[C. 1869, Two Student Medical Notebooks kept by E. B. Murtha at New York’s College of Physicians and Surgeons (Columbia) recording Medical Lectures by Professors Theodore Gaillard Thomas and Alonzo Clark].
Two content-rich medical notebooks capturing the cadences of the lecture hall: obstetrics, children’s diseases, pathology, and physiology
In the last 13 years of his life, Dr. Eugene B. Murtha (1845–1886) was a sanitation inspector for the Health Department of the City of New York. His death in 1886 from consumption, according to his obituary in the New-York Tribune, was onset by his occupation.¹
Seventeen years earlier, in 1869, Murtha had graduated from the Columbia University College of Physicians and Surgeons in New York City—then known simply as the “College of Physicians and Surgeons.” An Irish-American patriot, Murtha earned the distinction of first prize for the best graduating thesis for his work entitled The Poisonous Species of Rhus.² Dr. Murtha married Constance M. Isherwood.
Here are two content-rich medical notebooks owned by Murtha, each containing medical notes taken from lectures delivered by two of his professors at the College of Physicians and Surgeons: Dr. Theodore Gaillard Thomas (1831–1903) and Dr. Alonzo Clark (1807–1887). The notes are presented in a detailed and well-narrated manner and appear to be faithful transcriptions of his professors’ medical lectures: the notes, especially those of Professor Alonzo Clark, capture the cadences of the lecture hall.
The first notebook records lectures given by Dr. Theodore Gaillard Thomas on obstetrics and children’s diseases. Thomas received his medical degree from the Medical College of South Carolina in 1852 and interned at New York’s Bellevue Hospital and at the Emigrant Refuge Hospital. He was a professor of obstetrics and the diseases of women and children at the College of Physicians and Surgeons. His most important book was Practical Treatise on the Diseases of Women (1868).
As seen in Murtha’s notes, Dr. Thomas stressed the importance of physicians’ sympathy with women and children. Murtha records Thomas’ teaching on abortion, obstetrical instruments used; and various treatments and medicines:
Infantile colic in itself is not dangerous, but annoying to the mother, child, and practitioner. It comes on from the second to the fifth month of infantile life; is not so common after this. Does not diminish the patient strength much, but sometimes gives rise to convulsions. The pathology is this; the muscular structure of the infantile stomach is liable to contraction; if any crude, undigested substance passes down into the intestine of the child, spasm etc. is the result. It develops it self thus; spasm gives the child most intense agony, and sometimes all the muscles become affected. After death, at times, the muscle of the intestines is found in firm contraction. ... The symptoms are these; child will suddenly draw its knees up to its abdomen and scream lustily. It will kick violently and grow angry at the affection. They last fifteen or twenty minutes, sometimes two or three hours. Dr. [William H.] Par[r]ish of Philadelphia describes a colic with muscular spasm, and constitutional violence; after it passes away, the child will laugh and play, just as if nothing has happened, and this shows you it is been in consequence of excessive pain. But this is very rare, more a curiosity than anything else. Infantile colic comes on generally from four to six o’clock in the afternoon. Duty of the practitioner is to quiet pain at the time, and prevent a recurrence of the accident. Cause a free alvine evacuation; put the child into a warm bath, throw into the rectum an injection of anise, fennel or soapsuds With [1 dram] of assafoetida. Dewee’s carminative of infusion of fennel, magnesia, assafoetida, and camphorated tincture of opium, has become very popular, but I do not believe in it. (Vol. 1, pp160–161)
Professor Thomas’ lecture on obstetrical forceps comments on contemporary American medical practices and instruments and contrasts them with European practices:
Forceps. The forceps has probably saved more lives than any surgical instrument which is ever been invented. There is no record of the forceps having been used to save the child’s life up to the fifteenth century. Their use was discovered by Dr. Chamberlayne, an English Country physician; he has been much blamed for keeping it secret, but we should recollect that in those days it was customary to keep a medical discovery secret. ... Strange to say, no improvement was made till 1745 when the long forceps were discovered by [André] Levret and [William] Smellie in France and England about the same time. They have been variously altered since, nearly every obstetrician of any notoriety having made some addition. I advise you to get Davis’ forceps in selecting a short pair, as they will answer every case for which you may desire short forceps. I advise you too, to have a long forceps; they are of great advantage, as they enable you to seize the head in the superior strait, and exercise a great deal of force. The best are the ones invented by Prof. [George T.] Elliott of Bellevue Hospital Medical College in this City, by Ritkin of Germany, and the long forceps of Simpson. In France they hardly use any but the long forceps, calling the short ones mere “sugar tongs.” In England some few years ago, they hardly used any but the short forceps, an Irish obstetrician telling me “he would only use the long forceps in delivering a cow;” so great is national prejudice. Now, of the conditions which require the use of forceps. ... (Vol. 1, pp76–77)
The second notebook, identically bound, transcribes lectures given by Dr. Alonzo Clark concerning pathology and physiology. Although they are written out in a different hand, we attribute their keeping to Eugene B. Murtha and speculate that Murtha had a transcriptionist copy his notes (see below).
