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SURGICAL ESSAYS

BARON

D.

J.

LARREY,

\rr
Surgeon in Chief of the Hospital of the Roval Guard: One of the
Health; Pim Surgeon o' the Grind Aimv in Rmjia. Saxony

ancient
an-i

Injectors General on Service of Milltarj

France-

riu.

tog the

ears iBia

1813,

1814;

Ronoiar) Memtrr oi the Council ol Hea.thol ire Amies; Commancei "I the Roy., Order of the la-nion of Honour;
Kniglv of the Imperial Order of the Iron Crown; Member of the Institute of Egypt, of the Koyal Academy 0*
Medicine, &c.

TRANSLATED FROM THE FRENCH,

BY JOHN REVERE,

M. D.

Member of the Royal Physical Society of Edinburgh, &c. &c.

Gen:
*

N. G.

* BALTIMORE:
MAXWELL, 140 MARKET STREET.

1823.

wo
16X3
.

DISTRICT OF MATIYLAND, TO WIT:


REMEMBERED

That on -his tenth Hay of November, b the forty-eighth year of the independence
BE IT
D. of the said District, hath deposited in this oftV* the title of
of the United Stairs oi Ampiic. John Rever ,
a book, the right whereof ne lairm js proprietor, in the words following to wit-

Essavs by Baron D, J. Larr^v Surgeon in Chief o( the Hospital of the Rovai Guard; One of the ancient
Inspectors General on Service o f Mill tan Health) First Surgeon of thr GrinrJ Arrtu n Russia, Saxooy, and Fiance,
ihe Aimi' J-, Ccinn andri ol tj
u % al
Hopo. -i Ivien.bei of ihi Colo il o< Pi >i
dunng the years 1-12, 1813,
Order 01 the Lrgion of Honour; Knight of the Imperial Order o' the Iron Cio* d: Memi ei "' the Institute Oi Fgvpt.'of
Men.ler oi ihr Ko>. PhyTranslaten Irom the French, by John Revere,
the Roy*; Academy of Medicine &c

"Surgica

18U

M D

sical Society of

Edinburgn

fitc.

'

&c."

In conformity with the Act of the Congress o the United States, entitled, "An Act tor the encouragement ol 1- rr-ng,
by securing the copies of mips, charts, and boons, to the jutrmn ,od proprietors of such copies, during the rimes
"An Act Supplement ir to the Act, entitled *An Act for the
therein mentioned:*' -wid ^l-t fo the Act, ttiiitlpd
an'i books, to
encouragement ol fearninc, by seci. nng the copies o' maps, cnarts
thr auth >r* nod propi leturs of
such copies, curing the times therein mentioned/ and extending the benefits thereof to the iris of desiffnirtR engraving,

and etching, historical and other prints."

PHILIP MOORE,
Clerk oj the District oj

JOHN

P. TOT,

PU13TEH

Maryland.

TO

DAVIDGE,

B.

J.

M. D.

Professor of Anatomy in the University of Maryland, &c. &c.

Sir,

You have

the peculiar happiness of heing

one of the founders of an institution, which, in

your
self

own

time, and

the exertions of your-

and colleagues, has risen to a rank not

inferior to that of

our country.
a

hy

work on

which you

that

any School of Medicine in

know

of no person to

whom

department of the profession

teach,

and

to

which your

talents

have heen so successfully directed, can with

more propriety he
It

is

this

inscribed than

yourself.
I

take

opportunity of publickly testifying

my

with great pleasure, therefore, that

respect for your person and attainments.


J.

REVERE.

ADVERTISEMENT.

Tt

will

following

be recollected, that the author of the

work was one of the favourite surgeons

Emperor

of the late

panied

in all

of France;

whom

he accom-

military expeditions.

his

He

has

given a very detailed account of the medical de-

partment of the armies engaged


tions, in his

work

entitled,

Surgery and Campaigns."

umes

of this work,

all at

in

these opera-

"Memoirs

The

of Military

three

first

that time published,

vol-

were

translated by Professor Hall, of the University of

Maryland,

in

1815.

Since that time, the author

has published a fourth

volume,

containing

the

campaigns of Moscow and Paris, &c; which has


not yet been translated.

This work

is

not exclu-

sively professional, but contains also

some very

curious

movements

information

of the armies, &c.

respecting

the

ADVERTISEMENT.

VI

1821, the author published

In

the following

"Surgical Essays," which contain the results of

and experience on some

his observations

esting points of surgery,


in the

"Campaigns.'

To

inter-

more generally noticed


this collection

have

added another essay, that on wounds of the bladder,

extracted

from

the

fourth volume

of

the

Campaigns.
have entitled

for

two reasons;

this

work "Surgical Essays,"

first, because the

term essay,

is

nearly equivalent to the French word memoire;

and second, because the "Campaigns" are generally

known

in this

country by the

title

of

"Me-

moirs," &c.

TRANSLATOR.

CONTENTS.

Preface

-----ESSAY

Page.

I.

....

Of the Use of Moxa,

17

In affections of Vision

28

In affections of the sense of Smell

31
ib.

In affections of Taste,
In diseases of Hearing, Voice, and Speech,

ib.

-----------

In spasmodic affections of the Muscular System^

In Paralysis,

In Organic diseases,

37
-

In diseases of the Chest,


In Consumption,

Viscera,

80

1st,

Case 2d,

Case 3d,

82.

...--.
...

88

------

97

Case 5th,

Case 6th,

90

Case 8th,
-

98

99

Case 7th,

9th,

89

93

Case 4th,

Case

60

Abdominal

Rachialgia,

Case

50

57

-------74

Chronic and organic diseases of the

Rachitis,

33

104
110

CONTENTS.

Viii

Sacro-Coxalgia,

Femoro-Coxalgia,

Case

-114

H&

135

1st,

Case 2d,

139

Case 3d,

140

Case 4th,

142

Case 5th,

143

Case 6th,

146

Case 7th,

147

ESSAY

II.

On the Seat and Effects of Nostalgia; with


some

reflections on partial lesions of the brain, re-

sulting from spontaneous or mechanical causes,

ESSAY

153

III.

Remarks on the Properties of the

ESSAY

Iris,

207

IV.

Some Observations on Wounds of the Intestines,


followed by a remarkable case of this sort of lesion, 227

ESSAY

V.

On Fractures of the Neck of the Femur,


lowed by some

in fractures in general,

of

247

ESSAY
On Wounds

fol-

reflections on the formation of callus

VI.

the Bladder, and upon

foreign bodies remaining in that viscus,

certain
-

.f-

280

PREFACE.

ince the publication of the

Campaigns,

last

volume of

my

have occupied myself, as circum-

stances have permitted, in confirming, by a series

and cases collected

of researches

the surgical direction of which


care,

some maxims that

is

lume.

confided to

had merely pointed out

little

me

to

be

useful

to publish the present collection.

Essays or Notices,

It consists of

known, and

in the fourth vo-

This motive and a desire

have induced

my

had proposed for the

treatment of certain diseases but


that

the hospital

in

in

which are

contained the results of these researches, and the


cases on which they are founded.

The

of

first

the history of

these Essays has for

Moxa, and

its

mode

its

object

of application.

PREFACE.

This heroic remedy, which has frequently

my

tuted the subject of

gery

consti-

Clinical Lectures on Sur-

the Hospital of the Guard, has particu-

at

larly attracted the attention of the foreign physi-

who have been

cians

these lectures.

dence they

at

the habit of attending

in

Notwithstanding the
first

felt

in

remedy, they have yielded


favour of
of

it,

it,

the
to

efficacy

of the

the evidence

in

and at present not only speak well

but have generally adopted

method of

little confi-

it

as the

best

treating several chronic affections re-

puted incurable; as diseases of the spine and hip

pulmonary consumptions, and schirrhus of

joint,

the pylorus, &c.

The

my Cam-

publication of three volumes of

paigns, in

1812, the

first

of which contained a

plate representing the instruments used in this

operation, had already excited the attention of


practitioners to this remedy.

Since that period,

the memoir, accompanied with plates, inserted in


the fourth volume of the same work, published in

January, 1817, as well as the article

Moxa,

in

the Dictionary of the Medical Sciences, vol. xxxiv.

have extended
and

employment over

all

Europe,

have had long since the satisfaction of learn-

ing, that

from

its

it

many

foreign physicians have obtained

unexpected success.

PREFACE.
It is desirable that in

repugnance

in

XI

France there should be

less

using this cautery, unquestionably-

less severe than that of Pott, (the caustic potash,)

much

the pains of which, though less vivid, are

more

intolerable, from their being so

The

prolonged.

moxa

effects of the

more favourable,

as

think

much more

are also

much

have demonstrated;

and, although the cautery of Pott be

by many celebrated surgeons, yet

still

preferred

have good

reasons to hope that the cases spread through


these works, and the experience of those physi-

who

cians

actually

employ the moxa,

minds, and dissipate

all

exist against the

will

convince

prejudices which

all

employment

of this

still

mode

of cau-

have

collect-

terisation.

Since the printing of this Essay,

ed a considerable number of

One

of

my

colleagues will

make known,

keen under treatment

in

name

my ward

assertions.*

in detail,

of Lemaire.

for a

third stage, in consequence of a slight

which confirm

facts

more and more the truth of my

dier in the horse guard, by the

the ease of a grena-

This young man has

pulmonary consumption

wound; twenty-live to

and an emollient regimen, have conducted

this patient to a

thirty

in

the

moxas,

cure so perfect

that he has regained his usual flesh.

Doctor Chardel

will

no doubt publish also the case of a patient affected

with tic-doloureux of the face, extremely violent, and against which


the usual methods had been unsuccessfully employed.

ThirLy-five

caused

,the subject of

case,

is

this disease to disappear,

now

perfectly well.

and

Madame

de

(J

all

mo\as
this

PREFACE.

Xll

myself but

have allowed

speaking of the diseases against which

moxa with

ployed the

fine myself, as

ing of the

much

have emto con-

as possible, to the strict

of this work, I

title

Wishing

success.

in

latitude

little

mean-

have preferred

to

leave to physicians themselves the task of explaining,

more

length, the effects

at

remedy which

of this

have recommended.

topical

take

I will

the liberty on the present occasion to remark, that

there are very few dangerous diseases which can

be treated, with any certainty of success, without


the assistance of surgery, which I will call, with

Marcus Aurelius Severinus, and many other

cele-

brated physicians, the efficient medicine.


I

have presented

of the researches

in the

second essay the result

have been long engaged

the seat and effects of

diseases

certain

in,

on

of the

brain, as Nostalgia, as well as the causes of the


different

symptoms which characterise wounds

in different parts of this

this essay

appears

to

me

to

tion on the part of the reader.

constitute a

indicate the

merit some

The

cases,

atten-

which

part of this essay, are authentic

unquestionable;
ing light on

In this respect,

organ.

all

think they

may

assist in

and

throw-

the diseases of the encephalon, and

mode

of treatment the most appro-

PREFACE.

Some

priate in each.

Xlll

of these cases will be found

particularly interesting.

The

third essay, or rather notice, of the pro-

perties of the
I

iris, is

first

who

oculists

Suciete Philo-

in 1817, to the

communicated

matique.*

a development of that which

believe myself to have been the

attracted the attention of anatomists and


to

membrane.

the

independent

The

properties

subjects of the cases

tablish the truth of this opinion,

sented to the Medical Societies.


if it

of this

which

es-

have been preThis discovery,

be not of very great importance, at least

enables us to understand the true cause of the

motions of the pupil, and the nature of the morbid


aberrations which the

iris

may undergo, and throws


some complicated

light on the diagnosis of

dis-

eases of the eyes, which discourage the patient,

and cause the greatest uneasiness


I

have also included

in

this

to the physician.

collection

some

other essays already inserted in medical journals;


I

have thought that their

re- publication in

this

volume would render them more accessible

to

young physicians.

The

first

treats on

lesion of the intestines.

wounds of the
This subject

belly,
is

with

almost

* liulleiins de la Society Philomatique, year 1817, page 134.

PREFACE.

X1T

The

new, and merits particular attention.


tions

which accompany the

may be

ported

facts

that

useful to practitioners,

reflec-

have

and

fix

re-

their

opinions on the means to be employed in analo-

gous cases.

The

second relates to fractures of the neck of

the femur.

This accident, too frequently, leaves

who have

those

less serious;

suffered

it

infirmities,

more or

such as anchylosis of the articulation,

crookedness of the limb, with difficulty in moving


a false articulation in the place of the fracture,

it,

The apparatus

with incapacity of walking safely.


for

permanent extension, which many surgeons

still

employ, often produces chronic ulcers

in dif-

ferent parts of the limb; other practitioners leave


it

entirely

to

itself.

These two extremes are

equally injurious.

The method
subject

may

that I have long

to either of these

affirm

that

it

employed

is

not

inconveniences, and

has the double advantage of

attaining both the objects above proposed without

causing any accident, and of favouring the consolidation of the bone, according to the indication of
nature.

The
method,

apparatus which forms the basis of this


is

simple and easy of application.

be employed, with the necessary

It

may

modifications,

PREFACE.

XV

for fractures of the superior, as well as the infe-

rior extremities,

whether they be simple or com-

pound.

Such

is

the result of

experiments;

my

latest researches

shall be satisfied if this

and

new work

should contribute to the progress of surgery, and


,

give

me

a stronger

Paris, 1821.

title to

public esteem.

LARREY'S

SURGICAL, ESSAYS.

ESSAY

I.

OF THE USE OF MOXA.

During my

campaigns

in

North America,

Egypt, and Syria, having witnessed the truth of

what has been asserted by

travellers

and authors,

of the great benefits which the people of these

countries derive from the use of

morbid
every

affections, I

suitable

was induced

occasion,

moxa
to

in

many

seize

upon

which offered

in

my

practice, to try this remedy.

After having reflected well upon the nature of


the diseases which appeared to

me

to indicate its

application, I attentively observed the effects of


this cautery,

in its

mode

of action,

both

when

applied according to the method of the ancients^

THE USE OF MOXA.

18

and with the modifications that


made.

have also examined

the traces of impressions

when

it

left

have myself

dead body

in the

by

cautery,

this

has been found insufficient to restore the

equilibrium of the system, from the too advanced


state of the disease.

The

fortunate and

tained from

its

extraordinary results, ob-

application, in a great

desperate cases, have induced

me

to

the article devoted to

this essay,

it

number of

develope in

tiovnaire des Sciences Jledicales, which


cessarily very short.

undertaking

this

public,

fatal

prejudice against this

who have

bitants of Asia

not only for

and Africa have eulogized moxa,

its

power

in

many

curing

diseases

resist other remedies, but also for its pro-

phylactic effects.
ful

not

to practice in large hospitals.

without good grounds, that the inha-

It is not

which

ne-

be found useless to the

remedy, nor to those physicians

had an opportunity

is

cannot but believe that

will not

imbued with a

Dic-

in the

The

reputation of this power-

agent would undoubtedly have continued in

Europe,

if,

as in

China and Egypt,

applied with proper precautions.

it

It

had been
is

by re-

turning to the simplicity and perfection of this


first

mode

in deriving

of application, that

from

it

all

have succeeded

the advantages, which

THE USE OF MOXA.


the ancients discovered

19

to possess,

it

and in

re-

moving those objections which have been justly

made

to

it,

when

has not been applied with

it

the necessary precautions.

In the description

am

about to give of this

cautery, I shall endeavour to occupy the attention of the reader, in demonstrating its efficacy
in all the

above described cases.

inquire into

to
lost

in

the

which seems

origin,

its

night of

not stop

I shall

ages,

nor on

to

be

various

its

forms or modes of application among the different


people

who have used

minutely related,

it.

These circumstances,

may be found

in

the Diction-

naire, before mentioned, under the article

moxi-

bustion, by the celebrated Percy.

moxa, as used by my-

I will first describe the


self.

shall afterwards point

application; the regions

body on which

it

out

its

mode

of

and points of the human

should be placed.

shall af-

terwards make known the specific properties of

moxa, and

its

general effects at the time of

its

application; I shall retrace, succinctly, the maladies against

which

have employed the remedy

with success, analyzing, as far as possible,


particular effects in each.

some appropriate

cases,

Lastly,

which

in the course of a practice of

I shall

its

relate

have collected

more than thirty

THE USE OF MOXA.

SO

years; after which I think

it

be doubted,

will not

that the profession might derive great advantages

from

this cautery, if it

The

were more used.

composed of a

core, or cylinder of raoxa is

suitable quantity of carded cotton, rolled up,

sewed

and

This cylin-

in small pieces of fine linen.

der should be about an inch long, and of suitable


thickness;

its

size,

however,

An

to circumstances.

may vary according

instrument for applying

it,

which may be called a porte-mxa, represented


in the plate,

is

intended to

the cylinder on

fix

the point, where the application

The
from

metallic ring

the porte-moxa,

of

the skin by three ebony

bad conductors

of

caloric.

balls,

tion, as it

To
a

in the

same

ought to proceed slowly.

ink, the point

be made.

the

not necessary to hasten the combus-

apply the moxa well, we mark at

little

kept

kept up by

is

means of a blow pipe, represented


It is

is

which are

After lighting

apex of the cone, the combustion

plate.

be made.

to

is

first,

where the application

The surrounding

with
is to

parts should be co-

vered with a wet cloth, leaving the point marked


alone

exposed;

this

protects

the

neighbouring

parts from the contact of the sparks.

plying the

fire to

the apex of the moxa,

to be fixed on the point

marked

out,

After apit is

then

and by means

THE USE OF MOXA.


of the porte-moxa, retained in

21

its situation,

with the blow pipe, the combustion


until the

whole

is

To

consumed.

and

would be the

result, it is necessary

afterwards

to

to

immediately

we

of the body; but

should except, in the

that portion of the cranium,

think with

which

actual cautery, are felt too directly

which dangerous accidents may


which there are many examples.

Here

We

the

itself;

from

result,

and of

Dehaen

relates

two cases which prove the danger of

2.

only

by the cere-

membranes, or even the brain

upon

is

moxa, and especially those of the

effects of the

tion

place,

first

covered by the skin and pericranium.

bral

alkali.

some authors, we may apply the

moxa on any part

all

which

suppuration,

apply on the point, the volatile

According

others, that

kept up,

prevent deep

inflammation

profuse

is

while,

its

applica-

this region.*

should not apply

nose, nor ears;

we

it

on the eye-lids,

should also avoid

its

applica-

tion over the course of the larynx, trachea, ster-

num, mammae,
tion,

linea alba,

except upon the

and organs of generaperineum, towards

origin of the urethra, for scirrhus,

the

and chronic

engorgements of these parts, especially the prostate.


* See vol.

ii.

of the posthumous works of Pouteau, p. 44.

THE USE OP MOXA.

22

We

3.

should also abstain from the application

of every kind of cautery in the course of the

and those parts of the

superficial tendons,

where we have reason

to fear interfering

joints,

with the

capsular ligaments.

The

moxa are

the

of

effects

different

from

those of the metallic cautery, which appear to be


limited to the point immediately touched

The

fire.

by the

part becomes disorganized, in a great-

and

er or less degree, in proportion to the volume

thickness

which

it

of
is

and the

cautery,

the

applied.

It is

force

with

accompanied with a

vivid and sharp pain, that the patient supports

with

difficulty,

and

sometimes followed by a

is

destruction of the subcutaneous

very copious suppuration.


burns slowly,
is

to

me

to

and a

But the moxa, which

alarming to the patient, and

is less

more gradual.

nerves,

This remedy has

communicate

to the

also

appeared

surrounding parts,

together with a relative mass of caloric, a very


active and volatile

principle, furnished

cotton-like substances during combustion.

excitation and irritation,

by the

The

which result from the

two products, increased by blowing, propagate


themselves, by degrees, to the deep seated parts,
so as

to re-establish

the

action of

the nerves

which have become weakened or paralysed, and

THE USE OF MOXA.


to arrest the progress of the

lished in certain parts.

This

the method of

is

wish to obtain

moxa, we have only

to

burn, without using the blow pipe.

to

it

morbid cause estab-

When we

superficial effects from the


suffer

23

my

honourable colleague,

Baron Percy.
I

endeavour

shall

to explain

moxa, when

effects of the

of those diseases, in which

During

indicated.

marked, that the

its

first

the stimulating-

speak of the causes

it

appears

application,

to
I

me

to

be

have re-

degree of heat causes to

the patient rather an agreeable, than a painful


sensation;

this is

gradually increased, until the

pain becomes extremely acute.


ever, supports

prepared
the

first

stant,

for

it

it,

the

The

howmore courageously, as he is
patient,

and knows, by experience, after

application, that

it is

removed

in

an

in-

by the application of the Aq. Ammon.

The number

of

moxas

will

necessarily vary,

We

according to the duration of the disease.

may apply

one or two moxas at a time; but

it is

necessary to leave an interval of several days be-

tween each application; because the internal


fects of

one or two moxas, at most, are equal to

those of a great number, applied at the


instant,

number

ef-

upon the same region.

same

But a greater

at one time, would not be merely useless;

THE USE OF MOXA.

they would have the additional inconvenience of


causing to the patient very severe pains, which

he could not support, and of producing, at the

same time, from the number of eschars, a very


copious suppuration, which might be followed by

One or two ap-

traumatic fever and exhaustion.


plications at a time

quite

sufficient.

phere
L

is

may, therefore, be considered

humid

state

of

atmos-

the

not so favourable to the success of the

remedy, as clear and dry weather, which should

To

be always preferred for this operation.

favour

or assist the efficacious effects of this remedy, in

many

cases,

it is

proper

to

precede

by dry or wet cupping; and

either

its

application

to follow it

the internal exhibition of suitable remedies.

As

a powerful auxiliary of moxa, and as

cupping

is

there

considerable analogy between

is

by

its

revul-

sive effects, and those of the cautery, I shall take

the liberty, before proceeding farther, to

make a

short digression on this subject.

The
sel,

instrument used for this purpose,

either of glass,

is

a ves-

or some other transparent

substance, as horn, of a pyramidal or bell shape,

intended

to

produce a vacuum on part of the

surface of the body,

This

is

where

it

may be

applied.

sometimes effected by an air pump, fitted

to the cup,

and

at others,

by a combustible sub-

THE USE OF MOXA.


stance burnt in

Our

application.

medy,

is

to

it,

at the

%5

moment preceding

its

object in using this topical re-

produce a relative revulsion

in

the

part affected, from the interior towards the exte-

with or without blood-letting, according to

rior,

circumstances.

conceive that, to

cation, as fully as possible, the

fulfil this

indi-

vacuum should be

produced by means of a combustible substance,

which has the

effect of rarefying, or

diminishing

the air contained in the cup, and producing, at the


time, a relative mass of caloric, which

same
apply

itse'f to

the skin and penetrate

without, however, burning the part.

may

its tissue,

Thus, the

organic, capillary vessels of this covering, after

being swelled by the expansion of the aeriform


fluids

that they

com-

contain, being no longer

pressed by the external air which has been re-

moved from,
become

or considerably rarefied, in the cup,

slightly inflamed

by the contact of the ca-

loric

evolved during the combustion, employed for

this

purpose,

The

pelas.

which causes an
most

simple,

artificial

prompt,

erysi-

and

painful process, for obtaining these results,

use a

common cupping

tow has been burnt,

We

may

glass, in

in the

which a

least
is to

little fine

bottom of the vessel.

increase the quantity of caloric, and the

action of the cupping glass, by pouring upon the

THE USE OF MOXA.

26

tow a few drops of

alcohol,

this is particularly

necessary in dry cupping.

Cupping with

the air

same advantages;

the

nience arising from

its

pump

does not possess

besides

for,

the inconve-

weight, and that of having

a large number of cups, of different sizes, fitted

with brass tubes, so that the cylinder of the

may

be adapted to them,

pump

has also the objection

it

of removing, with the air, the heat of the part,

and of producing there a relative degree of cold;


in

fact,

We

the temperature

is

sensibly diminished.

obtain thus, but a simple swelling of that porof

tion

the cutis

included

within

the

cupping

glass, with but little redness, so that the deriva-

tion

nearly nothing.

is

pelled to scarify,

We

more or

are sometimes com-

less

deeply, to obtain

a sufficient quantity of blood; this kind of solution of continuity is not

without

its

inconveniences.

Sometimes filaments of the subcutaneous nerves


are wounded, from which nervous symptoms result;

sometimes small

branches of arteries are

divided, which produce hemorrhages difficult to


stop, of

which

veniences

are

have seen instances; these inconalways

attached

to

instruments

which we have not completely under the com-

mand

of the will.

But the

scarificator that I

THE USE OF MOXA.

which was invented by myself,* makes the

use,

scarifications

wish.

These

as

superficial, or

almost as

German

ence: those

made by my

as

scarificator,

and more uniform.

deep as we
all

the sur-

and are made with

much promptitude

English or

as

embrace

scarifications

face included within the cup,

ful

27

those with

with this

differ-

scarificator are less pain-

In

a word, experience

has proved to me, that this mode of cupping


best,

the

and most convenient.

It contributes

is

the

much,

with the moxas, towards the cure of those patients


for

whom

remedy

this last

is

indicated.

It.

is

es-

pecially convenient in every kind of phlegmasia,

and there can be no comparison made between

it

and leeches.
I will

method
is

now

retrace succinctly, and with as

as possible, the diseases

indicated; and

will

where the moxa

make known

the modifi-

cations, that one ought to observe in its

application, in each.

I shall

much

mode

of

begin with the dis-

eases of the organs of sensation, and successively

describe those where this cautery

ployed with advantage.


*

kind of fleam.

may

be em-

THE USE OF MOXA.

28

In Affections of Vision.

The

imperfect action of the membranes com-

posing the globe of the eye, incipient cataract,

and recent weakness or paralysis of the optic


nerves, truly indicate the application of moxa.

should

be

made

in

It

the course of the nerves most

intimately connected with those of the eye, such

and principal branches of the

as the trunk

facial,

those of the superior maxillary, and of tne frontal.

The

imparted

excitation

branches, propagates

itself,

to

these nervous

successively, and ex-

tends, at last, to those affected with

morbid condition of which


and the

vital

is

gradually dissipated,

properties of the diseased organs

restored in the same proportion.

property of the moxa, which


cious,

may

disease; the

be added,

if

we

is

To

the exciting

the most effica-

wish, the revulsive

and derivative property produced by the suppuration of the cauterized part,


to take place.

where

it

is

useless, or

It is

when we

suffer this

easy to distinguish the cases

necessary, from those in which

even injurious.

By

this

it

is

remedy,

have particularly stopped the progress of amaurosis,

and have caused

stances,

it

to

disappear, in some in-

where the blindness was complete; several

THE USE OF MOXA.


may

instances of this

of

my

be found

29
the history

in

campaigns; but that of the

English

little

boy, related in the third volume of those memoirs,

being the most remarkable,


of

give a

summary

it.

This blindness, according


to

I will

me by

to the

statement given

the father of the child, had seized him

suddenly

the Asturias, in Spain, during the

in

severe cold of winter, to which he was exposed.

This cold had, necessarily, produced upon him

more

eifects the

cut very short,

from Corunna

injurious, as his hair

had been

and he had travelled bare-foot

There was no doubt,

to Valladolid.

in this case, of the existence of amaurosis;

motion of the
be

difficult to

father of

iris,

however, remained.

would

give an adequate description of the

this child,

army, and

It

the

his

deep

condition of his son.


I conceived the

a corporal in the English


affliction

As

at the unfortunate

the blindness

hope of curing

was

recent,

this little patient,

otherwise very interesting.

After placing him with his father, in the best

ward of the

hospital,

be washed carefully

and having ordered him

to

in soap-suds, I directed the

exhibition of some diaphoretic bitters, and applied

the

moxa over

the course of the facial nerve, be-

hind the angle of the jaw.

The head was

well

THE USE OF MOXA.

30

rubbed with camphorated liniment, and, immediately afterwards, carefully covered

woollen night cap.

At

the moxa, the child

saw the

up with a

the second application of


light; at the fourth,

he distinguished objects and colours; after the


seventh, the function -of vision

was completely

restored.

When, with

the paralytic affection of the parts

of the eye, which

we have

pointed out, there are

joined symptoms of plethora in the vessels of the


parts diseased,
plication of the

it is

necessary to precede the ap-

moxa, by scarifying and cutting

the temples, nape of the neck, or shoulders, and


to take blood, if necessary,

or temporal artery.

from the jugular vein,

Leeches, without possessing

the advantages of cupping, are inconvenient, and,


especially,

when applied near

ecchymosis, which increases

the atony and

gorgement of the conjunctiva.

moxas must be

vulsives,

We

en-

The number

in proportion to the duration

severity of the disease.


fects of this

the eye, produce

may

assist

of

and

the ef-

remedy by aromatic fumigations,

re-

dry or humid, directed upon the eyes,

light alcoholic,

camphorated embrocations upon

the eye-lids, by the internal use of calomel, alone


or combined with other substances, according to

circumstances, and

by

electric

sparks directed

THE USE OF MOXA.

31

upon the upper eye-lid, where the moxa cannot


be applied,

In
I

of

if it

be paralysed.

affections of the sense of Smell.

have obtained no success from the application


moxa, with those persons who have

sense of smell.

lost

the

appears that the particular

It

modifications that the olfactory nerves undergo, in

the pituitary membrane, for receiving the impression of odours, render the nervous tissue of this

membrane

moxa.

of

effects

remedy

inaccessible to the exciting and electric

is

therefore,

that the

useless in this affection.

In

affections of Taste.

The same remarks


taste; I

think,

will

apply

to the sense of

have learnt from experience, that moxa

has no effect upon this sense.

In diseases of Hearing, Voice, and Speech.

When

deafness

is

the result of the impression

of a sedative, stupifying cause, as cold, applied

suddenly

humid

to the ear, or the influence of a current of

air directed

upon

this part, the

moxa,

if

ap-

plied over the course of the branches of the facial

THE USE OF MOXA.

32

nerve, and about the auditory opening, restores

The

the function of hearing.

calorific excitation

communicates the more readily

of this cautery

with the auditory nerve, as

it

has intimate anas-

tomoses with the small sympathetic; this remedy

cannot be supplied by a vesicatory.


late a great

number of cures

might re-

of deafness, in the

above described cases, from the employment of

moxa;

however, confine myself

shall,

to

the

concise exposition of a few.

young trumpeter of the ea?-horse guard,

af-

ter having imprudently bathed in the Seine, while


in a profuse

perspiration,

was suddenly deprived

of his voice, and the

power of hearing even the

The

nature of these infirmities

loudest sounds.

were, at

first,

mistaken, and were treated as

The

feigned.

however, was carried

patient,

if

to

the Hospital of Gros-Caillou, and placed under

my

care.

After having applied

scarification, to the nape,

and sides of the neck,

and between the shoulders,

moxas over the course

sounds,

and

seventh and
restored,

and

applied a series of

of the principal branches

of the nerves above indicated.


plication, the

At

young patient began


to

articulate

ninth, the

the

cupping with

the third apto

hear acute

some words;

articulation

hearing

perfect;

at

the

was nearly
after

the

THE USE OF MOXA.


thirteenth application,

back

to his

trumpeter was sent

regiment perfectly cured.

have obtained the same success with other

young

my

the

33

subjects, the cases of

campaigns, in

whom

which are related in

and hearing

loss of voice

had been produced by causes analogous

to those

which had acted upon the trumpeter.

In Spasmodic
I shall

moxa

in

affections of the

now proceed
paralytic

to

Muscular System.

relate

affections

the effects of

of the

system, with, or without neuralgia.


the

locomotive

I begin

with

first lesion.

When

convulsive and habitual motions of cer-

tain muscles

(which characterise

tic

douloureux)

have become chronic, whatever may be the cause;


or are the result of a mechanical cause, which

weakens the
the

moxa

is

tissue of the nerves of the muscles,

perfectly indicated: but

it

should be

applied as near as possible to the seat of the disease,

The

and upon the course of the injured nerves.


lesion consists in the chronic

engorgement and

inflammation of the membrane which invests the

nerves of the part affected, (nevrileme.)

This

remedy, by producing an excitation upon these


organs, causes a salutary derivation of the morbid

THE USE OF MOXA.

34

and re-establishes the course of the

principle,

nervous
It is

fluid.

not equally indicated in acute neuralgia,

proceeding from spontaneous causes, nor


tanic affections, because
tion

and tetanus.

it

augments the

have employed

effect, in this last disease.

I will

cases which, incontrovertibly,

moxa

in chronic tic

ed by almost

young

all

in

blow with a

irrita-

without,

relate

some

shew the success of

doloureux. a disease consider-

physicians as incurable.

tic

was sent

Caillou,

now

te-

soldier of the firimperial guard, at-

tacked with a
face,

it,

in

doloureux of the

to

left

side of the

the military hospital of Gros-

1811, six months after receiving a


foil

on that side of his face, on the

os malai, and over the course of the sub-orbitar

nerve.

This disease had resisted the application

of leeches,

alkaline

liniments,

and vesicatories,

which had been placed on the temple, and behind


the ear of the same side.

Six moxas applied

over the course of the sub-orbitar, and corresponding branches of the facial nerve, entirely removed
the involuntary and convulsive contractions, which

the patient had almost continually experienced in


the region affected.

Madame
with a

tie

D***

was

afflicted for

many years

doloureux, which began before the

THE USE OF MOXA.


and extended

right ear,

itself in

following the direction of

36

diverging rays,

the branches

of

the

temporal nerve, towards the upper part of the


forehead, and to the eye-lids of the corresponding

The paroxysms were

eye.

They were

violent.

periodical, but very

followed by head-ache, vio-

lent palpitations of the heart, oppression, nervous

spasms, and extreme coldness in the extremities.

The

convulsive contractions of the muscles of the

eye-lids, caused the eye to be closed up,


tirely

deprived the patient of sight, during the

She had vainly

paroxysm.

and

and en-

in Paris, a great

tried, in the country

number

of remedies,

more

or less extolled.

Having seen
I

this

lady in one of the paroxysms,

examined attentively the parts

affected,

made myself acquainted with every

and

thing which

could throw light on the causes and progress of

The

the disease.

principal temporal branches of

the facial nervs, could be traced by a practiced


finger,

resembling in form and

violin cords.

The

hardness, small

slightest pressure

made upon

these cords, caused a very acute pain to the patient.

This neuralgia was complicated with the

lesion of the greater part of the organs of inter-

nal

life;

I,

indications

at first, devoted

which these

my

attention to the

different alterations de-

THE USE OF MOXA.

36

manded, and when

thought

principal

applied

disease,

had insulated the

the

Three

moxa.

small cylinders were successively applied over the

course of the trunk, and principal branches, of the

and

nerve,

facial

six

Chinese moxas over the

branches, or cords, which

we have above pointed

Each application was followed by a sensible

out.

amelioration, and

all

the nervous

symptoms had

entirely disappeared before the ninth.

has returned, perfectly cured,

to

This lady

her usual resi-

dence, in one of the departments of the North,

where she enjoys

second patient,

Madame

de

years with a

at a

more advanced age,

* * *, had been affected for

doloureux of the

tic

left

many

side of the

with an incipient hemiplegia of the same

face,

side, the

larly

perfect health.

symptoms of which were, more particu-

manifest during the paroxysm of the neu-

ralgia.

great number of

remedies had been

unsuccessfully tried.

In this lady, as in the instance above related,


I preceded the
tions,

moxa by cupping with

and other means indicated.

She

scarifica-

also un-

derwent a suitable treatment for removing the

morbid cause of the neuralgia, without which the


cure could not have been perfected, and which

was continued

for

a long time after the moxas, the

THE USE OF MOXA.


number of which, great and

To my
now

37
was eleven.

small,

great and agreeable surprise, this lady

This was one of the

enjoys perfect health.

severest cases I have ever seen.

In Paralysis.
Paralysis, properly so called, varies much, both

and extent;

in degree

it

is

sometimes limited

an atony of the locomotive powers, without a

to

loss

of animal sensibility; in some very rare instances,


this last faculty is entirely lost, while the contractility

of the muscles remains perfect; or these two

properties are both affected, at the same time,

which constitutes complete paralysis.

We

often

find, also, that paralytic affections of the muscles

are accompanied with an increase in the animal


sensibility,

and these are characterized by pain,

with unnatural, and involuntary motions in the


affected

member.

In the

first instances,

appeared

to

me

the morbid principle has

to carry its effects to the sub-

stance of those portions of the encephalon from

which the

nerves of locomotion, or of animal

sensibility, arise, or to

their

own

texture.

nervous substance, once attacked by

The

this morbific

principle^ after having undergone changes propor-

THE USE OF MOXA.

38

tioned to the duration of the disease, finishes

by

falling into a state of atrophy, losing its vital pro-

In the dissections that

perties.

who had been long

persons
I

have made of

affected with paralysis,

have found the nerves of the paralyzed side much

smaller than those of the sound members, and destitute of

any shining appearance, with the charac-

ters of atrophy.

The

last affection,

doloureux,

I shall

having some

cess I have obtained with

moxa

remark, that the alteration


stance,

is

affinity

with tic

commence by shewing the


in

it.

in the

suc-

may here

nervous sub-

combined with a kind of phlegmasia,

which attacks the sheath of the nerves, or the cerebral or spinal membranes, which produces, to-

gether with a loss of power in the motions, a comparative neuralgia.

Nor

a less efficacious remedy;

in this case is the


it

acts in

moxa

two ways, by

producing an excitement in the debilitated tissue


of the medulla of the nerves affected, adapted to

restore the nervous fluid; and, by the suppuration


of the eschars of the moxa,
sion of the phlegmasia.

which causes a revul-

This suppuration

is

not

necessary in a simple paralysis, without neuralgia.

But

in the first instance,

gia)

it is

(where there

is

neural-

necessary to allow suppuration to take

place in the eschars of the moxa, and, for the most

THE USE OP
part,

it

is

39

]V%OXA.

indispensable to precede

by cupping, with scarifications,

application

its

made

my me-

in

thod, over the course of the diseased pare.

Mr. P * *
afflicted

his

*, an advocate of Paris,

had been

by a gradual wasting of

for three years

strength from a paraplegia, with neuralgia,

marked by an

inability of standing or walking,

nearly constant, trembling of the

violent pains,

lower extremities, emaciation, insomnia, and ex-

treme

irascibility.

All the usual methods in such

cases had been tried in vain.

The mix vomica,

which had been prescribed, only aggravated the


without increasing, at

neuralgia,

power

all,

the tonic

of the muscles.*

After having applied several series of cuppings,


at suitable distances, over the

lumbar region, and

in the course of the principal nerves of the lower

extremities,

began the application of moxa, two

at a time, beginning from that part of the verte-

bral column

where the disease appeared

to begin.

This was about the tenth or eleventh dorsal vertebra, the spinous processes of which
*

The

trials

which

produced similar

have made of this remedy,

results.

in

There can be uo doubt

pating the phlegmasia of the nervous membranes,

remarked

that

its

effects are constantly pernicious,

the opinion of some physicians,

who

extol this

proscribed in the practice of medicine.

some

made an

paralytics,

from

that, so far
it

augments

and

it.

have
dissi-

have
'

think, contrary to

remedy, that

it

should be

THE USB OP MOXA.

40

unnatural projection at that point, and the part

was very

The

painful to the touch.

first

applications calmed the pains,

The two

couraged the patient.

and en-

next were imme-

diately followed by spontaneous motions in the dis-

eased limbs, and a delightful calm, that, for the


first

time, for a great while, permitted the patient

sound, and from which he did not

to sleep

for eight hours.

awake

After the eighth moxa, he could

stand upright, and walk a few steps by means of


crutches.
ties

The

pains and tremors of the extremi-

entirely disappeared by the tenth appli-

had

and the contractility of the muscles was

cation,

sensibly increased.
sensibly

this,

every application

augmented the force and action of

all

the

properties in the limbs, so that their nutri-

vital

tion

After

was equally re-established.

tion has

This ameliora-

been gradually increasing, under the

ence of the moxas, which

influ-

have applied, two at a

time, at suitable periods, but never with a less interval

than five days.

suppurate a

little,

have allowed them to

for the reasons

given above.

After the twenty-sixth moxa, the patient could


walk, and went to the theatre on foot, with one
support.

After the thirty second,

that the cure had


It is

become as perfect as

conceived
possible.

remarkable, that -Mr. P * * * could walk

for

THE USE OP MOXA.

41

a long time with the assistance of a cane, without

The

pain, or inconvenience.

mities

were no longer

felt,

pains in the extre-

and the limbs reco-

vered, by degrees, their primitive form and size.

This paraplegia presented one remarkable phe-

nomenon, which

have never seen, so strikingly,

displayed in any other paralytic, that


ted in the same manner.

moxa produced
and

have trea-

Every application

of the

contractions as strong in the feet

as those which

legs,

from galvanism

result

upon the denuded nerves of recently

directed

amputated limbs.*

At my

return from Belgium, in 1815, 1 found at

the military hospital of Gros-Caillou, two soldiers


of the imperial guard, affected by paralysis, with

neuralgia of the fore arm and hand, in conse-

quence of gun-shot wounds of the arm.

In one,

the projectile had traversed the limb in


rior third,

other,

and passed behind the humerus;

the ball

cases, the paralysis

In both of these

was confined

to the

action, while the animal sensibility

of them, especially,

violent pains in the


* See the bulletin de
vol.

1.

in the

had passed through the middle

part of the arm, before the bone.

One

its infe-

la

muscular

was increased.

experienced the most

hand and

fingers,

Societe Pliilomatique,

May

with a

and June, 1793,

THE USE OF MOXA.

42

disagreeable sense of formication, at their extremiEmollients and narcotics, particularly opium,

ties.

had been employed without


lysis

success.

The

and pains had, however, continued

crease, and amputation

parato in-

was looked forward

to,

the only means of removing these torments.

as
I

encouraged them as much as possible, and devoted

my

personal attention to them.

After causing the limbs to be washed

soap suds,

applied the

moxa above

in

strong

the cicatrices,

and over the course of the injured nerves, proceeding from above, downwards.

The

pains and

formication disappeared rapidly, and the

motion gradually returned

One

fore-arm and hand.

in

who was

the muscles of the

of these soldiers left the

hospital perfectly cured, a few

the other,

power of

months afterwards;

sent to Val de- Grace, to be

cured of a psoric eruption, which had taken place


during his treatment for the wound,
care of one of

continued the

fell

under the

my old pupils, M. Desruelles, who


moxa with the same success.

Hemiplegia of the face has been considered

by authors,

until

now, as incurable, because no

one has dared to apply the moxa to this part.


Indeed, when applied in the usual way,

it

pro-

duces deep and extensive ulcerations, and other


accidents,

which may prove more troublesome than

THE USE OP MOXA.


the disease

It

itself.

is

43

which has induced

this

authors to forbid the application of this caustic on


the face; but the modifications that

have enabled me

to

apply the moxa upon the face,

as upon other parts of the body, only

the precaution to

much

have made,

make

have taken

the cylinders of cotton

smaller, and to prevent suppuration of the

eschars, by the application of the ammonia.

The first subjects attacked by this disorder,


who were cured by this method, were young soldiers of the imperial guard, who, in consequence

of sleeping upon the wet ground, in the open air,

during the

first

campaign

had one side of the

in

Prussia and Poland,

face paralyzed.

The eye

of

the affected side remained open during sleep, the

angle of the mouth of the opposite side was retracted, in consequence of the contraction of the

sound muscles, &c.

The

repeated application of small moxas, over

the course of the branches of the facial nerve, and

some of the anterior branches of the


pairs, restored, in these patients,

muscles.

The

cases of these

cervical

the paralyzed

young

soldiers are

recorded in the registers of the hospital of the


guard;
here,

lady

I shall

therefore dispense with stating

and confine myself


that I

had occasion

to
to

that

of a

treat, in

them

young
private

THE USE OP MOXA.

44
with

practice,

The

same success.

the

disease

presented the same characters, hut arose from a


different cause.

Miss de

M***,

since

Madame D***,

about

seventeen years of age, of a nervous constitution,

and very

delicate, uniting with the graces of a fine

mind, other qualities the most rare, had


afflicted,
left

been

'Yom her infancy, with a hemiplegia of the

side of the face, supervening on a verminous

fever.

Electricity,

and douches*- of mineral water,

The

had been unsuccessfully used.


extreme, and

gave

deformity was

the

countenance of this

young lady, otherwise very

beautiful, a disagree-

to

able character, especially upon the least smile.

A desire
ity,

to

be relieved from this shocking deform-

induced her to have recourse to the moxa,

which

proposed, as the only efficacious remedy,

contrary to the opinion of several physicians.

had a small porte-moxa, made


and

applied the

first

for the purpose,

cones over the course of

the trunk of the facial nerve, where

from the stylo-mastoid foramen.

it

passes out

From

this point,

I followed, in three diverging lines, the direction

of the principal branches of this nerve,

the
*

applications

at

suitable

distances.

continued column of water applied to a part.

used in France.

making

They

remedy much

THE USE OP MOXA.


were certainly

painful, but the

possessed great fortitude,

45

young

patient,

who

supported the appli-

The prompt and

cation without uttering a cry.

immediate application of the

volatile alkali, re-

moved,

The

moxa

in

an instant, the pain.

dried, and

eschars of the

in small black scales,

fell off,

by

the tenth, or thirteenth day, leaving a very small,


red, cicatrix, that time and sapponacious lotions
entirely removed.

At

the fourth application, there was a sensible

change

was but

in the disease; the

improvement, however,

slow, until the ninth application.

After-

wards, the progress was more rapid, and after the


seventeenth, the cure had arrived at the highest

degree of perfection, which the case admitted.

Both the angles of the mouth were

parallel; the

pronunciation, which, before this treatment, was

very

difficult,

now became

perfect.

The

paralyzed

eye could not be entirely closed, but, with

this

slight deformity, the muscular functions of the face

were almost

entirely restored.

Hemiplegia of the extremities, when

become chronic,
not recent,

is

much more

it is difficult

the portions of

the

brain,

from which the disease

obstinate.

to obtain

is

mote from the operations of

it

has

When

a cure, because

and spinal marrow,


derived, are too reart, especially if the

THE USE OF MOXA.

46
patient be

fat.

When

the paralysis

we may

the subjects are thin,


cure.

is

recent,

and

obtain a complete

have treated a great number of soldiers,

affected with hemiplegia, from the excessive cold

they suffered during the campaign of Russia.

moxa, applied

on

the

sides

column, and upon the course

The

of

the

vertebral

of

the

principal

nerves of the limbs, produced astonishing effects;


it is

true,

my

In

however, that the cure proceeded slowly.


relation of the

campaign of Egypt,

have

remarked, that moxa restored the moving powers


of the muscles of the superior extremities, para-

lyzed by wounds, however superficial, complicated

with lesion of the branches of the cervical pairs of


nerves.

have observed,

these paralyses,

the

it

also, that in relapses of

becomes necessary

moxas above the

upon the application

We

will

now

whom I
only. The

in

may be

relate the case of a

observed a

loss of

right shoulder,

should insist

remedy, as long as the

of this

disease remains, whatever


I

all

its

character.

young

The

lost

their sensibility

soldier,

animal sensibility

the external surface

of the arm, the fore-arm, and the hand,


tirely

re-apply

and over the

cicatrices,

course of the injured nerves.

to

in

this

had en-

young man.

skin of this part might be pricked, or burnt,

or pinched, without the patient feeling the least

THE USE OF MOXA.


same

pain; at the

pended

time, the motions

for a single

cuted with as

much

47
were not

sus-

moment, and could be exeforce,

and precision, as those

of the left arm.

This soldier had received a stab from a sabre,


above the

clavicle, in the

middle of the triangular

space formed by the union of the humeral extre-

mity of

and the acromion process.

this bone,

wound was very

superficial, indeed

ly be distinguished.

the

that

There

instrument

it

The

could hard-

reason to believe,

is

had only touched a few

branches of the cervicals, which are destined

to

form the cutaneous nerves, the organs of animal


sensibility, while those

which supply the muscles

are deeper, and, indeed, have a separate origin

from the spinal marrow.

