during the process is not an objection; but if it be more irritable afterwards, it shows that it has been used too strong. There is a certain stage of the tubercular disease, when over-excitement, from employing the iodine in too great quantity, might hurry on the softening process too quickly. It is here that the treatment demands the greatest judgment. In every case one of the following events may be expected to happen: either that the tubercular irritation will be arrested and gradually removed, be arrested and suspended, but not cured; or pass on to the softening process, which terminates in the production of an excavation. In all these different states of disease I ádvise the inhaling treatment to be employed.

I have formerly mentioned that at the period when I was preparing my first edition for publication, in the year 1830, Dr. Murray, of Belfast, in a treatise on animal heat, recommended the introduction of iodine to the lungs, diffused through warm aqueous vapour into the apartment; and hence it follows that without any communication-for I had not the pleasure of his acquaintance-we had thought of the same remedy; but I am well persuaded that the only certain and exact mode of employing it is by direct inhalation, so that the dose is defined; whereas, in the other mode, many circumstances must interfere with its regularity. Also I find the remedy infinitely improved by the addition of the conium.

In the Medical Gazette for April 6, 1839, we find a paper by Dr. Corrigan, of Dublin, recommending, as a mode of inhalation, the impregnation of the atmosphere of the apartment with iodine vapour, by a mode different from that of Dr. Murray; but the principle is of course essentially the same. I am gratified with the favourable testimony which this physician bears to the remedial influence of iodine vapour in phthisis pulmonalis; but I am not disposed to choose his method of employing it. The volatility of the iodine would cause the vapour to ascend to the highest parts of the apartment; it would attach itself to the linen furniture, and must, of necessity, find its way to the lungs of the patient in a very uncertain degree of strength. The objections of Dr. Corrigan and others to the direct method of inhaling which I recommend, is without foundation. It does not, as they state, cause irritation to the larynx and air-passages; but, on the contrary, its influence, if used of the proper strength, is soothing and agreeable. The addition of the conium divests the iodine of that irritating effect which would arise from its penetrating acrid qualities when used per se.

But we have a higher purpose to fulfil than the mere study of soothing the mucous membrane of the air-passages. The modus operandi of remedies is a question of secondary importance to their real effect, and may lead to endless controversy. It is my belief that this direct and very accurate mode of applying this powerful medicine, iodine with conium, induces a new action in the vessels and nerves of the lungs, which is calculated to supersede the diseased action. I also assign much effect to the stimulation of the absorbents, and have been led to believe that tubercles have in this manner been actually removed.

As the mode of conducting the inhaling process is of such sovereign importance, I shall be excused, I trust, if I enter at some length into this part of the subject.

Dr. Harwood, of Hastings, has lately published an account of the benefits to be derived from inhalation, in which he recommends his newly invented tin inhaler, stating, as the ground of preference over the glass inhaler commonly in use, that it is used with such perfect facility as to prevent fatigue; and, what I must admit, that it is not liable to be broken. I have carefully

'Nor is the great waste of the iodine a slight objection to this method. The author states that in the use of the apparatus, "about six drams of the tincture of iodine will be evaporated in an hour; and when he has it at work, as he says, "from eight to twelve hours out of the twenty-four," it would form no small item of expense, employed in a charitable institution!

examined the action of this inhaler, and must take the liberty of offering the following criticism. The ingress tube not dipping into the water, the fresh atmospherical air which enters when the patient inhales, cannot be more than slightly impregnated; and any one making a comparative trial with the glass inhaler, is at once made sensible of the great difference in the strength of the inhalation, from equal quantities of the ingredients used. Indeed this great defect in the construction of the apparatus will apply to any kind of medication of the water. As regards the use of iodine and chlorine, the objection of the metallic nature of this inhaler is a fatal one. I find that an action immediately takes place between these peculiar medicines and the tin, which weakens their properties very considerably. With the requisite alterations in the ingress tube, this will be rendered a very useful inhaler, when it is desired to employ herbs, or guns; water of a higher temperature than 120° being mixed with such articles to bring out their volatile principles; although the patient should wait the reduction of such temperature to the proper degree, or he would be injured by the direct application of so much heat to the sensible surface of the air passages.

I have not been able to pursuade myself of the advantage of the crescentshaped mouth-piece in Dr. Harwood's inhaler, over the flattened one of the glass tube.

With a well constructed glass inhaler I find all the satisfaction I can desire. The bottle should be large, and the tubes capacious. The one issuing from the bottle should be upright, passing off in a gradual slight curve, so that the vapour shall not be much cooled in the course of its progress; the ingress tube should dip very near to the bottom of the bottle, that all the air so introduced may receive impregnation. The patient must be desired to inhale by using at the same time suction and a pretty full inspiration, then to drop the under lip from the mouth-piece and make a free expiration; so conducting the process by pausing, and, if he like, little suspensions, in order that he may not experience any of the fatigue, which would certainly happen if breathing quickly, or using an inhaler with small tubes, or with too much water in the bottle.