Dr. Alonzo Clark received his medical degree from the College of Physicians and Surgeons in 1835. He held professorships at Berkshire Medical Institution, at Vermont Medical College, and at the College of Physicians and Surgeons. At the latter school and through his extensive clinical experience at Bellevue Hospital, Clark became an authority on typhus fever and peritonitis.
Murtha’s notes on Dr. Clark’s lectures reveal a physician with extensive clinical and observational experience. Clark has firm opinions, but, as a professor, recognizes the need to present various viewpoints and medical theories. Clark’s lectures include much on contemporary medical practices in New York City and include some autobiographical information:
Puerperal peritonitis is a very formidable form of peritonitis, which attends puerperal fever. It is a compound disease in my opinion, not simply a peritonitis, but a fever with peritonitis. The uterus is the great seat of the inflammatory disorder & comes on generally from two to six days after delivery; if the woman pass a week after labor without having it; she may be considered safe, although I treated one case of occurring thirty days after childbirth, & one happening before delivery, in which I had one of the five obstetrical cases of my life. There is no fixed rule regarding it, except that where the disease is prevailing in v. g. [e. g.] the ward of a hospital the obstetrician should not interfere, unless the mother is in danger. ... Affects primarily the inner surface of the uterus; I think that in peritonitis, the inflammation begins on the peritoneal covering of the uterus. I do not believe I ever saw a puerperal peritonitis, which was not associated with endometritis; a very frequent form is metro-peritonitis. With this endo-metriosis, if you examine post mortem you’ll find that the inflammation with pus has extended to the fallopian tubes. You may wonder why this simple inflammation is so commonly and quickly fatal. The cause is the result of this purulent inflammation – pyaemia. ... It is rare that an individual instance of this disease occurs alone, either in private or hospital practice; it is more apt to appear in the spring & this is accounted for by the fact that the windows &c. are kept closed during the winter & the impurities are absorbed into the walls &c. It is not propagated by contagion, probably; but in the air. Our Philadelphia friends do not appear willing to believe that puerperal fever is communicable; but here, we believe it firmly. A physician should follow his conscientious convictions in treating it & attending at the same time other lying-in-women. In what way is it communicable it is not easy to say; but those nearest the affected person in a hospital are most apt to take it. I have known a nurse menstruating to have it associated with metritis. ... Up to within a few years, both forms were regarded as an inevitably fatal; the purging doctrine was promulgated in order to empty the stomach &c. Another plan was the use of mercury, on the grounds that it diminished the plasticity of the blood & ‘twas given to produce ptyalism. I have seen but one case recover under this treatment & it was in charge of our late lamented colleague, Dr. Joseph M. Smith. Some years after this in 1841, I was induced to go up to Vermont & teach medicine in the Vt. Med. College; there I found that the local physicians had more puerperal fever to treat, than we had here in N. Y.; I found them using the Armstrong treatment – bleeding & opium, three grains about, – which appeared to have been forgotten by our brethren in this neighborhood. Remaining there some time & observing the good results, I came to the conclusion that they were due to the opium & determined to try the use of opium alone. I tried it here in nine cases, eight of which recovered – a very satisfactory result. (Volume 2, p73–77)
Clark speak with the authority of experience:
Croup. When I speak of croup generally I mean that variety known as the membranous; but as the two kinds are very much alike, it may be well to contrast them. Limited to the extent of the larynx & trachea, or the larynx trachea & larger bronchi. Distinguished as true & false croup; the former being a membranous exudation is often called membranous; the latter resembles the first in symptoms, but not in pathology, being merely a spasmodic contraction; an old name & a better one is laryngismus straddles. It is just a century ago (1767) since White first wrote of croup as we understand it now… Recognizable difficulty of breathing, equal in expiration & inspiration; unnatural loudness in the expiratory & inspiratory sounds; the voice is hoarse, sometimes entirely lost; cough is hoarse, ringing & brassy. ... False croup is not a continuous disease; membranous is. By the symptoms you cannot perhaps distinguish these forms; but in false croup there is usually an interval of rest, v. g. [e. g.]: the child will not be ill during the day, but towards the night the difficulty in breathing &c. will come on. Hence you will hear women saying that they have had eight children, all of whom have gone through the croup safely. Sometimes there is more difficulty, as there may be no remission; I saw a case of this kind at Passaic Bridge N[ew]. J[ersey]. where a child was for two weeks sick & the doctors could not tell whether it had true or false croup; it subsequently recovered, having