Some
facts,

hypotheses, drawn from these anatomical

form the object of a notice inserted

collection of

bulletins

d''Emulation,*

feel

to

of the

Societe

in the

Jledicale

which we refer those who may

any curiosity on the subject.

Several

upon

this

cuppings, with scarification, applied


small wound, already cicatrised, and

three moxas, were sufficient to restore the sensibility of the

whole limb, and place

situation as the rest of the body.


* Vol. v. year 1810.

it in

the same

This soldier was

THE USE OF MOXA.

4S

discharged from the hospital, a few weeks after-

wards, perfectly cured.

simple muscular paralysis of the inferior ex-

tremities
nal

may be

the result of an injury of the spi-

marrow, or of a relative compression of

medullary process, or of the Cauda equina.


compression

may

ment of the

spinal

this

This

arise from the asthenic engorge-

membranes, or the effusion of a

serous,

or sanguineous fluid into the vertebral

canal.

In this case, there

the membranes, as
plegia

is

no inflammation in

observed,

complicated

is

is

with

when

the para-

neuralgia;

this

in

case the moxas alone are indicated, and suppuration should not be allowed to take place.

The

application of this topical excitant and revulsive

should be

made along

the sides, and near the spi-

nous processes of the vertebrae; descending from


the highest point, where the disease commences,

and extending
os sacrum.

it

to the lateral

They may

the

of

also be applied along the

course of the sciatic nerves.


are treated with great success
of long standing,

regions,

These paraplegias

when they

are not

and are not complicated with

in-

continence of urine, a very troublesome symptom.


I

have obtained complete success, in a great num-

ber of these cases, from the moxa; but


tent myself with the following

I shall

summary.

con-

THE USE OF MOXA.


The

49

Viscount, Lieut. Gen.

was seized

with a paralysis of the inferior extremities, in the

second degree, with

art

unnatural projection of

the spinous processes of the last dorsal vertebrae,

deep seated pains


All

urine.

were

in

the

in this region,

and retention of

organic and sensitive functions

such an asthenic state, that they were

Various

performed but extremely imperfectly.


topical irritants, or rubifaciants,
to the limbs, unsuccessfully.

had been applied

hastened

to

employ

cupping, with scarification, preparatory to the

An

application of the moxa.

was allowed
tic

to

elastic

gum

catheter

remain in the bladder, light dras-

purges, repeated according to the state of the

patient,

overcame the retention of urine, and the

obstinate constipation, from which the patient

long suffered.

The

moxa induced a

two

first

applications of the

sensible improvement,

couraged the general.

At

had

which en-

the third, he began to

walk with the assistance of a cane;

at the fifth,

he

could walk without assistance; and, at the ninth,

he found himself perfectly

well.

This cure

remarkable in many points of view.

is

THE USE OF MOXA.

50

In Organic Diseases.
I will

now run

hastily over those organic dis-

which

have also employed the moxa

eases, for

with great advantage; and


explain

In

its

all

endeavor to

shall

success in each of them.

chronic affections of the head, I have

employed

this

remedy with great

In

success.

idiopathic epilepsy, hydrocephalus, chronic cephalaligia,

&c. &c. the applications ought to be

at the base of the cranium,

the points of union of the

made

and especially about

squammous sutures

of

the temporal bones with the lambdoidal suture.

These

points answer in the foetus, or very

young

infants, to the lateral, or posterior fontanelles.


is

useless to rise above the line

the base of the cranium from


skull cap; besides, there

may

It

which separates

what

is

called the

result from

it,

as

we

have already remarked, very serious accidents.


This superior hemisphere, being covered only by
thin teguments and aponeuroses, the caloric passes through
at the

them rapidly, and arrives immediately

membranes, which

it

predisposes to inflam-

mation, without having any effect upon the dis-

eased portions of the brain, which are so deep


seated, that the caloric

cannot approach them.

THE USE OP MOXA.


Indeed,

when we

51

recollect that the hemispheres of

the brain are five or six inches thick, and of a

pulpy consistence, we

shall be convinced, that the

when applied on

cautery,

the summit of this mass,

cannot have any effect upon the diseased part,

which

usually towards the base of the diseased

is

Finally, experience has demonstrated the

organ.

truth of this assertion.

I will

now

describe

some

cases of remarkable cures, obtained by the aid of

the moxa, applied to the part

young trumpeter

of

have pointed

the e,r-guard, having

received a blow upon his head, in a


horse, suffered

for

much

disfigured,

fall

two years epileptic

quently twice in a day.

out.

from his
fits,

fre-

The cranium was very

and had acquired

in a short time

such an increase of size, that his uniform hat,

which he received on entering the regiment, had

become

too small,

by

five or six lines.

The

eyes

were very prominent, and almost immoveable, the


countenance discoloured, the pulse slow, the respiration laborious, the pulsations of the heart very
distant,

and nearly imperceptible, and the extre-

mities almost always cold; standing and walking

were performed with

and

difficulty,

tive functions, especially vision,


faculties,

were very imperfect;

all

the sensi-

and the mental

in a word,

every

thing clearly indicated a constrained and com-

THE USE OF MOXA.

52

pressed state of the brain, the effects of which


increased according to the variations of the atmos-

phere, or other determinate causes.

After a free

bleeding from the jugular, repeated cupping from


the nape of the neck and temples, ice upon the

head, mustard baths to the legs, and the internal

we

exhibition of calomel,

applied fifteen moxas

about the head, especially over the parts where


the lateral and posterior fontanelles formerly existed.

at
to

The symptoms became

first

slowly, afterwards

gradually assuaged,

more rapidly,

so

as

render the paroxysms milder, and more rare;

and at

last

disappeared entirely; by the end of the

tenth month, the patient found himself perfectly

cured.

All

the

animal

and sensitive functions

were soon restored, and, what

very remarkable,

is

the arch of the cranium, was reduced through

whole circumference.
of these bones
this

primitive conformation

was restored gradually, and when

trumpeter

was before

The

its

left

too small,

the

hospital, his

had become

or six lines; so that, in the

hat,

which

too large by five

whole circumference of

the head, there had been a reduction of eight or


ten lines, which had taken place under the influ-

ence of the moxa; a change such as


observe in

the

thorax,

after

the

we sometimes
operation

of

THE USE OF MOXA.


empyema #

The

effect of

53

the topical revulsive

remedies applied about the head, and towards the


base of the cranium, was powerfully seconded, in

my opinion, by

the internal use of

camphor and

ca-

lomel combined, in large doses; sometimes by the


extract of bark, with opium, and at others, by

the nitrate of potash, and the extract of valerian.

The
as

patient used, besides, a decoction of barley,

prepared by the brewers, sweetened and

aci-

dulated with muriatic alcohol.

This patient was examined during the

treat-

ment, and after his cure, by a large number, both


of French and foreign physicians,

my

Lectures on Clinical Surgery.

seau, one
pupils,

who attended
Doctor Bois-

of the most distinguished of

my

was charged with the particular care

old
of

this patient.

grenadier of the infantry of the guard, was

carried to

the

military

hospital

lou, in the latter part of the


all

of

Gros-Cail-

year 18 17? having

the symptoms of hydrocephalus interims; such

as great weakness in the functions of the organs


of locomotion, especially in the inferior extremities.

* Sec the 3d \olume of

my

Campaigns, p.

\7'J.

THE USE OF MOXA.

54

This was likewise the case

in all the organs of

sense; the vision, particularly, being almost lost,

The

and the voice interrupted and weak.

had frequent

vertigos,

and a

dull,

patient

steady pain in

head, towards the occiput, with a constant

the

tendency

was

The

to sleep, or rather stupor.

slow,

and (caudal,) forty

pulsations in a minute.

five

pulse

or forty-six

Besides the pains

we have

above mentioned, the patient complained of a

dis-

agreeable sense of weight over the whole head, so


that he could not suffer

it to fall

either

backward

or forward, without being threatened with syn-

cope, which the least neglect in holding


instantly produced;

when an

it

straight,

ice-like coldness seiz-

ed upon the extremities, and the functions of circulation

and respiration appeared, at the same time,

suspended.

have had frequent occasion

serve these phenomena in this patient.

to ob-

The men-

tal

faculties of this grenadier did not

me

at all to participate in this lesion of the brain;

he related, with precision, that

appear

his complaint

to

had

arisen in consequence of plunging, head foremost,


into the Seine, from a very elevated place,

from that time he had not ceased

and

to suffer.

After having unloaded the cerebral vessels by


bleeding from the jugular vein and temporal artery,

and cupping with

scarification at the

nape

THE USE OF MOXA.

55

of the neck, I applied, for several days, ice upon


the head, and at length
cation of

moxas

had recourse

to the

posterior and lateral re-

We

gions of the head.

to the appli-

suffered several of the

eschars to suppurate, carrying the number to ten.

To

these

means were added mercurial

made every

the soles of the feet,

frictions to

four or five days.

After four months of this treatment, the grenadier


left

the hospital in very good health, and has re-

turned to his duty,

his functions

all

having reco-

vered their equilibrium.


I

have obtained the same success, by the same

means, in an English lady,

whom

Madam J**##,

occurred suddenly, so

as

and hemiplegia of the

left side,

second degree.

By

to

direct

produce apoplexy
carried to the

bleedings,

some vesicatories applied upon the head,


to

in

an acute dropsy of the right ventricle

have accomplished the cure of

was not

effected,

ice,
I

and

hoped

this lady;

however, until after

it

fifteen

months, by means of moxa, placed about the


bones of the cranium, between the occipital processes,

The

and on the sides of the vertebral column.

celebrated John Bell, and Doctor Morgen,

assisted

me by

their advice in the treatment of

this interesting patient, the

family.

mother of a numerous

THE USE OP MOXA.

56

A child,

between seven and eight years of age,

son of a retired officer,

English

lady, exhibited

M.
all

Walter, and of an
the

symptoms

of a

chronic dropsy of the ventricles of the brain, with

enlargement of the cranium.


ing situation,

when

my

take him under

being

fulfilled,

He was

was desired by
care.

The

in

an alarm-

his father to

first

indications

applied upon the nape of the

neck, and on the sides of the head, several moxas,

and afterwards the actual cautery twice over the


posterior

and

lateral

This

fontanelles.

little

patient was cured before the end of the ninth

month, at which period the cranium, which had

been measured before the treatment, was reduced


in circumference about six lines.

present, enjoys

perfect health.

The
It is

child, at

proper to

remark, that the sister of this child died of a


similar disease, as

was proved by

My

dissection.

brother in law, Doctor Coutanceau, attended this


little

patient during a short absence.

Since that time, another child of the same age,


of a scrophulous constitution, belonging to

M.

B.

a merchant, at Havre, and affected by the same


disease, characterized

by the same symptoms, has

been cured by the same means.


in this little patient,

There was

also,

a reduction of between three

THE USE OF MOXA.


and four lines

in the

cranium.

Spursheim were called

have removed

57

Doctors Ribes and

in consultation in this case.

entirely?

by the moxa applied,

upon the sides of the head and occiput, chronic


and rheumatic head-aches, which had resisted a
great

number

of remedies.

I think this caustic is co??ira-indicated in

however

diseases, attended with excitement,

tal

may

be extolled by some authors.

for being led

away from my

plain myself further on this point.

present,

it

would ex-

But, for the

or produced

the

Chest.

have employed moxa with great

success against asthma,


ry,

wire not

should rarely be employed.

In Diseases of

Of Asthma.

it

confine myself to remarking, that

I shall

such cases,

in

If it

subject,

men-

when

it

was not heredita-

by a bad conformation of the

thorax, and the subject not too far advanced in


life.

seen

I will
it,

admit

has for

state of the

its

also, that the disease, as I

have

essential character, an asthenic

pulmonary organs, and a spasmodic

and convulsive contraction of the pectoral muscles, resulting

from a latent engorgement, or

in-

flammation of the organic vessels of the muscles

and membranes, which


8

surround the chest; a

THE USE OF MOXA.

58

species of rheumatic affection, arising generally

from a suppression of cutaneous transpiration, or


other habitual discharge.

malady has
ed

resisted the

to restore the

In this situation,

common remedies

if

the

indicat-

suppressed function, and remove

the effects of this suppression in the part affected,,


the

greatest benefit

moxa, which

it is,

may be

derived from the

nevertheless, necessary to pre-

cede by one or more cuppings with scarification.

This

la3t

has for

organic

the

its

principal effect, to unload

capillary

vessels

of

the skin, and

subjacent muscles, and to produce, in the parts

weakened, some degree of excitement, which the

moxa gradually

We

increases.

ought to place cylinders of moxa in two

parallel lines on the sides of the chest,

the anterior

towards

attachments of the great pectoral,

and the great dental muscles.

The number

should

be proportioned to the severity of the disease.


I

my

might now relate numerous cases,

in point, of

success; I shall, however, content myself with

a summary of that of a young

who,

for

many

woman

of Paris,

years, and after each menstrual

discharge, (which was, however, regular) was tor-

mented with paroxysms

of asthma,

accompanied

with spasms, convulsive motions, and suffocation^

THE USE OF MOXA.


which were so

59

violent, that the situation of the

patient had been often very alarming.


I

began the treatment by cupping with

cation, the

scarifi-

whole anterior region of the chest;

to

these local bleedings, which I repeated several


times,

added the moxa, which I

afterwards

placed on the principal points of the circumference


of the thorax.

The

first

applications reduced and

retarded the paroxysms, so that the patient considered herself cured, and wished to do no more;

but she was suddenly seized with another very


violent paroxysm,

that

above mentioned, that


insisted especially
last;

the

number

sides of the chest,

is,

allayed by the means

cupping and moxa.

upon the employment of the


of cylinders

burnt upon both

was carried

paroxysms disappeared

entirely,

to twelve.

The

and after seven

or eight months of care, this young lady found


herself perfectly well.

have seen her some years

since this treatment, she enjoyed perfect health, not

having had the slightest return of her complaint.


Intermittent, nervous palpitations of the heart,
arising from weakness of this organ, and of the

spinal

moxa,

marrow, are successfully combatted


if

applied

by

on the sides of the vertebral

column, and about the region occupied by the

THE

60
heart.

USE OF MOXA.
persons attacked

have cured several

by these neuroses, by employing

The moxa

this

cautery.*

is equally indicated in old catarrhal

affections,

and chronic inflammations of the pleura,

especially

when

the disease does not arise from a

repelled blennoragia, or tetter, which

mon, or the presence of the syphilitic


either of these cases,

it is first

to

remove the

might relate numer-

ous cases in support of these precepts, but


pass at once to another disease,
ous,

my

In

virus.

necessary to bring

back the repelled discharge, and


poison by suitable means.

very conv

is

shall

much more

seri-

which has constituted a principal object of


researches, and meditations.

In Consumption.
I

might devote an entire memoir

to the special

object of showing the efficacy of moxa, in phthisis

pulmonalis, but

shall

allow myself but a short

digression respecting this terrible malady, acknow-

ledged by
ble,

all

authors and practitioners as incura-

and mortal.

No

one

who had

success I have

witnessed the extraordinary

obtained

from

this

remedy,

These neuroses should not be confounded with organic

in

lesions of the

heart, such as active or passive aneurism of this organ; for the curative

means are very

different.

THE USE OF MOXA.

61

ischialgia and femoro-coxalgia,* (which

haps, with

may per-

propriety, be termed rachidial, and

articular phthisis,) could avoid being predisposed

pulmonary con-

to think well of its application in

sumption, which only differs from them in

its

seat.

Indeed, these diseases present the same pheno-

mena,

same

arise

from the same causes, and produce the

effects;

it

also frequently happens, that the

disease of the spine accompanies phthisis pulmonalis.

In this last disease, as in rachialgia, the

moxa

produces a resolution of the lymphatic engorgements, or scrophulous tubercles, and of symptomatic

abscesses, or abscesses

by congestion, when

they are not too far developed.

produces a de-

It

tergent effect upon internal ulcers,

it

stops caries

of the bones, produces adhesion and cicatrisation

of the walls of abscesses, and purulent cavities,

established in the substance of the lungs, or any

other part, become the seat of phthisis.

word, the patient


in

proportion, as

is

conducted

we

insist,

to

In a

a cure complete,

as long as

may

be

necessary, upon the employment of this topical,


excitant and revulsive agent, but
tainly, but

most

which experience

will

used cer-

little

shew

efficacious against these diseases.


Discases of the spine, and hip joint.

to

be the

The

illter-

THE USE OF MOXA.

62
nal remedies,

more or

by authors, as

less extolled

the acetate of lead, and particularly the prussic


acid, are
useless.

for the
If,

most part injurious, at least

however, there be any reason

pect a particular virus,

it will

be

first

to sus-

necessary

to destroy this cause,

and when the disease

have become isolated,

to attack

We

should select, in

it

shall

by the moxa.

application, those parts

its

of the chest which are nearest to the diseased

portion of the lungs.

There can be no doubt, that

the hollow cylinder of wood, used by Laennec,

would be favourable

to this research;

perienced physician has no need of


sion, pressure

made with

care,

and

but the exit.

Percus-

habit,

and the

impression exerted by the fingers between the


ribs, will

enable ua to assign, with great certainty,

the seat of the disease.

To

prove the truth of

manner

assertions, in such a

as to leave no doubt, I

report a
I

my

summary

of

am now

some cases of

about to

phthisis, that

have cured by the moxa.

One

of

my

first

patients

was a young lady, about

nineteen years of age, Rosina


light, fair hair,

tall,

with

and a flattened chest; there was

an incipient curvature of the spine, with an unnatural projection of several of the spinous processes

of the dorsal vertebrae.

She had permanent pains

THE USE OF MOXA.

63

in this region, frequent cough, with aphonia, op-

pression, a yellow, purulent expectoration, a heat,

more or

less urgent, in the sternal region,

sides of the chest,

and a slow

fever, with an even-

ing paroxysm, followed by night sweats.

symptoms announced a

sively emaciated,

or ten months.

phthisis, carried at least

and had been

All these

This young lady was exces-

second stage.

to the

and the

in this state eight

great number of remedies

had

been vainly employed.


Thirteen moxas, applied on the sides of the
spinous processes of the dorsal vertebrae, and the

and preceded by cupping with

chest,

scarification,

applied successively at convenient intervals, con-

ducted the patient,

months,

to a

after

a treatment of eight

complete cure.

This lady has been

since married, and has two children,

who

enjoy^

with their mother, good health.

second young woman, of the same age, and

of a small size, having chestnut hair, and deeply

marked with
to various

weeks

the small-pox,

modes of treatment, and passed several

in the

Hospital de la ChariU, when

requested to take her under

There was a prominence


ehest,

the

had already submitted

scapula

my

was

care.

of the left side of the

projected,

and the corres-

ponding portion of the vertebral column, on the

THE USE Or MOXA.

()4

same

and permanent

side, deviated, with a fixed,

The cough was

pain in this part.

almost constant,

and was often accompanied with hemoptysis; there

was a continued
in the evening,

fever, with a slight exacerbation

and night sweats.

The

was extreme, and the skin discoloured.

emaciation

The

dis-

ease had existed about eighteen months; the physician

who attended her

in the hospital, consider-

ed the case incurable, and to have nearly ap-

proached

its fatal

termination.

But these alarming

symptoms were gradually dissipated by cupping


and moxas, the number of which was carried
twenty-one.

The

to

gibbosity of the spine, and the

deformity of the chest disappeared by degrees,

under the influence of


it is

true, nearly

who

before

this treatment,

two years.

stooped

which lasted,

This young woman,

very much, became erect,

her chest was enlarged, and she acquired that


freshness and plumpness in her appearance, which
is

generally observed in persons in perfect health.

After having enjoyed, more than a year, every

mark

of perfect health, she

was suddenly seized

with the symptoms of gastro-eitteritis, the progress of which

was slow and gradual.

ents, unfortunately for the patient,

the

The

par-

supposing that

malady could not be attended by unpleasant

consequences, contented themselves with employing

THE USE OP MOXA.


some

common

trifling,

medicines,

65
without

call-

ing in a physician, suffering the disease to go on.

But, the situation of their daughter becoming more


alarming, they determined upon calling in Doctor
Desruelles, one of

my

old pupils,

with admirable zeal,

who administered

the best remedies indi-

all

But, notwithstanding the

cated in her situation.

most assiduous attention, and the most suitable


treatment, this young
less

woman

died of marasmus in

than seven weeks after the attack of this

last

disease.

On examining

the body after death,

that the left lung, which

was

we found

originally diseased,

had become sound, having contracted a great number of adhesions, by membranous leaves, with the
pleura

We

costalis.

points of

its

also

remarked, on many

parenchyma, contractions, and deep

cicatrisations,

where, undoubtedly, were situated,

during the disease, so many purulent cavities.

The whole mass


least

in

one third of

which

it

of

the viscus was reduced to at

its

natural volume.

cavity

was contained, was perceptibly much

narrower than the other, and

This reduction was the

We

The

its

walls very weak.

effect of the cure.

observed in the right lung, one tubercle hol-

lowed out by a purulent


diameter.

The

ulcer, of several lines in

peritoneum, and intestines, were

THE USE OF MOXA.

6()

a state of suppuration, as well as the mucous'

in

membranes

of these viscera.

third patient also, of the

H. B. on
vours,

whom

same age and

nature had lavished

sex,

her

all

fa-

was threatened with imminent danger from

a consumption, very far advanced.

It

was even

declared, at the last consultation held on this case,


that art offered no further resources, in conse-

quence of the advanced state of the disease, and


the extreme debility of the
ever, being

warmly

take her under


to

my

young

solicited

patient.

How-

by her parents,

to

care, I yielded with reluctance

their reiterated requests,

and undertook the

treatment of this case in September, 1817.


I

shall dispense with relating the

the disease;

shall only say that the

symptoms

of

young patient

had a slow, continued fever, with an evening


paroxysm; flushing of the
quent cough, with

face, painful

expectoration

of

and
a

fre-

viscid,

greyish yellow substance, of a purulent character.

There was oppression, extreme weakness, aphonia


in the first

degree, pain between the shoulders,

and on the sides of the chest; the tongue,


the palate, and internal surface of the

were covered with

apthse,

veil of

pharynx

which appeared

to ex-

tend towards the larynx: the nails of the fingers

were curved. Twenty moxas, preceded bv cupping

THE USE OP MOXA.

67

with scarifications, and a seton on the

left side,

conducted this patient, by degrees,

an unex-

The

pected cure.

treatment had been continued

and she enjoyed a good

for eighteen months,

But

of health.
this case,

and

since the period

after a

factory state, this

to

when

year passed

in

young lady was

state

recorded

a very satis-

seized, in con-

sequence of some new causes, with an inflammation


of the bowels, of which she died, notwithstanding
all

the usual remedies were employed with the

most assiduous care.


the time, a single

The

There did not remain

symptom

at

of the first disease.

subject of the fourth case was a Belgian,

named P

thirty-four or thirty- five years of

age, of a dark complexion, very irritable, and

had arrived

at the

who

second stage of a pulmonary con-

sumption, which had existed for about two years.

The

symptoms

principal

frequent

and

painful

which had occurred


dantly, as to

of this disease were, a

cough,

daily,

with

hemoptysis,

and sometimes so abun-

become a true hemorrhage.

preceded by a

febrile

paroxysm, heat

It

was

in the chest,

redness of the tip of the tongue, and a circumscribed blush

by an

upon the cheeks.

It

was followed

icy coldness of the limbs, syncope, and an

almost entire cessation of the pulse.

was frequently

in a

The

patient

very alarming situation.

To

THE USE OF MOXA.

68

these symptoms were joined complete aphonia,

and deep apthae over the whole mucous membrane


of the mouth, nasal fossae, and probably also over

the larynx and pharynx.

There was no

specific

virus.

Notwithstanding the almost desperate state of

and the unfavourable prognostic of

patient,

this

several physicians,

termined
for

its basis,

tion of

called in,
it

de-

had

the repeated and successive applica-

cupping with scarifications on the back and


and

chest,

who had been

to try the following treatment;

fifteen

moxas, which were suffered

to

suppurate slightly.
After the fifteenth application of the moxa, the

hemoptysis was stopped, and returned no more.


All the other

symptoms disappeared gradually,

and the patient returned home, after having been

under treatment
health

for seven or eight months.

was soon re-established, and

his

His
usual

plumpness returned; the voice only remained weak.

One
first,

of the physicians,

who had been

consulted at

Mr. Laennec, and had detected extensive

cavities, in both lungs,

time, and with the

having examined a second

same instrument, the whole

circumference of the chest, recognized the cicatrisation of

the cure

these ulcerated

points,

and confirmed

THE USE OP MOXA.


The

subject of the fifth case,

is

69

of about twenty-seven years, a milliner,


suffering from a consumption
stage.

She was

advanced

in a state of

woman
who was

a young

to the third

marked marasmus,

with continued fever, night sweats, and habitual

Menstruation

expectoration of purulent matter.

had been long suppressed, and the os tincce was


nearly obliterated; it would scarcely admit a very
small elastic

gum

sound.

Besides the usual symp-

toms of consumption, there appeared between the


posterior edge of the right scapula, and the spin-

ous processes of the dorsal vertebrae, a rounded

tumour, formed by the preternatural curvature of


the posterior extremity of the third and fourth
ribs; in the intervals of

deep and obscure

which, could be perceived a

fluctuation.

The

slightest pres-

sure upon this point, caused to the patient violent

pains beneath the clavicle of the same side.

This

pressure excited a smart cough, accompanied with


copious expectoration.

communicated, upon

The

action of coughing

this point,

an impulse which

could easily be distinguished by the finger.

without the cylinder of Laennec,

we

Even

could easily

perceive that the lung of this side was excavated

by a very deep and extensive


I

my

was
care,

at last

cavity.

induced to take

this patient

under

by the repeated requests of her parents,

THE USE OF MOXA.

70
and by a wish

to ascertain,

stage of the disease, the

analogous to those which

if,

in this

very advanced

moxa would have


I

effects

had obtained from

its

application in diseases of the spine, in the very


last

stages.

Before applying the moxa to this

young woman,

by my

wished

friend Laennec,

the cavity of which

his cylinder.

who

my

diagnostic,

ascertained, with me,

have spoken, by means of

memorandum was taken

of this

which Doctors Ribes and Desru-

consultation, at

were present.

elles

to verify

At

length

proceeded to

apply the moxa, commencing at the tumour, about

which

From

applied, in succession, six.

this I

passed successively to other regions of the chest,

which

tions.

To my

supposed

to

be near the internal ulcera-

great surprise, the two

the pain and spasm, and gave to the


tient

first

calmed

unhappy pa-

a more refreshing sleep than she had enjoyed

This sensible amelioration encou-

for six months.

raged me, and

continued the application of this

remedy, with suitable modifications,


teenth.

The

ed by the

until the

fif-

projection of the dorsal region form-

ribs,

gradually disappeared, the cough

was calmed, the expectoration was diminished,


and became of a better appearance; the appetite
returned; in a word, the patient
better, so that she left her bed,

grew better and

and walked about

THE USE OE MOXA.


At

the chamber.

walk abroad

to

M. Laennec

length she became well enough

for

month of

fifth

71

this

She was

whole hours.

when

treatment,

as in the case of

M. P

in the superior

favourable state of the

young woman, made her very anxious


the country.

the more readily

her place of residence

and

were obliterated

posterior lobe of the right lung,

The very

found,

that the deep cavities

which we had before detected,

and cicatrised.

requested

He

again to see the patient.

in the

in Paris

to

go into

consented, as

was unhealthy, and

inconvenient for walking.

At
fat,

first

she found herself

and her cough almost

been exposed
night, the

to the

of

air,

her;

grew

but having

during a stormy
to the

was seized with a very severe

gastro-enteritis,

return to Paris.
ing,

open

left

better; she

wind having changed suddenly

north-east, she

tack

much

which induced her

at-

to

But, notwithstanding local bleed-

and other antiphlogistic means, she died on

the seventeenth

day

after this accident,

and

in the

ninth month of her treatment for consumption.

On opening

the body,

we

found the right tho-

racic cavity considerably contracted; the superior

half of the lung was retracted upon


in

some

hesions.

points,

The

itself,

compact

and traversed by membranous adinferior portion

was sound; several

THE USE OF MOXA.

72
slips

of

false

membranes established numerous

The bronchi*

adhesions with the pleura costalis.


of the

left

lung were

substance; and

filled

with a purulent mucous

we observed

in the substance of the

lung small suppurating points

The mucous mem-

brane of the stomach and intestines was inflamed,

and spotted with gangrenous

points.

This dissection verified the prognosis of Laennec, and

shewed the

beneficial effects of the

moxa

in

every stage of pulmonary consumption; since

in

this

patient

cavities,

The

it

had cleansed these ulcerated

and caused their cicatrisation internally.

subject of the following case

tunate; and, although the disease

vanced,

it

was conducted

to

was one of the door-keepers


at Versailles.

constitution,

was more

was equally ad-

a complete cure.
in the

for-

He

King's Chapel,

This man was of a phlegmatic

and about twenty-eight years of age,

with a tubercular consumption in the second stage,

when he came
the

to solicit

commencement

The

my

professional care, at

of the year 1818.

glands of the neck were engorged, aid the

countenance discoloured; he was oppressed, and

tormented with a hard, and almost constant cough,


followed by the expectoration of a matter of a

greyish colour, and of a fetid odour.

membrane

of the throat,

The mucous

and the entrance of the

THE USE OF MOXA.

73

pharynx was sprinkled with apthse; deep seated


pains were

felt in

the back, and sides of the chest.

There was constant

fever, with an evening parox-

ysm, and followed by profuse night sweats; in a

word, he had

As

it

fallen into a state of

appeared

to

me

marasmus.

that this disease origi-

nated in a specific virus, or, at

least, that this

was

the predisposing cause, I administered remedies


at the

same

This topical derivative was applied, two

at a

suitable to

combat

this

morbid cause,

time that I applied the moxas.

time, at suitable intervals,

and

at

proper periods,

on each side of the vertebral column, and on the

The number employed was

sides of the chest.

This treatment was continued

thirty-six.

teen months, but

it

The

functions of this pa-

were gradually restored; he has recovered

his flesh,

fif-

was followed by complete and

unlooked for success.


tient

for

and now enjoys perfect

health.

young English lady, named Maria

uniting with a most agreeable person, every pleas-

ing quality of mind and character, was equally

the

happy

in

being cured of a similar disease, in

first stage.

Only a half dozen moxas were

required in this case.


letters

from

this

have received several

young lady, which inform me that

she continued well.

10

THE USE OP MOXA.

74
I

appear

myself

confine

shall

me

to

sufficient

these

to

to

facts

opinions of

the

fix

which

practitioners on the efficacy of this cautery in pul-

monary consumption.

should also have spoken

of the advantages which might be derived from


this topical

remedy

drotharax,

if

it

is

my

only

in

readers.

when

state, that this

hydrops pericardii and hy-

had not mentioned

memoirs inserted
I refer

in

my

it

in several

campaigns, and to which

I will

observe, however, that

these diseases are in an incipient

remedy can be expected

a resolution of them, of which

to

produce

have had instances.

Chronic and Organic Diseases of the Abdominal


Viscera.
1st.

Of

the

Stomach

The

engorgements of

the coats of this viscus, and the scirrhus, which


is

ordinarily the result of them, constitute a dis-

ease which
tion.

is

almost always

fatal

in its

termina-

have found, from experience, that

all

internal remedies are either useless or injurious.


It is this

which has led

to the belief, that these

maladies are incurable, especially when the en-

gorgement of the pyloric

orifice

has gone to the

extent which renders the passage of the aliments


difficult,

or causes them to be rejected by vomiting.

THE USE OF MOXA.


However,

75

can assert, that even in this state, and

in several instances, the disease has yielded, to the

frequent application of

moxa upon

the epigastrium;

the combustion of which was increased by the blow


pipe, as in phthisis, in order that the caloric might

penetrate more deeply.

For the better appreci-

ating the efficacy of this exciting and revulsive


topical agent,

now give

will

history of some cases, of


this chronic

summary

persons aifected with

engorgement of the pyloric

the stomach, in a very advanced state.

had every reason

to

of the

suppose

this

orifice of

At

least, I

was the

case,

from the nature of the symptoms.

One
I

of the

first

patients, affected to the extent

have mentioned, was the valet-de-chambre of

General Rutty.

He

experienced, in the region of

the stomach, a dull, steady pain, with eructations


of a sharp taste, and disagreeable odour.

He had

frequent nsusea, and shortly after hav'ng taken


food, vomiting

siderable time.

dom and

came

on,

The

small, of

and continued

for a con-

alvine evacuations

hardened

were

sel-

matter, except after

taking some drastic purges, which the patient

fre-

quently did, by the advice of his physicians; after

which there was a discharge, more or

less

abun

dant, which was often followed by a diarrhoea.

THE USE OP MOXA.

76

The
fever,

patient

was

low continued

in a state of

When

and extremely emaciated.

lying upon

his

back,

he was

there could be observed,

through the abdominal walls, which were very


thin, in the

region of the pylorus, an ovoid tu-

mour, situated transversly, and of the size of a

Any

hen's egg.

The

painful.

pressure upon this point was

liver

appeared

beneath the margin of the

to

me

also to project

false ribs,

and

thought

that the spleen, and mesenteric glands, were in a

comparative state of obstruction.

The

belly

was

spotted with large varicose veins, and the skin

over the whole body was dull, dry? and scaly.

This valet-de chambre, aged forty years, had

made

the last campaigns of Spain, Russia,

Saxony.

It

and

was, no doubt, owing to his exposure

to diiferent seasons and climates, during these cam-

paigns, that

we ought

to refer the

cause of this

malady, being predisposed, probably, by a particular morbid principle.

After having applied cupping with scarification


to the

trium,

hypochondrium, the back, and the epigasI

commenced the

this last region;

and

application of

I insisted

moxa

to

upon the application

of this cautery until twenty-two had been applied,

with the suitable modifications already mentioned.

This treatment was continued

for fifteen or sixteen

THE USE OF MOXA.


months, after which, this
fectly well; all
flesh

man found

77
himself per-

the functions were restored; his

gradually returned, and he at present enjoys

perfect health, two years after his cure.

might relate a great number of other cases, of

persons attacked with the same malady in different degrees,

who were

equally cured by the same

means.
2d. Obstructions of the liver, spleen, or any

other viscus of this cavity,

may be combatted with


when

equal success by the moxa, especially


disease has not arrived at

its

the

greatest degree of

developement.
I will relate a single
titis,

example of chronic hepa-

with abscess, which was made

in a fortunate

crisis,

subject of this case

is

terminate

by means of moxa.

named Fer-

This man, aged about forty-five years, had

complained for seven months of dull pains


right side of the chest, which projected

than the
tion.

side,

left,

He

in the

much more

and suffered from obstinate constipa-

soon observed beneath the ribs of this

a dense tumour, but

little

tom of which, he perceived

He

The

one of the conductors of the

diligences between Paris and Rennes,


lura.

to

called in a physician,

painful, at the bot-

slight lancinating pains.

who

applied a plaster of

hemlock upon the tumour, and prescribed eight

THE

78

USE OP MOXA.

Bat the progress

drastic purges

continuing uninterrupted,
tation.

gree;

It

was

called in consul-

had then arrived at

the right

all

of the disease

its

highest de-

hypochondrium projected very

much, and there could be perceived beneath,


an ovoid tumour which detached

edge of the sternal


Its

ribs,

itself

of the size

from the
of a

fist.

circumference was hard, and a deep fluctua-

tion,

towards the centre was evident.

frictions

Mercurial

upon the tumour had been employed, and

the attending physician

had advised that a trocar

should be plunged into the centre of the tumour,


in

order to discharge the purulent matter, which

was suspected
sented in fact

to exist in
all

the signs of an hepatic abscess.

Before making the


agreed

to

the tumour, that pre-

however,

opening,

apply the moxa about

its

it

was

circumference,

without employing any other topical remedy.

After

the

application

of

the

the patient perceived that the

second moxa?

tumour had

di-

minished in volume externally? but that the deep

and lancinating pains had increased; he was also


reluctant to try the

we determined

moxa any

longer.

otherwise, and three

However,

new

cylin-

ders were applied, at intervals of two or three


days.

After the

violent cholic,

fifth,

the patient experienced a

which was followed by repeated

THE USE OF MOXA.


evacuations; at

alvine

first, bile

mixed with pus,

afterwards the evacuations were

The

lent.

quantity was

79

entirely

estimated

at

puru-

about a

These discharges were followed by a

pound.

disappearance of the tumour of the hypo-

total

chondrium, and internal lancinating pains, which

had

the patient

experienced

incessantly

until

that time.
It

evident that the

is

moxa induced

inflammation which,

sive

the adhe-

unquestionably,

took

place between the interior wall of the abscess,

and

corresponding

the

verse

point

of

the

trans-

which ulcerated, and

colon, the coats of

pus penetrated instantly into this

that the
testine.

in-

have reason to believe that the moxa

an excellent mode of producing resolution of

is

engorgements of the

liver,

and even of favoring

the passage of pus from hepatic abscesses into

some of the external emunctories.


I

saw

Egypt an hepatic

in

abscess, open spon-

taneously into the transverse colon and evacuated

by the

intestines.*

third

patient

affected

with hepatic abscess was treated in our hospital

by the same means,


the

pus was

The

case

is
*

also

in this case the

through the alvine passages.

preserved by one of
Sec the

evacuation of

first

volume of

my

my

pupils.

Campaigns.

THE USE OF MOXA.

80
3d.

We may

produce a salutary revulsion in

chronic engorgements of the uterus, which

are

almost always followed by cancerous ulcerations,

by the application

moxa upon

of

by cupping

region, preceded

depurative medicine.

lumbar

this region

in

have removed

ease, or prevented its attack

several

the

this

dis-

by these means

women, who had strong symptoms of

am now

and

in

it.

about to speak of phthisis of the

bone; or of that asthenic, rheumatic, or scrophulous

which generally

affection,

persons

in

the

young

and

boney

fibrocartilaginous

such

structures,

attacks

as

the

spine

junctions

the

of the bones of the pelvis, and the articulations


of the extremities.

Of
The

effects

of

Rachitis.

rachitis are,

softening of the

bones, curvature of the vertebral

more or

less gibbossity.

question, the best

column,

The moxa

remedy against

is,

this

and

without
disease.

Ancient and modern authors, especially Pouteau,

have spoken
illustrious

in

the highest terms of

it;

but the

Desault has informed us that the suc-

cess of this

remedy

is

most certain, when, con-

trary to the opinion of the

celebrated surgeon

THE USE OF MOXA.

81

of Lyons, the wounds, or eschars

moxa, are not suffered

to

already alleged.

sons

suppurate, for the rea-

to

is

requires

ap-

it

The

moxa.

applica-

be repeated, as often as the disease

it.

may be employed

ease;

we

In this intention,

after the combustion of the

It

the

ammonia upon the eschars immediately

ply the

tion

made by

is

any stage of the

in

however preferable

to

use

in

it

dis-

the

early periods, and before the deformity has be-

come

considerable.

moxa

placing the

It

is

necessary

directly over the spinous pro-

cesses of the vertebrae, lest they should

denuded and
the

carious.

application

avoid

to

as

It

near

is

as

desirable
possible

become

to

make

upon the

course of the posterior branches of the vertebral


nerves, between the transverse processes, so as

communicate, at the same time, with the spi-

to

nal

marrow.

Corsets,

they are employed

mere supports, are

They

than useful.
in pressing

down

the bone; but


disease will

mechanical means,

or other

if

as
in

retentive
this case

except

bandages,

or

more pernicious

will serve, to a certain extent,

the curvatures or projections of

the morbid, process continue, the

develope

itself

towards

tl^e

opposite

points, so as to affect the integrity of the internal

11

THE USE OF MOXA.

S2
organs.

It

necessary, therefore, to proscribe

is

the use of these machines; and limit ourselves to

the moxa, and internal remedies which will have

a tendency

to

second

effects.

its

The

intervals,

between the applications, should be proportioned


to the

age and strength of the subject.

better that

the

treatment should

be

It will

be

prolonged,

than that the patient should be exposed to accidents arising from inflammation, or a traumatic
fever,

produced by a great number of applications

with too short an interval between each.


relate a great

number

application of the

could

of cases of the successful

moxa

in this disease.

liachialgia.

The moxa

is

especially imperiously indicated in

dorsal consumption.
of

making a

take the liberty here

slight digression

upon

this

alarming

which has been considered, by almost

disease, and
all

I shall

physicians, as fatal.

It

has been designated

by the names vertebral disease, curvature of the


spine, ov.maladie

du Pott.*

interesting cases and

remarks made by

cian upon the disease,

'

Notwithstanding the

it is

See the Works of

this physi-

not generally detected

ti.is

author, vol.

iii.

THE USE OF MOXA.


until

it

has arrived at

its

S3

when

third stage,

resources of the art promise

much

less

the

than at

the first attack.

Until the time of Pott, very vague and uncer-

were entertained respecting diseases

tain notions

of the spine; the effect

At

cause.

was

often mistaken for the

time even, some distinguished au-

this

thors and practitioners consider ahscesses hy congestion,

which are constantly the result of caries

of the vertebrae, as a separate and independent

disease from that of the spine.*

The

researches

practice in

abled

me

made by me, during

camps and military

thirty years

hospitals,

have en-

to verify the principles of the celebrated

English physician; and to analyze, in the most

minute

malady

details, the

at its

phenomena presented by

My

different periods.

this

numerous

experiments have also made me acquainted with


a most powerful remedy against
application of moxa.

it;

the repeated

This indeed

is

the princi-

pal object of the present work.


It

me

appears to

desirable to change the unap-

propriate names by which the disease, of which

are

now about

to substitute

racter.

As

to treat,

has been designated, and

one which shall indicate


it

we

its

true cha-

consists in an inflammation of the


*

The Pathology

of Mover.

THE USE OF MOXA.

84

organic vessels of the fibro cartilaginous and osseous tissue of the vertebral apparatus, or of the

boney pieces of other parts of the trunk,


therefore, call
algia,

when

when

it

according to

it

it

its seat, viz:

will,

rachi-

attacks the spine; sacro-coxalgia,

seizes the sacro-iliac suture; sternalgia,

in the sternum; costalgia, in the ribs, or their <ar-

scapulalgia, in the scapula; and fernoro-

tilages;

when

coxalgia,

it

fixes itself in the eoxo-femoral

articulation, &c.
I

designate by the term rachialgia, that rheu-

matic or scrophulous affection, established

in

one

of the points of the vertebral column, the princi-

pal effect of which

mation

is

a latent or chronic inflam-

in the fibro-cartilaginous

of the vertebrae;

it is

and boney tissues

a true phthisis.

This inflam-

mation, so far from increasing the volume of the

weakens their

parts, by engorgement,

appears

to

accelerate the

tissue,

and

process of absorption

and decomposition; so that the bodies of the vertebrae,

where the

alteration first takes place,

degrees become softened.

have a tendency

The

to separate,

spinous processes

one from the other,

and project backwards, or press forwards, or


the right or

left;

this is

in different directions.

lages are

first

by

to

marked by the gibbosity

The

intervertebral carti-

decomposed or dissolved;

to this

THE USE OF MOXA.


effect,

85

absorption, erosion or caries of the osseous

substance, in corresponding points, soon succeeds,

and developes

itself,

more or

less

rapidly, ac-

cording to the intensity of the causes, the age,

and idiosyncrasy of the individual; the

caries

rarely attacks the spinous or transverse processes.

At

the

moment

first

emitted, by

of the erosion, there

the diseased vessels, a purulent,

all

serous fluid, which accumulates at

first

membranes, or investing, ligamentous


terwards

it

is

under the

texture.

becomes extravasated through the

Afcel-

lular structure towards the most depending points,

or towards those where


sistance;

it

meets with the least re-

and accumulates at places more or

remote, where

it

produces what

is

called sympto-

matic abscess, or abscess by congestion.


abscesses,

as

less

These

was ingeniously observed by the

English author, are constantly the result of caries;


or are one of

its

principal effects

The

progress of

these abscesses vary infinitely; most generally they

take place in the scapular or dorsal regions; the

matter spreads through the interstices of the muscles,

tendinous attachments, and transverse pro-

cesses;

accumulates in sinuses formed by the apo-

neuroses of the large muscles of the back; sometimes the pus passes under the pillars of the dia-

phragm, follows the direction of the psoas muscle,

THE USE OF MOXA.

86
and

in

collects

the fold of the groin, or passes

through the pelvis


ces,

it

to the nates.

In other instan-

follows the direction of the ribs,

and goes

some of the anterior parts

to form collections on

Indeed, nothing can be more irre-

of the chest.

gular than the course of these inflammations, and


the

development of the abscesses which result

from them.

This circumstance should render the

practitioner very circumspect in his prognostic, as


well as in the

employment

The symptoms which

of remedies.

first

indicate the existence

of this disease are, obscure, deep seated, local

They

pains.

at last

propagated

in the

nerves

which

and

become increased, and are

course of the spinal marrow,

emanate from

it;

especially

those which go to the extremities nearest to the


disease.

The

action of the muscles of these parts

becomes impaired, without being paralyzed; spasmodic pains, and a

sort of tension, (roideur) or

accidental retraction, with a sensation of cold,

dependent of the temperature of the


perienced in these limbs.

added

To

these

air,

in-

are ex-

symptoms are

dullness, oppression, loss of appetite,

ema-

ciation, slow fever, with irregular intermissions,

followed by colliquative sweats and marasmus.


I shall'

enter

progress of this

more

into detail

respecting

disease in speaking

the

of femoro-

THE USE OF MOXA.


coxalgia; the

same kind of

87

when

affection,

it

at-

tacks the coxo femoral articulation.


I shall only

observe here,

recommended by Pott
sess

in

the advantages that

The

moxa.

that the cauteries

rachialgia, do not pos-

have derived from

copious suppuration

sort of cauteries

occasions,

which the

first

weakens the patient

very considerably, without producing the desired


revulsion, especially if there be symptomatic abscesses.

before

If

these abscesses

efficacious

means have been

against the caries, whatever

tration of these means,

it

may

Now

the patient dies very soon.

vour

opened

are

is

early,

employed

be the process,
in the

adminis-

necessary to endea-

to stop the process of suppuration; it is suffi-

cient to produce an
fected,

excitement on the parts

divert the morbific principle,

to

change the

vital properties of the

double indication.

to

inflamed parts.

Moxa, preceded by cupping with


fulfils this

and

af-

I shall

scarification,

now

content

myself with pointing out the causes of diseases of


the spine, and making

known my mode

of treat-

ing abscesses by congetion, which are the principal effects of them.

The

causes of rachialgia are a rheumatic,

scrophulous

vice,

and, generally,

which can contribute

to

every

or

thing

destroy the vital forces

THE USE OP MOXA.

88
of the

and progress of

this

rare that

stopped in

it

is

spontaneously.

It is

which nature

The development

apparatus.

vertebral

is

are slow, but

affection

course,

its

it is

or cured

one of those diseases from

incapable of extricating

itself,

without the assistance of art;

its

also are generally fatal.

important there-

fore to hasten the


to

combat

me

taught
is

this

It

is

consequences

employment of suitable means

morbific

experience has

cause;

that the most powerful and efficacious

moxa.

great number of patients, whose situations

were considered desperate, have owed their safety to this heroic remedy.

mary

I will

now give a sum-

of several which confirm this truth.

I shall

afterwards have occasion to return to the theory


of the disease.

Case

General

1st.

variety of debilitating causes,

exhausted by a

was attacked with

a dorsal consumption, slow fever, great loss of

power

in

spine,

uneasiness and numbness in the lower ex-

tremities,

This

and marasmus

affection

medies.

