"February 15th, 1814.

"A stout, rugged, hardy fellow, of five and forty, had inAlicted a very narrow wound on his knee, but which had penetrated the capsular ligament, in the hollow near the patella. He had but little pain, and continued to hew with his broad-ax, (the instrument which had caused the wound,) for two or three days longer, till inflammation and pain commenced, with synovial discharge; the night after which he was seized with severe spasms extending up the large muscles of the thigh, which laid hold of the xiphoid cartilage and jerked it back towards the spine with great force. Under these circumstances I first saw him. I expected the immediate appearance of tetanus. The knee was very hot and inflamed, but his pulse was very obscure. I was much tempted to bleed him ad deliquium animi, according to the successful treatment of hydrophobia, but finally determined on the plan of mercury and opium; the opium soon induced intoxication, which was kept up for forty-eight hours, during which time the spasms disappeared; a large saturnine poultice was also applied to the knee. After this time the spasms were confined to the knee and its neighbourhood, but without pain, excepting in one point about two inches below the joint, without the smallest symptoms of inflammation. The pain in this part was intolerable, particularly at night. The swelling diminished in the joint, and with the use of anodyne liniments, and sedative or astringent poultices, the pain in a degree subsided for some weeks. It then returned in the same point; the knee swelled, the veins became turgid, and all the phenomena of white. swelling of the joint were assumed, except that pain remained in the point mentioned below the joint, which was entirely free from pain. There was little general fever; the pain was excruciating; he screamed day and night; no external application would give him the slightest relief. Large quantities of laudanum alone gave temporary ease; but even these began to fail. He had slept none for sixteen days and nights; his leg

and foot became edematous. The sensibility was extreme; touch him in any part and he was instantly all in motion, except his leg and knee, which nothing would induce him to move, and which he would suffer none to touch. He begged me to amputate the limb. But I still thought I could relieve him by mercury, and waited several days for a more tranquil period, in which the general system might be more obedient to the mercurial excitement. At the time mentioned, his pulse, instead of beating like a small cord, became more open. I then gave the mercury freely internally, and immersed the whole leg and foot in strong mercurial ointment. The mercury now soon brought the system under its influence; the excitement perceptible in the arteries; but no swelling of the gums, mouth or throat. The pain instantaneously left him. The swelling gradually disappeared. The mercury was continued for two weeks, at the end of which time I had him out of bed; and the flexor muscles of the leg are now regaining their elastic power.-I know not whether this case is very singular; I had one before somewhat similar, which I believe I communicated to you. You will ask why did I not bleed? After the use of the mercury and opium in the first instance, there was a peculiarity of pulse and countenance which deterred me. Something which I cannot describe, but which from experience had proved, that bleeding would not remove. Possibly, had I bled at first, much pain and labour might have been saved, and a safe period for the exhibition of mercury might have been presented. I have had few late publications, and am so much out of the way of the practice of others, that I know whether there is any thing new to you in this case; if not, take the design of being useful in place of the usefulness."

Yours truly,

Dr. Thomas P. Hereford.

WILLIAM WATSON.

REMARKS.

THE treatment of this case strongly exemplifies the power which mercury possesses to alter and control the morbid condition of the living human system: and whilst we witness its effects, we lament that we know so little of its modus operandi. Many learned and ingenious opinions have been advanced on the subject, but not one adventurer has been so fortunate as to elucidate the mystery. Though thus much, with no small share of satisfaction, we acknowledge to know of mercury, that, with its ordinary properties, it possesses a peculiar stimulant and alterative one; and that it is by this quality that it exerts a specific power in regulating and controlling the living actions of the human body. In the case before us there appears to have been something pathognomonic in many of the symptoms, and it certainly was a very desperate one. I am led to suppose that nothing but the severe local pain and morbid sensibility of the organ of touch prevented it from assuming all the symptoms of tetanus. I am also much disposed to believe that bloodletting would have been highly important in it had it preceded, or even accompanied the use of mercury; particularly if the man had been bled ad deliquium animi: For in such cases, the blood vessels being robbed of their due excitement by the muscles and nerves, bleeding sparingly would probably do little or no good; as it requires, to take off excess of nervous and muscular excitement and consequent irritability of the muscles, that the whole system should be thrown suddenly into a state of relaxation by copious bloodletting. At this period the blood vessels seem to draw upon the nerves and muscles for excitement, and thereby lessen and interrupt the morbid associations of the general system. This then affords a favourable opportunity for the introduction of mercury; it now much more readily imparts its stimulus to the system, and extinguishes morbid action, by establishing its own proper and specific excitement. But as VOL. V. No. 18.

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this patient lost no blood, I presume the remedy had to conflict with morbid excitement for a longer period before it could predominate. The topical application of the ung. merc. in the liberal manner in which it was used, must have been judicious and useful, uniting emollient with alterative virtues. I never employed it in similar affections but once, when it was attended with very happy conséquences; and it was upon the authority of my friend Dr. Watson that I then resorted to it. I also gave mercurials freely internally, and bled the patient copiously. The mercury quickly produced a ptyalitic effect, the symptoms yielded, but the patient recovered the use of the limb very slowly, notwithstanding the mercurial excitement was supported during the convalescence.

Although I have in these remarks supposed that venesection would have been a valuable auxiliary in the treatment of Dr. Watson's patient, I feel myself free to say that I am not confident thereof. Perhaps that indescribable something, which he has allusion to, derived from experience, and which was the result of personal observations made by a man, whose mind is at once cool, sober, discerning and apt; never rash and impetuous, but bold where boldness is required, and cautious when caution is necessary, may have well directed him in the management of the case; in fact the result has proved it, for if the advances towards the cure were not so rapid as I have supposed they might have been through the agency of the lancet, they were patient, ingenious, firm and successful. My design has been to draw the attention of the public to a remedy which I consider a sine qua non in most of those violent spasmodic affections arising from injuries of the joints; it seems to be too much confined to the diseases of the bloodvessels, and too seldom addressed to affections of the muscles from the action of local irritants.

FOR THE ECLECTIC REPERTORY.

Description of a Sick-Bed, proposed by JOHN RHEA BARTON, of the Pennsylvania Hospital.

THE Conveniencies of a sick-bed, and the disadvantages of the common kind, in the treatment of many medical and sur. gical cases, are already too well known to require any repetition. All that seems necessary here, is to state one or two of the principal objections to Earle's bed, as an apology for the construction of another for similar purposes. These are, that its great expense and complicated structure appear to prevent its use, except in a very few instances; and that the patient always requires at least two persons to assist him.

As the bed-stead and mattress, to be hereafter described, are more simple than the former, and the expense amounts only to about one third of it, and the patient is able to assist himself, merely by turning a crank at the side of his bed, if it possesses no greater advantages, it may seem worthy of

some notice.

In this bed, a broad board is substituted for a sacking bottom. In the centre of this board is a circular perforation, the diameter of which is about nine inches; on the under-side are placed longitudinally two cleets, distant from each other twelve inches, and including the hole; between these cleets is placed a kind of lid, the width of which is twelve inches and the length sixteen, and is hung by two hinges at its upper extremity, or that nearest the head of the bedstead, in such a manner that it comes directly under the hole in the board; at its lower extremity is attached a clamp or cross piece which projects on each side about an inch. Another piece is made precisely similar to the lid, except that instead of being suspended by hinges, it is made to slide between the cleets, and in the centre a hole is made to correspond with that in the broad board.