really had laryngismus stridulus. ... Treatment. If it is spasmodic croup I will not say you will need not give yourself any trouble; for on account of the severity of the spasm, death may ensue. ... Relief is generally obtained by simple gentle means, warm bath, inhalation of hot vapor, sponges which have been dipped in warm water, applied to the neck; syrup of ipecac to produce nausea is also used… As to the other form I cannot say as much for as yet we are not satisfied with the treatment; for in spite of all we can do, we lose the majority of cases. ... In the early part of my professional life I went to Boston & I heard the matter talked of there; a short time afterwards I tried this treatment with success in Pittsfield. Subsequently I called the attention of my medical brethren here in N. Y. to it & it was again revived. I make this statement, because I see that it has been claimed in the newspapers that a certain physician has the honor of introducing the plan & he does not contradict the folly. ... Now, the question comes, is tracheotomy a reliable operation in croup? I cannot say it is not; yet I must say that in no case with which I have been connected has it done any good. ... European physicians say that if it is performed early, the child’s chances of life are very much better. Where the propriety of or hope to be desired from the operation are doubtful, I think you are justified in referring the matter to the parents of the child, following their wish. (Vol. 2, p86–93)
The experience of Dr. Clark at Bellevue Hospital and at Massachusetts’ Maplewood Institute frame part of his lectures on typhoid fever:
I now turn to other fevers not so fatal as scarlet fever, but formidably fatal at the same time. They are the typhoid & typhus, the ephemeral & relapsing fevers. The two most common are the typhoid & typhus; both are contagious but in different degrees, & a occur epidemic but not together. The typhoid is indigenous here & is the fever of our country where miasmatic fevers are not existing. The typhus may rise up here, but it has always been imported as far as my knowledge goes. It has been called the “Irish fever,” & it does prevail in Ireland more than anywhere else & generally after a famine. A fearful epidemic of it here, beginning in 1846 lasted nearly seven years, & hardly a case of typhoid fever with its lesions &c. appeared. ... Regarding the contagion of typhoid fever it is doubted; Mr. [Pierre-Charles-Alexandre?] Louis who has written the most descriptive work on this disease, in the first edition of his work thought it non-contagious; but after more thorough observation, he gave it as his opinion, that it was epidemic & contagious. I observed this contagion some years ago in New England, where I used to spend my summer play-time. I saw a young man coming to a town where no epidemic of typhoid fever had prevailed for seven years from a town where typhoid fever existed in the family in which he had been living, and it spread till twenty five in the little place were attacked, only those who had attended some of the sick during the night being attacked; this was probably on account of the blinds being closed & the air confined after dark. I could cite you numerous instances of this kind, & again on the other hand, I could tell you of many cases of typhoid fever, where there was no evidence whatever of contagion. I have no doubt it occurs sometimes from the fermentation of old ponds, tanneries’s &c.; & in Bellevue Hospital, it sometimes arises spontaneously in the wards; these cases however, I have always found in the upper wards where the croton [Croton Aqueduct] water sometimes gives out – & never failed to find at the same time the privies impure. At Maplewood Institute, near Pittsfield Mass[achusetts]., it arose apparently spontaneously, & investigation found the privies &c. unclean. It has, then you will say a multiple origin; well, I don’t see how we can get out of admitting this fact. The inference you will draw will be to have ventilation good for the benefit of the patient & friends. Typhus as well as typhoid fevers are rarely ever communicated from one person to another, where the window is kept open, & there is ample room in the house. ... There is a certain kind of fever indigenous to New England. There have been fevers attended with eruption & exceedingly fatal, which have been called typhus fever, but I cannot see as there Is any connection between them; but I think that the physicians reporting it, have mistaken spotted fever for it. So I believe (but it ought to be an open question) typhus fever has never arisen spontaneously here. ... The mortality of typhus fever is not so much greater than that of typhoid as you would suppose perhaps from your general impression. It is very fearfully fatal in those to live by their brains – so much so that having treated a number of medical men who have had typhus fever & literally thousands of those who are usually admitted into hospitals, I am in the habit of saying that the laborer has three or four times greater a chance of life than an intellectual man. (Vol. 2, pp208–211, 222–223)
Fear of a cholera epidemic in New York City is the occasion of a history lesson and of memories of a cholera outbreak in Brooklyn in 1854. Interestingly, it includes a reference to a medical controversy about an intestinal “fungus,” possibly an early observation on pro-biotics:
