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THE

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES.

COLLABORATORS,

Elisha Bartlett, M. D. Professor of Pathological Anatomy in the Beik- shire Medical Institution.

Jacob Bigelow, M. D. Professor of Ma- teria Medica in Harvard University, Boston.

Edward H. Barton, M. D. Professor of the Theory arid Practice of Medicine and Clinical Practice in the Medical College of Louisiana.

N. Chapman, M. D. Professor of the Institutes and Practice of Physic and Clinical Practice in the University of Pennsylvania.

B. H. Coates, M. D. one of the Physi- cians to the Pennsylvania Hospital.

Reynell Coates, M. D. of Philadelphia.

D. Francis Condie, M. D. of Philadel- phia.

William P. Dewees, M. D. Late Profes- sor of Midwifery in the U7iiversity of Pennsylvania.

S. Henry Dickson, M. D. Professor of the Institutes and Practice of Medicine in the Medical College of the State of South Carolhia.

Gouverneur Emerson, M.D. of Phila- delphia.

Paul F. Eve, M. D. Professor of Sur- gery in the Georgia Medical College.

John W. Francis, M. D. Late Profes- sor of Obstetrics and Forefisic Medi- cine in Rutgers Medical College, New York.

E. Geddings, M. D. Professor of Patho- logy and Medical Jiirisprudence in the Medical College of the State of South Carolina.

W. W. Gerhard, M. D. one of the Phy- sicians to the Philadelphia Hospital, Blocklcy.

William 'Gibson, M. D. Professor of Surgery in the University of Pennsyl- vania.

R. E. Griffith. M. D. Professor of Materia Medica, Therapeutics, Hy- giene and Medical Jurisprudence in the University of Virginia.

Thomas Harris, Surgeon U. S. Navy, and one of the Surgeons of the Penn- sylvania Hospital.

E. Hale, M. D. Physician to the Massa- chusetts General Hospital.

George Hayward, M. D. Professor of the Principles of Surgery and Clini- cal Surgery iro Ha.rvard University, Boston.

William E. Horner, M. D. Professor of Anatomy in the University of Pennsyl- vania.

Ansel W. Ives, M. D. of Nev) York. Samuel Jackson, M. D. Professor of the Institutes of Medicine in the Univer- sity of Pennsylvania. Samuel Jackson, M. D. of Northumber- land, Pennsylvania. John George Morgan, M. D. Professor of the Principles and Practice of Sur- gery in Geneva College, New York. Valentine Mott, M. D. Professor of Pathological and Operative Surgery in the College of PhysicioMS and Sur- geons, New York. James Mac Donald, M. D. Resident Physician to the Bloomingdale Asy- lu7n, New York. James Moultrie, Jr. M. D. Professor of Physiology in the Medical College of the state of South Carolina. Reuben D. Mussey, M. D. Professor of Anatomy and Surgery in Dartmouth College, New Hampshire. T. D. Mutter, M. D. of Philadelphia. G. W. NoRRis, M. D. one of the Sur- geons to the Pennsylvania Hospital. R. M. Patterson, M. D. Late Professor of Nat^iral Philosophy in the Univer- sity of Virginia. Philip Syng Physick, M. D. Emeritus Professor of Anatomy and Surgery in the University of Pennsylvania. R. R. Porter, M.D. Resident Physician

to the Friends' Asylum Frankford. Thomas Sewall, M. D, Professor of Anatomy and Physiology in the Co- lumbian College, District of Columbia. AsHBEL Smith, M. D. of Salisbury, North Carolina.

Nathan R. Smith, Professor of Surgery

in the University of Maryland. Thomas Stewardson, M. D. one of the Physicians to the Philadelphia Hospi- tal, Blockley. A. F. Vache, M. D. of New York. John Ware, M. D. Professor of the Theory and Practice of Physic in Harvard University, Boston. John C. Warren, M. D. Professor of Anatomy and Surgery in Harvard University, Boston. Thomas H. Wright, M. D., late Physi- cian to the Baltimore Alms-house In- firmary.

EDITOR— Isaac Hays, M. D., one of the Surgeons to Wills' Hospital, ^c.

THE

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES.

Vol. XXI.

PHILADELPHIA: CAREY, LEA & BLANCHARD.

E. G. Dorsey, Printer.

1837.

\03

TO READERS ANb CORRESPONDENTS.

Communications have been received from Drs. Mettauer, Porter, Denny. Adam, Davis, Sharpless, Andrews, Bennett, Savory, Webber, Ourrell, and An- nan.

The following works have been received: An experimental Essay on the Re- lative Physiological and Medicinal Properties of Iodine and its compounds; being the Harveian Prize Dissertation, for 1837. By Charles Cogswell, A. B., M. D., Mem. Roy. Coll. of Surg., &c., &c. Edinburgh, 1837. (Prom the author.)

A Practical Treatise on the Principal Diseases of the Lungs, considered es- pecially in relation to the particular tissues affected. By G. Hume Weatherhead, M. D., Mem. of the Roy. Coll. of Phys., &c. &c. London, 1837. (From the author.)

