seemed to have arrived at the poriod of its natural severity, a catarrh of the vocal chords was diagnosed.

The fifth case was something anomalous, a seamstress of eighteen years old, Laura Op. She suffered, perhaps, five years, more or less; but the beginning attack was, for the length of a year, more especially severe. It came on of mornings every day, accompanied with acute pain in the throat-at times, intense stupidity. By violent exertion, overheating and the like, brought on cough, occurring more frequently as time progressed, so that she would have these spasmodic fits of coughing ten to twelve times in the twenty-four hours, one after another, with short intervals of quiet. She was kept on wine, and cared for in a warm room; but in less than a week she was suddenly seized with a general convulsion, and subsequent unconsciousness. During the progress of the case, about the 22d of May, 1862, occurred a similar series of coughing fits. An ordinary respiratory effort, followed by a remarkably hoarse sounding cough, singularly high in tone, ending with a whispering sound. Usually, there followed two or three such fits of coughing, with much apparent effort to cough in the intervals, causing much uneasiness-respiration otherwise normal in the intervals; but much effort very apparent and producing noise. By means of laryngoscopic observation, the throat, the back of the tongue, and the soft palate with the tonsils, present a normal aspect; but menstruation appears more oftener than usual. Examination by the ear showed rattling noises in both sides of the throat during respiration. The cough is a deep, harsh tone, but subsequently, a voice perfectly normal. Cold water cure here advised.

In one case of a ten year old boy, otherwise healthy, affected however, with a slight catarrh, and beside, with a deep, croup like cough, and coughs then as usually in a natural way. So often when he coughs strongly, the cough comes out deep and rough in tone, resembling croup, and is always limited to a sharp or shrill intonation. The larynx and the vocal chords, are proved to be in a normal condition, by inspection with the aid of the laryngoscope.

To conclude this article on spasmodic cough, I will append a few observations from Dr. Tobold:

"Nervous also called spasmodic coughs, have something in common with those that are denominated hysterical. They are characterized by spasms that occur with extraordinary violence. These attacks are separated from each other by long and entirely free intervals. They often appear at certain hours of the day, and are excited by other causes than the various

forms of cough that depend on morbid changes of the mucous membrane of the respiratory branch. In the majority of cases, I have met with nervous coughs in old women; in isolated cases also, in young, otherwise healthy maidens. In some cases, I was inclined to regard a strikingly anemic condition of the mucous membrane of the larynx, as the chief disease. Perhaps the nerve fibres in anemic mucous membranes are more inclined to hyper æsthesia."

Dr. Tobold recommends the use of a sponge applied locally, the same being saturated with tinct. ferri chlorid; also the use of electricity; other tonics also to be employed assiduously at the same time. Our few laryngoscopists in this country, use alum and glycerine locally, with much apparent success, combined with constitutional tonic measures.

FORTY YEARS' PRACTICE, OR REPORTS OF EXTRAORDINARY CASES.

BY NATHANIEL FIELD, M. D.,

Of Jeffersonville, Indiana, President of the Indiana State Medical Society.

Forty years in the medical profession, will familiarize the physician with all the diseases to which flesh is heir in the locality of his practice. He will become experimentally acquainted with their symptoms and treatment; so that when he meets with a case, however dangerous and complicated it may be, he is not compelled to resort to his books to enable him to make out a correct diagnosis, or to treat it successfully. Having often seen and combatted it before, he is fully prepared for it again. He is practically acquainted with the different modes of treating it, and he has firmly settled down upon what he considers the best remedies in the case. It matters but little to him what may be the speculations with regard to the etiology or pathology of the disease, or the modus operandi of the medicines which he knows will cure it. Having often administered them in similar cases with success, he is willing to trust them again. This is what we call "practical knowledge or experience," supposed to be of more value than the knowledge of a score of medical novitiates.

But in the course of many years' practice, cases will arise of an abnormal or extraordinary character, for which we have neither authority nor precedent; and which will tax the judgment of the physician to its utmost capacity. The following case is an illustration:

Some years ago, a small boy about five years of age, residing in the

city of Jeffersonville, apparently in perfect health, and while at play with other children of the family, was suddenly attacked with an epileptic fit, from which, however, he soon recovered. I was sent for to see him, but before I arrived, he was as well as though nothing had happened, having resumed his customary amusements. The parents of the boy were much surprised at the occurrence, and were unable to account for it. There was nothing in his appearance to indicate the slightest predisposition to the disease. He was the very picture of good health. As no cause could be discovered for the convulsion, and as there was no fever or any other sign of disease, no prescription was made.

