By Dr. Ebenezer Beardſley. F. M. S. Caſe of an amputation of the leg in conſequence of a divided artery. By John Spalding, Surgeon, F. M. S. A letter from Dr. Benjamin Gale, C. M. S. on the bite of a mad dog, communicated by Dr. Leverett Hubbard. F. M. S. Caſe ſhewing the good effects of the antiphlogiſtic regimen in the eruptive variolous fever. By Dr. Samuel Neſbitt, F. M. S. Hiſtory of a dyſentery, occaſioned by ſtagnant air. By Dr. Ebenezer Beardſley. F. M. S. Caſe of a diviſion of the tendo Achillis. By Dr. Samuel Neſbitt, F. M. S. Caſe of a wound in the Trachea Arteria and Aeſohpagus. By John Spalding, Surgeon, F. M. S. Caſe of an enlarged Gall bladder. By Dr. Ebenezer Beardſley, F. M. S. Caſe of Dyſenteric Symptoms from worms. By Dr. Samuel Neſbitt, F. M. S. Caſe of a ſchirrous in the pylorus of an infant. By Dr. Hezekiah Beardſley, F. M. S. Caſe of Calculi in the Lungs. By Dr. Eneas Munſon, F. M S.
CASES and OBSERVATIONS.
A Singultus (from an adheſion of the Liver to the Diaphragm) proving fatal. By Dr. Samuel Neſbitt. Read to the Society, 3d May, 1784.

ON the 4th of October, 1783, I was called in council with Dr. Eneas Munſon, to viſit Polydore, a Negro ſervent of Capt. Trowbridge of this city, aged 26; his ſymptoms were, a fixed pain under the Cartilago Enſiformis, a ſenſe of fulneſs at the pit of the ſtomach, with dyſpnaea, and very frequent hiccup that was violent, and affected greatly his pulſe, ſo as to produce the true faultering, or interrupted pulſe, he had no cardialgia, nor diſpoſition to vomit, only an eructation, ariſing from the ſpaſms of the diaphragm; he had been attacked twice with the ſame diſeaſe, in the courſe of the laſt twelve months, previous to the preſent. In the former attacks, Abſorbents, Correctors, and Antiſpaſmodics, had been tried to little purpoſe, the diſeaſe ſpent itſelf gradually, and the Singultus wore off, in proportion as the patient grew weak. Perhaps the tenſion and inflammation, gave way to relaxation and reſolution; but I make no doubt, left an adheſion of the Liver to the diaphragm, from the firſt attack; which might gain ground as the diſeaſe recurred, and I think it may be warranted from this circumſtance of the patient's being uneaſy in the intervals of the recited affections, with that ſenſe of fulneſs, at his ſtomach, and diſturbed reſpiration.

From the hiſtory of the diſeaſe, previous to the 4th of October, and the Symptoms now ſubſiſting, Dr. Munſon and myſelf were of opinion, that an inflammatory affection of the diaphragm and liver was deducible, and that the ſtomach and other viſcera were not affected. We adopted the antiphlogiſtic treatment, blood drawn and repeated, was ſizey and coheſive, the ſerum ſtrongly impregnated with bile, correctors and antiſpaſmodies were given to temporize, epiſpaſtics over the part affected were applied, and after a courſe of three weeks attendance (the ſymptoms gradually abating) the diſeaſe gave way, ſo as to leave the patient apparently well, except that ſenſe of fulneſs at his ſtomach.

On the 27th of March laſt, the patient called on me, complained of a head-ache, and of being much preſſed at his ſtomach, his pulſe moderate, and no return of hiccups. I preſcribed a cathartic, and heard no more of him, until the 29th of that month. When I viſited him, he complained of head-ache, an uneaſy breathing, with a ſmall frequent cough, the old ſenſe of fulneſs, but no pain or hiccups. I let blood which was florid, but not ſizey nor uncommonly coheſive. I preſcribed an emetic which operated gently, but excited no ſpaſms nor additional uneaſineſs. The 30th the head ache was encreaſed and ſome degree of fever. I preſcribed a bolus of five gr. merc. dulc. to be worked off with ſalts and manna.

On the 31ſt he ſeemed relieved, head-ache and ſymptoms abated. April 1ſt. found him no worſe, only preſcribed the dulcif. ſp. of Nitre, and diluents. The 2d of April, he complained more of his head, and that the room was dark, his fever gone, and pulſe rather ſmall and interrupted; but as the day was ſtormy, and the room he was then in was a dark room, I did not apprehend a failure of viſion. The 3d his complaints the ſame, and evident that viſion was affected, attended with a degree of ſtupor. I applyed a large epiſpaſtic to the nape of his neck. And on the 4th repeated the purge with the calomel, which not operating kindly an enema was given. On the 5th I found him totally blind, and ſo inſenſible as to afford no ſatiſfactory anſwer to any of my queſtions, his pulſe feeble and oppreſſed, accompanied with a ſubſultus tendinum. I gave him four portions of the factit. cinnabar, a ſcruple in each doſe, once in ſix hours. On the 6th I found his ſight a little reſtored, and more ſenſible, tho' ſtill incoherent in his anſwers and obſervations. I was favoured with Dr. Eneas Munſon in council this evening; we agreed to preſcribe an infuſion of the valerian, and to repeat the next morning, the mercurial purge; it did not operate. On the 7th we met in council, ordered the repetition of enemas, the purge not having operated; On this day the hiccups came on gradually at firſt, and with a conſtant eructation of a frothy mucus from the lungs and ſtomach. An anodyne was given this evening. On the 8th I found him much diſtreſſed with an increaſe of the hiccups, and a continuation of all the other ſymptoms; In the evening I preſcribed two anodynes, one to be given h. ſ. alter in four hours if the hiccups were violent. On the 9th his ſymptoms much the ſame, with the addition of a ſtrangury and retention of urine, through the whole of the night and day; I preſcribed an emollient fotus to the pubis, and a decoction of the cooling ſeeds and roots, propoſing to uſe the catheter in the morning if he was not relieved. On the 10th found he had paſſed urine freely in the night, the ſtrangury in ſome meaſure abated, the hiccups violent and almoſt inceſſant. I preſcribed antiſpaſmodic boluſſes of camphor, opium, and gum aſſaſaetida, to be waſhed down with infus. valerian; the hiccups were inceſſant, and the eructation ſo violent that he ſpouted up every part of drink or medicine, as ſoon as he attempted to ſwallow, altho' he manifeſted no averſion to anything offered him. On the 11th, he was evidently growing worſe, altho' the hiccups were not ſo violent, yet were they as inceſſant, with delirium, ſubſultus tendinum, and a trembling pulſe. On the 12th having paſſed a very reſtleſs night, the eructations and hiccups continuing, but leſs delirium; he complained of a burning heat in his belly, from which a mortification of the viſcera was apprehended. On the 13th in the morning he died, nor did the hiccups entirely leave him, until he breathed his laſt. On opening the body, in preſence of Drs. Hubbard, Munſon, Darling &c. it appeared as follows; the omentum adhered ſtrongly to the pe itoneum and inteſtines, ſo as not to be ſeparated without great difficulty, the fat of the omentum was entirely waſted, ſo as to be a mere parchment, except ſmall veſicles of fat, interſperſed over it, and gangrenous. The inteſtines only appeared to view, occupying the place of the ſtomach and liver, and ſtrongly drawn up to the diaphragm; the inteſtines were interſperſed with mortified ſpots, and adhered to each other by their external coats. The veſica urinaria was high in the pelvis, and diſtended with urine. The ſtomach appeared ſound, but drawn out of its place by the ſpaſms, lying under the arch of the diaphragm, and preſſed down under the advanced inteſtines. The liver adhered ſtrongly to the diaphragm, ſo as not to be ſeparated without tearing, and preſſed out of view under the arch of the retracted diaphragm. The anterior and convex part of the liver adhered to the diaphragm, ſo as to be almoſt inverted, and alſo adhered ſtrongly to the peritoneum below. The veſica fellis was ſmall, ſhrunk, with a ſmall quantity of bile, and adhered ſtrongly to that part of the duodenum to which it lay contiguous, and not to be ſeparated without laceration. On opening the thorax, the heart and its pericardium, was found lying (or rather preſſed by the contraction of the diaphragm) acroſs the thorax, with its apex to the left, and its top or auricles to the right; there was no fluid contained in the pericardium, the heart was about double the uſual ſize, and the vena cava and aorta greatly diſtended. The left lobe of the lungs was not to be ſeen untill the heart was drawn aſide, being preſſed down to the left ſide of the vertebrae, adhering ſtrongly to the pleura; neither lobe appeared otherwiſe diſeaſed. May I not, gentlemen, from the hiſtory of the caſe, and the appearances after death, be authorized to ſay, that a primary inflammation of the liver and diaphragm, was the proximate cauſe of the whole train of ſymptoms, and preternatural appearance of the abdominal & thoracic viſcera, that the Singultus originated from the heat of an inflamed liver, and its adheſion to the diaphragm, that the dyſpnaea and cough, were occaſioned by the great ſpaſmodic contraction of the diaphragm, diſturbing reſpiration; the heart's poſition and ſize, alſo, would naturally produce dyſpnaea, a tickling cough, &c. May we not very readily deduce the head ache, and loſs of viſion, delirium &c. from the poſition and preſſure of the heart, as thereby the entrance of the blood by the vena cava, was greatly obſtructed, and its exit thro' the pulmonic arteries and aorta, by the praeternatural curve of thoſe veſſels greatly interrutped, from whence might ariſe and ſubſiſt, thoſe affections of the brain ſo manifeſt in the laſt acceſſion of the diſeaſe.

The great and preternatural enlargement of the vena cava and aorta, prove the increaſed reſiſtance the blood met with, both on its return to and from the heart. How neceſſary then gentlemen is it, rightly to diſtinguiſh or develope, the true ſource of a ſingultus, as it may ariſe from various cauſes; I mean not that ſingultus, which is an attendant on death, and is irremediable from the nature of the caſe. An acrimony in the ſtomach, irritating the nervous parts, will produce a hiccup, originating from the ſame cauſe as the cardialgia, and removable on the ſame principle, by abſorbents, &c. But a ſingultus attended with pain at the pit of the ſtomach, or accompanied with pleuritic ſymptoms, denote an inflammation of the diaphragm, and may be ſtrictly accounted a pathognomic ſymptom of it. Here it is apparent, that abſorbents and correctors will remove the one, while the lancet and antiphlogiſtic regimen only is capable of effecting the other.

Caſe of a Puerperal Fever, ſucceſsfully treated with the Bark. By Dr. Elnathan Beach. Read October 13, 1785.

A Woman aged twenty-one, of a ſanguine habit, on the 19th of March, 1784, became mother of a living child; her labour was eaſy, natural, and every circumſtance favourable. On the evening of the 23d, I was called—found little or no fever attending; but great pain in the abdomen, accompanied with a violent diarrhaea, which had been of ſome days continuance; the lochial diſcharge irregular, the ſkin dry. I gave an opiate, to abate the ſeverity of the pain, and to correct the diarrhaea accompanied it with Rhubarb. This had the deſired effect, and ſhe reſted well the ſucceeding night. The next morning I found her in a free, gentle perſpiration, and without pain, except what was occaſioned by the operation of the purge. Upon theſe ſymptoms of amendment, I left her, and did not ſee her until the 26th; when I found ſhe had been attacked with rigors, which were ſucceeded by heat, thirſt, and fever, together with excruciating pains in the abdomen,—extending to the uterus, with a reddiſh ſtreak on the ſurface, ſpreading itſelf to the umbilical region, with other ſymptoms of an inflammation of that viſcus. I preſcribed the common antiphlogiſtic remedies, as evacuants, cooling febrifuges and aperients, together with epithems, cataplaſms, and injections; which courſe was perſiſted in until the 30th, when I found the ſtreak before mentioned was extended over the whole abdomen, and changed from a rediſh to a cineritious hue, the pulſe ſmall, the countenance pale and wan;—the part affected almoſt inſenſible to the touch. I directed to the uſe of the bark in decoction, acidulated with elixir vitriol. The next morning, the 31ſt, found the diſorder greatly increaſed, every ſymptom pregnant with danger— the abdomen almoſt covered with livid veſicles, the interſtices of a negro black, with a total inſenſibility of the part, copious diſcharges, ſanious and fetid, from the uterus. The countenance dejected and ghaſtly, the voice indiſtinct, pulſe weak and intermitting. The caſe being thus alarming, Dr. Andrews was conſulted, we agreed to make a thorough trial of the bark, and directed it to be taken in ſubſtance and decoction, accompanied with ſome alexipharmics. She took 1½ ounces a day, beſides the application of a ſtrong tincture externally, together with injections; and in a few days a deſquamation of the cuticle took place, the lividity diſappeared; her ſtrength gradually returned, and by the beginning of May, ſhe acquired her former health.

Two Caſes of difficult deglutition, from extraneous bodies lodged in the Gula. By Dr. Abraham Tomlinſon. Read October, 1784.

MR. Joſeph Smith, of Milford, aged 70 years, eating pieces of hard ſalted fleſh, without ſufficient maſtication, (his teeth being gone) a piece lodged in the gullet. Sundry methods were tried, by a gentleman of the medical profeſſion, to remove it, but they proved ineffectual. Nine hours after the accident I was called, and found him exerciſed with pain, and a tumour in his throat. I firſt preſcribed 2 or 3 ſpoonfulls of warm olive oil, to lubricate the parts; then I ordered him to drink ſome warm water, with a view to excite a nauſea and vomiting; this had the deſired effect, the fleſh being ejected by vomit in about 32 minutes.

CASE II.

JONATHAN NORTHRUP, of Milford, aged about 26 years, eating ſome beef and cabbage, ſwallowed a ſcale of beef bone in the cabbage, of a triangular figure, of more than one inch in length, from the baſe to the point: the point of which as well as the ſides, were thin and ſharp. This bone lodged in the gula, between the upper end of the ſternum and pomum Adami. The ſituation might be diſcerned by feeling with the fingers, on each ſide of the trachea. This caſe was attended with tumour and extreme pain.

In this diſtreſſed ſtate, Mr. Northrup made application to ſundry gentlemen of the faculty, who tried various methods to relieve him, among the reſt a pair of long, ſlender, curved, crane bills, were introduced, with a view to extract the bone; but all to no purpoſe. Twenty-four hours after this accident Mr. Northrup applied to me. I made uſe of the method preſcribed in the caſe of Mr. Smith; but it had no effect.