Observations on the Preservation of Health, in Infancy, Youth, Manhood, and Age: with the best means of improving the Moral and Physical Condition of Man. By John Harrison Curtis, Esq., &c. London, 1837. (From the author.)

Statistics of the Deaf and Dumb in the State of New York, the United States, and in various countries of Europe. By T. Royemn Beck, M. D. (From the author.)

Transactions of the Medical Society of the State of New York. Vol. III. 1836-7. Albany, 1837. (From the publishers.)

Suggestions with regard to the General Treatment of Fractures, with a new kind of splinting composed of Felt. By David S. C. H. Smith, M. D. Boston, 1831. (From the author.)

A letter respecting Santa Cruz, as a Winter Residence for Invalids, addressed to Dr. John C. Warren, of Boston, Mass. By Joseph Tuckerman. Boston, 1837. (From the author.)

Essai sur la Philosophic Medicale et sur les generalites de la Clinique Medi- cale. Par J. Bouillaud, Prof de Clinique, Med. de la Faculte de Medecine de Paris. Paris, 1836. (Prom Dr. Oppenheim.)

Der Wasserkrebs .der Kinder. Eine Monographic, von Dr. A. L. Richter. Berlin, 1828. (From Dr. Oppenheim.)

Erster Nachtrag zu den Carbildung, mit bezug auf Cholera. Von Dr. Kru- ger Hansen. Rostock und Giistrow, 1831. (From Dr. Oppenheim.)

Ueber dieBehandlungsweisen der Pseudarthrosen, und eine neue Heilmethode derselben, von Oppenheim. (From the author.)

Rede die zum Vortrage in des Versaumlung des Wiirtembergischen arztli- chen vereins am 30 May, in Ulne bestimmt war von dem homoopathischen Artze Med. Dr. Karl Kammerer. (From Dr. Oppenheim.)

Zweite Nachricht iiber die Wirksamkeit der unter dem Namen Chirurgesch- Medicinesche Akademie vereinigten Institute zu Dresden, Von Dr. B. W. Seiler. Dresden, 1834. (From Dr. Oppenheim.)

Beitrage zur Afklarung der Erscheinungen und Gesetze des oiganischen Le- bens. Von G. R. Treviranus. Ersten Bandes, Drittes Heft. Resultate neuer Untersuchungen iiber die Theorie des Sehens und iiber den innern Bau der Netzhauc des Auges. Mit Zwei Steintafeln und vier Kupfertafeln, Heraus- gegeben nach dem Tode des Verfassers und begleitet mit einer Vorrede vom Geheimen-Rath Tiedemann. Bremen, 1837. (From Dr. Von dem Busch.)

Die Syphilitischen Krankheitsformen und ihre Heilung. Mit Steter Riick- sicht auf die Beobachtungen und Erfalirungen der Neuesten Zeit. dargestellt Von Georg Fried. Handschuch, M. D. undC, &c. Miinchen, 1831. (From Dr. Oppenheim.)

Die Asiatische Cholera in Russland, in den Jahren 1829 und 1830. Nach rus- sischen amtlichen Gluellen bearbeitet. Von Dr. J. R. Lechtenstadt, Prof, &c. Berlin, 1831. (From Dr. Oppenheim.)

viii

TO READERS AND CORRESPONDENTS.

Die Indische Cholera. Von Dr. C. F. Harless, Prof., &e. Braunschweig, 1831. (From Dr. Oppenheim.)

An Address lo the Candidates for the degree of Doctor of Medicine, delivered at the annual commencement of the Medical College of South Carolina, March 15, 1837. By J. B. WmxRiDOE, A. M., M. D., President of the Medical Society, and ex-officio of the Medical College of South Carolina. Charleston, 1837. (From the author.)

The Medical Student, or aids to the Study of Medicine. Including a glossary of the terms of the science, and of the mode of prescribing— bibliographical no- tices of medical works; the regulations of different medical colleges, the union, &c. &c. Philadelphia, Carey, Lea & Blanchard, 1837. (From the publishers.)

University of the State of New York. College of Physicians and. Surgeons' Circular for 1837-8. New York, 1837. (From Dr. Brigham.)

Zeitschrift fur die gesammte Mediein, mit besonderer Riicksicht auf Hospital praxis und auslandische Literatur, January, February. March, April, May, 1837. (In exchange.)

Gazette Medicale de Paris, January, February, March, April, May, June, July, 1837. (In exchange.)

Bulletin General de Therapeutique, January, February, March, April, May, June, 1837. (In exchange.)

Journal de Pharmacie, June, 1837. (In exchange.)

Journal de Medecine et de Chirurgie Pratiques. January, February, March. April, May, June, July, 1837. (In exchange.)

Journal des Connaissances Medico-Chirurgicales, January, February, March. April, May, June, July, 1837. (In exchange.)

The Medico-Chirurgical Review, for January, April, and July, 1837. (In ex- change.)

The Edinburgh Medical and Surgical Journal, for January, April, and July. 1837. (In exchange.)