It

series of

tebral

curvature of

the genital organs,

in

the

first

the

degree.

had resisted a great number of re-

was decided

in

a consultation

that a

moxas should be applied upon the ver-

column,

and the region

of the

sacrum,

THE USE OF MOXA.

89

without discontinuing the bark and ferruginous


preparations
three

the

first

With

time administered.

that

at

applications a favourable change

took place; the strength of the patient returned

proportion as the

in

the seventh he was in a state to walk

At

ed.

and by the thirteenth he was

alone,
tion

to

go

campaigns
Case 2d.

in a situa-

mineral waters to complete a

to the

He

cure, already far advanced.


ral

were repeat-

applications

has

made

seve-

since.

Mademoiselle

twenty-five years was in the

first

aged about

stage of ma-

rasmus, with strong symptoms of pulmonary consumption.

The

dorsal

vertebrae were curved

backwards, and towards the right

side.

The

sca-

pula of the same side was detached from the trunk


about three centimetres,* by a
incipient abscess

announced the
brae.

by congestion.

first

tumour, or

stage of a caries of the verte-

In a word, this young lady was approaching

rapidly the end of her career

ed

soft

These symptoms

when

was

call-

to see her.

The
tient

debilitating

regimen

had been subjected

which

the

pa-

for several months,

was

to

replaced by one that was tonic and nourishing:


the

bark
*

combined

A centimetre
12

is

with opium

and balsamic

the .39371 part of an English inch.

THE USE OF MOXA.

90
and

gummy

moxas were applied

successively,

vals of three or four days,

spinous

Twenty

substances were prescribed.

upon the

processes of the dorsal

inter-

after

sides of the

vertebrae, near

the spaces which separate the transverse process-

The

es.

first

favourable change, was the sudden

and entire cessation of the symptoms of pulmonary


consumption, and, soon after, a reduction of the
projection of the dorsal vertebrae, the resolution
of the subscapular tumour, and the return of the

scapula to

its

natural situation.

By

degrees, the

general powers of the system returned, and the


internal

word,
I

organs

this

recovered their functions; in a

young lady now enjoys perfect health.

am now

about to give an account of a disease

nearly resembling the preceding; the case occur-

red

in the military hospital of

Case

Gros-Caillou.

3d. Joseph Richaulet, about twenty-three

years of age, a cannoneer in the foot guards, in

February,
the two

1816,

fists,

had a tumour of the

from the base of the spine of

its

of

and of an oval form, situated behind

the spinal edge of the right scapula.

its

size

inferior angle.

There was

It

extended

this bone, to

a fluctuation

below

through

whole extent, without pain or change of colour

in the skin.

The

patient

was constantly

bent; the

spinous processes of the dorsal vertebrae were pro-

91

THE USE OF MOXA.

minent and separated, and this portion of the


spine deviated a

little

When

the tumour.

towards the side opposite

the points corresponding to

these vertebrae were pressed a

little,

the patient

a violent pain, accompanied with a sense of

felt

weakness, which approached

to

syncope, when the

This tumour, and the

pressure was prolonged.

other symptoms which accompanied

enabled

it,

easily to recognize a disease of the spine, in

me

second or third stage.

rheumatic
in

tracted

campaign

ment

which

the cold and

result of a

this soldier

had con-

humid bivouacs

of the

in France, in 1814.

condition of the patient was so desperate,

The
that

affection,

was the

It

its

did not expect any success from the employ-

moxa; nevertheless,

of

resolved to try

the third application, which

At

effects.

its

made

with an interval of two or three days, along the


course of the dorsal vertebrae, which appeared to

be the most affected, the patient found himself


relieved.

was

diminished slightly, and

caused a drawing

at this time that I

made
I

The tumour

to

it

be

of it.*

prescribed anti-scorbutics, and the continua-

tion of the

moxa,

The last were

until

twenty- four were applied.

applied over the external wall of the

* Sec the plate in the 4th vol. of

my

Campaigns.

THE USE OF MOXA.

92

purulent sac, which prevented the approach of the

The

walls of the tumour.

cure of this soldier was

He

complete on the 23d of July last.*

has expe-

rienced, during the course of his disease, a short-

ening of his height about two centimetres.

This patient was presented

to the

Society of the

F; cnlty of Medicine before and after his cure.f

In vol.

ii.

page 396,

my Campaigns, may

et seq. of

be found many cases which establish the happy


effects of
tion,

moxa

in rachialgia, or dorsal

consump-

with incipient caries, and abscesses by con-

gestion, which are the consequences.

After having used the moxa until the progress

was arrested,

of the disease

abscess, in

some

to.

have opened the

manner described

cases, in the

the work above referred

It consists in

in

making

an oblique opening into the abscess, by means of a

narrow

knife,

heated to incandescence;

all

the

purulent matter contained in the sac, should be

evacuated instantly by dry cupping, and a slightly


compressive bandage applied.

The following cure,


in

my

* See

with those which are related

work, making known


my

this process

more

Campaigns.

t Lady Morgan,

in

her work on France, has

testified

her admiration of

the remarkable cures obtained in cases of this kind, by the aid of

remedy

in

at present not

used in England.

moxa, a

THE USE OF MOXA.

93

detail, will certainly justify the principles

laid

already

down.

Case

4th.

Peter Moussot, aged twenty-four

years, of a phlegmatic-bilious constitution, a fusilier in the sixth

regiment of the royal guard, in

the cold and wet

bivouacs of the campaign of

Saxony, towards the end of the year 1813, contracted a rheumatic affection, which became fixed

about the back.

mained of

The

only symptoms which re-

this affection, not relieved

a better regimen,

by rest and

were some periodical pains

about the same point; but suddenly, in the winter


of 1815, they

May, 1816,

In

were renewed with more


this soldier

was transported from

ward, where he had

the fever

violence.

been under an

anti rheumatic treatment, into mine.

He had

then

a considerable tumour between the spine, and the


posterior edge of the scapula.

the

first

inspection, the

by gibbosity, de-

of the spine towards the

lysis of the

recognised, at

malady of Pott, arrived

at the first stage; characterized

viation

left side,

body of the bladder, and of the

para-

inferior

extremities.

The

dorsal tumour was of an oval form, about

three centimetres in

projected nearly as

its

far.

greatest diameter, and

The

fluctuation

was

uni-

THE USE OF MOXA.

94
form through

its

The

whole extent.

was not

skin

discoloured.
I

commenced

by applying along

the treatment

the whole course of the vertebral column, dry cupping, and cupping with scarifications,

and

after-

wards moxa, with the usual remedies.

A favourable
applications,

change was produced by the

and the patient continued

to

first

improve.

However, the tumour, the volume of which underwent a rapid diminution by the fourth application,
went on much more slowly afterwards,
twenty-first,

until the

and then remained stationary

the twenty-fifth of July,

when a

small

suddenly appeared in the centre of

and announced

to us a

until

phlyctena

its

surface,

spontaneous and immediate

opening of the abscess.

Under

this conviction, I

hastened to plunge in a narrow bladed knife, heat-

ed

to

incandescence, making an incision about a

centimetre and a half in length, commencing at


the phlyctena, and directing

it

depending part of the tumour.

towards the most

vessel

would contain about a pound, was soon

which

filled

with

a serous, inodorous substance, of a white greyish


colour,

and mixed with albuminous

floculi.

cupping glass applied over the opening, removed


the

little fluid

which remained

in the cavity.

this part of the fluid, osseous, friable grains

In

were

THE USE OP MOXA.


observed, which
the carious

95

supposed were the remains of

portion of the body

of one of

the

vertebrae.

This operation threw the patient into a

state of

extreme debility during four days, which

op-

posed, by an antiseptic draught, and a strength-

ening

diet.

by frequent

febrile state then

chills,

announced

itself

followed by intense heat.

was accompanied with a painful sense

It

of constric-

tion in the hypochondriac regions, with dyspnoea,


slight cholic, diarrhoea,

and tenesmus, the urine

small in quantity, and of a reddish brown colour.

There was every reason

to believe that,

from the

aberration, or metastasis of a very acrid principle,

from the carious body of the vertebra,

to all

the mucous membranes, there had taken place in


all

these membranes, a chronic inflammation, which

was

the source of the

The

symptoms described.

application of cupping with scarification,

and large vesicatories upon the thorax and

belly,

together with the administration of mucilaginous

anodyne substances, dissipated the imminent danger by which the patient was threatened, and restored him to a favourable state.

Afterwards, for

the purpose of favouring the adhesion of the walls

of the sac, I applied

new moxas.

THE USE OF MOXA.

96

By

the twenty-fifth

of

November, 1816, the

patient might have been considered as being near-

He

ly cured.

walked well, but was unable

to

bend

the trunk forward or sideways, in consequence of

the anchylosis of the boney parts originally affect-

ed by the caries.
four centimetres.
tient,

of

who was

His height was shortened about


It is

evident, that in this pa-

perfectly cured, after a treatment

two years, the caries of the cartilages and bo-

dies of the vertebrae

must have been very exten-

was

so great a loss of substance.

sive, seeing there

Another process
geous,

if

will

be

the fluid contained in

spread into a portion of the

more advanta-

still

the abscess has

ct llular tissue,

communicates with the purulent sack.


sists in

which

This con-

passing a seton through the cellular tissue;

the fluid will pass out at the same time by both


the wounds, and will continue gradually to ooze
out, until

it

is

entirely evacuated.

Then,

if

the

caries of the bone which had furnished this fluid,

be stopped, as

we must suppose

complete cure of the patient


tain, as the

will

in this case, the

be the more cer-

matter of the abscess will be evacuated

gradually, and without allowing the external air to

communicate with the purulent cavity.


tients,

this

who have been

Two

pa-

treated with advantage by

method, will be spoken of hereafter.

THE USB OF MOXA.


Case 5th. Thomas, a

97

fusileer in the fifth regi-

ment of the guard, aged twenty-two years, had


experienced frequently after bivouacs rheumatic
attacks, with violent pain,

of

which

1816 returned, principally

between the

left

at the

same time,

scapula and the superior dorsal

vertebrae, a tumour, the progress of

rapid

summer

upper part

at the

There appeared

of the back.

in the

and remarkable; so that

after its appearance,

it

in

which was
days

fifteen

had acquired a considera-

ble volume, and presented an evident fluctuation

over

its

whole extent.

dorsal column

The upper

was strongly projected forward,

as to form a concavity behind.

to the alte-

posterior part of the body of the

vertebra, so that the spinous processes were


to

approach nearer

rior part of the

dency

to

each other, while the ante-

were

Twenty

ten-

from the corresponding part of

the bone placed above and beneath


rior extremities

made

body of each vertebrae had a

to separate

paralysis.

so

This appearance,

extremely rare, was owing, no doubt,


ration in the

part of the

it.

The

in a state of almost

supe-

complete

cuppings, and thirteen moxas,

were successively applied about the tumour


space of two months.

As

the

number

in the

of these

applications increased, their efficacy was manifest-

ed by the diminution of the pains, the reduced

13

THE USB OF MOXA.

9$

size of the tumour,

and the returning power of the

superior extremities.
ber, the

By

the twentieth of

tumour was one fourth of

and the patient getting well.

its

Novem-

original size,

This soldier having

been discharged from the service, returned home,

where the cure was, no doubt, completed.


Case

Dulard, a curassier of the guard,

fith.

having been subjected

to the pernicious influence

of the cold bivouacs in Russia,

was attacked with

a fixed pain in the lumbar region, with a remarkable numbness, and very great debility in the inferior extremities,

which terminated

in

an almost

complete paralysis.

The physicians of the Bourbonne-les-Bains, to


whom this soldier was sent, considered and treated

as a paralytic affection; but this

it

When
nised,

he was brought

was

our hospital,

useless.

recog-

by the symptoms already so frequently men-

tioned, a well

three

to

first

marked case

of rachialgia.

The

lumbar vertebrae formed a prominence of

about three centimetres; the slightest pressure on


the diseased part, caused severe pains, as well as

weak

The

convulsive motions in the lower extremities.

application of cupping, which

ordered to be

repeated during five or six days, along the spine,


the hypochondria, the flancs, the nates, and the
thighs,

was

so

evidently beneficial, that I was

THE USE OF MOXA.

99

enabled to commence the employment of the moxa,

and

to substitute for the cooling

remedies, until

then employed, tonics administered with modifications suited to the indications.

Fourteen moxas applied successively along the


sides of the tumour,

and towards the regions of

the back and sacrum, together with the cupping,


entirely

removed the complaint.

The

contractile

action of the extensor muscles of the lower extre-

by the

mities, particularly affected

paralysis,

was

restored; and progression, and the other functions,

were

re-established; so that

November, the patient was


cured, and he

left

by the twentieth of
in a

good way

to

be

the hospital in a few weeks

after.

Case 7th. Labaudre (Blaise,) aged twenty-eight


years, a soldier in the

first

regiment of infantry,

of the royal guard, after great indulgence,

first

observed, about six years since, pains in the back

and

pelvis.

He was

transferred, on the seventh of Septem-

ber, 1817, from the military hospital of Val-de-

Grace, where he had been for about six months,


to that of Gros-Caillou.

inguinal

There was

in the left

region an abscess by congestion, of an

oval form, of the size of the two

fists,

with evident

fluctuation through its whole extent, the skin not

THE USE OF MOXA.

100
at

all

discoloured.

Already one of the most pro*

jecting points of the abscess was almost open,

and

was accompanied with pains about the hip and


thigh of the

same

and the dorsal region.

side,

A distinct prominence, projecting about two centimetres, formed by the separation of the spinous

processes of the last dorsal vertebrae, shewed that


the nature of the original lesion had been mistaken
at the hospital of Val-de-Grace; of

scess

was but a symptom,

as this

which the ab-

tumour originat-

ed in the caries established in the bodies of the


dorsal or lumbar vertebrae.

Dry and

moist cupping, applied over the whole

dorsal region, and especially at the sides of the


swelling,

overcame the chronic inflammation, and

relieved

the patient.

After the application of

nineteen moxas, the tumour, which at


little

first

was a

diminished in volume, remained stationary,

and the point of which


again ready to open;

have spoken, appeared

was induced

to

pass a

seton through the integuments and cellular tissue


of the groin of the

prehend

same

side.

in the perforation, the

took care to com-

deep

cells of this

region, with which the purulent matter enclosed


in the sac

appeared

to

me

to

communicate.

evacuating gradually and indirectly


I

endeavoured

to

all

In

the fluids,

avoid a direct opening into the

THE USE OE MOXA.


tumour,

consequence of

in

thinness of

101
and the

softness,

its

walls, as well as from its being so

its

immediately connected with the abdominal viscera.

However, notwithstanding the remarkable


duction of this abscess,

its

me

absorbed, as to induce

walls
to

became

re-

much

so

apprehend their

opening spontaneously.

This circumstance deter-

mined me

a knife, heated to incan-

to

plunge

in

descence, in the manner above described.

During the three

first

months which followed

the operation, the patient was as well as could be

expected, in a person in his situation.

The

sup-

puration, though abundant, was of good quality;

the symptoms of fever, arising from absorption,

were dissipated;
well,

all

the functions were performed

and Labaudre began

to

walk about

But he no sooner found himself


in a

way

to get well, than

He was

ward.

out of danger, and

he returned

temperate habits, giving himself up


tion.

his

to his in-

to intoxica-

attacked a few days after these

excesses by violent cholics, scalding of the urine,

and a comatose

affection.

wound, which was

The

fistulous,

suppuration of the

became

entirely sup-

pressed, and metastasis to the lungs and brain,

manifested themselves at nearly the same time.

The

functions of these organs were disordered,

and gradually weakened, and,

after a

month of

THE USE OF MOXA.

10&
anguish,

and

died with marasmus

the patient

exhaustion.

Twenty-four hours
the body, which

and

was

The

flexible.

after

livid,

death,

we examined

the limbs were flaccid

viscera of the belly and chest

presented nothing very remarkable; the cranium

was not opened, but there was reason

to suspect

purulent state of the brain, from the paralysis of


all

ihe muscles of the extremities, and the symp-

toms of cephalalgia and mental aberration, which

were manifested before death.


After removing the abdominal viscera,
covered, as

had asserted

at the

moment

we

the pa-

tient entered the hospital, a purulent sinus,

extended from the fistulous wound

dis-

which

in the left illiac

region, along the psoas muscle, and behind the pe-

ritoneum, to the bodies of the second and third

lumbar vertebrae; the remaining portions of which

had approached and formed a mutual adhesion.

The

cavity which arose from the loss of substance

was invested by a ligamentous covering; osseous


vessels projecting from both pieces,

sides

formed on the

two small bridges; while the central points

approached each and formed a sort of anchylosis.

The

reader

may

see a representation of this mor-

bid structure in the fourth volume of the

already referred

to.

It

work

shews unequivocally that

THE USE OF MOXA.

103

however extensive, may

caries of the vertebrae,

be arrested, and that those parts destroyed by

may be

this ulceration

cicatrised; as

venereal caries of the cranium,

happens in

when properly

treated.*
It is evident that the caries

in the case of

had been arrested

Labaudre; that the bony portions,

destroyed by this affection, had become cicatrised

and united, and that nothing was wanting


*

have attended three

syphilis,

soldiers,

who

in

had the cranium furrowed out

in this

consequence of a constitutional

at several points; in one, through

the whole thickness of the external table and diploe of the frontal bone;
in

another

it

had extended

its

ravages into the sinuses of this bone, caus-

ing a great loss of substance; in the third there was caries of the frontal

and

occipital bones.

All three

now enjoy

perfect health.

The

loss of

substance or furrows, which resulted from these caries, could be observed

both by the eye and touch, under the integuments, which adhered closely
to them.
rates

its

The moxa

is

not indicated in these sort of caries.

progress, unless the cause of

same time by

specific

means.

speaking of the treatment that

shall

it

is

It

accele-

destroyed, or opposed at the

not terminate this note without

have adopted

in syphilis,

and employed

with great success in the hospital, the surgical department of which has

been entrusted to
into internal

my care for

and external,

twenty years. This treatment, which

deuto-chlorate of mercury, hydrochlorate of ammonia, and


of

opium

in equal parts; six, eight, or ten grains of this

in a sufficient quantity

pound of

of Hoffman's

in doses of

from two drams

ginous fluid, as milk.

gummy

extract

mixture, dissolved

liquor, are sufficient doses

sudorific syrup, or distilled water.

of from half an ounce to two ounces.

tered

I divide

consists in the internal administration of the

The

The

syrup

is

for a

given in a dose

second preparation

is

adminis-

to an ounce, in an appropriate mucila-

Mercurial frictions of from one to three drams

on the

soals of the feet every three or four days, followed

lotions

and exercise, constitute the external treatment.

by saponaceons

THE USE OF MOXA.

104

patient for completing the cure, as in the pre-

ceding cases, but the detergence of the purulent

si-

nus, which had disorganized the Cellular tissue of

the psoas muscle, and the

This

abscess discovered itself.*

where the

region,

illiac

fact proves, in

word, that these diseases are curable when

have the courage


of moxa, and

in

opening the abscesses, which

are the consequences of the caries,


at once to

remove

of a seton.

its

I shall

we

persevere in the employment

to

when

we take care

whole contents, or make use

terminate this part of the sub-

ject by a summary of two extremely curious cases.

Case

Sth.

John Joseph Bulliard, about twenty-

one years of age,

tall,

and of a

light complexion,

and a lymphatic constitution, a soldier

in

one of

the Swiss regiments of the royal guard, entered


the military hospital of Gros-Caillou, the sixth of

December, 1818,

to be treated for

which had been remarked


largest

for

two abscesses,

The

some months.

was situated on the dorsal region, and the

The

second on the upper portion of the sternum.


left

knee of

this patient

was tumefied, and the

motions of the joint very imperfect.


tenth,

The

ninth,

and eleventh dorsal vertebrae, formed a con-

A soldier

in

the second regiment of the royal Swiss Guards

under the same treatment


exhibiting the

at the hospital of Gros-Caillou,

same symptoms,

He

is

in a

way

to get well.

is

now

tor a disease

105

THE USE OF MOXA.


projection, and

siderable

the slightest pressure

upon the spinous processes of these

vertebrae,

He was

emaciated,

caused the most violent pains.

discoloured, and had a fever, with slight remissions,

&c.

From

all

became convinced

these symptoms, I

that this young Swiss was affected with an osse-

ous phthisis; established in the bodies of the last


dorsal vertebra, the sternum, and the femoro-tibial

symptomatic abscess, or abscess

articulation, with

by congestion.

This disease, which had already

arrived at the second stage, was caused, no doubt,

by a scrophulous

and onanism,

diathesis,

to

which

he had completely given himself up.


After observing the patient for some days,

prepared him
of which, at

He

vere.
to

it,

and

first,

moxa, the application

appeared

to

him extremely

se-

however, became gradually accustomed


at last suffered

cations to be

At

stancy.

to receive the

all

the necessary appli-

made, with great courage and confirst,

attended particularly to the

treatment of the tumour over the sternum, about

which

applied twenty Chinese moxas.

wards opened the symptomatic

abscess,

I after-

which was

about the size of a large hen's egg, by means of


the caustic potash.

14

THE USE OF MOXA.

106

The

purulent matter being evacuated, and the

eavity cleansed, there

was discovered a carious

point in the sternum, which

The

abscess.

ed

was the

origin of the

diseased portion of the bone cleans-

portions of the compact lamina of this

itself;

bone exfoliated, and afterwards cicatrized; and,


though the

soft

parts remained for a long time

ulcerated and fistulous, they, like the bone, also

healed up, under the salutary influence of

new

Chinese moxas placed around the part.

The tumour
mean

of the back had acquired, in the

time, so considerable a size, that

bled, both in volume

an

infant.

it

resem-

and appearance, the head of

placed along the sides of the whole

vertebral column,

commencing

at the

upper part,

and about the tumour, thirty moxas of cotton,


using the blow pipe.

The

the patient very much, he

first

having relieved

was encouraged

fer the applications to be continued.

to suf-

Pills of the

extract of hyosciamus, nitrate of potash, and cam-

phor, and some particular precautions, relieved


this

young man of the pernicious habit which he

had contracted.
security,

The

and

all

continued the treatment with

the success that one could expect.

abscess on the back remained stationary;

and, as the most projecting point exhibited indications of opening, after having arrived, at

the

THE USE OF MOXA.


moxa, and four months attention

thirtieth
case,

107

determined

to

to the

operate according to

my

with the lancet heated to incan-

method, that

is

descence.

selected one of

performing

this operation,

my

days for

clinical

which was followed hy

the discharge of about a pint and a half of fluid,


similar to that evacuated from the abscess of La-

baudre.

The

dressing being completed,

took

all

the necessary precautions to prevent accidents, or


to

A regimen

remove them.

been described

in the

similar to

what has

preceding cases conducted

him, with some interruptions,

to the desired end.

He

and

walked better and

better,

after a year's

treatment, he found himself, as far as regarded

the rachialgia,

in

way

But the tumour

to get well.

of the knee had increased in

the same proportion, notwithstanding

all

the usual

However,

remedies had been employed.

did

not wish to remove this focus of morbid action


before the rachialgia was entirely cured, for the

same reasons that


the sternalgia
fore, to
until it

devote

was

my

did not attack this


relieved.

continued, there-

attention to the dorsal disease

was cured; which was

far

advanced by the

end of the spring of the year 1820.


of the knee, in the

last, until

mean

time, having

The

disease

made great

progress, and being convinced that the caries had

THE USE OF MOXA.

108

attacked, deeply,

termined

to

the articulating pieces, I de-

amputate the thigh, which the unhap-

had long desir

patient

py

all

The

d.

operation,

though performed with precision and method, was


followed by a very alarmingly conical state of the

stump (cnicite.)
ed

my

have recourse

to

attend-

were strong-

Clinical Lectures on Surgery,

ly under the impression that


to

who

Several physicians,

should be obliged

another operation, but

sured them that this would not be the case.

been taught by experience, that

as-

had

this projection of

the bone, being the result of local irritation, and


the collapsed

state of the cellular

tissue,

would

cease with the exfoliation of the cut extremity of


the bone; and that then, there would

not.

be any

longer any cause of irritation; because the muscular fibre being then swelled out, and separated

by the

fatty substance

filling

anew

the cellular

parts would be brought back to-

tissue, the soft

wards the end of the stump, and restored


level with the cut extremity of the femur.

a second

many

authors, and
less

much
sible,

but
as
to

much

operation, so

may
it is

extremely

fall

by some

not only use-

It is

useless, inas-

difficult,

the saw

Thus,

is

practitioners,

be dangerous.

make

extolled

to a

not to say impos-

exactly

above the

points of the sequestrum (sequestre;) as the ne-

THE USE OF MOXA.

109

crosis takes place in the cylinder of the femur,


at

unequal distances from

ever

little

its

extremity; and, how-

dead bone, may

of the sequestrum, or

have much

escape, both nature and art would

greater difficulty in removing

questrum remained

With

entire.

danger of a second operation,


tioned

to

the

than

it,

hemorrhage,

if

the se-

respect to the

would be propor-

it

inflammation

or

of

membranes which might accompany

the fibrous

All these considerations will be developed in

it.

a separate memoir on this accident.

This phenomenon was exhibited


markable manner

in Bulliard,

comrades, whose thigh


similar disease.

to be

in

very re-

one of his

amputated

for

Thus, the portion of the dead

bone being exfoliated, the

came

also

and

in a

upon a

soft parts of the

level with the

bone, and perfectly healed.

stump

remaining sound

In a word, this pa-

tient left the hospital, at last, extremely well, on

the

first

of August, 1820.

He had

lost

about three

centimetres of his height; his natural plumpness

was restored, and every thing announced


soldier,
try, in

who

has

now returned

company with

case, enjoyed

that this

to his native coun-

the subject of the following

good health.

able in various respects.

This

cure

is

remark-

THE USE OP MOXA.

110
Case
ing case
little

The

9th.
is

success

not less surprising, though there

resemblance between

the nature of the disease.


of

it,

obtained in the follow-

it

is

but

and the preceding,

I will

give a

in

summary

because the moxa contributed much to the

safety of this soldier.

Louis Stobler, aged about twenty-one years,


one of the soldiers in the

regiment of the

first

royal Swiss guard, in a paroxysm of nostalgia,

threw himself from the third story of

his barrack,

with the intention of breaking a leg, so that he

might be sent home.

must be the

easy to anticipate what

result of such a

fall,

which was concentrated

fect of

and kidnies.
third,

It is

and the

anteriorly

the principal efin the right leg

This limb was broken


first

upon the

in its inferior

lumbar vertebra was luxated


last

dorsal

The

vertebra.

deep depression which was observed behind the


first,

and the unnatural projection formed im-

mediately over the spinous process of the last


vertebra; the sudden and complete paralysis of

the lower extremities, intestines and bladder; the

pains and death-like coldness

left

no reason to

doubt concerning the nature of this luxation.

though
soldier,

had no hopes of preserving


after

this

Al-

young

having restored him by suitable

THE USE OF MOXA.


means,

Ill

endeavoured, as soon as possible, to

fulfil

the indications which presented themselves.


I

applied at

several

first

series of cuppings,

with scarification, along the lumbar region and

around the

belly.

all

afterwards enveloped this

person in the skin of a sheep recently killed, while


it

was

smoking.

still

After this application,

had recourse immediately


phorated

oil

of camomile

to

embrocations of cam-

very warm.

All at-

tempts at reduction would have been useless and


injurious.

Two

bleedings from the arm, and a

third from the jugular, to relieve the effects of the

concussion, which had been violent, were successfully practised,

and the patient put upon cooling

and antispasmodic drinks.

Although the comminuted fracture of the leg


indicated amputation,

deferred

it

hope of safety which the wound

from the slight


offered; I con-

tented myself, therefore, with the application of

the apparatus which

such cases.

am

in the habit of using in

However, the patient having reco-

vered the use of his senses, and having passed

five

or six days without any increase of the alarming

symptoms already mentioned,

conceived some

glimmering hope of saving him by the most


siduous care.

The

paralysis of the

and abdominal viscera was carried

as-

extremities
to

such an

THE USE OF MOXA.

112

extent, that the patient

had no sensation of pain in

and heat

the limbs, notwithstanding the fracture

applied to ascertain their insensibility.

The

was readily relieved

retention of the urine

by means of a

gum

But purgative

allowed to remain in the bladder.

enemata has not


stinate

sufficient

constipation,

power

which

experienced after his

this
I

fall.

to relieve the ob-

poor young

hardened

fceces,

of a scoop

with which

made expressly

also compelled

to

it

man

was under the ne-

not only of relieving the rectum

cessity,

was

which was

elastic catheter,

was

filled,

of the

by means

for the purpose, but I

extend the scoop to the

sygmoid flexure of the colon, which was also so


full

that

it

projected into the

left

iliac

region

through the abdominal walls.


After twenty days of care, and tonic frictions

and embrocations over the whole body, there was


a sensible improvement, and the excretions began
to return.

However, there

still

remained a great

debility in the lower extremities,

and fixed pains

at the point of the luxated vertebra.

menced

the use of moxas, which

then com-

applied, two at

a time, along the sides of the last dorsal, and first

lumbar vertebra?.

By

the time eight

moxas were

applied, the sensibility and muscular motion of the


inferior extremities returned,

and

after eighteen

THE USE OF MOXA,

113

months treatment, the patient would have been


able to walk, but for the deformity and contraction of the fractured leg

that the limb should be

an operation which

dered unavoidable.

and

He

foot.

desired

removed by amputation,

had, for some time, consi-

performed

this operation in

the thick part of the condyles of the


disease extended very high.

tibia, as

the

Nothing interrupted

the healing of the stump, the cicatrix of which

was

linear.

The

motions and animal sensibility of the parts,

which had remained long

in

a state of paralysis,

were gradually restored, and the patient,


having moved about with

difficulty

by the

after
assis-

tance of crutches, was enabled at last to walk very


well with a
this

wooden

At

leg.

the end of two years,

Swiss arrived at a perfect cure.

He became

about four centimetres shorter than when he


entered the regiment.

finger's breadth

The

first

last false ribs are but

from the crest of the ilium and

there remains a deep depression beneath the spi-

nous process of the

last dorsal

vertebra,

which

projects very much.

This

which
the

is

the third case I have had of a luxation,

have believed

dorsal, or

to

be complete, of one of

lumbar vertebrae, produced sud-

denly by mechanical causes.

15

The two

first

are

THE USE OF MOXA.

114
inserted in
in the

my

Campaigns; and the patients are

Hotel Rmjal des Invalided.

curious

last exhibit, will consti-

phenomena which these


tute the subject of a

The

memoir which

propose to

publish on the consequences of these luxations.

Sacro- Coxalgia

Rheumatism sometimes produces such


upon the

sacro-iliac synchondrosis

especially in

young

effects

as to cause,

subjects, a gradual separation

of these two bones, and, of consequence, a sort of

This, indeed,

spontaneous luxation.

articulation in the osseous system,

is

where such a

kind of displacement can take place.


true, that

it is

It is also

generally produced by a mechani-

cause; such as

cal

the only

falls,

or violent compression

exerted in a direction opposite to the line of con-

nexion between the two bones.

may

also

birth to

happen

to

very young women,

uncommonly large

examples of

this;

This luxation

children.

in

giving

have seen

have been even obliged

to

apply a retentive and compressive bandage in a

young woman of seventeen years of age,

after a

laborious labour, which caused a separation of the


ilia

in

with the sacrum, similar to what takes place


the

female

Guinea

pig,

during parturition.

THE USE OP MOXA.

115

The symphysis, however, united, and this young


woman has been since very well.
The case communicated to the Academy of Surgery, towards the end of the eighteenth century,

M.

by

L'Heritier, Professor

Practice,

The

is

patient

the School

in

a striking example of

of

disease.

this

was a young farmer, who having

for

a long time suffered a rheumatic affection in the


right sacro-iliac region, experienced such a sepa-

ration of the two bones which form the symphysis,

that the ilium

M.

moved with

facility

up and down.

L'Heritier, after having used the actual caute-

ry, ingeniously conceived the idea of fixing the

two

bones together, by means of an elastic bandage; the

form and composition of which


design which has been

made

may

of

it,

be seen in the

which may be

found in the archives of the Faculty of Medicine of


Paris.

have seen

this dislocation

since, in

two young

soldiers,

produced suddenly by a spent

ball,

acting obliquely from above, downwards, upon the


ilium.

might relate here

in detail the case of

a patient affected with the same disease,

had under

my own

who

care, a short time since, at the

hospital of Gros-Caillou.

In this affection, the corresponding limb becomes


elongated, in proportion to the depression of the

THE USE OP MOXA.

116

ilium, if the displacement has taken place from

above downwards; and the reverse.

The

diagnostic in this lesion

er, the local

pains' increasing

and a manifest tumefaction

is difficult;

by direct pressure,

in the sacro-iliac re-

gion, will authorize us to believe that

happens, that

often

howev-

this disease

exists.

it

produces

It

in the

symphisis which unites the ilium to the sacrum, a


caries similar to

as

have described

and

what takes place

in the vertebrae;

speaking of rachialgia,

in

in the hip joint, or femoro-coxalgia, of

which

speak soon.

I shall

If the

malady be recent,

it

may be

relieved

by

the means employed by Professor L'Heritier, to

which may be added with advantage, the frequent


application of moxa.

If the disease

be old, and

especially with anchylosis of the bones in an un-

natural situation, the disease

The means
to be

incurable.

pointed out in rachialgia, ought then

employed

same nature.

is

in this affection,

But

which

is

of the

cannot too strongly advise

avoiding that portion of the skin which immediately covers the bone;

of consequence,

we must

choose the space which corresponds with the dis-

eased symphisis, as

No. 3 and
paigns.

it

is

indicated

4, of the fourth

volume of

the plates

my Cam-

THE USE OP MOXA.


The same kind

117

of affection sometimes attacks

and the scapulae, as

also the sternum, the ribs

have myself seen; and the result of


established in

these bones,

is

ceding cases.
scesses,

more of

the substance of one or


absolutely the

We

may

same

this disease,

as in the pre-

also affirm, that the ab-

which take place, more or

less

remotely

from the focus of the disease, are constantly pro-

duced bv the caries of these bones.

These ab-

scesses differ but

their nature

and devel-

opment from those which accompany

rachialgia,

little in

The names

properly so called.
costalgia,

of

sternalgia,

and scapulalgia, may be given

to these

diseases.
I

have remarked,

chialgia, that

when

in

all

these cases, as in ra-

the opening of the abscesses

takes place spontaneously, before the caries in the

bone producing them has

means above pointed


fatal.

On

out,

the contrary,

been stopped by the


the disease

when

the

moxa

is

always

is

applied

early in the complaint, so as to stop the progress


of the caries, the operation of opening them

is

followed by happy consequences, of which I have

seen numerous instances.

THE USE OF MOXA.

IS

JFemoro- Coxalgia.
I give this

name

to the latent or chronic inflam-

mation which takes place

in the fibro- cartilaginous

and osseous apparatus of the coxo-femoral articulation; it is similar to that

which has heen describ-

ed as attacking the vertebral apparatus, and the


sacro-iliac symphisis.

It is

ordinarily the effect of

a rheumatic affection, or exhaustion of the prolific

powers of the patient.

This disease may be an

hereditary,

or acquired scrophula;

syphilitic.

It is

is

it

necessarily hereditary,

the result of a scrophulous vice, as

is

rarely

when

we

it

see in

children.

With

these impressions, the means I employ in

removing rheumatic femoro-coxalgia, a disease

ways

accidental, are

generally those indicated,

with very few modifications,

when

symptoms which accompany

tic

same

as those

to those causes

same disease
Besides, the

this disease in chil-

produced by rheuma-

femoro-coxalgia in adults,

posed

in the

of a scrophulous character.

dren, are the

al-

who have been

ex-

which develope rheumatic

affections.

Rheumatic femoro-coxalgia rarely attacks very

young or very

old

persons;

it

manifests

itself.

THE USE OF MOXA.

Ill)

generally, from the first period of puberty to the

age of manhood,

when

i.

e.

during that period of


is

nearly termi-

of this

disease takes

the process of ossification

The development

nated.

place more readily,

when

the subjects arc exposed

vicissitudes of weather, the

to

are

felt

Young

effects of

which

on the fibrous and ligamentous systems.

soldiers subjected to fatiguing marches,

long campaigns

exposed

life

to

in

cold

climates, are

I particularly

it.

observed

and

the most
this in the

Russian campaign, which was long and laborious.


In the greater number of these young soldiers, the
disease being far advanced, and having been at
first

neglected, the result was unfortunate; how-

ever, I have had the happiness of treating

many

with unexpected success.

Before relating the cases of these patients,


will succinctly describe the

coxalgia.
less

announces

It

deeply seated,

symptoms

itself

of femoro-

by pains, more or

in the region of the

hip joint;

they are propagated shortly along the femur

to

the knee 7 where they are concentrated in such a

manner, as

to

attract

the attention both of the

patient and physician, to the knee joint.

This

circumstance

The

is

frequently a source of error.

patient generally keeps the leg and thigh in a


state of half-flexion; the motions are executed with

THE USE OF MOXA.

120

difficulty, especially those of

complete flexion and

extension of the limb, the nourishment of which

is

soon altered.

At

first,

the diseased limb becomes elongated,

so that the lower extremities are of unequal length.

This elongation

and paralysis

is

into

owing

to the state of relaxation

which the muscles surrounding

the joint have fallen, and to the engorgement and

inflammation of the synovial membrane.

may

It

also be attributed to the state of the ligaments,

and particularly that which attaches the head

of

the femur to the bottom of the acetabulum; upon

the place of insertion, and upon the substance of

which the rheumatic


produces

affection,

its first effects,

tion of synovial glands,

more

as well as

which

fossa of the articular cavity.

especially,

upon the

fills

collec-

the sigmoid

During the

first

pe-

riod of this morbid process, the pains are deep,

the patient experiences a general uneasiness, and


the functions of internal

life

are more or less dis-

turbed, according to the irritability of the patient;


febrile

paroxysms supervene, with intermissions

proportioned to their duration.

We

may

explain these last phenomena by the

stagnation of the fluids which lubricate the joint,

and the latent inflammatory

state of the capsular

ligaments, synovial membrane, and bones.

The

THE USE OF MOXA.


cartilages do not force back the

121

head of the femur

by their tumefaction, as some authors have asserted, (see volume xv. p. 33, of the Dictionnaire des
Sciences Medicales,) for

have uniformly found

them, on dissection, rather thin and dissolved, than


tumefied; their organization will not permit this
tumefaction.

By

this general

change in the articular parts ?

the head pf the femur

is

forced by degrees from

the bottom of the acetabulum, and an elongation


of the limb

is

produced; which becomes more re-

markable, from the inter-articular ligament having


lost all its elasticity, or

tached from

its

from

its

being even de-

point of insertion, either at the

bottom of the acetabulum, or the head of the

mur, which happens very early.

fe-

Indeed, as soon

as this ligament becomes separated at either of

these points, the femur, in consequence of

vatures and gravity, falling in a right

its

cur-

line, will

pause an elongation of the whole limb, in proportion to the loss of

power

in

those

parts

which

assist in attaching it to the pelvis.

But does the head


displaced, as
is

of the femur

become entirely

some authors have advanced;

not so,

what becomes

Before

it

of

or, if it

it?

has arrived at the edge of the aceta-

bulum, the erosion of the inter-articular ligament,

16

THE USE OF MOXA.

22
l

and articulating cartilages has taken place.

But

the luxation does not take place, unless

pro-

duced by a

fall,

thigh, sufficient

it is

movement

or forcible

of the

for displacing the articular ex-

tremity of the femur, then deprived of

its

ment, and of course easily displaced.

does not

occur spontaneously, however.

we

of dead bodies,

placed posteriorly,
cause of

it

effects of

to

find the

on dissection

head of the bone

we ought

fall,

If

It

liga-

dis-

to refer the essential

or a violent percussion; the

which have been

the extremity of

felt in

the bone, so as to produce a primitive or consecutive luxation.

Femoro-coxalgia

preceded or followed

which happened,

may

either have

luxation.

this

It

I think, to the patients

the subjects of the cases of Sabatier,

is

this

who were

my

illustri-

ous master.*

When

same time with the

luxation exists at the

disease of which I have been speaking, besides

the symptoms peculiar to femoro-coxalgia,


hibits those

which characterize

internal

erosive process

ex-

this luxation; but I

have never met with an instance of

numerous patients which

it

this in the

have treated.

But the

accompanied with a

is

serous, lymphatic discharge,

which

fills

at first

the acetabulum, and concurs, without doubt, in


* See the

Memoirs

of the Royal

Academy

of Surgery.

THE USE OF MOXA.

12f3

separating the head of the femur; the dimensions


of

which are reduced by the caries which attacks

its

surface.

It

spreads

itself at

the same time over

the whole extent of the articular cavity, perforat-

ing the thinnest points;


into the os ilium,

it

extends

itself

and penetrates the

by degrees

pelvis,

when

the fluid, before accumulated in the articulation,

suddenly poured out, and forms purulent sinuses.


At other times, the fibres of the capsular ligament
is

interseparate, and the fluid, infiltrating into the


stices of the

at points

neighbouring muscles, forms abscesses

more or

less distant

from the source.

At

moment, symptoms become more severe; the

this

limb

owing

may even undergo


to the caries of

a sudden shortening,

the head of

the femur,

or to the fluid escaping suddenly from the articular cavity,

which characterizes the second

When

this

ed

a spontaneous luxation, but

to

phenomenon

occurs,

it is

stage.

often attributif

we examine

attentively the conformation of the limb,

we

shall

characterize
not find any signs which decidedly
I repeat, except from mechanical
luxation.
this

reduccauses, that the head of the femur, though

ed by the caries, does not become luxated;


never seen a single instance of this, though

had occasion

who had

to dissect

have

have

a great number of persons

died of femoro-coxalgia.

THE USE OF MOXA.

124

The

third stage

characterized by the pro-

is

gress of the caries, the development of abscesses

more or

externally, at points
seat of the disease,
state

and by a

and cachectical

febrile

These

the patient.

of

remote from the

less

abscesses, for the

most part, are circumscribed, and present a uni-

form fluctuation at every point of their surface,


without local pain, or change of colour in the skin;

they increase slowly and insensibly, and,

when

they have gone to a certain extent, their walls

become

and they

thin,

At

neously.

this

finish

time, the

by opening spontapatient

into a

falls

and colliquative fever, the ulcerated

state of slow

parts become gangrenous, and the patient dies.

On opening

the body, purulent sinuses are found

about the joint, and the bones destroyed by the


caries.

Such

observed

When
it is

the progress of this disease, as I have

is

it

it

in

a great

number

has not passed the

first

of individuals.

or second stage,

susceptible of cure, especially

if

the patient

be removed from the action of the causes which

have produced

it.

have seen numerous exam-

ples of this, and there are

Campaigns.

many reported

am now about

to

others, not less interesting, at the


ticle.

But

if

in

my

make known
end of

this ar-

the disease has arrived at the third

THE USE OF MOXA.


stage,

it is

much more

difficult to

and obtain a cure; nevertheless,


the use of the proper remedies.

known

125

stop

its

progress

we ought
I will

these remedies, and their

to try

now make

mode

of appli-

cation.

In the

first

stage,

it is

necessary to relieve the

inflammation of the articulating parts by local,


derivative bleeding; for example, cupping with
scarification, applied repeatedly about the joint.

By

this operation, if

gorge, by

made

judiciously,

ligaments, the pain diminishes, and the

experiences a manifest

symptoms remain, or

dis-

it

will

if

relief.

If the

patient

inflammatory

they return in the course

has happened in some of

of the disease, as
patients,

we

degrees, the vessels of the articulating

my

be proper to introduce a seton into

the fold of the thigh, through the integuments,

and

cellular tissue, without touching the muscles,

or any of the crural vessels or nerves. I employed


this with

advantage

following cases; the

happiest

effects.

in

one of the subjects of the

moxa produces afterwards

the

"Quibus a diuturno coxendicis

dolore femoris caput suo loco excidit,

iis

crus ta-

bescit et claudicant, nisi urantur."*

Doctor Corref, one of the learned professors of


Berlin, had the goodness to inform me, in passing
*

Hippocrates, aphorism Ix. section 6, Bos<*uillon's edition.

THE USE OP MOXA.

126

through Paris at the beginning of the year 181(5,


that Professor Rust, formerly of Vienna, but

now

a professor in the university of Berlin, used with

great advantage, and without any preparation, the


actual cautery; which he applied about the articulation in three oblique

M. Rust had

chanter.

lines,

uniting at the tro-

a cautery made, the form

and thickness of which were such, that


served a sufficient degree of heat during

it

its

pre-

whole

application, to produce the necessary degree


cauterisation, without there being

putting

it

into the fire.

He

of

any necessity of

had observed, imme-

diately after the cauterisation, the limb suddenly

restored to

its

natural length, and become level

with the opposite.


this

have had occasion

remarkable phenomenon in several patients,

whcse cases are related below,


storation took place, in the

the
I

to verify

German

in

whom

this re-

manner described by

professor.

think this phenomenon

the following manner:

may be

explained in

If the elongation

of the

limb arise from a rupture of the inter-articular


ligament at one of

its

points of insertion, as well

as a paralytic state of the


as I

surrounding muscles,

have before described; the application of the

actual cautery to the region of the joint,

must have

the effect of producing, at the moment, a simulta-

THE USE OF MOXA.

127

neous, and almost tetanic contraction of these muscles,

and of restoring

to the

weakened ligaments

an elasticity and reaction necessary to

fix,

tempo-

rarily, the

head of the femur in the acetabulum;

which

returns suddenly by this artificial con-

to

it

What

traction.

confirms the above assertion, re-

lative to the rupture of the inter-articular liga-

ment

is; if

the patient, considering himself cured,

because the limbs have become of equal length,


exert himself in such a manner as to bring back

muscles the rheumatic affection, and like-

to the

wise that sort of paralysis which

quence of

the conse-

is

the limb will become again suddenly

it;

lengthened, and preserve this elongation for an


indefinite period; unless the action of the muscles

and the
ed.

elasticity of the ligaments are re-establish-

These

principles will be confirmed

the cases appended to this article.

by one of

This sudden

shortening, from the application of the actual cautery, proves

beyond a doubt that there

is

no luxa-

tion.

But

have observed

also, that

when we

confine

ourselves to the employment of the metallic cautery, the elongation of the limb gradually returns,

and that those symptoms of the


for a

moment

disease,

ceased, soon return.

which had

We

may

pre-

vent their return, however, by the repeated appli-

THE USE OF MOXA.

128

cation of moxa, and cure the disease

ing in

by persever-

its use.

Shall

we say then

metallic cautery

undertaking

is

necessary or useless? Without

decide upon this question, which

to

experience alone can

however

frightful

it

determine, and

definitely

may

be, I think it concurs

assisting the action of the

powerfully in

which, from

that the application of the

its

moxa;

not acting with the same energy,

does not stop so promptly the progress of the


disease.

The moxas

should be applied about the joint,

either one or even two at a time,

and courage of the patient

the strength

if

will permit.

It is ne-

cessary to allow an interval of one or more days

between the applications, according


produced or the

state of the atmosphere.

humid, and cold weather, are


that which

is

Foggy,

less suitable

than

dry and serene.

First Stage. In the


it is

to the effects

easy to conceive

first

how

period of the disease,


the means

ready pointed out may arrest

its

have

al-

progress, and re-

establish the vital properties in the parts affected.

Cupping, by unloading the engorged vessels of


the fibrous and osseous parts of the joint, favours
the circulation of the fluids in these vessels, and
restores the suspended functions in the lymphatics.

THE USE OF MOXA.


The

effects of the irritation

129

and inflammation be-

come gradually assuaged.


Hippocrates knew very well the happy

employment of cupping

arising from the

which he called the hip disease; as


the following passage of his work:

homine:"
fiat,

is

cucurbitam medicam

in this,

proved in

"De

"Quum coxendicum morbus

effects

locis

in

a fluxione

aflligere oportet,"

&c.