I then made a ſolution of four grains of tartar emetic, in warm water, which he drank, and in about fifteen minutes he brought up the bone by vomit, and was effectually relieved.

As it is one of the known laws of hydraulics, that fluids when preſſed, preſs undequaque, the application appeared plain to me in the recited caſes; for I conſidered the gula to be a flexible, cylindrical tube, which by means of its muſcular fibres, may be contracted or dilated. I alſo conſidered the great force of the muſcles employed in the action of vomiting; whereby the fluid contents of the ſtomach are forced through the upper orifice, into the aeſophagus, in a full ſtream; there meeting with reſiſtance from the offending body, will expand the gula, and being urged on by the impetus of the fluid, will overcome the reſiſtance and bear away the offending matter in the torrent of water by the mouth.— This, in fact, was the iſſue of the two caſes above.

I am perſuaded that the ſame method may be uſed with ſucceſs, in almoſt every caſe where the patient can be prevailed with, to drink a ſufficient quantity of water, or other liquid.

I could add more ſimilar caſes in confirmation of the practice, but perhaps the foregoing will be ſufficient.

Caſe of a fractured cranium, ſucceſsfully treated. By Dr. John Spalding. Read before the Society October 13th, 1784.

ON Saturday the 21ſt of Auguſt, 1784, I was called to viſit a ſon of Mr. Eraſtus Bradley, of this Town; aged ſeven years; who fell from a tree upon a ſtone wall, and fractured the right os parietalia. I arrived about half an hour after the accident, found a large wound through the external integuments and a conſiderable hemorhage from the wound; upon introducing my finger found the fractured bone depreſſed and compreſſing the dura mater; the child being delirious and much convulſed. Finding no proſpect of relief but from the trepan, I proceeded immediately to the operation: having denuded the cranium ſufficiently to admit the trephine, a hemorrhage enſued, rendering a delay neceſſary until the arteries were ſecured by ligature; then began a perſoration on the ſound part of the os bregmatis, near the os frontis, a little to the right of the ſutura coronalis, then introduced the elevator, with which I raiſed ſome ſmall pieces of the depreſſed bones, and took them out: but could not raiſe the largeſt, ſo as to diſengage it from the under part of the ſound ſkull; finding it neceſſary to make a ſecond perforation, I applied the trephine on the os bregmatis, back of the former, and introduced the elevator, with which I diſengaged the fractured piece, and took it out with my forceps, laying the dura matter bare the extent of the fracture. Then proceeded to dreſs the wound, after which I percieved the child had fainted, by reaſon of the •• diouſneſs of the operation and through the loſs of blood; I ordered a little ſpirits of lavender to be put into his mouth, freſh air to be admitted, and his extremeties rubbed, we ſoon perceived life in him, and he began to breath and ſtir his limbs.

In the evening I found his pulſe a little quickened, ordered him an enema, he appeared to be very reſtleſs but a little more ſenſible. In the morning he came to his reaſon ſo as to ſpeak and take ſuch nouriſhment as was preſcribed.

In the evening of the 22d found his fever had encreaſed, preſcribed a gentle cathartic, and in caſe it did not operate by morning, to aſſiſt it by an enema. He being drowſy all day, could hardly be perſuaded to take any thing.

The 23d found his drowſineſs and fever had increaſed; gave him ſome febrifuges & ordered his dreſſings to be kept wet with ſpirits, in order to facilitate the removal of the dreſſings next day.

Viſited him the 24th in company with Dr. Munſon—found his fever and ſtupor abated; dreſſed the wound: every thing appearing as favourable as could be expected.

Viſited him the 25th in company with Dr. Beardſley; dreſſed his wound, there being very little diſcharge, we preſcribed a gentle cathartic; and after its operation the Bark in decoction.

On the 26th with Dr. Munſon; the wound had come to ſuppuration, as the denuded part of the bones, now changed to a dark hue. We ordered a more copious uſe of the bark, and the wound to be continually wet with ſpirits; he was now perfectly ſenſible.

On the 27th dreſſed the wound, found a laudable diſcharge, and his fever moderate; ordered a cathartic, and the bark to be ſuſpended during its operation.

On the 28th with Dr. Munſon, dreſſed his wound, the dura mater began to ſlough, with a proper diſcharge from the wound; ſome ſmall pieces of bone being looſe.

On the 29th, found he had paſt a very good night; ſat up to have his head dreſſed; the wound diſcharged plentifully, and every ſymptom was in his favour.

On the 30th removed two ſmall pieces of bone, the wound diſcharged freely.

On the 31st dreſſed his wound; no apparent alteration, only a little more active and chearful.

September 1ſt the wound beginning to incarn, ſince which he has daily mended, and is now perfectly recovered.

Caſe of a Gangrene of the Scrotum, Read January, 1785.

MR. S— H—, aged forty years, a temperate man, and of a good conſtitution, by proſeſſion a ſhoe-maker and tanner, was ſeized with an intenſe pain in the glands of the left groin, on September the 19th, 1784, for which a plaiſter was applied, formed of the oily dirt which ſwine leave on fences after rubbing.

September 20th. I was ſent for, and the meſſenger told me that the pain was intolerable; but I was engaged another way, and concluding that the diſorder would ſubſide with an anodyne, I ſent him one.

September 21ſt. I viſited the patient, and found him in a high fever; the ſcrotum and penis greatly tumified, and of a livid colour; I immediately opened a vein,, and took away ſeventeen ounces of blood, which was as buffy as is uſual in a violent pleurify, with very little ſerum; I ordered a fomentation of bitter herbs boiled in water, to which was added rum. After uſing the fomentation, I applied a cataplaſm of white-bread, milk, and white roſe leaves, and I ordered him to take a few doſes of camphorated nitre.

September 22d. I found him ſtill under an high fever, and took twelve ounces more of blood, which was leſs buffy than before; the parts affected now appeared to be in a ſtate of mortification, black, and inſenſible to the touch; I ſcarified the penis and the ſcrotum in ſeveral places, without giving pain to the patient, and then applied ſtrong ſpirits and the cataplaſms as before; gave him a table-ſpoonful of the cortex peruv. and ordered him to take a like doſe every two hours, to be waſhed down with a ſtrong decoction of the ſame, with the addition of red roſe leaves.

September 23d. The tumour and inflammation were much abated; he complained of a pain in two of the fingers of his right hand, on which I obſerved tumours much inflamed, of a ripe cherry colour.

September 24th. The carpus of the ſame hand tumified and inflamed, and of a livid hue: I continued the ſame preſcriptions, with the addition of an emollient clyſter.

September 25th. I found his pulſe low, with great faintneſs and dejection of mind, apprehending that death would ſoon cloſe the ſcene. I ordered him ſome wine, which raiſed his ſpirits and abated his gloomy apprehenſions; and continued the dreſſings as uſual. I opened a tumour on his wriſt, which diſcharged purulent matter.

September 26th. I requeſted the aſſiſtance of my friend Dr. Neſbitt. We found the patient under a high fever, and bled him the third time, though we conſidered the caſe almoſt deſperate; we continued the bark, with the elixir vitriol, which was given with the utmoſt freedom, without any regard to the fever, as we judged it eſſential to the patient's recovery. In three days came on a digeſtion and ſeparation of the mortified parts, which by degrees were removed by the knife; we dreſſed the ulcer with dry lint, ſometimes making uſe of the ſpirits and the common digeſtive, till the whole of the ſcrotum was taken off, leaving the teſticles uncovered with the proſta ae glans; after the ſcrotum was ſloughed off, the ſtate of the juices was ſo acrid as to deſtroy two other coats, the cremaſter and the tunica vaginalis, which digeſted, and alſo ſloughed off, leaving the tunica albuginea in a ſound ſtate: he had violent pain in the teſticles, and there was reaſon to ſuſpect ſuppuration; when preſſed with the finger the parts were very elaſtic, which induced us to think that there was matter contained within: accordingly, we made a ſmall puncture through the tunica albuginea, but the diſcharge was only a bloody ſcrum; we continued the ſame treatment; the teſticles ſuffered the ſame very painful ſenſation for ſeveral days, and we concluded that matter was formed in them, and opened one of them to its centre to aſcertain it, but found only a diſcharge of bloody ſerum; the wounded teſticle was dreſſed with a digeſtive, and healed in a few days, at which time the ſurface of the teſtiticles next the perinaeum began to granulate and heal very faſt, and cauſed an adheſion, or union of the teſticles, from each extremity, which now reſembled a twin peach or apple; the ſpermatic chords ſuffered a great contraction, and the teſcles adhered cloſely to the perinaeum, and cicatrized favourably.

The preputium was entirely taken off the penis, the muſcles were diſeaſed, and partly deſtroyed, the urethra was left without a covering, but the bulb or glans was not affected; a covering however, gradually formed over the body of the penis, but leſs ſmooth than before. Soon after the diſcharge from the mortified parts abated, he complained of a pain in the left ſide of the abdomen, which extended up as far as the ſhort ribs, it was here tumified and inflamed; whereupon we ordered that part to be fomented four or five times a day with warm ſpirits, and the inflammation and ſwelling ſoon diſappeared: two or three days afterwards a pain came on in the right ſide, extending as it had done on the left; we applied the ſpirits as before, but without effect; we then ordered the application of a cataplaſm, which ſoon brought on a ſuppuration; we perforated the ulcer, and it diſcharged a large quantity of pus, which continued more or leſs for ten days; the patient remaining feeble and greatly emaciated with fever; we ordered a decoction of barley with figs, ſago, ſalop, and panada, (gruel had been his uſual diet, with a little wine) and he continued recovering for the ſpace of ten days, when he was ſuddenly ſeized with a pain in his bowels, ſucceeded by a fetid diarhoea: in twenty-four hours he was greatly reduced, frequently diſcharging two or three ounces of purulent matter, attended, with a bloody mucus; we gave him lenient purges, ſuch as ſenna, manna, and a ſolution of gum arabic, in barley-water; clyſters prepared with a decoction of the bark and red roſe leaves were frequently adminiſtered; theſe in a few days gave relief, and the matter of the internal ulcer being diſcharged through the return, the patient recruited every day, and on December the 5th, 1784, was able to attend his former buſineſs.

In forty-nine days he took fifty-eight ounces of that ſovereign medicine, the bark, which ſeemed to contribute in a great meaſure to his perfect recovery.

Caſe of a locked jaw ſucceſsfully treated by electricity. By Dr. Eneas Munſon. Read to the Society, April 6th, 1785.

JANE HARRISON, a ſervant maid, aged fourteen years, of a ſtrong and good bodily habit, on the 17th of February laſt, voluntarily threw herſelf out of a garret window, feet foremoſt, which gave her ſuch a violent ſhock as to deprive her of her ſenſes. She was immediately taken up, and many attempts made to bleed her, but it was with great difficulty that about twelve ounces of blood was obtained. She remained in a ſtate of inſenſibility during the day and the night following; but on Friday morning a little recovered, ſo as to ſpeak and talk with an air of chearfulneſs until evening; when there appeared a rigidity of her limbs, together with a deprivation of ſenſe for ſome time, and then a return of ſenſation, with ſome appearance of reaſon. On the evening of the 18th, I viſited her for the firſt time, and preſcribed for her a nervine antiſpaſmodic decoction for the night. On Saturday morning found her no better, but ſenſeleſs, with her jaws locked, which I was told had been the caſe during the night; so that ſhe was unable to receive any food or medicine; and by reaſon of the projection of the upper jaw, the upper teeth, which were very even and cloſely ſet, ſhut over the under teeth, quite down to the gums of the lower jaw, ſo that nothing could be introduced into her mouth but what was drained through a double row of thick ſet teeth. The muſcles in her neck, eſpecially the poſterior, were very ſtraight, with a rigidity of the whole ſpine; the countenance was very florid, the pulſe quick, but rather ſmall ſhe was ordered the liniment. ſaponac. with opium and ol. ſuccin. to embrocate the ſpine and part contracted; a camphorated antiſpaſmodic fomentation was ordered to be applied to the ſtomach, and enemas with fetid gums injected, and after the foregoing preſcriptions, at night ſhe was put into the warm bath, which produced a relaxation of a •• her ſpaſms. On Sunday morning ſhe appeared rational and chearful, and ſat up, but not without great complaint of pain acroſs her reins, extending under the ſternum, with univerſal ſoreneſs. She continued the foregoing preſcriptions, with the addition of valerian and faetida by the mouth. As ſhe was now able to ſwallow, ſhe remained calm during the day and better part of the night, but towards morning was ſeized with the contraction of the jaw again, together with violent ſtruggles and convulſions: in this ſituation ſhe continued during the day: at night with what laudanum was forced into the ſtomach, and injected with an enema, ſhe ſlept ſome time; but on Tueſday morning no relaxation of ſpaſm, but ſtupid and ſenſeleſs, with a great degree of opiſthotonos, and as I had, in ſeveral inſtances heretofore, proved unſucceſsful in the uſe of the grand ſpecific, viz. opium, I had determined, in my own mind, if ever I ſhould have a caſe of the kind under my direction, to depend upon opium no longer than I found it ſoporific; and if a quantity ſufficient to bring on and produce a manifeſt ſoporoſis did not remove the ſpaſm, I would ſeek a remedy from ſome other means. I therefore now endeavoured, at more lucid intervals, to get down ſome ſmall doſes of calomel, and tried the warm bath again, which, ſo far from yielding the relief as before we experienced, that it produced immediate convulſions, ſo violent as to render the continuation impracticable, ſhe was accordingly put to bed, and was, during Tueſday night, attended with all the ſymptoms of opiſthotonos, lock'd jaw, and emproſthotonos alternately; but as the ſpaſms of opiſthotonos & emproſthotonos counteract each other, they were productive of a tetanus, with a conſiderable elevation of the ſternum, attended with great pain and anxiety, with a total inability of ſwallowing. She remained in this ſituation, with convulſions, during Wedneſday night, when an epiſpaſtic was applied to the nape of her neck, and the calomel continued in ſmall doſes though the quantity got into the ſtomach was altogether uncertain; ſhe continued much in the ſame ſtate on Thurſday. She growing weaker and more diſtreſſed, and her caſe more deſperate, until Friday noon, I determined to try what effects electricity would produce. Accordingly a moderate ſized receiver was filled, which was diſcharged on her leg, and paſſed through the body to the head. This immediately produced a tremulous motion in her lips, before ſtiff and contracted, and a grating of the teeth, a ſymptom never before obſerved in the courſe of her complaints, on which I thought her going into a convulſion fit; but to my ſurprize her jaws were opened, and her tongue extended far out of her mouth, and ſhe rubbing it with her fingers. I aſked her if ſhe could ſpeak—ſhe gave me to underſtand ſhe could not. I then diſcharg'd a ſecond receiver in the ſame direction with the firſt, and her tongue was immediately at liberty, ſo that ſhe was able to ſpeak plainly: But obſerving her thumbs contracted, as they had been for twenty four hours, into the palms of her hands, there was a third ſhock paſſed through her arms, which looſed them inſtantly. On Friday night ſhe reſted quietly, and got up on Saturday morning; but on her return to bed ſhe was ſeized with fits, very ſimilar to hyſteric fits, but the locking of the jaws did not return; the common nervine, antihyſteric medicines were uſed, but to little purpoſe, till Monday, when recourſe was again had to electricity, which was found effectual for theſe fits, and was apply'd repeatedly on their return, until Wedneſday fortnight from the time of her fall, when the fits left her, and ſhe is now in a comfortable ſtate of health.