The Dublin Journal of Medical Science, July, 1837. (In exchange.)

The London Medical Gazette, June, July, 1837. (In exchange.)

The British and Foreign Medical Review. July, 1837. (In exchange.)

The Select Medical Library and Electic Journal of Medicine, August, Sep- tember, October, 1837. (In exchange.)

The Boston Medical and Surgical Journal, August, September. October, 1837. (In exchange.)

The Southern Medical and Surgical Journal, August, 1837. (In exchange.)

Authors of new medical books, desirous of having them reviewed or noticed in this Journal at the earliest opportunity, are invited to transmit to the Editor a copy as soon after publication as convenient, when the)^ will receive prompt attention. Under ordinary circumstances, very considerable delay is caused by the circuitous routes through which they are received.

Papers intended for publication should be sent,/?-ee of expense, as early after the appearance of the Journal as possible, in order to be in time for the ensuing number. Such communications should be addressed to "Carey, Lea & Blan- chard, Philadelphia, for the Editor of the American Joiirnod of the Medical Sciences.'" All letters on the business of the Journal to be addressed exclusively to the publishers.

CONTENTS.

ORIGINAL COMMUNICATIONS.

ESSAYS.

ART. PAGE

I. Report of four additional cases of Stone in the Bladder, in -which the ope- ration of Lithotripsy was successfully performed. By J. Randolph, M. D., Lecturer on Surgery, one of the Surgeons to the Pennsylvania Hospital, &c. &c. 13

II. Report of Cases of Lithotripsy. By N. R. Smith, late Professor of Sur- gery in the University of Maryland ----- 25

III. An Inquiry into the Pathology and Treatment of Secondary Abscesses, and other consecutive Disorders resulting from injuries and Surgical ope- rations. By John Watson, M. D., of New York. (Read before the New York Medical and Surgical ^Association, July 29th, 1837.) - - 37

IV. Remarks on Stammering. By Edward Warren, M. D., of Boston, Massachusetts - - - ____ -75

V. Clinical Report on the Surgical Department of the Philadelphia Hospi- tal, Blockley, for the months of May, June, and July, 1837. By William E. Horner, M. D., Surgeon, Professor of Anatomy in the University of Pennsylvania, &c.- - - - - - - -99

VI. Cases of Extensive Malignant Disease with Remarks. By E. Hale,

M. D. [Read before the Boston Society for Medical Improvement.] 112

VII. Remarks on the Action of Presence. By John W. Draper, M. D., Pro- fessor of Chemistry and Physiology in Hampden Sidney College, Va. 122

VIII. Case of Worms in the tJrinary Bladder. By Harvey Campbell, M. D.,

of Johnstown, Windham county, Conn. ----- 130

IX. Case of Rupture of the Urethra without external wound. By Samuel Webber, M. D., of Charlestown, N. H. - - - - - 133

REVIEWS.

X. Surgical Observations on Tumours, with Cases and Operations. By John C. Warren, M. D., Professor of Anatomy and Surgery in Harvard University, and Surgeon of the Massachusetts General Hospital. 8vo. pp. 607. Boston: Crocker & Brewster. 1837. - - - - 135

XI. Recherches Pratiques sur la Therapeutique de la Syphilis, ouvrage fonde sur des observations recueillies dans le service et sous les yeux de M. Cullerier, Chirurgien en chef de I'Hopital des Veneriens. Par Lucas- Championniere, Docteur en Medicine. Paris, 1836. pp. 415. 8vo.

Practical Researches relative to the treatment of Syphilis; a work founded upon observations collected in the service and under the eye of M. Culle- rier, Chief Surgeon of the Hopital des Veneriens. By Lucas-Champion- niere, M. D. - - - - - - - - 155

10

CONTENTS.

BIBLIOGRAPHICAL NOTICES.

ART. PAGE

XII. Maladies de I'llterus, d'apres les Lemons Cliniques de M. Lisfranc, faites a I'Hopital de la Pitie. Par H. Pauly. Paris, 1836. 8\ro. pp. 536.

On Diseases of the Uterus, from the Clinical Lectures of M. Lisfranc. By H. Pauly. --------- 179

XIII. Recherches sur quelques uns des accidents cerebraux produits par les preparations saturnines. Par A. Grisolle, Docteur en Medecine, chef de clinique de la Faculte de Medecine a I'Hotel-Dieu; litulaire de la Societe Medical d'observation; membre honoraire de la Societe Anatomique; cor- respondant de I'Academie de Medecine de Marseille. &c. Extrait de Jour- nal Hebdoniadaire des Progres, &c. Decembre, 1836. Paris, 1836.

