More recently, I saw a gentleman who had been seized at 9 o'clock A. M. with a chill, which was soon followed by the most intense head-ache, intolerance of light, pain in the back and limbs, as well as at the epigastrum. Being of a sanguineous and plethoric habit, I bled him; then applied sinapisms to the spine and epigastrium, and prescribed a beverage of cream of tartar and cold water. In the afternoon I found that the fever was still high, that he had vomited repeatedly, was much distressed with nausea, and had been gently purged. The sinapisms were ordered to be repeated, the cream of tartar to be discontinued, and small quantities of iced water to be used to relieve thirst during the night; doses of 5 grs. quinine (in powder) were left, one to be taken in very little water at 4 o'clock the next morning, and repeated every two hours thereafter. I visited him at 8 A. M. and found that the fever had continued high during the night, and remitted only towards morning. He had taken 15 grs. quinine, and now had but little fever, although the nausea still persisted, and had caused him to reject the quinine twice, but which being repeated was finally retained. During this day the febrile exacerbation was much less intense, and he was kept on the use of iced water with a little lime water added to it. On the following morning, the nausea still being troublesome, and, apprehending that the quinine in solution or in powder would be rejected, I gave it to him in pills, 4 grains every two hours until he had taken 16 grains. These were retained, the nausea gradually subsided with the fever, and in the afternoon he was convalescent. He suffered a little from debility, but without further treatment, he was out in a few days. In this case headache and, gastric irritation instead of being increased, subsided under the use of quinine.

We are frequently called to cases in which we cannot ascertain the periods of exacerbation and of remission because of the ignorance of the patient or of his attendants, or because those periods are not very strongly defined. In such cases we may safely presume that the remission, if there be any, will occur in the morning, as this is most usually the case in these affections. And, under this presumption, I always prescribe about 20 grs. of quinine to be given in 5 gr. doses at intervals of two hours, commencing at the dawn of the next day, without regard to any incidental circumstances. This last injuction is added, because without it the attendant may upon some trivial change assume the responsibility of omitting the remedy at the only time when it might be given with decided advantage. I have known several cases to terminate fatally by such omission to carry out the prescription; the excuse being that the patient had too much fever, or head-ache, or nausea, &c. We not unfrequently see cases so late that the life of the patient depends entirely on our ability to prevent another paroxysm. No circumstance then must be allowed to interfere with the use of the only certain preventive with which we are acquainted. If it cannot be given in one form it must be given in another; if the stomach rejects it, throw it upon the rectum. At all hazards, give it. If by this course you happen to

give the quinine before the remissions have been fully established, it will not increase the fever, but on the contrary lessen its intensity, and consequently hasten the establishment of the remission. We frequently induce a very decided remission in cases in which it has previously been very slight, by the administration of quinine a short time after the fever has reached its acme of intensity, as may be seen by reference to the cases just related.

Having thus far restricted my remarks to the use of quinine in fevers uncomplicated with true phlegmasia or inflammation, it is proper that I say a few words in relation to cases we occasionally encounter, in which genuine phlagmasiæ are complicated with remittent fever or the paroxysmal peculiarity. I allude now specially to the form of Pneumonia and Pleuro-pneumonia which has prevailed more extensively in Georgia and South Carolina, (and perhaps in other southern states) during the last year or two than formerly, and which has been attended with an extraordinary degree of mortality. From what I have seen of such cases, and learnt from my professional brethren here, and elsewhere, I am satisfied that whilst the inost striking element of the disease is an inflammation of the pulmonary organs, this is complicated with remittent fever. Indeed they present regular diurnal or tertian exacerbations and remissions of such decided character as to mislead the friends of the patient, and even his physician, into a degree of security which has often proved fatal. Seized with a violent attack of pneumonia, the patient finds himself at once quite ill, but is soon relieved from anxiety by an apparent amelioration of his condition. This continues until the next day, or perhaps the third, when another exacerbation supervenes and rapidly aggravates the condition of the lungs ; but the intensity of the symptoms again abates, and the patient is flattered with the hope of approaching convalescence, until a repetition of the paroxysmal affection places his life in imminent peril, if not beyond the reach of remedial means-and all this notwithstanding a vigorous antiphlogistic course of treatment. This disease has been particularly fatal on our plantations, where the daily or tertian amendments of the patient have induced the owners or overseers not to call in medical aid as early as they would have otherwise done.

