BIBLIOGRAPHICAL NOTICES.
Report of the Pennsylvania Hospital for the Insane, for the
year 1852. By Thomas S. Kirkbride, M. D., Physician to
the Hospital.
Dr. Kirkbride’s Twelfth Annual Report presents a most gra-
tifying account of the noble Institution under his charge. “ It
closes its twelfth year,” we learn, “ in a state of high prosperity ;
its buildings about as extensive as are desirable, nearly every
room in all its wards constantly required to accommodate those
who resort to it for relief, and its means of adding to the com-
fort and happiness of its patients, and carrying out a liberal
course of treatment, steadily rising in character, and increasing
in number and efficiency.”
The most important improvement made in the Hospital, during
the past year, is the introduction of gas for lighting the Hospi-
tal buildings. It is brought a distance of nearly two miles from
the Philadelphia Gas Works ; and its “ convenience, cleanliness,
safety, and economy” have been made so apparent, that Dr.
Kirkbride views it as really indispensable in an Institution
of the kind. And he considers it, besides, an important
remedy :—
“ The effect of cheerful, well-lighted halls and parlors is most strik-
ing upon every class of patients, as will readily be acknowledged by all
who have watched their appearance or heard their remarks, where an
improved mode of lighting has been introduced. There can be scarce
anything more dreary about such establishments at night, than the ap-
pearance of their long halls so dimly lighted as barely to prevent per-
sons runniug against each other, or parlors in which no one can read
but in immediate proximity to the feeble lamp. When it is remember-
ed, too, that the period during which this state of things exists, is often
for at least six hours out of the sixteen that patients are out of bed, it
may readily be understood how important it is to change all this gloom
into cheerfulness, and to substitute a bountiful supply of gas-light for
the obscurity commouly connected with ordinary lamps.”
Institutions, distant from large cities, “ can have the gas made
on the premises, about as cheap as it can be ordinarily bought,
and without difficulty, risk, or trouble of any kind.”
Among the points to which Dr. Kirkbride particularly adverts
in the Report before us, is the importance of a farm and
garden as an appendage to an Hospital for the Insane.
« No new Institution, I feel quite confident,” he says, “will hereafter be
put up on less than one hundred acres,which amount seems to be indispen-
sable to give the proper degree of privacy, to provide sufficient means of
labor and of exercise, and to furnish the supplies that are required.
It also seems well established that a wise foresight, sound views of the
objects and real capabilities of Hospitals for the Insane, and true
economy, should lead the older Institutions, less fortunately situated,
at the earliest possible day, to dispose of their present establishments,
and to provide new ones in more favorable locations. The experiment
of transferring a Hospital for the Insane from a city to the country,
of substituting new for old buildings, and having more than a hundred
instead of a few acres of land, was made by the Pennsylvania Hospital
in 1841, and I presume no one will now be found to doubt the pro-
priety of the course adopted, nor to raise the question, whether the
results of that change, costly as it was, have not been such as to justify
all the expense that was incurred.”
Among the desirable improvements that have been lately added
to the Institution,we notice with pleasure a calisthenium, intended
to give the female patients the free use of calisthenic exercises.
To free muscular exercise in the open air, Dr. Kirkbride attaches
prominent importance as a therapeutic resource in the treatment
of nervous disorders—quite as essential for the female as the male
sex. “ Muscles versus Nerves” is the motto which has been pleas-
antly adopted for the new calisthenium; and Dr. Kirkbride very
aptly introduces the following strain of remarks “from an intellig-
ent patient, in noticing this motto: ”
“ She very naturally inquired whether, if it was true that the use and
development of the muscles kept down nervous irritability and removed
nervous diseases, some very marked change had not come over the
views of professional men and hospital practice, for that, in her early
experience among the excited class, the grand object seemed to be to
keep down and weaken the muscles, and let the nerves take care of
themselves. Or else what could mean the varied and systematic
modes of direct depletion, with the low diet, and, above all, the
studied efforts to keep quiet these same muscles, either in a forced
recumbent position, or worse, if upright, in that machine, whose title
seems to have been framed in bitter irony of its real effects, the
tranquillizing chair? It seemed as though some grave surgical dis-
ease might be supposed to exist in every part of the body, which the
slightest movements of the muscles would aggravate. The muscles of
the tongue, however, were left at liberty, and full advantage was gene-
rally taken of this partial freedom, to give them, at least, abundant ex-
ercise, to the great annoyance of all in the vicinity. This criticism on
that mode of treatment could hardly have been more pointed or more
just. Much as it might reduce the muscular system, the experience
of this, and of most other patients, would certainly be, that the re-
duction brought with it neither tranquillity to the house, comfort to the
afflicted, nor composure to the disturbed mind.”