Researches upon some of the Cerebral disorders produced by the preparations of Lead. By A. Grisolle, Doctor in Medicine. Paris, 1836. - - 182

XIV. Medico-Chirurgical Transactions, published by the Royal Medical and Chirurgical Society of London, for 1836. Volume the twentieth. London, 1837. 8vo. pp. 402. 186

XV. Essay on the Mineral Waters of Carlsbad, for Physicians and Patients. By Chevalier John de Carro, M. D., of the Faculties of Edinburgh, Vien- na, and Prague, and Physician at Carlsbad during the Season. With Observations on the Microscopic Animalcules about the Hot Springs of Carlsbad. By Mr. A. J. C. Corda, of Prague, and a Flora of Carlsbad, by Professor C. B. Presl, of Prague. 12mo. pp. 136. Prague, 1835. - 198

XVI. Der Wasserkrebs der Kinder. Eine monographic von Dr. Adolph Leopold Richter, Stabsarzte des Koniglichen Medizinischen Friedrich- Wilhelms-Institutes, &c. 8vo. pp. 84. Berlin. 1828.

On the Water-Canker of Children. By A. L. Richter, M. D., &c. - 202 XVIL A Clinical Treatise on the Endemic Fevers of the West Indies, in- tended as a guide for the young practitioner in those countries. By W. J. Evans, Esq., M. R. C. S. London: John Churchill. 1837. 8vo. pp. 309. 208

XVIII. Die Syphilitischen Kranhheitsformen und ihre Heilung. Mit Ste- ter Riicksicht, auf die Beobachtungen und Erfahrungen der neuesten Zeit, dargestellt von Georg Freiderick Handschuch, der Medizin, Chirurgie und Entbindungskunde Doktor. Miinchen, 1831. 8vo. pp. 436.

On the different forms of the Venereal Disease, and their treatment, with especial reference to the results of recent observations and experience. By G. F. Handschuch, M. D. - - - - - - 211

XIX. Transactions of the Medical Society of the State of New York. Vol. III., Part II. Albany, 1837. 8vo. pp. 310. - - - - 211

QUARTERLY PERISCOPE.

FOREIGN INTELLIGENCE.

Special Anatomy.

PAGE

1. Thymus Gland. ByKrause 217

2. Minute Structure oif the Teeth. ByFroenkel - - - - 217

3. Origin of the optic nerve. By Stein - - - - - 218

PAGE

4. Laryngeal and Hypoglossal Nerves. By C.E.Bach - 218

5. Structure ofthe intestinal glands. ByBohm - - - - 218

6. Meibomian glands. By Zeis 218

General Anatomy and Physiology.

7. Artificial Digestion. By Dr. Tweedy John Todd - - 219

8. A comparative examination of

the Liquor Amnii in different periods of Foetal life. By Dr. C. Vogt - - - - - 219

CONTENTS.

11

PAGE

9. Composition of elastic tissue.

By Eulenberg and Schwann 220

10. Contractility of arteries. By Schwann - _ - - 220

11. Extra Uterine Foetation. By Drejir 220

12. Observations on Weber's ex- periment on the power by which the head of the thigh-bone is re- tained in the acetabulum. By Lauer ----- '220

Pathological Anatomy and General Pathology.

13. Microscopic crystals in the al- vine evacuations of persons la- bouring under t3^phoid fevers, ByM. Gluge - - - 222

14. Spontaneous Rupture of the Heart. By Dr. Mayer - 223

15. On the nature of Mucus, and discharges from the Urino-geni- tal organs. By M. Al. Donne 223

Materli Medica and General Therapeutics.

16. Physiological and Therapeuti- cal properties of pure Tannin. ByM. Cavarra - - - 223

17. Tartar Emetic. ByDrs. Crich- ton and Mayer - - - 224

18. Phlorizine. ByM. deKoninck 224

19. Parsley juice as a substitute

for quinine. By Dr. Pott - 225

Special Pathology and Special Therapeutics.

20. Enlargement of the Thymus Gland. 225

21. Decoction of Sarsaparilla and Nitric Acid, in certain cases of Chronic Cough. By Professor Graves - _ - . 226

22. Tartar Emetic and opium in the delirium of Typhus. By Dr. Hudson - - - - 227

23. Castor oil Frictions in Gout 227

24. On the indications for the use of Chlorine and Muriatic Acid Vapours, in Diseases of the Air Passages and Lungs. By Pro- fessor Albers - - - 227

25. Nvmphomania before puberty.

By M. Magendie - - - 228

26. Case in which the functions of hearing, speech and taste, but not of smell, were destroyed by the "wind of a ball." By Professor Magendie - - - - 230

27. Gelatinous softening of the sto- mach in children. By Dr. Aug. Droste 231

28. Scald Head. By Sir Francis Smith, M. D. - - - 232

29. Ulcers on the septum narium.

By Sir Francis Smith, M. D. 232

30. "Remedv for Ptyalism. By Knod and Kluge - - - 233

31. Protiodide of Mercury in Pso- riasis. By M. Poiret - - 233

Surgical Pathology and Operative Surgery,

32. Introduction of air into the veins during operations. By M. Amussat _ . . _ 233

33. Case of fall from a great height, with various injuries followed by recovery. By J. Patterson, Esq. 234

34. On excision of the smaller joints. By Dr. Gernet - - 234

35. Remarkable fragility of the Bones, By Mr. Baker - 235

36. Excision of a portion of the spleen. By Dr. Macdouald 235

37. Clinical Observations on open- ing Abscesses. By M. Lisfranc 236

38. Treatment of Hydrocele by in- jections of Iodine. By Mr, J. R. Martin .... 238

39. Ligature of the Arteria In- nominata. By Mr. Lizars - 239

12

CONTENTS.

