was wiped he faid it felt cool and comfortable; the rigidity of the muscles appeared, to abate, and a glow of heat fucceeded. The eruption noticed on the twenty-fixth, had now extended itfelf to the thighs. I ordered the cold water to be continued every two hours, increafing the coldnefs and quantity if it proved useful. These favourable symptoms continued for about half an hour; but the difcafe appeared to return with redoubled violence, especially on attempting to drink, which nearly strangled him, and prevented the use of any thing but a little wine. The use of the water was fufpended. At eight P. M. the pulfe flagged confiderably: I ordered the wine to be continued ad libitum, with thirty drops of laudanum every two hours; to rub in 3fs. of strong mercurial ointment every hour into the thighs, and five grains of calomel every two hours into the gums.

29th. The laudanum last night gave him almost immediate relief, and he dozed, without fpafms during the night, being awakened regularly to take his medicines. Butter of antimony was applied last evening, but only partially, as it gave him exquifite paio, and appeared to augment the fpafins. The fores have a floughy appearance; continue to wet them with the fpirits. The eruption has increafed fince yesterday, fome being of the fize of a small pin's head and filled with a whitish matter. Urine is paffed without much difficulty or fcalding, in larger quantity, and lefs coloured. A pulfation of the heart, which was first obferved three or four days ago, has become very violent, and is visible at a confiderable distance from him. It was remarked to be always greatly increased during his convulfions, but it is now more uniform. The pulfe both here and at the wrift beats about one hundred and twelve, but is ftrongeft in proportion at the heart. He fwallows with more eafe this morning, and the muscles of the back appear lefs rigid, as the arch formed when he is turned on his face to drink, is lefs than heretofore, and he now can drink flowly when lying on his back. His gums feem flightly affected by the mercury, of which he has taken about 3fs. and nearly half a pound of the ointment has been faithfully VOL. I.

I

subbed in. As he had had no ftool fince the twenty-third, I ordered a common glyfter, which operated once very copiously, with apparent benefit, the spasms recurring less frequently, and he can open his mouth nearly one half inch. The muscles of the body generally, are more relaxed, fo as to give great hopes of a favourable iffue. I prefcribed thirty drops of laudanum every hour, to continue the ointment every two hours, and defired the calomel to be omitted.

At 2 P. M. there was a remiffion of all the symptoms, and he feemed apparently better than he had been fince his first attack; his fpirits were high, and he eat voraciously. Appearances continued thus favourable till about 6 P. M. when in the act of drinking, a most violent convulfion seized him, in which his body was bent nearly into the form of a femicircle backwards; the muscles of the neck were particularly affected. This convulfion lafted without any abatement for about an hour, his face becoming very livid and respiration very torpid; the pulse at the wrift being scarcely perceptible, whilft the convulfive motion of the heart was greatly augmented; and at feven o'clock death released this unfortunate victim from his accumulated fufferings.

DISSECTION.

At to A. M. of the thirtieth, fifteen hours after his decease, the body was opened, the muscles remaining ftill rigid, though feveral purple blotches over the body and extremities, appeared to denote the tendency to putrefaction. The abdomen was much diftended from flatus in the alimentary canal. The adipofe matter was very fmall, the foetor confiderable. Of the omentum scarcely any thing remained but a thin transparent membrane. The stomach externally was found, but internally were several small appearances of inflammation, especially near the pylorus. It contained the panada he had laft taken, mixed with mucus, in amount about three-fourths of a pint. The spleen was altered flightly in its colour, being of a deeper leaden hue than natural. The liver was found; the gall-bladder large

and diftended with yellow bile, which had tinged the adjoining parts very confiderably. The kidneys and ureters were found; and the bladder, containing about two ounces of urine, was contracted, and its coats thickened, especially at its fundus. No inflammation appeared in it. The thoracic vifcera were found, except the heart, which appeared to be smaller than usual, and to be still under the influence of that spasmodic action which exifted fo powerfully in his laft moments. The carnæ columnæ especially appeared to be in a state of ftrong contraction, being permanently rigid, with none of that flaccidity, which might have been expected so long after death had taken place. The blood was not in coagula, but diffolved like molaffes, as in animals killed by lightning, appearing to indicate, that the whole mufcular fibres of the arterial fyftem had partaken of the general fpafmodic action.