Cholera. The name cholera is a term throughout the world, & there are few countries of the known world that have not been visited by it. It is believed to have originated in India. In 1817 it seems first to have broken its bonds & extended to other parts of Asia. ... When it came to reach this country, & whenever it came here, it has been traceable to ships &c. It has occurred as late as 26 days after a ship has left a port – among persons coming from infected regions. We do not believe that it can arise here, from decaying substances &c. It was first brought to this country by an emigrant-ship up the Saint Lawrence [River] to Quebec &c. In regard to this city, it did not occur here till after two emigrants arrived here from this ship, & one of them was the first case here. About the same time, a ship was landed here with cholera, & by the connivance & corruption of public officials, the passengers were allowed to proceed West &c. It has always, I believe, been imported into Europe, its home being away among the Ganges. The last time it appeared in Europe, it arose, I believe, from the meeting of pilgrims at Mecca. ... As regards the particular element of cholera, it is yet to a certain extent a question. Physicians, who saw this disease in 1832, were divided in opinion whether this was contagious as typhoid fever; but hospital observation would seem to say not. It was stated that it was produced by nurses &c., eating their food with unwashed hands, having on them the emesis &c., of cholera patients; but in opposition to this, drunken men have actually drunk this emesis &c., & have not been affected with the disease. My own idea is that cholera is spread as yellow fever is in Northern cities; that it is a subtle, never isolated poison, requiring certain conditions of soil &c. to be developed. – When it finds in N. Y. the necessary conditions, it will become epidemic. ... Many volumes have been written on the treatment of cholera, thousands of physicians have given their opinions on the subject, & the result of it is, that we do not know how to treat cholera. ... But still to the checking of the diarrhea, you must chiefly, if possible, address yourself. – I am disposed to recommend, too, during this stage, the plan of a physician, who had a hospital in Williamsburgh [Brooklyn] in the epidemic of 1854, the injection of brandy diluted with tea or coffee. But as you will not see an epidemic without reading of it, let me say to you, do not use too active a treatment. During the period of collapse, your chief office is to restore to the blood its water, & this you do by the judicious administration of diluents; & as soon as you can, try & prevent uraemia, which the suppression of urine threatens. ... I wish to refer to the new doctrine or to the old doctrine renewed, that the cholera poison is a fungus introduced into & multiplied in the intestine…this was first described by two English physicians, but the other observers found that this fungus could be referred to good, healthy, wholesome food, bran, barley &c. It has again been renewed within the last two years by the Germans with a great deal of positiveness; I am however a little sceptical – I am, in fact very skeptical; in other words, I do not believe it. (Vol. 2, 249–250, 254, 256–257)
The lecture on intermittent fever includes a reference to a medical book reviewed by Dr. Clark, a book which Clark himself edited in 1856:
Intermittent fever. I need hardly describe to you a paroxysm of intermittent fever, as almost everybody has seen or heard of it. ... At the same time the spleen becomes enlarged, but the liver does not undergo very much change. Spleen grows to weigh 16 pounds or more & of a color between slate & olive. The particular character of this enlargement seems to be more allied to a hypertrophy than to the deposit of any heterogenous matter. This enlargement will vary from twice to twenty or more times its natural size. This is the prominent lesion of intermittent fever, this & the deterioration of blood, loss of coloring matter and increase of the number of white corpuscles. If spleen were the maker of these white corpuscles ‘twould flood the blood with them under these circumstances; but I feel (as I told you at the Hospital the other day) we do not as yet know the office of the spleen. ... When the influence is diminished, but not entirely removed, the successive paroxysms will be later & later daily. This has been called postponing intermittent [fever]; however, when the disease is growing more & more severe, it occurs earlier & earlier each day till 4 A.M. rarely earlier; this form has been called anticipating intermittent [fever]. (By some mistake these forms have been transposed in Dr. [Elisha] Bartlett’s work on “Fevers of the United States,” which I reviewed.) ... Now as to the treatment. – You have learned from your materia medica how a lion shaking with the ague…drank from the cooling waters in which a certain tree had fallen & was cured. But I am disposed to ascribe this fable to Aesop. – However a good many years ago, the Jesuits brought from South America, a bark which would cure fever & ague, better than any remedy yet discovered. This was cinchoua bark; but chemistry has separated the substances & now we treat intermittent fever with the sulfate of quinia. The bark may be given, but the neater way, is to give quinine. Quinine, then is the sovereign cure