Midwifery.

40. Administration of the Ergot of Rve in anticipation of Uterine Hemorrhage. - - - 239

41. Pregnancy with Imperforate Uterus. ' - - - - 240

PAGE

42. Expulsion of the Placenta be- fore the birth of the child. - 243

43. CaBsarean operation performed four times with success in the same woman. By Dr. Charlton 244

Medical Jurisprudence and Toxicology.

44. Fracture of the Skull and Rup- ture of the longitudinal Sinus during Natural Labour. By Dr. Michaelis - - - -

45. Case of Poisoning by Liquor Potass^. By Darto'-Massart 247

246

Medical Statistics.

46. The inapplicability of Statistics to the Practice of Medicine. By M. Double - - - -

247

47. Bastardy in En gland and Wales 250

48. Bastardy in Prussia - - 250

Miscellaneous

49. Account of a man who submit- ted to be buried alive for a month, at Jaisulmer, and was dug out alive at the expiration of that period. By H. M. Twedell, Esq.

250

50. Lithotrity in Russia. By M. Huerteloup - - - . 252

51. Animal Flower - - 252

AMERICAN INTELLIGENCE.

Case of Hepatic Abscess opening into the right lung, with a post- mortem dissection. By Joseph Peace, M. D. - - - 253

Case of Amputation of the Foot. By G. R. B. Horner, M. D. - 255

Scirrhus of the Liver and Pylorus, terminating in ulceration, effu- sion into the abdominal cavity, peritonitis, and death. By S. Littell, Jr., M. D. - - - 256

Case of Suicide in a Child. By Isaac Parrish, M. D. - - 258

Case of Urinary Calculus in a girl, successfully treated. By T. D. Mutter, M. D. - - - 260

Statement of Deaths, with the Dis-

eases and Ages, in the City and Liberties of Philadelphia, during the year 1835 - - - 261 Statement of Deaths, with the Dis- eases and Ages, in the City and Liberties of Philadelphia, during the year 1836 - . . 264 Observations on the Bills of Mor- tality of Philadelphia, for the years 1835-36. By G, Emerson,

M. D. 267

Animal Magnetism - - . 268 Convulsionists of St. Medard - 274 Fracture of the Fifth Cervical Ver- tebra, without displacement of the body of the bone - - 276 Dunglison's Medical Student - 27G

THE

AMERICAN JOURNAL

OF THE

MEDICAL SCIENCES.

Article I. Report of four additional cases of Stone in the Bladder^ in which the operation of Lithotripsy was successfully performed. By J. Randolph, M. D., Lecturer on Surgery, one of the Surgeons to the Pennsylvania Hospital, &c. &c.

Since my last report upon the subject of lithotripsy, made in the Number of this Journal for November, 1836, I have performed this operation in four instances. The two first of these (making my four- teenth and fifteenth cases) occurred in the Pennsylvania Hospital in this city, and the report of them is furnished by my friend. Dr. James A. M'Crea, who was at that period house surgeon to this institution.

The sixteenth case occurred in an old gentleman of this city, seventy-three years of age, who had been for a considerable period under the particular charge of Dr. H. M'Murtrie, and this gentleman has had the kindness to furnish the statement of this case. The seventeenth case is that of a young gentleman, also of this city, who was cured most happily in a very short period, as will be seen by the report.

The following is Dr. M'Crea's account of the two first cases:

*'I trust the following cases will prove interesting to the readers of the American Journal, inasmuch as they are the first in which the complaint of stone in the bladder has been cured in the Pennsylvania Hospital by any other than a cutting operation.

''Within the last five years the instruments of M. Civiale and M.

No. XLI.— November, 1837. 2

14

Randolph on Lithotripsy.

Jacobson were employed in the treatment of several cases of calculus (not the most favourable, however,) without success, and great anxiety was felt by all those connected with the institution that the operation should be established upon its records by a favourable result.

"This, I am happy to state, has been accomplished in two cases; the latter, as will appear in its details, was one of the most unfavourable that could have possibly presented, and the successful treatment of which speaks volumes for the inestimable value of the operation, the case being one in which the gorget or scalpel could have offered very little hope of relief, thereby demonstrating the superiority of litho- tripsy over any and every other method of treating urinary calculus.

"Before entering upon the first case it may be well to mention, as indicative of the strong feeling in favour of the operation among the people of our country, that Mr. Askine came to the city predetermined to submit to no other operation before he had tested this, and confi- dent that he would shortly return to his family perfectly restored.

"Case XIY. Mr. Askine, aged 32 years, cabinet-maker by trade; of robust frame; cheerful disposition; good general health; admitted into the Hospital on the 26th of October, 1836. He had travelled from Pittsburg, where he has resided for the last 13 years, chiefly by water, with great comfort, very little exacerbation of symptoms being pro- duced by the journey.