Thus I have given an exact and plain narrative of facts only, in the caſe; and though, as doctor Sylveſter obſerves, one inſtance is ſcarce of conſequence enough to deſerve attention, yet as it is a diſorder ſo rare to this climate, but ſo often fatal when it happens, it will not, I truſt, be thought uſeleſs to communicate a method, though but once ſucceſsful. How far the early uſe of mercury may be depended on in this diſeaſe, I am not able, from my own experience, to ſay, though it has been recommended as a ſpecific in the diſorder. Yet in the caſe above recited, there appeared no amendment until the uſe of electricity, which moſt inſtantaneouſly relaxed the ſpaſms, to the aſtoniſhment of every byſtander. Indeed there was no room to doubt of its being the immediate and ſole cauſe of relief to the poor girl. Should this communication be an inducement to farther experiments of the kind in like diſorders, and prove it ſucceſsful, it will yield the moſt ample recompence and the higheſt ſatisfaction for this communication.

Caſe of an Haematemeſis ſucceſsfully treated. By Dr. Samuel Neſbitt. Read April 6th, 1785.

ON the 13th of November, 1773. about 9'clock A. M. I was called, to viſit Capt. Noble Hinman, aged 40, of a very plethoric habit, who was ſeized ſuddenly with a violent and copious diſcharge of blood from the ſtomach. The ſymptoms preceding, were, a ſenſe of fulneſs in the ſtomach, or rather an encreaſing diſtention thereof, which was ſoon followed with a nauſea, and a diſcharge of blood from the ſtomach by vomit, to the quantity of above two quarts, as the byſtanders judged. In this ſtage of the complaint, I received the call, and found the patient languid, and ſenſibly affected with the loſs of blood; his vomiting had ceaſed before I arrived. Notwithſtanding, I immediately bled him to the quantity of ſixteen ounces, gave him an opiate pill, preſcrib'd an aſtringent infuſion, and the decoctum corticis, with elixir vitriol. I directed all his drinks to be ſtrongly acidulated, to be given cold, and in ſmall quantities.

I remained with my patient two hours, and in conſequence of a return of the ſickneſs, and vomiting of blood (to the quantity of about two pounds by eſtimation) I again let blood, to the amount of twelve ounces.—I viſited my patient at one P. M. found him more ſenſibly affected by the loſs of blood, and although no return of the vomiting, yet there had been a diſcharge of blood by ſtool, procured by an enema previouſly adminiſtered. His countenance from being remarkably florid, was now become very pale, yet the evident continuance of the hoemorrhage and a tenſion of the pulſe, exceeding the then apparent ſtandard of ſafety, emboldened me to let blood again, to the amount of fourteen ounces; his medicines were continued, and the anodyne pill directed to be repeated occaſionally, if the vomiting returned: I then informed my patient and his friends, that I could promiſe no relief in the preſent caſe, unleſs I could reduce my patient to that ſtate of weakneſs, by the lancet, which might to them appear alarming, and preſerve, or rather ſuſpend him in that ſtate, until the ruptured blood veſſels collapſed, and the aſtringent medicines might have time to effect the conſtriction of the bleeding orifice. My patient and his friends acquieſced; of courſe no cordial of the vinous or ſtimulating kind, was, in this ſtage of the diſeaſe, adminiſtered; except what cordial was received by the decoctum corticis. At five, P. M. viſited my patient; he complained, while I was preſent, of a return of the ſenſe of fulneſs, which was ſoon ſucceeded by a very copious vomiting of blood. I held a large waſh-hand baſon, capable of containing three pints, to receive the contents of the ſtomach, which veſſel he fill'd, and, continuing to vomit, it ran over, at leaſt a pint, on the floor. I then judged, that at leaſt one half the quantity diſcharged was blood. It was obſervable, in this and the two preceding turns of vomiting, that the nauſea, and conſequent vomiting was excited by the previous accumulation of blood in his ſtomach. I immediately gave an anodyne pill, continued in ſmall quantities the decoct. corticis, and aſtringent infuſion, with the cold drinks ſparingly adminiſtered, and let blood again, to the amount of 12 oz. for the fourth time between nine in the morning and ſeven in the evening of the ſame day. Notwithſtanding all theſe evacuations, by haemorrhage and the lancet, no ſyncope enſued, only a deſirable languor. I again viſited my patient at late bed time, found no return of the vomiting, nor ſymptoms that indicated a freſh haemorrhage; the ſame regimen was directed through the night, with his drink ſtrongly acidulated, and with this caution, to be given in ſmall quantities, and frequently.

On the 14th, early in the morning, I viſited him; found his pulſe a little fuller, and exceeding the ſtandard of ſafety I had propoſed. I again let blood, to the amount of fourteen ounces, which evacuation he endured without ſyncope; the former regimen and medicine was perſiſted in, except the pills. At 10 A. M. I repeated my viſit, my patient had a diſcharge by ſtool, principally coagulated blood; as he had no returns of vomiting as yet, and had retained the decoct. corticis, &c. I ſtill found his pulſe not ſo languid as I wiſhed, I therefore let blood to the amount of twelve ounces: and complaining of ſome griping uneaſineſs in his bowels, I directed an emollient enema, and an opiate pill by the mouth, with a continuation of the former medicines, &c. I viſited him in the evening, no return of the vomiting, but found by the operation of the enema, directed in the forenoon, that a quantity of coagulated blood was diſcharged. I again let blood to the amount of twelve ounces, and gave an anodyne pill, he bore this laſt bleeding as formerly, without fainting, and continued the other medicines with the ſame precaution as before.

On the 15th I viſited him, found no return of the hoemorrhage by any evident ſymptom, therefore continued the decoct. corticis, &c. without the anodyne.

On the 16th, viſited him, beginning to recruit a little, having had no return of the haemorrhage, I thought it adviſeable to ſuſpend the aſtringent medicines, and interpoſe a lenient purge of manna only, which operated gently, and produced a diſcharge of ſome coagulated blood, which, apparently from its colour, was not produced by a recent haemorrhage.

On the 18th, finding no return of the haemorrhage, and judging that the ruptured veſſel, or veſſels, were ſufficiently coaleſced, I indulged my patient in a little more nutritious regimen, and ordered a continuance of the decoct. cort. as a reſtorative. The treatment, by God's bleſſing, had the deſired effect, and the patient, within three weeks from the firſt attack, was able to return to his ordinary buſineſs, and enjoyed his uſual ſtate of health.

I muſt acknowledge, gentlemen, that in the caſe now recited, although the plan adopted appeared to me rational, yet it was not put in execution without much concern, leaſt my patient ſhould miſcarry, and of courſe my bold practice be ſeverely cenſured; however, this with many other inſtances I have met with, to prove the power of the lancet in ſimilar caſes, has ſtrongly impreſſed on me the importance of blood letting. The indiſcriminate uſe of aſtringents in haemorrhages, and the good effects of blood letting, afford ſufficient matter for animadverſion, but at preſent I will take up no more of your time: another opportunity, perhaps, may produce ſome obſervations on theſe ſubjects from me, or ſome abler pen. At preſent my deſign is anſwered by a bare recital of a matter of fact.

It is worthy of remark, that the patient loſt, in about thirty-ſix hours, ninety-two ounces of blood by the lancet; and I am confident, by the moſt moderate calculation, double that quantity by haemorrhage. The blood drawn by lancet I weighed accurately.

Caſe of an Enteritis. By Dr. Ebenezer Beardſley. Read before the Society, April 5, 1786.

THAT article in our conſtitution, which obliges every member of the ſociety, to exhibit a hiſtory of all the remarkable caſes which occur in his practice, muſt, if duly obſerved, conduce in the higheſt degree to promote the deſign and end of our inſtitution. If we are faithful, accurate and perſevering in our obſervations, we ſhall ſoon be furniſhed with a number of facts and hiſtories, which at ſome future period may be very intereſting and beneficial to the public, and do honor to the ſociety. It is much to be regretted that hitherto, the faculty, in this country, have contributed ſo little to the general ſtock of medical knowledge. Our predeceſſors would have rendered an important piece of ſervice to us, and to future generations, if they had made and tranſmitted down, faithful hiſtories of the diſeaſes which prevailed in their times.

The dyſentery, ulcerous ſore throat, and moſt of the other diſeaſes which have been epidemical in this country, have been attended with pretty long intervals, during which the diſeaſes have not appeared at all, or in but a few inſtances: conſequently, on a general return of any of them, moſt of the practitioners who had been converſant with them being dead, and having left no obſervations on record for the aſſiſtance and inſtruction of ſucceeding practitioners, thoſe diſeaſes have been almoſt as new and ſtrange, and the proper mode of treating them as uncertain as though they had never occurred before. It cannot be doubted, under ſuch circumſtances, that many valuable lives have been loſt, before the nature of the diſeaſe has been underſtood, and a proper mode of treatment aſcertained. From whence it is probable the common and well known obſervation aroſe, that a new diſeaſe is more fatal on its firſt acceſſion, than in its advanced progreſs and later ſtages. For a number of years part, we have been ſo happy as not to be viſited with any epidemic diſeaſe: but I well remember, when the ulcerous ſore throat made its appearance about fifteen years ago, that there was not among my acquaintance, but one or two phyſicians, who had ever ſeen it before; which was alſo the caſe with reſpect to the dyſentery. We ought to eſteem it a peculiar happineſs, that we have now an opportunity, and have already made a hopeful beginning in the eſtabliſhment of a new aera in the healing art. With proper attention, ſhould our country have the misfortune to be viſited again with any kind of epidemic diſeaſe, it will be in our power to mark its origin, progreſs, effects, and termination, and to hand down to ſucceeding generations, a faithful hiſtory of the mode of treatment, ſucceſs, and every other circumſtance of importance.

With a view to contribute by example, as well as precept, to this important deſign, I now lay before you a caſe, which, from the violence of its acceſſion, rapid progre ſudden and fatal termination, appeared to deſerve attention.

JOHN CHAPPEL, a healthy, ſprightly boy, five years of age, on his return from ſchool, at noon, on Friday the 24th of June, 1785, was ſeized with ſickneſs at his ſtomach, and vomiting, which was ſoon after ſucceeded with thirſt, heat, and reſtleſſneſs. Theſe ſymptoms continued through the afternoon and night, during which time he ejected every thing he took into his ſtomach, and in the courſe of the night and next morning, brought up ten large worms of the round kind. On Saturday morning I firſt viſited him, at which time his pulſe was extremely quick, ſmall, and unequal; his countenance pale and ſunk, his reſpiration quick and laborious, and he was ſo reſtleſs that it was with difficulty that his attendants kept him on the bed; his thirſt was great, but he almoſt inſtantly threw up whatever was given to him. Nothing had paſſed his bowels ſince he was firſt taken ill, but his abdomen was not at all tumefied but rather contracted. He had his ſenſes perfectly, but did not complain of pain in his bowels, or elſewhere. I preſcribed magneſ. alb. the neutral mixtures, and other antiemetics, with emollient fomentations, enemas, and ſmall doſes of calomel through the day, but without any good effect. At evening the ſymptoms were much increaſed, at which time, Dr. Neſbitt, at my deſire, was called in to conſult his caſe. We both judged it to be a worm caſe, joined with inflammation from their irritation. The fomentations, enemas, calomel, &c. were continued, and epiſpaſtics were applied to his extremities. In the night his vomiting abated, ſo that he retained the medicines and drinks which were adminiſtered to him untill his ſtomach ſeemed to be overloaded, when they wer ejected to appearance from that cauſe. On Sunday morning we viſited him again, but though the vomiting was not ſo frequent, his dejected countenance, difficulty of reſpiration, weak, quick, unequal pulſe, and cold extremities, indicated his approaching diſſolution. He died at eleven o'clock this morning. No evacuation was obtained from the bowels, during the courſe of the diſeaſe, by the many injections which were uſed, aided by the calomel, &c. On the afternoon of the ſame day, I obtained permiſſion from the parents, to open the body, in company with Dr. Neſbitt and my brother. We found but one worm in the whole inteſtinal canal. The abdominal viſcera were all ſound and well conditioned, except about two inches of the lower part of the duodenum, or upper part of the jejunum, which was inflamed and ſphacelated, which appeared clearly to be the cauſe of his death. From the diſſection it appears, that the diſeaſe was originally a true enteritis, or inflammation of the bowels, and it is highly probable that the worms were not at all concerned in the production of it; but being diſturbed by the increaſed heat and diſagreeableneſs of their ſituation, quitted it in ſearch of a better. It alſo appears from this hiſtory and diſſection, that we ought not implicitly to truſt thoſe authors and others, who are too apt to conſider all diſeaſes of the inteſtines in children, as ariſing from worms. Such a pre-conceived opinion will be likely to blind us, with reſpect to the real cauſe, if it ſhould be of a different nature, and miſlead us perhaps fatally in our preſcriptions. Allen, in his Synopſis, adviſes the practitioner in treating the diſeaſes of children, if he meets with any ſymptoms he cannot readily account for, to place it to the account of worms. But this advice was certainly unbecoming a philoſopher and phyſician. It is much more ſafe and honourable to imitate the example of the great Boerhaave, who aſſures us that he made it an invariable rule, never to quit the bed-ſide of his patient, until he had fully aſcertained the ſtate and condition of all the important viſcera. All the common ſymptoms of worms in the inteſtines, ſuch as loſs of appetite, acidity, pains in the abdomen, alternate bound and looſe body, ſlimy and fetid ſtools, grinding the teeth, erratic fever, &c. may ariſe from an increaſed quantity of mucus in the inteſtines, obſtructions in the meſenteric glands, and dentition. Symptoms of a ſimilar kind, are alſo obſerved in other diſeaſes remote from this organ, particularly in the hydrocephalus internus. How abſurd then, and dangerous muſt it be, to treat diſeaſes in the ſame method, that are ſo diſſimilar in their cauſes and ſeat, merely becauſe there happens to be a ſimilarity in ſome of the ſymptoms! Notwithſtanding the great ſimilarity in the ſymptoms of ſome diſeaſes, there cannot be a doubt but what every diſeaſe has its own pathognomonic or diſtinguiſhing ſigns, by which it may be diſcriminated, by the attentive and ſkillful phyſician.