Besides, the advantages of cupping will be shewn

more

in detail, in an article specially devoted to

this subject.

The

combustion of the moxa produced by the

blow pipe,

is to

be preferred to that which takes

place spontaneously, without the aid of blowing;

because, in this last case, the column of air which


is

made

to pass forcibly

through the capillary tube

of the pipe, conducts, or transmits to a proportional depth, the caloric

disengaged during com-

bustion, together with a considerable portion of

oxygen.

It is to

the excitation which this double

principle produces deeply upon the diseased parts,


to

which the

efficacy of the

remedy

is

attributable.

Besides, the moxas at each application take


the internal irritation,

which

they communicate

to

the deeper seated

parts, increase their re-action, and restore


to their primitive state.

17

away

and the mass of caloric

them

THE USE OF MOXA.

130

Second Stage.
and there
the

moxa

is

If the caries

has commenced,

a purulent collection, the effects of

How-

are less prompt and efficacious.

ever, they often succeed, instances of which

come under my own observation;


courage practitioners
in their

to use

this should en-

them, and persevere

employment.

This second stage of the disease


ized, as

is

character-

have before observed, by a great elon-

gation of the limb, difficulty in moving


absolute immobility,
patient,

it

and slow fever.

Frequently, the above

pable shortening of the limb.


is

or even

extreme emaciation of the

mentioned causes may occasion a more or

joint

have

painful to the touch,

The

less pal-

part about the

and swelled at the

most depending points, where there may sometimes be distinguished a fluctuation, and incipient
depositions, at various distances from the joint.

In these cases, cupping

is less

indicated;

it

is

ne-

cessary to hasten the application of the moxa.

The

actual cautery should not be

employed but

with the greatest precaution, so as not to break


the walls of the abscess,

because

its

opening

if it

is

will establish

near the joint;


a communication

between the purulent sac and the external


from

which

will

result

air,

troublesome symptoms,

especially if the caries be not stopped, as I have

THE USB OF MOW.


before observed.

The

131

violent, but gradual excite-

ment, which the moxas communicate to the diseased parts, stops the morbid process, and appears

augment the action

to

of the absorbents; so that

the fluids, accumulated in the abscesses about the


joint or distant from

it, if

they be not too much

distended, are absorbed and thrown into the circulation.

am

ignorant of the

which the absorption of


but

am

this

parts through

matter

inclined to think that

it is

cellular tissue and venous system.

cases,

it

is

effected;

through the
In

all

these

announced by the diminution of the

is

tumour, and a pustular eruption*

which takes

place over the whole surface of the individual, as


well as the earthy and purulent sediment of the
urine, which
to the

The

is

constantly precipitated during rest

bottom of the vessel.


caries, or ulceration of the bone,

cicatrised,

yet,

an ulcer of the

like

leave a depression

may be

soft

proportioned to the

parts,
loss

of

substance, and the expansion, or development of


the osseous vessels which go from the edges of the
carious bone towards
*

Wc

its

centre, to produce cica-

kiiow that a cutaneous eruption, resembling ilea-bites, marks

often the termination of rheumatism.

We read

Memoirs

in the

of a young person

of the Royal

\cademy

who was completely cured

of fever, and several purulent stools.

of Sciences, the case

of an abscess after ten days,

THE USE OF MOXA.

132

which are

pi ces

limb

has attacked the boney

If the caries

trisation.

contact with the joint, the

in

remain shoitened, with deformity and

will

lameness.

Whatever may be
gia,

it

the effects of femoro-coxal-

very seldom that an anchylosis of the

is

bones composing

joint

this

takes

place;

bones preserve always a motion more or

which

these

less free,

favoured by the polish that they ac-

is

quire at their points of contact; for the articular


cartilages,

duced;

in

when once destroyed, are never repro-

a word, these surfaces become complete-

ly solidified,

the ligamentous parts which have

remained sound, become thickened, and the


ease

is

cured.

When

Third Stage.
sive,

dis-

the caries

is

very exten-

and the consecutive abscesses are large, and

near the source of the disease, art presents but

few resources.

However,

have known some

examples of cure when the disease has arrived at

and

this stage;

the

means advised

ought not

we

it

to

is

our duty,

in the

in all cases, to try

second stage.

But we

determine to open the abscesses until

are convinced that

we have no

reason to hope

that resolution will take place, and the source of

the matter which composes them

which

will

imply that the caries

is

be dried up;
stopped.

We

THE USE OF MOXA.


know

shall

by

its

this

133

by the cessation of the

absence when the affected limb

local pain,

moved,

is

by the returning nutrition, strength, and plumpness of the patient, and, especially,
scess,
to

though

it

does not increase in size,

the ab-

about

is

open spontaneously.
If at this period

at

when

this

result,

we

are so

happy

as to arrive

by the reiterated application of

moxas, the use of antiscorbutics, and tonics taken


internally,

which supposes

at least six or eight

months treatment; we may then try the operation

manner

suitable to these sort of abscesses, in the

described in

my Campaigns,* and which

have

The

retraced in the course of this article.


ration being performed in this manner,

ope-

we must

apply upon the external wall of the abscess, after

it

has been entirely evacuated, thick compresses soak-

ed

in

kept

camphorated
in its place

I think this

oil

of chamomile, heated,

and

by a slightly compressive bandage.

method preferable

present, which consists in

to that

used at

making a puncture

at

the most depending part of the tumour, by means


of a trocar, and allowing the matter contained in

the abscess to escape gradually.

By

this

method

of opening the abscess, the external air produces

a rapid change in the matter remaining at the


*

Page 399,

vol.

ii.

THE USB OF MOXA.

134

source of the disease, the parts are seized with a

gangrenous

But by my
of

affection,

and death shortly

follows.

process, I diminish the internal source

and contagion, by evacuating,

infection

means of dry cupping, the whole of the

The

tained in the sac.

by

fluid con-

walls of the abscess be-

come agglutinated together, and may more readily


contract a mutual adhesion; in a word, nature,
assisted

by

all

these means, acts with

more suc-

cess against the morbific causes.

During the dressings, which


quently to renew,

we

it is

necessary

fre-

should take care to keep the

walls of the sac constantly together, so as to pre-

vent the introduction of air into the wound.

As

far

as I

have observed, the scrophulous

femoro-coxalgia of children does not present any


sensible difference in the

have described.

symptoms from that we

In them, as in adults attacked

with rheumatic femoro-coxalgia, luxation of the

femur does not take place, except from some mechanical cause, acting in the course of the disease.
I

have had occasion

to treat

many

children affect-

ed with this complaint, and

my remarks

subject are similar to those

made upon

on this

soldiers.

have noticed, however, that the progress of the

disease

is

more prompt, and that

more rapidly

fatal.

its

termination

is

Internal remedies, as anti-

THE USE OF MOXA.

135

scorbutic and anti-scrophulous medicines, will not

progress; but the moxa, applied

in the

manner prescribed, produces astonishing

effects,

stop

its

and constantly removes the disease when


too far advanced.

could cite

not

it is

many examples

to

support this assertion.


I will

add

to these

reflections, that the actual

German

cautery, justly extolled by the

not appear to

me

be adapted to the scrophulous

to

coxalgia of very young patients.

pected that this severe cautery

much greater

method, a putrid
limit

small moxas,

will

much more mucous

age and disease, and we

therefore,

It is to

be ex-

produce a

destruction, as the soft parts of these

individuals are in a

tions,

professor

rheumatic femoro-coxalgia of adults, does

in the

local

to

from

by

this

produce;,

affection.

ourselves

made with

may

state,

We

should,

the application

of

the prescribed precau-

and the use of anti-scorbutics, which

will

assist the effects of these topical remedies.

In support of the principles established in this


article, as

they relate to the rheumatic femoro-cox-

algia of adults, I will

which appear

Cane

1st.

to

now

relate a series of cases

me to possess considerable interest.

Mademoiselle de

St.

aged

twenty- one years, possessed of extreme sensibility,

had been tormented

for a long time with violent

THE USE OF MOXA.

13(i

pains in the

left

iliac

region, towards the coxo-

femoral articulation, and in the knee of the same

were accompanied with a singular neu-

side; they

ralgia, the cause of

which was not recognized by

several physicians of Paris.

Doctor Corref, the person already mentioned,


requested

was

me

to

be called in

when

in an alarming situation,

striction of the

this

young lady

from a tetanic con-

pharynx and oesophagus, which

had been combatted without

We

success.

were

compelled to force a passage into the stomach by

means of an oesophageal sound.


applied cupping with

Afterwards, we

scarification, the

nervous

and inflammatory symptoms were entirely

dissi-

pated by the third day.

We

then turned our attention to the cause of

the various nervous symptoms which the patient

frequently

experienced, when

we

discovered a

hereditary, rheumatic femoro-coxalgia, with symp-

toms which indicated the disease


second stage.

There presented

to

itself

be in the

above the

crural arch, and below the anterior spine of the


os ilium, an ovoid tumour, projecting a

the bottom of which there

little,

was an evident

at

fluctu-

ation.

The inflammation which


ed readily

to

existed, however, yield-

the application of cupping

with

THE USE OF
after

scarification;

The

first

137

MOXA..

which we applied the moxa.

seven or eight applications produced an

extremely favourable change.

We

opposed the

which continued, by passing a seton

violent pains,

through the integuments under the crest of the


ilium,

which was kept there

moxas were applied


joint;

had

for fifteen days.

New

at various points about the

by the thirteenth application, the tumour

entirely disappeared.

There was a

conside-

rable purulent discharge from the uterus in this


case, varying with the state of the atmosphere.

The

diseased

extremity, which

was

at

first

about four centimetres longer than the other, was


considerably retracted; and, although partly bent,
it

was shortened about two centimetres.

The

twenty
cure was completed after the application of

moxas.

How

can

surprisingly
It is,

we

account then for the progress, and

happy termination

undoubtedly

difficult,

of this

nevertheless,

disease?
I

think

principles which
that by applying to this case the
established, hypothetical^, in the course
I

have

of this article,

we

shall be convinced, not only that

matter colthere was absorption of the purulent

formed in
lected in the abscess which had already
that the cathe pelvis behind the acetabulum, but
had perforated the bone. This I observed in a

ries

18

THE USE OF MOXA.

138
subject

who had died

of the disease in the mili-

tary hospital of Gros-Caillou, and

who probably

would have recovered

if,

moiselle de St.

his health;
,

like

and many other

Made-

patients,

he had rigorously observed the regimen which was


prescribed to him. But, at the

was every reason

to

moment when

there

expect a cure, this patient gave

himself up to every sort of intemperance, and even

onanism, of which he could not break himself,

to

and he sunk.

On opening

the body,

we found

the

cartilage of the acetabulum destroyed, the circum-

ference and bottom of this cavity carious, though

we

marks of

ed

perceive

could

upon

its

external

cicatrisation, similar to

what

in the cicatrisation of soft parts.

the femur had also lost

its

surface,
is

observ-

The head

of

cartilage and round

ligament, and this eminence was reduced to one


third of

its

volume by the

caries, to

which had

The

traces of a

succeeded a true cicatrisation.

considerable abscess were also observed in the


interior of the pelvis, with thickening of portions

of the periosteum corresponding to the seat of the


disease.
I

This specimen of morbid anatomy, which

have preserved, has been presented

ciety of

to the

So-

Medicine of the Faculty of Paris.

similar piece has been presented to the

society by Messrs. Beclard

and Cloquet.

same

It

was

THE USE OF MOXA.


taken from the body of a

whom

of age, in

changed

man about

forty years

the vertebral column was also

These two

lesions

him a femoro-coxalgia, and

rachi-

manner.

in a similar

constituted in

189

algia.*

But inasmuch

arrested the progress of the disease


at the third degree,

we

have occurred

it

selle

de St.

much

less

to

art,

had

when arrived

and effected a cure

patient; a fortiori, are


lieve

by

as nature, assisted

in this

not authorised to be-

Mademoi-

in the case of

In her indeed the disease

was

advanced, but was more complicated by

the different

accompanied

symptoms which
it.

In, this

it

produced, or which

young lady, there was

also

a shortening of the limb, from caries of the boney


parts which composed the joint, internal cicatrisation

and re-establishment,

in a great measure, of

the movements of the extremity, and of


tions.

This lady, with a

now good

all its

func-

slight lameness, enjoys

health.

Case 2nd.

grenadier of the cavalry, about

twenty-two years of age, entered the hospital of


Gros-Caillou, in December, 1814, presenting

all

the signs of a femoro coxalgia of the rigjit thigh,

with an abscess by congestion established on the


outer and anterior part of the ilio-femoral articu*

Sop Bulletin of the Society, No.

7, 1816.

THE USE OF MOXA.

140

lation of that side.

The tumour

projected about

was about

five or six long.

three centimetres, and

The

diseased extremity, which could with

culty execute the slightest motions,

diffi-

short of

fell

the level of the other about three centimetres.

Every thing announced a spontaneous

luxation,

except the characteristic signs of which


spoken, and which

have

have not met in any of these

patients.

The

repeated application of cupping with scari-

preceded

fication
fii.

h,

the

until

the

did not give any hope of producing a reso-

But

lution of the tumour.

ninth,

New

moxas, which,

was reduced

it

moxas caused

it

when, being obliged

to

after the eighth

a quarter of

to diminish,
to

go away,

its

and
size.

more and more,


1

entrusted this

patient to the care of Doctor Pigon; who, by con-

tinuing the same treatment, cured

him, leaving

scarcely any deformity or lameness, inasmuch as


this limb

was but a few millimetres shorter than

that of the opposite side.

Case

~&rd.

In October, 1814, I

saw another

femoro-coxalgia in the second stage, in the person


of

M. de

Ronsan, (Jean Cassimer,) aged about

thirty-two years, of the body-guard of the king.

This disease was the consequence of a rheumatic

THE USE OF MOXA.

141

which had been produced by cold and

affection,

wet bivouacs.

The

diseased limb was about four centimetres

longer than the opposite, and in a state of atro-

phy, with almost complete immobility. There was,


in the region of the nates,

an ovoid tumour, in the

centre of which there was an obscure fluctuation.

Other symptoms appeared

to

announce a sponta-

neous luxation of the femur, produced

manner that the head

in such a

of the bone seemed to rest

on one of the external points of the edge of the

acetabulum; but no pathognomonic signs of luxation confirmed this suspicion.

scarcely necessary to repeat that, guided

It is

by the

principles above laid

femoro-coxalgia,

down

in describing

applied cupping about the joint.

Some moxas had already diminished

the disease,

when Professor Rust, passing through Paris, on


his

way

to Berlin,

advised

me

to

apply the actual

cautery about the region of the joint, as a suitable

means of
length.

at once restoring the limb to its natural


It

was necessary

to see

and perform my-

self this operation, before I could

believe in the

result.

Three deep
part,

lines,

converging at their inferior

were traced with the actual cautery on the

posterior region of the joint.

Immediately after

THE USE OP MOXA.

142

this cauterisation, to

my

great surprise, the limb

unnatural length.

lost its

After

fifteen

ease, the pains in the knee returned,

days of

and the limb

became again elongated a centimetre and a


though

the

cauterisation

had

been

deep, and according to the views of

sufficiently
Jthe

professor.

The

thought

best to return, and which

to the

it

number

half;

German

application of moxas, to which I

of twenty-one,

continued

removed the pains

and the elongation, and restored the motions of


the

Mmb.

soldier

was

In February,

181 6, the cure of this

perfect, the limb being only a centime-

tre shorter than the other.

Case 4th.

We

meet more frequently with

fe-

moro-eoxalgia in the cavalry and artillery, who,

being more accustomed to bivouacs, are of conse-

quence more exposed

to

rheumatic affections.

Dubois (Jacques,) aged twenty-five years, entered the hospital of Gros-Caillou in February,

1816.

Violent and permanent pains in the right

knee, flexion of the leg, difficulty of moving, tumefaction about the ilio-femora'

iculation, slow

continued fever, emaciation, an ouid tumour with

obscure and deep fluctuation towards the inside of


the joint, or towards the external and posterior
part, according to the

"'

'

'de of the patient,

were

THE USE OF MOXA.


to

sufficient

143

announce the existence of femoro-

coxalgia.

The

limb was about three centimetres longer

than the other;

when

returned to

former position.

its

left to itself, it

At

immediately
the

first

ap-

pearance, one would have affirmed that sponta-

neous luxation was on the point of being completely effected;

my

prognostic was the reverse.

After cupping, four moxas quieted the pains;


but the tumefaction of the thigh, and
tion,

remained nearly the same.

its

elonga-

decided, as in

the preceding case, to employ the actual cautery,

according

to the

method of Professor Rust.

result of this application

The

was equally happy and

prompt; the diseased limb became about three


centimetres shorter.
it

began

pushed

However,

to lengthen again; the

to

the

number

in

a few days

moxas, which

of twenty-five, prevented

the elongation and completed the cure of the limb,

which remained only a centimetre and a half


shorter than the other.

Case

5th.

Malo, (Jean Claude,) aged about

twenty-three years, cuirassier in the

first

regiment

of the royal guard, in June, 1816, exhibited to us

a femoro-coxalgia

in the

second stage, arising from

a rheumatic affection, contracted

humid bivouacs

of Saxony.

in the cold

and

The symptoms, which

THE USE OF MOXA.

144

characterized the disease, seemed also to announce

a true displacement of the head of the femur,


forced from

its

socket towards one of the external

points of the edge of this cavity; so that several

surgeons could not be persuaded to the contrary,


until they

saw me perform the operation

fessor Rust,

same

of Pro-

which was again attended with the

The

success.

limb

lost

about three centime-

tres of its length.

Of

by the application

of cupping with scarification,

course, this

was preceded

and a suitable regimen.

My

experience in the two preceding cases, of

the tendency of the diseased extremity to become

elongated after the cauterisation, induced

me

to

suspect that this would take place in the present


instance.

In fact, in fifteen days afterwards, this

occurred,

and

moxas

to obtain

was obliged

to

apply

fifteen

a permanent shortening of the

limb.

Malo had become

perfectly cured after three

months treatment, when,


run, at his

first

attacked with

reproduced

in

consequence of a long

going out, he was again suddenly

new inflammatory symptoms, which

in the first twenty-four hours, all the

symptoms which had been remarked


of his

first

lapse,

it

entrance into the hospital.

at the period

In this re-

was evident that the inflammation of the

145

THE USE OF MOXA.

ligaments of the diseased joint produced these

phenomena, since the frequent application of cupping with scarification was sufficient to remove
them.
It is

with good reason that the ancients recom-

mended the most

perfect repose in treating dis-

Though they may he appar-

eases of the joints.

ently well, in consequence of the remedies em-

we

ployed,

should not suffer patients attacked

With femoro-coxalgia, to walk before the entire


restoration of the parts, the return of the elasticity

and re-action of the ligaments, the cessation

of the state of paralytic relaxation of the muscles

which surround the

joint, and, lastly, the cicatri-

sation of the internal ulcerations, whether they


exist

upon the articular surfaces, or are seated

in

the fibrous system; this at least supposes a space


of five or six months.

When
repeated

the inflammatory symptoms resist the

and

cation, it is

free use of cupping with scarifi-

necessary to pass a seton through

the integuments and cellular tissue of the region

nearest the articulation.

where general bleeding

is

There are even cases


indicated, though these

cases are rare, and the seton


place.

The

may supply

operation required for the seton

accompanied with an effusion of blood;


19

their
is

this local

THE USE OF MOXA.

146

bleeding disgorges more and more, the inflamed

The

vessels about the articulation.

irritation

and

suppuration produced by the seton, afterwards


assist in the resolution of the abscess.

we may
a

new

consolidate the cure

series of

Malo,

after

by the application of

This

moxas.

Finally,

is

what

did for

having employed antiphlogistic re-

medies; the patient experienced remarkable relief.

I insisted,

moxa,

until

nevertheless, upon the use of the

when

place shortly after,


fit

was complete, which took

the cure

this soldier

was returned

for duty.

Case

&th.

Raboullard, (Jacques,) aged twenty-

one years, a soldier in the second regiment of the


cuirassiers of the guard,

the top of a carriage

had been thrown from

into a ditch;

the

wheel

having passed over him, he remained for

five

and lying on his right

side.

hours plunged

in ice,

Violent pains suddenly seized upon the ilio-femoral articulation, the

same

side.

knee and lumbar region of the

In consequence of this accident, the

right inferior extremity

centimetre.

The

became elongated about a

pains sometimes moderate, and

at others severe, according to the circumstances


in

which the young man was placed, continued,

however, steadily
patient

came

to

to increase.

our hospital,

in

At

the time the

August, 1816, he

THE USE OF MOXA.


exhibited

symptoms

147

of a femoro-coxalgia, the elon-

gation of the limb having considerably augmented.

Cupping

glasses, applied methodically for

fif-

teen days, unloaded the vessels, and produced a

revulsive effect.

traced afterwards three rays

with the actual cautery over the region of the


coxa- femoral articulation, in the manner described

above. Fifteen moxas confirmed the sudden short-

ening of the limb produced by the cauterisation.

Case 7th.

Dunan, (Abraham,) a

soldier in the

sixth regiment of the royal guard, aged twentyfive years, of a lymphatico-sanguineous

tempera-

ment, in consequence of the campaign of Waterloo,


in the

month of June, 1815, began

to

feel

deep

seated pains in the right coxo-femoral articulation,

and the corresponding knee.

These pains came

on without any apparent cause, and were consi-

dered as rheumatic; they were

less severe

during

the pleasant weather, and returned in cold wet

weather, and whenever there was a sudden change


of temperature.

After remaining for forty days

in the hospital,

during the months of September

and October, the disease was diminished.

Dunan

then believing himself to be cured, returned

to his

duty; but in the month of January the pains re-

turned with increased severity, the limb became


longer than the other, and the patient was obliged

148
to

THE USE OF MOXA.

keep the leg

walking.

He

in a state of circumduction, while

felt also

violent pains in the hip

and

knee. Notwithstanding the severity of these symptoms,

it

was not

until the

month of October, that

there appeared in the middle part of the lumbar


region, a soft tumour with fluctuation, without any

change of colour

in the skin.

Dunan returned

to

the hospital in the early

part of December, presenting the following symptoms.

There was upon

pelvis,

answering

the external region of the

to the superior part of the sa-

crum, a tumour about the size of the two fists,


with fluctuation, but without any discolouration of
the skin.

It

yielded to pressure, but then became^

perceptible at the upper part of the thigh, which

was extended upon the

pelvis,

and could not be

bent without giving the patient intense pain.

The

leg was slightly bent upon the thigh, and returned

suddenly to a state of flexion, when the

efforts for

extension ceased; he was incapable of standing.

From

these symptoms, I at once recognized an

abscess by congestion, arising from a caries in the

coxo-femoral articulation.

Fourteen moxas were

successively applied, the pains diminishing


consi-

derably after each application.


teenth, the patient could

After the four-

bend the thigh upon the

THE USE OF MOXA.


pelvis,

149

and extend the leg upon the thigh without

experiencing

much

The opening

of the abscess

February,

fifteenth of

scribed;

pain.

was made on the

manner already

in the

de-

there was discharged about a pint of

serous pus, without odour, mixed with albuminous


floculi,

and small osseous fragments, the remains

of the caries of the head of the thigh bone.


first

fifteen

days which followed

were passed without accident.

The

this operation,

At

this period,

the patient procured for himself aliments, and in-

dulged himself

to

intemperance; the suppuration

was dried up almost

entirely,

and

its

character

changed; the wound only discharging a serous and

very
itself.

fetid matter;

These symptoms were opposed with

cess by the

means indicated

became of a better
in a

a malignant fever developed


suc-

in such cases; the pus

quality,

and was discharged

few drops at a time; the limb became short-

ened about one centimetre, and the patient could

bend the thigh voluntarily, without


pain.

His

flesh

now returned

feeling

daily, in a

any

remark-

able manner, and there was every appearance of

an approaching cure, which was effectually accomplished by the end of July, under the influence of
ten or twelve additional moxas.

returned to his regiment

fit

This soldier was

for duty.

THE USE OP MOXA.

150

terminate this recital of cases of femoro-

I shall

coxalgia, with a

who
on

of that of

M. R

>

treated in the city for a similar affection,

whom

(t. e.

summary

caustic, applied after the

manner

of Pott,

introducing peas into the eschar, opened over

the great trochanter of the diseased side)

had

been employed without success.

This case shews the


as the

inefficacy of this

malady had reached the third

to say, the limb

method,

stage; that is

had become elongated about two

centimetres, and an abscess by congestion had taken

place beneath the cauterised point; there was violent pain in this region,

and through the whole

limb, with slow and continued fever, &c.

Thirty-two moxas, applied successively

and

with the precautions indicated above, induced an


absorption of the matter contained in the abscess,

and cicatrisation of the ulcerated and carious parts,


as indicated

by the shortening of the limb.

In a

word, the cure was so perfect that, with the exception of slight lameness, the patient

almost as
this

much

disease.

facility

walks with

as before the attack

performed

this

of

very fortunate

cure in the course of the year 1818.


I

have employed the moxa with the same suc-

cess in lymphatic diseases of the other articulations of the limbs, especially in that called white

THE USE OF MOXA.

We

swelling of the knee.


effects of the

l6l
very much the

assist

cautery, which should be sometimes

preceded by a seton passed through the cellular


tissue

on the sides of the knee, by a uniform and

gradual pressure made with linen straps covered

with pure styrax, and placed carefully one over


the other; this dressing should be
six

days at a time.

or

left for five

have remarked, in such

cases, that the remains of the inter-articular cartilages,

and the

fluids

accumulated in the

joint,

become absorbed; the tumefaction of the boney


parts are gradually reduced; the ligaments acquire
their natural consistency, a smooth substance

formed on the surface of the condyles, which


places the cartilages; in a word, the cure

is

re-

is

at

length obtained, and the individual preserves at


last the

motions of the joint.

This disease

constitute the subject of another essay, to


I shall

immediately turn

my

Such are the diseases


appeared

to

me

will

which

attention.

for

which the moxa has

generally indicated, and which I

have combatted with the greatest success.


easy to conceive that this remedy

may be

It is

suitable

in other chronic affections; but I shall leave the

task of determining

them

to

other physicians.

Moxa.

/>'y /

f''''/4-

Fry

Ft//

6'.

''"^l

ESSAY

II.

ON THE SEAT AND EFFECTS OF NOSTALGIA;


WITH SOME REFLECTIONS OX rARTIAL LESIONS OF THE
FROM SPONTANEOUS OR MECHANICAL

Every

Ttil.VIN,

RESULTING

CAUSES.'

thing proves, contrary to the opinion of

some anatomists, that the

brain, or encephalon,

the essential and exclusive instrument of

all

sensations, either spontaneous, or impressed


this

organ by external agents.

have

satisfied

me

the

upon

great number

of facts relating to lesions of the brain, and


dissections,

is

many

of the truth of this

by very

assertion, long since established

distin-

guished anatomists, as Haller, Soemmering, and

Doctor Gall.

We

cannot doubt, in

mental diseases,

fact, that

like all the passions of the mind,

exclusively

in

the

brain.

have their seat

But does

nostalgia,

which has given rise to so many hypotheses and


different opinions respecting

20

its

seat

and morbid

ON THE SEAT AKD

154

effects, establish

this organ;

itself in

and docs

it

really alter the integrity of its functions?

This

an important question which

is

now endeavour

solve.

to

self,

for the present, to

tive

to

this disease,

shall

relating

and

to

will

confine

my-

some

facts rela-

describing

all

phenomena which accompany or characterize


with the differences which exist, or

between

this

which have
It is

morbid

affection,

may

the
it,

exist,

and other diseases

also their seat in the brain.

very evident that

all

the sensations are

transmitted directly to this organ,

nervous system, with which

it is

either by the

immediately con-

nected, or by the senses, the nerves of which establish also with

From

this

it

a direet and intimate relation.

unquestionable truth, the brain must

necessarily receive the


tions, and,

first effects

of these sensa-

according to the greater or less active

influence that these effects exert upon

substance,

its

pulpy

there will take place a proportional

alteration in

directly or

the

internal organs,

indirectly,

the

vital

which receive,
properties of

the encephalic nerves.

From
tion

this

may be

nervous correspondence an explanareadily given of certain pathological

phenomena, which have heretofore escaped the


eyes of observers.

155

EFFECTS OF NOSTALGIA.
Thus, the

first effect

of the ardent desire that

the individual attacked with nostalgia experiences to see once


is

more

unable to gratify

it,

his native country,

when he

must necessarily be followed

by a painful inquietude, which progressively

in-

This passion, resulting from sensations

creases.

transmitted to the brain by the senses, appears to


at

affect

first

the circumference

of the

where probably reside the organs

The

first

brain,

of induction.

pernicious effects of these moral impres-

produce, undoubtedly, a sort of expansion

sions

in the substance of the brain,

engorgement and

torpor of the vessels of this organ, and successively, of the

membranes which envelope

cavities;

its

the

first

pathological

it,

and

line

phenomena,

in these cases, are

weak-

also,

which are observed

ness

or aberration of the intellectual functions.

These

effects

afterwards

propagate

themselves

gradually, towards the deep seated parts of the


brain, which furnish the nerves of the organs of

sense

and locomotion; so that the functions of

these organs also become weakened, or undergo

changes which have their particular symptoms.

Wounds

of the

head, or any other external

causes which injure the brain at any of the points


of

its

periphery, or on

its

anterior or superior

surface, produce analogous results.

Hereafter, I

ON THE SEAT AND

156
shall

endeavour

sustain

them by

to

develope these ideas, and

to

cases.

In injuries of the head, which act eccentrically,

from the interior towards the surface, such as are

produced by mechanical causes, directed obliquely


from the base of the cranium towards
part; in metastases,

its

interior

which act from a point more

or less remote towards this same part; and in collections of fluid

formed in the cerebral cavities,

the alteration of the functions of the brain should

present a different progress, and have different


results.

In these instances, the compression

exerted upon the origin of some, or

all

of

is

the

nerves of locomotion; upon those of the mixt organs; and of the senses, the functions of which

may be

disordered or weakened

in

a proportion-

ate degree, while the intellectual faculties remain

partly or entirely sound; for

it

may be

said of

these faculties, as of the organs of sense, that they

may and do
I will

act separately.

not recapitulate the

phenomena or symp-

toms that solutions of continuity on the surface of


the cranium, with penetration, whatever
their nature,

may produce upon

the brain.

may be
These

are described in numerous treatises, or in published cases of

wounds of

the head.

EFFECTS OF NOSTALGIA.
Thus,

for

example,

it is

well

157

known

when

that

a foreign body compresses the brain at some points


of

its

superior surface, the mental functions are

more or
the

less sensibly affected;

power

and that

if it

be in

of art to relieve this compression,

by

allowing the extravasated fluid to escape, or by


extracting the body which exerts

it,

the intellectual

faculties return in the

same proportion.

had frequent occasions

to verify these

in the

phenomena

numerous wounds of the head, which

dressed, both in armies and in hospitals.


out stopping at this sort of wounds,

give some account of the facts which

have

With-

shall
I

have

first

have ob-

served in a great number of persons affected with


nostalgia during their lives, and after their deaths.

In these, as in the greater number of insane persons, the mental faculties

and those of the

life

become altered

at first;

of relation present, successive-

ly, the same phenomena. All persons affected with

nostalgia experience, indeed, mental

aberration;

such, for example, are the delightful and enchant-

ing pictures they present to themselves of the


place of their birth, while at a distance from

however rude and barren

it

may

it,

be; their expect-

ing to see their relations and friends advancing to

meet them, clothed

in

rich dresses, and with the

most affectionate greetings.

At

first

there

is

an

ON THE SEAT AND

15b
exaltation;

this is characterized

by a spontane-

ous augmentation of the temperature of the head,


increase of the pulse, irregular

movements

of the

individual, redness of the conjunctiva, looking in

various directions, and rapid and incoherent utterance.

To

constipation,

these succeed oppression, sighing,

and wandering pains

in

different

parts of the body.

To

this state of pyrexia,

and torpor of

all

succeed compression

the organs; the stomach and

diaphragm, being no longer stimulated as

by the pneumo-gastric nerves,


torpor,

fall

in health,

into a state of

and there appear symptoms of

gastritis,

or gastro-enteritis, which are, for the most part,

consecutive symptoms of lesion of the brain.

The

digestive functions are deranged, the fever be-

comes more severe, and proceeds with the ordinary consequences.


In the third stage, an asthenic state occurs, with
prostration of strength; melancholy seizes upon
the patient; he groans and weeps; often he has a

horror of aliments, and sometimes of transparent


fluids,

as water,

when the

character of hydrophobia.

disease assumes the

At

last, life

becomes

a burden, and the patient gives himself up to


death without reluctance,
execute

it

if

the hand which should

be not already paralyzed; or the

vital

EFFECTS OF NOSTALGIA.

159

powers become gradually extinguished, and he


dies insensible.

During the retreat

number

of

Moscow, we saw a great

whom

of our companions in

the brain was

thus affected by a temperature of from twentyfive to ninety degrees of Far.

On examining the
nostalgia we find.

bodies of persons dying of


First.

hemispheres of the brain


mation,

with

The

surface

in a state of

suppurating

points,

of the

deep

infla-

the seat and

extent of which vary; the arachnoides, and pia

mater participate

in this inflammation.

stance of the brain

sub-

softened, and the arteries

is

gorged with black and

The

fluid blood.

Second.

The

lungs are also engorged, and the cavities of the

heart very

much

agulated blood.
are

tines

dilated and filled with black co-

The stomach and

Third.

distended

with flatus

intes-

and their mu-

cous membranes injected, but do not present signs


of a true inflammation.
fore,

do not

die,

as

is

These

individuals, there-

generally supposed, of a

gastro-enteritis, but in consequence of the

changes which take place

The

morbid

in the brain.

inhabitants of cold and moist climates, as

Holland; or mountainous regions, as Switzerland

and Brisgau, are very susceptible of the moral


impressions which produce nostalgia; a remark

ON THE SEAT AND

160

which has been already made by many celebrated


physicians.

The

consequence of

troops

this

of

these

nations,

moral susceptibility,

ed most from the cruel vicisitudes

to

in

suffer-

we

which

were exposed, during the campaign of Moscow.*

While upon the burning

soil

of the old world,

whatever may have been said by other writers

who have never

seen that country,

did not ob-

serve a single individual in the army,


ited the slightest

contrary,

all

symptom

there

are

persons

it

as a second

few of our companions

who

this climate.

belonging to the Royal Swiss

Guard, have been sent

to the hospital to

for diseases not possessing


ter,

the

received so just and favourable an

have not sincerely regretted

Many

exhib-

On

of nostalgia.

idea of Egypt, that they considered

home;

who

be treated

any determinate charac-

but which speedily exhibited the signs of nos-

talgia.

This was particularly noticed during the

year 1820, and more especially at times when


the barometer stood very high.

cumstances, also,

all

Under

these cir-

cases of mental alienation

become exasperated, of which


most unequivocal proof.

The

have seen the

first

and most

markable of these patients, was a soldier


first

Swiss regiment.

He

* See the fourth volume of

entered at
my

first

re-

in the

the fever

General Description.

EFFECTS OF NOSTALGIA.

161

ward, but his situation presented nothing in

appearance alarming

to

its

Doctor Cornac, who pre-

scribed every thing that was required.

One day

was informed, during my

this unfortunate

man had committed

suicide in his

bed, a short time after the doctor had

ran immediately

bathed

to

his assistance,

that

visit,

him.

left

and found him

blood, and almost expiring of a large

in

wound which he had made

in

the region of the

The

heart, with a kind of knife called enstache.

wound was
breast;

it

situated immediately beneath the left

was directed, obliquely, from behind

for-

wards, about three inches in extent, following the


direction of the interval

seventh

ribs.

The

between the sixth and

muscles were divided, and the

instrument had penetrated into the chest through


the space between the ribs.
scarlet, frothy blood,

large quantity of

had escaped, and

still

This

tinued to be poured out from the wound.

induced me

to suspect

a deep injury of the lung?

and even of the pericardium.

wounded man were


able,

con-

The

lips of the

discoloured, the eyes immove-

watery and half closed, the pulse nearly

gone, the extremities cold, the voice


respiration scarcely perceptible.
surprise,

and the

To my

great

found at the edge of the wound seven

different incisions,

21

lost,

by which the part was cut

into

ON THE SKAT ANU

162

small, irregular, and


lines wide.

From

parallel slips,

this,

it

two or three

was evident

that the

patient ha'] repeated his operation eight or nine


times; undoubtedly reaching the lungs, until the

muscular power had become too much weakened

by the

loss of blood, to

in the wards,

repeat

it.

If the patients

and the overseers, had not heard the

plaintive cry which he uttered after the last blow,

and had not found the instrument strongly grasped in his right hand, the

medical jurist would

not have believed that the patient could have possessed the power of performing such an action.*

endeavour

I shall

phenomenon

give some explanation of this

to

at the

end of the case.

Notwithstanding the desperate state of the pahastened

tient, I

to simplify the

away

to cut

wound

as

much

der to procure a union, and


sage of the external
unsuccessful,
this patient,

me

to

air.

six incisions

all

intestines.

result

was

nevertheless retarded the death of

and so

was a pupil

having opened
almost

to intercept the pas-

far restored him, as to induce

The

conceive some hopes of his safety.

* While

or

as possible, in or-

Although the

in the

General Hospital of Thoulouse.

ber thai a lunatic, having concealed a razor


five

the torn strips, and

In

into his belly, almost in the

this cavity

remem-

the straw of his bed,

same

line,

made

one of them

between two and three inches, through which

the boweis escaped.

The

patient died the sooner, as he tore the

EFFECTS OF NOSTALGIA.

163

development of the pulse, heat, motions, respiration,

and colour of the

hemorrhage, and the return of the

of the

powers.

prescribed embrocations of the

camphorated
belly,

indicated a cessation

lips,

oil

vital

warm

of camomile, over the limbs and

and anti-spasmodic, mucilaginous drinks,

and edulcorated emulsions.

applied ice to the

head, and endeavoured to calm the mind of the


patient, promising to procure permission for his

return to his native country,

he paid no attention

if

he desired

to this proposal,

He was

in so absolute

But

which

state of mental aberration did not allow

appreciate.

it.

his

him

to

a state of in-

sensibility, that he did not manifest the least pain

at the first dressing,

doned himself
for

any thing;

and appeared

to his fate.
all

He

to

have aban-

displayed no desire

the functions of the

life

of rela-

tion were considerably weakened, and those of

internal

life

very much disturbed.

He

was, how-

ever, calm enough for several hours, and did not

But having

suffer

any remarkable accident.

away

the dressing during the night,

torn

symptoms of

traumatic inflammation supervened the following


day, and he sunk rapidly;

all

the remedies indi-

cated in such cases were unsuccessfully employed,

and he died between the

fifth

the accident in great anguish.

and sixth days of

ON THE SEAT AM)

164

The body was examined


death;

found the wound had

before remarked, into the

between the

the lung;

it

first

penetrated, as

cavity of the chest,

The

ribs.

blade

pierced a portion of

had afterwards grazed the pericar-

dium, and torn the


of

left

and seventh

sixtli

of the instrument had at

pounds

twenty-four hours after

About two

phrenic nerve.

left

blood, mixed

with serosity, had been

extravasated into this cavity

mem-

All the serous

branes were inflamed, and covered with a thick

albuminous substance, through which vessels were


already developed

The

produce mutual adhesions.

to

lung was divided about an inch deep, and

had become of the consistence of


through the rest of

its

the heart were very

much

black and

fluid

extent.

The

dilated,

The

blood.

liver, (heputise,)

left

cavities of

and

filled

with

lung, and the

viscera of the belly, were in a natural state.

The cranium

being sawed and opened,

was

astonished to find a layer of purulent albumen,

covering the whole periphery of the brain, and


that the arachnoides
ease.

marked

Many
in

was implicated

in the dis-

suppurating points were also re-

the cortical substance of this organ,

especially towards the anterior lobes, and at the

superior edges of the hemispheres.


of the dura mater,

and

all

The

sinuses

the vessels of the ence-

EFFECT* OF NOSTALGIA.

165

phalon, were engorged with black and carbonized

There was

blood.

also a great quantity of sero-

sity in the ventricles,

but the base of the cerebrum

and cerebellum were sound.

From

these facts

we may

infer, that a cephali-

developed gradually under the influence of a

tis,

profound moral affection, occasioned

by

his

Swiss

ardent desire to return home, had preceded

the attempt to commit suicide.

dour

in this

to explain this singular

I will

now endea-

phenomenon.

have already remarked that the cerebral sen-

sibility of this patient

was nearly extinguished

at

the time of his wound; for he did not manifest the


least pain
in

during the incisions which were made

removing the irregular

teguments had been


it,

as

had

strips into

cut,

preparatory

was remarked above.

not

painful

knife.

If

been extinguished

would never have been able


this

and

in
to

to

in-

dressing

the sensibility
this

he

soldier,

repeat eight times

operation with a dull

difficult

But how can we account

power exerted by the hand


sensibility of the patient

which the

for the

in this case,

muscular

when

the

was almost reduced

to

nothing, and the intellectual faculties in such a state


of aberration and weakness, that he could only an-

swer

to the questions

lables, in

proposed

to

him

in

monosyl-

a manner quite foreign to the subject?

ON THE SEAT AXJ>

66
This

will

to

fact,

and others analogous

be related

me

to

in

to

it,

which

the course of this essay, appear

demonstrate that the nervous cords of

animal sensibility, and those of loco-motion, have


a distinct origin in the
tions;

which seems

thesis

proposed by

to

brain,

or

its

prolonga-

render probable the hypo-

me

respecting the electrical

telegraph of the celebrated Soemmering, upon the

nerves of animal life.*

The secondary phenomenon


young Swiss, before and

presented by this

after his

wound, equally

support the assertions of Doctor Gall concerning


the seat of the organs which perform the intellectual functions.

This celebrated anatomist places

the seat of these organs in the circumvolutions

which occupy the surface of the anterior and superior half of the hemispheres of the brain.

The

individuals attacked with the dropsy of the ventricles,

or other spontaneous congestions, which

exert an eccentric compression upon one or more


points of the base of the cranium, so as to produce
partial or general paralysis in the organs of loco-

motion, without affecting those of the intellect,


furnish also proofs in favour of this opinion.

support of these ideas,

In

will give a further ac-

* See the bulletin of the Medical Society of Emulation,

vol. iv.

EFFECTS OF NOSTALGIA.
count of

my

my own

eyes.

167

observations on patients treated under

Jean Humbert, a soldier

in the fifth

regiment of

the infantry of the guard, entered the hospital in

the month of August, 1820, for a slight contusion


of the breast occasioned by a
ly well

fall.

He was

scarce-

from this accident when he manifested a

strong desire to return to his native country, one


of the valleys of Franche Comte.
of hisconvalescence,
self

fit

for

same time

advised him to return him-

duty immediately,

to

In consequence

promising at the

procure leave of absence for him; as

soon as the return should be made to the minister of war.

prescribed for him at the same

time a mild regimen and pediluvium.

withstanding

my

But

not-

symptoms

of nos-

talgia suddenly presented themselves and

became

all

exertions,

developed with extreme rapidity.


ter

had risen

and some

at this time to twenty-eight inches

lines.

The first symptoms which


in

young

this

soldier

manifested themselves

were signs of mental de-

rangement and pains of the head.


little,

his

The barome-

He

spoke but

ideas were incoherent, and he

passed

nearly the whole night in a state of somnambulism.

at

Except the cephalalgia, of which he spoke

first,

he complained of no pain; he carried

ON THE SEAT AND

168
his hand,

however, habitually

and was constantly

a state of restlessness and

His extremities were always cold and

insomnia.

his pulse slow


felt

in

to his forehead,

and irregular; unnatural heat was

about the vertex; the vessels of the conjunc-

were

tiva

the look wandering, and the

injected;

eyes watery.

repugnance

He

to use

did not eat, and

felt

a great

limpid drinks, such as pure

water, but drank with pleasure bitter and colour-

ed ptisans.

To

this state of excitement, soon

sort of general collapse;

the locomotive powers

became progressively weakened,


tient could

succeeded a

so that the

not rise from his bed; the sensitive

functions lost also their activity in the


portion; and the patient at last
state;

pa-

he would not answer

to

fell

same pro-

into a lethargic

any questions that

were proposed to him, in a word, his physical sensibility

was reduced

ployed, at

first,

to almost

nothing.

ing the disease assume an alarming character,

termined

to

and

cupping

de-

open the jugular vein, and afterwards

the temporal artery.


feet,

era-

but few curative means; but, see-

ice to the head,


to the

applied sinapisms to the

and both dry and moist

hypochondria and

belly;

mucila-

ginous and antispasmodic drinks, emollient, ano-

dyne enemata, and camphorated

oily

embroca-

169

EFFECTS OF NOSTALGIA.

dies

These reme-

were successively prescribed.

tions

were followed by a temporary calm; but the

made

cerebral affection developed itself anew, and

stimulus

such rapid progress, that the

exerted

by the pneumo-gastric nerves upon the stomach,


lungs, and no doubt, heart,

The

was almost annihilated.

functions also of these organs

were

essential-

ly altered, by a sort of paralytic affection or tor-

mem-

por, which induced an engorgement of their

branes, and

all

the symptoms peculiar to a phleg-

masia of these viscera.


Such, for the most part,

pulmonary angina,

gastritis

the origin of the

is

and

develope themselves, with more or


according

my

less facility,

to circumstances, but are, in fact, the

result of the disease of the brain.


to

which

enteritis,

subject

plete ataxia,

the patient

fell

But

to

return

com-

into a state of

and died without any appearance of

pain, on the evening of the ninth day of the attack.

The

dissection,

which was made twenty-four

hours after death, discovered


ject of the

first

case,

to

me, as

in the sub-

the whole intestinal tube

considerably distended by flatus; the mucous

mem-

branes of the stomach and intestines injected; the


liver

was a brown

colour, considerably engorged.

and projecting beyond the edge of the

22

ribs.

ON THE SEAT AND

170

On opening
I

the cranium and vertebral canal,

discovered an albuminous covering spread over

the whole periphery of the hemispheres of the


brain;

had

it

taken

mater and pia mater.

between

place

the

dura

Points of a yellowish sup-

puration penetrated, rather deeply, into the anterior lobes of this organ,

yellowish serosity

tity of

The

cles.

and a considerable quanfilled

the lateral ventri-

substance of the encephalon was thick-

ened, and the spinal membranes inflamed.

third patient,

at the

same time,

who died

in

of the

same

disease,

one of the fever wards, pre-

sented the same phenomena, both before and after


his death.

The

subject of the following case exhibited,

during his disease

and

remarkable peculiarities.

after

death,

his

some

This man was called

he was a soldier in one of the regiments

of the Royal Guard, twenty- three years of age,

and born

in the

department of the North, on the

frontiers of Belgium.

He

had a

fair

complexion,

and a lymphatic constitution, and entered

wounded ward

into the

of the hospital of Gros-Caillou,

towards the end of the month of February


on account of pains in the

left

last,

shoulder, accompa-

nied with a dull pain and numbness

in

the corres-

EFFECTS OF NOSTALGIA.

He

ponding arm.
the

manifested great repugnance to

among

of a soldier, and expressed

life

comrades a desire

To

171

to return to his native country.

symptoms were added every mark

these

his

of ex-

haustion of the physical and moral powers; the

melancholy result of onanism

man, by

his

own acknowledgment, had

edly indulged himself.


application

which

in

this

young

unreserv-

directed the successive

humid cupping about the parts

of

together with several Chinese moxas,

affected,

which calmed the pains, and restored the motions

At

of the arm.

himself cured,
regiment.

length this soldier, considering

left

the hospital and returned to his

Nevertheless,

recommend him

to the

took the precaution to

surgeon- major, as well on

account of the moral affection, as for the disease


for

which he entered the

hospital,

which was not

entirely removed.