On examining the throat, &c. the oefophagus was perfectly found, but the epiglottis and trachea were highly inflamed, especially the laft, increafing in redness as we approached to the lungs.

In the course of the disease, the patient took about 2400 drops of tincture of cantharides, about 2000 of tincture of opium, befides the quantity used in the glyfters, and nearly three gallons of wine.

I do not recollect any case recorded of diffection after death from tetanus. It remains therefore to be afcertained by future obfervation, whether inflammation of the trachea always exifts. From the neck being a part generally first affected in this disease, we might à priori judge this to be the cafe. One circumstance to be remarked however is, that in the above cafe no difficulty occurred in swallowing fluids, (except that only a fmall portion at a time could be taken,) which might not have been expected, confidering the highly inflamed ftate of the adjoining parts.

As all the muscles partake of the fpafmodic action of this disease, even the bladder, intestines and heart, may we not reafonably conclude, that the arteries partake in common of the fame ftate, in a greater or lefs degree? Will not this state of the

arteries, account for the apparently weak and quick pulfe, which is common in tetanus, and which is feldom excited to febrile action and fulness, even by the largest dofes of wine and laudanum? And may we not hence alfo explain the great tendency to folution of the blood, which is noticed in this disease? What would be the effect of bleeding in small quantities, and gradually increafing the quantity drawn, in removing this spafmodic ftate? Would not a vigorous action of the vessels be thereby excited, and an inflammatory cruft produced on the blood; as has been obferved in fome very malignant cafes of fever, where the depreffed puife and diffolved blood have gradually given way to violent action and fizy blood, requiring a continuance of the ufe of the lancet with greater freedom, to fubdue this more active, though lefs dangerous ftate of fever?

Is it not probable that the ftrangury (except in the very first inftance) was owing to the difeafe, and not to the medicine. taken, as it was always very trifling, even under the large and repeated doses of the tincture of cantharides? And has not this medicine rather proved beneficial by the inflammation it excites in the ftomach and bowels, than by its action on the urinary organs? for otherwife we muft fuppofe the ftrangury from the medicine and from the disease to differ greatly in their effects upon the fyftem.

Auguft ift, 1804.

An Account of the Efficacy of Sugar of Lead in curing Epilepfy. By BENJAMIN RUSH, M. D. &c. in a Letter to Dr. JOHN REDMAN COXE.

DEAR SIR,

A

BOUT four years ago, Mrs. Toy of Southwark brought her fon to me, a boy of ten years old, who, she said, had been afflicted for fome time with epileptic fits. I prescribed for him a pil of two grains of the acetate, commonly called fugar of lead, three times a day. In a few months it perfectly cured him, and I had the pleasure of hearing a few months ago, that he has continued ever fince to enjoy good health.

In the year 1802, I cured a boy of Mr. Robert E. Hobart of the fame disease, by the use of the fame dofe of the fame remedy. This boy was of a full habit. Previously to his taking the medicine, I drew eight ounces of blood from his arm, in order to increase the effect of the medicine, agreeably to the practice of Dr. Sydenham in a fimilar disease.

I am now adminiftering it to a boy of Mr. Adam Stricker, aged twelve years, in a low grade of epilepfy which had affected him for fome months. It has prevented a return of his fits nearly two months, and I am difpofed to believe it will finally cure him.

I have used the sugar of lead in feveral cafes of epilepsy in adults. In one of them it fufpended the fits for feveral weeks, but I am forry to add, in no cafe did it perform a cure.

The epilepfy is not fingular in yielding to medicines under puberty, which have little, or no effect, in adult age. Pulmonary confumption, chronic eruptions upon the head, fcrophula, the chorea fancti Viti, and several other diseases are often cured under puberty by remedies, which are ineffectual after the oneand-twentieth year of life.

Confidering how often epilepfy, and other convulfive diseases make their first appearance in childhood, and under puberty, it is confoling to reflect that we are poffeffed of a medicine which promises to be useful in them.

Left it should be fuppofed, the change which puberty makes in the fyftem concurred in the cure of the above cafes, it may not be amifs to add, that two of the subjects of them were under twelve, and the other between twelve and thirteen years

of age.

I was first led to prescribe the fugar of lead in the epilepfy, by hearing that a man had been cured of it, by fwallowing part of a table spoonful of white lead by mistake, inftead of a table spoonful of loaf fugar.

From, dear Sir,

August 2, 1804.

Yours fincerely,

BENJAMIN RUSH.