Amongſt the other ſymptoms which are common to worms, and the hydrocephalus, the ſlow pulſe, and dilated pupil of the eyes, are ſtriking marks by which the latter diſeaſe may be readily known.

Dr. Home of Edinburgh, in his clinical experiments affirms, that he diſcovered ſixteen years before he publiſhed thoſe experiments, a certain diagnoſtic ſymptom of worms, which in all that time had never failed him; which is, an oedematous ſwelling of the alae narium, upper lip, and often of the contiguous parts of the cheeks; the apertures of the noſtrils are alſo diminiſhed at leaſt the half of their natural ſize. Since I read his obſervations, I have ſeen a few worm patients, which I apprehended were ſwelled in the manner he deſcribes, but I could not ſatisfy myſelf fully; the ſubject deſerves farther attention. I ſhall conclude theſe remarks, with this practical caution, that in all caſes that are attended with heat, thirſt and a fever, though we may have ocular proof that the patient is troubled with worms, we ought to be circumſpect in the adminiſtration of hot, 〈…〉 , ſtimulating ſubſtances, however much they may be celebrated for their anthelmintic virtues.

Caſe of a deformed Foetus. By Dr. Leverett Hubbard. Read before the Society, April 5th, 1786.

IN the year 1786, I was called to a gentlewoman in the ſixth month of geſtation. I found her attended with a ſtrong pain in her breaſt, and left ſide of the abdomen: flooding largely. I examined the ſtate of the os uteri, found it not dilated in the leaſt, but tumefied and very hard; no preſſure from her pains. I immediately let blood, which abated the flooding, but not the pain. I preſcribed her an anodyne, which gave no relief: in two hours I gave her another doſe, which moderated the pain a little. I tarried all night, and in the morning I found the whole of the abdomen ſwelled to a prodigious ſize, with high fever and inflammation. I ordered a fomentation of bitter herbs, which abated the tumour and inflammation in ſome meaſure; after which came on a nauſea, and vomiting of a green bilious fluid, in quantity about three quarts. I gave her large doſes of the fel. vip. which abated the vomiting; ſoon after came on an univerſal languor and faintneſs; ſhe remained in that ſtate the greater part of the day. After the faintneſs abated, ſhe complained of a coldneſs of the abdomen, which on examination I found to be extreme: this alarmed me, the pulſe at the ſame time being very low. I gave her a little wine whey repeatedly, which accelerated the motion of the blood, raiſed the pulſe, and cauſed an increaſe of heat through the whole body, except the abdomen. Her pain left her; I repeated the fomentation with the addition of a little ſpirits, and the wine whey to be given now and then, and left her. In about twelve hours I was called again, her pain returning; I examined the ſtate of the os uteri, I found it a little dilated. Soon after a violent flooding came on: I judged that her preſent circumſtances required a ſpeedy delivery. By repeated trials I gently dilated the os uteri, ſo as to introduce two of my fingers, with which I could feel the foetus. Its poſition was preternatural; the abdomen firſt preſented, as I judged, but was miſtaken. By further examination, I found it could not be the abdomen, neither could it be the head, for it was not hard enough; my firſt intention was to change its poſition, ſo as to obtain the head, but could not by reaſon of a contraction attending every pain: after a little time obtained one of the feet, and ſoon after the other, which gave me great encouragement of a ſpeedy delivery; I brought forward the feet and legs, but to my great ſurpriſe the body ſtopt. Then with my left hand extended the thighs of the foetus as far aſunder as I could, and ſlipt the two fore fingers of my right hand, in order to obtain the extremity of the inteſtinum rectum. But to my aſtoniſhment, I found there was no inteſtinum rectum, but the ſame feeling below the thighs as there was in the firſt touch, as I mentioned before, which proved to be the pendulous body whic preſented to the birth, as delineated in the plate.

Finding I could do nothing that way, I then returned the legs into their former poſition, and by repeated trials, turned the child ſo as to feel one of the hands, after that the ſhoulder, and then the head which I cauſed to preſent, and ſoon after that obtained a delivery in the natural way.

I ſhould not have troubled you with this caſe, if the formation of the foetus had not been very ſingular. The beſt deſcription I can give you is this; as I obſerved before, it was in the ſixth month of geſtation, the foetus as large as uſual. The child, from the ſutura coronalis down to the loweſt or laſt true ribs was natural, except that the cranium was uncovered; upon the left, from the ſutura coronalis, down to the ſutura ſquamoſa and ſutura tranſverſalis, except a pericranium. I ſhall next proceed to the thighs; the end of the os femoris was rather flat than round, no os innominatum but a ligament formed, faſtened to the vertebrae immediately below the laſt true ribs, the ligament being about an inch long, gave liberty for the thighs and legs to move exactly as a ſwingle is moved by the motion of its ſtaff. A little below the joining of the thighs to the vertebrae, there was a neck formed a little larger than that on the ſhoulders, to which was formed a head as large as that of the natural, conſiſting of cerebrum and cerebellum, not contained in a cranium but a cartilaginous caſe, with a dura mater; which was ſeparate from the cartilaginous caſe, and covered with a ſkin, or ſcalp, as uſual, but no hair. Upon the right ſide of this falſe head (if I may ſo call it) appeared three ſmall perforations or inlets, placed in a triangular form, and were about an inch and an half from each other; two of which were about as large as a rye ſtraw, the other of an oval, about one fourth of an inch long, which was lower than the other. I introduced a probe into the ſmall perforations firſt, and found they did not extend more than half an inch; the other which I founded extended two or three inches in an aſcending direction, which with my knife, I laid open, and found it to be a ſmall tube or canal, a little reſembling the oeſophagus by its wicker like ſtructure; it extended no farther an entire tube, but was divided into a number of fine tubes or fibres, which were loſt in that which I called the cerebellum, or medullary ſubſtance. The left leg was flat, having two tibias and two fibulas articulated about half way from the patella to the ancle.

I ſhould have proceeded further in my diſſection and enquiry, but was ſuddenly called off.

What great reaſon have we to praiſe the great former of our bodies, that our children are not oftener deformed than they are.

On the fatal Effects of the Corroſive Sublimate of Mercury. Communicated by Doctor Levi Ives. Read February 7th, 1787.

ON Friday, Dec. 29th, 1785, Mr. I. S. nineteen years of age, through an unhappy miſtake of his own, ſwallowed four grains of the corroſive ſublimate of mercury, diſſolved in a ſmall quantity of water, which very ſoon excited a violent vomiting and purging, with intenſe pains and griping. It was about thirty hours after he took the fatal doſe, when I firſt viſited him. I found him attended with a conſtant nauſea, and purging of a ſanguineous mucus, with a quick, low pulſe, great thirſt, a moſt intolerable cardialgia, and griping. I directed a cooling purge, and to dilute plentifully with an infuſion of violets, together with an infuſion of gum arabic, which was taken freely, but without any mitigation of his complaints. Sunday morning found him as above deſcribed, and no alteration for the better. On Monday finding him ſinking under his complaints, directed to the uſe of ol. ric. with barley water and nitre, which gave ſome relief to his griping. Tueſday, January 1ſt, his purging and gripings much abated, yet attended with a very quick, low pulſe, cardialgia, and great thirſt. The preſcriptions of Monday were continued, and as his pains became erratic and more univerſal, I directed an anodyne for the night, tho' with little advantage. Wedneſday his diſtreſs became ſtill more univerſal, the ſame medicines were continued, with an anodyne at evening, which procured ſome reſt. Thurſday the 3d, found him diſtreſſed with the forementioned ſymptoms, and nature evidently ſinking. Friday the 4th, came on a ſmall haemorrhage from the noſe, with a ſingultus and a great acerbation of all the ſymptoms. Saturday and Sunday following no material alteration, except a manifeſt decay of ſtrength. On Monday came on a profuſe haemorrhage from the noſe, which continued until death cloſed the ſcene, which was on the eleventh day from receiving the fatal doſe.

The fatal effects of drinking cold water, when heated. Communicated by Doctor Samuel Neſbitt. Read April 4th, 1787.

ON the 11th of Auguſt, 1774, I was called to viſit Joſeph Kent, a labouring man, aged 45, of a robuſt habit. The account he gave of himſelf was, that a few days before, when warm with work, he had drank about a quart of cold water, after a hearty dinner of fiſh, the immediate effects of which were great diſtreſs at the pit of his ſtomach, a trembling and difficulty of breathing, with faintneſs; the trembling and faintneſs went off ſoon, but the difficulty of breathing and pain, increaſed, extending over the whole hypocondriac region, ſo as to give him the idea of cholic, which idea he retained through the whole diſeaſe, notwithſtanding every perſuaſion on my part, and the plaineſt indications to the contrary, as every enema and aperient in the courſe of of the diſeaſe operated readily. A phyſician was called immediately who had preſcribed a lenient purge and ſedatives; but without relief. I do not recollect whether venaeſection was premiſed; but I think it moſt probably was before my viſit, which was on the 4th or 5th day of the attack. I found him with every ſymptom of an extended and high inflammation, great diſtreſs and difficulty of reſpiration, accompanied with a ſevere ſingultus, and extreme pain in the region of the liver. I immediately let blood from the arm copiouſly, which was repeated often and occaſionally, without any permanent relief. For ſeveral days the moſt rigid antiphlogiſtic courſe was purſued, epiſpaſtics were applied & renewed to the coſtae, ſternum, and parts adjacent, gentle cathartics & enemas were adminiſtered, with the deſired effect as evacuants. Fotuſes of emollient herbs were repeatedly uſed, with now and then a gentle anodyne as a placebo. But the whole that was obtained from a bold antiphlogiſtic courſe, was a prevention of gangrene in the inflamed viſcera, and of courſe a leſs ſpeedy termination of the diſeaſe. The iſſue was a ſuppuration of the inflamed parts, probably about the 15th day of the diſeaſe. When ſymptoms of the hectic kind came on, and a formation of pus, the pains grew more tolerable, and an apparent diſtenſion began in the right hypochondrium, which in the ſequel, about two days before his death, became prominent a little below and to the right of the cartilago enſiformis, with a fluctuation about the time of his death, evident to the touch. Death was ſo evidently near at hand, that I expected no relief to the patient nor credit to myſelf would ariſe from a puncture of the abſceſs, and therefore deferred it until diſſection. On the ceſſation of the inflammatory ſymptoms, and the commencement of the hectic, the antiphlogiſtic courſe was exchanged for a regimen of the nutritious and reſtorative kind, with a light preparation of the bark. The patient finding no proſpect of relief from any remedies I had applied, and ſtill retaining the idea of cholic, as before recited, diſpatched a meſſenger for a famous cholic doctor reſiding in a neighbouring town, without my knowledge. I was informed, however, before the doctor's arrival, and deſired the nurſe to let me know that I might attend and ſtate the caſe to him previous to his attempting any thing for the patient. The doctor arrived about ten, in the night of the 4th of September, and immeditely pronounced the diſeaſe to be the cholic. I in vain endeavoured to remove every idea of the kind from his mind; contrary to my remonſtrances, he was put under a courſe of ſtrong aloetic purges, combin'd with aromatics, commonly called Hull's bitter powders. The operation was violent, and he died on the 6th, about thirty days from the firſt attack.

The appearance of the body, on diſſection, was as follows. On puncturing the abſceſs extending from the liver, a ſtream of pus iſſued to a diſtance from the body; when the viſcera were expoſed to view, the liver was found to have been greatly diſtended with pus, from whence the aforementioned tumour was formed, by a diſtenſion of the peritoneum and intervening teguments; it was a maſs of corruption, and its ſubſtance diſcharged by that and ſeveral ſmaller abſceſſes: the lower ſurface of the diaphragm was overſpread with numbers of ſmall tumours, of the ſize of nutmegs and hazel nuts containing pus; the mediaſtinum and the pericardium in a ſimilar ſtate, but the tumours ſmaller. In the place of lymph, in the cavity of the pericardium, there was found a purulent matter to a conſiderable number of ounces: The heart's ſurface was covered or encruſted like the diſtinct ſmall-pox in a ſtate of complete maturation, or a day or two paſt that period: the external ſurface of each lobe of the lungs was affected by previous inflammation, and matter was contained in the right cavity of the thorax, which communicated by an opening through the diaphragm with an abſceſs in the liver.

An extraordinary cauſe of an Aſthma, in the caſe of a Lady of this city, proving fatal. By Dr. Samuel Neſbitt. Read before the Society, April 4th, 1787.

IN the morning of the 24th of June, 1774, I was called to viſit Mrs. R—, aged thirty-eight years, in conſultation with Dr. Bontecou. We found the patient ſitting up, leaning her elbows on a pillow, ſupported by a ſtand, and in that poſture labouring for breath, with an emaciated countenance, feeble pulſe, and every ſymptom of great debility, unable to lay in a ſupine poſture, having thus paſſed her days and nights for ſome time, except now and then on a bed bolſered up: the patient was then pregnant, and about the ſixth or ſeventh month of geſtation. The diſeaſe had been gradually increaſing for about two years, with this addition, that in the period of geſtation the ſymptoms were much aggravated by her increaſe of bulk; it appeared to us impoſſible ſhe could endure thro' the remaining period of geſtation, if the ſymptoms increaſed with the bulk, even if her ſtrength would have admitted; but as the caſe then was, the ſituation of our patient was truly deplorable; however, we had not much time to deliberate on the caſe, for on the evening of the ſame day, premature labour came on; Dr. Hubbard was joined in the council, and delivered her in a few hours: we then hoped for an abatement of the ſymptoms, but none were obtained; every effort was made for her relief and recovery, but ſhe died on the evening of the 30th.

