The object was to produce partial intoxication and to keep it up. With this view, a half tumbler of whisky was given him at once, though with a good deal of difficulty, owing to the frequent spasms while in the act of drinking. The fluid was administered by means of a pipe-stem put between the teeth, the free end being immersed in the spirits in the tumbler. The spasmodic contraction of the muscles of the jaw sometimes being so great as to deeply indent the stem, and causes the patient to cry out to us to take it away from between his teeth. The whisky was to be repeated every two to three hours, and every two to four hours, according to effect; morphia given.

gr. of

Saturday 12th, 9 A. M.-No sleep during the night past Evidently much worse. Lies now with back much more arched; and cries out with the pain of the spasms every few seconds. Was able only to take some three-quarters of a pint of whisky during the night. Objected to it because of the difficulty of swallowing, and said it also made him sick at the stomach; when well, we learn that, he was not unaccustomed to the use of spirits. Pulse 120; temperature 101; respiration irregular, but about thirty in the minute; on counting with a watch, the spasams were observed to reappear every five to ten seconds, though they are of but two or three seconds' duration; about every two or three minutes one much more violent in character comes on; his whole body is bathed in perspiration, and his arms and legs are perfectly rigid.

We thought it useless to pursue the whisky treatment longer, but commenced at once the use of the calabar bean. For this purpose, we were compelled to use the crude article itself, neither the alcoholic extract nor the tincture being procurable. We happened, however, to have one of the beans, which had been presented us, as a sort of curiosity, by a friend, at the late meeting of the

"Kentucky State Medical Society," and at once sent an order to Mr. Wayne, of the firm of Suire & Co., of Cincinnati, for the extract. Upon being carefully decorticated, we found the contents of the bean to weigh fiftysix grains, and, on pulverizing, two grains were lost; the remaining fifty-four grains we had divided into eighteen. powders, each of three grains, the agreement being to give one every hour, until an effect was produced, then at shorter or longer intervals as might be indicated.

Dr. Rhodes remained with the patient until evening. On meeting again in consultation, at 8 o'clock P. M., he informed me that the first dose was given at 9 A. M., the second at 10, and, no appreciable effect following, at 103 it was repeated, then at 11, at which time no effect, either in a diminution of the general symptoms or by contraction of the pupils being apparent, he continued their administration every quarter of an hour until 2 o'clock, at which time the patient complained greatly of burning pain in the stomach, and a marked diminution of the rigidity of the muscles; the frequency and violence of the muscular contractions, was apparent for an hour, or an hour and a half, i. e.: between two and three or half-past three o'clock; he said that the contractions, though frequently present, were comparatively mild; though, being frequently jerked, he did not cry out. At at one time, he thinks, he went nearly as long as fifteen minutes without emitting any cry. Having given so large a quantity of the medicine, 48 grains, he had concluded to give no more until we should again meet in consultation.

On examining him at this time, 8 o'clock P. M., found his pulse 88 to the minute (the doctor says that between two and three o'clock it was 75); temperature 101; respiration as heretofore, so irregular from recurrent spasms that it was difficult to determine it, but might be placed

at thirty; the skin was still bathed in pesspiration, a little pool of at least half an ounce of sweat resting in the pit formed just above the sternum by the tense sterno-cleidomastoid muscles. He is very thirsty, and still complains of great burning heat of the stomach and bowels, though not nearly so much so as two or three hours since; he hawks up a foamy saliva, untinged by blood, every few minutes, and desires the attendants to constantly fau him. He has passed his water sufficiently freely during the day, and passes a good deal of wind per anum, of which he complains. On observing carefully the rigidity of his limbs it is evident that it has diminished most markedly; he can now lift up his legs, and bend them on the thighs, and the thighs on the pelvis. On making the experiment, I find I can bend the fore-arms and lift the arms from the shoulders, a thing impossible this morning; the rigidity of the abdominal muscles has also much diminished, though is yet very marked. His back and neck are perfectly rigid, though not so arched as hitherto. On examining his pupils, find them contracted and unyielding to light, though not contracted to the mere point, which I supposed the medicine capable of producing-am pretty sure that I have sometimes seen opium contract the pupils more. Despite the apparent improvement in some of the general symptoms, the relaxation of the muscles most especially, the fact is evident that the patient cannot really be considered better. His spasms are just as frequently recurrent now as formerly and of about the same violence. Counting, watch in hand, the poor fellow is racked from seven to ten times the minute. We now

gave a double dose of the calabar bean, the last we had, and applied a blister, three inches wide, over the spinal column, from the nape of the neck to the sacrum, and left grain doses of morphia to be given every half hour pro re rata.

The spasms continued in unabated frequency and violence, despite the regular administration of the morphia in such quantities, and though the blister drew well, he died of asthenia at 6 o'clock next morning. Up to the time of his death, the limbs remained flexible.

To sum up, though the physiological effect of the remedy used in the above recorded case was perfectly evident, which effect in accordance with our pathological ideas of the disease, we would suppose to tend toward overcoming the malady, yet, on taking a retrospective view of the case, we must admit that we can hardly say certainly that the progress of the disease toward its fatal termination seemed in the least affeeted. Had more of the article been at command to use, perhaps the result might have been different, but as it was, the intense burning pain of stomach and bowels, with the salivary expectoration, exhibited an effect disposed to produce some hesitation in raising the dose higher.

In the "Richmond and Louisville Medical Journal" for May, 1869, Dr. Greenleaf sums up 19 cases of tetanus, treated by calabar bean, 12 of which recovered—thus showing, according to statistics, a better record for the "bean," than is shown for any other remedy. Dr. G. very properly concludes his article by saying that in attempting to arrive at the virtues of any article of the materia medica, that only such cases as are recorded are accessible, and that probably "many unsuccessful cases may have occurred of which we are in ignorance, it being unfortunately the tendency of the profession to bury with their patients, the records of such cases."

Nothing in medicine is truer than Dr. G.'s observation, and I think we should ponder it well. The value of statistics in medicine, depends not alone upon the number of cases of disease recorded as cured, but just as much upon those terminating unsuccessfully. One of the strong

est objections to the numerical method of Louis, hard as it is upon statistics, is the imperfection of the records of the successful, and the neglect to record at all those terminating unfavorably.

The history of medicine might not unjustly be compared to a map of the world, and a record of cases terminating favorably alone, would be like a chart which alone had upon its face the open seas, continents and larger islands, showing to the sailor and traveler, the plain sailing and open day-roads of navigation and travel, but making no provision for the storms and the night by marking the shallows and sunken rocks, the breakers and whirlpools, the quicksands, pitfalls, morasses and hidden dangers.

The true value of this new therapeutic agent from which the profession has recently been led to expect so much, will depend upon the future record of all cases treated with it, regardless of their termination.

ART. II.-CASE: AMPUTATION OF SHOULDER JOINT. By HIRAM WANZER, M.D., Chicago, Illinois.

I was called, December 28th, ult., to Mr. C—, German, æt. 51. He was rather spare, small in stature, with constitution not vigorous. He had suffered from the age of sixteen, with discharging ulcers upon one leg and foot, which had healed two years since. He was one of the employees of Moody & Church. While engaged at a surfacing planer, which has a cylinder with three cutting knives, performing some 3,500 revolutions per minute, the fingers of the right hand were caught in the machinery, and its deadly work was not finished until the hand, fore-arm and arm, were drawn in and severed by piece meal, as far as the upper fourth of the humerus; further advance and destruction was prevented by the contact of