He
but a

remained

new

for

some days

disease declared

in this situation,

itself,

and on the

first

of the following April, he was re-conducted to the


hospital,

sented

and placed

all

affection;

the

in the fever

symptoms of a

although

reason, and almost

he had
all

ward.

He

febrile,

cerebral

lost the

pre-

use of his

the sensitive faculties, he

exhibited unequivocal signs of nostalgia; for dur-

ON THE SEAT AND

172

ing the delirium with which he was attacked, he

spoke incessantly of his country.*


Rubefacients were applied to the feet and legs,

and

all

the means usually employed in such cases,

were had recourse


which

To

to.

the slight delirium

at first manifested itself,

which increased

until it

succeeded stupor,

terminated

death;

in

all

the animal and sensitive functions were rapidly

destroyed, and the patient

The

plete prostration.

fell

limbs were seized with

paralysis, his hands crossed

and
I

was invited

to see

upon the abdomen,

Such was

his eyes closed.

his situation

him in the fever ward;

then the sixth day of the disease.

from his lethargy.

When

Questions,

w ere immoveable,
r

and without expression: the pupils were

lated;

the rays of the sun, as well as light

tions applied about the eye-lids, did not

any motion.

be nearly extinguished,

We

di-

fric-

produce

Being desirous of ascertaining the

state of the animal sensibility,

was

it

the eye- lids were sepa-

rated with the fingers, the eyes

is

when

blows, and agitation, could not rouse him

slight

dull,

com-

into a state of

which

supposed

to

applied lighted matches

are ignorant of the determining causes of this last attack; but

not improbable that

the.

chagrin and debility by means of spirituous liquors, which


especially at Paris.

it

patient might have endeavoured to dissipate his


all

soldiers use,

EFFECTS OF NOSTALGIA.
of flax

to different parts

applications did

D
in

not

nor could

any

the

of

17J
These

body.

produce any sensation in

perceive the slightest motion

of the burnt parts; the pulsations of the

heart and arteries, which were vermicular and


scarcely perceptible, did not undergo the slightest

change.

With
ment

the intention of producing a vivid excite-

in the solar plexus, I

made use

To my

ping about the epigastrium.


prise

it

of dry cup-

great sur-

produced, simultaneously, motions in the

superior eye-lids, contraction in the

and

iris,

cumduction of the globe of the eyes.

cir-

caused

these -motions to be executed at pleasure, after


several intervals, by the

vinced, Hiowever,

same means.

was con-

that the consciousness of the

patient did not remain, that he could not appreciate any of these sensations, and

was incapable of

seeing; as he did not exhibit the least sign of pain

on the application of the moxa, or the cuppingglasses,

which were quite warm, from the

spirit

The same

appli-

which had been burnt


cation,

when made

in

them.

to the limbs, did not

produce

any apparent phenomenon; though, when again


applied to the epigastrium,

it

determined a sensi-

ble contraction, especially in the

iris.

This

state

ON THE SEAT AND

174

remained even after death,


body, the pupils were

for,

on examining the

contracted.

still

Finally, after having passed

some time

in an

existence purely vegetative, and a state of almost

complete annihilation, the

which had retreated

last

to the

remnant of

vitality,

organs of internal

life,

was exhaled; the patient died on the seventh day


Thirty six hours

of the attack of the disease.

after death, I proceeded to the dissection of the

body, commencing at the abdominal cavity.


found
small
of

the

in

abdomen the serous coat

of the

intestines, especially the ilium, in a state

inflammatory

chronic

There

engorgement.

were remarked small whitish granulations, and


of adhesion between

points

the

intestinal

volutions.

The mucous membrane

tive canal

was white, through

the bladder was

filled

its

of the diges-

whole extent;

with urine of a deep red

the liver and spleen were gorged

colour;

con-

with

black fluid blood.

The

lungs were sound, but the pleura adhered

by membranous bands
heart and

When
to

me

to

its

of

old

dependencies were in a natural

the cranium was removed,

it

state.

appeared

present an extraordinary and unnatural

excavation, relatively to the proportions


subject.

The

formation.

The

sutures,

of the

and the ridges which are

EFFECTS OF NOSTALGIA.

175

generally observed, were entirely obliterated, and


the bone of this part, as through the whole cavity

of

was very

the skull,

The dura

thin.

mater did not present any remarkable pathological

moved

appearance; but, after having cut and reit,

found the arachnoides inflamed, and

spotted over with purulent, albuminous plates,

some of which extended through the pia mater

They

to the brain.

existed especially upon the

internal edges of the hemispheres,

and over the

whole superior surface of the anterior lobes of the


brain.

base of the

purulent abseess was formed at the


left

lobe of the cerebellum, which

one-sixth part larger than the right.

quantity of serosity

and extended

itself

The whole mass

filled

was

large

the lateral ventricles,

even into the vertebral canal.

of the cerebrum

was

in a state of

expansion and density, much more than

gene-

is

rally observed in inflammations of this organ.

The

expansion of the encephalon was carried

such

an extent at
all

its

periphery, that

it

to

projected into

the cavities of the cranium, while at the upper

parts of this boney case

it

was depressed.

Thus,

for example, the anterior extremities of the two

hemispheres were flattened and depressed over


the eminences formed by the orbit, so as to present

a cavity of a depth and form proportioned to these

ON THE SEAT AND

17G

boney eminences; while the internal edges of these


two lobes buried themselves

in the

two small eth-

moidal cavities separated by the crista

This dissection

galli.

furnishes incontestible

that in nostalgia, as well as in

proof,

the other gloomy

all

have already asserted

affections of the mind, as I

in the course of this essay, there is

a true eccen-

expansion, resulting from the erectility of

tric

its

substance; occasioned by onanism, and generally

by

causes of excitement*

all

It is

not without

some reason that persons attacked with


ease, say that their skull is
I

think

ready

this dis-

to burst.

have saved many persons attacked

with nostalgia by employing the means indicated


above, and administered with modifications adapt-

ed to the constitutions of the subjects, and the period of their disease, &c. Continued exercise, and

particularly the immediate departure of the patient for their

own

to their cure.

rous, cured

him

all

country, have contributed

professor of Montpelier, Viga-

the English

for the spleen,

who went

by advising them

and uninterrupted journeys on


*

We

much

to

foot, or

to consult

make long
horseback,

observe a similar phenomenon in hernia? cerebri, which some-

times occur after the operation

ol"

trepan.

The

first

may he

ntous, acute cercbritit,- the second accidental cerebrilis.

analogous to enteritis which occurs


i hernia.

in

called spo?ita-

I'his

affection

is

the portion of intestine strangulated

EFFECTS OF NOSTALGIA.

177

or by post, according to the wealth of the patient.

He

sometimes joined

to this

some innocent drinks,

differently coloured,

which he prescribed as very

valuable remedies.

Journeys

in picturesque situations,

to

mineral waters,

were recommended by

the physicians of antiquity, as at the present day,


to dissipate

melancholy, and prevent nostalgia.

Lymphatic idiosyncrasy, which has been already


mentioned; residing in a cold and humid climate,
to

which the person

is

unaccustomed; slavery, or

imprisonment,* idleness, venery and onanism, are


the general causes of nostalgia, and

all

the other

kinds of melancholic vesanisB; the effects of which


concentrate themselves, especially in

The

periods at which the barometer rises sud-

me

denly, have appeared to


to

the brain.

the most favourable

the development of these diseases.

To

vent this sort of cerebral affection in soldiers

have

who

lately joined their corps, it is necessary not

to suffer those individuals


it,

pre-

more repose than

is

who

are predisposed to

necessary to recruit their

strength, exhausted during the day; to vary their

occupations, and to turn their labours and recrea*

It is, especially, in

prisons that nostalgia and so

of the miiul take their origin.


is

practised in the United States, to

should be compensated.

It

many other affections

All the prisoners should he accustomed, as

some

sort of labour, for

ing their morals, and preventing a most pernicious idleness.

23

which they

would have the double advantage of improv-

178

ON THE SEAT AND

tions to their

own advantage,

of society.
exercises,

as well as to that

Thus, after the accustomed military


desirable that they should be sub-

it is

jected to regular hours, gymnastic amusements,

and some mode of useful instruction.

It is in this

manner, especially, that mutual instruction,


blished

among

the troops of the line,

and the

to the soldier

state.

is

esta-

beneficial

Warlike music, dur-

ing their repasts, or at their hours of recreation,


will contribute

soldier,
tions

and

much

to elevate the spirits of the

keep away those gloomy

to

which frequently produce the

effects

reflec-

which

have been traced above.


It is

by these precautions, and by the appli-

cation of these principles of hygiene, that I

the

happiness

had

preserve from nostalgia, and

to

every other serious complaint, the crew of our


frigate

in

North Sea,

the
in

pany, we did

tedious cruise

1787 and 1788,


not

lose

quence of a shipwreck.*
nal solicitude of the

we made

in

since, of this

but one man,

in

the

com-

conse-

It belongs to the pater-

chiefs of corps, enlightened

by their surgeon majors, whose duty

it is

to ex-

ecute the measures above indicated, to prevent


nostalgia, a disease as dangerous as
ous.

In a word,
* See the

first

if

it is

insidi-

these authorities do not put

volume of

my

Campaigns.

EFFECTS OF NOSTALGIA.
in requisition the talents

179

and experience of phy-

sicians to prevent the attack of these affections,


is

it

the duty of the last to neglect nothing to stop

their progress,

when they do appear,

to dissipate

their effects, and to conduct the patient to a cure.

With

this

intention,

has declared
describe,

methodically, the

the effects

it

is

in case the nostalgia

an individual,

itself in

which has appeared

In the

and

to

me

mode
to

period, which

is

will

now

treatment

of

be the best, with

have obtained from

first

it.

that of pyrexia,

necessary to unload the vessels of the head

by direct and derivative bleeding;

to

condense

gradually the fluids of this part by ablutions of


cold water, or ice applied to the vertex, according
to circumstances;

to

induce a derivation towards

the lower parts, and to favour the development


of the functions of

by means

of

the organs of internal

semicupium^

from about twenty-five

Reaumer; cupping

life,

at the temperature of

to twenty-six

degrees of

glasses, applied to the hypo-

chondriac, epigastric, and dorsal regions, and

lowed by camphorated,

oily embrocations; joined

with diluting and antispasmodic drinks.


nastic

fol-

Gym-

amusements, music, and constant exercise

should not be neglected.

ON THE SEAT AND

180

When
which

is

the disease has reached the second stage,


that of collapse,

sustain the strength of the

machics.

We

becontes necessary to

it

by

patient

light sto-

should apply dry frictions over the

whole body; moxas, or slight cauteries about the


base of the cranium, and, successively, rubefacients

over the head and epigastrium.


be put upon the use of

warm

na, cascarilla, and cinnamon.

The

patient should

infusions of cincho-

The

climate should

always be changed as soon as possible, leaving


cold and humid, for

warm, airy

situations,

and

countries inhabited by free people.

In the third stage, art can do but

only look

to

we

little,

nature to produce a salutary

can

crisis.

We

ought, however, during the whole course of

this

dangerous malady,

to treat

our patient with

great mildness and kindness.

To
more

sustain these precepts, and to render


intelligible, I

will

them

now give a summary

the cases of some patients that

of

have treated with

success.

The

first

named Jean Barbier, aged twenty-

five years, belonging to the first regiment of the

cuirassiers of the royal guard, after having re-

ceived a slight contusion upon the head, exhibited


all

his

the

symptoms

of nostalgia, a few days after

entrance into the hospital.

It

was

in

the

EFFECTS OF NOSTALGIA.
midst of the month of January

rometer

181

when

last,

the ba-

had risen suddenly from twenty-seven

inches,

two

lines.

The

lines, to

twenty-eight inches and some

desire that this soldier had

felt,

for a

long time, to return to his native country, as

have since learned from

his

comrades, joined to

the blow he had received upon his head,

may be

considered as the occasional causes of the disease.

The symptoms
was

in

increased rapidly, and the patient

danger for several days; however, they

became insensibly diminished under the treatment


I

have already marked

weeks he was

well,

out,

and

in less

and returned

than three

to his

duty; he

did not even wish to use the convalescence that

allowed him.

cupping upon the back,

some moxas

me

to

Bleeding from the jugular vein,


ice about the head,

to the sides of the neck,

and

appeared

to

be the remedies which produced the cure

in

this case.

The

second was Barbet, (Theophile) aged twen-

ty three years,

who was

sent to the hospital on

the eighth of January, of the same year, for a

he had had a few days before.

On

fall

the day after

his entrance, he exhibited signs of nostalgia.

His

comrades informed me that

had

been running

all

this

young

soldier

night from one ward to another,

talking constantly of his country and his relations.

ON THE SEAT AM)

18 2
In

fact, I

discovered in this patient

all

the symp-

toms of an incipient cerebral affection, accompanied with mental aberration, and disorder in the
sensitive functions.
tions

Otherwise, the muscular ac-

and digestive functions were not weakened.

did but

was persuaded that he would do

little

during the

first

two or three days;


well; but acci-

dents increased the disease, and this young soldier,

having spent a part of the night

after

in

running

over several of the wards, at length scaled the

He

garden wall and disappeared.

was endeavour-

ing to find the road to his native place,

met by some
back

soldiers of his regiment, and brought

to the hospital

at the

He

hour of

was

when he was

my

on the fifteenth of January,

visit.

restless

and

agitated;

an

unnatural

heat manifested itself about the head, the eyes

were injected; the pulse was vibratory, and gave


scarcely

answered
lables,

pulsations

fifty

to the questions

which had but

question.

in a minute.

He

put

little

to

him

in

He

only

monosyl-

connexion with the

did not manifest any desire for food

or drink, nor complain of any pain.

He

suffered

himself to be bled from the jugular vein, which

immediately

prescribed,

slightest evidence of pain.

without exhibiting the


I

afterwards directed

the immediate application of cupping to the re-

183

EFFECTS OF NOSTALGIA.

gions above indicated, and to the head, while the


patient

placed in a semicupium heated

was

to

twenty-five degrees of Reaumer, and afterwards

allowed to take chicken soup, and cooling mucilaginous drinks.

All the symptoms soon diminished under the


influence of this

mode

of treatment, and

dered his convalescence

when

expected

in the night of the twenty-

of the same month, the

first

barometer having

then risen to twenty- eight inches, eight

symptoms supervened, and,

lines,

new

for the second time,

having walked several times through the

after

hospital, with signs

of somnambulism,

he again

scaled the garden wall and took to flight.

learned

since

where
I

consi-

sufficiently established to

send him home upon a furlough, which


daily to receive;

that

this

soldier

reached

have

home,

he will probably get well.

had long since remarked, in a great number of

persons, that lesions, or alterations of those parts


of the brain which are connected with the base of
this

organ, or the ventricles, were followed by

weakness or

loss of the sensitive faculties, in the

organs of locomotion, and a very great


in the functions of respiration,
tual faculties

remain untouched.

difficulty

while the intellec-

ON THE SEAT AND

184

Dropsies of the ventricles of the brain, in

dif-

deep abscesses, or extravasations

ferent degrees,

into the cranium, towards the base of this organ,

produce these

Instances of this kind

results.

be found in the history of

my

Campaigns.

some

limit myself, therefore, to relating

may

I shall

interest-

ing facts, which undoubtedly confirm the truth of


these assertions.
I will begin

sixty- first

with that of a young soldier in the

regiment of the

line,

by the name

of

Cros, whose head was traversed from the forehead


to the

occiput,

by a ramrod shot

two paces, by one of

his

at a distance of

comrades, while playing

The wounded man was

together.

not deprived

of his understanding, but preserved, until the mo-

ment when he was trepaned,


ties.

The ramrod had

his intellectual facul-

passed over the median

line of the base of the cranium,

under the right

hemisphere of the brain, without having broken


in

upon

it;

so that the superfices of this organ

remained untouched.*
I relate in the fourth

page 207, a case, not

volume of the same work,

less

remarkable, of a young

grenadier of the ex-guard, named Barbin, who


survived a similar wound.
* See the third

This soldier marched

volume of ray Campaigns, and the cranium of

tient deposited in the Anatomical

Museum

this

of the School of Medicine.

pa-

EFFECTS OF NOSTALGIA.
with the

army

to

Moscow;

185

one of the combats

in

that his corps had to sustain, he was t'irown to the

ground, when he received, from the lance of a


Cossac, a

wound on

the back part of the head, to-

The

wards the centre of the lamdoidal suture.

weapon penetrated
left

into the posterior lobe of the

hemisphere of the brain two inches and a half

deep, undoubtedly, as far as the centrum ovale of


Vieussens.

upon the
hours

The wounded man was


and carried

where he received
tion required.

all

He

dead

but he was taken up some

field of battle;

after,

left for

to the

neighbouring city,

the assistance that his situa-

passed through a series of ex-

tremely severe symptoms, as

have described in

the case as related in the volume referred to above;


nevertheless, he was restored to

and afterwards returned

to

life

France.

and cured,

When

pre-

sented this soldier at the School of Medicine, and


the Societe Philomatique, he exhibited, at the

point indicated, a cicatrix ten lines deep, and from


fifteen to eighteen in

length, with a total loss of

voice, a paralytic affection of the superior extremities,

of the larynx, pharynx, oesophagus, and

stomach, together with a remarkable weakness in


the organ of vision.
lectual

faculties,

On

the other hand the intel-

which were

at first

were executed with surprising


24

suspended,

precision, as this

ON THE SEAT AND

186

man answered

in writing,

with propriety, to

all

the questions which were proposed to him.

This

fact, in

my

opinion,

is

that the organs of induction, as

still

is

stronger proof

asserted by Dr.

Gall, reside in the periphery of the anterior

superior half of the brain, at such an

and

elevation

that the considerable effusion into the interior of


this

organ,

which must necessarily have taken

place at the instant the

not reach

wound was

received, could

This portion of the encephalon then

it.

remained sound, while the nerves of the spinal

marrow, having been injured and compressed,

in-

stantly lost their properties of conducting the vital

stimulus,

tioned to
I will

ease of a

and suffered

add

to these

wound

above men-

two a summary of a third

of the head, which will also


of

shew

some of the cerebral

and the symptoms which characterize

their lesions.

The

rampan, (Edward)

is

M. De-

e^r-officer of cavalry,

who, in

subject of this case

fencing, on the second of

ed by a

organs

into a state of paralysis.

fall

the insulated condition


faculties,

the

foil,

March, 1817? was wound-

at the middle part of the left canine

region, near the ala nasi, in an oblique direction

from below, upwards, and a


point of the

breast piece.

foil

little

inwards, the

having been broken upon the

The

instrument penetrated

to

about

EFFECTS OF NOSTALGIA.

187

the distance of three inches and a half, through


the

left

nasal fossa; traversed, undoubtedly, the

cribriform plate of the ethmoid bone, near the

dura mater; and ap-

insertion of the falx of the

peared
to

to enter obliquely,

a depth of from eight

from before, backwards,

to nine lines into the pos-

and internal part of the

terior

anterior lobe of

left

the brain, so as to approach the anterior part of


the corpus callosum.

At
fuse

the

moment

wound, a pro-

hemorrhage occurred, and there was, proba-

bly, a

sanguineous effusion

the cranium.
fell

of receiving the

In a

moment

into the

afterwards, the patient

and

into a state of syncope,

senses,

interior of

which were restored

in

lost entirely

his

a very slow and

imperfect manner, with some remarkable circumstances.

The

vision

was restored

in the right eye, but the left

By

more than a month.

in both, but the patient

The

in

a few days

was deprived

degrees

it

itself

anew

it

for

was restored

was affected with diplopie.

sense of smell, after being entirely

veloped

of

lost,

de-

in the right nostril, ani the

patient readily distinguished on this side the odour


of alcoholic liquors from inodorous fluids: however, the perception of odours
tive on the left side.

altered, but in such a

The

was much

less ac-

sense of taste was also

manner

that the right half

ON THE SEAT AND

188

of the tongue perceived sapid bodies very well,

while the

left

was deprived of

organ was drawn towards the


tion to the hemiplegia,

This

this faculty.
left side, in

opposi-

which existed on the

right;

the commissure of the lips was also drawn to the

The

left.

hearing, which was at

first

right ear, was afterwards restored.

lost in the

All the right

side, struck with the paralysis, insensibly reco-

vered, for the most part,

The remembrance

of things having

proper names,

with

motions.

its

was

totally

any analogy

extinguished;

while the recollection of images, and every thing


susceptible of description remained per-

which

is

fect.

Thus,

for

example, the patient had a per-

fect recollection of the person

and features of M.

L^rrey, whose attentions he had frequently experienced for various diseases and wounds; he knew
hisn perfectly well,

he saw him constantly before

his

eyes, to use the expression of the patient, but yet

he eould never remember

his

distinguished him by that of


also

the

forgotten

friends.

He

name, so that he

M.

names of

Chose.

his

He had

relatives

and

could not recollect the names of the

different pieces

which compose a gun, though he

could describe them accurately.

The

mental aberration, which at

in this officer,

first

occurred

had ceased; but every thing which

EFFECTS OF NOSTALGIA.

189

related particularly to himself, to his military


fortunes, threw

him

into a state of alienation

and pro-

found melancholy; at the same time the conversations

which related

to

his

family,

him the

friends, restored to

full

relatives or

exercise of his

intellectual faculties.

The

subject of the following case, as respects

the insulated state of the cerebral organs, and the


distinctive character that a lesion of each of these

may

organs

offer,

presented the

most singular

anomalies, and curious phenomena.

Lecceur, a fusilier
infantry

in the

second regiment of the

of the royal guard,

about

twenty-two

years of age, of a robust constitution, and of a

very sprightly character; on the nineteenth of No-

vember, 1820, while fencing with one of


panions, was

by the

foil;

wounded severely

his

com-

in the right

eye

the button of which was broken off in

the meshes of his mask.

The

point of the remain-

ing part of the weapon pierced the upper eye-lid,

beneath the eye- brow, and at the inner side of the


orbit, penetrated

deeply into the cranium, passing

obliquely from the right to the


fore backwards, in such a

ment appeared

to

me

to

left,

manner

and from be-

that the instru-

have pierced the thin su-

ture which unites the os planum of the ethmoid


to the frontal

bone towards the internal orbitar

ON THE SEAT AND

190

Afterwards

foramen.

it

appeared

to

me

to

have

passed behind, or into the substance of the falx,


the

dura mater, before the

of the

first fold

sella

turcica, grazing unquestionably the inner side of

the right optic

Lastly, the point must

nerve.

have passed under the anterior lobe of the

left

hemisphere of the brain, which was necessarily


injured.

In this course, the narrow blade of the

have torn many

more or

!s

foil

must

and caused immediately

less extravasation,

phere, tow^r
terior

vessels,

under the

left

hemis-

the fissure of Silvius, into the an-

and corresponding

perhaps further.

The

fossa of the cranium,

small

wound

and

in the fold of

the eye-lid was surrounded with an ecchymosis,

which extended

over the whole orbitar re-

itself

There was a tumefaction

gion.

The man

did not

fall in

in

both eye

lids.

consequence of the wound,

nor did he even lose his intellectual faculties; but

he was immediately seized with severe pains

in

the head, especially on that side of the forehead

which was opposite

to the

wound; there was

also

a painful numbness over the whole right side of


the body, accompanied with slight convulsive mo.
tions of the face.

pear

to

have

was carried

This

lost for

soldier,

who does

not ap-

a single instant his reason,

at first to the barracks,

and was not

EFFECTS OF NOSTALGIA.

191

transported to the hospital of the guard until the


following morning.

paying
to

my

visit, so

was

that

at the time occupied in

was ready

him that assistance which

his

to

administer

alarming situation

required.

The

paralysis

was already manifest over the

whole right side of the patient, but the superior


extremity especially was entirely deprived of motion,

while the animal sensibility was preserved,

and afterwards even increased.

The apex

of the

tongue projected from the mouth, and was directed


to the right side in

an opposite direction

to

This circumstance induced me

hemiplegia.

the
to

believe that an extravasation of blood had ex-

tended

itself to the

cranium.

most depending points of the

believe I have given the explanation

of the cause of this difference, in an article in

Memoirs and Campaigns.


and

full,

The

pulse

not exceeding forty-five or forty-six pul-

sations in a minute; the respiration

were slow and


late a

my

was slow

difficult;

and deglutition

he could scarcely articu-

few words; he could not make me compre-

hend what he said respecting the cause of

his

accident.

After having made the patient


first

lie

down,

my

care was to lay open the small wound of the

eye-lid,

and

to

explore, as

much

as possible,

its

ON THE SEAT AND

192
whole extent.

A stylet

the bottom of

this

conducted with care

wound, enabled me

to

to

dis-

cover, at the middle point, and behind the internal wall of the orbit, a perforation

ed to

me

pass in the direction

to

which appearI

have marked

above towards the ethmoidal fossa of the cavity


of the cranium.

ims in practice

was

was not consonant

It

to

sufficient for

me

to

know

into the cranium, to establish


to direct

wound

me

to

my max-

penetrate into this opening;

in the

mode

it

that It penetrated

my

prognostic, and

of treatment that this

indicated.

After this

trifling operation, I bled the patient

freely from the right temporal artery, and appli-

ed repeated cuppings with scarifications,

to the

nape of the neck, between the shoulders, and


the hypochondriac regions.

The

feet

and

to

legs

were covered with mustard cataplasms, sprinkled


with very strong camphorated vinegar.

der

full

of

pounded

ice

was applied

to the

during the whole inflammatory period.


tient

was

blad-

head

The

pa-

put upon the use of cooling mucilagin-

ous drinks and

was bled

ice.

In the evening the patient

freely from the arm; purgative

enemata

were adminstered, and an embrocation of camphorated

oil

was applied

to the belly.

EFFECTS OF NOSTALGIA.
The

night was

very alarming,

being very much agitated;

193

the

patient

he complained con-

stantly of violent pains in the head, and a disa-

greeable sense of weight, which obliged him to

remain continually in the same

movement he experienced

least

He

threatened with syncope.


the

left side of

fect,

vertigo, and

the

was

always pointed out

the forehead as being the sent of

the pain, while the

convenience.

At

position.

The

wound occasioned him no


vision of the left eye

in-

was per-

but that of the right had undergone a par-

ticular alteration
after.

To

these

which

shall

make known

symptoms were joined a

which compelled me

of urine,

to

retention

use the

elastic

catheter, for the four or five

At my

visit

here-

first

gum
days.

on the twenty-third, the cephalalgia

and symptoms of compression of the brain being


very much augmented,
from the
tion

left

took a large bleeding

jugular vein; cupping with scarifica-

was again applied

to the

nape of the neck

and between the shoulders; and the application

upon the head and mustard cataplasms to


I insisted also upon
the legs, were continued.
the use of diluent laxatives, and I prescribed an
of ice

antispasmodic potion, with the addition of a large

dose of acetate of ammonia, a remedy very much


extolled

35

of

late

against

cerebral

affections.

194

ON THE SEAT AND

The

paralysis

of the

organs of motion

of the

right side of the face, and of the arm, had arrived


at the greatest degree; hut the retention of urine

ceased, and ahundant alvine evacuations succeed-

ed to an obstinate constipation, which


place during the

first

had taken

four or five days.

then

substituted, for

the diluent mucilaginous drinks,

chicken broth.

On

ease

the seventh day of the dis-

replaced the ice with a large vesicatory,

which covered the whole superior and

lateral sur-

Repeated cuppings were

also

applied over the right hypochondrium and

the

face of the head.

region of the stomach, and


tion

followed this applica-

by embrocations of camphorated

oil

of cham-

omile.

On

the ninth day the pains of the head became

relieved, the vertigo disappeared, and the speech

became more

easy.

The very imminent

which the wounded man had been

danger, in

until that time,

disappeared; the hemiplegia continued, but the


intellectual faculties

fected.

The

and precision
ed

to

had remained steadily unaf-

patient

answered

to the questions

with

propriety

which were propos-

him, and often joined in the conversation

of his attendants, though not without considerable mechanical difficulty.

EFFECTS OF NOSTALGIA.
I

195

have already observed that the vision of the

right eye presented one remarkable peculiarity.

The

patient, in fact, could only see with this eye

the

perpendicular half

placed before him, that

which received

of

is in

objects

which were

the axis of the pupil

their visual cone.

were removed from

When

they

towards the side of

this axis

the nose, they became visible, so that the patient

could see them entirely.

If,

on the contrary, they

were removed outwards, towards the temple, the


eye of the patient remaining

still,

the

bodies

also in succession, entirely disappeared, although

a part of the cone of rays, transmitted by the object,

still

penetrated through the pupil to the bot-

tom of the eye;

membrane which formed


alteration; its motions

same precision

opening, as well as the

for this

it,

had not undergone any

were performed with the

as those of the

left

eye.

This singular phenomenon, on account of which


I

presented the patient to the Society of the Fa-

culty of Medicine, at the first meeting in February,

seems

to prove;

First.

That

the retina

is

an

expansion of the optic nerve, since the eye was


not

injured by the

foil,

which

have touched the inner side


its

of

seems only

to

nerve,

at

this

passage into the cranium, before the

sella tur-

ON THE SEAT AND

196

Second. That the different organs have

cica.*

not only distinct properties, but that these same

organs

may experience
Third.

functions.

It

partial alterations in their

proves

that the

also,

ments which compose the nervous trunks

in con-

nexion with the encephalon, have a distinct


gin,

and receive from

it

fila-

ori-

particular stimulus,

relating to the functions over which these elemen-

tary filaments presi le.f

Another phenomenon, not


presented

Notwithstanding

individual.

this

in

remarkable, was

less

the exactness of his reasonings and the just combinations of his ideas, (for he

continued to play

still

at cards with his comrades and to beat them) he

had entirely
of things.

lost the faculty of recalling the

He

could not

tell

me

own

first

the names of any

had even forgotten

of his relatives or friends; he


his

name, and, though he saw me

he could never

names

recollect mine.

daily,

had before ob-

served this peculiar anomaly in the aberration of


the mental faculties in several

wounded persons,

especially in the subject of the preceding case.


It

would be curious

was found

in the

to

know

if

the ulcer which

brain of the celebrated Brous-

* It was afterwards ascertained that instead of the trunk of this nerve,


it

was

its

root that was injured by the point of the

foil.

t See the bulletin of the Medical Society above mentioned.

EFFECTS OF NOSTALGIA.
who had

sonnet,

also lost the faculty of

197

remember-

ing the names of persons and things, towards the

end of his career; had

must have existed


I

same por-

seat in the

its

of this organ, as the lesion that

tion

in

Lecceur and

suppose

M. Derampan.

leave to doctor Gall, and the other physicians

who

dissected the body of this celebrated physi-

cian, to

By
and

draw

the proper physiological inferences.

the nineteenth day the patient was relieved,

had conceived the greatest hopes of a cure.

Three

vesicatories,

which

the head, appeared to


fects.

To

these

me

applied successively to

to

produce excellent

applications,

moxas behind the ear of the same

ef-

added several
side,

and over

the course of the principal branches of the fascial

nerve of the paralyzed

side.

The

head and other symptoms of cerebral


tirely disappeared,

pains of the
affection en-

and the functions returned

the same proportion.

in

allowed him to use light

food and water, reddened with good wine.

Not-

withstanding this perceptible improvement in his


situation, the soldier grieved to see

prived of his leg and arm, though

every means in
the

first

cervical

my power

application of the

to

himself deI

had taken

encourage him.

moxa over

At

the anterior

pair of nerves of the paralyzed side,

strong contractions took place

in the leg

and arm.

ON THE SEAT AND

198
which

could

make return

influence of this cautery.

ed great surprise

under the

This phenomenon causand caused the

to the assistants,

weep with

patient to

at pleasure,

Tho

joy.

motions of the leg

returned promptly, so that this soldier could walk


on

the

thirty-first

day,

with

The

assistance.

functions of the muscles of the face were also re-

stored gradually.

The movements

returned more slowly; however,


establish

them

entirely,

hoped

arms

of the

to re-

by continuing the same

topical excitants.

The wounded man moved


to

walk

in the court of the

very well, and began


hospital,

and even

in

the city; afterwards he went on foot to present

himself at the meeting of the Society of Medicine,

on the eighth of February


tions

were

last.

in other respects

The

internal func-

when

perfectly well,

he was suddenly seized with diabetes, characterized by the abundance of the urine,

its

transpa-

rency, sweet taste, inextinguishable thirst, and

suppressed cutaneous transpiration.


sis

of this urine,

The

analy-

made by doctor Duponchel,

apo-

thecary to the hospital, proved that there existed


in this fluid, a large quantity of saccharine matter.
I think that this

new symptom, which again

litated the patient,

was produced,

gree, by the spiritus

in

Mindereri that

debi-

a great deI

had ad-

EFFECTS OF NOSTALGIA.

199

ministered in an appropriate potion, to the extent


of several

drams

at a dose.

followed, in this

respect, the opinion of the physicians,

who

commend

there

not

it

very large doses;

in

more powerful

be no doubt that

tifies

mucous membranes

the

This example jus-

the opinion of the ancients,

doses, a scruple at most.

had occasion

to

is

can

there

who advised

remedy should only be administered

this

re-

substance irritated exces-

this

the digestive viscera.

all

and

diurectic;

sively the kidneys and

of

now

remark

It

proves

that

in small

also, as I

have

another case, that the

in

immediate cause of diabetes consists essentially


a sort of phlegmasia of the kidneys and the

in

which have some degree of sympathetic

viscera,

connexion with them.


as

According

transmitted them to

league,

M. Lafond Gowzy,

written in January, 1820,

my

to these ideas,

old friend

and

col-

of Toulouse, in a letter
I

was anxious

to

pre-

scribe for the patient cooling mucilaginous drinks,

dry

frictions

over the whole body, and the appli-

cation of dry and

region; and

moxa over

humid cupping over the lumbar

would have successively applied the

these regions,

if

the malady had

yielded to the employment of the

On

the seventh day,

all

the

first

not

means.

symptoms of

dia-

betes disappeared entirely; the cupping seemed to

ON THE SEAT AND

200

me to be particularly the most


The patient was again restored

efficacious means.
to

an encouraging

he ate, drank, and slept well.

state;

waited the

weather to apply new moxas over

return of fine

the superior extremity; the motions of which were

executed very imperfectly, though the sen-

still

sibility of this limb

At

was, on the contrary, exalted.

last this paralytic affection,

ameliorated,

which M.

gradually

already very

much

approached a cure;

to

Henot, one of our most distinguished

assistant surgeons,

who was

particularly charged

with the care of this patient, very much contributed, by his zeal and assiduity.

This soldier waited with impatience


lescent discharge, which
that

his conva-

had promised him,

so

he might return home, where he was ex-

tremely anxious to go;

when on Monday,

the

eighteenth of February, he was informed by a


letter

from his brother, which some one had the

imprudence

whom

to

send

to

him, that a woman, with

he had been intimately connected, had kept

a considerable sum that his brother had sent


him, to enable him to return.

to

This news pro-

duced so strong an impression, that he suffered a


severe indigestion in consequence of a repast he

had just made.

He was

seized with pain in the

head, cholic, and repeated vomiting; he

lost his

EFFECTS OF NOSTALGIA.
speech, and

and

fell

the animal and sensitive functions,

all

into a state of stupor

accompanied with
in

201

and general torpor^

chills, slight

convulsive motions

the inferior extremities, which were seized,

twenty-four hours afterwards, with an icy coldness,

which
visit

artificial

heat could not dissipate.

Monday

on

the state

morning,

At my

found the patient in

have just described.

hastened to

cover the whole of the superior surface of the head


with a large vesicating powder of cantharides and

camphor,

in equal parts;

prescribed cooling en-

emata, some antispasmodic medicines, and the application of

warm

of the body.

flannels over the

The

disease,

however, made rapid

progress, and the paralysis seized

sense and locomotion.

whole

life

may be

it

of relation was

Tuesday, the twentieth;

were completely

the organs of

all

There was an involuntary

discharge of feces and urine, and


that the

whole surface

ed

by

annihilated, though the pulsation

life,

The

func-

although very weak, remain-

until the night of the twenty-first of

when

extinct

for all the other functions

of the heart and arteries continued.


tions of internal

said

this interesting patient expired.

February,

This was

the third month after the accident.


Dissection.

nium;

it

commenced by opening the

discovered to

26

me

Jfirst, all

cra-

the vessels of

ON THE SEAT AND

202

the dura mater engorged with black and fluid


blood.

This being taken away,

discovered upon

the superior surface of the encephalon a thin

al-

buminous layer, confounded with the arachnoides.

At

the inner side of the

os frontis,

and very near

mammary
to the

process of the

ethmoidal fossetie,

I observed a transverse opening about three lines


in length and one in diameter, with a separation of

one of the laminae of the internal table of the bone,

upon which

found a thin layer of the cortical

substance of the brain, that adhered to the edge of

The

this opening.

corresponding point of the en-

cephalon, presented a cavity answering to the cortical portion

detached; from this cavity originated

a canal, which passed superficially on the internal

margin of the upper part of the right hemisphere


of the brain, to a level with the concave edge of

the falx, passing above the olfactory nerve of the

same

side.

It

passed the furrow which separates

the two hemispheres, and penetrated into the


to about a depth of two
1. ft

lines.

left

In passing over the

optic nerve, and the root of that of the right, the

latter

near
tery;

was injured by the point of the instrument,

its origin,

and below the anterior cerebral

which was denuded

erably dilated.

The

at this point,

point of the

ar-

and consid-

foil at last

stopped

at the inferior wall of the lateral ventricle, very near

EFFECTS OF NOSTALGIA.
the

arm

left

of the

203

medulla oblongata.

This

oblique canal, which might be from two inches

and a half

to three inches long,

There was no

coat of coagulated blood.

suppuration; there was only a

reddish

tint

was lined with a

little

serosity of a

under the two lobes of the


This

phere of the brain.

fluid

traee of

left

hemis-

had extended

itself

deeply under the cerebellum, and into the vertebral canal.

The

organs of the chest, and the glandular

vis-

cera of the abdominal cavity, such as the liver,

kidneys and pancreas, offered nothing that was

The stomach

remarkable.

presented no morbid

appearance, but the jejunum had three intussusceptions, to an extent of from two to three or four
inches.

These intussusceptions were recent and

without inflammation.
ilium inflamed in
tines

were

all

found, nevertheless, the

its tunics.

The

large intes-

loaded, through their whole extent, with

masses of hardened stercoraceous matter.

This dissection

fully justified the prognostic I

had made on the nature and depth of the lesion of


the brain.

It

furnished a

new proof

in

support of

the assertion I had

made respecting the

effects of profound,

moral impressions, as nostal-

gia;

seat

and

which had seized upon the patient during

the last days of his treatment for the wound.

It

204

ON THE SEAT AND

demonstrated at least the possibility of curing-

wounds of the
fore considered

wound

brain,

which have been hereto-

mortal.

It

may be

of LeccBur

is

evident, that the

considered as cured, as

the serosity found effused under the

left

hemis-

phere, and even under the cerebellum, was no

doubt accumulated

when

all

stroyed.

these

at

the time

the vital forces of the patient

were de-

in

places

It is certain, that the blood,

was

at first occupied this space,

what proves

which had

entirely absorbed;

this, is the distance this soldier

went

on foot from the hospital of Gros Caillou to the

School of Medicine, and from

this place to the

hospital, without having experienced the slightest

aberration of the mental faculties.

Lastly,

it

is

incontestible, that the causes of his death must be

referred to the superficial alteration of the brain,

induced by the moral affection [nostalgia) of the


patient; to this

edly,

by the

he

was

effects of the

predisposed, undoubt-

wound and

the invagi-

nation of the intestines, the consequence of the

immoderate use the patient made of drinks of


every kind, that he procured clandestinely from
the other patients.

Might

not the intussusceptions

have

also the effect of causing the paralytic affec-

tion,

which, towards the termination of the case,

had seized the superior portions of the digestive

EFFECTS OF NOSTALGIA.

205

organs, to which the brain undoubtedly sends

stimulus

its

by the pneumogastric nerves; while those

of the organs of internal

life,

or the gangloinic

nerves, having been irritated by the acrid matter

detained in the lower part of these viscera,

have determined
tic

in these portions

an anti-peristal-

motion; as the invaginations, as

remarked, seemed

to

may

have before

have been formed from the

lower extremity of the

jejunum towards the up-

per?
Lastly,

this case,

which appear

to

me

to

be extremely interesting,

should induce practitioners


thing

in

similar

cases,

preceding,

as the

as well

to

neglect any

they

demonstrate

not

since

clearly that both deep and superficial lesions of

the brain are susceptible of cure.

Note.
acute
will

If the patient dies immediately after an

inflammation

of the

brain,

its

substance

be found to have acquired density, and

be in a state of expansion proportioned


degree of inflammation.

If,

to

to

the

on the contrary, the

inflammation has become chronic, the brain, after

having undergone an expansion,


state,

falls

into a soft

a consecutive effect of the disease or the

death of the parts.

ESSAY

III.

REMARKS ON THE PROPERTIES OF THE

I have

IRIS.*

generally observed that the irritation

or alterations carried on in the system of nerves


of organic
fluence,
life

life

have, directly or indirectly, an in-

more or

But

of relation.

evident,

less

upon those of the

lesions established exclusive-

ly in the nerves of the

life

of relation have none,

or nearly no influence upon the integrity of the


functions of the nerves, or organs of internal

or these effects,
nitely

if

they are manifested, are

more slow than

the

infi-

in the first case.

In support of this general opinion,

examine

life;

comparative

influence

I will

now

which the

diseases of one of these nervous systems produce

upon the other, and vice versa.


*

summary

matique in 1817,

This

conceive

of the following remarks was read at the Societe Philo*

See the bulletin of

this Society, vol.

iii.

p. 134.

208

REMARKS ON THE

be an important undertaking, and one which

to

constitutes the subject of a great question in phy-

But before entering upon

siology and pathology.


this

question, I will

examine what

first

the

is

sympathetic relation which exists between the


iris

and the retina or optic nerve?

Until of late,

it

has been generally acknowledg-

ed, that the contractile and retractile property of

the

from the nervous influence of the

arises

iris

The

number

of

the partisans of this opinion also advise not

to

optic nerve, or retina.

greater

perform the operation for cataract, especially extraction,

when

the

iris

is

deprived of motion;

because they suppose in this case that the visual

organ

is

also paralysed.

found by experience

But

that,

in

since

has been

it

certain cases, the

visual functions are restored after the depression

or extraction of the cataract, though the

before immoveable,

membranous

it

has been supposed that

partition could only contract

the retina received that impression which


quires
place.

in

order that this contraction

I shall

was

iris

endeavour

first

to

may

this

when
it

re-

take

demonstrate

the error of this assertion, and afterwards to shew,


as clearly as
of the iris

is

can, that the contractile property

independent of the nervous

ence of the retina or optic nerve.

influ-

PROPERTIES OF THE

am now

cases that

the

iris

my

researches, and the

have collected, that the properties of

depend especially upon

and the
the

convinced, by

209

IRIS.

its

peculiar tissue,

ciliary nerves, furnished principally

lenticular

ganglion

belonging to the

of the paralytic affection of this membrane,


it

and the reasons why

exists,

when

great

This arrangement shews the nature

sympathetic.

place

by

it

when

does not take

the optic nerves are paralyzed, or al-

tered by any disease whatever. Thus,

have seen

patients attacked with gutta serena, while the iris

preserved

its

whose sight

motions.

The

little

had the good fortune

English boy,
to restore in

Spain, after the campaign of Corunna, was an

example of

This case of gutta serp.na

this.

inserted in the third volume of

page

2-39,

and

is

is

my Campaigns,

cited in the preceding Essay on

Moxa.
In fully formed cataract, the retina

serve

integrity, so as to be ready to

its

functions,

when

it

may

pre-

resume

its

shall be placed in a situation to

receive the image of objects by the extraction or

depression of the opaque veil which intercepts the

passage of the luminous rays, though the


paralyzed;

upon the

because

lesion of a

to internal life,

27

this

last

affection

iris

be

depends

system of nerves which belong

and which have with the

life

of

210

REMARKS ON THE

relation but indirect communications,

small nervous anastomoses.

by means

of

would wish, how-

ever, not to be understood to include adhesions

contracted by the

iris,

which may be confounded

with paralysis of this membranous partition.

have witnessed many


this opinion,

of the

iris

facts

which go

to

support

and which prove that the immobility

does not contra-indicate the operation

of cataract.

The

retina and iris

may

also

be simultaneously

or separately affected, according to the nature or

manner

of acting of those causes which produce

One

the alteration.
ble as rare,

is

of the,se causes, as remarka-

the direct impression upon the

tis-

sue of these membranes by the rays of the sun,


received under certain circumstances.

number

great

of individuals were subjected to the influ-

ence of this cause, on the day of the late eclipse


of the sun.*

Two

soldiers

of

the

royal

guard presented

themselves at the hospital of Gros-Caillou, to be


treated

for

serious accidents produced by that

eclipse.

The first was named Jacquemort,


brigadier

in the train of artillery;

(Jean Baptiste)

being but

acquainted with the manner of observing


* Seventh of September, 1820.

little

this

PROPERTIES OP THE
phenomenon, he used an opaque
transparent point in the centre of

made himself

for the

this celestial

phenomenon.

vivid, inconvenient,

211

IRIS.
glass,
it,

having a

which he had

purpose of hetter observing

Notwithstanding the

and very painful impression

which he experienced from the passage

of the

solar rays through the lucid portion of the glass,

he continued

Soon

after,

to look until the

he perceived the

end of the

effects of

it;

eclipse.

he was

seized with vertigo, a severe pain over the whole


right side of the head, corresponding to the eye

which he had used, and was nearly deprived of the


sight of this eye; the

iris,

gan, remained uninjured.


this

soldier,

continuing

and other parts of the

Some weeks
to

or-

afterwards,

experience constant

acute pains in the head, presented himself at the


hospital,

and put himself under

arrival, on the seventh of

vessels of the eye


little

my

care.

its

were injected, and the pupil a

In this instance,

had

left;

but

it

motions, though the vision was very

obscure, indeed nearly

of rays

his

November, 1850, the

more contracted than that of the

preserved

At

lost.

we

see that a very small cone

fallen directly

that

its

the

optic nerve,

irritating effect

retina,

and

had been propagated

and even

interior of the brain.

upon the

to its

origin in

to

the

After two bleedings from

212

REMARKS ON THE

the temporal artery and jugular vein,

cupping with scarification


of the neck.

ment of

ice

established

to the

employed

temple and nape

passed afterwards to the employ-

upon the head, and moxas, which

re-

completely the visual functions; but

the patient continued to feel a dull pain on the


right side of the head.

The

second,

named Paintiaux, (Jean

Baptiste,)

a soldier in the fifth regiment of infantry, entered


the hospital, at the time

charged.
left

He had

when

the

first

was

dis-

observed the eclipse with the

eye, and had used a glass, the centre of which

was opaque, and the circumference transparent.

He

was

less

incommoded than the

first,

because

the solar rays were not directed upon the pupil,

through which but few passed; but the circumference of the lucid cornea, and especially the ocular

conjunctiva, had

received a very vivid im-

pression from the rays, which caused such an


idiopathic inflammation, that the vessels of this

membrane were

injected to the centre of the cor-

nea, over a great part of the surface of which, a


slight whitish opacity

developed

itself.

Suitable

remedies diminished the symptoms, but the pupil

was considerably
its

retracted, and the iris had lost

motions, while the retina had preserved

visual functions.

These

its

pathological facts prove

FROPEFTTFS OF THE

That the properties

evidently: First.

membrane, are independent

of this

of the retina.