We viewed the caſe as an empyema, and requeſted liberty of the relatives to open the body, but with great reluctance on their part, obtained leave to puncture the thorax. I punctured the right cavity of the thorax, but no fluid iſſued, I did not proceed to puncture the left, leſt I ſhould fail in finding a fluid contained, which was the apology made to the relatives; but loth to ſtop our enquiries, I enlarged the puncture a little with a ſcalpel, ſo as to introduce my finger, and found it obſtructed in its courſe by a hard body; we enlarged the opening in the courſe of the rib and diſtinctly felt a hard fleſhy ſubſtance, in form and ſhape like a pine apple, crouding up along the right cavity of the thorax, and preſſing ſtrongly the right lobe of the lungs upwards, and againſt the mediaſtinum. The tumour was a ſchirrhous enlargement of the liver, in form and about the ſize of a moderate pine-apple, with its apex projecting into the cavity of the thorax, and carrying by diſtenſion that portion of the diaphragm oppoſed to its ſuperior point, and reaching at leaſt to midway of the cavity: we were anxious to puſh our enquiries further, and to have examined more minutely into the ſtate of the affected viſcus and other of the viſcera, but the relatives would not admit of any further defacing of the corps, as they called it.

From theſe circumſtances, Gentlemen, thus diſcovered as it were by accident, the inveſtigation of the cauſe of our deceaſed patient's complaint and its gradual acceſſion, was apparent; the aggravated ſymptoms from geſtation by the increaſe of the uterus, and its conſequent preſſure on the ſuperior and affected viſcus, were likewiſe eaſy to be accounted for, and that no ſubſtantial relief was derived from delivery, we were at no loſs to determine, all being deducible from the grand and proximate cauſe, the unnatural diſtenſion and elevation of the diaphragm; the interruption of the ſame muſcular partition, ſo neceſſary in both acts of reſpiration; and the occupying by the tumour the greater part of that cavity prepared for the free action of the right lobe of the lungs.

From the hiſtory of this ſingular and unfortunate caſe, there appears no aera at which we could promiſe any ſucceſsful mode of treatment; at the time I ſaw the patient, the caſe was irremediable, and I am led to conclude that at no period of the diſeaſe when the complaint of the aſthma became apparent, was their much, if any chance for relief, as undoubtedly the ſchirrhous had obtained ſome conſiderable ſize before the difficulty of breathing was much noticed, and its cauſe being concealed, deſtroys the firſt principles of practice viz.

Inveſtigatio cauſae, ſaepe morbum ſolvit. CELSUS.
Caſe of a Hydrocephalus Internus. By Dr. Ebenezer 17, Beardſley. Read before the Society, October, 1787.

FRIDAY, January 13, 1787, Polly Edwards, daughter of Pierpont Edwards, Eſq. of this city, aged five years and three months, was ſeized with thirſt, and reſtleſſneſs; the next day ſhe was ſomething feveriſh, and dull, but play'd abroad. At night her complaints returned, and ſhe was feveriſh and reſtleſs through the night. Sunday, Monday and Tueſday, ſhe complained of a ſoreneſs in her head, which was ſo great as to be much affected from a ſlight touch; ſhe was alſo attended with a conſtant head-ach, and for the moſt part was dull and ſleepy, but had turns of anxiety and reſtleſſneſs: her thirſt continued, and her countenance was very florid. On Wedneſday, her diſorder was ſo increaſed that ſhe became confined to her bed. Thurſday night ſhe was very reſtleſs, her ſleep was much diſturbed and ſhe frequently cried out that ſome body pulled her hair. Her weakneſs increaſed ſo that ſhe became unable to bear her own weight, her eyes appeared bright, ſhining, and inflamed; ſhe picked her noſe, and often put her hands up to her face and head. She had no appetite for food from the beginning; ſhe voided three worms in conſequence of a purge of mercurius dulcis. Friday and Saturday, her anxiety and reſtleſſneſs increaſed, and ſhe frequently threw her hands round the back ſide of her head. Sunday her pulſe, which, from the beginning, had been quick, full and ſtrong, became remarkably weak and ſmall; and ſhe totally loſt her ſpeech, which returned no more.

This evening I ſaw her for the firſt time, in company with the Doctors Prime and Munſon, the former of whom, had attended her from the firſt acceſſion of the diſorder. Her face was very florid, and a little bloated, her eyes inflamed, weeping, and the pupils dilated, the pulſe was very ſmall and weak, ſo as hardly to be perceived, but not remarkably quick, her extremities were cold, but her head, eſpecially the hinder parts of it, were very hot; ſhe had little or no thirſt; ſhe had frequent turns of the greateſt anxiety and diſtreſs imaginable, during which, ſhe writhed her body, threw off the bed clothes, grated her teeth, ſtarted up on end in the bed, and clenched her hands round the backſide of her head. In the intervals between theſe paroxiſms, ſhe lay quite eaſy and compoſed, looked about, and took notice of the people and things around her. Her reaſon did not appear to be at all impaired; ſhe appeared to know every perſon of her acquaintance who came into the room, put out her tongue readily when deſired, for the inſpection of her phyſicians, &c. which continued till near the cloſing ſcene. In her intervals of eaſe, ſhe lay upon her back, with her feet drawn up. In her paroxiſms of diſtreſs, her eyes were convulſed. Through the whole of this week her anguiſh and diſtreſs continued to increaſe, her extremities became as cold as a corpſe, her pulſe was quick, weak, and ſo ſmall as ſcarcely to be perceptible; yet her head remained hot, and her cheeks highly coloured to the laſt. On Sunday morning ſhe expired without a ſtruggle or a groan. Purges of merc. dulc. with ſenna, rheubarb, and the Carolina pink root, had been the principal medicines. Theſe were ſucceeded by fomentations, ſemicupium, bliſters, wine and other cordials.

Dr. P. who attended the patient from the firſt acceſſion of the diſorder, had conſidered it as a worm caſe, and notwithſtanding the diſſent of the other phyſicians who were conſulted, he maintained his opinion with confidence to the laſt. To remove all doubts upon the ſubject, and to inveſtigate the nature of the diſeaſe, the body was inſpected in the afternoon of the ſame day. The inteſtines, which had been ſuppoſed to be the ſeat of the diſeaſe, were entirely ſound, without a ſingle worm or any other morbid appearance; which was alſo the caſe with the other viſcera of the abdomen, and the thorax. Finding no morbid appearance in the thorax or abdomen, we proceeded to inſpect the brain. After the external integuments were removed, the cranium was ſawed off a little above the ears, and carefully removed without injuring the dura mater, when with a ſcalpel, the upper part of the brain, with the ſurrounding integuments down to the firſt ventricle, were removed. The firſt and ſecond ventricles, being laid open, exhibited no morbid appearance, but upon cutting into the third and fourth, five or ſix ounces of clear tranſparent lymph flowed out, and ran into a veſſel which was placed to receive it. The diſſection was performed in the preſence of a number of the faculty and others, who were fully ſatisfied that this was the ſeat of the diſeaſe, and that the patient's death was occaſioned by a compreſſion of the brain, eſpecially the cerebelluum, from whence the remarkable failure and weakneſs of the vis vitae, loſs of ſpeech &c. which took place many days before death, though the animal functions remained found to the laſt: the reaſon of which is obvious from anatomy and phyſiology.

Caſe of a Schirrous tumour in the Pylorus, Meſentery, and Inteſtines, communicated by Dr. Ebenezer Beardſley, Oct. 17th, 1787.

MRS. Sarah Tuttle, aged 64, had for ſeveral years been afflicted with indigeſtion, nauſea, acidity, and heart-burn, with diarrhaea, and coſtiveneſs alternately. Lime water, ſoap, gum pills, bitters, and abſorbents, which her phyſicians had occaſionally preſcribed for her, afforded her a temporary relief, but the complaints often recurred, and increaſed, ſo as to render the laſt ſix or eight years of her life very uncomfortable. About the beginning of laſt July ſhe was taken down with a fever of the low depreſſed kind, attended with headach, vertigo, ſleepleſſneſs, frequent ſlight rigors, and the uſual complaints in her firſt paſſages. Auguſt the 10th, my advice was aſked. She was much emaciated, had a low feeble pulſe, conſtant nauſea, cardialgia, and ſickneſs at her ſtomach, with frequent ejections of an acid, ſlimy fluid, the thruſh, and a troubleſome and waſting diarrhaea.

She was wholly deſtitute of appetite, and had little or no quiet ſleep. I preſcribed watery infuſions of rheubarb, flowers of camomile, ſnake-root, and other ſtomachics, with the bark, and anodynes, which gave her great relief for ſeveral weeks. But the nauſea and ſickneſs at ſtomach returning, and finding no relief from ſtomachics, antacids, or any other medicines, at her requeſt, on the ſecond of September, I gave her about one ſcruple of ipecacuanha, which operated mildly five or ſix times. But the next day the ſickneſs, &c. returned, and ſhe was, in all reſpects, worſe than before. After this I directed her to the uſe of porter, which abated the nauſea and ſickneſs, but produced an intolerable burning and uneaſineſs in the ſtomach, upon which it was laid aſide. She continued ſlowly declining, without any remarkable alteration in her ſymptoms, till Saturday the 12th inſtant, when ſhe died, at about ten in the morning. The diſſection was performed by Dr. Spalding, in the preſence of Dr. Darling, my brother, and myſelf, the next morning. The thoracic viſcera, liver, ſpleen, omentum, and large inteſtines were in a ſound ſtate. The ſtomach was conſiderably diſtended, and filled with a fluid which reſembled chyle. At its lower orifice, there was an oblong ſchirrous tumour, of the ſize of a pullet's egg, and about two inches and an half in length, extending downwards into the duodenum. The ſchirrhus inveſted the pylorus on all ſides, and was nearly three quarters of an inch thick. The orifice was contracted to the ſize of a gooſe-quill, and upon cutt ng into the tumour, there was found a quantity of pus-like matter, of an aſh colour, and of the conſiſtence of thick cream. The ſubſtance of the tumour conſiſted of a number of round, hollow bodies, of a hard compact texture, which bore a ſtrong reſemblance to the round belly worm, but they adhered cloſely, at each end, to the ſurrounding parts. The meſentery, and a conſiderable proportion of the ſmall inteſtines were alſo in a ſchirrhous ſtate. The uterus, veſica urinaria, &c. were not diſeaſed, nor was there any ſphacelation in any part. It would be a curious and intereſting enquiry, if we were able to give a hiſtory of the origin, and progreſs of this diſeaſe. It is highly probable that it had been of many years ſtanding. The only practical deduction which I ſhall make from this caſe is, that, where a patient has been troubled for many years with ſimilar complaints in the primae viae, we ought to ſuſpect the exiſtence of a ſchirrhous or cancerous tumour, and to be on our guard againſt exhibiting to ſuch unhappy perſons ſtrong emetics, or any other acrid, ſtimulating medicines, all of which muſt increaſe the malady, and precipitate the ſufferer to the grave.

Caſe of a ſingular Wound in the Eye, from the burſting of a Gun. By Dr. John Spalding. Read before the Society, April 2d, 1788

MR. Ezra Curtis, aged twenty years, on the 18th of September, 1785, received a wound by the burſting of a muſket, the breech-pin of which, entering his right eye, drove the eye, with the whole of its bony orbit before it, until it was impeded in its progreſs by the vertebrae of the neck, and os maxilla inferior, or lower jaw. The ſpine of the pin paſſing through the coracohyoidaeus and part of the maſtoides muſcles, to the adipoſe membrane, without perforating the ſkin. The body of it was firmly wedged between the proceſſes of the vertebrae of the neck and the upper and outer angle of the lower jaw. The deſtruction of ſuch a number of large blood veſſels producing a violent haemorrhage from the wound, noſtrils and mouth, which was ſucceeded ed by a great degree of inflammation, and tumefaction of the face and neck, no ſuſpicion was entertained by the ſurgeons who attended him, or any other perſon, that the pin had entered the eye, till ſix months after, when a ſuppuration took place, and the tumour being opened, the pin was diſcovered, to the great ſurprize and aſtoniſhment of the ſurgeons and ſpectators. After the inflamation and tumour ſubſided, the end of the pin projected itſelf about three eighths of an inch beyond the ſkin, where it remained immoveably fixed, without admitting any change in its poſition from the ſtrongeſt efforts that could be made, until May 31ſt, when it was happily extracted.

Upon his firſt application to me, which was the firſt of May, I dilated the wound as much as the nature of the parts would admit; and then with a pair of ſtrong forceps, attempted to turn the pin ſo as to diſengage it; but after my utmoſt exertions I was obliged to relinquiſh the attempt, the caſe being of ſo ſingular a kind, and from the proximity of ſuch a large number of blood veſſels, attended with the utmoſt danger. On the 5th, I procured a conſultation of the faculty belonging to the city, in which it was agreed to denude a part of the jaw bone, and with a ſmall trephine cut out a piece oppoſite to the pin, in the ſhape of a creſcent; this operation I performed on the 8th, in preſence of the gentlemen of the faculty afore mentioned, and took out a ſmall portion of the jaw, about half the breadth of the ſcrew, by which it was looſened a little, ſo as to admit of more motion than before, but all our efforts to extract it proving ineffectual, and fearing that the jaw would be rendered wholly uſeleſs if the painful operation of cutting it any further ſhould be repeated; I determined, as the dernier reſort, to attempt to ſaw off the ſpine of the ſcrew as near to the body of it as poſſible, hoping by that means to give it more liberty to turn within the narrow circumference to which it was confined. On the 15th, having fixed a ſmall hand viſe to the end of the ſpine which projected out, and fixed that vice into a larger one which was faſtened to a bench; I then began the difficult, painful and laborious operation, which I continued till his ſtrength and patience were exhauſted. On the 16th, I reaſſumed the operation, and repeated from time to time as his ſtrengh would admit, until the 29th, when the ſeparation was compleated, and the ſpine of the ſcrew was extracted without difficulty, the body of it ſtill remaining b hind. In attempting to extract it I unfortunately broke my forceps; but having provided myſelf with a ſtronger pair, on the 31ſt I happily extracted it, to the inexpreſſible joy of the patient; who had exhibited an uncommon degree of fortitude and reſolution through the whole of his ſevere ſufferings and diſtreſs. The jaw, which had been immoveably fixed from the beginning, ſo that it was with great difficulty he got down a ſufficient quantity of food for his ſupport, gradually recovered its former motion, the wound healed well, and except the loſs of the eye, he is now perfectly recovered.

Caſe of a fatal Peripneumony. Communicated by Doctor Ebenezer Beardſley. Read January 2, 1788.