In all the cases of pneumonia, complicated as above stated, that have come under my observation, I have not hesitated to combine the use of quinine with that of the lancet, antimonials and opiates, and have uniformly had every reason to be entirely satisfied with the result. They do not require, nor can they bear, the same amount of depletion usually regarded as necessary in common pneumonia and pleurisy, and they very rarely yield to antiphlogistics alone. In furnishing my own testimony to the efficacy of the suggested combination, I might add that of other practitioners of distinction, who, entertaining the same views with myself, have met with similar success. It is scarcely necessary to add that the quinine should be given during the periods of remission, and as liberally as though there were no organ in a state of inflammation.

I have now freely and without reserve, given my views in relation to the use of quinine in our remittent fevers-and in lauding, as I have done, its efficacy, I cannot but apprehend that the charge of ultraism will be preferred against me by those who are still unacquainted with its properties. Be this as it may, I fear nothing from the test of time and experience, and will be amply compensated for the temporary odium, if this article will induce any who may have been backward in the use of quinine to give it a fair trial under the circumstances here recommended. It should be borne in mind, however, that we occasionally meet, even in this latitude, cases of typhoid fever, or of enteritic fever, in which quinine possesses no peculiar efficacy. But these fevers do not present the paroxysmal type, and can therefore be easily distinguished from those in which it is useful.-Southern Med. and Sur. Jour.

Excision of the Inferior Maxillary bone for Osteo-Sarcoma. By WILLIAM H. DEADERICK, M. D., of Athens, Tennessee.-The operation of which I propose to give a very brief account, was performed nearly thirty-seven years ago, and at that period, so far as I am informed, was unknown in surgery. Since that time it has been repeatedly executed, and the claim of having originated it has been set up by a foreign surgeon. By comparison of dates it will be seen that my operation preceded that of M. Dupuytren by two years.

On the 6th of February, 1810, Jesse Lay, a lad of about fourteen years of age, was brought to me on account of an excrescence which gradually arose from his gums, and which, in consequence of long neglect, completely enveloped the lower maxillary bone of the left side. It filled the inside of his mouth to such an extent as greatly to interfere with respiration and deglutition. Externally, the tumor exhibited the appearance of a wen of considerable size, and as it was daily augmenting it was evident that nothing short of its entire removal, with the portion of the bone it occupied, could save the life of the patient. Accordingly an incision was commenced just below the left ear, and continued along the course of the bone to the centre of the chin; a second one was made at right angles to the first. The integuments were then dissected from the tumor, and the bone sawed off at the angle of the jaw, and half an inch from the centre of the chin nearest the angle divided. The integuments were united in the usual manner, and the boy had a speedy and perfect recovery. The youth at the time of the operation, although fourteen years of age, was not larger than boys usually are at ten or eleven; but immediately afterwards commenced growing, and attained the ordinary stature of manhood. A well trained whisker hides, in a great measure, the scar left by the incision, and at a short distance the effects of the operation would not be observed.

Athens, Nov. 1st, 1846.

NOTE. Dupuytren is the generally accredited author of the operation above described. This distinguished surgeon removed a portion

of the lower jaw for a cancerous affection of the gums in 1812. The operation of Dr. Deaderick, it will be seen, was performed two years prior to that time. Dupuytren's case was reported to the Faculty of Medicine at Paris, by Lisfranc, in 1813. The report of Lisfranc is republished in the Dictionnaire des Sciences Medicales, vol. xxix. p. 430. Dr. Deaderick did not give to the public any account of his operation before 1823, when he described it in the American Medical Recorder.

Dr. Mott, in a letter to Mr. Liston, has preferred a claim to priority in this operation. He says, "I claim for myself and my country originality in the operation of exsection of the lower jaw at the temporo-maxillary articulation, and in different proportions for osteo sarcoma. I avow and declare solemnly that before my first exsection of the lower jaw for osteo-sarcoma, I never saw, read or heard of anything of the kind ever having been done in any country." He adds, "We repeat and aver, that the exsection of the lower jaw of even a fourth part, much less a half or two-thirds of it, for any form of sarcoma involving the whole texture of the bone, has never in our opinion been performed by any surgeon, past or present, until by myself at the time above stated."