for intermittent fever & it is a cure. Here the drug does everything, nature nothing, & here you have the satisfaction of knowing that you, the doctor, cure the disease. Different modes of giving it, may here referred to. – Formerly, when I first enter the profession, a purge &c. beforehand were thought necessary. Now, this preparation is thought unnecessary & consequently cruel. ... Our rule at Bellevue Hospital is, that the patient is permitted to have one paroxysm after he is admitted; a second he may have, but a third he ought not to have. If the patient remains in the miasmatic district, you are not going to have so great success. I do not know that there are any better agents than quinine & the other preparations of cinchoua. It is claimed that our willow has a bitter principle, salacine, which will answer the purpose. So it is claimed of the cornus florida – dogwood & eupatorium perfoliatum – wormwood. (Vol. 2, pp 173–177)
Clark recalls his own medical mentor and mentions a medical instrument, a “laryngo-scope,” he helped to invent:
Oedema Glottidis. In this disease the membrane swells by effusion in such a manner as to make little watery movable balls of considerable size, sometimes overhanging the larynx in such a manner that the patient can expire but not inspire. ... Circumstances under which oedema glottidis will occur are various; I am seen it depending on syphilitic ulceration in the larynx; again I have seen it from a cut in the throat. In the ordinary sore throat it may occur, but does not often. It occurs too in some cases of small-pox. My preceptor the late Dr. [John B.?] Beck wrote a paper to prove that it was of this that the great [George] Washington died. It is not a very uncommon occurrence, nor yet is it very common; you may suspect it where a person with sore throat dies suddenly. It is pretty easily diagnosticated especially now that we have the laryngo-scope; the finger too will detect the swelling & I think it is your duty first to use your finger & see if you find soft adhesions &c. Dr. [Gurdon] Buck has invented an instrument in accordance with a suggestion I made some years ago & it has been employed with considerable success. The means of relief, then, are not medical but surgical – a safe & simple operation which is often of service. (Vol. 2, p85–86)
The students Dr. Clark benefit from his first-hand observations; Clark is careful to include the viewpoints and opinions of other physicians:
Miasmatic remittent fever is also called Bilious or African or periodic fever &c. Is more fatal in different places according to the virulence of the poison. It is called remittent fever, because there are periods when the fever is less; it is a continued fever with remissions and exacerbations. ... It is remarkable that gradually these miasmatic fevers give way to typhoid fever. I remember about the year 1846 or 7 at the meeting of the State Medical Society in Albany, hearing the physicians of Oswego & that region about giving an account of their first typhoid fever cases; they had had cases yielding to quinine, but after a while the type of fever changed into typhoid, & under quinine they lost a great many. The following year, however, under other treatment they had a different story to tell. ... The patient is attacked in nearly the same way as when he is going to have fever & ague. There is a feeling of lassitude, then a chill perhaps somewhat lengthened & then a fever, continuous & prolonged, but no perspiration; then it goes through the night & the next day. ... Then the patient will have a headache, he will have pain in the back & soreness of the limbs; the face will be suffused & if it is a severe case vomiting & irritability of the stomach may occur; there may be vomiting of blood. ... [Remission is] more constant at four in the morning than at any other time. This I observed in the N. Y. Hospital, when I had sixty patients suffering from remittent fever, to attend to at one time & rose every two hours to see how they were getting on. It is in the latter stages the jaundice appears, occurs quite intense, observable even on the dead body, making you think perhaps you are dealing with Yellow Fever. ... Treatment. It will require no great amount of reasoning, if you admit quinine to be good in intermittent fever, to admit that the same remedy will be good in the more intense poisoning of remittent fever. Quinine is the remedy. The late Dr. F. U. Johnson at the N. Y. Hospital in 1832–3 & 4, was the first one I saw it using it, but whether he got the idea from his reading, or whether it was his own thoughts, I do not know. ... Now, what do you do with your Calomel? The western men cannot get along without and what a row they kicked up when Dr. [William Alexander] Hammond – (late Surg[eon]. Gen[eral]. U. S. A[rmy].) sent it out of the army, except on “special orders.” But the question is, do those who are treated with calomel get well quicker or in greater number? I cannot say; for I have never used it in remittent fever, so little faith have I in it. But you are justified in using it, even if your teacher here tells you he doesn’t believe in it; you have so many good men who advise its use. (Vol. 2, pp178–183)