JULIA MEIGS, daughter to Mr. Joſiah Meigs, of this city, a lovely and beautiful child, aged ſeven months, was taken about eight days ago, with a cold, attended with a cough and feveriſhneſs, eſpecially at night. But the ſymptoms were ſo ſlight, that her parents were not alarmed about her until Tueſday morning, the 23d of October, 1787, when, by the advice of a phyſician, ſhe took a doſe of emetic tartar. On the evening of the ſame day I viſited her, at which time her pulſe was quick, hard and ſtrong; her reſpiration quick, laborious, and accompanied with a rattling noiſe: her ſkin was dry and ſhe was very thirſty. Her countenance was pale and full, with a kind of ſhining, leucophlegmatic appearance, which extended over the whole body. The emetic which ſhe took in the morning operated ſeveral times, both upward and downward, but without affording any relief. I preſcribed ſmall doſes of emetic tartar, as a febrifuge, with pediluvium, and diluting drinks. Wedneſday morning there was no abatement of the ſymptoms, the pulſe continued quick and hard, the reſpiration laborious, attended with a noiſe not unlike the boiling of a pot, her thirſt was great, and her ſkin, notwithſtanding the pediluvium, &c. remained dry.

It now appeared that the diſeaſe was a true peripneumony, and from its rapid progreſs there was reaſon to apprehend a ſpeedy and fatal termination,

I attempted to bleed her in ſeveral places in her arms and feet, but the veins were ſo imperceptible, that all my attempts were unſucceſsful. I then had recourſe to deep ſcarification and cupping, which I repeated in ſeveral places.; but with all my endeavours I could not extract more than two or three ounces of blood, which was very thick, without ſcarce any appearance of ſerum. Nitre, can phor, &c. with diluting drinks, were freely exhibited, bliſters were applied to the ſternum & ſides, and emollient cataplaſms to the lower extremities. The ſteam of a warm decoction of emollient herbs was received into the lungs, and emollient nitrated enemas were frequently injected. But all theſe remedies proved ineffectual:— ſhe made an eaſy exit on Friday morning.

As there had been ſome difference in the fentiments of the phyſicians who ſaw her during her illneſs, ſome of them having ſuſpected that the diſorder was the croup, or that ſuffocating diſeaſe vulgarly called the rattle , the body was opened in the afternoon of the ſame day.

The diſſection was performed by Dr. Neſbitt, in the preſence of ſeveral gentlemen of the faculty. Both lobes of the lungs were deeply and extenſively inflamed, and in ſeveral places entirely ſphacelated. No other morbid appearance was found in any of the viſcera, only the liver appeared to be of an unuſual ſize and hardneſs, but there were no ſigns of inflammation upon it.

The hiſtory and diſſection of this ſubject afford ſome very important practical hints, with reſpect to the diſeaſes of infants and children. Diſeaſes of the lungs are more frequent, violent and fatal in infancy than in adult age. A large proportion of children who die under two years of age are carried off by diſeaſes in this organ; and, to the beſt of my recollection, many of thoſe which have fallen under my obſervation, have been attended with the ſame ſymptoms which occurred in the preſent caſe. But I muſt candidly own, that I have not been wont to conſider and treat ſuch caſes as ſtrictly inflammatory, and of courſe have neglected venaeſection, or uſed it very ſparingly, and the proper antiphlogiſtic regimen and medicines, for emetics, pectoral detergents, &c. Other practitioners, as far as I am acquainted, have purſued the ſame courſe. But for the future, whenever I find an infant attended with a dry cough, difficulty of reſpiration, a hard, quick pulſe, thirſt, &c. I am reſolved to be more upon my guard againſt an inflammatory affection of the lungs; and, where it is poſſible, to bleed ſuch ſubjects as readily as I would adult perſons attended with the ſame ſymptoms.

I beg leave to propoſe it as a queſtion to you, my learned brethren, whether, in ſuch a caſe as the foregoing, where no vein can be found from whence a proper quantity of blood can be obtained, it would not be warrantable to open an artery? and whether a puncture in the temporal artery, which is perhaps the moſt eligible, would not be admiſſible?

Caſe of an amputation of the leg, in conſequence of a divided artery. By John Spalding, Surgeon. Read to the Society, 2d January, 1778.

MR. James Robinſon, Jun. of Durham, aged tenty-two years, on the 27th of March, 1787, cut his leg with a ſtraight edged axe, which divided the poſtica arteria, near the junction of the fibula to the tibia tranſverſely, about one and three-fourths of an inch from where it goes off from the tibialis anticus, from which proceeded a violent hoemorrhage, which was reſtrained for the preſent by a common bandage; it remained ſecure to all appearance, until April 4th, when it began to digeſt and the hoemorrhage returned with as great force as before, and was again ſuppreſſed by compreſs and bandage. On the 5th the hoemorhage returned a ſecond time, when the Doctors Cole and Gaylord, were called in, who made a ligature round the divided artery, by which the bleeding was reſtrained until the 6th; in the morning the hoemorrhage returning, I was called to the aſſiſtance of thoſe gentlemen; we agreed to make a ligature on the upper part of the divided artery, which reſtrained the bleeding until the 11th; but the ligature not inveſting the wounded artery, but the muſcles only, immediately below it, which we diſcovered to be the caſe after amputation, the upper end of the artery having receded from the wound ſo far as to be out of the reach of the needle, and the upper branch of the poſtica dilated, ſo as to form a ſort of aneuriſm; we then, not knowing the impoſſibility of ſecuring the artery, agreed to fix on Pettit's tournequet, and clear the wound of the grumous blood, and cut away the muſcles on each ſide the wound, ſo as to admit the needle to paſs ſo deep, if poſſible, as to encircle the artery; which operation proved unſucceſsful as the former. We ordered the tourniquet to remain, that in caſe of its bleeding it might be reſtrained, but to be ſo looſe as not to obſtruct the circulation in the leaſt, unleſs upon a return of the hoemorrhage. He remained free from hoemorrhage until the 14th, when they were again alarmed by the blood flowing from the wound; they ſent a meſſenger after me and the gentlemen before-mentioned; we met in the evening, and from the loſs of blood, which he had ſuſtained at different times, and the improbability of ſaying the limb by any further efforts, made known our ſentiments to him and his friends, deſiring them to call in ſuch further counſel as they ſhould think proper, which they accordingly did. We met on the 15th, and after maturely examining his caſe, gave it as our opinion, that amputation was the only means of ſaving his life; obſerving, at the ſame time, that his recovery was doubtful, from his extreme weakneſs: however, as there appeared no alternative, we proceeded, and amputated the limb in the modern method, by the double inciſion, &c. The wound digeſted Well, had very little of the ſymptomatic fever, owing, perhaps, to the previous loſs of blood. He recovered ſooner than uſual, has a fine coat of fleſh, which covers the ſtump, and he now enjoys a good ſtate of health.

Caſe of the Bite of a Mad Dag. Communicated to the Society by Dr. Benjamin Gale. C.M.S.

THE ſaliva of a mad dog, when mixed with the refluent blood, is known to be a ſlow, but deleterious poiſon, and unleſs relieved by art, brings on a train of grievous ſymptoms, which terminate in death.

The inhabitants of theſe northern States, have not been expoſed to the bite of mad dogs, until within the compaſs of a few years, and for that reaſon I conclude phyſicians have not paid proper attention to ſearch after a rational and radical cure.

If you judge the following hiſtory worthy to be communicated to the public, you have my liberty to do it, in that way, and by thoſe methods, you may think will render it moſt uſeful to thoſe who may have the misfortune to be bit by a mad dog. The truth of the facts may be relied upon, and is well known in this vicinity.

A mad dog, on the 4th of October, 1786, came from the north part of this town, about ſixteen miles from the ſea. In his courſe down he paſſed through the eaſt part of the town of Guilford, and again entered and paſſed through this town on the poſt-road, as far as the weſt pariſh of Saybrook, where he was purſued, overtaken, and killed. He attacked and bit a child in Eaſt-Guilford, in the vertebrae of the neck, the wound much lacerated. In this town he bit a girl about eight or ten years of age, through her cloaths in her hip, one tooh perforated the ſkin and drew blood. In his whole courſe, in the whole of cattle, hogs, dogs, including the children, he wounded the ſame day, to the number of fifteen or ſixteen; all the dogs bitten, were killed ſoon after being bit, except one, which was permitted to run at large until it manifeſtly ſhewed ſymptoms of madneſs, and then was killed: all the other animals bitten run mad and died, except one ſow, which ſuckled a number of pigs, ſix or eight weeks old; ſhe was bit in the tip of one ear, which was perforated by one tooh only—The ſow nor her litter of pigs were in any perceptible manner affected; which, I conceive, was owing to the poiſon paſſing into the blood, being immediately drawn off by the lacteals, and diſſeminated among the whole litter of her pigs, before it had contaminated the maſs of blood, it might not affect either ſow or pigs; as it is well known the moſtdeleterious poiſon may be taken in ſo ſmall a doſe, as not to injure the animal machine.

I had certain advice the ſame day the child was bit at Eaſt-Guilford, by one who both ſaw the dog and the child, ſoon after it was bit; and again ſaw the dog as he was paſſing through this town, and informed me it was mad, which was the occaſion of its being purſued and killed.— Never expecting to have ſuch a caſe, I had ſpent but little thoughts on the ſubject; but had taken ſo much notice of of practical writers on the ſubject, in the courſe of my reading, as to think their preſcriptions trifling and inſignificant. Being anxious for the ſafety of the children bitten, recollecting I had an abridgement of all the medical caſes that had been read before the royal ſociety, and finding one among others, which I looked upon rational, and which had been ſucceſsful ſo late as the year 1731, which was put in practice by Mr. Floyer, in conſequence of the recommendation of Dr. James, who never had made trial of the medicine himſelf, which was turpeth. min. ſeveral times repeated. The trial was made firſt on dogs that were mad; giving for the firſt doſe twelve, the ſecond twenty-four, the third forty-eight grains, and the method ſucceeded: it was afterwards tried on three of the human kind, and was ſucceſsful in all three.— Concluding the child bitten would fall under the care of Dr. Todd, a young gentleman who had ſtudied under my care, I immediately wrote him my advice, as follows, founded on that intimation given in the philoſophical tranſactions, No. 441, page 241. (which ſee) I adviſed him to dreſs the wound with equal parts of ſ. nit. and ſ. marin, finely pulverized, to ſcarrify the wound as much as the part would admit, if neceſſary, and to fill the wound with it, and likewiſe to incorporate with it the digeſtive.

Common ſalt I had experienced of great efficacy in wounds from the bite of dogs not mad, and the addition of ſ. nit. I took as a hint from the worthy preſident of your ſociety, and then immediately to give an emet. of turpeth miner. proportioned to the age of the child, ſo as to puke it three or four times. And to repeat it for four or five times, at the diſtance of four, five or ſix days, taking in the intermediate days a portion of calomel in theriac. audrom. ſufficient to purge it two or three times the next day. The calomel to be taken at night going to bed, and a draught of canker weed, boiled in milk and water, every night. By canker weed, I mean an herb brought into our aſſembly by a member ſome years paſt, famous for its uſefulneſs in the malignant ſpecies of the apthae, accompanied with a putrid fever, in order to ſpread its utility thro' the government. Mr. B. Batram, the famous botaniſt, of Philadelphia, once ſhewed me the ſame plant, and told me it was ſovereign in the bite of the rattleſnake, and termed it prenanthes, a name however I never could find in any botanic writer. By this method, carefully attended, the child got well, and remains ſo to the preſent time.

The girl bitten the ſame day in this town, I viſited the next day from principles of philanthropy, concluding they had ſent for a phyſician who at preſent reſides among us. I aſked the mother of the child whether her daughter had been bitten by the mad dog the preceding day? who told me with a ſmiling countenance ſhe had, and ſeemed wholly unconcerned. I then aſked her whether ſhe had conſulted a phyſician? ſhe told me ſhe had not. I then endeavoured to convince her of the great danger her child was in; but it made no impreſſion on her. I aſked leave to ſee the wound, which was on her hip. I carefully examined the wound, and found one tooth had perforated the ſkin and drew blood. A little below where the tooth had perforated the ſkin there appeared a ſtreak, which looked like blood ſettled under the ſkin from being bruiſed, but rather of a darker hue. As the woman was ſo unconcern'd, I did not think proper to urge a ſcarification, but adviſed her to make a poultice of wheat bread and milk, and incorporate as much of the ſ. marin. as could well be mixed after it was reduced to the conſiſtence of a poultice, and to wear it ſteadily. The contuſed part appeared to be about one third of an inch in length, and the width of the narroweſt tape. I told her if ſhe would permit me to give her child medicines, I would do it gratis, which ſhe at laſt conſented to. I put her upon the ſame courſe of medicine I had adviſed in the caſe of the other child. The poultice ſeparated a large ſlough from the wound, but not deeper than the cutis, about an inch long and half an inch wide, and afterwards ſoon healed. I ſhould have thught the tooth paſſing thro all the cloaths the child had on, it might have wiped off all the ſaliva, in which I conceive the poiſon is contained, had it not caſt off ſo large a ſlough. The child continuing the courſe of medicine preſcribed, had no ſymptoms of the rabies.

Caſe ſhewing the good effects of the antiphlogiſtic regimen in the eruptive variolous fever. By Dr. Samuel Neſbitt. Read to the Society at their annual meeting, January 2, 1788.

JOSIAH TUTTLE, of Eaſt-Haven, aged twenty-one years, of a large frame and rigid fibres, was ſeized on his paſſage from New-York, on Saturday, the 9th of June, with the eruptive variolous fever; the ſymptoms ran very high, but at that time, he ſuppoſed he had only caught cold by ſleeping on the deck, and did not ſuſpect he had received the infection. On his arrival that evening, or the next morning, Dr. Hotchkiſs was conſulted, who bled him, and preſcribed febrifuges. On the 10th, about ten at night, I ſaw the patient for the firſt time, found him very reſtleſs, with great delirium, a ſtrong throbbing pulſe, ſkin hot and dry, his countenance very florid, his eyes inflamed, and a great determination to the head, with a conſtant nauſea and eructation of bilious phlegm. I immediately let blood to the amount of twenty ounces, then gave him a ſtrong ſolution of emetic tartar. During its operation he ejected great quantities of bile: after the operation of the emetic, I gave him a cooling purge, which had its deſired effect, thoroughly cleanſing the inteſtinal canal, the vomit having failed in that part of the operation. I remained with the patient until about four o'clock in the morning, and had an opportunity of remarking that he obtained relief from all and every part of the treatment; the delirium almoſt gone, the reſtleſſneſs, &c. ſo that he could lie compoſed, which, before theſe evacuations, required the family to detain him in bed. I enquired on my firſt ſeeing him, whether he had not been expoſed to the ſmall-pox, as at that time no ſatisfactory information could be received from him; I ſtrongly ſuſpected the ſmall pox, and was determined in this inſtance, to try the effects of the antiphlogiſtic regimen: he was allowed only a ſheet to cover him when in bed, the doors and windows of the room open conſtantly, and in the day enjoined to be led out; his drinks were beverage impregnated with nitre, &c.