The operation of Dupuytren is admitted not to have been for osteosarcoma, but for a cancerous sore situated over the angle of the jaw. Ribes, in the Dict. des Sci. Med., referring to this operation, has the following words : "These facts lead to the hope that fungus, or osteo-sarcoma of the lower jaw, a disease so formidable that it has in many cases been vainly attacked with the iron and fire, will henceforward, since the operation of M. Dupuytren be removed by amputation of a portion more or less considerable of the lower jaw without the danger of any accident, and, if the disease be local, with the certainty of success."

Many years before these predictions were uttered in Paris, the operation had been successfully performed by a young surgeon in the backwoods of Tennessee.

In a lecture delivered by Dr. Houston, of Dublin, in 1844, and published the same year in the London Lancet, the honor of having originated this operation is claimed for Mr. Cusack, who has performed it twelve times. The lecturer says, "The grand exploit of amputating the lower jaw, even from its articulations, the boldness of which has been only equalled by its success, has now become a standard operation in surgery. Persons afflicted with the distressing and loathsome disease for which this operation is undertaken, were formerly allowed to die, without any idea being entertained of the possibility of saving them; but now that a great mind, relying on a sound knowledge of the capabilities of the human frame, has set the example of extirpating the diseased mass in toto, many surgeons have fearlessly followed in the path thus laid open for them, and have derived honor from the success which crowned the enterprise. The success of this operation, both as regards immunity from danger, rapidity of convalescence, and the useful quality of masticatory apparatus which follows, is almost incredible."

Upon this passage Dr. Townsend, in his edition of Velpeau's Surgery, comments thus: "To whomsoever, therefore, the honour of this great triumph belongs, mutatis mutandis, the eulogium ought to apply equally well in Dr. Houston's conceptions, who, doubtless, would not desire to diminish one iota of it, because a name of different orthography from that of the justly respected Mr. Cusack, should happen to be found by a species of anaplastic substitution, to dovetail more completely than his with the historic facts in the case. We say cheerfully with all our heart palmam qui meruit ferat!"

Dr. Deaderick's is the name which seems "to dovetail" most "completely with the historic facts," and to him, therefore, must the palm be awarded. True, he operated but once, and his operation was not made known to the world for many years afterwards; but it was undertaken for what appears to have been osteo-sarcoma; it involved the excision of nearly one-half of the lower jaw bone, and was crowned with perfect success. Dr. Deaderick did not call the disease osteo-sarcoma, but, in his account of his operation published in the Medical Recorder, described it as "a cartilaginous tumor." In the brief notice of it given above he applied no name to the affection, and the title prefixed to his communication is ours. Every medical reader knows how vague is the term "osteo-sarcoma," and what a diversity of morbid growths are called by that name. From the description of the tumor in Dr. Deaderick's case we have no doubt it would be styled osteo-sarcomatous.

It appears, then, that Dr. Deaderick preceded Dupuytren in the operation of excising the lower jaw bone two years, and that he anticipated Dr. Mott by eleven years, although he neglected to publish an account of the operation until after Dr. M. had communicated the results of his to the world; consequently Dr. M. was unapprised of what had been done by his countryman. He may still claim "for his country," if he cannot for himself, "originality in the operation," for Cusack's operations were performed two or three years subsequently to Dr. Mott's first. The operation has been performed by Dr. M. seventeen times. In a note appended to his letter to Mr. Liston, Dr. Deaderick's operation is referred to, and this brief, obscure notice is all the allusion to it that we have found in looking through the American edition of Velpeau's great work on surgery. We have deemed it but an act of justice to a modest and worthy member of the profession to give these dates in connexion with the history of his case.- Western Journal of Med. and Surg.

A large Tumour of the Mamma, spontaneously cured. Reported by A. B. GREENE, M. D., of Sumter County, Georgia.-The subject of these remarks is a negro woman belonging to Col. M. A short time after she arrived at the usual age for the full development of the sexual organs, the right mamma was observed to be largest, and inereased in dimensions gradually and continuously, unattended with pain, except what was induced by its suspension, when not properly supported. About twelve months preceding her pregnancy, my at