We close this acceptable report, with the warmest feelings of
gratification at the renewed evidence which it offers, of unceasing
devotion to the physical comfort and therapeutic management of
the insane.
On the Employment of Iodide of Potassium as a Remedy for the
Affections caused by Lead and Mercury. By M. Melsens.
Translated by William Budd, M. D. [Published in the British
and Foreign Medico-Chirurgical Review, for January, 1853.]
Dr. Budd, in his preface to M. Melsens’ Memoir, very justly
observes, that, “if as M. Melsens alleges, and as his numerous
experiments seem conclusively to show, iodide of potassium is not
only a safe, certain and radical cure for the common forms of
saturnine and mercurial poisoning, but an equally sure preventive
of the injurious effects so frequently produced by emanations from
lead and mercury, the fact is one that cannot be made too
widely known.” And M. Melsens has attempted further to es-
tablish a relation between the iodide of potassium and mercury,
as therapeutic agents, which is no less deserving of attention.
His starting point in reference to mercurial and saturnine poison-
ing is, that the metallic substance is in actual union with the affected
part or parts, and is retained there in the form of some insoluble
compound. “The iodide of potassium, after its absorption into
the blood, combines with the metallic poison, and forms with it a
new and soluble salt—liberates the poison from its union with the
injured part—dissolves it out, so to speak, from the damaged
fibre, and sets it once more afloat in the circulation.” And the
double iodide of mercury (or lead) and potassium is assumed to
be eliminated through the kidneys almost as soon as formed, with
any excess of iodide of potassium present.
The modus operandi of the antidote proposed here is apparently
in antagonism with established views of antidotical action. In
attacking a poison in the stomach, our purpose is to convert it
from a soluble to an insoluble compound, with the aim of prevent-
ing its absorption into the circulation. But the object here is
the reverse, to restore the poison to the current of the circula-
tion, and cause its final elimination by uniting it with a substance
readily cast out of the system.
It appears, from the experiments of M. Melsens, that the kid-
neys are the principal outlet for the iodide of potassium from the
system ; that, under ordinary circumstances, it is seldom or never
traced in the fecal evacuations ; and that even when associated
with active purgatives, it is with extreme difficulty made to pass
through the bowels into the stools. So much for the channel of
elimination. The essential chemical point in the eliminative
process is the fact that all the mercurial and saturnine compounds
which can possibly occur in the economy, are soluble in the
iodide of potassium ; the presence of the organic substances of
the body not hindering these reactions. We quote at length
M. Melsens’ views and statements on these questions; and first
as to mercury:
“It is well known that persons who have undergone mercurial treat-
ment have observed, even after an interval of many years, that gold
placed in contact with their perspiration has become coated with mer
cury, especially when excessive perspirations have been caused by the
use of the vapor bath. If this fact be true, it proves that the system
may absorb and retain mercury for a long time under forms which I.
will not try to define, but which very probably result from the insoluble
compounds which the salts of mercury form, either with the organic or
inorganic materials of the body, or with both conjoined. Perhaps the
mercury may even occur in the metallic state, as some have admitted;
at any rate, it is present in the body in such form as to be retained
there. The principal combinations which might thus occur may be re-
duced to the following:
1.	Combinations of corrosive sublimate, whether in its simple state,
or as modified by the animal substances of the economy—namely,
a. With albumen.