On the afternoon of the 11th, I viſited him, the eruption was then evident, he was much better, but ſtill too much fever for his ſafety, and had now and then intervals of wildneſs and delirium: I let blood again, to the amount of about ſixteen ounces, gave him frequent doſes of the nitre, his drinks and regimen continued.

On the 13th, I was called to viſit him, chiefly to determine whether the eruption was the ſmall-pox; their doubts aroſe from his being ſo well, and ſo free from any complaint, and the eruption ſo diſtinct and favourable, that the family and others ſaid it was impoſſible to be the ſmall-pox, and therefore pronounced it was the chicken pox. On inſpection I was convinced otherwiſe; I continued to affirm it was the ſmall-pox, that he was paſt all danger, and felt very happy to ſee the good effect of a bold antiphlogiſtic courſe. Dr. Hubbard agreed to inoculate the family who had been expoſed, I therefore, as a matter of convenience, and a ſaving to the family, reſigned my patient to the care of the Doctor, perfectly ſatisfied with the iſſue of my experiment: the Doctor carried him through with eaſe and ſafety, he making no complaint, except from a few puſtules on the ſoles of his feet.

This caſe, Gentlemen, and many other obſervations I have had opportunity to make in the diſeaſe, leads me to draw this conclusion, that the good or bad management of the eruptive fever, in moſt habits, ſtamps the extent and future progreſs of the diſeaſe, perhaps I may venture to ſay, the very nature of the pock; and that in this ſtage chiefly, if not principally, is the ſkill of a phyſician manifeſted and called for.

Hiſtory of a Dyſentery, in the 22d regiment of the late Continental Army, occaſioned by the Barracks' being over crowded, and not properly ventilated. Communicated by Doctor Ebenezer Beardſley. Read Jan. 2, 1788.

ABOUT the firſt of April, 1776, the American army under the command of his Excellency Gen. Waſhington, marched from Boſton to New-York, at which place they arrived about the middle of the month. The ſick and invalids having been left behind in the hoſpitals, the whole army was in perfect health.

The troops were quartered in barracks, and in the houſes of the citizens, till about the 10th of May, when they went into tents, except the 22d regiment, under the command of Col. Samuel Wyllys, who for want of tents, continued in their quarters in Smith Street.

The regiment were very healthy till about the middle of the month, when more than one hundred men were taken down with the dyſentery in the ſpace of one week. Such a ſudden invaſion of this formidable diſeaſe alarmed me very much, and I was greatly ſurpriſed, upon enquiry to find, that there was not a ſingle dyſenteric patient in the whole army, except thoſe which belonged to our regiment. From this circumſtance I concluded, that the diſeaſe was occaſioned by ſome cauſe peculiar to the city; but after a particular enquiry, I could not find that there was a ſingle inhabitant ſick with this diſeaſe in the city: thoſe who lived in the ſame ſtreet with us, and many of them in the ſame houſes, were free from that or any other acute diſeaſe. For ſeveral days I was much perplexed and entirely at a loſs to determine what had given riſe to the diſeaſe. At length I obſerved, that not only the inhabitants who lived with us were free from the diſtemper, but ſeveral whole companies of the ſame regiment had nothing of it. This led me to conſider more minutely the circumſtances and ſituation of the ſick, the whole of which were quartered either in low, underground rooms, or in chambers or garrets, which were ſo ſituated at not to admit a free circulation of air. The rooms were alſo conſiderably leſs than uſual in proportion to the number of men. Having made theſe diſcoveries and obſervations, I concluded at once that the diſeaſe originated from the confined and putrid atmoſphere, which theſe unfortunate men lived in. I immediately communicated my obſervations to the Colonel, and requeſted that the men, both ſick and well, might be removed out of thoſe rooms into ſuch as were more airy and capacious. This meaſure was attended with the moſt ſalutary conſequences: Thoſe who ſick recovered in a ſhort time, except two, who died; and no more being ſeized with the diſtemper, in a few weeks the regiment became quite healthy. This ſtriking inſtance of the pernicious effects of putrid, ſtagnant air, was of great ſervice to me in the courſe of the campaign. In the months of July, Auguſt and September, the dyſentery, bilious and other fevers of the putrid kind, became very rife in the army. I took great pains to procure for our men who were down with thoſe diſorders, large rooms; and to have them well ventilated, and cleanſed once or twice a week. Yet under theſe circumſtances I frequently found, caeteris paribus, that the ſick who lay in and near the corners of the rooms, were handled much more ſeverely than thoſe who lay in and near the middle of them. I do not remember to have met with this obſervation before, but I think it is of no ſmall importance in the treatment of dyſenteries, and other putrid fevers.

From the foregoing hiſtory the following practical deductions may be made. Firſt, that caeteris paribus, people who live in airy, capacious houſes, are leſs liable to be ſeized with dyſenteries and other putrid fevers, than thoſe who live in ſmaller houſes and breathe a more confined air. Secondly, that patients labouring under theſe diſeaſes inſtead of being confined in ſmall, tight rooms, (the common and fatal practice of the country in general) ought either not to be confined to the houſe at all, or to be placed in the moſt ſpacious and airy rooms. Thirdly, that it is highly probable that ſmothering feather beds, warm, cloſe rooms, and over careful nurſing, are among the principal cauſes of the fatality which too often attends this claſs of diſeaſes. Fourthly, that perſons in the latter ſtages of a pulmonary conſumption, when they uſually ſpit large quantities of purulent matter, and their perſpiration and other excreta are of a putrid diſpoſition, ought to be treated in this reſpect, as tho' they were ſick with a dyſentery or other putrid fever; which will not only conduce to their preſervation and comfort, but is the only means of ſafety to their attendants and friends.

Caſe of a diviſion of the Tendo Achillis. By Dr. Samuel Neſbitt. Read to the Society, January 2d, 1788.

WILLIAM HOTCHKISS, aged ten years, ſon of Captain Stephen Hotchkiſs, of this city, on the 3d of October, 1783, was wounded a little above the heel of his left leg, by the ſtroke of a drawing knife. I happened to be preſent at the time of the accident, and on examining the wound, found a compleat diviſion of the tendon of the gaſtrocnemei muſcle, commonly called the tendon of Achilles, about three quarters of an inch above its inſertion into the os calcis; having no convenient dreſſing on the ſpot, I dreſſed it ſuperficially, ſo as to preſerve it from the action of the air; the accident happening abroad, he was carefully conveyed home, with his leg and foot placed in the moſt favourable poſture to prevent the receding of the tendon.

In conſequence of a call, I viſited the patient, and in the preſence of Dr. Eneas Munſon, examined the wound. A compleat diviſion of the tendon was clearly aſcertained, and that part of the tendon adjoining the muſcle was found receded about an inch and a half from the lower part, and hid under the common integuments of the parts. We concluded to bring the divided ends of the tendon into contact, by ſuture; and in order thereto, found it neceſſary to make a longitudinal inciſion, about two inches, thro' the integuments previous to a ſuture of the tendon, thereby expoſing the receded point of the tendon about half an inch; I then paſſed an armed needle through each extremity of the tendon, about half an inch from the divided extreme, previouſly placing the limb in a ſtate of flexion, with the heel ſtrongly bent back, and, by means of ſtraps, &c. continually through the cure, retained in that poſition. The wound was then dreſſed up with ſmall pledgets of dry lint, and a pledget of the linim. arcoei. over the whole. Reſt was enjoined the patient, a ſtrict antiphlogiſtic regimen preſcribed, and an anodyne for the night. On the 4th we viſited our patient: found him much eaſier than we expected: ordered an emollient cataplaſm over the dreſſings: an enema to be adminiſtered, and an anodyne for the night.

On the 5th we viſited our patient: the tenſion and inflammation moderate: he had reſted well: therefore found no occaſion to alter the above method; but directed as before.

On the 6th we removed the dreſſings, the wound beginning to digeſt, and the divided part remaining in compleat contact, gave a favorable aſpect to the caſe: dreſſed with warm pledgets of liniment arcoei. purſued the antiphlogiſtic treatment, reſt, and anodyne, h. ſ. with the ſtricteſt attention to the flexure of the limb and foot. On the 7th we continued the ſame treatment; fever and other ſymptoms moderate, the aſpect of the wound favourable; repeat an enema, and the anodyne, h. ſ.

On the 8th dreſſed the wound as uſual, tenſion and inflammation of the parts moderate, a laudable diſcharge of pus, and the future beginning to looſen, ſo as to call our attention more particularly to the aſſiſtance of bandages and the ſtrap, leſt the parts, by inattention or a ſudden motion, might be torn aſunder. Continued the regimen and the anodyne h. ſ.

On the 9th the diſcharge and appearance of the wound continued favourable, the thread was removed, and the parts remaining yet in complete contact, a ſmall ſlough beginning to caſt off from that part of the tendon that was compreſſ'd by the thread. Treatment as uſual, only with the omiſſion of the anodyne, and the addition of an oily embrocation to the knee, ancle, &c.

On the 10th the ſloughs caſt off, a fine appearance of a granulation, or increaſe of that part of the tendon caſt off, and the ſymptoms in every reſpect mild and favourable.

The 11th granulations increaſe, and appear to extend themſelves along the whole ſurface of the denuded tendon, the parts in complete contact, with a laudable diſcharge from the wound.

The 12th, granulations increaſing a little too faſt, praecip. merc. r. was added to the former dreſſings,

The 13th, and for ſome days, the fungus rather luxuriant rendered the continuance of the precipitate neceſſary; however, the granulations, gradually ſubdued and reſtrained, changed their appearance and texture, from a ſoft fungus, to that of a tendon; ſo that at the end of the month a complete cure took place, without any accident or bad ſymptom, except a trifling one of a fall, which the patient had in attempting to walk after the wound was completely cicatrized, by which, on examination, there appeared to be a laceration, or ſeparation of the integuments in contact with the exterior ſurface of the tendon, and a ſmall diffuſion of blood marking the extent of the tranſverſe and longitudinal inciſion. As ſoon as the patient was fit to go abroad, a ſhoe was contrived with a high heel, and the limb guarded by a ſtrap, to prevent a ſudden extenſion of the limb or muſcle, and this regulation complied with for ſome months, gradually lowering the heel to the ſtandard of the other foot, ſo that by degrees, a free and perfect uſe of the limb was reſtored, and at the preſent no difficulty remains, but is as active as any lad of his age and conſtitution.

The apparatus made uſe of to reſtrain the limb in a ſtate of flexure, and its muſcles from any unfavourable action, were a ſtrong piece of paſteboard, accommodated to the upper part of the foot or inſtep and ancle, and confined by bandage, which by its preſſure againſt the anterior and inferior part of the leg, prevented the elevation of the foot; the leg was preſerved in a ſtate of flexure, and the gaſtrocnemei muſcle in a ſtate of conſtant relaxation, by a ſtrap affixed to the heel of a ſlipper, that went over all the bandages on the foot, and led to a bandage above the knee, with a buckle to lengthen or ſhorten it at pleaſure. The few inſtances that occur, or are recorded of ſimilar caſes, induced me to lay this before you, Gentlemen, more eſpecially, as there have been many objections offered againſt ſutures in the caſe of ſuch wounds,: it is true, the patient referred to in this caſe, was young and of a ſpare, delicate habit, and of courſe leſs diſpoſed to inflammation, and a numerous train of bad ſymptoms, common to ſuch wounds in the plethoric and adult habit, yet, in my opinion, it does not argue againſt the ſafety of the practice, provided the antiphlogiſtic method is carried to the extent ſuch plethoric habits require, as the degree of ſymtomatic fever alone, in ſuch, and perhaps all wounds, (not in themſelves mortal) muſt determine the proportion of danger or difficulty.

Caſe of a Wound in the Trachea Arteria and Oeſophagus. By John Spalding, Surgeon. F. M. S. Read to the Society April, 2, 1788.

ON January the 22d, 1781, I was called to viſit Mrs. Potter, aged 58 years, who had been afflicted with a large ſcrophulous tumour on the ſore part of her neck, and much ſubject to melancholly, and under temptations to put a period to her life, for a number of years. On the 22d day of January, ſhe, with a pair of ſhears (which ſhe had ſecreted for that purpoſe) attempted her own life, by thruſting one blade of them into her throat; cutting the trachea about two thirds off; and wounding the oeſophagus. I arrived about half an hour after, and found a deep and frightful wound in her throat; the fore part of the trachea open, and extended about an inch. Dr. Ives being in the neighbourhood, was called in to aſſiſt me. I made two ligatures on the trachea, one on the right and the other on the left ſide of it; directed her to ſwallow nothing but liquids, until I ſaw her again; and to keep her head in a prone ſituation. On the 23d, found ſhe had ſlept very little, her pulſe calm, the wound diſcharging a gleety matter copiouſly: dreſſed it with lint dipped in balſ. traumaticum; directed her to take 20 drops of the balſam, in a tea of baum. On the 24th found her pulſe a little accelerated, and her reſt diſturbed in conſequence of a cough: preſcribed a tea of flaxſeed and honey, with a doſe of the elixir aſth. to be taken at night, and chicken broth ſparingly, on account of the difficulty of deglutition, which never failed to excite the cough. The wound diſcharged a viſcid gleet; ordered a ſaline draught, and a cooling enema: her cough abated, and ſhe reſted better. On the 25th found a full pulſe, a dyſpnea, with an inflammation on the ſcrophulous tumour threatening a gangrene. I let blood, & gave her a ſolution of ſal nit. ordered her feet to be bathed in warm water, and to take her broth ſparingly, part of which eſcaped through the wound.