"The complaint had manifested itself about six months ago, (May last,) by the symptoms usually characterizing its early stages, and continued to advance without much distress for three months. Since that time he has been unable to retain his urine for a longer pe- riod than one to two hours, and towards the close of the day, after moderate exercise, this period was much shortened. He has suffered several times from acute inflammation of the bladder, which was subdued by rest, leeches, and other antiphlogistic treatment. He had also several attacks of irritation and inflammation about the sphincter ani, productive of great pain and inconvenience. With the exception of these occasions, he has superintended his business since his attack. The character of the urine has been turbid, occasionally a great deal of mucus and sediment accompanying its discharge; quantity very variable.

''Oct. 27th. Has had a restless night, passing his urine very fre- quently— hourly, almost; with a disposition to chilliness, to which it may be stated he has been unusually subject ever since the commence- ment of his disease. Pulse 92 per minute, with slight thirst and heat of skin. R. mixt. neut. ^ss. occasionally; tepid fomentations to pe- rinaeum.

Randolph on Lithotripsy.

15

"Oc/. 28//«. Dr. Randolph sounded the patient in my presence. The stone was readily detected at the neck of the bladder, and com- municates to the instrument the feel of a soft calculus. After sound- ing, a little sand passed, and the patient had a well marked chill. The chill recurred upon the evening of the succeeding day, after which he was very comfortable until the day of the operation.

"On the 2nd of November, Dr. Randolph, in the presence of his colleagues, a very large assemblage of physicians, students of medi- cine, and gentlemen, who had been attracted by the novelty and extreme interest of the case, introduced the brise-pierre articule of M. Jacobson into his bladder, seized and crushed the stone three several times. During the movements of the operator the patient did not exhibit any evidence of pain, and in reply to an inquiry rela- tive to his sufferings, answered that he felt no inconvenience or un- pleasant sensation. He walked from the operating theatre to an adjoining chamber, and about an hour afterwards made use of a warm bath. He expressed great relief from distress and pain, had no chill or fever, and passed his water but once during the night. On the following morning a large quantity of sand and a fragment of some size passed out, and during the day three or four distinct fragments of considerable size passed through the urethra, without pain or incon- venience. The patient, in fact, was unconscious of their passage.

''Nov. 5th. Some difficulty of passing urine arose from a collection of mucus and sand at the neck of the bladder, giving rise to some degree of pain. A chill followed the passage of the agglutinated mass.

"Since that time he has had no pain or other unpleasant symptom. Appetite excel lentj takes exercise in the open air, and is fast regain - ino- streno-th.

*'Nov. lOth. Dr. Randolph sounded the patient with the instrument of M. Jacobson, and detected a small fragment, which he immediately broke, and it passed out in the afternoon. Dr. R. expressed the opinion that it would have passed out in a day or two without assist- ance.

"Discharged, November l6th, 1836, perfectly cured of every symp- tom of stone.

"Upon the third day after the first operation a small piece of wax, about the size of an ordinary buck-shot, passed from the bladder, being evidently the nucleus of the stone, as the larger fragments of the stone which had been passed corresponded to and closely fitted upon its surfaces. The patient could in no manner account for this singu- lar occurrence, having never had any other instrument introduced into his urethra than a metallic sound.

16

Randolph on Lithotripsy,

"I believe no case has ever been recorded in which this usually protracted and painful disease was relieved so fully and unequivocally in a shorter time, but fourteen days having elapsed from the perform- ance of the first operation to the discharge of this patient. Letters from him of a recent date entirely confirm his complete restoration to health and usefulness.

''Case XV. The subject of this case is a member of the medical profession, from a sister states and the existence of disease of the bladder being of long standing, the account of the patient, Dr. Silas Tompkins, of New Bedford, Massachusetts, has been prefixed to the history of the operation, as detailed by himself upon entering the hospital.

'In July of 1832, (he says,) I suffered from an attack of paraplegia, commencing with a sensation of numbness in the left heel, and a par- tial loss of powder over the bladder, so that I w^as obliged to make an eftbrt of from half a minute to a minute before I could command its action. This state did not continue long without an increase of un- favourable symptoms; the sensation of numbness extended up to the knee, and in the course of two or three wrecks my gait became clumsy and staggering. I soon lost the power of retaining or expelling my faeces, and was obliged to have constant recourse to the catheter to evacuate the bladder.

'I continued to walk, or rather hobble about, until September, when I lost all power of motion, and nearly all sensation below the sternum. About the 1st of November a fistula in ano was formed, which discharged copiously and reduced me very much, so that I kept my bed for eight months.

'In June, 1833, I so far regained my health as to retain urine for six or eight hours, and had a moderate command of the rectum.

'In the summer and autumn of 1834, however, it became necessary to introduce a catheter four or five times in the course of a sino-le night, and it w^as about this time that blood was first observed to fol- low a discharge of urine, particularly after exercise in a carriage.