Diphtheria comes next to be considered, not because it is an inflammation, but because it resembles croup; it is not a local disease, but a general one, attended by a poison in the blood. The term has been comparatively lately introduced into the profession by Brettonneau [Pierre Bretonneau] of France, & is derived from a Greek word signifying the skin of an animal. ... ‘Twas known to the Roman physicians as Ulcus Egyptica or Ulsus Syriaca, they mistaking the exudation for an ulcer. It has been epidemic in various places France, Spain Italy &c. An Ex-President of this college wrote a paper stating that in the last century towards its close, it appeared on Long Island & here in New York. It appeared here as an epidemic too, about 10 or 12 years ago, but whether imported or not, cannot be said; but the first case appeared in New Haven, in the family of a gentleman who had just returned from Europe. Appeared in New York some few weeks after – when cannot be exactly said. – It begins very variously; for instance at the beginning of the epidemic here, not unfrequently it was ushered in by chill, head-ache & high fever; after a little while its invasion was very mild. But the degree of violence with which it begins cannot be taken as a standard of severity of the disease & there are numerous grades of the severity of the invasion. ... Extends occasionally to the oesophagus, when it is less fatal. Extends to the mouth sometimes, & I have seen the cheeks, lips, tongue &c. covered by it. In rare forms it occurs upon the eye, but then it does not extend. It may occur also in the vagina, rectum, & even on blistered surfaces, stumps of amputated limbs, old sores &c. This shows that it is a constitutional disease. ... The duration of the membrane varies from two to twenty days. I have known but one case lasting twenty days; it was a case of Dr. Noyes of this city; in 23rd St. & 9th Ave. in the person of a little girl, who was hardly affected by the disease until the 17th day and she died on the 20th. – Artificial removal of the membrane does not prevent its recurrence; the readiest mode of removal, I think, is by the use of salt. ... At one time it was the opinion of the profession that this diphtheritic membrane was of vegetable growth – epiphyte. I took to this opinion at first, but afterwards saw that these epiphytes were merely accidental & grew on the outside of the membrane. – The membrane is the most important part of the disease only when it passes into the trachea; it is the constitutional affection of the blood to which we must look. ... Treatment of diphtheria. – The question comes; are you to interfere with this membrane? It is just as well to leave it alone, when it is not in an important place. The French writer’s advice the use of nitrate of silver, muriatic acid & other caustics. We are here inclined to abandon them, even after reading the reports of Bretonneau, Trousseau & others. Any way I would go no farther than Dr. Jennerson of the immortal – advises; make one good application of a solution of nitrate of silver. – Among the other solvents, the easiest of application & the least harmless [harmful?] is common salt; but as you cannot introduce it into the nose &c. you’ll have to use it with the vaporizer; here comes also your lime-water vapor, as always spoken of in the treatment of croup. (Vol. 2, pp93–96, 99)
Chronic hydrocephalus. The word chronic refers purely to time & not to the degree of the disease; this is a prolonged hydrocephalus; there is an effusion of water; when it is without the ventricles they call it hydrocephalus chronicus externus; when within hydrocephalus chronicus internus. If it is the latter & you wish to tap it, you will have to penetrate the brain; so that it is important to recognize it before hand. We can give no reason why it should occur in one place more than the other. It is congenital or developed shortly after birth; when congenital it is often associated with the brain incompletely developed. These cases are always idiotic, having no volition they are generally entirely helpless; reflex action, however, is not impeded. ... Diagnosis is pretty easy, as the features are tolerably distinct. You can get the sense of fluctuation by putting one finger on the fontanelle & percussing from behind. Enlargement of the cranial bones & lifting up & pushing forward of the forehead are facts to be noticed. ... By holding a lighted candle at the front part of the head in a dark room & holding up a dark screen so as to cut off the light, you can see the watery effusion at the back of the head. ... In regard to the management, but little can be done… Compression has been suggested, compression by a cap of adhesive plaster; but the effect of this, when carried too far, is to produce a sort of coma. I have abandoned it, as I have found no permanent good in it. I do not know that tapping is of any use; a surgeon of this city tells me that he has performed the operation 30 times; in 29 no good result followed; in the thirtieth he never heard what the issue of the case was. Whether nature ever produces a cure or not, I can only say that but little confidence is to be placed in nature; although I knew intimately a gentleman connected in business with my father, whose head was full of ridges and bumps which would have puzzled even Dr. Fowler the phrenologist himself. These ridges &c. were said to have been the result of a chronic hydrocephalus, which he had in infancy. I only know that he was a very intelligent man, an exceedingly smart business operater [sic] & lived to a good old age, dying in this city. (Vol. 2, pp34–36)