On the 26th, I found her pulſe very full, with great difficulty in reſpiration, and the ſcrophulous tumour much inflamed; ordered her feet to be bathed in warm water, and took from her about twelve ounces of blood, which gave her immediate relief: continued the nitrous ſolution, and ſhe reſted much better that night than the preceding; the wound continuing to diſcharge a gleet with a little purulent matter. On the 27th, perceived an abſceſs had formed in the body of the tumour, which had emptied its contents into the wound, part of which was diſcharged by the mouth; the inflamation abated, the gleet leſs, a diſcharge of pus, and the fever abating. On the 28th, I found, by a fit of coughing the night before, the ligatures had given way, her breath and liquids which ſhe took came out at the wound; I then paſſed an armed needle through the divided muſcles and trachea, making three ſutures on the gaping wound, drawing the edges into cloſe contact; then dilated the ſcrophulous tumour, at its depending ſinus, in order to give vent to the matter, adviſing her not to take any thing into her mouth for ſeveral hours; ſhe reſted better than ſhe had done at any time before. On the 29th, found the inflammation much abated, owing to the free diſcharge at the depending orifice; her reſpiration relieved, yet on her taking drink ſome of it eſcaped through the wound; the matter diſcharged was of a better kind. I directed her head to be kept ſtill and in a prone ſituation. On the 30th, found ſhe had reſted very well, her mind a little more compoſed, the tumour leſſening daily, ſhe could ſwallow much better, eſpecially when ſhe took but a little at a time; her fever ſubſiding, and the appearance of the wound favourable. On the 31ſt, ſhe had a craving appetite for food that was more nouriſhing; gave her an egg beat up with wine and ſugar; ſhe ſwallowed it without much difficulty; and appeared mending in every reſpect. Feb. 1ſt, found her craving ſolid food; I informed her it was not admiſſible under her preſent circumſtances, and muſt content herſelf with her liquid diet, until the wound cicatrized. On the 2d, found ſhe had reſted very well, ſwallowed with eaſe, very little of it eſcaping at the wound. From this time ſhe mended daily, and the wound incarned and cicatrized, and ſhe now enjoys her uſual health.

Caſe of an enlarged Gall Bladder. By Ebenezer Beardſley. Read April 2d 1788.

MRS. Scott, a healthy temperate induſtrious woman aged 44, was ſeized with a violent paroxyſm of the bilious colic, attended with the uſual ſymptoms of nauſea, vomiting, ſevere pain in the abdomen and coſtiveneſs. She obtained relief from purges and other remedies commonly uſed in that diſorder; and in about a week was quite free from pain and diſeaſe, except a ſlight jaundice, which diſappeared within a few weeks, in the uſe of ſaponaceous and other medicines. She continued healthy for about three months, when ſhe was again attacked with a more ſevere fit of the cholic, which laſted longer and was more difficult to cure than the former: this paroxyſm, like the firſt, was ſucceeded by a jaundice, which was more obſtinate than before; but at the end of ſix or eight weeks it diſappeared, and left her to appearance in a ſtate of health. She continued apparently healthy for about four months, when ſhe was attacked with a third paroxyſm of cholic, which was much more ſevere than either of the former. Aloetic purges, fomentations, enemas, &c. removed the conſtipation of the bowels and pain in about a week. But from this period ſhe began to complain of an inceſſant cardialgia, which preyed upon her without intermiſſion: an obtuſe, deep ſeated pain in the pit of her ſtomach and right hydochondrium, a yellowneſs in her eyes and ſkin, obſtinate coſtiveneſs, with other ſymptoms of an inveterate jaundice. For theſe complaints ſhe took mercurials, ſoap, lime-water, gum pills, abſorbents, bitters, &c. But notwithſtanding her complaints daily increaſed, her appetite forſook her, the heat and uneaſineſs about her ſtomach became intolerable, and in about four months ſhe died, quite emaciated. Soon after her death I examined the body in preſence of my brother and another phyſician. Upon making a tranſverſe inciſion through the integuments, a little below the diphragm, we were ſurpriſed at the ſudden and violent protruſion of a hard elaſtic body through the aperture we had made, which upon farther examination we found to be the gall bladder, diſtended to the enormous length of ten inches, and proportionably large in its diameter.

The coats of the bladder, notwithſtanding the amazing diſtenſion, were thick, hard, and elaſtic, we ſeparated it from the liver, and opened it by a longitudinal inciſion from the neck to the fundus, and found that the diſtenſion and enlargement, were occaſioned by a preternatural fleſhy ſubſtance, which appeared to have ſprouted out from all that part of the bladder which is connected with the liver, and had gradually increaſed to ſuch a monſtrous ſize. The fungus, or fleſhy ſubſtance, conſiſted of coarſe parallel fibres, not unlike the muſcular parts of lean beef, and from the middle of it we extracted near an ounce of a ſoft, grey coloured calculus. The end of the fungous ſubſtance, next to the fundus of the bladder, was in a ſtate of ſuppuration, and there was a ſpoonful of very thick cream coloured pus about it. It did not adhere to the bladder any where but at its inſertion into the liver. There was no appearance of bile in the gall-bladder, the communication with the liver being wholly cut off by the fungous body.

What could have given riſe to this formidable diſeaſe? Muſt there not have been a previous wound, laceration, or inflammation in the part whence the fungus iſſued?

Permit me again ſo repeat the practical caution, which I gave at the cloſe of the hiſtory of the ſchirrous pylorus, at our laſt meeting, againſt the uſe of ſtrong emetics in long continued biliary obſtructions. In a caſe like the preceding, their effects muſt be terrible to the unhappy ſufferer.

Caſe of Dyſenteric Symptoms from worms. By Dr. Samuel Neſbitt. Read before the Society April 2, 1788.

IN the winter of 1784, I was called to viſit a child of the Rev. Bela Hubbard, Aged two years. The child was ſeized on the night preceeding with a violent fever, great reſtleſſneſs, a conſtant nauſea, and vomiting, attended with alarming dyſenteric ſymptoms, viz. a frequent diſcharge of an acrid mucus, reſembling in colour beef brine, a diſtreſſing teneſmus, with a tumefaction and tenſion of the abdomen. Under theſe circumſtances I found my little patient on the morning ſucceeding the attack. The dyſenenteric ſymptoms were ſo ſtrongly marked, that, overlooking the circumſtance of worms, I bent my whole attention to deterge the acrid offending matter; and accordingly preſcribed two gr. of emetic tartar, to be diſſolved in four table ſpoonfulls of warm water, and one ſpoonfull to be given every half hour, until the child had taken the whole, or a ſufficiency to clear well the ſtomach. The firſt ſpoonfull ſuppreſſed every appearance of ſickneſs at the ſtomach, the ſecond was given, and the whole according to the directions above, without any apparent diſpoſition to vomit. Its operation was cathartic, and procured, within three hours from the firſt doſe of the tartar, a diſcharge of thirty two large worm of the round kind. Some of them meaſured 8 and 9 inches in length, none, that I remember, 〈◊〉 ſhort of four inches. The firſt diſcharge contained twenty, which were forced into the anus in ſuch a body, that the aſſiſtants found it neceſſary to relieve the child by the hand. Two diſcharges more compleated the number, they were all alive and ſquirming on the receiver. From the expulſion of ſuch a number of diſagreeable tenants, every dyſenteric ſymptom vaniſhed, the tenſion of the abdomen and fever ſubſided, and from that period a perfect recovery took place, without any further aſſiſtance from medicine.

Thus, gentlemen, without aſſuming any credit to myſelf, a happy and ſpeedy iſſue was, by accident, obtained in the preſent alarming caſe, and by a medicine, which, in its operation, proved the moſt active and powerful anthelmintic I had, or ever have met with in my practice; curing, as Celſus ſays, Tuto, cito & jucundo.

I moſt ſincerely wiſh we could always be ſo fortunate in our preſcriptions, when we are right in our conjectures of the proximate cauſe of diſeaſes. But it is not to be expected that a miſtaken theory will always terminate ſo favourably.

Caſe of a ſchirrhus in the Pylorus of an infant. Communicated by Doctor Hezekiah Beardſley. Read April 2, 1788

A CHILD of Mr. Joel Grannis, a reſpectable farmer in the town of Southington, in the firſt week of its infancy, was attacked with a puking, or ejection of the milk, and of every other ſubſtance it received into its ſtomach almoſt inſtantaneouſly, and very little changed. The foeces were in ſmall quantity and of an aſh colour, which continued with little variation till its death. For theſe complaints a phyſician was conſulted, who treated it as a common caſe ariſing from acidity in the prima via; the teſtaceous powders and other abſorbents and correctors of acid acrimony, were uſed for a long time without any apparent benefit. The child, notwithſtanding it continued to eject whatever was received into the ſtomach, yet ſeemed otherwiſe pretty well, and increaſed in ſtature nearly in the ſame proportion as is common to that ſtate of infancy, but more lean, with a pale countenance and a looſe and wrinkled ſkin like that of old people. This, as nearly as I can recollect at this diſtance of time, was his appearance and ſituation when I was firſt called to attend him; he was now about two years old. I was at firſt inclined to attribute the diſorder to a deficiency of the bile and gaſtric juices, ſo neceſſary to digeſtion and chylification, joined with a morbid relaxation of the ſtomach, the action of which ſeemed wholly owing to the weight and preſſure of its contents, as aliment taken in ſmall quantities would often remain on it, till by the addition of freſh quantities, the whole, or nearly all was ejected; but his thirſt, or ſome other cauſe, moſt commonly occaſioned his ſwallowing ſuch large draughts as to cauſe an immediate ejection, and oftentimes before the cup was taken from his mouth. It did not appear that he was attended with nauſea or ſickneſs at his ſtomach, but he often complained that he was choaked, and of his own accord would introduce his finger or the probang, ſo as to excite the heaving of the ſtomach and an ejection of its contents; the uſe of this inſtrument was generally neceſſary if the ſtomach did not of itſelf, in a few moments, diſcharge its contents, the choaking would in that ſhort ſpace of time become almoſt intolerable, which by this diſcharge was entirely removed. In this ſituation, with very little variation of ſymptoms he continued till death cloſed the painful and melancholy ſcene, when he was about five years of age. He was uncommonly chearful and active conſidering his ſituation. A number of the moſt reſpectable medical characters were conſulted and a variety of medicines were uſed to little or no effect. His death, though long expected, was ſudden, which I did not learn till the ſecond day after it took place. This late period, the almoſt intolerable ſtench, and the impatience of the people who had collected for the funeral prevented ſo thorough an examination of the body, as might otherwiſe have been made. On opening the thorax, the oeſophagus was found greatly diſtended beyond its uſual dimenſions in ſuch young ſubjects; from one end to the other of this tube, between the circular fibres which compoſe the middle coat, were ſmall veſicles, ſome of which contained a table ſpoonful of a thin fluid like water, and ſeemed capable of holding much more. I next examined the ſtomach, which was unuſually large, the coats were about the thickneſs of a hog's bladder when freſh and diſtended with air, it contained about a wine pint of a fluid exactly reſembling that found in the veſicles before-mentioned, and which I ſuppoſe to have been received juſt before his death. The pylorus was inveſted with a hard compact ſubſtance, or ſchirroſity, which ſo completely obſtructed the paſſage into the duodenum, as to admit with the greateſt difficulty the fineſt fluid; whether this was the original diſorder, or only a conſequence, may perhaps be a queſtion. In juſtice to myſelf I ought to mention, that I had pronounced a ſchirroſity in that part for months before the child s death. On removing the integuments of the abdomen, I was ſtruck with the appearance of the veſica fellis, which was nearly five inches in length and more than one in diameter, it lay tranſverſly acroſs the abdomen, and was bedded into the ſmall inteſtines, which were ſphacelated wherever they came in contact with it; its contents were rather ſolid than fluid, and reſembled fleſh in a highly putrid ſtate; its colour was that of a very dark green, like the juice of the night-ſhade berry, and a fluid of the ſame colour exuded through its ſphacelated coats. The neceſſity there was of interring the body that evening, put a ſcop to any further examination.

I ſhould have been happy, Gentlemen if I had been able to have given you a more particular and accurate deſcription of this very ſingular caſe, but the above-mentioned circumſtances forbad.

Caſe of Calculi in the Lungs. Communicated by Dr. En •• s Munſon. Read April 2, 1788.

MR. CALEB HOTCHKISS, aged 45 years, of a chole ic diſpoſition, died of a 〈…〉 of the lungs, in the month of December, 1784. His diſeaſe by his own account of 〈…〉 , comm •••• about 15 years before his death. 〈…〉 in the year 17 9, he was 〈◊〉 with extreme pain in his 〈◊〉 , at different periods, which ended in a nephritis; and at length in an haemoptoſis, when, by coughing, a calculus was thrown out from his lungs, after which he paſſed about 12 years of tolerable health; he lived a ſedentary life, and was able to purſue a moderate courſe of ſtudy, and preached occaſionally, until July 1784, when I was conſulted in his caſe. He complained of a general laſſitude and weakneſs, attended with a ſlow fever and cough, with a quick, hectical pulſe; tho' without any pain in or about the cheſt. His cough was neither hard nor frequent: he had been riding ſhort journies, for the purpoſe of recruiting his health, and had found ſo much advantage thereby, that he was determined to take a more lengthy one of ſome hundred miles. But his weakneſs and Hippocratic countenance, together with a ſmall hemoptoe which attended his cough, made me diffident in recommending ſo lengthy a journey as was propoſed, and the more ſo on account of a number of ſmall calculi, which at different times he had coughed up, tho with leſs irritation than might have been expected, they being of very even, ſmooth ſurfaces, but of different figures, and about the ſize of a large orange ſeed. But ſeeing the great confidence he had of the advantages he ſhould derive from the propoſed journey, I conſented, rather than adviſed to it, with all the precautions I thought neceſſary for one under his infirmity. He returned in about ſix weeks, and appeared rather recruited, and continued ſo until the month of September, when his cough increaſed, and on the 9th he raiſed about a pint of blood from his lungs; which came ſo faſt and ſuddenly upon him, as to threaten an immediate ſuffocation. I was called in the night, but before I arrived his haemoptoe ceaſed. But juſt on my entrance into the room he expectorated a large mouthfull, which appeared by candle light to reſemble a mixture of blood and pus. This I directed to be thrown into a ſmall veſſel of water, and after maceration, found it to conſiſt of a portion of the internal membrane of the lungs, about one inch and a quarter in length, and half the breadth, and about a quarter of an inch thick. About this time he expectorated another calculus, after which he continued gradually to decay, until the latter end of December following, when welcome death cloſed the ſcene.

As this is but the ſecond caſe of the kind that has fallen under my obſervation, in the courſe of thirty years practice, I narrate it as ſomething ſingular, with this remark only, by way of quaere. As, in the preſent caſe, many ſevere pectoral complaints were terminated with a fit of the gravel, whether very conſiderable relief may not be expected in like caſes, from thoſe means which have proved ſo ſpecific in reſolving and bringing off calculous matter from the kidnies and ureters? Which is humbly ſubmitted to thoſe more ſkilful and experienced to determine.