Xavier Bichat, who in his divifion of animal and organic life,* evinces in the firft, the relations and connections of each organic part with the brain and the nerves, independently of their private functions, affimilations, fecretions, and excretions; but if these are impeded and fufpended, a state of perturbation is introduced from the fystem of organic life to that of animal life. Without fecretion," fays he, "no digeftion-without digestion, no nutrition-without exhalation, or without excretion, no abforption." Hence the tumultuous effect on the centre of all animation and circulation, when a deleterious or morbid cause cannot be digested, eliminated, and refolved: hence, no doubt, the fyphilitic poifon received on the membranes of the urethra, produced the long continued miferies and strange fituation of the above fubject.

II. I wish to be understood that the ufe of bougies in the cafe of agonorrhea, feems to me preferable to injections, or to any other kind of artificial stimulus, because, it appears to me the handieft, and better calculated to excite a fufficient degree of inflammation. It has befides, the double advantage of remedying other local affections, should they exist, as obstructions, ftrictures, gravel, &c. I have found that the common compound bougies, provided they are of a fufficient confiftency, answer much better than the elastic ones, because the ingredients with which they are made, are perhaps, more irritating when heated by the parts, and perhaps decompofed. The bougie when introduced into the bladder, does not require to be left any length of time, nor to be used more than once a day, and for five or fix times, after which, I rarely failed in obtaining the defired effects. Should no inflammation occur, the cafe must be different, and the bougie by frequent introduction, becomes as little irritable as the schneiderian membrane of habitual fnuffers. Any other remedy which can be adapted to the circumstances of the cafe, I need not mention; as no particular rule of their exhibition could be determined, and fhould be left to the judgment of practitioners.

* Recherches philofophiques fur la vie et la mort.

Obfervations on the occafional injurious Effects of Leeches. By JAMES STUART, M. D.

HYSICIANS observing the bites of leeches to be occafi

PHYSI

onally followed by troublesome inflammation, ulceration, and gangrene, have attributed these to fome venomous quality of the infect. But, as the precautions founded on this opinion, have proved ineffectual in obviating the evils noticed, the opinion may be justly fufpected to be fallacious.

Though the species of the leech be confiderably numerous, there are but three which will stick. The fnail tailed, the broad tailed, and the large brown leech with a reddish belly. The first adheres tolerably well; but growing only to an inch in length, they cannot be employed to any advantage. The second grows to an inch and an half; but from an uncertainty in his functions, always gives place to the large brown leech, which laft is, at this time, the fpecies moft generally employed in medicine. This, in common with the fame family, has the general figure of the worm, and grows from two to four inches long. The body is composed of rings, which supply the power of contraction and of fwimming. The fkin on the back is blackish, or brown, befpangled with minute yellow fpots, which, as it approaches the fides, is bordered with a narrow streak of yellow. From this last, the belly is of a reddish colour, and interspersed with a number of yellow spots. His head is fmall. But that which claims our attention most particularly, is the structure of his mouth. This is of a triangular figure, and compofed of two lips, which are made to conform at pleasure, to the convenience of the animal. Within thefe are fituated three folid teeth, fo fharp and ftrong, that, they are capable of piercing the skins of men, or even those of horfes, or oxen. A little posterior, is obferved a small protuberance, anfwering, in appearance, and most probably in ufe, to a tongue, which, when flaccid, very exactly clofes all the

cavity within the teeth. With this structure of the leech, his thirst of blood is proverbial. Hence Horace,

Quem vero arripuit, tenet occiditque legendo,

Non miffura cutem nifi plena cruoris birude.

Whether accident or defign has prefented him with his prey, the first care of the leech is to prepare an opening for the exit of his favourite repaft. This is done by inferting his three fangs into the skin. Next, withdrawing thefe, he closes his lips round the wounds and retracts his tongue farther into his mouth, fo as to produce a vacuum. By which means, the weight of the atmosphere being removed from the blood-vessels embraced by his lips, while its force remains the fame on the parts without, the blood is forced into the mouth fo ftrongly, as to fill his twenty-four little ftomachs, containing in the aggregate from two to three drachms of blood, in the short fpace of a few minutes.