Hay Asthma is said to come on from the pollen of flowers; it is not a settled question – but is generally believed. Most frequent from July to September. Some are said to be especially affected buy the Alanthus [Ailanthus] tree. – Going to sea, sometimes keeps off a customary attack even going only as far as Fire Island. It is curious in its action; Dr. Beck’s two cases will illustrate this, two men were subject to asthma – one a resident of this city, the other of Newburgh. The New Yorker always was attacked with asthma when he went to Newburgh & the Newburgher, invariably when he came to New York. Treatment: the oldest plan is to produce nausea buy emetic substances, tartar emetic, lobelia inflata – a most acrid substance &c.; ipecac relieves some but causes asthma in others. More rapid relief is from something that acts more directly on the nervous system – the inhalation of stramonium [jimson weed?] in pipe – breathing the smoke – nitre paper cut in small pieces, two or three inches square & burnt, the patient inhaling the smoke. Inhalation of Hoffman’s anodyne will frequently give relief. But the old trouble remains that what will produce relief in one, will not in another. I have seen Iodide of Potassium given and producing relief, but not, as some say curing. (Vol. 2, pp123–124)
Bright’s disease of the Kidney is called also albuminuria, uraemia & by a new name nephria. I do not know whether this latter will be adopted by the profession or not, but our Sanitary Commission has adopted it. But certainly no man deserves more than his name should be commemorated than does Dr. [Richard] Bright. It is a disease which is much more common than we were formerly willing to admit. When I attended lectures at this college about 1831 (‘twas then in Barclay St.) the doctrine was that this dropsical affection was caused by the fact that the exhalants were more active then the absorbents. It is a disease of autumn and winter being less frequent in summer. ... As to the cause I can say little to you. I know what occurs oftener in those who abuse alcoholics [alcoholic drinks], but I know too, it occurs in temperate people. I know too, it generally occurs at changeable seasons of the year when persons are apt to take cold. Then if the man has a carousal (by which I mean gets gloriously drunk) & sleeps under a cart, he is apt to get acute Bright’s Disease, without however any disorganization. ... [T]he first thing you do is to examine the urine. The examination is usually made with heat & nitric acid, which are generally sufficient. Albumen coagulates at about 156°, I believe. ... You ought to avoid in sending after urine for test purposes, not to have it brought in a bottle which has had hair oil in it &c. &c. ... Now as it the method of treatment. We may, very true, speak of cure, but not very confidently; when I read some years ago, a paper on this subject before the Academy of Medicine, I could not point to a single instance of a cure in Bright’s Disease. But now I can call to mind a baker’s dozen who have recovered from the disease – well twelve or fifteen years ago, & in all probability permanently. ... Purgatives I have already spoken of to you, but I generally reserve them for emergencies, but salines & senna may be given at periods for temporary relief. The best diuretics I have used are the Acetate of Potash & Riverius mixture. Sometimes the system becomes used to one diuretic & then you have recourse to another. ... Iron is almost always used, as it is suggested by the countenance, the kind most in favor is the old muriated tincture this is a very old preparation and has gained its place probably by acting as a diuretic sometimes. The Carbonate is very much used in the form of lozenges, as the chocolate is pleasant to take, especially for children, who almost, to use old Quack Sherman’s advertisement “cry for it.” Corrosive chloride of mercury is used by some physicians, given till its effects are seen in the mouth, then discontinued for a while. I cannot say it is a great favorite with me, but I feel bound sometimes to use it, when other things fail, for it came into use with the knowledge of the disease. (Vol. 2, pp151–154, 156, 160, 162–163)
Recommended treatments are specific; Clark has a confident tone, but is not afraid to point out the limits of his own medical knowledge:
Dysentery. The mucous membrane of the large intestine may be inflamed & no other mucous membrane inflamed at the same time; & this inflammation we call dysentery – a disease frequently fatal. Has special tendencies; there being a good deal of vascularity… Often there is a hemorrhage which may prove fatal. ... Dysentery is one of those affections which recognizes season of the year. Rare in winter & spring; seldom makes its appearance before midsummer, but is a disease properly of autumn. Apt to be caused by the same condition which gives rise to Asiatic Cholera; I saw several cases during the cholera year before last – Summer 1866–; but it did not remain – as it usually does – after the cholera had disappeared. We cannot say what causes dysentery. We may say summer conditions &c. &c., but that is about all. A certain physician of Philadelphia, said that limestone districts were the ones attacked; but he has, I believe, corrected this statement as it has prevailed as an epidemic, where the[y] are obliged to go fifty or sixty miles for their lime. I know no hypothesis for the cause of the disease, except that it is a summer or autumn affection. ... Whether this disease yields to remedial agency, or follows a regular course laid out by nature, I am not at liberty to state. – In the first place, there is the mercurial treatment, which I do not believe in. Then there is the purgative treatment, a dose of Rochelle or Epsom salts daily. But the plan adapted by the profession here in New York is a moderate amount of catharsis to clear the intestine of foecal matter, which, as I told you yesterday, is imprisoned as a hardened, irritating mass in the saeculi of the colon. (Vol. 2, pp128, 130–132)
