110; lancinating pain in left side of head and face; rigors, and bowels constipated. Ordered cold to head and face, and a black dose to be repeated in six hours, if it does not operate. He has had spiculæ of bone pass into the fauces, which he expelled from the mouth within a few days.
16th, A.M.—No better. Cathartic has operated freely. Pulse 120; skin hot and dry; thirst and pain remain the same. Has been very restless during the night. Venesection [16 ounces (∼475 ml)]. Ordered calomel, [10 grains (∼650 mg)], and ipecac, [2 grains (∼130 mg)], followed in four hours by castor oil.
8, P.M., same day.—Purged freely; pulse less frequent; pain in head moderated; skin moist. R. Antim. et potassa tart., [3 grains (∼195 mg)]; syr. simplex, [6 ounces (∼180 ml)]. Dose a dessert spoonful every four hours.
17th.—Improving. Expresses himself as "feeling better in every respect;" has no pain in the head.
18th.—Is walking about house again; says he feels no pain in the head, and appears to be in a way of recovering if he can be controlled.
At this date I shall leave the case at present. The result, and a few remarks of a practical nature, together with the mental manifestations of the patient, I reserve for a future communication. I think the case presents one fact of great interest to the practical surgeon, and, taken as a whole, is exceedingly interesting to the enlightened physiologist and intellectual philosopher. In my effort to be brief, which I fear you will think an utter failure, I have omitted much in my notes that might interest some readers. Allow me to say here, that I have seen a communication in "The Reflector and Watchman," stating that "there is a piece of bone loose in the top of his head, as large as a dollar, which will have to be removed, should he live." The fractured portions of bone, excepting those which were removed at the first dressing, have united firmly, and the above remark was made unadvisedly. Should you think these notes of sufficient importance to deserve a place in your Journal, they are at your service.
Yours, very respectfully,
J. M. Harlow.
Cavendish, Vt., Nov. 27, 1848.