That the ocular conjunctiva extends


the transparent cornea, covering
that

its

213

THIS.

it

first

Second.
over

itself

entirely; but

more

tissue at this point is infinitely

deli-

and that the colouring part of the blood

cate,

does not pass into

its vessels,

except

a violent

in

inflammation of the conjunctiva.


will

now

relate

some cases which shew the

relations of the properties of the iris with cataract.

A lad, aged about

fourteen years, a gunsmith, in

1818, received a smart blow, by accident, from a

ramrod, on the middle part of the lower edge of the

This blow was immediately followed by

left orbit.

loss of sight in

the

perfectly preserved

iris

remained

tient

months.

same

the eye of the

in

However,

as he

The

motions.

its

this state

side, while

from ten

pa-

to eleven

apprehended the

loss of

the other eye, the vision of which appeared to

grow weaker, he came

to consult

ing attentively examined


following

it, I

left

After hav-

subjected him to the

treatment: Cupping

was applied to the

me.

with scarification

temple, to the neck, nape

of the neck, and between the shoulders.


slight vomit, he

and

was put upon the use of

commenced

placed the

first

the

on the

After a
bitters,

application of moxa.
left

side,

approaching as

REMARKS ON THE

<J14

near as possible to the origin of the optic nerves;


a second was applied between the left angle of the
maxilla and the mastoid process, over the course
of the trunk of the facial nerve of the

same

side;

four or five other small ones were successively

placed over the corresponding temporal region.

After the application of the

first

moxas, the patient

received the impression of light, and was soon


able to distinguish objects; this faculty developed
itself progressively,

became

and the vision of that side

motions of the

had continued

iris

with as much precision as


organ;

The

as perfect as that of the right eye.

it

was

this

in a

to

be performed

healthy state of the

circumstance which became the

principal subject of

my

reflections.

This young man considered himself perfectly


cured for several months;

in fact,

he saw with

both eyes equally well. After this time, the vision


of the left eye
after lost

it

became sensibly obscured, and soon

Alarmed

altogether.

cident, he again

came

to

claim

my

new

ac-

assistance.

at this

at once found that a perfect cataract


in the crystalline lens,

was formed

which intercepted

in

this

eye the passage of the luminous rays, and pro-

duced complete blindness.

remarked that the


and was

in

at the

had preserved

same time
its

motions,

a perfect state of integrity.

There

iris

PROPERTIES OF THE

were two remarkable circumstances


the

was the paralysis

first

loss of vision,

while the

iris

The

in this case;

of the retina, and the

least alteration; the second

tion of the cataract.

215

IRIS.

did not undergo the

was the rapid forma-

first

proves, in the most

unquestionable manner, that the properties of the


iris

are independent of

t-he

retina;

the second,

that the crystalline lens does not nourish itself by


imbibition, but by a vascular circulation like the

other parts of living organized bodies;

for, if

the

very delicate vessels of the crystalline lens had

not been

where they pass from the

ruptured

capsule to the lens,

would not have

it

transparency so rapidly.*

ments of the pupil of


perfect

Besides, the

this side,

harmony with those

lost

its

move-

were always

in

of the iris of the

right eye.

In tetanus,

when

nerves of animal

life

contraction, the iris


ties;

it is

are in a state of permanent

is

not changed in

in

health.

In

certain diseases of the

* Soemmering injected these vessels even to the capsule

it

proper-

of the pupil, are executed the

brain, as dropsy of the ventricles, the

as they

its

observed, that the alternate contraction

and enlargement

same as

the muscles excited by the

all

same pheof"

do not admit the colouring part of the blood beyond

the lens, but


this capsule,

has been improperly concluded that the crystalline nourishes

imbibition.

itself bi

REMARKS ON THE

216

nomena are observed.

The

sensitive

functions

are considerably weakened or paralyzed, by the


concentric or eccentric compression that the nerves

exam-

of the organs of sense (the optic nerves for


ple) experience at their origin,

by the

the ventricles, while the

remains uninjured

and preserves

iris

They may be even

movements.

its

dilatation of

sympathetically increased, by irritating the sys-

tem of organs of internal

An

purges or emetics.*
disease,

this

by means of drastic

life,

English lady, affected by

two children,

which

have

also

treated in the city, and a grenadier in the horse

who was under my

guard,

care in the hospital of

Gros Caillou, have furnished striking examples

There can be no doubt

this.

was attacked with a dropsy

of

that this grenadier

of the ventricles of the

brain, in consequence of falling violently upon the

back of
the

his head.

At any

rate,

he presented

all

symptoms which were gradually developed,

and advanced
cipal

to

a very high degree.

symptoms were

a dull

The

prin-

pain, with a sense of

heaviness in the head, a great weakness of

all

the

senses, and of the speech, a sensible alteration of


all

the animal functions, except the intellect, which

* In verminous diseases, the motions of the

and sometimes convulsive; the


See also

in

vision,

iris

or pupil are accelerated,

however, remaining

unaffected,

the fourth case of the preceding memoir, the effects of excitants

acting upon the nerres of internal

life.

PROPERTIES OF THE
was

natural; the right

lysis in the

cold.

succeeded

However,

in this

in curing, the iris

properties and motions.

its

seized with para-

second degree, and the legs were weak

and habitually

whom

arm was

217

IRIS.

patient,

preserved

all

remarked, that the

pupil dilated in proportion to the activity of the


drastic purges which were administered.

made

the same remark on a great

of pa-

tients

with wounds

number

have

of the head, attended with loss

of sight, and a striking change in the organs of

animal

The

life.

iris, for

the same reasons,

may

lose its

organic properties, while the optic nerve, retina,

and other parts of the eye, preserve perfectly their


integrity,

and execute

all

their functions.

wo-

man, thirty-four years of age, of a dark complexion,

and of a constitution sound and robust, came

to consult

me

in the course of the last winter, for

an affection of

was

this kind.

The

iris, in

both eyes,

completely paralytic and dilated, so that the

opening of the pupil could be made


about a quarter of a

line in

means of the most powerful

diameter only, by

excitants,

impression of a sudden and vivid

withstanding

this

to contract to

light.

and by the
But, not-

very striking deformity, she

perceived objects very readily, and distinguished,

28

REMARKS ON THE

218

even exactly? their figures and colours, provided


they were not brought too near to the eyes.
I have since

had occasion

diers of the guard, this

to see in several sol-

membrane

entirely lose its

motions by percussion on the edge of the orbit,


or a punctured

wound

of the cornea, with lesion of

the larger circumference of the


sion remained unaffected.

But

iris,
it

while the

vi-

should also be

remarked, that the same mechanical causes may


destroy the
as

we have

vital

properties of both membranes,

seen in a guard-du-corps, and in a

was even

soldier of the royal guard; the patient

discharged on account of this infirmity.


In organic affections of the viscera of internal
life,

such as chronic inflammations of the heart,

pericardium, or some of the principal viscera of


the abdomen, the opening of the

gradually

iris

contracts to such a degree, that the pupil becomes

sometimes completely closed, and does not permit


the passage of the luminous rays.

preserves the integrity of

its

But

visual

which may be restored by the operation


cial pupil.
it

will

the retina

properties,
for artifi-

Nevertheless, from these observations,

be important to know,

if

the individual at-

tacked could perceive objects, before the complete


occlusion

of the pupil, for in

the operation will be useless.

case of amaurosis

PROPERTIES OF THE

My

remarks upon

iritis

having run through


tion,

which

is

its

all

go

to

219

IRIS.

shew, that, after

stages, this inflamma-

ordinarily caused by repelled sy-

philis, has for its results, as has

been judiciously

observed by the Austrian Professor Beer; First,


the discolouration of the anterior surface of the

Second, Ectropium, or the

diseased membrane.

destruction of a part of the diameter of the open-

ing of the pupil, and especially of

segment.

superior

its

have never observed that the semi-

circular cut,

which

is

sometimes formed in the

superior part of this membrane, ever takes place

This

in its inferior portion.

part loses

latter

its

motions, while the tattered remnant, (le lambeau)

which has survived the destruction of the other


part, preserves
sibly.

non;

but

movements more or

its

have often remarked


it

has

wards. It appears

appeared

phenome-

me

to

be

in a grenadier treated in

my

never

more evident, than

this

less sen-

to

to

depend upon the disposition

of the ciliary nerves and vessels which are directed, principally, from the superior part to
rest of this

all

the

membrane.

An English navy officer of between twenty-seven


and twenty-eight years of age, was suddenly
tacked by a violent opthalmia, with

iritis.

at-

Slight

ulcerations of the transparent cornea, with a pro-

REMARKS ON THE

520

digious turgescence of the ocular conjunctiva were

manifested, and produced a true cheraosis; this


repulsion of the

resulted from a metastasis, or


syphilitic virus,

This alarming disease; which was success-

penis.
fully

from one or more chancres on the

combatted and overcome by the usual means,

was followed by a discolouration and


the

iris,

paralysis of

the pupil continuing dilated, while the

visual functions

remained.

still

The

chemosis was

removed by excision around the whole circumference of the transparent cornea; but there

still

existed a considerable number of capillary vessels

which traversed from one side


it

was necessary

remove,

to

to the other,

to restore its

which
trans-

parency.*
It is

undoubtedly very

difficult

to

determine

the causes of the dilatation and contraction of the


pupil and to explain

man and most

its

mechanism.

But, as in

animals, these motions appear to be

independent of the

will of the individual,

it

may

be presumed that the stimulus which produces


*

think the conjunctiva

is

formed of two

distinct parts; the first

palpebral conjunctiva, which appears to participate

mucous membranes; the second,


of the serous.

The

first

is

in

is

the

the properties of the

the ocular conjunctiva, seems to partake

the seat of opthalmia from gonnorhcea and

other catarrhs; the second becomes inflamed with other parts of the eye,

from the influence of virus, or mechanical causes.

PROPERTIES OF THE

the contraction of the fibres of the


sively furnished

221

IRIS.

exclu-

iris is

by the nervous branches which

arise from the opthalmic ganglion, belonging to

the system of nerves of internal

ought

to

remember: First. That

curtain, in man, and


rectly one or

many

membranous

this

animals, receives di-

two filaments from the nasal nerve,

belonging to the

branch of the

first

Second. That the motions of

pair.

But we

life.

cerebral

fifth

this partition

be modified, more or less perceptibly,

appear

to

in the

same individuals; either under the

ence of a very strong

membranous
of images

That

this

irritates this

or by the sudden appearance

veil,

more or

of an aspect

with respect

which

light,

influ-

their colour or

to

less

excitant,

form.

Third.

partition appears really to execute

motions under the

its

tacit influence of the will of the

individual, but expressed by the repetition of the

phenomenon,

in

paroquets.*

From

birds,

certain

conceived that the

these
iris

of the

reflections

is

family of

may be

it

mixed organ, a por-

* According to the celebrated Cuvier, the ray, or thornback, appears


not only to possess the faculty of moving

but

it

disposed in the form of a grated palm


fall

this

pupil at will, like paroquets,

tlie

also presents a prolongation at the superior

at will, before the crystalline

opaque membranous

pupil at

Anatomy.

will.

leaf,

which

lens, like

veil is entire,

and

edge of
this fish

a lattice.
this ray

this

opening,

no doubt

lets

In the torpedoe

can cover the whole

See the second volume of the Lectures on Comparative

REMARKS ON THE

222

of which, to

tion

a certain extent, and

in par-

ticular species, is submissive to the control of the

while another portion exe-

will of the individual,

cutes

its

From

motions without this participation.*"

scribe in a

mode

structure,which

this

nerves sent to this

of distribution of the

curtain,

relaxation

the pupil

hereafter de-

more detailed manner, and from the

membranous
the

I shall

of

we may

the

iris

conclude then; that

or the

dilatation

of

produced by the folding up of the

is

flexuous arteries, naturally arranged in a zig-zag


spiral

or in

lines,

and by the engorgement

of

these vessels, determined by the stimulus that the

nervous filaments of the opthalmic ganglion transmits to this

membrane. But the contraction of

moveable curtain, or closing up of the pupil,

this

is

un-

doubtedly produced by the engorgement of the small


arterial or ciliary crown,

of a purse.

which acts

like the cord

This engorgement appears

to

be de-

termined by the stimulus of the long ciliary nerves,

which render themselves from the nasal nerve


within the compass of this opening, without com-

municating with those of the lenticular ganglion.

The

irritations also of the

stomach or lungs de-

termine often the contraction of the pupil, while


*

We

ter of

remark the same properties

in the

urinary bladder; the sphinc-

which contracts by the stimulus of the nerves

the bodv of this

membranous

sac

is

oi"

animal

life,

stimulated bv those of internal

while
life.

PROPERTIES OF THE

223

IRIS.

those of the intestines, uterus or bladder have ap-

peared
as

we

to

me

often

to cause a dilatation of this opening,

remark

in children affected with ver-

minous diseases.
Notwithstanding these two systems of nerves,
the

movements

of the iris are certainly indepen-

dent of the nervous influence of the retina; this


will

be evident from the following expose of

The

cameleon has no moveable

rior of the eye; this is

compensated for by the

external eye-lid, which in this animal


liar

We

form and structure.

facts.

the inte-

iris in

find,

is

of a pecu-

however, behind

the cornea a small pearl-like zone, covered with

gilded

strise,

This zone, of

almost imperceptible.

an extremely dense and compact texture,

is

con-

founded with the ciliary processes, and adheres

to

the circumference of the capsule of the crystalline, of

which the anterior segment projects be-

yond the edges about one

line.

zone therefore does not appear

to

This pearl-like
have any other

use than that of refracting the luminous rays to-

wards the

crystalline lens;

orbicular eye-lid, which

is

while

the

external

attached to the

cir-

cumference of the globe of the eye (the motions of

which
very

it

follows)

fine fold

tracts its

by a membranous compact and

of the conjunctiva, dilates or con-

opening

to

modify the passage of the

REMARKS GN

24

TIfE

luminous rays, by means of two planes of movefibres, circular

and radiating, which enter

into its composition.

This opening, which indeed

able

supplies the place of a pupil, has a rounded form,

which

little elliptical,

closes itself entirely, not-

withstanding the assertions of some naturalists.

There

another singular phenomenon observed in

is

this reptile, viz. that its eyes

move and perceive

objects in opposite directions;

if,

for example,

we

enclose in a cage of glass, a cameleon and a small


frog, this last animal,

threatens

it,

alarmed by the danger which

runs to the opposite side of the cage,

and endeavours

to

avoid

leon, without changing

with one of

its

its

The

enemy.

its

place, follows

little

the cameleon seizes

it

long and flexible tongue, and swallows

it

it

its

prey

eyes, while the other remains im-

moveable; at the moment when the


expects

came-

least,

animal

with

its

with the

greatest facility.

In a dissection that

ing

my

made

residence in Eygpt,

of a cameleon, dur-

could not find any

organ of hearing, which appeared

wanting

in this animal.

It is

me

to

be

no doubt for this

reason that nature has endowed


culty of perceiving at the

to

it

with the

same time with both

faits

eyes, objects which are placed in opposite directions.

PROPERTIES OF THE

225

IRIS.

Prochaska, one of the most expert anatomists


in

Europe, has demonstrated by some exquisite in-

which

jections,

the structure of the

I possess, that

radiating, and circular vessels of the

iris

is

elementary muscular

the

fibre.

same

as that

These

injections demonstrate that these fibres, like

of the

the folds and coronary parts of the

iris,

as well as

the spiral fibres of the arteries themselves, are

formed of a

series of small capillary arteries, very

perceptible

with the microscope, turning upon

each other in such a manner as

to

form these

fibres partly or wholly, according to the forma-

tion or particular use of

These

each of these organs.

spiral capillary arteries are found twist-

ed together and surrounded


disappears

which

substance,

by an extraneous

by

and

injection;

which the same anatomist asserted

to

be fibrine

in the muscles, concreted or thickened

albumen

cellular tissue
in the arteries, and a strong thin

in the intestines and

propriety,

as

hemorrhages,

iris.

We

have done

may compare, with


in

the' disposition

my memoir

of these

on

primitive

these peculiar retractile fibres, to the

arteries,

filaments which compose cords of different sizes,

and

at last cables.

selves by

These

fibres shorten

means of the engorgement

or by the afflux

29

of

blood

them-

of the vessels,

which runs through

PROPERTIES OF THE

226

IRIS.

them, in the same manner as cords, when

in

certain state of tension, shorten themselves more

or less by imbibing any liquid, as

these means
for

we can

elevate enormous masses; as

example vessels of war, which may be

wards launched

By

water.

into the sea

after-

with the greatest

facility.

As

a proof of the truth of the assertion

made, concerning the


produced by the

have

eifect of this contractility,

afflux of blood into the elementa-

ry vessels of the moving


to observe; that

when

near the origin of

its

the portion which

is

a muscle

is

be sufficient

cut transversly,

nutritive or organic arteries,

the most distant becomes

The same

capable of contraction.
in all the muscles,

fibre, it will

when

in-

thing happens

the arteries sent to them

are tied, at least until nature has replaced these


arteries

by other vessels which establish a new

circulation.

blood,

into

Besides,

we

these minute vessels

galvanic vital excitations,


ture;

think that the afflux of


is

unknown

produced by
in their na-

which arise no doubt from the encephalic

nerves in the organs of locomotion, and from those


of the ganglions in the muscular organs of internal

life.

ESSAY

IV.

SOME OBSERVATIONS ON WOUNDS OF THE


INTESTINES,
SOIXO-WEI) BIT

Wounds

A.

REMARKABLE CASE OF THIS SORT OF LESION.

penetrating into the eavity of the

ahdomen, with

lesion of the intestines,

considered by

all

authors, with reason, as very

However,

dangerous and mortal.


quent occasion
these lesions,

to

have been

remark

when they

susceptible of cure.

In

in

have had

my Campaigns,

result

from

fire

fre-

that

arms, are

making known the

sources of nature in these dangerous cases,

re-

have

also pointed out the means to be employed, or the

processes to be used to conduct these wounds to a

happy termination.
Suppose, for example, that the projectile

tra-

verses a part of the cavity of the belly, in an adult,


so that a portion of the tube of the ilium, or of the

large intestine,

is

destroyed

at a

given point.

228

OBSERVATIONS ON

There

be

will

attrition of the parts struck

projectile,while there

bouring parts
,.

is

by

the

produced upon the neigh-

a certain distance, a commotion

to

with stupor, from which will result a sensible contraction in the

wound, and an engorgement more

or less considerable in the surrounding tissue.

The intestinal
ly

substances either escape external-

by the wound, or they

part, of

which

collect at the

wounded

have spoken, without communicat-

ing with the abdominal cavity. This

is

an admirable

provision of nature, and indicates to the surgeon

the course he ought to pursue under such circum-

Following these salutary indications,

stances.

have taken care,

in these cases, to

wounded portion

of intestine, to separate

bring

seek for the


it

and

the edge of the opening into the abdo-

it to

men, and

to

keep

it

there by means of a ligature pas-

sed into the mesentery; or to reunite the wounded

gut by means of a suture.

In both cases

we have

reason to fear a series of alarming symptoms, such

hemorrhage, which may result from the

as internal

rupture of the adhesion, or the new division of


blood-vessels; for the last operation cannot be per-

formed without renewing the edges of the wound.

We

should especially apprehend the extravasa-

tion of the
belly.

It is

fecal

matter into

the cavity of the

necessary to attend to the adhesions, and

WOUNDS OF THE INTESTINES.

229

to content ourselves with applying to the


fine lint

wound

covered with a balsamic unguent, and an

we

appropriate bandage; however


dilate the edges

of the external

should always

wound even

to

the aponeuroses.

After many battles

have had occasion

to dress

a great number of soldiers with wounds of

this

kind, and they have generally been cured in this

way.
Until the eschars

fall off,

the alvine substances

pass in small quantity by the wound; but afterwards,

not finding any obstruction, they pass out in abun-

dance, and continue to do so until the

Then

clean.

it

becomes necessary

wound

is

to favour the

approximation of the edges of the wound of the

abdominal walls, and of the


intestine

first,

and concentric bandage.

same time gradually

and a

light compressive

The two wounds

at the

contract; the corresponding

adhesion and form a cicatrix.


the

straps

at last into contact, contract a mutual

come

first in

of that of the

by the assistance of adhesive

applied over the

parts

lips

wound

the interior

This takes place

of the intestine, proceeding from

towards the exterior; the intestinal

tube always undergoes a contraction proportioned


to the loss of substance.

for the

The

primitive adhesion,

most part, becomes at last effaced, and the

230

OBSERVATIONS ON

parts which

had been transposed, recover

their

respective and natural position with the return of

phenomenon which

their functions; a

noticed of

wounds

abdomen

of the

in

formerly

which the

omentum has escaped.*


Incised or punctured

wounds

of the intestines

do not follow the same course, nor present the

same phenomena;
more

is

difficult,

think also, that their prognosis


especially

they

if

are

certain extent; they require also the most

of

prompt

assistance.

One

of the two following processes are general-

One

ly indicated in their cure.

consists in retain-

ing the wounded portion of intestine opposite the

wound

of the

abdomen by means

passed into the mesentery, so as

to

of a ligature

prevent the

al-

vine matter from escaping into the cavity of the ab-

domen; and allowing time

wounded

intestine, as

to

nature to insulate the

happens

in

gunshot wounds,

until the causes of irritation are entirely dissipat-

ed.

The

injured parts recover by degrees their

natural position, and

the lips of the intestinal

wound approach each

other to form a cicatrix, the

ultimate object of nature.

This

is

undoubtedly

the most desirable and easy process.


"Sec volumes second, third,

antl fourth

of"

my

Campaigns.

WOUNDS OF THE INTESTINES.


The

231

second consists in bringing together the

lips of the

wound, by means of a simple suture,

or an invagination assisted and sustained by ligatures passed into the thickest part of the two ends
of the divided intestine, and sometimes with inter-

This

nal supports.

by John

last

is

recommended

wounds

of the intes-

method

Bell, not only for

tines with loss of substance, as gunshot wounds,

or those resulting from gangrene, but even in simple wounds.

Without entering

into a detailed consideration

of the advantages and disadvantages of these different methods,

that which

point out, in a few words,

will

believe to be the best in punctured

or incised wounds, as

have already given fny

opinion respecting gunshot wounds.

The
tines,

process of Littre in wounds of the intesof whatever

nature,

undoubtedly the

is

least calculated to

augment the

jured parts; but

has also the inconvenience of

it

irritation of in-

prolonging the disease and inducing an

artificial

anus for some time.

notwith-

Sometimes

also,

standing every precaution, and before the injured


portion of the intestines has contracted adhesions,
it

returns spontaneously into the belly, and allows

the alvine matter, to escape into this cavity which

becomes speedily

fatal.

At

others,

also

that

232

OBSERVATIONS ON

portion of the intestine which protrudes beyond


the external opening, becomes
strangulation, with the usual

company

For

it.

is

after the accident.

means we ought
and

to

mean
it

be

It only re-

kind of suture, and the

employ

to

ac-

am induced

method of the ancients,

to point out the best

efforts,

the most desirable, provided

made immediately
mains

symptoms which

these reasons,

all

to believe that the

the suture,

swelled, causing

to assist the salutary

prevent the inflammation which

generally occurs; such

is

the principal object of

the following reflections.


In a suture for wounds of the intestines,

necessary to keep
First.

cond.

in

view the following

it is

points:

To preserve the lips in exact contact. SeTo comprehend within the points of the su-

ture only, the least possible portion of the intestinal


tube, lest

we

an obstacle

Third.

so diminish its diameter as to present

passage of the fecal matter.

to the

The mode

of suture most suitable,

pointed out above; for, whatever

ed

the

to

wounds

may be

is

that

assert-

contrary by authors, the reunion of

of the intestines

is

parts of the body, by their

effected, as in other

own

vessels;

and the

adhesions will be prompt and easy, in proportion


as the divided parts are brought into exact contact,

and preserved

in this state

by the suture

WOUNDS OP THE INTESTINES.


indicated.

In

the

experiments which

upon living animals,

Anatomy and Physiology, which


which
I

it is

delivered at

in Paris,

experiments

easy to repeat, the truth of the remarks

have just made concerning wounds of the

tines,

made

Lectures on Surgical

in the

Toulon, and Val-de Grace,

833

intes-

After having made one

was demonstrated.

or more wounds, in different directions, in the


intestinal tube,

which was

by an incision

laid bare

into the belly, in dogs of different ages,

these

wounds by means

du

of the suture

with the precaution of making


threads of different colours

united

pelletier,

double, using

it

alternately.

These

threads ought to be not only waxed, but covered

with mild cerate.

It is

necessary to take the pre-

caution of leaving them of sufficient length to be retained out of the cavity of the belly, until the period of extraction.

Now the adhesive inflammation

not taking place before the

fifth

day,

it is

prudent

not to attempt to remove the ligatures before the

seventh day, or they

remain

may even

until the ninth.

tracting them,

we ought

opposite directions, which

For the purpose of ex-

draw them gently

to

may be

made, we should take care

wounded
30

to

in

easily done, as

The

they are of different colours.

the

be allowed to

suture being

return the fold of

intestine into the cavity of the belly,

OBSERVATIONS ON

234
so that

it

may move

freely: for in retaining

it

at

the edge of the external wound, as in the process


of Littre,

is

it

inflected in such a

obstruct the course of

engorgement of
I

tier,

propose in

its

contents,

manner

and

as to

to cause

an

its tunic.

preference the suture du pelle-

because that which has heretofore been re-

commended by

authors, embraces a

much

larger

portion of the intestine, and favours the swelling

and turning outwards of the edges of the wound,


to the true indications in

which are contrary

such

cases; indeed, mutual adhesion can only take place

at the lateral points of the two lips of the wound.

There may
of the

be, undoubtedly, adhesions of the

wound with

edge

the other surrounding parts,

but unnatural adhesions, whatever

may be

said to

the contrary, are temporary; nature at last, insensibly, separates

them

tion of the intestine,

of the

to restore the peristaltic

and thus

alvine matter.

to

mo-

favour the course

Before having remarked

this disposition of adhesions in lesions or displace-

ments of the intestines,

phenomenon

in

wounds

had observed the same

of the belly in

which the

epiploon had escaped, which, after having been


retained at the edges of the
it

wound through which

had passed by adhesions, often very extensive,

relieves

itself

of

these connexions, and returns

WOUNDS OF THE INTESTINES.


gradually into the abdominal cavity to
situation.*
in

whom

If

were not

it

its

235
original

for this, the individual,

these organs are so essential to the func-

tions of internal

would be exposed

life,

to

In unnatural adhesions, in ar-

greatest dangers.

anus, even of the longest standing,

tificial

the

when

the opening closes in consequence of the re-union


of the

intestine,

by means of the method of

Desault, or that of Dupuytren; these adhesions,

become gradually removed, and the gut

say,

moves

This

free in the abdominal cavity.

strikingly the ease

of the anus

is

when

is

more

the preternatural state

not the consequence of a great loss

and the adhesions

of substance in the intestine,

are recent.
It is

logical

easy to convince ourselves of these physiotruths,

by repeating

Nevertheless,

animals.

my

experiments on

we have

to

oppose the

inflammation, which has a tendency to develope


itself constantly

under the influence of the mecha-

nical irritation,

which the suture must necessarily

Certainly, from

produce.

my

experience,

we

can-

not employ in these cases, more efficacious means

than cupping with scarification; the application of

which should be made


* See in

the

my

omentum

Campaigns

tlie

at the instant that the first

Memoir on Wounds

Iiad escaped; vol.

iv.

page 373.

of the Nelly, in wlik-li

OBSERVATIONS OH

23b

We

inflammatory symptoms appear.


it

in

must apply

a series of parallel lines, from the upper to

The applications
frequently as may be judged

the lower part of the belly.

should be repeated as

The

necessary.

scarifications

should

made

be

with the instrument, which has been already described, and in such a

manner

as to run over, with

instrument, the whole surface of the skin

this

which has been previously reddened by the cups;


the air of which has been rarefied by means of a

piece of fine tow, burnt in the bottom of the cups.


is

preferable to the syringe, with

which the spring

scarificator is generally used,

This method

the incisions of which can only be


ing,

made by

press-

which renders them more painful, more dan-

my mode

gerous, and more imperfect, while, by


scarifying, the punctures are uniform,

and

of

entirely

under the control of the will of the surgeon.

To

these depletive and derivative topical remedies,

we ought

to

add

oily

embrocations, luke

warm

baths, emollient enemata, and cold mucilaginous

drinks, taken frequently in small quantities; general

bleeding

is

sometimes indicated.

This constitutes the basis of the mode of

ment recommended by me
low fever, addressed
cine of New-Orleans.

to

in an essay

the
I

treat-

on the

Academy

of

yel-

Medi-

hope the success

will

WOUNDS OF
answer

my

pears to
tion,

237

THi: INTESTINES.

expectations; for the yellow fever ap-

me

an inflamma-

to consist, principally, in

more or

less

the

severe, of

serous

mem-

brane of the abdominal viscera; having for


principal

vomiting,

symptoms, pains of the


as

intestines

its

and

spontaneous cholera morbus,

in

malady from which the yellow fever does not

The

sentially differ.

a
es-

cholera morbus, which suc-

ceeds to a mechanical irritation, acting directly

upon the

intestines, exhibits the

and may have the same


tions are the

When we

same
shall

results;

in all these

now,

the^ indica-

kinds of affections.

have overcome the inflammatory

symptoms, by the means which


pointed out, which

same progress,

we

shall

know by

have already
the cessation

symptoms which characterize acute

in-

flammations of the intestinal-gastric system,

we

of those

may

increase with advantage the peristaltic mo-

tion

of the intestines, and favour the intestinal

evacuations by means of calomel combined with


fresh castor

oil,

or syrup de chicoree in suitable

doses; by embrocations of the belly with campho-

rated

oil

of chamomile; and by emollient enemata.

Sometimes, especially when the engorgement of


the injured parts assumes a chronic character,

we

are obliged to apply over the abdomen a vesicatory, consisting of

powdered cantharides and cam-

238

OBSERVATIONS ON

phor, in equal parts; taking care

to expose

first

the cantharides to the vapour of boiling water,


for the purpose of depriving
tating,

volatile

principles,

them

of their irri-

without taking from

them their power of causing suppuration. Lastly,

we

finish the treatment

by the use of

light tonics,

such as the aromatic bitter infusions, with orange


flower water, and dry, or slightly alcoholic
tions over the
It

whole surface of the body.

necessary to keep the convalescent to a

is

strict

fric-

regimen, so as to prevent any obstruction

to

the alvine matter in the diseased portion of the

which remains

intestine,

for a long time in a state

of contraction and sluggishness.

The

following case will illustrate the phenome-

na which accompany incised or punctured wounds


of the intestines

same time

it

will

have laid down on

The

treated by suture,

this

mode

leer in the sixteenth

named

Jolin (Jean

years, a fusi-

Regiment of the Guard

This

playing with one of his comrades

in the field adjoining the

by

the

of treatment.

Baptiste) aged about twenty-three

fell

at

confirm the precepts which

subject of this case was

soldier, while

and

barracks of Courbevoie,

accident upon the

which he held unsheathed

made a deep wound

in

point

in his

of

his

sabre,

hand, and which

the abdomen.

He was

WOUNDS OF THE INTESTINES.


transported to Puteau,

239

a neighbouring village,

where the physician, M. Carre, gave him the

first

assistance.

"This

soldier," says

M. Carre

"had a transverse

after the cure of his patient,

wound

in a letter to us,

of about fifteen lines in extent, on the right

side and at the lower part of the abdomen, with

protrusion of a large portion of the ilium which

was already tumefied.

The

of nausea without vomiting.

examined the por-

protruded intestine and

of

tion

patient complained

there found a

large wound, from which liquid stercoracious matter

was discharged, which obliged me

suture at

this

make a

to

point, immediately after

which

returned the intestine into the cavity of the abdo-

men.

had not with me

thread, but used that of a


the thread

was

black; the

at the time needles

woman who was

At

at

and had one

stool.

his entrance into Gros-Caillou the

of the

Guard

the journey, which was very tedi-

ous, the patient vomited copiously,

bloody

present,

wound was dressed and

the patient sent to the Hospital of the

Paris." During

and

Surgeon

Guard removed the dressings and discov-

ered a portion of the small intestines swollen, but


not offering any appearance of a solution of continuity;

this

he returned into the cavity of the

OBSERVATIONS ON

240
belly without

much

The

effort.

patient being ex-

tremely weak, could give no account of what had


passed; the surgeon therefore, not observing any
thing remarkable in the protruded portion of the

contented himself with reducing

intestine,

it

by

the taxis; he applied afterwards suitable b .ndages

and prescribed mucillaginous drinks and emollient

The

enemata.

patient, however,

was not relieved;

he passed the remainder of the night in a state of


constant anxiety, with frequent vomiting of

bili-

ous matter, accompanied with violent colicky pains,

tenesmus and small bloody

At my

visit in

stools.

the morning,

saw the wound,

which has been above described, but without protrusion of


cavity:

any of the contents of the abdominal


could learn nothing from the patient; he

could only inform

me

that the surgeon

who had

dressed the wound at Puteau had asked for a needle and thread

of a

woman who was

present at

the operation, which he had seen in his hand; but

he

knew

he had

nothing of

felt

its

having been used, because

nothing.

However, conformably
cases, I unbridled the

to

my

wound

precepts in such

of the integuments,

and the opening made by the sabre

in the apone-

urosis of the great oblique muscle, and I then dis-

covered a considerable collection of blood, behind

WOUNDS OF THE INTESTINES.


the

wound and

241

in the peritoneal cavity;

several

convolutions of the intestines had already adhered


together. Although the symptoms of strangulation
still

remained,

adhesions, and

did not dare to break

to

seek for the strangulated portion

of this viscus, lest


sation, or

up these

should increase the extrava-

open again some

arterial branches

might then be about uniting.

which

therefore content-

ed myself with evaluating the extravasated blood


collected in this kind

the

wound with

and dressing

of reservoir,

a linen rag, covered with the un-

guent of styrax, with an appropriate bandage.

small branch of the iliolumbar artery having been

opened
it

in the

incision,

passed a ligature about

and the haemorrhage ceased.

The

pulse of the patient was small and quick,

the countenance
dull

pale and discoloured,

and watery, and the extremities

cold;

the eye

he had

nausea and vomiting at short intervals, followed

by small bloody

dejections,

colicky pains and tenesmus;

despaired of relieving

minent danger
theless,

the

abdomen was

These symptoms alarmed me very much.

swollen.
I

accompanied with

tempting
31

in

wished
to

my

patient from the im-

which he was placed.


to

Never-

employ cupping before

at-

discover the strangulated fold of the

OBSERVATIONS OX

212
intestine,

which

in cases of

had surprisingly
I

assisted

spontaneous volvulus

me.*

had scarcely applied the three or four

first

cups when the tumefaction of the belly became


sensibly diminished; the
lief,

patient experienced re-

and had shortly afterwards

ed with

clots of black blood.

bilious stools mix-

repeated the ap-

plication of this topical derivative in such a

man-

ner as to cover the whole surface of the abdomen.

To

the cupping,

added camphorated

brocations, light anodyne, emollient

em-

oily

cataplasms,

and enemata of the same nature, which were

accompanied with light


with some

stria}

Through

bilious dejections,

also

mixed

of black blood.

that night

the patient

was

tranquil;

but on the following morning the pains recurred


with increased force, and were accompanied with

The

nausea and some vomiting.


taneous relief which

had before procured from

cupping induced me again


I also

insisted

almost instan-

to

have recourse

to

it.

upon the employment of emollient

embrocations, anodyne, mucilaginous drinks with


ice,

and especially upon emollient enemata.

again obtained a sensible amelioration,

worst symptoms disappeared,


* 1

might relate many examples of

this; I

and the
regret

acquainted with this practice in the colick of Madrid.

my

all

the

patient

not havin

WOUNDS OF THE INTESTINES.

243

remained quiet for eight or ten hours.

They

returned again, however, and nearly at the same


hour.

came

During the paroxysm, the abdomen


swollen; the

be-

alvine evacuations suppress-

ed, the urine small in quantity and limpid, the

colicky pains more or less severe, and the pulse

underwent

analogous changes.

In a word,

repeatedly saw this patient in so alarming a

situ-

ation that I momentarily expected to see him die.

However,

after having repeated again

and again,

the application of dry cupping with scarifications;

and after having insisted upon the use of sedatives

and purgatives, especially enemata,


sensible amelioration,
at last conceived
dier.
I

To

obtained a

and so much success, that

some hopes of saving

this sol-

arrive earlier at this desirable result,

applied over the whole surface of the abdomen

a vesicating powder, consisting of equal parts of

canthandes and camphor, which had been exposed


to the

vapour of boiling water.

On

the evening

of the eleventh day of the accident, the patient

himself remarked two phlegmonous engorgements,

which were formed


deed,

from

this

in the parotid regions.

moment,

all

the

In-

inflammatory

symptoms suddenly disappeared from the abdomen, and on the thirteenth dav, the patient had
copious stercoracious dejections, assisted, no doubt,

244
by

OBSERVATIONS ON

a few grains of calomel administered the even-

ing before, in some castor


eoree.

and syrup, dp chi-

oil

favoured the suppuration of the paro-

tumours by the application of cataplasms, and,

tid

as soon as there was evident fluctuation,

applied

the caustic potash, which accelerated the process


of suppuration,

and allowed the discharge of a

large

of

formed

quantity

purulent

in the cellular tissue.

was immediately followed by

matter,

was

which

This salutary

crisis

the discharge through

the external wound, of a small cord about three

and a half inches long, formed of a

thread tied at the end, which presented

wound;

at the

removed

it

in the

of black

bit

itself first

presence of the

young physicians who attended my

Clinical

Lec-

tures on Surgery, of which Jolin, at this time^


constituted the principal subject.

The unexpected
proved

to

me what

discharge

of

this

ligature,

the patient himself had de-

clared shortly before, that a suture of the intestine

had

really been

made, and

could then easily

account for the phenomena which


in the course of this disease.

induced me to write
first

to

had observed

This circumstance

the gentleman

who had

seen the patient, in order to obtain from him

information of
dressing; I

all

that had been done at the

have already reported

his

first

answer.

WOUNDS OF THE INTESTINES.


The

grew

patient

245

better awl better, nor was his

convalescence tedious or painful.

The wound

of the

abdomen soon

cicatrised; all

the functions gradually returned: before the seventieth day

of

the

accident,

completely cured, and

patient

was

by the

the hospital

Every thing indicated that the adhe-

eightieth.
sions

left

the

which

tions of the

had

observed

at first

wounded

intestine,

in the

which

convolu-

think

was

the ilium, were spontaneously detached, and that

the peristaltic motion was restored

in this intestine;

that the causes of irritation were dissipated; and


that the

cicatrisation of the intestine

had com-

pletely taken place.

The

kind of needle, and the mode of suture,

contributed

Under

much towards

this

happy termination.

the article Aiguille, in the " Dictionnaire

des Sciences .Medicates,"

have remarked, that

for the suture of the intestines, the

ing needle, rather

we

fine, is

common sew-

preferable to that which

use for wounds of the integuments; (for the

reasons of this opinion, see this article.)

haemorrhage which took place

at first in

The

John by

the external wound, and by the intestinal tube,

was the

effect of the division of

a great number

of small arterial branches in the parietes of the

abdomen and

intestine.

It is also

very evident

WOUNDS OF THE INTESTINE^.

246
to

me, that the inflammation which attacked

all

the membranous viscera of this cavity was advan-

tageously combatted by the repeated application


of dry and

humid cupping.

hardly say too much

In

a word,

am

can

in praise of these therapeutic

agents, in acute inflammations of the


chest.-

abdomen and

satisfied that they powerfully con-

tributed to this remarkable cure.

This soldier was presented


the Faculty of Medicine, and

to the
I

Society of

have seen him

frequently since this time; he enjoys perfect health;

every thing shews that the intestine had


adhesions, and that
of the

abdomen,

small intestines.

it

like

lost

its

floated freely in the cavity

the

other portions of the

There was some appearance

of

a hernia at the cicatrix, which was prevented by


the application of an elastic bandage.

ESSAY

V.

ON FRACTURES OF THE NECK OF THE FEMUR;


FOLLOWED BY SOME REFLECTIONS OX THE FORMATION OF CALLUS

IN

FRACTURES IX GENERAL.

The

uncertainty which

has heretofore pre-

vailed in our ideas of the formation of callus, in

fractured bones, and of the


in

of restoration

bones seized with necrosis, has certainly re-

tarded very
in this

much the progress

branch of pathology.

vented from attaining


in

mode

to that

the treatment, which

reached, at a period
trated
less

We

knowledge

have been pre-

degree of perfection

we might otherwise have

when French surgery

by so many discoveries,

if

is illus-

we had been

prejudiced observers of the phenomena which

accompany the consolidation

The

of our

of bones in fractures.

great number of facts which have presented

themselves in

my

practice, during the quarter of a

century which has just

elapsed,

have induced

ON FRACTURES OF THE

248

me

to study the laws

by which nature accom-

plishes this consolidation; and have enabled

me

to

analyze these phenomena, to mark their progress,

and

which have

to verify the judicious assertions

been made on their character by a great number


physicians, surgeons, and

of

have

Of

also

this

who

physiologists,

formed their opinions on experience.

number are Brun, one

and Professor

of

my

first

masters,

in the ancient College of Surgery,

Toulouse; Scarpa and Pinchinatti, celebrated

in

my

Italian surgeons; and Richerand and Leveille,

The

honourable colleagues.
searches, and

my

result of these re-

observations, have led

me

to

establish modifications on the methods generally

pursued

me

to

in the

to

treatment of fractures, which seem

have perfected the means indicated

the reduction of these fractures.

pectation that

may

in the ex-

hereafter compose an entire

work on

this subject, I shall limit

notice to

what appears

esting,

But

in

to

me

to

myself in

this

be the most inter-

and on which authors have differed most.

Fractures of the neck of the femur, for the most


part, take place in persons
earlier periods of

life,

when

is

the

ossification

first

who have

passed the

and rarely before the time

entirely finished; that

approach of old age.

The

is,

at

density that

the bones acquire at this period, and especially

NECK OF THE FEMUR.


at a

more advanced stage

of

249
the insulated

life,

state of the neck of the femur, and

direction, enable us to

its

oblique

account for the

facility

with which this small portion of the bone

may be

fractured.

Indeed

it

should be recollected; First. That

the neck of the femur diminishes gradually in


thickness, and increases in density as the patient

advances in years. Second. That


the osseous cylinder
its

is

this portion of

intersected obliquely from

base to the head of the femur, in which

it

ter-

minates, by the axis of the thigh, at the extremity


of a long lever.

Third. That

this portion is free

and insulated within the capsular ligament, while


the head of the bone
inelastic

fixed in its cavity

by an

and very strong ligament. Fourthly, and

That

lastly.

is

not directly protected by any of

it is

the thick muscles which surround


recollect these circumstances,

it.

When we

we can

easily con-

ceive that this portion of the femur, especially in

advanced age, must be exceedingly


fractured
trifling,

liable to

be

by mechanical causes, even the most

when they

act

upon the opposite extremity

of the lever formed by this bone, in the direction

of the oliquity, and towards the projecting angle


of union which the base of this eminence forms

with

the

32

great

trochanter.

This

is

evident,

ON FRACTURES OF TIIE

250

because on the one side of the powerful resistance

opposed
tion

head of the bone

to the

which

it

experiences at the

in

the devia-

moment when

the

mechanical cause acts; arising from the external

and superior wall of the acetabulum, the very thick


edges of which

rise

riodal eminence,
direction.

On

above the level of

and prevent

this sphe-

luxation in this

its

the other hanci, the percussion, or

violent efforts, acting towards the

two designated

points, concentrate themselves at this portion of

the extremity of the lever, which intersects sud-

denly and obliquely the axis of the column of


support of the individual; and carrying their effects

upon the oblique and

fragile

of the femur, the fibres

portion of the neck

which compose

it

being

extremely distended, must necessarily give way.

Thus,

for

example,

if,

after

having slipped upon

the external edge of one foot, so as to suddenly

displace that of the opposite side, and having lost


his equilibrium, one falls

limb

displaced, the fracture of the neck of the

first

femur

is

upon the trochanter of the

inevitable.

This fracture may likewise present variations,


according

to the

various causes which produce

and the differences which may exist


tion of the patient at the

moment

it,

in the situa-

of the

fall.

NECK OP THE FEMUR.

When

25]

a fracture has taken place at some point

of the neck of the femur included within the articular cavity, (and

it is

which

of this part of

wish

to be understood exclusively to speak,) the symp-

toms or phenomena which characterize

it

and

are,

the same, and can only be con-

must always be

founded with the separation of the epiphysis of


eminence, from the

effects

does not essentially

it

and indications of which


Besides, this solu-

differ.

young sub-

tion of contiguity, only takes place in


jects, while that of continuity in the

neck of the

femur does not generally happen, except


period

when

this

this part of

at a

the femur has lost

its

elasticity.

The

first

sign of fracture

is

the immobility of

the limb, and incapacity in the patient to use


In examining

his support.

care, and comparing


side,

we

find

it

it

it

it

with that of the opposite

in a state of retroversion

from

within, outwards, so that the sole of the foot

almost in a transverse
ral

elongation

for

afterwards with

line.

There

is

when compared with

is

an unnatuthe

other

limb, and, contrary to the opinion generally re-

ceived,

when

we

can hear and perceive very distinctly,

the thigh

is

put in motion, a crepitation of

the osseous fragments; pain

is felt in

the region of

the joint, and swelling soon comes on,

&c

ON FRACTURES OF THE

252
I

have asserted that these symptoms were, with

very few variations, almost always the same;


if

we

for

represent to ourselves the parts which arc

connected with the ilio-femoral articulation, especially the

attachments of the muscles of the pelvis

we may

to the thigh bone,

easily satisfy ourselves

that in every case of fracture of the neck of the

femur, the whole of the limb


the

moment

rotary

of the fracture

movement from

experience at

of this bony part, a

within, outwards, and from

This

behind, forwards.

will

evident, because

is

all

the muscles which move the thigh, attach themselves by

their tendons to

the two trochanters,

situated on the outside of the articular cavity, and

below the base of the neck of

this bone, so that

the insertion of the greater number of these muscles

is

made

in

an oblique

line

from the

iliac,

pubic, and obturatric regions, to the summit of the


little

trochanter, and the small tendinous cavity of

the great trochanter, turning from before, back-

wards, and from within, outwards, the inner side


All these muscles,

of the articulation.

say, con-

tracting themselves simultaneously, must produce

the retroversion of which

throw the

The

foot outwards; this

elongation

is

have spoken, and

symptom

is

uniform.

explained by the loss of the

curvature, or obliquity, which

the

thigh

bone

NECK OF THE FEMUR.


makes

253

The two

at its superior extremity.

frag-

ments of the neck of the femur being broken and


separated, are necessarily drawn from the situa-

were

tion they

previous to their solution of con-

in

tinuity, in an oblique

direction; because on one

part, the weight of the thigh, and

its

rotation out-

wards, change the relations of the inferior fragment, dragging

it

little

downwards: while on the

other, the round ligament retains the head of the

frmur, with the superior fragment, in the aceta-

bulum,

For

in the

same

situation as before the fracture.

fragment does not, nor cannot experience

this

any deviation:

head must remain immoveable,

its

which takes place

in consequence of the swelling

in the interarticular ligament, the length

which diminish

ibility of
It is

important

in the

and

flex-

same proportion.

to recollect the anatomical struc-

ture in the treatment of this accident.

For these

reasons, the elongation must be accounted a constant and primitive sign of this fracture, though

the limb

may

at last

become shortened by the

ments riding over each other.

frag-

Lastly, fracture of

the neck of the femur must be considered a more


or less important accident, in proportion to the
age, health, and corpulence of the patient.

The

bones unite with difficulty

advanced

in age,

and

in

persons far

in those affected with

any

254

ON FRACTURES OF THE
morbid

specific

the indication

vice;

is

alw

but,

iys the

however complicated,
same.