Z>. Albumen, and the materials of the brain.
c.	Gelatine.
d.	The nitrogenous extractive matters of the blood, of muscle,
of the urine, &c.
e.	Albumen, fibrin, muscular fibre, pelatine, whether in the
natural state or modified by digestion.
f.	Matters of the bile.
2.	Mercurial soaps.
3.	Phosphates of mercury.
4.	Mercury in the metallic state. (?)
All these compounds are soluble in alkaline or neutral pure iodide ot
potassium dissolved in one of the liquids of the body. I have made
experiments with each of the compounds here enumerated, and have
always succeeded in dissolving them under whatever circumstances. If
the iodide of potassium be associated with a dilute acid which has no
energetic action either on the solution of the salt or on the principles
which occur in the body, the solution of the fixed mercurial compounds
is still effected perfectly. In obtaining this last result I operated with
lactic acid. After fixing corrosive sublimate on nervous filaments,
muscular fibre, or on tendons, it is only necessary to wash them for a
short time in a solution of iodide of potassium, whether acid, alkaline,
or neutral, in order to remove entirely the mercurial salt. It is espe-
cially with a solution of albumen and sublimate that these properties
admit of being perfectly demonstrated; indeed, the experiment has been
for many years a class experiment in M. Dumas’ course at the School of
Medicine. It is only necessary to pour a solution of iodide of potassium
on the precipitate formed by albumen and sublimate, in order to see the
liquid become instantly limpid. The iodide of mercury possesses a
property which I must not omit to point out. This compound, as is
well known, is soluble in caustic potash. Now, although caustic potash
is not found in the living body, the alkalinity of the greater number of
the greater of the fluids which are found there is worthy of being borne
in mind, and acquires a certain degree of interest when viewed in rela-
tion to the following experiment. Mercury coarsely divided was placed
under a layer of water holding in solution caustic potash and iodide of
potassium. After some weeks’ contact a considerable quantity of mer-
cury was found dissolved in the liquid.
It is well known that metallic mercury in contact with alkaline
chlorides in solution, itself passes in part to the state of chloride. It
remained for me to prove that this reaction might occur in perfectly
neutral or even in alkaline fluids. It was necessary in this experiment
to guard against the intervention of the carbonic acid of the air, or of
the acids sometimes diffused in the air of chemical laboratories. It ap-
peared to me quite necessary to make this experiment, especially as it
was possible that mercury might exist in the body in the metallic state,
and yet act as a poison ; in which case, the experiment I have just cited
would still permit the hope that the poison might become dissolved by
the action of the iodide of potassium, rendered alkaline by the fluids of
the living body.
When metallic mercury is shaken in a solution of iodide of potassium,
whether neutral or slightly acidulated with hydrochloric acid, the solu-
tion soon acquires an alkaline reaction—an incontestable proof that the
oxygen of the air has laid hold of the potassium of the iodide, which, in
its turn, has yielded its iodine to the mercury, the iodide of mercury
thus formed having entered into combination with the iodide of potas-
sium remaining in excess. It suffices to shake vigorously a neutral or
slightly acidulated solution of iodide of potassium with an excess of
mercury, for the space of a minute, in order to see the reaction occur.
This might be easily done as a class-experiment, to show the tendency
of the alkaline haloid salts to form double salts with the corresponding
haloid salts of the metals properly so called. An analogous phenomenon
may be observed, although less readily, with common salt, and, indeed,
simple potash excites the oxidation of mercury, and dissolves small
quantities of the oxide. When these experiments are made in closed
vessels, it is easy to demonstrate the disappearance of oxygen, by ana-
lysing the air which has been operated on.’’
The solubility of the compounds of lead in iodide of potassium,
is, it is admitted, of more difficult proof. On this point he says:
“ I shall content myself with observing, therefore, that the iodide of
lead is soluble in alkaline liquids, and that it has a marked tendency to
combine with alkaline iodides. These facts have appeared to me to
constitute adequate motives to induce medical men to employ the treat-
ment by iodide of potassium for complaints which, however much they
may be relieved, are, according to our best physicians, rarely, if ever,
radically cured.