'The first' attack of acute cystitis occurred in June, 1835. Great pain in the region of the bladder, along the course of the urethra: strangury, hemorrhage, &c., accompanied by a good deal of sympa- thetic fever, since which my bladder has never been free from disease, very irritable, sometimes but 20 or 30 minutes elapsing without an involuntary discharge: urine constantly morbid, containing large quantities of mucus, occasionally mixed with blood. Since this period the catheter has been constantly employed; and although but little retentive power remains, there is a slight expulsive power left.

Randolph on Lithotripsy.

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'In the autumn of 1836 I was satisfied, after repeated attempts to detect the presence of stone with a sound, of the existence of a cal- culus of some size in mj bladder, and immediately resolved to submit to lithotripsy; and accordingly wrote to Dr. Randolph in relation to my case, Avho advised my visiting Philadelphia and entering the Pennsylvania Hospital.'

"Such was the brief history given by this gentleman on the 13th of December, 1836, when he first came under my notice as a patient in this institution.

"Doctor Tompkins was sounded by Dr. Randolph on the 15th, and the stone readily found; it appeared to be very large, apparently nearly filling up the bladder. The bladder itself appeared very much thickened and irregular, diminished in size, and communicating to the sound a cellular arrangement, as if bands had been thrown across it, or subdivisions of its cavity had taken place. Upon being irritated it contracted spasmodically, with so much force that it was impossible to turn an instrument in it.

"The patient, it will be remembered, at this time had very little control over the passage of the urine; it generally passed involunta- rily, notwithstanding which, however, it was discharged with consi- derable force, and from this circumstance Dr. R. was induced to hope that the fragments of stone would be passed without much difiiculty.

"On the 21st of December, Dr. Randolph commenced the opera- tion in the presence of a large assembly of professional and other gentlemen, by introducing the hrise-pierre into the bladder, and v/ith- out much difficulty caught and broke the stone twice. After this he was unable to seize the stone, owing, in a great measure, to the vio- lent contraction of the bladder, rendering it almost impossible to ex- pand the blades of the instrument. The patient bore the operation remarkably w^ell, probably owing to the sensibility of the bladder being somewhat diminished. A few hours after the operation he had a chill, followed by fever, which passed off" during the night by per- spiration. The several succeeding days, calculous matter, about the same in quantity as usually follows the first operation under similar circumstances, was discharged with the urine. The stone was soft and evidently a phosphate of lime.

"On the 28th of December the operation was repeated with success, the stone twice broken, and subsequently a great deal of calculous matter with fragments of considerable size have been voided. No chill or other unpleasant symptom followed this operation.

''January 9.nd. The operation was again performed, and upon this occasion a diiTerent form, of the hrise-pierre used. The stone was

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Randolph on Lithotripsy.

readily caught and very satisfactorily crushed twice. No disagree- able effects supervened after this, the third operation upon the stone.

''January 11th. The stone was on this day twice caught and broken, and large fragments passed oft' for several days subsequently.

''January 16th. The instrument was introduced to-day and the same successful results followed. Tlie stone is evidently much re- duced in size. Large quantities of sand and smaller fragments were passed immediately after the operation.

"January 25th. The instrument having been introduced, four or five distinct fragments of calculus of some size, were caught and tho- roughly crushed, a large quantity of calculous matter was extracted between the blades of the instrument, and the patient passed a much larger quantity of stone after this than after either of the former opera- tions,* some hemorrhage took place afterwards, but it soon ceased.

''February 12th. Upon sounding the patient this morning, two or three fragments were discovered at the neck of the bladder, which seemed to lie in cells, or dilated pouches,* one of them indeed, a day or tw'o previous, had passed into the urethra an inch or more in ad- vance of the membranous portion, and gave rise to some irritation and a chill. An eftbrt was made to extract it, but it was found to be so large in size, as to create apprehension lest an attempt to remove it would excite too much irritation, and it was therefore returned to the bladder. Two large fragments were then crushed without the slightest pain or inconvenience to the patient, and a large quantity of fine sand with six or seven fragments of large size passed during the following forty-eight hours.

^'The operation was continued on the 23d and 2rth of February, with similar favourable results.

"On the 9th of March, Dr. Randolph sounded the patient and could find but one small fragment remaining, which he was of opinion would have readily passed had not a little swelling taken place at the mouth of the urethra, thereby somewhat contracting its calibre. This frag- ment was therefore broken, and it passed oft' immediately after the operation. Although this operation did not occupy more than a minute, it occasioned a great deal of pain and some hemorrhage. The patient remarked after the operation, that his urethra had been unusually tender previous to the introduction of the instrument.

"A few days subsequent to this operation, a fragment of calculus made its appearance in the urethra, and Dr. Tompkins being very anxious to get rid of it, very imprudently passed a sound curved at its point, behind it, and in his eff"orts to draw it forward, pushed it through the urethra into the substance of the corpus cavernosum. In

Randolph on Lithotripsy.