The

treatment

of this fracture ought always to be established on


the same principles; and these should be founded

on a perfect knowledge of tne laws which nature


observes

in

uniting solutions of continuity, or in

restoring a loss of substance in bones.

It is the

uncertainty of this knowledge which has led to the

formation of a great number of

among authors and


to be

employed

Indeed,

if all

difl'erent

opinions

practitioners, as to the

means

in the reduction of these fractures.

surgeons were convinced that the

union of bones, or the callus which serves to pro-

duce the reunion of the fractured portions, and

to

repair or cicatrise solutions of continuity in them

with loss of substance, could be effected by the


vessels of those osseous parts

which remain sound,

and not by intermediate substances, nor by the


ossification of the fibrous or cellular

membranes

them

internally,

which f envelope them, or


they could not certainly
to

we

be employed

to

line

differ as to the process

favour this operation.

are impressed with

But

if

the idea that callus can

only be formed by the aid of the periosteum, or

by the interposition of a peculiar albuminous

sub-

stance between the fragments, designated by the

partizans of this opinion by the

name

of Jibro-

NECK OF THE FEMUR.


Cartilage,

we must

which can

fulfil

necessarily

invent processes

these different views.

Thus, according

to the first hypothesis, the par-

by the periosteum endeavour

tisans of ossification

to bring

255

back the lower fragment of the neck of

the bone towards the internal attachments of the

capsular

endeavouring

ligament;

fibrous sac as

much

apply

to

this

as possible about the frag-

ments, for the purpose of obtaining from

it

a union,

not to be obtained from the periosteum, inasmuch


as the neck of the femur
is,

however, a thin

more perceptible

destitute of

is

tissue, the fibres of

at the anterior part,

(There

it.

which are

and appear

to arise from the internal attachments of the liga-

ment.
fibres,

This

tissue,

which

is

differs nevertheless

According

composed of

parallel

from the periosteum.)

to these views, fractures of the

neck

of the femur are considered as incurable, that

is,

as being necessarily accompanied with false articulations,

anchylosis, or great infirmities.

means formerly resorted

to,

and

still

The

used, concur

powerfully in producing these results.

One

of

the most powerful of these was the spica bandage,

applied about the diseased joint.

According

to the

second hypothesis,

in

order to

obtain a more solid and thicker callus, an attempt


is

made

to separate the inferior

from the superior

ON FRACTURES OF THE

256

fragment, for the purpose of favouring the deposition

and formation of the intermediate suhstance

proper

to

produce

callus.

It is

with this intention

that bandages, or apparatuses for producing per-

manent extension

of different forms,

chanism more or
vented.
ture in

By
its

less

and of a me-

complicated, have been

work

of re-organization, the object

rendered more remote, the

tarded; a circumstance which


serious consequences.

and Avicenna,

digious

number

From

is

aggravated, and

evil

sometimes rendered incurable; or the cure

crates

in-

these means, instead of assisting na-

not

is

is re-

exempt from

the time of Hippo-

until the present day, a pro-

of apparatuses, of permanent ex-

tension, have been employed, from the application

of which, there can be no doubt that there has

never been any benefit derived.

Whatever may be

the

mode

of extension, in

fractures of the neck of the femur,


useless,

but generally pernicious.

it is

It

not only

is

useless,

because the displacement of the fragments cannot

extend beyond the thickness of these fragments,


except from a considerable rupture of the
cular

may

capsule,

and from the

projection

arti-

which

be made through this rupture towards the

obturutricjossa; when the inferior portion of the

neck of the femur

is

separated from the head of

NECK OF THE FEMUR.

257

the bone which remains immoveable in the ace-

tabulum, where

is

it

retained by the round liga-

ment; this circumstance


rior fragment,

is

The

very rare.

whatever may be the contraction of

the muscles which are inserted towards

base

its

two trochanters, cannot ride over the supe-

in the

because this

rior,

infe-

last

fills

the articular cavity.

But these two fragments may

lose the relation of

their first points of continuity,

when they are

kept in

by the proper means.

this state

not
dis-

placement of the lower fragment inwards, so as

bury

itself

in

to

the obturatric region for exam-

ple, does not readily take place; except from im-

proper management or violent


patient

is

efforts,

before the

prevented by severe pains which give

him notice of the danger of moving, and induce

him
any

remain

to

in

a perfect state of repose.

In

state of things, the inferior fragment cannot

separate from the edges of the acetabulum but a

few

lines;

most
place
for

and

it is

easy to bring

it

back by the

trifling efforts into its first situation,


it

in

to

contact with the superior fragment,

which extension

Extension

and

is

is

perfectly useless.

especially injurious

manent; because the

effects of it

when

it is

per-

extend to the

ligaments of the ilio-femoral articulation, which

are already torn; the distention of them causes


3.J

ON FRACTURES OF THE

258

shooting pains, and frequently

which

new

result traumatic fever, an

which accompany

injuries,

the accidents

These same

it.

to

upon

attach and to put in

action the ligatures of this complicated

But other

may

accidents

also affect the joints of the foot and knee,

which we are ohliged

from

machine.

evils arise besides the violent pains in

the articular ligaments of


tremity, notwithstanding

all
all

the joints of the exthe precautions that

can be taken, in consequence of the long time

which we are obliged

The

apparatus.

to

keep up the action of the

integuments are apt

ed so as to produce ulcers, often

But should nature


will

resist all

to

be

affect-

difficult to cure.

this

violence, there

remain a preternatural elongation of the

jured limb, arising from the imperfect manner

in-

that

the two fragments were brought into contact originally.

For by the permanent extension, we take


the neck of the femur

away from

which determines
served in

this elongation;

my memoir

the same phenomenon

its

as

obliquity,

have ob-

on femoro-coxalgia,* where
is

described.

This

chiefly

arises from the rupture of the inter-articular liga-

ment, or

from

the

erosion

of

this

ligament,

which then becomes incapable of retaining the


*

See the third volume of iny Campaigns.

NECK OF THE FEMUR.


Femur

in

the limb

On

natural situation; the elongation of

its

then determined by

is

259

this point, the question

its

weight.

proposed by the Pro-

fessor of Montpellier, respecting the effects of the

fracture of the neck of the femur,

contrary to his opinion.


ion

founded

is

doubt

it,

in

may be 'resolved

Nevertheless, this/op'u-

the supposition, and

do not

that this celebrated surgeon intended to

treat fractures of the neck of the femur, not with

machines

for

making permanent extension, but

only with a retentive apparatus, proper to aid the


indications of nature in the formation of callus.

When
be

the

union

necessarily

is

perfect

by

followed

and exact,
a

it

shortening

will

pro-

portioned to the nature of the fracture and age


of the patient.

In no case can this shortening

exceed three or four


substance.

lines,

except from a loss of

But the greater the density

of the

bone, the greater will be the obstacles to the

soft-

ening of the extremities of the two fragments, in

order that the vessels

may become

developed;

permanent extension must certainly augment, and


in fact

does augment these obstacles.

standing
thors

all

Notwith-

these inconveniences, almost

who have

all

au-

heretofore written on fractures of

the neck of the femur, extol this method for their


reduction; nor do practitioners cease to employ

it:

ON FRACTURES OF THE

260

we

also see but

this

few perfect cures obtained from

method.

This want of success, and the serious accidents


frequently the consequence of this

mode

of treat-

ment, induced some celebrated surgeons of the


century to lay aside these machines, and

to

last

abandon

the fractured limb to a simple relative position,

without the application of any apparatus.


for example, Sabatier,

my

illustrious master,

Thus,
caused

the patient to be laid on a straw bed, well stuffed,

and placed the fractured limb between two long


cushions,
t>y

filled

means of

army

to the

with oat chaff, which were attached

strings.

Mursinna, surgeon general

of the king of Prussia, kept the leg

bent upon the thigh, and this upon the pelvis, by

means

of a roller,

which maintained the limb

this state of flexion.*

Of

late,

in

permanent exten-

sion has

been again brought into fashion, and con-

stitutes

one of the principal articles in the Dic-

tionnaire des Sciences Medicales, in which the

machines employed for


sented.!

this extension are repre-

Thus men pass from one extreme

to

another.
*

M.

Canin, ex-principal surgeon to the army, has given

of the apparatus applied to the patient.

+ Sec volume ninth of the Dictioiiuairc.

me

a drawing

NECK OF THE FEMUR,

261

Indeed the methods of Sabatier, Mursinna, and


other surgeons equally respectable, have their in-

The

conveniences.

most important, no doubt,

the mobility of the limb, or

its

is

want of fixedness,

from which results a relative displacement

in the

fragments, by the different movements executed


patient; an accident

by the

which destroys their

connexion, retards and even prevents the formaat least renders the union de-

tion of callus, or

formed, so as to deprive the limb of

its

natural

conformation and rectitude.*


If

we suppose

the limb, which

that, in the process of

held in a state of flexion, re-

is

mains perfectly immoveable;


during

this position will

sion of the limb,

which

oppose

consequence of
1

this

itself to the

exten-

and

difficult,

without assistance, in

permanent

have seen in some persons,

formed

will also lose considerably

progression impracticable

the callus

support will then be

in its length;

Mursinna,

who had

flexion.

suffered a fracture of the

neck

of the femur, and for which the method of Sabatier had been employed, a
false articulation

formed

in

the place of the fracture, from a want of union

of the fragments, owing to their constant motion.


also take place in

have seen several instances of

one case of which

M.

implanted

M.

accident

this in soldiers treated after this

may

far.

method,

be reported hereafter.

me

femur

in

which the superior fragment

is

the spongy substance of the trochanter, and in a situation

analogous to that
sinna.

will

Ribes has shewn to


in

The same

consequence of permanent extension carried too

in

which the thigh

is

placed

in

the apparatus of

Kibes's patient had died, the thigh remaining bent.

Mur-

ON FRACTURES OF THE

262
This

be easily understood

will

if

we

attend to

the relative situation of the ends of the two frag-

ments of the neck of the femur, when the limb

This

placed in this situation.

relation

is

such,

is

that the head of the bone remaining fixed at the


bottom, of the acetabulum, in a line nearly per-

pendicular, cannot be in contact with the other

fragment, except at the anterior half of

its frac-

tured surface; and the inferior fragment will not

touch the other, except

at the superior half of its

Now

fractured surface.

there cannot be adhesion

and communication between the vessels of the two


fractured surfaces, except at these two points,

in-

stead of taking place through their whole extent;

from which there must result a callus


sive, less

exten-

less

and one that requires a much

solid,

longer time to form.


I

have seen several patients, treated according

to this

method,

and even die


extension.

afflicted

in

consequence of

might

vations, a great

with serious infirmities,

cite, in

this

permanent

support of these obserthis I

number of-examplcs, but

conceive would be useless to those acquainted with


the structure of these parts.
practitioners would

I will,

however wish that

compare the methods

sent used with that which


scribe.

at pre-

am now about

however, relate a curious

to de-

fact in

NECK OF THE FEMUR.

my

support of

respecting the

opinion

permanent

attending

inconveniences

263
serious

extension;

which the celebrated Hunter communicated


pupils,

when

to his

lecturing on diseases of the bones.

from the Italian, as related by

I shall

translate

Doctor

Alsalini, late first surgeon

it

to the

viceroy

of Italy, and one of the pupils of Hunter; this


fact

was observed

"A

at

Edinburgh.

patient endeavouring to escape from the

lunatic hospital, in which he

was detained, climbed

wall; but he

had scarcely reached

up

the garden

the top

when a

threw him back

At

was detached, and

large stone

into the

the cries of this

garden and broke

unhappy man,

his leg.

several persons

The

ran and transported him to his bed.

sur-

geons being called immediately, applied the apparatus

used in fractures.

The

patient remained

tranquil for some hours, but then began to complain of the conduct of the surgeons,

cused of being mistaken.

He

who he

ac-

confined to assert

that they had dressed the sound leg instead of the

one that was fractured, and urgently called upon

them

to take

so strongly

away

bound

the splints in which they had

his leg.

Being threatened with

a straight jacket, he became


* See the

volumes.

Manual of

tlie

Army

silent,

and pretended

Surgeon, by this author,

in

two small

ON FRACTURES OF THE

264

might be

to feel great relief, so that he

During the

left alone.

night, he took advantage of the ab-

sence of the attendants, to remove the apparatus,

and applied

it

as well as he could to the sound

limb; he afterwards enveloped the fractured limb

and carefully concealed

in a pillow of feathers,

it

in the straw of his bed, taking care, no doubt, to

keep the limb

"On

straight.

the other hand, he allowed the limb which

was covered with


but

view,

the apparatus to be exposed to

without

suffering

his

medical

atten-

dants to approach too near; keeping them off by


feigning a paroxysm of madness whenever they

wished

to

He

come near him.

situation for a long time,

ways remarked

and as

to

The

in this

his attendants al-

was well bandaged,

that the limb

they assured the surgeons that


ble state.

remained

it

was

in a favoura-

patient would not allow the surgeon

examine the bandage

until

he thought himself

well; at last, however, he undeceived him, by ex-

posing the injured leg, which was

up

the pillow.

in

this

envelop,

very much surprised

to

perfectly

This

lesson,

covered

After having removed

and washed

straight."

still

it,

it

from

the surgeon

was

find the limb well,


is

certainly

though given by a madman.

and

a useful

NECK OP THE FEMUR.


From what

65

have said respecting the fracture

of the neck of the femur, there are two indications to be fulfilled to facilitate the union of the

fragments and to conduct the patient

The

first consists in

in giving to the patient

er;

to

a cure.

placing the fragments togeth-

and fractured limb a

suitable position; and performing coaptation, with-

out making either extension, or counter-extension.

The

relative

and rectitude of the limb

position

being established,

it

is

necessary to preserve

in this situation by a retentive

apparatus.

parts of this apparatus and the

ing

it

mode

it

The

of apply-

constitute the subject of the second indica-

tion.

The

condition necessary for fulfilling the

indication are;

first to

place the patient in a hori-

zontal position, so that the thigh

is

parallel

with

In this situation the two fragments of

the pelvis.

the fractured neck of the femur are


at every

first

point;

so that

when

in contact

the inflammatory

process takes place, the blood-vessels belonging to

each fragment, as they become developed and


elongated, will adhere and anastomose together,
to

form the

callus;

a condition which

is

absolutely

necessary.

The membranes, we

repeat, contribute but in-

directly to this purpose; in this

34

new

ossification

ON FRACTURES OF THE

266
they

fulfil

no other function than that of transmit-

ting to the bones, which they cover, the vessels ne-

cessary for their nourishment. Except from a mor


bid condition, or from an aberration of vital properties, these

membranes do not become

altered,

nor participate in cases of preternatural


fication,

which we sometimes observe


inflammations;

chronic

ossi-

in certain

under the influence

which we frequently see a great number of

of

differ-

ent tissues converted into a substance of an osse-

ous nature
these

form
ural

it

will

or

having an osseous

appearance;

perhaps be most proper to

call

ossi-

But when a healthy and

concretions.

ossification takes place, solely

nat-

destined

to

unite bones which have been broken or separated

by any cause, or

to repair

of substance in them;

performed,

and

in

an accidental

this ossification

fact

is

must be

actually performed

same manner, and according

in the

loss

to the

same

laws as those which preside during the formation

ly be

and growth of the bones.

acknowledged

must certain-

at present, notwithstanding

the assertions of the greater


gists of the last

It

number

of physiolo-

century and of some modern an-

atomists, that this ossificatation is the result of


arterial

action; as is evident from maceration in

diluted

muriatic

acid,

and the

disease's

which

NECK OF THE FEMUR.


These

attack the tissue of the bones.

particularly evident in the callus

Nature,

unite.

267
vessels are

where the bones

say, after having produced a

vascular network, which passes out from as

many

centres as there are principal nutritive arteries,

extends their ramifications

to the different point6

of the circumference; these

points of ossification, the

ways proportioned

constitute

number

these points

which

to the extent of the

ossification

many
al-

is

convex or

In every instance

concave surfaces of the bones.


of

of

so

develop themselves

uniformly from the centre towards the circumference, so as to have no connexion with the peri-

Sometimes even these vascular, diver-

osteum.

gent shoots of ossification penetrate into the tenthe

extremities

of bones.

dinous

insertions

This

seen in certain gallinacious birds, and I

is

at

have several times remarked

it

in

There

man.

is

preserved in the Cabinet of Anatomy of the School


of Surgery, of the

Marine

of Brest, the skeleton

of a galley-slave, in which are seen on

the ex-

tremities of the bones of the limbs and that of

the pubis, as

many

different forms
insertions.

and

The

osseus processes or points of


sizes as there are

tendinous

base of these processes

is

con-

tinued to the bone, while the point was lost in the


substance of the tendon.

ON FRACTURES OP THE

26S
we

If

the

Cv

follow attentively

be made

in directions

principal nutritive

arteries

and we should not

points,

ing

shall see,

very distinct-

wa3 observed by Haller, the process

sification to

the

transmission of

louring matter in the bones of young ani-

mals fed on madder, we


ly, as

the

find

diverging from

towards remote

one atom of colour-

matter in the fibrous tunic of

There are

is

bones.

the

certain gallinacious birds, for exam-

ple the black Spanish hen, in which

osteum

of os-

of a

the

peri-

brown colour; the bones of

this

however, have the same white colour

bird,

those of other animals.

as

Professor Andravi, be-

ing at the Practical School in 1790, shewed us

one of these birds,


culiarity.
I

made

at

It is

in

which

remarked

this

pe-

easy to repeat an experiment that

this Practical School.

It

consists

in

separating a portion of the cylinder of one of


the long bones, as the humerus, in a living animal,

and cutting the two ends of the hony

cylinder,

thus denuded by means of a chissel or gouge, tak-

ing care to avoid the periosteum.


tion of the
will

remain

Thus

bone

will

in the

No

reproduc-

take place, but the cavity

limb with a false articulation.

have seen many individuals who,

in

con-

sequence of fractures of the limbs, especially the


arms, had

lost

a great part of the body of the

269

NECK OF THE FEMUR.


bone, which the disorganizing cause had
ted from

its

separa-

periosteum; as many parts remaining

imperfect in these instances, as there were places


in

which there had been been

loss of

substance in

the cylinder of the humerus.*

When, by any mechanical

portion of

cause, a

one of the bones of the fore-arm or leg

is

destroy-

ed, so as to cause a considerable loss of substance,


if

the neighbouring bone has not been fractured,

the cicatrix, which results from the wound with


loss

of substance, remains depressed; presenting

a proportionate excavation or cavity, no reproduction of the bone having taken place. But there,
is

nothing to prevent the gelatinous or albuminous

substance of modern anatomists being poured out


into this space; or the ossification of the surround-

ing fibrous or cellular membranes, of the physiologists of the last century, from taking place.
fact

i^

that

the

new

ossification,

The

necessary to

r nlace this loss of substance, does not occur; be-

cause the vessels of the two fragments being considerably distant from each other cannot elongate

themselves

sufficiently,

adhere together
loss of

to

so as

form

to

anastomose and

callus, or to repair the

bone.f

* See the second volume of

my

Campaigns.

t See the design of the two bones of the ieg in volume eighth of "the
Journal Coniplementare."

ON FRACTURES OF THE

270

The

instances which

we

see of the apparently

complete reproduction of bony


necrosis, are not affected

cylinders, after

by means of the

perios-

teum, as the greater number of ancient and mod


ern authors have supposed; but by the vessels
the

coj'tical

substance of the

bone remaining

sound, though the core or internal part,


state of necrosis.
its

oi*

is

in a

This internal part presents

at

surface inequalities, and furrows which have,

very improperly, been attributed


the

absorbents;

sult of the

but in

fact

to the effect of

they are the re-

separation of the internal vessels of

the sound cortical layer from the external surface


of the dead part of the bone with which
contact.
tion,

when

was

in

This process, a sort of osseous vegeta-

developes and extends

cording

it

to the

itself

more or

less ac-

age of the patient, and the period

the foreign body has been extracted.

patient be young, and the dead part

If the

removed

at a

proper period of the disease, the two broken portions of the shaft, in

which

it

was enclosed, deve-

lop themselves in every direction, and at last

fill

up the whole space previously occupied by

the

dead bone; often involving in their action a great


part of the limb, inducing swelling, with temporary
induration of the fibrous membranes and other sur-

rounding parts, which have led

to the belief of a

NECK OP THE FEMUR,


true ossification by the periosteum.

every part returns


the
is

271

But afterwards

to its natural state; the walls of

bony case approach each other, the cavity

gradually effaced, and this

reduces

itself to a

new

osseous portion

volume proportioned

to the de-

gree of development of the vessels of the


But, except from a

cal layer.

new

bone, which

may

new

then cause

every kind of aberration, as

corti-

disease in the
it

to

undergo

have before

said,

there will always be a depression and shortening of


the limb, proportioned to the loss of substance of
the old bone.

my

'

But

it is

not

my

upon necrosis.

reflections

purpose to extend

This subject

is

treated with great care and profound erudition in


the Dictionnaire des Sciences Medicates.
sides, all

my

Be-

remarks, drawn from experience,

have already been made by Haller, Scarpa, Brun,

and other celebrated surgeons of the

The

century.*

last

absorbents have no power of acting upon

hard bodies which are separated from living


ganized parts.

Thus,

or-

have found fragments of

bone, which were separated from their membranes


or fibrous attachments at the
fracture, in gunshot

wounds, remain

years in the living parts, and

same

form

and

polish,

See the works

instant

ot'

of their

for

whole

still

present the

(especially

when they

Richerand sml Leyeille.

ON FRACTURES OP THE

272
belonged

to

a part which was compact,) as at the

period of their separation from

the

fractured

bone.
I

might relate

truths, a great

in

support of these physiological

number

of facts; but

it

will cer-

tainly be sufficient to present the following reflections,

complete the solution of the problem

to

which at present occupies me.


In the operation of trepanning, for example,
the

pericranium

raspatory,

removed by means

is

the

and we have never seen the dura

mater form bone

to close

How

the cylindrical saw.


It

of

up the

-hole

made by

then

is this

effected?

certainly does take place in proportion to the

age of the patient, and the

When

he

is

ner,

we

of

substance.

young and the crown of the trephine

small, the hole


cases,

loss

may

be closed up entirely.

see the edges of the opening

In

grow

all

thin-

and approach each other from the circumfer-

ence towards the centre, so as to leave a hole


scarcely perceptible, and which disappears with
age.

This process of

ossification does not surely /

belong either to the pericranium or dura mater;


the

first

membrane

at least is destroyed;

the second concurred in the ossification,

it

and

if

would

form a sort of vertical stopple, which might be


seen and easily distinguished.

Besides,

we may

Oil
%jO

NECK OP THE FEMUR.


imagine

that

result to

the

disagreeable

consequences

functions

the brain

of

osseous production through a hole

would

from

made

this

in the

cranium.

The

following case

is

an illustration of what I

have advanced.

Champ-de-

In a manoeuvre of cavalry, at the

Mars, under the command


on the

first

of

Marshal Bessieres,

of June, 1803, the Sieur Plaigniol,

aged twenty- five years, a brigadier


of horse grenadiers,

in the corps

was thrown with

his horse at

the instant of a charge, and crowded beneath the


feet of the other horses of his

When

company.

he was taken up after the charge, he was found


to be without appearance of sense or life; he was
transported to the hospital, where the surgeon of
the guard paid him every attention; his situation

was most alarming.

The

following morning at

a contused wound

near the
bone.

orbit,

in

my

visit, I

discovered

the right parietal

region,

with fracture of the subjacent

There were swelling and ecchymosis

of

all

the soft parts of the cranium and face, especially

on the right side.

was

also

The

shoulder of the same side

extremely discoloured, and there was an

evident crepitation along the spine of the scapula,

which was fractured.


35

Ail the rest of the surface

ON FRACTURES OF THE

274
of the

body was spotted with ecchyraosis.

The

pulse was scarcely perceptible and very slow, the


extremities cold, and

He had

suspended.

and ears, and the

all

the intellectual functions

bled from the nose, mouth,

fceces

and urine were discharged

involuntarily; indeed, his death

was momentarily

expected.

Notwithstanding his desperate

With

freely,

was

the

known resources

this intention, I laid

open the wound

anxious to have recourse to


of art.

situation, I

all

and exposed, through

star-like fracture, at the point

its

whole extent, a

where the anterior

and superior angle of the parietal bone unites


with the corresponding point of the frontal.

Se-

veral branches of the temporal artery were tied,

and the fractured parts scraped over their whole


enable

surface, to
I

was content

common

dressing.

plied about
tions of hot

the

at

me
the

to

apply

the

trephine.

time with a simple and

Repeated cupping was ap-

the chest and shoulders;

embroca-

camphorated vinegar were made over

abdomen and lower

extremities, and cordial

drinks and stimulating enemata were administered.

After dilating the wound, the patient began

to exhibit

some

signs of

life,

and

to utter a

few

words; the pulse and heat became more developed;


slight convulsive motions of the right side of the

NECK OF THE FEMUR.

275

body became manifest, while the whole

of the left

was seized with paralysis; the alvine and

side

urinary dejections
the patient was

continued involuntary, and

still

much

agitated.

copious bleed-

ing from the arm was made in the course of the


night, and mustard cataplasms applied to the feet.

On

the fourth day, symptoms of compression of the

brain being developed,

did uot hesitate to apply

the crown of the trephine at the lowest point of


the fracture, at the angle of a depressed part.

This

last

was removed, when there issued from

the cavity of the cranium about an ounce of black


fluid

blood, which

was extravasated under the

anterior lobe of the brain, between the falK of the

dura mater, and the fissure of Silvius;


of the brain

was torn

this

meninge

a considerable extent,

to

and there was ecchymosis of the external surface of the designated portion of the encephalon.

The
ly,

extravasation seemed to have extended deep-

for the blood, without

changing colour, con-

tinued to run out for several minutes, the head

having been placed

in a favourable position.

Af-

ter this operation, the patient recovered in part

the use of his senses, with the exception of his


sight, of

which he was

danger continued

totally

deprived.

The

for nine or ten days; but at last

suppuration took place, a part of the dura mater

ON FRACTURES OF THE

276

exfoliated, granulations developed

themselves in

directions, osseous lamina? detached themselves

all

successively from edges of the opening, the swel-

cranium gradually declin-

ling about the face and

ed, and. after the fortieth

day of the treatment,

the cicatrix of this large

wound was completed

<m the circumference towards the centre.

fr

One

part remained for a long time fistulous, and deeply depressed.

The

pulsations of the brain were

perceptible through this

bin and cellular cicatrix,

the opening not being

completely closed up for

several

months;

however,

it

became gradually

consolidated, and the pulsation disappeared. Lastly,

notwithstanding the loss of substance resulting

from the application of the trephine, and the extraction of the detached fragment, as large as that

removed by the crown


sels

of the instrument, the ves-

on the edge of this bony opening developed

and elongated themselves so as

to

come

and contract mutual adhesions, and


tirely

the

vacuity which

in contact

to close en-

before existed.

The

cicatrix is so perfect, that at present this opening

cannot be traced.

The

hemiplegia was gradually dissipated under

the influence of moxas applied to the nape of the

neck, and sides of the spine.

The

sight

was im-

perfectly restored in the left eye, the vision of the

NECK OF THE FEMUR.


right being entirely

lost.

277

think that the force

impressed by the percussion of the hoof of the


horse, ruptured the optic nerve of this side, while

the extravasation which compressed the medullary

substance of the brain, giving origin to the nerve


of the opposite side, had the effect of weakening

and suspending the

functions of this nerve,

vital

which the moxas contributed

same

true as respects the

is

objects,

which

he could with
for

several

this

memory

of

The

names and

soldier had entirely lost: for

difficulty

months

restore.

to

remember

after

his

though partly restored, remains

his

fall;

own name

this

faculty,

very imperfect.

still

Fractures of the maxillary bones, the perios-

teum of which

is

very thin and almost entirely

in-

vested with tendinous insertions, unite very read-

when the fragments can be kept

ily

in contact, be-

cause the vessels of these bones are very numerous and develope themselves easily, in consequence
of the

number and

which penetrate
also

size

of the nutritive arteries

into their substance; the callus

very rapidly formed, especially

jects.

But we must not suppose

in

is

young sub-

that nature re-

quires the presence of this intermediate substance


in

order to produce a union of these bones, more

than in the other bones of living parts.


I

think that

it is

Lastly,

the vessels only of each fragment

ON FRACTURE? OF THE

278

that establish their union and consolidation.


cases, the reduction

all

jaw

In

of the dimensions of the

or maxillary bones will be proportioned to the

extent of the loss of substance, because the space

by

left

we

this

destruction

is

not filled up.

neglect to put together

after having extracted


will

Also

if

bony fragments,

the

the foreign

bodies, there

remain with a mobility of the fragments,

'a

vacuity proportioned to the loss of substance.*


I

have seen

in

many

patients, especially

persons, the compact substance of the

young
laminae

first

of one of the long bones, the tibia for example,


exfoliate, after

having

lost their vitality

by some

cause which had destroyed the periosteum over


its

whole anterior surface, as hospital gangrene.

have seen these laminae replaced by granulations,


vascular and

of a bright red

in parallel lines

colour,

arranged

which succeeded the dead

minae as fast as they were detached.

These

la-

vas-

cular granulations became soon ossified; that

is

the phosphate of lime was rapidly substituted for


these red

vessels, giving to

* See among other cases which confirm

named Vaute,

a corporal

This soldier survived


in

his

in

my

this

remark, that of a person

the 88th demi-brigade of the

wound

the hospital of Clim-enton.

posited in

them the colour and

for eight years.

He

The prepared head

cabinet of morbid anatomy.

For

army

of Egypt.

died a violent death


of this patient

is

de-

a minute account of

sec the Dictionnaire des Sciences Medicales, vol.xxix.

it

NECK OF THE FEMUR.

consistence of bone.

new

cellular

279
membrane

of

considerable density, furnished by the neighbour-

ing tissues, afterwards extended over this


ossification; but there

new

remained always at the

catrix a depression, proportioned to the loss

ci-

of

substance.

The

under the same anatomical

patella exists

circumstances as the neck of the femur, the fracture of which constitutes the principal object of

That

this memoir.

is, it

equally destitute of

is

periosteum, being covered with a thin tissue com-

posed of parallel
tinuation

fibres,

of the

of that

muscles of the

which

ed, therefore, that

it

evidently a

con-

tendon of the extensor

It has

leg.

is

been heretofore believ-

cannot unite

ded by a fracture through

its

when

it is

divi-

whole thickness.

Nevertheless, the re-union or consolidation of the

fragments

may

be perfectly made, often without

leaving the least trace of the fracture,

when they

are brought into immediate contact by a suitable


apparatus; this

reunion

is

have repeatedly witnessed. This

effected by

means of the communication

of the vessels of each fragment, which develope

themselves the more readily as this bone

spongy.

On

is

very

the contrary, where the means of re-

union are neglected, there remains a proportionate


separation; the fractured edges of the fragments

ON FRACTURES OF THE

280

becoming somewhat

thiner,

though they preserve

nearly the same volume as at the period of their

fracture.

common

to

band, forming a ligament

fibrous

both fragments,

developed; this

is

is

derived from the fibres of the triceps extensor


femoris, in the substance

embedded
These

like a

fibres,

of which the rotula

is

sesamoid bone.

being at

first

separated from the

fractured patella, contract themselves laterally and

afterwards elongate themselves to produce this

lig-

ament, destined to unite the two fragments, and

prevent a too great separation.


injected

the

Soemmering has
which

of the callus

vessels

to

unites

fractured bones.

Anchyloses of the
prolonged

joints,

immobility,

which arise from

or a

latent and

age,

chronic

rheumatism, are formed without the assistance

of

a fibrous medium, but exclusively by the vessels

These bones

of the parts which are in contact.

lose at first their articular cartilages; the

deprived

of

this

cartilaginous

points

envelop become

gradually inflamed; the extremities of the osseous


vessels lose their curvature, and, if I

may

be

al-

lowed the expression, develope and elongate themselves,

and endeavour

thus to form a union.

to

anastomose together and

Any

one

may

convince

themselves of the truth of this by examining the

NECK OF THE FEMUR,


skeleton of Peyret,

deposited in the

2S1

museum

of

the Faculty of Medicine.

In some patients attacked with caries of the

who

vertebrae,

have had the good fortune

by moxa, but who afterwards died


diseases,

cure

to

of

other

have also remarked that the investing

ligaments or periosteum of the vertebrae, did not


assist

in the cicatrisation of the carious

of these vertebrae.

portions

place beneath these

It takes

membranes, and by the proper vessels of

fibrous

the bones, which develop themselves and endea-

vour

unite.

to

The

pressed down, so as

vertebrae

themselves

are

to favour this communication

and union.*

The growth

of the teeth in

all

animals

is

com-

pleted on the outside of the alveolar processes;


in

many

animals, as the elephant, they contract a

mutual adhesion
tact, after

cavities;

at the points

in

immediate con-

they have passed out from these bony

when

fractured at their roots, they unite

like the other bones.

The

the same phenomena and

callus in
is

them presents

formed according to

the same laws; for the teeth, as well as the patella

and neck of the femur, are destitute of periosteum,


as

it is

observed

*See

the

36

in the other parts of the osseous

memoir on Rachialgia

in

my

Campaigns,

vol. iv.

282

ON FRACTURES OF THE

system.

very thin cellular tissue envelones the

roots of the teeth, and separates

them from the

alveolar processes.
If,

on the contrary, the vessels of the bone are

af-

fected by any specific morbid cause, however sound

may be

the state of the

periosteum, no reunion

will take place in fractured bones.

Again, though

the periosteum of old, does not essentially differ

from that of young persons, the callus


occurring at this time of
difficulty,

life is

in fractures

formed with great

and does not take place

until a consid-

erable time has elapsed; because the texture of

the bones being

much more dense and compact,

the vessels which form the callus are developed

very slowly.

It is

undoubtedly here that the

os-

seous ferrule, of the partisans of the ossification


of the periosteum, would manifest

itself, if it

ever

took place.

Every thing proves then contrary,

to the opin-

ion generally established and recently maintained


in

some very respectable works, that the union

and restoration of bone

is not,

nor cannot be made

by any but the proper vessels of the injured


osseous pieces; and not by the membranes which

envelope, or line them internally, nor by other in-

termediate substance.

As

it is

by the same me-

chanism, (the interposition of certain substances.)

NECK OF THE FEMUR.

283

that the same anatomists explain the formation of

the cicatrix in wounds of the soft parts,


serve, in passing, that this cicatrix

same manner

is

will ob-

made

in the

as the union of hones; for without

the development and mutual adhesion of the vessels of the divided

we

could not expect to

cicatrix.

This destroys en-

parts,

have any reunion or

tirely the idea of the

pretended reunion of parts

totally separated from the rest of the living body;

and demonstrates the error of those who think


these cicatrices are made, as

have before remark-

ed, by

means of an intermediate glutinous sub-

stance,

poured out by the vessels of the

wound.

may

lips of the

Besides, the vessels of these cicatrices

be exhibited and injected as in united bones,

and with much greater

facility.

Returning once more


ef the femur,

will

to fractures of the

neck

observe, that the true means

of promoting the intentions of nature for the perfect

union of the bony fragments,

ably the wounded

and
it

to

is

to fix

immove-

limb in a suitable apparatus,

inform the patient of the position in which

should be kept, during the time necessary for

its

union; from sixty to ninety-five days, according to

the age of the patient, and other circumstances.

This apparatus

consists of

compresses, which

are preferable to splints; of one or more eighteen

ON FIUCTURES OF THE

284

bandages; of bags of oat

tail

forms and

of

sizes;

of various

chaff,

two cushions of straw, and a

cloth to roll over them, and several other pieces,

which

it is

unnecessary to mention.

While the limb

is

held by an assistant in a pro-

per position, we apply


soaked

in

at

first

some repercussive

the compresses,

fluid, as

camphorated

wine or vinegar, mixed with the white of an egg;


the eighteen tailed bandage
as

fold

to

is

one upon the other;

next applied, so
lastly,

we

ter-

minate the dressing with the cushions rolled

in

their retaining cloth; a strong girdle should be

attached to the superior extremity of the external


cushion, and passed around the pelvis.

a wooden

sole,

we

Instead of

pass under the sole of the foot

a stirrup, made with a double piece of linen of a


suitable length and size, to
state of

permanent

flexion.

keep the

foot in a

This stirrup ought

to

be fixed by means of strong pins upon the two


cushions,

being

after

crossed over the

instep.

This apparatus being applied, we leave the patient in a state of repose,

tion in

which

it

first,

is

until

in the posi-

has been placed, as long as

be judged proper.

removed

and the limb

The

the swelling, which

dissipated.

It is

may

apparatus should not be


is

observed at

important, however,

to

avoid changing the dressings, as much as possible.

NECK OF THE FEMUR.

285

after the twentieth day, because at this time the

inflammatory process for uniting the bone commences.

After the

twenty-four hours,

first

it is

no longer necessary to wet the apparatus.

This apparatus, more


apply,

difficult to

describe than

have constantly found possessed of great

The

advantages.

pieces which compose

first

when placed uniformly upon

it,

the surface of the

fractured limb, after coaptation, exert a steady,

moderate, and uniform compression over the muscles, so as to


this,

overcome their

we have no reason

to

action; for, without

apprehend a displace-

ment; these pieces keep the fragments


relative

By

as well as splints, without the

position

inconveniences

which attend their application.

the assistance of this apparatus,

we can

when

perfectly oblique fractures, even

ments ride over each other; of course

much more
whether

in

in their

readily done

simple

have never found

it

or

when they are


compound

retain

the frag-

this can

be

transverse,

fractures.

necessary to have recourse to

mechanical means for producing permanent extension, the objections to

above.

which have been exposed

Indeed, none of the pieces of this appa-

ratus will be found to cause irritation, or exert

upon the limb a tedious or


neither have the patients

painful compression;

whom

have treated

in

ON FRACTURES OF THE

286
this

manner, had traumatic fever, even for a mo-

This apparatus

ment.

also unites to a great de-

gree of simplicity, such a degree of solidity, that

have caused a great number of persons with

manner,

and

of the thigh

fractures

be carried

to

badly hung carriages

in

considerable distances,

dressed in this

leg,

to

without displacement of

the fractured bones, and without the patients having experienced serious inconvenience.*
Finally, experience has proved to

apparatus, which

is

purely retentive,

the indications in these cases.

ments

me

that this

fulfils

best

keeps the frag-

It

favours the formation of callus,

in contact,

and preserves the limb perfectly immoveable and


straight.

The

apparatus for fractures of the superior

extremities

is

more simple; a pasteboard under

the arm, with a bandage,

is

the chief; a scarf to

suspend the forearm, and a pyramidal cushion


*

liavc

shown

to the

(Dominique,) a canonier
the Invalides.
shot

wound,

in the

in

Academy of Medicine
in

a person

named

Justice

the er-guard, at present in the Royal Hotel of

This soldier, who had his right thigh fractured by a gun1

809 at the battle of Katisbon, had an

body of the femur, and an ulcer of the heel

a shortening of about sis inches.

The two

artificial joint

ol the

same

formed

side, with

fragments separated from each

other and rounded at their extremity, could be perfectly distinguished

through the thick fleshy part of

this limb.

This distressing infirmit) was

the result of the application of the apparatus for permanent extension

employed

for this case in

one of the army hospitals.

NECK OE THE FEMUR.


fixed

by a bandage

support
or

body, to give a uniform

to the limb, are sufficient for either

compound

the

to the

287

first, it

simple

fractures of the clavicle or arm.

is

In

necessary that the scarf embrace

the whole arm, carrying the elbow a

wards, by means of regular folds


fixed by a few stitches.

little

back-

the scarf,

in

Those of the forearm

are preserved by a similar apparatus; in

all

cases

splints are either injurious or useless.

The

last

person for

whom

employed the appa-

ratus which I have thus described,

general, the Baron Fririon.

aged about

is

lieutenant

This general

fifty-five years,

officer,

fractured the neck of

the femur of the right side, by falling violently at


his full length, on the first of

The

November, 1819.

fracture being very evident, and

ledged by the medical men called

prepare the apparatus, and

to

preceded

it

to

acknowhastened

in, I

apply

it,

having

by the application of cupping with

scarification over the bruised

and painful parts of

the thigh; a very useful precaution.

The
ed,

the

is

operation for this fracture,

long and

difficult,

apparatus should

because
be

it

without

pain,

of an hour of fever.

all

applied

accuracy and uniformity.

dured

if

and

well perform-

the pieces of

with

perfect

General Fririon enwithout a quarter

The apparatus was

not

NECK OF THE FEMUR.

288

renewed but once before the twentieth day, and

was

entirely

removed on the seventy- fifth day

after the accident.

The

limb was found

in

its

proper situation without any deformity, and without the least excoriation;

about three

began

to

lines.

it

was only shortened

In the fourth month, the general

walk with crutches; he now walks with

the greatest ease, and without limping; the limb

has recovered

its

primitive plumpness and form;

indeed the cure may be considered

pei'iect.

ESSAY

VI.

ON WOUNDS OF THE BLADDER,


AND UPON CERTAIN FOHEIGN BODIES REMAINING IN THAT

TThe

ancients considered

der mortal; this opinion

aphorisms of

of the blad-

expressed in one of the

Hippocrates; cui persecta vesica,

wounds have

Although

Ipfhale.

is

wounds

VISCTTS.

become

since

more complicated, from the invention

of fire arms,

made

surgery, by the progress which

it

the operation of lithotomy and

the treatment of

wounds
ism

is

of this

in

has

organ, has proved that

this

in

aphor-

not always true. Nevertheless, the subject

has not been very

fully treated

by authors.

The

Chirurgical Nosography of Richerand, one of our

most modern and learned works, has made no men*

The

translated

land

in

three

first

volumes of the "Campaigns" of Oaron Larry, were

and published by Professor Hall, of the University of Mary-

1815.

A.

fourth volume, containing the Campaigns of

&c. has since been published


part of the following essay

is

in

Paris, but

not translated.

Moscow,

The

first

taken from this volume, which Professor

Hall had the kindness to loan to mo.

37

is

Trans.

290

ON WOUNDS

tion of

Those authors who have written on

it.

subject, say hut

little

signs, or the course

pursue

to

respecting the diagnostic-

which

is

it

remove the immediate

viate those

most proper to

effects,

and

which may accompany these

when they

especiallv

the

to ob-

lesions;

are complicated with the pre-

sence of foreign bodies in the bladder; which

is

the pr ncipal object of the present essay.

empty,

If the bladder be

the

wound

it is

very secure from

of a pointed instrument, or a ball pass-

ing through the diameter of the pelvis; at any


rate this accident very rarely happens.

considerably

which
tants.

is

it is

exposed when distended by urine,

for the most

The

But

part the case with comba-

excitement of battle

time during which the mind


trifling impressions,

late in the bladder

is

allow the urine to accumu-

and

to

In this essay,

the pelvis, so that

fill

no wounding cause can enter


without wounding

and the long

drawn away from

this circle of bones

this viscus.

propose

to trace the

phenome-

na which accompany punctured, incised, and gunshot wounds of the bladder.

Punctured or incised wounds of the bladder,


such as are made by swords, bayonets, lances, &c.

may

pierce the bladder at

some point of

cumference, or pass through where

its

its cir-

parietes are

91

OP THE BLADDER.

In this last case, the

govered by the peritoneum.

wounds are generally

However prompt

mortal.

the contraction, in this case, the urine escapes

through the wound corresponding


the abdomen, spreads through

immediately a
on the

fatal

to the cavity of

and produces

it

inflammation.

field of battle

many

have dressed

whom

soldiers in

the

bladder had been thus pierced, and they have


died within the

first

all

forty-eight hours, of inflam-

mation and gangrene.

But,

if

instrument

the

pierce this sack at one of the points not covered

by the peritoneum, the wound

is

susceptible of

cure, unless the internal haemorrhage be too great.

The

most certain symptom of

this injury

is

The

discharge of urine from the wound.

the
dis-

eharge may be momentary, intermittent or continued; according to the situation of the

wounded per-

son, or the changes which take place in the blad-

urine will appear at the

The

der.

wound

is

made when the

pierced at

its

bladder, being very

superior part; after the urine

charged the edges of the wound

come

moment

in contact

the

full, is
is

dis-

will contract

and

and form an adhesion; especially

if

the urine be readily evacuated by the natural passages. Should there be any obstacle to the passage
of the urine existing in the urethra, the bladder will

then become

fiiled

and distended so as

to

open anew

292

ON WOUND8

the lips of the

The same

suffer the urine to escape.

accident might take place,

ing passed a
too soon;

wound and

gum

elastic catheter

after hav-

if

were removed

it

another introduction of the instrument

would prevent the urine from escaping through


the

wound and

restore

it

to its natural course.

nally, its emission will be permanent,

continue for a considerable

Fi-

and perhaps

time, if the

wound

occur at one of the most depending parts of the


bladder.

When

the course of these

wounds

is

extensive

and not direct, abscesses are often formed at the


parts

different

where the urine has escaped.

These abscesses should be opened immediately,


and an

gum

elastic

catheter introduced into the

urethra; one of the most important circumstances


to be

observed in the treatment of

the bladder.

Warm baths,

all

wounds

camphorated

oily

of

em-

brocations to the abdomen, cooling antispasmodics,

frequent enemata, cupping with scarification about


the wound, and bleeding,
ally

may each

employed with advantage,

in

be occasion-

persons suffering

from punctured or incised wounds of


I will

relate here a

appear

to

me

to

summary

this organ.

of two cases which

be interesting.

Joseph Perrier, a chasseur


being on horseback

in

in

the

*>a?-guard,

a charge of cavalry, was

OF THE BLADDER.

293

wounded

in

right

thigh

by the lance of a

Cossac.

This weapon,

after

having pierced the

the

skin and fascia-lata on the upper and outside of

the limb, passed

obliquely from below, upwards

and inwards, through

glands

the inguinal

to-

wards the crural arch, under which the point of


the weapon glided, inwards and backwards, some
distance from the symphisis pubis.

That part

the anterior wall of the bladder which

is

of

uncov-

ered by the peritoneum was opened by the lance;


the urine escaped immediately through the wound.

Soon afterwards, the patient discharged

a large

quantity of urine mixed with blood through the


natural passages.
fect

After this haemorrhage a per-

calm succeeded, the urine was no longer

dis-

charged through the wound and the patient considered himself cured.

The

bladder, in this case, being relieved from

the urine the edges of the

wound were brought in

contact, and contracted an adhesion; subsequently

suppuration took place, an abscess was formed

in

the course of the wound, which opened spontaneously,

suffering a quantity of urine and pus

escape.
fistulous.

This wound remained

for a long

to

time

Nevertheless, by the aid of a catheter

introduced into the urethra, a counter opening in


the groin, suitable dressings,

and the assiduous

294

ON WOUNDS

attentions of

M. Champion,

my

one of

pupils, he

was cured.
Case 2d.

In a

bull fight

which we saw

gos, on our entrance into Spain


dier,

who was

The

the arena.

in

upon the unfortunate


ing to avoid him,
diately

Bur-

1808, a sol-

in

intoxicated, wished, in imitation of

Ion torreros, to set at defiance


bull

at

fight with the

furious animal dashed

soldier,

fell to

and

who,

in

endeavour-

the ground; he was imme-

empaled on one of the horns of the

bull,

and thrown violently a considerable distance backwards.

universal

dience, at the

cry was uttered by the au-

same moment one of the

pid combatants leaped upon the


ced him

with

his

and

sword,

animal,
killed

pier-

him

in-

immediately sprang over the barrier

stantly.

and ran

to the assistance of the soldier,

senseless

upon the arena.

and made the

first

who

lay

had him transported

which

directly to the hospital, to

intre-

attended him

dressing.

found a lacerated wound about an inch and a

half long on the

upper part of the right thigh,

passing obliquely from behind forwards, and a

lit-

tle

outwards, towards the groin of the same side.

