been some days sick with lung fever. On abatement of the symptoms, an appetite was expressed for boiled salt. pork and greens. The doctor gave his consent to the trial of it. This food, perhaps the worst that could have been thought of, might have turned the scale against recovery. The complaint was speedily aggravated, and the patient sunk in two or three days.

From suggestions already presented, it will be understood that in certain forms of chronic disease, as dyspepsia, constipation, and in some cases of local pains, a due attention to diet, air, exercise, and other hygienic influences, with little or no medication, are all that will be required; but when there is an attack of fever or inflammation, even if it be not severe, my opinion is, that without delay a physician should be consulted; a physician skilled in all the known methods of investigating disease, one who can estimate the influence of mental and physical temperament, and adopt the proper mode of arresting and dispersing an acute form of disease before it has fully seated itself in its most dangerous location.

CHAPTER XXIV.

MILK AND VEGETABLE FEEDING FOR SURGICAL

OPERATIONS.

It is hoped that observation and experience will be admitted in explanation of a decided partiality I entertain for a diet of farinaceous preparations, with milk and fruits, in connection with grave operations in surgery. I have already mentioned the case of Jason Pattee, upon whom the operation of tying both carotids, for a large bleeding nævus upon the vertex of the head, was performed in 1827.1 His food was milk and bread and mush, etc., both before and for a length of time subsequent to the operation.

Another case occurred in 1852. Early in November of .that year, Luther B. Gordon, aged nineteen, came to Cincinnati from Indiana, with a large bloody compress bound upon his left ear, and was admitted into St. John's Hospital. The irregular cavities of the ear, and the space between the angle of the jaw and the mastoid process, were occupied by elastic and pulsating tumors. The enlargement was noticed about eight years before; the progress was slow, and nothing was done. A month before his arrival, one of the tumors burst, with an alarming flow of arterial blood. The removal of the compress, drawing

1 Amer. Jour. Med. Science, Vol. v., p. 316.

along with it the crust covering the opening, was followed by a fresh jet of blood. From the time of the first bleeding he had been kept chiefly on farinaceous food. On the 18th of November, I tied the left carotid. The pulsation ceased, and the tumor very slowly diminished. In four weeks I tied the right carotid. The patient was unconscious in both operations, from the inhalation of two parts of ether to one of chloroform. One ligature came away in sixteen days, the other in twenty. On the 28th of January, seven weeks after the last operation, Mr. Gordon left for home. The last of April his physician wrote me that there were no remains of the swelling, and that he regarded the difficulty as perfectly cured. From that time till this year, 1861, I heard nothing from him. A letter of inquiry, which I wrote in the spring, followed him through several post-offices, and having found him, drew from him a reply, dated July 18th, 1861. I had always entertained fears that the aneurismal enlargement might some day return. He writes: "Previous to the past year I think there has been very little change since I left Cincinnati. Within the past year there has been a slight enlargement of the aneurism, perhaps partially in consequence of arduous labor. During last winter I walked two and a half miles each day, and had the charge of a large school..... The hemorrhages have been slight, and, not frequent."

In addition to a bland diet in moderating the force of the circulation after the ligation of large arteries, it has seemed to me that the horizontal position of the patient. ought to be persevered in until the reparation of the lesion is considerably advanced, inasmuch as the heart is not called upon, in this position, to give the blood so great an impetus as is required when the body is erect. This

patient, Mr. Gordon, was kept in the horizontal position twelve days after the tying of each carotid artery.

A case of tumor, probably malignant, within the right angle of the lower jaw, and extending to the root of the tongue, occurred in our city hospital. As a preliminary to its removal, I tied the carotid. The patient, a young man under twenty-five years, was not scrupulous in observing directions. From the third day after the operation, he was up and walking about the surgical ward. On the fifth day I was summoned in haste on account of alarming hemorrhage at the wound. The bleeding was arrested by ice, compression, and a persevering horizontal position. The wound at length healed, and the patient, a foreigner, left for New York, with a view to return to his European friends. I did not hear from him afterwards.

Miss Sarah Jane Lenhart, an uncommonly beautiful young lady of seventeen, from Brown county, Ohio, was brought to Cincinnati with an osteo-sarcoma of the left side of the lower jaw, extending into the ramus. This was in the summer of 1845, before ether and chloroform were employed as anaesthetics.

Miss Lenhart remained four weeks for the operation, fed with milk and farinaceous preparations, submitting to the manipulations of the boastful mesmerists of the city, each of whom promised her an entire insensibility for the operation. They all failed, however, to put her into a state that bore even the semblance of sleep.

Particularly desirous to save her from that deformity of the mouth which follows the division of the facial nerve, I determined to tie the carotid and dissect out the diseased bone. All this was done. Half the entire jaw, with the condyle and coronoid, was removed, without wounding the facial nerve or the duct of Retno. Miss L. remarked, after

the operation, that "it did not hurt her much." The wounds healed readily, and there was no return of the disease afterwards. The deformity was very slight. Four years afterwards, this beautiful and amiable young lady met with her death by being thrown from a carriage.

Wilson M. Stark, aged thirty-three, came to Cincinnati from Lower Sandusky, Ohio, on the 10th of July, 1845, with a large bony tumor on the upper part of the right arm and shoulder. The swelling commenced in the upper half of the arm bone, four years before, and now involved most of the shoulder-blade and a part of the collar-bone. The last two years it had greatly increased, and was very painful. As the weather was excessively hot, I declined operating, and waited for a change. In seventeen days a copious rain fell, followed by a cool northwest wind. The next day, the 28th of July, I proceeded to the operation, and removed the arm with the entire shoulder-blade, and the outer half of the collar bone. The wound healed kindly, and in three weeks he left for home, by canal boat, in which he passed two hundred miles, and completed his journey, thirty miles more, in a stage-coach. The wound was entirely healed in three weeks after he had reached his home. There has been no indication of a return of the disease (osteo-sarcoma) since.

A letter from Mr. Stark, dated October 15, 1861, informs me that his general health has been good until within the past year, in which he has been troubled with dyspepsia. As I requested him to give a particular statement of his diet while at Cincinnati, if his recollection would enable. him to do it, he replies, under date of December 9, 1861: "My memory is distinct as to the matter. After I arrived in Cincinnati, and before the operation, I lived on baked potatoes with a little salt, and a little milk toast for each