From what has been faid, it appears there is but one species of leech commonly employed for medical purposes. From hence it follows, the opinion that the bad effects from their bites proceed from the quality of the leech, must be erroneous. For, this being admitted, to fuppofe these are induced by a venomous quality, is to fuppofe, that fome individuals are endowed with a quality with which others of the fame fpecies of animals are not; which would be abfurd. I am aware, it may be faid that this noxious quality of the lecch is adventitious, and that it depends upon the qualities of the waters from which they are taken. But this fuppofition, ftill, does not folve the difficulty; for as they are all kept a confiderable time before use, in clean water, and this often changed, their fuppofed poisonous qualities, were they adventitious, must be washed off, and we, confequently, fhould never witness any bad effects from their bites.

The fallacy of the generally received opinion, further appears from the organization of the infect. For, as the teeth

are deftitute of punctures in their points, they are not calculated to the introduction of any fubftance into a wound. And, were it even poffible any poisonous particles should adhere to the teeth, and be introduced with them, as the animal feeds by fuction, its very functions, joined to the conftant efflux of blood from the punctures, muft prove a certain preventive to thefe particles remaining long enough to produce any mifchievous effects.

Much more might be faid, but as this is deemed fufficient to prove that injurious confequences from the bites of leeches. cannot depend upon any innate or adventitious quality in them, I fhall difmifs the fubject, and proceed to inquire, on what these consequences do depend.

I attribute them to the state of the fyftem, or to that of the particular part, to which they are applied.

I conclude this to be the cafe,

1. Because, the effects mentioned, never occur, except iú fuch cafes as evidence the presence of a morbid diathefis, general or local, in the part to which they are applied.

2. Because, they frequently do occur where fuch diathesis exifts.

Of the truth of the first of these pofitions, we have daily proofs in the application of leeches in ophthalmia, where the disease is topical and they are not applied immediately to a part under inflammation. In this cafe, bad effects never fucceed.

Cafes of inflammation, ulceration, or gangrene, from the ap plication of leeches in a general morbid diathesis, or immediately to a part under disease, have occurred under the obfervation of almost every practitioner who has ever been in habits of employing them.

I have witnessed many; the following of Capt. R. A. mentioned in Vol. I. No. 2. communication the 10th, of the Philadelphia Medical Museum, feems, to me, one of the most impreffive, and well calculated to my purpofe. In this cafe the diathefis had a strong tendency to gangrene.

When I first saw him, on the 31st of July last, a partial sphacelus had taken place in one of the nates, and the cellular membrane of the perinæum was destroyed. The scrotum was nearly divested of cuticle and much tumefied; but, as I understood, had fubfided fince the attendance of Doctor Rufh. I was informed blifters had been applied to the fcrotum and to the parts affected with fphacelus on the 29th, when the Doctor was first called in; and leeches to the fcrotum on the 30th. Auguft ift, there was an appearance of gangrene on the fcrotum.-August 2d, appeared feveral fphacelated spots, the fize of the finger nail, immediately on the parts of it to which the leeches had been applied. The fame day they were punctured with a lancet. August 3d, the sphacelus had extended fo far as to destroy nearly one half of it. On the fame day, in concurrence with Doctor Rufh, I removed with the knife, several large portions of fphacelated skin and cellular membrane from the nates and perinæum. On the 4th I laid open the perinæum, in its whole length, from near the anus to the fcrotum, down to the urethra. The 6th I removed with the fcalpel, all that part of the fcrotum to which the leeches had been applied, being nearly one half, down to the testis.

The leech produces the injuries here noticed, by the forma tion of a vacuum on the part to which he is applied. By this means, the ufual fupport from the preffure of the atmosphere being removed from a part of the fyftem, while it remains the fame on other parts, the tone of the part under the influence of the leech is diminished, while, at the fame time, and by the fame causes, that of the latter is relatively increased.

And hence arife two most certain and active predisposing causes of inflammation, a general increase of tone and a local debility.

From this view of the subject, I conclude that bad confequences are to be apprehended from leeches,

1. When applied in an inflammatory diathefis before general bleedings have been performed.

2. In a general gangrenous diathesis.