A little practice also improves the power of the respiratory muscles so that any little difficulty, which may by possibility be felt at the first by a very delicate and nervous individual, is soon overcome. When care is used to prepare the inhaler properly, the accident of fracture is easily guarded against. With respect to the influence of other medicines used in this way of inhalation, I beg to refer the reader who is curious on the subject, to the second edition of my cases in illustration.

Thus I hope to have made a useful addition to my former statements of the importance of the inhalation of iodine and conium in tubercular phthisis, as constituting one most valuable part of the systematic plan of treatment which I recommend; and if I should ever have appeared to speak of it as the sole and exclusive remedy to be employed, and to be used empirically, I have not done justice to myself, and to my enlarged views of the pathology and treatment of consumption.

Did I not feel the necessity of restricting myself in the discussion of my subject in this letter, I could much increase the evidence of the success of the treatment which I wish to advocate, by the relation of numerous cases of great amendment, or recovery, from tubercular phthisis in its different stages. I might also bring forward instances of relief and cure of various conditions of tracheal and bronchial disease, effected by means of inhalation and combined treatment.

I will, however, now conclude by observing, in the language of the poet, to the enemy of the inhaling practice, if such there should continue to be,

"Si quid novisti rectius istis,

Candidus imperti: si non, his utere mecum."-HORAT.

In the treatment of tubercular phthisis, so much the most mortal of all

diseases, no one need apprehend that he shall add unnecessarily to his means of giving relief.

I am, sir, your obedient servant,

Wimpole street, Feb. 3, 1840.

CHARLES SCUdamore.

For the American Medical Intelligencer.

ART. II.—ON THE INFLUENCE OF OXYGEN IN VARIOUS PHYSIOLOGICAL ACTS.

Dr. R. Dunglison.

BY WILLIAM B. WALLACE, M. D.

Lawrenceburg, Kentucky, March 20, 1840.

To

Sir, as a constant reader of your very valuable periodical, to which my partner Dr. Dedman, of this place, is a subscriber, I have looked with interest in it to see some treatise on the defective and excessive aeration of the blood, as connected with the pathology of disease. My attention was first called to this subject in noticing the astonishing increase of muscular power which is produced by the voluntary inspiration of the largest quantity of air which the lungs will contain. It is tested in lifting heavy bodies, such as that of a full sized man. The person to be lifted will place himself in a horizontal position, and two men, one on each side, will endeavour to raise the body in the usual manner, or without inflating the lungs. They will find that it requires a considerable exertion. Then, at a given signal, each lifter will simultaneously inspire as much air as the lungs can contain, and after breathing repeat the process twice. At the last expiration, by preconcerted signal, they will endeavour to lift the body on the points of their fingers; and it will generally be raised with nearly as much ease as a body not weighing one fourth of its weight lifted in the customary manner. the complete success of the experiment, it will be proper for the lifters to place their fingers in positions most suitable to balance the body, and the person lifted to exert the extensor muscles to prevent flexion of the limbs. In this manner I have seen the body of a man weighing two hundred pounds, lifted with ease, long before Sir David Brewster's letter to Sir Walter Scott on this subject, in which that learned chemist (to the disgrace of philosophy) classes the experiment among his cases of "natural magic," or, as I understand him, a phenomenon inexplicable on philosophical principles. In delivering a course of lectures at Dayton, in Ohio, I ventured to explain this "natural magic" illusion, by assuming that the great ease with which the body was lifted, was occasioned by the stimulating effects of the increased quantity of oxygen imbibed by the blood, and acting directly on the brain and nervous system-thus increasing proportionally the muscular power. A gentleman present, who, perhaps, like Brewster and Scott, had a penchant for the marvellous, objected to the theory, and insisted that to the success of the experiment, it was necessary that the person lifted should also make full inspirations. Some of the gentlemen then tested the principle by lifting inanimate substances, and found the effects of increased respiration equally remarkable in those cases.

When we reason by analogy, on the remarkably sudden and almost entire deprivation of muscular power observable in those who descend into an atmosphere of carburetted hydrogen, [?] which is sometimes found in the bottoms of wells, &c., and by which the system is deprived of the necessary stimulus of oxygen, it seems to me a matter of no astonishment that when, by a voluntary increase of respiration, four or five times the usual quantity of air is inhaled, and the imbibition of oxygen thereby proportionally increased, that there should be a corresponding increase of its stimulating

effect upon the muscular power. As connected with this subject I will refer to the circumstance which is a matter of common observation, that persons who are about to make any great muscular effort, as in lifting, &c., involuntarily make a full inspiration before the exertion. I will merely add, that by voluntarily increased respiration the production of animal heat seems to be also increased, as I have often in very cold weather whilst lying in bed practised it successfully for this purpose.