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this situation it gave rise to a great deal of swelling and irritation ; finally exciting inflammation and suppuration, and requiring to be extract- ed externally, through an opening made into the abscess by a lancet. A swelling of the testicles, it should also be stated, took place, followed by inflammation and suppuration of the cellular texture of the scrotum. For the relief of this, free incisions were made into the scrotum, through which a large quantity of matter was discharged, the swelling gradually subsided and the Doctor entirely recovered from all these occurrences previous to his leaving the Hospital, which he did about the first of May, perfectly free from every symptom of stone, and able to retain his urine four or five hours without inconvenience. Dr. Tompkins returned home and published an account of his case in the Boston Medical and Surgical Journal, in which he states the fragments "were expelled very readily, till by imprudently attempt- ing to extract some large pieces, I wounded the urethra, producing stricture for a time, which prevented any large fragments from pass- ing out| otherwise I should have been cured much sooner."

Case XN I.— Reported by H. M'Murtrie, M. D. "The first time I was summoned by Mr. Wm. Y. Birch to see him professionally was in 1829. It was at night; his complaint diarrhoea, which yielded in a day or two to the usual remedies. In five or six weeks similar symptoms occurred, and he continued in this way till 1831, complaining of nothing but the singular and apparently periodical loose state of his bowels. About this time the intervals became shorter, so that not a week elapsed but he had an attack; and in the course of a few months scarcely a night passed that he was not compelled to rise five or six times in the course of the night. In this way did the disease continue to harass and debilitate him, wdth occasional but short intervals of relief, until his death, in spite of the various plans of treatment suc- cessively adopted by myself and others. In 1831 he began to exhibit symptoms of dysuria, trifling at first, but soon increasing in frequency. Here, as in the diarrhoea, all attempts to eftect a cure were in vain; and, by the commencement of 1832, 1 had made up my mind that these new symptoms originated from the combined effects of a relaxed state of the sphincter of the bladder and an enlargement of the middle lobe of the prostate. It was about this time that, on his return from a ride into the country with a friend in his carriage, he passed a quantity of bloody urine, w^iich alarmed him excessively, and induced me to suspect there might be a stone in his bladder. Still there was no pain. I closely and repeatedly questioned him on this point; all that he complained of was a sensation, as he described it, in the glans penis. An eminent surgeon of this city was now applied to, who

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Randolph on Lithotripsy.

sounded him with great care twice, at an interval of several days. No stone could be found. Convinced by this that my former opinion was correct, and taking into consideration the age of the patient, at that period 68, 1 confined m j views of treatment to a palliative course, prescribing for symptoms as they arose, and endeavouring to keep up his general health.

"In this state matters continued with but little variation till April, 1836, when he had a chill, followed by high fever, and which for several days threatened to terminate fatally,

*'In the beginning of April, 1837, at his request, I had a consultation with Dr. Randolph on his case, at which it v/as agreed that he should be sounded again by that gentleman. This was done on the 13th, and to my great surprise the instrument struck directly against a calculus, which, from the ring it sent forth, was judged to be a hard one and of tolerable size. The operation of lithotripsy was of course determined on, and accordingly, on the

"in/i .^pril, Dr. Randolph, in presence of Dr. Kirkbride, myself, and a pupil of the operator, introduced the hrise-pierre articule of M. Jacobson without the slightest difficulty, (the bladder of the patient being not very irritable and his urethra large,) seized the stone, and broke it four times. The patient complained but very little, and certainly experienced but very little pain. No constitutional dis- turbance ensued; fragments of the stone, of a red colour, apparently formed of uric acid, came away during the next three days, without any pain, and, in fact, without the knowledge of the patient.

''24th. Dr. Randolpli repeated the operation in my presence, and with similar success; caught the stone and crushed it four times. No constitutional disturbance ensued; and the patient, on rising from his bed, observed ivith a laugh, ''it was all very fine, but he would be very glad to get rid of us. He suffered no pain at all from this opera- tion. Calculous matter, as before, came away during the next three days.

"29th. The operation continued by Dr. Randolph in my presence; the instrument caught the stone without difficulty and crushed it. On this occasion the bladder was much more irritable than at any preceding period, contracting firmly on the brise-pierre, so that the stone was crushed but twice. Several large fragments of the calculus, accompanied by smaller ones, came away in a few hours. In the afternoon the patient had a chill, followed by fever. Ten grains of Dover's powder produced a free perspiration in the course of an hour; the fever left him, and he passed on the whole a comfortable night.

''May 7th. The brise-pierre again introduced by Dr. Randolph in

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my presence. The stone caught and crushed with the greatest faci- lity; frao:ments passed for the next two or three days.

"MaylM. Operation repeated hj Dr. Randolph, yery successfully; the stone caught and crushed four times in two or three minutes. No apparent suffering on the part of the patient. Fragments pass as usual. The outer portions or surface of the stone as smooth as if glazed.

''3Iai/ 21st. Operation continued successfully; stone caught at once and crushed four times. No pain complained of by the patient. Fragments pass away as usual.

"May 9.5th. About midnight Mr. Birch was seized with a spasmodic aSection of the throat, accompanied with considerable difficulty of breathing and total inability to </