A lecture on vaccination includes a history lesson, a quotation from a letter written by Edward Jenner, the pioneer of the smallpox vaccine, and observations on Clark’s own work on vaccinations in 1842:
Vaccination belongs to the prophylaxis of smallpox. Was discovered by Edward Jenner in the latter part of the last century, when he practice vaccination on the human body. In 1801, the matter was sent to this country to Drs. [Valentine] Seaman and [Benjamin] Waterhouse. Since that time new matter has been imported from Europe & obtained anew from the cow here. The protective virus may be obtained from the cow either by inoculating with vaccine or smallpox matter. The mode of vaccinating is to insert a small quantity of virus under the skin; there are many different ways of doing it, but the ordinary lancet is as good an instrument as any. It has been said that the vaccine matter is losing its protective power, which is not quite so complete as during the first twenty years of its use. But I have examined into this matter & find that the protection does not last, being most likely to be lost in the period of passing from puberty to manhood. It is complete in some, but incomplete in others; & as you cannot tell who is protected, & who is not, it is well to be revaccinated. When the revaccination takes, it is thought to be a sign that the person is not protected against the contagion of smallpox. I confidently believe then, that a second vaccination is necessary. ... In three days after inoculation, a little vesicle forms on the arm, preceded by redness on the second day. This vesicle resembles, but is a little larger than – the smallpox eruption; it matures on the eighth day but the virus is ready for removal on the seventh. – Dr. Jenner writing to Dr. Waterhouse says: “My dear Doctor: – Hold what political principles you please, but do not, I pray you, vaccinate with matter removed after the 8th day.” The patient has had swelling & soreness under the arm; this soon passes off & is rarely so severe to require the person to leave his occupation, unless it be a very laborious one. Occasionally the pustule becomes an ulcer, & this was the case in the new matter, imported and used under my direction in 1842; this new matter appears to be more active. Another accident is erysipelas which may be severe enough to destroy life; but this is not common, & need not deter you from practicing vaccination. (Vol. 2, pp225–227)
A one-page autograph note signed by Eugene B. Murtha is laid into the volume containing notes from Professor Theodore Gaillard Thomas’ lectures at the College of Physicians and Surgeons on obstetrics and diseases of children (here, Vol. 1). In the note, dated December 8, 1870, he refers to small omissions and one gap in the transcription of his notes. In regard to the latter gap, he writes:
At page 172, you will find a note that the lectures on spasmodic croup and catarrhal croup are omitted. The reason is I was absent myself from these lectures and did not consequently have any notes to transcribe.
It is almost as if now-Dr. Murtha is passing his notebooks along to a current student. The handwriting of this short note appears to be the same as that used for Prof. Thomas’ lecture notes. The identically bound second volume of notes (Dr. Alonzo Clark’s lectures on pathology and physiology), however, appears to be written in a different hand. This second notebook is initialed at the end “C. K. S.” and is datelined “‘Asylum’ [Pennsylvania?] – Nov. 22, 1870.” We speculate that Murtha had someone else transcribe his actual classroom lecture notes into this volume. It remains possible too that Murtha himself received the notebook from a more senior medical student or graduate, but, as the two volumes are identically bound, this does not seem likely.
Description: [C. 1869, Two Student Medical Notebooks kept by E. B. Murtha at New York’s College of Physicians and Surgeons (Columbia) recording Medical Lectures by Professors Theodore Gaillard Thomas and Alonzo Clark].
[New York, c. 1869–1870]. 201pp. and 288pp. Two Notebooks. Full calf; gilt tooled borders on covers; all edges marbled. 8½ x 6 inches. Nineteen-line holograph note signed “E. B. Murtha” laid into first volume. Both volumes lacking spines; brief wear at edges; good. Manuscript very clean and easily legible.
References: Kelly & Burrage. DAMB Shrady, ed., History of the College of Physicians and Surgeons of New York (New York, 1907), passim.
1. Obituary within New-York Tribune, August 26, 1886, p8. 2. Crimmins, Irish-American Historical Miscellany: Relating Largely to New York City… (New York, 1905), p388. See Catalogue of the Officers and Students of Columbia College… (NY, 1869) p138
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