On

a further examination,

found that the very

sharp and curved horn, after having lacerated the


inguinal glands, had passed under the crural arch,

OF THE BLADDER.
and buried
ty had
It
its

295

where

itself in the pelvis,

its

extremi-

met with the bladder distended with urine.

was not pierced, but was no doubt denuded of


cellular

membrane, and weakened

portion of this

for a

membranous

at this point,

sack, formed a

hernia under the crural arch, so as

tumour of the

to

size of a pullet's egg.

present a

There was

at first a considerable haemorrhage, no doubt from

Some of the branches

of the crural artery,

the horn had lacerated in

its

which

course through the

The

deep-seated parts of the groin.

cold, his countenance discoloured,

patient

was

and the pulse

very small; he was affected with great anxiety


and ischuria.
coffee, in

order

caused him
to

to

drink a

little

strong

diminish the intoxication and

restore the vital powers.

This was followed by

copious vomiting, which relieved the patient;


greatest source of distress

the

then remaining was

the frequent desire to pass urine.


I

dilated the

wound

internally,

and passed a

sound, so as to detach that part of the tegument of


the groin which covered the herniary tumour,
(cystocele)

and then cut upon the most projecting

part of the skin, so as to lay bare the whole tu-

mour.

Before attempting

its

reduction,

took

the precaution of introducing into the bladder an


elastic

gum

catheter, by which

the organ was

ON WOUNDS

296

emptied; the instrument was allowed to remain.


I

afterwards reduced the displaced part of this

membranous

sack;

gradually into

its

causing the urine

proper cavity.

to

return

The system

became immediately soothed, and we conceived

The wound was

then

brought together and carefully dressed with

lint,

great hopes of our patient.

and the whole supported by a retentive bandage.


Suitable remedies were prescribed, and particular directions given that the catheter should not

be removed

until the cicatrisation of the

wound

in

the groin, lest a return of the hernia should occur.

On my

return from Madrid,

found this man per-

fectly cured.

Although the bladder was not penetrated,

it

was nevertheless injured, and, without prompt


assistance,

it is

probable that the portion of the

bladder in which the urine was retained, would

have been perforated


gulation,
I

will

and the

life

in

consequence of the stran-

of the patient exposed.

now endeavour

to explain the effects of

injuries of this viscus from gunshot wounds, in

which the foreign body has either passed through


or remains in

its

cavity;

and

will then point out

the method, which experience has proved to

me

be the best for extracting the foreign body.


the

ball, after

entering the bladder,

still

to

If

preserve

OF THE BLADDER.

momentum,

its

side,

it

will

297

pass through the opposite

and either escape externally, or bury

the surrounding parts.

itself in

In this case, the urine will

escape immediately, mixed with blood, by one or


both wounds. There

will

be a diminution, or

total

suppression of urine by the unethra; the patient


will

he

pass more or less blood through this passage;

will

experience severe and permanent pains in

the direction of the wound; there will be frequent

and painful attempts

to urinate

with nausea, and

sometimes vomiting; extreme anxiety and

restless-

ness; paleness of the countenance; spasmodic state

of the pulse; and the patient will often moan, or


utter plaintive cries. In entering or passing out, the
ball

may have

injured the rectum; the urine will

then enter into this intestine, and, mixed with


contents,

there will

pass

out

through

the

wound,

its

when

not remain any doubt of the double

lesion of these organs.

Should the bladder be perforated at a point


corresponding with the cavity of the abdomen; as
for example,

where

it

is

covered on

its

posterior

part by the peritoneum, the urine generally extravasates into this cavity, causing an inflammation
of that membrane.

This spreads rapidly over

all

the viscera, producing pain, oppression, internal


heat, stupor, gangrene, and death; which seize at

38

298

ON WOUND!;.

the same time the organs of animal


of internal

life.

The

life,

and those

are affected by a sort

first

of metastasis, by which the urinous principle

thrown upon the brain.

The

which denotes the presence of

is

particular odour,
this

volatile sub-

stance, manifests itself over the whole system in

the cutaneous transpiration.

These are the

sort

of

wounds mentioned by

Hippocrates, Aristotle, and Galen, when made by

But when they are made

cutting instruments.

in

any other part of the bladder than that covered by


the peritoneum, so that no communication

is

form-

ed with the peritoneal cavity, the wounds, as we

have already

may

urine

said,

are curable.

pass immediately by the wound,

rare that

it

membrane

in the direction of the

its

Although the

infiltrates, at

first,

it is

into the cellular

wound; because

edges and walls become engorged and swollen

from the contact of the


passage of
tached,

may

it

then

When

this fluid.

the eschars are de-

again flows through the wounds, and


penetrate the cellular

cause serious accidents.

prevented by keeping
catheter; but
as for

and thus oppose the

ball,

its

These

in the

example, when

it

membrane and
effects

urethra a

introduction

is

it

may

gum

be

elastic

not always easy;

encounters splinters of

OF THE BLADDEU.
bone

in the

extended
It often

canal, or

to the

when

299

the inflammation has

neck of the bladder.

happens

that,

from the laceration of the

mem-

arterial branches or varicose veins of this

branous sack, an effusion of blood into


takes place;
irritation,

from which there

recognize this internal haemorrhage

by the symptoms
by the smallness

of retention, and inflammation,

of the pulse, the paleness of the

and the dryness of the wounds.

face,

cavity

its

deep seated

accompanied with heat and inflamma-

We may

tion.

arises a

It

is

rare

that the blood coagulates in the bladder, from

mixture with the urine,

it

may

evacuated through catheter.


emollient, and

anodyne

its

therefore be easily

In such cases,

warm,

injections, will be found

These accidents become complicated

beneficial.

with wounds of the bladder, and render their


treatment

difficult.

In every case,

wound

at

it

which the

is

proper

ball

to dilate freely the

has entered and passed

taking care, of course, not to wound impor-

out;

tant parts. This will be found to prevent engorge-

ment and inflammation, which

when
the

usifally

supervene

By

unloading

this precaution is neglected.

vessels,

it

has the effect of local bleeding;

an effect much more salutary than can be obtained

from opening one of the veins of the arm or

leg;

#N WOUNDS

300

the eschars are detached more easily, and


expelled, and

readily

course, be

the cicatrisation

more rapid and exact.

are
of

will,

pledget of

lint

over each wound, some compresses, and a retentive bandage,

sary

form the

to subject the

nous

regimen,

first

dressing.

patient to a cooling, mucilagi-

prescribe

to

It is neces-

emollient

enemata,

vapour baths, and embrocations of eamphorated


of chamomile over the abdomen.

oil

The symptoms,
are generally

which
to

for the first three or four days,

violent;

during this

that of inflammation,

is

it is

period,

first

not necessary

sound the patient, or examine the wound care-

fully;

it is

better to wait a

has taken

separate, the

bladder,
its

gum

so

as

the

the

to

army

begin

elastic catheter should be

to

imme-

to

prevent

urinous infiltration

wounds.

This course contributed

the cure of several soldiers attached to


of Egypt,

bladder.

cases,

eschars

consequences, and to accelerate the cica-

trisation of the

much

the

suppuration

introduced through the urethra into the

diately

and

When

place.

little, until

who had received wounds

have collected several of these

which were inserted

my Campaigns.
of this Hind

is

of

in

the second volume of

The most remarkable

instance

that of a subaltern officer, in

whom

OP THE BLADDER.

301

the ball had traversed both the bladder and rec-

who recovered

tum;

I will

give here a

entirely.

summary

of a case, very ana-

logous to this, which occurred to

campaign of 1813,

in the

me during

the

person of the Sieur Bur-

not, lieutenant in the twenty-sixth regiment of light

infantry.

of

This

officer

Hanau, on the

ket

ball,

was wounded

in the battle

thirtieth of October,

by a mus-

which traversed the scrotum, dividing

the right spermatic cord, and penetrated obliquely through the lower part of the pubis, near the

symphisis, touched the urethra, entered into the

bladder, passed through

its

towards the

left

perforated

through both

its

side,

walls,

and

bas-fond, posteriorly

finally

rectum

the

passed out at

the upper part of the thigh, about an inch from

the margin of the anus.

The

discharge of urine

and stercoraceous matter by the wound and

no reason to doubt the double injury.

tine,

left

The

patient

ence, where

was carried
I

his treatment.

by the

intes-

wound

had occasion

The

little

to the hospital at

to follow

May-

him and direct

urine that had escaped

of the scrotum,

was

sufficient to de-

stroy the vitality of the cellular tissue of these


parts.

The

extirpation of the testicle, which the

rupture of the cord had also deprived of

deep

scarifications,

life,

and

stopped the progress of the

ON WOUNDS

30
gangrene.

After the eschars were detached,

all

the unpleasant symptoms ceased; and the patient,

who

until then

had but

little

himself out of danger.

cause for hope, found

kept an

elastic

gum

catheter in the urethra and bladder, prescribing

The

emollient enemata and a suitable regimen.

urine and stercoraceous matter passed for some

time through the posterior wound; and, at different


periods in the progress of the cure, small bony
fragments, the evulsion of which had been accom-

panied with profuse haemorrhage, passed by the


urethra.
first,

The wound

of the scrotum cicatrised

but that of the thigh remained for a long

time fistulous, during which the patient was

mented by an almost continual discharge of


coraceous matter, mixed with urine.
ter was constantly used,

The

tor-

ster-

cathe-

which evidently favoured

the cicatrisation of the wounds of the bladder,

and the discharge of the foreign bodies.


attending surgeon,

M. Dugat,

The

frequently found

small bony fragments in the eye of the catheter.

At

the end of two months, this officer was com-

pletely cured.

M.

Bastier. surgeon-major of a battalion of ser-

vice in Italy, has sent

German Gazette

me

a translation from the

of Saltzburgh for the year 1812,

a case analogous to the one

have

just related.

OF THE BLADDER.

"The

ball entered

303

by the pubis and passed out

through the sacrum.

The

urine and fecal matter

passed out through the posterior wound, but the


urine only escaped through the anterior wound.

The

inferior extremities

were

in a state of para-

but the patient was cured, notwithstanding

lysis;

these unfavourable circumstances."

all

The

following case, extracted from the

Academy

of the

Memoirs

of Sciences, year 1725, proves

gun shot wounds of the bladder may be

that

accompanied with dangerous haemorrhage.

mason of Lausane, about twenty-five years

of age, received a gun-shot

men,

in

The

17^4.

ounce, entered the

left

wound

ball,

in

which

side of the

the abdo-

weighed

an

abdomen, about

an inch above the pubis and two fingers breadth


from

the linea

alba*

piercing the rectus mus-

cle, the epigastric artery, the fundus of the blad-

der, and
finally

left

sacrum on

as

its

left

side,

and.

passed out three fingers breadth above

the anus.
the

the

The

tunics of the spermatic vessels on

side were

flammation in the
ceration of the

wounded which caused an

in-

The

la-

testicle

and scrotum.

bladder was considerable;

urine was only discharged through the

the rectum not being injured."

the

wound;

ON WOUNDS

304
The

patient suffered severely from haemorrhage

during the

first

few days.

It

appeared that the

blood accumulated in the bladder producing the

alarming symptoms which ordinarily accompany


these

haemorrhages;

insomnia, delirium, ardent

thirst, retention of urine, tension of the

&c.

In a

word the patient was

in a

abdomen,

most alarm-

ing situation.

"After having unsuccessfully had recourse to


various means,

M.

Martin, his physician, threw

He

emollient injections into the bladder.

that they favoured the dilatation of the


this viscus,

and

thought

wound

facilitated the discharge

of

of the

blood and urine through them and the urethra.

From

this time the

alarming symptoms disappear-

ed, and the patient got well."

In reading this case,

it is difficult,

to

determine

whether the detention of the blood and urine arose


from the introduction of the catheter before the
injections

were employed, or whether the favour-

able change, which so suddenly occurred in this


patient, arose from the
tions;

employment

of the injec-

remedy always advantageous when em-

ployed with discrimination.

I will

not undertake

to resolve these questions.

How

can

we

explain the fact that a foreign

body may perforate the bladder

at

one of

its

305

OP THE BLADDER.
points and remain in

cavity?

its

We may

easily

conceive that a fragment of bone, a small piece of

money? a button, or any other thin


tached by the

ball,

may

edges,

angles or

its

body de-

and projected before

the bladder, after having pierced


of

flat

its walls,

it

into

by one

be turned upon

its

has received, and by

axis by the impulse which

it

the mass^ of fluid which

traverses, so as to pre-

sent to the other wall

stop and

fall into

with respect to

ed

its

this

it

its

largest surface;

But

the cavity of the bladder.

balls,

spherical form,

when

the lead has preserv-

how can they be stopped by

membranous sack without passing

through?

and thus

Must we

entirely

not suppose that their pas-

sage through the hard or soft walls of the pelvis

has retarded their motion; so that when they arrive in the cavity of the bladder, the quantity of

urine contained in

it

prevents their further pro-

gress?

When
bodies

the balls of lead are very small, these

may

be spontaneously expelled

through

the urethra, or through the passage by which they

have entered, by

artificial

means.

The example

of a captain, cited in Theophilus Bonnet,

is

one of

the most remarkable.

"This

officer

had received a

pistol shot in

the

right side of the abdomen, and the ball had pene-

39

ON WOUNDS

306

trated into the bladder.


cicatrised and the

The wound

patient

closed and

was cured;

but, after

some time, severe pains occurred, similar

to those

produced by the presence of a calculus

in the

bladder; and, after great efforts, a small ball of


lead of the size of a pea, was voided through the

urethra."

Small grains of this metal


expelled by

which

means of an

will

also be readily

elastic

will favour their discharge.

gum catheter,
They may be

gradually increased until the largest sized instru-

ment

These foreign bodies may

employed.

is

thus either pass through the urethra or get entangled in the eyes of the instrument.

have

given great relief to several persons affected with


gravel in this way; calculi of considerable volume

may

thus pass either through the canal or the in-

strument.

According
his time
calculi

to

were

Prosper Alpinus, the Egyptians

in the habit of extracting urinary

without an incision, by means of a

ing instrument.*

when

in

It is

dilat-

probable that this was done

the calculus was small, which no doubt

may

be done with advantage in the female.

But the

modern Egyptians are unacquainted with

this art.

The

disease of the stone must be rare


*

Vide chapter

xiv.

among

this

OP THE BLADDER.

my campaign

people, as, during


it

was not spoken

What
lowed

remain

will

be

and

irregular;

the

proportioned
of the

der

will

into

the

the ball be

if

bladder?

The

to

an inflam-

weight,

its

substance and

mass,

the

body

foreign

and with

the urine will infiltrate, producing in

gangrene and death.

Under some very

common

peculiarly

may gain

ball

its

course

This termination has been

most

the

pass

will

cellular tissue of the pelvis,

stances, the

Ulcera-

form.

its

the

and perforation of the blad-

succeed;

undoubtedly

al-

effects

foreign body be large

soon produce

will

it

suppuration

tion,

it

in

injurious, if the

mation
nature

in that country,

of.

consequences will arise

to

307

in

the

army.

favorable circum-

the perineum,

duce a gangrenous abscess, which may open,

proeith-

er naturally or artificially, and the ball escape;


it

may

also pass

by the rectum

in a similar

man-

ner.
If the foreign

body be

small,

and with a smooth

surface, the bladder will not be so

by

it;

its

matter,

much

affected

surface will soon be covered with earthy

deposited

by the

nae will be in succession formed,

and

be the nucleus of a calculus, which


to increase

New

urine.

it

will

lami-

thus

will continue

The symptoms which announce

its

ON WOUNDS

308
presence

in the

bladder, will be the same as those

which indicate the existence of a


it is

more

ball is

difficult to

But

calculus.

recognise cases in which the

The

naked, or without an envelop.

are,undoubtedly, more vivid

pains

because the metallic

substance, in immediate contact with the mucous

membrane

of the bladder, causes an irritation

painful than

what

is

The

substance.

calcarious

more

produced by the presence of


almost continual

spasmodic contraction of the bladder conceals the


ball in its bas

to detect

it;

fond, so that

it

may

almost impossible

it is

also be covered

by a layer of

blood, albumen, a piece of linen or wadding, or

even a portion of a thin membranous


that the sound or catheter

may

producing any sensible shock.

touch

without

it

to recognise

it;

direct the extremity of the sound

bas-fond of the bladder, and,

towards the

so

Nevertheless, an

experienced hand should be able


it is sufficient to

pellicle;

with

the assistance of the finger introduced into the

rectum, the

ball

may be

strument can touch

it;

so raised

besides,

jecting towards this intestine.

may be made
which
about.

he

to

will

it

up that

will

be

the in-

felt

pro-

Lastly, the patient

execute different motions, during


perceive the bullet to be rolling

These, together with the symptoms which

characterize a gun-shot

wound

of the lower belly

OP THE BLADDER.

309

or pelvis, without the discharge of the ball, should

confirm our opinion of the existence of a foreign

body

in this viscus^

Taking

for granted that this foreign

body

is

lead, ought we, before performing an operation,

by means of quicksilver,

to

attempt to dissolve

as

some authors advise; because, when these two

it

substances are brought in contact, in certain proportions, the lead becomes dissolved, forming a

amalgam, which may be discharged through

liquid

the urethra?

The

experiments of Ledran, the most zealous

method, admit of some doubts

partisan of this

as to their accuracy and fidelity.

nature are, besides,

this

Experiments of

difficult

to execute,

and

those of Ledran, having for their object only the


extraction of a small portion of a lead catheter,

weighing

about two drams, cannot serve as a

rule for attempting the solution of a musket ball,

weighing

at least an ounce.

But, supposing that

the musket ball could be dissolved in the bladder,

are

we

sure of finding

after

the accident?

trary

we

it

naked, even immediately

Certainly

not; on

are almost sure, during the

four hours, to find

it

first

the con-

twenty-

covered either by coagulated

blood, or, perhaps, by a portion of mucous

brane, which

it

mem-

has detached from the walls of

ON WOUNDS

310
the bladder in

its

possible that

may

The

of lead.

with

it

ball

Finally,

course.

it

is

quite

be iron or brass, &c. instead

may

also

have carried along

portions of the bones or clothes, the pre-

it

sence of which in the bladder will be as pernicious as this projectile

In

itself.

all

these cases,

injections of quicksilver will be useless; and by

the quantity and

increasing

substances in the bladder,

aggravating

the

all

will

it

become

symptoms.

should then be rejected

We

weight of foreign

in

This

injurious,

remedy

such cases.

have already spoken of the course neces-

sary to be pursued for the extraction of grains of


lead, or other small foreign substances; but
these,

bodies are too large to pass through the

urethra,

it

then becomes necessary to

opening for their discharge.

what
doing

when

is

make an

Let us next inquire

the safest and most desirable method of

this.

Shall

we

take the opening by which

the ball has penetrated, supposing this to be at

some point of the belly corresponding with the


bladder?

Many

authors, and

among them some

very celebrated surgeons, have approved of


I shall avoid citing

this.

them, as this would be unne-

cessary in forming an opinion of the propriety of


the following reflections.

OF THE BLADDER.
Whatever may be
nal

wound has

it is

311

the direction that the exter-

taken, from the course of the ball,

almost impossible that

it

should be found in

a direct line with that of the bladder; so that the

surgeon can conduct an instrument from the one


to the other, to seek the ball at the bottom of this

First. Because the directness of the line,

viseus.

leading from the one to the other, must cease, the

moment

the urine

is

evacuated; as the cavity of this

sack entirely disappears from the contraction of

and

walls;

wound.
internal

it

Second. Because both the externa! and

wound

retract and close, almost entirely,

from the contraction and

which render

Even

if

its

thus removed from the external

is

we

retractility of the parts,

researches

all

difficult

and

fruitless.

should dilate the external wound, and

thus succeed in finding the opening into the bladder,

it

be able

ment
if

would be necessary

to

enlarge

to introduce the forceps.

of the

to divide

any of the larger

so as to

This enlarge-

wound would be dangerous,

inflammation had taken place, or

happen

it,

if

especially

we should

vessels rami-

fying upon the walls of this organ; this dilatation

would

also facilitate the infiltration of the urine

into the cellular

membrane

of the pelvis.

Besides, after having extracted the ball in this

way, supposing

all

the circumstances favourable

ON WOUNDS

312
to its

accomplishment,

if

a portion of the clothing,

or other body which yields readily to the touch,

should remain in the bladder,

it

nucleus to a calculus; for which

would serve
it

as the

would be equal-

necessary to perform the operation of litho-

ly

tomy

at

some subsequent period, and the patient

would have thus

suffer

to

making a counter opening


this sack,

we may prevent

of which

two operations.

By

at a

depending part of

all

the inconveniences

have spoken, and have the double

advantage of

facilitating the extraction of all the

foreign bodies, and the cicatrisation of the gun-

shot
I

wound

of the bladder.

propose then, as the means most simple and

sure, the sub pubic

tomy; which

and

I usually

lateral operation of litho-

perform with a bistoury, a

sound and forceps. This process,


always succeeded,
cidents.

slight

is

in

which

have

rarely accompanied with ac-

haemorrhage from the transverse

artery of the perineum sometimes supervenes; but


this

To

may be

readily stopped by tying the vessel.

obtain from this operation

we may

desire,

it is

all

the benefits that

necessary to perform

the foreign body, which renders

it

it

before

necessary,

altered the state of the bladder; and as

lias

wounds

of this viscus are often accompanied with severe

inflammation,

it

is

necessary to have recourse to

OP THE BLADDER.

313

the operation either before this has taken place,


or after

it

has terminated.

single fact, of

which

am now

about to re-

trace succinctly the history, shews that this operation has been practised, with the intention of

extracting a ball concealed in the bladder.

Still

this did not take place until long after the acci-

my

dent; while

operation, of which

shall give

an

account after having related a summary of the

was performed a few days

case,

first

after the

accident.

Case

ist.

"A German

soldier received a gun-

shot wound, at about twenty paces, in the year

1800.

The

ball

perforated the sacrum, at about

the junction of the third or fourth false vertebra,

passed through the rectum, and penetrated into


the bladder.
four weeks.

The wound cicatrised at the end of


The patient, during this time, com-

plained of severe pains in the pelvis, and observed


the sensation of something round rolling in the bladder,

when

The

pains continued after the cure, but he lost by

the position of the body was changed.

degrees the sensation he had

at first

of the presence of a foreign body.

experienced

Ten years

afterwards, the physicians of the hospital of

Wer-

theim perceived that there was a hard body on


the side of the neck of the bladder.

40

The

opera-

ON WOUNDS

314
tion of lithotomy

was performed with success by

Langenbeck, when a calculus, of the


small hen's egg,

which was

The

common

of the

following

occurred

was found

of a

to conceal the ball,

size."

summary

is

size

of a case which

In passing through the wards

to myself.

of the large hospital at Witepsk, in Russia, on the


thirtieth of August, 1812,

was stopped by the

wounded

distressing cries of a

officer,

M. Guenou,

lieutenant in the ninety second regiment of the


line.

went immediately

him with
on

care.

He

to

him, and examined

had received a gunshot

the inlernal and

wound

superior part of the right

groin, passing obliquely inwards, towards the ca-

The

vity of the pelvis.

careful introduction of a

large probe shewed an excavation of the pubis,

and, from the direction followed by the probe,

was a

that there

lesion

indeed, was not equivocal;

of the bladder.
for,

wound was surrounded by a

This,

though the external


blackish eschar,

The

suffered bloody urine to exude.

it

patient ex-

perienced in the region of the bladder exceedingly severe

and permanent pains, with a continual

desire to pass the urine.

The

urine,

mixed with

blood, ran in a small interrupted stream, which

caused
cries.

the

patient

to

utter

the

His pulse was nervous and

most piercing

febrile,

and heat

315

OF THE BLADDER.
with

were beginning

thirst

manifest

to

them-

selves; but, the paleness of the countenance remain-

ed, and the voice was hoarse and interrupted.


of sleep since the occurrence of the ac-

Deprived

was

cident, this olicer

When

ety.

extreme anxi-

in a state of

he moved, either

he perceived a sensation as

to the right or left,

something were

if

rolling within him.


I

was informed by him

that these

symptoms

were the result of a gun-shot wound, which he

had received

at the battle of

Witepsk, on the 30th

of July, at the distance of about seventy paces,

and that the

ball

had not passed

me

cumstances induced

to

out.

suppose that the

which had produced the wound

this point, I

cirball,

in the groin,

in the bladder; and, to satisfy

stopped

These

sounded the patient.

had

myself on

had some

ficulty in detecting the foreign body, but at

dif-

last

perceived that the sound touched some foreign substance, though the shock

Before proceeding

which
wished

sultation;

to the operation of lithotomy,

conceived

to

have

was scarcely perceptible.

my

indispensable and urgent, I

opinion confirmed by a con-

which was accordingly convened on the

following morning, the 4th of August.

My friend,
The

Dr. Ribes was one of the persons consulted.


necessity of the operation was admitted, and

it

was

ON WOFNDS

316
determined that

should be performed immedi-

it

After every arrangement was made, the

ately.

operation was performed in less than two minutes,

and the

ball,

(which

have deposited

in the cabi-

net of the School of Medicine) presented to the


patient.

It

was encrusted with a small portion

bone; and one of


blood.

its

sides covered

This would have been

by a layer of

sufficient to

useless the injection of quicksilver, which

The

posed at the consultation.

of

render

was pro-

extraction of the

was followed by the discharge of a small

ball

fragment of bone, a piece of cloth, and some coagulated blood; and afterwards two emollient
jections

were thrown

into the bladder.

in-

Lint with

compresses and a bandage were then applied over

The

the wound.

patient

was placed

in

a conve-

nient situation and a suitable regimen prescribed.

With

the exception of a slight haemorrhage, which

took place next day, and which

Some

no accident occurred.
self

the

readily stopped,

fever manifested

it-

on the third day, the suppuration took place,

wound became

cleansed, and, on the seventh

day, the urine was discharged through the natural


passages.

Cicatrisation soon took place;

the thirty-second day of the operation,


left

the

regiment.

hospital,

He

perfectly

wrote

to

and, on

M. Guenou

cured, to rejoin his

me from Moscow

to

thank

317

OF THE BLADDER.
me, and

to request

me to

obtain for him the decora-

tion of the legion of honor;

procured.

which was accordingly

sergeant major in the twentieth regiment of

the line,
left leg,

who had

received a slight

was lying

operated upon

in the

wound

same ward

M. Guenou.

in

assuring

me

that

Encouraged by the
upon

instantaneous success of the operation

companion, he desired me

in the

which

his

operate upon him;

to

he had suffered

for

twenty years,

from a stone in the bladder; which could not be


detected either at Metz, Mezieres, or Besancon;

where he had been

in garrison

with his regiment

at different periods.
I

immediately sounded him, and, with

ficulty, I

became

satisfied that

consultation, the calculus

he was correct.

was performed by myself,

in the last case.

had some

the stone with the forceps.

be enveloped

in

On

was recognised and the

necessity of the operation admitted;


tion

little dif-

It

in the

the opera-

same way

as

difficulty in seizing

appeared

a kind of membraneous

to

me

to

pellicle,

which had, no doubt, deceived the other practitioners

who had examined

traction

was

him. However, the ex-

effected with sufficient promptitude,

and the patient cured without any accident.

The

stone having presented some peculiar and

ON WOUNDS

318
uncommon

respect to

gravity, colour and density,

cific

ed

characters, with

it

to the

Faculty of Medicine.

spe-

its

have present-

The

nucleus

consisted of several grains of a ferruginous aspect.*

In speaking of gunshot wounds penetrating the

bladder from above,

have only spoken of two sorts

of solutions of continuity in this viscus.

which the

until

falls

into its cavity,

removed by

affecting both walls, in

where

it

is lost

in the substance of

But

the adjoining parts, or passes out entirely.

far

re-

art or nature; the other

which the projectile passes

through the organ, and

when

in

projectile perforates one of the walls of

the organ and

mains

The one

the above observations were written,

was

from supposing that a projectile, the force of

which was weakened by passing through a mass


of living flesh,

could

lacerate the walls of the

bladder in such a manner, that a portion of the

sphere should penetrate


into the cavity.

walls without falling

its

But the

facts

which

am now

about to relate, show the possibility of such an


event.

deavour

Before describing these cases,


to give

I will

en-

some explanation of the pheno-

menon.
* This essay on -wounds of the bladder was published thus far, in the
fourth

volume of the "Campaigns"

in 1817.

from the Bulletins de la Sociele Medicate

The remaining

part

is

D*Emulation, November,

taken
1822.

OF THE BLADDER.

We

may suppose

that the ball,

pursued a course more or

ped

319
after

having

less tortuous, is

stop-

at one of the cellular or fibrous points of the

external surface of the bladder, so as to touch

The

tunics.

presence

of a

its

body soon

foreign

induces an inflammation in the surrounding parts,

which encircles a great part of the circumference


of the ball, forming a sort of cyst, which envelopes
it,

and prevents

pies.

At

moving from the place

its

it

occu-

the same time, that point of the bladder

in contact with the ball, after having

undergone

the process of inflammation and suppuration,


ishes by

fin-

perforating the wall of the sack, by the

The

process of ulceration.

ball

becomes thus a

part of the cavity, and this metallic point, being


constantly wet by the urine, has the earthy matter

deposited upon

weight of the

surface,

projectile, until

the cavity

ly into

its

which always

augmenting the
at last entire-

it falls

of the bladder.

tends

to

overcome

Or
all

nature,

obstacles,

and to establish the equilibrium of the functions,

may, by a spontaneous

body from an organ


ing thus
trise.

made

The

easily, as the

effort,

separate the foreign

so important,

and the open-

may

close, or cica-,

in the bladder

projectile will be displaced the

suppuration extends

itself

more

most rea-

dily from the exterior of the bladder, to those

ON WOUNDS

320
parts

where

finds the least resistance.

it

may

It

afterwards remain at a certain distance from the


bladder, and manifest itself beneath the integu-

ments; from which

it

will be easy to extract

These are the two courses which the


follow,

parts

when

and

bladder.

It

to

is

surround these foreign bodies, and

to the inflam-

which we must refer

tissues, to

these singular phenomena.

It is

periods

explain the different

the

which

contractility of the tissues

mation of these

may

ball

retarded by the thickness of the

it is

contiguous to the

elasticity,

it.

thus that

we may

may

elapse,

that

without the patient experiencing any violent pain,

between receiving the wound, and the time when


the foreign body

We

der.

may

falls

also

into the cavity of the blad-

understand the intermission

which sometimes takes place


duced by the emission of

wound, when the

ball, after

in

urine

had existed
trised.

its

through

the

is

expelled to a

walls, so that the opening

in them,

will

pro-

having communicated

with the cavity of the bladder,


distance from

the pain,

now

which

becomes closed up and


relate

two

cica-

facts in support of

the explanation which has just been given.


I

inserted the

Medicale

first in

the Bulletin de la Societe

d? Emulation in the

year 1821.

It

was

OF THE BLADDER.

M.

furnished by

321

Souberbielle; I have seen and

interrogated the subject of the case.

The

patient

was a soldier in the 135th regiment of the

named Dapret, who had


rable second of

wound

ribs,

the groin of the


pubis.

May, 1813, near

in the left flank,

over the false

memo*

Halle, a gunshot

which passed obliquely

which were cut deeply,

same

side,

The wound was

no projectile found.

which occur

received, on the

line,

and a

little

into

behind the

dressed methodically, but

After the

in all gunshot

first

symptoms,

wounds, the patient

was apparently cured, and returned

to his usual

occupations for two or three years without feeling

pain or other inconvenience.

But, at the end of

the year 1815, a tumour, accompanied with fever

and other

local

inflammatory symptoms, occurred

above and behind the horizontal branch of the


pubis, near the wound, at the bottom of which

the patient perceived, some weeks afterwards, a

sense of tearing, which was immediately followed

by an urgent

desire to pass his urine, and a dimi-

nution of the tumour.

A large

quantity of blood

and purulent matter was discharged with the


urine.

The

blood disappeared in a few days, but

the pus continued to pass out with the urine for

some time.
41

ON WOUNDS

322
From

time until the commencement of the

this

year 1821, the patient experienced a sense of


heaviness and pains in the region of the tumour.

At

this time a skilful

surgeon sounded him, and

thought he recognised a calculus in the bladder;


but at the moment when every thing was arranged
for the operation, the foreign

body could not be

Other surgeons having

found.
patient,

also

were equally unsuccessful.

standing the symptoms of which


the patient, according to his

sounded the
Notwith-

we have spoken,

own acknowledgment,

continued to apply himself in his usual occupations until the

month of June, 1821, when,

rather

exercise, he

all

the

of an

violent

after

was attacked with

symptoms which characterize the presence


irregular

calculus

in

the

bladder.

The

pains especially were extremely severe, so that

he could scarcely endure them; however, he supported them until the early part of the month of

August, submitting

which he was
sulted,

to the frightful suffering

afflicted.

who, at the

first

M.

with

Souberbielle was con-

introduction of the sound,

recognised the foreign body which had been before

remarked.

Being an experienced surgeon, he

at

once proposed the operation of lithotomy, which


the patient joyfully acceded

to.

This surgeon

then performed the lateral operation of lithotomy,

OP THE BLADDER.
#nd extracted the

ball (a biscayen)

323-

weighing four

ounces, two drams;* one half of the sphere was

covered with several laminae of earthy matter,

The

rities.

by aspe-

in diverging rays, terminated

arranged

patient

perfectly cured in a very

was

short time.

Before making the application of


the above remarks,

shall

another case analogous to


support of

Mr.

J.

my
M. Remy,

it,

summary

give a

which

this fact to

will

of

go far in

opinion.

about

fifty

years of age, a

captain in the 108th regiment of the line, while

marching at the head of

his

battalion,

at

the

unfortunate battle of Waterloo, was struck by a


ball

on the

left

jectile, after

was

rib,

and buried

deeply; passing downwards and forwards

towards the pubis


it

pro-

having pierced the integuments, cut

the anterior extremity of the tenth


itself

The

hypochondriac region.

lost.

abdominal cavity, where

in the

This gunshot wound was immediately

followed by the

fall

of the patient, and a free dis-

charge of blood and stercoraceous matter from the

wound.
to

M. Remy was

carried in the ambulance

Jemmapes, where he passed the eight

first

days without assistance, or without taking any


*

The

biscayen

incrustation

generally

weighs

then had increased

its

about four ounces;

weight two drams.

the

calculous

324

ON WOUNDS

thing but a

little

From

water.

he was trans-

this

ported to one of the English hospitals at Brussels,

where he remained

until the period

which did not take place


ber, in the

same year.

this officer discharged a

end of Decem-

until the

During

of his cure:

the

first

few days,

good deal of blood by the

urinary passages, and he thought that a part of


the urine was discharged with the excrements by

While a prisoner

the wound.

in

visiting the hospitals at Brussels, I


tient.

The

stercoraceous matter

Belgium, in

saw

still

the wound, but in less quantity than at

Towards

this pa-

passed by
first.

the end of July, a tumour of consider-

able size manifested itself at the lower part of the


right groin and towards the pubis, accompanied

with darting pains,

difficulty in

passing the urine,

and a disagreeable sense of weight.

After two

or three days of severe pain, there was suddenly

discharged from the wound a large quantity of


fluid matter, serous

ous odour.

The

and purulent, having a urin-

discharge was so copious that

the mattress was soaked through by


this time the patient

found

relief.

The

it.

From

discharge

by the urethra of blood and pus, which had

fre-

quently occurred before, ceased entirely; and the

urinary functions were entirely restored.


artificial

anus

gradually

The

disappeared, and the

OV THE BLADDER.
wound

of the

abdomen

325

By

cicatrised.

the end of

the year 1815, the patient, requiring no further,

medical

aid,

returned

himself perfecly cured.

to

France, considering

Nevertheless, he never

eeased to complain of a dull pain and sense of


heaviness at the lower part of the linea alba, and

behind the pubis.

These symptoms

M. Remy

me on

consulted

the

first

increasing,

of October,

1821.
After having related the above circumstances,
this officer

a very

informed

me

that he then experienced

painful heaviness, in the spot above

tioned; vvhich he ascribed to the presence


ball

menof thfc

with vvhich he was wounded at the battle of

Waterloo.

On

examination, a small hard elastic tumour of

an ovoid shape could be perceived, situated deeply


beneath the lowest part of the linea

complained of pain when

This induced me

to

this

was

alba.

M. Remy

slightly pressed.

propose making an incision,

for the purpose of seeking for the projectile.

as

foresaw some

ration,

difficulty in

executing this ope-

though apparently very simple,

Ribes in consultation, performing


ence.

An

incision

But

it

called Dr.

in his

pres-

was made into the thick integ-

uments which covered the tumour, the patient


tyeing rather fat; a cellular cyst about the size of a

ON WOUNDS

326

hen's egg was then separated, and removed entire,

by which the

linp'i

alba and

left

pyramidal

muscles were laid bare, without our perceiving

any trace of the


covered

However, we

projectile.

in the linea alba a small opening,

dis-

through

which we introduced a probe, by which we

dis-

covered a hard body, situated about three centimetres deep, between the
of the os pubis, and the

left

horizontal branch

body of the bladder.

did not hesitate to dilate inferiorly the aponeuroportion of this opening, to enable

tic

more readily
vered. But

at the foreign

it

was

which enveloped

body that

so closed
it,

that

it

up

me
I

to arrive

had

disco-

in the fibrous cyst

could be disengaged

only by making a free incision into this cyst.

The

extraction was effected by means of a small pair


of polypus forceps.
to

be a

ball

This foreign body was found

about two ounces in weight, incrusted

with a circular layer of calculus matter, having


the same characters, as was observed upon the

biscayen of Dapret.

The

patient

was

perfectly

cured in the course of three or four weeks, and


Jias

returned home perfectly well.

JF THE BLADDER.

327

Reflections on these two cases.

From
That

these facts

it

appears probable:

First.

in the first patient, the biscayen, after hav-

ing passed

through a part of

parabola, from

its

the hypochondrium through the walls of the belly,

stopped behind the pubis, between the poste-

rior surface of the horizontal branch of this bone,

and the bladder.


sphere

in

Having buried a part

the substance of this

remained immoveable

of

its

bony portion,

it

in its position, until the for-

mation of the tumour of which

have spoken.

This tumour was an abscess, which the presence


of this foreign body

had induced.

would necessarily detach, on the one

This abscess
side, that sur-

face of the foreign body buried in the bone, and,

on the other,

affect the

corresponding part of the

coats of the bladder; which must have been perfo^

rated by the process of ulceration, and the opening which then resulted, permitted the matter ac-

cumulated
bladder,

in the abscess to

and

have already
its

be discharged into the

to pass out

by the urethra, as we

The

biscayen, detached from

related.

osseous adhesion, must necessarily have follow-

ed the course of the liquid, and be carried by

its

ON WOUNDS

328

own weight towards


where

it

was, in some sort suspended for some

years: a portion

time

the

the opening in the bladder,

of

its

surface constituting for

a part of the walls of

this

viscus.

This part must have been continually moistened by


the urine, as

it

was no doubt situated

at the bot-

tom of the body of the bladder.

The

other portion of the biscayen was retained

and suspended by the membranous and fibrous


which nature had early formed about

cyst;

it,

and

which did not give way, even when the weight of


the foreign body was considerably increased by

the incrustation, which

part of

its

surface.

covered a considerable

At length a

violent exertion

of the patient having separated the edges of the

opening of the bladder, the


ty of this organ;

where

its

ball fell into the cavi-

presence was immedi-

ately perceived, by the distressing sense of weight

and severe pains which such a body as an iron


ball,

covered with calculous asperities, would una-

voidably produce.
recognising

its

There was no merit then

in

existence; the indication was obvi-

ous, but the execution

more

however was one which was

difficult;

easily

the difficulty

overcome by

art

experienced surgeon, familiar with anatomy. Both


these

When

qualities

are united

in

M.

Souberbielle.

the patient was sounded by the other sur-

WF THE BLADDER.
geons, the

first

329

recognised the presence of the

foreign body, because he had tor an instant turned

the beak of the sound towards the pubis (perhaps

without being conscious of


projected.

But

in the

where the biscayen

it)

subsequent examinations,

the instrument being introduced into the bladder,

only the upper part of the bas-fond was explored.

The

finger introduced into the rectum could not

distinguish the foreign body.

no means surprising that


until it

think
tion

it

had

it

fallen into the

It is, therefore,

by

was not discovered

bladder.

Besides we

fortunate for the patient that the opera-

was not attempted before the entrance of the

biscayen into the bladder, and the cicatrisation of


the opening through which

it

Be-

had passed.

cause, by operating sooner, the patient would have

been exposed

With

respect

second case,
first,

to

it

some serious accidents.


to

Remy, the

appears evident

subject

me,

to

of

the

that,

at

the ball had pursued a course similar to that

of the biscayen in Dapret, and had pierced one of

the walls of the bladder, without falling into


cavity.

its

After receiving for some time calculous

laminae from

the urine,

nature, in

opening into the bladder by

closing the

cicatrisation,

pelled the ball which had gradually

made

upwards and forwards, towards the tinea


42

had exits

way

alba, to

330

ON WOUNDS

the spot from which

it

was extracted.

bable also, that the lesion of

made

where the

pubis,

tion of the bladder separated

being detached,

it

we add

and

it,

retrac-

that, after

readily passed through the cel-

membrane towards

able, as well as

was stopped,

ball

The

the linea alba.

cure of the lesion of the intestine

ous

pro-

bladder was

the

That the successive

as in the biscayen.

If

is

at that part of its wall contiguous to the por-

tion of the

lular

It

is also

remark-

the extraction of the projectile.

to these cases

extravasations

the
the

into

effects of sanguine-

bladder, in

conse-

quence of the injury of vessels which communicate

with the urinary

completed,

lesions of this viscus arising from


It

we

passages,

think, the history of

all

shall

have

the organic

wounds.

sometimes happens, especially in young sub-

jects, that the arterial blood is

poured directly

into the bladder or one of the tubes

ate in this

which termin-

membranous sack, forming, notwith-

standing the continual

flow of the urine, a co-

agulum

presence may either pro-

so thick that

its

duce the symptoms common

to calculi, or

of general disease, throwing the


sort of ataxia.

But how,

it

a state

patient into a

may be

inquired, can

the blood coagulate while remaining in the blad-

der with the urine?

Without pretending

to re-

OF THE BLADDER.
solve this question,

may

we think

331

that this coagulation

take place; First. Because

hae-

arterial

all

morrhages are accompanied with a suppression of


urine, to a certain extent; as well from the diminution of the fluid necessary for this secretion, as from

the direct or sympathetic inflammation of the kid-

Secondly. Because

neys.

when

the blood has ar-

rived suddenly, in large quantity, in the bladder,


it

displaces,

by

specific gravity, the urine

its

the bas-fond of this viscus; where

proportion as the subject

late, in

febrile

as

is

coagu-

will

it

from

in a state of

is

heat, or as the blood may be more

plastic,

observed in young persons of robust consti-

tutions.

The

coagulum, being once formed, resists the

dissolving

power of

urine,

and acquires

ence by the earthy matter which

upon

its

surface; in this

case

it

foreign body as pernicious as a

operation of lithotomy

is

is

its

deposited

may become a
The
calculus.

equally indicated for

the extraction of the coagulum, after

certained that

consist-

we have

density and consistence

is

as-

such

that aqueous injections into the bladder, such as

may be made

with the machine of

cannot dissolve

it.

It

is,

M.

J. Cloquet,

generally, easy to dis-

tinguish a coagulum from a true calculus; at any


rate, I did this in the case of a

man who had been

332

ON WOUNDS

wounded by a sword

in the right

kidney, in

whom

there was a considerable extravasation of blood


into the bladder.

Notwithstanding the evacuation

of blood through the urethra, a large

was formed, of such a consistence

coagulum

as to cause the

patient great anguish, and to induce a state of ner-

vous spasms that, continued

until death,

took place at the end of forty

which

days after the

wound.

On examining
wound

the body after death, besides a

in the right kidney,

the sword, with

made by

lesion of one

the point of

the

of

principal

branches of the emulgent artery, a hard, black

coagulum was found

man

this

in the bladder.

in consultation

Having seen

a few days before his

death, and being satisfied that there was a large

quantity of coagulated blood

in

the bladder,

proposed the operation of lithotomy for the purpose of evacuating this organ, and to dissipate the
general spasm with which the patient was affected,

which no doubt contributed

internal

haemorrhage and

proposition

was

rejected.

that the operation,

if

to

keep up the

adynamia.
It

is

But

the

very probable

practised at a proper period,

might have been attended with satisfactory results.

Besides,

arisen from

it.

no serious injury
I

could

have

think then that the operation of

OP THE BLADDER.

333

lithotomy for extracting coagulated blood, hard-

ened in the bladder, may with propriety be per-

formed

in

"Many

some

cases.

surgeons

may

not be prepared to admit

M.

the explanation which has been given by

rey, of the suspension of the

by a part of

its

Lar-

the bladder-

ball in

sphere, and, of consequence, the

incrustation of that portion bathed by the urine.*

But, whatever explanation

two cases, related by

M.

may be

given of these

Larrey, there can be no

doubt that they are worthy of being inscribed in


the annals of medical science.

appear

We

to

me remarkable

have never seen, as

Two

circumstances

in these cases.

First.

know, foreign

far as I

become incrusted when they have been

bodies

lodged in other parts than those cavities having

mucous

surfaces, for example, the bladder, diges-

Second.

tive passages, uterus, &c.

On

hand, large calculi have been known

the other

to pass

out

from the bladder by the hypogastrium, in conse-

quence of an abscess.

last fact,

recorded by

also seen

by Doctors

This

Doctor G. Caumont, was

Lalauric, Segalat, &c. &c. the following

mary
*

The

ety, in

is

a sum-

of the case."
following remarks are added by one of the

whose transactions the

members

of the Soci-

latter part of this essay appeared.

ON ROUNDS

334

"A

man, twenty years of age,

for five years of

who

surgeon,

who had uflered

ardor urince, was sounded by a

discovered a hard body in the blad-

Sometime afterwards, the man was again

der.

sounded, and no calculus could then be found.

was prescribed, and the man

re-

suitable regimen

turned to his usual avocations.

But

the symp-

toms increased rapidly; a tumour manifested


in

the hypogastrium, and terminated

tion.

On

the third day, the patient

a painful sense of weight, and


introduced,

it

in

felt in

itself

suppurathe ulcer

when a probe was

touched a hard body, which the

surgeon discovered to be a calculus, and extract-

ed

This stone was of an oval form, with a

it.

smooth surface, and weighed about nine drams.

large quantity of pus and urine followed

extraction,

and continued

ulcer, the edges of

to

its

be discharged by the

which became hardened.

But

a catheter, kept

in the

this yielded to the use of

urethra and bladder.

The

ulcer of the hypogas-

trium cicatrised, immediately after which the patient

was seized with dysuria, which terminated

with the discharge of a small stone from

the

urethra.

"In

his report

upon

Deschamps explains

this interesting case,

M.

the discharge of the stone

by the hypogastrium by saying,

'It

is

probable

OF THE BLADDER.
that

it

was

at first

335

lodged in a particular cyst of

the bladder, having a partial communication with


the interior of the viscus.
efforts of the patient,

this cyst

That from the

required by

became inflamed, and a

tion having

been communicated

violent

his profession,
local

inflamma-

to the neighbour-

ing parts, by degrees extended even to the inte-

guments, and in the centre of


parts, an abscess

this

was formed.'

mass of inflamed

'Thus,' adds this

learned reporter, 'the extraction of the calculus

was permitted.

The same

thing occurred which

has sometimes happened in calculi of the kidneys,

and vesicula

fellis, &c.

"

THE EXD.

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