“ I have proved that metallic lead becomes dissolved in a solution of
iodide of potassium, rendered alkaline by potash. It is well known how
rapidly certain metals become oxidized when exposed to moist air, in
the presence of even feeble acids, like the carbonic acid of the atmos-
phere. This is the case with iron, and indeed with lead. The inter-
vention of an alkali sometimes suffices to prevent oxidation. Such is
the case with iron. Lead, copper, and zinc become oxidized, on the
contrary, more rapidly in contact with an alkaline liquor. I have
proved that granules of perfectly metallic lead, bathed by a solution of
iodide of potassium, rendered alkaline by potash, become, after a time,
partly dissolved in this mixture?’
The legitimate sequitur of these chemical reactionsis obviously
increased activity of certain salts of mercury in the stomach,
when followed by the administration of iodide of potassium.
And this point seems to be made out both by reference to the
statements and experiments of other chemists, and to M. Melsens’
own researches with particular reference to the subject. And
as a confirmatory fact, it is asserted that, in the treatment of
secondary syphilis, “ the administration of iodide of potassium
often causes intense suffering in patients who have been treated
by mercurials.”
Analogous results are shown to have occurred after the
administration of iodide of potassium to animals who have taken
lead compounds—that is, aggravation of the poisonous phe-
nomena. And, hence, it is urged that “ great caution is neces-
sary in the employment of this remedy in man, for the first few
days.” For, “ at the moment when the metallic compounds fixed
in the body become dissolved or transformed, phenomena of
acute poisoning may occur, caused by their liberation.”
Numerous cases are adduced of the successful application of
this treatment to the relief of lead poisoning and mercurial
poisoning. In fact, it is impossible to disbelieve in the reme-
dial value of the agent, after perusing the mass of testimony by
which it is attested. We confess, however, that plausible as is
the theory of its action, we do not clearly understand the rapidly
succeeding activity and disappearance from the system which we
are asked to admit in the combination of the poison and antidote.
A Discourse, on the Times, Character and Writings of Hippo-
crates, read before the Trustees, Faculty, and Medical Class
of the College of Physicians and Surgeons, at the opening of
the term, 1852-53. By Elisha Bartlett, M. D., Professor
of Materia Medica, &c. New York, 1852.
This elegant and instructive picture of the life and times of
the Father of Medicine, will be read with general interest, and
must take a place in our permanent medical literature.
The Physician's Pocket Dose and Symptom Book; containing
the Doses and Uses of all the principal Articles of the Materia
Medica and Chief Officinal Preparations, ^c. frc. By Joseph
II. Wythes, M. D. Philadelphia, Lindsay & Blakiston: 1853.
pp. 246.
This will be found an exceedingly convenient little pocket
manual, especially useful to the young practitioner, in the emer-
gencies which he so often encounters in the commencement of
practice.
I
What to observe at the Bed-Side and after Death in Medical
Cases. Published under the authority of the London Medical
Society of Observation. Philadelphia : Blanchard and Lea.
1853.
This little book strikes us as meeting a want that has long
been felt—in offering suggestions for uniformity and precision in
the observation of disease. The form of arrangement of symptoms
and after-death appearances, appears to have been originally
framed by Dr. Walshe, and thrown into its present shape by a
Committee of the London Medical Society of Observation, under
the supervision of Dr. Ballard. These names are a guarantee for
the thorough execution of the plan; and a rapid glance at the
work has impressed us most favorably of the completeness with
which it has been accomplished.
Introductory Lecture to the Course of Chemistry at the Jefferson
Medical College. By Franklin Bache, M. D.
Introductory Lecture to the Course of Chemistry at the Pennsyl-
vania Medical College. By John J. Reese, M. D.
We have to acknowledge with pleasure the receipt of these
very able and instructive introductories to the branch of
Chemistry, in the institutions designated. Dr. Bache’s elo-
quent discourse cannot fail to sustain his high reputation as a
Chemist and Teacher: and Dr. Reese’s maiden effort is an ap-
propriate introduction to the successful course which, we learn,
he has delivered.