About two weeks afterward he had another strong convulsion, lasting several minutes; but as before, passed off without any constitutional disturbance following it, and he was soon as rational and playful as ever. Being at the time absent from my office, Dr. W. F. Collum was called in, but finding the boy perfectly well, and like myself, not being able to detect any cause for the attack, and conjecturing that he might have worms, prescribed some anthelmintic. No worms, however, were expelled. In a day or two the fits returned, and were repeated at short intervals for about ten days, during which time I am confident he must have had a thousand! After an ineffectual effort to arrest them, Dr. Collum retired in despair. I was again summoned to attend him, and exhausted every resource in my power to relieve him. The family were in great distress and were prodigal in the employment of the best medical advisers. Prof. Powell, Prof. Drake and Dr. Richardson, of Louisville, were called in to assist me in searching out the mysterious cause of the terrible affliction. The patient was examined from the crown of his head to the soles of his feet, in the hope of detecting some local irritation, but none was found. After a few visits, the first two distinguished gentlemen, satisfied that nothing could be done to arrest the convulsions, abandoned the case. Dr. Richardson, however, persevered in assisting me to the end, curious as it seemed to me, to see the result. As he made but one visit a day, the burden of the labor necessarily devolved on me. Day and night, I was annoyed with repeated calls to visit the patient, and "do something for him." It was impossible to sleep at home or at the residence of the distracted family. Every antispasmodic had been tried in vain. All kinds of remedies, internal and external, based upon all manner of theories and hypotheses, respecting the pathology of the disease, had been employed to the fullest extent, and to no purpose. The convulsions were still

going on at intervals of ten minutes, defying the combined wisdom of two medical schools and two old doctors besides.

Driven to desperation, and worn out with fatigue and anxiety, I resolved to sit by the bedside of the patient one whole night, and try, if possible, to ascertain the cause of the trouble. It was in the month of December; and, long as the night was, I requested the family to retire to rest, and leave me alone with the patient, assuring them, if he grew worse, they should be notified of it. They assented to the arrangement, and I accordingly took charge of the patient for the night.

From the first, I had come to the conclusion that the irritation, whatever it was, had its seat somewhere in the periphery of the nervous system, and not in the encephelon or medulla spinalis, as my friend, Dr. Richardson, supposed; and the idea occurred to me that if I would notice what muscles were contracted first when a paroxysm came on, it might possibly give me a clue to the precise point of irritation, and, perhaps, the cause of it. With this impression, and in the hope that I might make a discovery that would relieve the little sufferer and myself, I carefully watched the commencement of the paroxysm. I observed that the muscles of the left side of the face invariably began to twitch on the recurrence of a fit. After the passing off of a convulsion, and while in a state of unconsciousness, I raised the upper lip as high as possible, and passed the index finger of the right hand around the alveoli, and lo, and behold! the corona of the second canine tooth, instead of having caused by its pressure the absorption of the root of the deciduous tooth, had passed behind it and forced it through the alveolus and gum and into the lip. I had often seen the same thing, but as this little boy was not quite old enough to shed his first crop of teeth, nothing of the kind was suspected in his case. Fondly hoping that I had found the latent cause of the frightful malady, I hastily slit the gum vertically and removed the old tooth. After pressing the edges of the incised gum together, and wiping the blood from the lips, I sat down to await the result. In less than an hour the convulsions began to subside, and before day they were entirely gone. As soon as it was light, the parents of the child entered the room, anxiously inquiring how he was. I informed them that between midnight and day the fits entirely disappeared. They could scarcely believe it. But there was the patient as bright, cheerful and rational as though he had never been sick. They were at a loss to account for the wonderful change; and acted as if they thought I had performed a miracle on

their son. I did not relieve their suspense, but kept what had transpired during the night a profound secret from them and the numerous friends visiting the house. I did not tell Dr. Richardson, who visited him in the afternoon, as usual; but left him in the dark as to the sudden change. He manifested much surprise; and made many inquiries, respecting the treatment during the night-whether any new remedy had been tried, and how it came that the fits left so abruptly under the treatment which had hitherto proved a failure. But no explanation was given at the time, and not until the family had removed from Jeffersonville, did I reveal to my colleague the facts in this singular case.

My reason for this reticence was, that I felt that the oversight of the cause of all the suffering to patient and relatives, and all this labor and vexation to the physicians in attendance, was a reproach to the profession.

It was a humiliating reflection, that five old and respectable practitioners of medicine, and two of them professors in medical schools, should allow a child to have fits for ten days, the result of so simple a cause, and not soon detect it! Here we were, day after day, holding consultations and philosophising about the pathology of the diseaseone proposing the moxa, another ptyalism, another a blister on the head or the nape of the neck, and another something else equally as useless and injurious, when there was nothing the matter but an insignificant mechanical irritation, which could have been removed in one minute, provided we had been blessed with just common sense enough to see it.

*ON THE IDENTITY OF THE WHITE CORPUSCLES OF THE BLOOD WITH SALIVARY, PUS, AND MUCOUS CORPUSCLES.

BY JOSEPH G. RICHARSON, M. D.,

Formerly Resident Physician at the Pennsylvania Hospital.

The nature of the nucleated corpuscles so abundant in the saliva has long been a subject of some uncertainty, and although they have probably, as favorite test objects for the higher powers, been more frequently examined by microscopists than almost any other constituent of the glandular secretions, observers seem to have been generally contented to accept them simply as useful measures for the capacity of the

*Pennsylvania Hospital Reports, 1869.