1

As the subjects to which these hints relate have not been treated on by any authors whose works have come under my observation, I have thought proper to make them, from a desire that others, more competent than myself to investigate, may be induced to direct their attention to this unexplored field of philosophical research, and am very respectfully your obedient

servant.

WILLIAM B. WALLACE.

[The subjects, to which our correspondent attracts attention in the preceding paper, have received more attention than he is aware of. The experiment of raising the human, or any inanimate body on the tips of the fingers, by a joint and simultaneous effort, was tried, years ago, most philosophically in this city, and it was clearly shown, that muscular or animate force was not necessary for the result; but that it could be produced equally well when a simultaneous effort was made by any of the ordinary inani mate mechanical powers. It was but requisite that they should be exerted together, and at once, in order that surprise should be elicited as to the comparatively trifling amount of force that was demanded. We do not think, that Dr. Wallace's hypothesis of the power-communicating influence of oxygen will stand the test of examination. We take in a full inspiration to fix the chest, before we make use of exertion with the muscles that arise from it and pass to the arm. These matters, however, as well as the influence of respiration on calorification, our correspondent will find discussed in the second volume of the Editor's "Human Physiology."

We may add, by the way, that Sir David Brewster meant by "Natural Magic," not "a phenomenon inexplicable on philosophical principles," but one which, seeming to be magical, is explicable on those principles.-ED.]

BIBLIOGRAPHICAL NOTICES.

Report of the State Lunatic Asylum at Worcester, Mass.'

The whole of this report has the same excellencies that were possessed by its predecessors; and its perusal renews our regrets that Pennsylvania is not yet possessed of so admirable an institution as the one from which it emanates. Dr. Woodward deserves great credit for his able annual contributions to the official reports, and for the zeal and intelligence which they exhibit him to possess as the medical superintendent. We feel satisfied, however, that his notions in regard to the causes of insanity are not as historically accurate as he conceives them to be; and that too extensive an agency is assigned to one secret vice, on which we had occasion to express our sentiments in the 2d volume of the "Intelligencer," p. 340.

1 Seventh Annual Report of the Trustees of the State Lunatic Hospital at Worcester, December, 1839. 8vo. pp. 102. Boston, 1840.

The tables contained in the report before us are highly interesting. In table xii. 418 cases are recorded as having been admitted before insanity had continued one year of these, 370 or nearly 9 in 10 have recovered; 48 failed to recover; 34 remain in the hospital, and 17 have died.

There have been in the hospital 161 cases-of duration from one to two years; of these, 96 have recovered or are curable, and 64 have failed to recover, or have died.

There have been 411 cases in which the disease had existed more than two years; of these, 72 have recovered; and lastly, of 247, who had been insane over five years, only 19 recovered.

Table xiv. exhibits the unlooked for fact, that in this institution those over 40 years of age recovered in greater proportion than those under 40.

Table xvi. estimates the number of cases of insanity induced by intemperance at seven and a quarter per cent.

Table xvii. is interesting, and its object will be borne in mind, we trust, in future. The influence of the moon on the insane we regard to be a mere popular superstition, and as such have always denounced it. (Elements of Hygiène, p. 158. Philad., 1835.) Dr. Woodward's results—to use his own language “are far from establishing the common opinion, that excitements come at the full moon."

Prof. T. D. Mitchell's Address to the Medical Graduates of Transylvania University.

The valedictory of Prof. Mitchell is appropriate; and many of his inculcations are eminently worthy of being treasured up by his young auditors. The profession to which we belong is elevated and noble; how much responsibility rests upon its members not to sully its fair banner; yet how often have we to deplore the obliquities of some of them. Nor is this surprising. The portals of the professional edifice are wide and the entrance easy-too easy. Many ill-educated-we use the term in the enlarged senseindividuals are consequently admitted; and liberal and liberalizing as is the study and practice of our calling, it cannot make amends for deficiencies of early breeding, prevent the incursion of uncharitableness, or correct deepdyed moral obliquities. It was judicious, however, in Professor Mitchell to attract the attention of his hearers to this important topic.

“Gentlemen, you are not about to mingle with the world, as physicians only, but also as members of society; and I feel it to be my duty to press upon you, in the third place, the great importance of established and correct principles of action. I am aware, that too many graduates in medicine, place a low estimate on moral tactics; but you may rest assured, that the right observance of these is essential to your true respectability, in every civilised community. It can hardly be expected, that our profession will ever be without bears, and hyenas, to provoke the odium and slander of the censorious. But this should never be allowed to derogate, in the least, from the importance of those traits, which dignify the possessor and bless society. I would fain impress upon you, as a truth, not to be nullified by the lapse of time, that each one of you, will be just what your principles of action shall make you. These, and these alone, will stamp your character, indelibly; they will move every purpose, guide every step, bless or curse. You cannot be ignorant, that nine tenths of the discord and strife prevalent in the medical profession, in all countries, is the fruit of base principles of